Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS)
Authors: Krishnan Anand , Mathur Prashant , Kulothungan Vaitheeswaran , Salve Harshal Ramesh , Leburu Sravya , Amarchand Ritvik , Nongkynrih Baridalyne , Chaturvedi Himanshu Kumar , Ganeshkumar P. , K S Vinay Urs , Laxmaiah Avula , Boruah Manjit , Kumar Sanjeev , Patro Binod Kumar , Raghav Pankaja Ravi , Rajkumar Prabu , Sarma P. Sankara , Sharma Rinku , Tambe Muralidhar , Arlappa N. , Mahanta Tulika Goswami , Bhuyan Pranab Jyoti , Joshi Rajnish P. , Pakhare Abhijit P. , Galhotra Abhiruchi , Kumar Dewesh , Behera Binod Kumar , Topno Roshan K. , Gupta Manoj Kumar , Rustagi Neeti , Trivedi Atulkumar V. , Thankappan K. R. , Gupta Sonia , Garg Suneela , Shelke Sangita Chandrakant ,   ICMR-NNMS investigator group, Krishnan Anand , Mathur Prashant , Kulothungan Vaitheeswaran , Salve Harshal Ramesh , Leburu Sravya , Amarchand Ritvik , Nongkynrih Baridalyne , Chaturvedi Himanshu Kumar , Ganeshkumar P. , K S Vinay Urs , Laxmaiah Avula , Boruah Manjit , Kumar Sanjeev , Patro Binod Kumar , Raghav Pankaja Ravi , Rajkumar Prabu , Sarma P. Sankara , Sharma Rinku , Tambe Muralidhar ,   Co-investigators, Arlappa N. , Mahanta Tulika Goswami , Joshi Rajnish P. , Pakhare Abhijit P. , Behera Binod Kumar , Gupta Manoj Kumar , Rustagi Neeti , Thankappan K. R. , Gupta Sonia , Shelke Sangita Chandrakant ,   Collaborators, Bhuyan Pranab Jyoti , Galhotra Abhiruchi , Kumar Dewesh , Topno Roshan K. , Trivedi Atulkumar V. , Garg Suneela 
Published: July 2021

Abstract
Background
The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18).

Methods
NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) – Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises.

Results
Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3–3.3) in rural public to 9.0% (95% CI; 6.2–13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities.

Conclusion
Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.