In rural areas NCDs are the leading cause of adult death. India’s rural health system faces great challenges in tackling the rapidly escalating burden of NCDs. In India’s rural healthcare system, routine NCD management is mostly provided at the PHC. The major limitation to providing care in rural communities is the lack of fully trained medical personnel and the considerable strain on PHC resources due to huge burden of NCDs, resulting in poor access and inadequate quality of care. To address these limitations, we implemented the Rural m-Health NCD Prevention Program. The innovations of the program are two-fold: (1) it address the lack of trained medical personnel by ‘task shifting,’ where in the local community health workers (CHW) are trained and delegated some of the tasks traditionally performed by fully qualified medical personal; and (2) and the use of mobile phone technology to standardize and increase access to care.
The target community is the population of 50,000 in 115 habitats in 24 villages in Lathur Block, Kancheepuram District, Tamil Nadu. Since 2009, the project lead, Dr. Mohan Thanikachalam has been part of the team that designed and implemented the population-based PURSE-HIS study to assess the prevalence of NCDs in 8080 participants in urban and rural communities, which includes 3038 participants from Kancheepuram District. Based on the PURSE-HIS, the prevalence of diabetes was 15% in the target area with mean HbA1C of 9.1 ± 2.2 in women and 9.9 ± 2.1 in men (very poor control). The prevalence of hypertension was nearly 25%. The only NCD oriented intervention in the project area is the ‘’The Tamil Nadu state government’s Tamil Nadu Health Systems Project, were screening is opportunistic resulting in missed cases and despite providing services free of cost, only a few of persons consistently seek treatment due to lack of awareness and want of motivation. To address these limitations, we implemented the PPP model, the Rural m-Health NCD Prevention Program for mass screening for NCDs at home/village level and connect them to treatment available at the PHCs.