India Hypertension Control Initiative (IHCI), 2021

Overview

By December 2021, the IHCI program was implemented in 101 districts across 19 states and enrolled more than 20 lakh patients in 13,000+health facilities. In the 26 initial Phase I districts, nearly one-fifth (22%) of the estimated total number of people with hypertension in the district were enrolled. The enrollment slowed in 2020 due to COVID-19 pandemic. The states implementing IHCI and number of districts in each state are: Punjab (10), Madhya Pradesh (6), Kerala (9), Telangana (20), Maharashtra (13) West Bengal (10), Chhattisgarh (5) Karnataka (2), Andhra Pradesh (2), Sikkim (4), Goa (2), Bihar (4), Rajasthan (2), Jharkhand (2), Tamil Nadu (1), Uttar Pradesh (4), Puducherry (1), Nagaland (2), Gujarat (2).

We analysed annual indicators for five Phase I and three Phase II states where the project was operational for six or more months as of 31 December 2020. Documentation was easier during the pandemic for the four states using the Simple app (Punjab, Maharashtra, West Bengal, Karnataka). However, in Kerala, Telangana, Madhya Pradesh and Chhattisgarh, there were challenges in documenting visits due to non-availability of staff and fear of COVID-19. Of the total 9,91,214 hypertensives registered in the health facilities since initiation of the project, 7,36,884 (73.4%) were under care (defined as having at least one visit in the last 12 months) in 4,505 health facilities between April 2020 – March 2021. Nearly one-fourth of the patients did not have any follow-up visits in the previous 12 months. Of 7,36,884 patients on treatment, 47% (n=3,44,038) had their blood pressure under control during the most recent visit in the first quarter of 2021. Nearly one-fourth (23%) had uncontrolled BP despite continuing to attend health facilities, and 27% did not have a documented visit in this period. Overall, blood pressure control was highest (55%) at Health and Wellness Centres and second highest (48%) at PHCs.

We compared the key indicators in 2020 and 2021 for the initial 26 Phase I districts. The quarterly cohort blood pressure control rates declined in the second and third quarters of 2020 due to COVID-19-related disruptions; control rates started improving in the first quarter of 2021. Community-level hypertension control improved in 21 project districts in 2021 compared to 2020. Among the estimated 46 lakh hypertensives across initial Phase I 26 districts, BP control increased more than four-fold, although from a very low baseline: 6.1% achieved BP control in Q1-2021 compared to 4.9% in Q1, 2020 and 1.4% in Q1-2019. Overall, the number of patients with controlled BP continued to increase over three years (2,83,457 in Q1-2021; 2,18,340 in Q1-2020 and 64,704 in Q1-2019). The numbers declined in Kerala due to poor documentation during the pandemic and inability to provide medication refills at the subcentre level. Six districts achieved more than 10% community level BP control.

Medication availability at the district level has improved in the initial 26 districts due to better planning, streamlining of procurement process and field-level monitoring. Punjab, Madhya Pradesh and Telangana had hypertension protocol drug stocks for nearly six months. Kerala had only a one-month stock and Maharashtra had a two-month stock available in May 2021. In several Phase II states, slow medication procurement up to one year in some states delayed implementation.