Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS).
Health systems
Human resources
Medicines
Noncommunicable diseases
Primary health care
Technologies
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
31 Jul 2021
31 Jul 2021
Historique:
received:
13
09
2020
accepted:
14
05
2021
entrez:
1
8
2021
pubmed:
2
8
2021
medline:
4
8
2021
Statut:
epublish
Résumé
The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.
Sections du résumé
BACKGROUND
BACKGROUND
The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18).
METHODS
METHODS
NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises.
RESULTS
RESULTS
Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities.
CONCLUSION
CONCLUSIONS
Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.
Identifiants
pubmed: 34332569
doi: 10.1186/s12913-021-06530-0
pii: 10.1186/s12913-021-06530-0
pmc: PMC8325187
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
757Subventions
Organisme : Ministry of Health and Welfare, Government of India
ID : Dy.No.C-707
Investigateurs
Anand Krishnan
(A)
Prashant Mathur
(P)
Vaitheeswaran Kulothungan
(V)
Harshal Ramesh Salve
(HR)
Sravya Leburu
(S)
Ritvik Amarchand
(R)
Baridalyne Nongkynrih
(B)
Himanshu Kumar Chaturvedi
(HK)
P Ganeshkumar
(P)
Vinay Urs K S
(VU)
Avula Laxmaiah
(A)
Manjit Boruah
(M)
Sanjeev Kumar
(S)
Binod Kumar Patro
(BK)
Pankaja Ravi Raghav
(PR)
Prabu Rajkumar
(P)
P Sankara Sarma
(PS)
Rinku Sharma
(R)
Muralidhar Tambe
(M)
N Arlappa
(N)
Tulika Goswami Mahanta
(TG)
Rajnish P Joshi
(RP)
Abhijit P Pakhare
(AP)
Binod Kumar Behera
(BK)
Manoj Kumar Gupta
(MK)
Neeti Rustagi
(N)
K R Thankappan
(KR)
Sonia Gupta
(S)
Sangita Chandrakant Shelke
(SC)
Pranab Jyoti Bhuyan
(PJ)
Abhiruchi Galhotra
(A)
Dewesh Kumar
(D)
Roshan K Topno
(RK)
Atulkumar V Trivedi
(AV)
Suneela Garg
(S)
Informations de copyright
© 2021. The Author(s).
Références
Global Health. 2015 May 07;11:18
pubmed: 25947094
BMC Health Serv Res. 2018 Aug 6;18(1):606
pubmed: 30081898
Bull World Health Organ. 2007 Apr;85(4):279-88
pubmed: 17546309
BMC Health Serv Res. 2016 Aug 22;16(1):419
pubmed: 27550219
PLoS One. 2020 Feb 18;15(2):e0229081
pubmed: 32069323
WHO South East Asia J Public Health. 2014 Apr-Jun;3(2):154-160
pubmed: 28607301
BMC Health Serv Res. 2015 Sep 23;15:408
pubmed: 26399634
WHO South East Asia J Public Health. 2017 Sep;6(2):69-73
pubmed: 28857065
J Perinatol. 2016 Dec;36(s3):S9-S12
pubmed: 27924110
Health Aff (Millwood). 2018 Aug;37(8):1321-1330
pubmed: 30080459
Int J Tuberc Lung Dis. 2016 Jun;20(6):717-28
pubmed: 27155173
Public Health Rev. 2020 May 13;41:8
pubmed: 32435518
J Family Med Prim Care. 2018 May-Jun;7(3):565-570
pubmed: 30112310
PLoS One. 2021 Mar 2;16(3):e0246712
pubmed: 33651825
PLoS One. 2017 Feb 7;12(2):e0171284
pubmed: 28170413
Indian J Community Med. 2011 Dec;36(Suppl 1):S57-62
pubmed: 22628913
WHO South East Asia J Public Health. 2019 Apr;8(1):18-20
pubmed: 30950425
Bull World Health Organ. 2013 Dec 1;91(12):923-31
pubmed: 24347731
Health Place. 2013 Sep;23:26-32
pubmed: 23743004
J Nepal Health Res Counc. 2018 Jul 03;16(2):149-155
pubmed: 29983428
PLoS One. 2018 May 10;13(5):e0196106
pubmed: 29746481