Extended day prescription refills for hypertension can be a game changer for health service delivery at the last mile

At an event organised by FPAI, to release a policy brief and set of recommendations from Banaras Hindu University, health experts and senior representative of the government called for the need to focus on solutions to improve last mile delivery of health services

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

Speaking at the event, Dr Sudarshan Mandal, Deputy Director General, National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke (NPCDCS), Dte 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. For the 22 crore hypertension patients, more than 8 crore diabetics and all the other suffering from NCDs in India, this can revolutionise health care delivery.”

Department of Community Medicine, Institute of Medical Sciences, Banaras Hindu University along with GRID Council under Project REACH-HTN, conducted an analysis across 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 of public health systems for their treatment – particularly those in rural India. It encouraged a number of innovations such as use of differentiated drug delivery system and 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.”

Vandana Shah, Regional Director, Global Health Advocacy Initiative (GHAI) said, “COVID 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 a number of 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).”

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 per cent population has hypertension and only 13.8 per cent 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.”

Recommendations:

• To strengthen management, monitoring and treatment compliance for hypertension, develop criteria for patients who are eligible for extended prescriptions
• Build the capacity of healthcare workers for measurement of blood pressure and efficient management
• Leveraging telemedicine services and mobile based applications for patient monitoring and follow-up
• Strengthen the drug supply chain with efficient forecasting and stock procurement
• Decentralise drug procurement at local (district) and state levels
• Simplify the anti-hypertensive drug list by limiting the number of categories and drug molecules prescribed
• Rationalise indenting and budget allocation practices as per local burden and coverage targets