A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others.

1. DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL
ERA COLLEGE OF NURSING
National Programme for Prevention and
Control of Cancer, Diabetes,Cardiovascular
Diseases and Stroke

2. Introduction
 In India, Non-Communicable Diseases (NCDs) like
Cardiovascular Diseases (CVD), Cancer, Chronic
Respiratory Diseases, Diabetes are estimated to account
for around 60% of all deaths, .
 The Government of India has been implementing National
Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)
since 2010 up to District level under the National Health
Mission.
 NPCDCS has a focus on awareness generation for
behaviour and life-style changes, screening and early
diagnosis of persons with high level of risk factors and their
referral to appropriate treatment facilities i.e.
 Community Health Centres and District Hospital for
management of non-communicable diseases including
cardiovascular diseases. The strengthening of
infrastructure for screening, early detection, treatment and

3. Objectives
 Health promotion through behaviour change with
involvement of community, civil society, community
based organizations, media etc.
 Screening at all levels in the health care delivery
system from sub-centre and above for early detection
of diseases covered under the program including
management and follow up.
 To build capacity at various levels of health care for
prevention, early diagnosis, treatment, rehabilitation,
IEC/BCC, operational research and rehabilitation.
 To provide logistic support for diagnosis and cost
effective treatment at primary, secondary and tertiary
levels of health care.
 To support for development of database of NCDs
through Surveillance System and to monitor NCD
morbidity and mortality and risk factors.

4. Strategy
 The strategies for prevention, control and
treatment of NCDs would have following
components:
 Health promotion awareness generation and
promotion of healthy lifestyle
 Screening and early detection
 Timely affordable and accurate diagnosis
 Access to affordable treatment
 Rehabilitation

5. Activities
 The package of services would depend on the
level of health facility (Sub-centre, PHC, CHC,
DH) and may vary from facility to facility.
 The range of services will include health
promotion, psycho-social counselling, outreach
activities including screening diseases and their
risk factors, management (out-andin-patient), day
care services, home based care and palliative
care as well as referral for specialized services as
needed.

6. Newer Initiatives:
 Population based screening (PBS) for NCDs namely
diabetes, hypertension and common cancers (oral,
breast and cervix) has been expanded to more than
400 districts. Screening is being provided through
trained frontline workers (ASHA & ANM) and
suspected cases are referred to Medical Officers at
PHC.
 Initiation of NCD App for capturing patient wise data
and further follow up from PBS districts.
 Under Ayushman Bharat, NCDs are included in the
spectrum of services being offered at Health and
Wellness Centres
 Pradhan Mantri National Dialysis Program (PM-NDP)
is being implemented in 35 States/UT in 496 Districts.

7. Continued
 Prevention, early detection and treatment of
rheumatic fever and rheumatic heart diseases.
 “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 co-morbidities in India.
 National Multi-sectoral Action Plan for prevention and
control of NCDs has been developed through series
of consultations with various stakeholders including
other Ministries / Departments.
 Inclusion of prevention and management of Chronic
Obstructive Pulmonary Disease (COPD) and Chronic
Kidney Disease (CKD) in program.

8. Continued
 India Hypertension Management Initiative (in
collaboration with ICMR).
 Opportunistic screening of common NCDs
including Diabetes, Hypertension and Cancer, is
being done among the attendees of the India
International Trade Fair (IITF) at Pragati Maidan,
New Delhi during 14-27 November, every year.

9. Program infrastructure
 Till March, 2020, there are 665 District NCD Cells, 637 District
NCD Clinics, 4472 CHC NCD Clinics, 181 Cardiac Care Units
and 218 Day Care Units functional in the country.
 Pattern of assistance The funds are being provided to 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 North-Eastern 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).

10. Performance:
 Around 6.61 crore persons attended NCD Clinics
and were screened for common NCDs like
Diabetes, Hypertension, CVDs and common
Cancers during 2019-20. More than 1.1 crore
population has been covered under Population
Based Screening so far. In addition, during
outreach activities, 5.6 crore NCD check up were
conducted

11. Package of Primary Health Care
Services
 (i) Care in pregnancy and child-birth
 (ii) Neonatal and infant health care services
 (iii) Childhood and adolescent health care services including
immunization.
 (iv) Family planning, Contraceptive services and Other Reproductive
Health Care services
 (v) Management of Common Communicable Diseases and General
Out-patient care for acute simple illnesses and minor ailments
 (vi) Management of Communicable diseases: National Health
Programmes
 (vii) Prevention, Screening and Management of Non-Communicable
diseases
 (viii) Screening and Basic management of Mental health ailments
 (ix) Care for Common Ophthalmic and ENT problems
 (x) Basic oral health care
 (xi) Geriatric and palliative health care services
 (xii) Trauma Care (that can be managed at this level) and Emergency
Medical services

12. Monitoring and Supervision
 The overall responsibility for monitoring and
supervision of field activities is with the Primary
Health Centre Medical officer. Review of the
programme should be an integral a part of
monthly review meetings, field supervision, and
data monitoring. Recording and reporting at all
levels would be aligned with NPCDCS guidelines.
 The following indicators would be used to monitor
the programme, and these would be synergized
with existing records and reports under the
NPCDCS programme. Data would also need to
be disaggregated by age and sex to enable
creation of a data base to enable learning and
better focus programmatic efforts

13. CONTINUED
 i.% of population over 30 years whose blood
pressure and blood sugar was measured in last
two years.
 (ii) % of population over 30 years who were
screened for Oral Cancer.
 (iii) % of women over 30 years screened for
Cervical Cancer.
 (iv) % of women over 30 years screened for
Breast Cancer.
 (v) % of those screened positive for HT/DM who
were examined at the PHC/CHC

14. CONTINUED
 Vi.% of those who were initiated on treatment at
PHC or above who are still under treatment, un-
interrupted for the last three months
 (vii) % of those currently on treatment who have
achieved blood pressure/sugar control
 (viii) % of those who were screened positive for
each of the cancers that underwent biopsy at the
CHC/DH
 (ix) % of those who underwent treatment for each
of the cancers who are screened periodically.

15. Competencies required to conduct
NCD screening
 These can be divided in to three categories –
general skills, administrative skills and clinical
skills: ™
 General skills: Organizing work processes during
screening days; communications skills ™
 Administrative skills: process of enumeration and
family folder creation (ASHA); follow up to ensure
continuity of care; documentation and reporting
(ASHA/ANM) ™
 Clinical knowledge and skills: signs, symptoms
and sequelae of hypertension and diabetes,
history taking, skills for measurement of blood
pressure and blood glucose, drugs and side
effects, referral (ASHA/ ANM), OVE, CBE, and

16. Training Schedule
 (i) Suggested schedule for the three-day training
for ANM and five day training for ASHA, with
content suitably structured for the roles of each. ™
Principles and value of prevention,
 early detection and management ™
Signs,
 symptoms and basic pathology of HT and
diabetes ™
Complications/sequel of HT and
diabetes; ™
 Skills - use of risk assessment tools,
 history taking, key messages in raising
awareness, behaviour change modification.

17. Continued
 Measurement of blood pressure ™
Measurement of
blood glucose (Glucometer) ™
Drugs and side
effects;
 referral; ™
 follow up to ensure compliance with treatment,
motivation and support for lifestyle changes,
 community meeting,
 patient support groups,
 continuity of care

18.  Overview of the NPCDCS programme; and the
health systems approach to integrate primary
care for NCDs ™
 Organizing weekly screening days, roles and
responsibilities
 ™
Enumeration and family folder creation; record
keeping;

19. Orientation/sensitization
 workshop for MO’s (one day):
 Session 1: Overview of the NPCDCS programme;
orientation on prevention, early detection and
management through a health systems approach
to primary health care.
 Session 2: Standard Treatment Guidelines; drugs
and diagnostics
 Session 3: Referral pathways; follow-up
arrangements;
 Session 4: Understanding performance based
incentives, supportive supervision for
ANMs/ASHAs

20. Guideliness to prevent the
NPCDCS
 Modified Write-up of National Programme for
Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke
(NPCDCS) 0
 Guidelines for Prevention and Management of
Stroke 0
 Handbook for Counsellors - Reducing Risk
Factors for NCDs_1 0
 Operational Guidelines of NPCDCS (Revised -
2013-17)_1 0
 Operational Guidelines on Prevention, Screening
and Control of Common NCDs_1 0