Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS).

The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

Krishnan A ，Mathur P ，Kulothungan V ，Salve HR ，Leburu S ，Amarchand R ，Nongkynrih B ，Chaturvedi HK ，Ganeshkumar P ，K S VU ，Laxmaiah A ，Boruah M ，Kumar S ，Patro BK ，Raghav PR ，Rajkumar P ，Sarma PS ，Sharma R ，Tambe M ，Arlappa N ，Mahanta TG ，Bhuyan PJ ，Joshi RP ，Pakhare AP ，Galhotra A ，Kumar D ，Behera BK ，Topno RK ，Gupta MK ，Rustagi N ，Trivedi AV ，Thankappan KR ，Gupta S ，Garg S ，Shelke SC ，ICMR-NNMS investigator group ，Co-investigators ，Collaborators ... -  《BMC HEALTH SERVICES RESEARCH》

Assessment of primary care facilities for cardiovascular disease preparedness in Madhya Pradesh, India.

Pakhare A ，Kumar S ，Goyal S ，Joshi R ... -  《-》

Preparedness of healthcare facilities of manipur in the management of noncommunicable diseases: A cross-sectional study.

Gupta A ，Gitanjali T ，Christina S ，Janani L ，Jamsheer MKM ，Akoijam BS ... -  《-》

Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India.

Kaur P ，Borah PK ，Gaigaware P ，Mohapatra PK ，R Das NK ，Uike PV ，Tobgay KJ ，Tushi A ，Zorinsangi ，Mazumdar G ，Marak B ，Pizi D ，Chakma T ，Sugunan AP ，Vijayachari P ，Bhardwaj RR ，Arambam PC ，Kutum T ，Sharma A ，Pal P ，Shanmugapriya PC ，Manivel P ，Kaliyamoorthy N ，Chakma J ，Mathur P ，Dhaliwal RS ，Mahanta J ，Mehendale SM ... -  《-》

The capacity of primary healthcare facilities in Bangladesh to prevent and control non-communicable diseases.

The rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs). A cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities' readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered 'ready' to manage NCDs. The general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs. All levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh.

Kabir A ，Karim MN ，Billah B 《-》