A Roadmap to Address Non-Communicable Diseases in India:
It gives me an immense sense of happiness and honor when I look back at the journey of the Partnership to Fight Chronic Disease (PFCD) in the course of the last seven years and the efforts that we are making for the well-being of the society through various multi-stakeholder initiatives targeted towards addressing the continuously growing burden of non-communicable diseases (NCDs) in India.
After engaging with over 100 key opinion leaders across all stakeholder groups over the last 18 months, the PFCD released an evidence-based National Blueprint – “SANKALPDisha Swastha Bharat ki”, a one-of-its-kind initiative in India. The members of the National Advisory Group and the Working Group of “SANKALP” guided the development of this document by providing valuable insights.
The National Blueprint is a result-oriented action plan with an objective to devise a framework to control and prevent the growing burden of NCDs in India through a collective multi-sectoral response. PFCD adopted a tiered engagement framework, including periodic discussions and interactive sessions with key decision-makers from the Government, both at the Center as well as some of the prioritized states. This included four regional multi-stakeholder consultations in 2014 and one in 2015.
The paper identifies three thematic tracks converging to form this evidence-based pathway, specifically: Policy and Surveillance, Strengthening of Healthcare Systems and Healthcare Financing. These three key aspects are imperative to meet the WHO 2025 goal of reducing premature NCD mortality by 25% by the year 2025.
PFCD aims to complement the Government of India’s efforts towards curbing the incidence of NCDs in the country, and to bring about a positive and constructive shift from issue-stating to problem-solving, while working within the constraints that exist. The primary target audiences for this document are all related stakeholders at the central and state governments as well as the private sector.
Post the release of this action plan “SANKALP”, PFCD aims to continue its journey to find sustainable solutions to fight chronic diseases in India through a multi-stakeholder approach and engagement framework.
Taking a step forward, PFCD aims to adopt a robust engagement plan with the target audience identified earlier in this document and work with them to access the feasibility of the recommendations proposed in this document. Our immediate next steps would entail working closely with a few states and draw up a demonstrable model to reduce the burden of NCDs that could act as a benchmark for others to replicate.
In the subsequent phase of this campaign, the team is preparing to undertake a comparative impact assessment of NCDs on the socio-economic wellbeing of a community, before and after an inclusive and sustained program implementation to control and curb the growth of NCDs.
In 2016, the PFCD would continue its deliberation on Healthcare Financing, which is one of the most important aspect to manage and address NCDs. The primary objective of this activity is to better understand the complex financing system as well as conduct further discussions on the existing gaps and challenges. In the earlier part of 2015, the PFCD held a focused discussion on Healthcare Financing titled “Innovative Models of Healthcare Financing
for a Healthier India”, with participation from state and national-level policy makers, insurance specialists, economists, medical fraternity, academicians and others.
What PFCD started working on 18 months back is a reality now. While the project itself is a major achievement, it is just the beginning of our journey.
I wish you all a Merry Christmas and Happy New Year 2016!
NCDs Key Focus Area for the Government: DG ICMR Dr Soumya Swaminathan
Emphasis on epidemiology, comprehensive treatment and care through strategic interventions,
Director General of the Indian Council of Medical Research (ICMR) Dr Soumya Swaminathan said that NCDs is one of the key intervention areas for the government and all the possible efforts would be undertaken in this regard.
Delivering the Special Address during the release of the National Blueprint on NCDs – “SANKALP – Disha Swastha Bharat Ki”, she talked in detail about the changing dynamics in disease burden over the last few years, different aspects associated with NCDs, and the strategic initiatives being undertaken by the ICMR and the government to deal with the issue. Here are some of the excerpts from her speech on the momentous occasion.
Recognizing the growing threat of NCDs
In terms of NCDs, there has been not just a growing burden but a growing recognition of the problem as well in the last few years. The ICMR had taken cognizance of this quite early on and released the first report in 2004 on the burden of four major NCDs – hypertension, diabetes, cancer and cardio vascular. With the changing dynamics, the ICMR is now undertaking the State-level Disease Burden Initiative in partnership with the Public Health Foundation of India (PHFI) and the Institute for Health Metrics and Evaluation (IHME) under the aegis of Ministry of Health and Family Welfare, Government of India. This initiative would work closely with a network of academic partners
across India, and importantly with policy makers at the national and state level for guidance and utilisation of the findings to improve health programmes and planning.
State-level Disease Burden Initiative
It is a collaborative initiative on state-level disease burden estimation in India. In this effort, the methods of the Global Burden of Disease (GBD) study, developed by a global network of researchers coordinated by IHME, will be utilised to generate rigorous estimates of all the major drivers of health loss at the state level in India. In addition to the scientific papers, the initiative will produce multi-level disseminations through policy-briefs, workshops and seminars to raise the discourse and monitor changing disease trends. Latest GBD interactive visualisation tools will be used to bring to life the initiative’s findings. Reportedly, this will allow a variety of contrasts between states, which will be particularly useful for policy makers in understanding trends of
disease and risk factor in order to plan further action.
States to play a key role in mitigating NCDs burden
Health is a state subject and active participation of states is very important especially for a country like India. Without the state involvement, it would be very difficult to do national level planning as states are diverse in terms of the level of healthcare awareness, access to the people, levels of poverty, and so on. Therefore the needs of one state are often quite different from the needs of other states. The size of most of the states in India is bigger than many countries worldwide. Therefore we would not be able to yield optimal outcomes unless we account for variations in disease burden trends across the states.
Risk factor determination for chronic disease
Apart from just doing disease burden estimates, it’s important to do risk factor determination as well. The contribution of risk factors has increased significantly over the last several years, with major contributors being air pollution and tobacco smoking. The extent of these factors varies from state to state. The ICMR is taking the lead in this area as well and will be very shortly launching a study to understand the risk factors for chronic disease at the state level. Many of these things we probably already know but we’ll be able to document the extent and who knows there may be some surprises in store for us as well in terms of risk factors.
Traditional communities are at increasing risk of NCDs
It is quite disturbing actually to see the increasing rates of hypertension and diabetes in communities which were traditionally not considered to be at the high risk. This is because of the drastic change in their lifestyle, diet and so on. The tribal communities have completely been divorced from their traditional way of life, their traditional diet and the way they used to live. Their diets which used to be very diverse and protein content, now have become a cereal based diet – just like any other urban dweller. A lot of things have been imposed on those people and we are seeing the effects of that by way of the increasing rates of NCDs and chronic disease.
Majority of India’s population lacks optimum nutrition diet
The latest survey by the National Nutrition Monitoring Bureau shows that less than 5% of India’s population gets the required amount of fruits and green leafy vegetables. Additionally, more than 70% of the population is not even getting more than 1 RDA of proteins. So we are in a situation where our diets are completely dominated by cereals and lack fresh fruits and vegetables. This is partly contributed to the low socio economic conditions of people as well as partly to ignorance as there are lot of locally and cheaply available processed food so one doesn’t want to buy expensive stuff like fruits and vegetables.
Prevention is the key mantra:
In terms of these chronic disease that we are talking about – certainly prevention is not only much more cost effective but also much more beneficial for people in the long run. This is an area where we haven’t done enough and I would like to see research focused more on how we develop a sustainable prevention programme that’s actually driven and accepted by the community because unless a change happens in the community itself, it’s going to be
very difficult to sustain.
Expert Opinion – Time to Shift Gears: Towards a Healthier India
Dr. Prabhakaran Dorairaj:- While we continue with the programme for the prevention of communicable diseases, we also require innovative methods of addressing non-communicable diseases (NCDs). The reduction in NCDs has been globally driven
by policy changes, particularly in the areas of tobacco control, salt reduction and diet as well as providing an enabling environment for physical activity. But in my opinion, the most important problem we face right now is the
shortage of trained physicians to manage NCDs, and therefore focus needs to be on improving the health systems and one of the areas is capacity strengthening to manage NCDs. The other significant aspect is community engagement and community organization because we need people to say. All we are focusing on right now is providing information
to people by which they say ‘I know’, but we want people to say ‘I want and I can and for that we need innovative approaches.
Dr. Damodar Bachani:- The draft National Health Policy 2015 speaks a lot about NCDs and once it is officially released, the NCDs will come under the focal area and would attract virtually equal attention given to reproductive & child health and
communicable diseases. This would enable us to drive more resources which are urgently required to manage and address NCDs. For effective solution to this public health problem, firstly we need to have a national policy framework in place for NCDs and then convenience the state governments to seriously take up the issue and work towards implementing best practices and effective interventions. Most importantly, we also need to simultaneously work towards strengthening the existing health systems to address NCDs in terms of training the existing workers and so on.
Dr. Ratna Devi:- Patients play an important role as individuals, especially if you’re talking about reversing the epidemic as they are the ones who have to bring that behavior and lifestyle changes to be able to decrease the number in the long
run. There has been very little movement in the patient area, especially in diabetes and hypertension, although there has been a lot of good work done by cancer groups. In other areas of NCDs only physician-driven work is
happening, but now it needs to move beyond the physician-driven movement and patients need to take ownership so that more work that is happening in the prevention aspect comes to the forefront. The World Health Organization
is presently working towards forming an India-centred NCD alliance, so we hope that the patients will get more platforms and bring their voices to the forefront.
Dr. Anand Krishnan:- Although we lack in terms of generating evidences to make NCD-related policies, we still have sufficient evidence available for most basic activities to take place and involve the government and the private sector for effective intervention. The private sector is much better in research-based activities than the public one, but the problem is that the findings are not that well shared, does not come into the public forums and are not scientifically featured. Therefore, the government has to change the way it generates and uses evidences. The government also needs to encourage the private sector to share its findings so that it can be used for the welfare of the community.
Dr. Sanjiv Kumar:- The government is pivotal in any public health programme so they have a very important role to play. India is increasing its focus on NCDs, and its inclusion in the draft Public Health Policy 2015 is one such step in this direction. The Ministry of Health has constituted four task forces – Primary healthcare, standard treatment protocol and guidelines, human resources for health, and costing of healthcare services – to look into different aspects. When it comes to NCDs, prevention is the key and therefore the need of the hour is to change the perspective to address this public health problem as 99.99% of NCDs can be managed at home by bringing lifestyle changes. Therefore, we need a holistic approach to mitigate the NCD burden; an all-inclusive approach with participation from all ministries rather than just the health ministry.
National Blueprint in the News
Dr Kenneth Thorpe’s video interview on Rajya Sabha TV (RSTV)
The full interview can be watched on the official YouTube channel of Rajya Sabha TV:
Rajya Sabha TV (RSTV) is an Indian cable television network channel owned and operated by Rajya Sabha . While focusing on current national and international affairs, it provides a platform for knowledge-based programmes for the discerning viewer.
Wanted: a roadmap to tackle non-communicable diseases
Later this month, the PFCD will release a national blueprint in consultation with NCD experts from across India to help address and manage the problem through improved surveillance, data and intervention.
Blueprint on chronic diseases calls for preventive care
“An integrated and evidence-based chronic disease management framework is missing in India. The blueprint could be a “formative step” toward achieving the vision of a healthy India by 2025.” – Kenneth Thorpe, Chairman, PFCD
“India is witnessing a rapid health transition due to changing disease patterns, with NCDs attributing to higher mortality and morbidity rates. Addressing NCDs takes on paramount importance as alarming statistics show that they pose a serious threat to both the social and economic development of the country.” – PFCD’s chairman Dr. Kenneth Thorpe.
Why India needs a multi-sectoral approach to non-communicable diseases
“PFCD aims to adopt a robust engagement plan with the target audience identified in the document and work with them to access the feasibility of the recommendations proposed in this document. With a sharper focus on states in India which are home to a significant burden of NCDs, the team intends hosting periodic consultations adopting a multi-sectoral approach and engaging relevant stakeholders from the state, private sector, patient groups, NGOs, etc. A phase-wise approach will be adopted to undertake deeper engagement with the states and in turn identify and further the repertoire of best practices in the country.” – Aman Gupta, country representative, PFCD
Download the December 2015 PFCD India Newsletter.