Why NCD care must be taken to the
people.
| Dr.Poonam |
Noncommunicable
diseases such as diabetes, respiratory diseases, cancer and heart
diseases are taking a severe toll on public health across the WHO
South-East Asia Region. Approximately 8.5 million lives, many of them
premature, are lost each year due to noncommunicable diseases (NCDs),
making them the Region’s leading cause of death and a key source of
public health expenditure.
With the NCD burden expected to rise in coming years, due largely to the Region’s rapid development and associated lifestyle changes, countries have taken steps to arrest the problem: multisectoral plans are being developed; health promotion campaigns are being carried out; exposure to NCD risk factors such as alcohol and tobacco are being curtailed; and NCD monitoring has been enhanced. But as countries strive to make a one-third reduction in premature deaths caused by NCDs by 2030, there is an important tool that remains underutilized: the primary health care system.
With the NCD burden expected to rise in coming years, due largely to the Region’s rapid development and associated lifestyle changes, countries have taken steps to arrest the problem: multisectoral plans are being developed; health promotion campaigns are being carried out; exposure to NCD risk factors such as alcohol and tobacco are being curtailed; and NCD monitoring has been enhanced. But as countries strive to make a one-third reduction in premature deaths caused by NCDs by 2030, there is an important tool that remains underutilized: the primary health care system.
By bringing NCD care to the primary
health care level, health authorities have the opportunity to ensure
appropriate services are provided to the right people, at the right
place and at the right time. While policies aimed at providing
high-tech care at central hospitals can have results, their impact
will always be limited and will almost always be reactive. Primary
health facilities are not only better equipped to provide the
holistic, patient-centered focus that preventing and managing an NCD
requires, but they can also enhance equity and access to NCD care –
an aim central to the Sustainable Development Goals.
There are several steps that health
authorities can take to bring NCD care directly to the people and to
roll-back their tragic and costly burden.
First, national health and
development policies must be re calibrated. This means putting the
primary health approach front and center of national NCD action
plans, as well as drafting and implementing a range of supporting
protocols, from clear policies outlining the spectrum of primary
level NCD services to well-defined diagnostic and treatment
guidelines. This will enhance the health system’s structural
coherency, and will also allow patients and health workers to better
navigate it.
Second, health care workers at the
primary level must be given the knowledge and skills to provide NCD
and associated risk factor care. This means providing comprehensive
training for front line health workers in NCD screening and management
strategies as well as enabling them to provide effective advice on
NCD prevention, including healthy lifestyle messages. A team-based
approach that harnesses a range of skillsets is required, and may
include developing additional cadres of health counselors or social
workers.
Third, the availability of generic
essential medicines and basic technologies for NCD management must be
guaranteed at the primary level. To do so, procurement policies must
be reviewed and essential medicine lists updated. Every person
suffering from diabetes, for example, must be able to access a blood
glucose meter at their local health care provider, just as all
persons suffering from a respiratory disease should be able to access
the technologies and medicines that ensure they can breathe easy.
Finally, health authorities must put
in place funding mechanisms to facilitate primary level NCD care.
While shifting NCD care to the primary level will reduce health
system expenditures overall (not to mention out-of-pocket costs borne
by patients), making this possible nonetheless requires effective
budget allocations and robust planning. At the same time, increased
taxation of health-damaging commodities such as tobacco, alcohol and
unhealthy foods and beverages should be considered, both as a means
to diminish demand for these products as well as to increase revenue
for NCD prevention and control.
Importantly, the shift to a primary
health approach to NCD care must occur alongside efforts to achieve
universal health coverage. Primary health facilities are crucial to
the goal of ensuring all people everywhere get the care they need
without facing financial hardship, meaning gains in coverage will
accelerate efforts to reverse the NCD burden. The pursuit of
universal health coverage must be seen as an essential component of
the wider campaign to tackle NCDs effectively.
To be sure, preventing and managing
NCDs is one of the greatest challenges health authorities across the
Region face. The NCD burden is already causing significant social and
economic costs, with any increases certain to exacerbate negative
outcomes and further stymie development. In turning the situation
around and meeting global and regional NCD targets, shifting
screening and management of diabetes, heart diseases, cancers and
respiratory diseases to the primary level is of vital importance. A
healthier, more prosperous South-East Asia Region will be the result.
