Mareike Kroll, Revati Phalkey & Erach Bharucha, University of Cologne, Cologne, Germany
Sayani Dutta, Bharati Vidyapeeth University, Pune, India
Presentation Title: Challenges for monitoring non-communicable diseases in Pune, India
The rising burden of non-communicable diseases (NCDs) constitutes one of the major global public health challenges in the 21st century. In India, NCDs contribute to an estimated 53% of all deaths, mainly attributable to cardiovascular disease, chronic respiratory disease, cancer and diabetes. NCDs are largely preventable, given their link to common risk factors such as tobacco and alcohol abuse, unhealthy diet and lack of physical activity amongst others. Due to the quality adjusted life years lost and the long-term treatment costs involved in chronic care, they pose a threat to economic and social development, especially in emerging economies in the Global South. Urban agglomerations pose special challenges to health given their socio-economic and environmental dynamism. Improvement of urban health therefore requires tailor-made efforts strongly focusing on health promotion, disease prevention and chronic disease management. Effective interventions require reliable evidence and routine surveillance data. Taking this as a point of departure, the objective of this collaborative research project between the University of Cologne, Germany and Bharati Vidyapeeth University, Pune, India, was to develop and test a model sentinel surveillance system for selected NCDs in three pre-identified research sites in Pune. The system aimed to involve private health care facilities, particularly at the primary health care sentinel sites, given that they are the first point of care for over 80% of ambulatory consultations.
Key Lessons Learned
- Improvement of urban health requires tailor-made efforts strongly focusing on health promotion, disease prevention and chronic disease management. Effective interventions require reliable evidence and routine surveillance data. Disease surveillance, defined as the ongoing systematic collection, analysis and interpretation of health data (disease burden, health risk factors, access to health care), is an important foundation for planning, executing and evaluating public health interventions.
- Despite the increasing prevalence of NCDs, the majority of the current surveillance efforts in India focuses on communicable diseases. The private sector is not adequately included in surveillance programs despite its dominant role in urban health care. Reliable data on the disease burden of NCDs and their risk factors do not exist in Pune.
- Preliminary results from the pilot study show that involvement of private practitioners in NCD surveillance is feasible and important given that they are the main entry point into the health care system and play an important role in initial screening, diagnostic and treatment of NCDs.
- Major barriers include a lack of knowledge regarding surveillance, the limited infrastructure in these clinics with lack of manpower, limited record keeping and low availability of electronic medical records, legal aspects (e.g., alternate practitioners are not supposed to provide allopathic treatment) and poor relationship between the private and the government sector. Clear reporting structures and training of participating practitioners are therefore important prerequisites for regular surveillance.
Policy/Practice Implications of Research
- Reporting of the selected diseases must either become mandatory, or incentives must be provided for voluntary reporting, e.g., of selected sentinel sites. Since the private health care sector is largely unregulated, the integration of private practitioners must be ensured. A specific problem arises from the fact that Ayurveda and homeopathy practitioners are an important source for primary care in Pune, though they are legally not allowed to provide allopathic treatment. Legal barriers discourage these practitioners from reporting tuberculosis or diabetes cases.
- A standardized format for data collection, as well as a procedure for data analysis and regular, timely dissemination of results, needs to be developed and implemented. The limited availability of electronic devices and electronic medical records at the primary care level remains a challenge. Therefore, a responsible authority must be identified and equipped with the necessary infrastructure.
Knowledge Gaps and Needs
- Combating the rising burden of NCDs requires multi-sectoral action on various levels.
- NCD surveillance is an important part of the process to derive evidence-based health policies and programs.
- In low- and middle-income countries, the lack of comprehensive and standardized electronic medical records (especially on the primary care level), lack of other data sources such as health insurance data and absence of unique patient identifiers to link different data bases hinder the implementation of NCD surveillance systems.
- Overcoming the challenge of integrating the often unregulated private sector in surveillance activities.
- Increasing the availability of socioeconomic and spatial data, in order to identify social and spatial health disparities within a population is of high priority in low- and middle-income countries, which are often characterized by widening health disparities.
- More interdisciplinary research is required on these issued to develop adequate NCD surveillance structures in the Global South.