COHESION Study

Abstract<br> Background: Proper functioning of health system across its goals is pivotal for health and<br> wellbeing of the population. However, emergence of non-communicable diseases (NCD),<br> imposed immense challenges to health. Amid all NCD, hypertension remained the biggest risk<br> for morbidity and mortality and also a challenge for better health system performance. Dearth<br> of information correlating hypertension and health system issues necessitate the call for a<br> study, to explore, capacity of health system to combat emergence of hypertension<br> (COHESION).<br> Methods: The study was conducted within the population cohort of Birbhum population<br> project, among hypertensive individuals detected earlier. 300 individuals, selected by simple<br> random sampling, interviewed with help of tablet device in ODK-Collect android application.<br> Blood pressure; family and health care expenditure; health seeking; responsiveness of health<br> system and other socio-demographic information collected, collated and analysed.<br> Results: Poor health seeking and control of hypertension (9%), extensive out of pocket<br> expenses (90% had OoPE) and poor to average responsiveness observed. Disease management<br> was suboptimal but associated to out of pocket expenditure with medicine having the major<br> share. Government and private sector departed significantly for expenditure but not with<br> disease control or responsiveness. Inequity in relative expenditure, social status driven system<br> responsiveness found. Regular treatment, longer disease duration, underweight found<br> protective for better blood pressure control.<br> Conclusion: Overall preparedness of health system for tackling NCD burden, seems to be<br> poor. Systems cannot ensure effective treatment, fair financing or good responsiveness. Rather<br> unjustified economic burden exerted over poor while seeking treatment. Even systems<br> responded less towards the poor. These findings may help in policy inputs and stressed on<br> further exploration on the matter.