The Covid-19 outbreak has dealt a heavy blow to the Gurugram health department’s efforts against non-communicable diseases (NCD) such as heart problems, cancer and diabetes, officials said on Wednesday.
This is because population-based screening (PBS) campaigns carried out by ASHA workers and auxiliary midwife nurses (ANMs), to detect prevent, detect and control five common NCDs in the district, have been hampered with resources being diverted to battle the coronavirus disease, they said.
Non-communicable diseases, according to a 2017 National Health Mission module for ANMs, are responsible for 60% deaths in India. These are led by coronary heart disease, stroke, and hypertension (45%), chronic respiratory disease (22%), cancers (12 %), and diabetes (3%).
Surveillance for these diseases, implemented under the health ministry’s National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS), was greatly expanded in 2017.
“Earlier, we used to conduct what we called ‘opportunistic screening’, where anyone above 30 years of age who came to a health care centre would be checked for three diseases, including hypertension, diabetes and oral cancer. In women, we also checked for breast and cervical cancer,” said Dr Jai Prakash Sharma, district surveillance officer, Gururgam.
Sharma said opportunistic screening was replaced with the PBS method of surveillance in 2017, where 37% of the population (above the age of 30) would be screened for NCDs.
In Gurugram, this is now done by about 1,000 trained ASHA workers, 230-odd ANMs, and an estimated 50 nurses and medical officers each.
ASHA workers conduct door-to-door campaigns around their respective primary health centres (PHC) and urban PHCs, and refer cases to the nearest health care centre or sub-centre for treatment. They also carry out routine follow-ups with patients.
“Last year, the target population for screening was about 870,000 people, men and women. Of these, across 35 UPHc and PHCs in the district, we managed to screen 16.5% of the target, which is around 1.5 lakh individuals,” a medical officer with the health department’s NCD division said.
“This year, a few PHCs have not screened even a single person. Others screened only between 100 and 150 people each. By the end of the year, we may reach about 8% of last year’s target,” the doctor said, seeking anonymity.
These door-to-door campaigns, the doctor said, have come to a standstill this year after the Covid-19 outbreak in March.
Dr Virender Yadav, chief medical officer, confirmed this. “PBS cannot be a priority in the middle of a pandemic, as most of our staff are involved in Covid response. ASHA workers and ANMs particularly, which would usually do the PBS exercise for an incentive of Rs 50 per household, are now occupied with contact tracing, following up with Covid patients, door-to-door screening for SARI and ILI symptoms, and so on,” he said.
Yadav added, “Checking for these five NCDs requires close contact between the field worker and the patient. Though ASHA workers may still choose to do NCD screening for the financial incentive, we cannot encourage it because it puts them at greater risk of contracting Covid-19 from someone in the community. It is a catch-22 situation.”
Dr Sunita Rathi, nodal officer for prevention and control of NCDs, declined to provide a comment for this story, though her office did confirm the medical officer’s claims. “We are just in the process of preparing the quarterly report and can give better data once it is ready,” said an administrative staffer, who also declined to be identified.
Experts believe the public health ramifications of this diminished surveillance can be assessed in earnest only after the pandemic has passed.
Dr Prabhakaran Dorairaj, a Gurugram resident and vice-president (research and policy) at the Public Health Foundation of India, said, “In the next four to five years, we may see an increase in background morbidity due to NCDs. They are deadly in themselves but also increase chances of mortality in cases of co-infection with diseases like Covid-19.”
“Recent work by WHO shows that these kind of disruptions of routine health services is a global issue. Locally speaking, the challenge isn’t so much about lack of surveillance, but lack of secondary and tertiary care that patients with these illnesses will soon require,” Dorairaj added.
“Opportunistic screening is a key strategy of the NPCDCS that has been understandably affected by the ongoing Covid crisis. The recently launched Great Barrington Declaration (by infectious disease epidemiologists and public health scientists) recognises that the current situation can produce devastating effects on short and long-term public health effects, including worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. The Declaration recommends a ‘Focused Protection’ strategy to minimise mortality and social harm while better protecting those who are at highest risk.” said Rajib Dasgupta, chairperson, Centre of Social Medicine & Community Health, JNU.