Abstract
Abstract Introduction In 2022, Bangladesh reported a 23.5% prevalence of hypertension among adults.1 Additionally, the country is experiencing an increasing burden of Non-Communicable Diseases (NCDs), which accounted for 70% of all deaths in 2019.2 Bangladesh is also undergoing an epidemiologic transition from infectious diseases to NCDs, causing a dual burden on the healthcare system.3 Additionally, there is a critical shortage of healthcare workers, with a disproportionate concentration in urban areas.4,5,6 Purpose Given Bangladesh's healthcare context, strategic task shifting can help alleviate healthcare shortages. By redistributing the workload among the health workforce teams, tasks are transferred from highly skilled workers to those with less training, which could be beneficial for managing hypertension. This enables non-physician healthcare workers to play a crucial role in areas with limited physician access.7 Methods Bangladesh Hypertension Control Initiative (BHCI) was established to improve hypertension control and prevent cardiovascular disease in primary healthcare facilities of Bangladesh. At the primary healthcare facilities (UHC), a team dedicated to hypertension care performs the following tasks: screening, registration, prescribing medicine, assessing complications, recording patients’ follow-up, referral, and providing medicine and lifestyle advice. To reduce the burden of follow-up patient at the UHCs, registered patients with hypertension, controlled (BP<140/90 mmHg) only by Amlodipine (step 1 of the ‘Hypertension Management Protocol for Primary Healthcare Setting in Bangladesh’) for at least three months or the last three visits to the UHCs were assigned to 8 Community Clinics (CC) in Sylhet district. These clinics are located within the community, and Community Health Care Providers (CHCPs) are trained health workers in these clinics. Result BHCI registered 81,563 hypertensive patients in 54 UHCs until August 2022. Of these, 61% had their blood pressure under control, and 29% missed their visits for the last three months. By shifting the task of medicine refilling and follow-up to the community clinics, 1101 patients were assigned to these 8 CCs from March 2022 to August 2022. At the end of August 2022, 80% of patients had their blood pressure under control (BP<140/90 mmHg), 8% missed their visit for the last three months, and 74% visited the CCs for follow-up. Conclusion Task shifting is a new initiative in Bangladesh's healthcare system, and implementing medicine refilling and follow-up through community clinics has shown promising results. This approach could serve as a scalable model for decentralising hypertension care by task shifting in other countries.Outcome of medicine refilling from CC