National health programmes for

non communicable disease

Presented by
Dr Khyati Boriya
 OBJECTIVES
• To know about the national health
programs for non communicable
diseases
• Understand relevance of NHP
• Description of NHP for non
communicable diseases

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 Content
• Introduction- Noncommunicable diseases,risk factors
of NCDs, %deaths internationally and nationally due to
NCDs.
• National mental health programme- Aims,
objectives, strategies,mental health care, district mental
health programme , thrust areas and limitations.
• National programmes for control of
blindness-, National and international WHO definition
for blindness ,types of blindness, causes of blindness
,national programme for blindness, revised
stratigies,objectives,organizational structure of
NPBC,service delivery and referral system,activities of
programme, new initiatives, vision 2020,prevention of
blindness.
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 Content

• National programmes for the control of

cancer– About cancer ,causes of cancer ,cancer
problems worldwide and in India ,control, methodology of
cancer registration ,goals and objectives of NCCP ,national
cancer control programme,existing schemes, recent news
of cancer.
• National programmes for the control of
diabetes-overview of the diabetes disease,diabetes
control programme,objectives of programme,stretegies of
programme, scheme.

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 Introduction
• Non communicable disease(NCD) is a
medical condition or disease that is
non infectious or nontransmissible .
• Chronic noncommunicable diseases
are assuming increasing importance
among the Adult population in both
developed and developing countries.
Cardiovascular diseases and cancer
are at present the leading causes of
death in developed countries .

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Noncommunicable diseases include-
• Cardiovascular diseases
• Renal diseases
• Nervous disorders
• Mental disorders
• Musculoskeletal conditions such as arthritis and allied
diseases
• Chronic non specific respiratory diseases for e.g chronic
bronchitis ,emphysema ,asthma.
• Permanent results of accidents
• Blindness
• Cancer
• Diabetes
• Obesity
• Various metabolic and degenerative diseases
• Chronic results of communicable diseases
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• Of the 57 million global deaths in 2008 , 36 million or
63% were due to non-communicable diseases (NCDs)
• By the cause ,cardiovascular diseases were responsible
for the largest proportion of NCD deaths - 47.9%
• Followed by cancers- 21%
• Chronic respiratory diseases -11.72 %
• Digestive diseases-6.1%
• Diabetes-3.5%
• And rest NCDs were responsible for- 9.78%
• As population will age ,annual NCD deaths are projected
to rise substantially , to 52 billion in 2030.

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• India is experiencing a rapid health transition with a rising
burden of NCDs causing significant morbidity and mortality
,both in urban and rural population ,with considerable loss in
potentially productive years (age 35-64 years) of life . NCDs are
estimated to a account for about 53% of all deaths
• Pie chart showing proportional mortality (% of all deaths all ages)
communicable,maternal,perinatal,a
nd nutritional conditions
% of total deaths ,all ages
CVD

respiratory diseases
2% 10%
6% others NCDs
10% 37%

cancers
24%
11%
diabetes

injuries
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Non communicable diseases risk
factors
• Tobacco
• Insufficient physical activity
• Harmful use of alcohol
• Unhealthy diet
• Raised blood pressure
• Overweight and obesity
• Raised cholesterol
• Cancer associated infections
• Environmental risk factors

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National mental health
programme

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 National mental health programme
• The national mental health
programme(NMHP) was launched during
1982 with a view to ensure availability of
mental health care services for all
,especially the community at risk and
underprivileged section of population.
• Eleven institutions have been identified
for imparting basic knowledge and skills
in the field of mental health to the
primary health care physicians and
paramedical personnel,at present this
programme covers 94 districts.

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 AIMS OF NMHP
• Prevention and treatment of mental and neurological
disorders and their associated disabilities
• Use of mental health technology to improve general
health services
• Application of mental health principles in total
national development to improve quality of life

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Objectives of NMHP
• To ensure availability and accessibility of minimum mental
health care for all in the foreseeable future, particularly to the
most vulnerable and underprivileged sections of population
• To encourage application of mental health knowledge in
general health care and in the social development
• To promote community participation in the mental health
services development and to stimulate efforts towards self-help
in the community

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NMHP STRATEGIES
• Integration of mental health with primary health care through
the NMHP
• Provision of tertiary care institutions for treatment of mental
disorders
• Eradicating stigmatization of mentally ill patients and
protecting their rights through regulatory institutions like the
Central Mental Health Authority and State Mental Authority.

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Mental health care
• The mental morbidity requires priority in mental
health treatment
• Primary health care at village and subcentre level
• At primary health centre level
• At district hospital level
• Mental hospital and teaching psychiatric units

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District mental health programme
components
• Training programmes of all workers in the mental health
team at the identified nodal institute in the state
• Public education in mental health to increase awareness and
to reduce stigma
• For early detection and treatment , the opd and indoor
services are provided
• Providing valuable data and experience at the level of
community to the state and centre for future planning ,
improvement in service and research.

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• District mental health programme has now incorporated
promotive and preventive activities for positive mental health
which includes :
• School mental health services :life skills education in schools
,counseling services.
• College counseling services: through trained teachers
/councellors.
• Work place stress management :formal and informal sectors
,including farmers ,women,etc
• Suicide prevention services :counseling centre at district level
,sensitization workshops, IEC,help lines etc.

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Thrust areas
• District mental health programme in an enlarged and more
effective form covering the entire country.
• Modernization of mental hospitals in order to modify their
present custodial role.
• Upgrading dept. of psychiatry in medical colleges and enhancing
the psychiatric content of medical curriculum at undergraduate
and post graduate level.
• Strengthening the central and state mental health authorities
with a permanent secretariat. Appointment of medical officers at
state head quarters in order to make monitoring role more
effective.
• Research and training in the field of community mental health,
substance abuse and child adolescent psychiatric clinics.

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 Limitations of NMHP
• There is no initiative from the mental health professional to take
active part in this programme.most of them are not aware of the
programme.
• There is shortage of professional manpower and training
programmes are not able to meet the demand in providing all
medical private practitioner and medical officers
• The targets set for the programme are not achieved till today after
lapse of more than one decade.this indicates that there is a poor
commitment of the government,psychiatrists and community at
large.
• The programme has given more emphasis on the curative services
to the mental disorders and preventive measures are largely
ignored . More public awareness programme are required.

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• WHO defines blindness as “visual acuity of less than 3/60 (snellen) or its
equivalent”
• Simple Definition: Inability of a person to count fingers from a distance of 6
meters or 20 feet
• Technical Definition: Vision 6/60 or less with the best possible spectacle
correction
Causes of blindness
Cataract
1% 1% 1%
5% 1% refractive errors 20%
6%
glucoma

20% posterior segment

disorder
64% surgical complication

posterior capsular
opacification
corneal blindness

Other 21
 Types of blindness
• Curable blindness: That stage of blindness where the
damage is reversible by prompt management e.g. cataract
• Preventable blindness: The loss of blindness that could
have been completely prevented by institution of effective
preventive or prophylactic measures e.g. xerophthalmia,
trachoma, and glaucoma
• Avoidable blindness: The sum total of preventable or
curable blindness is often referred to as avoidable blindness.

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• Magnitude of Problem in India
Estimated prevalence of blindness :

• 11.2 per 1000 population

• 0.1 per 1000 population : 0‐14 years
• 0.6 per 1000 population: 15‐49 years
• 77.3 per 1000 population: 50 years & above
• Female (12.2 per 1000 population) > Male (10.2 per
1000 population)
• 15 millions are suffered with blindness in India.

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National Programme for Control of Blindness
• Launched in year 1976
• 100% centrally sponsored programme
• Incorporates the earlier Trachoma Control Programme (started
in 1968)
• Goal: To reduce the prevalence of blindness from 1.4 to 0.3%
World Bank assisted cataract blindness control project (1994‐2002):
• Implemented in 8 states.
• 15.35 million operations had been done against 11 million
target.
• IOL implantation had been increased from 3% in 1993 to 75% in
2002.
DANIDA assistance to NPCB (1998‐2003) :
• Funds were utilized for the training , development of MIS,
supply of equipment.
WHO assistance for prevention of blindness:
• Development plan for“Vision 2020:the right to sight ”initiative.
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 Revised strategies
Based upon the finding of survey conducted during 1998-99 &
1999-2000
1.To make the NPCB more comprehensive by:
• Strengthening services for other blindness like corneal
blindness
• Refractive errors in school going childrens
• Improved follow up services for cataract operated persons.
• Treating other causes of blindness like glaucoma .
2.To shift
• Eye camp approach to a fixed facility.
• From conventional surgery to IOL implantation for batter
quality post operative vision.

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3. To expand the world bank project activities
like constructions of eye OTs, eye wards at dist. Level, training
of eye surgeons, modern cataract surgery & supply of eye
equipments.

4. To strengthen participation of voluntary organizations in the

programme & to earmark geographic areas to NGOs and govt.
hospital & improve the performance of govt. units.

5. To enhance coverage of eye care services in tribal &

underserved areas through identification of bilateral blind
patients, preparation of village wise blind register & giving
preference to bilateral blind patients for cataract surgery .

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Objectives
• To reduce backlog of blindness through
identification & treatment of blind.
• To develop eye care facility for every district.
• To develop human resources for eye care
services.
• To improve quality of service delivery.
• To secure participation of civil society & private
sector.

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Infrastructure Development for Eye Care
• Item Current achievement

• Strengthening of PHCs 5,633

• Centre Mobile Units 80
• Strengthening of District Hospitals 445
• Upgrading of Dept. of Ophthalmology in Medical Colleges 82
• Establishment of Regional Institutes 11
• Ophthalmic Assistant training centers 39
• District Mobile Units 341
• State Ophthalmic Cells 21
• Establishment of DBCSs 604
• Eye Bank (Govt.) 166
• Paramedical Ophthalmic Assistants posted 4,881

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Organizational Structure for NPCB

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Service Delivery & Referral System

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Activities
• Cataract operation: IOL implantation has been emphasized.
• Involvement of NGOs.
• Civil works: Construction of eye wards, OTs & dark room were
undertaken in 7 states under World Bank assisted project.
• Training to eye surgeons, PHC MO, ophthalmic assistant,
ophthalmic HWs.
• Commodity assistant like sutures & IOLs, slit lamps, A‐ scans,
Yag lasers, keratometres are procured centrally & distributed to
states & DBCS.
• IEC
• MIS
• Monitoring & evaluation rapid assessment surveys, beneficiary
assessment survey, visual outcome surveys
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• Collection & utilization of donated eyes:
Nearly 20,000 donated eyes are collected per annum
• School Eye Screening Programme :
First screening by trained teachers.
Children suspected to have refractory errors are confirmed by
ophthalmic assistants.
Corrective spectacles are prescribed or provided free of cost to
poor.

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New Initiatives
• Dedicated eye wards & eye OTs in DH & SDH as per demand.
• Appointment of Ophthalmic surgeons & O.A. in new DHs &
SDHs.
• Appointment of O.A. in PHCs
• Appointment of Eye Donation Counselors in eye banks
• Grant‐in‐aid for NGOs for management of various eye diseases
• PPP
• Special attention to NE States
• Telemedicine in Ophthalmology
• Vitamin A supplement and MMR vaccination through DBCS
funds.

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Vision 2020: Right to Sight
• A global initiative has been taken to reduce avoidable
• blindness by 2020.
• India also has committed to this initiative.

Plan of action
1.Target diseases:
• Cataract, Refractive Errors, Childhood Blindness, Glaucoma,
Diabetic Retinopathy.
2.Human resource development
3.Infrastructure development:
• Proposed 4‐tier structure includes:
• Centres Of Excellence (20)
• Training Centres(200)
• Services Centres(2000)
• Vision Centres(20,000) 34
 • Centers of excellence 20: Professional leadership, strategy
development, continued medical education, laying of standards and
quality assurance,reasearch.
Tertiary • Training centers 200:Tertiary eye care including retinal surgery,
corneal implantation,glacoma surgery ,training etc.

• Service centers 2000:Cataract surgery, other common eye surgeries,

facilities for refraction, referral services
Secondary

• Vision centers 20000:Refraction and prescription of glasses, primary

eye care, school eye screening programme,screening and referral
Primary services.

Proposed structure for vision 2020 : the right to sight

Prevention & control of blindness:
1. Initial assessment.
2. Methods of interventions.
• Primary eye care.
• Secondary eye care.
• Tertiary eye care.
• Specific programmes.
 Trachoma control.
 School eye health services.
 Vit.A prophylaxis
 Occupational eye health services.
3.Long term measures
4.Evaluations.
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• Global Elimination of Blinding Trachoma:
Trachoma still endemic in 46 countries.
There are 146 million active cases of the
disease.
• Almost 6 million people are blind or visually disabled as a
result of trachoma.

• SAFE strategy:
S –Surgery
A‐ Antibiotic use
F‐ Facial cleanliness
E‐ Environment improvement

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CANCER
ABOUT CANCER
• Cancer may be regarded as group of diseases
characterized by an :
• (1)abnormal growth of cells
• (2)ability to invade adjacent cells & even
distant organs
• (3)the eventual death of the affected patient if
the tumour has progressed.
• Cancer can occur at any site or tissue of the
body & may involve any type of cells.
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CAUSES OF CANCER

(1)ENVIROMENTAL FACTORS : responsible for 80 to

90% of all human cancers.
(a)tobacco
(b)alcohol
(c)dietary factors
(d)occupational exposures
(e)viruses
(f)parasites
(g)others
(2)GENETIC FACTORS 40
CANCER PROBLEM WORLDWIDE
 CANCER afflicts all communities worldwide;
 approx. 12.7 million people are diagnosed with
cancer in 2008
 14.1 million cancer cases around the world in
2012
 Lung cancer is the most common cancer
worldwide contributing 13% of the total number
of new cases diagnosed in 2012 while breast
cancer is the second most common & colorectal
cancer is third most common in 2012.
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CANCER PROBLEM IN INDIA
• It is estimated that during the year 2008,
• 9.4 lakhs new cancer cases ; of these 4.3 lakhs
were males & 5.1 lakhs were females.
• Incidence rates 98.5 per one lac population
• Same year 6.3 lac persons died of cancer out of
which 3.21 lac males & 3.12 lacs females
• Mortality rate is 68 per lac population.
• More than 2/3rd of cancer patients are already in
an advanced & incurable stage when diagnosed.
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 CANCER CONTROL
 PRIMARY PREVENTION :
 Control of tobacco & alcohol consumption
 Personal hygiene
 Radiation
 Occupational exposures
 Immunization
 Foods, drugs & cosmetics
 Air pollution
 Treatment of precancerous lesions
 Cancer education

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NATIONAL CANCER CONTROL
PROGRAMME
i. For data base of cancer cases, national
cancer registry programme (ncrp) was
initiated in 1982.
• There are 2 types of registries :
• (a)population based cancer registry
• (b)hospital based cancer registry
• At present 25 population based registry & 6
hospital based registry.
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METHODOLOGY OF CANCER
REGISTRATION
o In developed countries like USA notification of
cancer is compulsory for every hospitals.
o The hospitals in areas with compulsory
notification & the hospitals cancer registries,
abstract the information from the patient
records on a specified proforma & send it to
the registry(passive method). This is known as
HOSPITAL-BASED REGISTRIES.

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o However, where trained staff for abstracting
the records is not available with the individual
hospital, the workers from registry scan
through the patient records from different
hospitals, clarify incomplete or contradictory
information, & abstract data(active method).
o In India, cancer registry is through the active
methodology.
o Known as POPULATION-BASED REGISTRIES

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 GOALS & OBJECTIVES OF NCCP
1. Primary prevention of cancers by health
education.
2. Secondary prevention by early detection &
diagnoses of cancers.
3. Strengthening of existing cancer treatment
facilities, which are inadequate.
4. Palliative care in terminal stage of cancer.

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EXISTING SCHEMES UNDER NCCP
AS ON 1ST JUNE 2008
i. Recognition of NEW REGIONAL CANCER
CENTRES(RCCs)
ii. Strengthening of existing RCC
iii. Development of ONCOLOGY WING
iv. District Cancer Control Programme
v. Decentralized NGO Scheme

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 RECENT NEWS OF CANCER
• By 2025, cancer is estimated to cross 15 lakh in
INDIA, which is 35% higher than the 2014
• Increase in number of cancer cases may be
attributed to larger number of ageing population,
unhealthy lifestyles, use of tobacco, unhealthy
diet & others
• Mortality due to cancer in 2015 is 5,05,428 while
in 2014 it was 4,91,598 acc. to NCRP
• Based on NCRP data, while 1 in 14 women in
India have a chance of developing cancer, 1 in 16
for men.
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 NATIONAL CONTROL
PROGRAMME FOR THE
DIABETES
 Over view of diabetes disease
• DEFINITION:-
• It is a metabolic disease in which there is high blood
sugar levels(more than 160mg/dl) over the
prolonged period.
• Sign& symptoms:-
• Weigh loss
• Polyuria
• Polydipsia
• Polyphagia ect….
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DIABETES..CONTROL PROGRAMME.
This programme is focus on the health
promotion, capacity building including human
resources development, early diagnosis and
management of this disease with integration
with primary health care system

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 objectives
• Prevent & control of diabetes through lifestyle
changes.
• Provide early diagnosis &treatment for the
diabetes.
• Buildup the capacity at various level of health
care that is primary level, secondary level,
tertiary level.
• Train human resource that is doctors, nursing
staff and paramedics to cope with the incresing
burden of diabetes.

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• Establish and develop capacity for palliative &
rehabilitation centers.
• Reduce the risk of gestational diabetes and
reduce the risk of MMR, IMR

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 Strategies
• It include healthy life style through health
education and mass media effort at district ,
state, & country level
• Opportunistic screening of persons above the
age of 30 year.
• Establishment of health centers like PHC, CHC,
district level.
• Strengthening of tertiary level health care
facilities.
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• Long term sustainability of the programme.
• Services delivery will be through existing public
health infrastructure and system.
• The various approaches such as mass media,
community health education, interpersonal
communication will be used for life style changes.
• Increases physical activites .
• Stress management.
• Regular blood sugar testing.

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 scheme
• Urban health check up scheme for the diabetes.

Objectives:-
• To screen urban slum population for the diabetes.
• To create data-base information for the
prevalence of diabetes.
• To sensitize the urban slum population about
healthy life style.
• Blood sugar will be checked for all >_ 30 years
and all pregnant women to all age .
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 References
• Wikipedia

• K.park

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THANK YOU

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