By A.R. Selva Swetha, Research Analyst – ICTPH
This is a period of global demographic and developmental transition, which has been witness to significant behaviour and lifestyle changes. The next two decades of epidemiological transition pose a grave challenge, with dramatic shifts expected in the world’s health needs. Major non-communicable and chronic diseases are fast replacing the traditional scourges of infectious diseases and malnutrition as the leading causes of death and disability. According to the WHO, infectious diseases are projected to account for less than a quarter of the India’s disease burden in 2020. The increase in the proportion of non-communicable diseases, to become the principal burden of disease and disability in India creates the pressing need to provide for universal annual screening of every individual using standardised screening protocols and to give primary care, integrated within a protocolised framework, a much higher degree of importance relative to secondary and tertiary care.
In this context, within the Health Systems approach, we have sought to standardise the patient experience across our Rural Micro Health Centres (RMHCs). A complete end-to-end protocol has been developed: from the time the patient walks into the clinic, to the various patient interactions, to checkout. Every patient is made to go through a Pre-Consultation Protocol where a set of simple anthropometric measures are taken, followed by a Nurse-Patient Protocol where Vital Signs and Auscultations are measured. These two sets of protocols precede the clinical disease protocols at Consultation, which follow the SOAP methodology for diagnosis and treatment. The set of clinical disease protocols in the paper have been evolved in partnership with the the University of Pennsylvania School of Nursing. The list is not exhaustive – protocol development is ongoing and will organically evolve based on the RMHC patient feedback loop. The integration of these protocols with the Health Management Information System, which will evolve towards a decision support system, containing more comprehensively codified protocols and where the entire process of patient consultation is prompted step-by step, will enable greater adherence to standard protocols and minimise any diagnosis errors.
Jamison, D. T. (2006). Disease Control Priorities in Developing Countries (2nd ed., pp. 3-36). New York: Oxford University Press.
WHO – Health Transition. (2011). Retrieved March 14, 2011, from World Health Organisation: http://www.who.int/trade/glossary/story050/en/index.html