National Program for Prevention and Control of Non communicable Diseases (NP- NCD)
National Program for Prevention and Control of Non communicable Diseases (NP- NCD)
Non Communicable Diseases (NCDs) are chronic diseases that are not transmissible from one person to another. Taking this definition into account, NCDs may thus include wide spectrum of medical disorders both acute and chronic like Cancers, Diabetes, Hypertension, Cardiovascular Diseases and Stroke, Chronic Kidney Diseases (CKDs), Chronic Obstructive Pulmonary Diseases (COPDs) and Asthma, Non- Alcoholic Fatty Liver Disease (NAFLD), and a gamut of other diseases.
As per WHO, the NCDs are collectively responsible for more than 74 percent of all deaths worldwide including heart disease, stroke, cancer, chronic respiratory diseases and diabetes.1) These diseases have public health importance globally and in India. NCDs cause significant morbidity and mortality, both in urban and rural population and across all socio-economic strata, with considerable loss in potentially productive years of life. NCDs are also responsible for the maximum out-of-pocket expenditure on health.2) The economic output lost due to NCDs excluding mental conditions is estimated to be $ 3.55 trillion for India for the period of 2012-2030.3) Taking cognizance of these facts, Sustainable Development Goal 3 (Target 3.4) aims to reduce premature mortality from NCDs by one-third by 2030 in the world. SDG-3 also stresses on prevention and control of tobacco and alcohol use .4,5) The National Health Policy, 2017 also emphasises the need to halt and reverse the incidence of NCDs and seeks to focus on common NCDs.6 NCDs are emerging as a major public health challenge worldwide and people above the age of 30 years are most at risk of getting such diseases. India is also experiencing rapid demographic and epidemiological transitions with a steep rise in the burden of lifestyle related chronic NCDs. With rapid epidemiological transition with higher Disability-Adjusted Life Years (DALYs) and mortalities, prevention and control measures for NCDs are required to be accelerated to reduce the burden of NCDs in India.
Burden of Non Communicable Diseases-
Global Scenario:
The global NCD burden remains unacceptably high. NCDs are responsible for 41 million of the world’s annual deaths. 17 million of these deaths were premature (30 to 70 years). Burden is greatest within low- and middle-income countries, where 77 percent of all NCD deaths and 80% of premature deaths occurred.1 Among NCDs, the four top killers that together account for more than 80% of all premature NCD deaths annually include cardiovascular diseases (17·9 million), cancers (9.3 million), chronic respiratory diseases (4.1 million), and diabetes (2.0 million).
Indian Scenario:
| · As per the WHO – NCD India profile – 2018, NCDs are estimated to account for 63% of all deaths in country of which the cardiovascular diseases lead with 27% overall mortality cause followed by chronic respiratory diseases (11%), cancers (9%), diabetes (3%) and others (13%) | |
| · As per India State-Level Disease Burden Initiative CVD Collaborators – 2016, there were 54.5 million cases of cardiovascular diseases, 23.8 million cases of ischemic heart diseases, 6.5 million cases of stroke, 55 million cases of COPD, 38 million cases of asthma and 65 million cases of diabetes.8 In 2016, cardiovascular diseases were responsible for 28.1 percent deaths, while chronic respiratory diseases contributed to 10.9 percent deaths and cancers contributed to 8.3 percent deaths.7 Four common NCDs (Cardiovascular Diseases, Cancers, Chronic Respiratory Diseases and Diabetes) account for 23 percent of the total premature mortality in 30-70 years age group.1 |
Risk factors:
- Most NCDs are strongly associated with major risk factors such as:
- Tobacco use (smoking and smokeless)
- Alcohol use
- Unhealthy diets
- Insufficient physical activity
- Air pollution (indoor and outdoor)
- If above risk factors are not managed, they may lead to the following biological risk factors:
- Overweight/obesity
- Raised blood pressure
- Raised blood sugar
- Raised total cholesterol/lipids
- The other factors due to which an individual might develop NCDs are:
- Stress
- Hereditary factors
Behavioural and physiological risk factors associated with NCDs and the disease outcome.
National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and stroke (NPCDCS).
NPCDCS programme is implemented in phasewise manner in following districts.
| Sr.No. | Year | No. of Dist. | Name of the District | |
| 1 | 2010-11 | 2 | Wardha & Washim | |
| 2 | 2011-12 | 4 | Amravati, Bhandara, Chandrapur and Gadchiroli | |
| 3 | 2014-15
|
5 | Nandurbar, Osmanabad, Parbhani Satara and sindhudurg | |
| 4 | 6 | Thane, Pune, Nashik, Jalana, Nanded, Ratnagiri | ||
| 5 | 2017-18 | 17 | Rest 17 districts (Akola, Ahemadnagar, Aurangabad, Beed, Buldhana, Dhule, Gondiya, Hingoli, Kolhapur, Jalgaon, Nagpur, Latur, Solapur, Raigad,Sangli, Palghar, Yavatmal) | |
| 6 | 2020-21 | 2 | 2 NUHM (Mumbai and Suburban) | |
| Total | 36 | |||
In 2023-24, Government of India has changed the program name from National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and stroke (NPCDCS) into National Program for Prevention and Control of Non communicable Diseases (NP- NCD)
Objectives of National Programme for Prevention and Control of NCDs:
- The objectives of NP-NCD are as follows:
- Health promotion through behaviour change with involvement of community, civil society, community-based organizations, media and development partners.
- Screening, early diagnosis, management, referral and follow-up at each level of healthcare delivery to ensure continuum of care.
- Build capacity of health care providers at various levels for prevention, early diagnosis, treatment, follow-up, rehabilitation, IEC/BCC, monitoring and evaluation, and research.
- Strengthen supply chain management for drugs, equipment and logistics for diagnosis and management at all health care levels.
- Monitoring, supervision and evaluation of programme through proper implementation of uniform ICT application across India.
- To coordinate and collaborate with other programmes, departments/ministries, civil societies.
Ø Strategies of NP-NCD:
Following are the strategies of the programme:
- Health promotion for prevention of NCDs and reduction of risk
- Screening, early diagnosis, management, referral and follow up of common
- Capacity building of health care
- Evidence based standard treatment
- Uninterrupted drug and logistics
- Task sharing and people-centered
- Information system for data entry, longitudinal patient
- Monitoring, supervision, evaluation and surveillance including technology enabled
- Multi-sectoral coordination and linkages with other National
- Implementation research and generation of
- MANAGEMENT STRUCTURE
| Composition | Roles and Responsibilities | |
| State NCD Cell | Joint Director (NCD)-State Nodal Officer
State Program Manager State Program Coordinator Finance cum Logistic Consultant Data Entry Operator |
· Prepare State Action plan.
· Develop district wise information of NCD diseases. · Organize trainings. · Ensure appointment of sanctioned staff. · Release of funds and submit SOE and UC. · Maintaining MIS. · Monitoring the program · Public awareness through IEC/ BCC · Convergence with NRHM activities. |
| District NCD Cell | Civil Surgeon –District Nodal Officer
District Program Officer District Program Coordinator Finance cum Logistic Consultant Data Entry Operator |
· Prepare District Action plan.
· Maintain and update district data base. · Conduct sub district/ CHC trainings. · Maintain fund flow and submit UC. · Maintaining District MIS. · Public awareness through IEC/ BCC · Convergence with NRHM activities/other related departments. |
Ø Package of services
| Level of care | Package of services |
|
Community level |
• Active enumeration of the eligible population and registration of the families, risk assessment of NCDs using Community Based Assessment Checklist (CBAC), Mobilization of community for screening of NCDs at nearest AB-HWC.
• Health promotion, lifestyle modification, follow up for treatment compliance and lifestyle modification. |
|
Sub-centre / SHC-HWC |
• Health education for awareness generation and behaviour change, organising wellness activities.
• Screening of Diabetes, Hypertension, three common cancers (oral, breast and cervical). • Referral of suspected cases to PHC/PHC-HWC or nearby health facility for diagnosis confirmation and management. SHC- HWC team to also facilitate the referrals and follow up on referred suspected patients. • Dispensing of prescribed medicines and follow up of patient for treatment compliance and lifestyle modification. • Tele consultation services from SHC-HWC to HWC- PHC/UPHC. • Maintaining Electronic Health Records (EHR) and generation of ABHA IDs. |
|
PHC / PHC- HWC/ UPHC- HWC |
• Health promotion activities including wellness activities for behaviour change.
• Screening of Diabetes, Hypertension, three common cancers (oral, breast and cervical), COPD and Asthma, CKD, NAFLD among OPD attendees. • Confirmation of diagnosis, treatment initiation, and management of common NCDs as per standard management protocol and guidelines. • Referral of complicated NCD cases to higher facilities. Bi-directional referral linkages to be established and follow up to be ensured. • Tele consultation services and counselling services. • Maintaining Electronic Health Records (EHR) and generation of ABHA IDs. |
|
CHC/SDH |
• Health promotion including counselling.
• Opportunistic screening of Diabetes, Hypertension, three common cancers (oral, breast & cervical). • Screening of COPD and Asthma, CKD, NAFLD, STEMI among suspected cases. • Confirmation of diagnosis, treatment initiation, and management of common NCDs as per standard management protocol and guidelines • Teleconsultation services and counselling services. • Maintaining Electronic Health Records (EHR) and generation of ABHA IDs. • Management of cases of common NCDs and regular follow-up. • Referral of complicated cases to District Hospital/higher healthcare facility. |
|
District Hospital |
• Opportunistic screening of Diabetes, Hypertension, three common cancers (oral, breast and cervical).
• Screening of COPD and Asthma, CKD, NAFLD, STEMI among suspected cases. • Diagnosis and management of cases of common NCDs: outpatient and inpatient care, including emergency care particularly for cardiac and stroke cases. • Management of complicated cases of common NCDs, or referral to higher healthcare facility. • Follow-up cancer chemotherapy and palliative care services for cancer cases, physiotherapy services for NCDs including Stroke patients, Dialysis facilities for CKD patients, etc. • Health promotion for behaviour change and counselling for NCD cases. IEC activities on important Health Days. • Bidirectional referral linkages and follow up mechanism to be established and ensured. • Tele consultation services and counseling services. • Maintaining Electronic Health Records (EHR) and generation of ABHA IDs. |
| Medical College/ Tertiary Cancer Centres | • Diagnosis and management of complicated cases of common NCDs acts as tertiary referral facility.
• Comprehensive cancer care including prevention, early detection, diagnosis, treatment, palliative care and rehabilitation at Tertiary Cancer Centres. • Support programme in capacity building of health staff. • Support programme in preparing standard guidelines and protocols. • Support in supervision, monitoring, evaluation and operational research. • Bidirectional referral linkages and follow up mechanism to be established and ensured. • Teleconsultation services and counselling services. • Maintaining Electronic Health Records (EHR) and generation of ABHA IDs |
- Population Based Screening (PBS) Programme –
National NCD Portal assists the healthcare providers and managers in service delivery and monitoring of Population Based Screening (PBS) for Non Communicable diseases (NCDs) at all levels (National, State, District, Block, PHC and Sub Centre level). The software addressed key issues of making Electronic Health Record (EHR), standardizing the recording and reporting system, creating unique personal health ID, streamlined the upward and downward referrals across health facilities, tracking follow-up, preparation of work plan for the health personnel and digitizing health record for every individual. The NCD application has also automated, referral management of NCDs.
The system enables population enumeration, risk assessment and screening of the entire population and collects information on risk factors for NCDs for 30+ population and management and follow up of those found to be diagnosed with any of the five NCDs. The system is used by health workers and mid-level health providers at Sub-Health centres and doctors and Nurses at Primary Health Centre. The programme managers at district, state and national level regularly access the dashboards to seek implementation insights. Community health workers, nurses, doctors, and programme managers can use these applications on devices like phones, tablets, or computers.
Main objective
- ASHA would administer Community Based Assessment Checklist (CBAC) for all individuals of 30 years and above age group in the population.
- Through CBAC administration, a scoring is done for individuals, which is not a point of elimination but a score of 4 or more implies high risk.
- In addition, the tool includes questions related to symptoms of cervical cancer, breast cancer, oral cancer and Chronic Obstructive Pulmonary Diseases (COPD) and Asthma.
- All the identified individuals of age 30 years and above are referred for screening of common NCDs.
- PBS is implemented phasewise manner in all 34 districts of Maharashtra.
| The National NCD Portal is a suite of 6 applications: | |
| ASHA Mobile App | To capture Population enumeration and CBAC Assessment |
| HWC App | To screen the population for five common NCDs and enable referrals to PHC by ANM/CHO at the SHC, HWCs |
| PHC Web Portal and App | To validate patient screening, complete diagnosis/ manage/ refer to higher centres by MO in PHC and backward referrals for follow-ups. Mobile app version is about to be launched for the same. |
| CHC/DH Portal and App | To confirm diagnosis of patients referred from PHCs and initiate treatment and backward referrals. |
| Admin Portal | To manage the master data for facility and users at district and state levels |
| Health Officials Dashboard | Dashboard for district, State and National NCD officials to monitor the status of programme implementation and NCD indicators. |
a) Opportunistic Screening: – For persons of 30 years and above age who report directly in OPD of PHC, NCD screening should be carried out by a Medical Officer, aided by the PHC Nurse. Such screening involves history-taking (such as family history of NCDs, personal history of behavioural risks factors e.g. alcohol consumption, tobacco use, unhealthy dietary habits, physical inactivity etc.), general physical examination and calculation of BMI, blood pressure measurement, blood sugar estimation etc. to identify those individuals who have NCDs as well as those at risk of developing NCDs. The diagnosed individuals are counseled and put on lifestyle modifications and treatment.
OTHER INITIATIVES –
Public Health Department, Maharashtra implementing National Program for Non-Communicable diseases. Access to affordable cancer for one and all project provides technical support in effective implementation of below mentioned strategies of public health department
- Health promotion for prevention of Common Cancers and reduction of risk factors.
- Screening, early diagnosis, management, referral and follow up of common Cancers.
- Capacity building of health care providers for health education, Early diagnosis and timely treatment
- Monitoring, supervision, evaluation and surveillance.
- Multi-sectoral coordination and linkages with other National Programs.
- Gap analysis and Infrastructure development
Following are the key interventions and services started at public health facilities of Govt. of Maharashtra under technical support from Access to affordable cancer care for one and all, Maharashtra
- Maharashtra Cancer Warrior Services –
- Maharashtra Cancer Warriors (MCW) are the alumina of Tata Memorial Centre. Under the Project we have restarted the services in Phase 2 which were stopped due to COVID Pandemic.
- Under this initiative TMH Alumina visit District Hospitals Twice in a Month and provide cancer OPD and IPD services depending on the infrastructure available at respective Hospital level.
- The details thereof are as follows,
*For Tertiary cancer care facility
- Day Care Chemotherapy –
- Under the Capacity Building components, we have started Day Care Chemotherapy centers in Maharashtra the services details are as follows,
- Cancer Diagnosis Van :-
- Providing cancer diagnostic vans in 35 districts to diagnose cancer in rural areas.
- At present approval has been received for the purchase of 8 mobile cancer diagnostic vans, which will provide preventive oncology facilities and diagnosis, biopsy and histopathology facilities.
- For this, in the year 2023-24, the supplementary demand rate is Rs. 8 crore funds have been sanctioned. This year 8 mobile cancer diagnosis vehicles have been procured in the state.
- This cancer van will help in early diagnosis of common cancer cases.
- STEMI (ST Elevation in Myocardial Infarction) Project –
The death and disability due to coronary artery diseases have markedly increased in last couple of decades. 3% to 4% of Indians in rural areas and 8% to 10% in urban areas have CAD. According to government data, the death has increased due to Heart diseases in year 2016.
Main Causes of Heart Diseases –
- Hypertension and Diabetics
- Family History
- Unhealthy Diet
- Physical Inactivity and sedentary lifestyle
- Tobacco chewing, Alcohol addiction
- Stress
Objectives
- Reduce mortality in-patient with Acute Myocardial Infarction by catering to unmet needs of in the treatment of AMI.
- Raise awareness among community regarding recognition of warning signs of acute myocardial infarction and availing emergency services in such episodes
About STEMI Project
Project is based on spokes and hub model.
Spoke – The Sub District Hospital and District Hospital with functional CCU/ ICU and/or capability to handle cardiac emergency will be included as spoke. 145 spoke have been identified across the state. Facilities designated as spoke will have two beds reserved for admission of MI patients will be well equipped to handle emergencies.
ECG machines will be installed in these spokes which will be connected with Cloud. ECG reading will be sent to specialist with cloud connectivity and within 10 minutes specialist will diagnose the patient and prescribe the treatment. If a patient is suffering from MI, Specialist will instruct the facility trained staff for thrombolysis under their supervision. Hence, Patient will get span of 24 hours after thrombolysis to be transferred to Hub.
Hub – Hub are the tertiary cardiac centre where cardiologist and CATH labs services are available and performs surgeries like Angiography, Angioplasty and Bypass. (Ex. Medical Colleges, Govt. University, Private hospitals empanelled under Mahtama Jyotiba Phule Arogydayi Yojana –MJPAY) services/ surgeries in these will be free of cost.
- MOU signed between Commissionerate of Health Services, Mumbai & Service provider Tricog Health India on 23/04/ 2024 for provision of technology based ECG & Interpretation services under STEMI Maharashtra
- STEMI Maharashtra Project expansion in 34 districts by inclusion of 2126 Health facilities as spokes (In process)
220 Facilities includes:
– RH/SDH/DH/GH/WH in additional 22 districts.
– 1906 PHCs in 34 Districts
Beneficiary:
Citizens
Benefits:
As above
How To Apply
Online