National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) — India

Background & Evolution

• Cardiovascular diseases (CVD) & Stroke
• Diabetes (Type 2)
• Cancers (Oral, Cervical, Breast)
• Chronic Obstructive Pulmonary Disease (COPD) & Asthma

Objectives

1. Prevent and control common NCDs through behaviour and lifestyle change
2. Screen and manage hypertension, diabetes, and common cancers at primary care level
3. Strengthen the health system for NCD management — human resources, infrastructure, diagnostics
4. Build capacity of health workers at all levels
5. Generate evidence through surveillance, monitoring and evaluation

Key Components

1. Health Promotion & Awareness

• Behaviour Change Communication (BCC) targeting tobacco use, unhealthy diet, physical inactivity, harmful alcohol use
• School health, worksite wellness, community-level campaigns
• National Action Plan aligned with WHO Global Action Plan for NCDs (2013–2020/2030)

2. Population-Based Screening (at Health & Wellness Centres / Sub-Centres)

• Hypertension & Diabetes — screening of all adults ≥30 years
• Cancer screening — oral (visual inspection), cervical (VIA/VILI), breast (clinical breast examination)
• Opportunistic + outreach screening via ASHA workers

3. Service Delivery Levels

4. NCD Clinics

• Established at every Community Health Centre (CHC) and District Hospital
• Provide free drugs for hypertension and diabetes
• Managed by Medical Officers trained in NCD care

5. Human Resource Development

• Training of ANMs, ASHAs, Medical Officers, and specialists
• National NCD Helpline (1800-11-4000) for public guidance

6. Diagnostics & Drugs

• Essential NCD medicines (antihypertensives, antidiabetics, aspirin, statins) freely available at public facilities
• ECG, blood glucose, lipid profile at CHC level

7. District NCD Cell

• Each district has a District NCD Cell for coordination, monitoring, and data management
• Headed by a District NCD Officer

Targets (Aligned with WHO & Sustainable Development Goals)

• 25% relative reduction in premature mortality from NCDs by 2025
• 80% availability of affordable essential medicines for NCDs
• Halt the rise in obesity and diabetes
• Reduce harmful alcohol use by 10%
• Reduce prevalence of raised blood pressure by 25%
• 30% reduction in tobacco use
• Universal Health Coverage goal — 70 million people screened for hypertension and diabetes annually under Ayushman Bharat

NPCDCS → NP-NCD Transition (Post-2017)

• Comprehensive Primary Health Care now includes NCD management as a core package
• HWCs (upgraded Sub-Centres and Primary Health Centres) serve as the first point of contact for NCD screening and early management
• CBAC (Community Based Assessment Checklist) used by ASHAs to screen individuals ≥30 years for NCD risk

CBAC Tool — Community Screening

• Tobacco/alcohol use
• Physical activity
• Dietary habits
• Family history of NCDs
• Waist circumference, blood pressure, blood glucose

Surveillance

• ICMR-NCD Risk Factor Surveillance
• STEPS Survey (WHO-aligned)
• Integrated Disease Surveillance Programme (IDSP) — NCD component
• National Family Health Survey (NFHS) — NCD indicators

Challenges

• Fragmented implementation across states
• Shortage of trained NCD specialists at district level
• Poor drug supply chain continuity
• Low awareness of NCDs in rural areas
• Dual burden of communicable + non-communicable diseases
• Data under-reporting and incomplete NCD registries

Key Facts for Examination

Strategies of NP-NCD

1. Health Promotion & Primary Prevention

• Behaviour Change Communication (BCC): Mass media, interpersonal communication, and social media campaigns targeting tobacco use, harmful alcohol consumption, unhealthy diet (excess salt, sugar, fat), and physical inactivity — the four shared behavioural risk factors for NCDs
• SHAKE / MPOWER / REPLACE frameworks aligned with WHO best-buy interventions
• School health programmes — integrating NCD prevention into the curriculum
• Worksite wellness programmes — targeting working-age adults
• Fit India Movement and Eat Right India campaigns as complementary national initiatives
• Tobacco control under COTPA (Cigarettes and Other Tobacco Products Act) and NTCP (National Tobacco Control Programme)

2. Strengthening Primary Health Care for NCDs

• Health & Wellness Centres (HWCs) — upgraded Sub-Centres and PHCs under Ayushman Bharat as the frontline for NCD screening and management
• Comprehensive Primary Health Care (CPHC) package mandates NCD services at the sub-centre level
• ASHA workers deploy the CBAC (Community Based Assessment Checklist) for door-to-door screening of all individuals ≥30 years for risk factors
• Task shifting — training ANMs and MPWs to measure blood pressure and blood glucose

3. Early Detection Through Population-Based Screening

• Universal screening of all adults ≥30 years for:
  • Hypertension (BP measurement)
  • Diabetes (random blood glucose → fasting if abnormal)
  • Obesity (BMI, waist circumference)
• Cancer screening:
  • Oral cancer — Visual inspection of oral cavity (by health worker)
  • Cervical cancer — VIA (Visual Inspection with Acetic Acid) / VILI
  • Breast cancer — CBE (Clinical Breast Examination)
• Opportunistic screening at all health facility visits
• ASHA-facilitated outreach and follow-up of screen-positive individuals

4. Continuum of Care — Diagnosis, Treatment & Rehabilitation

• NCD Clinics at every CHC and District Hospital for free diagnosis and management
• Free essential medicines for hypertension and diabetes (antihypertensives, metformin, glipizide, aspirin, statins) at public facilities
• Referral linkages: Sub-Centre → PHC → CHC → District Hospital → Tertiary/Cancer Centre
• Palliative care integration for advanced cancer patients
• Cardiac care units and stroke management at district level
• DEIC (District Early Intervention Centres) for rehabilitation support

5. Human Resource Development & Capacity Building

• Training of Medical Officers in NCD diagnosis and management protocols
• Training of ANMs, ASHAs, MPWs in screening tools (CBAC, BP measurement, CBE)
• District NCD Officer at each district to coordinate programme activities
• Specialist training — cardiologists, diabetologists, oncologists at tertiary level
• Integration of NCD topics into undergraduate and postgraduate medical curricula

6. Intersectoral Coordination & Multi-Sectoral Action

• Collaboration across ministries: Agriculture (food policy), Education, Urban Development, Sports, Finance (taxation on tobacco/alcohol)
• National Multi-Sectoral Action Plan (NMSAP) for NCDs — formally engages non-health sectors
• Partnership with FSSAI (food safety) for reducing salt/sugar/fat in processed foods
• Smart Cities Mission — designing urban environments to promote physical activity (walkways, cycling lanes)
• Involvement of PRIs (Panchayati Raj Institutions) and ULBs (Urban Local Bodies) in awareness activities

7. Surveillance, Monitoring & Evaluation

• ICMR-INDIAB Study — national diabetes and metabolic syndrome prevalence data
• WHO STEPS Survey — standardised NCD risk factor surveillance
• National NCD Monitoring Framework — tracks 9 voluntary global targets and 25 indicators
• HMIS (Health Management Information System) — NCD data entry at all facility levels
• NCD registries — cancer registries (PBCR/HBCR) under ICMR-NCDIR (National Centre for Disease Informatics and Research)
• District-level monitoring through District NCD Cells

8. Health Financing & Universal Health Coverage

• NCD care integrated into Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) — cashless treatment for hospitalisation due to NCDs in empanelled hospitals
• Free screening and treatment at public facilities — removing financial barriers
• Reduction of out-of-pocket expenditure (OOPE) as a core strategy
• Results-Based Financing — incentivising states for NCD outcomes

9. Research & Innovation

• ICMR-funded research on NCD burden, risk factors, and cost-effective interventions
• Health Technology Assessment (HTA) India — evidence-based policy recommendations
• Digital health tools — telemedicine for NCD follow-up in remote areas
• eSanjeevani platform for NCD consultations

Summary Matrix