National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS): Operational Guidelines

Objectives

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke seeks to establish a comprehensive, sustainable system for reducing non-communicable disease risk, illness, disability and death in India. It combines prevention, health promotion, early detection, affordable diagnosis and treatment, rehabilitation, palliative care, surveillance, research and workforce development, while aiming to reduce out-of-pocket expenditure and catastrophic financial consequences.[1][2][3]

• Promote healthy lifestyles by addressing tobacco and harmful alcohol use, unhealthy diet, excess salt intake, physical inactivity, obesity and stress, and by raising awareness of cancer warning signs and regular health checks.[4][5][6]
• Detect diabetes, hypertension and common cancers early through opportunistic and outreach screening, particularly among people aged 30 years and above, followed by referral and continuing follow-up.[1][5][7]
• Provide a graduated package of preventive, promotive, curative, supportive, rehabilitative and palliative services for cancer, diabetes, cardiovascular disease and stroke across primary, secondary and tertiary care.[8][2]
• Build health-system capacity for diagnosis, treatment, information, education and communication, behaviour-change communication, operational research and rehabilitation at all levels of care.[5]
• Develop non-communicable disease surveillance and databases covering morbidity, mortality and risk factors, including strengthened cancer registry networks.[1][5][3]
• Expand cancer-care capacity during the Twelfth Five-Year Plan through National Cancer Institutes, State Cancer Institutes and Tertiary Care Cancer Centres, alongside district-level chemotherapy day-care provision and cancer-registry networking.[3][9]

Programme targets for March 2017 included 640 district-hospital non-communicable disease clinics, 2,500 clinics at sub-divisional hospitals, community health centres and primary health centres, 35 State Non-Communicable Disease Cells, 640 District Non-Communicable Disease Cells, coronary care units in at least a quarter of districts, two National Cancer Institutes, 20 State Cancer Institutes and 50 supported tertiary cancer-care centres.[3]

Implementation

Implementation is integrated within the National Health Mission, using common administrative, financial and reporting structures while retaining specialised non-communicable disease capacity at district level and above. The model links community and primary care with community health centres, district hospitals, medical colleges and tertiary cancer centres, and combines public provision with structured engagement of civil society, non-governmental organisations and private providers.[1][8][10]

• Establish National, State and District Non-Communicable Disease Cells to develop guidance, prepare plans, coordinate implementation, manage commodities and funds, supervise services, and monitor physical and financial performance.[11][12][13]
• Deliver community-level health promotion, counselling and screening through auxiliary nurse midwives, male health workers, Accredited Social Health Activists and local platforms including camps, Village Health and Nutrition Days, schools and workplaces.[1][6]
• Strengthen sub-centres and primary health centres to provide risk-factor assessment, opportunistic blood-pressure and blood-sugar screening, cancer-warning-sign identification, basic diagnosis, treatment, counselling, referral and follow-up.[2][10][7]
• Operate non-communicable disease clinics at community health centres and first referral units, with laboratory support, chronic disease management, cancer screening, referral services and contract staff.[14][7]
• Strengthen district hospitals with outpatient, inpatient, emergency, intensive-care, rehabilitation, physiotherapy, laboratory and cancer-care services, including cardiac care units and selected chemotherapy day-care facilities.[2][14][15]
• Use medical colleges, tertiary cancer centres and specialised institutes for advanced care, mentoring, outreach, clinical training, treatment protocols and operational research.[2][13][16]
• Train medical officers, specialists, nurses, laboratory technicians, programme managers, finance and logistics personnel, data-entry operators and community-level workers through national, state and eligible institutional training arrangements.[17][13][18]
• Engage private laboratories and other approved providers where public diagnostic capacity is unavailable, while maintaining district-hospital treatment, referral and follow-up roles.[1][11]

Financing for interventions up to district level uses a common non-communicable disease flexi-pool within the National Health Mission. Government of India funds flow through State Health Societies to District Health Societies and approved programme accounts, while financial management groups oversee releases, expenditure reports, utilisation certificates and audit arrangements. Tertiary healthcare activities sit outside this flexi-pool.[3][10]

Tertiary cancer-care assistance is delivered through State Governments and formalised by tripartite memoranda of understanding involving the institution, State Government and Government of India. Maximum one-time assistance is 120 crore Indian rupees per State Cancer Institute and 45 crore Indian rupees per Tertiary Care Cancer Centre, including the State share; up to 30% may support civil, electrical, renovation or infrastructure works.[19][20][16]

Monitoring relies on facility registers, Health Management Information System reporting, field observations, review meetings, surveillance, financial management reports and monthly or quarterly submissions through district, state and national structures. Reporting templates track screening, suspected and diagnosed cases, referrals, treatment, follow-up, chemotherapy, cardiac care, counselling, physiotherapy, outreach and fund utilisation, often disaggregated by sex and reported cumulatively.[11][21][22][23]

Monitoring & Evaluation

Monitoring combines routine service reporting, surveillance, financial oversight, supervisory review and facility-level data systems across the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. It tracks non-communicable disease morbidity, mortality and risk factors, alongside service delivery, physical targets, expenditure and utilisation of funds.[1][8][10][11]

• Develop and maintain non-communicable disease databases through surveillance, risk-factor surveys, cancer registries, operational research and applied research. The Indian Council of Medical Research cancer registry programme is supported to expand a national cancer-case database, including rural coverage, with registries for other non-communicable diseases considered subsequently.[5][8]
• Use non-communicable disease cells at national, state and district levels to supervise implementation, monitor physical and financial targets, conduct field visits, hold review meetings and support programme personnel and infrastructure.[8][11][13]
• Collect data through the Health Management Information System, Management Information System, prescribed registers, chronic disease cards, referral cards and screening records. These capture risk factors, blood sugar, blood pressure, body mass index, suspected and diagnosed cases, treatment, follow-up, referrals, medicine availability and complications.[8][12][24][7]
• Report monthly from sub-centres, primary health centres, community health centres and district facilities through district and state non-communicable disease cells. Primary health centre reports are due to district cells by the fifth of each month, district reports to state cells by the tenth, and state reports to the National Non-Communicable Disease Cell by the fifteenth.[21][22][25][26][23]
• Measure programme-specific indicators, including screening camps; people screened; suspected diabetes, hypertension and common cancers; clinic attendance; referrals; diagnoses; treatment and follow-up; tertiary referrals; coronary care unit activity; chemotherapy; counselling; physiotherapy; and sex-disaggregated monthly and cumulative results.[21][22][25]
• Compare state performance against baselines, annual targets, monthly achievement, cumulative achievement since April, achievement since programme inception and percentage achievement. The 2012 to 2017 target framework also covers cancer institutes, tertiary cancer centres, chemotherapy day-care, cancer registry networking, non-communicable disease clinics, state and district cells, and coronary care units.[3][27]
• Require District Health Societies to monitor fund use and submit quarterly financial management reports to State Health Societies, supported by expenditure reports, utilisation certificates, audits, periodic account reviews and action on audit objections, internal-control weaknesses and disallowances.[10][28]
• Assess tertiary cancer-care proposals through eligibility review, inspection where warranted, Standing Committee appraisal, procurement plans, financial capacity, staffing, infrastructure, regulatory permissions and previous-grant utilisation. Grantee institutions must settle utilisation certificates within one year.[19][29][30]

Formal outcome evaluation methods, independent sanctions for under-performance and comprehensive surveillance targets are not consistently specified in the supplied extracts, although routine reporting, supervisory responsibility, audit and technical review provide the principal accountability mechanisms.[11][15][18][20]

Costing & Financing

Financing is principally organised through National Health Mission structures and a common non-communicable disease flexi-pool for interventions up to district level, supplemented by separate one-time support for tertiary cancer-care institutions. States may allocate funds across eligible flexi-pool components within their approved overall allocation, while tertiary healthcare remains outside that flexi-pool.[3][10]

• Channel Government of India funds through State Health Societies to District Health Societies and approved programme non-communicable disease cell accounts; District Health Societies may transfer funds to block-level Rogi Kalyan Samitis for programme activities.[10]
• Support clinics, laboratories, equipment, renovation, contractual staff, medicines, consumables, screening supplies, referral transport, information, education and communication, cardiac-care services, cancer-care services and monitoring arrangements.[17][14]
• Provide one-time tertiary cancer-care assistance of up to 120 Indian rupees crore per State Cancer Institute and up to 45 Indian rupees crore per Tertiary Care Cancer Centre, including the state share. Up to 30% of sanctioned assistance may fund civil, electrical, renovation or infrastructure works.[19][16]
• Apply a standard financing ratio of 75% Central Government and 25% State Government contributions, changing to 90% and 10% respectively for north-eastern and hilly regions. The central contribution is non-recurring, while institutions or State Governments meet recurring costs, including manpower, maintenance, facilities and medicines for patients below the poverty line.[29][30]
• Release tertiary cancer-care assistance through State Governments, with up to 75% of the Government of India share potentially released at sanction and the remaining 25% after procurement or construction is finalised.[20]
• Require institutions or State Governments to provide land, meet expenditure above central equipment ceiling prices, and bear recurring and manpower costs. Equipment costing above 1 Indian rupees crore is subject to Central Government ceiling prices.[19]
• Track fund utilisation through Financial Management Reports, including reporting in lakh Indian rupees, expenditure statements, utilisation certificates and audit arrangements.[23][10]

The supplied material does not provide an overall programme budget, consolidated allocation, expenditure total, quantified funding gap, unit costs for routine non-communicable disease services, or broader economic assumptions.[5][3][11]