India is currently undergoing an epidemiological transition, with non-communicable diseases (NCDs) claiming more lives than ever before. According to WHO, out of the total 98.16 lac estimated deaths in India reported in 2014, NCDs held over 60% share.
NCDs are primarily driven by four major chronic conditions — cardiovascular disease, diabetes, chronic respiratory disease and cancers – which together are responsible for over 80 per cent of the NCD related mortality. These conditions are strongly influenced by social and behavioral factors, resulting from multiple drivers including tobacco use, excessive alcohol use, unhealthy diet rich in salt, sugar and saturated/trans-fats and sedentary lifestyle which need to be addressed to reduce the risk of NCDs. Looking at such high mortality due to NCDs, much needs to be done to strengthen screening, early diagnosis, timely and appropriate treatment and follow-up procedures and services for chronic NCDs.
Considering the fast changing disease burden of NCDs, it is important to have a proper data management, analysis and reporting mechanism for NCDs and their risk factors, which would aid both the Centre as well as the states to guide policy development and evaluation of the impact of prevention programs. The WHO has also underlined the need for countries to strengthen national capacity to manage and analyze the data, and to interpret and utilize survey results in a standardized way.
India has embarked upon a challenging yet integrated National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). As of March 2015, over 450 districts across the country have been covered under this national program through a network of 36 state NCD cells, 179 district NCD cells, 180 district NCD clinics, 65 cardiac care units, 61 district day care centers and 1,362 community health centers. In the period between April 2014 and March 2015, around 60 lakh patients have visited the NCD clinics. All these numbers are going to grow exponentially as services reach out in all districts of the country in the coming years, and therefore justifying establishment of a sound functional information system in place.
While the primary objective of this national program is to prevent and treat major NCDs at an early state, a key to achieving this is to technically assess the data gathered from the NCD clinics and use it by health analysts and policy works to devise appropriate strategies.
Another important area that we need to focus on is to link up NCD related data system with Health Management Information Systems (HMIS) across all healthcare establishments, hospitals and laboratories engaged in diagnostics in order to have proper information about the disease trends and outcomes. As health is a state subject, therefore state health authorities should work towards computerization of facilities with adequate IT infrastructure and manpower for enabling data capture and transmission to higher levels. Additionally, NCDs surveillance should not remain confined to the public health sector, but needs to involve the NGO and private sector as well. This would be possible through public-private partnership (PPP) mode.
The Partnership to Fight Chronic Disease (PFCD), in its National Blueprint on NCDs – SANKALP, Disha Swasthya Bharat Ki – emphasized on the need to have a robust surveillance for the chronic disease. Some of its recommendations were:
Inter-ministerial co-operation to integrate NCDs management protocol across all departments
Policy shift from curative to preventive care and to make ‘healthy living’ a social norm
Strengthen Health Information System and establish a robust surveillance system
The Blueprint also called for the establishment of a three-pronged surveillance mechanism with key components, including Management Information System reporting, state wise NCDs surveys, institutional capacity building, e-prescriptions and telemedicine. The MIS reporting system would measure, store and analyze the data to improve treatment quality; manage costs by reducing unnecessary tests; and improve preventive care based on patient health history. Similarly, e- prescriptions would ensure accurate documentation of patient health statistics, diagnostic data, drug disbursement, and supply requirements, while telemedicine would help in timely disease management and curb the travel cost for the patient.
Surveillance enables the successful implementation of primary, secondary and tertiary prevention measures, resulting in increased population longevity, improved productivity of working age population and reduced financial and economic losses. Through regular surveillance, one can better understand the natural history of diseases and identify priority areas for epidemiological and policy research.
All stakeholders need to join hands to create, establish and the use Health Management Information System for effective planning, implementing and monitoring of strategies and programs for NCDs.
India is facing a dual burden of communicable and non-communicable diseases, and on top of that the central government’s spending on health stands at only 1.2 per cent of GDP. Health is a state subject in India. Therefore, the state is responsible for improving public health and the standard of living of its people.
As per the recommendation by the 14th Finance Commission, the transfer of taxes to the states was increased from 32 per cent to 42 per cent. This has created a wonderful opportunity for the state governments to allocate additional funds towards health in order to strengthen their overall healthcare system.
The central government has now started recognizing the role of states in expanding innovative approaches to tackle the growing burden. It is important for the state governments to develop a coordination with the central government in order to effectively execute certain initiatives including strengthening of primary healthcare services, building of healthcare infrastructure and encouraging public private partnerships.
The low investment on health results in lack of proper health infrastructure especially in the rural settings, therefore forcing people to depend on much expensive private treatment. A 2014 rural health statistics report revealed that nearly 35,000 of the 183,000 public health facilities in rural areas do not have their own premises. Also, there is a shortage of 6,700 public health centers and 2,350 community health centers as of early 2014.
The shortage of qualified medical professionals is one of the key challenges posed by the low healthcare spending. The rural infrastructure has a shortage of-
With health encapsulated in the growth story of India, it is imperative for the central and state governments to work together and better leverage the state’s increased share of the tax pool for health, formulating effective plans and policies to reduce the burden of NCDs. PFCD is working in the similar direction through consultative process with experts across India in order to examine new healthcare financing options from the public and private sectors to improve insurance coverage for NCDs, especially at the primary healthcare level.
The Indian Express Group and Express Healthcare organized the first edition of the Healthcare Sabha 2016 – The National Thought Leadership Forum on Public Healthcare. The two-day event was supported by the National Health Mission of the Union Ministry of Health & Family Welfare.
The conference brought together an interdisciplinary group of professionals working in public healthcare on the same platform to discuss on cohesive, unified and innovative ways to achieve the vision of The National Health Mission which is ‘Universal Access to Equitable, Affordable and Quality Healthcare Services’.
Dr Kenneth Thorpe, Chairman, Partnership to Fight Chronic Disease (PFCD) was one of the dignitaries to inaugurate the Healthcare Sabha along with Navin Mittal, Secretary Finance & Commissioner Government of Telangana, Dr Henk Bekedam, WHO Representative to India and Dr Srinath Reddy, President, Public Health Foundation of India.
Dr Kenneth Thorpe’s Keynote Address:
SANKALP – Disha Swasthya Bharat Ki: Implementing a National Blueprint on NCDs
The second day of Healthcare Sabha began with a keynote address by Dr Kenneth Thorpe. He spoke on the rising incidence of NCDs in the world and highlighted India’s burden of NCDs. He pointed out that unless NCDs are brought under control, they will be a serious dampener to India’s growth story. He also highlighted that the country is set to lose US$4.58 trillion between 2012 and 2013 due to the growing burden of NCDs.
Dr Thorpe gave an overview of PFCD’s initiatives to address the growing burden of NCDs in India. At the same time, he also imparted the good news that NCDs are preventable and can be brought under control with clearly outlined strategies. He also drew attention to the unholy nexus between poverty and NCDs. To tackle the danger of NCDs from the country’s horizon, he spoke on the need for effective partnership between key stakeholders of healthcare in India. Dr Thorpe also urged cross-functioning of the ministries for effective interventions such as reducing tobacco consumption, spreading awareness on the danger of sedentary lifestyle, integrated chronic disease networks, stronger public healthcare systems, among others. He ended his presentation with recommendations that would help create a blueprint that successfully tackle NCDs and improve India’s health indicators.
PFCD is a part of 20-member Country Advisory Committee (CAC) of HealthRise India Program, which is a five-year, $17 million global program being funded through Medtronic Philanthropy.
The global program is specifically designed to expand access to care for cardiovascular disease (CVD) and diabetes among underserved populations. The CAC serves four objectives:
Advise HealthRise India around the issues of access to and utilization of chronic disease care in India
Inform the implementation of demonstration projects
Translate and disseminate insights from the demonstration project to other programs across the states and India more broadly, and even globally
Contribute to the process of new grant making opportunities in India.
HealthRise organized its second CAC meeting on April 29 2016, in which a decision was taken to organize an Innovation Workshop under the aegis of the Ministry of Health & Family Welfare (MoH&FW) around August/September this year. PFCD is on the planning committee to design a workshop that will:
Showcase the various innovations experimented in the field of prevention and control of chronic conditions such as CVDs, Diabetes, Cancers, Chronic Lung disease, etc.
Present barriers to successful innovation in chronic disease prevention and control.
Share learning lessons from successful models of innovation in chronic disease prevention and control in India.
Explore opportunities for integration of successful models in national programs.
Explore opportunities for public-private partnerships in new initiatives for prevention and control of CVDs, Diabetes, Cancer, Chronic Lung disease, etc.
The Indian Council for Research on International Economic Relations (ICRIER), a not-forprofit economic policy think tank, organized an International Seminar on “Tackling Chronic Diseases in India” on May 23 2016 in New Delhi. The event was attended by several prominent stakeholders including Dr Henk Bekedam, WHO Representative to India; Dr R R
M L R Siyambalagoda, Additional Secretary (Medical Services), Ministry of Health, Nutrition and Indigenous Medicine, Government of Sri Lanka; and Dr Udaya Mishra and Dr Irudaya Rajan, Professors, Centre for Development Studies, Thiruvananthapuram (Kerala).
Aman Gupta, PFCD Country Representative (India), delivered the keynote address at the seminar and talked about the importance of a multi-stakeholder partnership to manage NCDs as well as advocated for a need to increase public health spend and introduce multipayer system to deal with the challenges related to high out-of-pocket expenditure in India.
He also talked about the making of the national blueprint SANKALP, which is a one-of-itskind framework with a clear focus on multi-sectoral, solution driven approach.
The last section of the seminar was dedicated to presentation on two working papers authored by ICRIER, namely “Prevention of Chronic Diseases: Reorienting Primary Health Systems in India” and “Surveillance of Chronic Diseases: Challenges and Strategies for India”. The presentations talked in detail about the gaps and challenges in the two areas and the recommendations to overcome the issues.
Dr. Damodar Bachani, Deputy Commissioner (NCD), Ministry of Health and Family Welfare made a special visit to the Department of Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta on May 20th. Dr Bachani is also the Director Professor, Department of Community Medicine, at the Lady Hardinge Medical College & Associated Hospitals in New Delhi. Dr Kenneth Thorpe, PFCD Chairman, acted as a host to Dr Bachani at the Emory University.
In his address, Dr Bachani provided a perspective on the changing disease burden in India and the need for a multi-stakeholder approach. Underlining the various initiatives undertaken by the Ministry of Health & Family Welfare to address the growing burden of NCDs, Dr Bachani talked in detail about changing disease burden in India, risk factors & determinants, national response in health sector and the shift towards a multi-sectoral action plan.
Download the June 2016 PFCD India Newsletter.