EXPLAINER: How Haryana is equipping docs to fight ‘silent killer’ liver diseases

In India, viral hepatitis affects nearly 6 per cent of the population, while non-alcoholic fatty liver disease (NAFLD) impacts around 25 per cent. Though both are serious and potentially life-threatening conditions, they are largely preventable and manageable if diagnosed early and treated appropriately. However, a key challenge lies in the limited training of doctors at primary and community health centres (PHCs/CHCs) and district hospitals leading to frequent referrals to higher healthcare centres. This not only delays treatment but also places a heavy burden on patients. Recognising this gap, the state government, under the National Viral Hepatitis Control Programme (NVHCP), has launched a dedicated initiative to train primary care doctors, enabling them to detect and manage liver diseases at an early stage.

What is the initiative?

Under the NVHCP, a focused training initiative is underway to equip the doctors at PHCs and CHCs with the necessary skills to identify early symptoms of hepatitis B and C, initiate timely treatment, and prevent disease progression.

What is the objective of the programme and how many doctors have been trained so far?

The primary aim of the programme is to strengthen early diagnosis and decentralise care, reducing the dependence on higher-level medical facilities and improving patient outcomes. Over the past year, more than 800 doctors have received specialised training through ECHO (Extension for Community Healthcare Outcomes) virtual learning platform. The training sessions are led by Dr Parveen Malhotra, senior professor and head, department of medical gastroenterology, PGIMS Rohtak, and Dr Parveen Boora, State Nodal Officer, NVHCP Haryana.

Why is the training necessary?

The high prevalence of viral hepatitis and fatty liver disease, coupled with the growing number of patients visiting PHCs, CHCs, and district hospitals, makes it essential to train grassroots-level doctors. “There is an urgent need to empower primary care providers with basic knowledge of hepatitis B and C. The objective is to manage uncomplicated cases locally, while referring complex cases to higher centres like the PGIMS. This approach not only brings treatment closer to patients’ doorsteps but also enhances treatment compliance,” said Dr Malhotra.

How is it proving useful at the primary care level?

Training frontline doctors is already showing significant impact. It allows early detection and timely treatment of liver diseases, particularly hepatitis B, C, and NAFLD. According to Dr Malhotra, early intervention helps prevent progression to liver cirrhosis—a life-threatening condition where liver transplantation often becomes the only solution. Unfortunately, transplants are costly and available at limited government centres, making them inaccessible to most patients. Crucially, Viral Hepatitis and NAFLD together account for nearly 50 per cent of liver cirrhosis cases requiring transplantation. By empowering primary care physicians to manage these conditions early, the programme not only saves lives but also reduces the financial burden on patients and the healthcare system, Dr Malhotra added.

What is ECHO?

ECHO India is a non-profit trust that enables capacity building through its innovative tele-mentoring “Hub and Spoke” model. Dr Sandeep Bhalla (vice-president) and Paromita Das (general manager) said the model connects a central team of experts (the “hub”) with cohorts of learners (the “spokes”) through a virtual platform. The goal is to “move knowledge, not people”, thereby making specialist knowledge accessible to healthcare workers in remote and rural areas using cutting-edge digital infrastructure.