CANDI 24 AUGUST 2021

EDITORIAL SECTION
Focusing on diseases sidelined by COVID-19
GS 2 – Health
Context:
Strengthening the primary healthcare system will help tackle the burden of noncommunicable diseases.
Key Stats of the Non Communicable Disease
 Nearly 71% of all deaths worldwide occur due to non-communicable
diseases (NCDs) such as hypertension, diabetes, cardiovascular diseases,
chronic respiratory diseases, and cancer.
 Cardiovascular diseases such as stroke, heart attacks and coronary artery
disease are the top cause of global deaths.
o One out of every four deaths occurs due to cardiovascular diseases,
especially among younger patients.
 In the Indian subcontinent, there is early onset and rapid progression
of such diseases, and a high mortality rate.
 Premature loss of life due to NCDs in the age group of 30-69 years is also
very high among Indians.
 Half the deaths due to cardiovascular diseases occur in the age group of
40-69 years.
Concerns
 The rapid spread of COVID-19 has severely tested primary healthcare
systems, which perform myriad functions, across the world.
o Maternal healthcare services, immunisation, health surveillance, and
the screening and management of NCDs have all been severely
disrupted.
 A World Health Organization (WHO) survey conducted in May 2020 among
155 countries found that low-income countries were the most affected
by this disruption.
o More than half (53%) of the countries surveyed had partially or
completely disrupted services for hypertension treatment, 49% for
treatment for diabetes and diabetes-related complications, 42% for
cancer treatment and 31% for cardiovascular emergencies.
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 Data from the National Health Mission’s Health Management
Information System in India show that emergency services for
cerebrovascular diseases dropped by about 14%.
 Among NCDs, persons with diabetes are at an exceptionally higher risk of
severe clinical outcomes of COVID-19.
 A recent study reported that nearly one in every two Indians living with
diabetes is unaware of their condition.
o They are at higher risk of dying if they contract COVID-19 because of
uncontrolled glucose levels in their blood.
o Findings from an observational study in Delhi show that 47.1% of
hospitalised COVID-19 patients had diabetes.
 Lockdowns and reduced physical interactions led to loneliness,
especially in the geriatric population.
o This resulted in mental health disorders such as anxiety and
depression.
o Lockdowns increase exposure to NCD risk factors as people became
more likely to increase their consumption of alcohol and tobacco and
adopt an unhealthy diet.
 In India, those with NCDs find that productive years of life are lost and
there is high-out-of-pocket expenditure on treatment.
Way Forward
 Although most countries reported that they had included NCD services in
their national COVID-19 preparedness and response plans, only 42% of lowincome countries did so.
 India’s response plan to address the growing burden of NCDs must
include tobacco cessation activities as tobacco consumption has been
indisputably linked to hypertension, cardiovascular diseases and
stroke.
 Alternative strategies have been established in most countries to
support those at the highest risk so that they continue receiving
treatment for NCDs.
o Among the countries reporting service disruptions, half are using
telemedicine.
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o A positive impact of the pandemic has been that two-thirds of the
countries are now collecting data on the number of COVID-19 patients
who also have a NCD.
 There is an urgent need for national and State health policymakers to
draw up a road map which gives equal weight to patients living with
NCDs.
o Utilising the existing network of NGOs while respecting local factors
will go a long way in tackling the growing burden of NCDs.
o Campaigns on maintaining a healthy lifestyle need innovation;
o The monotony of broadcasting the same message over and over again
must be broken.
 Screening for NCDs at the grassroots level and the delivery of locally
relevant and contextual messages for health promotion and primordial
prevention of NCDs can be significantly improved by incentivising the already
overburdened ASHA workers.
 Access to essential NCD medicines and basic health technologies in all
primary healthcare facilities is essential to ensure that those in need
receive treatment and counselling.
 Strategies must include mitigation efforts to address administration
challenges, a strong health workforce, infrastructure, supplies, maintaining
the standard of care, and continued access and care for the vulnerable
populations.
 Also, the importance of physical activity and mental health due to
restrictions on movement should be brought to the forefront.
 The use of alternative modalities such as online platforms for
disseminating information on exercise and mental health management
must be made available to the marginalised.
 Telemedicine can reduce travel expenses, thus lowering patients’
expenditure burden.
 Urgent action is needed using the ‘all of society approach’ to achieve
the WHO goal of a 25% relative reduction in overall mortality from
cardiovascular diseases, cancer, diabetes, or chronic respiratory
diseases by 2025.
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o This can be achieved by strengthening the primary health system to
prevent, diagnose and provide care for NCDs in the future, especially
during health emergencies such as a pandemic.
CONNECTING DOTS FOR PRELIMS
National Family Health Survey -5 (Phase-1)
 Released by the Union Ministry of Health and Family Welfare,
Government of India.
 All rounds of surveys are conducted by the International Institute for
Population Sciences (IIPS), Mumbai, as the nodal agency.
 Earlier the Health Ministry itself used to conduct District Level
Health Survey (DLHS) and Annual Health Survey (AHS)
 MoFHW decided to conduct integrated NFHS with a periodicity of
three years in lieu of different surveys from 2015-16 onwards to meet
the requirement for frequent, timely and appropriate data at the
National, State, and District levels.
 Latest factsheet for 22 states and UT’s for the phase-1 of the 2019-
20 NFHS-5 was released on Universal Health Coverage Day on
12th December, 2020.
 About Universal Health Coverage Day
o The goal of Universal Health Coverage (UHC) as stated in
the UN Sustainable Development Goals (SDG No. 3)
o India moved step closer to its commitment to SGGs, when in
2018 the country launched a national health protection
scheme, Ayushman Bharat, to achieve UHC.
 Main objective is to provide reliable and comparable datasets on
health, family welfare and other emerging issues.
 Four rounds of NFHS (1992-92, 1998-99,2005-06 and 2015-16)
have been successfully completed in India.
 NFHS -5 is being conducted in around 6.1 lakh sample households
to provide disaggregated data up to district levels.
 The state factsheets released include information on 131 key
indicators.
 NFHS-5 includes new focal areas such as:
o Expanded domain of Child Immunization,
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o Components of Micro Nutrients to children,
o Menstrual Hygiene,
o Frequency of Tobacco and alcohol use,
o Components of Non-Communicable Disease (NCDs),
o Expanded age from measuring hypertension and diabetes
among all, aged 15 years and above.
 Key Findings of the Survey
o Full immunisation drives among children aged 12-23 months
have recorded substantial improvements across
States/UTs/Districts.
o More than two-third fully immunized in all mentioned states
and UTs except Nagaland, Meghalaya, and Assam.
o In almost 3/4th of districts 70 percent or more children aged
12-23 months are fully immunized against childhood disease.
o Overall Contraceptive Prevalence Rate (CPR) has increased
substantially in most of the Phase-1 states/UTs and it is
highest in Himachal Pradesh and West Bengal (74 percent).
o Use of the modern method of contraception has also increased
in almost all states/UTs.
o Increase in the percent of women receiving the recommended
four or more Antenatal Care (ANC) visits by health providers in
many States/UTs.
o Institutional Delivery is over 90 percent in 14 out of the total
22 States and UTs.
 While an increase in institutional births, there has also
been a substantial increase in C-section deliveries in
many states/UTs especially in private health facilities.
o Infant and Child mortality across most States/UTs have
declined in the past half-a-decade.
o Unmet needs of family planning have witnessed a declining
trend in most of the phase-1 States/UTs.
o Malnutrition or Stunting among children below five years did
not improve at all while acute undernourishment or wasting
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worsened in the last half-a-decade in a majority of the surveyed
states and UTs
o Anaemia among women and children continues to be cause of
concern.
o For both men and women, there is a lot of variation in the high
or very high random blood glucose levels across surveyed
phase-1 states/UTs.
o Prevalence of elevated blood pressure (hypertension) among
men is somewhat higher than in women.
Source: THE HINDU