By Irene Calimlim, Alyssa Dilly, and Alexis Barab
On January 9-January 10, the Bharati Vidyapeeth University, College of Nursing at Sangli hosted a conference on “Changing Demands, and Improving Quality Outcomes in Nursing: A Global Perspective.” Three of our long-term volunteers, interns, and fellows went to present on a session of the changing demands of healthcare systems.
Already the major health burden for industrialized countries, non-communicable diseases (NCDs) are increasing rapidly in developing countries. NCDs, also known as chronic diseases, are not passed from person to person. They are of long duration and generally slow progression: cardiovascular disease (heart disease, hypertension), diabetes (particularly Type II diabetes), chronic respiratory diseases (emphysema, bronchitis), and cancer. Due to drastic demographic and economic changes, India, like many other developing countries, sits at the intersection of the epidemiological transition from communicable diseases to NCDs. Thus, India endures a double burden of still fighting infectious disease while struggling to prevent and manage the rise of NCDs. And NCDs are definitely on the rise. According to predictions by the WHO, NCDs will account for almost 75% of all deaths in India by 2030. Additionally, India is facing an epidemic of diabetes, with over 62 million confirmed diabetes patients. By 2030, India will have the largest number of diabetes patients in the world, projected to surpass 100 million.
Current health systems around the world are still focused on targeting health through curative medicine and innovative technology. These efforts have shown great success at eradicating many communicable diseases and finding cures, but it is a system that is highly focused upon treating the symptoms of a disease. Yet, health is more than the presentation of disease, and there are many factors that play into a person’s health outside of healthcare. Health begins where we live, learn, work, and play. Patients can come in the doctor’s office and the most that doctors can do is treat the symptoms, prescribe a treatment regimen, or give lifestyle recommendations, and then the patient goes back to the environment that caused them to get sick in the first place. The landscape of diseases is shifting towards chronic, non-communicable diseases. These are diseases that are preventable; they require more targeted efforts at behavior change but also working on more upstream factors of health such as making sure that people have the ability to make healthy lifestyle choices by having healthy, enabling environments.
So what role can nurses have in combatting this global health issue? Nurses can play an integral role in preventing, reducing, and treating NCDs. The more than 19 million nurses and midwives in the world make up the largest group of healthcare providers. Nurses can and must transform from a strictly curative role to a role in disease prevention and health promotion; they should provide health education on an individual and community level, have access to continuing education resources in order to specialize and build their capacity for care, and work interdisciplinary with other healthcare and public health professionals in order to provide the most comprehensive care.
Advantageous characteristics of nurses include earning trust and respect from the public, having access to all levels of the population, working with patients over the course of the lifespan, utilizing a horizontal approach to healthcare, providing a range of services – from immunization to palliative care and everything in between – and finally providing individual and community-level interventions. WHO Global Forum for Government Nursing and Midwifery Officers met in 2012 to focus on strengthening the role of nurses and midwifery in NCDs. According to this program, nurses and midwives must: “play a central role in health service delivery – promotion, prevention, treatment and rehabilitation – in areas of great health need, where they may be the only frontline providers of health, especially in remote areas … developing and strengthening human resources for health means recognizing that nursing and midwifery services play a vital role in improving health service delivery”.
Seventy two percent of India’s 1.2 billion person population lives in rural areas. India’s National Rural Health Mission, which went into effect in 2005, aimed to provide healthcare to all of India’s rural population. Despite this mandate, Maharashtra alone is lacking 2,830 health sub-centers, 380 primary health centers, and 182 community health centers to adequately serve the rural population of more than 112 million people. Conditions of the existing Government healthcare centers are often inadequate, and many are simply inaccessible to the rural poor. Of the 10,580 healthcare sub-centers, 7.4% lack a regular water supply and 21.3% lack electricity. Of the 1,809 primary health care centers, 13.3% lack a labor room, 15.4% lack an operation theater, 8.6% lack electricity, and 18.9% lack a consistent water supply. Without water, it is impossible to keep healthcare centers sanitary and functioning. Without electricity, x-rays machines, life support machines, refrigerators for medication, and lights cannot function. Additionally, within the existing Government healthcare sub-centers, primary care centers, and community health centers, in Maharashtra alone, we are lacking 2,417 male health assistants, 194 nurses, 859 female health assistants, 673 lab technicians, 110 pharmacists, 249 surgeons, 140 obstetricians and gynecologists, 287 physicians, 184 pediatricians, 860 specialist doctors, and 235 radiologists.
In rural India, it is not only nurses and medical specialists who have a large role to play in non-communicable diseases. The current lack of infrastructure and effective governance in rural areas combined with poverty and social, religious, and gender-based inequalities make trained local village health workers and community workers the best health advocates for rural areas. As NCDs are largely preventable, village health workers and community members have the ability to help empower rural individuals to take health into their own hands and promote healthy behaviors to prevent NCDs. These workers are part of the community in which they work, and as such, they are trusted by their communities to work on an individual, family, and community level.