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 Non-Communicable Diseases for 2017–2022 provides India’s overarching framework to reduce preventable morbidity, disability and premature mortality from cardiovascular diseases, cancers, diabetes and chronic respiratory diseases.[1][2]Its vision is that all Indians attain the highest possible health, wellbeing and quality of life at every age, free from preventable non-communicable diseases and premature death.[2]

The Plan seeks to promote healthy choices, prevent avoidable disability and mortality, raise political priority and resources, build national capacity for multisectoral partnerships, create supportive environments, strengthen accessible and affordable primary care, and establish sustainable surveillance, monitoring and evaluation.[2]It contributes to the Sustainable Development Goal of reducing premature deaths from the four main non-communicable diseases by one third by 2030.[3]

• Reduce exposure to tobacco and alcohol use, unhealthy diets, physical inactivity, household and ambient air pollution, raised blood pressure, raised blood sugar, raised cholesterol, overweight and obesity.[1][4][5]
• Strengthen integrated and multisectoral coordination, health promotion, health-system strengthening, and surveillance, monitoring, evaluation and research as the Plan’s four strategic action areas.[6][2]
• Promote health-supporting policy, legal, fiscal and structural measures that address social determinants, behavioural risks and environmental risks.[7][2]
• Provide comprehensive promotive, preventive, diagnostic, curative, rehabilitative and palliative services under universal health coverage, with access to essential medicines and technologies.[8][9]
• Expand screening, early detection, referral, follow-up and continuing management for hypertension, diabetes, oral cancer, cervical cancer and breast cancer.[3][10]

The National Non-Communicable Disease Monitoring Framework establishes targets for 2020 and 2025, including a 10% and 25% reduction respectively in premature mortality from the main non-communicable diseases.[11]By 2025, it aims to reduce alcohol use, insufficient physical activity, raised blood pressure, salt intake and tobacco use by 10%, 10%, 25%, 30% and 30% respectively; reduce household use of solid fuels by 50%; halt the rise in obesity and diabetes; and increase cardiovascular risk management coverage and availability of essential medicines and technologies.[11][12]

Implementation

Implementation follows a whole-of-government, health-in-all-policies and whole-of-society model, recognising that non-communicable disease determinants extend beyond the health sector.[3][13]The Plan combines prevention, lifestyle modification, regulation, early detection, treatment, health promotion and health-system reform, while adapting national priorities for state, district and local implementation.[1][4]

• Coordinate national policy through an Interministerial Committee chaired by the Secretary of Health and Family Welfare, supported by Joint Secretary-level nodal officers in relevant ministries, thematic working groups, Technical Advisory Groups and the Central Non-Communicable Disease Division.[14][13][15]
• Refer unresolved intersectoral issues to the Committee of Secretaries, which is intended to align policies, support programme review and secure budgetary allocation for multisectoral action.[14][13]
• Establish state-level coordination forums, committees of secretaries and district interdepartmental mechanisms, with States encouraged to prioritise the response because health-service delivery falls within their jurisdiction.[4][16][17]
• Engage Union and State Governments, Parliament, the judiciary, civil society, academia, professional bodies, media, private-sector organisations, international agencies and development partners.[18][2]
• Require ministries to prepare action plans, designate nodal officers and submit progress reports, which the Central Non-Communicable Disease Division should consolidate for the multisectoral action plan.[15]

Health promotion actions include healthy public policies, supportive settings in schools, workplaces, hospitals, villages and cities, mass-media campaigns, curriculum reform, food labelling and reformulation, restrictions on unhealthy-food marketing to children, physical-activity promotion and safer household cooking fuels.[19][20][21][22]Proposed fiscal measures include higher taxation and cess on tobacco, alcohol, foods high in fats, salt and sugar, and sugar-sweetened beverages, alongside potential tax reductions for sports goods and physical-activity equipment.[23]

Service delivery is to be strengthened through the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, integrated with the National Health Mission and District Health Societies.[24]Operational measures include health-facility preparedness assessments, workforce recruitment and training, standard management guidelines, integration of AYUSH providers, electronic medical records, telemedicine, mobile-health support, patient self-care and improved access to medicines and technologies.[8][9]The Plan also envisages mapping and capacity-building of non-governmental organisations and private providers, flexible-pool and untied funding for services in urban and marginalised populations, and public-private partnership arrangements.[25]

Monitoring arrangements include India’s National Monitoring Framework, a national non-communicable disease database, an integrated programme-management information system, standard data protocols, periodic surveys, surveillance registries and research priority-setting.[14][26][27]The Indian Council of Medical Research is proposed to coordinate data collection, compilation and synthesis, while a national steering committee and quality-assurance mechanisms are intended to oversee monitoring and evaluation.[28][26]Indicators include coordination meetings, nominated ministry officers, resource allocations, service readiness, workforce training, treatment and follow-up coverage, access to medicines, functional surveillance registries and adolescent risk-factor data.[28][8][9][27]

The Plan calls for sustained investment, increased programme allocations, financial protection and sustainable funding mechanisms.[2][19]Potential health-promotion financing sources include Corporate Social Responsibility funds, the Consolidated Fund of India, grants, loans and taxes on unhealthy products.[28][29]No consolidated national budget, quantified funding gap or overall costing methodology is specified in the supplied material.[2][28]

Monitoring & Evaluation

The Plan establishes surveillance, monitoring, evaluation and research as a strategic pillar, using the National Non-Communicable Disease Monitoring Framework to track progress in prevention, service delivery and multisectoral implementation. It combines global-framework-consistent indicators, national targets, periodic surveys, administrative information systems, research and review mechanisms, but does not provide a single consolidated reporting timetable or formal sanctions for non-performance.[6][2][14][30]

• Apply India’s National Non-Communicable Disease Monitoring Framework, comprising 10 country-specific targets and 21 indicators for 2025 across morbidity, mortality, risk factors and health-system response.[18]
• Track outcome targets for premature mortality, alcohol use, obesity and diabetes, physical inactivity, raised blood pressure, salt intake, tobacco use, household solid-fuel use, cardiovascular risk management, and access to essential medicines and basic technologies.[31][11][12]
• Measure a 10% reduction in premature mortality from major non-communicable diseases by 2020 and 25% by 2025; the 2025 framework also targets reductions in alcohol use, physical inactivity, raised blood pressure, salt intake, tobacco use and household solid-fuel use.[11]
• Establish a strengthened information base, national non-communicable disease database and integrated programme-management information system, linking existing Health Management Information Systems with non-communicable disease services and patient identifiers.[14][26]
• Conduct periodic indicator, health-facility, school-based and capacity surveys; harmonise data collection; use standardised tools and protocols; and maintain surveillance registries, including for adolescent risk factors.[27][32]
• Monitor implementation of multisectoral coordination through indicators such as interministerial committee meetings, nominated nodal officers, ministry resource allocations, coordination mechanisms, stakeholder consultations and health-promotion activities.[28][16][5]
• Track health-system performance through service preparedness, workforce availability and training, district use of Standard Management Guidelines, patient treatment and follow-up, AYUSH provision, mobile-health coverage, and availability of essential medicines and technologies.[8][9]
• Monitor implementation of risk-factor policies through amended advertising and labelling rules, alcohol and urban-transport policies, unhealthy-product controls, physical-activity scheme allocations, tobacco-control compliance, healthy-setting standards and insurance coverage.[33][20][21][34][35][22]
• Strengthen mortality and environmental surveillance through the Sample Registration System, Medical Certification of Cause of Death, air-quality monitoring by pollution-control boards and environmental-health assessment.[36][37]
• Assign monitoring roles to the Ministry of Health and Family Welfare, State and District non-communicable disease Cells, the Indian Council of Medical Research, the National Technical Advisory Group, National Tobacco Control Cell and State Tobacco Control Cells, alongside other named ministries and partners.[18][28][25][27]
• Require the Central Non-Communicable Disease Division to obtain stakeholder progress reports and prepare consolidated implementation reports, while the Interministerial Committee and Committee of Secretaries review policy alignment, implementation and intersectoral disputes.[13][15]
• Use quality-assurance structures, periodic national surveys, operational and policy research, health-impact assessments, policy reviews and follow-up of agreed actions to support accountability.[38][39][30][13][15]

Several extracts explicitly leave reporting frequency, data-source specifications, indicator definitions, evaluation methodologies, baseline values, named accountability leads and enforcement arrangements unspecified.[18][33][40][31]

Costing & Financing

The Plan seeks sustained investment, increased budget priority and financial protection for non-communicable disease care, but it does not present a consolidated costed budget, financing gap analysis or quantified economic assumptions for the full 2017–2022 programme.[2][19][41]

• Mobilise resources through Corporate Social Responsibility funds, the Consolidated Fund of India, international and other grants, loans, donors and development partners, and taxes on unhealthy products.[28][5][29]
• Secure budgetary allocations through multisectoral mechanisms, including the Committee of Secretaries, and require ministries to allocate resources to activities that contribute to non-communicable disease prevention and control.[28][13]
• Scale up non-communicable disease flexi-pool allocations and establish flexible or untied funds for services in urban areas and among marginalised populations; monitor States’ allocation and use of flexible-pool funds.[25][42]
• Improve financial protection through government-financed insurance, risk pooling and expanded coverage for outpatient care, medicines and non-communicable disease services, particularly for people below the poverty line.[35][22][30]
• Use fiscal measures, including higher taxation and cess on tobacco, alcohol, foods high in fats, salt and sugar, and sugar-sweetened beverages, while considering tax reductions for sports goods and physical-activity equipment.[23][43]
• Support related measures through viability-gap funding, multilateral soft loans, external commercial borrowings, lower horticulture insurance premiums, interest subvention and possible minimum-support-price arrangements for fruit and vegetables.[44][45]
• Provide one-time grants of up to 120 crore Indian rupees for each State Cancer Institute and up to 45 crore Indian rupees for each Tertiary Care Cancer Centre, financed at a 60:40 Centre-to-State ratio or 90:10 for North-Eastern and Hilly States.[10]
• Fund the National Programme for Palliative Care through the non-communicable disease flexipool under the National Health Mission.[46]

The economic case notes that inaction could produce trillions of United States dollars in lost resources over three decades, that non-communicable diseases account for more than 47% of out-of-pocket health expenditure, and that population-wide interventions addressing lower-level social determinants are more cost-effective than higher-level health-sector interventions.[3]

Other than the specified cancer-centre grants and fiscal measures, the material does not specify monetary programme costs, total allocations, funding commitments, funding gaps, expenditure schedules or cost-effectiveness estimates.[34][8][27][47]