Population based – Individual Screening Protocol for Rural Indian Populations

By Zeena Johar, President – ICTPH

The WHO Health Systems framework (WHO, 2007) defines six components of a Health System – service delivery; health workforce; information; medical products, vaccines & technologies; financing; leadership and governance. Within this framework, the evolving ‘chronicity’ (long duration and slow progression) of the global disease burden requires a highly integrated response to provide continuum of healthcare, within a population, that does not have tertiary care as its focal point (Allotey, 2010) but community based care. In 2000, the World Health Assembly endorsed a three component global strategy (WHO, 2005) for the prevention and control of non-communicable diseases comprising of (i) surveillance to track and monitor major risk factors, (ii) promotion of health to reduce these risk factors and (iii) improved management to promote access to healthcare (Alwan, 2010). It is indeed the case that prevention, treatment and management of chronic diseases entails a core set of interventions – primary prevention, proactive high-risk case identification (through routine screening and assessment of risk factors), education, efficient referrals, pharmacological and psychosocial interventions, long term surveillance, and monitoring and assessment of quality of care (Samb, 2010). In a health system designed to address the double burden of infectious and chronic disease and implement this set of interventions, Health Extension Workers (HEWs) are needed to bring care close to the community and play a critical part in early detection and support for long-term self-management and home-based care (Samb, 2010).

This paper details the age-specific evidence based protocol as assembled by IKP Centre for Technologies in Public Health (ICTPH). The Health Systems approach at ICTPH aims to redefine primary healthcare towards an inclusive continuum, accommodating evolving chronicity. The four elements defining the ICTPH Health Systems approach are human resource, infrastructure, technology, and financing. Provisioning enhanced diagnostic capability through the village-based Rural Micro Health Centre (RMHC) allows for optimum condition management. Basic haematology, biochemistry, ophthalmology, curative care, intervention management are provisioned through a RMHC for a population of 10,000 people through a village-based nurse and a network of health extension workers. The village-based RMHCs anchor multiple functions, wherein establishing a relationship focused on ‘Wellness’ with the household is of utmost importance. Wellness as defined within the ICTPH Health Systems context, not only provisions curative services for management of acute conditions but also risk-profiles populations targeting secondary prevention at a population level.

Download the paper here.


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Alwan, A. (2010). Monitoring and Surveillance of Chronic Non-communicable Diseases: Progress and Capacity in High Burden Countries. Lancet , 376, 1861-1868.

ICTPH. (2010). Retrieved January 12, 2011, from IKP Centre for Technologies in Public Health (ICTPH): www.ictph.org.in

Samb, B. (2010). Prevention and Management of Chronic Diseases: A Litmus Test for Health Systems Strengthening in Low Income and Middle Income Countries. Lancet , 376, 1785-1797.

WHO. (2007). Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes – WHO Framework for Action. Geneva, Switzerland: World Health Organization.

WHO. (2005). The WHO STEPS Surveillance Manual – WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance. Geneva: World Health Organization.

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