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 Table of Contents  
EDITORIAL
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 53-55

The coronavirus disease-2019 pandemic and noncommunicable diseases-need for primary health care system strengthening


1 Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
2 Public Health Specialist RD Appartments, Sector 6, Dwaraka, New Delhi, India
3 Formerly with WHO Regional Office for South East Asia

Date of Submission10-May-2021
Date of Acceptance13-May-2021
Date of Web Publication16-Jul-2021

Correspondence Address:
Dr. K R Thankappan
Department of Public Health and Community Medicine, Central University of Kerala, Periya, Kasaragod - 671 320, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_25_21

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How to cite this article:
Thankappan K R, Dawa N, Narain JP. The coronavirus disease-2019 pandemic and noncommunicable diseases-need for primary health care system strengthening. Int J Non-Commun Dis 2021;6:53-5

How to cite this URL:
Thankappan K R, Dawa N, Narain JP. The coronavirus disease-2019 pandemic and noncommunicable diseases-need for primary health care system strengthening. Int J Non-Commun Dis [serial online] 2021 [cited 2021 Aug 5];6:53-5. Available from: https://www.ijncd.org/text.asp?2021/6/2/53/321621



Coronavirus disease-2019 (COVID-19) pandemic first reported in China in December 2019 has so far caused 2.99 million deaths in the world and 180,550 deaths in India as on April 19, 2021.[1] The total number of cases in India was 15.31 million, the second-highest after the United States with 32.48 million. The second wave of the pandemic seems to be much worse than the first wave. The number of new cases increased from 11,794 in the 1st week of February 2021 to 256,828 as of April 19, 2021.[2] The number of new deaths per day has gone up from 116 in the 1st week of February 2021 to 1757 as of April 19, 2021.[2] The situation is alarming and urgent actions are required from all sections of the society in order to reduce the impact of this pandemic. Mortality reduction from the pandemic is one of the top priorities. In order to reduce mortality from this disease high-risk groups should be identified and they should be given priority in the management. Older people and those with chronic noncommunicable diseases (NCDs) are at a higher risk of mortality from COVID-19.


  Coronavirus Disease-2019 and Noncommunicable Diseases Top


Globally, 71% of all deaths in 2016 were due to NCDs and 85% of these deaths below the age of 70 years (premature deaths) were in low- and middle-income countries. In India, NCDs accounted for 63% of all deaths (cardiovascular diseases 27%, cancers 9%, chronic respiratory diseases 11%, diabetes 3%, and other NCDs 13%).[3] After COVID-19, The mortality rates have been highest in the elderly and among those with major NCDs such as cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes. Close to a quarter (22%) of the world's population were reported to have a disease condition that increases the risk of COVID-19 deaths and a majority of these conditions were NCDs.[4] Over three fourth of the COVID-19 deaths were in the elderly in the US and death rates increased as the age increased.[5] NCD risk factors such as obesity and tobacco use were reported to be associated with COVID-19 deaths.[6] The pandemic also affected NCD management since several of the staff working for NCDs were diverted to COVID 19. Treatment of hypertension, diabetes, and its complications were affected in about half of these patients.[4] Identification of older people and those with NCDs is a priority for reducing mortality from NCDs. This can only be done by strengthening the primary health care system in the country.


  Strengthening of Primary Health System is Urgently Needed Top


The 1978 Alma-Ata declaration of health for all was reinforced in the 2018 Astana declaration by the WHO in the global conference on primary health care.[7] The spirit of the conference was that primary health care approach is foundational to achieving our shared global goals in Universal Health Coverage.[7] We need to strengthen the primary health care system and use them effectively and efficiently in order to address the COVID-19 pandemic in India.

India has a strong primary health care system in place with 160,713 subcenters (SCs) including 3302 urban SCs, 30,045 primary health centers (PHCs) including 5190 urban PHCs, and 5685 community health centers (CHCs) including 350 urban CHCs. In the year 2019, there was one SC available for a population of 5616 against the norm of 5000, a PHC for an average population of 35,567 against 30,000 and a CHC for 165,702 against 120,000.[8] In addition, there is one Anganwadi worker and one accredited social health activist (ASHA) for every 1000 population. The grass root level workers can identify the older people above the age of 60 years and make sure that all of them are vaccinated against COVID-19 and reverse quarantine is followed. In addition, people older than 45 years with any NCD should also be identified and vaccinated. They can also make sure that people with NCDs are getting proper care such as medications for hypertension and diabetes are regularly taken, blood pressure and blood sugar are monitored regularly. They can also facilitate online consultation for NCDs with both public and private health systems depending on the availability and feasibility.

They can also make sure that COVID protocol is implemented as directed by the national and state governments including proper mask wearing, physical distancing, hand washing/sanitizing, etc. In addition, “avoiding the three Cs” (closed spaces, crowded places, and close contact settings) are followed as far as possible.[9] The strengthening of primary health care system can ensure drastic reduction of COVID-19 cases which will, in turn, reduce the number of serious cases requiring intensive care including ventilator facilities. If the number of serious cases is reduced, they can be effectively managed by our secondary and tertiary health care system. Therefore, the key is strengthening the primary health care system to address the COVID-19 pandemic. COVID-19 pandemic may be used as an opportunity to strengthen our primary health care system.

Filling up of the existing vacancies of staff, on-the-job training and supportive supervision; strengthening health information system including surveillance and laboratory diagnostic capacities; uninterrupted supply of essential drugs and vaccines; and adequate financial resources are some of the immediate requirements. Establishment of Health and Wellness Centers under the Ayushman Bharat scheme provides an excellent and unique opportunity to strengthen primary health care but they need not only be expanded but also strengthened by improving health infrastructure.[10] The ASHA workers did a great job last year, but the remuneration they get is pathetic. One cannot be expected to survive with the amount, while our expectations from her are enormous. Their remuneration must, therefore, be enhanced[11] and they be provided with adequate supervisory support from health staff in order for them to discharge their duties efficiently and continue to render services such as providing medicines to patients in home isolation, monitoring those in quarantine, and participate in active case finding in the community. In addition, they assist in prevention activities such as NCD screening, promoting behavior change, community mobilization and so doing establish collaboration with Panchayathi Raj Institutions and Mahila Mandal. In order to assist in surveillance, contact tracing, and analysis of real-time data that guide action at the district level, the district epidemiologists must be recruited without delay by all states as desired by our Prime Minister, while monitoring COVID response last year.[12] Unfortunately, the positions still lie vacant in many states while COVID continues to spread relentlessly in both urban and rural areas. A major reason being that many states offer a salary so low that no one with post-graduate degree in public health is willing to take up this job. The PHC staff be supported by modern technology[13] such as smartphones, and PHCs linked with medical colleges or an urban health facility by telemedicine so that the quality of care in PHC can be improved.



 
  References Top

1.
WHO, Corona Virus Disease (COVID-19) Dashboard. Available from: http://www.covid19.who.int. [Last accessed on 2021 Apr 19].  Back to cited text no. 1
    
2.
COVID19 India. Available from: https://www.covid19india.org/. [Last accessed on 2021 Apr 19].  Back to cited text no. 2
    
3.
WHO. Deaths from NCDs in India. Available from: https://www.who.int/nmh/countries/2018/ind_en.pdf?ua=. [Last accessed on 2021 Apr 19].  Back to cited text no. 3
    
4.
World Health Organization. Rapid Assessment of Service Delivery for NCDs during the COVID-19 Pandemic. Geneva: World Health Organization; 2020. Available from: https://www.who.int/publications/m/item/rapid-assessment-ofselvice-delively-forncds-dllli ng-the-covid-19-pandemic. [Last accessed on 2021 Apr 19].  Back to cited text no. 4
    
5.
Centers for Disease Control and Prevention. Corona Virus Disease. SE 2019 (COVID19). Increased Risk of Hospitalization or Death. Available from: https://www.cdc.gov/coronavims/2019ncov/need-extra-precautions/older-adults.html#anchor 1606159374271. [Last accessed on 2021 Apr 19].  Back to cited text no. 5
    
6.
Van Zyl-Smit RN, Richards G, Leone FT. Tobacco smoking and COVID-19 infection. Lancet Respir Med 2020;7:664-5.  Back to cited text no. 6
    
7.
World Health Organization. Global Conference on Primary Health Care 25-26, 2018, Astana, Kazakhstan. Available from: https://www.who.int/teams/primary-health-care/conference. [Last accessed on 2021 Apr 19].  Back to cited text no. 7
    
8.
Government of India Ministry of Health and Family Welfare. Statistics Division, Rural Health Statistics 2018-19. National Health Mission. Available from: https://main.mohfw.gov.in/sites/default/files/Final%20RHS%202018-19_0.pdf. [Last accessed on 2021 Apr 19].  Back to cited text no. 8
    
9.
Japanese Government. Avoiding the Three Cs: A Key to Preventing the Spread of COVID-19. Available from: https://www.japan.go.jp/kizuna/2020/avoiding_the_three_cs.html. [Last accessed on 2021 Apr 19].  Back to cited text no. 9
    
10.
Dawa N, Narayan T, Narain JP. Managing health at district level: A framework for enhancing programme implementation in India. J Health Manage 2021;23:119-28.  Back to cited text no. 10
    
11.
Abdel-All M, Angell B, Jan S, Howell M, Howard K, Abimbola S, et al. What do community health workers want? Findings of a discrete choice experiment among Accredited Social Health Activists (ASHAs) in India. BMJ Glob Health 2019;4:e001509.  Back to cited text no. 11
    
12.
Dutta SS. Express News Service. As COVID-19 Spreads, States Rush to Hire Epidemiologists at Ridiculously Low Salaries. The New Indian Express, April 23, 2021.  Back to cited text no. 12
    
13.
Garg S, Bhatnagar N, Singh MM, Borle A, Raina SK, Kumar R, et al. Strengthening public healthcare systems in India; learning lessons in COVID-19 pandemic. J Family Med Prim Care 2020;9:5853-7.  Back to cited text no. 13
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