Hypertension, also known as high or raised blood pressure, is a serious medical condition which - when left uncontrolled - can increase the risk of heart, brain, kidney, and other diseases. Nearly 1 in 4 people in Nepal suffer from hypertension, and less than 5% of hypertension patients have the condition under control.

To strengthen the detection and management of hypertension at the primary health care level, the Ministry of Health and Population (MoHP) in Nepal had launched the Hypertension Care Cascade Initiative in May 2023. Supported by NORAD and WHO, the project was piloted in Kavrepalanchowk district.

Dr Dipendra Raman Singh, Director-General of Department of Health Services, signs a commitment to complete the Bagmati Kavrepalanchok Hypertension Care Cascade Initiative during the launch program held on 17 May 2023. Photo credit: WHO Nepal/A.Maharjan

More than 200 primary health care workers, associated with 165 local health facilities, in the district have been trained on proper treatment and care protocols for hypertension under this initiative.

Jointly organized by Kavre District Health Office, Provincial Health Directorate (Hetauda), and Epidemiology and Disease Control Division (EDCD) at the Department of Health Services, with facilitation by Kathmandu University School of Medical Sciences and WHO, these trainings demonstrate the commitment of the government at all levels towards improving access to hypertension care at the local level. The Government of Nepal aims to provide 1.5 million people with hypertension and diabetes protocol-based treatment services by 2025.

Dignitaries from the Ministry of Health and Population and WHO inaugurating the Bagmati Kavrepalanchok Hypertension Care Cascade Initiative at the premises of Dhulikhel Hospital, Bagmati Province. Photo credit: WHO Nepal/A.Maharjan

The hands-on training and use of practical scenarios provided participants a comprehensive understanding of hypertension care, including proper blood pressure measurement, monitoring patients, treatment and follow-up protocols, and medication stock management. Notably, the program emphasized the importance of proper documentation protocols, enabling accurate and complete recording of patient information and effective follow-up, starting from the point of diagnosis. WHO also provided a digital blood pressure monitoring device to all participating health facilities.

Participants learn the accurate way to measure blood pressure in an orientation session held in Dhulikhel, Bagmati Province. Photo credit: WHO Nepal

“People usually don’t take hypertension seriously. Most are not even aware that it can cause heart stroke,” says Sabita Shrestha, a Senior Auxiliary Nurse Midwife, who attended one of the orientation sessions. “Because of lack of symptoms, many patients don’t come for regular follow-ups and medications. I think I can now communicate more effectively with the patients, following a uniform protocol to treat, diagnose, and provide referrals.”

Recognizing the importance of such trainings, one of the participating municipalities — Roshi Rural Municipality — requested WHO to conduct a similar training for all the Auxiliary Health Workers, Auxiliary Nurse Midwives, and health assistants working in the municipality’s primary health care centers.

Participants calculate the number of hypertensive patients in their areas during the orientation session held in Roshi Municipality, Dhulikhel, Bagmati Province. Photo credit: WHO Nepal

The training was conducted in June utilizing the municipality’s budget and with technical support from EDCD, Kavre Health Office, the provincial health authority, and WHO. Around 50 health workers were trained.

Since the completion of the training, Roshi Municipality has conducted free health screenings in local communities, purchased essential medicines, and initiated the use of better reporting and patient tracking tools and treatments as per updated protocols.

Healthcare workers in Mangaltar Health Post, Roshi Municipality, study the new registers, protocols, and treatment cards provided by the WHO and municipality team (pictured left). Photo credit: WHO Nepal

"With these additional trainings, we have now trained 90% of registered healthcare workers in PHCs in Roshi Municipality who are now confident to deliver quality hypertension care and can now make a lasting impact on the health of their communities," said Ganga Shrestha, Health Section Chief of Roshi Municipality. “Together we can support the MoHP’s ambitious goals set to serve the Nepali people affected by hypertension.”

Following the success of the training in Roshi Municipality, other municipalities in Kavrepalanchowk have also allocated budget for training their healthcare workers, and have requested WHO’s technical support.

“Most preventive health care and screening for early disease detection and management take place in the primary health care setting. Therefore, it is vital to strengthen primary health care. WHO is proud to support this important initiative which will help to improve and enhance prevention and control of hypertension at the local level,” said Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal.

The Ministry of Health and Population is now planning to replicate the project in other districts of Nepal.