NPCDCS - Prevention and Control of Cancer, Diabetes Cardiovascular Diseases and Stroke

India has been experiencing a rapid demographic, environmental and lifestyle-related transitions. As a result, there has been a major transition in the magnitude and pattern of diseases across the nation. While cases of communicable diseases and reproductive and nutritional disorders have seen a decline, there has been a rise in non-communicable diseases (NCDs), including chronic lung diseases, heart ailments, cancer and diabetes. 60% of deaths are the result of NCDs in the country. Over half of death cases due to NCDs are premature affecting productive population. Effective control of NCDs is necessary due to economic and social implications caused by premature deaths and disabilities.

For the purpose of preventing and controlling major NCDs, the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010 in 100 districts across 21 states. The programme focuses on health promotion, early diagnosis, management and referral of cases, in addition to strengthening the infrastructure and capacity building.

(Note - Information on this page has been sourced from the websites of National Health Systems Resource Centre and Directorate General of Health Services.)

Features and Benefits of NPCDCS

The features and benefits of the programme are as follows:

  • Health promotion, awareness and promotion of healthy lifestyle
  • Access to inexpensive treatment
  • Rehabilitation
  • Screening and early detection
  • Timely, affordable and exact diagnosis

Objectives of NPCDCS

The objectives of the programme are as follows:

  • Health promotion through behaviour change by encouraging involvement of community, community-based organizations, civil society, media etc.
  • Population-based screening and opportunistic screening at every level in the healthcare delivery system for early detection of diabetes, hypertension and common cancers. Outreach camps are envisaged.
  • To control and prevent chronic NCDs, particularly common cancer, hypertension and diabetes.
  • To build capacity at different levels of healthcare for prevention, treatment, early diagnosis, rehabilitation, IEC/BCC and operational research.
  • To support diagnosis and affordable treatment at primary, secondary and tertiary levels of healthcare.
  • To support development of database of NCDs via Surveillance System and monitor NCD morbidity and mortality and risk factors. States are granted funds under NCD Flexi-Pool via State PIPs of respective States/UTs, with the Centre to State share in ratio of 60:40 (other than for North-Eastern and Hilly States, where the proportion is 90:10).

There is the Tertiary Care Cancer Centers Scheme that aims to establish/strengthen 20 State Cancer Institutes and 50 TCCCs for providing comprehensive cancer care in the nation. There is a provision for allowing a ‘one time grant’ of Rs. 120 crores per SCI and Rs. 45 crores per TCCC, which is to be utilized for building construction and procurement of equipment, with the Centre to State share in the ratio of 60:40 (other than for North-Eastern and Hilly States, where the ratio is 90:10).

Achievements of NPCDCS

  • For programme management, State NCD Cells have been set up in 36 States/UTs. District NCD Cells have been set up in 390 district headquarters. (This data is until March 2017).
  • Provision has been made to offer free diagnostic facilities and free drugs to NCD patients at NCD clinics in the district and CHC levels. Until March 2017, 388 District NCD Clinics and 2115 CHC NCD Clinics have been set up in the nation. Additionally, 133 Cardiac Care Units for emergency Cardiac Care and 82 Day Care Centres for cancer chemotherapy have been established in identified districts.
  • For preventing and controlling common NCDs in the community, a new strategy for Population-based Screening of common NCDs has been initiated under the umbrella of NHM.

Package of Services

Health FacilityPackages of Services
PHC• ‘Population based/Opportunistic’ Screening of diabetes, hypertension and three common cancers - breast, oral, and cervical.
• Clinical diagnosis and treatment of common NCDs, including diabetes and hypertension, referral of complicated cases of DM/HTN to CHC/DH.
• Identification of early signs of common cancer.
Sub Centre• Generate awareness of early warning signs of common cancer and other risk factors of NCDs.
• ‘Population based/Opportunistic’ Screening of common NCDs.
CHC/FRU• Early diagnosis via clinical and laboratory investigations.
• Diagnostics facilities: Total Cholesterol, Lipid Profile, Blood sugar, Blood Urea, Creatinine, X-Ray, ECG and USG Opportunistic’ Screening of common cancers - Oral, Breast and Cervix.
• Management of common NCDs
• Referral of complicated cases to higher healthcare facility
Medical CollegeMentoring district hospitals, diabetes, early diagnosis and management of cancer, CVDS and other associated illnesses, health personnel training, operational research
District Hospital• Diagnosis and management of cases of CVDs, COPD Stroke, Diabetes, and Cancer, including emergency services especially for Myocardial Infarction & Stroke.
• Lab. investigations and diagnostics: Blood sugar, Lipid Profile, KFT, LFT, X-Ray, ECG, USG ECHO, CT Scan, MRI, etc.
• Referral of complicated cases to higher healthcare facility. ‘Opportunistic’ Screening of NCDs.
• Follow-up chemotherapy for cancer cases, rehabilitation and physiotherapy services.
Tertiary Cancer Centre• Mentoring of district hospital and outreach activities,
• Training health personnel
• Operational research

Outcomes Expected

The programme and interventions would create a comprehensive sustainable system for bringing down the rapid rise of non-communicable diseases, disabilities and deaths as a result of NCDs. The below outcomes are expected.

  • Decrease in exposure to risk factors, lifestyle changes resulting in reduction in non-communicable diseases.
  • Better quality of life
  • Early detection and on-time treatment leading to increase in cure rate / control and survival.
  • Decrease in prevalence of physical disabilities, providing user-friendly health services to the elderly population of the country.
  • Decrease in deaths and disability because of burns, trauma and disasters.
  • Decrease in out-of-pocket expenses on management of NCDs, thus preventing catastrophic implication on those who are affected.

Initiatives Under The Programme

  • For preventing and controlling common NCDs, a new strategy for population-based screening of common non-communicable diseases has been initiated under the umbrella of NHM. This will make use of the services of the Frontline-workers and health-staff of the existing Primary Healthcare System in screening of NCD risk factors and early detection and referral of NCDs. Operational Guidelines have been introduced and training of the states has been initiated.
  • Guidelines for preventing and managing Chronic Obstructive Pulmonary Disease and Chronic Kidney Disease are being included in the programme to prevent and manage the chronic respiratory and kidney diseases, respectively.
  • A pilot project on ‘Integration of AYUSH with NPCDCS’ has been initiated in six districts. This includes Bhilwara, Gaya, Surendranagar under Central Council for Research in Ayurvedic Sciences; Krishna and Darjeeling under Central Council for Research in Homeopathy; and Lakhimpur-Kheri under Central Council for Research in Unani Medicine.
  • Pilot intervention has been introduced for preventing and controlling Rheumatic Fever and Rheumatic Heart Disease under the platforms of NPCDCS and Rashtriya Bal Swasthya Karyakram, in three districts.
  • RNTCP has been integrated with NPCDCS. Here, the “National Framework for Joint Tuberculosis-Diabetes collaborative activities” has been developed to articulate a strategy for ‘bi-directional screening’, early detection and improved management of tuberculosis and diabetes comorbidities.
  • Opportunistic screening of common NCDs is being done among the IITF attendees at Pragati Maidan, New Delhi from 14 to 27 November every year. In addition to such diseases and lifestyle related risk factors, this initiative helps to boost awareness about the prevention and control of NCDs. On an annual basis, over 70,000 persons are screened at the IITF. Suspected cases of diabetes, hypertension and common cancers get referred to designated hospitals for further management.
  • An application, referred to as mDiabetes, has been launched for awareness generation, to promote adherence of treatment and develop healthy habits among the public with special focus on certain groups.

Conclusion

Non-communicable diseases are presently the leading cause of preventable deaths and disability in the country. To control and prevent this, the government introduced the National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010. This programme was integrated with the National Health Mission in 2013 to allow opportunistic screening for common NCDs, at District and CHC levels, via NCD clinics.