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1. ROLE OF PERIPHERAL HEALTH
CENTRES IN NON-COMMUNICABLE
DISEASES
DR. SHAFI-UR-RAHMAN KHAN
DEPT. OF COMMUNITY MEDICINE
K.G.M.U. LUCKNOW

2. INTRODUCTION
• In 2011, out of the 65 million global deaths, 36 million deaths or
63.2% were due to Non-Communicable diseases.
• Major NCDs are Cardiovascular diseases, Diabetes, Cancers and
Chronic respiratory diseases.
• Nearly 80% of NCD deaths occur in low and middle income
countries.
• NCDs will account for nearly 44 million deaths annually by 2020.
• NCDs kill at a younger age in low and middle income countries.
• In India, the estimated deaths due to NCDs in 2008 were 5.3 million.
• The prevalence of Diabetes, Hypertension, Ischemic heart disease
and Stroke in India is 62.47, 159.46, 37.00 and 1.54 respectively per
thousand population.
• There are 28 lakh cases of different types of Cancers in India, with
occurrence of 11 lakh new cases and about 5 lakh deaths annually.

3. NCD is a Medical condition or Disease
• which is not infectious
• with long duration
• relatively slow in progress
• which a person is unaware of the disease unless or
otherwise examined
• a silent killer of people
• usually called “Chronic Diseases”

4. Major Non-Communicable Diseases
• Cardiovascular diseases mainly
Hypertension and Stroke
• Diabetes
• Cancer
• Chronic Respiratory diseases

5. Risk factors of NCDs
Behavioral Risk factors { can be modified }
1. Tobacco use
2. Physical inactivity
3. Unhealthy diet including high intake of Salt, Sugar
and Transfat and low intake of Fruits and
Vegetables
4. Harmful use of Alcohol
5. Stress and household air pollution

6. Biological Risk factors { can be controlled }
1. Overweight / Obesity
2. High Blood Pressure
3. Raised Blood Sugar
4. Raised Total Cholesterol / Lipids
Background Risk factors { cannot be changed }
1. Age
2. Gender
3. Family history
4. Ethnicity
5. Prior Stroke or Heart attack

7. Objectives of NPCDCS
1. Health promotion through behavior change with
involvement of community, civil society, community based
organizations, media etc.
2. Opportunistic screening at all levels in the health care
delivery system.
3. To prevent and control chronic NCDs.
4. To build Capacity at various levels of health care for
Prevention, Early diagnosis and treatment, IEC, Operational
research and Rehabilitation.
5. To support for diagnosis and cost effective treatment at
Primary, Secondary and Tertiary levels of health care.
6. To support for development of database of NCDs through
Surveillance system and to monitor NCD morbidity and
mortality and risk factors.

8. Strategy of NPCDCS
1. Health Promotion.
2. Screening, Diagnosis and Treatment.
3. Establishment or Strengthening of Health
Infrastructure.
4. Human Resource development.
5. Miscellaneous services.
6. Outreach services.
7. Integration with AYUSH.
8. Public Private Partnership.
9. Research and Surveillance.
10. Monitoring and Evaluation.

9. Role of Sub-Centre
1. Health Promotion
- Behavior and life style changes through health
promotion is carried out by frontline health
worker – ANM and Male health worker.
- Various approaches such as Camps, Interpersonal
communication, posters, banners etc. to educate
people at Community/ School/ Workplace
settings.
- Camps may be organized in the village on VHND
when ANM goes to the village for immunization
and other health services.

10. Key messages that need to be
conveyed to the Public include :-
a. Increased intake of healthy foods.
b.Increased physical activity through
sports, exercise etc.
c. Avoidance of Tobacco and Alcohol.
d.Stress management.
e. Warning signs of Cancer etc.

11. 2. Opportunistic Screening
- During the Sterilization/ VHND Camps, ANM/Male
health worker will record history of persons at and
above the age of 30 yrs for Alcohol and Tobacco intake,
physical activity, Blood Sugar, Blood Pressure and BMI.
- For Blood Sugar measurement, glucometer, glucostrips
and lancets will be provided to Health worker.
- ANM or Male health worker will be trained for such
screening.
3. Referral
- ANM or Male health worker will refer the suspected
case of Diabetes and Hypertension to the P.H.C./ C.H.C.
for further diagnosis and management.

12. 4. Data Recording and Reporting
- ANM or Male health worker at Sub-Centre will maintain
data in prescribed format.
- Common register of all the persons [ > 30 yrs ] screened
at Sub-Centre, Sterilization/VHND Camps, Health Melas
or under any other activity.
- Referral card in duplicate, one to be given to the patient
[ the suspected case > 140 mg/dl ] and other to be
retained at the Sub-Centre for future reference and
follow up.
- Follow up register of the confirmed patients for
maintaining record of Blood glucose at regular
intervals, record of availability of basic medicines to the
patient and record of any complications of the patient
related to Diabetes, Hypertension and Cancer.

13. Role of P.H.C.
1. Health Promotion activities
- Educate regarding common risk factors.
- Promote health in different settings [ healthy
workplace, health promoting schools ] to prevent
the emergence and reduce the existing risk
factors in the community.
2. Opportunistic Screening
- Screening using glucometer and Blood pressure
measurement.
- Risk assessment and management through
opportunistic screening

14. 3. Clinical management and Follow up
- Clinical diagnosis, treatment and follow up of common
CVDs including Hypertension and Diabetes.
4. Identification of Early warning signal of
Common Cancer
- To identify early warning signals of common cancer like
Oral Cancer, Breast Cancer and Cervix Cancer.
5. Referral
- Establish an effective referral mechanism { Two way }
with nearest CHC, District hospital, Medical college
and Cancer management institute.

15. 6. Community Involvement
- Motivate and create role models in the community.
- Work closely with other Sectors/Departments for
NCD prevention.
7. Training and Supervision
- To organize training session for different cadre of
health workers for prevention of NCDs.
- Supportive Supervision of the activities undertaken
by paramedical workers.

16. ROLE OF C.H.C.
- Under NPCDCS, each C.H.C. shall establish a free
‘NCD Clinic’ for comprehensive examination of
patients referred from Sub-Centre as well as
reporting directly.
- The Clinic shall run on all working days or at least
thrice a week.
- Following activities will be performed by a C.H.C.
under NPCDCS :-

17. 1. Screening
- Opportunistic Screening of persons above the age
of 30 yrs shall be carried out at C.H.C.
- Such Screening will involve simple history, general
physical examination, calculation of BMI, blood
pressure, blood sugar estimation etc. to identify
those individuals who are at a high risk of
developing Cancer, Diabetes and CVD, warranting
further investigation/action.

18. 2. Prevention and Health Promotion
- Apart from clinical services, C.H.C. shall be
involved in promotion of healthy lifestyle
through health education and counselling to
the patients and their attendants.
- Counsellor shall counsel on the merits of
healthy diet and nutrition, harmful effect of
Tobacco and Alcohol, warning signs of Cancer
etc.

19. Key messages that need to be
conveyed to the Public include :-
a. Increased intake of Healthy foods.
b. Increased physical activity through
sports, exercise etc.
c. Avoidance of Tobacco and Alcohol.
d. Stress management.
e. Warning signs of Cancer.

20. 3. Lab. Investigations and Diagnostics
- Blood sugar, Total cholesterol, Lipid profile, Blood
urea, X-ray, ECG, USG { to be outsourced, if not
available }
4. Diagnosis and Management
- Diagnosis, management, counselling and
rehabilitation related to common CVDs, Diabetes
and Stroke cases will be undertaken at OPD/IPD
level.

21. 5. Referral
- Complicated cases of Diabetes, High Blood Pressure
etc. shall be referred from C.H.C. to the District Hospital
for further investigations and management.
6. Data Recording and Reporting
- “NCD Clinic” at C.H.C. shall maintain individual
diagnosis, treatment and referral records on the patient
chronic disease card with verbal and pictorial advice for
the patient.
- This record shall be send monthly to the District NCD
Cell.

22. 7. Human Resources for C.H.C. NCD Services
- For providing effective comprehensive care at CHC,
following staff are appointed on contract basis by
the state government namely one M.B.B.S. Doctor,
one Staff Nurse and one Counsellor.

23. THANKS