PROGRAMME BACKGROUND

India is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCD) surpassing the burden of Communicable diseases like water-borne or vectorborne diseases, TB, HIV, etc. The Non-Communicable Diseases like Cardiovascular diseases, Cancer, Chronic Respiratory Diseases, Diabetes, etc. are estimated to account for around 60% of all deaths. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke and Diabetes are also projected to increase over the years.

In order to prevent and control major NCDs, the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010 with focus on strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral.

Under NPCDCS, NCD Cells are being established at National, State and District levels for programme management, and NCD Clinics are being set up at District and CHC levels, to provide services for early diagnosis, treatment and follow-up for common NCDs. Provision has been made under the programme to provide free diagnostic facilities and drugs for patients attending the NCD clinics. Cardiac Care Units (CCU) are also being set up in identified districts for providing facilities for emergency Cardiac Care. Day Care Centres at the identified districts are setup to provide facilities for Cancer care.

During the period 2010-2012, the programme was implemented in 100 districts across 21 States. Review of the initial phase of programme implementation helped to identify the bottlenecks and accordingly the programme was re-strategised and scaled-up. The programme aims to cover the entire country by March 2017.

The modified strategies are as follows:

•  Health promotion through behavior change with involvement of community, civil society, community based organizations, media etc.
•  Outreach Camps are envisaged for opportunistic screening at all levels in the health care delivery system from sub-centre and above for early detection of diabetes, hypertension and common cancers.
•  Management of chronic Non-Communicable diseases, especially Cancer, Diabetes, CVDs and Stroke through early diagnosis, treatment and follow up through setting up of NCD clinics.
•  Build capacity at various levels of health care for prevention, early diagnosis, treatment, IEC/BCC, operational research and rehabilitation. 
•  Provide support for diagnosis and cost effective treatment at primary, secondary and tertiary levels of health care.
•  Provide support for development of database of NCDs through a robust Surveillance System and to monitor NCD morbidity, mortality and risk factors.

Total cost of the programme for period 2012-2017 is Rs. 8,096 crore (share of Government of India is Rs. 6,535 crore and that of State Governments is Rs. 1,561 crore). The funds are being provided to the States under NCD Flexi-Pool through State PIPs of respective States/UTs, with the Centre to State share in ratio of 60:40 (except for NE and Hilly States, where the share is 90:10).

For the Cancer component, there is the Tertiary Care Cancer Centers (TCCC) scheme, which aims at setting up/strengthening of 20 State Cancer Institutes (SCI) and 50 TCCCs for providing comprehensive cancer care in the country. Under the scheme there is 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, with the Centre to State share in the ratio of 60:40 (except for North-Eastern and Hilly States, where the share is 90:10).

PROGRAMME PERFORMANCE

As on March 2016, the programme is under implementation in all 36 States/UTs. A total of 298 District NCD Cells and 293 District NCD Clinics have been established in the country. Also, there are 103 functional Cardiac Care Units for emergency cardiac care and 64 Day-Care Centres for Cancer care at the District levels in the country.

During 2015-2016, more than 1.29 crore persons have been screened in the designated NCD Clinics. Among these NCD Clinic attendees, around 8% were diagnosed to be Diabetics and 12% were Hypertensives. Also, around 90,000 persons were diagnosed to be suffering from Cardiovascular diseases and over 13,000 persons were detected to be having common Cancers (including Oral, Cervical and Breast Cancers) among them. During 2015-2016, around 96 lakh persons were screened under various outreach activities for common NCDs (in Camps and PHC/SC), and they were referred to higher Centres for diagnosis and management.

RECENT INITIATIVES UNDER NPCDCS

• Inclusion of guidelines for prevention and management of Chronic Obstructive Pulmonary Disease (COPD) and Chronic Kidney Disease (CKD) under NPCDCS, to prevent and manage the chronic respiratory and kidney diseases respectively, which are also major causes of death due to NCDs.
• For early detection of Diabetes, Hypertension and common Cancers in the community, guidelines are being issued to the States for initiating “Population-based Screening of common NCDs” utilising the services of the Frontline-workers and Health-workers under the existing Primary Healthcare System.
• Pilot project on ‘Integration of AYUSH with NPCDCS’ has been initiated in six districts in the country. AYUSH facilities and methodologies are being integrated with NPCDCS services for prevention and management of common NCDs, wherein the practice of Yoga is an integral part of the intervention.
• Pilot intervention has been initiated for the prevention and control of Rheumatic Fever and Rheumatic Heart Disease under the platforms of NPCDCS and RBSK (Rashtriya Bal Swasthya Karyakram), in three select districts (Gaya - Bihar, Firozabad - Uttar Pradesh and Hoshangabad - Madhya Pradesh). This intervention would be scaled up to other districts in a phased manner.
• Another initiative is the integration of RNTCP with NPCDCS, wherein the “National Framework for Joint Tuberculosis-Diabetes collaborative activities” has been developed to articulate a national strategy for ‘bi-directional screening’, early detection and better management of Tuberculosis and Diabetes comorbidities in India