Health Policy and Strategies to Prevent Non...
Transcript of Health Policy and Strategies to Prevent Non...
Health Policy and Strategies to Prevent NonCommunicable Diseases in India: Options, Opportunities and Way Forward
Dr Sathyanarayana
Indian Institute of Public Health
Strategies to Prevent Non-Diseases in India: Options,
Opportunities and Way Forward
SathyanarayanaMBBS, MPH, MBA, DHA, PhD
Indian Institute of Public Health-Bangalore
Overview
• Indian Institute of Public HealthHealth Foundation of India (PHFI)
• Current healthcare status of NCDs
• Global/International Health Policies and Local • Global/International Health Policies and Local Implications related to NCDs
• NCDs prevention/barefoot nurse projecttrial experience to screen NCDs.
• NCDs Preventive strategies
Overview
Indian Institute of Public Health-Bangalore, Public Health Foundation of India (PHFI) role
status of NCDs
Global/International Health Policies and Local Global/International Health Policies and Local Implications related to NCDs
barefoot nurse project-a community trial experience to screen NCDs.
• Indian Institute of Public Health
• Understanding approaches to tackle NCDs (ideological construct for healthcare approach)
–Clinical medicineClinical medicine
–Public Health
–Global health
Indian Institute of Public Health-Bangalore
Understanding approaches to tackle (ideological construct for healthcare approach)
Strategies to address NCDs: A Spectrum APPROACH
• Myocardial infarction/
– Clinician/cardiologist
–Epidemiologist DIAGNOSIS
–Social scientist DIAGNOSIS
–Public health specialist
Strategies to address NCDs: A Spectrum APPROACH
Myocardial infarction/heart attack
Clinician/cardiologist DIAGNOSIS
DIAGNOSIS
DIAGNOSIS
Public health specialist DIAGNOSIS
Status of Non-Communicable DiseasesCommunicable Diseases
Current situation of • 1 out of 4 adult dying because of NCDs before the age of 70. Indian likely to loose
3.5 trillion USD before 2030 due to treatment+productivity
• 47% of hospital admission in rural India is financed through loans and sale of assets.
• About 30% of people in rural India did not opt for treatment because of financial constraints. constraints.
• 39 million Indians are pushed to poverty because of ill
• Nearly 61% of all deaths are attributed to NCDs and diabetes.
• 23% are at risk of premature death due to these diseases.
• Alcohol, tobacco, poor diet intake and lack of physical factors for NCDs.
Current situation of Health care in India1 out of 4 adult dying because of NCDs before the age of 70. Indian likely to loose
treatment+productivity loss.
% of hospital admission in rural India is financed through loans and sale of
30% of people in rural India did not opt for treatment because of financial
million Indians are pushed to poverty because of ill-health every year.
61% of all deaths are attributed to NCDs such as heart diseases, cancer
due to these diseases.
, tobacco, poor diet intake and lack of physical activity are major risk
Source: 2017 Report of the World Health Organization
58 million: total deaths globally 2015
3.8 million men and
worldwide died in 2018 from coronary heart worldwide died in 2018 from coronary heart
disease
35 million (of these) deaths due to NCDs
58 million: total deaths globally 2015
million men and 3.4 million women
worldwide died in 2018 from coronary heart worldwide died in 2018 from coronary heart
disease
35 million (of these) deaths due to NCDs
ACTUAL AND PROJECTED NUMBERS OF ACTUAL AND PROJECTED NUMBERS OF DEATHS IN INDIA BY CAUSE 1990DEATHS IN INDIA BY CAUSE 1990
4.0
6.0N
um
ber
of
dea
ths
(mil
lio
ns)
Communicable diseasesCardiovascular diseasesOther non-communicable diseasesInjuries
0.0
2.0
4.0
1990Nu
mb
er o
f d
eath
s (m
illi
on
s)
ACTUAL AND PROJECTED NUMBERS OF ACTUAL AND PROJECTED NUMBERS OF DEATHS IN INDIA BY CAUSE 1990DEATHS IN INDIA BY CAUSE 1990 AND AND 20202020
Communicable diseasesCardiovascular diseasesOther non-communicable diseasesInjuries
2020
11%
7% 2%
DEATHS IN INDIA (2015)
8%36%
29%
Cardiovascular diseases
Chronic respiratory diseases
Other chronic diseases
DEATHS IN INDIA (2015)
7%
8%
Communicable diseases,perinatal maternal conditionsand nutritional deficienciesInjuries
Cancer
Diabetes
Source : WHO
RISING CHRONIC DISEASE BURDENSRISING CHRONIC DISEASE BURDENS
WHY ARE INDIANS EXPERIENCING A GREATER RISK OF COMMUNICABLE DISEASES?
• Increased Life Expectancy
(Longer period of exposure to risk factors)
• Ethnic Susceptibility• Ethnic Susceptibility
(Experience of Indian migrants)
• Altered Living Habits
(Increased levels of risk factors)
WHY ARE INDIANS EXPERIENCING A GREATER RISK OF NON COMMUNICABLE DISEASES?
Increased Life Expectancy
(Longer period of exposure to risk factors)
(Experience of Indian migrants)
(Increased levels of risk factors)
GLOBALNATIONAL COMMUNITY
Development
(stage and speed)
Perceptions
(cultural)(stage and speed)
Distribution
(equity)
Demand- Supply
(trade)
(cultural)
Priorities(socio
Pathways
(availability, access
COMMUNITY FAMILY INDIVIDUAL
Beliefs
Behaviours
Perceptions
cultural)Behaviours
Biology
cultural)
Prioritiessocio-economic)
Pathways
availability, access)
Globalization/International health policies and LOCAL implications on NCDsLOCAL implications on NCDs
Globalization/International health policies and LOCAL implications on NCDsLOCAL implications on NCDs
Globalization - A comparison between
Country (2000) 109 USD
China
Brasil
IndiaIndia
Mexico
Argentina
Venezuela
L’Atlas. Le Monde Diplomatique, 2005.
between countries and towns revenues
USD City
900 New York
600 Osaka
400 Los Angeles400 Los Angeles
390 Paris
300 Chicago
100 Hambourg
L’Atlas. Le Monde Diplomatique, 2005.
Globalization - A comparison betweencompanies
• Total revenue of top 10 pharma companies = million USD
• Total revenue of bottom 80 countries in a list of 188 countries = 420452 million USDcountries = 420452 million USD
• Total revenue of Pfizer = 70696 million USD
• There are total 125 countries with revenue less than 69332 million USD
between countries and pharma companies revenues
Total revenue of top 10 pharma companies = 433752
Total revenue of bottom 80 countries in a list of 188 420452 million USD420452 million USD
70696 million USD
There are total 125 countries with revenue less than
Globalization = Neoliberal policies
• Free market
• Comodify even basic needs or needs to market goodsneeds to market goods
• Promote maximization and consumerism (buy -1 get one)
• Shift power centers from democratic representatives to market superpowers
Globalization = Neoliberal policies
even basic needs or use basic goods; (ex:water)goods; (ex:water)
Promote maximization and consumerism
Shift power centers from democratic representatives to market superpowers
Communication to consumers; MIS-MATCH between Science and Commerce
Occasional
NUTRITION PYRAMID
IN MODERATION
PLENTY
Colas and other sugary drinks
Chips and salted snacks
Biscuits chocolates and other candy
Fast food (Burgers, pizzas etc.)
MATCH between Science and Commerce
ADVERTISING PYRAMID
?
?
Globalization = Neoliberal
- destroy cultures/promote
(coconut water/butter milk
- Constraint / eliminate welfare
the role of State (Govt)the role of State (Govt)
Neoliberal policies
promote consumers identity;
milk vs coca cola)
welfare state/Minimize
Current policy
Govt
Disease control programs √
Health care and Health Systems
Govt
Private
√
√
√
The mechanics of disease Health system
The mechanics of disease control’s failure
Disease controll programs
Need balance between “Development” and “Road to Health”Need balance between “Development” and “Road to Health”
Donors/Politicians, international donors and agencies “helping” the health systems to achieve their objectives
Donors/Politicians, international donors and agencies – Are they really “helping” the health systems to achieve their objectives
Public-private partnerships ???Conflict of goals
‘Local solutions’ will be always more effective and sustainable than
‘international prescriptions’
‘Local solutions’ will be always more effective and sustainable than
‘international prescriptions’
Contextualize and localize international prescriptions rather than selling out local culture to international market
Contextualize and localize international prescriptions rather than selling out local culture to international market
….Be aware of False positives and false negatives while drawing poverty lines….Be aware of False positives and false negatives while drawing poverty lines
Examine which is the ‘lever’ operating from behind…….Examine which is the ‘lever’ operating from behind…….
Analyze openly the reasons for alleged public sector failure ??…….Analyze openly the reasons for alleged public sector failure
Preventive StrategiesPreventive Strategies
MOULDING
THE
GLOBAL LEVEL: International Agencies; Trans
GLOBAL COVENANTS, COMMERCE & COMMUNICATIONS
NATIONAL POLICY FRAME WORK THE
HEALTH MARKETS
INDUSTRY PRACTICES
Private-Public Partnerships; Health Dividend
WORK
Political, Economic, Social Motivators
MOULDING
THE
GLOBAL LEVEL: International Agencies; Trans-National Trade and Media
GLOBAL COVENANTS, COMMERCE & COMMUNICATIONS
CONSUMER CONSCIOUSNESSTHE
HEALTH MARKETS
INDUSTRY PRACTICES
Public Partnerships; Health Dividend
CONSCIOUSNESS
Health Professionals,
Civil Society; Media
NATIONAL/STATE LEVEL: PUBLIC HEALTH INTERVENTIONS
Policy InterventionsPolicy Interventions
Enabling Environment Health Beliefs and Behaviours(Financial, Social, Physical) (Community; Individual)
DesiredChange
NATIONAL/STATE LEVEL: PUBLIC HEALTH INTERVENTIONS
Educational InterventionsEducational Interventions
Enabling Environment Health Beliefs and Behaviours(Financial, Social, Physical) (Community; Individual)
DesiredChange
PRINCIPLES OF NCDs PREVENTION• Small reductions in risk factor
the whole population, result in
events
• Non-drug measures prevent risk
and reduce it in persons who haveand reduce it in persons who have
profile
• Drug therapy to reduce risk is
who are a high risk of adverse
• Best results are achieved through
based prevention and high
approaches.
PRINCIPLES OF NCDs PREVENTIONfactor levels, when achieved across
in a large reduction of CVD/NCDs
risk across the whole population
have already acquired a high riskhave already acquired a high risk
is most cost-effective in persons
events in the next 10 years.
through a combination of population
high risk individual management
RISK FACTORAssociation
Cause
Acting to reduce risk across the population
Acting to protect persons at high risk
NCDs PREVENTION
Address the bulk of the distribution through small shifts (Population Attributable Risk)
POPULATION BASED
+
Widespread Effect = Large Benefits
NCDs PREVENTION
Address the individuals at the highest ‘absolute’ risk of a NCDs event (Ex: Comprehensive Cardiovascular Risk)
+
HIGH RISK
High Impact = Cost-Effective use of resources
PATHWAY TO HEALTH PROMOTION
Knowledge I know
Motivation I want
Skills I can
Enabling Environment
PATHWAY TO HEALTH PROMOTION
I Act
Perform Personally
Reach & Teach Reach & Teach (Involve Others)
It is possible
Enabling Environment
Barefoot Nurse Projecttrialtrial
To Screen NCDs at community level
Barefoot Nurse Project-Community trialtrial
To Screen NCDs at community level
NCD life course approachNCD life course approach Early screen and referral
-Female
• BP• Diabetes• Haemoglobin
Barefoot nurse Trained to screen
Criteria to select barefoot nurse
Conceptualisation of sustainability of the study model
-Female-Education 10-12th stds-Local community/village-Willing to work
Prefer unemployed-nursing; pharmacy;labtechnician; home health assistant trained person
• Haemoglobin• Vision• Urine test for chronic
Kidney disease• Weight/height
Also plan to introduce in phased manner-Pregnancy test--Sanitary pads, -pain balms-Nutrition powders/millets
• BP- 15Rs• DM-25 Rs• Hb-40 Rs
• BP: 120/80 mmhg• Blood sugar:
Nominal charges Data entry
The entire money goes to BFN –creates livelihood option while screening services
Conceptualisation of sustainability of the study
Nutrition powders/millets
• Hb-40 Rs• Vision-25Rs• Urine test-
25Rs• Wt/ht-2Rs
• Blood sugar: 120gms%
• Hb:12gms%• Vision: +/-• Urine protein:+++• Pregnance:+/-• Wt/ht:• Phone number:• Age:
Benefit to barefoot NURSE
-LIVELIHOOD OPTION
• Alerting early signals of diseases
• Prevent complications, consequences of NCDs
Benefit to PUBLICBENEFIT TO
BAREFOOT nurse
BENEFIT TO STAKEHOLDERS
-LIVELIHOOD OPTION-Opportunity to work in neighbourhood area-Will be allocated 2500 houses-
NCDs• Community
members are screened for diseases at their door step: bridging last mile connect
signals
• Creation of jobs to local women
• Women
• Disease screening DATA can be utilised to optimise
BENEFIT to donor BENEFIT TO THE STATE
BENEFIT TO STAKEHOLDERS
• Women empowerment
• Sense of fulfilment responsibility to local community
to optimise preventive and promoting health care services and to frame policies
Pilot Project in
• Piloted in Doddaballapura taluka, Bangalore Rural
• 25 Barefoot Nurses trained and working in their local Covering 1.5 lakh population
• Barefoot nurses working closely with PHCs last mile connectlast mile connect
• Offering services Basic Health Screening such as
– BP, Diabetes, Anaemia, Vision
– Chronic Kidney diseases,
– Pregnancy test
– Providing access to Hygiene and wellness products at the door step of the community
in KARNATAKA
Bangalore Rural district of Karnataka
trained and working in their local communities;
working closely with PHCs in the Taluka and bridging
Screening such as
access to Hygiene and wellness products at the door step of the
Key learning-Situation Assessment
• Low-income communities are willing to pay and promotive health services.
• Ability to leverage Partners in the value to the communityvalue to the community
• Technology can be used to enhance the effectiveness of service delivery.
• Model has the potential for scalabilityand for impacting health in the
• Development of local human resource and creating livelihoods
Situation Assessment
communities are willing to pay for preventive services.
in the ecosystem to enhance
can be used to enhance the effectiveness of
scalability and sustainabilityand for impacting health in the long-term.
Development of local human resource and potential for
New wellness products planned to introduce
• Sanitary pads
• Pregnancy kits
• Urine kits for chronic kidney disease
• Nutrition powders for children• Nutrition powders for children
• Deworming tablets
• First aid kit
• Ayurveda primary care manual in local language
• Ayurvedic / Homeo/unani family kit
New wellness products planned to introduce
Urine kits for chronic kidney disease
Nutrition powders for childrenNutrition powders for children
Ayurveda primary care manual in local language
family kit
SCIENTIFIC EVIDENCE
APPROPRIATE POLICY
EFFECTIVE PROGRAMMES
SCIENTIFIC EVIDENCE
APPROPRIATE POLICY
EFFECTIVE PROGRAMMES
Progress Report
• Average earning is Rs. 8,205
• 98% of BFNs are female
• IN 3 months, 12,255 people • IN 3 months, 12,255 people expected to screen 55,000
• Following Chart shows data Individual Income Generation for the month
rogress Report
8,205/- per BFN
female and 75% are married
people are screened and people are screened and 55,000 by December 2019
Following Chart shows data for July 2019 & Individual Income Generation for the month
Name BP BS
Baby-17 265 161
Chandra devnagar 13 8
Nagamma-12 340 263
Bidyut-new-15 98 89
Chetana New vf 278 222
Chandrakala-03 149 126
Preethi vrpura 1 1
Roja-10 297 177
Uma-11 282 212
Manjula DA-06 61 47
Sunita-13 262 201Sunita-13 262 201
Leelavathi 280 203
Arunavati-02 273 177
Indrani new 192 118
Shobha vr pura 11 4
Anita-01 555 423
Manjula 175 79
Managalagowramma new 147 110
Rajini-new number 90 31
Dhanalakshmi tubgere 92 68
Chandrakala vr pura 1 1
GRAND TOTAL 3863 2722
Hb Atp Vision Total
96 117 55 12925
6 4 0 578
72 47 1 11589
11 22 2 3862
130 134 17 15293
132 149 1 10107
1 0 0 0
131 145 48 13100
77 30 1 11983
33 22 1 3292
57 248 7 1125057 248 7 11250
93 21 6 13062
111 88 9 13086
62 166 32 9257
7 0 3 540
293 380 55 31228
36 17 2 6144
51 11 0 6116
32 35 0 3128
26 45 3 3933
1 0 0 40
1458 1681 243 180513
8205
THE BAREFOOT NURSE THE BAREFOOT NURSE KIT KIT
KIT BAG
THE BAREFOOT NURSE THE BAREFOOT NURSE
MagadiMagadi Rd 1st cross, Next to leprosy hospital, SIHFW premises, Rd 1st cross, Next to leprosy hospital, SIHFW premises,
Bengaluru, Karnataka 560023Bengaluru, Karnataka 560023
Public Health Foundation of IndiaBAREFOOT NURSE PROJECT
Name:
ID Number:
Phone Number: +91
IDENTIFICATION CARD
THE KIT THE KIT CONTAINSCONTAINS
Hb METER
REFRACTIVE ERROR FOROPTER
CONTAINSCONTAINS
BP MONITOR MEASURING TAPE
CONTAINSCONTAINS
BLOOD SUGAR METER
URINE TEST
CONTAINSCONTAINS
WEIGHING SCALE
PREGNANCY TEST
THERMOMETER
HEALTH RECORD HEALTH RECORD MAINTAINENCE MAINTAINENCE
HEALTH CARD
HEALTH RECORD HEALTH RECORD MAINTAINENCE MAINTAINENCE
BAREFOOT NURSE MOBILE APPLICATION
Karnataka state
Number of Taluks in operation-9 (Spread across 6 districts)
1. Doddaballapura2. Hoskote3. Devanahalli3. Devanahalli4. Nelamangala5. Anekal6. Magadi taluk7. Hadagali taluk8. Bidar, Bidar taluk9. Gulbarga, Alanda taluk
TRAININGTRAINING
Reaching millions...millions...Saving lives …..Saving lives …..
Kit Distribution -Aland Taluk, Gulbarga Aland Taluk, Gulbarga dist
Plan for expansion Nov 2019
Ajmer Rajasthan
Aurangabad, MH
Plan for expansion Nov 2019-June 2020
Chamba HP
Bhopal, MP
Tinsukia Assam
Villupuram, Tamil Nadu
Indicators to assess the study outcomes
• % of target population visited the houses • Number of people screened for
anaemia, vision, ht/wt• Number of beneficiary requested for repeated screening• Number of beneficiary first time detection and referral of NCDs• Number of beneficiary first time detection and referral of NCDs• Average amount of money earned per week/ month, per
barefoot community nurse• % BFNs using the app• % of timeliness of data entry in app,• % of completeness of data entry into app
Indicators to assess the study outcomes
of target population visited the houses of people screened for diabetes, hypertension,
Number of beneficiary requested for repeated screeningfirst time detection and referral of NCDsfirst time detection and referral of NCDs
Average amount of money earned per week/ month, per
of timeliness of data entry in app,% of completeness of data entry into app
Way forward - Goal of the proposed project
• To promote livelihood through an entrepreneurship Model in the health & well
• Innovation in training to standardize through audio• Innovation in training to standardize through audiovisual approach
• https://www.youtube.com/watch?v=JcggEF23nPk
• https://www.youtube.com/watch?v=h_76cGwgl0A
Goal of the proposed project
livelihood through an entrepreneurship well-being space
training to standardize through audio-training to standardize through audio-
https://www.youtube.com/watch?v=JcggEF23nPk
https://www.youtube.com/watch?v=h_76cGwgl0A
Bangalore Urban slums: Proposed Plan
• Screening of all urban slums in Bangalore
• Need 500 kits• Need 500 kits
• Need 500 barefoot nurses
• 3 community coordinators
Bangalore Urban slums: Proposed Plan
Screening of all urban slums in
Need 500 barefoot nurses
community coordinators
Wisdom of Alternate systems and NCDs Prevention
• If we go back to history the Canon encyclopaedia of medicine in five books philosopher Avicenna/IbnaSina
• The Canon of Medicine remained a medical authority for centuriescenturies
• Moses Maimonides was the most prominent physician. His 10 medical treatiestranslation, show his humanism as a physician and emphasis on preventive medicine.
• His medical writings confirm his knowledge of Greek and Persian as well as contemporary medieval
Wisdom of Alternate systems and NCDs Prevention
Canon of Medicine is an five books compiled by Persian
IbnaSina and completed in 1025
remained a medical authority for
was the most prominent Jewish medieval 10 medical treaties, all now available in English
translation, show his humanism as a physician and emphasis on
medical writings confirm his knowledge of Greek and Persian as well as contemporary medieval
Philosophy of modern medicine
• Unfortunately the modern medicine grown up on war metaphor, a war against bacteria, a war against cancer, war against infectious diseases, against cancer, war against infectious diseases, so essentially you poison, destroy or pulverise
Philosophy of modern medicine
Unfortunately the modern medicine grown up a war against bacteria, a war
against cancer, war against infectious diseases, against cancer, war against infectious diseases, so essentially you poison, destroy or pulverise.
District HospitalNCD Clinic, Geriatric Clinic, Cardiac Care Unit,
Cancer Care [Health Promotion; Early diagnosis & Management; Home Based Care; Day Care Facility]
Tertiary level InstituteMedical Colleges, Tertiary Cancer
Centres of Excellence
[Tertiary care, Training, Research]
Co-existence of different systems is criticalwith in PUBLIC SECTOR services
Community Health CenterNCD Clinic, Geriatric Clinic
[Health Promotion, Early diagnosis & Management; Laboratory Investigations, Home Based Care, Referral]
Sub CenterScreening Services
[Health Promotion; Opportunistic Screening; Referral]
District HospitalNCD Clinic, Geriatric Clinic, Cardiac Care Unit,
Cancer Care Facility etc.Health Promotion; Early diagnosis & Management; Home Based Care; Day Care Facility]
Tertiary level InstituteMedical Colleges, Tertiary Cancer Centres, Regional geriatric Centres,
of Excellence
[Tertiary care, Training, Research]
Referral
existence of different systems is criticalPUBLIC SECTOR services
Community Health CenterNCD Clinic, Geriatric Clinic
[Health Promotion, Early diagnosis & Management; Laboratory Investigations, Home Based Care, Referral]
Sub CenterScreening Services
[Health Promotion; Opportunistic Screening; Referral]
Opportunities and
• Political will
• Healthy Public Policy
• Resource Mobilization
• Sustainable Infrastructure & Systems• Sustainable Infrastructure & Systems
• Human resources & their capacity building
• Convergence & Integration
• Partnership & Collaboration
• Quality assurance, M&E for evidence
and Challenges
Sustainable Infrastructure & SystemsSustainable Infrastructure & Systems
Human resources & their capacity building
Convergence & Integration
Partnership & Collaboration
Quality assurance, M&E for evidence
Choices
Legislation
Summary: CAPACITY FOR CONTROL OF NCD
Knowledge,skills
ENERGETIC PROFESSION
Resources Networks Action Plans
ENVIRONMENT
Legislation
Regulation
Information
Health Beliefs
EMPOWERED
COMMUNITY
ENABLING
Facilities
Taxation
Summary: CAPACITY FOR CONTROL OF NCD
Health Care
(Availability,Access)
Taxation
Enforcement
ENVIRONMENT
THANKSTHANKSTHANKSTHANKS
Bangalore slum status
• The number of slums in Bangalore has grown from 159 in 1971, to over 2000 slums (notified and non
• Those living in slums accounted for just over population in 1971 and an estimated lakhs live in slums)lakhs live in slums)
• Karnataka Slum Development Board in Bangalore City.
• Karnataka has seen growing unemployment, larger numbers to the unorganized work-force and deepening urban poverty.
• In Bangalore, nearly one-third of slum dwellerspoverty line, with a monthly income of less than
Bangalore slum status
number of slums in Bangalore has grown from 159 in 1971, to over 2000 slums (notified and non-notified) in 2015.
living in slums accounted for just over 10 percent of the city’s population in 1971 and an estimated 25 to 35 percent in 2015. (30
Slum Development Board 2011 says 597 slum areas are
unemployment, larger numbers to the and deepening urban poverty.
of slum dwellers fall below the with a monthly income of less than Rs 2500 ($55).
National Programs for NCDs prevention
• National Cancer Control Program
• National Blindness Control Program
• National Mental Health Program
• National Iodine Deficiency Disorders Control Program• National Iodine Deficiency Disorders Control Program
• National Tobacco Control Program
• Trauma Care Facility on National Highways
• National Deafness Control Program
National Programs for NCDs prevention
National Cancer Control Program
National Blindness Control Program
National Mental Health Program
National Iodine Deficiency Disorders Control ProgramNational Iodine Deficiency Disorders Control Program
National Tobacco Control Program
Trauma Care Facility on National Highways
National Deafness Control Program
National Programs for NCDs prevention
• National Program for Prevention and Control of
• Pilot Project on Oral Health
• National Program for Prevention and Control of Cancer, Diabetes, CVD, StrokeDiabetes, CVD, Stroke
• National Program for Health Care of the Elderly
• Pilot Program for Prevention of Burn injuries
• Disaster Management/Mobile Hospitals
National Programs for NCDs prevention
National Program for Prevention and Control of Fluorosis
National Program for Prevention and Control of Cancer,
National Program for Health Care of the Elderly
Pilot Program for Prevention of Burn injuries
Disaster Management/Mobile Hospitals
STRATEGIES1. Health Promotion for healthy life styles that preclude NCDs and their risk
factors 2. Specific prevention to reduce exposure to risk factors 3. Early Diagnosis through periodic/opportunistic screening of population and
better diagnostic facilities 4. Infrastructure Development and facilities required for management of NCDs5. Human Resources and their capacity building for prevention and treatment
of NCDs5. Human Resources and their capacity building for prevention and treatment
of NCDs6. Establish Emergency Medical Services
disability and mortality due to NCDs7. Treatment and care of persons with NCDs including rehabilitation and
palliative care 8. Health Legislation and population and evidence based interventions
wherever applicable through multisectoral9. Building evidence for action through surveillance, monitoring and research
STRATEGIESfor healthy life styles that preclude NCDs and their risk
to reduce exposure to risk factors through periodic/opportunistic screening of population and
and facilities required for management of NCDsand their capacity building for prevention and treatment and their capacity building for prevention and treatment
Emergency Medical Services with rapid referral systems to reduce
of persons with NCDs including rehabilitation and
population and evidence based interventions multisectoral approach for prevention of NCDs
for action through surveillance, monitoring and research.
DIET AND PHYSICAL ACTIVITY ARE LINKED TO
MANY DISEASES
• CORONARY HEART DISEASE
MANY RISK FACTORS
•
•• STROKE
• MANY CANCERS
• DIABETES
• OSTEOPOROSIS
•
•
•
•
•
DIET AND PHYSICAL ACTIVITY ARE LINKED TO
MANY RISK FACTORS
HIGH BLOOD PRESSURE
ABNORMAL BLOOD LIPIDS ABNORMAL BLOOD LIPIDS
HIGH BLOOD SUGAR
OVERWEIGHT & OBESITY
DISORDERED CLOTTING MECHANISMS
INFLAMMATORY PROCESSES
DIET: KEY COMPONENTS
• Low Intake of Fruits & Vegetables
• Unhealthy Fats
• Refined Carbohydrates• Refined Carbohydrates
• Low Intake of Fibre
• Excess Calories
DIET: KEY COMPONENTS
Low Intake of Fruits & Vegetables
PHYSICAL ACTIVITY: KEY ISSUES
• Settings :
• Urban Design :• Urban Design :
• Domains :
PHYSICAL ACTIVITY: KEY ISSUES
Schools
Workplace
Communities
Safe Pedestrian PathwaysSafe Pedestrian Pathways
Protected Cycle Lanes
Green Areas
Work Related At
Home
Transport Related
Leisure Time Activities
Care
Services
System levels
Global, integrated, continuous and effective
Acceptable, accessible (and affordable)
criteria
Performance or quality criteria for developing health systems
Services
Local System Integrated: no gaps, no overlaps and optimal flow of patients and information
LHS Ex:Decentralised, permanently accessible, polyvalent
Referral services
Centralised, not permanently accessible to all, specialised
Global, integrated, continuous and effective
Acceptable, accessible (and affordable)
Performance or quality criteria for developing health systems
Integrated: no gaps, no overlaps and optimal flow of patients
Ex:Decentralised, permanently accessible, polyvalent
Centralised, not permanently accessible to all,