Innovative ComHIP project in Ghana shows that bringing healthcare closer to where people live, work and shop effectively tackles hypertension – the most deadly non-communicable disease; Digital health tools were a key enabler in the program; The control rate of people with hypertension enrolled and retained in the program for over a year climbed from 36% to 72%; The Ghanaian government is integrating the model into national policy and plans to scale-up to additional regions; This form of community-based care could save millions of lives in other countries and for other NCDs.
Today, the Novartis Foundation and partners announced the results of an innovative approach to hypertension management in Ghana. The community-based hypertension improvement project (ComHIP) tested a new model to detect, diagnose and treat hypertension earlier by placing screening points in local shops and businesses and strengthening existing facilities. This captured patients beyond the reach of traditional health facilities. Digital health tools connected the new screening points with community health workers and physicians; supported nurses’ decision-making; and empowered patients to self-manage their condition through messages sent to their mobile phones.
For people enrolled and retained in the program for over a year, hypertension control rates rose from 36% to 72%.
The ComHIP results demonstrate the huge 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 program 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 Ghana Health Service, FHI360, The Ghana School of Public Health, and The London School of Hygiene & Tropical Medicine.
Peter Lamptey, Professor of Non-communicable Diseases at The London School of Hygiene & Tropical Medicine stated: “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. That’s why it’s so encouraging to see that community-based and patient-centered care can improve hypertension control rates – it has the potential to save so many lives."
Dr. Ann Aerts, Head of the Novartis Foundation, said: “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. 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 multisector partnerships and digital solutions can revolutionize the way health systems around the world tackle NCDs.”
The success of the three-year 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 program to additional regions.
Dr. Emmanuel Ankrah Odame, Director of Policy Planning, Monitoring and Evaluation at the Ghana Ministry of Health, said: “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.”
Dr. Koku Awoonor-Williams, Director of Policy Planning, Monitoring and Evaluation at the Ghana Health Service, explained: “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.”
 Lloyd-Sherlock P., Beard J., Minicuni N., Ebrahim S., Chatterji S. Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control, International Journal of Epidemiology, 2013 [p.126].
 Joffres M, Falaschetti E, Gillespie C, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open 2013;3:e003423. doi: 10.1136/bmjopen-2013-003423
Alexander Kumar / Novartis Foundation | When the shopkeeper measures blood pressure: Novartis Foundation and partners prove effectiveness of community-based approach to tackling hypertension in Ghana