2. 1
Hyper-
tension
Diabetes
Type II
At the time of
diagnosis
10+ years post
diagnosis
20+ years post
diagnosis
Heart attack or stroke
Heart failure
Diabetes
Kidney failure
Trouble with memory or
understanding
~10-15% of cases have
Retinopathy
30% have at Year 10 post
T2D Dx
~65% develop Retinopathy;
20% will have PDR/DME
~15% of cases
have Neuropathy
~50% develop the
condition
~60-65% have Neuropathy;
20% develop severe symptoms
Diabetes
Cardio vascular
complications
~20% of diabetics have
Nephropathy
~30% develop the
condition
>50% develop the condition,
12-15% proceed to ESRD
COPD
~60% have HYT &
Dyslipidaemia comorbidity
2-4X risk of CV disease,
to organ damage
High risk of NALFD/
NASH
~30% have Asthma
comorbid
~50% have pulmonary
hypertension
May even lead to CV
complications
Typical Manifestation of NCD’s: An illustration
3. 2
Complexity of Diagnosis & Interventions
For patients
For doctors
Limited awareness on self monitoring and self diagnosis of conditions
- hence dependency on frail lab infrastructure especially in rural areas
Lack of dedicated primary health models that can address Chronic conditions through
early intervention
Heavy dependency on the already stretched tertiary set up
Limited awareness on additional complications resulting from chronic conditions
Non compliance /limited compliance of patients to prescribed drugs and treatment
schedules
Lack of standard guidelines for practitioners to address comorbid conditions
Most patients turn up at escalated complication stages
4. 3
Piramal Swasthya NCD programme objectives
Early intervention to prevent the incidence
S Strengthen Public Health system to tackle NCD
P Patient compliance enhancement
A Awareness - chronic conditions & complications
Disease management to halt progressD
E
5. 4
NCD Service Strategy @ Piramal Swasthya
Preventive Promotive Predictive
Awareness
A.1 Lifestyle
A.2 Condition &
comorbidities
A.3 Nutrition
Disease management
C.1 Drug prescription & dispensation
C.2 Specialist consultation
C.3 Referral services
C.4 Follow up & closure
C.5 Periodic diagnosis
Patient segmentation
E.1 Systematic risk
assessment
Screening
B.1 Community screening
B.2 Door to door screening
Health system strengthening
D.1 Training of health out reach
workers
D.2 Partner with Public health system
Evidence based health
F.1 Personalized follow
up
A
B
C
D
E
A
E
B C
D
are independent unit of services. Each of these units when executed independently
or in combination with other units result in an output/outcome with specific
measurement.
Service
combinations
Example Performance Measures Output/Outcome
A.1+B.1+D.1 WDF Assam # of beneficiaries covered
# of awareness campaigns
# of health workers trained
Carried 6 Lac screening
2000+ awareness campaigns
Trained 6000 ASHA and 10000 community health
workers
A+B+C+D+E+F CASALUD,
Mexico
Model created for preventive and
disease management of NCDs
Screened 1.3 mn beneficiaries and averted 25000
beneficiaries from developing the condition
F
F
Conceptualization stage
6. 5
Platform
A. Awareness
& Counselling
B. Screening
&
identification
C. Disease
Management
D. Health
system
strengthening
E. Patient
segmentation
F. Evidence
based
A.1 Lifestyle
A.2 Condition &
comorbidities
A.3 Nutrition
C.4 Follow up &
closure
F.1
Personalized
follow up
A.1 Lifestyle
A.2 Condition &
comorbidities
A.3 Nutrition
C.1 Drug Rx &
dispensation
C.2 Specialist
consultation
C.3 Referral
services
C.4 Follow up &
closure
C.5 Periodic
diagnosis
D.1 Training of
health out reach
workers
D.2 Partner with
Public health
system
E.1 Systematic
risk
assessment
A.1 Lifestyle
A.2 Condition &
comorbidities
A.3 Nutrition
B.1
Community
screening
C.1 Drug
prescription &
dispensation
E.1 Systematic
risk
assessment
B.2 Door to
door screening
C.1 Drug
dispensation
C.3 Referral
services
C.4 Follow up
F.1
Personalized
follow up
Health
information
hot line
Tele-
medicine
4 Wheeler
2 Wheeler
Primary
Health center
Piramal Swasthya Platforms & NCD services
Not Applicable
7. 6
NCD projects at Piramal Swasthya: Reach, services &
Impact (2013 to October 2015 – project areas: Assam, WB, Odisha, Telangana)
Screened 5,25,775 beneficiaries for Hypertension and Diabetes
Diagnosed and confirmed 67,445 cases for Hypertension and Diabetes
Confirmed 56,485 comorbid cases through outreach screening and diagnosis
Representative case study – Project area Assam
• Patient ID: SP0223005380B000441; Date of registration : 11/27/2014 – Time - 02:30:32 PM
• Diagnosed for : Diabetes Mellitus
• Diagnosed through Lab test : RBS
• Lab test result : RBS = 263 mg/dl (at the time of registration)
• Intervention: Beneficiary was put on Metformin for 2 months with follow up
• Patient revisit date : 01/25/2015 – Time - 12:14:35 PM
• Lab test result on revisit: RBS = 140 mg/dl
