Surveillance of chronic diseases | challenges and strategies for India
The need to develop a robust public health surveillance system has increased manifold for India because of the ongoing demographic and epidemiological transition and the rising challenges of chronic diseases. In this regard, the presence of robust chronic disease risk factors, morbidity and mortality surveillance mechanisms can go a long way in prevention and reduction of socioeconomic costs associated with such illnesses.
In the last century, chronic disease surveillance was not a major health concern or policy focus although there were explicit policy efforts for collection of vital statistics related to cancer in India under the National Cancer Registry Programme (NCRP). However, with growing burden of chronic diseases, in the last decade two important chronic disease risk factor surveillance efforts were initiated in India. These studies are namely, WHO-ICMR Non-Communicable Disease (NCD) risk factor surveillance and NCD risk factor survey under the Integrated Disease Surveillance Project (IDSP).
Investing in chronic disease risk factors, morbidity and mortality surveillance is the need of the hour and desires greater social, political and governmental support. Moreover, the public health system in India should also be prepared to devote greater financial and human resources to support development of a robust chronic disease surveillance system. Although NCDs surveillance is outlined as an important strategy under the National Programme for Prevention and Control of Diabetes, Cardiovascular diseases and Stroke (NPCDCS), the focus is on early diagnosis and opportunistic screening at selected facilities.
Although, the public health system is grappling with resource constraints but there is room for more efforts to undertake systematic population-based chronic disease surveillance in India.
Organization and implementation of population-based chronic disease surveillance requires additional resources and is dependent on ability to recruit appropriate human resources for the surveillance operations. In addition, local support is critical to create a conducive environment to contact respondents and for information recording.
Also, there is a need for developing mechanisms for engagement of AYUSH sector and community health workers (ASHAs or others) in population based surveillance. But it should be backed by a sound incentive mechanism to ensure good coverage and programme outreach. Incentives should also be provided for screening as well as follow up activities.
Private sector can be useful partner in NCDs surveillance. However, private sector would need support and enabling environment to come up with services through public-private partnership (PPP) mode. Also, the public sector should develop institutional capacity to facilitate and support PPP initiatives. Clearly, it is a major challenge ahead to ensure quality improvement as well as sustainability of efforts in the area of NCDs surveillance.