In the last two years, even as the Covid-19 pandemic threw unprecedented challenges at us, it has been a priority to ensure that the vast population of India living with Non-Communicable Diseases (NCDs) like high blood pressure should not fall out of the treatment net. Hypertension on its own is a major cause of premature death worldwide and the problem is compounded when we consider that patients with hypertension –which, when left untreated, leads to cardiovascular disease and chronic kidney disease – are at a significantly higher risk of death from COVID-19. Perceived as a condition that can be treated with relative ease and due to its high prevalence, hypertension fails to evoke the same panic and fear that other deadly non communicable diseases such as cancer, stroke or heart attack do. This chronic condition, has a notoriously poor treatment adherence rate and low awareness, making it a major public health challenge in India.
Left untreated, high systolic blood pressure is responsible for at least 10.4 million deaths and 218 million disabilities adjusted life years (DALY) globally. More than 60% of all deaths in India are due to NCDs and a large number of these deaths are linked to the underlying condition of hypertension. As many as one in four adults have high blood pressure in India. Among people with high blood pressure, only half have been diagnosed and of those, only 1 in 10 have blood pressure under control. Untreated hypertension also leads to unnecessary health care costs – impacting both governments and individuals. India has committed to a 25% relative reduction in the number of people suffering from high blood pressure by 2025. Despite the unprecedented challenges thrown at us by the ongoing pandemic, we are firmly on the path to achieving this target. By 2024, over 15 crore people will get treatment for hypertension, and be able to protect themselves from heart attack, stroke and kidney failure. At the centre of this public health response is the vast network of Ayushman Bharat-Health and Wellness Centres (AB-HWCs) powered by the Government of India’s telemedicine service. In country where millions live in remote and far-flung corners, the rapidly growing network of AB-HWCs will play a critical role in fixing the last mile. Recently celebrating its 4th year anniversary, the AB-HWCs have grown to more than 1.18 lakh across the country and clocked over 3 lakh tele-consultations in a single day on the e-Sanjeevani platform. Each HWC is being converted to a one-stop centre for first level of screening and treatment in far-flung corners of the country. A tea worker residing in the remote tea gardens of Alipurduar, West Bengal, and earning low wages, cannot afford to buy blood pressure medicines from a private dispensary. Nor can they afford to spend an entire day commuting to a primary health centre every other week for a refill of their medicines. Hence operationalizing more and more HWCs is a key strategy to improving treatment access.
Simple policy innovations can go a long way in strengthening this access and enable people to continue their treatment. At the start of the pandemic, anticipating a major setback in treatment availability, the Ministry of Health and Family Welfare, introduced a seemingly minor health system reform that has the potential of saving millions who are already suffering from chronic illnesses. A guidance note from the MoHFW to all states issued on April 14th, 2020 advised that “all known diagnosed patients of hypertension, diabetes, chronic obstructive pulmonary disease and mental health to receive regular supply of medicines for up to 3 months through ASHAs or health sub-centres on prescription.” In a country where non-adherence to anti-hypertensive medications is as high as 45%, leaving millions exposed to heart attack, stroke and other major health catastrophes, this was an effective and easy-to-implement measure. The recent Indian Public Health Standards has further enshrined this as a standard protocol, safeguarding the poorest sections of our society. The poor daily wage labourer or farm worker will no longer have to make multiple trips to the health centre for their medicine refills. Steps are also being taken to improve the drug logistics system.
Finally, for us to tide over the NCD crisis, technology must play a critical role. With telemedicine services available in more and more AB-HWCs, the treatment coverage and continuum of care will undergo a paradigm shift. Strong networks, robust technology and simple interfaces have ensured that the e-Sanjeevani platform improves treatment quality. Emergency interventions, difficult diagnostic approaches are becoming possible in remote places. A direct line of communication in real time, between a specialist doctor at the district hospital and a Community Health Officer treating the patient in a remote location, has been a game changer in a country where 500 million rely on the public health system for their primary care and access to medicines. Taking lessons from our past successes – polio eradication, tuberculosis control and the more recent, successful roll out of the Covid vaccine, India is well prepared for the NCD battle. Preventing, treating and controlling high blood pressure can be a strategic win and should be a priority for all stakeholders of the Indian health system.
(Dr Sudarsan Mandal is the Deputy Director General (NPCDCS), Ministry of Health and Family Welfare, Government of India)
