This will help ensure that patients receive appropriate and high quality standardised care at affordable cost, and reduce the provision of inappropriate or unsafe care.

Following a series of workshops and guidance on building capacity in evidence-based medicine, Minister for Health Ummy Mwalimu launched the fifth edition of the National Essential Medicine List for Tanzania (NEMLIT) and revised Standard Treatment Guidelines (STGs).

STGs are systematically developed statements that assist healthcare professionals and prescribers in deciding on appropriate treatments for specific clinical problems.

The collaboration journey began at a workshop held in 2015, where iDSI core partners, HiTAP and PRICELESS SA in collaboration with PATH, paid a scoping visit to Tanzania to explore areas where health technology assessment (HTA) could be introduced to support health resource allocation. Here it was agreed that incorporating a priority-setting process into the NEMLIT revision would be the best place to start establishing a priority-setting mechanism in Tanzania.

A follow up workshop with representatives from the Tanzanian Ministry of Health and Social Welfare was held to identify gaps in technical skills and capacity related to medicine selection processes. Key challenges identified included a lack of understanding of the ongoing role of the NEMLIT or Standard Treatment Guidelines; and a lack of skills and resources to keep them up to date and fit for purpose. In a bid to help tackle these challenges, in 2016 PATH and iDSI (PRICELESS and HITAP) supported the Tanzanian Ministry of Health in facilitating a workshop on National Essential Medicines Lists (NEML), with the aim of fostering capacity strengthening to develop a HTA process.

Once a full draft of the updated NEMLIT and Standard Treatment Guidelines was completed by the secretariat it was reviewed by PRICELESS SA. The new essential medicines list is now more prioritised than before, decreasing from approximately 500 medicines to 400 medicines facilitating rational medicine use.

The support from iDSI to Tanzania ensured that the review of the NEMLIT and Standard Treatment Guidelines was more structured; and incorporated a more systematic, evidence-informed process.

PATH is part of the Access and Delivery Partnership (ADP), an initiative funded by the government of Japan. PRICELESS is part of the International Decision Support Initiative (iDSI) which receives funding support from Bill & Melinda Gates Foundation, the UK Department for International Development, and the Rockefeller Foundation.

Hypertension is a leading risk factor for mortality in India with more than 200 million people in the country estimated to have high blood pressure (BP). There is, however, very little awareness about this silent killer with 75% of the rural and 60% of the urban Indian population unaware of their hypertensive status. BP control in these patients is worse, 90% of the rural and 80% of the urban Indian population have a BP above recommended target values. This needs to be addressed by providing urgent attention towards provision of access to diagnosis, management and monitoring of hypertension at the primary care level. For clinical guidance on this issue, the Ministry of Health and Family Welfare, India recently published the standard treatment guideline on screening, diagnosis, assessment, and management of primary hypertension in adults in India. This guideline balances the best available evidence with what is operationally feasible and affordable in the context of the Indian public health system, by using a pragmatic adaptation methodology, which was recently published in the BMJ.

Steps towards improvement

The State Government of Kerala, with technical assistance from iDSI, is now planning to implement quality standards which are measurable prioritised recommendations from this guideline. It aims to increase identification of new cases of hypertension by providing opportunistic BP measurement to adults when they visit a primary healthcare center (also called family health center). It also aims to improve BP control in hypertensive patients by setting clinic BP targets. Technology will be used to measure adherance to these recommendations and track patient compliance and blood pressure control. The State Government of Kerala will be integrating indicators for hypertension in the Aadhar linked electronic  medical records captured by Kerala Government’s eHealth project. This is in accordance to the cochrane review on ‘Interventions used to improve control of blood pressure in patients with hypertension’, which recommended that primary care clinics need to have an organized system of regular follow-up and review of their hypertensive patients.

Find out more

This work on hypertension quality standards implementation in Kerala was recently presented by iDSI in the First NCD Congress in Chandigarh, India, you can view the presentation here. The final results from this work will be available next year and will contribute to the evidence base on how to improve detection and management of hypertension in low and middle income countries.