Author: Dr. Haresh Chandwani, General Manager - Projects, ECHO India
In recent years, lifestyle habits of people across the world and in India have changed drastically. From poor sleeping patterns and increased stress levels to alcohol consumption and minimal physical activity, we are living in a new normal that poses more health implications than ever. Incidences of Non-Communicable Diseases (NCDs) like cancer, diabetes, and cardiovascular diseases are surpassing those of infectious and water-borne illnesses and affect nearly 60% of the population. [1]
As India faces this dual burden of communicable and non-communicable diseases, Cardiometabolic Syndrome or CMS, acts as a precursor to the latter. Recognized as a disease entity by the World Health Organization (WHO) and the American Society of Endocrinology, Cardiometabolic Syndrome is a clustering of metabolic dysfunctions characterized by insulin resistance, hypertension, impaired glucose tolerance, and atherogenic dyslipidemia, which is inherently seen in patients with obesity.
While it is a health condition that encompasses several metabolic abnormalities, atherosclerosis, where arteries get inflamed due to fat and cholesterol buildup [2], is of growing concern as it can cause heart attacks, strokes, and Coronary Artery Disease (CAD). When compared to Americans and Europeans, CAD is more prevalent among Indians [3] [4]. Similarly, CMS can increase the chances of individuals developing type 2 diabetes [5] and hypertension. However, compared to young adults, CMS is more common among the elderly population, and individuals residing in urban areas and the Northeast regions are at higher risk [6].
To reduce the burden of NCDs and improve healthcare outcomes across the country, the Government of India is running various initiatives such as the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY), National Tobacco Control Programme (NTCP), and Eat Right India.
The impact of Cardiometabolic Syndrome on NCDs, however, underscores the need for additional efforts focused on management and prevention. One of the critical steps in this direction is upskilling healthcare professionals to effectively diagnose, manage, and thereby prevent CMS. Capacity-building initiatives, especially at the primary and secondary levels, can improve patient outcomes and reduce morbidity while easing the burden on healthcare systems.
A Collaborative Approach to Enhancing Cardiometabolic Syndrome Care and Management
As a complex and multifaceted condition, Cardiometabolic Syndrome requires a skilled public health workforce, including doctors, nurses, and allied health providers, to identify key challenges and implement evidence-based strategies to enhance care. At the primary and secondary levels, medical officers can play an active role in providing diagnostic and treatment facilities and increasing awareness of various health issues and welfare schemes in their communities.
To support the capacity-building of medical officers working in Health and Wellness Centres under the Ayushman Bharat Yojana, ECHO India organized a Training of Trainers (ToT) on its collaborative initiative on Cardiometabolic Syndrome (CMS) in February 2024.
The program is being introduced in partnership with government public health entities such as state National Health Missions (NHMs), the Directorate of Public Health (DPH), and Municipal Corporations. ECHO India will also collaborate with premium medical institutions like the All India Institute of Medical Sciences (AIIMS) for academic support.
Over a span of three years, the initiative will aid the tele-mentoring of 1500+ medical officers (Mos), with an aim to reach over 1,35,000 lives. The medical officers trained under the program will be able to help their communities manage and treat illnesses associated with Cardiometabolic Syndrome.
Expanding Reach: Capacity-Building Across Geographies
Managing Cardiometabolic Syndrome (CMS) becomes pivotal in preventing the onset and progression of Non-Communicable Diseases (NCDs). The intricate link between the two lies in shared pathological mechanisms, with insulin resistance, inflammation, and dyslipidemia (elevated cholesterol or fats) being common contributors to both CMS and NCDs.
Hence, this capacity-building initiative will be implemented in six states with a high prevalence of NCDs across India, including Karnataka, Maharashtra (NCDs account for 62.9% of all deaths), Tamil Nadu (NCDs constitute 62.4% of all deaths), Gujarat (NCDs constitute 61.2% of all deaths), Arunachal Pradesh, and West Bengal (NCDs account for 61.8% of all deaths)[7]. The project envisages a vibrant digital network that will facilitate tele-ECHO sessions, enabling the Continuing Medical Education (CME) of the primary healthcare workforce across these states.
In the initial phase, state partners, including state NHMs and Municipal Corporations, will undergo extensive training to apprise them of the ECHO Model, and hub sites with all the necessary technical equipment will be set up to conduct the sessions. An eight-modular training curriculum will be designed on Cardiometabolic Syndrome and related health conditions, which will be further tailored according to the local settings and requirements of the region. Additionally, a series of webinars for various cadres of health professionals and public health practitioners will be organized at a later stage, aiming to sensitize the large audience on Cardiometabolic Syndrome.
Key Takeaways and the Way Forward
● By reaching 1,350,000 patients over the course of the program, we aim to decrease the burden of CMS in underserved regions of the country while encouraging communities to adopt preventive measures.
● Increased individual capacities of trained Medical Officers will aid effective diagnosis, management, treatment, and prevention of Cardiometabolic Syndrome and associated health conditions.
● Efficient and cost-effective training will enable task-shifting and rapid knowledge transfer, resulting in a strengthened and robust health system.
● Enabling a comprehensive and advanced assessment of patients’ needs, especially at the primary healthcare level.
● By leveraging technology, ECHO India aims to bridge the digital divide and develop a virtual Community of Practice, empowering a vast cadre of healthcare workers to establish and implement best practices across diverse economic and cultural contexts.
As Cardiometabolic Syndrome serves as a major driver of non-communicable diseases and poses a significant public health challenge in India, strengthening our healthcare workforce through targeted upskilling and capacity-building initiatives is the need of the hour.
To collaborate with ECHO India or know more about the program, reach out to us at projects.team@echoindia.in.
Together, we can create a healthier future for India.
Sources:
[1] Global Burden of disease study, 2019
[5] https://www.who.int/news-room/fact-sheets/detail/diabetes
[6] Global Burden of disease study, 2019
[7] National Health Profile 2020 – CBHI, DGHS, MoHFW, Govt. of India