BackgroundGovernment of India has launched National Program for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) to address high prevalence of non-communicable diseases (NCDs) in India. Cardiovascular diseases (CVDs) constitute a significant portion of NCD burden. While this program is yet to be launched in all districts of Madhya Pradesh state of India, we performed this study to understand facility-level gaps that need to be addressed to improve CVD services in primary care provided by the public sector.MethodsThis is a cross-sectional questionnaire based study. A standardized questionnaire was self-administered to 85 medical officers from as many primary care facilities from 24 districts of the state. These medical officers were working in two types of primary care facilities – primary health center (PHC) and community health centers (CHC). Facilities were assessed for 36 items in 5 domains (human-resource, equipment, drug supplies, point-of-care tests and laboratory services) with a focus on management of hypertension and diabetes mellitus in primary-care. Each item was to be answered as either present or absent at the facility where medical officer was working. We compared availability of an item across two levels of primary care facilities. All statistical analysis were done using Microsoft Excel.ResultsAvailability of facilities was least in laboratory services, and human resource domains followed by drugs, and better in equipment and point-of-care supply domains. Across these domains, availability of items in CHCs was (37.1, 49.0, 56.1, 67.9 and 80.9 % respectively) and in PHCs (11.8, 18.2, 44.2, 55.1, and 55.3 % respectively).DiscussionCurrent facility assessment study shows critical gaps in key items required for management of NCDs at primary care level. Human resource and laboratory services need to be strengthened the most, followed by sustained availability of all required drug classes, equipment and related supplies, and upgrading point-of-care testing. There are larger gaps in PHCs, which are level 1 facilities, as compared to CHCs, which are level 2 facilities in primary-care.ConclusionsIncreasing burden of NCDs like hypertension and diabetes mellitus necessitates public health response through health systems. Therefore health system preparedness in form of trained human resources, functional laboratories and well stocked pharmacies are essential in primary care facilities.
Urbanization is on increase because of heavy population pressure, industrialization, and better job opportunities in plane areas compared to Himalayan terrain. The urbanization has also added hypertension because of very fast life and lack of recreational opportunities within easily accessible distances. Deforestation is the permanent destruction of indigenous forests and woodlands. The term does not include the removal of industrial forests such as plantations of gums or pines. Deforestation is clearing of forests on a massive scale, often resulting in damage to the quality of the land. Urbanization is one of the major causes of the deforestation. Urban green space planning is an important component of urban ecosystems; provide many environmental and social services that contribute quality of life in the cities.The green spaces are said to be the lungs of the urban ecosystem. The process of urbanization led to natural landscape change. In the process tree cover, green spaces and wetlands were recklessly converted into built-up areas in the past and the process is still going on. Due to availability of required infrastructure, Dehradun was named interim capital of the nascent Himalayan state of Uttarakhand in 2000. Other regions of Uttarakhand is also experiencing rapid urbanization. The hill districts adjoining Dehradun district have witnessed a four-fold increase in the number of towns between 1901 and 2001. The population of Dehradun registered increase of 41.08 % between1961-1971, 32.84 % between 1971-81, 25.39 % between 1981-91 and during 1991-2001 it increased by 52.45 %. The temporal imaging of remote sensing data and socio-economic data of 1982 will be used for overall spatial monitoring.DOI: http://dx.doi.org/10.3126/ije.v3i4.11731 International Journal of EnvironmentVolume-3, Issue-4, Sep-Nov 2014Page: 57-73
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