Noncommunicable diseases (NCD) such as diabetes, respiratory diseases, cancer and heart diseases are taking a severe toll on public health across the WHO South-East Asia Region. Approximately 8.5 million lives, many of them premature, are lost each year due to NCDs, making them the region’s leading cause of death and a key source of public health expenditure.
With the burden of noncommunicable diseases (NCD) expected to rise in coming years, due largely to rapid development and associated lifestyle changes in the WHO South-East Asia Region, countries have taken steps to arrest the problem: multisectoral plans are being developed; health promotion campaigns are being carried out; exposure to NCD risk factors such as alcohol and tobacco are being curtailed. NCD monitoring has also been enhanced. But as countries strive to make a one-third reduction in premature deaths caused by NCDs by 2030, there is an important tool that remains underutilised: the primary health-care system.
Ensures equity
By bringing NCD care to the primary health-care level, health authorities have the opportunity to ensure appropriate services are provided to the right people, at the right place and at the right time.
While policies aimed at providing high-tech care at central hospitals can have results, their impact will always be limited and almost always be reactive. Primary health facilities are not only better equipped to provide the holistic, patient-centred focus that preventing and managing an NCD requires, but they can also enhance equity and access to NCD care — an aim central to the Sustainable Development Goals.
There are several steps that health authorities can take to bring NCD care directly to the people and to roll back their tragic and costly burden.
First, national health and development policies must be recalibrated. This means putting the primary health approach front and centre of national NCD action plans, as well as drafting and implementing a range of supporting protocols, from clear policies outlining the spectrum of primary-level NCD services to well-defined diagnostic and treatment guidelines.
Second, health-care workers at the primary level must be given the knowledge and skills to provide NCD and associated risk factor care.
Third, the availability of generic essential medicines and basic technologies for NCD management must be guaranteed at the primary level. To do so, procurement policies must be reviewed and essential medicine lists updated. Every person suffering from diabetes, for example, must be able to access a blood glucose meter at his or her local health-care provider, just as all persons suffering from a respiratory disease should be able to access the technologies and medicines that ensure they can breathe easy.
Finally, health authorities must put in place funding mechanisms to facilitate primary-level NCD care. While shifting NCD care to the primary level will reduce health system expenditures overall, not to mention out-of-pocket costs borne by patients, making this possible nonetheless requires effective budget allocations and robust planning. At the same time, increased taxation of health-damaging commodities such as tobacco, alcohol and unhealthy foods and beverages should be considered, both as a means to diminish demand for these products as well as to increase revenue for NCD prevention and control.
Importantly, the shift to a primary health approach to NCD care must occur alongside efforts to achieve universal health coverage.
Dr. Poonam Khetrapal Singh is the Regional Director, World Health Organization South-East Asia Regio n
