NCD Interventions Under NHM 14.05.2019

1. NCD Interventions Under NHM 14.05.2019

2. NPCDCS In order to prevent and control major NCDs, the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is being implemented with focus on: • Strengthening infrastructure, human resource development, health promotion, early diagnosis, management and referral. • Under the programme, NCD Clinics are being set up at District and CHC levels, to provide services for common NCDs. • In identified districts, Cardiac Care Units (CCU) and Day Care Centers are also being set up for providing facilities for emergency Cardiac Care and Cancer Chemotherapy respectively.

3. NPCDCS Infrastructure 36 543 3084 578 168 168

4. Comparative Position of Infrastructure in past 5 Years is as under:

5. Programme Management under NPCDCS • State Headquarter: State NCD Cell • Manpower: 1 Programme Officer, 1 Programme Coordinator, 1 Finance/Logistic Officer, 1 Data Entry Operator • District Headquarter: District NCD Cell • Manpower: 1 Programme Officer, 1 Programme Coordinator, 1 Finance/Logistic Officer, 1 Data Entry Operator • District NCD clinic: • Manpower: 1 Physician, 2 Nurses, 1 Lab Technician, 1 Physiotherapist, 1 Counselor, 1 Data Entry Operator • Cardiac Care Unit (CCU) in selected districts: • Manpower: 1 trained Cardiologist & 4 Nurses

6. Status: Comparative position of persons attended the NCD Clinics and screened under NPCDCS for last 5 years is as below:

7. Status: Comparative position of Outreach activities (Including Population Based Screening) data: At Camps/ PHCs/Sub-centres for last 5 years is as below:

8. Population-based Prevention, Control, Screening and Management of Diabetes, Hypertension and Common Cancers (Oral, Breast and Cervical) Initiative (PBS): • New initiative - launched as a package under Comprehensive Primary Health Care • Screening is targeted of all persons >30yrs age in community, for common NCDs (DM, HTN, & Oral, Breast & Cervix Cancers ) & NCD risk factors, and refer suspected cases to PHC/CHC • Prevention, control & screening services are being provided through trained frontline workers (ASHA & ANM), and the referral support and continuity of care is ensured though PHC, CHC, District Hospitals and other tertiary care institutions It is being implemented in 219 districts as a part of comprehensive primary health care under National Health Mission (NHM).   • PBS can help in better management of diseases by the way of early stage of detection, follow up, treatment adherence. • It will also generate awareness on the risk factors of NCDs. • The initiative has Linkages with NPCDCS and Tertiary care institutions like SCIs and TCCCs.

10. Workflow • Everyone above 30 years of age is to be covered (about 37%) • Sub Centre/HWC is the nodal unit • Leveraging ASHAs for population enumeration and Community Based Assessment Checklist(CBAC) through home visits • ANM will do CBAC review, supportive supervision and home visits for motivating people for attending the screening • Sub Centre/HWC - Weekly- ANM – BP, RBS, referral and follow up • Oral- Breast- Cervical cancer screening at PHC/CHC/DH level • Medical officers, Nurses, Technicians at PHC/CHC for supportive supervision, confirmation, drugs dispensing and follow up • Nurses and LHVs to serve as mentors and trainers and assist in case of staff shortages • Navigation services by ASHA .

11. Status under PBS: • Training Modules have been developed for training of various categories of health staff viz. Nurses, ANMs, ASHAs and MOs. • Currently, Universal Screening for common NCDs is being rolled out in 24,016 SCs across 219 districts. (as per data shared by states). • 1,55,084 ASHAs, 37,584 ANM/MPWs, 10,135 Staff nurses and 11,024 Medical officers have been trained on PBS of common NCDs. (as reported HWC portal). • NCD Module for the Comprehensive Primary Health Care IT application is in use across 8288 Health care facilities (3256- SHC, 4254 – PHC, 778 UPHC). (as reported on HWC portal). • Screening has been initiated and till 31st December, 2018, more than 1.08 crore persons have been screened under the programme in the States.

12. Population-based NCD Screening ProgramCPHC-NCD Application • Developed in association with Tata Trusts and Dell to capture individual patient-wise data and ensure management. • National level training was conducted in April, 2018, followed by state level training. • It has tablet based application for ANM and web based software for PHC and above facilities. • National level training of trainers for software was conducted in April, 2018, followed by state level training. • 11035 Personnel (Medical Officers/Staff Nurse/ANM/Community Health Worker) have been trained on tablets till 31st March 2019.

13. CPHC-NCD Solution Apps 5 Apps which provide Continuum of Care across facilities and locations : • ANM Tablet App • PHC MO Web Portal • CHC Portal • Administrator’s Portal • Health Officials Dashboard

14. Training Cascade model Training for Population Based Screening (PBS) ASHA, ANM, Nurses and MOs National ToTs Done – being done by states Training of NCD Software Application: National ToTs done Training of Field level functionaries ( ANM, ASHA, MO, Staff Nurse, DEO, DDM) by states Tata Trusts is providing training and implementation Support

15. CPHC- NCD Software usage status

16. CPHC- NCD Software usage status

17. Status of NCD Application Usage ( As on 6th May’19)

18. CPHC-NCD APP: Pan India Cumulative status in lakhs

19. State wise status of CPHC- NCD Application use (As on 6th May’19)

20. State wise status of CPHC- NCD Application (As on 6th May’19)

21. Tablet & Login Status for CPHC- NCD Application (As on 6th May’19) • 10925 ANMs and 691 MOs have Logged in past 30 days and 1,10,690 Tablets are available

22. Tablet & Login Status in GoI CPHC- NCD Application (As on 6th May’19)

23. State Wise Training on CPHC-NCD Application • Trained 12274 personnel in 27 states. • Yet to start trainings in 8 states/UTs (Nagaland, Sikkim, Andaman & Nicobar, Daman & Diu, Dadra & Nagar Haveli, Chandigarh, West Bengal, Lakshadweep)

24. Pradhan Mantri National Dialysis Program (PM-NDP) • National Dialysis Programme was launched during year 2016-17 to support in all district hospitals in a PPP mode under NHM. • Service Provider should provide medical human resource, dialysis machine along with RO water plant infrastructure, dialyzer and consumables. • Payer Government should provide space in District Hospitals, Drugs, Power and water supply and pay for the cost of dialysis for the poor patients • Guidelines of National Dialysis Programme including the Model Request for Proposal (RFP) for PPP were developed and released on 7th April 2016.

25. All States/UTs were requested to incorporate proposals for roll out of National Dialysis Programme in Programme Implementation Plans and approval was provided to all States in 2016-17 and 2017-18 for provision of free dialysis services to poor. • Based on the proposals received from the states, over Rs. 153 Crore was approved in 2016-17; over Rs. 178 Crore in FY 2017-18 and Rs.194 Crore for FY 2018-19.

26. Status under PMNDP • 18 States/UTs- are operating in PPP Mode • NHM Funded (16 States): Andhra Pradesh, Arunachal Pradesh, Delhi, Goa, Gujarat, Jharkhand, Karnataka, Madhya Pradesh, Rajasthan, Telangana, Tripura, Uttar Pradesh, West Bengal, Odisha, Himachal Pradesh, Uttarakhand. • State Funded (2 States): Haryana and Bihar. (In Bihar, currently no patient is getting free dialysis services) • 14 States/UTs- are operating In-house Mode • NHM Funded (10 States): - Jammu & Kashmir, Kerala, Maharashtra, Mizoram, Puducherry, A&;N, Punjab, Daman & Diu, Tamil Nadu, Sikkim. • State Funded (4 States): - Chandigarh, D & N Haveli, Manipur, Lakshadweep. • In 04 States- Meghalaya, Assam, Chhattisgarh and Bihar (Bihar- which is currently under State budget fund) tender is under progress for PPP Mode. • PMNDP has not been implemented by 01 state: Nagaland.

27. Contd… • PMNDP has been implemented in total 32 States /UT in 437 Districts in 757 Centres deploying 4420 machines. • Total 4.17 lakh patient availed dialysis services and 40.57 Lakhs Hemo-dialysis Sessions held- as on 31st March 2019.

28. Way Forward • NPCDCS- • Approved NCD Clinics, Day Care Centers,CCUs to be made functional • Recruitment of contractual staff under NPCDCS • Ensure availability of drugs/consumables in NCD clinics • IEC & Advocacy needs to be strengthened at all levels • Reporting on time • Population-based NCD Screening(PBS)- • Overall screening to be improved • Status to be sent on time

29. Way Forward • Population-based NCD Screening Program CPHC-NCD Application- • Training for Software and Population Based Screening • Tablet Procurement to be completed soon • IT infrastructure to be made ready (2 Desktop/Laptops, Internet facility, Printing) in PHC, CHC and District hospital (PC for MO and Nurse both is recommended) • All the functional HWC to use NCD Application and Medical Officers to start using NCD application so as to bring focus on care continuum • Monitoring of the programme through State and district NCD cells. • PMNDP • Approved dialysis centers to be established. • DVDMS portal to be regularly updated. • Meghalaya, Assam, Chhattisgarh ,Bihar and Nagaland may expedite.

30. THANK YOU

31. NPCDCS-Infrastructure Details

32. NPCDCS-Infrastructure Details

33. National Program for Palliative Care Palliative care is an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illnesses, through the prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. The Ministry of Health and Family Welfare has been making efforts to address the growing need for palliative care in the country. National Program for Palliative Care, launched in 2013, is a part of the National Health Mission with the following activities: • At district level: a) OPD/IPD services b) Referral services c) Home-based palliative care d) Training • At HWC (PHC & SC) level: • a) Identification of patients with palliative care needs • b) Basic nursing procedures • c) Psycho-social & spiritual support • d) Home-based palliative care • e) Referral services • f) Bereavement support • g) Community awareness • Provision of support under NPPC: Rs. 48.4 lakh per district/annum

34. Achievements so far • Till date, 346 districts in 29 states/UTs, have been covered. 2. Standard Protocols & Training manuals on Palliative Care for doctors, nurses & Community Health Workers have been developed 3. Certain amendments were effected in Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985 in 2014, which shall allow: • A single regulation for morphine & other ENDs across the country; • A single license to hold and use Essential Narcotic Drugs; • A single agency – the State Drugs Controller – to issue licenses and monitor it.

35. Way Forward • Enhancement of skilled manpower in palliative care. • Expansion of program in all districts of the country in phased manner. • Operationalization of Palliative Care Units already supported.