RAG-SACA-5: HEALTH SYSTEM STRENGTHENING ACTIVITIES FOR BETTER HYPERTENSION CARE

Abstract

Raised systolic BP was responsible for 10·4 million deaths and 218 million disability adjusted life years across the globe in 2017. A disease that largely affected high-income countries in the past, has now been shown to affect low-income and middle-income countries disproportionately. Weak health infrastructure, poor access, high illiteracy rates, poverty, high costs of drugs, bad dietary habits and skewed national health priorities have been found to contribute to the poor performance of these countries in the hypertension care cascade. While there are several effective targeted as well as population-level interventions available to choose from, most countries have failed to integrate them effectively into their hypertension control strategies. Health system-strengthening activities such as capacity building, task shifting and appropriate use of digital health technologies can help bridge some of these gaps. Certificate Course in Management of Hypertension (CCMH) is a joint certification program designed and implemented by the Public Health Foundation of India (PHFI) in collaboration with the British & Irish Hypertension Society (BIHS), the International Society of Hypertension (ISH) and the Centre for Chronic Disease Control (CCDC). CCMH is an ten month course with once- a- month contact sessions, being conducted on a designated weekend at regional training centres across India. It is fundamental objective is to enhance the knowledge, skills and core competencies of practicing PCPs in the management of Hypertension and to build their network with other PCPs and existing specialists. A total of over 2000 primary care physicians have been trained in the initiative so far. The course is being adapted in collaboration with the American Heart Association for online education of prescribers as well as non-prescribers. In addition, PHFI has also instituted an innovative assisted telemedicine healthcare delivery model - Digisahayam - which acts as an inter-operable system setting up multiple innovations in digital health technology on a single platform. It works on the model of task sharing and task shifting while embedding electronic health records (EHR), point-of-care diagnostics (13 common lab tests including ECG), in-built clinical decision support system and numerous state-of-the-art digital health technologies. Approximately 16,000 teleconsultations have been conducted in three clinics in India over the span of 18 months.