PEN-PLUS Strategy
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Context
- Africa has adopted a new strategy to boost access to the diagnosis, treatment and care of severe non-communicable diseases (NCD).
Details
- Called ‘PEN-PLUS, A Regional Strategy to Address Severe Non-communicable Diseases at First-Level Referral Health Facilities’, the strategy is aimed at bridging the access gap in treatment and care of patients with chronic and severe NCDs.
- Health ministers of African countries endorsed the strategy at the 72nd session of the World Health Organization (WHO) Regional Committee for Africa in Lome, Togo to reduce premature mortality from NCDs.
NCDs
- The term NCDs refers to a group of conditions that are not mainly caused by an acute infection, result in long-term health consequences and often create a need for long-term treatment and care.
- Severe non-communicable diseases are those chronic conditions that lead to high levels of disability and death among children, adolescents and young adults if left undiagnosed or untreated.
- NCDs include heart diseases, cancers, diabetes, asthma among others.
Key facts
- Noncommunicable diseases (NCDs) kill 41 million people each year worldwide, equivalent to 71% of all deaths globally- according to WHO.
- Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD.
- According to World Health Organization (WHO) projections, the total annual number of deaths from NCDs will increase to 55 million by 2030, if timely interventions are not done for prevention and control of NCDs.
- Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs.
Modifiable behavioral risk factors
Modifiable behaviors, such as tobacco use, physical inactivity, unhealthy diet, and the harmful use of alcohol, all increase the risk of NCDs.
- Tobacco accounts for over 7.2 million deaths every year (including from the effects of exposure to second-hand smoke) and is projected to increase markedly over the coming years.
- 1 million annual deaths have been attributed to excess salt/sodium intake.
- More than half of the 3.3 million annual deaths attributable to alcohol use are from NCDs, including cancer.
- 6 million deaths annually can be attributed to insufficient physical activity.
Metabolic risk factors
Metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs:
- raised blood pressure
- overweight/obesity
- hyperglycemia (high blood glucose levels) and
- hyperlipidemia (high levels of fat in the blood).
In terms of attributable deaths, the leading metabolic risk factor globally is elevated blood pressure (to which 19% of global deaths are attributed), followed by overweight and obesity, and raised blood glucose.
NCDs and India
- In India, nearly 5.8 million people (WHO report, 2015) die from NCDs (heart and lung diseases, stroke, cancer and diabetes) every year or in other words 1 in 4 Indians has a risk of dying from an NCD before they reach the age of 70.
- In a report “India: Health of the Nation’s States” by Ministry of Health and Family Welfare (MOHFW), Government of India (GOI), it is found that there is increase in the contribution of NCDs from 30% of the total disease burden- ‘disability-adjusted life years’ (DALYs) in 1990 to 55% in 2016 and also an increase in proportion of deaths due to NCDs (among all deaths) from 37% in 1990 to 61% in 2016. This shows a rapid epidemiological transition with a shift in disease burden to NCDs.
Actions to beat non-communicable diseases
- The epidemic of NCDs cannot be halted simply by treating the sick, healthy persons have to be protected by addressing the root causes. Reducing the major risk factors for NCDs is the key focus of MOHFW to prevent deaths from NCDs. Tackling the risk factors will therefore not only save lives; it will also provide a huge boost for the economic development of the country.
- MOHFW, GOI is already implementing “National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular disease and Stroke” (NPCDCS-launched in 2010) as part of National Health Mission (NHM), with the objective to increase awareness on risk factors, to set up infrastructure (like NCD clinics, cardiac care units) and to carry out opportunistic screening at primary health care levels. The programme focuses on strengthening infrastructure, human resource development, health promotion & awareness generation for prevention, early diagnosis, management and referral to an appropriate level of healthcare facility for treatment of the Non-Communicable Diseases (NCDs).
- In response to the “WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020”, India is the first country to adopt the National Action Plan with specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025.
- The global action plan has suggested 9 targets for countries to set. But India has taken the unprecedented step of setting a tenth target to address household air pollution. India’s National Monitoring Framework for Prevention and Control of NCDs has committed for a 50% relative reduction in household use of solid fuel and a 30% relative reduction in prevalence of current tobacco use by 2025.
- Integration of NPCDCS with the National Health Mission (NHM) resulted into augmented infrastructure and human resources particularly in the form of frontline workers- the ANM and the ASHA. With the active participation of these frontline workers the population-based periodic screening of hypertension, diabetes, and common cancers (oral, breast, cervical cancers) is initiated to facilitate the early detection of common NCDs.
- Prevention and management of chronic obstructive pulmonary disease (COPD) and chronic Kidney disease (CKD); and better management of co-morbidities such as diabetes and tuberculosis are also considered under the programme.
- A population-based initiative for prevention, control and screening for common Non-Communicable Diseases (NCDs) i.e. diabetes, hypertension and common cancers has been rolled out in the country under NHM and also as a part of Comprehensive Primary Health Care. Under the initiative, persons more than 30 years of age are targeted for their screening for the common NCDs, in which there is focus on screening of breast cancer and cervical cancer among women. Screening of these common NCDs is an integral part of service delivery under Ayushman Bharat – Health and Wellness Centres.
- Preventive aspect of NCDs is strengthened under Comprehensive Primary Health Care through Ayushman Bharat Health Wellness Centre scheme, by promotion of wellness activities and targeted communication at the community level. Other initiatives for increasing public awareness about NCDs and for promotion of healthy lifestyle include observation of National & International Health Days and use of print, electronic and social media for continued community awareness. Furthermore, healthy eating is also promoted through FSSAI.
- Fit India movement is implemented by Ministry of Youth Affairs and Sports, and various Yoga related activities are carried out by Ministry of AYUSH. In addition, NPCDCS gives financial support under NHM for awareness generation (IEC) activities for NCDs to be undertaken by the States/UTs as per their Programme Implementation Plans (PIPs).
- Integration of AYUSH with NPCDCS is a further step for promoting healthy life style changes among the population. Health promotion through social media is also being used to generate awareness about prevention and control of NCDs, such as use of mobile technology in applications called mDiabetes for diabetes control, mCessation to help for quit tobacco, and no more tension as a support for mental stress management.
- All stakeholders should join together to reduce premature deaths from NCDs by one third by 2030, the commitment made in 2015, as a part of Sustainable Development Goals.
- Young people can contribute in different ways to prevent NCDs such as sharing information/ targeted messages on key risk factors about NCDs on social media; organizing and supporting interventions to ensure healthy lives and promote wellbeing for all people, at all ages.
PEN PLUS STRATEGY OF AFRICA
- In the African Region, the proportion of mortality due to NCDs ranges from 27-88 per cent. In Africa, the most prevalent severe non-communicable diseases include sickle cell disease, type 1 and insulin-dependent type 2 diabetes, rheumatic heart disease, cardiomyopathy, severe hypertension and moderate to severe and persistent asthma.
- The new PEN PLUS strategy of Africa urges countries to put in place standardized programmes to tackle chronic and serious non-communicable diseases by ensuring that essential medicines, technologies and diagnostics are available and accessible in district hospitals. The survey urged governments to ensure that people seeking care in private hospitals could access services for severe non-communicable diseases.
- Additionally, the strategy recommends that countries should bolster the protocols for prevention, care and treatment of chronic non-communicable diseases through the training and strengthening the skills and knowledge of health workers.
- By offering noncommunicable disease care as a package of services available at primary and district health facilities, patients will find their expenses decrease as they spend less money on transportation, lodging in cities and less time in commuting to the health facilities.
- The PEN-PLUS strategy builds on existing WHO initiatives for integrated detection, diagnosis, treatment, and care of non-communicable diseases in primary healthcare facilities.
- It has shown promising results in Liberia, Malawi, and Rwanda, with a significant increase in the number of patients accessing treatment for severe noncommunicable diseases and, a concomitant improvement in outcomes for these patients.
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