When the Karnataka Health Promotion Trust (KHPT) and the Government of Karnataka (GoK) began a pilot project to develop a Primary Health Care model for Non-Communicable Diseases (NCDs), for diabetes and hypertension, in Mysuru, they were not sure of its outcome.
KHPT’s idea was to make Mysuru the base “to design, develop, implement and evaluate comprehensive primary health care (CPHC) models that address critical gaps in the coverage of affordable, accessible and quality primary healthcare services in urban areas.”
The project was planned with an interdisciplinary approach involving professionals and local administrative departments. A cadre of 21 community health workers (CHWs) were also trained to work part-time as incentivised health workers who will offer customised services to the community. The idea was to create a new perspective to primary healthcare where the team would develop what it calls “patient-centred continuum of care models” to transform the health and wellbeing of the city.
The project also had the support of the Medtronic Foundation, working with underserved communities. (Medtronic is a multinational medical-technology company.)
Four years later, the pilot is showing encouraging results. And the KHPT team executing the project on finds it is turning out to be a successful incentive-based CHW, replicable and scalable. In fact, the tools, technology, and processes that have been developed through the model have been adopted by Indian Council of Medical Research (ICMR) for the National Task Force Project on NCDs among the tribal population of six states of the country.
Dr N Swaroop, Thematic Lead, Comprehensive Primary Health Care, KHPT, points out, “Our intervention has significantly impacted the footfall of patients to the Urban Primary Health Centre (UPHC), which has increased tenfold, from a mere 200 in August 2017 to 2,600 per month till date,”
He explains that 32,500 adults were screened out of 60,000 catered by the UPHC, of which 3,105 patients were identified either with diabetes or hypertension. Of these, 1,800 patients were retained in the project, while the rest were lost to follow up due to various reasons including death or migration out of Mysuru. Of the retained patients, 48 percent who were diabetic and 34 percent who were suffering from hypertension have shown clinical improvement.
Care is key
According to Swaroop, personal care is key—curative, promotive, preventive or palliative. Care requires every component and needs to be “comprehensive, continuous, patient-centred, coordinated, integrated, accessible, available, acceptable, affordable and of quality.”
The model also looked at population-based care. It meant reaching out to a population in a given catchment area (slum/slum-like area) stratifying the population at risk, prioritising them and providing them with the required services. This, clubbed with ensuring safe drinking water, adequate sanitation facilities and efficient garbage disposal, would bring in behavioural changes that could transform the health status of the community.
The team used a multi-pronged approach including local Health and Wellness Centres and healthcare providers. For preventive health, it involved local bodies such as the slum development board, the water and sanitation department, food and civil supply, the city corporation, among others.
Ganga from Kumbarkoppalu had been living with gestational diabetes for six years. Post-pregnancy she was advised by doctors to discontinue her medication since her sugar levels had normalised. Later, a random test revealed high sugar levels and it was later confirmed she had diabetes.
This sent Ganga into a depression and she neglected herself. The NCD project also counsels patients living with diabetes and hypertension. Ganga developed a rapport with programme associate Bhavya and in just two sessions, Ganga found solutions to tackle her problems.
A CHW since 2019, the 38-year-old Geetha handles about 77 persons with diabetes and hypertension and visits three homes a day. “I love interacting with people in my circle,” she says, smiling. And it’s this patient-centric approach that is helping bridge the gap between diagnosis and care.