Non-communicable diseases (NCDs) are the emerging challenges that many low and middle-income countries are experiencing in addition to their existing health burdens. Recently, Bangladesh is seeing a dramatic shift in causes of mortality from infectious diseases to NCDs. High blood pressure (known as HTN) and Diabetes Mellitus (DM) account for 67% of the total disease burden in the country. The most recent (2017) Bangladesh Health and Demographic Survey (BDHS) and the WHO’s STEPwise Approach to NCD Risk Factor Surveillance have reported a prevalence of DM between 8.4 and 10.0%, and HTN between 25.2 and 27.2% among adults aged more than 18 years. HTN and DM during pregnancy pose a great risk to the mothers of developing complications which may result in adverse pregnancy outcomes.
Bangladesh has an extensive primary healthcare network down to the domiciliary level. The sub-district level network consists of a hospital at the sub-district level, clinics at the union level, community clinics at the grassroots level of an area of about 6-10,000 populations, and approximately 50 domiciliary workers. This primary healthcare network is mostly engaged with delivering reproductive, maternal, newborn, child, and adolescent health (RMNCAH) services although recent efforts have been made to streamline NCD-related services in the primary healthcare settings.
Under the non-communicable disease control (NCDC) operational plan of the 4th sector program (known as HPNSP), the concerning program has established NCD corners at the sub-district hospitals, developed an NCD management model. The model follows the National Guidelines for Hypertension and Diabetes Mellitus Management in Primary Health Care which was adapted from the WHO’s Package of Essential Non-Communicable (PEN) protocol to guide screening of the high-risk populations, assessment and management of HTN, DM, and high blood cholesterol, and task sharing through a team-based approach. To date, this model has already been implemented in 100 sub-districts.
However, one of the major concerns of the NCD management model is to establish a functional referral linkage along the pathway from the community up to the sub-district hospital. As NCD management includes long-term services to a client, effective client-tracking and medicine-refilling mechanisms need to be in place. above all of these, a client registration system along with the capability to maintain individual-level longitudinal service records is essential.
To improve the NCD management model, the NCDC program of the Directorate General of Health Services (DGHS) with support from the Research for Decision Makers (RDM) project of the United States Agency for International Development (USAID), and technical assistance from icddr,b digitized the service delivery processes. This electronic NCD management system has connected community workers through the first-line facility to the sub-district hospital. It starts with registering the target population at the household level and screening them for potential NCD clients.
Thereafter, the potential clients are referred to the first-line facility for initial screening and counseling followed by a further referral to the sub-district hospital for a full investigation, medication, and counseling by designated physicians and health professionals.
Following successful testing of the system in one union, the electronic NCD system was piloted in 3 sub-districts (Baraigram, Kotchandpur, and Saturia) with support from the USAID. Later on, JICA has rolled-out the system in their project areas where icddr,b provided the technical support. Currently, the NCDC program has taken up the responsibility to scale it up in at least 100 more Upazilas by the current sector program.
Note: I am one of the co-investigators in this project
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