Non Communicable Disease(NCD)-Global Scenario & Role of family Physician Dr Rajesh Jain MD EX-Medical Officer- WHO Project Manager Diabetes Prevention Control Project- Uttar Pradesh(NRHM) & Supported by World Diabetes Foundation,Denmark

Global NCD Targets 20%15% <15.0% 23%15% 32.2%24.0% HED* <1.2% 8.7 6.0 gm 35.2%30.0% * Heavy episodic drinking Source of icons: World Heart Federation Champion Advocates Programme

Seven Strategies: Prevention and Promotion Clinical Management Increasing Patient Compliance Action with NGOs, Professional Bodies & Other Stakeholders Monitoring, Research and Surveillance Capacity Building Policy and Regulatory interventions

Seven Strategies: Prevention and Promotion Clinical Management Increasing Patient Compliance Action with NGOs, Professional Bodies & Other Stakeholders Monitoring, Research and Surveillance Capacity Building Policy and Regulatory interventions

Translating Chronic Care Model into Our Primary Care Coordinated, Continuous and Comprehensive Care Productive Interactions Multidisciplinary NCD Team Physician MO Nurse / DE Dietician Pharmacist Informed, Empowered Patient Self-management support 46 Decision support Efficient Clinical Information System Community Resources

Focus 2015: Initiatives to Improve Clinical Outcome of NCDs No Strategy Activity 1. Informed, Empowered Patient 1. Development and implementation of Peer Support Diabetes Program. 2. Multidisciplinary NCD Team 2. Development and implementation of an appraisal system / incentive to recognize health center with excellent Diabetes care, based on QA achievement. 3. Personalized NCD care by Medical Officer and Diabetes Educator in health centres. 47 47

Focus 2015: Initiatives to Improve Clinical Outcome of NCDs No Strategy Activity 3. Self-management support 4. Development and implementation of Hypertension audit as a new Quality Assurance / National Indicator Approach. 5. Development of CVD Record Book (merging the current Diabetes and Hypertension Book) to facilitate management according to the Global Cardiovascular Risk. 4. Efficient Clinical Information System 6. Strengthening the National Diabetes Registry. 48 48

1. Peer Support Diabetes Program The program module was reviewed twice and now in the final stage of preparation. NCD will be responsible for developing the program and training modules, conduct training, implement and monitor the program.

Peer Support Diabetes Program Rationale: Informed, Empowered Patient is one of the crucial component of the Chronic Care Model. Patients are more likely to accept advise from their peers or people living with the same condition. Successful implementation of a Peer Support Group Program in other countries (e.g. US, Canada) have shown to: Help patients understand and in control of their disease better; Help patients achieve good disease control; and Reduce rates of referral to hospitals due to complications.

Certified Training for GPs This program has been carried out by 100 centers across India by 200 trainers across country PRAYAS – since 2009-13, “mentor-mentee system”. Lucknow ,Prayas (and Aventis,Bohreinger,WDF) – peer as trainers during diabetes education session.

2. Appraisal System for Excellent Diabetes Health Centre ,Uttar Pradesh This appraisal system will act as a motivational drive for healthcare providers to improve quality of Diabetes care at 42 District hospitals and 634 CHC by 2018 in Uttar Pradesh. NCD Clinic at CHC & District hospital 2014, involving officers from the Family Health Development Division, State Epidemiologist (NCD), Family Medicine Specialists, Medical Officers and Diabetes Educators. 3000 Doctors & 6000 Staff Nurse and 1 lakhs ASHA to be trained in Diabetes & NCD Control by 2018 Programme is supported by World Diabetes Foundation,WDF,Denmark. NCD Training for Doctors and Nurse in 20 Districts with Bohreinger already started.

3. Personalised NCD Care Definition: Rationale: Personalised care planning empowers individuals (patients with chronic diseases), promotes independence and helps people to be more involved in decisions about their care. It centres on listening to individuals, finding out what matters to them and finding out what support they need. Rationale: Individuals with long term conditions will be at a point be able to take more control over their condition and understand how it affects their lives. 70% of individuals with a long term condition say their care has improved as a result of personalised care planning (GP Patient Survey 2009/10, Department of Health, UK).

ASHA, ANM & Volunteers as agent of change Basic concept of Coverage of NCD ASHA, ANM & Volunteers as agent of change Positive behavioural change at the community level through effective interventions Extensive coverage through collaboration between NGOs, ASHA & Volunteers Target Uttar Pradesh: 200 Trainers 1,00000 ASHA, 6000 ANM,GNM 3000 GP Trained by 2018

Strategies Scope Increasing awareness & knowledge Healthy eating Health-promoting living environment Translation of knowledge into sustainable actions Scope Healthy eating Active living Smoke-free Weight management Early detection of NCD risk factors

Behavioural Changes Scope Behavioural changes Healthy eating Separating sugar/creamer from hot beverages Increasing availability of fruits and vegetables Increasing availability of plain drinking water Increasing understanding on relationship between intake, calories and activity physical Smoke-free Smoke-free areas – enforcement of existing regulations and voluntary smoke-free areas Active living Walking 10,000 steps Regular and planned physical activity/exercise sessions Weight management Regular self-monitoring of BMI Early detection of NCD risk factor Regular self-monitoring of BMI, blood pressure and blood sugar Use of “health diary” – regularly updated

Environmental Changes Scope Health-promoting living environment Healthy eating Community events – separates sugar/creamer from hot beverages Community events – availability of fruits & vegetables Community events – availability of plain drinking water Healthy stalls or food vendors Smoke-free Enforcement of smoke-free areas gazetted under regulations Smoke-free announcement for community events Recognition for voluntary smoke-free homes Active living Creation of walking tracks with health messages notices on eating, calories and physical activities Weight management Self-monitoring facilities Early detection of NCD risk factor

Summary In order to achieve the voluntary NCD global targets, we need to prioritise our actions NCD prevention NCD control / management What are the biggest contributors or determinants? What factors are within our control? What factors are beyond? Can we do more beyond clinical care? Social determinants of health