National programme for prevention and control of non communicable disesases

National programme for prevention and control of non communicable diseases.

1. National Programme for the Prevention and Control of
Non-Communicable Diseases
(NP-NCD)
COMMUNITY MEDICINE SEMINAR
Presented by
ROLL NOS. 199 to 204

2. 199
•Overview of NCDs
•Introduction and Evolution of NP-NCD
200•Organizational structure of NP-NCD
•Strategies and Finances of NP-NCD
201•Diabetes, Cancer, STEMI, Stroke, Hypertension
•COPD, Asthma, NAFLD
202
•CKD and Pradhan Mantri National Dialysis Program
•Monitoring and Evaluation of NP-NCD
•Targets and Achievements under NP-NCD
204
•Newer Initiatives and Updates under NP-NCD
•Linkage with Sustainable Developmental Goals
•Linkages with other programs
PLAN OF PRESENTATION

3. •Overview of Non-Communicable Diseases
•Introduction and Evolution of NP-NCD
•Introduction of National Multisectoral Action Plan
SIMRAN SWETA
Roll no. 199
SUBTOPICS COVERED

4. Non-Communicable Diseases
Non-communicable diseases (NCDs) are medical conditions or diseases
that are not caused by infectious agents. These are chronic diseases of long
duration, and generally with slow progression and are the result of a
combination of genetic, physiological, environmental and behavioural
factors.
Source: https://www.wbhealth.gov.in/NCD/

5. Impairment or deviation from normal and have one or more of following:
●Permanent
●Leave residual disability
●Non reversible pathological alteration
●Require special training of the patient for rehabilitation
●Require a long period of supervision, observation and care.
Source : Park’s Textbook of Preventive & Social Medicine

7. Global burden of NCDs
●According to WHO, NCDs are responsible for 41 million of the world’s annual
deaths.
●Four top killers among NCDs that account for more than 80% of all premature
NCD deaths include :
Source: Operational guidelines NPNCD (2023-2030)

8. Probability of premature mortality from NCDs
Source : WHO NCD data portal (2019) (https://ncdportal.org/)

9. Burden of NCDs in India
●As per WHO-NCD India profile 2018, NCDs
are estimated to account for 63% of all
deaths in country.
●As per the report of National Cancer
Registry Program (2020), the incidence of
cancer in India is 13.92 lakhs.
●According to the report of Global Adult
Tobacco Survey (GATS-2) (2016-2017), there
are 266.8 million(18.82%) tobacco users in
India.
Source: Operational guidelines NPNCD (2023-2030)

10. Non-modifiable risk factors:
●Age,
●Gender
●Hereditary factors
●Race
Risk factors
Modifiable risk factors:
●Tobacco use
●Alcohol use
●Unhealthy diets
●Insufficient physical activity

11. Source : Operational guidelines NPNCD (2023-2030)

12. Evolution of
NPNCD
National Programme for
Prevention & Control of
Non-Communicable
Diseases

14. Under NPCDCS:
●NCD Cells are established at National, State and District levels along with
NCD Clinics at District and CHC levels.
●For district level activities under NPCDCS, States are given financial
support under the umbrella of NHM. The funds are being provided to States
under NCD Flexi-Pool, with the Centre to State share in ratio of 60:40.
●Cardiac Care Units (CCU)are also being set up for providing emergency
Cardiac Care & Day Care Centres for Cancer care.

15. 1.Health promotion.
1.Screening, early diagnosis, management, referral & follow-up.
1.Capacity building of health care providers.
1.Strengthening supply chain.
1.Monitoring, supervision and evaluation of programme.
1.Multi-sectoral coordination.
Objectives of NPNCD:
Source: Operational guidelines NPNCD (2023-2030)

16. Population Based Screening
●Launched in the year 2016, PBS helped in better management of diseases by
early detection.
●Under this initiative, persons more than 30 years of age are targeted.
●Screening services are being provided for common NCDs including :
Hypertension, Diabetes and three common (cervical, breast & oral) cancers .
Source: NMAP for Prevention and control of NCDs Revised version (Oct 2017)

17. •Organizational structure of NP-NCD
•Strategies and Finances of NP-NCD
SNEH CHAUDHARY
Roll no. 200
SUBTOPICS COVERED

18. Organizational Structure Overview
District NCD Division
Headed by: District Nodal
Officer/ District Programme
Officer
Contractual Staffs
-District Programme
Coordinator - Finance cum
Logistics Consultant - Data
Entry Operator
-Located at: District
Programme Management
Unit (DPMU) or other space.
3
State NCD Division
Headed by: Mission
Director, NHM
Technical Support:
Senior-level Health
Services Officer
Contractual Staffs:-
-State Programme
Coordinator
- Finance cum Logistics
Consultant
- Data Entry Operator.
2
National NCD Division
Headed by: Joint Secretary
(NCD), MoHFW
Technical Staff: Deputy Director
General (DDG), Dte. GHS,
Officials, Staffs, Consultants
1
2

19. Central Level Organizational Structure
District action plan
including physical
and financial
targets
Ensure identified
key human
resources at health
facilities
Maintain district
epidemiological
profile for identified
NCDs
Ensure regular
supply of drugs,
diagnostics and
logistics.
Monitor
implementation of
NP-NCD
Conduct health
promotion and
public awareness
activities.
Preparation of
District PIP for
submission to State
NHM
Organize trainings
for capacity
building at all levels
of human resources
Coordination with
other related
National and State
Health Programmes

20. State Level Organizational Structure

21. District Level Organizational Structure

22. NP-NCD Strategies Overview
OBJECTIVES
•Health promotion through behavior
change.
•Screening, early diagnosis,
management, referral, and follow-
up at each healthcare delivery level
•Capacity building for healthcare
providers.
•Strengthening supply chain
management for drugs and logistics.
•Monitoring and evaluation through
uniform ICT application.
•Coordination with other programs
and sectors.
STRATEGIES
•Health promotion and risk factor
reduction.
•Screening and early diagnosis.
•Evidence-based treatment
protocols.
•Uninterrupted supply of drugs and
logistics.
•Task sharing; people-centered care.
•Information systems-patient
records.
•Multi-sectoralcoordination.
•Implementation research for
evidence

23. Activities at Community level
●Active enumeration of the eligible population and registration of families done by
ASHA .
●Risk assessment using Community Based Assessment Checklist (CBAC) for all the
individuals .
●Health promotion
●Mobilization for screening of NCDs.
Operational Strategies:
●Utilize community forums like VHSNC(Village Health Sanitation & Nutrition
Committee ), MAS(Mahila Arogya Samitis), SHGs(Self-help Groups) for awareness
and promotive activities.
●Skill enhancement of frontline workers (ASHA, ANMs).
●Follow-up visits for behavior change and treatment adherence.

24. Activities at Sub-Centre
• 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.
• Teleconsultation services from SHC-HWC to HWC- PHC/UPHC.
• Maintaining Electronic Health Records (EHR) and generation of ABHA IDs

25. Operational Strategies:
●Organize wellness activities and IEC campaigns.
●Facilitate referrals and track referred patients.
●Counsel patients and their families on lifestyle modifications.

26. Activities at PHC
• 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.
• Teleconsultation services and counselling services.
• Maintaining Electronic Health Records (EHR) and generation of ABHA IDs
Operational Strategies:
●Ensure bidirectional referral linkages and follow-up mechanisms.
●Maintain Electronic Health Records (EHR) and generate ABHA IDs.
●Utilize teleconsultation services.

27. Activities at CHC
• Health promotion including counselling.
• Opportunistic screening of Diabetes, Hypertension, three common cancers (oral,
breast and 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
•Data recording and reporting to district NCD division on the 7th day of every month

28. Activities at 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.

29. • 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.
• Teleconsultation services and counselling services.
• Maintaining Electronic Health Records (EHR) and generation of ABHA IDs.
• Data reporting to state NCD division on 7th day of every month

30. Activities at Tertiary Cancer Centres/Medical
College
•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

33. Overview of NP-NCD finances
●The finances for the National Programme for Prevention and Control of Non-
Communicable Diseases (NP-NCD) are managed under the common NCD
flexi-pool of the National Health Mission (NHM).
●This funding structure provides states and union territories (UTs) with the
flexibility to budget and reallocate funds for NCD interventions within their
respective NHM Programme Implementation Plans (PIP).
●States and UTs are required to integrate their budget for NCD interventions
within their State NHM PIP.
●The flexi-pool mechanism permits states to allocate funds across various
components under the overall NCD budget. This flexibility allows for reallocation
among different components, with approval from the Government of India, while
adhering to the broad framework of NP-NCD.

34. Project Implementation Plan (PIP)
●The PIP is developed to propose budgets for regular and need-based activities
biennially, ensuring that all necessary interventions are adequately funded.
●A bottoms-up approach is followed where the planning process starts at the
district level and works its way up to the national level i.e. the MoHFW

35. •Diabetes, Cancer, STEMI, Stroke, Hypertension
•COPD, Asthma, NAFLD
SNEHA
Roll no. 201
SUBTOPICS COVERED

36. RISK FACTORS
Non ModifiableModifiable
•Age
•Sex
•Family History
•Genetic Factors
•Obesity
•Elevated serum cholesterol
•Cigarette smoking
•Alcohol
•Sedentary habits
•Stress

37. DIABETES MELLITUS

38. Prevalence
•Globally in 2021 around 537 million individuals are living with diabetes , making up 10.5% of the global population.
•In India ,there are estimated 77 million people above the age of 18 are suffering from diabetes and nearly 25 million people are prediabetics.


SOURCE : https://www.who.int/india/health-topics

39. EPIDEMIOLOGICAL TRIAD
SOURCE : K park 27th edition
AGENT
HOSTENVIRONMENT
•Pancreatic disorder
•Defects in insulin formation
•Destruction of B cells
•Decreased insulin sensitivity
•Genetic defects
•Autoimmunity
•Age
•Gender
•Genetic factors
•Obesity
•Maternal
Diabetes
•Sedentary lifestyle
•Diet
•Alcohol
•Malnutrition

40. SCREENING
1.Blood sugar estimation
2.Glycated Haemoglobin(HbA1C) by autoanalyzer
Diagnosis



https://main.icmr.nic.in/sites/default/files/guidelines/ICMR_GuidelinesType2diabetes2018
Parameter Normoglycemia (mg/dl)Prediabetes(mg/dl)Diabetes (mg/dl)
WHO ADAWHO ADA
FPG < 110 < 100 110-125 100-125
(IFG) (IFG)
≥ 126
2-h PG < 140140-199(IGT) ≥ 200
HbA1C< 5.7%5.7-6.4%≥ 6.5%
Random plasma glucose≥ 200 (with symptoms
of diabetes)

41. Guidelines for referral and treatment
Refer to a Medical Officer

Nearest facility for laboratory investigations

Confirmed diagnosis

Primary Healthcare Centre

SOURCE : Operational Guidelines Of NPNCD 2023-30
RBS ≥ 140 mg/dL

42. Treatment
1 month’s supply of drugs
Three month supply with regular visit by ANM/ASHA for compliance checking
OR
Three month stock with ANM at centre, to be given to the patient each month
Follow up at Primary Healthcare
Centre after end of three months
Annual Specialist Consultation at
nearest CHC with an NCD clinic
( LFT ,KFT, Serum Electrolyte ,
Fundus examination)

43. mDIABETES
A free SMS based programme aimed at generating awareness on healthy living,
disseminating diabetes specific information and helping diabetics to adhere to
the treatment.
SOURCE : Operational Guidelines Of NPNCD 2023-30

44. HYPERTENSION

45. Prevalence
•According to NFHS – 5, 2021
= 24% and = 21% (aged above 15 years)
Warning signs



SOURCE : K park 27th edition

46. Screening
•Blood pressure measurement
Source : JNC VIII guidelines https://www.ahagenerals.org
CategorySystolic Diastolic
Normal < 120< 80
Pre –hypertension 120 -13980-89
High Blood Pressure
Stage 1140 -15990-99
Stage 2160 or higher100 or higher

47. Indian Hypertension Control Initiative (IHCI)
•(IHCI) is a multi- partner initiative between MOHFW, ICMR, WHO & State government.
• IHCI was launched in November 2017 and was implemented in 25 districts across 5 states
•By December 2020, IHCI was expanded to 52 districts across ten states.
•Adopted “25 by 25” goal.



SOURCE :https://www.ihci.in/

48. SOURCE : https://www.ihci.in/

49. CANCER

50. Prevalence
•As per National Cancer Registry program (2020), the prevalence of cancer is
estimated to be 3.6 million.
•Nearly 800,000 persons die every year due to cancer in India.
•As per the Globocan data, incidence of cancer in India 2020 :-
Breast cancer - 25.8%
Oral cancer - 14.8% in males
4.6% in females
Cervical cancer - 18%

SOURCE : Operational Guidelines Of NPNCD 2023-30

51. EPIDEMIOLOGICAL TRIAD
AGENT
HOST ENVIRONMENT
SOURCE : K park 27th edition
•Biological (Viruses , parasite)
•Nutritional (Dietary factors)
•Chemical (tobacco and
Alcohol)
•Age
•Sex
•Genetic
•Custom
•Habits
•Behaviour
•Physical (sunlight, air
pollution)
•Biological
•Social

52. Screening methods for some common cancers
SOURCE : Operational Guidelines Of NPNCD 2023-30
Name of diseaseTest
Breast Cancer•Breast examination
•Mammography
•FNAC
Cervical Cancer•VIA Screening
•PAP Smear
•Colposcopy
Oral Cancer•Mouth cavity examination
•Biopsy and histopathology

53. Self Breast Examination Cervical cancer sampling

54. National Cancer Registry Programme
•In India National cancer Registry program under ICMR. It provides data on
incidence , mortality and distribution of cancer
•National cancer control programme was launched in 1975-76
•In 2010 this programme was integrated with NPCDCS
•Schemes included
v Regional cancer centre scheme
vOncology wing development schemes
vDecentralized NGO Scheme
vResearch and training
SOURCE : K park 27th edition

55. Tertiary Care Cancer Centres(TCCC) Scheme
•This scheme aims to strengthen State cancer institutes (SCI) and TCCCs for
providing comprehensive cancer care in the country .
• There is a provision for giving a ‘one time grant’ of Rs. 120 crore per SCI and
Rs. 45 crore per TCCC, to be used for building construction and procurement
of equipment .
• Centre to state share in the ratio of 60:40 (except for North –Eastern and hilly
states, where the share is 90:10).
SOURCE : Operational Guidelines Of NPNCD 2023-30

56. STEMI

57. Prevalence
•In India, IHD accounts for 23.8 million cases . As per India –State Level
Disease Burden Initiative 2016 .
•1st Leading cause of death.



SOURCE : Operational Guidelines Of NPNCD 2023-30
Warning signs
•Chest pain
•Nausea , sweating
•Pain in jaw , neck ,shoulder , back

58. Screening
At CHC / District Hospital
•Blood Pressure Management
•Blood Sugar Estimation
•ECG
•Lipid Profile Test
•Cardiac Enzyme Test (Troponin , Creatinine , Kinase , Myoglobin)
•C - Reactive Protein Test
•Platelet Function Test
•Bleeding Time
•Clotting Time
SOURCE : Operational Guidelines Of NPNCD 2023-30

59. STROKE

60. Prevalence
•Strokes accounts for 1.17 million cases and 7,00,000 deaths in 2016.
•3rd leading cause of death.

Warning signs


SOURCE : Operational Guidelines Of NPNCD 2023-30

61. Screening
At CHC / District Hospital
•Blood Pressure Measurement
•Blood Sugar Estimation
•CT – Scan / MRI with or without Contrast
•Bleeding Time
•Clotting Time
•Lipid Profile Test


SOURCE : Operational Guidelines Of NPNCD 2023-30

62. Critical Care Units Set-up
•Under Pradhan Mantri – Ayushman Bharat Health Infrastructure Mission ( PM –
ABHIM ) Scheme, the financial and technical support is provided to all States/UTs
for establishments of 50 to 100 bedded Critical care Units [ Cardiac Care Unit
(CCU)/ Cardiac and stroke Care Unit (CSCU)] in all district with 5 lakh population
•Special training will be given to health professional and nurses
•All will district hospitals will have support for diagnostics facilities
•In case the facility is not available in the district hospital, these investigations may
be outsourced in Public Private Partnership (PPP) model / pattern or as per state
policy/practice .
•Thrombolysis services could be provided .

SOURCE : Operational Guidelines Of NPNCD 2023-30

63. CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASTHMA

64. Prevalence
•There are 37.8 million cases of COPD contributing to 17.8% of the global
burden .
•There are estimated 34.3 million cases of asthma contributing to 13% of
global burden
RISK FACTORS
SOURCE : Medical officer manual for prevention and management for COPD and Asthma
Modifiable Non modifiable
•Tobacco use
•Indoor & outdoor air pollution
•Allergens
•Occupational agents
•Secondhand smoke
•Age
•Hereditary

65. Screening
•Pulse Oximeter AT CHC / PHC / District
•Peak Flow Meter Hospital
•Spirometer
•X- Ray At CHC /District
•Arterial Blood Gas Analyzer Hospital
SOURCE : Operational Guidelines Of NPNCD 2023-30

66. Protocol for screening and diagnosis
SOURCE : Medical officer manual for prevention and management for COPD and Asthma

67. NON- ALCOHOLIC FATTY LIVER DISEASE

68. Prevalence
•It is estimated that approximately 1 billion individuals are affected worldwide.
•In India, 9% -32% of the general population is affected .
Risk factors
•Obesity
•Diabetes mellitus
•Hypercholesterolemia
•Metabolic syndrome
•Hypothyroidism

SOURCE : Operational guidelines for the integration of NAFLD into NPCDCS

69. SCREENING
At CHC / District Hospital
•Liver Function Test
• Lipid Profile Test
• Fibroscan

SOURCE : Operational Guidelines Of NPNCD 2023-30

70. CHC LEVEL
DISTRICT HOSPITAL LEVEL
•Detailed investigation and management of the patient which were referred
through PBS will be done in District Hospital.
•Risk stratification for advanced liver disease will be done .

SOURCE : Operational guidelines for the integration of NAFLD into NPCDCS
CHC MO takes history, clinical examination and USG is done
If diagnosed with NAFLD•Perform LFT and CBC
•Calculate FIB 4 or NFS score

71. STATE LEVEL
•Implementation of National guidelines for diagnosis and treatment of NAFLD
•Adapt, translate, and dissemination plan for IEC.
NATIONAL LEVEL
•Designing of the training manual of ASHA, Multi Purpose Worker, Community
Health officer, Staff Nurse and Medical
•Capacity building of master trainers
•Design and dissemination of Information Education and
Communication(IEC)
•Develop the Monitoring and evaluation Framework for NAFLD component
SOURCE : Operational guidelines for the integration of NAFLD into NPCDCS

72. •Chronic Kidney Disease – Pradhan Mantri National
Dialysis Program
•Monitoring and Evaluation of NP-NCD
•Targets and Achievements of NP-NCD
SNEHA CHOUDHARY
Roll no. 202
SUBTOPICS COVERED

73. CHRONIC KIDNEY DISEASE
•Prevalence in India: 17% (2016)
•9th most frequent cause of death (2017)
•Rising burden: 30th cause of DALYs in 1990

20th cause of DALYs in 2016CKD
Need for affordable and accessible dialysis services
across the country
Sources – [1] Guidelines for establishing peritoneal dialysis services, MoHFW
[2] https://www.kidney.org
•Dialysis – lifetime requirement
•Large out-of-pocket expenditure

74. PMNDP
Pradhan Mantri National Dialysis Program
•Announced in the 2016 Union
Budget
•Aim – strengthen District Hospitals
to provide affordable dialysis
services
•Model – Public-Private Partnership
Service Provider
•Medical HR
•Dialysis machine
•RO water plant
•Dialyser
•Consumables
Payer Government
•Space in DH
•Drugs
•Water, power supply
•Cost of dialysis
Source – Evaluation report of Pradhan Mantri National Dialysis Program

75. FINANCING
PMNDP
Pradhan Mantri National Dialysis Program
For BPL Patients
100% expenses
covered by Govt
under NHM
For non-BPL Patients
Same rate as paid by
Govt for the BPL
patient (subsidized)
PHASES
First phase (2016)
Hemodialysis
2019
Peritoneal dialysis
IMPLEMENTED IN ALL 36 STATES/UTs
Source – Guidelines for establishing peritoneal dialysis services, MoHFW

76. PMNDP Portal
•Launched – 5th May 2022 by Health
Minister
•Concept – “One Nation One Dialysis”
•Portability and Accessibility
•Building of “Renal Registry” – visibility
of vacant slot
Source – https://pmndp.mohfw.gov.in/en
SCHEDULING

77. MONITORING AND EVALUATION
TARGETS AND ACHIEVEMENTS

78. MONITORING OF NP-NCD
•Day-to-day follow up of activities
during their implementation
•Data derived from program reports.
What is monitoring?
Source – [1] Park’s Textbook of Preventive and Social Medicine, 27th Edition
[2]Training Manual for NCD Programme Managers at State and District Level
Collection of data on
specified indicators
Reporting to program
managers at intervals
Indicates
・extent of progress
・achievement of
objectives
・use of resources

79. MONITORING OF NP-NCD
•Progress reports/ statistics
•Staff meetings – monthly,
quarterly, annually
•Supervisory visits
•Periodic reviews (eg. Common
Review Mission)
WHY MONITOR?
“What gets measured,
gets done”
Methods
Source – Training Manual for NCD Programme Managers at State and District Level

80. MONITORING OF NP-NCD
•Progress reports/ statistics
•Staff meetings – monthly,
quarterly, annually
•Supervisory visits
•Periodic reviews (eg. Common
Review Mission)
Data
Methods
Source – Training Manual for NCD Programme Managers at State and District Level

81. NATIONAL NCD PORTAL
•Software for implementation and monitoring of NP-NCD – by
MoHFW, Tata Trusts, Dell
•Comprises 6 Applications as per hierarchy
ASHA Mobile App
HWC App
PHC Web Portal and App
CHC/DH Portal and App
Admin Portal
Health Officials Dashboard
Source – Operational Guidelines NP-NCD 2023-2030

82. NATIONAL NCD PORTAL
•Population enumeration (> 30
years)
•Risk assessment
•Screening
•Collection of information of risk
factors
•Management and follow up of
cases
•Software for implementation and monitoring of NP-NCD – by
MoHFW, Tata Trusts, Dell
•Comprises 6 Applications as per hierarchy
Role of the Digital System
Source – Operational Guidelines NP-NCD 2023-2030
CDSS
CLINICAL DECISION
SUPPORT SYSTEM

83. Studies by WHO,
NGOs; Research by
medical colleges
Achievement of
yearly targets
Monthly program
report; National
NCD Portal
EVALUATION OF NP-NCD
Measures –
•The degree to which objectives and
targets are fulfilled
•Quality of results obtained
•Productivity of available resources in
achieving objectives
Involves collecting SPECIAL DATA on an
as-and-when required basis (cf. monitoring)
3 COMPONENTS
Concurrent
evaluation
Annual
Evaluation
External
evaluation
1
2
3
What is evaluation?
Source – [1] Park’s Textbook of Preventive and Social Medicine, 27th Edition
[2]Training Manual for NCD Programme Managers at State and District Level

84. INDICATORS IN NP-NCD
•Existence of 5 “layers/steps” of the Program
INPUT

PROCESS
OUTPUT
OUTCOME
IMPACT
•Infrastructure
•Human
resources
•Training
•Advocacy and
communication
•Enrolment and
ABHA-ID
creation
• Screening
•Proportion of
individuals with
NCD under
control
•Reduced
incidence of
HTN and DM
•Creating a monitoring and evaluation
framework requires indicators at each such
step.
Indicators
⇩
TARGETS
Source – [1] Training Manual for NCD Programme Managers at State and District Level
[2] Operational Guidelines NP-NCD 2023-2030

85. TARGETS
NATIONAL NCD MONITORING FRAMEWORKWHO-GLOBAL NCD MONITORING
FRAMEWORK
Source – [1] Operational Guidelines NP-NCD 2023-2030
[2] https://www.who.int/publications/i/item/ncd-surveillance-global-monitoring-framework

86. TARGETS
10 NATIONAL NCD TARGETS9 GLOBAL NCD TARGETS
Source – [1] https://stroke.ncdirindia.org/NCD_Action.html
[2] https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1

87. NATIONAL MONITORING FRAMEWORK
for Prevention and Control of NCDs
10 TARGETS
FOR 2025
Drug therapy and
counselling coverage
(to prevent heart
attack and stroke)
by 50%
↓ Alcohol use by 10%
↓ Premature
mortality from NCDs
by 25%
↓ Household air
pollution by 50%
↓ Tobacco use by
30%
Essential
medicines and
technologies
coverage by 80%
↓ Prevalence of
raised BP by 80%
↓ Prevalence of
insufficient physical
activity by 25%
↓ Mean population
intake of salt by 30%
Halt the rise in
obesity and diabetes
prevalence (0%
increase)
Source – National Multisectoral Action Plan for Prevention and control of Common NCDs 2017-2022

88. NATIONAL MONITORING FRAMEWORK
for Prevention and Control of NCDs
21 INDICATORS
MORTALITY AND MORBIDITY
•Unconditional probability of
dying between ages of 30
and 70 from NCDs
•Cancer incidence by type of
cancer
RISK FACTORS
•Alcohol use
•Diabetes and Obesity (3)
•Physical inactivity (2)
•Raised blood pressure
•Salt/sodium intake
•Tobacco use (2)
•Household air pollution
•Low fruit and vegetable
intake
NATIONAL SYSTEMS
RESPONSE
•Drug therapy to prevent
heart attacks and strokes
•Essential NCD medicines
and basic technologies to
treat major NCDs
•Cervical cancer screening
•Oral cancer screening
•Breast cancer screening
•Access to palliative care
•Hepatitis B vaccine
2 12 7
Source – https://stroke.ncdirindia.org/NCD_Action.html

89. How have we obtained the baseline data and how do we know if
these targets are being achieved?
SURVEYS

90. NATIONAL NON-COMMUNICABLE DISEASE
MONITORING SURVEY: NNMS
•Survey by the ICMR-NCDIR, Bengaluru in
collaboration with 11 institutes
•To monitor India’s progress towards
achieving the 10 National NCD Targets
•September 2017 to July 2018

VISIONNationally representative survey to establish baseline and assess progress towards
achieving NCD targets
Source – NNMS 2017-18 Factsheet

91. ACHIEVEMENTS UNDER NP-NCD
•Yet to know if targets are being achieved – proposed surveys based on
prototype of NNMS
•Significant achievements under NP-NCD: FacilityCumulative no. of
facilities established
As on
01.04.14
As on
30.09.22
Cardiac
Care Units
(CCU)
61193
District
Day Care
Centers
38268
Source – [1] pc.odisha.gov.in/sites/default/files/2023-01/Non%20Communicable%20Diseases%20%20Nutrition%20Lifestyle%20%26%20Management.pdf
[2] 2022-23 Annual Report Department of Health and Family Welfare MoHFW GoI

92. ACHIEVEMENTS UNDER NP-NCD
30 CRORE PERSONS SCREENED FOR COMMON
NCDs AT HWCs – Health and Wellness Centers
Source – pc.odisha.gov.in/sites/default/files/2023-01/Non%20Communicable%20Diseases%20%20Nutrition%20Lifestyle%20%26%20Management.pdf

GRAPHS SHOW
NUMBER OF
PERSONS
SCREENED AT
HWCs

93. ACHIEVEMENTS: NATIONAL NCD PORTAL
Source – https://ncd.nhp.gov.in

94. ACHIEVEMENTS: PMNDP
Source – https://pmndp.mohfw.gov.in/en

95. WORLD HEART DAY
29th SEPTEMBER
NATIONAL CANCER
AWARENESS DAY
4th FEBRUARY
WORLD DIABETES DAY
14th NOVEMBER
ACHIEVEMENTS: NCD HEALTH DAY CAMPAIGNS

96. ACHIEVEMENTS: NCD HEALTH DAY CAMPAIGNS
WORLD KIDNEY DAY
9th MARCH
WORLD STROKE DAY
31st OCTOBER
WORLD HYPERTENSION DAY
17th MAY

97. OTHER INITIATIVES: “BEST PRACTICES”
Source – 2nd Chief Secretaries’ Conference New Delhi

98. CHALLENGES
•Inadequate medicine supply, equipment
•Inadequate training, shortage of health workers
•Inadequate financing (<0.5% GDP for NCDs)
•Deficiency of emergency services, palliative care
•Limited demand generation through health
promotion
Sources – [1] Nath A. Health systems challenges and opportunities in tackling non-communicable diseases in rural areas of India. Natl Med J India. 2021
[2] Thakur JS. Burden of noncommunicable diseases and implementation challenges of National NCD Programmes in India. Med J Armed Forces India. 2020
[3] National Multisectoral Action Plan for Prevention and control of Common NCDs 2017-2022

99. OPPORTUNITIES
mDiabetes NMAP PMNDP ToT
workshops
Source – Nath A. Health systems challenges and opportunities in tackling non-communicable diseases in rural areas of India. Natl Med J India. 2021

100. •Newer Initiatives and Updates under NP-NCD
•Linkage with Sustainable Developmental Goals
•Linkages with other programs
SOMYA
Roll no. 204
SUBTOPICS COVERED

101. NEWER INITIATIVES
1. Population based screening (PBS) [Age>30] expanded to >400 districts for 5
common NCDs i.e., HTN, Diabetes, Cancers of the oral cavity,cervix and breast
2. Initiation of NCD App (Jan 2021)
3. Under Ayushman Bharat, NCDs included in the services provided
4. Pradhan Mantri National Dialysis Program (PM-NDP) implemented in 35
States/UT in 496 districts (Dec2022)
5. Inclusion of prevention, early detection & treatment of Rheumatic fever and
rheumatic heart diseases(2016)

102. 6. “National framework for Joint Tuberculosis-Diabetes collaborative activities” has
been developed for ‘bi-directional screening’
7. National Multi-sectoral Action Plan has been developed (2017-22)
8. Inclusion of prevention & management of Chronic Pulmonary Disease (COPD) &
Chronic Kidney Disease (CKD) (2016)
9. India Hypertension Management Initiative (ICMR collaboration)
10. Opportunistic screening among attendees of the India International Trade Fair
(IITF) at Pragati Maidan, New Delhi during 14-27 November, every year.

Source: https://dghs.gov.in/content/1363_3_NationalProgrammePreventionControl.aspx

103. ●Focussing on the technology and IT based solution in healthcare, Ayushman
Bharat Digital Mission (ABDM) was launched
●Ayushman Bharat Health Account (ABHA) is an unique identifier(self-declared
username) that enables to share and access health records digitally.

104. WHO Global Action Plan (2013-2030)
(for the Prevention & Control of NCDs)
●On 66th World Health Assembly, WHO Global NCD Action Plan 2013-2020
made
VISION: A world free of the avoidable burden of noncommunicable diseases.
GOAL: To reduce the preventable and avoidable burden of morbidity, mortality and
disability due to noncommunicable diseases. It has“25 indicators 9 voluntary global
targets by 2025”
●On the basis of 77th World Health Assembly(June2024): Implementation
roadmap has been developed 2023–2030 for the Global action plan for the
prevention and control of NCDs in the response of the recommendations of
the mid-term evaluation of the global action plan(2013-2020).
Source: (https://www.who.int/teams/noncommunicable-diseases/governance roadmap)

105. Voluntary Global Targets

107. NMAP
●National Multisectoral Action Plan (NMAP) was introduced to offer roadmap and policy
options to guide multisectoral efforts involving other Ministries/Departments.
Vision
Goal
“All Indians enjoy the highest attainable status of health, well-
being and quality of life at all ages, free of preventable
Noncommunicable Diseases (NCDs) and premature death.”
Promote healthy choices, reduce preventable morbidity, avoid
disability and premature mortality due to NCDs in India.

108. Newer Initiatives
1. Population based screening (PBS) [Age of 30yr or above] expanded to >400
districts for 5 common NCDs i.e., HTN, Diabetes, Cancers of the oral cavity,cervix and
breast
2. Initiation of NCD App (Jan 2021)
3. Under Ayushman Bharat, NCDs included in the services provided
4. Pradhan Mantri National Dialysis Program (PM-NDP) implemented in 35
States/UT in 496 districts (Dec2022)
5. Inclusion of prevention, early detection & treatment of Rheumatic fever and
rheumatic heart diseases(2016)

109. 6. “National framework for Joint Tuberculosis-Diabetes collaborative activities” has
been developed for ‘bi-directional screening’
7. National Multi-sectoral Action Plan has been developed (2017-22)
8. Inclusion of prevention & management of Chronic Pulmonary Disease (COPD) &
Chronic Kidney Disease (CKD) (2016)
9. India Hypertension Management Initiative (ICMR collaboration)
10. Opportunistic screening among attendees of the India International Trade Fair
(IITF) at Pragati Maidan, New Delhi during 14-27 November, every year.
Source: https://dghs.gov.in/content/1363_3_NationalProgrammePreventionControl.aspx

110. WHO Global Action Plan (2013-2030)
( for the Prevention & Control of NCD)
●On 66th World Health Assembly, WHO Global NCD Action Plan 2013-2020 made
VISION: A world free of the avoidable burden of noncommunicable diseases.
GOAL: To reduce the preventable and avoidable burden of morbidity, mortality and disability
due to noncommunicable diseases.
It has“25 indicators & 9 voluntary global targets by 2025”
●On the basis of 77th World Health Assembly(June2024): Implementation roadmap has
been developed 2023–2030 for the Global action plan for the prevention and control
of NCDs in the response of the recommendations of the mid-term evaluation of the
global action plan(2013-2020).
Source: (https://www.who.int/teams/noncommunicable-diseases/governance roadmap)

111. NMAP
●National Multisectoral Action Plan (NMAP) was introduced to offer roadmap and policy
options to guide multisectoral efforts involving other Ministries/Departments.
Vision
Goal
“All Indians enjoy the highest attainable status of health, well-
being and quality of life at all ages, free of preventable
Noncommunicable Diseases (NCDs) and premature death.”
Promote healthy choices, reduce preventable morbidity, avoid
disability and premature mortality due to NCDs in India.

112. Four strategic action areas :
Source: NMAP for Prevention and control of NCDs Revised
version (Oct 2017)

113. SDGs in relation to NCDs
Source: https://
ncdalliance.com

114. Linkages with other Programmes
1.Joint TB-diabetes collaborative activities
2.National Programme for Palliative care (NPPC)
3.Integration with National Urban Health Mission (NUHM)
4.National Oral Health Programme (NOHP)
5.National Tobacco Control Programme (NTCP)
6.National Programme for Health Care of Elderly (NPHCE)
7.National Programme for Control of Blindness and Visual Impairment (NPCB&VI)
8.Fifteenth Finance Commission (FC-XV) on Health Sector Grants
9.Ayushman Bharat - Pradhan Mantri – Ayushman Bharat Health Infrastructure Mission
(PM-ABHIM)

115. 10.Ayushman Bharat - PM-JAY
11.Ayushman Bharat-NDHM(National Digital Health Mission)
12.Emergency Response and Health System Preparedness Package (ECRP)
13.Rashtriya Bal Swasthya Karyakram (RBSK)
14.Rashtriya Kishor Swasthya Karyakram (RKSK)
15.Maternal health
16.e-Sanjeevani
17.Affordable Medicines and Reliable Implants for Treatment (AMRIT)
18.Rastriya Arogya Nidhi (RAN)

116. Thank You!