A large number of organisations are working with various segments of the community in India to spread the message of healthy living in order to prevent non-communicable diseases (NCDs) like diabetes, hypertension and cancer. Though the message reaches the people, there is no follow-up action.
A panel discussion organised in the city last week under the aegis of India Health Progress, a consortium of international NGOs, patient groups and doctors, laid bare the need for a healthcare provider to constantly keep in touch with the community.
Several organisations, some headed by doctors, and the State government's arm, Tamil Nadu Health Systems Project (TNHSP), participated. How could the lacunae be filled, was the subject of the panel discussion.
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It is a given that a good knowledge of the burden of NCDs is a pre-requisite so that the focus remains on health promotion activities. One of the participants, Jerard M. Selvan, deputy director of TNHSP, sought a population-based prevention strategy. While the government has made all-out efforts to involve its hospitals in screening and treating women for cervical cancers, the difficulty is in holding on to the patients and ensuring that they return for every level of treatment, he said. According to him “good cross linkages” would reduce the cost per person of treatment.
“The incidence of lifestyle diseases is anywhere between 40 and 60 per cent in the community, depending on where they come from,” said diabetologist V. Mohan. “Our studies showed that middleclass and poor families in slums are equally affected.” The Rajiv Gandhi Government General Hospital's experience shows that merely conducting health camps and asking people to return for further follow-ups does not help. A camp in north Chennai earlier this year to identify persons with hepatitis infections, found three persons who tested positive for the infection. They were advised to come to the hospital for treatment. But none came.
After this experience, doctors at GH tried another approach. During the diabetes and hypertension screening camp held soon after, doctors took down the mobile numbers of patients with abnormal readings. The phone numbers were passed on to the councillors in the respective localities, who would visit the patients and urge them to continue treatment. Again, the project failed as less than one per cent returned for a follow-up.
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Similar stories emerge from other parts of the country as well. Purvish M. Parikh, managing director of AmeriCares India, a non-governmental organisation, which works in a few pockets in Maharashtra and Orissa, has an electronic database of patients in its mobile units. Although patients are provided with health cards, they need constant reminders to return for follow-ups, he said. What is missing is continuous motivation to follow up on the message and carry forward with improvements to sanitation and healthcare facilities. For this, the government must make a conscious effort to increase spending on healthcare and improve infrastructure and sanitation, India Health Progress has recommended.