NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CVD AND STROKE

India is experiencing a rapid health transition with a rising burden of Non Communicable Diseases (NCDs). According to a WHO report (2002), cardiovascular diseases (CVDs) will be the largest cause of death and disability in India by 2020. Overall, NCDs are emerging as the leading cause of deaths in India accounting for over 42% of all deaths (Registrar General of India). NCDs cause significant morbidity and mortality both in urban and rural population, with considerable loss in potentially productive years (aged 35–64 years) of life It is estimated that 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. There are an estimated 25 Lakh cancer cases in India. According to the National Commission on Macroeconomics & Health (NCMH) Report (2005), the Crude Incidence Rate (CIR) for Cervix cancer, Breast cancer and Oral cancer is 21.3, 17.1 and 11.8 (among both men and women) per 100,000 populations respectively.

The main preventable risk factors for NCDs are tobacco consumption; poor dietary habits, sedentary life style, stress etc. National Family Health Survey III (2005-06), reported that the prevalence of current tobacco use was 57•0 % among men and 10.8% among women. Over 8 Lakh deaths occur every year due to diseases associated with tobacco use. The cancer registry data reveals that 48% of cancers in males and 20% in females are tobacco related and are totally avoidable. Common cancers caused by smoking tobacco are lung, larynx, pharynx and esophagus, while cancers of the mouth, tongue and lip are due to chewing and smoking tobacco.

Objective
  • Prevent and control common NCDs through behavior and life style changes
  • Provide early diagnosis and management of common NCDs
  • Build capacity at various levels of health care for prevention, diagnosis and treatment of common NCDs
  • Train human resource within the public health setup viz doctors, paramedics and nursing staff to cope with the increasing burden of NCDs
  • Establish and develop capacity for palliative & rehabilitative car

  • Strategies
      1. Prevention through behavior change
      2. Early diagnosis
      3. Treatment
      4. Capacity building of human resource
      5. Supervision, monitoring and evaluation

    Scrrening,Diagnosis,Treatment

    • Screening (opportunistic screening i.e. wherever the service delivery and opportunity exists e.g. Mobile Medical Units, Rashtriya Swasthya Bal Karyakram (RSBK), melas etc.) for early detection of non-communicable diseases especially diabetes, high blood pressure and common cancers may be carried out.

    • The screening of target population (age 30 years and above, and pregnant women) shall be conducted either through opportunistic and/or camp approach at different levels of health facilities and also in urban slums of large cities.

    • Screening of pregnant Women would be integrated and through Ante natal Clinic under RCH program of NRHM. This is expected to be done for all pregnant women.

    • 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 screening of school children shall be carried out during the routine school health check-up activity under the school health program.

    • Mobile Medical Units under NRHM/RSBK are to be utilised for the purpose of screening.

    • The suspected cases of diabetes and high blood pressure shall be referred to higher health facilities for further diagnosis and treatment/management.

    • Opportunistic screening for common cancers (breast, cervical and oral) among the population 30 years and above, at different level of health facilities shall be carried out. Patients with high risk factors e.g. smoking or chewing tobacco, family history, obesity etc. would be screened. In case of breast self-examination is to be promoted while the clinical examination may be done only in 50 years above.

    • The ANMs shall be trained for conducting screening for NCDs at sub centre level.

    • Each district shall be linked to nearby tertiary cancer care facilities to provide referral and outreach services.

    • The suspected cases of various cancers shall be referred to District Hospital and tertiary cancer care (TCC) facilities.

    • For screening of diabetes, support for Glucometers, Glucostrips and lancets are provided to the state under NRHM. The procurement is now decentralized and it is for state Govt. to procure the equipment as per their need and requirement.

    • The common infrastructure/manpower available under different programmes such as National Program for Health Care of Elderly, National Tobacco Control Program, National Mental Health Program and overall NRHM etc. shall be utilized for early detection of cases, diagnosis, treatment, training and monitoring under NPCDCS.