NPCDCS

Background

The country is experiencing a rapid health transition with a rising burden of Non-Communicable Diseases (NCDs) which are emerging as the leading cause of death in India accounting for over 60% of all deaths with considerable loss in potentially productive years (aged 35-64 years) of life.

The NCDs like cardiovascular disease, cancer, chronic respiratory disease, diabetes and other NCDs are estimated to account for over 60% of all deaths, making
them the leading cause of death. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke and diabetes are likely to increase over the years. 

According to National Family Health Survey 5 (NFHS-) 2019-21,  1 in every 5 persons suffers from hypertension (defined as SBP ≥140mmg Hg and/or DBP ≥90mmg Hg or is taking medication to control blood pressure) in 18 states/UTs. The prevalence of overweight/obesity (defined as BMI ≥25kg/m2), as most states/UTs, is 1 of every 5 persons.

NAFLD, the abnormal accumulation of fat in the liver in the absence of secondary causes of fatty liver, such as harmful alcohol use, viral hepatitis, or medications is a serious health concern as it encompasses a spectrum of liver abnormalities, from a simple non-alcoholic fatty liver (NAFL, simple fatty liver disease) to more advanced ones like non-alcoholic steatohepatitis (NASH), cirrhosis and even liver cancer. Over the last two decades global burden of NASH has more than doubled. NAFLD is emerging as an important cause of liver disease in India.

Epidemiological studies suggest the prevalence of NAFLD is around 9% to 32% of the general population in India with a higher prevalence in those with overweight or obesity and those with diabetes or prediabetes. Researchers have found NAFLD in 40% to 80 % of people who have type 2 diabetes and in 30% to 90 % of people who are obese. Studies also suggest that people with NAFLD have a greater chance of developing cardiovascular disease. Cardiovascular disease is the most common cause of death in NAFLD. Once the disease develops, there is no specific cure available, and health promotion and prevention aspects targeting weight reduction, healthy lifestyle, and control of aforementioned risk factors are the mainstays to disease progression and prevent the mortality and morbidity due to NAFLD.

NAFLD is an independent predictor of future risk of cardiovascular diseases, type 2 diabetes and other metabolic syndromes like hypertension, abdominal obesity, dyslipidaemia, glucose intolerance.

The cost implications of NCDs to society are enormous and run into thousands of crore of rupees that include direct costs to people with illness, their families and indirect costs to society, due to reduced productivity.

Major risk factors for these NCDs are raised blood pressure, cholesterol, tobacco use, unhealthy diet, physical inactivity, alcohol consumption, and obesity which are modifiable. The other non-modifiable risk factors such as age, sex and heredity are also associated with the occurrence of NCDs. Hence a majority of cancers and CVDs can be prevented and treated if diagnosed at an early stage.

About NPCDCS

• 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) under the National Health Mission.
• 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.
• During the period 2010 - 2012, the programme was implemented in 100 districts across 21 States. The programme at present covers the entire country.
• During February 2021, Ministry of Health and Family Welfare launched the operational guidelines for Integration of NAFLD (Non-Alcoholic Fatty Liver Disease) with NPCDCS.

Objectives

1. Health promotion through behavior change with involvement of community, civil society, community based organizations, media etc.
2. Outreach Camps 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.
3. 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.
4. Build capacity at various levels of health care for prevention, early diagnosis, treatment, IEC/BCC, operational research and rehabilitation.
5. Provide support for diagnosis and cost effective treatment at primary, secondary and tertiary levels of health care.
6. Provide support for development of database of NCDs through a robust Surveillance System and to monitor NCD morbidity, mortality and risk factors.

Strategy

• Health promotion, Awareness generation and promotion of healthy lifestyle - The focus of health promotion activities will be on
• 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
• Screening and early detection - Common cancers (breast, cervical and oral), diabetes and high blood pressure screening of target population (age 30 years and above) will be conducted either through opportunistic and/or camp approach at different levels of health facilities and also in urban slums of large cities.
• Timely, affordable and accurate diagnosis
• Access to affordable treatment
• Rehabilitation

Achievements so far

Under NPCDCS, 682 District NCD Clinics, 191 District Cardiac Care Units, and 5408 Community Health Center NCD Clinics has been set up. A total of 7,04,631 Accredited Social Health Activist (ASHAs), 2,19,113 Auxiliary Nurse Midwife (ANM)/Multipurpose Workers (MPW), 28,912 staff nurses, 76,567 Community Health Officers (CHOs) and 29,648 Medical Officers (MOs) have been trained on universal screening of common NCDs.

To access the complete guidelines, click here.

Source : Ministry of Health and Family Welfare.

Related resources

1. Operational Guidelines - Prevention, Screening and Control of Non-Communicable diseases