Evaluation of NPNCD (National Programme for Non-Communicable Diseases)

1. Background and Evolution

2. Objectives of the Programme

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
4. Train human resources (doctors, paramedics, nursing staff) to cope with rising NCD burden
5. Establish and develop capacity for palliative and rehabilitative care
6. Monitoring, supervision, and evaluation through a uniform ICT application

3. Components of the Programme

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

• 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

• 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

• NCD clinic for comprehensive management
• Capacity-building of local healthcare providers
• Specialist services and tertiary referrals

B. Cancer Component

• 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

1. Programme Monitoring - Data collection, performance management, data quality assurance
2. Evaluation - Use of data for decision-making, rapid assessment of program effectiveness and impact
3. Learning - Documentation, reporting, and dissemination of findings
4. 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

• 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)

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)

7. NP-NCD 2023-2030: Revised Strategy

• 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

• 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

Major Changes and Advances: NPCDCS → NP-NCD (2023)

At a Glance: The Core Shift

1. Expansion of Disease Scope (Most Significant Change)

2. Shift from Opportunistic to Population-Based Screening (PBS)

• ASHAs fill the Community-Based Assessment Checklist (CBAC) at household level
• Screens individuals 30 years and above
• 5 conditions covered: Hypertension, Diabetes, Oral cancer, Cervical cancer, Breast cancer
• Moves care from facility-based to doorstep screening
• Dramatically increases reach beyond those who self-present to facilities

3. Integration with Ayushman Bharat Architecture

• Ayushman Bharat Health and Wellness Centres (AB-HWCs), now renamed Ayushman Arogya Mandirs (AAM), are the primary delivery platform for NCD screening and management
• Services at AAM now include:
  • PBS via CBAC (by ASHAs)
  • Free essential medicines and diagnostics
  • Teleconsultation via e-Sanjeevani
  • Health promotion (yoga, diet, tobacco cessation, self-care)
  • Wellness activities
• Continuum of care through referral to higher centres and reverse referral back to AAMs once patients are stabilized
• Preventive cancer services mainstreamed under Comprehensive Primary Health Care at HWCs

4. Digital Health and Technology Integration

5. New Flagship Initiative: "75 by 25"

• Target: Bring 75 million people with hypertension and diabetes under standard care by 2025
• Strategies:
  • Increase screening, registration, diagnosis, treatment, and control rates
  • Health system strengthening for continuum of care
  • Leverage Ayushman Arogya Mandirs as the backbone
  • Strengthen PBS and patient adherence by CHOs, ANMs, and ASHAs
  • Strengthen supply chain for NCD drugs
  • Utilize NCD Portal for data analysis and feedback
  • Community health camps
• This initiative did not exist under NPCDCS

6. Multisectoral Action: From Single-Ministry to Multi-Ministry

• Provides roadmap for multi-ministry engagement
• Ministries actively involved:
  • Housing & Urban Affairs - non-motorized transport, cycling tracks, parks
  • Education - sports in school curriculum
  • Youth Affairs & Sports - expanding playfields
  • Food & Agriculture - nutrition and salt reduction
• Reflects recognition that NCD risk factors (physical inactivity, diet, tobacco) require whole-of-government response
• Aligned with WHO HEARTS Technical Package for cardiovascular disease management

7. Human Resources: Task Sharing and New Cadres

• Community Health Officers (CHOs) at HWCs take on expanded NCD management roles
• ASHAs and ANMs trained for CBAC completion and first-level NCD screening
• Separate NP-NCD refresher trainings developed (beyond CDSS training)
• Discussion-based trainings with role plays to simulate community scenarios
• Non-physician healthcare providers trained to prescribe and manage HTN/DM using Standard Treatment Protocols (STPs)

8. Standard Treatment Protocols (STPs) and Evidence-Based Care

• Hypertension
• Diabetes
• COPD/Asthma
• CKD
• NAFLD
• Stroke
• Cancer (cervical, oral, breast)

9. Strengthened Monitoring and Evaluation (M&E) Framework

1. Programme Monitoring - data collection, performance management, data quality assurance
2. Evaluation - decision-making, rapid assessment of effectiveness and impact
3. Learning - documentation and dissemination
4. Planning - indicator definition and data sourcing

• Dashboard-based review at district (monthly) and state (quarterly) levels
• 10% of collected NCD Portal data must go through quality checks each quarter
• Annual/bi-annual review meetings with all stakeholders
• Indicators now cover inputs, processes, outputs, outcomes, and impact

10. SDG and Global Framework Alignment

• SDG 3.4 - Reduce premature NCD mortality by one-third by 2030
• SDG 3.8.1 - Universal health coverage index (NCD tracer indicator)
• WHO Global Action Plan for NCDs 2013-2020 targets (tobacco 30%, BP 25%, mortality 25%, etc.)
• National Health Policy 2017 goals to halt and reverse NCD incidence
• 2nd National Conference of Chief Secretaries (January 2023) action points on NCDs

Summary: NPCDCS vs NP-NCD - Key Advances