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Training PPT for MOs NPCDCS.pptx
1. National Programme for Prevention & Control
of Cancer, Diabetes, CVDs & Stroke (NPCDCS)
District Surveillance Unit
District NCD Cell, Shivamogga
Training of Medical Officers
on Population based NCD Screening
Role of MO & Support Staff in
Population Based Screening
2. NCD Burden in India
• Currently Leading cause of preventable deaths and disability
• Major NCD’s- CVD such Heart attacks & stroke, DM, Chronic
Respiratory Diseases (COPD and Ashtma) & Cancer.
• About 60% of Premature mortality placing them ahead of
communicable diseases, Maternal, prenatal and Nutritional
conditions (WHO 2014 )
4. Major cause of deaths in India, 1990 and 2016
Source: Health of the Nation’s States - The India State-Level Disease Burden Initiative. New Delhi, India : ICMR, PHFI, and IHME, 2017
5. 9.4
3.2
1.9 1.6 1.4 1.3 1.3
0.6
0
1
2
3
4
5
6
7
8
9
10
High Blood
Pressure
Acute Resp
Infect
Diarrheal
Disease
AIDS Diabetes TB Traffic
Injuries
Malaria
Global
Deaths
per
Year
(
millions
)
World Health Organization
High blood pressure kills nearly
as many people worldwide
each year as all infectious
diseases combined
Source: World Health
Organization 2010
High Blood Pressure: World’s Leading
Killer
6. 0%
20%
40%
60%
80%
100%
Have high
blood
pressure
Aware Treated Controlled
1.4
Bn
650
M
510
M
190
M <14%
Less than 1 in 7 with
hypertension
worldwide have it under
control
Source: Mills KT et al. Circulation. 2016 Aug 9;134(6):441-450.
Most with Hypertension
do not have it under control
9. Objectives of NPCDCS
• Health promotion- Civil society, community based
organizations, media etc
• PBS & Opportunity screening at all levels in the health care
delivery system from Sub centre and above for early
detection of DM, HTN & Common cancers
• Outreach camps
• Prevent and control of Chronic NCDs
• To build capacity at various levels of health care for
prevention, early diagnosis, treatment, rehabilitation,
IEC/BCC & operational research
• To support for diagnosis and cost effective treatment at
primary, secondary and tertiary levels of health care
• To support for development of database of NCD’s through
surveillance system and to monitor NCD morbidity and
mortality and risk factors
10. Health Facility Packages of Services
Sub Centre • Health promotion & counseling ‘Opportunistic’ Screening of
Diabetes using glucometer kits and Blood Pressure measurement.
• Awareness generation of early warning signals of common cancer
Referral of suspected cases to CHC/ nearby health facility
PHC • Health promotion for behavior change and counseling
‘Opportunistic’ Screening of Diabetes using glucometer kits and
Blood Pressure measurement.
• Clinical diagnosis and treatment of NCD’s Identification of early
warning signals of common cancer Referral of suspected cases to
CHC
CHC/FRU • Early diagnosis through laboratory investigations Management of
common NCDs
• Lab Investigations and Diagnostics: Blood sugar, Total Cholesterol
,Lipid Profile, Blood Urea, XR, ECG,USG. ‘Opportunistic’ Screening
of common cancers (Oral, Breast and Cervix) Referral of
complicated cases to District Hospital/higher health care facility
11. Health Facility Packages of services
District Hospital • Diagnosis and management of NCDs (outpatient, inpatient and
intensive Care ) including emergency services particularly for
Myocardial Infarction & Stroke.
• Lab investigations and Diagnostics: Blood sugar, Lipid Profile, KFT, XR,
ECG,USG ECHO, CT Scan, MRI etc
• Referral of complicated cases to higher health care facility .
• ‘Opportunistic’ Screening of NCDs including common cancers(Oral,
Breast and Cervix) Follow up chemotherapy in cancer cases
• Rehabilitation and physiotherapy services
Medical College • Early diagnosis and management of Cancer, Diabetes, CVDs and
other associated illnesses
• Training of health person
Tertiary Cancer
centre
• Outreach activities Comprehensive cancer care including prevention,
early detection, diagnosis, treatment, palliative care and
rehabilitation
• Training of health personnel
12. Expected Outcomes
• The programs and interventions would establish a
comprehensive sustainable system for reducing rapid
rise of NCDs, disability as well as deaths due to NCDs.
• Early detection and timely treatment helps in increase
in cure rate and survival Reduction in exposure to risk
factors, life style changes leading to reduction in NCDs
• Improved quality of life
• Reduction in prevalence of physical disabilities
including blindness and deafness Providing user
friendly health services to the elderly population of the
country
• Reduction in out-of-pocket expenditure
14. Raising awareness on Risk factors of NCDs,
healthy lifestyle, screening.
Address these issues in meetings VHSNC/VHND,
camps etc.
Individual and family counselling for those who
have diagnosed.
Training, need assessment and develop training
plan for all support staff including VHSNC/MAS.
Manage and/or timely referral of cases.
15. Monitor the Staff Nurse / pharmacist /lab
technician for maintenance of records and reports
on screening, treatment, counselling, referral and
follow up and timely submission to higher level.
Each follow up visit should be recorded.
Every Tuesday Geriatric day to be conducted in all
PHC’s.
Ensure proper inventory management (drugs (3
months’ supply of drugs for each patient
diagnosed with DM and HT)
16. Drug Selection Selection of
Drugs based
on following
factors:
• long-
acting
• affordabili
ty
• availability
in good
quality
• evidence
through
drug trials
20. • ASHAs will complete a Community Based Assessment
Checklist (CBAC) for all women and men over 30 years
in their population.
• CBAC captures data related to various risk factors of
NCDs
• A score of below four implies Low risk which does not
mean that the individual is to be exempted from
screening, as NCDs could exist, even in the absence of
risk factors.
• A score of four and above will be referred to screening
camp or nearest health facility for confirmation
25. Role of supporting staff (PHCO/CHO)
• In places where ASHA is not available, PHCO/CHO will do
work assigned to ASHA
• Raising awareness about NCDs and their risk factors
• Review completed CBAC: for cancer symptoms/ epilepsy/
COPD and refers as appropriate
• Identify individuals at risk (CBAC score > 4)
• Screening for NCDs & referring individuals need
confirmation and initiation of treatment plan
• Ensuring availability and maintenance of equipment for
screening
26. Role of PHCO/ CHO in PBS
• Provide follow-up management
• Accompany patients to health facilities/ referral centres:
to guide for consultation and diagnostic processes(where
ASHAs are not available).
• Maintain NCD register: with the demographic details, risk
factors, symptoms, BP/ blood glucose readings,
symptoms requiring investigation for cancers, referral,
treatment follow-up data an complications.
• Maintains NCD register.
• Co-ordinate with the PHC team: MO, Staff nurse,
Laboratory Technician and other staff, in smooth
implementation of the NPCDCS Programme.
27. Role of ASHA in PBS
• Line Listing of all adults above the age of 30 years
• Completing the Community Based Assessment Checklist
• Organizing a screening day- understanding the work-flow
processes
• Undertaking follow up for treatment adherence and
enabling lifestyle changes
• Home Visits, Village Health Nutrition Day (VHND), and
meetings of Village Health Sanitation & Nutrition
Committee (VHSNC) to all adults over 30 years of age
28. Role of ASHA in PBS
Mobilize the community to attend screening
• On fixed date & time of ANMs visit to village and to PHC/SC for Ca
Cervix screening
• 30 people to be screened in a day (12-13 days to screen target
population over the entire year.
• ASHA to help ANM in recording the measurements.
• To ensure VHSNC & MAS members present to support her in
undertaking health promotion activities.
29. Role of ASHA in PBS
• People who are already diagnosed with HTN & DM to be assessed
on monthly basis, not necessarily on screening day.
• Follow up of referred patient by ANM/Mo PHC or escort them to
the health facility for either diagnosis and management .
• Follow up home visits for treatment adherence, enabling lifestyle
changes and referring in case of any complications to MO (PHC).
30. CBAC -Community Based Assessment Checklist
Figure: Community based activities for identification of high risk
persons
32. ASHA PHCO/CHO
Community Level Activity
1. Estimation population to be screened
2. Enumerating adults >30 years in routine
home visits
3. Filling up family health cards
1. Session on NCDs and their risk factors during
VHND/UHND
2. Raising awareness about NCDs , healthy
lifestyle, treatment compliance in regular
home visits
3. Distribution of health promotion material
1. CBAC completion of all > 30 years
2. Creation of individuals health cards
3. Maintenance of Village register/Family folders
4. Assessing risk and mobilization on priority
for screening
5. Identification of population- individuals with
any risk factors, individuals with no risk
factors, known cases of NCDs
1. Supervision of population enumeration
2. Cross verification of 10% of population
1. Identify volunteer in the village or member from
VHSNC
2. Ensure supply of health promotion materials
1. Ensure supply of CBAC form, WC measuring
tape, family card, registers etc.
2. Training of ASHA in CBAC form filling
3. Supportive supervision- joint visit with ASHA in
the community.
33. Role of ANM & ASHA
ASHA PHC0/CHO
Health Facility Level Activity
1. Escort diagnosed patient at SC to PHC
2. Escort all patient of cancer screening from the
community
3. Ensure patient gets adequately investigated and
treated
4. Participate in NCD related meeting/training
held at PHC
1. Lifestyle counselling/BCC for people with
diabetes and Hypertension
2. Counselling non- compliant patients to for
treatment adherence
3. Annual screening of individuals who were not
found to be at risk in CBAC
4. Escort patient to higher centre for investigations
and treatment of cancer from the community
1. Enable attendance of individuals for screening
through motivation, reminders, escort
2. Managing patient flow in coordination with
volunteer
3. Support ANM in taking Anthropometric
measurements. Measurement of BP/RBS, as
required
4. Assist ANM in maintaining records in screening
register
1. Ensure availability of consumable and non-
consumable required for screening
2. Make individual patient NCD card with unique
ID
3. Anthropometry of individuals comes with
CBAC
4. Measures –BP, RBS
5. Record keeping
6. Referral to PHC for investigation and treatment
1. Monthly submission of screening record
2. Procure all consumable /non-consumable for SC
screening
3. Participate in all NCD related meetings.,
Trainings
4. Assist opportunistic training at PHC, if required
1. Provide follow up management for patient
(monthly drug supply, periodic blood pressure
/blood sugar measurement)
2. Referral of cancer at risk patient to PHC/CHC
3. Filling up individuals patient NCD Card
4. Counselling of patient for lifestyle modification
and treatment compliance
35. Follow up visit
• Patients must be informed to come for follow up in the PHC after
one to three month (depending upon drug dispensing policy)
• Before coming for a follow up visit, patients with DM should be
advised to get his/her fasting blood sugar done at the Sub centres.
If possible, HbA1C should also be done from the CHC or District
Hospital.
• During the follow up visit, the patient will return the empty blister
pack and bring the fasting blood sugar report. Weight & BP will be
checked for all patients on every visit.
• Medical officer will review the status of the patient and advise
accordingly.
Editor's Notes
Lets look at the burden in the country first. In 1990, 38% of deaths were due to NCDs and in 2016, it has drastically increased to 62%.
High blood pressure went from being the 4th leading risk factor in 1990 for GBD to the number one risk factor in 2010.
Despite the heavy burden of illness and death from hypertension, many countries have been slow to respond. Just over half with HTN know they have it and just 1 in 7 globally have it under control. These proportions are significantly higher in LMICs. Yet HTN is probably the easiest to treat and effective treatment is available and can be relatively inexpensive.
The ANMs will have a prominent role in implementing the Programme at the level of the sub-centre.
Active enumeration: over 30 years in the families and registration of families through individual health cards placed
within a family health folder. The family and individual member would be allocated a unique
health ID which will help in identification of family members. ASHAs will normally undertake
completion of the health cards. In some urban areas where ASHAs are not currently available and
in states like Tamil Nadu where ASHAs are available only in tribal areas, the ANMs will undertake such enumeration
