CPHC NCD IT System- helping keep Hypertension (HTN) under control.

Mr. Thovisie (name changed) is 45 years old married man with 3 children. He lives in the small hilly town of Mokokchung with no proper medical facility.  He developed a habit of drinking, smoking and chewing tobacco over the last 10 years. As a result of his vice habits, many health issues developed one after the other. However, as he hails from an economically poor family, he could not afford to travel to other bigger towns for medical check-ups.  One fine day the health worker in his area insisted on screening for Non-Communicable Disease and his vitals related to hypertension showed some abnormality. While the health care worker entered the screening records of Mr Thovisie in the CPHC NCD application, the application’s inbuilt algorithm suggested referral of the individual. Thus, Mr Thovisie was referred to his nearest PHC/CHC for further examination. Unfortunately, the medical officer at the facility diagnosed Mr. Thovisie with hypertension and put him on treatment. Further, he was advised to bring about lifestyle modification, the need for adherence to treatment and regular follow-ups with his local public health care worker at the HWC-HSC in his vicinity.

The CPHC NCD IT system supports the Government of India’s ambitious population-based screening (PBS) and management of NCDs under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) for the management of hypertension, diabetes and three common cancers. This comprehensive IT system caters to the data/information requirements of facilities at all levels of the public healthcare system. The most essential aspect of this system is that a single, unique longitudinal health record for every individual is created which allows healthcare providers to securely access and update patient information, as well as receive reminders and alerts.

Mr. Thovisie has Ms. Pongen as his Community Health Officer (CHO), to thank for his controlled hypertension. The CHO has been serving the community for more than five years at a nearby Health and Wellness Centre (HWC) in the district of Mokokchung, Nagaland. In her words, “….it really gives me joy and feel satisfaction in my profession for getting the opportunity to serve humanity”, she describes her philosophy towards her work. The workload of the CHOs is ever increasing be it clinical, social, documentation and reporting of the same. The profession of a CHO involves a multitasking role, counselling for lifestyle modification and follow-up for treatment adherence is one of the important activities associated with better patient outcomes in all treatments, especially those of chronic non-communicable conditions. Ms Pongen recalls her sit-down with Mr Thovisie during one of the follow-ups- Mr Thovisie was counselled on ways to change his lifestyle: making dietary modification-reduce salt intake and intake of unhealthy fats, the inclusion of easily locally available dietary fibre-rich foods, reduce the use of alcohol and tobacco/smoking, regular exercise and management of stress. This was followed by advice on continuous, timely intake of prescribed medication and regular check-ups at the Health and Wellness Centre (HWC). It was easier said than done. Constant reminders and suggestions during follow-ups, helped Mr. Thovisie and his family bring about the advised changes to his lifestyle gradually. Another noteworthy change about Mr. Thovisie that was observed was, he started to avail/utilize the healthcare services regularly, to check his disease status.   All these tiny but substantial details were digitalized in the NCD HWC Application. These details were referred to in the successive follow-ups. The major value addition of the application was the SMS reminders that were sent to Mr Thovisie for undergoing regular follow-ups with his CHO and collecting medicine from HWC.  

Keeping track of the patients and their health status is a very difficult task by following the traditional practices of flipping pages to search the records of the patients. Most often the health history records are incomplete and sometimes records are misplaced and, in some cases destroyed due to several reasons. Applications and portals of the CPHC NCD IT System are helping the public healthcare staff in many ways. “After the introduction of the CPHC NCD App in the health centres, it has completely changed the daily management of the diseases and has made our work easier and systematic,” says Ms Pongen. The application has guided the health workers systematically in carrying out the daily routine of health care services and management. The CPHC-NCD IT system is very user-friendly, educative and systematic, with many user-friendly buttons and menus. The System has ultimately made the collection and storage of information more convenient, reliable and secure for health workers as well as for patients.

NCDs annually claim approximately 41 million lives (71% of deaths) around the globe. This staggering data includes 14 million lives of people who die prematurely between the ages of 30 and 70 years, due to NCDs. Four groups of diseases account for over 80% of all premature NCD deaths: CVD, cancers, respiratory diseases and diabetes.  LMICs bear a huge toll of these NCD deaths. A majority of these premature deaths are preventable. WHO Report 2015 informed that every year around 5.8 million people die from NCDs (CVD, lung diseases, cancer and diabetes, and that every 1 in 4 Indians has a risk of dying from NCD before reaching the age of 70 years.

Responding to WHO’s “Global Action Plan for the Prevention and Control of NCDs 2013-2020”, India adopted the National Action Plan with specific national targets and indicators aimed at reducing the number of premature deaths from NCDs by 25% by 2025.

Common non-communicable diseases like hypertension and diabetes are easily treatable with certain lifestyle modifications and adherence to proper medication. Today, the medication for these two diseases is available free of cost at the nearest Health and Wellness Centres. India is making its way to achieve Universal Health Coverage, by providing medications, diagnostics and care free of cost to help millions of Indians, like Mr. Thovisie, thereby cutting the out-of-pocket expenditure. The ultimate goal of the NPCDCS program is to ensure a “continuum of care”. Such a huge operation requires a comprehensive, efficient, low-cost, technology-driven platform NCD IT System is the answer.