From inequity to access: A landmark project ensuring healthcare for millions in India

In this edition, we're taking you to the heart of South Asia – India, where a significant healthcare shift is underway.?

As the world's second-most populous country, India's battle against NCDs is not just a national concern – it’s a global one.??

A new project is set to change the narrative for those living with diabetes and hypertension. Advancing India's '75 by 25' plan, its goal is clear: to ensure equitable care for 75 million people by 2025.?

Led by the Ministry of Health and Family Welfare and the WHO Country Office in India, the ambitious project aims to reach out to both the bustling cities and the quiet rural areas, including tribal peoples and underserved communities.?

WDF programme managers Mette Skar and Dr. Radha Valaulikar ’s visit to Madya Pradesh, India, paints a vivid picture of the vital role that community-level health workers play on the ground.?

Read on to see how this project is strengthening the backbone of the country's healthcare.

A bold initiative

The new project, called Strengthening NCD Management in Primary Care in India, marks a major development, being the first time WDF supports a national-level project in India and the first collaboration with MoHFW and WHO.???

'This partnership serves as an ideal platform to advocate for systemic changes, particularly in integrating NCD management with critical areas like maternal health. It allows us to bring about change on a scale we have not seen before' – Leif Fenger Jensen , WDF’s Managing Director.?

India has been the largest recipient of WDF funding, with multiple projects focused on gestational diabetes care, community-level type 2 diabetes care and awareness, comprehensive eye care and diabetic retinopathy.??

It is not just about numbers; it's about people. By strengthening the capacity of primary-level health facilities to bring care closer to home, the new project seeks to reduce out-of-pocket costs due to delayed detection and complications and ensure equitable access to care for those who need it most, such as residents of marginalised and low-income urban areas and people living below the poverty line.?

Marking a new milestone in NCD treatment programmes, WHO India will extend its expertise and resources to MoHFW and state governments, overseeing coordination, planning, and monitoring.?

'WDF’s support for our work in India has arrived at a critical time, allowing us to sustain the momentum of our efforts over the past five years. It also empowers us to strive towards, and hopefully exceed, the targets we've set in alignment with the Government of India's plans', explains WHO representative to India Dr Roderico Ofrin .?

WHO's network of NCD consultants on the ground will facilitate this process, ensuring the program's successful implementation and significant impact.

'Our on-ground teams are adapting strategies for each state, with a focus on strengthening primary care. We aim to bring a systemic shift in NCD management, not just in the 400 districts selected for this project, but nationwide. It is a substantial task, but a necessary one. We're confident that, together, we can effect a lasting change in NCD care.'

Key components of the project:?

• Strengthening Policy and Financing: Enhancing policy, programme, and financial measures at the state level to deliver services at the primary healthcare level.?

• Building Capacity: Training healthcare providers at the primary level, including community health workers.?

• Improving Care Pathways: Strengthening the patient care pathway, including the rollout of unique health IDs and using existing health information systems.?

• Enhancing Quality of Care: Improving glucose monitoring and the use of the NCD portal at the facility level for consistent monitoring and follow-up.?

• Supply Chain Management: Enhancing supply chain management at state, district, and facility levels.?

• Data and Innovation: Collecting, analysing, and reviewing data to support decision-making and innovation.

‘75 by 25’

The WDF project was launched to support the implementation of the '75 by 25' Roadmap – an ambitious plan launched by the Indian Government at the 2023 G20 New Delhi summit to reach 75 million people with diabetes and hypertension under care by 2025.??

The '75 by 25' Roadmap builds on key country initiatives like the health reform (Ayushman Bharat), the National Programme for Prevention and Control of NCD, and the India Hypertension Control Initiative (IHCI).??

IHCI was started in 2018 by MoHFW, WHO India and partners to empower primary care to manage hypertension and diabetes. After five years, IHCI has successfully scaled up to 155 districts in 27 states, improving blood pressure control rates from 16% to 46%. Over 26,500 Health and Wellness Centers (HWCs) provide follow-up care, and 26 million people are on protocol-based treatment, and the national NCD portal is used in most HWCs.?

The new project will support MoHFW with the '75 by 25' Roadmap by scaling up IHCI’s effective model and will be rolled out across 400 districts out of 785, covering all 28 states and 8 Union Territories of India. The focus is on ensuring availability, usability, and quality of care, setting a new standard for healthcare delivery.

Catalysing systemic change for millions?

The comprehensive nature of the WDF project sets forth clear goals to tackle the challenges of the health system:?

• Strive to ensure at least 75% of target districts have access to essential diagnostics and medicines for diabetes and hypertension. This involves equipping at least 50% of primary care clinics in target districts with trained healthcare professionals and community health workers who can deliver protocol-based care.?

• Enhance the use of health information systems. This includes addressing gaps in diabetes treatment protocols and improving the capacity of healthcare workers at the primary healthcare level.?

• Increase community awareness about diabetes and hypertension by involving Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), and Community Health Officers (CHOs) in outreach efforts.?

• Increase the annual use of government funds for NCDs at the state level, showing a keen commitment to improving healthcare infrastructure and services.

By addressing critical areas and leveraging a strong collaboration, this national project is ready to catalyse a major shift in India's healthcare system, backing up the '75 by 25' initiative.??

This is the culmination of the ambitions of our partnerships in India. The model addresses WHO health system building blocks and leverages a mature digital health landscape and we see it as a blueprint for future large-scale, high-quality care interventions.', shares WDF’s Sr Programme manager Mette Skar.??

Its goals reflect a commitment to improving the lives of millions and setting a new standard for NCD care. 'It's about immediate impact and long-term systemic change'.

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