Addressing NCDs should be at the core of COVID-19 response By Dr. Lakith Peiris

The last few months have been a whirlwind in the health sector. Not just in Sri Lanka, but across the world, healthcare providers were met with unprecedented challenges following the rapid spread of the Novel Coronavirus.

Perhaps one of the most encouraging developments to emerge from this crisis has been the exemplary response by Sri Lanka’s healthcare sector. Like many around the world, our medical staff and front-line workers have displayed immense courage throughout the pandemic.

The overall Sri Lankan response can surely serve as an example of how early, decisive, and coordinated action from all stakeholders can be leveraged to avert the kind of situation; currently playing out in countries which are worse affected, often despite having greater resources at hand.

In this endeavor, I am also proud to state that private healthcare has also played a critical role. While the national healthcare system and resources were employed to curb the spread of the pandemic, private healthcare providers catered to other essential health needs of our population. Although COVID-19 took us by surprise, the resilience of our healthcare sector ensured that we strived forward, despite it all.

However, although we are no longer in lockdown and are adapting to a “new normal”, the threat of the pandemic is not over just yet. While our response systems have stepped up by strengthening COVID-19 surveillance, testing and treatment, the probability of a second wave of the pandemic is still a reality. The private healthcare system in Sri Lanka is equipped and fortified to continue to provide access to quality routine healthcare for all Sri Lankans, despite the challenges a second wave may pose.

Addressing the root cause: how can we craft our COVID-19 response better? 

A recent paper published in The Lancet (a science journal), highlighted the importance of preventing and controlling Non-Communicable Diseases (NCDs) during this pandemic. NCDs were identified as a major risk factor for patients with COVID-19. More specifically, research stated that the presence of a comorbidity increased the risk of patients with COVID-19 (The Lancet, 2020).

This finding is particularly concerning in the case of Sri Lanka, as NCDs are estimated to account for 83% of all deaths (WHO, 2016). NCDs also rank among the top 10 causes of premature death in Sri Lanka, with cardiovascular diseases in the lead.

Globally, restrictive measures such as lockdowns, social distancing and travel restrictions have had a greater impact on people living with NCDs. These measures have limited their ability to access to preventive or health promotion services. Quarantine and lockdown can also lead to an increase in poor NCD behavioral risk factors, including unhealthy diet, physical inactivity, tobacco use, and harmful use of alcohol (BBC News, 2020). In Sri Lanka, the ongoing pandemic has distinctly revealed the vulnerability of those with underlying conditions.

The Government of Sri Lanka, along with private healthcare providers have pledged to undertake the prevention and cure of NCD’s as a key priority. This means we improve access to healthcare for all, promote healthy habits amongst our people and advance the standards of performance of the sector, to better address the challenges of non-communicable diseases.

In the long term, the Government of Sri Lanka along with private healthcare providers need to take a collaborative approach to tackling this issue. Private-Public partnerships in setting up diagnosis centers and private sector involvement in the treating of NCDs is the way forward.

How can NCDs be at the core of COVID-19 response? 

In the present, continued and strengthened focus on NCD prevention and management are interlinked aspects of healthcare delivery. An adaptive response is required to account for the needs of people living with NCDs. Healthcare providers need to support and manage the increased risks of people with known NCDs and exercise sensitivity about the vulnerability of those with undiagnosed NCDs.

As patients with chronic diseases are at greater risk of COVID-19, there is a danger of an extra burden being placed on already stretched health services. Not only NCD patients with the presence of comorbidities are at an increased risk of infection, but health-care staff working in NCD clinics are also at the risk of infection. Some NCD specific responses to COVID-19 as suggested by the World Health Organization involve:

• Engaging NCD health-care staff in planning COVID-19 response strategies.
• Prioritizing NCD patients and health-care staff for COVID-19 testing.
• Using telemedicine more to maintain continuity of care for people living with NCDs.
• Prioritizing community-level services in a safe way to cater for NCD patients’ needs.
• Using technology to provide online information on exercise and wellness.

The battle against NCD’s is not one the already stretched national healthcare sector can fight on its own. Heavy demands of the emerging NCD agenda are causing disparities in health financing and service provision. 50% of outpatient care is reliant on the private sector, making private healthcare providers crucial to the treatment of NCDs in Sri Lanka.

(The author is the President of the Association of Private Hospitals and Nursing Homes. Established in 1972, the Association has played an important role in the regulation of the country’s private health sector while facilitating in skills development among healthcare workers.)