Control of non-communicable diseases
The Health Department’s initiative in the area of non-communicable diseases (NCDs) control has brought a significant percentage of the population into the community-level screening programme now under way in the State.
However, the unearthing of a huge new population of those with diabetes and/or hypertension in the community has posed a new set of unexpected challenges for programme implementers.
The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) is being carried out in five districts in the State. However, Kerala broke new ground when it launched its own NCD control programme in the rest of the districts last year, taking up the initiative to screen the entire population and to provide free medications to those detected with NCDs in the community.
Kerala has so far screened 53.07 lakh population for NCDs, through medical camps and clinics being held at primary health centres or at the sub-centre-level. The number of new cases of diabetes detected so far — from April 2012 to August 2013 — is 2.79 lakh. The newly detected cases of hypertension during the same period come to 3.35 lakh. Newly detected cases of persons with both diabetes and hypertension came to 1.84 lakh. Nearly 2,000 new cases of cancer (between March and August, 2013) and about 7,000 new cases of cardiovascular diseases were also detected through screening, followed with confirmatory lab tests at secondary care centres. “The focus of the NCD control programme should be on creating awareness on NCDs in the community and in launching community-level initiatives for the primary prevention (risk reduction strategies) and primordial prevention (long-term measures aimed at preventing future health hazards) of these diseases. However, with the steady increase in the newly detected cases of diabetes or hypertension, we have not been able to give attention to anything but arranging huge quantities of medicines for this newly screened population,” a senior health official told The Hindu.
In the last one year, the Health Department has spent Rs.12 crore just for purchasing drugs through the Kerala Medical Services Corporation — including insulin – which is being distributed free-of-cost through primary and community health centres (PHCs and CHCs).
“The entire funds being allocated for the NCD control programme, including Central funds, are being sucked up by the drug distribution component. Programme officers in districts say that ensuring NCD drugs availability in PHCs has been taking up all their time and that throughout the year, one or other drug falls short because of unexpected demand,” the senior health official said.
He pointed out that as soon as it was made known that insulin, various high-end drugs such as Glimepride and lab tests were being offered free-of-cost through PHCs, a significant portion of those seeking treatment in the private sector too began coming to the PHCs. Even though physicians had been instructed that insulin and high-end drugs should be prescribed strictly as per treatment protocols, wherever protocol compliance was lax, these expensive medicines fell short.
Regular treatment, adherence to prescription medications, and follow-ups being the key to keeping NCDs under control, the erratic supply of drugs has been posing many problems in the community too. People either discontinue treatment or buy only those drugs which they can afford. “With new cases being detected every day, draining the programme funds on drugs has to stop. We have allocated another Rs.8 crore for drugs supply for this year and the rest of the requirement will have to be met from the general indent for drugs.
“From next year, the entire NCD drug requirement of every PHC or hospital will have to be covered in the annual drug indent which each institution head sends. Insulin being the mainstay of diabetes management, we have tried to include a large part of this requirement under various national programmes for urban health or geriatric care also,” a senior programme official said. But with the magnitude of the NCD burden in the State still emerging, it might very well be like pouring water in a leaking container.