NCDs are primarily driven by four major chronic conditions – cardiovascular disease, diabetes, chronic respiratory disease and cancers – which together are responsible for over 80 percent of the NCD related mortality
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 policydevelopment 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 InformationSystems (HMIS) across all health care 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:
- Strengthen the NCD department within the Ministry of Health and Family Welfare at both center and state levels
- 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.
Disclaimer: The views expressed in the article above are those of the authors’ and do not necessarily represent or reflect the views of this publishing house
Dr. Damodar Bachani
Director Professor, Department of Community Medicine, Lady Hardinge Medical College & Associated Hospitals