Integrating World Health Organization Package of Essential Noncommunicable Disease Interventions at Primary Health Care - An Impact Evaluation Study from a Mountainous State of India.

Background: Noncommunicable diseases are the leading cause of death globally. This single-arm interventional (pretest-posttest) study was conducted in one rural and one tribal district of Himachal Pradesh. Persons with NCDs (cardiovascular disease, chronic obstructive pulmonary disease, diabetes mellitus) reporting to outpatient departments were enrolled. Components of the World Health Organization Package of Essential Noncommunicable Disease (WHO-PEN) protocols 1 and 2 were used. Nonphysician health workers managed NCD patients, providing individualized counseling on behavioral risk factors of major NCDs. The counselling was conducted at baseline, three months, and six months from enrolment, using brief interventions based on the "5As" and "5Rs" models. Follow-up was done at baseline, three months, six months, and 12 months postenrollment to assess outcomes. Methods: Change of 10-year risk of developing cardiovascular disease (CVD) using the WHO/International Society of Hypertension risk-assessment charts for SEAR and changes in behavioral and biological risk factors were compared to the baseline after one year of behavioral change intervention. Results: The 10-year CVD risk ≥20% decreased significantly from 17.9% at enrolment to 5.4% after one year of behavioral interventions. Significant improvements were seen in blood pressure, blood sugar control, and behavioral risk factors. Conclusions: Implementing the WHO-PEN protocols is feasible for managing NCDs at the primary healthcare level. Involving a health worker or counselor is essential for initiating and sustaining healthy behaviors and ensuring the individual's treatment compliance.