Engaging Multiple Public Health Stakeholders to Improve Hypertension and Associated Multimorbidity Management in India: Findings From a Large Community-Based Initiative

Objective: Most hypertensives in India also have associated co-morbidities, especially diabetes. Thus, integrated multistakeholder interventions are required for effective management. Design and method: We implemented a comprehensive community-based initiative among a population of 400,000 in select rural and urban communities of north and south India. The initiative comprised: i) population-based doorstep screening, regular follow-up of adults over 30 years for hypertension and common associated co-morbidities and improved health system linkage; ii) regular health provider education to manage hypertension and associated co-morbidities via continuing medical education programs, certificate courses to build physician's capacity; iii) training of community health workers to improve detection and management of hypertension and associated co-morbidities; iv) establishing disease registries in health facilities to improve the quality of care; v) advocacy to improve availability of medicines, increased prioritisation of hypertension and associated co-morbidities by public health authorities; vi) multiple contextually relevant communication campaigns, highlighting hypertension and associated multimorbidity prevention and control round the year to increase awareness of the population and public health stakeholders. Results: The regular sustainable efforts in engaging with multiple public health stakeholders (health systems, public health authorities, communities) and building trust led to better implementation of the initiative. 147828 individuals were home screened for hypertension, associated multimorbidity and related risk factors. There was improved linkage to the health system along with improvement in blood pressure and sugar control. 16775 patients were registered in disease registries established in public and private health facilities. There was a significant increase in the proportion of hypertensives attaining blood pressure control Baseline: 41.7% (95%CI: 40.9-42.4), third follow-up visit: 47.0% (44.5-49.5). Over 100 health awareness events and health camps were organized in collaboration with the local public health stakeholders. 400 health providers (10 physicians, 300 pharmacists and 100 community health workers) were trained for providing better management of hypertension and associated multimorbidity. There was also an improvement in availability of lab tests and medicines for management in the health system. Conclusions: Innovative contextual engagement with public health stakeholders can improve the implementation of complex health interventions and lead to improved hypertension and associated multimorbidity management.