Community Psychiatry in India

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NCD program in Kerala, a reality check.

Today’s report in the Hindu gives a reality check on the NCD (noncommuicable diseases) program in Kerala. With the central plan to integrate the 5 central health schemes (see earlier post here) under the rubric of the NCD, it makes sense to make a situation appraisal so as to plan ahead. Kerala may be the first state to take the baby steps in this direction as it already has  active Mental health, palliative, geriatric and NCD programs.

Some excerpts and comments:

NCD drugs are in short supply across the State and in many districts, there are no stocks available anymore. Even the basic drug for diabetes, metformin, and glucometer test strips for blood glucose monitoring are totally out of stock in many places. Apart from NCD drugs, some 150 commonly used drugs are also totally out of stock in most districts.

The inability of the State to provide uninterrupted supply of the drugs defeats the very objective of the NCD control programme because strict and uninterrupted adherence to prescription medications and regular follow-ups are crucial for keeping all NCD-related complications under check.

As far as the mental health program is concerned it also has its share of adversarial news coverage. It has been mainly for the unavailability of mental health doctor (at-least a trained medical officer in mental health) in certain districts like Iddukki to continuously run the program. Uninterrupted drug availability has also been a problem as in the report on the NCD program. However mental health program also has the additional problem of drug excess approaching the expiry date. This has been because of the centralised drug intending which is quite out of sync with the dynamic need on the filed.

The decision to provide NCD drugs for free to all those detected with diabetes or hypertension had been ill-conceived and several senior Health officials had warned the government that this was a huge commitment which will be difficult to sustain,” a senior Health official said. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is being carried out in five districts in the State since 2012. There is no free drug distribution under NPCDCS. But the State took a decision to extend the scheme across the State and to use State’s funds to screen the entire population and provide drugs free of cost.

The decision has proved to be a huge drain on the exchequer because all the funds allocated for the programme – both Central and State funds – are now being spent on purchasing drugs while the other components of the programme, like activities to promote primary prevention of the disease in the community, have not taken off at all.

The uni-modal biomedical model for public health is something which all have to be forewarned on, not just for its medicalisation of programmic architecture but also for the perverse diversion of funds for irrational and financially nonviable pharmacotherapy.

Hence, a directive was issued to all PHCs/CHCs to calculate their individual requirement of NCD drugs, so that it can be included in the general indent for drugs being sent to KMSCL by every hospital.

“In the long-term, the focus should be on encouraging people to adopt risk reduction strategies and adopting policies that encourage healthy living. Apart from a few basic drugs, no government can afford to offer statins or expensive insulins free to the people for a lifetime. This was a populist measure which has gone horribly wrong,” the Health official added.

 Drug intending at the point of care is definitely the way ahead. It is at the core of integration of care of chronic illnesses into the health system architecture.

 

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