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 establish a comprehensive, sustainable response to major non-communicable diseases through prevention, health promotion, early detection, diagnosis, treatment, rehabilitation and palliative care.[1][2][3]It aims to reduce risk-factor exposure, disability, deaths, out-of-pocket expenditure and catastrophic financial effects, while improving quality of life, cure rates and survival.[3][4]

• Promote healthy lifestyles, including healthy diets, physical activity, weight reduction, avoidance of tobacco and harmful alcohol use, stress management, and awareness of cancer warning signs.[5][6][7]
• Screen people aged 30 years and above for diabetes, hypertension and common cancers through opportunistic, facility-based and outreach approaches, and identify people requiring further investigation or referral.[8][7]
• Strengthen capacity for prevention, diagnosis, treatment, health communication, operational research, rehabilitation and surveillance across primary, secondary and tertiary care.[1][8]
• Provide integrated care for cancer, diabetes, hypertension, cardiovascular diseases, stroke, chronic obstructive pulmonary disease and chronic kidney disease, with particular attention to affordable and user-friendly services for older people.[3][9]
• Expand cancer-care infrastructure by March 2017 through two National Cancer Institutes, 20 State Cancer Institutes, 50 tertiary cancer-care centres, chemotherapy day-care facilities in at least 25% of districts, and cancer-registry networking across 70 institutes.[4]
• Expand district hospital non-communicable disease clinics to 640, sub-district, community health centre and primary health centre clinics to 2,500, State and District non-communicable disease cells to 35 and 640 respectively, and cardiac-care facilities to at least 25% of districts by March 2017.[4]
• Develop State Cancer Institutes as apex institutions for comprehensive cancer care, mentoring, outreach, referral, treatment protocols, research and workforce development, and enable Tertiary Care Cancer Centres to deliver comparable functions at a smaller scale.[10]
• Strengthen comprehensive cancer prevention, diagnosis, treatment, after-care, palliative care, rehabilitation, cancer registration, specialist training and translational research.[11][12]

Implementation

Implementation combines integration within the National Health Mission for services up to district level with specialised tertiary-care arrangements, using a decentralised network of sub-centres, primary health centres, community health centres, first referral units, district hospitals and cancer centres.[1][2][4]National guidelines provide a common framework, while States may adapt implementation to local needs and develop State and District action plans.[8][13]

• Integrate non-communicable disease activities into a common National Health Mission flexi-pool for health promotion, screening, case detection, follow-up, information, education and communication, behaviour-change communication and innovations; retain tertiary healthcare outside the National Health Mission.[4][14]
• Deliver health promotion, counselling, risk assessment, opportunistic blood-pressure and diabetes screening, identification of cancer warning signs and referral through sub-centres; provide clinical diagnosis, treatment and follow-up through primary health centres; and operate non-communicable disease clinics at community health centres, first referral units and district hospitals.[14][9]
• Strengthen district hospitals with clinics, laboratories, diagnostic equipment, essential medicines, rehabilitation, emergency care, chemotherapy day care, palliative-care guidance and feasible four-bed cardiac-care units.[9][15]
• Link district facilities with tertiary hospitals, cancer centres, private laboratories and non-governmental organisations to extend diagnostics, outreach, referral and continuity of care; outsource unavailable tests in accordance with State policy.[2][9]
• Engage communities, civil society, community-based organisations, local authorities, other government departments, media and private providers in health promotion and behavioural change.[8][6]
• Train health professionals through designated nodal agencies, central training plans, master trainers, medical colleges and specialist institutions, covering prevention, screening, clinical management, cancer care, coronary care and programme management.[16][15][17]
• Govern implementation through National, State and District non-communicable disease cells within the Directorate General of Health Services, State Health Societies and District Health Societies, supported by contractual personnel for coordination, epidemiology, training, monitoring, data management, finance and logistics.[18][19]
• Use national technical committees and technical resource groups for guidance and progress review, while permitting States to establish additional technical-support mechanisms.[14]
• Transfer funds from the Government of India through State Health Societies to District Health Societies and, where applicable, block-level Rogi Kalyan Samities; assign financial-management groups responsibility for accounts, expenditure reporting, utilisation certificates and audits.[14][20]
• Monitor delivery through surveillance databases, a Management Information System, standard reporting formats, field visits, review meetings, operational research and evaluation studies.[2][18][20]Monthly and quarterly reports track screening, referrals, diagnoses, treatment, follow-up, chemotherapy, physiotherapy, counselling, physical progress and financial performance.[19][21][22]
• Support State Cancer Institutes and Tertiary Care Cancer Centres through State-endorsed proposals, expert appraisal, Central inspection, Standing Committee review and a tripartite Memorandum of Understanding.[10][23]Maximum one-time assistance is 120 crore Indian rupees per State Cancer Institute and 45 crore Indian rupees per Tertiary Care Cancer Centre, with States or institutions responsible for recurring costs, land and expenditure above equipment ceilings.[23]

Monitoring & Evaluation

The programme establishes a multi-level monitoring, reporting and accountability system for the prevention and control of non-communicable diseases, combining surveillance, routine facility data, physical and financial progress reviews, field supervision and programme-specific reporting from sub-centres to national level.[2][18][20]

• Develop surveillance-based databases to monitor non-communicable disease morbidity, mortality and risk factors, supported by risk-factor surveys, cancer registries, operational research and a Management Information System.[1][8][2][18]
• Monitor implementation through National, State and District Non-Communicable Disease Cells, using review meetings, field visits, field observations, prescribed reporting tools and Health Management Information System data.[2][18][13]
• Track programme expansion against March 2017 targets for cancer institutes and centres, chemotherapy day-care facilities, cancer-registry networking, non-communicable disease clinics, State and District cells, and cardiac-care-unit coverage.[4]
• Measure service delivery through monthly and cumulative, sex-disaggregated indicators covering clinic attendance, in-referrals, screening, suspected and diagnosed cases, treatment initiation, follow-up, tertiary referrals, cardiac-care treatment, chemotherapy sessions, counselling and physiotherapy.[21][24][25][22][26]
• Record screening and referral activity through common registers, referral cards and follow-up records, including regular documentation of blood glucose, medicine availability and complications among confirmed patients.[7][27][28][29]
• Require monthly reporting from sub-centres and primary health centres to District Non-Communicable Disease Cells, district reports to State cells by the 10th of each month, and State reports to the National cell by the 15th of each month.[28][29][22][26][30]
• Assign reporting responsibility through signed forms identifying the responsible official’s name, designation and reporting date.[28][29][21][24][22]
• Require District Health Societies to monitor fund use and submit quarterly financial management reports to State Health Societies, while financial management groups oversee accounts, expenditure reporting, utilisation certificates and audit arrangements.[14][20][31]
• Use national technical committees, technical resource groups, nodal agencies and quarterly State Programme Manager reviews to assess implementation progress, training quality and operational constraints.[16][14][20]
• Assess tertiary cancer-care proposals through eligibility review, Central inspection, Standing Committee appraisal, procurement controls, grant-utilisation certificates and construction or procurement milestones.[10][23][32][33]

Some sections specify surveillance, reporting frequencies and operational indicators in detail; however, a comprehensive national outcome-indicator framework, data-quality protocol, independent evaluation timetable and sanctions for non-reporting are not consistently specified.[4][21][34][32][33]

Costing & Financing

Financing combines National Health Mission support for district and below-district non-communicable disease services with targeted, non-recurring assistance for tertiary cancer-care infrastructure. States, districts and supported institutions retain substantial responsibility for recurrent expenditure, staffing, maintenance, land and expenditure above approved equipment ceilings.[4][14][23][32]

• Finance primary and secondary prevention, screening, case detection, follow-up, health promotion, communication and innovation through a common non-communicable disease flexi-pool, with States able to reallocate funds between components within prescribed limits and Government of India approval requirements.[4][20]
• Channel Government of India funds through State Health Societies to District Health Societies and, where applicable, block-level Rogi Kalyan Samities, with financial management groups responsible for budgeting, accounts, fund release, reporting, utilisation certificates and audits.[14][20][31]
• Support district and lower-level delivery through assistance for cardiac-care units, screening devices, medicines, consumables, referral transport, contractual staff, laboratory strengthening, renovation, equipment, information and communication activities, surveillance and information systems.[8][16][2][9]
• Provide one-time assistance 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, with the stated amounts including the State contribution.[23]
• Require States or institutions to meet recurrent and manpower costs, provide land at their own cost, finance equipment expenditure above Central Government ceiling prices, and maintain services including medicines for patients below the poverty line.[10][23][11][32]
• Permit up to 30% of sanctioned tertiary cancer-care assistance for civil, electrical, renovation and infrastructure works.[23][11][32]
• Apply a normal 75:25 Central Government-State funding ratio for tertiary cancer-care grants, adjusted to 90:10 for North-Eastern and hilly regions; the Central share is non-recurring.[32][35]
• Provide specified monthly pay scales for contractual District Non-Communicable Disease Clinic and Community Health Centre clinic personnel, although the source gives ranges rather than a single payable amount.[19]

The material identifies prevention and health promotion as important measures to reduce the high costs of non-communicable disease treatment, but does not provide a total programme budget, quantified funding gap, cost-effectiveness analysis, unit-cost schedule or wider economic assumptions.[2][3][20][35]