High blood pressure is a major risk factor for cardiovascular disease. 24.6% of adults aged 18+ in Bangladesh have hypertension — yet only about 14% of these patients have their blood pressure under control.
A multisectoral action plan adopted by the Government of Bangladesh aims to reduce the prevalence of raised blood pressure by 25% by 2025 following WHO global targets. NHFB has been working with NCDC, DGHS, and Resolve to Save Lives (RTSl) since 2018 to implement a scalable model of hypertension control at Upazila Health Complexes and Community Clinics.
After a successful pilot in Sylhet in 2018, the program scaled to 54 facilities in 6 districts in 2021, expanded to 182 facilities in 23 districts in 2022, and by January 2025 reached 310 facilities in 44 districts across Bangladesh.
“Implementation of a model for hypertension control at primary health care level is an important agenda of the Non-Communicable Disease Control Program (NCDC), Directorate General of Health Services (DGHS).”
Each letter of H·E·A·R·T·S is a core component of the WHO hypertension control package. Below is how BHCI delivers each one at Upazila Health Complexes across Bangladesh.
Information on four behavioural risk factors for CVD is provided. Brief interventions are described as an approach to counselling on risk factors and encouraging healthy lifestyles.
BHCI develops Information, Education & Communication (IEC) materials with effective health messages. Medical Officers (MOs) and Senior Staff Nurses (SSNs) spend dedicated time counselling patients on lifestyle change at every visit.
A collection of protocols standardising the clinical approach to managing hypertension and diabetes.
BHCI co-developed the national hypertension treatment protocol adopted by NCDC/DGHS. Upazila Health Complex and facility staff are sensitised to follow it through training, Quality Improvement (QI) cycles, and advocacy meetings.
Information on CVD medicine and technology procurement, quantification, distribution, and facility-level handling of supplies.
Inter-division, inter-district, and inter-facility medicine transfer mechanism established. Facilities procure NCD medicines using the Medical & Surgical Requisite (MSR) fund, with systematic refilling at Community Clinics to sustain patient access.
Guidance on a total-risk approach to the assessment and management of CVD, including country-specific risk charts.
Prevention of stroke and heart attack through proper blood-pressure screening and diagnosis. Every enrolled patient receives a structured risk assessment and targeted follow-up.
Guidance and examples on team-based care and task-shifting for CVD management, plus training materials.
NCD corner roster established at every Upazila Health Complex with two dedicated nurses and one NCD doctor. Community Clinic refilling staff handle routine medicine supply so clinicians focus on clinical decisions.
Information on how to monitor and report on CVD prevention and management, including standardised indicators and data-collection tools.
NCD staff trained on the Simple App; Civil Surgeons use the Simple Dashboard to track district performance; Upazila Health & Family Planning Officers (UH&FPOs) use the Simple App for facility-level review.
Based on WHO HEARTS, BHCI implements five core intervention strategies at enrolled primary-care facilities across Bangladesh.
Standardized, evidence-based treatment protocols aligned with the WHO HEARTS technical package. Step-by-step clinical guidelines for hypertension diagnosis, treatment initiation, and follow-up at the Upazila Health Complex and Community Clinic level.
Multi-disciplinary health teams with optimized task distribution — community health workers, nurses, and physicians collaborating for efficient patient management, improved reach, and sustainable coverage at the primary care level.
Ensuring an uninterrupted supply of essential antihypertensive medicines at all enrolled facilities. Systematic procurement, forecasting, and distribution mechanisms eliminate stock-outs and support long-term treatment adherence.
Patient education, counselling, and support for lifestyle modifications. Regular follow-up systems, appointment reminders, and adherence coaching to achieve sustained blood pressure control and prevent cardiovascular complications.
Digital health management through the HEAL-BD platform for real-time patient tracking, clinical outcome monitoring, and program performance dashboards — enabling data-informed decisions at facility, district, and national levels.
BHCI has scaled from a 4-Upazila pilot in Sylhet (2018) to covering 47 districts and 328 facilities across all 8 divisions of Bangladesh by March 2026.
Hypertension prevalence among adults aged 18+ in Bangladesh
Source: BCPS National Survey 2022Of hypertensive patients currently have their blood pressure under control nationally
Source: Program Monitoring DataNHFB, NCDC, DGHS & RTSl partnership delivering primary care hypertension services
BHCI Program RecordsBHCI is a multi-stakeholder initiative bringing together government, civil society, and global health organizations.
BHCI operates under the National Non-Communicable Disease (NCD) Action Plan of the Government of Bangladesh. Coordination is led by NCDC within DGHS, with NHFB providing technical expertise and Resolve to Save Lives providing global program support and quality improvement.
Administrators and policymakers need accurate information. But nurses and other non-physician health care workers are the primary users of a digital tool. If the tool is fast and user-friendly, they will use it.
The evidence and recommendations in the WHO HEARTS playbook are based primarily on experiences developing and implementing Simple — a user-friendly mobile app built for hypertension and diabetes management across busy primary care settings in low- and middle-income countries. The India Hypertension Control Initiative launched Simple in October 2018; it expanded to Bangladesh, Ethiopia and Sri Lanka and — as of January 2026 — the app has been used by 5,387 public-health facilities to manage 4,432,692 patients with hypertension and diabetes.
Perspectives from the clinical and global-health leaders driving BHCI.
“BHCI shows what is possible when primary-care teams are given evidence-based protocols, the medicines they need, and a simple digital tool they actually want to use. The 58% BP-control rate in our enrolled facilities is the result of that combination.”
“Bangladesh is demonstrating that hypertension control at scale is achievable in low- and middle-income settings. BHCI is one of the global reference programs for national hypertension-control initiatives.”
How hypertension control is changing daily life at Upazila Health Complexes, Community Clinics, and NCD corners.
“Since joining the NCD corner I take my medicine every month and my blood pressure is much better. The nurse knows me by name now.”
“The Simple App lets me finish a follow-up visit in a few minutes. I spend the rest of the time counselling patients on diet and salt.”
“Community Clinic refilling means patients no longer travel to the upazila for a simple medicine pickup. Loss to follow-up has dropped sharply.”
