Two years of COVID-19, when the State’s entire health system was oriented solely towards fighting the pandemic, has nearly broken the back of many public health initiatives that Kerala had been vigorously pursuing in the pre-COVID days.
Now that it is evident that COVID will be another public health problem like dengue or H1N1 that the State will have to deal with in the long term, the health system is struggling to wrest back the edge it had been gaining over its biggest challenge, the control of non communicable diseases (NCD).
According to the latest estimate in a State-wide prevalence study (unpublished data, ICMR study), 24% of the adult population in Kerala has diabetes and a whopping 40%, hypertension, one of the highest NCD prevalence rates reported in the country.
In March 2018, Kerala had integrated its NCD control programme with India Hypertension Control Initiative (IHCI), a major national initiative in protocol-based and standardised management of diabetes and hypertension, in the four districts of Thiruvananthapuram, Thrissur, Kannur and Wayanad (scaled up to cover nine districts in February this year).
The thrust of the programme was in enabling those with diabetes or hypertension have better control over their blood sugar/pressure levels so that they do not develop serious complications.
Everyone over 18 years coming to sub centres or PHCs were being screened, registered and put on protocol-based management. With baseline disease control rates remaining poor in the State – 13% for hypertension, 16% for diabetes-- the programme intended to raise the control rate to at least 50 % .
“The programme was thus following up 3.5 lakh patients and documenting their progress. In the first year itself, we could improve the control rates to 40%. But then after COVID, this slipped to 36%. Our training programmes, documentation were all affected. Primarily, screening for NCDs, new case detection and follow-up suffered heavily as patients stopped visiting hospitals. After nearly two years, we are hopeful again of gaining lost ground because patients are beginning to come back and control rates are inching up again,” a senior Health official told The Hindu
Despite the setbacks to the NCD programme during COVID, catastrophic fall outs may have been reduced because the system could ensure that all NCD patients in the register were reached their drugs at home without fail every month.
Apart from the ₹32 crore that is being spent on NCD drugs annually, additional drugs, including insulin were purchased at ₹5-10 crore for making home delivery
“We are yet to see any indications of worsening complications due to NCDs, probably because of drug compliance and because many risk factors like consumption of junk food, alcohol, smoking and stress were reduced during COVID. But the fall out of sedentary life during the pandemic period, we are yet to see,” he added.
The State is now preparing to catch up by launching a population-based screening programme for screening all persons above 30 years and following them up through a registry. Rather than wait for patients to come to hospitals, the system will now go into the community to pick up those with NCDs.
