Needs and priorities of People Living With Noncommunicable Diseases (PLWNCDs) in India during and beyond the COVID-19 pandemic
Nada India Foundation as Governing Board member of Health India Alliance supported and signed the statement by PLWNCDs including the Healthy India Alliance (India NCD Alliance).
The statement was submitted to MoHFW, UNDP India and WHO Country Office for India.
A statement by PLWNCDs including the Healthy India Alliance (India NCD Alliance)
PLWNCDs need special attention
India has reported 785996 active cases as of COVID-19 with 65288 deaths and 2839882
recoveries (September 1, 2020; MoHFW website).
Noncommunicable Diseases (NCDs) and co-morbidities, specifically chronic obstructive
pulmonary disease, heart disease, hypertension and diabetes are major risk factors for
developing severe manifestations of COVID-19. As per data available on the website of the Ministry of Health and Family Welfare, Government of India (MoHFW, GoI), more than 70% of deaths from COVID-19 are due to co-morbidities. The COVID-19 pandemic has had widespread health impacts, revealing the particular vulnerability of those with underlying conditions. While it is important to focus on health systems resilience, the challenges and priorities of People Living With NCDs (PLWNCDs) warrant particular attention. PLWNCDs include not only those people who have one or more NCD, but also those who are primary care providers to anyone with an NCD. Many PLWNCDs have had to bear the compounded burden of one or more NCDs, along with COVID-19 or be care providers for family members who contracted COVID-19.
Their increased vulnerability, disruption in treatment and management regimes due to limited access to healthcare and supportive services, and impact on mental health due to ensuing stress and anxiety, need special focus. We congratulate MoHFW, GoI for its untiring efforts to deal with the COVID-19 pandemic. From the perspective of PLWNCDs, particularly significant are the “Telemedicine Practice Guidelines”, that enable registered medical practitioners to provide healthcare using telemedicine. These guidelines hold immense importance during the current COVID-19 pandemic, given that PLWNCDs continue to encounter challenges in accessing routine health care services, due to restricted access to healthcare facilities.
The recently announced National Digital Health Mission under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, is yet another critical step in enabling PLWNCDs. However, while these critical steps by the Government are welcome and appreciated, we feel that PLWNCDs should be accorded increased attention. We, the members of the Health India Alliance – HIA (India NCD Alliance), including PLWNCDs, call for more inclusive national level action to check and address challenges faced by PLWNCDs, arising due to restricted access to healthcare and supportive services, during quarantine and/or social isolation periods.
We are encouraged that the 73rd World Health Assembly Resolution on the COVID-19 response also recognises that PLWNCDs require particular attention in the response. Additionally, The UN Economic and Social Council (ECOSOC) adopted a Resolution on the United Nations Inter-agency Taskforce on the prevention and control of NCDs. The Resolution recognises that PLWNCDs are more susceptible to COVID-19 and among the hardest hit by the pandemic.
In 2019, PLWNCDs, in collaboration with HIA launched the India Advocacy Agenda for People Living with NCDs, calling for an integrated approach to NCD prevention and control, with PLWNCDs being key stakeholders in issues related to their health and wellbeing. COVID-19 has further reinforced the need for a people-centred response to NCDs within the broader umbrella of Universal Health Coverage (UHC) and COVID-19 preparedness plans.
Call to Action to prioritise PLWNCDs in national COVID preparedness plans We, PLWNCDs, including members of the HIA (India NCD Alliance) look up to MoHFW’s leadership in prioritising the physical and mental health of our citizens, especially the most vulnerable, in the aftermath of COVID-19. Further, We request the Government to consider the following recommendations:
a) For PLWNCDs 1. Facilitate arrangement of two to three months of uninterrupted availability of essential medicines for PLWNCDs to minimise disruption in routine treatment and care. 2. Meaningful involvement of PLWNCDs in issuing clear guidelines for people with underlying conditions, including NCDs, as a part of the COVID-19 unlock procedures. 3. Ensure the National Health Protection Mission fully covers the cost of treatment during pandemics and emergency situations, for one and all alike. 4. Establish protocol(s) for appropriate customised treatment, care and safety measures for PLWNCDs who test positive for COVID-19.
b) For healthcare workers 1. Issue clear guidelines for health care providers regarding the special needs and priorities while treating a PLWNCD with COVID-19 infection, given the increased risk associated with pre-existing conditions. 2. Include palliative care support through online training in palliative care, for COVID-treating doctors and nurses. 3. Extend continued tele-medicine support to PLWNCDs so that disruption in accessing public health facilities does not lead to disruption of treatment and care regime.
c) For civil society 1. Actively engage civil society as an active partner in the national NCD response, as stated in the National Multisectoral Action Plan for the Prevention and Control of NCDs. 2. Support civil society engagement in the national pandemic response, ensuring support percolates to the hard-to-reach communities and locations, and vulnerable groups such as PLWNCDs. 3. Intensify public education in remote and hard to reach communities with the support of community health workers and civil society.
d) Communication on COVID-19 for PLWNCDs 1. Involve PLWNCDs and civil society in public campaigns to: promote positive mental health and minimise fear, anxiety, and social isolation, among PLWNCDs, and citizens at large; provide advisories to PLWNCDs to stay safe and minimise their risk for COVID-19, while optimally manging their NCDs. 2. Foster innovative strategies that build on enduring behaviour change to support Build Back Better towards a sustainable and resilient health system and empowered PLWNCDs.
The experiences of PLWNCDs underscore the need to invest more in telemedicine and encourage partnerships with civil society to build resilient communities and health systems. Experience of those affected by COVID-19 hold immense potential in building resilient health systems, post-COVID-19 and for being prepared for any such public health adversities in the future.
We, members of HIA, including PLWNCDs reiterate our commitment to working with the Government of India in its fight against COVID-19 and NCDs. We request MoHFW to convene a Joint Working Committee to develop guidelines centred around the needs and priorities of people with lived experiences, to protect themselves from contracting COVID-19 and manage their NCDs effectively. The guidelines may be developed based on the recommendations provided above, to develop a people-centred approach to NCD prevention and control during COVID-19.
Thanking you,
With Best Regards,
Members of the Healthy India Alliance (India NCD Alliance)
1. Dr. Monika Arora - Executive Director, HRIDAY (HIA Secretariat) 2. Dr. V. Mohan - President, Madras Diabetes Research Foundation 3. Mrs. Jyotsna Govil - Vice Chairman, Indian Cancer Society (Delhi) 4. Dr. K. Srinath Reddy - President, Public Health Foundation of India 5. Dr. Rana J. Singh - Deputy Regional Director (Tobacco and NCD Control), The Union South East Asia 6. Dr. M. R. Rajagopal - Chairman, Pallium India 7. Dr. S. Arulrhaj - Chairman & Head Acute Medicine, Sundaram Arulrhaj Hospitals 8. Dr. D. Prabhakaran - Director, Centre for Chronic Disease Control 9. Dr. Swati Bhave - Executive Director, Association of Adolescent and Child Care in India 10. Mr. Narendhar - Executive Director, Alzheimer’s and Related Disorders Society of India 11. Ms. Sutapa Biswas - Executive Director, Cancer Foundation of India 12. Dr. Ratna Devi - CEO, Dakshayani and Amaravati Health and Education (DakshamA) 13. Mr. Suneel Vatsyayan - Chairperson, Nada India Foundation 14. Dr. Ravinder Mohan - Head (Knowledge, Education, Training and Research), CanSupport 15. Dr. Sangeeta Goswami - President, MIND India 16. Dr. Ishu Kataria - Senior Public Health Researcher, RTI International (India) 17. Dr. Apoorva Gomber - Co-founder, Diabetes India Youth in Action 18. Ms. Nupur Lalvani - Founder Director, Blue Circle Diabetes Foundation
About Healthy India Alliance The Healthy India Alliance (HIA) or the India NCD Alliance was established in October 2015. HIA (www.healthyindiaalliance.org) is a coalition of 18 multi-disciplinary Civil Society Organisations (CSOs), with its Secretariat at HRIDAY. HIA is engaged in multipronged action for NCD prevention, management and control. HIA prioritises synergistic action with key stakeholders like People Living with NCDs (PLWNCDs) and youth. The Alliance has focused on capacity building of national and sub-national CSOs, on the burden of NCDs, commercially driven NCD risk factors, importance of health promoting policies and the role of CSOs in augmenting the national and sub-national NCD response.