National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)

• NPCDCS was launched on 4^th Feb’2014 by the Hon’ble Health Minister Shri Lal Thanzara and currently the programme was implemented in all districts namely Aizawl, Champhai,Kolasib,Mamit, Lawngtlai, Lunglei, Serchhip & siaha District.
• Currently, under the programme, we have:

1 State Nodal Officer at State NCD Cell, DHME, MINECO

Dr. Catherine Lalmuanawmi

·         103 Contractual Staff.

OBJECTIVE OF THE PROGRAMME:

• Health promotion through behaviour change with involvement of community, civil society, community-based organizations, media etc.
• 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. Outreach camps are also envisaged. (30 years & above)
• To prevent and control chronic non-Communicable diseases, especially Cancer, Diabetes, CVDs and Stroke.
• To build capacity at various levels of health care for prevention, early diagnosis, treatment, IEC/BCC, operational research and rehabilitation.
• To support for diagnosis and cost-effective treatment at primary, secondary and tertiary levels of health care.

STRATEGY:

• —Health promotion, awareness generation and promotion of healthy lifestyle
• —Screening and early detection
• —Timely, affordable and accurate diagnosis
• —Access to affordable treatment
• —Rehabilitation

A.     Health Promotion

Given that the major determinants to hypertension, obesity, high blood glucose and high blood lipid levels are unhealthy diet, physical inactivity, stress and consumption of tobacco and alcohol, awareness will be generated in the community to promote healthy life style habits. For such awareness generation and community education, various strategies will be devised /formulated for behaviour change and communication by inter personal communication (IPC), involvement of various categories of mass media, civil society, community-based organization, panchayats/local bodies, other government departments and private sector. The focus of health promotion activities will be on:

• Salt reduction
• 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 

B. Screening, diagnosis and treatment

• Screening and early detection of non-communicable diseases especially diabetes, high blood pressure and common cancers would be an important component. The suspected cases will be referred to higher health facilities for further diagnosis and treatment
• 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.
• The screening of the urban slum population would be carried out by the local government/municipalities in cities with population of more than 1 million
• The ANMs will be trained for conducting screening so that the same can be also conducted at sub centre level. Each district will be linked to nearby tertiary cancer care (TCC) facilities to provide referral and outreach services. The suspected cases will be referred to District Hospital and tertiary cancer care (TCC) facilities.
• For screening of diabetes, support for Glucometers, Glucostrips and lancets maybe provided to the state or rate contract may be utilised for this purpose. Efforts are being made to have rate contract at central level failing which it may be done by states themselves.
• The common infrastructure/manpower envisaged can be utilized for early detection of cases, diagnosis, treatment, training and monitoring of different program such as National Program for Prevention Control of Cancer, Diabetes, CVDs and Stroke (NPCDCS), National Program for Health Care of Elderly

C. Establishment/Strengthening of Health infrastructure

• Community health centers and district hospitals would be supported for prevention, early detection and management of Cancer, Diabetes, Cardiovascular Diseases and Stroke. Support would be provided for establishing NCD clinics and strengthening laboratory at Community health centers and district hospitals.
• In order to provide cardiac care and cancer care at district level, the districts not having Medical College hospitals and not covered under Scheme for Upgradation of District Hospitals to Medical College hospitals, would be provided financial assistance for establishing at least 4 bedded cardiac care unit. This includes provision for renovation and purchase of equipments such as ventilators, monitors, defibrillator, CCU beds, portable ECG machine and pulse oximeter etc. for cardiac care and chemotherapy beds. Financial support for the essential contractual staff such as doctors and nurses at these units would also be provided under the programme.
• The contractual manpower at district level will be utilized for NCD Clinic and CCU as well as for day care Chemotherapy unit. The contractual manpower provided at CHC level will be utilized to run the NCD Clinic.
• The details of establishment/strengthening of health infrastructure are given separately along with details of manpower on contract at Sub Centre, PHC, CHC, district NCD Clinic and district CCU/ICU and cancer care units.

D. Manpower development

Under NPCDCS, health professionals and health care providers at various levels of health care would be trained for health promotion, NCD prevention, early detection and management of Cancer, Diabetes, CVDs and Stroke. For imparting training both for the programme management and for specialized training, diagnosis, treatment of cancer, diabetes, CVDs and strokes, the nodal agency/agencies will be identified to develop the training material, organize training of health care providers at different levels and for monitoring the quality of the training. Structures Training programmes will be developed to provide quality training with appropriate curriculum to various category of staff.

D. Miscellaneous services:

Financial support would be provided to district and CHC/FRU/PHC for procurement of screening devices, essential drugs, consumables, transport of referral cases as per the details annexed for treatment of Cancer, Diabetes, CVDs and Stroke.

E. Outreach services:

These services are proposed to be provided periodically in the programme districts in collaboration with tertiary care hospitals / institutes for early detection of common cancers, diabetes, CVDs and stroke.

F. Integration with AYUSH:

AYUSH doctors can play an important role in prevention and control of NCDs through primary health care network. They can be involved in health promotion activities through behaviour change, counselling of patients and their relatives on healthy lifestyle (healthy diet, physical activity, salt reduction, avoidance of alcohol and tobacco) meditation, Yoga, opportunistic screening for early detection of noncommunicable diseases and their risk factors, and treatment using Indigenous System of Medicines. The AYUSH practitioner can supplement the efforts to operationalizing these activities and thus need to be integrated with the National NCD prevention and control programs especially NPCDCS.

G. Public private partnership:

It is proposed to involve NGOs, civil society and private sector in health promotion, early diagnosis and treatment of common NCDs through suitable guidelines as per the need at Central, State, District levels and below.

H. Research and surveillance

• —Support would be given to States and Institutes for surveillance & research on NCDs. Emphasis would be given on creating database, applied and operational research related to the programme. Survey for risk factors for NCDs would be conducted at frequency and by methods decided by experts.

• —Cancer registry programme of ICMR would be supported for having a data base for cancer cases in the country including rural areas. Registries for other NCDs can also be considered in due course of time.

I. Monitoring & evaluation

• Monitoring and evaluation of the programme would be carried out at different levels through NCD cells, reports, regular visits to the field and periodic review meetings. National, State and District NCD Cell would be established/strengthened to monitor and supervise the programme by providing the support for contractual manpower, establishment of physical infrastructure and for field visits, contingencies etc. Management Information System (MIS) would be developed for capturing and analysis of data.
• The strategies proposed will be implemented in all States /UTs covering all districts in the country and will be implemented at secondary and primary levels of health delivery system.
• The guidelines on operational aspects and financial norms of the programme have been given in details to facilitate the effective implementation of the programme.

COMPONENTS:

• Prevention through behaviour change
• Early diagnosis
• Management of cases
• Capacity building at different level of health facilities
• Supervision, monitoring and evaluation

HUMAN RESOURCES:

• State NCD Cell comprises of

1 State Epidemiologist

1 State Programme Co-ordinator

1 State Finance cum Logistic Consultant

1 DEO

• District NCD Cell comprises of

1 District Epidemiologist

1 District Finance cum Logistic Consultant

1 District Programme Co-ordinator

1 DEO

• District NCD Clinic comprises of

1 Medical officer

1 Physiotherapist

2 GNM Nurses

1 Counsellor

1 Lab Technician

1 DEO

• CHC NCD Clinics comprises of

1 Medical Officer

1 GNM Nurse

1 Lab Technician

1 Counsellor

CCU, Civil Hospital, Aizawl comprises of

1 Cardiologist/Medicine Specialist/Medical Officer

4 GNM Nurses

PACKAGE OF SERVICES:

Sub-centre:

• Population Based Screening through CPHC-NCD Apps
• ‘Opportunistic’ Screening of Diabetes using glucometer kits and Blood Pressure measurement.

• Awareness generation of early warning signals of common cancer
• Referral of suspected cases to CHC/ nearby health facility

PHC:

• Health promotion for behaviour change and counselling
• ‘Opportunistic’ Screening of Diabetes using glucometer kits and Blood Pressure measurement.
• Clinical diagnosis and treatment of common CVDs including
• Hypertension and Diabetes
• Identification of early warning signals of common cancer
• Referral of suspected cases to CHC

CHC/FRU:

• Prevention and health promotion including counselling
• Early diagnosis through clinical and laboratory investigations
• Management of common CVDs, diabetes and stroke cases
• Lab. investigations and Diagnostics: Blood sugar, Total Cholesterol, Lipid Profile, Blood Urea, XR, ECG, USG (To be outsourced, if not available)
• ‘Opportunistic’ Screening of common cancers (Oral, Breast and Cervix)
• Referral of complicated cases to District Hospital/higher health care facility

District Hospital:

• Diagnosis and management of cases of CVDs, Diabetes, Stroke and Cancer (outpatient, inpatient and intensive Care)
• Lab. investigations and Diagnostics: Blood sugar, Lipid Profile, KFT, X-Ray, ECG, USG, ECHO, CT scan, MRI etc (To be outsourced, if not available)
• Referral of complicated cases to higher health care facility
• Health promotion for behaviour change and counselling
• ‘Opportunistic’ Screening of NCDs including common cancers (Oral, Breast and Cervix)
• Follow up chemotherapy in cancer cases
• Rehabilitation and physiotherapy services

Tertiary Cancer Centre:

• Mentoring of District Hospital and outreach activities
• Comprehensive cancer care including prevention, early detection, diagnosis, treatment, palliative care and rehabilitation
• Training of health personnel
• Operational Research

EXPECTED OUTCOMES:

• The programmes and interventions would establish a comprehensive sustainable system for reducing rapid rise of NCDs, disability as well as deaths due to NCDs.
• Broadly, following outcomes are expected at the end of the 12th Plan:
• Early detection and timely treatment leading to increase in cure rate and survival
• Reduction in exposure to risk factors, life style changes leading to reduction in NCDs

• Reduction in out-of-pocket expenditure on management of NCDs and thereby preventing catastrophic implication on affected individual

FUNCTIONING OF NCD CLINIC:

• NCD Clinic functions on all working days, during OPD hours from Monday to Saturday
• Checking of blood sugar and blood pressure are done free of cost
• Screening for common cancers i.e., breast (breast examination), cervical(pap smear) & oral(oral examination) are also done
• Counselling on life style diseases, behaviour change and risk factors of NCD to patients and their family members
• Providing Physiotherapy to patients requiring the service and to bedridden patients
• Diagnosis and management of cases of CVDs, Diabetes, Stroke and Cancer
• Referral of complicated cases to higher health care facility
• Follow up of cancer patients on chemotherapy

ACTIVITIES:

Observation of important days:

• National Cancer Awareness Day on 7^th November
• World Diabetes Day on 14^th November
• World Cancer Day on 4^th February
• World Heart Day on 29^th September
• World Hypertention Day on 17^th May
• World Stroke Day on 29^th October