Though prior trials have shown the effectiveness of community-based hypertension detection and care delivery models, their adoption and translation to practice has been slow. In this study, we will develop and test strategies for the implementation and scale-up of a proven multicomponent hypertension intervention (MCHI) in Pakistan that comprises health education, blood pressure (BP) monitoring and referrals by lady health workers (LHWs) and hypertension management by physicians in primary care settings.

In this 24-month hybrid type III implementation-effectiveness cluster-randomised controlled trial, we will recruit 3000 adult hypertensive patients from two rural districts of Pakistan. We will engage public health sector managers, physicians and LHWs and use the Consolidated Framework for Implementation Research to identify barriers and facilitators to the implementation of an already proven-to-be-effective MCHI. Using Expert Recommendations for Implementing Change and the modified Delphi technique, a set of implementation strategies addressing barriers will be identified. The strategies will be categorised as level 1 (requiring a change in processes), level 2 (requiring a change in infrastructure) and level 3 (financial restructuring). Basic health units and 250–300 households from their catchment will be considered as clusters. Clusters will be randomised in a ratio of 1:1 to intervention and control. While MCHI will be offered in both trial arms (intervention and control), the aforementioned implementation strategies will be randomised to the intervention arm only, starting with level 1 and moving to levels 2 and 3 as needed. Baseline and 6-monthly follow-up surveys, each of 6 months duration, will be conducted to collect data from the recruited participants on sociodemographics, cardiovascular disease (CVD) risk factors, CVD-related expenses and quality of life. The primary outcome will be the mean difference in BP-lowering medications per participant between the intervention and control arms. The primary outcome will be analysed using a linear mixed model with fixed effects for baseline value of the outcome. Additional outcomes include implementation outcomes: proportion of LHWs conducting health education, BP screening and monitoring, facility referrals and proportion of physicians diagnosing and treating hypertensive patients; effectiveness outcomes: proportion of participants with controlled BP and improved EQ-5D-5L score.

Ethical approval has been obtained from the Ethics Review Committee of Aga Khan University Pakistan (ERC # 2023-9084-26739). Findings will be reported to: (1) study participants; (2) funding body and institutes collaborating and supporting the study; (3) provincial and district health departments to inform policy; (4) presented at local, national and international conferences and (5) disseminated by peer-review publications

NCT06726057.

Although physical therapy services are a part of the Essential Package of Health Services in Pakistan, they do not receive their due importance. This qualitative study aimed to explore the in-depth insights regarding the factors that influence the provision of physical therapy services in public sector hospitals of Karachi, Pakistan using the WHO’s health systems framework.

Exploratory qualitative study.

Three public sector hospitals located in Karachi, Pakistan were selected for this study. In-depth interviews were conducted with a total of 12 physical therapists working in the outpatient departments of the selected hospitals.

Findings were categorised into six major themes within the health systems framework, shedding light on various factors influencing the quality of care provided to the patients. These encompass issues such as inappropriate facility infrastructure, limited staff availability and competency, challenges with equipment adequacy and functionality, insufficient financial support, low staff incentivisation and the absence of a regulatory council.

The findings exhibited that the physical therapy services are constrained by various factors at the public sector hospitals in Pakistan. Improvement is recommended at various levels to increase the adequate staffing, financial support, provide the necessary equipment and ensure its functionality. The development of the regulatory council for physical therapy services is the need of the time to address the above solutions.