National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS): Operational Guidelines (Revised: 2013-17)

Objectives

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke seeks to reduce the burden of major non-communicable diseases through an integrated continuum of health promotion, prevention, risk-factor reduction, screening, diagnosis, treatment, rehabilitation, palliative care and surveillance.[1][2]It prioritises cancer, diabetes, hypertension, cardiovascular disease and stroke, while district-level service provisions also encompass chronic obstructive pulmonary disease, chronic kidney disease, rheumatic heart disease and related complications.[3][4]

• Promote healthier diets, salt reduction, physical activity, tobacco and alcohol avoidance, obesity reduction, stress management, regular health checks and awareness of cancer warning signs.[5][6]
• Screen people aged 30 years and above for common cancers, diabetes and high blood pressure through history-taking, physical examination, body mass index, blood-pressure measurement and blood-sugar testing, with referral for confirmation and treatment where needed.[5][4]
• Provide affordable, cost-effective diagnosis and treatment across primary, secondary and tertiary levels, including emergency care, chemotherapy, rehabilitation, palliative care and transport for serious referrals.[7][8][6]
• Improve early detection, survival, quality of life and user-friendliness of services for older people, while reducing physical disability, deaths and out-of-pocket expenditure associated with non-communicable diseases.[9][10]
• Strengthen comprehensive cancer-care capacity and universal access through State Cancer Institutes and Tertiary Care Cancer Centres, envisaging 20 institutes and 50 centres during the Twelfth Five-Year Plan, 2012 to 2017.[11][12]
• Develop surveillance databases and registries for morbidity, mortality and risk factors, including cancer-registry functions and participation in the Indian Council of Medical Research National Cancer Registry Programme.[7][13]

Implementation

Implementation is integrated with the National Health Mission, combining primary-care delivery below district level with more specialised district, referral and tertiary services.[7][9]National guidance permits States to adapt implementation to local needs through State Programme Implementation Plans, supported by a common non-communicable disease flexi-pool for activities up to district level.[5][10]

• Establish National, State and District Non-Communicable Disease Cells within the Directorate General of Health Services, State Health Societies and District Health Societies to plan, coordinate, supervise, manage funds, maintain data and guide implementation.[14][15][16]
• Deliver health promotion, opportunistic screening, counselling, follow-up and referral through sub-centres, primary health centres, camps and outreach activities, using auxiliary nurse midwives, male health workers and community platforms.[17][18]
• Operate Community Health Centre non-communicable disease clinics and strengthen district hospitals with clinics, laboratories, cardiac-care units, cancer-care capacity, day-care chemotherapy, diagnostic services and contracted multidisciplinary staff.[19][3][8]
• Refer complicated cases through defined pathways from community facilities to district hospitals and tertiary institutions, outsourcing unavailable diagnostic investigations through public-private partnerships or State-approved arrangements where necessary.[4][8][3]
• Engage communities, panchayats and local bodies, civil society, non-governmental organisations, private partners, other government departments and mass media in behaviour-change communication and service delivery.[5][2]
• Involve practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy in health promotion, lifestyle counselling, yoga, meditation, opportunistic screening and relevant treatment through the primary healthcare network.[19][2]
• Build workforce capacity through cascade training led by master trainers and designated nodal agencies, covering clinical staff, health workers, laboratory technicians, programme personnel and specialised cardiac and cancer-care providers.[20][21]
• Monitor physical, financial and service-delivery progress through the Health Management Information System, standardised monthly reporting, review meetings, field observations, surveillance, operational research and planned independent evaluation.[15][21][22]
• Track programme targets including 640 district-hospital non-communicable disease clinics, 2,500 sub-divisional hospital, Community Health Centre and Primary Health Centre clinics, 35 State cells and 640 District cells by March 2017.[10]
• Route Government of India funds through State Health Societies to District Health Societies and block-level Rogi Kalyan Samitis, with financial management groups responsible for accounts, releases, expenditure reports, utilisation certificates and audits.[14][21]
• Fund tertiary cancer institutions through maximum permissible assistance of 120 crore Indian rupees for a State Cancer Institute and 45 crore Indian rupees for a Tertiary Care Cancer Centre, normally shared 75% by the Central Government and 25% by the State, or 90% and 10% respectively in North-Eastern and hilly regions.[12][23]Recurring costs, land and expenditure above equipment ceilings are borne by the institution or State Government.[12][24]

Monitoring & Evaluation

Monitoring combines routine service reporting, physical and financial performance tracking, surveillance, supervisory review and institutional grant accountability across the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke.[2][15][21]

• Maintain non-communicable disease surveillance databases covering morbidity, mortality and risk factors, supported by state and institutional risk-factor surveys, operational research and cancer registry activities linked to the Indian Council of Medical Research National Cancer Registry Programme.[7][2][21][13]
• Use a computerised Management Information System, standard recording formats and reports from facilities, district cells and state cells to capture and analyse programme data.[2][21]
• Report through a hierarchy from sub-centres and primary health centres to community health centres, district hospitals, District Non-Communicable Disease Cells, State Non-Communicable Disease Cells and the national cell.[21]Facility and programme-cell reports are generally monthly, with state reports due to the national cell by the fifteenth of the month.[21]
• Record screening, suspected cases and referrals at sub-centres and primary health centres, including sex-disaggregated counts where required; primary health centres submit consolidated monthly reports to District Non-Communicable Disease Cells by the fifth of each month.[25]
• Track Community Health Centre and district-hospital clinic attendance, referrals, diagnoses, treatment, chemotherapy, counselling, physiotherapy, screening camps and higher-level referrals through monthly and cumulative reporting formats.[26][22]
• Compare monthly and cumulative achievements against annual targets and previous cumulative performance, with reports requiring a reporting date and the responsible official’s signature, name and designation.[22]
• Monitor planned physical and financial targets through national, state and district Non-Communicable Disease Cells, review meetings, field visits and observations, surveillance and evaluation studies.[2][15][16]
• Convene quarterly reviews of state programme managers to assess physical and financial progress and address implementation constraints.[21]District Health Societies submit quarterly financial-management reports to State Health Societies.[14]
• Track defined Twelfth Plan service-capacity targets, including 640 district-hospital non-communicable disease clinics, 2,500 lower-level clinics, 35 State Non-Communicable Disease Cells and 640 District Non-Communicable Disease Cells by March 2017.[10]
• Plan independent evaluation of programme components and use operational research to identify implementation gaps and assess innovative interventions.[21]
• Require cancer-care grantees to undergo proposal appraisal, possible inspection, Standing Committee review and utilisation-certificate processes; utilisation certificates must confirm expenditure for the sanctioned purpose.[12][23][24][27]

The supplied material does not set out a single comprehensive health-outcome indicator framework, universal evaluation methodology or sanctions for non-performance, although it provides detailed routine reporting, target tracking and financial accountability mechanisms.[15][11][13]

Costing & Financing

Financing is channelled principally through the National Health Mission non-communicable disease flexi-pool, with Government of India funds released through State Health Societies to District Health Societies and, where applicable, block-level Rogi Kalyan Samitis.[10][14][21]

• Fund prevention, health promotion, screening, case detection, follow-up, service integration, innovation and information, education and communication activities up to district level through the flexi-pool; tertiary-care activities are financed separately.[10]
• Allow states limited flexibility to reallocate flexi-pool resources among eligible activities, subject to Government of India approval.[10]
• Use shared National Health Mission administrative and financial structures to optimise scarce resources and support long-term programme sustainability.[7]
• Provide central technical, financial and logistical support to states implementing the programme.[1][7]
• Support screening devices, medicines, consumables, referral transport, contractual personnel, diagnostic services, laboratory strengthening, cardiac-care capacity and information, education and communication activities.[19][3][15]
• Manage funds through state and district financial-management groups responsible for accounts, releases, expenditure reporting, utilisation certificates and audits.[14][21]
• Finance tertiary cancer-care infrastructure through maximum assistance of 120 crore Indian rupees for a State Cancer Institute and 45 crore Indian rupees for a Tertiary Care Cancer Centre.[12][28]
• Apply a 75% Central Government and 25% State Government contribution to approved tertiary cancer-care grants, changing to 90% and 10% respectively for North-Eastern and hilly regions.[23][28]
• Permit up to 30% of sanctioned tertiary cancer-care assistance for civil and electrical works, including renovation and infrastructure improvement.[12][23]
• Require states or institutions to provide land, recurring expenditure, manpower costs and amounts above equipment ceiling prices; central tertiary cancer-care assistance is non-recurring.[12][23][24]

Beyond specified tertiary cancer-care grant ceilings and cost-sharing provisions, the supplied material does not provide a consolidated programme budget, annual allocations, unit costs, quantified funding gaps, resource-mobilisation targets or economic assumptions.[12][29][28]