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Center for NCD Prevention

The Centre for NCD Prevention of NNOS is currently involved in a Project to prevent renal damage among the rural population, so that the expensive alternative of organ transplant is avoided. NNOS is taking steps towards implementing cost-effective Non Communicable Disease prevention strategies.

NNOS realized that organ transplantation helped save the lives of a certain section of the population, but was out of reach for the vast majority because of the cost involved. Organ failure prevention as much as possible is the only way forward for them. So, NNOS looked to start a program to control Non Communicable Diseases in rural areas, including kidney failure. It studied a working model on that established by a leading Nephrologist, Dr. M. K. Mani (Kidney Help Trust), through universal screening and treatment for Diabetes and Hypertension, which seemed to prevent 60% kidney failures, 70% heart attacks and 80% strokes. With some changes to that model and with support from Kidney Help Trust and from the WHO funded TN Health Systems Project, NNOS started a Project to establish the costs and scalability of a Public Private Partnership in this area. The Project was rolled out in Lathur Block, Kancheepuram District, TN, with funding from the Willingdon Corporate Foundation.

During the last three years, door-to-door demographic data on 28000 residents collected, BP measured of 23100 accessible persons of age 10 and above, urine sugar measured of 24500 accessible persons of age 5 and above. Of them, those identified and confirmed after repeat tests as being diabetic are 1800 and hypertensive are 2000, with 400 of them being both. Thus 3400 persons need treatment. Of them, 700 preferring to have their own treatment; remaining 2700 being our target group. Thus 2500 persons are in need of the treatment (1300 for diabetes and 1500 for hypertension,300 both). Among those above the age of 10, prevalence of hypertension and diabetes were seen to be of the order of 15%, and 8%, respectively, with four out of five of them unaware of their condition. Lack of adequate infrastructure at the Primary Health Centre level makes this difficult and hence the next stage of the project envisages some solutions for this.

In addition to this, a small sized parallel project is being run in that project area to study the effectiveness of using mobile phone technology to nudge persons to adopt dietary and lifestyle changes needed to complement the effect of medication.


WAY FORWARD / EXPANSION PLANS FOR THE PROJECT

Near - Term :

Increase the number of beneficiaries :

500 persons get followed up every one month using mobile technology on compliance with needed treatment and complementary actions - in future mobile solution will be expanded to all 3000 participants

Incorporation new mobile tools :
  • Linkage to care: send automated appointment reminders in SMS or IVR format to ensure that participants consistently follow up and avail the treatment provided at the PHCs
  • Develop decision support system (DSS) for lifestyle intervention: DSS will support CHWs to provide standardized lifestyle advice based on physical activity, diet, weight, tobacco and alcohol use
  • Mobile phone messaging: provide customized SMS/IVR directly to patients to reinforce self-monitoring behaviors and lifestyle interventions
  • Automated data analysis: incorporate automated data analysis to track overall program delivery/ efficiency.

Short - Term :

Build Sustainability :

Sustainability through targeted efforts to build capacity at the individual (self-management skills, part-pay for point-of-care services ), family (empower women in the family for lifestyle changes) and community level (increasing awareness; and advocacy for long-term government involvement in this PPP effort.

Long - Term :

Scale up to larger populations and other locations :

The evidence generated from this project has substantial potential to inform decision-making for key stakeholders on a scalable PPP solution While the study is limited to one rural region of India, integrating the intervention with the existing primary healthcare system, which is broadly similar in all parts of India, will help enhance the relevance of the results across India and other regions with similar health system structures.