Rapid assessment of NCD services rollout in Health and Wellness Centres in North-Eastern Indian state: A cross- sectional study.

Abstract

The creation of health and wellness centres (HWCs) to deliver comprehensive primary healthcare (CPHC) is a programmatic response to the changing demographic and epidemiological profile in India. Since the north-eastern (NE) states face distinct challenges to routine healthcare services, and it has been two years since the rollout of non-communicable disease (NCD) services through the HWCs, a rapid assessment of the rollout with respect to all components of CPHC was undertaken in the NE state of Manipur. The assessment was undertaken using a mixed methodology to assess the rollout of NCD services under CPHC based on the functionality criteria of HWCs. The districts and the facilities were sampled purposively using pre-defined criteria. Primary data were collected using adapted pre-tested semi-structured tools and an interview schedule, which were triangulated with facility-based records and field observations. The data were anonymized, analysed thematically and presented under the domains of CPHC. The assessment aided in identifying progress and challenges in the rollout of NCD services through the HWCs. Overall, the initiative was successful in generating demand and community awareness of the expanded range of services at the primary level. Yet, constraints posed by infrastructural gaps, logistical delays, training gaps, fund flow and weak community-level convergence compounded by the COVID-19 pandemic challenged seamless NCD service delivery. In as much as the attainment of universal health coverage is dependent on NCD prevention and control, the rollout of NCD services is dependent on strong institutional structures, especially at the primary level. The assessment highlights the need to strengthen the HWCs through adequate financing, human resources, logistics for medicines and technology, community participation, citizen engagement and change management.