George Institute urges govt to build capacity to fight burden of cardiovascular diseases

New Delhi: Substantial reduction in cardio-vascular risk in rural and urban areas across the country can be achieved by equipping the frontline village health workers to screen community for risk and then establish a referral system by which the high-risk cases can be seen by the doctor at the primary health care centre. Both the doctor and the village-level health worker can be enabled by technology to perform their tasks and responsibilities.

The George Institute for Global Health conducted a study across 54 villages of Bhimavaram District in Andhra Pradesh over a period of 18 months involving 65,000 people. In this project, technology-enabled screening and assessment of cardio-vascular risk by village-level health workers, coupled with a referral and treatment system involving doctors in primary health centres was carried out. The preliminary trends showed that there is considerable scope and great potential for revolutionizing cardiac care in rural areas of the country.

“The contribution of non-communicable diseases, especially cardiovascular diseases, to death and disability in India continues to grow at an alarming rate. There is need to emphasize on preventive healthcare than just solely depending on curative healthcare. In the SMARThealth project, we tested a system and process whereby screening and management of non-communicable diseases can be integrated at the primary health care level. The trends from the project show that effective use of existing infrastructure and equipping frontline healthcare workers helps in reducing the risk of cardiovascular diseases. The project has yielded promising preliminary results and we have extended it to other conditions like mental health, diabetes, kidney disease, etc.,” says Dr Vivekanand Jha, Director of the George Institute for Global Health India.

Funded by the Global Alliance for Chronic Diseases Grant (GACD), the SMARThealth project incorporates a behaviour change component as a part of which, the enablers and barriers to providing diagnosis and treatment are systematically identified and redressed. “This involves identifying systemic gaps at all levels – individual and community, as well as government and policy levels,” points out Dr Jha.

As per the Global Burden of Disease (GBD) 2016 data, CVD causes 17.64 million deaths worldwide, out of which 2.75 million occur in India. As per the GBD data, Ischemic heart disease was the leading cause of death in India (both among men and women) with an increase of 53% from 2005.

When the project began a few years ago, it was evident from studies done earlier that assessment of cardio-vascular risk among people in the community could be the first step to effective treatment.  “We developed an app which could be used by village level ASHA workers to systematically screen people at their homes. The app uses algorithm-based calculations in the form of red, orange and green flashes corresponding to high, moderate and low risk,” says Dr D Praveen, Head, Primary Health Research, George Institute, India.

With ASHA workers visiting people’s homes and taking their case history, measuring their blood pressure and sugar levels, people for the first time understood the gravity of the risk that they are susceptible to and decided to go to the doctor. The high-risk patients were seen by the doctor and given basic medicines. Also, the village-level health worker followed-up on each patient and ensures that they adhere to the treatment given by the doctor.

Under the SMARThealth programme, a total of 53,478 (86%) individuals above the age of 40 years were screened by the ASHAs in 54 villages of West Godavari district of Andhra Pradesh. The preliminary data from the study shows that 16% of the people were found to be at high risk of CVD. Amongst the high risk CVD patients, 40% have consulted a PHC doctor, and 38% private practitioners for their treatment. ASHAs followed up 85% of high CVD risk patients at least once, of which 75% of patients informed that they are taking medicine for CVD.