Strengthening NCD (HTN & DM) services in the state of Assam, India

Objectives

To operationalise a state-wide, comprehensive diabetes and hypertension management programme at primary care level, through enhanced public primary service delivery, incl. COVID-19 preparedness, strengthened health system and empowered communities.

Approach

The project will leverage public primary care, for example strengthening mobile medical units (MMUs) and primary level clinics to address non-communicable diseases (NCDs) during and after the COVID-19 epidemic.

The project builds on platforms created during WDF15-956 and WDF11-654, i.e. telemedicine system, electronic medical records and peer educators.

Project activities include strengthening of service delivery through three tracks:

Advocacy and knowledge generation:

- Biannual health facility assessments conducted jointly with National Health Mission (NHM) to facilitate operationalisation of NCD service delivery aligned with national primary health care reform (Ayushman Bharat); action plan to address gaps co-created with NHM.

- Provision of technical support to district and state level health authorities to streamline supply chain processes, incl. biannual assessments of indenting, procurement and distribution of drugs and consumables related to NCDs. Findings to be shared with authorities and action plan for improvements to be agreed and jointly rolled out.
- Substantial M&E component to be rolled out, incl. HR structure (district programme coordinators) to facilitate implementation embedded within the public system. Facilitation of knowledge & best-practices exchange by convening annual diabetes conference in North Eastern India. Health system strengthening

- Capacity building of primary level health care professionals (HCPs) on prevention and care of NCDs and COVID-19. Refinement of training modules in consultation with NHM; modules to be tailored for each level of HCPs (CHW (community health worker), nurse, doctor). Trainings to be convened using Training of Trainers (ToT) approach.

- Quality of care to be strengthened through a) creating managerial capacity of HCP supervisors (part of public health care set-up) to provide supportive supervision to trained HCPs, b) provision of quarterly continuing medical education (CME) and technical training to HCPs on NCD guidelines and COVID-19. Telemedicine platform to be used for mentoring sessions, c) provision of mentoring support to CHWs through existing government health helpline (call centre).

- Leveraging of telemedicine and electronic health record system; IT infrastructure to be upgraded and operational; staff at MMUs and primary level clinics to be trained to operate the system. Telemedicine hub to be established and linked to provide distance consultations.

- Roll out of comprehensive NCD programme across primary level clinics and MMUs. Programme to be based on continuum of care concept; prevention, screening and diagnosis to be provided at point of care; referral gaps and loss to follow-up to be mitigated by deployment of telemedicine consultations.

- Piloting of innovative point of care technology, incl. HbA1c testing and artificial intelligence (AI) based equipment for screening of complications at selected MMUs to assess feasibility. Results to be presented to NHM for potential scale-up.
Community engagement:

- Operationalisation and activation of community health committees (Jan Arogya Samitis) in relation to selected primary level clinics as envisaged under the Ayushman Bharat. Committees to ensure community ownership, health promotion action and accountability of service providers. Situational analysis and action plan to be co-created with NHM. Peer educators from previous projects to be empowered to form peer support groups for diabetes patients. Groups to address DM self-management, psychosocial support and COVID-19 prevention.

Results at completion

NCD service delivery strengthened across Assam state (all 33 districts)
1,139 primary level doctors trained ain DM, HTN and COVID19 management; yearly refresher trainings conducted; CHWs trained through cascade training
3,825 primary level clinics established or strengthened to provide T2DM care and prevention
78 MMUs equipped with upgraded telemedicine technology and electronic medical records
536 primary level clinics linked with telemedicine services and 400 HCPs trained to operate the system
One telemedicine hub established and operational, and 69,470 telemedicine consultations provided
1,115,200 people underwent risk assessment for diabetes; 133,323 people screened for diabetes, 13,524 diagnosed with diabetes, and 102,108 people referred to treatment.
4 Sanjeevani MMUs strengthened with HBA1C devices and Kits as a pilot to showcase point of care diagnosis and point-of-care and AI based equipment screening for complications; 1,763 high risk persons received HbA1c test.
70 model community health committees made functional; 76 peer educators trained and peer support group established