Comprehensive community health scheme for the cantonments

Abstract

As per WHO report, worldwide death toll due to Non -Communicable Diseases (NCD) would rise from 38 million in 2012 to 52 million in 2030. While in India, 5.4 million people died in 2014 and accounted for 60 per cent deaths due to NCD, 55% deaths were in premature age of 30 to 69. The highest number of deaths i.e. 26 per cent is due to cardiovascular diseases, 13 per cent due to chronic respiratory diseases, 7 per cent due to followed by 2 per cent due to diabetes. 12% constitute deaths due to other non-communicable diseases. Now, government has planned to reduce the mortality by 25% by 2025 and introduced National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Strokes (NPCDCS) program. Though primary, secondary and tertiary objectives are very well defined, it lacks routine screening for the early detection. Various programs of government have included preventive, curative and palliative care. However, the emphasis is still on cure and preventive aspect is lacking. National Health mission has two pillars. National Urban Health Mission (NUHM) and National Rural Health Mission (NRHM). While these missions cover the poor population in urban and rural areas, the population above poverty line is neglected. Prevention includes awareness and early diagnosis. While the awareness about the communicable diseases has started getting support, in case of communicable diseases it is in introduction stage. There is also a lack of strong screening system to deal with the menace. As population are engaging with a larger incidence of lifestyle diseases, screening strategies are important to identify these diseases early. National cancer control program started in 1975 and National cancer registry in 1982. In spite of such programs the deaths are on higher side. There are 60% women with breast cancer in stage 3 and stage 4 when cure is not possible. It is well known fact that cancer if detected early, reduces the mortality by 30%. Same is true about other diseases. However, all the programs lack early detection by means of routine tests. With this aspect in mind, a policy intervention is suggested that includes: 1.Routine screening for the early detection of various non communicable diseases that 2.Covers entire population A Comprehensive Community Health Program is proposed for the cantonments that integrates all existing community health programs for non-communicable diseases (NCDs), leverage on the factors those made the schemes successful, target different population groups through Anganwadi , ASHA and Female or Community health workers, routine screening for the age group 40-74 and implementation of the scheme through community participation at school , work place and community level that covers entire population . Cantonment Act 2006 has a provision that central government can initiate such a scheme for health exclusively for the residents of the cantonments. According to this paper, the scheme would require utmost 1% of the cantonment budget. If implemented, it would help will to reduce the mortality rate in the cantonments. A stable program after its successful implementation in the cantonments may be helpful in adjoining municipalities and further scaled up for state and national health care.