Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Loading...
Kaur, P, Kunwar, A, Sharma, M, et al. India Hypertension Control Initiative—Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics, India. J Clin Hypertens. 2020; 00: 1– 10. https://doi.org/10.1111/jch.14141
The India Hypertension Control Initiative (IHCI) is a multi-partner initiative, implementing and scaling up a public health hypertension control program across India.
A cohort of 21,895 adult hypertension patients in 24 IHCI sentinel site facilities in four Indian states (Punjab, Madhya Pradesh, Maharashtra, and Telangana), registered from January 2018 until June 2019 were assessed at baseline and then followed up for blood pressure (BP) control and antihypertensive medication use.
Among all registrations, 11 274 (51%) of the patients returned for a follow-up visit between July 2019 and September 2019. Among patients returning for follow-up, 26.3% had BP controlled at registration, and 59.8% had BP controlled at follow-up (p < .001). The absolute improvement in BP control was more than two times greater in primary care (48.1 percentage point increase) than secondary care facilities (22.9 percentage point increase). Most IHCI patients received prescriptions according to state-specific treatment protocols.
This study demonstrates that a scalable public health hypertension control program can yield substantial BP control improvements, especially in primary care settings. However, high loss to follow-up limits population health impact; future efforts should focus on improving systems to increase the likelihood that patients will return to the clinic for routine hypertension care.
--
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
These are the materials used for disseminating information, provide education and to establish proper communication within the community about hypertension management
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
These documents have some major facts about hypertension and the IHCI project
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
This document explains the best practices to follow to avoid getting hypertension or to keep hypertension under control
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
Journal articles published as part of the Indian Hypertension Control Initiative (IHCI)
--
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
IHCI project's "Simple" app has won a gold award under the "Research on Citizen-Centric Services by Academic/Research Institutions" category at the 27th National e-Governance Conference held in Mumbai on 3rd September 2024. The National E-Governance Award by the Department of Administrative Reforms and Public Grievances (DARPG) is a prestigious recognition that highlights the impact of our work in improving hypertension care through effective monitoring and documentation through a digital solution.
Discovery, development, and deployment of a user-centered point-of-care digital information system to treat and track hypertension and diabetes patients under India Hypertension Control Initiative
Background
Hypertension affects 28.5% of Indians aged 18–69. Real-time registration and follow-up of persons with hypertension are possible with point-of-care digital information systems. We intend to describe herein the experiences of discovering, developing, and deploying a point-of-care digital information system for public health facilities under the India Hypertension Control Initiative.
1. Kaur, P., Kunwar, A., Sharma, M. et al. J Hum Hypertens (2022).
Hypertension is the leading single preventable risk factor for cardiovascular disease. The India Hypertension Control Initiative (IHCI) project was designed to improve hypertension control in public sector clinics. The project was launched in 2018–2019 in 26 districts across five states: Punjab (5), Madhya Pradesh (3), Kerala (4), Maharashtra (4), and Telangana (10), with five core strategies: standard treatment protocol, reliable supply of free antihypertensive drugs, team-based care, patient-centered care, and an information system to track individual patient treatment and blood pressure control.
For implementing HEARTS in India, the Awards Committee of the World Hypertension League would like to congratulate the Ministry of Health and Family Welfare, Government of India; the Indian Council of Medical Research; the World Health Organization; and Resolve to Save Lives
There are 5 crucial components of effective hypertension care that are part of the IHCI programme.
The Government of India initiated a population-based screening programme for hypertension, diabetes and cancers of the breast, cervix and oral cavity. IHCI complements this screening programme and will accelerate progress towards Government of India targets by ensuring a continuum of care.
The project activities focus on:
Adoption of standardized treatment protocol for hypertension management, agreed upon by State-level stakeholders and consistent with national and global policies
Hypertension is a serious, and growing, health issue in India today. There are an estimated 20 crore adults with hypertension, of whom approximately only 2 crores have it under control. The Government of India has adopted the "25 by 25" goal, which aims to reduce premature mortality due to non-communicable diseases (NCDs) by 25% by 2025. One of the nine voluntary targets includes reducing the prevalence of high BP by 25% by 2025.
IHCI aims to accelerate progress towards the Government of India's NCD target by supplementing and intensifying evidence-based strategies to strengthen the building blocks of hypertension management and control.
IHCI was awarded the at a UN General Assembly side-event held on 21 September 2022 in New York. The award recognizes India’s “highly impactful, large-scale hypertension intervention within India’s existing primary health care system”
Kunwar A, Durgad K, Kaur P, Sharma M, Swasticharan L, Mallela M, et al.. . Global Heart. 2021;16(1):82. DOI:
Background: Hypertension is the leading risk factor for cardiovascular disease in India, but less than 10% of the estimated people with hypertension have blood pressure under control. The India Hypertension Control Initiative (IHCI) was implemented to strengthen hypertension management and control in public sector health facilities. Since late March 2020, lockdown due to the COVID-19 pandemic limited healthcare access and disrupted the provision of essential health services. IHCI quickly implemented adaptive interventions to improve access to medications.
These are one pagers for the NCD staff to refer as check points during measuring blood pressure for 18 year & above or 30 years & above patients based on the state's requirement
Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions.
Background: Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood pressure (BP) control in public sector health facilities in Punjab and Maharashtra, India, where the India Hypertension Control Initiative (IHCI) was implemented.
Methods: We analyzed the records of people enrolled for hypertension treatment and follow-up under IHCI between January 2018 and December 2021 in public sector primary and secondary care facilities across 23 districts from two states. Each state followed a different treatment protocol. We calculated the proportion with controlled BP at each step of the protocol. We also estimated the mean decline in BP pre- and post-treatment.
We have adopted an agile and user-centered approach in each phase in selected states of India since 2017. A multidisciplinary team adopted a hybrid approach with quantitative and qualitative methods, such as contextual inquiries, usability testing, and semi-structured interviews with healthcare workers, to document and monitor utility and usability.
During the discovery phase, we adopted a storyboard technique to understand the requirement of a digital information system. The participatory approach in discovery phase co-designed the information system with the nurses and doctors at Punjab state of India. Simple, which is the developed information system, has a front-end Android mobile application for healthcare workers and a backend dashboard for program managers. As of October 2022, over 24,31,962 patients of hypertension and 8,99,829 diabetes were registered in the information system of 10,017 health facilities. The median duration of registering a new patient was 50 seconds, and for recording a follow-up visit was 14 seconds in the app. High satisfaction was reported in 100 app users’ quarterly interviews.
Simple was implemented by administering a user-centered approach and agile techniques. It demonstrated high utility and usability among users, highlighting the benefits of a user-centered approach for effective digital health solutions.
Read the complete article in SAGE Digital Health Journal:
Parasuraman Ganeshkumar
Aarti Bhatnagar
Daniel Burka
Kiran Durgad
Ashish Krishna
Bidisha Das
Mahima Chandak
Meenakshi Sharma
Roopa Shivasankar
Anupam Khungar Pathni
Abhishek Kunwar
Prabhdeep Kaur
Conclusion: Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions. We recommend treatment protocols starting with a single low-cost drug and escalating with the same or another antihypertensive drug depending on the cost and availability.
Read the complete article in Global Heart Journal:
Prabhdeep Kaur
Manikandanesan Sakthivel
Vettrichelvan Venkatasamy
Padmaja Jogewar
Sandeep S. Gill
Abhishek Kunwar
Meenakshi Sharma
Anupam Khungar Pathni
Kiran Durgad
Swagata Kumar Sahoo
Amol Wankhede
Navneet Kumar
Vishwajit Bharadwaj
Bidisha Das
Tejpalsinh Chavan
Suhas Khedkar
Lalit Sarode
Sampada D. Bangar
Ashish Krishna
Roopa Shivashankar
Parasuraman Ganeshkumar
Pragati Pragya
Balram Bhargava
The proportion of the estimated people with hypertension who had it controlled and documented in public clinics increased three-fold, albeit from very low levels (1.4–5.0%). The IHCI demonstrated the feasibility of implementing protocol-based hypertension treatment and control supported by a reliable drug supply and accurate information systems at scale in Indian primary health care facilities.
Lessons from the IHCI’s initial phase will inform plans to improve screening in health care facilities, increase retention in care, and ensure a sustained supply of drugs as part of a nationwide hypertension control program.
--
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
Antihypertensive drug supply is sometimes inadequate in public sector health facilities in India. One of the core strategies of the India Hypertension Control Initiative (IHCI) is to improve the availability of antihypertensive drugs in primary and secondary care facilities. We quantified the availability of antihypertensive drugs in 2019–20 and described the practices in supply chain management in 22 districts across four states of India.
Twenty-two districts from 4 states (Punjab, Madhya Pradesh, Telangana, and Maharashtra) were studied. We described the practices and challenges in supply chain management. We collected data on drug procurement from 2018 to 2020 and drug availability from April 2019 to March 2020. Quantity procured, the proportion of facilities with stockout at the end of each quarter, and availability of drugs in patient days were tabulated.
All states selected drug- and dose-specific protocols with Amlodipine as the initial drug and shifted to morbidity-based forecasting. The total number of antihypertensive tablets procured for the 22 districts increased from 16 million in 2017–2018 to 160 million in 2019–2020. The proportion of facilities with Amlodipine stock-out was below 5% during the study period. Amlodipine stock was available for at least 60 patient days from the third quarter of 2019 onward in all districts.
This study demonstrates that including best practices can gradually strengthen the procurement and supply chain for antihypertensives in a low-resource setting. As the program was rapidly growing, there were still gaps in the procurement and distribution system which needed to be addressed to ensure the adequacy of drugs. We recommend that best practices, including choosing a single protocol, basing supply on projected patient load rather than an increment from historical levels, and using simple stock management tools, be replicated in other districts in India to increase and sustain coverage of hypertension treatment.
Methods: We collected data from 29 IHCI districts of 5 states (Kerala, Madhya Pradesh, Maharashtra, Punjab, and Telangana) during April–May 2020. The population included individuals diagnosed with hypertension and enrolled under IHCI in all public sector primary care health facilities. We contacted a convenience sample of more than one-third of the functional HWC/SC and analyzed the proportion of facilities and patients who received drugs. We also contacted a convenience sample of patients telephonically to estimate their self-reported availability of drugs.
Conclusion: Of the 4245 HWC/SC, more than one-third were contacted telephonically, and 85–88% had received antihypertensive medications for community-level distribution. Among 721,675 patients registered until March 2020, 38.4% had received drug refills through HWC/SC or home delivery by frontline workers during the lockdown. We demonstrated the feasibility of community-level drug distribution for patients with hypertension during the COVID-19 lockdown in India. The adaptive strategy of community-based drug distribution through HWC/SC and home delivery appears feasible and may help improve access to hypertension care during the COVID-19 pandemic and beyond.
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
Task-sharing and team based care involving Auxiliary Nurse Midwife (ANMs) for BP monitoring and drug refills to patients initiated on treatment
Measurement of BP and other health system indicators using monitoring systems
Support for implementation science to promote continuous quality improvement
IHCI activities are supported by a cadre of Cardiovascular Health Officers (CVHOs) and Senior Treatment Supervisors (STSs). CVHOs are public health professionals recruited under the project at the State and district level who work closely with the Government in the operationalisation of the project. They provide supportive supervision, monitoring and evaluation and advocacy at the State and district level and are recognised to be of great value in supporting the rollout of the Initiative. Senior Treatment Supervisors (STSs), are non-medical graduates deployed under the project at sub-district level to support CVHOs in supervision and monitoring.
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
IHCI was launched in November 2017. In the first year, IHCI covered 26 districts across five states - Punjab, Kerala, Madhya Pradesh, Telangana, and Maharashtra. By December 2020, IHCI was expanded to 52 districts across ten states - Andhra Pradesh (1), Chhattisgarh (2), Karnataka (2), Kerala (4), Madhya Pradesh (6), Maharashtra (13), Punjab (5), Tamil Nadu (1), Telangana (13) and West Bengal (5).
Phase I
Phase II (started)
Phase II (upcoming)
Kerala
Andhra Pradesh
Andaman and Nicobar
Madhya Pradesh
Bihar
Arunuchal Pradesh
Maharashtra
Chhattisgarh
Assam
Telangana
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
For implementing HEARTS in India, the Awards Committee of the World Hypertension League would like to congratulate the Ministry of Health and Family Welfare, Government of India; the Indian Council of Medical Research; the World Health Organization; and Resolve to Save Lives
India Hypertension Control Initiative: Blood Pressure Control Using Drug and Dose-Specific Standard Treatment Protocol at Scale in Punjab and Maharashtra, India, 2022
Background: Hypertension treatment coverage is low in India. A stepwise simple treatment protocol is one of the strategies to improve hypertension treatment in primary care. We estimated the effectiveness of various protocol steps to achieve blood pressure (BP) control in public sector health facilities in Punjab and Maharashtra, India, where the India Hypertension Control Initiative (IHCI) was implemented.
Methods: We analyzed the records of people enrolled for hypertension treatment and follow-up under IHCI between January 2018 and December 2021 in public sector primary and secondary care facilities across 23 districts from two states. Each state followed a different treatment protocol. We calculated the proportion with controlled BP at each step of the protocol. We also estimated the mean decline in BP pre- and post-treatment.
Results: Of 281,209 patients initiated on amlodipine 5 mg, 159,292 continued on protocol drugs and came for a follow-up visit during the first quarter of 2022. Of 33,450 individuals who came for the follow-up in Punjab and 125,842 in Maharashtra, 70% and 76% had controlled BP, respectively, at the first step with amlodipine 5 mg. In Punjab, at the second step with amlodipine 10 mg, the cumulative BP control increased to 75%. A similar 5% (76%–81%) increase was seen in the second step after adding telmisartan 40 mg in Maharashtra. Overall, the mean (SD) systolic blood pressure (SBP) decreased by 16 mmHg from 148 (15) mmHg at the baseline in Punjab. In Maharashtra, the decline in the mean (SD) SBP was about 15 mmHg from the 144 (18) mmHg baseline.
Conclusion: Simple drug- and dose-specific protocols helped achieve a high control rate among patients retained in care under program conditions. We recommend treatment protocols starting with a single low-cost drug and escalating with the same or another antihypertensive drug depending on the cost and availability.
Read the complete article in Global Heart Journal
Authors
Prabhdeep Kaur
Manikandanesan Sakthivel
Vettrichelvan Venkatasamy
Padmaja Jogewar
IHCI was awarded the 2022 UN Interagency Task Force and the WHO Special Programme on Primary Health Care Award at a UN General Assembly side-event held on 21 September 2022 in New York. The award recognizes India’s “highly impactful, large-scale hypertension intervention within India’s existing primary health care system”
The Simple app is used in several IHCI states for longitudinal reporting of patient outcomes and for managing the hypertension program.
Simple is fast, free software for clinicians to manage patients with hypertension and diabetes that is developed with IHCI and exported all over the world.
Using an Android app, healthcare workers can easily manage blood pressure and blood sugar measurements, as well as recording medications and scheduling follow-up visits. A web-based Simple dashboard gives health system managers the feedback they need to improve NCD management across facilities. Patients can install a smartphone app to chart their own progress and remember to take their medications.
Learn more at
IHCI involves the Ministry of Health & Family Welfare, Indian Council of Medical Research, State Governments, and WHO-India.
Email: [email protected]
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
Abhishek Kunwar
Meenakshi Sharma
Anupam Khungar Pathni
Kiran Durgad
Swagata Kumar Sahoo
Amol Wankhede
Navneet Kumar
Vishwajit Bharadwaj
Bidisha Das
Tejpalsinh Chavan
Suhas Khedkar
Lalit Sarode
Sampada D. Bangar
Ashish Krishna
Roopa Shivashankar
Parasuraman Ganeshkumar
Pragati Pragya
Balram Bhargava
Features of Simple App include:
New patients can be registered in less than one minute
Follow-up patients can have their information entered in less than
15 seconds
Existing patient data can be retrieved in 5-7 seconds with BP
passport cards
High-risk patients are automatically prioritized at the top of the list of overdue patients
Nurses can call overdue patients through a toll-free, anonymized service
with a single click
Automatic reminder messages are sent to patients who miss visits
Progress can be monitored on a real-time basis and performance can be
monitored daily or monthly
Reports are generated automatically, saving time spent on compiling and
verifying paper records
All patients’ health information is stored and shared in line with
government data policy
WhatsApp support group for nurses and doctors provides a platform to
resolve queries related to the Simple App
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
Gujarat
Himachal Pradesh
Punjab
Haryana
Manipur
Jharkhand
Meghalaya
Karnataka
Mizoram
Nagaland
Tripura
Odisha
Uttarakhand
Puducherry
Rajasthan
Sikkim
Tamil Nadu
Uttar Pradesh
West Bengal
One of the important components of the IHCI program is each state's hypertension treatment protocol. Doctors have found protocols to be useful and simple for hypertension care and management.
In each state, it is possible to adopt a single treatment protocol with consensus of the State governments and relevant stakeholders. Practical treatment protocols with specific medications, dosages, and steps to take if blood pressure is not controlled can streamline care, simplify drug procurement, and improve patient adherence.
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
States can use these modules for team-based training at the PHC level such that all members are aware of the entire team’s roles to ensure the best outcomes for patients and to improve BP control.
The major aim of this module is to build competencies of health professionals at the primary health care level to treat hypertension as per the standard state-specific treatment protocol using a patient-centric approach. This module also aims to build capacity for strengthening drug logistic systems at the district and health facility levels. Additionally, this module provides strategies and guiding principles for information systems, monitoring and supervision of the hypertension control program.
Population-based surveillance for hypertension awareness, treatment, and control in nine districts - India Hypertension Control Initiative, 2018–19
Hypertension control is the crucial indicator for cardiovascular disease programs. We conducted a baseline cross-sectional survey to estimate hypertension awareness, treatment, and control in the selected districts in 2018–19, where the India Hypertension Control Initiative is being implemented. We conducted cross-sectional surveys in nine project districts for 18–69 years age group. The sample size was 624 per district. The study population was individuals with raised BP/diagnosed HT. We estimated the proportion and 95% confidence intervals (CI) for each district’s awareness, treatment, and control. We computed unadjusted and adjusted prevalence ratios (APR) with 95% CI for factors associated with BP control. Hypertension was defined as systolic blood pressure (SBP) > = 140 or diastolic blood pressure (DBP) > = 90 mmHg or treatment in the previous two weeks. Control was defined as SBP < 140 and DBP < 90 mmHg. Among 7047 who had hypertension, 52.4% were aware, 40.8% were on treatment, and 14.5% had BP control. BP control was below 5% in two districts, 5–15% in three districts, and more than 15% in four districts. Among hypertensives aware of the diagnosis, the factors (APR with 95% CI) associated with control were lack of alcohol consumption [1.28 (1.09–1.52)], recent visit to government [1.98 (1.57–2.50)] or private facility [1.99 (1.61–2.46)] and treatment with single drug [2.40 (1.98–2.90)] or multiple drugs [2.84 (2.27–3.55)]. The simple, rapid population-based surveys can document awareness, treatment, and control changes. Improving access to treatment for hypertension through the public or private sector should be a high priority for India.
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
Indian Council of Medical Research – Technical lead and implementation partner Principal Investigator: Dr P. Ganeshkumar, Scientist E and Head of Division of Noncommunicable Diseases, ICMR- National Institute of Epidemiology, Chennai. Coordinator at ICMR HQ: Dr Meenakshi Sharma, Scientist G, NCD Division, ICMR HQ, New Delhi Co-Investigator: Dr Prabhdeep Kaur Professor and Chair, Issac College of Public Health, IISc Bengaluru
MoFHW - National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke Mr Vishal Chauhan, Joint Secretary (NCD), MoFHW, New Delhi Dr Leimapokpam Swasticharan, NPCDCS Nodal Officer, DGHS, MoFHW, New Delhi
WHO Country Office India – Implementation partner Dr Fikru Tullu, Team Leader, NCD, WHO Country Office India Dr Abhishek Kunwar, National Professional Officer (NCD) Dr Kiran Durgad, Senior CVHO
AIIMS, New Delhi – Technical support Dr Ramakrishnan S, Professor of Cardiology, AIIMS, New Delhi
Dr Tapas Chakma, Scientist G, National Institute for Research Tribal Health, Jabalpur, Madhya Pradesh
Dr Sampada Dhayarkar, Scientist D, ICMR- National AIDS Research Institute, Pune, Maharashtra
Resolve to Save Lives, an initiative of Vital Strategies Dr Bhawna Sharma, India Lead, Resolve to Save Lives, India Dr Anupam K Pathni, Deputy lead, Country Office, India
For any queries please write to [email protected]
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
This guide can be used to train nurses in the field to succeed in their role in the hypertension program. It teaches how to screen patients correctly, register and follow-up with patients, retrieve defaulters, record patient visits, and to report data.
This guide can be used to train medical officers to ensure BP is measured for all adults visiting the OPD, treat all patients with high BP, initiate treatment as per protocol, counsel patients for follow-up, refer patients to local care, and report data.
This guide can be used to train ANM staff in the field to succeed in their role in the hypertension program. It teaches how to screen patients correctly, register and follow-up with patients, retrieve defaulters, record patient visits, and to report data
This guide helps pharmacists to understand their role in the hypertension program. From maintaining hypertensive drug stock, to drug dispensing, to recording and reporting, to awareness generation with patients.
This guide will help the supervisor to understand and conduct the supervision visit systematically to improve program performance in order to provide high-quality healthcare services.
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
Read the complete article in Journal of Human Hypertension
Authors
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
,
&
Changing patterns in health-seeking behaviour and prescription practices for treatment of hypertension in nine districts – insights from India Hypertension Control Initiative, 2018-19 and 2023-24
The India Hypertension Control Initiative (IHCI) aimed to strengthen public sector primary care for hypertension treatment and control. Our study describes changes in health-seeking behaviour, prescription practices, and key predictors influencing treatment adoption in the public sector using data from IHCI repeat cross-sectional surveys. We conducted baseline (2018-19) and follow-up (2023-24) surveys in nine districts across five Phase I states in India - two districts each from Punjab, Madhya Pradesh, Telangana, and Kerala, and one from Maharashtra. We conducted the survey among 3,900 adults (18–69 years) per district at two time points. We computed frequencies and proportions for socio-demographic variables, healthcare utilisation, blood pressure (BP) control, drug availability, medication costs, and prescription practices. We used a log-binomial model to estimate unadjusted and adjusted prevalence ratios (PRs, APRs) with 95% confidence intervals for factors influencing care-seeking for hypertension in government facilities. Among 2,873 baseline and 3,276 follow-up respondents, the proportion seeking treatment at government facilities increased from 20% to 32%. Individuals on treatment were 1.5 times more likely to use government facilities in 2023-24 than in 2018-19 (aPR 1.54, 95% CI: 1.4–1.7). BP control improved in government (37% to 48%) and non-government (35% to 47%) facilities. Drug availability (always available) in government facilities rose from 72% (425/588) to 81% (844/1041), with Amlodipine 5 mg remaining the most prescribed drug (18%). The proportion of individuals paying for medications dropped from 47% to 9%. There was increased public sector use, improved BP control, enhanced drug availability, and reduced costs, possibly due to IHCI interventions. We recommend using representative surveys for NCD surveillance to monitor healthcare utilisation patterns and assess the impact of interventions on hypertension outcomes.
Read the complete article in BMC Public Health
Authors
,
,
,
,
Dr. Abhishek Khanna, Consultant (IHCI)
Dr. Shweta Singh, Consultant (IHCI)
Mr. Praveen Kumar, Data Management Coordinator (IHCI)
Dr. Sailaja Bitragunta, Consultant (Medical)
Dr. Mohamed Azarudeen, Consultant (Medical)
Dr. Shubhabrata Das, Consultant (Medical)
Mr. Azhagendran. S, Consultant (Non-Medical)
Dr. Ankita Dahiwade, Scientist-C
Dr. Roopa Shivashankar, Senior Technical Advisor – Cardiovascular Health,
Dr. Ashish Krishna, Senior Technical Advisor – Hypertension Control,
Mr. Swagata Kumar Sahoo, Technical Advisor – Supply Chain
Ms. Diya Nag, Communications Manager
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
Ms. Jhilam Mitra, Consultant (Non-Medical)
Mr. Vettrichelvan Venkatasamy, Consultant (IT)
Ms. Amirthammal Guna Grace, Scientist-C (Data Analyst)
Mr. Arumugam V, Scientist-C (IT)
Mr. Prakash, Technical Assistant
IHCI was launched in November 2017. Since then there have been many key moments in the program as it scales across the India.
Aug
EVENT: REGIONAL REVIEW + TRAINING MEETING Regional review cum training meeting with “India Hypertension Control Initiative” field teams from UP, Bihar, Jharkhand, Chhattisgarh and Odisha at Varanasi
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
LAUNCH: BIHAR Bihar launched IHCI in Vaishali district on 21st July 2020, in Muzaffarpur on 1st September 2020, in Jamui on 9th December 2020 and in Purnia on 1st March 2021
July
EVENT : STS REVIEW + TRAINING MEETING IHCI STS Review Cum Training South Region 04 - 09 July 2022 at ICMR - National Institute of Epidemiology - Chennai
May
May
EVENT
Sec-DHR & DG-ICMR Prof Dr Balram Bhargava, WHO-India, and Ministry of Health and Family Welfare officials released the "India Hypertension Control Initiative" 2021 Progress Report. The report shares the best practices to scale hypertension treatment in primary care in India. Read the IHCI Progress Report
Month
Event
Jun
EVENT
IHCI ran an event called #KNOWYOURNUMBER to encourage people to be screened for high blood pressure. Please see photos below from North Goa District Hospital from June 2021.
Apr
LAUNCH: GOA
Goa launched IHCI program on April 7, 2021.
Month
Event
Dec
LAUNCH: UP 28th December 2020, Uttar Pradesh launched IHCI in Varanasi district
Dec
PUBLICATION
An IHCI article was published in the Journal of Clinical Hypertension: India Hypertension Control Initiative—Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics
Oct
LAUNCH: KARNATAKA
On 1st October 2020, Karnataka launched IHCI in two districts: Chikmagalur and Raichur
Sep
LAUNCH: ANDHRA PRADESH Andhra Pradesh launched IHCI in Krishna district on 28th September 2020 and in Visakhapatnam district on 24th February 2021
Sep
LAUNCH: WEST BENGAL On 18th September 2020, West Bengal launched IHCI in five districts: Howrah, Birbhum, Purba Medinipur, Paschim Medinipur and Purba Bardhaman
Date
Event
Nov 13
TRAINING
Doctors and NCD program managers from all over India, including new states Uttar Pradesh, Bihar, Jharkhanbd, Chhattisgarh, Himachal Pradesh, and Goa gathered in Lucknow to train for IHCI.
Jul 31
PHASE TWO
IHCI held the National Level Scale-Up Consultatitive Meeting in New Delhi where Phase II of the IHCI program was launched. This was a key milestone in the IHCI programme.
Feb
REVIEW MEETING
Punjab held the first state-level IHCI review meeting in Chandigarh
Month
Event
Nov
LAUNCH: TELANGANA
In November 2018, Telangana launched IHCI in nine districts: Warangal Urban, Warangal Rural, Jangaon, Mahabubabad, Jayashankar Bhupalapally, Karimnagar, Peddapalli, Rajanna Sircilla and Jagityal.
Nov
LAUNCH: MAHARASHTRA
In November 2018, Maharashtra launched IHCI in four districts: Bhandara, Satara, Sindhudurg and Warda.
Apr
LAUNCH: KERALA
On April 7, 2018, Kerala launched IHCI across four districts: Thiruvananthapuram, Kannur, Wayanad and Thrissur.
Apr
LAUNCH: MADHYA PRADESH
In April 2018, Madhya Pradesh launched IHCI in three districts: Bhopal, Chhindwara and Ratlam.
Jan
LAUNCH: PUNJAB
In January 2018, Punjab was the first State to launch IHCI in five districts: Gurdaspur, Pathankot, Hoshiarpur, Mansa and Bathinda.
Date
Event
Nov 28
START
Ministry of Health & Family Welfare and Indian Council of Medical Research launched India Hypertension Management Initiative (IHMI), now called IHCI. Read article...
July
Chairperson - Secretary, Ministry of Health and Family Welfare, Government of India
Co-Chairperson - Secretary DHR and Director General, ICMR
Convener - Dr Meenakshi Sharma, Scientist F, ICMR Hqrs
Additional Secretary, National Health Mission
Joint Secretary – NCD program/ Director – NCD program
Director General of Health Services, and/or a representative
Executive Director, NHSRC
WHO Representative to India, and/or a representative
Secretary Health, State governments implementing the project, and/or a representative
Secretary Health, State governments implementing the project, and/or a representative
Chairperson -Dr Balram Bhargava, DG, ICMR
Co-Chairperson – Dr Roderico H. Ofrin, WHO Representative to India
Convenor - Dr Meenakshi Sharma, Scientist F, ICMR Hqrs
WHO - Dr Fikru Tullu, Dr Abhishek Kunwar
© Copyright 2022 IHCI. All rights reserved. Maintained by ICMR - National Institute of Epidemiology, Chennai
ICMR - Dr Prabhdeep Kaur, Scientist E, NIE, Chennai
DGHS – Dr Tanu Jain, DADG, Dr Sudhir Gupta, Addl DDG (NCD)
AIIMS - Dr Ramakrishnan, Professor of Cardiology, AIIMS, New Delhi
NHSRC – Focal point for HWC
Resolve to Save Lives Initiative – Dr Bhawna Sharma, India Country Lead
Special invitees – Experts
Two state nodal officers - invited in rotation