Npcdcs

NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER,DM,CVD AND STROKE

1. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CARDIOVASCULAR DISEASE AND STROKE (NPCDCS) Presented By: Dr. SANTOSH KUMAR SOREN JRA 1 Department of PSM Duration: 30 Minutes

2. OUTLINE 1. Programme background 2. Objectives 3. Strategies 4. Risk Factors 5. Facilities at different level of Health facilities 6. Referral and Treatment 7. Targets 8. New Initiative under the programme 9. Achievement

3. India is experiencing a rapid health transition with a rising burden of non communicable disease (NCDs) which are emerging as the leading cause of death in this country over 42% of all deaths with considerable loss in potentially productive years (Age 35-64 yrs) of life. It is estimated that the overall prevalence of DM, HTN, IHD and Strokes is 62.47, 159.46, 37.00 and 1.54 respectively, per 1000 population of India. As per WHO, development of an integrated approach that targets all major common risk factors of cardiovascular diseases, diabetes mellitus, cancer and chronic respiratory diseases is the most cost-effective way to prevent and control them. Keeping these in view, National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS) was initiated in the second half of 2010 with focus on strengthening of infrastructure, human, resource development, health promotion, early diagnosis , treatment and referral. It was implemented in 100 backward and inaccessible districts across 21 States during 2010-12. National Cancer Control Programme was ongoing since 1975-76 .

4. OBJECTIVES : • Prevent and control common NCDs through behaviour and life style changes, • Provide early diagnosis and management of common NCDs, • Build capacity at various levels of health care for prevention, diagnosis and treatment of common NCDs, • Train human resource within the public health set up viz doctors, paramedics and nursing staff to cope with the increasing burden of NCDs, • Establish and develop capacity for palliative and rehabilitative care, • Support for development of database of NCDs through Surveillance System and to monitor NCO morbidity and mortality and risk factors . The above objectives will enable the country in achieving the WHO voluntary targets related to NCDs.

5. STRATEGIES : The Strategies to achieve the above objectives are as follows: 1 . Health promotion, awareness generation and promotion of healthy lifestyle 2. Early Diagnosis through screening 3. Timely, affordable and accurate diagnosis 4. Access to affordable treatment 5. Rehabilitation 6. Supervision, monitoring and evaluation

6. The focus of NPCDCS is on promotion of healthy life styles, early diagnosis and management of diabetes, hypertension, cardiovascular diseases and common cancers e.g.cervix cancer, breast cancer and oral cancer . Risk factors and levels of Non Communicable Diseases Prevention and Management Behavioural Risk Factors Physiological Risk Factors Disease Outcome • Tobacco • Alcohol • Physical inactivity • Diet Primary prevention (Health Promotion) • Overweight, Obesity • Blood pressure • Blood glucose • Cholesterol • Chronic respiratory diseases Secondary prevention (Early diagnosis and Case Management) • Heart disease • Stroke • Diabetes • Cancer Tertiary prevention (Case Management and Rehabilitation)

7. HEALTH PROMOTION The major risk factors for cancer, hypertension, obesity, diabetes and cardiovascular diseases are unhealthy diet, physical inactivity, stress and consumption of tobacco and alcohol . Attempts are being made to prevent these risk factors by creating general awareness about the NCDs and promotion of healthy life style habits among the community. Such interventions will be done at all levels of government health facilities and also through the peripheral health functionaries and NGOs.

8. Health Promotion cont… The various approaches such as mass media, community education and interpersonal communication are used for behaviour change focusing on the following messages : • Increased intake of healthy foods • Salt reduction • Increased physical activity/regular exercise • Avoidance of tobacco and alcohol • Reduction of obesity • Stress management • Awareness about warning signs of cancer etc. • Regular health check-up Interpersonal communication is to be carried out through ASHAs/ AWWs/SHGs/Youth clubs, panchayat members etc. for which education material is to be developed at central/state level to facilitate IEC/BCC activities. These workers/groups also help in social mobilisation for diagnostic camps. Targeted intervention programmes will be designed to bring awareness in schools and workplaces.

9. EARLY DIAGNOSIS Screening and early detection of non-communicable diseases especially diabetes, high blood pressure and common cancers would be an important component. The screening of target population (age 30 years and above, and pregnant women) will be conducted either through opportunistic and/or camp approach at different levels of health facilities and also in urban slums of large cities. The screening of the urban slum population would be carried out by the local government/municipalities in cities with population of more than 1 million. The screening of school children will be carried out during the routine school health check-up activity under the school health programme . The suspected cases of diabetes and high blood pressure will be referred to higher health facilities for further diagnosis and treatment.

10. Early Diagnosis Cont.. Opportunistic screening for common cancers (breast, cervical and oral) among the population 30 years and above will be carried out at different levels of health facilities . Screening for prostate cancer at CHC and District Hospital levels in 60 years+ male can also be considered. The HW (F) will be trained for conducting screening so that the same can be also conducted at sub centre level . For screening of diabetes, support for glucometers , glucostrips and lancets would be provided to the states under NHM. AYUSH doctors can play an important role in prevention and control of NCDs through primary health care network. They can be involved in health promotion activities through behaviour change, counselling of patients and their relatives on healthy lifestyle ( healthy diet , physical activity, salt reduction, avoidance of alcohol and tobacco) meditation, yoga, opportllnistic screening for early detection of non-communicable diseases and their risk factors , 'and treatment using Indigenous Systems of Medicine.

11. Early Diagnosis Cont.. Hub and spoke model is proposed for providing comprehensive care, where hub would be the tertiary care hospital/Medical College and spokes would be the districts. The suspected cases from the periphery will be referred to District Hospital and Tertiary Cancer Care (TCC) facilities. The common infrastructure/manpower envisaged can be utilised for early detection of cases, diagnosis, treatment, training and monitoring of programmes such as National Programme for Prevention and Control of Cancer, Diabetes, CVDs and Stroke, National Programme for Health Care of Elderly (NPHCE), National Tobacco Control Programme (NTCP ), National Mental Health Programme (NMHP) etc.

12. FACILITIES AT DIFFERENT HEALTH LEVEL Primary Health Centres (PHC ) Community Health Centres (CHC ) Tertiary Cancer Centre (TCC ) Primary Health Centres (PHC) Health Promotion for behavior and life style changes will be carried out by organising various camps, interpersonal communication, poster, banners etc. Opportunistic screening of population above 30 years will be carried out using BP measurement and Blood Glucose by strip method. The suspected cases of diabetes and hypertension will be referred to CHC of higher health facilities for further d iagnosis and management.

13. Treatment Cont… Community Health Centres (CHC) NCD clinics are being established at CHCs to manage common NCDs like cancer, diabetes , hypertension, cardiovascular diseases and stroke, where comprehensive examination of patients referred by lower health facility/Health Worker as well as of those reporting directly is conducted for ruling out complications or advanced stages of common NCDs. Screening, diagnosis and management (including diet counselling , lifestyle management) and home based care are the key functions of the clinic. For providing effective care at CHC level under the programme , financial assistance has been provided to each CHC for purchase of furniture, equipment, computer etc and recurring expenditure includes support for laboratory investigations (blood sugar measurement, lipid profile, ultrasound, X-ray and ECG etc.) contractual manpower (1 doctor, 2 nurses, 1 counsellor and 1 data entry operator) home based care and miscellaneous expenditures.

14. Treatment (Community Health Centres ) Cont… District Hospital The selected districts have been strengthened to provide comprehensive preventive, supportive and curative services for cancer, diabetes, hypertension and cardio vascular diseases . The district hospital has been provided the financial support for strengthening of Cardiac Care Unit (CCU), NCD clinic, human resource on contract (1 specialist, 2 nurses, 1 physiotherapist, 2 counsellors , 1 data entry operator and 1 care coordinator), drugs arid consumables , transport of referred/serious patients, IEC and miscellaneous expenditure. For care of cancer patients, each programme district hospital has been provided the financial support for day care chemotherapy facility, chemotherapy drugs, hiring of manpower (1 medical oncologist , 1 cyto -pathologist, 1 cyto -pathology technician and 2 nurses ), consumables, investigations ( mammography ) etc.

15. Treatment Cont… Tertiary Cancer Centre (TCC) Under cancer component of the programme , there was provision of one time financial assistance of maximum Rs.6 crore for strengthening of comprehensive cancer care at medical colleges/institutes/district hospitals as TCCs. The comprehensive cancer care included provision of radiotherapy, chemotherapy, surgical oncology and diagnostic facilities . Seven Tertiary Cancer Centers have been strengthened for providing comprehensive cancer care in the country.

16. GUIDELINES FOR REFERRAL AND TREATMENT Government of India has developed operational guideline in 2016 for prevention, screening and control of common, non-communicable disease. Those who systolic BP more than 140 and Diastolic BP more than 190, Random Blood sugar 140 & above would be referred to a Medical Officer at the nearest health facility for confirmation, conducting lab investigation and initiation of treatment. Those who are found positive for pre cancerous/ cancer lesion will be referred by ANM/ Staff nurse in specified screening site to the appropriate PHC/CHC/District Hospital for confirmation and treatment by trained specialists.

17. Guidelines for Referral and Treatment Cont.. 3. One the diagnosis of DM/HTN is established patient must receive at least one month drug from PHC. Once the condition is stable provide the patient with a 3 month supply of Drug with the ANM/ASHA visiting the patient each month for ensuring, compliance, checking on diet and life style modification BP & BS. 4. Patient will go to the PHC for first follow-up at the end of the first three month after diagnosis or sooner if required. An annual specialist consultation at the nodal CHC with NCD clinic is also recommended. 5. Those individual who are on treatment under care of private practitioner they could be offered the choice of taking drugs from the Public Health System.

18. CANCER COMPONENT UNDER NPCDCS Cancer is an important health problem in India with nearly 10Lacs new cases occurring every year in the country. It is estimated that there were 2.8 Million cases in the country at given point of time. In 2010 NCP was integrated with NPCDCS. The objectives of the programme are: Primary prevention of cancer by health education. Secondary prevention i.e. early detection and diagnosis of common cancer like CA Cervix, Mouth, Breast and Tobacco related cancer by screening/ self examination methods. Tertiary prevention i.e. strengthening of existing institutions of comprehensive therapy including palliative care.

19. SCHEMES The schemes under the revised programme are: 1. Regional Cancer Centre Scheme 2. Oncology Wing Development Scheme 3. Decentralized NGO Scheme 4. IEC Activities at Center Level. 5. Research and Training.

20. CANCER SERVICES UNDER NCPDCS Common Diagnostic Service- Basic Surgery, Chemotherapy and Palliative care for cancer cases is made at 100 District Hospitals. Each district is being supported by Rs. 1.66 Crores per annum for the following- Chemotherapy drugs are provided for 100 patients at each District Hospital. Day care Chemotherapy facilities is being established at 100 District Hospitals. Facility for lab investigation including mammography is being provided at 100 District Hospitals. Home based palliative care is being provided for chronic, debilitating and progressive cancer patients at 100 District Hospitals. 4. Support is being provided by contractual man power through 1 Medical Onchologist , 1 Cytopathologist , 1 Cyto pathology Technician, 2 Nurses for day care. 5. Altogether 45 centers were to be strengthened at TCCs to provide comprehensive cancer services at a cost of 6 Crores in each during 2011-12.

21. WHO has developed a comprehensive global monitoring framework for prevention and control of NCDs (2013-2020), which was endorsed by World Health Assembly in May 2013. This includes 9 voluntary targets. Indicators and Targets for NCD Prevention & Control in India: Framework element Target Outcome 2020 2025 Premature mortality from NCDS Relative reduction on overall mortality found CVD , DM, Cancer or COPD 10% 25% Alcohol use Relative deduction in alcohol use 5% 10% Obesity & Diabetes Halt the rise of obesity and Diabetes prevalence No midterm target is set Physical inactivity Relative reduction and prevalence of insufficient physical activity 5% 10% Raised BP Relative reduction in prevalence of raised BP 10% 25%

22. Indicators and Targets for NCD Prevention & Control in India…Cont Framework element Target Outcome 2020 2025 Sodium intake Relative reduction in population intake of salt, recommended level of less than 5gm per day 20% 30% Tobacco use Relative reduction I prevalence of current tobacco use 15% 30% Drug therapy to prevent MI & Strokes Eligible people receiving drug therapy and counseling to prevent MI & Strokes 30% 50% Essential NCD medicines and basic technologies to treat major NCDs Availability and affordability of quality, safe and efficacious essential NCD medicines in both public and private facilities 60% 80% Household indoor air pollution Relative reduction in household use of solid fuels as a primary source of energy for cooking 25% 50%

23. NEW INITIATIVES UNDER THE PROGRAMME 1. Inclusion of guidelines for prevention and management of COPD, CKD under NPCDCS. 2. For early detection of DM, HTN, Common Cancers in the community guidelines are being issued to state for initiating population based screening of common NCDs. Pilot projects on integration of AYUSH with NPCDCS has been initiated in 6 districts in the country. The practice of Yoga is an integral part of the intervention. Pilot intervention has been initiated for prevention and control of Rheumatic fever and RHD under the platform of NPCDS and Rashtriya Bal Swasthya Karyikaram (RBSK). Integration of RNTCP with NPCDS wherein the national framework for joint tuberculosis and diabetes collaborative activities.

24. CAPACITY BUILDING OF HUMAN RESOURCE For capacity building of health personnel the Nation Institute of Health and Family Welfare (NIHFW) has been identified as a nodal agency under the programme . During 11 th Plan about 800 Doctors are trained for health promotion, prevention, early diagnosis and management of DM, HTN, CVD and Strokes. However the specialized training in cancer care and management of CCU is to be taken up during 12 th Plan. BUDGET The total cost of the programme is estimated to be about 11000 Crores . This programme would be on cost sharing basis of 75:25 with Govt. of India and State except States in North East and Hilly Areas, where the share would be 90:10 between Center and State.

25. ACHIEVEMENTS On March 2016 the programme is under implementation in all 36 States/ UTs. The total of 298 District NCD Cell and 293 District NCD Clinic have been established in the country. There are 103 functional Cardiac Care Units for emergency cardiac care and 64 Day Care centre for cancer care at the district level in the country.

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