Managing Hypertension in India: Can the Private Sector Be a Game-Changer?

Krishna, a 43-year-old from Telangana, was put on hypertensive medication when his blood pressure was found to be dangerously high during an unrelated visit to the local Rural Medical Practitioner (RMP). With limited access to standard healthcare, millions like Krishna in rural India, rely upon the local private providers, who arbitrarily adapt the blood pressure screening protocols which often results in delayed or inaccurate diagnosis.¹

This isn’t a rare occurrence. It reflects a widening healthcare gap in India, where the lack of adequate regulation of the private sector tends to add to the crisis.

Why is hypertension a crisis?

Hypertension is the leading risk factor for cardiovascular diseases, which cause nearly one-third of deaths globally.² In India, with over 220 million affected, and only 12% of them having it under control³, the situation requires urgent intervention.

Alert to the growing burden, the Government of India launched the India Hypertension Control Initiative (IHCI) in 2017. Despite the significant progress IHCI has made using the public health system, India is likely to fall short of the 25% reduction in hypertension by 2025 goal.

What’s the missing link?

While the concerted efforts to manage hypertension nationally under IHCI have borne significant results, one key link may have been overlooked-the private sector.

Private sector, including informal practitioners such as RMPs, cater to over 70% first-time care seekers, especially in rural and peri-urban areas.¹ However, many of these providers do not follow the routine opportunistic screening protocols for hypertension.¹ A recent study involving private practitioners in Telangana found that blood pressure is typically checked only if a patient reports symptoms such as headaches, dizziness or palpitations.¹ This reactive approach delays diagnosis and treatment, exposing patients to a greater risk of complications.

This highlights a deeper issue-the need for effective integration and adequately regulated involvement of the private sector into national healthcare goals-for tackling India’s hypertension crisis.

The Role of the Private Sector in Hypertension Management

India’s private healthcare sector has immense potential and is making rapid growth. Its dominance in service delivery, especially in the rural and underserved regions, its state-of-the-art infrastructure and pioneering role in health technology make the private sector an asset that can be harnessed to improve outcomes. Here is how the private sector can contribute to hypertension management in India:

1. Enhancing Access

Evidence supports that private clinics, pharmacies and even community spaces such as barbershops⁴ can serve as screening hubs. Task sharing with local points-of-contact such as pharmacists can bridge the screening and care gap^.5

2. Healthcare Technology Innovations

Private sector plays a pivotal role in India’s health tech sector. Insights can be drawn from the utility of digital health apps such as IHCI’s Simple App, wearable devices and access to teleconsultation and telemedicine services in bettering healthcare access and remote monitoring for better management. For instance, portals like e-sanjeevani have made remarkable contributions in improving healthcare access among the underserved populations such as women and rural care seekers.⁶

3. Streamlining Supply Chain to Improve Drug Availability

Through bulk procurement of drugs, pharmaceutical innovation and a seamless supply chain, the private pharmaceutical industry can enhance drug availability.

4. Capacity Building and Community Engagement

The private sector can help scale and implement continuing medical education programs, ensuring that private providers are regularly apprised of standardized treatment and screening protocols in line with IHCI. Additionally, local providers can promote community engagement to foster healthier lifestyles, promoting awareness and self-care.

Are Public-Private Partnerships the Answer?

Public-Private partnerships (PPPs) offer an effective way to utilize the private sector’s potential. PPPs in health aim to synergize all stakeholders to contribute their best to strengthen all national policies and programmes for improving the health of the population. These are collaborative mechanisms aimed at enabling government and private entities to share resources, responsibilities and risks for better health outcomes.⁷

PPPs in Healthcare Can Take Many Forms:

• Partnerships for Health Service delivery, wherein private players offer public-funded services in public facilities.⁸
• Collaborations involving health infrastructure such as a facility where a public agency utilizes private infrastructure for service delivery.⁸
• Integrated models, where private providers lease or build a facility to deliver free or subsidized care to specific populations.⁸

PPPs are a promising solution to effective hypertension management. However, identifying opportunities for high-impact collaborations and investments, clarity in governance, accountability, transparency and shared decision making will be crucial to their success. A systematic approach to critical decisions regarding private sector involvement is key to sustainable partnerships.⁹ Other successful PPP models in healthcare, such as Patient Provider Support Agencies (PPSA) that facilitate private sector integration into India’s National Tuberculosis Elimination Programme^10,11 and Kenya’s Healthy Heart Africa¹² initiative can guide national efforts towards successful partnerships to tackle hypertension crisis.

The Road Ahead

Collective effort and partnerships between public and private sectors are key to solving India’s hypertension crisis. Through PPPs India can:

• Expand the reach of services
• Improve the efficiency of care delivery
• Attain its goal to contain hypertension

With the right strategies, we can shift from isolated efforts to a nationally coordinated movement-one that engages diverse stakeholders, public and private-ensuring accessible and quality care for millions.

References:

1. Gupte, S. S., Sachdeva, A., Kabra, A., Singh, B. P., Krishna, A., Pathni, A. K., Sharma, B., Moran, A., Mamindla, A. R., Kannuri, N. K., & Deo, S. (2024). Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-11560-5
2. World Health Organization. (2021, June 11). Cardiovascular diseases (CVDs). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
3. World Health Organization. (2020, September 16). Hypertension. https://www.who.int/india/health-topics/hypertension
4. Victor, R. G., Lynch, K., Li, N., Blyler, C., Muhammad, E., Handler, J., … & Elashoff, R. M. (2018). A cluster-randomized trial of blood-pressure reduction in black barbershops. New England Journal of Medicine, 378(14), 1291-1301.
5. Das, H., Sachdeva, A., Kumar, H., Krishna, A., Moran, A. E., Pathni, A. K., … & Deo, S. (2023). Outcomes of a hypertension care program based on task-sharing with private pharmacies: a retrospective study from two blocks in rural India. Journal of Human Hypertension, 37(11), 1033-1039.
6. Government of India, 2025. Annual Report 2024-25, Ministry of Health and Family Welfare. https://mohfw.gov.in/sites/default/files/Final%20Printed%20English%20AR%202024-25.pdf
7. World Bank. (n.d). PPP Online Reference Guide. Retrieved on May 28, 2025, from https://ppp.worldbank.org/public-private-partnership/PPP_Online_Reference_Guide
8. Stucke, A., Humphreys, D., & The Economist Intelligence Unit. (2019). Public-Private partnerships for emerging market health. In IFC Public-Private Partnership (PPP) Think Tank Discussion at the 2019 Global Private Health Care Conference. https://www.ifc.org/content/dam/ifc/doc/mgrt/eiu-briefing-paper-ppps-final.pdf
9. World Health Organization. (2024). Supporting Member States in reaching informed decision-making on engaging with private sector entities for the prevention and control of noncommunicable diseases: a practical tool. https://iris.who.int/bitstream/handle/10665/378209/9789240094840-eng.pdf?sequence=1
10. Arinaminpathy, N., Deo, S., Singh, S., Khaparde, S., Rao, R., Vadera, B., … & Dewan, P. (2019). Modelling the impact of effective private provider engagement on tuberculosis control in urban India. Scientific Reports, 9(1), 3810.
11. Deo, S., Jindal, P., Gupta, D., Khaparde, S., Rade, K., Sachdeva, K. S., … & Dewan, P. (2019). What would it cost to scale-up private sector engagement efforts for tuberculosis care? Evidence from three pilot programs in India. PloS one, 14(6), e0214928.
12. Ogola, E. N., Okello, F. O., Herr, J. L., Macgregor-Skinner, E., Mulvaney, A., & Yonga, G. (2019). Healthy Heart Africa–Kenya: a 12-month prospective evaluation of program impact on health care providers’ knowledge and treatment of hypertension. Global heart, 14(1), 61-70.