NPCDCS NATIONAL PROGRAM FOR CONTROL OF DIABETES CARDIOVASCULAR DISEASES STROKE Dr Shamin Eabenson

NPCDCS ppt Dr Shamin Eabenson

1. NATIONAL PROGRAM FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CARDIOVASCULAR DISEASE AND STROKE Dr Shamin Eabenson 1

2. Dr SHAMIN EABENSON 2

3. Burden of Non-communicable Diseases India is experiencing a rapid health transition with large and rising burden of NCD, especially CVD, DM, cancer, stroke. It is estimated that NCD’s account for 60% of all deaths as per WHO report 2014. Considering the fact that the burden of NCD is surpassing the burden of communicable diseases in India, the need for National Programme for prevention & control of Cancer, DM, CVD & Stroke, envisaged. 3

4. During the 11 th five year plan period, this programme was launched in January 2008, The programme was implemented in 20,000 subcenters in 700 community healthcenter in 100 identified districts across 21 states. Under 12 five year plan(2012-13) the programme is beeing expanded to all the districts across the country with focus on strengthening of infrastructure, human resource development, health promotion, early diagnosis, treatment and referral for prevention and control of cancer, diabetes, cardiovascular diseases and stroke. 4

5. Objectives of NPCDCS 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 setup viz doctors, paramedics and nursing staff to cope with the increasing burden of NCDs, and Establish and develop capacity for palliative & rehabilitative care. 5

6. Strategies Promotion of healthy life styles-by education Early Diagnosis Treatment Capacity building of human resource Surveillance, Monitoring & Evaluation 6

7. Promotion of healthy life styles- by education   Awareness about major risk factors like, unhealthy diet, physical inactivity, stress, warning signs of cancer and consumption of tobacco & alcohol. Education through - mass media, community programmes , interpersonal communication, and social mobilization through NGO's 7

8. Early diagnosis opportunistic screening of persons above the age of 30 years. Screening involves simple clinical examination and physical measurements (GRBS & BP) warranting further investigation/ action. The investigations which may not be carried out in the health facilities can be outsourced. 8

9. Treatment “NCD clinic’’ will be established at CHC and District Hospital (NCD here refers to 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 will be conducted for ruling out complications or advanced stages of common NCDs. Screening, diagnosis and management (including diet counseling, Lifestyle management) and home based care will be the key functions. 9

10. Development of trained manpower Health personnel at various levels will be trained for health promotion, prevention, early detection and management by a team of trainers at identified Training Institutes/ Centres . These Training Institutes/ Centres will be identified by the State in consultation with the Centre. 10

11. Strengthening , structural monitoring and evaluation of Tertiary level health facility Government medical college/ hospital will be strengthened as tertiary cancer centers and will be provided with all comprehensive cancer care services Regular monitoring and review of the scheme will be conducted at the District, State and Central level through monitoring formats and periodic visits and review meetings. 11

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13. PACKAGES OF SERVICES TO BE MADE AVAILABLE AT DIFFERENT LEVELS UNDER NPCDCS 13

14. Activities at Sub centre Health promotion for behavior change: organising camps, interpersonal communication, posters & banners. ‘Opportunistic’ Screening using B.P measurement and blood glucose by strip method. Referral of suspected cases to CHC. 14

15. Activities at Community health centre Prevention and health promotion including counseling. Early diagnosis through clinical and laboratory investigations. (Common lab investigations: Blood Sugar, lipid profile, ECG, Ultrasound, X ray etc.) Management of common CVD, diabetes and stroke cases (out patient and in patients.) Home based care for bed ridden chronic cases. Referral of difficult cases to District Hospital/higher health care facility. 15

16. Activities at District Hospital   Early diagnosis of diabetes, CVDs, Stroke and Cancer Investigations: Blood Sugar, lipid profile, Kidney Function Test (KFT),Liver Function Test ( LFT), ECG, Ultrasound, X ray, colposcopy , mammography etc.(if not available, will be outsourced) Medical management of cases ( out patient , inpatient and intensive Care). Follow up and care of bed ridden cases & Day care facility. Referral of difficult cases to higher health care facility. 16

17. Activities at Tertiary Cancer Centre  Comprehensive cancer care including prevention, early detection, diagnosis, treatment, minimal access surgery after care, palliative care and rehabilitation. 17

18. Urban health check up scheme Screen urban-slum population for DM & BP To create data base for prevalence of DM & BP in urban slum To sensitize urban slum population about healthy life style. (GRBS is checked for all >30yrs and pregnant ladies) 18

19. Cancer component Objectives: Primary prevention of cancer by health education Secondary prevention: early detection and diagnosis of common cancers like Ca cervix, mouth, breasts and tobacco related cancer by screening / self examination Tertiary prevention: strengthening the existing institutes of comprehensive therapy including palliative care. 19

20. Activities: 1. Strengthening regional cancer centres : Rs. 3 crore provided during plan period to TMH, Mumbai, AIIMS, Delhi, CNCI, Kolkata. Oncology wing development scheme: to fulfill the geographic gap. The quantum of central assistance of rs . 3 crore per institution is given. Decentralized NGO Scheme: IEC activates. Research & training: it will be organized at central level. 20

21. Services provided under the program: Common diagnostic services, basic surgery, chemotherapy and palliative care for cancer cases at 100 DH. Each district is being supported with Rs. 1.66crores per annum for: Chemotherapy drugs provided to 100 patients at DH Day care chemotherapy facilities is established at 100 DHs Facility for lab investigation including mammography is provided at 100 DH. 21

22. Home based palliative care is being provided for chronic, debilitating and progressive cancer patients at 100 districts. Support is provided by contractual man power through 1 medical oncologist, 1 cytopathologist , 1 cytopathology technician, 2 nurses for day care. State cancer institutes will provide comprehensive cancer diagnosis, treatment and care services. 45 centers are being strengthened as tertiary cancer care centers. 22

23. Institutional framework for the implementation of NPCDCS activities Program Structure-Integration with NRHM. Financial management group (FMG) of Programme Management support units at state and district level, which is established under NRHM, will be responsible for financial management Funds from Government of India will be released to the State Health Society. State Health Society will retain funds for state level activity and release to the District Health Societies. 23

24. District Health Society (DHS) At the district level all programme societies have been merged into the District Health Society (DHS). The Governing Body of the DHS is chaired by the Chairman of the Zila Parishad / District Collector. District health society will pass on the funds to the Rogi Kalyan Samities of Block level for the activities under the programme . 24

25. Technical Resource Groups To provide technical guidance, advice and review the progress of the programme for enhancing the quality of implementation of NPCDCS, two Technical Resource Groups (TRG) have been constituted, one for cancer component and other for Diabetes, Cardiovascular Diseases and Stroke (TORs), who will provide the guidelines.   25

26. Guidelines for referral treatment SBP >140mmHg, DBP >90mmHg or RBS >140mg/dl, should be referred to MO for confirmation. Those who are positive of cancer/precancerous lesions will be referred by ANM/staff nurse at specified screening site to appropriate PHC/CHC/DH for confirmation and treatment. Once the diagnosis is established the patient should receive at least1 month supply of drugs at PHC. 26

27. Once patient is stabilized drugs are provided by ANM/ASHA visiting the patient each month. A three month drug supply is stocked with them. The patient has to go to the PHC for the first follow up at the end of the first 3 months after diagnosis and sooner if required. Those individuals who are already on treatment under the care of private practioner , they could be offered the choice of taking drugs from public health system. Community follow up of these individuals would be by ASHA’s making visits to enable positive behavior modification. 27

28. Thank you 28