Hypertension: Trained Laypeople Improve Healthcare in Rural Africa

Hypertension is one of the leading causes of heart attacks and strokes worldwide. In many low- and middle-income countries, a significant portion of those affected remain untreated. Access to hypertension treatment is particularly limited in remote areas due to a lack of medical care, which includes the mountainous small state of Lesotho in southern Africa.

The use of specially trained lay staff for medical tasks is considered a promising approach. However, until now, there were no substantial studies on hypertension treatment. A research team from the University of Basel, led by Prof. Dr. Niklaus Labhardt and Dr. Alain Amstutz, has now examined this in cooperation with SolidarMed, the Ministry of Health of Lesotho, and the National University of Lesotho. The results are published in 'Nature Medicine'.

Tablet-App Guides Lay Staff through Treatment

In the study, 103 trained laypeople tested more than 6,600 individuals for hypertension in their villages over five months. They identified hypertension in over 1,200 people, with more than 500 exhibiting medically problematic levels. Approximately half of the identified hypertension patients received a prescribed antihypertensive therapy following clear protocols and with digital decision support from the trained laypeople.

A tablet-based clinical decision app helped the lay workers adjust the dosage of the antihypertensive drugs Amlodipine and Hydrochlorothiazide for each patient according to specific guidelines during the study. They optimized the therapy through regular follow-ups over the subsequent weeks. Patients with hypertension in the control group received treatment in healthcare facilities by medical professionals, as usual.

The care provided by lay helpers outperformed the usual treatment at healthcare facilities. Simultaneously, the researchers found no significant differences in severe side effects or complications between the two groups. The lay-supported model was thus as safe as the usual treatment. The study demonstrates that the lay-supported model can work better in remote regions than the standard care provided at often distant healthcare facilities.

'After two weeks of training, lay helpers from the village, with digital support, are well equipped to care for people with hypertension,' says Co-Study Leader Prof. Dr. Niklaus Labhardt from the University of Basel. 'This can significantly improve the treatment situation for many hypertension patients.'

As a next step, the researchers aim to explore the cost advantages of this care approach.

Significance for Health Systems in Countries with a Shortage of Professionals

The results from Lesotho illustrate how the so-called 'Task Shifting' approach can be implemented in practice: Laypeople are specifically trained, closely supervised, and work with clear protocols as well as digital decision support. This allows treatments to be brought closer to people and lessens the burden on healthcare facilities.

'Every small reduction in blood pressure lowers the risk of later stroke or heart attack,' emphasizes Labhardt. SolidarMed implemented the model in collaboration with the health authorities in Lesotho and ensured training, supervision, and integration into the existing healthcare system.

'In our cooperation with SolidarMed, we learned that the use of trained laypeople from the community for screening, early detection, and follow-up of hypertension can reduce hospital admissions. This helps improve access to healthcare for underserved, remote villages,' says Lebohang Sao, Health Officer in the Butha-Buthe District from the Ministry of Health in Lesotho.

'In many countries, trained laypeople are an essential part of primary care,' confirms Jochen Ehmer, Medical Director of SolidarMed. 'The study shows that they – with appropriate guidelines and digital support – can also safely co-manage chronic diseases such as hypertension.'

The study is part of the multi-year research program 'Community Based Chronic Care Lesotho' (ComBaCaL), an applied research collaboration between Switzerland and Lesotho. ComBaCaL is funded by TRANSFORM, a support program of the Swiss Agency for Development and Cooperation (SDC).

'ComBaCaL provides solid scientific evidence and significantly contributes to the impact of international cooperation,' says SDC Research Officer Martina Schmidt. 'Such projects are of particular importance in the current development policy context.'

Original publication

Felix Gerber et. al. (2026). Lay community health worker-led care with mobile decision support for uncontrolled hypertension: a cluster-randomized trial. Nature Medicine. 10.1038/s41591-026-04208-w

University of Basel

Founded in 1460, the University of Basel is Switzerland's oldest university. Once a centre of European humanism, it is now an internationally oriented, research-intensive university with focal points in Life Sciences and Medicine. Located at the tri-border region of Switzerland, Germany, and France, it forms the heart of the region's science and innovation cluster. As a full university, it combines all scientific disciplines in teaching and research. Its achievements rank it among the top 150 universities worldwide according to international rankings and among the top 15 in the German-speaking world.

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