Integrated digital approach for prevention and control of noncommunicable diseases: Review of the progress of “mukhyamantri nirog yojna” in the state of Himachal Pradesh, India

Abstract

Noncommunicable diseases (NCDs) are on the rise globally. The proportional mortality by NCDs in India is 72% (including 12% due to injuries). Most of the NCDs share common risk factors. The approach of delivery for NCD related programs in India is vertical and fragmented. In order to address the rising burden of NCDs, the state of Himachal Pradesh in India has adopted a comprehensive approach known as Mukhyamantri Nirog Yojna by integrating all existing NCD-related vertical programs for the purpose of implementation, surveillance, and to ensure continuum of care from November 2018. The digital surveillance of all NCDs risk factors, cancers, diabetes, cardiovascular diseases, stroke, chronic obstructive pulmonary disease, chronic kidney disease, blindness, deafness, mental illness, and stroke is ensured through E-Health card software. Till March 31, 2020, a total of 1.78 million (41.43% of the entire +18 population) individuals have been enrolled under the surveillance. More than 67% are at risk of developing NCDs. About 38% of all on risk have been screened for NCDs by the auxiliary nurse midwife, out of which 12.3% have high blood pressure, 6.2% have increased waist circumference, and 5.4% have increased blood sugar. About 73% of the screened positive has been diagnosed by the doctors for further management. The basic health services such as risk assessment, screening, diagnoses drugs, and follow-ups are available free to all through the public health system under this strategy. This approach is an efficient, cost-effective, and reliable strategy to address the common NCDs collectively and can be considered for upscaling in other states and low- and middle-income countries.