NPCDCS, ADOLESCENT HEALTH PROGRAMME, AND NATIONAL MENTAL HEALTH PROGRAMME

Source: Park's Textbook of Preventive and Social Medicine

1. NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CARDIOVASCULAR DISEASES AND STROKE (NPCDCS)

Background and Origin

• During the 11th Five Year Plan: 100 identified districts in 21 states were covered.
• During the 12th Five Year Plan: The programme was extended to cover all districts of the country in a phased manner.

A. Diabetes, Cardiovascular Disease and Stroke (DCS) Component under NPCDCS

• Health promotion
• Capacity building including human resource development
• Early diagnosis and management
• Integration with the primary health care system

Major Objectives:

1. Prevent and control common NCDs through behaviour and lifestyle changes.
2. Provide early diagnosis and management of common NCDs.
3. Build capacity at various levels of health care for prevention, diagnosis and treatment of common NCDs.
4. Train human resource within the public health set-up (doctors, paramedics, nursing staff) to cope with the increasing burden of NCDs.
5. Establish and develop capacity for palliative and rehabilitative care.

Implementation and Strategies:

• The programme is to be implemented in 20,000 sub-centres and 700 Community Health Centres (CHCs) in 100 districts across 21 States/UTs.
• Strategies include:
  • Promoting healthy lifestyle through massive health education and mass media at country level
  • Opportunistic screening of persons above 30 years of age
  • Establishment of NCD Clinics at CHC and District level
  • Development of trained manpower
  • Strengthening of tertiary level health facilities
  • Service delivery through existing public health infrastructure

Behavioural Change Messages (via mass media, community education, interpersonal communication):

• Increased intake of healthy foods
• Increased physical activity
• Avoidance of tobacco and alcohol
• Stress management

Activities at Sub-Centre

• Health promotion for behaviour and lifestyle change through camps, interpersonal communications, posters, banners, etc.
• Opportunistic screening of population above 30 years using BP measurement and blood glucose by strip method.
• Suspected cases of diabetes and hypertension are referred to CHCs or higher health facilities for further diagnosis and management.
• Glucometer, optium test strips and auto-disabled lancets are procured centrally and provided to states.

Activities at CHC (NCD Clinic)

• Diagnosis by required investigations: blood sugar measurement, lipid profile, ultrasound, X-ray and ECG.
• Management and stabilization of common CVD, diabetes and stroke cases (outpatient and inpatient).
• One nurse undertakes home visits for bedridden cases.
• Supervises work of health workers and attends monthly clinics in villages.
• Complicated cases of diabetes, high blood pressure are referred to the district hospital.

Activities at District Hospital (NCD Clinic)

• Screens persons above 30 years for diabetes, hypertension, CVD, etc.
• Detailed investigation of persons at high risk of developing NCDs and those referred from CHCs.
• Provides regular management and annual assessment of persons suffering from cancer, diabetes and hypertension.
• Manages people with established cardiovascular diseases.
• Provides home-based palliative care for chronic, debilitating and progressive patients.
• Promotes healthy lifestyle through health education and counselling to patients and their attendants.

Urban Health Check-Up Scheme for Diabetes and High Blood Pressure

1. To screen urban slum population for diabetes and high blood pressure.
2. To create database for prevalence of diabetes and high blood pressure in urban slums.
3. To sensitize the urban slum population about healthy lifestyle.

NCD Cells

Achievements under the Programme (as on 30th September 2015)

New Initiatives under the Programme

1. Intervention for prevention and control of Rheumatic Heart Disease under NPCDCS and Rashtriya Bal Swasthya Karyakram (RBSK).
2. Integration of AYUSH with NPCDCS.
3. Integration of RNTCP with NPCDCS - to articulate a national strategy for management of TB and diabetes comorbidities in India.

Guidelines for Referral and Treatment (Operational Guidelines 2016)

1. Systolic BP over 140 mmHg and diastolic BP over 90 mmHg, or random blood sugar of 140 mg/dl and above - referred to medical officer for confirmation, laboratory investigations and initiation of treatment.
2. Those positive for cancer/precancerous lesions - referred by ANM/Staff Nurse to appropriate PHC/CHC/District Hospital for confirmation and treatment by trained specialist.
3. Once diagnosis of hypertension/diabetes is established - patient must receive at least a month's supply of drugs from PHC. Once stable, state may provide 3-month supply, with ANM/ASHA visiting each month.

Indicators and Targets for NCD Prevention and Control in India

B. Cancer Component under NPCDCS

Objectives of the Cancer Component:

Schemes under the Revised Programme:

1. Regional Cancer Centre Scheme

• Existing Regional Cancer Centres are being strengthened to act as referral centres for complicated and difficult cases at the tertiary level.
• One-time assistance of Rs. 3 crores is provided to Regional Cancer Centres (except TMH, Mumbai and IRCH-AIIMS) for strengthening, and to CNCI, Kolkata on approved pattern of funding.

2. Oncology Wing Development Scheme

• Initiated to fill geographic gaps in the availability of cancer treatment facilities.
• Central assistance provided for purchase of equipment, which includes a cobalt unit besides other equipment.
• Manpower is to be provided by concerned state government/institution.
• Quantum of central assistance: Rs. 3 crores per institution.

3. Decentralized NGO Scheme

• Meant for IEC activities and early detection of cancer.
• Operated by nodal agencies; NGOs are given financial assistance for health education and early detection activities.

4. IEC Activities at Central Level

• Wider publicity about Anti Tobacco Legislation, discouraging consumption of cigarettes and other tobacco products.
• Creating awareness about ill effects of tobacco consumption.
• November 7th is observed as National Cancer Awareness Day.

5. Research and Training

• Training programmes, monitoring and research activities organized at the central level.
• Training manuals developed under NCCP for capacity building in cancer control at district level: a. Manual for health professionals b. Manual for cytology c. Manual for palliative care d. Manual for tobacco cessation

Cancer Services under NPCDCS:

1. Common diagnostic services, basic surgery, chemotherapy and palliative care for cancer cases is being made available at 100 district hospitals.
2. Each district is being supported with Rs. 1.66 crores per annum for:
   • Chemotherapy drugs for 100 patients at each district hospital.
   • Day care chemotherapy facilities established at 100 district hospitals.
3. Home-based palliative care is being provided for chronic, debilitating and progressive cancer patients at 100 districts.
4. Support is being provided for contractual manpower through:
   • 1 Medical Oncologist
   • 1 Cytopathologist
   • 1 Cytopathology technician
   • 2 Nurses for day care
5. State Cancer Institutes (SCI) will provide comprehensive cancer diagnosis, treatment and care services. SCI will be the apex institution in the state for cancer treatment activities.
6. 45 centres were to be strengthened as Tertiary Cancer Centres (TCCs) to provide comprehensive cancer care services at a cost of Rs. 6.00 crore each during 2011-12.

2. ADOLESCENT HEALTH PROGRAMME

Background

• Nutrition
• Sexual and reproductive health
• Mental health
• Addressing gender-based violence
• Non-communicable diseases
• Substance use

Priority Interventions:

1. Adolescent nutrition; iron and folic acid supplementation.
2. Facility-based Adolescent Reproductive and Sexual Health (ARSH) services (Adolescent health clinics).
3. Information and counselling on adolescent sexual reproductive health and other health issues.
4. Menstrual hygiene.
5. Preventive health check-ups.

Rashtriya Kishor Swasthya Karyakram (RKSK)

• Introduces peer-led interventions at the community level.
• Supported by augmentation of facility-based services.
• Broadens the focus of the adolescent health programme beyond reproductive and sexual health.
• Brings in focus on:
  • Life skills
  • Nutrition
  • Injuries and violence (including gender-based violence)
  • Non-communicable diseases
  • Mental health
  • Substance misuse

Weekly Iron and Folic Acid Supplementation (WIFS) under National Iron+ Initiative

• Launched in 2013, this initiative addresses iron deficiency anaemia.
• WIFS targets adolescents aged 10-19 years.
• Rolled out in 32 states and UTs.
• Covered around 3 crore beneficiaries in December 2013.
• Part of the broader National Iron Plus Initiative which targets pregnant women, lactating mothers, children, adolescents and women in reproductive age group.

RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent Health Services)

• A continuum of care approach adopted under NRHM.
• Brings focus on adolescents as a critical life stage.
• Linkages between child survival, maternal health and family planning efforts.
• Strengthens referral linkages between community and facility-based health services.

3. NATIONAL MENTAL HEALTH PROGRAMME (NMHP)

Background and Launch

• Ensure availability of Mental Health Care Services for all, especially the community at risk and underprivileged sections of the population.
• Encourage application of mental health knowledge in general health care and social development.

Aims of NMHP:

Objectives of NMHP:

1. To ensure availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of population.
2. To encourage application of mental health knowledge in general health care and in social development.
3. To promote community participation in mental health services development, and to stimulate efforts towards self-help in the community.

Programme Strategies:

1. Integration of mental health with primary health care through the NMHP.
2. Provision of tertiary care institutions for treatment of mental disorders.
3. Eradicating stigmatization of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority and State Mental Health Authority.

District Mental Health Programme (DMHP) - Components:

DMHP - Promotive and Preventive Activities (New Incorporations):

• School mental health services: Life skills education in schools, counselling services.
• College counselling services: Through trained teachers/counsellors.
• Work place stress management: Formal and informal sectors, including farmers, women, etc.
• Suicide prevention services: Counselling centre at district level, sensitization workshops, IEC, helplines, etc.

Thrust Areas of NMHP:

1. District mental health programme in an enlarged and more effective form covering the entire country.
2. Streamlining/modernization of mental hospitals to modify their present custodial role.
3. Upgrading department of psychiatry in medical colleges and enhancing the psychiatric content of the medical curriculum at undergraduate and postgraduate level.
4. Strengthening the central and state mental health authorities with a permanent secretariat. Appointment of medical officers at state headquarters for more effective monitoring.
5. Research and training in community mental health, substance abuse and child adolescent psychiatric clinics.

Monitoring

NMHP - Essential Services (PHC Level):

The Mental Healthcare Act, 2017

• The United Nations Convention on the Rights of Persons with Disabilities was ratified by the Government of India, making it obligatory to align policies and laws with the convention.
• The Mental Healthcare Bill, 2013 was introduced in Parliament to:
  • Protect and promote rights of persons with mental illness during delivery of health care in institutions and in the community.
  • Ensure health care, treatment and rehabilitation of persons with mental illness in the least restrictive environment possible.
  • Regulate public and private mental health sectors within a rights framework.
  • Achieve greatest public health good and promote principles of equity, efficiency and active participation of all stakeholders.
• Suicide has been decriminalized under the Act.
• The bill received assent of the President of India on 07.04.2017.
• The Ministry constituted a committee of experts for formulating rules and regulations under the Act.