COHESION Study

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