SUB-OPTIMAL HEALTH SYSTEM CAPACITY TO EFFECTIVELY MANAGE HYPERTENSION IN RURAL INDIA

Abstract

Abstract Objective: Despite the high burden of hypertension in rural India, limited information is available on the primary health system's capacity for its management. We aimed to determine the burden of hypertension and the health system's capacity to manage it in rural India. Design and method: We implemented a comprehensive diabetes and hypertension prevention and management program entitled “UDAY” in epidemiologically transitioning rural areas of North (Sonipat) and South (Vizag) India. Rural areas comprised a population of 200,000 and were being provided primary healthcare through six public primary healthcare facilities. A representative population based cross-sectional survey, using a multistage cluster random sampling technique among 6173 participants aged 30 years and above was done to determine the prevalence, awareness, treatment and control of hypertension. In addition, all the public primary healthcare facilities and all primary care providers (including private) were surveyed to assess the health system's capacity to manage hypertension according to the Indian Public Health Standards (IPHS) and other international/national standard guidelines. Data were obtained using an interviewer administered questionnaire, anthropometry, biosample collection, health facility survey and provider survey. Hypertension was measured using standard definitions and protocols. Results: The mean age was 48.0 (SD ± 12.7) years. Age-standardized prevalence of hypertension was 23.5% [95% CI: 22.5–24.6]. Among those with hypertension, awareness rate was 46.4% [43.8–49.0], treatment rate 35.3% [32.9–37.8] and control rate 26.3% [24.1–28.7]. Of all the public primary healthcare facilities (n = 6), none had the full sanctioned number of health staff, two did not have functional BP equipment, and no facility had all six classes of antihypertensive medicines available as recommended by the IPHS. Among 41 providers, only 9 (29%) reported using any standard guidelines for managing hypertension. Conclusions: Despite the high hypertension burden, public primary healthcare facilities relied upon by rural population, are inadequately equipped in terms of diagnostics, therapeutics, equipment and workforce to effectively manage hypertension. Health system strengthening along with providers’ training in guideline based hypertension management is imperative to improve management.