Abstract

BackgroundCardiovascular diseases (CVDs) are the leading cause of mortality in India. India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Our study assessed blood pressure and blood sugar coverage achieved by frontline workers using Lot Quality Assurance Sampling (LQAS).MethodsLQAS Supervision Areas were defined as catchments covered by frontline workers in primary health centres in two districts each of Uttar Pradesh and Delhi. In each Area, 19 households for each of four sampling universes (males, females, Above Poverty Line (APL) and Below Poverty Line (BPL)) were visited using probability proportional to size sampling. Following written informed consent procedures, a short questionnaire was administered to individuals aged 30 or older using tablets related to screening for diabetes and hypertension. Using the LQAS hand tally method, coverage across Supervision Areas was determined.ResultsA sample of 2052 individuals was surveyed, median ages ranging from 42 to 45 years. Caste affiliation, education levels, and occupation varied by location; the sample was largely married and Hindu. Awareness of and interaction with frontline health workers was reported in Uttar Pradesh and mixed in Delhi. Greater coverage of CVD risk factor screening (especially blood pressure) was seen among females, as compared to males. No clear pattern of inequality was seen by poverty status; some SAs did not have adequate BPL samples. Overall, blood pressure and blood sugar screening coverage by frontline health workers fell short of targeted coverage levels at the aggregate level, but in all sites, at least one area was crossing this threshold level.ConclusionCVD screening coverage levels at this early stage are low. More emphasis may be needed on reaching males. Sex and poverty related inequalities must be addressed by more closely studying the local context and models of service delivery where the threshold of screening is being met. LQAS is a pragmatic method for measuring program inequalities, in resource-constrained settings, although possibly not for spatially segregated population sub-groups.

Highlights

  • Cardiovascular diseases (CVDs) are the leading cause of mortality in India

  • Given the growing burden of CVDs nationwide [11, 17, 18], and the increasing push towards Universal Health Coverage (UHC), India has been seeking to redesign the scope of health care delivery across the spectrum [19,20,21]

  • In 2016, the Government of India launched policies and guidelines to support the rollout of Comprehensive Primary Health Care including prevention and control of Non-Communicable Diseases (CPHC-NCD) [21]

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Summary

Introduction

India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Cardiovascular diseases (CVDs) are the leading cause of mortality in India [1, 2]. CVD mortality, morbidity, and risk factors are known to affect equity groups variably: those with lower socio-economic status (i.e. lower incomes and education) are more vulnerable than those with higher socio-economic status [9,10,11,12]. In 2016, the Government of India launched policies and guidelines to support the rollout of Comprehensive Primary Health Care including prevention and control of Non-Communicable Diseases (CPHC-NCD) [21]. Female Male Median Range Illiterate Up to primary or below Primary to secondary Higher than secondary Hindu Muslim Christian Don’t know/won’t say General Other Backward Classes Scheduled Caste Scheduled Tribe Don’t know Never Married Separated/divorced Widowed Unemployed Agriculture-self employed Agriculture-labour Non-agriculture labour/casual labour Non-agriculture-self employed Service/salary Home maker Other

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