Dr. Baridalyne Nongkynrih, Dr. Mohan Bairwa
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi
Globally, noncommunicable diseases (NCDs) are responsible for about 70% of all deaths, resulting in nearly 15 million premature deaths globally i.e., deaths between the ages of 30 and 69 years. The majority of these deaths at 85% occur in low- and middle-income countries (LMICs). NCDs such as cancer, CVD, CRD, diabetes and mental health – can result in a cumulative output loss of US$ 47 trillion over the period 2011-2030 i.e. nearly 75% of the global GDP in 2010. CVDs and mental health diseases are the two main contributors to the global economic burden of NCDs. In India and other South-East Asian countries, NCDs affect a relatively younger population as compared to the western countries.
In LMICs, PHC for NCDs can support constrained health system in the prevention and management of NCDs. This is especially critical in the case of management of chronic conditions which might require frequent access to health care services and monitoring. In addition, often chronic conditions need to adopt a continuum of care approach, and primary health care services can be a critical component of the health system in meeting these needs of NCD care.
A primary health care approach to NCD management can play a key role in the prevention, screening, and management of NCDs and chronic care conditions. This may include community health workers involved in surveillance of NCD risk factors and also disease in the population; health promotion – from tobacco cessation to messaging on harmful alcohol use, encourage physical activity and better diet to also messaging on accessing health services and management of NCD in primary care settings.
Evidence from countries such as New Zealand, Mexico, countries of the OECD, England and Wales show that reduction in cause-specific premature mortality from asthma, cancer and CVD is attributed to treatment and improvements in primary care. Community engagement is key to ensuring better acceptance and adhering to preventing and treatment measures on NCDs. In Thailand, a primary care system based on community participation started in 1985 through the recruitment of health volunteers, establishment of health centres and a drug cooperative system. Strong health infrastructure, competent staff, and secured budget boost PHC capacity to address NCD prevention, case management, referral, and rehabilitation. Community engagement through village health volunteers improves NCD awareness, enrolment in screening and adherence to interventions.
Efforts have also been made to outline pathways for NCD management in primary health care. Evidence based guidelines can lay the foundation for effective NCD management at the primary health care level with the necessary adaptations for local or country needs. For example, the WHO has recommended the Package of Essential Noncommunicable Disease Interventions (WHO PEN) for primary care in low-resource settings. The components include protocols for clinical diagnosis guidance on essential medicines and diagnostic technologies and indicators to monitor the programme. WHO PEN lays emphasis on using a people-centred approach to care, ensure continuity of care to improve patient outcomes, whilst making efficient use of limited resources.
Integrating NCDs in primary care offers a cost effective, affordable, and equitable model of care that can reduce morbidity and mortality from NCDs. Scaling up coverage of evidence-based interventions for NCDs in primary care could play a major part in reaching the SDG target to reduce premature mortality from NCDS by one third by 2030 through prevention and treatment. There is a need to review the current PHC strategies to adapt to the changing epidemiology of diseases, changing demographic and emerging health conditions. To meet the needs of the planned and ongoing PHC reforms, it is also crucial to build the capacity of health system at all levels with the ultimate goal of improving the quality of care and achieving Universal Health Coverage.