National Health Programs II

Dr. Madhu Gupta

Professor
Department of Community Medicine and School of Public Health,
PGIMER

31-10-2023
Objectives
To learn about following programs under National Health Mission
• Reproductive Maternal Newborn Child and Adolescent Health
(RMNCHA)
• National Vector Borne Disease Control Program (NVBDCP)
• National Program for Prevention and Control of Non Communicable
Diseases

31-10-2023
Reproductive,
Maternal, Newborn,
Child and
Adolescent Health
(RMNCH+A)

20/05/2024 National Health Programs - II 3

 Introduction
• Reproductive and Child Health (RCH):

• Reflect health status of community and country

• Account for 60% of total health budget

• Requires life cycle approach and continuum of care

• 2013: Launch of RMNCH+A

• Emphasis on continuum of care and lifecycle approach

• Linking RCH with family planning, adolescent health, HIV services, prenatal diagnostic techniques

• Linking home and community-based services to facility-based services

• Ensuring linkages, referrals, and counter-referrals to create a continuous care pathway

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 Introduction
The trend of Maternal Mortality Ratio (MMR) in India over the past 15 years
Status of Maternal Mortality Ratio (MMR) in India
300

254
250

200
178

150
122
113
103 97
100

50

0
2005 2010-12 2015-17 2016-18 2017-19 2018-20

Source: Sample Registration Survey (SRS) MMR Special Bulletin, 2005 to 2020

20/05/2024 National Health Programs - II 5

 Introduction
Causes of maternal death in the Million Death Study

Cause of death Proportion (%) (2007-14) Projected national figures

(2020)

Hemorrhage 47.2 47.1

Pregnancy-related infection 12.0 11.8
Hypertensive disorders 6.7 6.7
Abortion 4.9 5.0
Other direct causes 19.6 19.7
Indirect causes 9.8 9.7
Source: Meh C,Sharma A,Ram U,Fadel S,Correa N,Snelgrove JW,ShahP,Begum R,Shah M,Hana T,Fu SH,Raveendran L, Mishra B, Jha P.
TrendsinmaternalmortalityinIndiaovertwodecadesinnationallyrepresentativesurveys. BJOG2022;129:550–561.

20/05/2024 National Health Programs - II 6

 Introduction
Status of Child health in India
India has shown progress in Sample registration System indicators:
Year NMR IMR U5MR

2016 24 34 39

2017 23 33 37

2018 23 32 36

2019 22 30 35

2020 - 28 -

NMR-Neonatal Mortality Rate; IMR-Infant Mortality Rate; U5MR-Under 5 Mortality Rate; SRS-Sample registration system
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 Introduction
Causes of child mortality in India

Child mortality Infant mortality Neonatal mortality

Prematurity & low birth weight (29.8%) Prematurity & low birth weight (35.9%) Prematurity & low birth weight (46.1%)

Pneumonia (17.1%) Pneumonia (16.9%) Birth asphyxia & birth trauma (13.5%)

Diarrheal diseases (8.6%) Birth asphyxia & birth trauma (9.9%) Neonatal Pneumonia (11.3%)

Other non-communicable diseases Other non-communicable diseases Other non-communicable diseases

(8.3%) (7.9%) (8.4%)

Birth asphyxia & birth trauma (8.2%) Diarrhoeal diseases (6.7%) Sepsis (5.7%)

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 Goals and Targets
Indicators related to maternal and child health: Status and targets

Indicator Status NHP 2017 SDG 2030

Maternal Mortality Ratio (per 1,00,000 live births) 97 100 by 2020 < 70

Infant Mortality Rate (per 1,000 live births) 28 28 by 2019 < 20

Neonatal Mortality Rate (per 1,000 live births) 22 16 by 2025 < 12

Under 5 Mortality Rate (per 1,000 live births) 35 23 by 2025 < 25

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 The Premise and Approach
Continuum of Care: RMNCH+A approach
ACROSS LIFESTAGES ACROSS LEVELS OF CARE

Family /
Health facilities at
various levels : PHCs,
Outreach home and
FRUs, DH services community
care

Appropriate Referral & Follow up

05/20/2024 MATERNAL HEALTH STRATEGIES 10

 The 5 x 5 Matrix

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 The 5 x 5 Matrix
List of Minimum Essential Commodities
Reproductive Health Maternal Health Newborn Health Child Health Adolescent Health
•Tubal Rings • Injection Oxytocin •Injection Vitamin K • Oral Rehydration Salt •Tablet Albendazole
• Tablet Misoprostol (ORS)
•IUCD 380-A, IUCD 375 •Mucous extractor • Zinc Sulphate •Tablet Dicyclomine
• Injection Magnesium
Dispersible Tablets
•Oral Contraceptive Pills Sulphate •Vaccines - BCG, Oral •Sanitary Napkin
(OCPs) / (Mala-N ) • Tablet Mifepristone Polio Vaccine (OPV), • Syrup Salbutamol &
(Only at facilities Hep B Salbutamol nebulising
•Condoms conducting Safe solution
Abortion Services)
•Emergency • Vaccines - DPT,
Contraceptive Pills(ECP) Measles
-(Levonorgestrel 1.5mg) JE (19 States),
Pentavalent vaccine (in 8
•Pregnancy Testing Kits States)
(PTKs) - Nischay
• Syrup Vitamin A
Cross cutting Commodities as per level of facility
• Iron & Folic Acid (IFA) Tablet, IFA small tablet, IFA syrup
• Syrup /tablets : Paracetamol, Trimethoprim & Sulphamethoxazole, Chloroquin and Inj. Dexamethasone
• Antibiotics : Cap /Inj. Ampicillin, Metronidazole, Amoxycillin; Inj. Gentamicin, Inj. Ceftriaxone;
• Clinical /Digital Thermometer; Weighing machine; BP apparatus; Stop Watch; Cold box; Vaccine carrier; Oxygen; Bag & mask
• Testing for Haemoglobin, urine and blood sugar

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 Key Features and Strategies

Heath Systems strengthening : Five high impact

Infrastructure, Human interventions across five
resources, drugs & key life stages
commodities, referral transport
Convergence & partnerships
with other Ministries/
departments, development
partners, civil society
organisations & other
stakeholders
Prioritisation of investments : Integrated monitoring and
High Priority Districts, tribal blocks,
accountability through good
marginalised populations in governance, use of data,
underserved areas …also urban communitisation & grievance
slums redressal
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 The 5 x 5 Matrix

Reproductive Health
• Focus on spacing methods, particularly PPIUCD at
high case load facilities

• Focus on interval IUCD at all facilities including

subcentres on fixed days

• Home delivery of Contraceptives (HDC) and

Ensuring Spacing at Birth (ESB) through ASHAs

• Ensuring access to Pregnancy Testing Kits

(PTK-"Nischay Kits") and strengthening
comprehensive abortion care services.

• Maintaining quality sterilization services.

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 Components of Care
Family Planning
• India: First country to launch a National Programme for Family Planning (1952)

• Current goals: Population stabilization, promotion of reproductive health, reduce maternal, infant & child
mortality and morbidity

• Promotion of spacing methods (interval IUCD)

Training of health personnel in IUCD insertion at all levels of health facilities

Ensure availability of IUCD CuT380 A

Ensuring IUCD services on fixed days at all sub-centres and PHCs

Strengthen the counselling system at the facilities with high caseload

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 The 5 x 5 Matrix

Maternal Health
• Use MCTS (RCH portal) to ensure early registration of
pregnancy and full ANC
• Detect high risk pregnancies and line list including severely
anemic mothers and ensure appropriate management.
• Equip delivery points with highly trained HR and ensure
equitable access to EmOC services through FRUs; Add
MCH wings as per need
• Review maternal, infant and child deaths for corrective
actions
• Identify villages with low institutional delivery & distribute
Misoprostol to select women during pregnancy; incentivize
ANMs for domiciliary deliveries

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 Key Maternal Health Strategies
Maternal Health Strategies

Strategies aimed at all women Strategies targeted towards subsets of women

All women (15-49 yrs) All pregnant, intra partum or post partum women

Intrapartum Pregnant or postpartum women

•Nutrition
•Violence
•Education Facility Home Facility/Outreach Home
Services Services services Services
•Empowerment
•Prevention and
Delivery in Skilled ANC PNC CHW post Skilled
treatment of diseases HC, attendant at partum attendant
BEmonC home
(e.g., HIV, cancers)
in facility &
access to
CEmonC

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 Maternal Health Strategies

Strategies aimed at all women Strategies targeted towards subsets of women

Pregnant, intra partum or postpartum Women not wanting

women with complications to have children

Facility Services Pregnant Non-Pregnant

Safe Family planning

EmOC B EmOC abortion
C EmOC

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 The 5 x 5 Matrix

Newborn Health Child Health

• Early initiation and exclusive • Complementary feeding, IFA
breastfeeding supplementation and focus on nutrition
• Home based newborn care through • Diarrhoea management at community
ASHA level using ORS and Zinc
• Essential Newborn Care and
• Management of pneumonia
resuscitation services at all delivery
points • Full immunization coverage
• Special Newborn Care Units with • Rashtriya Bal Swasthya Karyakram
highly trained human resource and (RBSK): screening of children for 4Ds’
other infra structure (birth defects, development delays,
• Community level use of Gentamycin deficiencies and disease) and its
by ANM management

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 The 5 x 5 Matrix

Adolescent Health
• Address teenage pregnancy and increase contraceptive
prevalence in adolescents

• Introduce community-based services through peer

educators

• Strengthen ARSH clinics

• Roll out National Iron Plus Initiative including weekly IFA

supplementation

• Promote Menstrual Hygiene

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 Newer Initiatives
1. National Iron + Initiative: Weekly Iron Folic Acid Supplementation (WIFS) for 13 crore adolescents

2. Emphasis on spacing: Doorstep delivery of contraceptives; Postpartum IUCD /FPS

3. “Delivery Points”: ~16000 health facilities with caseloads above laid down benchmarks

4. Improving Infrastructure: 468 Maternal and Child Health Wings with 28000 additional beds

5. Reaching out to adolescents in their own spaces besides facility-based care

6. Strengthening pre-service and in-service training of ANMs and nurses

7. Moving Beyond Numbers towards Quality of Care: Quality Assurance Guidelines, skills labs etc.
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 Monitoring and Evaluation

Various mechanisms for monitoring and evaluation:

1. Civil registration system for births and deaths from pubic and private facilities

2. Web-enabled Mother and Child Tracking System (RCH portal): Antenatal and postnatal care, immunization

3. Maternal Death Review (MDR) to identify causes of maternal death and service delivery gaps

4. Perinatal and Child Death Review to initiate state-specific child health interventions

5. Health Management Information System (HMIS) for relevant, timely and accurate data

6. Review Missions for progress against key targets and indicators

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 Monitoring and Evaluation

Various mechanisms for monitoring and evaluation:

7. National Surveys: NFHS, Sample Registration System, District Level Household Survey

8. Rapid programme assessments to identify operational bottlenecks

9. Leveraging technology: GIS maps, existing databases, GPS for ambulances, video conferencing

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National Vector Borne Diseases Control
Program
Targeted for elimination: Malaria, Lymphatic Filariasis and Kala-azar
Outbreak prone and climate sensitive diseases: Malaria, Dengue and JE
Diseases included
• Malaria
• Dengue/DHF
• Chikungunya
• Kala-Azar
• Filaria
• Japanese Encephalitis
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Objectives
• To prevent mortality due to Vector Borne Diseases namely Malaria,
Kala azar, Dengue/DHF and Japanese Encephalitis
• To reduce morbidity due to Malaria, Dengue/DHF, Chikungunya and
Japanese Encephalitis
• Elimination of Kala-azar and Lymphatic Filariasis.

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 Malaria

• Life threatening parasitic disease caused by parasites Plasmodium

• Vector: Transmitted by the infective bite of female Anopheles
mosquito
• Develops disease after 10 to 14 days
• 95% population in the country resides in malaria endemic areas and
80% of malaria reported in the country is confined to areas consisting
20% of population residing in tribal, hilly, difficult and inaccessible
areas.

31-10-2023
Epidemiological Situation
• In 2020 total 186,532 cases (119,088 Plamodium falciparum cases)
and 93 deaths were reported.
• In 2021, a total of 64520 cases of malaria and 35 deaths have been
reported till July 2021.
• 89776 cases and 49 deaths reported during the same period in 2020
• 28.13% decline in malaria cases and 31.13% decrease in falciparum
malaria.

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Trend of Malaria Cases And Deaths 2001-
2021

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Strategy of Malaria Control in India

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Road Map for Malaria Elimination
• Launch of National Framework for Malaria Elimination (NFME) 2016-
2030 in February.
• Dissemination of NFME 2016- 2030 to all States and UTs.
• Launched Operational Manual for Malaria Elimination - April,2016
• Launched The National Strategic Plan (NSP) 2017-2022 for Malaria
Elimination

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Algorithm for diagnosis & treatment of
Malaria

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Achievements
• Reduction in malaria morbidity and mortality by 91% and 90%
respectively between 2000 and 2020.
• From 2015 to 2020. there was decline of nearly 84% in malaria cases
and 76% in deaths.
• In 2012 and in 2020 India has achieved National Annual Parasite
Incidence (API) less than 1 per 1000 population, 0.14 per 1000
population.

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 Dengue

• Causative organism: Dengue Virus 1,2,3,4

• Vector: Dengue Fever is transmitted by Aedes mosquito, breeds in clean
water, indoor pots, bathrooms, below pots, coolers, tyres etc.
• There is no drug available to cure the dengue infection
• Dengue is endemic to all States/UTs (except Lakshadweep and Ladakh).
• Upsurge in the cases of Dengue during July- November in northern
parts of the country.
• In southern and western parts of the country, the disease has become
perennial
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DISTRIBUTION OF DENGUE/DHF IN INDIA

Indian scenario, approximately 0.8 million dengue cases

have been recorded from 2017 to 2022 followed by 1,000
deaths. Maximum cases of dengue have been recorded in
2021 followed by 2019.

Endemic district

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Dengue situation in the country since 2010 to
2021 (till 30th September)

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MANAGEMENT OF DENGUE CASE
• Early reporting and diagnosis of the suspected dengue fever
• Management of dengue fever is symptomatic & supportive
• In severe dengue cases, the following treatment is recommended
• Replacement of plasma losses
• Correction of electrolyte and metabolic disturbances
• Blood transfusion

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 DO'S AND DON'TS

• Remove water from coolers and other small containers at least once in a
week
• Use aerosol during day time to prevent the bites of mosquitoes
• Do not wear clothes that expose arms and legs
• Children should not be allowed to play in shorts and half sleeved clothes
• Use mosquito nets or mosquito repellents while sleeping during day time
• Stagnant water in drains, garbage and coolers more than a week is alarm
for dengue

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 GOI initiatives for Dengue control
• Developed guidelines and operational manuals for technical guidance to the
States and other stakeholders
• Established Sentinel Surveillance Hospitals with laboratory support
• Ensuring the functional diagnostic facility (SSH/ARL) and availability of kits.
• Maintain the uniformity and standard of diagnostics IgM MAC ELISA test kits
• Trainings are imparted for capacity building of programme
• Monitoring of disease situation
• Advisories were issued to sensitize the States for preparedness to deal with
any future outbreak.

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 Chikungunya
• Chikungunya caused by Chikungunya virus.
• Vector: This disease is transmitted by Aedes mosquito, both Ae.
aegypti and Ae. Albopictus
• The disease re- emerged in the country after a gap of almost three
decades.
• Sign Symptoms: fever, chills, headache, nausea, vomiting, joint pain,
severe joint pain (arthritis) and rash
• There is no specific treatment for chikungunya.

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Chikungunya situation in the country since
2010 to 2021 (Prov. till 30th September)

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 Kala-azar
• Caused by a protozoan parasite of genus Leishmania donovani
• Vector: Sandfly Phlebotomus argentipes
• Primarily infects reticuloendothelial system and may be found in
abundance in bone marrow, spleen and liver.
• Sign and symptoms- Recurrent fever, loss of appetite, pallor and
weight loss and weakness, spleen enlarges rapidly to massive
enlargement, Liver - enlargement, anaemia - develops rapidly

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Kala-azar Elimination Programme
Goal
• To improve the health status of vulnerable groups and at-risk population living in Kala-azar
endemic areas by the elimination of Kala-azar so that it no longer remains a public health
problem
Target
• To reduce the annual incidence of Kala-azar to less than one per 10,000 populations at block
PHC level.

Objective
• Reducing Kala-azar in the vulnerable, poor and unreached populations in endemic areas
• Reducing case-fatality rates from Kala-azar to negligible level
• Reducing cases of Post Kala-azar Dermal Leishmaniasis to interrupt transmission of Kala-azar
• Preventing the emergence of Kala-azar and HIV/TB co-infections in endemic areas.
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Strategy
• Early diagnosis & complete treatment (EDCT): Liposomal
Amphotericin B (LAMB) in a single dose of 10 mg/kg as the first choice
treatment regimen for the Indian Subcontinent
• Integrated Vector Management with Indoor residual spraying (IRS)
and construction of pucca houses.
• Advocacy, Communication for behavioral Impact and Inter-sectoral
convergence
• Capacity Building
• Supervision, Monitoring and Evaluation

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Kala Azar Trends in India: 2014 to 2021
(Aug)

There has been 40% decline in KA cases up to August 2021, compared to corresponding
period of 2020. PKDL cases have increased in 2021 (Aug) by 17% compared to corresponding
period of 2020

31-10-2023
Achievements
• In 2020, out of 633 endemic blocks, only 16 blocks (12 blocks in
Jharkhand & 4 blocks in Bihar) reported above elimination threshold.
• Remaining 97.5% blocks achieved the elimination target.
• Till August 2021, only two blocks of Jharkhand have reported above
elimination threshold.
• West Bengal and Uttar Pradesh states have sustained the elimination
target since 2017 & 2019, respectively

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Lymphatic Filariasis
• Causative organism: Parasites nematodes belonging to super family
Filarioidea: Wuchereria bancrofti and Brugia malayi are found in India
• Vector: Mosquito Culex quinquefasciatus and Mansonia
annulifera/M.uniformis
• Vector species breeds preferably in dirty and polluted water
• Endemic in 272 districts {15 districts (Odisha-7, Jharkhand-4,
Telangana-4) included in 2020} across 20 States/UTs (16 States &4
UTs).
• Population at risk from the filaria infection is about 670 million

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FILARIA ENDEMIC DISTRICTS

Endemic district 257

(in 21 States/UTs)
Population: 650 Million

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National Filaria Control Programme
(NFCP)
• Launched in the country in 1955
Objective
• To undertake control measures in endemic areas and to train
personnel to man the programme.
• The main control measures were mass Diethylcarbamazine (DEC)‐
medicated salt administration, antilarval measures in urban areas and
indoor residual spray in rural areas

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Strategy for Elimination of Lymphatic
Filariasis
• Recurrent anti-larval measures at weekly intervals.
• Environmental methods: source reduction by filling ditches, pits, low
lying areas, deweeding, desilting, etc.
• Biological control of mosquito breeding through larvivorous fish.
• Anti-parasitic measures: 'detection' and 'treatment' of microfilaria
carriers and disease person with DEC by Filaria Clinics in towns
covered under the programme.

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Japanese Encephalitis
• Causative organism: JE virus
• Vector: Japanese Encephalitis (JE) transmitted by infected Culex
vishnui
• Primarily breeds in rice fields mainly in rural areas.
• JE is reported under Acute Encephalitis Syndrome (AES) which is
characterized by rapid onset of high grade fever, headache, neck
stiffness, disorientation, coma, seizures, and ultimately death.
• High case fatality and disability are major concerns associated with JE

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JE situation in the country since 2013 to
2021 (till 21st September)

31-10-2023
Achievements:
• JE Vaccination:Out of six vector borne diseases, JE is the only disease
against which vaccination is available.
• Strengthening of Critical Care services:
Early Referral of JE cases
Establishment of Pediatric ICUs (PICUs)

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 National Program for Prevention and
Control of Non Communicable Disease

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 Introduction to NPNCD
• NCDs account for 63% of all deaths, of which the • Pilot phase in 10 districts
20
cardiovascular diseases lead with 27% overall 08

mortality cause 20 • NPCDCS launched in 100 districts

10

20
• Integrated with NHM; rolled out in 36 states/UTs
13-
14
20
• 468 districts approved
15-
16
20 • 616 districts approved

16- • Population-based screening

17

20 • National Program for Non-Communicable Diseases (NPNCD)

Fig. Burden of Non Communicable Diseases in India
23
20/05/2024 NPNCD Training Programme 57
 Diseases covered under NP-NCD
• Hypertension
• Diabetes
• Cancer
• Stroke
• Chronic Kidney Disease
• Chronic Obstructive Pulmonary Disease
• Non-alcoholic Fatty Liver Disease (NAFLD)
• ST elevated Myocardial Infarction

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 National NCD Division
Headed by Joint Secretary (NCD), MoHFW
Deputy Director General (DDG) is the technical head
at the Directorate General Health Services
Organizational Structure of
NPNCD

State NCD Division

Headed by Mission Director, NHM
Technical support is provided by the State Nodal Officer/State Program
Officer - NCD
State Programme Coordinator, Finance cum Logistics Consultant and Data
Entry Operator

District NCD Division

Headed by District Nodal Officer/District Programme Officer - NCD
(DNO/DPO – NCD)
District Programme Coordinator, Finance cum Logistics Consultant and Data
20/05/2024 Entry Operator NPNCD Training Programme 59
 Operational Strategies

1. Health promotion for prevention of NCDs and reduction of risk factors

2. Screening, early diagnosis, management, referral and follow up of common NCDs

3. Capacity building of health care providers

4. Evidence based standard treatment protocols

5. Uninterrupted drug and logistics supply

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 Operational Strategies

6. Task sharing and people-centered care

7. Information system for data entry, longitudinal patient records

8. Monitoring, supervision, evaluation and surveillance including technology enabled interventions

9. Multi-sectoral coordination and linkages with other National Programmes

10.Implementation research and generation of evidences

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 Goals and NCDs
• Sustainable Development Goal 3 (Target 3.4) aims to reduce premature mortality from
NCDs by one-third by 2030 in the world.
• SDG-3 also stresses on prevention and control of tobacco and alcohol use.
• To reverse the incidence of NCDs and seeks to focus on common NCDs
• To reduce premature mortality from cardiovascular diseases, cancer, diabetes or chronic
respiratory diseases by 25% by 2025.
• The Union Health Ministry has unveiled the “75/25” initiative, aiming to revolutionize the
management and prevention of (NCDs) in India. Target of providing Standard Care to 75
million individuals with hypertension and diabetes by 2025.
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Objectives of NP-NCD
• Behaviour change with involvement of community, civil
Health promotion society, community-based organizations, media and
development partners

• Early diagnosis, management, referral and follow-up at

Screening each level of healthcare delivery to ensure continuum
of care

• At various levels for prevention, early diagnosis,

Build capacity of treatment, follow-up, rehabilitation, IEC/BCC,
health care providers monitoring and evaluation, and research.

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 • For drugs, equipment and logistics for
Strengthen supply diagnosis and management at all health care
chain management levels.

Monitoring, • Programme through proper implementation

supervision and of uniform ICT application across India.
evaluation

coordinate and • with other programmes,

collaboration departments/ministries, civil societies.

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 Monitoring, Supervision and Evaluation

Fig. Data flow mechanism under NPNCD Fig. Six applications in the National NCD Portal

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 Risk Factors and NCDs

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 NCD Service Delivery
• NCD services: Health promotion, psycho-social counselling, screening, case
management, emergency cardiac and stroke care services, day care and
palliative care services for cancer, as well as referral for specialized services,
as needed.
• Bi-directional referral linkages covering all levels of health care facilities shall
be established to assure care both for NCDs and associated unforeseen
emergencies and follow up care

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 NCD Service Delivery – Community Level
• Active enumeration of the eligible population and registration of the
families
• Risk assessment of NCDs using Community Based Assessment Checklist
(CBAC)
• Mobilization of community for screening of NCDs at nearest AB-HWC
• Health promotion, lifestyle modification
• Follow up for treatment compliance

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 National NCD Portal
• ASHA Mobile App - To capture Population enumeration and CBAC Assessment
• HWC App - To screen the population for five common NCDs and enable referrals
• PHC Web Portal and App - To validate patient screening, complete diagnosis/ manage/
refer to higher centres by MO in PHC and backward referrals for follow-ups.
• CHC/DH Portal and App - To confirm diagnosis of patients referred from PHCs and
initiate treatment and backward referrals.
• Admin Portal - To manage the master data for facility and users at district and state
levels.
• Health Officials Dashboard - Dashboard for district, State and National NCD officials to
monitor the status of programme implementation and NCD indicators.
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31-10-2023
Achievements under NPCDCS:
• Media Campaigns: World Cancer Day, World Kidney Day,
World Stroke Day
• “National Framework for Joint Tuberculosis Diabetes
collaborative activities”.
• To leverage mobile technology, an application called m-
Diabetes is being used.
• Convergence between NUHM and NPCDCS
• Improved linkages between population based screening
and facility based activities.
• Strengthening of Tertiary Cancer Care Centres under
NPCDCS.
• Pradhan Mantri National Dialysis Program (2016-2017).
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References:
1) National Centre for Vector Borne Disease Control
https://ncvbdc.mohfw.gov.in/index1.php?lang=1&level=1&sublinkid=5
784&lid=3689

2) National Health Mission

https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1048&lid=6
04

3)NPCNCDs: https://main.mohfw.gov.in/?q=Major-Programmes/non-
communicable-diseases-injury-trauma/Non-Communicable-Disease-
II/National-Programme-for-Prevention-and-Control-of-Cancer-Diabetes-
Cardiovascular-diseases-and-Stroke-NPCDCS
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 Thank You

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