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. 2024 Aug 2;24(1):884.
doi: 10.1186/s12913-024-11354-9.

India Hypertension Control Initiative: decentralization of hypertension care to health wellness centres in Punjab and Maharashtra, India, 2018-2022

Tejpalsinh A Chavan  1   2 , Mogan Kaviprawin  3 , Manikandanesan Sakthivel  3 , Navneet Kishore  3   4 , Padmaja Jogewar  5 , Sandeep Singh Gill  6 , Abhishek Kunwar  7 , Kiran Durgad  7 , Amol B Wankhede  8 , Vishwajit Bharadwaj  9 , Suhas N Khedkar  10 , Lalit Sarode  11 , Bidisha Das  12 , Sampada D Bangar  13 , Vettrichelvan Venkatasamy  3 , Ashu Gupta  6 , Mosoniro Kriina  3 , Ashish Krishna  14 , Anupam Khungar Pathni  14 , Swagata K Sahoo  14 , Ganeshkumar Parasuraman  3 , Roopa Shivashankar  15 , Pragati Pragya  15 , Meenakshi Sharma  15 , Prabhdeep Kaur  3
Affiliations

India Hypertension Control Initiative: decentralization of hypertension care to health wellness centres in Punjab and Maharashtra, India, 2018-2022

Tejpalsinh A Chavan et al. BMC Health Serv Res. .

Abstract

Introduction: The India Hypertension Control Initiative (IHCI) emphasizes decentralized patient-centric care to boost hypertension control in public healthcare facilities. We documented the decentralization process, enrolment pattern by facility type, and treatment outcomes in nine districts of Punjab and Maharashtra states, India, from 2018-2022.

Methods: We detailed the shift in hypertension care from higher facilities to Health and Wellness Centres (HWCs) using the World Health Organization (WHO) health system pillar framework. We reviewed hypertension treatment records in 4,045 public facilities from nine districts in the two states, focusing on indicators including registration numbers, the proportion of controlled, uncontrolled blood pressure (BP), and missed visits among those under care.

Results: The decentralization process involved training, treatment protocol provision, supervision, and monitoring. Among 394,038 individuals registered with hypertension from 2018-2021, 69% were under care in 2022. Nearly half of those under care (129,720/273,355) received treatment from HWCs in 2022. Care of hypertensive individuals from district hospitals (14%), community health centres (20%), and primary health centres (24%) were decentralized to HWCs. Overall BP control rose from 20% (4,004/20,347) in 2019 to 58% (157,595/273,355) in 2022, while missed visits decreased from 61% (12,394/20,347) in 2019 to 26% (70,894/273,355) in 2022. This trend was consistent in both states. HWCs exhibited the highest BP control and the lowest missed visits throughout the study period compared to other facility types.

Conclusion: We documented an increase in decentralized access to hypertension treatment and improved treatment outcomes over four years. We recommend operationalizing hypertension care at HWCs to other districts in India to improve BP control.

Keywords: Blood pressure; Decentralization; Health system; Hypertension; Implementation; India; Non-communicable diseases; Patient-centric care; Primary health care.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Registration of individuals with hypertension by facility type, year and state, Punjab and Maharashtra, India, 2018–21 (N = 394,038)
Fig. 2
Fig. 2
Proportion of individuals with hypertension at registration and recent visit by type of facility, Punjab and Maharashtra, India, 2018–22 (N = 273,355)
Fig. 3
Fig. 3
Treatment outcome among individuals with hypertension under care by year, Punjab and Maharashtra, India, 2019–22
Fig. 4
Fig. 4
Treatment outcome among individuals with hypertension under care by facility type and year, Punjab and Maharashtra, India, 2019–22
See this image and copyright information in PMC

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