Community based Screening programme in Primary HealthCare(PHC) institutions to tackle Non Communicable Disease(NCD) burden in Sri nLanka
Dr Thalatha Liyanage,M.B.B.S., D.F.M., MSc &M.D (Com.Med)
Director NCD, Ministry of Health
Background
In Sri Lanka, 71% of annual deaths are due to chronic NCDs.Cardiovascular Diseases, Diabetes, Cancers and Chronic Respiratory diseases are rapidly increasing over the last few decades accounted for 29.6%, 9.4%, 3.9% and 8.5% of mortalityrespectively. Risk factors; smoking, use of alcohol, unhealthy diet and lack of physical activity are prevalent. These diseases are manageable by early detection, treatment and life style modification. In order to address the burden, Ministry of Health formulated NCD Policy with nine strategic objectives in 2009 in par with global action plan for NCD prevention.
WHO Package of Essential NCD (WHO PEN) for detection, prevention, treatment and care of NCDs including CVD and risk factors was a sustainable efficient intervention to achieve theNational policy objectives. PEN was introduced in one of the 26Districts(Badulla) in the country in 2009 and the concept was piloted in two Districts (Kurunagalla & Polonnaruwa) to identify the method of implementation by JICA(Japaneese InternationalCooporation Agency). Latter the concept was streamlinedthroughout the country through Healthy Life Style centers (HLCs) since August 2011.
Methodology
Country consists of 26 Districts and each District comprise of several Primary Health Care institutions (PHCs) with varying facilities to provide curative services. HLCs were established inPHCs where infrastructure facilities are already available.Necessary equipment, health guidance tools and documents were provided. Screening for NCDs, risk factors, health guidance and referral where necessary are the main activities in the HLCs. Guideline was issued from Ministry of Health on recruitment, screening, follow up and information managementfor monitoring. People 40-65 years of age are screened for risk behaviours, BMI, fasting capillary blood sugar and Blood pressure and cardiovascular risk according to WHO/ISH risk prediction chart and managed according to the Managementprotocol. Circular was issued 16 essential drugs list to beavailable in all PHCs. Quarterly and annual reviews at District and Central levels are evaluating the programme.
Results
In 2011 there was 297, HLCs in 22 Districts and in 2013 the number expanded to 668 in all Districts. Medical Officer of Health (MOH) area is a designated area with a population of 100,000-150, 000.The target is to have two or more HLCs per MOH area. Out of 331 MOH areas, 265 (80 %) MOH areas have at least one HLC and 155 (48%) MOH areas have two or more HLCs.
Screening coverage among 40-65 population in 2011, 2012 and 2013 first quarter is 2.3%,3.95%and 5.29% respectivelyshowing increasing trend. Analysis of screened data indicates lower prevalence for smoking (4.98%) and alcoholism (5.8% )than national average but overweight (26.2%),obesity(6.40% ) and high Blood pressure (13.04 %)were somewhat similar. Mean fasting blood glucose level was 14.2%, which is higher than the previous values (11.5%) (Risk factor surveillance- 2008). More than 30% risk of developing the CVD event within next 10 years is 1% among a sample.
Discussion
HLCs in PHC institutions which provide affordable accessible and acceptable services in close proximity to the people is important to detect the risk factor s and NCDs earlier to make the productive quality lives through early detection, treatment and life style modification. It facilitates risk factor surveillance and implement culturally and sector specific interventions. Sincethe male participation is poor, it’s necessary to use a different approach as of work place screening for detection of NCDs and NCD risk factors early for better outcome.
