Npcdcs notes detailed from park textbook psm with flowcharts as well
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I now have all the NPCDCS content from Park's textbook. Let me compile the full detailed notes with flowcharts.
NPCDCS - National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke
Park's Textbook of Preventive and Social Medicine
1. BACKGROUND & RATIONALE
- India is experiencing a rapid health transition with a large and rising burden of chronic NCDs - especially cardiovascular disease, diabetes mellitus, cancer, stroke, and chronic lung diseases
- In 2016, NCDs accounted for 60% of deaths in India
- NCDs are surpassing the burden of communicable diseases
- Existing health system was mainly focused on communicable diseases
- Need: A dedicated programme for NCD prevention and control
Origin:
- Initially: National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was envisaged
- Later integrated with the National Cancer Control Programme (NCCP)
- Final programme: NPCDCS (Cancer + Diabetes + CVD + Stroke)
2. TWO COMPONENTS
┌──────────────────────────────────────────────┐
│ NPCDCS │
├─────────────────────┬────────────────────────┤
│ Component A │ Component B │
│ DCS Component │ Cancer Component │
│ (Diabetes, │ │
│ Cardiovascular │ │
│ Disease & Stroke) │ │
└─────────────────────┴────────────────────────┘
3. COMPONENT A: DCS (Diabetes, Cardiovascular Disease & Stroke)
Objectives
- Prevent and control common NCDs through behaviour and lifestyle changes
- Provide early diagnosis and management of common NCDs
- Build capacity at various levels of health care for prevention, diagnosis and treatment
- Train human resource - doctors, paramedics, nursing staff within public health setup
- Establish and develop capacity for palliative & rehabilitative care
Coverage/Scale
- 20,000 sub-centres and 700 CHCs in 100 districts across 21 States/UTs (initial phase)
- During 11th Five Year Plan: 100 identified districts in 21 states
- During 12th Five Year Plan: Covered all districts of the country in a phased manner
4. STRATEGIES (DCS Component)
┌────────────────────────────────────────────────────────────┐
│ STRATEGIES UNDER NPCDCS (DCS) │
├────────────────────────────────────────────────────────────┤
│ 1. Health Promotion via Mass Media │
│ 2. Opportunistic Screening (>30 years) │
│ 3. NCD Clinics at CHC and District level │
│ 4. Trained Manpower Development │
│ 5. Strengthening Tertiary Health Facilities │
│ 6. Service delivery through existing public health │
│ infrastructure │
└────────────────────────────────────────────────────────────┘
Behavioural Change Communication (BCC) Messages
- Increased intake of healthy foods
- Increased physical activity
- Avoidance of tobacco and alcohol
- Stress management
5. ACTIVITIES AT EACH LEVEL OF HEALTH CARE
┌───────────────────────────────────────────────────────────────────────┐
│ LEVELS OF IMPLEMENTATION │
│ │
│ SUB-CENTRE │
│ ├─ Health promotion: camps, IPC, posters, banners │
│ ├─ Opportunistic screening of population >30 years │
│ │ ├─ BP measurement │
│ │ └─ Blood glucose (strip method) │
│ └─ Refer suspected diabetes/HTN cases → CHC/higher facility │
│ Equipment: Glucometer Optium Xceed, test strips, lancets │
│ │
│ CHC (Community Health Centre) │
│ ├─ NCD Clinic established │
│ ├─ Diagnosis by investigations: │
│ │ Blood sugar, lipid profile, USG, X-ray, ECG │
│ ├─ Management and stabilization of CVD, diabetes, stroke │
│ │ (OPD + IPD) │
│ ├─ Nurse (appointed under programme): │
│ │ ├─ Home visits for bedridden cases │
│ │ ├─ Supervise health workers │
│ │ └─ Attend monthly village clinics │
│ └─ Refer complicated cases → District Hospital │
│ │
│ DISTRICT HOSPITAL │
│ ├─ NCD Clinic at district hospital │
│ ├─ Screen persons >30 years: diabetes, HTN, CVD │
│ ├─ Identify high-risk individuals for further investigation │
│ ├─ Detailed investigation for: │
│ │ ├─ High-risk individuals (from screening) │
│ │ └─ Referred cases from CHCs │
│ ├─ Regular management + annual assessment: │
│ │ Cancer, diabetes, HTN patients │
│ ├─ Management of established CVD │
│ ├─ Home-based palliative care (chronic/debilitating patients) │
│ └─ Health education & counselling │
└───────────────────────────────────────────────────────────────────────┘
6. REFERRAL FLOWCHART (NPCDCS)
COMMUNITY / SUB-CENTRE LEVEL
│
▼
Opportunistic screening (>30 years, all pregnant women)
│
├── BP > 140/90 mmHg ──────────────────────────────────┐
│ │
└── Random blood sugar ≥ 140 mg/dL ────────────────────┤
│
▼
Refer to MEDICAL OFFICER at
nearest facility (PHC level)
│
▼
Confirmation + Lab investigations
+ Initiation of treatment
│
┌─────────────┴─────────────┐
▼ ▼
Stable case Complicated case
│ │
▼ ▼
Monthly supply from PHC Refer to DISTRICT HOSPITAL
(after 3 stable visits, for further investigations
refer back to SC level) and management
│
▼
Severe/Specialist cases
Refer to TERTIARY CARE
7. CANCER SCREENING REFERRAL PATHWAY
ANM / Staff Nurse at Specified Screening Sites
│
▼
Screen for Cancer / Pre-cancerous lesions
│
▼ (Positive finding)
Refer to PHC / CHC / District Hospital
│
▼
Confirmation + Treatment by Trained Specialist
(as per operational framework for cancer screening and management)
8. COMPONENT B: CANCER COMPONENT
(Integrated from the National Cancer Control Programme)
The cancer component focuses on:
- Screening for common cancers (oral, breast, cervical)
- Referral pathway for positive/pre-cancerous lesions
- ANM/Staff Nurses trained for frontline cancer screening
9. URBAN HEALTH CHECK-UP SCHEME (for Diabetes and High Blood Pressure)
Objectives:
- To screen urban slum population for diabetes and high blood pressure
- To create a database for prevalence of diabetes and high BP in urban slums
- To sensitize urban slum population about healthy lifestyle
Target Population: All persons ≥30 years + all pregnant women of all ages
10. NCD CELLS - ADMINISTRATIVE STRUCTURE
┌──────────────────────────────────────────────────┐
│ NCD CELL ADMINISTRATIVE HIERARCHY │
│ │
│ NATIONAL NCD CELL (Centre) │
│ │ │
│ ▼ │
│ STATE NCD CELLS │
│ │ │
│ ▼ │
│ DISTRICT NCD CELLS │
│ │
│ Function: Implement and monitor NPCDCS │
└──────────────────────────────────────────────────┘
11. ACHIEVEMENTS (As on 30th Sept 2015)
| Facility | March 2014 | September 2015 |
|---|---|---|
| State NCD Cells | 21 | 36 |
| District NCD Cells | 96 | 195 |
| District NCD Clinics | 95 | 201 |
| District CCU Facilities | 51 | 65 |
| District Day Care Centres | 38 | 61 |
| CHC NCD Clinics | 204 | 1362 |
Programme under implementation in all 36 States/UTs as of 30th Sept 2015
12. NEW INITIATIVES UNDER NPCDCS
- Rheumatic Heart Disease - Intervention for prevention and control under NPCDCS and RBSK (Rashtriya Bal Swasthya Karyakram)
- Integration of AYUSH with NPCDCS
- Integration of RNTCP with NPCDCS - to articulate a national strategy for management of TB-Diabetes comorbidities in India
13. GUIDELINES FOR REFERRAL AND TREATMENT (Govt. of India, 2016)
Hypertension/Diabetes Referral Criteria
- SBP > 140 mmHg or DBP > 90 mmHg
- Random blood sugar ≥ 140 mg/dL → Refer to medical officer for confirmation + investigations + treatment
Drug Supply Protocol
- Once diagnosis established: Patient receives at least 1 month's supply from PHC
- Once condition is stable: Follow-up managed at sub-centre/community level
Cancer Referral
- Positive for cancer/pre-cancerous lesions → ANM/Staff Nurse refers to PHC/CHC/District Hospital for confirmation and treatment by trained specialist
14. SUMMARY FLOWCHART - COMPLETE NPCDCS OVERVIEW
┌───────────────────────────────────────────────────────────────────┐
│ NPCDCS │
│ (National Programme for Prevention and Control of │
│ Cancer, Diabetes, CVD and Stroke) │
└───────────────┬──────────────────────┬────────────────────────────┘
│ │
┌───────────▼──────────┐ ┌────────▼────────────────────────┐
│ Component A (DCS) │ │ Component B (Cancer) │
│ Diabetes, CVD, │ │ Oral / Breast / Cervical │
│ Stroke │ │ Cancer Screening │
└───────────┬──────────┘ └────────┬────────────────────────┘
│ │
┌───────▼───────────────────────▼──────────┐
│ HEALTH CARE DELIVERY LEVELS │
├──────────────────────────────────────────┤
│ Sub-Centre → Screening + IEC + Refer │
│ ↓ │
│ CHC → NCD Clinic + Stabilization │
│ ↓ │
│ District Hospital → NCD Clinic + │
│ Advanced management + Palliative care │
│ ↓ │
│ Tertiary Care → Specialist management │
└──────────────────────────────────────────┘
│
┌───────▼──────────────────────────────────┐
│ ADMINISTRATIVE OVERSIGHT │
│ National NCD Cell → State → District │
└──────────────────────────────────────────┘
QUICK REVISION POINTS (High-Yield for Exams)
| Point | Detail |
|---|---|
| Programme launched | Integrated from NPCDCS (DCS) + NCCP (Cancer) |
| 11th FYP coverage | 100 districts in 21 states |
| 12th FYP coverage | All districts of India |
| Screening age | >30 years (opportunistic) |
| Urban scheme targets | ≥30 years + all pregnant women |
| HTN referral cut-off | SBP >140 / DBP >90 mmHg |
| Blood sugar referral cut-off | Random BS ≥140 mg/dL |
| Screening tool at sub-centre | BP cuff + Glucometer Optium Xceed (strip method) |
| New integrations | AYUSH, RNTCP (TB-DM), Rheumatic Heart Disease + RBSK |
| Status (2015) | Implemented in all 36 States/UTs |
| CHC NCD Clinics (2015) | 1362 |
Source: Park's Textbook of Preventive and Social Medicine, Chapter on Health Programmes in India - NPCDCS section, pp. 534-536
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