Diabetes has one of the fastest rising disease burdens in India.

Research shows that a quarter of all diabetics did not know they were diabetic [1] until they were diagnosed. In addition, the research also shows that there was a higher prevalence of undiagnosed diabetes in younger participants (<40 years).  This highlights the importance of surveillance and screening especially among the younger populations both in rural and urban areas for early diagnosis of diabetes in India.[2]

Effective policy planning and development of scalable public health interventions relies on the implementation of an effective national and state level surveillance system. A robust surveillance system is able to provide timely and relevant information about diabetes and its complications, identify high-risk groups, and track related risk factor information.

To date, a comprehensive national and state level surveillance effort is lacking in India. Up to 2011, two surveillance studies on non-communicable diseases (NCDs ) 1) the joint World Health Organization and Indian Council on Medical Research risk factor surveillance and 2) the Integrated Disease Surveillance Project have been conducted, however the first was only conducted in 6 states with a sample size of less than 45,000 while the Integrated Disease Surveillance Project’s first phase was conducted in seven states with a sample size of 35,000. While the NCD risk factor surveillance showed that high prevalence of diabetes, hypertension and obesity exist in urban areas with slightly lower prevalence rates in semi-urban and rural areas, such data is not seen as generalizable to the whole country due to differences in the Indian population with respect to culture, ethnicity, and socio- economic conditions. Improving country-level surveillance and monitoring through an integrated approach of looking at NCDs and recognizing the heterogeneity of the Indian population when developing public health policy and interventions must be a top priority in the fight against NCDs.

[1] Arvind Gupta et al. Prevalence of diabetes and cardiovascular risk factors in middle-class urban participants in India, BMJ Open Diabetes Res Care. 2014; 2(1): e000048.

[2] Arvind Gupta et al. Prevalence of diabetes and cardiovascular risk factors in middle-class urban participants in India, BMJ Open Diabetes Res Care. 2014; 2(1): e000048.

One group that is prioritizing the development of a public and private sector approach towards combating diabetes and other NCDs is the Partnership to Fight Chronic Disease (PFCD). The group has adopted a multisectoral strategy by bringing together leaders from the central, state and local government (Public Health Department-Govt of Maharashtra, National Health System Resource Center), government medical institutions(AIIMS, PGIMER) and research organizations focused on NCD research (PHFI, IDRF).  Their seminal document “Sankalp Disha” [1] summarizes the three main tracks as

1) Policy and surveillance

2) Strengthening the Health Care System

3) Increasing of Healthcare Financing.

Although the main focus of the plan is on government action, the private sector needs to be part of the decision making dialogue for all three tracks. There is a belief that many of the national health policies or data collection efforts have not succeeded because they have avoided the private sector. Under the PFCD action plan, identified roles for private sector physicians could be to augmenting public services with additional patient education, shift focus from curative to preventative care, advocate for the inclusion of preventative services in insurance schemes (e.g. covering a higher number preventative visits as opposed to just hospitalization) and perhaps most importantly, use their role as a trusted medical provider to raise public awareness about the causes of NCDs, management of risk factors and adoption of a healthy lifestyle.

Smruti Shah is a Director at Lighthouse Health Solutions, LLP (http://www.lighthousehealth.org) a public health research firm based in New Delhi

[1] Sankalp Disha, Swastha Bharat Ki, October 2015:prepared by SPAG Asia (http://www.fightchronicdisease.org/sites/default/files/pfcd_blocks/SANKALP-DISHA%20SWASTHA%20BHARAT%20KI.PDF)