{"id":3486,"date":"2024-05-15T09:00:00","date_gmt":"2024-05-14T23:30:00","guid":{"rendered":"https:\/\/hepatitissa.asn.au\/communitynews\/?p=3486"},"modified":"2024-09-04T23:49:10","modified_gmt":"2024-09-04T14:19:10","slug":"mobilising-the-whole-health-system","status":"publish","type":"post","link":"https:\/\/hepatitissa.asn.au\/communitynews\/2024\/05\/mobilising-the-whole-health-system\/","title":{"rendered":"Mobilising the Whole Health System"},"content":{"rendered":"\n

The pathway to global elimination of viral hepatitis is \u201cIntegration\u201d. This was one of the stand-out messages at the World Hepatitis Summit 2024<\/a> (WHS2024) in Lisbon where successful integration strategies were presented. The key to this approach is to make hepatitis screening, monitoring and clinical management part of the broader health system, delivered along with other infectious diseases screening and care.<\/p>\n\n\n\n

One example is India\u2019s National Viral Hepatitis Control Program<\/a> (NVHCP) which integrates viral hepatitis prevention, diagnosis and management into existing health services, mobilising the whole health system as a response to reach elimination.<\/p>\n\n\n\n

Speaking at the WHS2024 Integrate session on 10 April, Dr. Sandhya Kabra, Deputy Commissioner of the Indian health ministry\u2019s Division of Viral Hepatitis, described the NVHCP strategy as \u201cpiggy-backing\u201d on other existing services, such as reproductive and child health immunisation, AIDS control and blood transfusion services.<\/p>\n\n\n\n

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Integration with reproductive and child health services allows for screening and infant vaccination with little additional cost. (Scroll down for full slide set.)<\/figcaption><\/figure>\n\n\n\n

\u201cWe use the same infrastructure and staff,\u201d she said, expanding the \u201ccapacity\u201d by training existing staff. She said one of the key services the program integrated into was maternity care which has 50,000 community level sites, giving the program access to a crucial target group for hepatitis B vaccination and immunisation.<\/p>\n\n\n\n

… we piggybacked on it and made it a hepatitis helpline as well.<\/p><\/blockquote><\/figure>\n\n\n\n

The Program also integrated with the Tuberculosis system which had an existing helpline. \u201cSo we piggybacked on it and made it a hepatitis helpline as well,\u201d she said.<\/p>\n\n\n\n

According to Dr Kabra, when health authorities launched the program, they were \u201cvery well aware\u201d they had a \u201cvery tough task\u201d ahead to reach elimination by 2030 because the program only started in 2018 and expanded to include hepatitis B in 2019.<\/p>\n\n\n\n

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Dr Sandhya Kabra at the WHS 2024 with slide showing the launch of India’s National Viral Hepatitis Control Program in 2018. (Scroll down for full slide set.)<\/figcaption><\/figure>\n\n\n\n

Given India\u2019s complex system of governance with numerous states and districts, and the need to reach its immense population of 1.4 billion, the NVHCP adopted a strategy that relied heavily on integrating viral hepatitis services into the existing health infrastructure including administrative setups, buildings and staff.<\/p>\n\n\n\n

The integrated approach, said Dr Kabra, avoids duplication, allowing 100 per cent domestic funding and thus ensuring sustainability. National level operations include the overseeing of prevention, diagnosis and program management by the National Viral Hepatitis Management Unit, Steering Committee and Technical Resource Groups which liaise with corresponding states and districts level units which implement service delivery at community health centres, primary health centres, and wellness centres.<\/p>\n\n\n\n

Integrating into existing screening services reduces double-handling, and maximises opportunities, getting \u201cthree tests done with one prick\u201d<\/p><\/blockquote><\/figure>\n\n\n\n

Integration with existing family health, drug and  HIV services ensures access to priority groups such as pregnant women, newborns and people who use drugs. Other existing \u201cmechanisms\u201d include cancer control, tuberculosis, dialysis, blood transfusion and counselling programs.<\/p>\n\n\n\n

Integrating into existing screening services reduces double-handling, and maximises opportunities, getting \u201cthree tests done with one prick\u201d.<\/p>\n\n\n\n

Between July 2018 and December 2023, the NVHCP carried out approximately 91.5 million hepatitis B and hepatitis C tests, with over 300,000 patients accessing treatment. There are 978 treatment sites in 711 districts across the country and 4,900 people trained who are able to go on to train others.<\/p>\n\n\n\n

While the program has been successful, Dr Kabra said challenges remain. These include India’s vast geographical expanse and huge population, limited availability of finger prick test kits, lack of child-appropriate medications, and allocation of resources to states not always conforming to standard protocols prescribed by agencies.<\/p>\n\n\n\n

Dr Kabra\u2019s strong message was for countries which have an existing health system to not neglect that fact, to use the existing system instead of trying to build an entirely new \u201cvertical\u201d hepatitis program, and a “humble request” to agencies to align with local government protocols.<\/p>\n\n\n\n

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Many states in India<\/figcaption><\/figure>\n\n\n\n
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Many districts within a state e.g. Madhya Pradesh<\/figcaption><\/figure>\n\n\n\n
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Multi-level health system in each district<\/figcaption><\/figure>\n\n\n\n
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Blue bubbles are the national vertical structure, lilac bubbles the services mobilised for the program<\/figcaption><\/figure>\n\n\n\n
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\"\"\n\t\t\t\n\t\t\t\t\n\t\t\t<\/svg>\n\t\t<\/button><\/figure>\n<\/figure>\n","protected":false},"excerpt":{"rendered":"

One of the keys to viral hepatitis elimination is to make hepatitis screening, monitoring and clinical management part of the broader health system, delivered along with other infectious diseases screening and care.<\/p>\n","protected":false},"author":2,"featured_media":3487,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_FSMCFIC_featured_image_caption":"","_FSMCFIC_featured_image_nocaption":"","_FSMCFIC_featured_image_hide":"","footnotes":""},"categories":[11],"tags":[36,265],"issue":[],"ppma_author":[56],"class_list":["post-3486","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-policies-research","tag-hepatitis-elimination","tag-world-hepatitis-summit"],"acf":[],"yoast_head":"\nMobilising the Whole Health System | HepSA Community News<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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