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. 2021 Jul 31;21(1):757.
doi: 10.1186/s12913-021-06530-0.

Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS)

Anand Krishnan  1 , Prashant Mathur  2 , Vaitheeswaran Kulothungan  3 , Harshal Ramesh Salve  1 , Sravya Leburu  3 , Ritvik Amarchand  1 , Baridalyne Nongkynrih  1 , Himanshu Kumar Chaturvedi  4 , P Ganeshkumar  5 , Vinay Urs K S  3 , Avula Laxmaiah  6 , Manjit Boruah  7 , Sanjeev Kumar  8 , Binod Kumar Patro  9 , Pankaja Ravi Raghav  10 , Prabu Rajkumar  5 , P Sankara Sarma  11 , Rinku Sharma  12 , Muralidhar Tambe  13 , N Arlappa  6 , Tulika Goswami Mahanta  14 , Pranab Jyoti Bhuyan  15 , Rajnish P Joshi  16 , Abhijit P Pakhare  8 , Abhiruchi Galhotra  17 , Dewesh Kumar  18 , Binod Kumar Behera  9 , Roshan K Topno  19 , Manoj Kumar Gupta  10 , Neeti Rustagi  10 , Atulkumar V Trivedi  20 , K R Thankappan  21 , Sonia Gupta  12 , Suneela Garg  22 , Sangita Chandrakant Shelke  13 ; ICMR-NNMS investigator group; Co-investigators; Collaborators
Collaborators, Affiliations

Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS)

Anand Krishnan et al. BMC Health Serv Res. .

Abstract

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: 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: 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: 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.

Keywords: Health systems; Human resources; Medicines; Noncommunicable diseases; Primary health care; Technologies.

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Conflict of interest statement

None declared.

Figures

Fig. 1
Fig. 1
NNMS 2017-18: Surveyed public and private primary level health facilities
Fig. 2
Fig. 2
NNMS 2017-18: Surveyed public secondary level health facilities
See this image and copyright information in PMC

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