Author:
Chavan Tejpalsinh A.,Kaviprawin Mogan,Sakthivel Manikandanesan,Kishore Navneet,Jogewar Padmaja,Gill Sandeep Singh,Kunwar Abhishek,Durgad Kiran,Wankhede Amol B.,Bharadwaj Vishwajit,Khedkar Suhas N.,Sarode Lalit,Das Bidisha,Bangar Sampada D.,Venkatasamy Vettrichelvan,Gupta Ashu,Kriina Mosoniro,Krishna Ashish,Pathni Anupam Khungar,Sahoo Swagata K.,Parasuraman Ganeshkumar,Shivashankar Roopa,Pragya Pragati,Sharma Meenakshi,Kaur Prabhdeep
Abstract
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.
Publisher
Springer Science and Business Media LLC
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