India is 20 yrs behind in managing non-communicable diseases, shows survey

Pilot assessment in Shimla and Udaipur shows high prevalence of hypertension, diabetes and poor health infrastructure

By Kundan Pandey
Published: Saturday 05 October 2013

While the Central government is gearing up to control non-communicable diseases (NCD) in the country, a pilot surveillance carried out in two districts—Shimla in Himachal Pradesh and Udaipur in Rajasthan—shows the task is not going to be easy.

There is significant prevalence of NCD in both districts, and more than 50 per cent of expenditure is out of the pocket of the patient, says the assessment conducted by MAMTA Health Institute for Mother and Child, a health and development organization working in many areas, including HIV/AIDS and NCDs. The assessment was supported by international organization Medtronic Philanthropy with the aim to develop the socio-technical framework for NCD management in the country. Public Health Foundation of India (PHFI) with other two organizations presented the results of assessment here on Friday.

The two districts were selected on the basis of medical facilities available and government approval.
The district-level assessment, which surveyed a total of over 7,250 individuals, 36  health facilities and 35 healthcare providers in both districts, points to prevalence rates for hypertension and diabetes of 9.5 per cent and 4.2 per cent respectively, in Shimla and 10.1 per cent and 5 per cent in Udaipur within the population above 15 years of age. The national averages for hypertension and diabetes are 5.59 per cent and 6.19 per cent respectively, as determined by the combined opportunistic screening by the National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS).

Alarmingly, one in three individuals above the age of 55 years in both districts was found to be hypertensive, while one in six is diabetic. Total 52 per cent of the 3,430 individuals surveyed in Shimla were not aware of the signs and symptoms of hypertension. This coupled with the higher than expected prevalence of hypertension, which is a leading risk factor for heart disease, emphasises the need for effective interventions to manage these metabolic risk factors if health outcomes related to heart diseases are to be improved.

The survey reveals that primary health centres (PHCs) in both Shimla and Udaipur districts have only 37 per cent and 30.1 per cent facilities respectively. Even district hospitals or medical colleges of both districts do not have sufficient facilities; in Shimla it was only 79.1 per cent and in Udaipur it was 88 per cent. The researchers compared the facilities.

In the survey, the gaps are identified on basis of availability of health facilities according to the Indian Public Health Standard.

Executive Director of MAMTA, Sunil Mehra said that in both district people are paying for health expenses from their pockets which may have catastrophic effect on the family. “At the system level, the community health centre and primary health centre need significant improvement in both the districts. While major policy directives and guidelines remain uniform, local situation analysis followed by specific action plan needs to be developed for successful implementation of strategies for prevention, early diagnosis, management and long-term follow-up of persons with NCDs,” Mehra said.

President of PHFI, K Srinath Reddy, said that the country is 20 years behind at least as far as NCD intervention is concerned. He said that the framework of the assessment captures the whole health system and prioritizes quantitative and qualitative assessments of both the demand for health care by individuals within a community and the supply of healthcare delivered by a health system.

He further said that use of this framework will allow local decision makers to identify and prioritize barriers and bottlenecks in their health system and opportunities to address these issues, strengthen the overall health system serving the community and ensure people in need are better able to navigate entry and use of the system.
Medtronic Philanthropy has plans to expand the surveillance programme to entire country in coming five years, said Paurvi Bhatt, senior director, Global Access, Medtronic.


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