National Programme For Prevention And Control Of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS)

Objectives

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke seeks to establish a comprehensive, sustainable response to the rising burden of non-communicable diseases, associated disability and premature deaths. It combines prevention, health promotion, risk-factor reduction, early detection, affordable diagnosis and treatment, rehabilitation, palliative care and referral services for cancer, diabetes, hypertension, cardiovascular diseases and stroke.[1][2]

• Promote healthy diets, physical activity, reduced salt intake, avoidance of tobacco and alcohol, obesity reduction, stress management, regular health checks and awareness of cancer warning signs.[3][4]
• Detect diabetes, hypertension and common oral, breast and cervical cancers early through opportunistic and camp-based screening, principally for people aged 30 years and above.[5][3]
• Improve cure rates, survival and quality of life through timely treatment, while reducing disability, including blindness and deafness, and limiting out-of-pocket spending and catastrophic financial effects on affected households.[2][6]
• Build health-system capacity for prevention, diagnosis, treatment, information, education and communication, behaviour-change communication, operational research, rehabilitation and surveillance.[5][3]
• Expand cancer-care capacity through National Cancer Institutes, State Cancer Institutes, Tertiary Care Cancer Centres, district chemotherapy day-care facilities and cancer-registry networks.[6][7]
• Expand non-communicable disease clinics, State and District Non-Communicable Disease Cells, and coronary care capacity, including a target for such facilities in at least one quarter of districts by March 2017.[6]

The programme is designed as a continuum of care across primary, secondary and tertiary levels: health promotion and screening at community level; clinical assessment, diagnosis and follow-up at Community Health Centres and district hospitals; and specialised referral, cancer treatment and complex care at tertiary institutions.[8][2][9]

For tertiary cancer care, State Cancer Institutes are intended to act as state or regional apex institutions for coordination, referral, outreach, research, protocols and workforce development, while Tertiary Care Cancer Centres support comprehensive treatment and mentor cancer activities in nearby districts.[7][10][11]

Implementation

Implementation is integrated within the National Health Mission, using decentralised delivery through State and District Health Societies and Non-Communicable Disease Cells. The approach combines nationally developed guidance and technical support with State flexibility to adapt implementation to local needs, incorporate activities in Programme Implementation Plans and coordinate delivery across relevant health and development programmes.[5][3][12]

• Establish and strengthen National, State and District Non-Communicable Disease Cells to plan, coordinate, supervise, monitor and evaluate implementation, supported by programme officers, finance and logistics staff, data-entry personnel and other contractual workers.[13][14][15]
• Deliver health promotion through auxiliary nurse midwives, male health workers, counsellors, camps, Village Health and Nutrition Days, schools, workplaces, mass media, printed materials, community leaders, self-help groups and civil-society organisations.[14][4]
• Screen at sub-centres, primary health centres, Community Health Centres, urban slums and outreach camps; refer suspected cases to Community Health Centres, district hospitals and tertiary facilities using referral cards and defined follow-up arrangements.[3][16][17]
• Operate free non-communicable disease clinics at Community Health Centres on working days or at least three times weekly, providing examination, risk assessment, early diagnosis, counselling, treatment and referral for directly attending or referred patients.[16][9]
• Strengthen district hospitals with non-communicable disease clinics, laboratories, cardiac-care units, cancer diagnostic services, chemotherapy day-care facilities, emergency management, rehabilitation and palliative-care capacity.[8][18][19]
• Use public-private partnerships or State-approved outsourcing for unavailable laboratory and diagnostic services, while linking district hospitals with private laboratories, medical colleges and tertiary cancer centres for outreach, referral and continuity of care.[1][18]
• Train health workers and specialists through structured curricula, master trainers, e-learning, hands-on sessions and designated institutions, including specialist preparation for cardiac care, cancer screening, chemotherapy and radiotherapy-related services.[8][20]
• Engage communities, local bodies, other government departments, non-governmental organisations, civil society, AYUSH practitioners and private providers within national, State and district guidelines.[3][8][1]

Funding for interventions up to district level is channelled through the National Health Mission non-communicable disease flexi-pool, with State Health Societies retaining State allocations and transferring approved grants to District Health Societies and programme accounts. Tertiary-care activities are managed separately from this flexi-pool.[6][12]

Financial management groups within State and District Programme Management Support Units maintain accounts, manage fund releases, prepare expenditure statements and utilisation certificates, and arrange audits. District Health Societies monitor fund utilisation and submit quarterly financial management reports to State Health Societies.[12][21]

Tertiary cancer-centre support uses proposal-based selection, Central assessment or inspection, Standing Committee appraisal, State recommendations and a tripartite memorandum of understanding between the institution, State Government and Ministry of Health and Family Welfare. States must provide land where required, contribute their funding share and meet recurring staffing and operating costs.[7][22][23]

Programme operations are supported by standard recording and reporting formats, a computerised Management Information System, routine facility-to-district-to-State reporting, quarterly reviews and surveillance databases for morbidity, mortality and risk factors. The approach also includes cancer registries, risk-factor surveys, independent evaluation and operational research to identify and address implementation gaps.[1][20][21]

Monitoring & Evaluation

The programme combines surveillance, routine service reporting, financial oversight, supervision and periodic review across national, State, district and facility levels. It specifies extensive operational indicators and reporting deadlines, although a unified outcome-evaluation framework and comprehensive performance thresholds are not fully specified.[1][12][21]

• Establish and maintain non-communicable disease surveillance databases, risk-factor surveys, disease registries and a Management Information System to monitor morbidity, mortality, risk factors and programme data.[5][1][21]
• Track infrastructure and service-expansion targets, including cancer institutes, tertiary cancer centres, clinics, chemotherapy day-care facilities, State and District Non-communicable Disease Cells, cancer-registry networking and coronary care unit coverage, with several targets set for March 2017.[6]
• Record screening, referrals, diagnoses, treatment, follow-up, counselling, physiotherapy, chemotherapy and cardiac-care activity, using sex-disaggregated fields and cancer-site categories where required.[24][25][26][27][28]
• Require sub-centres to report monthly to Primary Health Centres, Primary Health Centres to report to District Non-communicable Disease Cells by the fifth of each month, District Non-communicable Disease Cells to report to State Cells by the tenth, and State Cells to report to the National Cell by the fifteenth.[21][24][25][29][30]
• Use National, State and District Non-communicable Disease Cells, review meetings, field visits, technical committees, operational research and independent evaluation to supervise implementation and address constraints.[1][12][21][31]
• Require financial management groups to manage accounts, fund releases, expenditure reporting, utilisation certificates and audit arrangements; District Health Societies monitor fund utilisation and submit quarterly financial management reports to State Health Societies.[12][21]
• Apply additional accountability mechanisms for cancer-centre grants, including expert assessment, Central inspection where needed, Standing Committee appraisal, tripartite Memoranda of Understanding, procurement controls and utilisation certificates.[22][23][32]

Several extracts identify indicators and reporting formats but do not specify a complete indicator dictionary, evaluation methodology, outcome targets, performance thresholds or sanctions for non-performance.[2][26][11]

Costing & Financing

Financing is channelled principally through the National Health Mission non-communicable disease flexi-pool and State Health Societies, with programme funds transferred onwards to District Health Societies and relevant service-delivery levels. The document provides detailed cost-sharing rules for tertiary cancer centres but does not specify an overall programme budget, funding gap or economic forecast.[6][12][21][22]

• Provide Central Government technical, financial and logistics support to States, using shared National Health Mission administrative and financial structures to support resource optimisation.[33][5]
• Fund primary and secondary non-communicable disease activities through the flexi-pool, including prevention, screening, follow-up, information and behaviour-change activities; manage tertiary activities separately.[6]
• Allow limited inter-component fund flexibility under National Health Mission rules, subject to a ceiling of 10% and notification to the Government of India.[21]
• Support district and lower-level services through staffing, screening equipment and supplies, medicines, consumables, referral transport, laboratory strengthening, renovation, cardiac-care units, chemotherapy facilities, training and information activities.[3][8][18][19]
• Cap assistance during the Twelfth Five Year Plan at 120 crore Indian rupees for each State Cancer Institute and 45 crore Indian rupees for each Tertiary Care Cancer Centre, inclusive of the State contribution.[7][22]
• Require a 25% State contribution for cancer-centre grants, reduced to 10% in North-Eastern and hill States; the Central share is 75%, or 90% in those regions.[22][23]
• Permit up to 30% of cancer-centre grant funding for civil, electrical, renovation and infrastructure works, while requiring States or institutions to provide land and meet recurring staffing, maintenance and operating costs.[22][23][34]
• Release up to 75% of the Government of India cancer-centre share at sanction and the balance after procurement or construction is finalised; require expenditure above applicable equipment ceiling prices to be met by the State or institution.[22][32]
• Require separate bank accounts, Statements of Expenditure, Utilisation Certificates and audits, with grant utilisation monitored by State Governments and financial management units.[21][23][34]

Although prevention and early detection are presented as important for reducing household out-of-pocket expenditure and catastrophic financial consequences, the source does not quantify these savings, specify unit costs for most interventions, or identify a total funding gap.[2][7][22]