This presentation contains in brief about various Non-communicable diseases (NCDs) and International interventions to combat NCDs. It also contains recent updates on current problem statement of common NCDs and updates on National Programme for Prevention and Control of non-Communicable Diseases (NP-NCDs).

1. HARIMU BARGAYARY
POST GRADUATE
RESIDENT
Epidemiology of Non-Communicable
Diseases (NCDs)
with special reference to
National Programme for Prevention and
Control of Non-Communicable Diseases
(NP-NCDs)
1

2. CONTENTS:
1. Introduction​
2. Problem statement
3. Specific Epidemiology of common
NCDs
4. Global strategies to tackle NCDs
5. NP-NCDs
6. ​Summary​
7. Important days observed for NCDs
8. References
2

3. NON-COMMUNICABLE DISEASES
(NCDS)
“It refers to a group of diseases where there are
no known pathogens that cause the disease and
these cannot be transmitted from one person to
another. ”
3
INTRODUCTION

4. It includes –
 Cardiovascular Diseases (CVDs)
 Renal, Nervous and Mental diseases
 Musculo-skeletal conditions
 Chronic non-specific Respiratory diseases
 Permanent results of Accidents, Senility,
Blindness, Cancer, Diabetes, Obesity and
various other metabolic and degenerative
diseases
 Chronic results of Communicable diseases 4

5. COMMON RISK FACTORS
Modifiable
Risk-
factors
Tobacco
use in any
form
Physical
inactivity
Alcohol
abuse
Unhealthy
diet
Stressful
lifestyle
5
Non-Modifiable
Risk-factors
• Genetic makeup
• Race and Ethnicity
• Gender
• Age
• Family history
*** Air pollution -> also considered
as one of the major risk factors for
NCDs.

6. PROBLEM
STATEMENT

7. 7
Global:
Percentage of
Total deaths due
to NCDs (2019).
GLOBAL
SCENARIO:
Total: 74%; Males: 72%; Females:
75%

8. GLOBAL: CHANGING PATTERN OF DISEASE
8

9. INDIAN SCENARIO
9
Cardiovascular
diseases
(CVDs)
Cancers
Chronic
Respiratory
Diseases
(CRDs)
Diabetes
Other NCDs
Communicable
, maternal,
perinatal and
nutritional
conditions
Injuries
Proportional mortality
NCDs are estimated to account
for
of all death

10. 10
Figure: Percentage of total
deaths due to NCDs 2019: Total- 66%, Males- 67%, Females- 65%

11. 2019 REPORT ON NCD
Indicators Global India Uttar Pradesh Meerut
Percentage of
total deaths
due to NCDs
74% 66% - -
Percentage of
NCD deaths
occurring
under 70 years
42% 54% - -
Probability of
premature
mortality from
NCDs
18% 22% - -
NCD age-
standardized
death rate
479 per
100000
population
558 per
100000
population
- -
11

12. % share of DALYs to
total Disease Burden
(GBD 2019)
Uttar Pradesh India
% DALY accountable for
NCDs
47.9 55
% DALY accountable for
Injuries
11.6 12
12

13. 13
Top 15 causes of DALY 1990-2019

14. EPIDEMIOLOGY
Of specific common NCDs

15. CARDIOVASCULAR
DISEASES (CVD)
Comprises of a group of
diseases of the heart and the
vascular system.
Includes:
 Coronary / Ischemic Heart
Disease
 Hypertension
 Rheumatic Heart Disease
 Congenital Heart Disease
 Valvular Heart Disease
 Peripheral Vascular Disease, etc. 15

16. 16
China
India
Russian
Federation
United
States of
America
Indonesia
0 1,000,000 2,000,000 3,000,000
4,000,000 Number of Deaths
Countries with the Highest Number of CVD Deaths
2010
2019

17. 17
Figure: Proportion of CVD deaths by Cause: Global(2019).

18. 18
CVD burden attributable to modifiable risk factors.

19. SIGNS AND SYMPTOMS: - Chest pain
- Shortness of breath
- Dyspnoea
- Nausea and vomiting
- Fatigue
CORONARY HEART
DISEASE
 a.k.a Ischaemic Heart Disease
 Impairment of heart function due to
inadequate blood flow to the heart compared
to its needs.
 Caused by obstructive changes in the
coronary circulation to the heart.
19

20. 20
Figure: Six-year risk of developing Myocardial infarction at various levels of Systolic
Blood Pressure (SBP) and Serum Cholesterol in smokers and non-smokers.
Curve a -> Risk in the absence of smoking and elevated serum
cholesterol
Curve b -> Risk in smokers
Curve c -> Risk with elevated serum cholesterol
Curve d -> Risk with smoking and elevated serum cholesterol

21. PREVENTION OF CHD
Population strategy High risk strategy Secondary prevention
1. Dietary modification
2. Avoid smoking
3. Regular physical
activity
4. Weight control
5. Control of HTN and
DM
1. Identifying risk
2. Specific advice
1. Drug trials
2. Coronary surgery
3. Use of pace-maker,
etc.
21

22. STROKE
• WHO defined stroke as ‘rapidly developed clinical signs of
focal (or global) disturbance of cerebral function, lasting >
24 hours or leading to death, with no apparent cause other
than of vascular origin’.
• Transient ischemic attack (TIA): ‘a transient episode of
neurological dysfunction caused by focal brain, spinal cord
22

23. Presenting features of Stroke Presenting features of TIA
● Sudden numbness or weakness in the
face, arm, or leg, especially on one
side of the body
● Sudden confusion, trouble speaking, or
difficulty understanding speech
● Sudden trouble seeing in one or both
eyes
● Sudden trouble walking, dizziness, loss
of balance, or lack of coordination
● Impairment or loss of consciousness
● Transient weakness, numbness or
paralysis of face, arm, or leg, typically
on one side of your body
● Transient slurred speech or difficulty
understanding others
● Transient blindness in one or both eyes
or double vision
● Curtain like appearance in front of eye
(Amaurosis fugax)
● Transient dizziness or loss of balance
or coordination
23

24. 24

25. PROBLEM STATEMENT
⮚ As per GBD 2019, there were 12·2 million incident strokes and 101 million prevalent
strokes, 143 million DALYs due to stroke, and 6·55 million deaths from stroke.
⮚ Globally, stroke was the third-leading cause of death and disability combined in
2019.
⮚ In India, it is estimated that incidence of stroke varies from 116 to 163 per 100,000
population. According to recent reports by ICMR “India: Health of the Nation’s
States”, stroke was 4th leading cause of death and 5th Leading cause of Disability
Adjusted Life Years (DALY) in 2016.
25

26. 26

27. HYPERTENSION
Classification Systolic
blood
pressure
(mmHg)
Diastolic blood
pressure
(mmHg)
Normal < 120 AND < 80
Prehypertension 120 – 139 OR 80 – 89
Stage 1 HTN 140 – 159 OR 90 – 99
Stage 2 HTN >= 160 OR >= 100 27
Table: JNC 8 Classification of blood pressure in
adults.
Abnormally elevated blood
pressure

28. 28
90-95% 5-10%

29. PROBLEM STATEMENT
GLOBAL
 The global prevalence of HTN was estimated to be 1.13 billion killing 10
million people each year.
 The overall prevalence of HTN in adults is around 30-40%.
 It is estimated that the number of people with HTN will increase by 15-
20% by year 2025.
 The largest number of SBP related death per year are due to IHD
(4.9million), Haemorrhagic stroke (2 million) and Ischaemic stroke
(1.5million). 29

30. NFHS 5 REPORT
Indicators INDIA UTTAR
PRADESH
MEERUT
Male Female Male Female Male Femal
e
Mildly elevated blood pressure
(Systolic 140-159 mm of Hg
and/or Diastolic 90-99 mm of Hg)
(%)
15.7 12.4 15.2 11.5 17.4 12.6
Moderately or severely elevated
blood pressure (Systolic ≥160 mm
of Hg and/or Diastolic ≥100 mm
of Hg) (%)
5.7 5.2 5.2 4.9 7.6 5.5
Elevated blood pressure (Systolic
≥140 mm of Hg and/or Diastolic
≥90 mm of Hg) or taking medicine
24.0 21.3 21.7 18.4 26.2 20.0
30

31. RULE OF HALVES
31

32. PREVENTION OF HTN
Primary Secondary
Population strategy High risk strategy 1. Early case detection
2. Treatment
1. Dietary modification
2. Weight control
3. Regular physical
activity
4. Behavioural changes
5. Health education
6. Self-care
1. Detection of high risk
individuals, and
2. Tracking of Blood
pressure
32

33. 33
Lifestyle modifications to manage HTN:

34. DIABETES MELLITUS
According to both World Health Organisation (WHO) & American Diabetic
Association (ADA):-
“ Diabetes is a group of metabolic disorders characterized by hyperglycemia
resulting from defects in insulin secretion, insulin action or both.”
34
WHO classification:
1. Diabetes mellitus (DM)
• Type 1 or insulin - dependent DM
• Type 2 or non insulin - dependent
DM
• Malnutrition related DM
• Other types (secondary to pancreatic,
hormonal, drug-induced, genetic and
other abnormalities)
2. Impaired glucose tolerance (IGT)
3. Gestational diabetes mellitus (GDM)

35. AMERICAN DIABETES ASSOCIATION (2019)
CLASSIFICATION:
35

36. ESTIMATED NUMBER OF ADULTS (20-79) SUFFERING
FROM DIABETES BY REGION IN 2017.
36

37. 37
Projected Global prevalence of
DM

38. PROBLEM STATEMENT - INDIA 38

39. NFHS-5 REPORT
Indicators INDIA UTTAR PRADESH MEERUT
Female Male Female Male Femal
e
Male
Blood sugar level -
high (141-160 mg/dl)
(%)
6.1 7.3 4.7 5.8 5.8 7.3
Blood sugar level -
very high (>160 mg/dl)
(%)
6.3 7.2 4.5 5.0 7.8 7.9
Blood sugar level -
high or very high (>140
mg/dl) or taking
medicine to control
13.5 15.6 10.0 11.6 14.4 16.0
39

40. SYMPTOMS OF T2DM
40

41. 41
Tertiary prevention
•3 months HbA1C monitoring
•6 months KFT monitoring
•Yearly ocular checkup
•Reflex monitoring
•Corrective surgeries
Primordial prevention
•Regular exercise
•Weight control
•Avoidance of refined sugar
Primary prevention
•Regular RBS monitoring
•3 months HbA1c monitoring
•Regular physical exercise
•Weight control
•Avoidance of trans-fat
•Prudent diet
•Regular fruit and vegetable consumption
•Stop smoking and alcohol consumption
Secondary prevention
•Oral GTT
•RBS monitoring
•Urine strip sugar monitoring
•Exercise and dietary modification
•Adhere to medication
PREVENTIVE MEASURES

42. OBESITY
DEFINITION:
Obesity may be defined as an abnormal growth of the adipose tissue due
to an enlargement of fat cell size (hypertrophic obesity) or an increase in
fat cell number (hyperplastic obesity) or a combination of both.
Overweight is usually due to obesity but can arise from other causes such
as abnormal muscle development or fluid retention.
42

43. BODY MASS INDEX (BMI)
WEIGHT (Kg)
HEIGHT2 (m2)
BMI =
Classification BMI (kg/m2) Risk of co-morbidities
Underweight < 18.50 Low (but risk of other
clinical problems
increased)
Normal range 18.50 – 24.99 Average
Overweight: > 25.00
Pre-obese 25.00-29.99 Increased
Obese class I 30.00-34.99 Moderate
Obese class II 35.00-39.99 Severe
Obese class III > 40.00 Very Severe
Table - WHO classification of Overweight and Obesity (acc. to BMI) in
adults:
43

44. Table – WHO BMI classification for Asian population:-
Nutritional status BMI (kg/m2)
Underweight < 18.5
Normal range 18.5 – 22.9
Overweight 23 – 24.9
Obese I 25 – 29.9
Obese II > 30
44

45. OTHER INDICATORS OF OBESITY
 Body weight
 Skinfold thickness
 Waist circumference & Waist : Hip Ratio
45
 Brocca Index = Height (cm) minus 100
 Ponderal index =
 Lorentz’s formula = Ht (cm) – 100 / 2 (women) or 4 (men)
 Corpulence Index = Actual Weight / Desirable Weight
Height (cm) / Cube root of body weight (kg)

46. PROBLEM
STATEMENT
46
WORLD:-
• 5th leading risk of global deaths.
• In 2016, > 1.9 billion adults (>18yrs) were overweight.
• In 2019, > 38.2 million children (< 5yrs) were
overweight/obese.
• In developing countries, nearly 30 million children are
overweight.
• In developed countries, 10 million children are overweight.
• Atleast, 3.4 million adults die each year as a result of
overweight/obesity.
• It also attribute to 44% of diabetes burden, 23% of
ischaemic heart disease burden and 7-14% of certain
cancer burdens.

47. 47

48. PERCENTAGE OF OVERWEIGHT IN UTTAR PRADESH.
1.5%
12.5%
16.5%
3.1%
18.5%
21.3%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
CHILDREN MEN WOMEN
2015-16
2020-21
48
Source: NFHS-4 (2015-16) and NFHS-5 (2020-21) data.

49. PREVENTIVE MEASURES
(OBESITY)
49
Primary prevention
• Regular physical exercise
• Limiting screen time
• Choosing healthier foods
• Limiting unhealthy foods
Secondary prevention
 Increasing physical activity
 Dietary changes
 BMI screening
Tertiary prevention
 Diet therapy
 Exercise
 Behavioural modification
 Pharmacological treatment
 Surgical procedures

50. CANCER
Cancer includes a wide variety of diseases that may arise at any
part of the human body with certain set of common characteristics,
such as:
(i) uncontrollable division and growth of abnormal cells,
(ii) lack of cell differentiation, and
(iii) ability to spread to both adjacent and distant organs
(metastasis). 50

51. DISTRIBUTION OF CASES AND DEATHS BY WORLD AREA IN 2020
51

52. PREDICTED CANCER INCIDENCE IN THE YEAR 2040
52

53. DISTRIBUTION OF CASES AND DEATHS FOR THE TOP 10 MOST
COMMON CANCERS IN 2020 FOR BOTH SEXES
53

54. MALES
54
FEMALES

55. CANCER – PROBLEM STATEMENT IN INDIA 2020
Males Females Both sexes
Population 717100976 662903415 1380004378
No. of new cancer cases 646030 678383 1324413
Age standardized incidence rate (world) 95.7 99.3 97.1
Risk of developing cancer before the
age of 75 yrs. (%)
10.4 10.5 10.4
No. of cancer deaths 438297 413381 851678
Age standardized mortality rate (world) 65.4 61.0 63.1
Risk of dying from cancer before the age
of 75 yrs. (%)
7.4 6.7 7.1
5 yrs. Prevalent cases 1208835 1511416 2720251
Top 5 most frequent cancers excluding
non-melanoma skin cancer (ranked by
cases)
Lip, oral cavity,
lung, stomach,
colorectum,
oesophagus
Breast,
cervix uteri,
ovary, lip,
oral cavity,
Breast, lip,
oral cavity,
cervix uteri,
lung,
55

56. RISK FACTORS ASSOCIATED WITH DIFFERENT CANCERS
56
Risk factors Types of cancer associated
Tobacco consumption (both smoking and
smokeless)
Cancers of lungs, lips, oral cavity, larynx,
pharynx, esophagus, etc.
Excessive alcohol consumption Cancers of esophagus, liver, colon, kidney,
pancreas, etc.
Dietary factors
Red meat consumption - Colorectal cancer; Smoked fish - Stomach cancer; Lack of
dietary fiber - Colon cancer; High saturated fat diet - Breast cancer; etc.
Food contaminants
Aflatoxins - Hepatocellular carcinoma; Organochlorines - Pancreatic cancer, Lymphoma
and Leukemia, etc.
Occupational chemical exposures
Aniline - Bladder cancer; Coal tar - Skin cancer; Nickel, Chromium, Asbestos - Lung
cancer; Benzol - Leukemia

57. Risk factors Types of cancer associated
Occupational radiation exposures
Ionizing radiation - Leukemia, Breast and Thyroid cancers; UV radiation - Skin cancers
Reproductive and Hormonal factors
Female sex hormones, menopause, Use
of OCPs, Hormone replacement therapy
Endometrial, ovarian and breast cancers
Environmental pollution Lung cancer, leukemias, lymphomas, etc.
Infectious agents
Hepatitis B and C viruses - Hepatocellular carcinoma, Human papilloma virus - Cancer
cervix; Epstein-Barr virus - Burkitt’s lymphoma, Nasopharyngeal carcinoma; Human
immunodeficiency virus - Kaposi sarcoma; H. pylori bacteria - Stomach cancer; Chronic
liver fluke infestation - Liver cancer
57
RISK FACTORS ASSOCIATED WITH DIFFERENT CANCERS
Contd…

58. CANCER CONTROL
PRIMARY PREVENTION SECONDARY PREVENTION
1. Control of Tobacco and Alcohol consumption
2. Personal hygiene
3. Reduce exposure to Radiation
4. Reduce Occupational exposures
5. Immunization
6. Control of Air Pollution
7. Treatment of Pre-cancerous lesions
8. Appropriate legislations
9. Cancer education
1. Cancer registration
2. Early detection of cases
3. Treatment
58

59. SCREENING METHODS
FOR SOME COMMON CANCERS
Screening for - Methods
Cancer cervix Pap smear test
Breast cancer • Breast Self-examination
• Mammography
Lung cancer • Chest radiography
• Sputum cytology
59

60. CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
GOLD COPD Report 2023 (definition):-
COPD is a heterogeneous lung condition characterized by:
A. Symptoms: Dyspnea cough and sputum production
B. Airway abnormality: (Bronchitis, bronchiolitis) or parenchymal
abnormality: (Emphysema, small airway disease) causing persistent, mostly
progressive, airflow obstruction.
C. Confirmation of disease: It is often determined by spirometry (FEV1/FVC
<0.7 post-bronchodilation), which is treatable but is not fully reversible.
60

61. PROBLEM STATEMENT
 COPD is the third leading cause of death worldwide, resulting in 3.23 million
deaths in 2019.
 It is estimated that increased prevalence of smoking in LMICs coupled with elderly
populations in high-income countries will result in around 5.4 million annual deaths
from COPD and related conditions by 2060.
Indian Scenario
 11% annual deaths in India are attributable to COPD and its related conditions.
 The contribution to DALY is over 6.4% in the year 2016 which increased from 4.5%
in 1990. 61

62. 62

63. PREVENTION (COPD)
63
SECONDARY AND TERTIARY PREVENTION:-
1. EARLY DIAGNOSIS IS DONE BY :- PFT, CXR, ABG
ANALYSIS, ALPHA-1-ANTI-TRYPSIN .
2. SPECIFIC TREATMENT INCLUDES :-
BRONCHODILATORS, IV. AND INHALATIONAL STEROIDS,
THEOPHYLLINS.
3. PULMONARY REHABILITATION PROGRAME.
4. OXYGEN THERAPY AT HOME
5. STEAM INHALATION.
6. REGULAR EXPERT COUNSELLING

64. Global
Strategies
to Tackle
NCDs
64

65. KEY GLOBAL MILESTONES
IN
NCD CONTROL
65
2000 2003 2008 2010 2011
Global
strategy for
Prevention
and Control of
NCDs
WHO
Framework
Convention on
Tobacco
Control
Action plan on
the Global
Strategy for
the Prevention
and Control of
NCDs
2008-2013
First WHO
Global status
report on
NCDs
UN Political
declaration on
Prevention
and Control of
NCDs

66. KEY GLOBAL MILESTONES
IN
NCD CONTROL
66
2013 2014 2015
WHO global
NCD action
plan 2013-
2020,
including 9
global targets
and 25
UN General
Assembly adopted
Outcomes
document on
NCDs with
National targets
for 2025
NCDs are
made part of
the new SDG
Target 3.4.
Contd…
2012
WHO sets a
landmark “25% by
2025” target to
reduce premature
deaths from non-
communicable
diseases by 25% by

67. 67

68. 68

69. WHO STEPwise
Approach
69
- Survey methodology developed by WHO known as “the STEPS Non-
communicable Disease Risk Factors Survey”.
- The STEPS instrument is comprised of three different levels or "steps" of risk
factor assessment:
 Step 1 (questionnaire),
 Step 2 (physical measures) and
 Step 3 (biochemical measures).

70. NATIONAL PROGRAMME
FOR PREVENTION AND
CONTROL OF
NON-COMMUNICABLE
DISEASES
70

71. NATIONAL PROGRAMME FOR PREVENTION AND
CONTROL OF NON-COMMUNICABLE DISEASES
15
Earlier known as
NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER,
DIABETES, CARDIOVASCULAR DISEASES AND STROKE (NPCDCS)
(NP-NCDs)
 It was first launched in the year 2010 as
NPCDCS.
 Renamed to NP-NCDs on 5th May, 2023.

72. EVOLUTION OF NP-NCD
72
2010 2013-2014 2016 2023
 NPCDCS
launched in
100 districts
of 21 states
Scaled up in a
phased manner to
cover all districts of
the country
Subsumed under
NHM
Initiated Population
based screening of
common NCDs as
part of
Comprehensive
Primary Health
care.
NPCDCS
renamed as NP-
NCDs
Inclusion of
COPD, CKD,
NAFLD & STEMI

73. 73

74. OBJECTIVES
1. Health promotion through behaviour change.
2. Screening, early diagnosis, management, referral
and follow-up
3. Build capacity of health-care providers
4. Strengthen supply chain management
5. Monitoring, supervision and evaluation of
programme
6. To co-ordinate and collaborate with other
programmes, departments/ministries, civil societies. 74

75. ORGANIZATIONAL STRUCTURE OF NP-NCD
75
NATIONAL NCD DIVISION
• Headed by Joint
Secretary
(NCD), MoHFW
STATE NCD DIVISION
• Headed by
Mission Director
(NHM)
DISTRICT NCD DIVISION
• District Nodal
Officer / District
Programme Officer
– NCD (DNO /
DPO-NCD)

76. FUNCTIONS UNDER DIFFERENT ORGANIZATIONS
National NCD Division State NCD Division District NCD Division
 Nodal agency
 Implement National Multi-
sectoral Action Plan
 Develop Technical and
Operational Guidelines,
SOP, Treatment protocols,
Training modules, Quality
benchmark, Monitoring and
Reporting systems and
tools, IEC materials.
 Monitoring & Joint
Supportive Supervision
Mission visit to the States/UTs
 Release of Funds as per State
PIP
 Capacity building
 Integration with other National
Health Programmes
 State Action Plan
 Implement National Multi-
sectoral Action Plan
 Ensure presence of Human
Resources
 Maintain District-wise
epidemiological profile
 Ensure regular supply
chain
 Monitoring & designing IEC
materials
 Preparation of State PIP.
 Release of funds to districts.
 Submission of state
expenditure and utilization
certificate
 Organize state & district
level capacity building
training
 District Action Plan
 Ensure presence of Human
Resources
 Maintain District epidemiological
profile
 Ensure regular supply chain
 Monitoring & preparing media
plan
 Preparation of District PIP
 Submission of expenditure and
utilization certificate
 Organize capacity building
training at all levels of
human resources
 Co-ordinate with other National
& State Health Programmes
76

77. STRATEGIES
o Health promotion
o Screening, early diagnosis, management, referral and
follow-up of common NCDs
o Capacity building
o Evidence based standard treatment protocols
o Uninterrupted drug and logistics supply
o Task sharing and people-centered care
o Information system for data entry, longitudinal patient
records
o Monitoring, supervision, evaluation and surveillance
including technology enabled interventions
o Multi-sectoral coordination and linkages
o Implementation research and generation of evidences
77

78. HUMAN RESOURCES
Health Facility Human Resources
Community level ASHA
Sub-centre / SC-
HWC
CHO; MPW-Female/ANM; MPW-Male
PHC/ PHC-HWC/
UPHC-HWC
MO (MBBS); MPW-Female/ANM; Staff Nurse; Lab
Technician; Pharmacist
CHC/ UCHC Physician/ Gen. Medicine (MD); MO (MBBS);
Dentist; Staff Nurse; Cousellor; Dietician;
Physiotherapist; Lab Technician; ECG/ EEG
Technician; Pharmacist
SDH/ District
Hospital
Physician/ Gen. Medicine (MD); MO (MBBS); Dentist;
Staff Nurse; Cousellor; Dietician; Physiotherapist; Lab
78

79. TRAINING AND
CAPACITY BUILDING
79
State ToT workshops
for District level
Nodal officers
District Level
Training
Block Level Training

80. 1. District NCD Programme Officers (DNPOs)
2. Medical Officers (MOs)
3. Community Health Officers (CHOs)
4. Data managers
5. Frontline health workers and their
supervisors
80
Health-care personnel who require
training:-

81. MONITORING, SUPERVISION AND EVALUATION
4 components:
1. Programme monitoring: Data collection, performance
management and evaluation
cycle
2. Evaluation: Use of data for decision making, rapid
assessment of
program effectiveness and impact
3. Learning: Documentation, Reporting and Dissemination of
81

82. DATA FLOW MECHANISM FOR OPPORTUNISTIC SCREENING
82

83. POPULATION BASED SCREENING
Data from PBS comes from 3 sources:
1. National NCD Portal – suite of 6 applications:
83

84. POPULATION BASED SCREENING
2. Clinical Decision Support System (CDSS) Integrated
Patient Pathway:
84

85. POPULATION BASED SCREENING
Contd…
The CDSS Integrated Patient Pathway
- was developed through the Integrated Tracking, Referral, Electronic
Decision Support and Care Coordination (I-TREC) initiative with AIIMS and its
partner institutions.
***With the joint efforts of MoHFW, Dell Technologies, Tata Trust and I-TREC
team, the CDSS has been fully integrated with the current National NCD
Portal.
85

86. POPULATION BASED SCREENING
Contd…
3. AB-HWC Portal
- This portal provides with the following data state-wise:
1. Proposed, Progressive and Operational HWCs
2. Human Resources
3. Training
4. Medicines and Diagnostics
5. Service deliveries such as total footfalls, yoga/wellness
sessions conducted, persons screened for HTN, DM and Cancers (Oral, Breast
and Cervical) and the persons received treatment for HTN and DM
86

87. INDICATORS FOR MONITORING AND EVALUATION
Indicators State/District level District/Block level Data source Frequency
INPUT
indicators
Infrastructure Status of State/ District
NCD division
Status of District/
CHC NCD Clinics
Monthly reporting
forms
Quarterly
Human
resources
- Approved HR - Sanctioned / Filled
post report
Half Yearly
PROCES
S
indicators
Infrastructure Saturation of having
- Standard Rx. Protocols for HTN & DM
- NCD clinics
- Chemotherapy, COPD, STEMI, Stroke,
Hemodialysis services
Monthly reporting
forms
Monthly,
Quarterly,
Annually
Training % of Programme officers/ MOs/ SNs/ CHOs/
ANM/ MPW/ ASHA trained for NP-NCD
Training report Quarterly
Advocacy and
Communication
No. of meetings conducted and IEC activities Meeting minutes &
Published reports
Quarterly,
Annually
IT system
usage
% of health facilities reporting through IT
system
National NCD
Portal / State
owned IT system
Monthly,
Quarterly,
Annually
% of active MOs in
last 30 days
87

88. INDICATORS FOR MONITORING AND EVALUATION
Indicators National level State/District/Block level Data
source
Frequency
OUTPUT
indicators
Enrolment &
ABHA-ID
creations
- Saturation of enrolment of all eligible population > 30
years on National NCD portal
- Saturation of creating ABHA-ID of all enrolled
population
National
NCD portal
Monthly,
Quarterly,
Annually
Screening - Saturation screening of all eligible
population
- % of eligible population diagnosed
for common NCDs
- % of eligible population put on
standard of care (LSM) for common
NCDs
- % of eligible population diagnosed
with COPD, Asthma, Stroke, STEMI,
NAFLD, CKD
- % of eligible population who initiated
Rx. for the above.
Monthly
reporting
forms /
National
NCD Portal
Monthly,
Quarterly,
Annually
Outcome &
Incidence
- Reduced
incidence
of HTN &
- % of patients on control and cohort
reporting of HTN & DM
- % of individuals with controlled HTN
National
NCD Portal
Monthly,
Quarterly,
Annually 88

89. 89

90. 90

91. 91
District Meerut – updated report in NCD portal

92. 92

93. 93

94.  National Mental Health Programme(NMHP)
 National Programme for Control of Blindness and
Visual Impairment (NPCB&VI)
 National Programme for Prevention and Control of
Deafness (NPPCD)
 National Programme for Prevention and Control of
Fluorosis (NPPCF)
 National Programme for Health Care of the Elderly
(NPHCE)
94
Health
Programmes
Related
to NCDs:

95.  National Programme for Tobacco Control and
Drug Addiction Treatment (NPTCDAT)
 National Oral Health Programme (NOHP)
 National Programme for Prevention and
Management of Trauma and Burn Injuries
(NPPMTBI)
 National Organ Transplant Program (NOTP)
 National Programme for Palliative care (NPPC)
 National Iodine Deficiency Disorders Control
95
Contd…
Health
Programmes
Related
to NCDs:

96. SUMMARY:
96
•Noncommunicable diseases (NCDs) kill 41 million people each year, equivalent
to 74% of all deaths globally.
•Each year, 17 million people die from a NCD before age 70.
•Cardiovascular diseases account for most NCD deaths, or 17.9 million people
annually, followed by cancers (9.3 million), chronic respiratory diseases (4.1
million), and diabetes (2.0 million including kidney disease deaths caused by
diabetes).
•These four groups of diseases account for over 80% of all premature NCD
deaths.
•Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets
all increase the risk of dying from an NCD.
•Detection, screening and treatment of NCDs, as well as palliative care, are key
components of the response to NCDs.

97. IMPORTANT DAYS OBSERVED FOR NCDS
Date Days
4th February World Cancer Day
15th February International Childhood Cancer Day
1st – 30th March Colorectal Cancer Awareness Month
4th March World Obesity Day
20th March World Oral Health Day
17th May World Hypertension Day
31st May World No Tobacco Day
29th September World Heart Day
1st – 31st October Breast Cancer Awareness Month
1st October International Day for the Elderly
10th October World Mental Health Day
29th October World Stroke Day
1st – 30th November Lung Cancer Awareness Month
14th November World Diabetes Day
15th November World COPD Day 97

98. REFERENCES
1. Park’s Textbook of PREVENTIVE AND
SOCIAL MEDICINE – K. Park; 27th
edition
2. IAPSM’s TEXTBOOK OF COMMUNITY
MEDICINE – AM Kadri; 2nd edition
3. NCD Data Portal of WHO;
https://ncdportal.org/;
https://ncdportal.org/CountryProfile/GH
E110/IND
4. https://ncd.nhp.gov.in/ ; National NCD
Portal - India
5. Operational Guidelines of National
Programme for Prevention and Control
of Non-Communicable Diseases (2023-
2030) pdf.
les/NFHS-5_Phase-II_0.pdf
7. Global Cancer Statistics 2020:
GLOBOCAN Estimates of Incidence and
Mortality Worldwide for 36 Cancers in
185 Countries; International Agency for
Research on Cancer/World Health
Organization.
https://cacancerjournal.com
8. 356-india-fact-sheets; India; Source:
www.who.int; IARC, GLOBOCAN 2020.
9. https://www.who.int/teams/noncommuni
cable-diseases/surveillance/systems-
tools/steps/instrument
10.https://google.com

99. THANK YOU