With India’s diabetes burden expected to cross the 100-million mark by 2030, as against the earlier estimate of 87 million, a white paper on ‘Management and Care of Diabetes in India’ suggests public-private partnership to deal with the burden of disease.
At present, more than 61 million people in India have diabetes, compared with 50.8 million last year, showing an increase of over 12 per cent. The International Diabetes Federation estimates that 9.2 per cent of adults in India have diabetes, making its prevalence second only to China. In 2012, diabetes caused 983,000 deaths in India, the largest contributor of mortality.
Considering the rising burden of non-communicable diseases (NCDs) and common risk factors to major non-communicable diseases, the government initiated an integrated National Program for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS).
“Given the rapidly increasing prevalence of the disease, governmental delivery systems at the States and Centre alone will not be able to combat increasing threat of NCDs in the country,” said Sayeda Hameed, member of Planning Commission at a recent National NCD Summit organised by the Confederation of Indian Industry and pharmaceutical company Eli Lilly.
“We need multi-sectoral collaborative efforts to address the present and future challenges posed by NCDs in the country wherein every sector needs to share personal responsibility. Plans for the health sector in the 12th Five Year Plan cannot be an isolated one and it needs to be integrated with the plans of all sectors,” Ms. Hameed said.
The white paper, brought out by the CII, suggests starting a clinical registry of the people suffering from diabetes mellitus and all individuals seeking services from NPCDCS be given health card with unique identity number to track their treatment.
Duplication of diagnostic tests leads to wastage. To avoid this, medical history of the patient can be linked to the Aadhaar card (UID) on a medical record system, it says. A program surveillance unit should be set up to conduct performance audit and ensure quality control.
The MIS (management information system) for NPCDCS should be mainstreamed with other cross-sectoral initiatives being carried out by the government and other development partners (like World Bank, USAID, FAO, WFP, UNICEF, WHO) while also engaging Panchayati Raj Institution members in community-based monitoring. The Village Health Committee (VHC) should form the link between the healthcare providers and the community.
A nodal agency at the national level should be provided accreditation to training courses for healthcare providers to be followed uniformly by all States, the white paper suggests. Importantly, it favours an OPD (out-patient department) based insurance scheme for NCDs like diabetes. The existing reimbursement systems like Rashtriya Swashthya Bima Yojana (RSBY) cover only the hospitalisation and not chronic illnesses like diabetes. There is a need to extend this to the out-patient care for diabetes and hypertension to prevent subsequent expenditure on treating complications.
Drugs should be available, accessible and affordable at all levels of health system — the Primary Health Centres, Community Health Centres, District Hospitals and teaching centres.
While targeting the adolescents and children, health educators should reach out to school children through National Rural Health Mission’s School Health Program. The white paper recommends a focus on health education and prevention activities like exercise, dietary control and stress management in children and young adults.
