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 and integrated response to non-communicable diseases, reducing illness, disability, premature deaths and financial hardship while improving early detection, timely treatment, survival and quality of life.[1][2][3]It covers cancer, diabetes, hypertension, cardiovascular diseases, stroke and associated services, spanning prevention, screening, diagnosis, treatment, referral, rehabilitation, palliative care and follow-up.[4][5][6]

• Promote healthy lifestyles through healthier diets, physical activity, weight reduction, stress management, avoidance of tobacco and harmful alcohol use, and awareness of cancer warning signs and regular health checks.[1][7][8]
• Reduce behavioural and biological risk factors, including physical inactivity, unhealthy diet, household air pollution, overweight or obesity, raised blood pressure, blood glucose and cholesterol.[1]
• Provide opportunistic and camp-based screening for people aged 30 years and above, particularly for diabetes, hypertension and common cancers, alongside clinical confirmation and management of suspected cases.[9][7][5]
• Strengthen capacity for prevention, diagnosis, health communication, treatment, rehabilitation, palliative care, operational research and surveillance across primary, secondary and tertiary levels.[9][7][10]
• Improve affordable access to diagnosis, essential treatment, emergency care, follow-up and referral, with an intended reduction in out-of-pocket spending and catastrophic financial consequences.[9][2][3]
• Develop surveillance databases and cancer-registration capacity to monitor morbidity, mortality, risk factors and cancer cases.[9][4][11]

A dedicated cancer-care strengthening component aims to expand comprehensive tertiary cancer services during the Twelfth Five-Year Plan, supporting State Cancer Institutes as state-level apex institutions and Tertiary Care Cancer Centres as regional referral and mentoring facilities.[12][11][13]These institutions are intended to provide prevention, early detection, diagnosis, treatment, aftercare, palliative care, rehabilitation, research, professional training, treatment protocols and outreach.[11][13]

Implementation

Implementation combines integration of services within the National Health Mission at primary and secondary levels with specialised district, tertiary and cancer-care structures.[9][4][3]The Central Government provides technical, financial and logistical support and national coordination, while States prepare plans, implement activities and adapt delivery arrangements to local needs.[1][7][14]

• Embed prevention, screening and follow-up in sub-centres and primary health centres, where auxiliary nurse midwives and health workers provide behaviour-change counselling, measure blood pressure and blood glucose, identify cancer warning signs, issue referral documentation and support follow-up.[15][8][16]
• Operate non-communicable disease clinics at community health centres, first referral units and district hospitals to provide comprehensive assessment, laboratory investigation, diagnosis, treatment, counselling, rehabilitation, emergency care and referral.[17][5][18]
• Strengthen district hospitals through equipment, renovated facilities, laboratories, essential medicines, contractual staff, day-care chemotherapy and feasible cardiac care units, using outsourcing or public-private arrangements for unavailable diagnostic services where permitted by State policy.[17][14][6]
• Link district facilities with tertiary cancer centres, medical colleges and other specialist institutions for outreach, mentoring, specialist referral and continuity of care for complicated cases.[7][4][6]
• Engage communities, civil society, non-governmental organisations, private providers, self-help groups, local leaders and media in health promotion, awareness, screening and service delivery partnerships.[9][4][10]
• Train medical, paramedical, programme-management, finance, logistics and data personnel through designated nodal institutions, cascade training, structured curricula, e-learning and practical training.[19][20][21]

Governance is organised through National, State and District Non-Communicable Disease Cells, working with State Health Societies, District Health Societies and National Health Mission programme-management structures.[15][14][10]National functions include guidelines, standard operating procedures, procurement, logistics, fund release, information systems and monitoring, while State and district cells plan, supervise, manage data, coordinate staffing and report physical and financial progress.[14][10][22]

Financing for district-level and below-district interventions is channelled through a common non-communicable disease flexi-pool, with States incorporating approved activities into National Health Mission Programme Implementation Plans and retaining limited flexibility to reallocate funds subject to Government of India approval.[3][15][21]Funds flow from Government of India to State Health Societies, District Health Societies and approved programme accounts; financial management groups maintain accounts, prepare expenditure reports and utilisation certificates, and arrange audits.[15][21]Tertiary healthcare is financed separately from the National Health Mission.[3]

Monitoring uses Health Management Information System reporting, standard facility and district proformas, field observations, review meetings, surveillance, operational research and evaluation studies.[14][21][23]Reports capture attendance, screening, referrals, diagnoses, treatment, follow-up, counselling, chemotherapy, physiotherapy and sex-disaggregated monthly and cumulative activity, with defined monthly reporting routes from facilities to district, State and national cells.[23][24][25][26]Programme targets included establishing two National Cancer Institutes, 20 State Cancer Institutes, 50 tertiary cancer centres, district non-communicable disease clinics and expanded lower-level clinics by March 2017.[3]

For tertiary cancer strengthening, eligible government and qualifying autonomous or non-government institutions submit State-endorsed proposals, action plans, infrastructure and staffing evidence, financial commitments and required regulatory documentation.[12][27][28]Proposals undergo expert inspection and Standing Committee appraisal, and assistance is released through a tripartite memorandum of understanding between the institution, State Government and Government of India.[27][13][29]Maximum assistance is 120 crore Indian rupees for a State Cancer Institute and 45 crore Indian rupees for a Tertiary Care Cancer Centre, including the State share; institutions or States meet recurring staffing, maintenance and other recurrent costs.[27][30]

Monitoring & Evaluation

Monitoring combines non-communicable disease surveillance, routine service reporting, financial oversight and institutional review across national, State, district and facility levels. Core systems include non-communicable disease databases, cancer registries, the Health Management Information System, standard reporting formats, field visits, review meetings and operational research.[9][4][14]

• Develop surveillance databases to track morbidity, mortality and behavioural or biological risk factors, and support risk-factor surveys, applied research and cancer registration, including expansion of the Indian Council of Medical Research cancer registry programme.[9][4][11]
• Monitor implementation and physical and financial targets through National, State and District Non-Communicable Disease Cells, supported by the Health Management Information System, field observations, review meetings, surveillance, operational research and evaluation studies.[14][10]
• Maintain standard registers, chronic disease cards, referral cards and follow-up records for screening, diagnosis, treatment, complications and referral of people with diabetes, hypertension, cardiovascular diseases, stroke and cancer.[5][18]
• Submit facility reports monthly to District Non-Communicable Disease Cells, with primary health centres reporting by the fifth day of each month, district reports sent to State Non-Communicable Disease Cells by the tenth, and State reports sent to the National Non-Communicable Disease Cell by the fifteenth.[31][23][26][32]
• Record monthly and cumulative data, disaggregated where specified by sex, on clinic attendance, referrals, suspected and diagnosed cases, treatment, follow-up, counselling, chemotherapy, physiotherapy, screening camps and screening outcomes.[23][25][33]
• Hold quarterly reviews of State Non-Communicable Disease Managers to assess physical and financial progress and address implementation constraints.[21]
• Require financial management groups to maintain accounts, prepare expenditure reports and utilisation certificates, arrange audits and submit quarterly financial management reports from District Health Societies to State Health Societies.[15][21]
• Review cancer-care grant proposals through inspection, expert assessment and Standing Committee appraisal, including checks of facilities, patient loads, staffing, financial capacity, regulatory approvals and previous grant utilisation.[12][27][13]
• Require supported cancer institutions to settle utilisation certificates within one year, monitor grant use and free-treatment commitments, and participate in the National Cancer Registry Programme using their own resources.[29][30]

Specified programme targets for March 2017 included two National Cancer Institutes, 20 State Cancer Institutes, 50 functioning tertiary cancer-care centres, day-care chemotherapy in at least 25% of districts and cancer-registry networking of 70 institutes. Targets also included 640 district-hospital non-communicable disease clinics, 2,500 lower-level clinics, 35 State Cells, 640 District Cells and coronary care unit facilities in at least 25% of districts.[3]Detailed indicator thresholds are provided mainly in reporting proformas and selected service standards; the source does not set out a single comprehensive evaluation design, data-quality protocol, publication process or sanctions for non-reporting.[25][26][14]

Costing & Financing

Financing combines National Health Mission support for prevention and district-level non-communicable disease services with separate funding for tertiary healthcare and one-time grants for cancer-care institutions. Funds flow from the Government of India through State Health Societies and District Health Societies to approved programme accounts, supported by financial management groups responsible for accounting, expenditure reporting, utilisation certificates and audits.[3][15]

• Use the Non-Communicable Disease Flexi-Pool to fund interventions up to district level, allowing States to allocate approved funds between components within prescribed limits and subject to Government of India approval.[3]
• Require States and Union Territories to submit annual Programme Implementation Plans under National Health Mission arrangements to seek funding, while monitoring fund release and expenditure through monthly statements of expenditure.[20][21]
• Support district and community-level delivery through funding for screening devices and supplies, essential medicines, consumables, referral transport, clinics, laboratories, cardiac-care units, cancer-care services, equipment, contractual staff, training, information activities and logistics.[7][19][17]
• Distinguish non-recurring support for district-hospital equipment, renovation and laboratory strengthening from recurring expenditure on staff remuneration, drugs and information, education and communication activities.[17]
• Provide one-time assistance for State Cancer Institutes and Tertiary Care Cancer Centres, while requiring States or institutions to provide land, meet recurrent and personnel costs, maintain equipment and cover expenditure above applicable equipment ceilings.[12][27]
• Limit the use of cancer-institution grants for civil, electrical, renovation and infrastructure works, and permit staged release of the Government of India share, subject to procurement or construction progress.[27]
• Use a central contribution of 75% for most cancer-institution grants and 90% for North-Eastern and hilly regions, with the respective balance funded by State Governments.[29]
• Permit cross-subsidy from patients able to pay, require affordable user charges approved by State Governments, and require free treatment for Below Poverty Line patients in accordance with State policy.[27][29]

No overall National Programme budget, annual allocation, unit-cost schedule, quantified funding gap, resource-mobilisation target or economic model is specified in the supplied material.[4][21][30]The extracts identify expected financial protection outcomes, including reduced out-of-pocket expenditure and catastrophic costs, but provide no quantified estimates.[2]