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Time of India
03-06-2025
- Business
- Time of India
Study finds critical medicine shortages for diabetes, hypertension at rural health facilities
New Delhi: A joint survey conducted by the ICMR and the WHO, along with other institutes, has revealed critical medicine shortages for managing diabetes and hypertension at rural health facilities, from sub-centres to sub-district hospitals, across 19 districts in seven states. The study has also found a shortage of specialists at the community health centre (CHC) level and these findings are similar to the rural health statistics report of 2020-21, indicating a shortfall of physicians (82.2 per cent) and surgeons (83.2.9 per cent) at the CHC-level. The study findings, published in the "Indian Journal of Medical Research (IJMR)" suggest that among public health facilities, PHCs, district hospitals and government medical colleges in India are better prepared to manage services for diabetes and hypertension. Across all the facilities, the domain score for equipment was the highest and for medicines, it was the lowest. However, the availability of all medicines was better at tertiary-care facilities (public and private) compared to other levels of public health facilities. A cross-sectional survey of the health facilities was conducted in 19 districts of seven states, which included an assessment of both public and private health facilities. The Indian Public Health Standards and other relevant guidelines were used for the assessment. The service domain score for four domains: equipment, medicine, diagnostics capacity and staff, including the availability of guidelines, and the overall readiness score was calculated following the service availability and readiness assessment manual of the World Health Organisation (WHO). In two phases of data collection, 415 health facilities were covered, of which 75.7 per cent were public and 24 per cent were private. The number of facilities assessed varied across the states. More than half (57.6 per cent) of the health facilities assessed were primary level (33.5 per cent), followed by secondary (33.5 per cent) and tertiary (10 per cent) facilities. More than half (56.3 per cent) of the health facilities were in rural areas. More than three-fourths of all public and private health facilities reported being involved in the follow up of diabetes and hypertension patients. The most common mode of follow ups across all facilities was self-reporting by patients (61.4 to 100 per cent), except for in SCs (29.5 per cent). At SCs, the most common mode of follow up was home visits by health workers (60.4 per cent). The availability of out-referral and in-referral registers across all levels and types of facilities was between 25 and 53.8 per cent and 14 and 61.5 per cent, respectively. "Most public health facilities (from SCs to SDHs) reported stockouts of essential medicines for managing diabetes and hypertension. Out of the 105 SCs assessed, nearly one-third (37/105; 35.2 per cent) reported stockouts of tablet metformin, and nearly less than half (47/105; 44.8 per cent) reported stockouts of tablet amlodipine," the study stated. The median duration of the stockouts for the medicines ranged from one to seven months. The SCs reported more stockouts of essential anti-diabetes and anti-hypertensive medicines compared to any other types of facilities. These medicines were better available at government medical colleges compared to any other levels of public health facilities. The medicine availability score at the primary health centres (PHCs) was just 66 per cent, far below the ideal threshold of 100 per cent. "Our findings suggest that among public health facilities, PHCs, district hospitals and government medical colleges in India are better prepared to manage services for diabetes and hypertension. Across all the facilities, the domain score for equipment was the highest, and for medicines, it was the lowest," the study said. It mentioned the ICMR-India Diabetes Study (ICMR-INDIAB) report's evidence of an NCD epidemic spreading to rural areas in India, in addition to the urban areas, due to changes in the lifestyle. Therefore, improving the preparedness of the SCs will further enhance the primary-care services closer to the homes of people, it stressed. The government has already accelerated its efforts towards strengthening Comprehensive Primary Health Care (CPHC) for achieving Universal Health Care by committing resources and efforts through its flagship Ayushman Bharat Health and Wellness Centres (AB-HWCs). These were recently renamed as Ayushman Arogya Mandirs. "During our assessment, the majority of PHCs (64 per cent) were converted to Health and Wellness Centres (HWCs). This indicates that PHC-HWCs were better prepared to provide comprehensive services compared to SCs, as nearly half of them (52.3 per cent) were transformed into HWCs. However, we found that diagnostic services were less available at district hospitals, indicating that secondary higher-level public health facilities were not fully prepared to manage complications of these two conditions," the study pointed out. Efforts to strengthen diagnostic services are essential for the continuum of care, as there will be in-referrals of patients from peripheral public health facilities to DHs, it said. Lessons from the India Hypertension Control Initiatives (IHCI) project can be adapted to ensure a reliable drug supply and accurate information systems in primary health care facilities, it added.
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Business Standard
03-06-2025
- Health
- Business Standard
Study finds key drug shortages for diabetes, BP at rural health centres
A joint survey conducted by the ICMR and the WHO, along with other institutes, has revealed critical medicine shortages for managing diabetes and hypertension at rural health facilities, from sub-centres to sub-district hospitals, across 19 districts in seven states. The study has also found a shortage of specialists at the community health centre (CHC) level and these findings are similar to the rural health statistics report of 2020-21, indicating a shortfall of physicians (82.2 per cent) and surgeons (83.2.9 per cent) at the CHC-level. The study findings, published in the "Indian Journal of Medical Research (IJMR)" suggest that among public health facilities, PHCs, district hospitals and government medical colleges in India are better prepared to manage services for diabetes and hypertension. Across all the facilities, the domain score for equipment was the highest and for medicines, it was the lowest. However, the availability of all medicines was better at tertiary-care facilities (public and private) compared to other levels of public health facilities. A cross-sectional survey of the health facilities was conducted in 19 districts of seven states, which included an assessment of both public and private health facilities. The Indian Public Health Standards and other relevant guidelines were used for the assessment. The service domain score for four domains: equipment, medicine, diagnostics capacity and staff, including the availability of guidelines, and the overall readiness score was calculated following the service availability and readiness assessment manual of the World Health Organisation (WHO). In two phases of data collection, 415 health facilities were covered, of which 75.7 per cent were public and 24 per cent were private. The number of facilities assessed varied across the states. More than half (57.6 per cent) of the health facilities assessed were primary level (33.5 per cent), followed by secondary (33.5 per cent) and tertiary (10 per cent) facilities. More than half (56.3 per cent) of the health facilities were in rural areas. More than three-fourths of all public and private health facilities reported being involved in the follow up of diabetes and hypertension patients. The most common mode of follow ups across all facilities was self-reporting by patients (61.4 to 100 per cent), except for in SCs (29.5 per cent). At SCs, the most common mode of follow up was home visits by health workers (60.4 per cent). The availability of out-referral and in-referral registers across all levels and types of facilities was between 25 and 53.8 per cent and 14 and 61.5 per cent, respectively. "Most public health facilities (from SCs to SDHs) reported stockouts of essential medicines for managing diabetes and hypertension. Out of the 105 SCs assessed, nearly one-third (37/105; 35.2 per cent) reported stockouts of tablet metformin, and nearly less than half (47/105; 44.8 per cent) reported stockouts of tablet amlodipine," the study stated. The median duration of the stockouts for the medicines ranged from one to seven months. The SCs reported more stockouts of essential anti-diabetes and anti-hypertensive medicines compared to any other types of facilities. These medicines were better available at government medical colleges compared to any other levels of public health facilities. The medicine availability score at the primary health centres (PHCs) was just 66 per cent, far below the ideal threshold of 100 per cent. "Our findings suggest that among public health facilities, PHCs, district hospitals and government medical colleges in India are better prepared to manage services for diabetes and hypertension. Across all the facilities, the domain score for equipment was the highest, and for medicines, it was the lowest," the study said. It mentioned the ICMR-India Diabetes Study (ICMR-INDIAB) report's evidence of an NCD epidemic spreading to rural areas in India, in addition to the urban areas, due to changes in the lifestyle. Therefore, improving the preparedness of the SCs will further enhance the primary-care services closer to the homes of people, it stressed. The government has already accelerated its efforts towards strengthening Comprehensive Primary Health Care (CPHC) for achieving Universal Health Care by committing resources and efforts through its flagship Ayushman Bharat Health and Wellness Centres (AB-HWCs). These were recently renamed as Ayushman Arogya Mandirs. "During our assessment, the majority of PHCs (64 per cent) were converted to Health and Wellness Centres (HWCs). This indicates that PHC-HWCs were better prepared to provide comprehensive services compared to SCs, as nearly half of them (52.3 per cent) were transformed into HWCs. However, we found that diagnostic services were less available at district hospitals, indicating that secondary higher-level public health facilities were not fully prepared to manage complications of these two conditions," the study pointed out. Efforts to strengthen diagnostic services are essential for the continuum of care, as there will be in-referrals of patients from peripheral public health facilities to DHs, it said. Lessons from the India Hypertension Control Initiatives (IHCI) project can be adapted to ensure a reliable drug supply and accurate information systems in primary health care facilities, it added.
The Hindu
22-04-2025
- Health
- The Hindu
Looking back to the strength of a people's movement against filariasis
The World Health Organization has sought to eliminate filariasis, globally, by 2030, a decade later than its original target of 2020. While India's target year is now 2027, this deadline has been arrived at after several revisions: the National Health Policy had originally set the goalpost for 2015. Filariasis, clearly, has been difficult disease to eradicate. While pioneering experiments by vector specialists over the years have helped India reduce its disease burden, consistent efforts are needed to eliminate the disease, reports have acknowledged. 'Filariasis is the common term for a group of diseases caused by parasitic nematodes belonging to the superfamily Filarioidea. Adult worms of these parasites live in the lymphatic system, cutaneous tissues or body cavity of the humans and are transmitted through vectors', explains a documents from the National Centre for Vector Borne Diseases Control. Filariasis caused by nematodes that live in the human lymph system is called Lymphatic Filariasis (LF). The burden of lymphatic filariasis is massive in India, with as many as 670 million persons at risk for the disease, according to a report published in the Indian Journal of Medical Research in 2022. While the disease has been around for decades in India, there still exist many misconceptions about it, says S. Sabesan, former director of the Indian Council of Medical Research -- Vector Control Research Centre, Puducherry. Kerala's story with filariasis Kerala was instrumental in spotlighting filariasis in India. In 1984-85, a group of filariasis affected persons in Alappuzha formed an association, and its president contested the general election that year, aiming to attract the attention of politicians and bureaucrats. It bore fruit. A Member of Parliament from Kerala S. Krishna Kumar, became the deputy minister in the Union Health Ministry. He called for action against filariasis in Kerala, which set the ball rolling, recalls Dr. Sabesan. Kerala's culture of associations helped to further the project of eliminating filariasis, he says. All associations were amassed under the umbrella of the Filariasis control movement or 'Filco' movement. The project targeted removing floating vegetation where mosquitoes that cause the disease breed. The mosquitoes lay eggs on leaves and the larvae absorb oxygen from the air sacs in the roots of the plants. Understanding the breeding pattern of the mosquitoes helped remove the floating vegetation, which was then placed as manure in coconut groves. To control mosquitoes the State Health Department also targeted Kerala's large resource of ponds and water bodies to develop aquaculture, using fish from dams. The fish would feed on the larvae, curtailing mosquito breeding. Interdepartmental support Support also came from Kerala's Agriculture Department which saw the potential of improving livelihoods in rural areas. Shramdhan workers cleaned temple tanks, canals and water bodies, and NABARD pitched in with financial support to remove the plants, and establish aquaculture. In two years, inland fisheries had been developed. To add value to the removed water vegetation, hemp was cultivated. This improved the quality of fertilisers that coconut groves received. Ultimately, the Health Department roped in the Education Department to raise an army of schoolchildren who could spread awareness to help improve adherence to treatment of the disease. The Health Department also used the knowledge of how village residents checked the feet of eligible young women to check if they harboured the disease before offering a marriage proposal. The Department made a young woman with lymphatic oedema, in whose family many women had been rejected owing to the disease, their mascot. The young woman recovered from filariasis after treatment and this boosted people's confidence. Her story was made into a short film, Yudham (war) and exhibited, giving further fillip to treating the disease. Alongside, the Department trained Filco workers to detect the disease and bring in patients for treatment. Free clinics were opened to offer treatment. The next step was checking for hidden disease, which involved mass drug administration. Soon, the number of cases fell drastically indicating that the disease was in the elimination stage. A win, and a mass strategy The success of the experiment was shared at the WHO's meeting in 1996 in Kuala Lampur and the World Health Assembly decided on a strategy of administering a single dose of diethylcarbamazine citrate (DEC). In India, the annual single dose mass therapy was introduced in 2002, but the nation-wide the scheme did not help in eliminating the disease, for want of follow-up care. In 2006, the Union Health Ministry introduced the drug Albandazole that can have an effect on adult worms of the parasite. But there was a lack of compliance, even though the drugs were distributed. The Health Ministry found that despite distributing the drug there, was no reduction in the number of cases. Meanwhile in Kerala another development took place. The salt story Through a project, salt-infused with a low dose of the drug DEC was introduced in Kerala. This project was launched with the support of the salt corporation in Thoothukudi in Tamil Nadu. Within a year, the number of filariasis cases fell significantly. The project's success was expanded in Tamil Nadu's Kanyakumari district in 2003. By 2020, the Indian Council of Medical Research launched DEC salt in Andaman and Nicobar and successfully eliminated another variety of filariasis. This salt therapy could be used as an adjunct therapy across the country Dr. Sabesan has said in the white paper he has published on the subject: Not only is it odourless, but it also doesn't change the colour of food and is safe for pregnant women and children as well. For the success to be sustained it is imperative that we achieve the target of elimination, he says. 'Tamil Nadu is doing well. But filariasis is found in Karnataka, Andhra Pradesh, Bihar and Uttar Pradesh as well. There are areas where filariasis is a challenge. If uncontrolled, filariasis will be reintroduced, as the vector is already present in the atmosphere. The low density carriers will build up gradually. So it is necessary to continue surveillance even after elimination is declared. Vector entomologists must focus on the mosquitoes and the vector,' he emphasises.
