Hypertension Management in Tribal Primary Health Centers: Advancing Equity and Access

Abstract

Hypertension, often called the "silent killer," is emerging as a major public health concern in India, including among tribal populations that were once considered low-risk. In Jharkhand (a state in India), a region with a high proportion of tribal populations and predominantly rural communities, the prevalence is rising. Contributing factors include delayed diagnosis, restricted access to healthcare, limited awareness about health, and lifestyle shifts such as greater consumption of alcohol and tobacco. There are also notable differences across genders and a rising trend in obesity, particularly in areas with significant tribal presence. The state's primary healthcare system faces multiple challenges, including poor road connectivity, workforce shortages, and cultural barriers to accessing care. Despite these challenges, Jharkhand has made significant progress through the National Programme for Prevention and Control of Non-Communicable Diseases (NCDs). Community-based screening by Accredited Social Health Activists (ASHAs), the use of e-Sanjeevani for tele-consultation, and a robust referral system have improved diagnosis and treatment linkage. Innovative outreach strategies, such as home-based clinics during tribal festivals, have potential in overcoming access barriers in remote tribal areas. To strengthen and scale these efforts, researchers have proposed the HTN-AAROGYA framework, focusing on Accessible Awareness, Routine care, Outreach, Guidance, Yield, and Assistance. This model uses digital tools and community engagement to promote culturally sensitive, decentralized hypertension management. Jharkhand's experience offers scalable lessons for other tribal regions in India, emphasizing the need for tailored strategies, continued research, and policy-level support to address the growing NCD burden.

Keywords: community health; developing country; health system development; high blood pressure; hypertension; jharkhand; non-communicable disease; primary care; tribal health; tribals.

Figure 1. Hypertension Tribal Network for Accessible Awareness, Routine care, Outreach, Guidance, Yield, and Assistance framework

Co-created by Dr. Himel Mondal and Napkin AI (https://www.napkin.ai) for this article