NATIONAL TOBACCO CONTROL PROGRAMME

(NTCP)
 Launched by: Government of India in 2007–08 during the 11th Five-Year Plan.
 Main Aim:
1. Create awareness about the harmful effects of tobacco consumption.
2. Reduce production and supply of tobacco products.
3. Ensure effective implementation of The Cigarettes and Other Tobacco
Products Act (COTPA), 2003.
4. Help people quit tobacco use.
5. Facilitate implementation of strategies for prevention and control of
tobacco as per WHO Framework Convention on Tobacco Control
(FCTC).

Implementation and Expansion

 During the 11th Five-Year Plan, NTCP was implemented in 21 States covering
42 Districts.
 Based on the results of the Global Adult Tobacco Survey (GATS) India 2009–
2010, which showed a high prevalence of tobacco use, NTCP was upscaled in the
12th Five-Year Plan with a goal to reduce tobacco use prevalence by 5% by
its end.
 As per GATS-2, the number of tobacco users reduced by about 81 lakh (8.1
million).
 Currently implemented in all 36 States/UTs, covering around 612 districts
across the country.

Main Thrust Areas

 Training of health and social workers, NGOs, school teachers, and enforcement
officers.
 Information, Education, and Communication (IEC) activities.
 School programmes for awareness among students.
 Monitoring of tobacco control laws.
 Coordination with Panchayati Raj Institutions (PRIs) for village-level
activities.
 Setting up and strengthening cessation facilities, including
pharmacological treatment facilities at the district level.

Implementation Structure
NTCP operates through a three-tier structure:
1. National Tobacco Control Cell (NTCC) – at the Central level.
2. State Tobacco Control Cell (STCC) – at the State level.
3. District Tobacco Control Cell (DTCC) – at the District level.
 Tobacco Cessation Services are also established at the district level.
 Dedicated funds and manpower are provided for effective implementation.
 From the 12th Five-Year Plan onwards, STCC and DTCC plans have been
subsumed in the Flexi-pool for Non-Communicable Diseases (NCDs) under
the National Health Mission (NHM).
National Tobacco Control Cell (NTCC)
 Located in the Ministry of Health and Family Welfare (MoHFW).
 Responsible for policy formulation, planning, implementation, monitoring,
and evaluation of NTCP activities.
 Functions under the Joint Secretary, MoHFW, with technical assistance from
officers in the Directorate General of Health Services (DGHS).

Major Functions at National Level:

 Conducting public awareness and mass media campaigns for behavioural
change.
 Establishing tobacco product testing laboratories.
 Mainstreaming research and training on alternative crops and livelihoods with
other ministries.
 Monitoring, evaluation, and surveillance.
 Integrating NTCP into the health-care delivery system under the National
Health Mission (NHM).

State Level Implementation

 Dedicated State Tobacco Control Cells (STCCs) ensure effective
implementation and monitoring of tobacco control initiatives.
Key State-Level Activities:
 State-level advocacy workshops.
 Training of Trainers (ToT) for staff under DTCC.
 Refresher training for DTCC staff.
 Training on tobacco cessation for health-care providers.
 Training and sensitization programmes for law enforcers.

District Level Implementation

 Dedicated District Tobacco Control Cells (DTCCs) manage implementation
and monitoring at the local level.
Key District-Level Activities:
 Training of key stakeholders – health and social workers, NGOs, school
teachers, and enforcement officers.
 Information, Education, and Communication (IEC) activities.
 School programmes for awareness.
 Monitoring tobacco control laws.
 Setting up and strengthening cessation facilities, including
pharmacological treatment at the district level.
 Coordination with Panchayati Raj Institutions to promote tobacco control
at the grassroots level.

NATIONAL PROGRAMME FOR CONTROL AND

TREATMENT OF OCCUPATIONAL DISEASES
(NPCTOD)
Launched: 1998–99
Under: Ministry of Health & Family Welfare, Government of India
Nodal Agency: National Institute of Occupational Health (NIOH), Ahmedabad (ICMR)

Aim / Objectives
 To assess the magnitude of occupational diseases in India.
 To prevent and control occupational diseases among workers.
 To create awareness about occupational health hazards.
 To strengthen diagnostic and treatment facilities for affected workers.
 To train healthcare professionals in the field of occupational health.

Activities / Components
 Conducting surveillance of occupational diseases.
 Establishing specialized occupational health clinics in high-risk areas.
 Health education and awareness programmes for workers and employers.
 Research and data collection on occupational health hazards.

Achievements (So Far)

 Identification of high-risk occupations and industries.
 Training and awareness programmes initiated through NIOH.
 Improved diagnostic capacity in some industrial regions.

Limitations / Challenges
 Limited coverage — not implemented nationwide.
 Insufficient data on occupational diseases in unorganized sectors.
 Low awareness among workers and industries.
 Inadequate funding and infrastructure for occupational health services.

Major Occupational Illness

The National Institute of Occupational Safety & Health (NIOSH) has identified 10 leading work-related
illnesses and injuries based on:
a) Frequency of occurrence
b) Severity of individual cases
c) Potential for prevention

Leading Occupational Diseases

 Occupational lung diseases rank first (e.g., Silicosis, Asbestosis,
Byssinosis).
 Occupational asthma shows prevalence ranging from 10% to nearly 100% in
certain high-risk occupations.
 Occupational cancer is the second leading work-related disease, followed by:
o Cardiovascular diseases
o Reproductive disorders
o Neurotoxicity
o Noise-induced hearing loss
o Dermatological conditions
o Psychological disorders
Categories of Major Occupational Diseases
1. Occupational injuries
2. Occupational lung diseases
3. Occupational cancers
4. Occupational dermatoses
5. Occupational infections
6. Occupational toxicology
7. Occupational mental disorders
8. Others

Grouping of Occupational Disorders (According to Etiological Factors)

 Occupational injuries: Ergonomic-related factors
 Chemical factors: Dust, gases, acids, alkalis, metals, etc.
 Physical factors: Noise, heat, radiation
 Biological factors
 Behavioural factors
 Social factors

Prevalence of Major Occupational Diseases in India

Disease Prevalence / Occupation
6.2–34% in mica miners, 4.1% in manganese miners, 30.4% in lead & zinc
Silicosis miners, 9.3% in coal miners, 27.2% in iron foundry workers, 54.6% in slate-
pencil workers
Asbestosis 3% in asbestos miners, 21% in mill workers
Byssinosis 28–47% in textile workers
Nutritional
Workers’ BMI found significantly low
Status

National Programme Highlights

 Occupational health included in National Health Policy (1983 & 2002).
 National Programme for Control & Treatment of Occupational Diseases
launched in 1998–99.
 Nodal agency: National Institute of Occupational Health (NIOH),
Ahmedabad (ICMR).

Global Strategy for Occupational Health (WHO-SEARO, 1999)

Ten Major Areas for Action:
1. Strengthening international and national policies for health at work.
2. Developing healthy work environments.
3. Promoting healthy work practices and health at work.
4. Strengthening occupational health services.
5. Establishing support services for occupational health.
6. Developing occupational health standards based on scientific risk
assessment.
7. Developing human resources for occupational health.
8. Establishing registration and data systems, information services, and public
awareness systems.
 9. Strengthening research in occupational health.
10. Developing collaboration in occupational health services and
organizations.

NATIONAL PROGRAMME FOR PREVENTION AND

CONTROL OF DEAFNESS (NPPCD)
Introduction
 Hearing loss is the most common sensory deficit in humans.
 Globally, it is the second leading cause for “Years Lived with Disability
(YLD)”, after depression.
 In India, a large number of young people are hearing impaired, resulting in
loss of productivity both physically and economically.
 An even larger portion of the population suffers from mild or unilateral (one-
sided) hearing loss.
 To address this preventable disability, the Ministry of Health & Family
Welfare, Government of India launched the pilot phase of the NPPCD (2006–
2008) in 10 States and 1 Union Territory.

Programme Execution & Expansion

 During the 11th Five-Year Plan, the programme was a 100% Centrally
Sponsored Scheme.
 Under the 12th Five-Year Plan, both Centre and States shared financial
responsibility following NRHM norms.
 Initiated: 2007 (pilot mode) in 25 districts of 11 States/UTs.
 Expanded to: 192 districts across 20 States/UTs.
 Planned Expansion: To cover an additional 200 districts in a phased manner,
aiming for nationwide coverage by March 2017.

Objectives of the Programme

1. Prevent avoidable hearing loss due to disease or injury.
2. Early identification, diagnosis, and treatment of ear problems causing
deafness.
3. Medical rehabilitation for all age groups suffering from hearing impairment.
4. Strengthen inter-sectoral linkages to ensure continuity of rehabilitation
services.
5. Develop institutional capacity for ear care by providing equipment,
materials, and training.
6. Long-term Objective:
o To prevent and control major causes of hearing impairment and
deafness.
o To reduce the total disease burden by 25% of the existing level by the
end of the 12th Five-Year Plan.

Components of the Programme

1. Manpower Training & Development
o Training from medical college specialists (ENT, Audiology) to grass-
root workers for prevention, early detection, and management.
 2. Capacity Building
o Strengthening ENT and Audiology infrastructure at district hospitals,
CHCs, and PHCs.
3. Service Provision
o Early detection, management, and rehabilitation of hearing and
speech-impaired individuals across all levels of healthcare.
4. Awareness Generation (IEC/BCC Activities)
o Promoting early identification of hearing impairment, especially in
children.
o Reducing stigma associated with deafness through public awareness
campaigns.

Strategies
 Strengthen service delivery for ear care.
 Develop human resources for ear and hearing care services.
 Promote public awareness through effective IEC strategies, emphasizing
prevention of deafness.
 Enhance institutional capacity at district, community, and primary health
centers under the programme.

Expected Benefits
 Comprehensive services — prevention, early identification, treatment, referral,
and rehabilitation available at PHCs, CHCs, and district hospitals.
 Reduction in the number and severity of hearing-impaired persons.
 Decrease in the extent of ear morbidity and hearing impairment.
 Improved referral networks and service systems for people with ear diseases.
 Increased awareness among health and grass-root workers, helping in
community-level detection and referral.
 Enhanced capacity of district hospitals for better quality ear and hearing care.

NATIONAL MENTAL HEALTH PROGRAMME

(NMHP)
Introduction
 To address the huge burden of mental disorders and the shortage of
qualified mental health professionals, the Government of India launched
the National Mental Health Programme (NMHP) in 1982.
 The programme aims to make mental healthcare accessible and affordable
to all, especially the underprivileged and vulnerable populations.

Burden of Disease
 Psychiatric symptoms such as worry, tiredness, and sleeplessness affect more
than half of adults at some point.
 About 1 in 7 adults experience a diagnosable neurotic disorder.
 India contributes 18% of the global population, and according to WHO:
o Burden of mental health problems: 2443 DALYs per 10,000 population
o Age-adjusted suicide rate: 21.1 per 100,000 population
o Economic loss (2012–2030): USD 1.03 trillion
  National Mental Health Survey (NMHS) 2015–16 (NIMHANS):
o 10.6% of adults in India suffer from mental disorders.
o Lifetime prevalence: 13.7%
o 15% of adults need mental health intervention.
o Urban prevalence (13.5%) is higher than rural (6.9%).
 Treatment gap: 70–92% of people with mental disorders do not receive proper
treatment due to stigma, lack of awareness, and shortage of
professionals.
 Psychiatrist ratio: 0.75 per 100,000 population (WHO recommends 3 per
100,000).

Programme Overview
 Launched: 1982 by the Government of India.
 Purpose: To combat the high prevalence of mental illness and the
inadequacy of mental health infrastructure.
 District Mental Health Programme (DMHP): Introduced in 1996 as part of
NMHP.
o Coverage: 743 districts across India.
 National Tele Mental Health Programme (Tele MANAS): Launched on 10
October 2022 to provide digital mental health support.

Objectives of NMHP
1. Ensure availability and accessibility of minimum mental healthcare for all.
2. Integrate mental health knowledge into general healthcare and social
development.
3. Promote community participation in mental health service development.
4. Enhance human resource development in mental health sub-specialties.

District Mental Health Programme (DMHP)

Components:
 Early detection and treatment of mental disorders.
 Training:
o Short-term training for general physicians to diagnose and treat common
mental illnesses.
o Health workers trained to identify and refer mentally ill individuals.
 IEC (Information, Education & Communication):
o Generating public awareness about mental health and reducing stigma.
 Monitoring:
o Simple record keeping for programme tracking and evaluation.

Tertiary Care Component of NMHP

 Re-strategized in 2003 to include:
1. Modernization of State Mental Hospitals.
2. Upgradation of Psychiatric Wings in Medical Colleges/General Hospitals.
 Manpower Development Schemes (A & B) added in 2009 to improve specialist
training and workforce capacity.
National Tele Mental Health Programme (Tele MANAS)
 Announced: Union Budget 2022
 Implemented by: Ministry of Health & Family Welfare (MoHFW)
 Aim: To provide universal, equitable, and affordable mental healthcare
through 24×7 tele-mental health services across all States and UTs.
Objectives of Tele MANAS:
1. Ensure 24×7 access to mental health counselling and care through a national
tele-network.
2. Expand service reach to anyone, anywhere in India, at any time.
3. Provide integrated counselling, video consultations, e-prescriptions, and
linkages to in-person services.
4. Support vulnerable and hard-to-reach groups.
5. Helpline Numbers: 1800-89-14416 or 14416 (toll-free).

Mental Healthcare Act, 2017

 Replaced: Mental Health Act, 1987.
 Objective: To ensure the right to mental healthcare services and protect the
dignity and rights of individuals with mental illness.
 Aligned with: UN Convention on the Rights of Persons with Disabilities (UNCRPD).
 Key Provisions:
o Right to affordable and quality mental healthcare services.
o Decriminalization of suicide.
o Focus on community-based care and respect for patient autonomy.

NATIONAL PROGRAMME FOR PREVENTION & CONTROL OF

CANCER, DIABETES, CARDIOVASCULAR DISEASES & STROKE
(NPCDCS)
Programme Background
 India is undergoing a rapid health transition with Non-Communicable
Diseases (NCDs) surpassing Communicable Diseases in burden.
 Major NCDs: Cardiovascular diseases, Cancer, Chronic Respiratory Diseases,
Diabetes.
 Impact:
o Account for ~60% of all deaths in India.
o Cause loss of productive years of life.
o Premature deaths due to heart diseases, stroke, and diabetes are
projected to increase over time.
 Launch: 2010
 Focus Areas:
o Strengthening infrastructure and human resources
o Health promotion
o Early diagnosis, management, and referral

Programme Structure
 NCD Cells: Established at National, State, and District levels for programme
management.
  NCD Clinics: Set up at District and CHC levels for early diagnosis,
treatment, and follow-up.
 Free diagnostic facilities and drugs provided for patients attending NCD
clinics.
 Cardiac Care Units (CCU): Established in select districts for emergency cardiac
care.
 Day Care Centres: Set up in identified districts for Cancer care.

Initial Implementation
 2010–2012: Implemented in 100 districts across 21 States.
 Re-strategised: Based on initial phase review, the programme was scaled-up to
cover the entire country by March 2017.

Modified Strategies
1. Health promotion through behavior change, involving community, civil
society, NGOs, media, etc.
2. Outreach Camps: Opportunistic screening at sub-centre level and above for
Diabetes, Hypertension, and common Cancers.
3. Management of NCDs: Through early diagnosis, treatment, and follow-up
at NCD Clinics.
4. Capacity building: At all healthcare levels for prevention, early diagnosis,
treatment, IEC/BCC, operational research, and rehabilitation.
5. Support for diagnosis and treatment at primary, secondary, and tertiary
levels.
6. Surveillance: Development of robust database to monitor NCD morbidity,
mortality, and risk factors.

Programme Cost & Funding

 Total Cost (2012–2017): Rs. 8,096 crore
o Centre: Rs. 6,535 crore
o States: Rs. 1,561 crore
 Funding Mechanism: NCD Flexi-Pool through State PIPs
o Centre:State ratio: 60:40 (except NE and Hilly States: 90:10)

Cancer Component (Tertiary Care Cancer Centers)

 Aim: Setting up/strengthening 20 State Cancer Institutes (SCI) and 50
Tertiary Care Cancer Centres (TCCCs) for comprehensive cancer care.
 Grants:
o SCI: Rs. 120 crore
o TCCC: Rs. 45 crore
o Centre:State share: 60:40 (NE & Hilly States: 90:10)

Programme Performance (as of March 2016)

 36 States/UTs covered.
 District NCD Cells: 298
 District NCD Clinics: 293
 Cardiac Care Units (CCU): 103
 Day Care Centres for Cancer: 64
  Screening (2015–2016):
o 1.29 crore persons screened at NCD Clinics
o 8% diagnosed with Diabetes
o 12% diagnosed with Hypertension
o 90,000 diagnosed with Cardiovascular Diseases
o 13,000 detected with common Cancers
o 96 lakh screened through outreach activities and referred for further care

Recent Initiatives
1. Inclusion of COPD and CKD guidelines under NPCDCS.
2. Population-based screening of Diabetes, Hypertension, and common Cancers
via frontline health workers.
3. Integration of AYUSH services in six pilot districts, with Yoga as part of
interventions.
4. Pilot project for prevention and control of Rheumatic Fever & Rheumatic
Heart Disease in select districts (to be scaled up).
5. Integration with RNTCP: “National Framework for Joint Tuberculosis-Diabetes
collaborative activities” for bi-directional screening and better management.