Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS)

Abstract

Background The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). Methods NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) – Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. Results Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3–3.3) in rural public to 9.0% (95% CI; 6.2–13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. Conclusion Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

Prevalence, Awareness, Treatment and Control of Diabetes in India From the Countrywide National NCD Monitoring Survey

“…The strengths and limitations of this survey findings include the general strengths and limitations of NNMS that have been described elsewhere ( 10 , 11 ). Several studies either provide random blood glucose estimates to report the prevalence of diabetes or self-reported history ( 17 , 18 , 21 ).…”

“…One eligible adult aged 18–69 years from every household was selected by the KISH method thus, totalling a sample of 12,000 adults. For the health facility survey, one each of public primary, community health centers, district hospital and primary private hospitals within and, near the PSUs were included in the survey sample ( 9 – 11 ).…”

Socioeconomic Inequality in Awareness, Treatment and Control of Diabetes Among Adults in India: Evidence from National Family Health Survey of India (NFHS), 2019-2021

“…The novelty of our study lies in the fact that we used a full sample of individuals interviewed above 15 years of age NFHS-5, 2019-21. This large sample of individuals gives us robust estimates for prevalence and ATC of diabetes, and our is much higher that is found in the other small-scale studies 24,27,28,31,33,41,42 , which might be attributed to the fact that increasing diabetes prevalence and varying methods used in estimation.…”

“…Increased funding for diabetes management from the central government and state governments is urgently needed. Some studies have previously pointed out the need for preparedness in the primary and secondary health care centres in India, for tracking non-communicable diseases 42 . The state of healthcare remains in utter despair, where the rural counterpart is severely handicapped and marred with challenges compared to their urban counterparts 34,42 .…”

Improving symptom assessment and management in the community through capacity building of primary palliative care: A study protocol of exploratory research

“…The GLOBOCAN 2020 estimated 19.3 million new cases of cancer and 10 million bereavements due to cancer in 2020 (Sung et al, 2021). Both private and public primary care facilities and public secondary facilities are inadequately prepared to address the burden of non-communicable diseases (NCDs) in India (Krishnan et al, 2021). Inequitable access to palliative care is one of the greatest disparities in global health care and lack of access to palliative care in low-and middle-income countries (LMICs) has led to a huge burden of preventable suffering (Knaul, Bhadelia, Rodriguez, Arreola-Ornelas, & Zimmermann, 2018).…”