Community Health Worker-Based Strategies for Hypertension Management in the Asian Context

Low- and middle-income countries in Asia are experiencing a rapidly increasing prevalence of hypertension, yet they have some of the lowest rates of hypertension detection, treatment, and control in the world. Thus, the implementation of effective evidence-based interventions for hypertension is urgently needed. Focusing on four Asian countries – Bangladesh, China, India, and Nepal – this perspective article aims to: 1) Review evidence of the effectiveness of community health worker (CHW)-led interventions for hypertension control, 2) Highlight the key components of effective interventions, 3) Identify barriers to implementation, and 4) Select implementation strategies to overcome modifiable barriers. Our review suggests that CHW-led interventions have resulted in significant reduction in blood pressure in all countries and in varying context within these, as well as in reducing hypertension risk factors, including unhealthy diets, physical inactivity, and tobacco use, improving detection and linkage to care for newly diagnosed hypertension participants, and increasing medication uptake and blood pressure control in individuals with hypertension. Key components of effective interventions include blood pressure screening, linkage to primary care, and regular follow-up visits that incorporate blood pressure monitoring, health education, care follow-up, counseling, and support for medication adherence. Modifiable barriers to successful implementation of the intervention include CHWs’ high workload, CHWs’ low knowledge and skills for hypertension management, lack of supportive supervision, shortcomings of medical record system for hypertensive individuals, conflicting priorities in the health system for disease management, and patients’ lack of trust in the medical system. We selected five implementation strategies to address these barriers: conduct ongoing training for CHWs, modify incentive/allowance structures, conduct ongoing training for health care providers, audit and provide feedback, and use advisory boards and workgroups. There is a need for trials that test bundles of strategies for implementation of a CHW-led hypertension control program in these four countries and beyond.