Non Communicable Diseases Policy of India - An analysis

HEALTH POLICY ANALYSIS
Non Communicable Diseases Policy of India –
National Programme for prevention and
control of Cancer Diabetes Cardio vascular
diseases and Stroke
Dr. Shammy Rajan
Assistant Surgeon
Department of Health Services
Government of Kerala
1Dr. Shammy Rajan

Introduction
• India started various programmes to prevent and
control different Non communicable diseases
(NCDs) from 1970s onwards
• There was hardly any policy direction on
prevention and control of NCDs and their risk
factors
• Prevention and control of NCDs like Diabetes,
Hypertension, Cardiovascular diseases etc were
not addressed in any of the initial programmes
http//www.ijcm.org.inviewimage.aspimg=IndianJCommunityMed_2011_36_5_7_94703_b3
2Dr. Shammy Rajan

3
http//www.ijcm.org.inviewimage.aspimg=IndianJCommunityMed_2011_36_5_7_94703_b3
Dr. Shammy Rajan

• WHO described NCDs as Cancer, Diabetes,
Cardiovascular diseases and Respiratory
diseases
http://www.who.int/mediacentre/factsheets/fs355/en/
4Dr. Shammy Rajan

Background
• India is a large nation with rapid development
and urbanization
• Population- 1.237 billion (World Bank,2012)
• GDP per capita- 1489.24 USD (World
Bank,2012)
• Public sector in health- 33.5% (NFHS-3)
5Dr. Shammy Rajan

International context
• Third Epidemiologic Transition1
• In developing countries, the transition is causing
the double burden of both infectious diseases
and noncommunicable diseases upon which the
NCDs possess the major share.4
• The study conducted in Accra, the most
urbanized and modern city of Ghana, gives the
typical picture of relation between pace of
development of a nation and the speed of
epidemiological transition.2
6Dr. Shammy Rajan

• A comparative study, which was done among
four Latin American countries, shown similar
scenario.3
• But it is a fact that cost-effective public health
interventions are not reaching developing
country populations who need them.
Programs to deliver these interventions are
too often patchy, low quality, inequitable, and
short-lived.5
7Dr. Shammy Rajan

• NCDs kill more than 36 million people each year.
• Nearly 80% of NCD deaths - 29 million - occur in low- and middle-
income countries.
• More than nine million of all deaths attributed to NCDs occur
before the age of 60; 90% of these "premature" deaths occurred in
low- and middle-income countries.
• Cardiovascular diseases account for most NCD deaths, or 17.3
million people annually, followed by cancers (7.6 million),
respiratory diseases (4.2 million), and diabetes (1.3 million).
• These four groups of diseases account for around 80% of all NCD
deaths.
• They share four risk factors: tobacco use, physical inactivity, the
harmful use of alcohol and unhealthy diets.
http://www.who.int/mediacentre/factsheets/fs355/en/
8Dr. Shammy Rajan

Indian Context
• In India, diabetic patients will increase from 19 million
in 1995 to 87 million by 20306
• 66.6% of all cause mortality will be due to Non
Communicable Diseases (NCDs) by 20207
• The overall prevalence of diabetes, hypertension,
Ischemic Heart Diseases (IHD) and Stroke is 62.47,
159.46, 37.00 and 1.54 respectively per 1000
population of India(2010)
http://www.pib.nic.in/newsite/erelease.aspx?relid=63087.
• The total cancer cases are likely to go up from 979,786
cases in the year 2010 to 1,148,757 cases in the year
2020.8
9Dr. Shammy Rajan

Government of India(GoI) started efforts to control
NCDs from 1970s and supported states who came
with individual programmes9
Legal measures taken by Government of India
aiming at non communicable diseases
• Mental Health Act 1987
• Tobacco control act 2003
National Health Policy – 2002 mentioned high
burden of mortality due to NCDs and injuries but
there was no clear directions on prevention and
control
10Dr. Shammy Rajan

• High level officials from the GoI and WHO met on March
11, 2005 at Chennai during the 3rd Madras Diabetes
Research Foundation – University of Alabama National
Seminar on “Epidemiology of Non-communicable diseases”
to discuss about the health burden due to NCDs.
• They came with the idea of constituting a network of
professionals with expertise in NCDs for capacity building,
for conducting high class research in NCDs in India as well
as to formulate health care policies for preventing NCD in
India
• Thus INN was formed
www.ncd.in
11Dr. Shammy Rajan

Actors
• NCD division under DGHS
• State Governments
• NRHM
• World Bank
• WHO
• ICMR
• AIIMS
• PHFI
• INN
12Dr. Shammy Rajan

• World bank published reports on NCD burden
of India and gave many policy
recommendations
• ICMR, AIIMS, INN and PHFI conducted various
studies on NCDs and published them
13Dr. Shammy Rajan

Policy process
11th 5 year plan(2007-11) - strategies
• To start a national program for prevention and
control of Diabetes, Cardio vascular disease
and stroke
• Initial expenditure of 1250 crores
• Annual expenditure of 500 crores
16Dr. Shammy Rajan

A Steering Committee has been constituted to review and expedite the
National Programme for Prevention and Control of Diabetes,
Cardiovascular Diseases and Stroke in the Chairmanship of Director
General of Health Services with following members:
• (i) Director General of Health Services Chairman
• (ii) Dr. K. Srinath Reddy ,Director PHFI Co-Chairman
• (iii) Shri Vineet Chawdhry,Joint Secretary, MOH&FW ,Member
• (iv) Dr. R.N. Salhan, Addl. Director ,General, Dte.GHS , Member
• (v) Dr. Jagdish Prasad, Addl.D.G,
• Principal & M.S Sufdarjung Hospital ,Member
• (vi) Dr. Bela Shah, Senior DDG(NCD), ICMR ,Member
• (vii) Prof. Madhuri Behari, HOD, Neurology, AIIMS , Member
• (viii) Dr. Ajay Ajmani, Sr. Specialist and HOD, Department of
Endocrinology, RML Hospital Member
18Dr. Shammy Rajan

• (ix) Dr. V.K. Bahl, Prof. and HOD, Department of Cardiology, AIIMS
Member
• (x) Prof. A.K. Das, MS and Dean, JIPMER, Pondicherry Member
• (xi) Dr. B.K. Tiwari, Adviser, Nutrition, Dte.GHS Member
• (xii) Dr. Harshvardhan, HOD, Cardiology, RML Hospital Member
• (xiii) Prof. A. Ramachandran, Director, Diabetes Research Centre,
Chennai. Member
• (xiv) Dr. V.Mohan, Diabetes Research Centre, Chennai Member
• (xv) Dr. Cherian Varghese, NPO, WHO Member
• (xvi) Dr. Jerzy Leowski Regional Adviser, SEARO, WHO Member
• (xvii) Dr. K. Anand , Associate Prof. Department of Community
Medicine, AIIMS Member
• (xviii) Dr. Sudhir Gupta, CMO (NCD), Dte. GHS Member Secretary
19Dr. Shammy Rajan

• They designed a programme called NPDCS
• Piloted on January 2008
• 10 states were covered
– Punjab
– Rajasthan
– Karnataka
– Kerala
– Tamil Nadu
– Assam
– Madhya Pradesh
– Andhra Pradesh
– Sikkim
– Gujarat
20Dr. Shammy Rajan

• On 2011 January, GoI introduced a
programme called National Programme for
Prevention and Control of Cancer, Diabetes,
Cardiovascular disease and Stroke (NPCDCS)
by incorporating Cancer into this programme
21Dr. Shammy Rajan

POLICY CONTENT
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23
Objectives Strategies Achievement
Prevent and control common
NCDs through behavior and
life style changes
Prevention through behavior
change
Behavior change from
childhood level as a part of
early prevention.
Provide early diagnosis and
management of common
NCDs
Early Diagnosis Early diagnoses was planned
to be done by screening all
adult above 30 years of age
Build capacity at various levels
of health care for prevention,
diagnosis and treatment of
common NCDs
Treatment Uninterrupted supply of
medicines
Train human resource within
the public health setup viz.
doctors, paramedics and
nursing staff to cope with the
increasing burden of NCDs
Capacity building of human
resource
Training to staff of different
sectors.
Establish and develop capacity
for palliative & rehabilitative
care.
Surveillance, Monitoring &
Evaluation
Supervision, monitoring and
evaluation concurrently and
periodically.Dr. Shammy Rajan

IMPLEMENTATION PLAN
• The programme was planned to be
implemented in 20,000 Sub-Centers and 700
Community Health Centers (CHCs) in 100
Districts across 15 States/UTs.
• During 2010-11, it was implemented in 6482
Sub- centers, 205 CHCs, across 30 districts in
21 states
• Extended to 100 districts by 2011-12
24Dr. Shammy Rajan

BUDGET
• Estimated total outlay of Rs. 1230.90 crores
• Rs.499.38 crores for interventions on diabetes
and cardiovascular diseases & stroke
• Rs.731.52 crores for cancer control
• Cost Sharing: Centre – 80% and State- 20%
• The allocations for various level of institutions
were mentioned under separate heads
26Dr. Shammy Rajan

Monitoring and evaluation
• National NCD cell does the over all monitoring
and evaluation
• NCD cell at different levels have to supervise
and monitor the programme
• Done through HMIS, Review meetings, Field
observations, surveillance, operational
research and evaluation studies
27Dr. Shammy Rajan

Current Situation
12th 5 year plan – key strategies
• Health Promotion for healthy life styles that
preclude NCDs and their risk factors
• Specific prevention strategies which reduce
exposure to risk factors
• Early Diagnosis through periodic/opportunistic
screening of population and better diagnostic
facilities
• Infrastructure Development and facilities
required for management of NCDs
29Dr. Shammy Rajan

• Human Resources and their capacity building for
prevention and treatment of NCDs
• Establish emergency medical services with rapid
referral systems to reduce disability and mortality due
to NCDs
• Treatment and care of persons with NCDs including
rehabilitation and palliative care
• Health Legislation and population based interventions
through multi sectoral approach for prevention of
NCDs
• Building evidence for action through surveillance,
monitoring and research.
30Dr. Shammy Rajan

Critique
As per anecdotal evidence;
• Budget was allocated till 2012-13 financial year
• No funding since 2013-14
• During 2013-14, fund diverted from NPHCE
• Proposed staff strength could not be achieved
• Lack of good quality data
• Infrastructure development was poor
• No measures for evaluation
31Dr. Shammy Rajan

• More emphasis on diagnosis and treatment
• Prevention and control measures were
minimal
• Poor referral system
• Problem of cancer and stroke was not
addressed properly
32Dr. Shammy Rajan

References
1. Harper K, Armelagos G. The Changing Disease-Scape in the Third Epidemiological
Transition. Int J Environ Res Public Health. 2010 Feb;7(2):675–97.
2. Agyei-Mensah S, de-Graft Aikins A. Epidemiological Transition and the Double
Burden of Disease in Accra, Ghana. J Urban Health Bull N Y Acad Med. 2010
Sep;87(5):879–97.
3. Albala C, Vio F, Yáñez M. [Epidemiological transition in Latin America: a
comparison of four countries]. Rev Médica Chile. 1997 Jun;125(6):719–27.
4. Amuna P, Zotor FB. Epidemiological and nutrition transition in developing countries:
impact on human health and development. Proc Nutr Soc. 2008 Feb;67(1):82–90.
5. Victora CG, Hanson K, Bryce J, Vaughan JP. Achieving universal coverage with
health interventions. The Lancet. 2004 Oct 29;364(9444):1541–8.
6. Duran A, Khot A. Strengthening the Health System to Better Confront
Noncommunicable Diseases in India. Indian J Community Med Off Publ Indian
Assoc Prev Soc Med. 2011 Dec;36(Suppl1):S32–S37.
33Dr. Shammy Rajan

References
7. Srinath Reddy K, Shah B, Varghese C, Ramadoss A. Responding to the threat
of chronic diseases in India. Lancet. 2005 Nov 12;366(9498):1744–9.
8. Takiar R, Nadayil D, Nandakumar A. Projections of number of cancer cases
in India (2010-2020) by cancer groups. Asian Pac J Cancer Prev APJCP.
2010;11(4):1045–9.
9. Srivastava RK, Bachani D. Burden of NCDs, Policies and Programme for
Prevention and Control of NCDs in India. Indian J Community Med Off Publ
Indian Assoc Prev Soc Med. 2011 Dec;36(Suppl1):S7–S12.
10. http://data.worldbank.org/indicator/SP.POP.TOTL
11. http://www.who.int/mediacentre/factsheets/fs355/en/
12. http://www.pib.nic.in/newsite/erelease.aspx?relid=63087
13. www.ncd.in
14.http://planningcommission.nic.in/aboutus/committee/wrkgrp11/wg11_co
mble.pdf
15. http://mohfw.nic.in/index.php
34Dr. Shammy Rajan

Non Communicable Diseases Policy of India - An analysis

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