Challenge
Ensure time-bound access to affordable and community-based detection of NCDs in low income urban communities.

Outcome
An integrated healthcare delivery platform for delivery of high quality healthcare services at the last mile.

Impact
Detection of high risk suspects for NCDs early in the disease lifecycle.

A holistic approach to NCD Care
Every year, roughly 5.8 million Indians die from NCDs. NCDs contribute to 53% of the total disease burden in the country, resulting into 60% of the total deaths. India will account for 25% of global NCD burden by 2030, causing economic losses of $4.58 trillion. Affordable and community-based detection of NCDs is a challenge and current health systems remain ineffective in their response. Our program aims at early identification of NCDs among migrant & low income populations especially women. It is designed around point-of-care screening technology that is deployed by community health workers. Through a rigorous technology selection process, we sourced 5 diagnostic devices (diabetes, hypertension, cardiovascular disease, body weight and respiratory diseases); integrated into a single mobile based platform that enables a provisional diagnosis among low income communities. Key programmatic features include:

1. “Problem forward” not “product forward”: using technologies appropriate for low resource settings, accurate, easy to integrate, cost effective and portable.
2. Integrated approach to chronic diseases: based on common risk factors (diet, lifestyle, pollution), early symptoms & general examination, instead of disease-specific approaches
3. Operational optimization: redistribution of work flows and technology to ensure cost effectiveness and logical service delivery at the last mile. Training of health workers for service delivery, lifestyle counselling and diagnostic screening was conducted to ensure high quality services at the last mile.

The initiative was piloted in collaboration with HLFPPT and is now being scaled in partnership with Sukhibhava, a community based organization in Bangalore. We have reached out to over 31,000 low-income migrants & women in urban slums and screened over 1,300 patients since inception. There was a 28% increase per month in uptake of services and 59% of those screened visited the clinic for further evaluation, 11 times increase over the baseline clinic footfall. Screening currently costs INR 66 per patient— at least five times lower than conventional costs. The intervention has also identified potential high risk patients with Diabetes Prevalence = 28.7% – 33.1% (Higher than 130 mg-dL) & Hypertension prevalence of = 45% – 48% of cases lying outside the normal range of (120/80).

Overall, the program enhanced access to existing clinics, increased the traction among communities, induced pro-active health seeking behaviour, established norms to profile semi-skilled healthcare workers and also established semi-skilled health workers are trusted source of information and healthcare service provider in the community.