CONTEXT

The rapid spread of COVID-19 has severely tested primary healthcare systems, which perform multiple functions, across the world.

Maternal healthcare services, immunisation, health surveillance, and the screening and management of non-communicable diseases (NCDs) have all been severely disrupted.

WHAT ARE NON- COMMUNICABLE DISEASES?    

• A non-communicable disease is a disease that is not transmissible directly from one person to another. 
  • Hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, cancer etc.  are some examples of such diseases.

RISK OF NCDs

Globally:

• Nearly 71% of all deaths worldwide occur due to non-communicable diseases (NCDs).
• Cardiovascular diseases such as stroke, heart attacks and coronary artery disease are the top cause of global deaths.
  • One out of every four deaths occurs due to cardiovascular diseases, especially among younger patients.

Indian sub-continent:

• In the Indian subcontinent, there is early onset and rapid progression of NCD diseases, and a high mortality rate.
  • Premature loss of life due to NCDs in the age group of 30-69 years is also very high among Indians.
  • Half the deaths due to cardiovascular diseases occur in the age group of 40-69 years.
• In India, those with NCDs find that productive years of life are lost and there is high-out-of-pocket expenditure on treatment.

GOVERNMENT INITIATIVE

• To address the growing burden of NCDs, the National Health Mission launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, in 2010.
• The programme focusses on strengthening infrastructure, promoting good health, human resource development, early diagnosis, management and referral.

IMPACT OF COVID-19 ON NCD SERVICES

Disruption of NCD services

Globally:

• • A World Health Organization (WHO) survey in 2020, conducted among 155 countries found that:

• Low-income countries were the most affected by this disruption.

• • Thus, outcomes in COVID-19 patients with pre-existing cardiovascular disease risk factors or with established cardiovascular disease can be worse than others.
• In most countries, staff working in the area of NCDs were reassigned to support patients with COVID-19, and public screening programmes were postponed.
• Shortage of medicines, diagnostics and technologies were the main reasons for discontinuing services in one-fifth of the surveyed countries.

India:

• Data from the National Health Mission’s Health Management Information System in India show that:
  • Emergency services for cerebro-vascular diseases dropped by about 14%.
  • Among NCDs, persons with diabetes are at an exceptionally higher risk of severe clinical outcomes of COVID-19.
• A recent study reported that nearly one in every two Indians living with diabetes is unaware of their condition.
  • They are at higher risk of dying if they contract COVID-19 because of uncontrolled glucose levels in their blood.

Physiological  impact:

• Lockdowns and reduced physical interactions have led to loneliness among the people.
  • This resulted in mental health disorders such as anxiety and depression.
• It has also increased exposure to NCD risk factors as people became more likely to increase their consumption of alcohol and tobacco and adopt an unhealthy diet.

SOLUTIONS

Access to essential NCD medicines and basic health technologies in all primary healthcare facilities is essential to ensure that those in need receive treatment and counselling. For this multidisciplinary approach is imperative-

Cessing Tobacco:

• As tobacco consumption has been indisputably linked to hypertension, cardiovascular diseases and stroke, the global response plan to address the growing burden of NCDs must include tobacco cessation activities.

Use Telemedicine:

• Those countries which are reporting service disruptions, must bring telemedicine facilities in use.
• This will also help in effective data collection on the number of COVID-19 patients who also have a NCD and can reduce travel expenses, thus lowering patients’ expenditure burden.

 Policy making:

• There is an urgent need for national and State health policymakers to draw up a road map which gives equal weight to patients living with NCDs.

NGOs Network:

• Utilising the existing network of NGOs while respecting local factors will go a long way in tackling the growing burden of NCDs.

Awareness campaigns:

• Campaigns on maintaining a healthy lifestyle need innovation; the monotony of broadcasting the same message over and over again must be broken.

Incentivising ASHA:

• Screening for NCDs at the grassroots level and the delivery of locally relevant and contextual messages for health promotion and primordial prevention of NCDs can be significantly improved by incentivising the already overburdened ASHA workers.

CONCLUSION

• An urgent action is needed using the ‘all of society approach’ to achieve the WHO goal of a 25% relative reduction in overall mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases by 2025.
  • This can be achieved by strengthening the primary health system to prevent, diagnose and provide care for NCDs in the future, especially during health emergencies such as a pandemic.

Reference:

1. https://www.thehindu.com/opinion/op-ed/focusing-on-diseases-sidelined-by-covid-19/article36049030.ece