National NCD Programmes and Challenges 1 Outline Understand

National NCD Programmes and Challenges 1

Outline Understand the following regarding NPCDCS and NCD program in India • • • Policy and Strategic framework for implementation Objectives, Strategies and Activities Infrastructure Areas of integration with other health programmes Progress Challenges 18 February 2021 2

Programmes related to NCDs in India 1. 2. 3. 4. 5. 6. 7. 8. NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular disease and Stroke) National Mental Health Programme National Iodine Deficiency Disease Control Programme Pradhan Mantri National Dialysis Programme National Fluorosis Control Programme National Oral Health Programme National Blindness Control Programme National Deafness Control Programme We will focus mainly on NPCDCS 18 February 2021 3

Policy & Strategic Framework for Implementation (as perceived in 2010 at the time of launch in 100 districts) • • • In India, the estimated deaths due to NCDs in 2008 were 5. 3 million The overall prevalence of diabetes, hypertension, ischemic heart diseases (IHD) and stroke in India was 62. 47, 159. 46, 37. 00 and 1. 54 respectively per 1000 population. It was estimated that there were about 28 lakh cases of different type of cancers in the country with occurrence of about 11 lakh new cases and about 5 lakh deaths annually. • Govt. of India had already launched a flagship program called National Health Mission (NHM) in 2005 with the objective of expanding access to quality health care to rural populations. • Different States also had initiated some of the activities for prevention and control of noncommunicable diseases (NCDs) especially cancer, diabetes, CVDs and stroke. • In this scenario, the Central Govt. proposed to supplement their efforts by providing technical and financial support through NPCDCS. 18 February 2021 4

Background about National Health Mission (NHM) The crucial strategies under NHM were • • • Integration of Family Welfare and National Disease Control Programmes under an umbrella approach for optimization of resources and manpower; Strengthening of outreach services by incorporation of village health worker called ASHA; Efforts for communitization of services through formation of Health and Sanitation Committees at village, block and district level; Registering Rogi Kalyan Samities for improving hospital management; Strengthening and upgrading the public health infrastructure to Indian Public Health Standards (IPHS); and Consolidation of the District Level Programme Management Unit through the induction of professionals. 18 February 2021 5

Integration of NCD interventions in NHM through NPCDCS • For optimization of scarce resources and provision of seamless services to the end customer / patients and ensuring long term sustainability of interventions. • Sharing administrative and financial structure of NHM became a crucial programme strategy. • The NCD cell at various levels would ensure implementation and supervision. • Simultaneously, it would attempt to create a wider knowledge base in the community for effective prevention, detection, referrals and treatment strategies through convergence / linkage with the ongoing interventions: • National Health Mission (NHM) including National Tobacco Control Programme (NTCP), National • Mental health Programme and National Programme for Health Care of Elderly (NPHCE) Convergence with other programmes dealing with (i) communicable diseases like TB, (ii) RCH, (iii) Adolescent /School Health etc. 18 February 2021 6

Objectives of NPCDCS • Health promotion through behavior change with involvement of community, civil society, community based organizations, media etc. • Opportunistic screening at all levels in the health care delivery system from subcentre and above for early detection of diabetes, hypertension and common cancers. Outreach camps were also envisaged. • To build capacity at various levels of health care for prevention, early diagnosis, treatment, IEC/BCC, operational research and rehabilitation. • To support for diagnosis and cost effective treatment at primary, secondary and tertiary levels of health care. To support for development of database of NCDs through Surveillance System and to monitor NCD morbidity and mortality and risk factors. • 18 February 2021 7

Strategy • Health promotion, awareness generation and promotion of healthy lifestyle • Screening and early detection • Timely, affordable and accurate diagnosis • Access to affordable treatment • Rehabilitation 18 February 2021 8

• The programme division at the national level would develop broad guidelines and strategy for implementation of different components of the programme. • The States may adopt and modify these guidelines as per their need and circumstances for implementation of the programme. • Involvement of community, civil society and private sector partnership would be vital, and suitable guidelines would be made for the same. 9

Strategy. . 2 • Establishment/Strengthening of Health infrastructure • Human Resource development • Integration with AYUSH • Public private partnership • Research and surveillance • Monitoring & evaluation 18 February 2021 10

• • Recent initiatives: • Universal NCD Screening (Populations based screening) • IT software (NCD Application) developed for recording and reporting • Inclusion of COPD & CKD interventions under programme Expected Outcome : establish a comprehensive sustainable system for reducing rapid rise of NCDs, disability as well as deaths due to NCDs 11

Activities • Package of services enlisted for various government health facilities • Key monitoring indicators and targets set • Institutional framework for the implementation of NPCDCS activities prepared • • Integration with NHM, State Health Society and District Health Society • Technical resource groups planned Establishment/Strengthening of Health infrastructure • PHCs, SCs, CHCs, DH, NCD Clinics, Cardiac Care Units, Support for Cancer and Lab strengthening 18 February 2021 12

• Management structure: • National NCD Cell, State NCD Cell and District NCD Cell • Financial guidelines prepared along with HR-TORs and indicative list of equipment & drugs • Different types of forms and reporting formats also designed • New components added later such as guidelines for one time financial assistance under Tertiary Cancer Care Scheme 13

National NCD Cell S C CD ture P N truc as r f In State NCD Cell District NCD Clinic Cardiac & Stroke Care Unit Day Care Cancer Centre CHC NCD Clinic PHC / Health & Wellness Centres Sub-centre / Health & Wellness Centres 18 February 2021 14

Scale-up of NPCDCS 2017 -18: 2013 -14: • Rolled out in 36 States/UTs • Integration with NHM • TCCC Scheme initiated Total 669 districts approved 2015 -16: Total 468 districts approved 2018 -19: Total 708 districts approved 2010: Program launched in 100 districts of 21 States 18 February 2021 15

Scale-up of Infrastructure (cumulative no. of facilities established) 36 36 36 21 State NCD Cell District NCD Cell 96 District NCD Clinic 95 452 390 298 179 667 644 639 616 495 388 293 180 CHC NCD Clinic 1362 204 0 18 February 2021 2018 -19 2017 -18 2016 -17 2015 -16 2014 -15 2013 -14 192 175 156 133 88 65 61 Cardiac Care Unit 2019 -20 500 1000 1500 2115 1587 2000 3827 2519 2500 3000 3500 4000 4406 4500 5000 16

Diagnosis of common NCDs in District/CHC NCD Clinics in last six years (Opportunistic screening data) No. of persons diagnosed in lakhs 70 58, 42 60 2014 -15 (n=59. 2 lakh) 2015 -16 (n=129 lakh) 2016 -17 (n=224 lakh) 2017 -18 (n=466 lakh) 2018 -19 (n=680 lakh) 2019 -20 (n=661 lakh) 49, 96 50 40 30 20 10 7, 15 5, 59 2, 26 0, 61 0 Diabetes 18 February 2021 Hypertension CVDs 0, 77 0, 11 Common Cancer 17

Areas of integration of NPCDCS with other Health Programmes (under NRHM/NUHM) 18 February 2021 18

Progress: Publications regarding different aspects of programme • Guidelines and Training Modules for different category of personnel: • Program manager at State & District level, MO, SN, ANM, ASHA, Counselors, MPWs, CHWs, etc. • IEC material, flip charts, etc to be used at different levels • Guidelines and training manual on integration of ayurveda in NPCDCS • Operational guidelines on integration of homeopathy in NPCDCS 18 February 2021 19

Progress: Publications regarding different aspects of programme • Training manual on integration of unani medicine in NPCDCS • Guidelines for Population based screening • National framework for joint TB-Diabetes collaborative activities • National multi sectoral action plan for prevention and control of common NCDs 20

Challenges in NPCDCS implementation IEC & Advocacy: ◦ Strong advocacy & IEC needed to raise public awareness and develop strategies to modify risk factors Finance & Logistics: ◦ Irregular supply of drugs/consumables in NCD clinics: an issue in most States ◦ On one hand there is low Central budget allocation for NCD, and on the other hand, there is under-utilisation of NPCDCS budget in many States 18 February 2021 21

Challenges in NPCDCS implementation Monitoring & Evaluation: ◦ Regular Hand-holding supervision by Programme Managers ◦ Robust ‘Data-base of NCDs’ needed to understand landscape of NCDs & associated risk factors, so as to plan evidence-based local response ◦ Management Information System is the need of the hour: Online/Web-based reporting system Human Resource: ◦ Recruitment of Staff and their Capacity Building under NPCDCS at all levels ◦ State/District Nodal Officer has many additional charges ◦ Under HR-rationalisation policy of NHM, dedicated contractual manpower for NPCDCS provided for Service Delivery at NCD Clinics, as per case-load and need 22