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 Table of Contents  
EDITORIAL
Year : 2019  |  Volume : 4  |  Issue : 3  |  Page : 63-64

World NCD Federation guidelines for prevention, surveillance and management of noncommunicable diseases at primary and secondary health-care for low resource settings: A key milestone achieved


Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research; President, World NCD Federation, Chandigarh, India

Date of Web Publication27-Sep-2019

Correspondence Address:
Dr. J S Thakur
Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_37_19

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How to cite this article:
Thakur J S. World NCD Federation guidelines for prevention, surveillance and management of noncommunicable diseases at primary and secondary health-care for low resource settings: A key milestone achieved. Int J Non-Commun Dis 2019;4:63-4

How to cite this URL:
Thakur J S. World NCD Federation guidelines for prevention, surveillance and management of noncommunicable diseases at primary and secondary health-care for low resource settings: A key milestone achieved. Int J Non-Commun Dis [serial online] 2019 [cited 2019 Nov 14];4:63-4. Available from: http://www.ijncd.org/text.asp?2019/4/3/63/268139



Noncommunicable diseases (NCDs) have emerged as a major concern globally, contributing to nearly three-fifths of morbidity and mortality. The disease pattern is changing from infectious to chronic NCDs in many developing countries due to epidemiological transition.[1] The diversity of multifactorial causation in the epidemiology of NCDs and health system requirements prohibits a simple “one-size-fits-all” approach. While we must make efforts for health promotion in different settings, early detection, adequate management, and surveillance are the keys to combat these diseases.[2] Owing to the unavailability of comprehensive operational guidelines for prevention, surveillance, and management of NCDs at the primary and secondary healthcare settings, the World NCD Federation envisioned developing guidelines that will provide a simple and comprehensive guidance on prevention, surveillance, and management aspects of common NCDs targeting primarily health-care professionals, including front-line workers, community health workers, and primary healthcare doctors[3] at national and state levels across low-middle-income countries (LMICs). The developed guidelines present a practical way and solutions, that could contribute towards preventing, controlling and managing the growing burden of NCDs globally as the various existing National and International guidelines are for few conditions and complex to implement in primary care in low resource settings.[4] In addition to the algorithms for the management of the diseases, the guidelines describe the policy and non-policy interventions for prevention of NCDs, management strategies separately for primary and secondary healthcare setting including referral to tertiary healthcare facility. It is first attempt for comprehensive guidelines covering nine NCDs. The existing WHO guidelines cover only two conditions i.e. Type 2 diabetes and Chronic Obstructive Pulmonary Disease (COPD).[4] It also provides a model for mSTEPS for surveillance[5] and implementation framework. The overall objective is to improve the use of best practices, ensure quality of care, and reduce premature mortality due to NCDs as envisioned in global monitoring framework in low-resource settings. These guidelines will serve as a basic tool for the practicing physician and community health workers at every level of health care to deliver quality NCD prevention and care.

These operational guidelines have been developed by about 165 experts from various national and international organizations and are covered under the heads of prevention, surveillance, and management. The three major guidelines development groups have worked with one each for prevention, surveillance, and management and nine further subgroups on disease management, with one for each selected NCD, namely type 2 diabetes mellitus, hypertension, cardiovascular diseases, chronic respiratory diseases, cancers, mental health disorders, cerebrovascular diseases/stroke, chronic kidney diseases, and chronic liver diseases (alcoholic liver disease and nonalcoholic fatty liver disease).[3] The guidelines have gone through extensive review by internal and external peer-reviewing process involving specialists and public health experts with extensive experience both nationally and internationally.

After incorporating the changes in the drafts suggested in the Expert Group Meeting held on March 7 and 8, 2018, followed by reviews and improvements by different groups,[3] an external review meeting was held in August 2018 at Chandigarh where the drafts were again reviewed by an external reviewer and underwent changes to shape the final document.

For the first time, a monitoring and implementation framework with predefined targets and indicators for LMICs has been developed as a part of the guidelines which is based on the NCD Global Monitoring Framework. The framework will assist the policy-makers and program managers for effective uptake and roll out these guidelines. It is intended that this framework will be implemented in few districts to assess the gaps in the existing NCD program. Guidelines are being published as a supplement issue of the IJNCD and also abridged version with algorithms in regular issue of IJNCD for wider dissemination.

The developed guidelines will provide a roadmap and help in reduction of premature NCD mortality and achieving sustainable development goals (SDGs), especially in the context of low-resource setting. It may help in reorienting and strengthening the building blocks of the existing health systems to combat the epidemic of NCDs. The guidelines can be adapted and implementation of the recommendations in different countries may vary as per the structure of the health system of the country. Provision of essential medicines and technology, especially point-of-care technology, is essential for effective implementation. The World NCD Federation is planning pilot implementation in few districts and will organize capacity building training at national and subnational level as per requirements. If any country has to implement these guidelines, they may constitute a task force or working group to work out the roadmap and the modalities of implementation according to existing socio-political conditions as this needs multisectoral participation and involvement. Based on the experience, the World NCD Federation will come up with periodic revisions of guidelines in coming years. We are sure that the guidelines will be helpful in strengthening existing health systems, capacity building of program managers, and cadres of healthcare workers, for prevention, surveillance, and management of NCDs at national, regional, and international level. It will also help in contributing and achieving targets and indicators under global monitoring framework and SDGs by 2030.



 
  References Top

1.
Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1151-210.  Back to cited text no. 1
    
2.
Ministry of Health and Family Welfare GoI. Prevention, Screening and Control of Common Non-Communicable Diseases: Hypertension, Diabetes and Common Cancers. In: Mission NH, editor. New Delhi 2016. p. 48.  Back to cited text no. 2
    
3.
Thakur J, Bhadada S. World NCD Federation guidelines for prevention, surveillance, and management of noncommunicable diseases at primary and secondary health-care settings. Int J Noncommun Dis 2018;3:43-4.  Back to cited text no. 3
    
4.
World Health Organization. Prevention and Control of Noncommunicable Diseases: Guidelines for Primary Health Care in Low Resource Settings. Geneva: WHO, 2012.  Back to cited text no. 4
    
5.
Thakur J, Jeet G, Tripathy J. m-STEPS: Developing and implementing a smart innovative android tool for noncommunicable disease risk factor (STEPS) survey in India. Int J Noncommun Dis 2016;1:91-3.  Back to cited text no. 5
    




 

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