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Evaluation of NPNCD (National Programme for Non-Communicable Diseases)
1. Background and Evolution
India is experiencing a rapid health transition with a large, rising burden of chronic NCDs - particularly cardiovascular disease, diabetes mellitus, cancer, stroke, and chronic lung diseases. NCDs accounted for 60% of all deaths in India in 2016.
The programme evolved through several stages:
| Year | Programme |
|---|---|
| 1975-76 | National Cancer Control Programme launched |
| 1984-85 | Programme revised to expand cancer treatment facilities |
| 2010 | NPCDCS launched by integrating Diabetes/CVD/Stroke + Cancer programmes |
| 11th Five Year Plan | Covered 100 districts in 21 States/UTs |
| 12th Five Year Plan | Expanded to all districts in a phased manner |
| 2023 | Renamed NP-NCD with revised Operational Guidelines 2023-2030 |
2. Objectives of the Programme
- 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
- Train human resources (doctors, paramedics, nursing staff) to cope with rising NCD burden
- Establish and develop capacity for palliative and rehabilitative care
- Monitoring, supervision, and evaluation through a uniform ICT application
3. Components of the Programme
A. Diabetes, Cardiovascular Disease and Stroke (DCS) Component
At Sub-Centre level:
- Health promotion for behaviour and lifestyle change (camps, IPC, posters, banners)
- Opportunistic screening of population above 30 years (BP + blood glucose by strip method)
- Glucometer, test strips, and auto-disabled lancets supplied centrally
- Suspected cases referred to CHC/higher facilities
At CHC level (NCD Clinic):
- Diagnosis: blood sugar, lipid profile, ultrasound, X-ray, ECG
- Management and stabilization of common CVD, diabetes, and stroke cases (OPD + inpatient)
- Long-term follow-up and referral to district hospitals for complications
At District Hospital:
- NCD clinic for comprehensive management
- Capacity-building of local healthcare providers
- Specialist services and tertiary referrals
B. Cancer Component
Objectives:
- Primary prevention - health education on tobacco, alcohol, lifestyle
- Secondary prevention - early detection screening for cervical, oral, breast, and tobacco-related cancers
- Tertiary prevention - strengthening institutions for comprehensive therapy including palliative care
4. Evaluation Framework
The programme uses a four-component Monitoring and Evaluation (M&E) cycle:
- Programme Monitoring - Data collection, performance management, data quality assurance
- Evaluation - Use of data for decision-making, rapid assessment of program effectiveness and impact
- Learning - Documentation, reporting, and dissemination of findings
- Planning - Defining indicators and data sources
Evaluation Indicators
Input Indicators
- Proportion of health facilities that are fully functional
- Proportion with trained human resources (sanctioned vs filled posts)
- Proportion with functional equipment
- Proportion with stock-out of IEC materials/consumables
- Status of State/District NCD Division infrastructure
- Status of District/CHC NCD Clinics
Process Indicators
- % of training sessions conducted against targets
- % display of IEC materials
- % of meetings with schools/workplaces
- % of community meetings conducted
- Proportion of health facilities sending reports on time
- Saturation of districts having Standard Treatment Protocols (HTN, DM)
- Saturation of districts having functional NCD Clinics
Output Indicators
- % households screened for CVD, diabetes, stroke, cancers
- % of diagnosed cases put on treatment
- % controlled with treatment
Key output findings from field evaluation studies (2023):
- Diabetes: ~90% of households screened, 96% of positives diagnosed and treated, 78% controlled
- Stroke: 96% of screen-positives diagnosed and treated, 92% controlled
- Cancer: 86% of households screened, 82% diagnosed and treated, only 50% controlled - the weakest outcome
- Health promotion activities in schools and workplaces were largely NOT being implemented
Outcome / Impact Indicators (National Targets)
| Framework Element | Target by 2020 | Target by 2025 |
|---|---|---|
| Premature mortality reduction (CVD, cancer, DM, COPD) | 10% relative reduction | 25% |
| Tobacco use reduction | 15% | 30% |
| Raised blood pressure reduction | 10% | 25% |
| Salt/sodium intake reduction | 20% | 30% |
| Physical inactivity reduction | 5% | 10% |
| Drug therapy to prevent heart attacks/strokes (eligible persons) | 30% coverage | 50% |
| Essential NCD medicines availability in public/private facilities | 60% | 80% |
| Household solid fuel use reduction | 25% | 50% |
| Halt rise of obesity and diabetes prevalence | - | Halt rise |
(Source: Park's Textbook of Preventive and Social Medicine)
5. Achievements
- Expansion to all districts across India
- Establishment of NCD Clinics at CHC and District Hospital levels in identified districts
- Geriatric units approved in 520 districts across 35 states (from 2017-18)
- Rehabilitation units set up at CHCs
- Glucometers and screening equipment supplied centrally
- Task-sharing with ASHAs and ANMs at sub-centre level
- Standard Treatment Protocols (STPs) developed for HTN, DM, and other NCDs
- Digital patient records via the National NCD Portal launched
- High screening rates achieved in districts with active implementation (>85-90%)
6. Challenges and Gaps (Evaluation Findings)
Based on field evaluations and published research, the following challenges have been documented:
| Theme | Specific Issues |
|---|---|
| Inadequate Training | Gaps in screening technique training; inadequate training on NCD mobile apps |
| Work-related challenges | Lack of specific targets per health worker; no incentives provided |
| Community challenges | Low public awareness about the programme; community reluctance to participate; no identity cards for beneficiaries |
| Technical challenges | App-related glitches; equipment malfunction/non-availability |
| Resource scarcity | Shortage of equipment; shortage of PPE; undersupply of IEC material |
| Political will | Lack of political commitment at local/state level hampers programme execution |
| COVID-19 impact | Disruption of services, transport restrictions, overwhelming workload on health staff |
| Vertical integration | Programme still largely vertical; weak integration with RMNCH+A and other NHM components |
| Data quality | Incomplete reporting; the NCD portal requires 10% data quality checks each quarter which is often missed |
| Human resource gaps | Large gap between sanctioned and filled posts at all levels |
7. NP-NCD 2023-2030: Revised Strategy
The updated programme (renamed NP-NCD) incorporates:
- Expanded scope to include mental health, oral health, hearing loss, trauma/injury
- CDSS (Clinical Decision Support System) integration for standardized care
- People-centered and task-sharing approaches
- Uninterrupted drug and logistics supply chains
- Role plays and community-scenario training for health providers
- Stronger inter-ministerial coordination (Housing, Transport, Education, Sports ministries)
- SDG alignment - particularly SDG Target 3.8.1 on universal health coverage
8. Summary Assessment
The NPNCD/NP-NCD is a well-designed programme addressing the rising NCD burden in India. Its strengths are wide geographic coverage, integration of multiple NCD verticals, and linkage to primary health care. However, evaluation consistently shows that:
- Service delivery (screening, diagnosis, treatment) is reasonably good where infrastructure exists
- Health promotion activities remain poorly implemented
- Cancer control outcomes are the weakest among all NCD components
- Human resource shortfalls and supply chain issues remain the most critical operational barriers
- ICT-based monitoring is improving but data quality assurance remains a challenge
Sources: Park's Textbook of Preventive and Social Medicine (Chapter on National Health Programmes, 7th reference); NP-NCD Operational Guidelines 2023-2030; Field evaluation of NPCDCS, GJMEDPH 2023
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