Top medical research institute Banaras Hindu University, senior government officials and public health leaders have said that policy measures like an extended prescription for chronic diseases like hypertension helped India cope better with the chaos unleashed during the pandemic. At an event organized by the Family Planning Association of India (FPAI), to release a policy brief and set of recommendations from Banaras Hindu University, health experts and senior representatives of the government called for the need to focus on such nimble yet effective solutions to improve last-mile delivery of health services.

In early 2020, soon after Covid struck, recognizing the need to safeguard India’s massive population group of ‘people living with NCDs’ (PLWNCDs), the Ministry of Health and Family Welfare, showed tremendous foresight by recommending a seemingly minor health system reform that could potentially save millions of those who are already suffering from chronic conditions like cardiovascular disease, diabetes or cancer. A guidance note from the MoHFW to all states issued on April 14^th, 2020 advised that “all known diagnosed patients of hypertension, diabetes, chronic obstructive pulmonary disease and mental health to receive a regular supply of medicines for up to 3 months through ASHAs or health sub-centres on prescription.”

Speaking at the event, Dr Sudarshan Mandal, Deputy Director General (NPCDCS), Date GHS, Ministry of Health and Family Welfare, said “The government order calling for medicines to be available for chronic diseases in Primary Health Centres (PHCs) and Ayushman-Bharat Health and Wellness Centres (AB-HWC) was a timely measure that safeguarded many lives. It continues to be relevant and can be an important strategy to ensure that more and more people can keep their blood pressure properly treated and under control. While all NCDs require a continuum of care and treatment, it is critically important to focus on hypertension and diabetes mellitus, also called the silent epidemics of India.”

Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University, and GRID Council under Project REACH-HTN analyzed 4 states to gauge the success of making blood pressure medicine refills available for extended days as per the government guidance. Speaking at the release of this policy brief, Dr Sangeeta Kansal, Professor at the Department of Community Medicine, BHU and principal investigator of the project said, “Our analysis revealed that issuance of the government order recommending that medicines be made available for at least a month, has been overall beneficial for those relying on public health systems for their treatment – particularly those in rural India. It encouraged several innovations such as the use of a differentiated drug delivery system and the disbursement of medicines through ASHAs and ANMs. The primary benefit was that it decentralised the process of drug delivery, bringing medicines closer to the people. IHCI districts were particularly efficient and structured in rolling out this government order.”

The recently released WHO guideline on hypertension treatment (2021), recommends that patients with stable blood pressure can be asked to visit clinics at 3-6 month intervals as an important strategy to improve hypertension control. Highlighting how ensuring treatment adherence has become a global priority, Ms Vandana Shah, Regional Director, Global Health Advocacy Initiative (GHAI) said, “Covid has put a spotlight on health systems across the world as they struggle to keep up with an unforeseen burden of care. Preparedness is the need of the hour. Making medicine refills available, particularly in the remotest corners of the country is one such important solution. The policy brief issued by BHU has several important recommendations which can be implemented to further strengthen access to treatment such as a more streamlined and decentralised drug procurement system for the health and wellness centres (HWCs).”

BHU’s analysis showed that by December 2020 most states had provided hypertension medicines with relative success. Maharashtra was able to disburse extended days prescriptions for up to 90 days to almost 100% of hypertensives registered with the NPCDCS program. Sufficient medicines were purchased in advance, sub-centres used as a drug depot and HWCs rapidly scaled up. In Karnataka, the frontline health worker was asked to dispense medicines to hypertensive patients for one month at a time to avoid possible wastage. The study also noted that at least 40% of districts under the India Hypertension Control Initiative (IHCI) benefitted from a robust rollout of the order for extended days drug supply.

Speaking at the occasion, Dr Kalpana Apte, Secretary General, FPA India said, “Despite blood pressure medicines being safe, affordable and easily available, the control rates are dismal worldwide. Over 30% of the world population has hypertension and only 13.8% of cases are considered controlled. In India as well a large proportion of people diagnosed as hypertensive do not have their BP under control. This makes them extremely vulnerable to cardiac events and death. The guidance for extended days prescription, issued just when India was entering a hard lockdown nationwide, has immense potential of fixing the woes of last-mile service delivery.”