The government needs to target existing human resources, reequip them to help promote health and prevent disease. If we are able to harness the complete potential of primary health care, it can become a platform for health responses to NCD
Non-Communicable Diseases (NCDs) today have become one of the leading causes of death globally as well as in the South East Asian region. NCDs account for almost eight in ten deaths, especially in low and middle income nations.
The World Health Organization (WHO) estimates that 60 per cent of the deaths occurring in Nepal can be attributed to NCDs. These chronic diseases predominantly have various modifiable determinants. The WHO has classified the risk factors caused by these determinants into two categories viz. behavioral and biological risk factors.
Behavioral risk factors include tobacco use, physical inactivity, unhealthy diet, and alcohol abuse, whereas biological risk factors include elevated blood pressure, obesity, raised blood glucose level, and serum cholesterol.
A nationally representative cross-sectional survey was conducted by Nepal Health Research Council (NHRC) under the supervision of the Ministry of Health and Population (MoHP) and the technical assistance of WHO in Nepal. According to this survey, the prevalence of modifiable behavioral risk factors, most commonly tobacco use and alcohol abuse, was found to be high among the Nepalese population.
NCDs mostly occur in the population under the age of 60 years, and what could be more threatening to a nation’s development and economy than having its most productive population ailing in sickness. It has been estimated that over the next 15 years low and middle income nations will have to face a cost of 12 trillion dollars due to lost productivity and medical costs attributed to NCDs.
NCDs have claimed the lives of many and have significantly affected the quality of lives of the population. Although NCDs are now a major public health problem in Nepal, it is still unclear as to how NCDs can be addressed at Primary Health Care level.
Primary Health Care (PHC) is a practical approach to making essential health care universally accessible to individuals and families in the community in an acceptable and affordable way, with their full participation. The concept and approach of primary health care is constantly evolving and holds the potentiality to tackle the rising threat posed by NCDs. However, it needs to be retooled and better focused towards issues that relate to preventing the modifiable risk factors causing NCDs.
Primary care in low and middle income countries is traditionally focused on infectious diseases like malaria, tuberculosis, HIV etc. However this era of globalization has now become both a boon as well as an encumbrance in terms of all the changes it has wrought upon us. Changes in lifestyle, food habits have resulted in people leading a more sedentary lifestyle, which in turn has increased the cases of Cardiovascular Diseases (CVD) and diabetes mellitus.
Increasing trend of motorization has increased the number of road traffic accidents. If we are to consider the other dimension, increase in life expectancy–population ageing–has also contributed to NCD prevalence. Alterations of such kind have transformed the pattern of disease burden especially of developing nations like Nepal.
We are now struggling due to the burden created by existing and reemerging infectious diseases along with new and emerging NCDs. It is now time for our health ministry to turn their heads both ways to tackle this triple burden of diseases.
In response to the cross-sectional survey that was conducted by NHRC, WHO and MoHP, the Government of Nepal (GoN) has developed a Multisectoral Action Plan for the Prevention and Control of Non Communicable Diseases (2014-2020).
This plan aims to prevent NCD by promoting health through education, strengthening existing institutions for early diagnosis and better treatment, empowering communities etc. It is an effective long term plan, yet it is still somehow missing the point of going at the primary level of health care to tackle NCD.
Primary care cannot be effective if it stays frozen in its old concept of the 1970’s, the time it was developed. It needs to evolve along with the transformations brought about by time. A good example of this could be the use of technology to disseminate health information to the public, which is one of the methods of primary care.
Another challenge faced when tackling NCDs is workforce crisis. In our nation most of our skilled human resources are lost to brain drain, whereas the ones remaining migrate to urban centers and high income countries. This has hampered the health workforce as well; Nepal faces a scarcity of health care providers, especially in rural areas.
Here too adoption of principles of primary health care can provide a solution. A shift in focus, towards the mobilization of non-doctors to reach out to people, can prove to be an effective strategy to solve this problem created due to workforce scarcity. For instance, a team of trained outreach workers and health educators can be deployed to visit villages to raise awareness of NCD risk factors, influence participation in various screening tests and much more.
The government needs to target the existing human resources, reequip them to help promote health and prevent disease. If we are able to harness the complete potential of primary health care, it can become a golden platform for further health responses to NCD.
A version of this article appears in print on May 23, 2017 of The Himalayan Times.