Revitalising primary health care centres to treat diabetes, hypertension patients in Delta

Until now, several studies have shown that hypertension and diabetes mellitus are highly prevalent in Nigeria and other low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Also, recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation.

Indeed, Non-Communicable Diseases (NCDs) are global public health concerns, with four conditions receiving a priority status by the World Health Organisation (WHO): cardiovascular diseases (CVD), chronic respiratory diseases, diabetes mellitus and cancers.

Described as the “invisible epidemic”, NCD mortality exceeds that of communicable, maternal, perinatal and nutritional conditions combined.

According to a study published in the journal BMC Public Health and titled, “Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries: a scoping review”, NCDs are the largest cause of mortality both globally and in the majority of low- and middle- income countries where approximately 80 per cent of the global deaths from NCDs occur.

They noted that management of NCDs required regular availability of drugs, laboratory facilities, data collection tools, trained healthcare workers and educated and empowered patients in addition to health services tailored to the social and life characteristics of individuals.

The researchers said there is strong evidence that primary care is one of the most cost-effective strategies in curbing morbidity, disability and premature mortality of hypertension and diabetes.

The need for effective primary care interventions was stated in the Alma Ata Declaration in 1978, which emphasised effective healthcare systems as a reflection of social determinants rather than hospitals and doctors alone. The Declaration proposed a focus on Primary Health Care (PHC), which challenged the view of biomedicine, dominated healthcare system. PHC conceptualised healthcare as scientific, socially acceptable and universally accessible and based on the principles of equity and community participation.

PHC has again been in the spotlight with the 40-year anniversary of the Alma-Ata Declaration and the global community reasserting its principles in the Astana Declaration, which emphasised the importance of PHC in achieving universal health coverage and the sustainable development goals, and on the prevention and management of NCDs.

Recognising the importance of PHC, the WHO has developed the Package of Essential Non-communicable Disease Interventions (WHO PEN) for primary care in low-resource settings. The WHO PEN has a special focus on hypertension and diabetes and their integrated management given their burden.

Consequently, research and policymaking efforts are underway in many countries including Nigeria to revitalise PHCs to tackle hypertension and diabetes.

Delta State is blazing the trail in Nigeria with the flag off of its first Diabetes and Hypertension Clinic (DHC) on Monday, November 16 at Obior Healthcare Facility in Obior, Aniocha North Local Government Area (LGA) of the Delta State by Delta State Contributory Health Commission (DSCHC).

Director General and Chief Executive Officer (CEO) of DSCHC, Dr. Ben Nkechika, told journalists that three other Diabetes and Hypertension Clinics are also being established at Polobubo Healthcare Facility in Warri North LGA, Oporoza Healthcare Facility in Warri South West LGA and Ovwor-Olomu Healthcare Facility in Ughelli South LGA of the State.

Nkechika said the DHCs were established under a Public Private Partnership (PPP) programme with SANOFI Aventis, a French pharmaceutical company, and the partnership is geared towards enhancing the availability and quality of diabetes and hypertension management in rural communities in Delta State.

Nkechika emphasised that the Commission was established to provide health care for all residents of the state and not indigenes alone.

“The health insurance Commission is designed to give free medical health services to those who are sick but do not necessarily have the money to provide healthcare. The category under which such people falls in is called the equity health plan.”

He listed them to include the pregnant women, children under the age of five years, the elderly and those that have the inabilities to pay due to financial challenges, “We have a way of identifying and helping them.

Nkechika assured the people that the Commission also has the benefit package for people who are not covered under the federal government basic healthcare package, which allows people with National Identity Management Commission (NIMC) registration number to walk into any center for treatment.

He noted that the Commission has also come up with the idea of people having healthcare services closer to them, “Based on this we have identified healthcare facilities that have been built but not operational, we will find a way to make it operational.

“Anybody in the community is free to walk into this facility and do you blood sugar test, Blood Pressure (BP) check. Once you are found that you are Diabetic or pre Diabetic, you will be put into a programme where you will be supported with all the requirements to continue treatment”.

He disclosed that the partnership with SANOFI, has yielded positive result as SANOFI, has agreed to give the Commission drugs at a discounted price, “and these drugs will be provided for all our enrollees free of charge but all you need to do is get enrolled into the programme.”

He assured the community that doctors would be trained to manage cases, identified it early and ensure that there is no case of Diabetes complications just as he called on the Community to take the opportunity to utilise the facility as identified Diabetic cases would be registered and given free support.

Speaking at Obior Health facility, Chairman of the DSHC, Dr. Isaac Akpoveta, said the clinics were private-public partnership initiative in ensuring that people at the rural areas get access to quality healthcare service.

Akpoveta said: “Our commission is very concern of people in the rural area to ensure that the people are healthy to produce the food for the nation. It is a PPP arrangement with SANOFI pharmaceutical company and the service is free of charge.

“Diabetes and hypertension are sicknesses that silently killed. When you have too much sugar in your blood, it destroys all the vital organs in your body, and hypertension is off course causes stroke and once you have a stroke, your life will never be the same”.

Former Deputy Governor of the State, Chief Benjamin Elue, pledged that the people would own and protect the facilities.

General Manager, Nigeria and Ghana Country lead, Nigeria, Folake Odediran, who also spoke at the ceremony, said Sanofi entered into a memorandum of understanding (MOU) a year ago to jointly address the rising burden of diabetes and hypertension in the State.

Odediran said: “Under the partnership, both parties set common goals to implement end-to-end healthcare initiatives to support patients in their health journeys. We set out to promote disease awareness and patient education across the state, train 400 healthcare workers, establish diabetes and hypertension clinics, support people living with diabetes, and provide quality affordable medicines for patients.

“The Commission and Sanofi have since been working tirelessly to achieve these common goals. Therefore, it is a great privilege for me, and a humbling experience too, to see us successfully commission the Diabetes and Hypertension Clinics, DHC project in Delta State today.

“The increasing burden of diabetes and hypertension is a major public health concern. This is because these diseases are not just health problems but also a development challenge as they impact the quality of life, undercut productivity and force many people and families into poverty due to catastrophic expenditures on treatment. Gaps exist in health care systems.

“The DHC project is one of several healthcare initiatives under our partnership with the Commission. It aims to bring healthcare closer to the people and thereby eliminate some barriers, which prevent people from accessing healthcare.

“The DHC is a centre of excellence dedicated to supporting people living with diabetes and hypertension most especially at the primary level of care and in hard-to-reach communities. DHCs are well equipped, with the health workers well trained, to effectively manage diabetes and hypertension at primary care level and to refer patients when necessary”.