India is experiencing a rapid health transition with a rising burden of Non Communicable Diseases (NCDs). Overall, NCDs are emerging as the leading causes of death in the country accounting for over 42% of all deaths (Registrar General of India). NCDs cause significant morbidity and mortality both in urban and rural population, with considerable loss in potentially productive years (aged 35–64 years) of life.
It is estimated that the overall prevalence of diabetes, hypertension, Ischemic Heart Diseases (IHD) and Stroke is 62.47, 159.46, 37.00 and 1.54 respectively per 1000 population of India. There are an estimated 25 Lakh cancer cases in India.
Considering the rising burden of NCDs and common risk factors to major Chronic Non –Communicable Diseases, Government of India initiated an integrated National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The focus of the programme is on health promotion and prevention, strengthening of infrastructure including human resources, early diagnosis and management and integration with the primary health care system through NCD cells at different levels for optimal operational synergies. National Cancer Control Programme, an on-going programme, has been integrated under NPCDCS.
The programme is being implemented in 100 districts spread over 21 States during 2010-11 & 2011-12) at an estimated outlay of Rs. 1230.90 crore (Rs.499.38 crore for interventions on diabetes and cardiovascular diseases & stroke and Rs.731.52 crore for cancer control) on a cost sharing basis between the Centre and the States at the rate of 80:20. These districts have been selected keeping into account their backwardness, inaccessibility & poor health indicators.
Services offered under NPCDCS
Major risk factors for these NCDs are raised blood pressure, cholesterol, tobacco use, unhealthy diet, physical inactivity, alcohol consumption, and obesity which are modifiable. Hence a majority of cancers and CVDs can be prevented and treated if diagnosed at an early stage. Health promotion and prevention of chronic NCDs are yet to be adequately addressed in the country’s health system. Presently, Clinical services, too, are not adequately equipped to provide the required level of care for these diseases in primary and secondary health-care settings. Therefore, the appropriate strategies have been devised to be implemented under NPCDCS to ensure that the NCDs can be prevented and managed in an effective manner.
A. Cardiovascular Diseases (CVD), Diabetes & Stroke
· A Cardiac care unit at each of the 100 district hospitals.
· NCD clinic at 100 district hospitals and 700 Community Health Centres (CHCs) for diagnosis and management of Cardiovascular Diseases (CVD), Diabetes & Stroke.
· Provision for availability of life saving drugs, to each district hospital in 100 districts.
· Opportunistic Screening for diabetes and high blood pressure to all persons above 30 years including pregnant women of all age groups at 20,000 Sub Centres.
· Home based care for bed ridden cases in 100 districts.
· Support for contractual manpower and equipments at the 100 district hospitals & 700 CHCs for management of NCDs including health promotion activities.
· Common diagnostic services, basic surgery, chemotherapy and palliative care for cancer
cases at 100 district hospitals.
· Support for Chemotherapy drugs at each district hospital
· Day care Chemotherapy facilities at 100 district hospitals.
· Facility for laboratory investigations including Mammography at 100 district hospitals
· Home based palliative care for chronic, debilitating and progressive cancer patients at 100 districts.
· Support for contractual manpower and equipment for management of cancer cases at the 100 district hospitals.
· Strengthening of 65 centre Tertiary Cancer Centres (TCCs)
Achievements so far
ü Operational Guidelines developed
ü Training Modules developed for Health Workers and Medical Officers.
ü Human Resource under National NCD Cell in place
ü Human Resource under State and District level in process
ü Signed MOU Received from 11 States
ü Setting up of State and District NCD cells in process
ü Funds for implementation of NPCDCS in 27 districts across 19 states were released in March 2011 foropportunistic screening, establishment of ‘NCD clinic’ at CHCs and District Hospitals.
ü Efforts are being taken to increase awareness for promotion of healthy lifestyle through Mass media.
ü Funds for conducting training workshops were released to NIHFW and Indian Nursing Counsel.
ü Pilot Project on School based Diabetes Screening Programme initiated in 6 districts
ü Proposal for surveillance of NCD risk factors is under submission
The programme, thus, attempts to achieve behaviour change in the community to adopt healthy life styles including dietary patterns, enhanced physical activity and reduced intake of tobacco and alcohol resulting in overall reduction in the risk factors of common Non-Communicable Diseases in the country.