India is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCD) surpassing the burden of Communicable diseases like water-borne or vectorborne diseases, TB, HIV, etc. The Non-Communicable Diseases like cardiovascular diseases, Cancer, Chronic Respiratory Diseases, Diabetes, etc. are estimated to account for around 60% of all deaths. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke and Diabetes are also projected to increase over the years.

Fig. :  Change in top 15 causes of DALYs, both sexes, ranked by number of DALYs, 1990–2016, Goa by ‘India: Health of the Nation’s States Report 2017’

Leading causes of DALYs 2016 in the state (India: Health of the Nation’s States The India State-Level Disease Burden Initiative –Report 2017) are: 

• Ischemic heart disease [11.0%]
• Diabetes [4.1%]
• COPD [4.1%]
• Stroke [4.0%]
• Road injuries [2.8%]
• Falls [2.7%]
• Depressive disorders [2.3%]
• Chronic kidney disease [2.3%]

In order to prevent and control major NCDs, the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched with focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral.

Under NPCDCS, NCD Cells are being established at State and District levels for programme management, and NCD Clinics are being set up at District and CHC levels, to provide services for early diagnosis, treatment and follow-up for common NCDs. Provision has been made under the programme to provide free diagnostic facilities and drugs for patients attending the NCD clinics. Cardiac Care Units (CCU) is set up in Hospicio Hospital for providing facilities for emergency Cardiac Care. Day Care Centres facilitities available at Goa Medical College & Hospital for Cancer care. Palliative Care OPD is set up at Hospicio Hospital, Margao.

The modified strategies are as follows:

•  Health promotion through behavior change with involvement of community, civil society, community based organizations, media etc.
•  Outreach Camps are envisaged for opportunistic screening at all levels in the health care delivery system from sub-centre and above for early detection of diabetes, hypertension and common cancers.
•  Management of chronic Non-Communicable diseases, especially Cancer, Diabetes, CVDs and Stroke through early diagnosis, treatment and follow up through setting up of NCD clinics.
•  Build capacity at various levels of health care for prevention, early diagnosis, treatment, IEC/BCC, operational research and rehabilitation.
•  Provide support for diagnosis and cost effective treatment at primary, secondary and tertiary levels of health care.
•  Provide support for development of database of NCDs through a robust Surveillance System and to monitor NCD morbidity, mortality and risk factors.

Chief Medical Officer, NCDC – Dr. Rupa Naik

Nodal Officer, NCDC – Dr. Kedar Raikar

Human Resource Status:

• STEMI Goa Project

Introduction: The STEMI-Goa Project is an innovation of Government of Goa launched in the State in December 2018.

Aims of the STEMI-Goa project:

1. To reduce mortality from STEMI in the state of Goa
2. To reduce morbidity resulting from STEMI in the state of Goa 

Keeping in line with the objectives of Ayushman Bharat, the STEMI-Goa project aims at taking the best health practices and modern technology to all parts of the State and benefit the rich and the poor alike.

The Project focuses on taking thrombolysis to the periphery using a Hub & Spoke Model. At the start of the Project, there were 12 spokes (Peripheral Govt. Hospitals) and 1 Hub (Goa Medical College & Hospital). Recently, Government of Goa has partnered with 3 leading PCI-capable private hospitals in the State (Healthway Hospital, Old Goa; Manipal Hospital, Dona Paula and Victor Hospital, Margao) and the spokes has been expanded to 5 spokes in the peripheral Govt. Hospitals (CHC Bicholim, PHC Betki, PHC Candolim, PHC Sanguem and PHC Balli).

Fig. Hub and Spoke model of STEMI Goa Project

Programme description:

• • Hub & Spoke Model

• Use of Tele-ECG 

• Thrombolysis using Inj.Tenecteplase/Inj. Reteplase at the spokes by trained Medical officers

• Transfer to the Hub using ALS/Cardiac ambulances.

• InstaCare app for coordination

• Defibrillator to all spoke centres & Non-invasive ventilators to District hospitals
• Extensive training, protocols, reference material
• Use of technology in health care, universal health coverage, reduction of Out Of Pocket expenditure

Fig: A summary of flow of events in STEMI-Goa Project

Implementation partners:

• Directorate of Health Services, Goa
• Goa Medical College & Hospital
• Tricog Health Services, Bengaluru (for Tele-ECG services)
• GVK-EMRI (for ALS and Cardiac Ambulances)

Programme Outcomes: 

Training modules have been distributed to Medical Officers during the STEMI training.

STEMI Materials are distributed to all the spoke centres to be displayed in the Casualty.

• Changing diabetes barometer

Key objectives are as follows:

1. Create awareness to move the focus from treatment to prevention
2. Early detection to increase diagnosis & timely treatment of diabetes & reduce acute and chronic complications related to diabetes.
3. Building Capacity in the healthcare system to handle  the challenges of diabetes through accredited training programs for Doctors  and all other HCPs
4. Reduce out-of-pocket expenditure of the citizens of Goa on management of diabetes
5. Mandatory screening for gestational diabetes mellitus  (diabetes  In pregnancy)
6. Improve outcomes by special patient focused initiative & systematic counselling on the 4 pillars of diabetes care, viz., Diet, Exercise, Monitoring & Treatment

ACT (Awareness and Advocacy, Capacity Building &Treatment) to changing diabetes® in Goa, is a unique implementation model for improving diabetes management & outcomes in patients with diabetes in the state.

Awareness /Advocacy

• Creating awareness and advocacy to move from curative to preventive care
• Using the ‘community oriented, and community based’ interventions to ensure healthy lives and promote well-being for all PwDs at all ages

Capacity Building

• Improve the overall capacity in the healthcare HR of the state
• Train HCPs through accredited programs at primary, secondary and tertiary levels on improving overall understanding and management of people with diabetes
• Special training camps for primary care health workers, viz., AWWs & ANMs across the state.

Better Treatment

• Regular individualized support through Diabetes Educators (DEs) in the Community Diabetes Centers (CDCs) to ensure compliance & good outcomes for the treatment
• Creation of Goa specific diabetes care guidelines
• Ensure reach of other program benefits, viz., Ophthalmic care,
• GDM, type1, foot care & other complications focused patient at risk counselling & camps

Fifteen CDCs have been set up across Goa in all DHS Hospitals and GMC. These hospitals cover nearly 61.47% of Goan Population.

Progress report:

• MEGA MEDICAL CAMP

Mega Medical Camps are mass screening of population of all age groups including both males and females in collaboration with Goa Medical College, Goa Dental College, Bambolim – Goa and Directorate of Health Services.

Consultants/Senior Residents/Junior Residents from GMC along with the doctors from Directorate of Health Services and services of Mobile Dental Van are utilised along with the resident doctors of Goa Dental College to screen the patients in various communicable and non communicable disease.

During these camps, the multiple Health Services are provided for the patients such as Gynaecology OPD, Medicine OPD, Paediatrics OPD, Surgery OPD, ENT OPD, Ophthalmology OPD, Orthopaedic OPD, and Dental OPD along with super speciality services.

These Mega Medical Camps are conducted with the help of our Medical team and local governing bodies such as schools, local panchayat, etc. Every Mega Medical camp approximately screens 500 to 1000 patients,

• 28 Mega Medical Camps are held across Goa till Feb 2020.
• Total No. of patients referred from camps is 3,843.

Total No. Patients Screened are 16150

• Patients referred from camp are treated on Priority Basis at GMC & GDC

1. NCD Camps: are outreach programmes conducted monthly under each Health Facility. Free drugs and diagnostics are provided in NCD Camps. Focus of action is on health promotion, early diagnosis; prompt initiation of treatment as well as screening for complications and referrals to PHC/ District Hospital Goa Medical College, and Goa Dental College as the case may be.

Following is the data for NCD Camps from April 2018-Feb 2020

NCD Camp data from April 2019 to Feb 20 (North Goa)

• 2 cases of Oral Cancers detected & are treated at GDC.
• 2 cases of Breast Cancer & Cervical Cancer detected & are treated for the same.
• Till Feb 2020, 882 NCD Camps have been conducted.

• Screening for Breast Cancers using iBreast Device:

To decrease the burden of advanced breast cancer in Goa, Govt. of Goa is launching 12 iBreast devices to screen for breast cancer. iBreast Exam device , is a hand held, mobile connected, radiation free device operable by nurses and community health workers for early detection of breast lumps at the point of care. Screening of women will be done in the OPD, outreach and during the camps. Two machines have been already installed at SDH Chicalim. More machines will be procured by next 6 months. Training of Medical Officers, Staff nurses and ANMs on use of iBreast Device has been already conducted.

CDB Goa Periodic Project Review Report Jun – 2020

• Telemanas advt.2022-23 – South Goa District Hospital