Table 7.

Ongoing challenges in existing hypertension programs and corresponding solutions.

Step	Challenge	Solution
1→ Establishing administrative structure	• Transitioning from donor-funded program to government-owned program.	• Jointly implement program with ministry of health from program start. • Develop a transition plan that considers roles, responsibilities, and budgeting for products and services long-term.
2 → Treatment protocols	• Converging on a universal treatment protocol.	• Build evidence for treatment protocols through demonstration programs.
3→ Medications and BP devices	• Medication stock-outs • Limited uptake of fixed dose combination medications. • Variable medication quality and affordability • Lack of availability of validated BP devices. • Poor awareness among providers and program managers of the importance of BP device validation. • High cost of BP devices.	• Market shaping to reduce prices of fixed dose combination antihypertensive medications. • Strengthen procurement and supply chains in LMICs. • Build capacity of ministry of health staff to forecast medication supply needs. • Advocate for reduced out-of-pocket medication fees for patients • Advocate for coverage of NCD medications and services under national health insurance schemes.
4→ Training of health care workers and supervision	• Learnings from training not being implemented or sustained. • Need for frequent trainings due to frequent turnover of staff.	• Assess the impact of training and areas for improvement. • Conduct refresher training. • Provide ongoing clinical mentorship. • Expand training to include community health workers, patient champions, and community-based providers.
5→ Information systems	• Lack of electronic health records • Limited use of data for program improvement.	• Government investment in electronic health records. • Build capacity for continuous quality improvement utilizing program data. • Include key hypertension control indicators in program reviews at national/subnational levels.
6→ Enroll patients and pilot	• Transitioning from pilot projects to scale-up. • Lack of human resources for scale-up.	• Scale-up team-based care through capacity building of existing health care workers and training new cadres of health care workers. • Roll-out packages of differentiated service delivery specific to location context. • Government investment in hypertension care.