NPCDCS / NP-NCD
National Program for Prevention & Control of Cancer, Diabetes, CVD & Stroke
Milestones
● 2010 — National Program for Prevention & Control of Cancer,
Diabetes, CVD & Stroke (NPCDCS) launched
● May 2023 — renamed by MoHFW to National Program for
Prevention & Control of Non-Communicable Diseases (NP-NCD)
Diseases added recently:
● Non-Alcoholic Fatty Liver Disease (NAFLD)
● Chronic Kidney Disease (CKD)
● ST-elevation Myocardial Infarction (STEMI)
Management Structure of NCD Cell
Level (State→Village) Facility Key Services
State NCD Division — Overall program management
District NCD Division District Hospital NCD Clinic, Cardiac Care Unit, Cancer Care Facility
Block (Rogi Kalyan Samiti) CHC NCD Clinic, Lab Investigations, Early Diagnosis &
Treatment, Home Based Care, Referral
Village (Village Health Committee) Subcentre Health Promotion, Screening, Opportunistic
Screening, Referral
★ Nodal Agency: National Institute of Health & Family Welfare (NIHFW)
WHO Global Monitoring Framework — Targets for NCDs (by 2025)
Indicator 2025 Target
Relative reduction in Premature Mortality from NCDs 25%
Halt the rise in Prevalence of Obesity & Diabetes —
Relative reduction in Prevalence of Insufficient Physical Activity 10%
Relative reduction in Prevalence of Raised Blood Pressure 25%
Relative reduction in Mean Population Salt Intake 30%
Relative reduction in Prevalence of Current Tobacco Use 30%
Relative reduction in Alcohol Use 10%
Relative reduction in Household use of Solid Fuel (Indoor Air Pollution) 50%
Availability & Affordability of Essential NCD Medicine 80%
Indicator 2025 Target
Eligible people receiving Drug Therapy & Counseling 50%
New Initiatives (overall NPCDCS)
● m-Health Strategies — m-Diabetes & m-Cessation interventions
● K4H — Knowledge for Health for NCDs
● Linkage with other Programs — NPPC, NTCP, NPHCE, NMHP, NPCBVI, NUHM, RBSK, etc.
2 Components of NPCDCS
● i. Diabetes, Cardiovascular Disease & Stroke component of NPCDCS
● ii. Cancer component of NPCDCS
i. Diabetes, CVD & Stroke Component
Objectives
● Behavior & Lifestyle Changes
● Early Diagnosis & Management
● Human Resource Training
● Palliative (medical care for people with serious illnesses, focusing on pain relief, symptom management, and
improving the quality of life for both patients and their families.) & Rehabilitative Care
Strategies
● Health Education
● Screening of people above 30 years
● NCD Clinic at Community Health Centre (CHC) & District Level
Activities — Level-wise
Level Key Activities
Sub-Centre Health Promotion (behavior & lifestyle) · Camps, Posters, Banners, Interpersonal
Communication · Opportunistic Screening (>30 yrs) · Referral of suspected cases to CHC
CHC NCD Clinic · Investigation & Management · Home visits by Nurse for bedridden cases ·
Referral of complicated cases to District Hospital
District Hospital NCD Clinic · Health Promotion · Screening (>30 yrs) · Detailed Investigation & Management ·
Home Based Palliative Care for chronic patients
Guidelines for Referral & Treatment
● Blood Pressure: Systolic BP > 140 mmHg & Diastolic BP > 90 mmHg
● Blood Sugar: RBS ≥ 140 mg/dL
● Found positive for Cancer or Precancerous lesion → referred
Once diagnosed with Hypertension / Diabetes:
○ Patient must receive at least a month's supply of drugs from PHC
○ First follow-up visit — after 3 months of diagnosis
○ Annual Specialist consultation — at nearest NCD clinic in CHC
● Patients under treatment of a Private Practitioner can be offered choice of drugs from Public Health System
● Follow-up visits by ASHA — to encourage Behavioral Modification, Treatment Compliance & Regular Checkup
New Initiatives (Component i)
● Interventions for Rheumatic Heart Disease (RHD) under RBSK & NPCDCS
● Integration of AYUSH with NPCDCS
● Integration of NTEP with NPCDCS — for management of TB & Diabetes comorbidities
Achievement: Under implementation in all 36 States & UTs
Urban Health Checkup Schemes
● To Screen — Urban Slums for Diabetes & High Blood Pressure
● To create Database — for prevalence of Diabetes & High BP in urban slums
● To Sensitize — Urban Slums about Healthy Lifestyle
● Blood Sugar & BP checked in — People > 30 years & Pregnant Women
ii. Cancer Component
Milestones
● 1975–76 — National Cancer Control Program
● 1984–85 — Program revised
● December 2004 — Program subsequently revised
● 2010 — Integrated with NPCDCS
Objectives (Levels of Prevention)
Prevention Level Focus
Primary Prevention Health Education
Secondary Prevention Early Diagnosis by Screening
Tertiary Prevention Strengthening of existing institutions for Comprehensive Therapy (Palliative
Care)
Schemes
● Regional Cancer Centre Scheme — existing Regional Centres strengthened to act as Referral Centres
● Oncology Wing Development
● Decentralized NGO Scheme
● IEC Activities at Central Level
● Research & Training Programs — training manuals for Health Professionals, Cytology, Palliative Care & Tobacco
Cessation
Services
● Diagnostic Services
● Surgery
● Chemotherapy
● Home Based Palliative Care
● Contractual Manpower: 1 Medical Oncologist, 1 Cytopathologist, 1 Cytopathology Technician & 2 Nurses
National Cancer Registry Program
● Started in 1982 by ICMR
2 Types of Registries:
○ Population Based Cancer Registry
○ Hospital Based Cancer Registry
National Tobacco Control Programme (NTCP)
Components:
● Mass Media Campaigns for Awareness
● Tobacco Cessation Facilities
● Tobacco Control Cells
● Tobacco Product Testing Laboratories
● Adult Tobacco Surveys
Tobacco Control Legislation — COTPA 2003 (Cigarette & other Tobacco Products Act):
● Prohibition of Smoking in Public Places
● Prohibition of Advertisement of Cigarette
● Prohibition of Sale of Cigarette below the age of 18 years
● Prohibition of Sale of Tobacco Products near Educational Institutes
● Statutory (Pictorial) Warnings on Tobacco packs
● Mandatory Depiction of Tar & Nicotine contents
Quick Revision — Must-Remember Numbers
Fact Value
NPCDCS launched 2010
Renamed to NP-NCD May 2023
Nodal agency NIHFW
Screening age > 30 years
Diagnostic threshold — BP SBP >140 / DBP >90 mmHg
Diagnostic threshold — RBS ≥ 140 mg/dL
First follow-up after diagnosis 3 months
National Cancer Registry started 1982 (ICMR)
COTPA enacted 2003
Legal age for tobacco sale 18 years