National Multisectoral Action Plan for Prevention and Control of Common Noncommunicable Diseases (2017-2022)

Objectives

The National Multisectoral Action Plan for Prevention and Control of Common Noncommunicable Diseases, 2017–2022, provides India’s national framework for reducing preventable morbidity, disability and premature mortality from cardiovascular diseases, cancers, diabetes and chronic respiratory diseases. Its vision is for all Indians to attain the highest possible health, wellbeing and quality of life throughout life, free from preventable noncommunicable diseases and premature death.[1]Its goal is to enable healthier choices and reduce preventable illness, avoidable disability and premature mortality.[1]

• Increase the priority and resources given to noncommunicable disease prevention and control, while strengthening national capacity for multisectoral partnerships.[1]
• Address behavioural, dietary, environmental, metabolic and wider social determinants, including tobacco and alcohol use, unhealthy diets, physical inactivity, household and ambient air pollution, raised blood pressure, raised blood glucose, raised cholesterol, overweight and obesity.[2]
• Improve supportive environments so that individuals, families and communities can make healthier choices, using health-promoting policies, legal, fiscal and structural measures.[3]
• Strengthen primary health care to provide accessible, affordable and quality prevention, screening, early diagnosis, treatment, rehabilitation and palliative care, with financial protection under universal health coverage.[4]
• Establish sustainable surveillance, monitoring, evaluation and research systems to support evidence-based policy, programmes and regular reporting on key trends.[1]

The plan is organised around four strategic areas: integrated and multisectoral coordination mechanisms; health promotion; health-systems strengthening; and surveillance, monitoring, evaluation and research.[5]It adopts a Health-in-All-Policies and whole-of-government orientation because the determinants of noncommunicable diseases extend across social, cultural, economic, political and environmental sectors.[6]

Its wider policy context includes the Sustainable Development Goal ambition to reduce premature mortality from the four principal noncommunicable diseases by one-third by 2030.[7]The associated National Noncommunicable Disease Monitoring Framework sets targets for 2020 and 2025, including reducing premature mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease by 10% by 2020 and 25% by 2025.[8]

• Reduce by 2025 alcohol use and insufficient physical activity by 10% each, raised blood pressure by 25%, salt or sodium intake and tobacco use by 30% each, and household use of solid cooking fuels by 50%.[8]
• Halt the rise in obesity and diabetes, expand preventive drug therapy and counselling for eligible people at cardiovascular risk, and achieve 80% availability and affordability of essential medicines and basic technologies.[8][9]
• Promote healthy food environments, physical activity, safe cooking fuels, clean air, tobacco control, alcohol control and regulation of foods high in fat, salt and sugar.[10][11]

Implementation

Implementation combines national policy coordination with subnational delivery, integration into existing health programmes and action by sectors beyond health.[1]The plan uses a phased implementation framework: activities during 2017–2019 focus on governance mechanisms, procedures, guidelines, capacity building, health-system strengthening and surveys; activities during 2019–2022 focus on legislation, regulatory measures, policies, information, education and communication, training and further capacity building.[12]

• Coordinate Union ministries and departments through an Interministerial Committee chaired by the Secretary of Health and Family Welfare, supported by Joint Secretary-level nodal officers in line ministries.[12]
• Refer unresolved interministerial issues to the Committee of Secretaries, which guides policy and legislative review and supports cross-government resolution.[13]
• Establish or strengthen the Central Noncommunicable Disease Division, Technical Advisory Groups, state-level standing committees and district-level interdepartmental coordination mechanisms.[14][15]
• Engage State Governments, Union Territories, civil society organisations, the private sector, professional bodies, academia, development partners and United Nations agencies in planning and implementation.[3][15]
• Develop ministry-specific action plans and apply comparable coordination structures at state and lower administrative levels, recognising that States are central to locally appropriate multisectoral action.[16][17]

Health-service delivery is centred on integration of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke within the National Health Mission.[18]National, state and district noncommunicable disease cells supervise health promotion, early detection, treatment, referral and partnerships, while district health structures share administrative and financial arrangements.[18]Population-based screening covers people aged over 30 years for hypertension, diabetes and oral, cervical and breast cancers, supported by community risk assessment, referral and back-referral, free diagnosis and treatment, and information technology-based records.[19]

• Conduct facility audits and needs assessments, recruit and retain the workforce, revise cadre guidance, train staff, and implement standard management guidelines and essential-medicines policies.[20]
• Integrate AYUSH providers, mobile health, electronic health, telemedicine, electronic medical records and unique patient identifiers into service delivery where appropriate.[21][22]
• Develop partnerships with non-governmental organisations and private care providers, including capacity building and guidance for comprehensive service provision, particularly for urban and marginalised populations.[23]
• Expand social health insurance, outpatient-care and medicine coverage, and financial-protection arrangements for noncommunicable disease care, including for populations below the poverty line.[24]

Monitoring is designed around indicators aligned with the global monitoring framework.[1]India’s National Noncommunicable Disease Monitoring Framework comprises 10 targets and 21 indicators for 2025, covering mortality, morbidity, risk factors and health-system response.[25]A proposed National Steering Committee oversees monitoring, surveillance and evaluation, while the Indian Council of Medical Research coordinates data collection, compilation and synthesis for monitoring and evaluation.[26][27]

• Establish national databases, an integrated programme-management information system, standard data protocols, quality-assurance arrangements and interoperable links with existing Health Management Information Systems.[22]
• Conduct periodic risk-factor, health-facility, school-based and capacity surveys, harmonise data sources, and make nationally comparable trend information available.[28]
• Track governance, service, financing and health-promotion measures, including coordination meetings, nodal-officer appointments, workforce training, medicine availability, healthy-settings adoption and stakeholder engagement.[27][24][20]

The plan calls for sustained investment and increased allocation of resources, but does not provide a consolidated total budget or funding-gap estimate.[1]Proposed financing routes include government allocations, flexible-pool funding, Corporate Social Responsibility resources, grants, loans and taxes on unhealthy products.[27][23]

Monitoring & Evaluation

The plan places surveillance, monitoring, evaluation and research among its four strategic areas, using a National Noncommunicable Disease Monitoring Framework aligned with global monitoring arrangements to track implementation and outcomes.[5][25]India’s framework includes 10 targets and 21 indicators for achievement by 2025, covering morbidity, mortality, risk factors and health-system response.[25]

• Monitor premature mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease, with reduction targets of 10% by 2020 and 25% by 2025.[8]
• Track risk-factor targets for alcohol use, physical inactivity, raised blood pressure, salt or sodium intake, tobacco use and household solid-fuel exposure, alongside targets for cardiovascular preventive treatment and access to essential medicines and technologies.[8][9]
• Establish a National Steering Committee for monitoring, surveillance and evaluation, and record committee meetings and State participation in an NCD Capacity Survey.[26][22]
• Assign the Indian Council of Medical Research responsibility for coordinating data collection, compilation and synthesis for monitoring and evaluation.[27]
• Develop a data-management system, national database and integrated programme-management information system that use existing Health Management Information Systems and support cross-sector information analysis and dissemination.[22]
• Apply standard protocols for collecting, analysing and reporting service data under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, including patient linkage through unique identifiers.[22]
• Conduct periodic risk-factor, health-facility, school-based and national surveys using standardised methods and tools, while harmonising data across surveys and other sources.[28][29]
• Track implementation measures including coordination-body meetings, appointment of nodal officers, ministry resource allocations, State and district mechanisms, stakeholder consultations, policy briefs and establishment of a National NCD Portal.[27][30]
• Measure service delivery through patient treatment and follow-up, availability of AYUSH services, mobile-health coverage, workforce training, implementation of Standard Management Guidelines, essential-medicine availability and health-protection coverage.[21][23][20]
• Monitor health-promotion measures through annual reporting, resource mobilisation beyond Ministry of Health and Family Welfare grants, taxation indicators, food-labelling and reformulation measures, tobacco-control implementation, healthy-food access and physical-activity actions.[10][31][32][11][33]
• Strengthen cause-of-death information through the Sample Registration System and Medical Certification of Cause of Death, and use pollution-control bodies to share air-quality data on high-risk areas with the Ministry of Health and Family Welfare.[34][35]
• Obtain progress reports from ministries and subnational bodies, undertake policy health-impact and sector-capacity assessments, and prepare consolidated multisectoral implementation reports.[36]

Governance and review arrangements include an Interministerial Committee, Central NCD Division, Technical Advisory Groups, State-level standing committees and district coordination mechanisms; unresolved intersectoral matters may be referred to the Committee of Secretaries.[13][15][14]Quality-assurance structures are intended to support national and subnational monitoring and evaluation.[22]The supplied material does not specify a single consolidated reporting timetable, complete indicator baselines, formal sanctions, or a uniform evaluation methodology for all strategic areas.[25][12][9]

Costing & Financing

The plan seeks increased priority and resource allocation for noncommunicable disease prevention and control, sustained investment, and sustainable financing mechanisms for multisectoral and health-promotion activities.[1]It identifies prevention-oriented, population-level interventions as generally more cost-effective than interventions higher in the prevention pyramid, and identifies tobacco control as cost-effective at both population and individual levels.[6][25]

• Mobilise financing through Corporate Social Responsibility funds, the Consolidated Fund of India, international grants, other grants, loans and taxes on unhealthy products.[27][37]
• Use tobacco and sugar-sweetened-beverage taxation as health-promotion instruments, with a proposed highest Goods and Services Tax slab of 28% and an additional cess for tobacco, foods high in fats, salt and sugar, and sugar-sweetened beverages.[10][17]
• Scale up flexible-pool budget allocations and untied funds for noncommunicable disease services, including services for urban and marginalised populations and engagement with non-governmental organisations and private providers.[23]
• Expand insurance, risk-pooling and social health-protection arrangements to cover outpatient care, medicines and noncommunicable disease services, particularly for below-poverty-line populations.[24][38]
• Support resource identification through Technical Advisory Groups, which are expected to consider affordability and ministries’ resource requirements, and through United Nations Country Team support for fiscal and material resources.[15]
• Provide one-time grants of up to 120 crore Indian rupees for a State Cancer Institute and up to 45 crore Indian rupees for a Tertiary Care Cancer Centre, using Centre-to-State funding ratios of 60:40 or 90:10 for North-Eastern and hilly states.[19]

The source describes a substantial economic burden: noncommunicable diseases accounted for an estimated 6.0 million deaths in India in 2016, or 62% of total mortality, and more than 47% of out-of-pocket health-care expenditure.[7]It characterises the projected burden over the following three decades as trillions of dollars in lost resources.[7]Apart from the specified cancer-centre grants and funding shares, the supplied text does not provide a total plan budget, programme-wide allocations, expenditure totals, costed implementation plan, quantified funding gap or detailed economic assumptions.[19][13]