Scaling Blood Pressure Control Starts with Leadership

When it comes to designing health programs that prevent disabling heart attacks and strokes and premature deaths from cardiovascular disease, the evidence is clear. The World Health Organization’s (WHO) HEARTS technical package has treated more than 34 million patients around the world; when implemented correctly and consistently, HEARTS gets the results that matter: better blood pressure control and healthier people.

However, many noncommunicable disease, cardiovascular disease, and hypertension programs don’t implement HEARTS strategies as designed—or at all. This reflects a persistent gap between knowing the technical guidance and having the practical skills to adapt and apply it within varied country contexts.

Strengthening Capacity and Leadership for Hypertension Control (SCALE-HTN Control) is a new training program led by technical experts at RTSL and WHO that supports national and sub-national program managers to deliver high-quality, HEARTS-based care at the primary health care level (see Box 1 below).

The SCALE-HTN Control curriculum

The SCALE-HTN Control training guides program managers to translate global guidance and real-world experience into ready-to-implement action plans. SCALE-HTN Control’s 12 modules walk participants through each element of a successful hypertension program, from screening with accurate measuring devices, to evidence-based treatment protocols, to improving medicine accessibility, to information systems and data interpretation. Participants learn how to structure team-based care that keeps patients at the center, and how to advocate and adequately budget for the program’s needs.

The five-day training prioritizes active engagement and peer-to-peer learning: through hands-on exercises, small-group problem solving, peer exchange, and discussions facilitated by RTSL staff and WHO colleagues. One day of the program includes a local field visit to a facility currently implementing HEARTS—an opportunity to observe HEARTS in practice and to debrief as a group on what they saw going well and what could be improved. Participants discuss their contexts in-depth, learn from others in similar positions, and problem solve with technical experts in real-time—closing the knowledge-skill gap.

Over the course of the training, participants develop and refine a context-specific action plan with support from the program facilitators. These plans reflect the realities of their programs and address real problems in feasible ways, making them ready to share with partners and stakeholders back home.

A select number of participants complete an additional facilitator orientation prior to the program start and support RTSL staff to deliver the training. This additional capacity strengthening not only helps the program run smoothly but also prepares these participants to deliver the training to their peers back home.

Developing a training program that meets the need

Over the course of two years, RTSL and WHO designed, user-tested, and iteratively refined the program with program managers from various countries and contexts. When initial feedback suggested that the modules were too text-heavy and abstract, they were updated to have a more dynamic presentation and practical focus: including videos and real-world country case studies and various individual and group exercises that keep members engaged and allow ample opportunity to share lessons learned. The field visit was added to bring HEARTS to life and bring the abstract to reality.

These enhancements have ensured the training program is relevant to all program managers—from those who have yet to integrate any aspect of HEARTS into their programs to those who are implementing all aspects but not seeing the results they desire—and that they meet the needs of the participants.

Participants engage in the SCALE-HTN control program in hosted WHO SEARO (top), WHO WPRO (middle), and WHO WPRO (bottom)

In less than two years since inception and one year since launch, the SCALE-HTN Control training has meaningfully translated HEARTS-based strategies and guidance into country-level action.

As of June 2026, RTSL and WHO have trained 81 program managers from 20 countries across three WHO regions—Southeast Asia, Western Pacific, and Eastern Mediterranean.

The training has also since cascaded to the national level in the Philippines and Indonesia as a direct result of the facilitator training segment of the program. In total, twenty-three facilitators from Sri Lanka, the Philippines, Egypt, and WHO are now ready to deliver this training in their areas; Vietnam, China, and India are actively building momentum to follow; and the program directly inspired Egypt and others to conduct similar trainings for frontline health workers.

Beyond these direct outputs, the trainings have increased the visibility and credibility of blood pressure control as a strategic entry point for broader primary health care and NCD strengthening, elevating hypertension on national NCD agendas. They further deepened strategic partnerships with host governments and WHO regional and country offices. The initiative is also establishing an emerging community of practice that further promotes peer learning, cross-country collaboration, and ongoing mentorship—a qualitative infrastructure with the potential to continue generating impact long after each training cohort concludes.

As global momentum grows to reduce the burden of noncommunicable disease and its primary risk factor, high blood pressure, the SCALE-HTN Control training program for national and sub-national program managers will ready countries to act efficienty, effectively, and at scale, saving millions of lives.