Decentralization of India Hypertension Control Initiative services to maintain continuum of care for hypertensive patients during COVID-19 pandemic in Telangana

Abstract

The India Hypertension Control Initiative (IHCI) was launched in Telangana, India, with the vision of maintaining the continuum of care for hypertensive patients and improving treatment outcomes through provision of free hypertension medication. Decentralization of the IHCI towards more patient-centred services was undertaken to bring free medication and follow-up services closer to the community in the hopes of improving follow-up and control rates for hypertensive patients. To determine if decentralization of hypertension follow-up services and free medication to peripheral health centres improved continuity of care and treatment outcomes in hypertensive patients and helped to mitigate disruption during the coronavirus disease 2019 (COVID-19) pandemic, hypertension outcomes were reviewed before and during the COVID-19 pandemic, for patients registered in health centres that decentralized free medication and follow-up services to subcentres – the intervention group – and in health centres that did not decentralize these services – the non-intervention group. Hypertensive patients had higher rates of monthly follow-up and controlled blood pressure in the decentralized facilities than in the non-decentralized facilities, where these services were limited to primary and secondary health centres. Comparing follow-up rates and blood pressure control rates before and during the COVID-19 pandemic, these were maintained for patients in the decentralized facilities whereas they were significantly lower for patients in the non-decentralized facilities. The IHCI decentralized model appears to have contributed to continuity of care for people with hypertension and to have maintained this continuity against system shocks such as that of the COVID-19 pandemic. Decentralization of free medicines and follow-up services to the first and most peripheral point of contact in the primary health care system brings these essential services closer to home, which can encourage patients to seek services from the public sector – capturing a strong case for a primary health care foundation to the strengthening of systems for universal health coverage.