To keep Non Communicable Diseases in check:

Primary care centres can play bigger role

By Dhaneshi YATAWARA

In the recent past, cardiovascular diseases, diabetes, cancer and chronic lung diseases, which form a major portion of the package of Non Communicable Diseases - (NCDs), have been the main cause of almost two thirds of the world's death toll. According to the World Health Organization (WHO), in 2008, of the total 56 million human deaths in the world, nearly 36 million have died due to NCDs.

According to reports, NCDs are the leading cause of death across the globe killing more people than all other causes combined. The alarming fact is that today NCDs are mostly affecting the low and middle income communities. According to the latest WHO reports 80% of world's deaths due to NCDs occur in the low and middle income countries.

NCD deaths are projected to increase by 15% globally between 2010 and 2020, according to WHO. Alarmingly the greatest increase, according to WHO reports would be in Africa, the Eastern Mediterranean and South East Asia where they will increase by over 20%. Vulnerable and socially disadvantageous people get sicker and die sooner than people of higher social positions.

The World Health Report 2010 (22) states that each year, 100 million people are pushed into poverty because they have to pay directly for health services; in some countries, this may represent 5% of the population forced into poverty each year. The report indicates that direct out-of- pocket payments still represent more than 50% of total health expenditures in a large number of low and middle-income countries.

In the international backdrop Sri Lanka is no exception. "Seeing the growing trend of NCDs and the plight of the low and middle income families due to their health expenditures the Ministry of Health wanted to initiate a new method to control this unhealthy situation in the country," said Dr. (Ms.) Susie Perera, Director of the Policy Analysis and Development Unit of the Ministry of Health. Explaining further she said that the excellent maternal and child care and the immunization programs in the country were developed on an effective structure that provided a solid foundation for the country's achievement.

"Today we need such an emphasis to control the increasing NCDs and to manage it properly. Most importantly patients suffering from such diseases need a proper guidance for the proper management of the disease which is more effective than just giving medicine. So, we at the Ministry of Health had to think of a system that would support a system that would address all these factors," Dr. Perera said.

For the past few years the Government carried an exceptional program to strengthen the specialised health services throughout the country by emphasizing on developing the main hospitals of a district - i.e. teaching hospitals, general and district hospitals. Examining the health services network of the country the Ministry officials found that the primary healthcare network can be successfully used to control the growing trend of NCDs which would eventually dilute the number of patients coming to the main hospitals in the cities.

"The clinics become over crowded and considering the number of patients it won't be possible for a doctor to give guidance to the patient to properly manage his or her condition," she said. "NCDs are equally present among the rural and the urban. There is no significant difference. Though no one is sure of why is it so we can not make an exception to rural populace thinking that their chances of having NCDs are low," Dr. Perera added. Accordingly in order to address every part of the country the health officials identified that the central dispensaries and divisional level hospitals can play a bigger role to address the situation.

Thus the Ministry of Health initiated the Primary Healthcare Development program having two pilot projects in Hambantota, Weeraketiya area and Polonnaruwa. "These areas were selected on the under privileged situation that prevails in the areas compared to other parts of the country," Dr. Perera explained.

According to new initiatives at the primary healthcare facilities the patients will be treated not only at the medical clinic but there will be a guidance clinic too that would direct, monitor and analyse the patients up to date condition by a specially trained staff.

"People suffering from NCDs like diabetes, cardiovascular diseases, chronic lung disease, etc., need to maintain their diet, salt intakes and exercise and on top of it should know about their health status.

It is important for them to independently manage their health conditions," she said.

Today to an extent we have sufficient number of doctors working all over the island and by upgrading the infrastructure and working conditions at the primary hospital level we can easily appoint doctors to those areas, she added.

According to Dr. Perera doctors may need to be given a special training on community medicine as some doctors may not be familiar with that subject. The new method the Ministry of Health initiated to upgrade the primary healthcare condition have options for all these necessities. Chronic NCDs are associated mostly with four risk factors, according to the doctors. i.e. - smoking, alcohol, unhealthy diet and physical inactivity. The health workers working in the new set up are trained and guided with the necessary scientific information.

"One of our main aim is to give more attention to the under privileged people suffering from NCDs," she said. According to the WHO Global Status report on Non Communicable Diseases 2010 - " In low-resource settings, treatment for cardiovascular disease, cancer, diabetes or chronic lung disease can quickly drain household resources, driving families into impoverishment.

NCDs exacerbate social inequity because most payments for healthcare in low- and middle-income countries are private and out-of-pocket; such costs weigh more heavily on those least able to afford them, increasing the risk of impoverishment. "

Preventing NCDs is important for eliminating poverty and hunger because these diseases have a negative impact on productivity and family income and also because a substantial proportion of household income is spent on healthcare in low-income countries. NCDs' negative impact on national economies also means fewer jobs and therefore fewer people escaping poverty. Each year, NCDs are estimated to cause more than 9 million deaths before the age of 60 years with concomitant negative impacts on productivity and development.

If common development goals are to be achieved people should be free from disease and disabilities. Thus the Sri Lankan program to upgrade the primary healthcare would be a key factor in the country's overall development.