Chronic Care Foundation (CCF) announces the findings of a niche research about gaps, quality and care of chronic diseases Diabetes, Heart Disease and Chronic Kidney Disease, commissioned in India for the first time.

NCCDs in India - 'A study of the gaps, quality and cost of care'
Chronic Care Foundation (CCF) has commissioned a niche research project using the services of one of the India's leading Market research Organizations across four regions of India. The research - 'Non-communicable chronic diseases (NCCDs) in India - A study of the gaps, quality and cost of care', has been conducted across Government and private facilities at all levels of service delivery (Primary, Secondary and Tertiary).

As stated by Dr. Anoop Misra, Chairman of the Medical Advisory Board of CCF: 'This is a first-of-its-kind truly representative study for the Indian subcontinent, and clearly delineates gaps in quality of health care, emphasizing room for improvement in diagnostic and treatment facilities at each level of health care in the area of diabetes, chronic kidney disease and heart disease. Physicians, hospital management, government and private healthcare institutions, policy makers, insurance companies and even patients would benefit from this elaborate study. If these gaps are properly taken care of, we would witness the next level of healthcare in this country akin to that seen in developed countries.'

The study was conducted in two stages; an exploratory and a survey stage. The Target groups for this study were Medical Service Providers and Beneficiaries - both affected and unaffected. The geographical coverage and sample size is across four regions of India and two levels i.e. Urban and Rural. In total 360 PSUs (primary sampling units) were covered across India and a total of 1800 beneficiaries included.

This research undertaken by CCF provides data on emerging trends in society on demand for health care services and the need in the delivery system for the management and treatment on NCCDs in India. Recommendations will emerge in the final report to improve the delivery system and management of chronic care services at Government and private medical facilities, role and scope of involvement of different stakeholders - service providers, policy makers, corporate, patients and the community at large, initiatives and interventions required by the Government on policy and the private sector in combating the impact of chronic diseases in our society.

Some of the key findings of this research project highlight that 86% of districts with high rural population do not have adequate provision of the most basic diagnostic tests required for managing these chronic diseases. Only 34% of the rural respondents find access to diagnostic centers easy, nearly half of the PSUs surveyed do not have any treatment facilities for any of the three ailments, while a significantly higher proportion of respondents reported to visit health facilities outside their ward/village due to non-availability of services in their ward/village. Moreover, 80.9% of the PSUs in high rural areas do not have treatment facilities for any of the chronic ailments.

Further, the findings reveal that only 45% of total respondents find easy access to medicines, this was most difficult for stroke and chronic kidney disease patients. There is a high dependency on private facilities due to inadequate services at the government managed units. On quality aspects, the Indian Public Health Service (IPHS) standards were the benchmark for this study and the findings revealed that a very low proportion of Health Care Facilities (HCFs) adhere to the quality parameters laid down by IPHS standards.

Only 60% tertiary HCFs had guidelines about time taken to admit a patient. On Sterilization standards and methods followed, boiling was the most common method used especially in rural areas, due to lack of alterative equipment. Primary health care facilities were found to lack the infrastructure facilities as suggested by IPHS guidelines. It is also significant to note that Blood Bank facilities are present in less than 50% of Tertiary HFCs. On the arena of cost of care, the study found that the direct cost contributed to about 45.8% of the total expenses in rural areas as compared to 39.6% in urban areas. Hospitalization expenses contributed the most to the total costs. In rural areas, this cost reached a staggering 79.1% of the total expenses due to lack of facilities locally and people having to move out for hospitalization and specialized care.

It was also found that lack of basic education was a major contributor to the lack of awareness amongst the populace in understanding the preventive aspects of chronic diseases. Of the 754 unaffected respondents covered in both rural (24%) and Urban (76%) areas, with a mean age of 41.5 years, it was found that 31.8% were without any form of education or schooling and 60.3% were educated up to 12th grade only. Rural respondents in the age bracket 35-40 years having relatively lower levels of education are the ones who lack awareness of chronic ailments.

The use of Information technology for clinical and administrative purposes, a much-needed method to improve patient care, was only seen predominantly in the tertiary and urban HCFs. CCF identified the need to make technology more affordable and accessible to the other levels of care in the country to improve efficiency and delivery of care standards.

Covering the area of awareness for prevention with IEC material, the study found that only 10% of HCFs had material on education about chronic diseases, once again mostly in the tertiary level care centers. Aspects such as dietary counseling, proper medication, and the significance of rehabilitation services was practically non-existent and those that existed were only in the urban areas. CCF identified that there was an urgent need to generate awareness about insurance in rural areas, explore the gaps within intenders and address the barriers to taking insurance.

Mr.Harpal Singh, the Chairman of the Board of trustees, CCF, in his opening remarks highlighted that: 'This study by CCF was a major step forward to contribute to the body of knowledge about chronic diseases (NCCD). As this is one of the primary focus areas of work at the foundation, through this study CCF will carve its way forward and build an agenda for action by involving stakeholders and working in partnership with them.' He also called for: 'collective action and for a momentum to be created to galvanize action by all concerned, be it the government, policy makers, service providers and the community.'

The study by CCF has been supported by: Strategic Knowledge Partners, Apollo Hospitals Educational and Research Foundation, Baxter India Pvt. Ltd, MSD Pharmaceuticals Pvt Ltd India, Aventis Pharma Ltd, sanofi-aventis group India, Knowledge Partners, Vitalhealth Software India, Associate Partners, ASSOCHAM, GE Healthcare, Johnson and Johnson Medical.

About Chronic Care Foundation (CCF)
CCF is a registered Public Charitable Trust that was founded in 2006, to promote good health by proactively minimizing the incidence and effects of non-communicable chronic diseases in society. CCF is committed to empowering the community with an accessible, efficient health care system that improves the safety and quality of care of patients with chronic, cardiovascular disease, diabetes and kidney disease in India, through prevention, advocacy, education and collaboration amongst stakeholders within the community.

About Chronic Diseases

• By 2020, chronic diseases are expected to claim 7.63 million lives in India. Cardiovascular, respiratory diseases, cancer and diabetes account for 53% deaths in India, more than those caused by infectious diseases.
• India accounts for nearly 20% of the world's population suffering from heart diseases. There are over 60 million coronary heart patients and over 57.2 million diabetes patients in India and these numbers increase every year.
• It is estimated that less than 50% of End-Stage Renal Disease (ESRD) patients get to see a doctor and about 14-15% in total are on any form of long-term therapy. Over 70% of patients who start therapy drop out in the first year, primarily due to lack of funds. Less than 10% of all Indian ESRD patients get any meaningful Renal Replacement Therapy (RRT).
• According to various studies one in every six adolescents in the metros is overweight and 80% of these obese teens grow into obese adults and are twice as likely to suffer from heart attacks.
• Two in five Delhi students have high cholesterol and diabetes is common.
• It has been envisaged that by 2015, China, India and Russia stand to lose on an average between US $23 billion and US $53 billion annually in forgone national income, due to deaths from heart diseases, stroke and diabetes.

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