What do these stories tell us about Public-sector Primary Healthcare for non-communicable diseases control?
1. Lack of non-communicable diseases control programs:
Established health centers like that of Rajpur do not even have basic setups for the diagnosis and treatment of non-communicable diseases. There is a lack of a basic laboratory to diagnose or monitor even the commonest non-communicable diseases. Similarly, there are not enough drugs that can be used to manage diseases like diabetes and hypertension.
Ensuring that the health facilities serving at the lowest level of the public health system are equipped with trained clinicians, basic medical equipment and appropriate drugs can allow patients with such non-communicable diseases to receive adequate care. In a country, where >60% of adult mortality can be attributed to non-communicable diseases [World Health Organization — Noncommunicable Diseases (NCD), Country Profile: Nepal, 2014], this has to become a new priority.
2. Lack of community outreach for non-communicable diseases:
The existing healthcare systems of Nepal do not have proper community services and outreach. People often have to travel long distances even for basic health checkups which can be easily transferred to outreach clinics. Blood pressure measurement and basic laboratory tests are some of the basic services that can be easily provided through outreach clinics. These fairly simple services have the potential to increase follow-ups at the health clinics and ensure continuity of care. Similarly, an outreach clinic could be a great avenue to refill a prescription that does not need to be adjusted. Providing basic laboratory tests and refilling prescribed medications for cases that are under control, aided by proper clinical guidelines at the outreach clinics closer to people’s homes or workplaces will cut a lot of burden for patients.
3. Lack of focused individualized care:
The Female Community Health Volunteers (FCHVs) of Nepal do not receive formal training in non-communicable diseases. Because of this, we have not been able to mobilize a highly successful cadre of community health workers in the key areas of prevention and management of non-communicable diseases that are based on lifestyle like diet modification, physical activity, smoking cessation, and alcohol moderation.
FCHVs can be instrumental in providing focused individualized care to patients with non-communicable diseases. Allowing patients of Hypertension to have their blood pressure checked, encouraging patients of Diabetes to self-examine their feet at night, reporting unusual symptoms, or obtaining counseling on risk factors at homes and workplaces through FCHVs can go a long way in preventing costly and even life-threatening complication of non-communicable diseases.
4. Lack of trust in public sector healthcare:
As outlined above, health care services for non-communicable services are nearly absent in the public healthcare facilities of Nepal, more specifically at the primary level. This chronic inadequacy of services has decreased the trust of the people towards what can be expected from the public sector. As the supply remains inadequate in public health facilities, the demand for services for non-communicable diseases is also less. In a country where 57% of people have a daily wage below $2 [Asian Development Bank, Country Poverty Analysis (Detailed), 2013], it is unfortunate that the public sector is unable to provide even the basic services for the diseases that afflict a significant percent [Percentage with raised BP 25.7%; Percentage with raised fasting blood glucose 3.6 %, STEPS Survey 2013, Government of Nepal, Nepal Health Research Council and World Health Organization] of the adult population. As a result, people have no option but to rely on the unregulated and expensive private sector.