National Action Plan and Monitoring Framework for Prevention and Control of Noncommunicable Diseases (NCDs) in India

Objectives

India’s non-communicable disease strategy is aligned with the World Health Organization global monitoring framework and seeks to prevent and control cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, together with their major behavioural and metabolic risk factors.[1]Its overarching goal is a 25% relative reduction in the risk of premature mortality from non-communicable diseases by 2025, through the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke and wider multisectoral action.[2]

• Reduce premature mortality from the four principal non-communicable diseases by 25%.[2]
• Reduce harmful alcohol use by 10%, while addressing alcohol regulation, treatment and enforcement as relevant policy areas.[2]
• Halt the rise in obesity and diabetes prevalence.[2]
• Reduce insufficient physical activity by 10%.[2]
• Reduce raised blood pressure prevalence by 25% and mean population salt or sodium intake by 30%.[3]
• Reduce current tobacco use by 30% and household solid-fuel use by 50%, thereby addressing household indoor air pollution.[3]
• Ensure that at least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes.[3]
• Achieve 80% availability of affordable essential non-communicable disease medicines and basic technologies in public and private health facilities.[3]

The national monitoring framework encompasses 10 targets and 21 indicators through 2025.[4]Its areas of action therefore span mortality reduction, prevention of tobacco use and harmful alcohol use, healthier diets with lower salt and unhealthy fats, physical activity, control of raised blood pressure and blood glucose, obesity prevention, access to preventive treatment and essential technologies, and reduction of indoor-air-pollution exposure.[1][4][3]

Implementation

Implementation combines integrated district health services, health promotion and early detection, strengthened primary care, and coordinated action by government, civil society and private-sector actors.[1][2]The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke is delivered under the National Health Mission with an objective of equitable universal coverage; it was operating in 100 districts and planned phased expansion to all districts during the Twelfth Five Year Plan.[1]

• Strengthen stakeholder capacity, mechanisms and mandates to enable cross-sectoral prevention and control of non-communicable diseases.[1]
• Develop healthy-behaviour policies and programmes in schools, workplaces and communities, alongside health-system capacity for health promotion, early detection and treatment.[2]
• Engage civil society and private-sector organisations in the development and implementation of prevention and control policies.[2]
• Reduce alcohol use through regulatory guidance, awareness campaigns, addiction-treatment capacity, enforcement of drunken-driving measures, marketing controls, pricing policies and community action.[2]
• Prevent obesity and diabetes through breastfeeding promotion, early detection, healthy-food promotion, nutrition policies, food reformulation, restrictions on marketing to children, fiscal measures and supportive nutrition-monitoring environments.[2]
• Promote physical activity through national guidance, public campaigns, school and workplace programmes, active transport, safe walking and cycling infrastructure, and participation by urban-development, municipal and transport authorities.[2]
• Implement national non-communicable disease and tobacco-control strategies, extend tobacco-control coverage to all districts, enforce tobacco-control legislation, and establish intersectoral arrangements consistent with the World Health Organization Framework Convention on Tobacco Control.[3]
• Engage food producers, processors, retailers, caterers, commercial operators, civil society and consumers to reform food composition, increase access to healthier foods, promote low-sodium salt and provide evidence-based public campaigns.[3]
• Strengthen primary healthcare through generic preventive medicines, basic diagnostic tests, counselling, tobacco-cessation services, professional training and affordable palliative care.[3]
• Coordinate action on indoor air pollution, develop relevant guidelines, support alternative livelihoods for tobacco farmers and workers, and consider progressive restrictions on packaged smokeless tobacco products.[3]

Progress is intended to be monitored through the National Noncommunicable Disease Monitoring Framework, whose targets and indicators were developed through consultation with national stakeholders and an advisory group in line with the World Health Organization framework.[4]The supplied material does not specify budgets, funding allocations, reporting schedules, data sources, surveillance instruments, evaluation methods or formal accountability arrangements.[1][4]

Monitoring & Evaluation

The National Noncommunicable Disease Monitoring Framework is intended to monitor implementation and progress towards India’s national non-communicable disease targets through 2025, aligned with the World Health Organization global action and monitoring framework.[4]It uses 21 indicators and 10 targets developed through consultation with national stakeholders and an advisory group.[4]

• Track premature mortality from cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, including the target of a 25% relative reduction in the risk of premature mortality from these conditions.[4][2]
• Monitor behavioural and metabolic risk factors, including alcohol use, obesity and diabetes prevalence, insufficient physical activity, raised blood pressure, mean population salt or sodium intake, tobacco use and household use of solid fuel.[4]
• Assess progress against targets to reduce alcohol use by 10%, insufficient physical activity by 10%, raised blood pressure by 25%, mean population salt or sodium intake by 30%, current tobacco use by 30%, and household solid-fuel use by 50%.[2][3]
• Assess whether the rise in obesity and diabetes prevalence is halted.[2]
• Measure service coverage and access, including the goal for at least 50% of eligible people to receive drug therapy and counselling to prevent heart attacks and strokes, and the target for 80% availability of affordable essential non-communicable disease medicines and basic technologies in public and private facilities.[4][3]
• Use the target framework to cover access to preventive drug therapy, and the availability and affordability of essential medicines and technologies.[4]

The supplied material identifies national targets and indicators but does not specify data sources, surveillance instruments, reporting frequency, reporting responsibilities, evaluation design, review processes or formal accountability mechanisms.[4][3]

Costing & Financing

No programme budget, costed implementation plan, funding allocation, financing source, resource-mobilisation target, funding gap or economic assumption is specified in the supplied material.[1][3]

• Identify pricing policies for alcohol as a potential policy measure, without providing tax rates, projected revenues, expenditure requirements or monetary estimates.[2]
• Consider fiscal measures relating to foods containing unsaturated fats, without specifying their design, cost, revenue implications or funding use.[2]
• Promote affordable essential non-communicable disease medicines, basic technologies, cost-effective generic preventive medicines and affordable palliative care, but provide no quantified financing requirements or affordability thresholds.[3]
• Improve the affordability of healthier foods through engagement with food-sector stakeholders and food reformulation measures, while leaving associated public and private costs unspecified.[3]

The material therefore describes affordability and fiscal-policy considerations as elements of prevention and service delivery, rather than as a quantified financing framework.[2][3]