Bangladesh initiates trainings on Package of Essential Noncommunicable Disease Interventions

Dhaka, 2 July 2019 - Directorate General of Health Services (DGHS) together with WHO and Japan International Cooperation Agency (JICA) organized in Dhaka between 12-14 May and 19-21 May, the first team-based trainings on the Bangladesh Package of Essential Noncommunicable Disease Interventions (PEN) for Primary Health Care (PHC).

The trainings have been attended by two Upazila Health & Family Planning Officers, 14 Medical Officers, 22 nurses, and 10 Sub-Assistant Community Medical Officers (SACMO) coming from Upazila Health Complexes and District Hospitals of Narsingdi and Cox’s Bazar districts.

WHO Bangladesh/ Syed Mahfuzul Huq

The activities aimed to prepare participants to prevent and manage the increasing burden of noncommunicable diseases (NCDs), particularly heart attacks, strokes, and diabetes, taking into account their modifiable risk factors, especially tobacco use, high dietary salt intake, high blood pressure and high blood sugar.

The training package has been developed by WHO Bangladesh, adapting from the “Package of Essential Noncommunicable (PEN) disease and healthy lifestyle interventions – Training modules for primary health care workers” elaborated by WHO Regional Office for South-East Asia for the member states. The training also incorporates sessions on Bangladesh’s “National protocol for integrated management of hypertension and diabetes using a total cardiovascular risk approach in primary health care settings”.

The activity is part of the project ‘Strengthening Health Systems through Organizing Communities (SHASTO)’ developed by DGHS and JICA.

WHO Bangladesh/ Syed Mahfuzul Huq

Bangladesh has made good progress in reducing burden of communicable diseases, but now faces the pressing health and development challenge of NCDs. Every year, four major NCDs-cardiovascular diseases, cancers, respiratory diseases, and diabetes- claim lives of more than 470 000 people in the country. Many of these deaths are premature, presenting a threat to the social and economic development of the country.

Despite high burden, PHC is not well prepared to provide NCD services, the main challenges being lack of medicines, equipment, skilled workforce and referral system. Besides, PHC in Bangladesh are designed to rather address acute and emergency care, whereas NCD require much education on healthy lifestyle and support to provide patients the skills for self and continuing health care.

Paradigm concerning NCD needs to change at PHC in such a way that the delivered care is proactive, people centered, cost effective and sustainable. In the light of this, WHO PEN is a hands-on innovative approach to respond all these challenges.

Management of NCD in current health system often focuses on single risk factor such as hypertension or high blood sugar. However, PEN considers the continuous relationship between multiple risk factors for cardiovascular diseases. By calculating a person’s absolute risk of having a heart attack or stroke in the next ten years, PEN enables healthcare workers to tailor care for patients according to their risk level. This approach would result in avoiding many years of drug therapy to patients with low cardiovascular risk and giving priority to patients with high overall risk.

WHO Bangladesh/ Syed Mahfuzul Huq

A team-based care strategy is also included in PEN to provide patient-centered continuous care. Team-based care uses multidisciplinary teams which include primary care physicians, nurses, SACMO and community health workers. Teams reduce the workload of physicians by distributing the task among other health care workers, a particularly important aspect in settings facing shortages of physicians.

Successful implementation of PEN in PHC settings will not only strengthen the health system but also empower primary care workers to provide high quality NCD care. Considering the impact of NCDs on the population and global calls for accelerated action on NCDs, PEN implementation is essential for a functioning health system and will help fulfill the government’s commitment to achieving universal health coverage by 2030.