Govt prepares to battle non-communicable diseases at primary healthcare level
India’s primary healthcare system will soon be equipped to combat non-communicable diseases (NCDs) and mental health. Nearly eight lakh health workers will be trained to screen and refer such patients to district hospitals, said Dr. Sanjiv Kumar, executive director of National Health Systems Resource Centre (NHSRC), a central government institute which provides technical support to the health ministry. In an interview to Mint, he elaborated upon NHSRC’s proposals to combat NCDs. Edited excerpts:
What is NHSRC doing in the field of NCDs?
We provide technical support to government of India for various health systems related issues. In the area of non-communicable diseases, we are assisting the health ministry in rolling it out in primary healthcare. People who are driving it are from Directorate General of Health Services. We are providing health system perspectives. We are working out with the ministry about the role of Accredited Social Health Activists (ASHA). ASHAs are related to any need in the country for the communities. ASHAs work among the communities and they are crucial for all diseases including NCDs. We are building their capacity.
In the new vision of heath, the health sub-centres are to become health and wellness centres. They will be providing comprehensive care including the NCD. There are 200,000 of them in the country, each looking after a population of approximately 5000. Each sub-centre has one auxiliary nurse and mid-wife (ANM), two at some places and some also have a male health worker. Once the sub-centres become health and wellness centres, they will be headed by a manager who is a nurse practitioner, or someone who has AYUSH background. They will be given training for six to nine months for managing the sub-centre.
This programme is being rolled out. It will soon be rolled out in the whole country.
Which all NCD will they focus on?
That states will have to prioritise according to their specific needs. But some are common for all – cardiovascular diseases, hypertension, common cancers, i.e. breast and cervical cancer for women, and we are now including oral cancer for men. This list is still being prepared. There is also discussion of some elements of mental health.
Right now, manager is the only addition to the existing work force at the sub-centres.
Budget comes up as an important issue whenever we talk about NCD. Do you think there are enough funds to manage NCDs in the entire country?
First we have to start activities for this, budget will flow only after that.
Funds for NCDs have to be calculated properly. It is not only those that go under the head of NCD. The government has announced a list of drugs which should be available free of cost in all health facilities. This list includes drugs for NCD. Once all this is rolled out, then all these components will add up and the budget will also increase.
Once the sub-centres have health and wellness, then the salaries of their staff will also have some share in NCD component. The doctors in PHCs are also treating for diabetes and screening for cancer. If they are spending 10% of their time on this, then 10% of their salary should be put under NCDs. As National Health Mission pays for their salaries, it is NHM budget, and not NCD budget.
I will say that what we will do further will require a lot more budget.
Are we moving towards integration of various ministries to tackle NCD?
Yes. Government is serious, it is looking at NCD holistically.
NCD people focus only on detecting cancer, hypertension and diabetes. A lot more work is required outside these sectors. In schools, we have to see that children have right eating habits and do physical activities. Health ministry has to coordinate with other ministries to regulate processed food.
There has been a lot of consultation about sustainable development goals. In SDG, first three goals are continuation of millennium development goals (MDG). Next three goals are related to NCD and other three are cross-cutting.
Government is already looking at SDG in which NCDs are a major component.
In SDG, goals are inter-related. For example, inequity in health is due to poverty which is the first goal of SDG. Other goals also contribute to health. It is a good opportunity for us to bring health in all sectors, not just ministry of health.
Can you give a specific example about relationship of health with SDG?
There is one goal regarding road traffic accidents, which are increasing by the day. We had almost 12% of deaths in India in 2014 due to road traffic accidents. Ministry of transport maintains standards of safe roads. Ministry of commerce looks into safety measures in cars like air bags which save lives during accidents.
Another example is air pollution which cuts across various sectors. Air pollution leads to NCDs like cardiovascular diseases and cancers, apart from respiratory disorders. To control air pollution, one has to go to ministry of industries as industries create pollution, ministry of commerce as vehicles release pollutants, and environment ministry for regulations.
MDG did not have such opportunity, but SDG do. Ministry is looking at finalizing a system in which every ministry related to health start working at various components. This is in the process of being worked at.
How is MDG different than SDG?
MDG covered targets related to mother and child health and HIV/AIDS and other communicable diseases and environmental health. They were very good platform to bring national players together, bring politicians and governmental agencies together. They were crucial in reducing maternal mortality ratio (MMR) and infant mortality rates (IMR). According to my calculations, 3200 children are living every day because of reduction in IMR.
SDG learnt from MDG. Five years of intense consultations have gone into developing SDG.
Tackling NCD needs cross-cutting engagement of various sectors. Through SDG, we are entering the process and government is starting to building systems for it.