The world noncommunicable disease federation's international certification course of primary health-care physician in noncommunicable diseases: Key to strengthen primary health-care interventions in noncommunicable diseases

Abstract

Noncommunicable diseases (NCDs) have become a major global problem, accounting for approximately three-fifths of morbidity and mortality. Due to the epidemiological shift, the disease pattern in many developing nations is shifting from infectious to chronic NCDs.[1] NCDs cause 41 million deaths every year, accounting for 80.2% of all deaths worldwide. There are over 15 million (38%) premature NCD mortality that is avoidable and preventable. Around 77% of all NCD deaths occur in low-middle-income countries (LMICs).[2] Primary health care (PHC) is essential for achieving universal health coverage and reducing the prevalence of NCDs. However, there is a huge capacity gap, and the majority of primary care physicians are not competent to diagnose and treat NCDs, especially in LMICs.[3] A well-functioning primary care system, including ambulatory primary care administered through primary health centers, is cost-effective and can meet up to 90% of health-care demand in poor and middle-income countries, including NCDs.[4] Primary care is more than just a first point of contact; it is the base of a health-care system. It is available to all patients and can manage NCDs in their early stages by providing first contact, continuity, and integration of care. According to the World NCD Federation guidelines for NCDs in PHC settings and the WHO package of essential noncommunicable Package, high-impact important NCD interventions can be offered through PHC to improve early detection and treatment. Approximately 80% of disease conditions, according to estimates, can be handled at the primary care level with a primary care physician and a community health worker.[5] Almost 52% of all conditions, especially NCDs, can be managed at the primary care level.[6] The phrase “gatekeeping” refers to the role of primary care physicians or general practitioners in improving access, which has a significant impact on service utilization, health outcomes, health-care expenditures, and patient satisfaction. There is a lack of effective implementation of NCD services at the PHC level, due to a lack of trained health workforce and essential supplies for implementing comprehensive NCD care programs (standards of treatment protocols, referral, and follow-up for NCDs).[7] To address this huge capacity gap of PHC professionals, the World NCD Federation has initiated an International Course as “Certification of PHC physician in NCDs” which focuses on meeting the requirements of the Global NCD Agenda under the Global strategy for prevention and control of NCDs.[8] The World NCD Federation aimed to develop this e-learning course to provide simple and comprehensive guidance on the prevention, surveillance, and management of common NCDs to health-care professionals, including frontline workers, community health workers, and PHC doctors. The objective of the course includes the development and implementation of a certification course for primary health physicians in NCDs at the global level and capacity building of the primary health physician to understand and acquire the skills of major NCDs. The course structure includes the e-learning program, including core modules of 12 weeks and a contact program of 3–4 days. The core modules will focus on the basics of NCDs; health promotion and health and wellness with the inclusion of an integrated approach, the socioeconomic impact of NCDs and the health system approach; NCD surveillance; NCD management and standard treatment guidelines; developing and effective implementation of national NCD programs and multisectoral action plan for NCDs; palliative care and medical emergencies in NCDs; global monitoring framework and evaluation at facility level/PHC level; and clinical decision support system and role of family medicine. The contact program includes skill development, including the use of risk prediction scores for major NCDs; collection and measurement of risk factor data for NCDs; blood pressure monitoring and glucometer usage; anthropometric measurements (height, weight, body mass index, waist circumference, and skin fold thickness); investigations necessary for the diagnosis of NCDs; biochemical measurements and interpretation; ECG reading and interpretation; and visual inspection by acetic acid for cervical cancer, oral examination, and clinical/self-breast examination. The World NCD Federation also released evidence-based operational NCD guidelines developed by experts from several national and international organizations. The guidelines detail policy and nonpolicy approaches for NCD prevention, surveillance as and management of 9 NCDs for primary care settings. These guidelines will serve as a key foundational tool for practicing physicians and community health professionals at all levels of health care to provide effective NCD prevention and care.[9] The training will be accredited and will ensure the standards required for meeting NCD targets and indicators and the Sustainable Development Goals (SDGs) by 2030, which are intended to be achieved by countries. Registration for the course is open and can be done online (https://www.worldncdfederation.org/international-certification/) as and few full scholarships are also available. It is expected that this first-of-kind course will help in the capacity building of partial hospitalization programs, the effective implementation of the National NCD Program, and the realization of SDGs in LMICs.