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| (L-R) Dr Ratna Devi, CEO, DakshamA Health and Education, Dr Kenneth Thorpe, Chairman of the Partnership to Fight Chronic Disease (PFCD) and Dr Shashank Joshi, President, Indian Diabetic Association |
With non-communicable diseases (NCDs) like asthma, arthritis, cancer, diabetes and heart disease taking more than 36 million lives each year, they have emerged as one of the biggest threats to India’s health. They pose a double menace as NCDs not only affect the quality of life but also drive up healthcare costs thereby hindering healthcare access and affordability.
Express Pharma & Express Healthcare, Indian Express Group publications conducted an Idea Exchange with Dr Kenneth Thorpe, Chairman of the Partnership to Fight Chronic Disease (PFCD) to delve more into this situation and mull on effective measures that need to be implemented to tackle the growing threat of NCDs in India. Thorpe was joined by Dr Shashank Joshi, President, Indian Diabetic Association and Dr Ratna Devi, Chief Executive Officer, DakshamA Health and Education.
Viveka Roychowdhury, Editor of Express Pharma and Express Healthcare, moderated the session which offered perspectives from three major stakeholders i.e. policy expert, clinician and a patient/ NGO to the questions posed by her and the audience.
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Dr Kenneth Thorpe
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Thorpe stressed on the gravity of the situation as far as NCDs are concerned and said, “The magnitude of the problem of chronic diseases/ NCDs in India is substantially growing. To fill the gap between what’s needed in terms of system delivery and patient treatment, I think there is a growing interest in coming up with a blueprint or a comprehensive healthcare reform framework that really focuses on three issues i.e. how to do a better job in preventing the growth of chronic diseases, how to increase the disease detection rate and building a primary care, chain-based care management system.”
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Dr Shashank Joshi
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Joshi, a strong advocate of prevention and early diagnosis to stop the advent of chronic diseases said, “Chronic diseases are a common threat because of fundamentally sedentary work habits, improper diets and probably some genetic transformation. Hence, NCDs should be a common goal/theme and deliverables must be achieved by healthcare workers. We are one of the largest exporters of doctors and healthcare workers across the world. Yet, healthcare (in India) is grossly understaffed. We have one of the worst doctor to patient ratios. But, the bigger challenge in prevention is actually looking at pre-disease (hidden disease) and that burden is very large. It needs a political will and individual will to make a change. We are not yet empowering either our policy makers or our individuals to make that change. That needs to happen. It has to be a movement. Until we are able to crystallise the movement, we will not be able make a dent on our numbers.”
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Dr Ratna Devi
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Ratna was emphatic that unless people understood the gravity of the situation and became more pro-active in maintaining their own health, it would be difficult to curb NCDs.
Giving the example of the HIV campaign where patients themselves formed peer groups, got themselves tested and helped remove the stigma associated with the disease, she said, “In the NCD segment this kind of movement is yet to start. Though there are a few organisations that are working in particular areas, especially the cancer groups where there is a lot of advocacy, awareness is being generated and enrollment has happened so people are coming forward to seek treatment, it is still at a very nascent stage. Lot of work needs to be done to get people mobilised to work together and become aware so that they start working towards prevention and manage their health by themselves.”
Thorpe also spoke on successful programmes implemented in the US to curb smoking and effective diabetes management programmes implemented in several countries like Finland and China, as examples of initiatives that can be emulated in India to deal with NCDs.
The three speakers also gave their recommendations on the measures that need to be implemented by the Government to curb NCDs in India.
| Idea Exchange: Recommendations |
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Dr Thorpe emphasised on the need to develop a national framework or road-map for driving the kind of reforms that will really prevent the growth in NCDs, do a better job of early detection and then manage and work with patients to do that. His first recommendation was to recognise the power of partnerships. Pointing out that the magnitude of this problem is quite substantial, he said that the Government is not going to solve this by itself. So, patients, providers, employers and employees, should work collaboratively as part of their process. He also suggested finding ways to unleash an extraordinary amount of entrepreneurship and innovation, which in his opinion is already here in India. He said, in many sectors of the Indian economy there has been a lot of innovation in international leadership and entrepreneurship and advised harnessing it to make it a part of the reform process, and coming up with innovative ways to prevent disease or for delivery system reforms. He highlighted that India spends a real low amount of money on healthcare and the bulk of it is paid out of pocket. Hence, as part of the framework discussion, there should be a debate on the role of private insurance and examine whether the kind of private insurance that currently exists in the market makes any sense in terms of treatment of the chronically ill patients. He said that probably there is a big gap between what the insurance covers and what is really needed to provide healthcare services which are clinically effective to chronically ill patients. So, if one can get more money from the private sector then it is an opportunity for the Government sector to increase their commitment towards those at the lower end of income distribution and come up with a national framework for public health infrastructure which can be initially adopted at the state-level. He says that a road-map which gauges the wide variety of stakeholders i.e. insurance groups, provider groups, patient advocacy groups, employers, and takes the best of the best will lead to a lot of good thinking. Then there will be people, who are some of the best, sitting at the table trying to solve the problem. – Dr Kenneth Thorpe Dr Joshi pointed out that we need to recognise that NCDs are an epidemic in India and our healthcare professionals, especially the Health Ministry needs to recognise that we should not be in NCD-denial mode. He mentioned that while a tobacco control programme and smoking-cessation has just come in place, we also need to ban and tax fast foods very aggressively because by breaking our ancestral habits and embracing such foods, as well as becoming physically inactive, we are seeing an increasing incidence of hypertension, diabetes or heart disease as well as stress and depression. Besides aggressively tackling NCDs at each stage, from predisease to the end stage, Joshi believes we need to empower our patients. Therefore we need to have more nutritionists, more counselors, more support systems in place as well as peer groups. He also mentioned that though the Food Security Bill passed by the previous Government will give cereal security, not providing protein will make beneficiaries diabetic. We need a movement to generate awareness on these issues, said Joshi. – Dr Shashank Joshi Dr Devi’s first recommendation is to recognise patients as a very strong voice that can contribute very positively at different levels. The second one is to empower them with the right amount of knowledge and the tools. There is a lot of information available but how to understand that at an individual level to be able to connect or correlate to the disease condition or the disease syndrome that the patient has, is very difficult. She feels that is the reason why we hear a lot of stuff but we do not really imbibe or understand what exactly it is trying to convey. So, Dr Devi wants to empower them with the right knowledge and the right tools. She clarifies, that there are a lot of diagnostic kits and home made kits available in the market but again how easy are they to use, how comfortable are people really buying the stuff because one may buy an instrument but the paraphernalia that goes with it is sometimes is not available. So empower the patients so that they are able to use the tools with the right knowledge and the right information. Thirdly, make the patients responsible for their own disease outcomes, manage their own disease in a way that they feel happy at the end of a certain period that they have achieved the targets they set for themselves. She mentioned that it is very difficult in the current situation because our health system is over burdened so that kind of space just does not exist. Counselors from amongst the patients or caregivers can come forward and do the work for them. – Dr Ratna Devi |
In her closing remarks Roychowdhury thanked the speakers for their insights and said it is to be hoped that such debates will pave the way for effective policies and strategies which would help in bringing down the numbers of NCD incidence in the country.
EP News Bureau – Mumbai