Tools and Guidance to Facilitate Scaling Up Effective Management of Hypertension
A six-step guide for program managers starting up national or subnational hypertension control programs
Overview: The process of starting a hypertension (HTN) program can be broken down into six steps, and augmented by the set of practical, standardized tools on the Resolve to Save Lives LINKS website and the WHO HEARTS technical package that can be adapted to the local program and setting. The six steps and corresponding tools in this guide are aligned with the 2021 WHO Guideline for the pharmacological treatment of hypertension in adults.
Select each step below to see the accompanying guidance and resources or
For supplementary implementation guidance from HEARTS in the Americas, please consult HEARTS in the Americas: Guide and Essentials for Implementation.
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Establish administrative structure and survey current resources
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Establish a Memorandum of Understanding (MOU)
This MOU (or equivalent agreement) is established between partner organization(s) and government entities that are collaborating on the HTN control program.
General Tools and Templates
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Establish relevant contracts
Contracts are created for essential program components such as staffing and workspace.
General Tools and Templates
There are no tools or templates for this step. Contracts will differ based on vendor type and country.
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Form a technical working group
A working group will provide technical decision-making, e.g., selection of program sites and selection of a treatment a protocol.
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Conduct a needs assessment, survey current resources and care delivery models
A baseline survey documents existing staff numbers, antihypertensive medications and BP measurement devices at the national level and the program scope of work.
General Tools and Templates
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Budgeting
The budget should be comprehensive, including both product and operational elements for program start-up and maintenance.
General Tools and Templates
In development
Country Specific Examples
In development
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Select a standard hypertension treatment protocol
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Convene a consensus conference to discuss and agree upon a drug and dose specific protocol
Convene the technical working group and any other relevant stakeholders (e.g. Ministry of health officials). Larger countries may opt to establish sub-national conferences and protocols, e.g., provincial-level protocols.
General Tools and Templates
WHO HEARTS "E" module
WHO tool for the development of a consensus protocol for treatment of HTN
Simple, practical HTN treatment protocols (English) Spanish, ChineseCountry Specific Examples
Ethiopia Hypertension Prevention and Control project Consensus Planning Meeting Agenda
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Secure stakeholder approval of protocol
All relevant stakeholders should approve the protocol. Typically, the Ministry of health will have final approval.
General Tools and Templates
There are no tools and templates for this step. The approval process may vary by institution or Health Ministry.
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Format and distribute protocol document
The protocol document should have a simple, clear design that lends itself to a poster, job aid or handout. It will be distributed at the facility level for display.
General Tools and Templates
Calcium channel blocker initial monotherapy as first line treatment
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Ensure start up supply of medications and blood pressure (BP) measurement devices
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Inventory current medications
Conduct an inventory survey. The inventory should include medications at the store and facility level.
General Tools and Templates
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Inventory current blood pressure devices
Conduct an inventory survey at the facility level.
General Tools and Templates
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Forecast medication needs
Program supervisors work with facility-level managers to project future needs.
Initial drug supply forecasting should incorporate program growth scenarios. Forecasting should also plan for multi-month refills (six months or longer) for patients with stable, controlled blood pressure.
General Tools and Templates
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Forecast blood pressure device needs
Program supervisors work with facility-level managers to identify any gaps and project future needs of BP devices.
General Tools and Templates
Blood pressure device forecasting for opportunistic screening
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Procure and monitor medications
Assess the current procurement process and consider alternative options as relevant.
Monitor medications on a regular basis and reorder as appropriate.
General Tools and Templates
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Procure blood pressure devices
Assess the current procurement process for BP devices and consider alternative options as relevant
General Tools and Templates
How to choose an automated device
A 90-second primer on automated digital BP monitors
Automated digital BP devices fact sheet
WHO technical specifications for automated non-invasive BP measuring devices with cuff
Suggested Requirements for External Validation Studies
Country Specific Examples
Example of a Request for Proposal for blood pressure devices
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Utilize and strengthen supply chains
Strengthen supply chain for medicine distribution and establish procedures for monitoring and refilling medication inventory.
General Tools and Templates
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Train health care workers and activate health system supervisors
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Develop training materials
When developing materials, consider adapting pre-existing training materials of good quality.
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Train program supervisors
The Training of Trainers program includes individuals such as facility managers and program coordinators, who in turn will train healthcare workers in their facilities. It is recommended to include a review of program goals as a part of the training.
General Tools and Templates
Country Specific Examples
India Hypertension Control Initiative training of trainers presentations
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Train health care workers
Supervisors facilitate practical training which includes topics such as measuring blood pressure, hypertension management, data collection, data entry and reporting.
General Tools and Templates
BP measurement checklist
Preparing an individual for BP measurement
Why Hypertension is an important issue
How to diagnose hypertension
What to do after a diagnosis of hypertension
Resolve to Save Lives Hypertension FAQs -
Establish process for facility-level monitoring and mentorship
Create a standard form recording intervention fidelity and practice supportive supervision.
General Tools and Templates
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Implement an information system for monitoring (digital or paper system)
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Establish hypertension indicators
Establish program indicators based on the HEARTS "S" module indicators.
Country Specific Examples
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Create portable patient hypertension record
The patient card records patient information, cardiovascular health history, hypertension treatment dates, BP measurements and medications.
If information system is digital, include a QR code on the patient card if technology allows.
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Establish process for data analysis
Establish a method for calculating indicators. Ensure data security and privacy, as well as quality control.
General Tools and Templates
Simplified Indicator Calculator/Registration
Standards to Facilitate Data Sharing and Use of Surveillance Data for Public Health Action
Country Specific Examples
Country X Example: Simplified Indicator Calculator/Registration
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Establish process and timeline for reporting
Prepare reports summarizing indicators, e.g., number of patients enrolled, number of patients treated and proportion with controlled BP
Paper based system
India Hypertension Control Initiative registry, annual & quarterly report (non-digital)
Digital system
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Enroll patients and observe the program in a pilot setting
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Opportunistic screening
Encourage placement of BP devices in highly trafficked areas of healthcare facilities so that all patients receive a BP measurement at registration.
Establish new patient referral linkages from district hospital facilities to local primary care facilities.
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Manage existing hypertension patients
Establish a standardized system for patient follow up during treatment initiation and for patients with stably controlled blood pressure.
Consider implementing a team-based care model, which can alleviate shortages of medical doctors and nurses and allow more decentralized care.
Country Specific Examples
Strategies to prevent and reduce patient loss to follow up (India Hypertension Control Initiative
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Community-based screening and management
Identify well-trafficked locations or events in the community where community health care workers can conduct screening.
Establish new patient referral linkages from community to local primary care facilities.
Consider house-to-house screening.
Country Specific Examples
Hypertension Control in Integrated HIV and chronic disease clinics in Uganda in the SEARCH study
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