India Hypertension Control Initiative

Problem Statement

Despite progress of the IHCI towards 20% of estimated hypertension (HTN) burden, new registrations have seen a steady decline over past 2-3 months. The PBS HTN yield is 20-25% of the estimated HTN burden.

Programme Description

Objective

To accelerate enrollment of rural and urban population for Hypertension treatment through door to door screening of individuals in Wardha and Bhandara Districts of Maharashtra.

A pilot was conducted in Wardha district in March 2019 for catchment area of two identified Sub Centres, which covered a population of approximately 10,000 across six villages. A total of 4,100 individuals of age group of 30 years and above were screened for Hypertension and Diabetes by Multi-Purpose Workers (Female) and ASHAs. In a time span of twenty days, 970 individuals suspected for Hypertension and Diabetes were line listed by six teams, and mobilized for confirmatory diagnosis which was planned in a camp approach. At the village level, five camps were organized where identified individuals were screened for confirmatory diagnosis and treatment was initiated for diagnosed NCD cases. Approximately 750 suspected individuals were reported to attend these NCD camps, and within two identified Sub Centres, 430 Hypertension and 120 Diabetes cases were enrolled in IHMI in April and May 2019.

Based on the findings from the pilot, a strategy for scaling up the initiative at the division level was planned to ensure universal screening for individuals of age group 30 years and above in the division by March 2020. The screening will be initially undertaken in rural areas followed by the urban areas. A target based on the prevalence has been already specified and accordingly demand of medicines has been calculated and entered into e-Aushadhi portal.

Trainings for service providers in the Wardha and Bhandara district has been completed, and 49 CHOs from Bhandara and 54 CHOs from Wardha have been trained so far in IHMI and Diabetes protocols and Simple Application.

One hundred additional facilities have been created to initiate, monitor and escalate treatment as per IHMI and Diabetes protocols. Door to door screening has been initiated in the both districts and will be further escalated upon completion of re-orientation of Medical Officers on IHMI.

Programme Outcomes

Approximately 750 suspected individuals underwent screening for confirmatory diagnosis and 430 Hypertension and 120 Diabetes cases were diagnosed and enrolled in IHMI in April and May 2019. A detailed report for all screened individuals was prepared, where 78 patients were identified to receive lifestyle modification. Forty-eight patients refused to undergo treatment and were not registered under IHMI.

In addition, 35% prevalence of Retinal Haemorrhage (n=35) and 17% elevated Creatinine levels (n=560) was recorded in these camps. All the remaining Hypertension cases recorded based on prevalence estimates are to be enrolled by December 2019. (need more data on treatment adherence)

Scalability

Undertaking door to door or populationbased screening has enabled higher case detection, including complicated cases.This intervention builds on an existing programme and uses existing staff to undertake an intensive effort to improve case detection, making it a potentially scalable model.

Implementation Partners

Government of Maharashtra in collaboration with the IHMI/ICMR

Source : We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019