Ghana has reported positive results of its community-based hypertension improvement project (ComHIP) that aimed to detect, diagnose and treat hypertension earlier by placing screening points in local shops and businesses and strengthening existing facilities.

Digital health tools were used in the three-year ComHIP pilot to connect the new screening points with community health workers and physicians; to support nurses’ decision-making; and to empower patients to self-manage their condition through messages sent to their mobile phones.

The pilot found that for people enrolled and retained in the programme for over a year, hypertension control rates rose from 36% to 72%.

The ComHIP results demonstrate the potential of community-based care and suggest that the method could save millions of lives if replicated in other countries and for other non-communicable diseases (NCDs).

In addition to improving hypertension control rates, participants enrolled and retained in the programme for over a year experienced an average reduction of 12mmHg in systolic blood pressure and an average reduction of 7mmHg in diastolic blood pressure.

ComHIP is important because in Ghana, just 4% of people with hypertension have their condition controlled, compared to 53% in the USA. Hypertension is the leading risk factor for cardiovascular disease – the most deadly non-communicable disease.

The project was implemented in partnership with the Novartis Foundation, the Ghana Health Service, FHI360, the Ghana School of Public Health, and the London School of Hygiene & Tropical Medicine.

“The ComHIP experience has global value. Cardiovascular disease is the leading cause of death worldwide, and disproportionally affects low- and middle-income countries where risk factors such as hypertension are poorly controlled,” said Professor of Non-communicable Diseases at The London School of Hygiene & Tropical Medicine, Peter Lamptey.

“That’s why it’s so encouraging to see that community-based and patient-centred care can improve hypertension control rates – it has the potential to save so many lives,” continued Professor Lamptey.

Head of the Novartis Foundation, Dr Ann Aerts, noted that the most exciting thing about implementing digital health in the real world is how simple solutions that use existing technology can significantly impact people’s health. “ComHIP not only showed that non-traditional health players such as shopkeepers can play an essential role in healthcare delivery, but also that mobile phones can make an enormous difference to people with hypertension,” said Dr Aerts.

“Digital technology was the glue, connecting people who screened positive for hypertension at the shops with healthcare workers, and helping patients adhere to medication, diet and exercise regimes – ultimately saving lives. This evidence demonstrates how multi-sector partnerships and digital solutions can revolutionise the way health systems around the world tackle NCDs,” continued Dr Aerts.

The success of the ComHIP pilot led the Ghanaian government to integrate the project training curriculum and treatment guidelines into Ghana’s national policy, and commit to scaling-up the programme to additional regions.

“Hypertension rates in Ghana are increasing, so preventing its devastating consequences is a priority for the Government of Ghana. We were pleased with the ComHIP model of community-based care because its use of existing infrastructure makes it sustainable and easy to replicate,” said Director of Policy Planning, Monitoring and Evaluation at the Ghana Ministry of Health, Dr Emmanuel Ankrah Odame.

Director of Policy Planning, Monitoring and Evaluation at the Ghana Health Service, Dr Koku Awoonor-Williams, added that the ComHIP model shows that a community-based approach to hypertension management can save thousands of lives if it is scaled up to cover the entire country. “We’re exploring how we can make this a reality,” concluded Dr Awoonor-Williams.

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