Trends & Projections of NCDs in India Diabetes 2000: 32 million (WHO) 2010: 51 million (International Diabetes Federation) 2030: 80 million (WHO) Cardio-vascular Diseases 1998: 19 million (ICMR) 2005: 38 million (Nat. Com. Macroeconomics & Health) 2015: 64 million (Nat. Com. Macroeconomics & Health) Cancer Estimated number of persons with cancer: 2.8 million Annual Incidence: 1.1 million NCD Deaths 5.2 million (50.5%) of all cause deaths

Structure & Organisation Union Govt. Ministry of Health & Family Welfare – NCD cell; still evolving 35 States (provinces) - NCD cells at State & District planned (each distt. Is about 1.5 million) About a dozen vertical NCD programs including National Program for prevention and control of Cancer, Diabetes, CVD & Stroke and National Rural Health Mission NCD programs plan 10,000 US$ for 2012-17 (increase of nearly five times than last plan) Many activities in NCD field, yet un-coordinated

NRHM flow chart health care delivery in India State Project Management Unit State Health Mission State Health Society District Project Management Unit District Health Mission District Health Society Block Health & Sanitation committee CHC RKS PHC RKS Village Health & Sanitation committee Untied Fund Sub Centre ASHA PW

Key Interventions of National Program for prevention and control of Cancer, Diabetes CVD & Stroke Key Area Activities Health Promotion Public awareness through multi-media Counseling for healthy lifestyle (Balanced diet, regular exercise, avoid alcohol and tobacco) Early Diagnosis Screening of persons above 30 years for diabetes and hypertension at all levels; facilities up to Sub-centre level Case Management Facilities for diagnosis and treatment (NCD Clinic) at Comm. Health Centre level & above CCU at District Hospital and above Treatment of cancer at District Hospital & above Capacity Building Infrastructure Development & Equipment Training of human resources at all levels Management & Monitoring NCD Cell at National, State & District level Surveillance, monitoring & evaluation Regular review meetings

Activities in NCD Prev. & control National NCD summit 23-24 Aug 2011 at N. Delhi Food labeling for nutritional information by FSSAI food authority Indian International Trade fair health ministry’s pavilion with NCD theme Nov 2011 NCD theme painting competition and ministry’s calendar for 2012 Awareness through National TV network in states. Health promotion courses Increase in the Post Graduate seats across India Central Drug standard control organization (CDSCO) AYUSH department for Yoga and others School Health and School Health Policy Tobacco Control & Increase in taxation on Tobacco

Challenges Large Population Diversity in culture, belief and systems Inaccessibility; difficult terrains Individual & Institutional affordability Private sector catering to 80% healthcare Uniform model cannot work uniformly Provision of lifelong care to NCD patients Unwillingness of experts to go to villages Medicare by quacks and chemists

Lessons learnt Shortage of Specialist (e.g. Medical Oncologist /Endocrinologist/Cardiologist/Medical Physicist/ Cyto-pathologist/Cyto-pathology technician Need of intensive clinical training Delay in procurement of equipment Availability of space Health Management Information System Poor Record Management Proper linkages/network with Tertiary centres and Medical colleges is absent NCD management cannot replace the healthcare delivery system

Next steps The NCD Program needs to be taken into mission mode ( like NRHM - another program) A dedicated male health worker in addition to Female Health Worker needs to be employed at sub-centre (lowest level) exclusively for NCD Strengthening / development of health care delivery system at different levels Screening needs to be sustained and be integrated with health care delivery system Human Resource capacity building to be done Provision of drugs for poor and needy at all levels

Trade fair 2011 Ministry’s Pavilion - NCD Theme Thank You