National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS): A Community Health Nursing Perspective
1. Introduction
Non-Communicable Diseases (NCDs) have emerged as the leading cause of morbidity and mortality globally, with a disproportionate burden on low and middle-income countries like India. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was initiated by the Government of India to address this growing epidemic through a comprehensive approach that focuses on prevention, early detection, and management of these conditions.
For community health nurses, understanding the NPCDCS framework is vital as they serve as frontline healthcare providers, particularly in rural and underserved areas. This program integrates NCD interventions within the National Health Mission (NHM) framework to optimize resources and provide seamless services to patients while ensuring the long-term sustainability of these interventions.
Key Facts
- NCDs account for approximately 63% of all deaths globally
- In India, NCDs are responsible for 60% of all deaths
- Cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes are the four major NCDs targeted under NPCDCS
- The economic burden of NCDs in India is estimated to be $4.58 trillion by 2030
2. History and Background of NPCDCS
The NPCDCS program evolved from earlier initiatives focused on specific non-communicable diseases. The journey began with the National Cancer Control Programme (NCCP) in 1975, followed by the National Diabetes Control Programme in 1987. Recognizing the need for an integrated approach to tackle multiple NCDs, the government launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2010.
Initially, NPCDCS was implemented as a pilot program in 100 districts across 21 states during the 11th Five Year Plan. Following its success and the growing burden of NCDs, the program was expanded nationwide during the 12th Five Year Plan period (2012-2017). Currently, NPCDCS is being implemented in all districts across India.
In 2022, the program was renamed as the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), while retaining the core components and strategies of NPCDCS. This rebranding reflects a more comprehensive approach to addressing all NCDs rather than focusing only on specific conditions.
| Year | Milestone |
|---|---|
| 1975 | Launch of National Cancer Control Programme (NCCP) |
| 1987 | Initiation of National Diabetes Control Programme |
| 2010 | Launch of NPCDCS in 100 districts across 21 states |
| 2013 | Revised operational guidelines released for NPCDCS |
| 2015-16 | Expansion of NPCDCS to all districts |
| 2022 | Rebranding as National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) |
3. Objectives of NPCDCS
The NPCDCS program has well-defined objectives aimed at addressing the growing burden of non-communicable diseases in India. These objectives guide the implementation strategies at various levels of the healthcare system.
- Health promotion through behavior change involving communities, civil society, community-based organizations, and media
- Opportunistic screening at all levels of the healthcare delivery system from sub-center and above for early detection of diabetes, hypertension, and common cancers
- Early diagnosis and treatment of non-communicable diseases including cancer, diabetes, cardiovascular diseases, and stroke
- Capacity building of healthcare providers for prevention, early detection, and management of NCDs
- Development of tertiary care facilities for treatment of cancer and cardiovascular diseases
- Rehabilitation and palliative care for chronic, debilitating, and terminal conditions
- Robust surveillance system for monitoring NCD trends and risk factors
Mnemonic: “PRECISE”
For remembering the key objectives of NPCDCS:
- Promotion of healthy lifestyles
- Robust screening and early detection
- Effective management of diagnosed cases
- Capacity building of health workforce
- Integration with existing health systems
- Surveillance and monitoring
- Establishment of specialized care facilities
4. Organizational Structure of NPCDCS
The NPCDCS program follows a multi-tiered organizational structure that facilitates implementation at national, state, district, and community levels. This hierarchical structure ensures coordinated efforts and oversight while allowing for adaptations based on local needs and resources.
National Level Structure
- National NCD Cell: Located within the Ministry of Health and Family Welfare, it provides overall policy direction, technical support, and funding.
- National Programme Coordination Committee (NPCC): Reviews program implementation and provides guidance.
- Technical Resource Groups: Offer specialized guidance for specific components of the program.
State Level Structure
- State NCD Cell: Responsible for program planning, implementation, monitoring, and evaluation within the state.
- State Program Officer: Coordinates program activities and liaises with the national cell and district units.
District Level Structure
- District NCD Cell: Focal point for program implementation at the district level.
- District NCD Clinic: Provides specialized care for NCD patients.
- District Program Officer: Oversees implementation of program activities.
- District Cardiac Care Unit and Day Care Center: For management of cardiovascular emergencies and cancer care.
Community Healthcare Facility Level
- Community Health Centers (CHC): Host NCD clinics for screening, diagnosis, and management.
- Primary Health Centers (PHC): Conduct screening and basic management of NCDs.
- Sub-Centers: Frontline healthcare facilities engaged in health promotion and early detection.
| Level | Key Components | Primary Functions |
|---|---|---|
| National | National NCD Cell, NPCC | Policy formulation, resource allocation, technical guidance |
| State | State NCD Cell, State Program Officer | Program planning, implementation, monitoring |
| District | District NCD Cell, NCD Clinic, Day Care Center | Specialized care, coordination of district activities |
| CHC/PHC | NCD Clinics, Healthcare providers | Screening, diagnosis, basic management |
| Sub-Center | ANMs, ASHAs | Health promotion, early detection, referral |
5. Components of NPCDCS
The NPCDCS program comprises two major components: (i) Cancer and (ii) Diabetes, Cardiovascular Diseases, and Stroke. Each component addresses specific aspects of prevention, early detection, diagnosis, treatment, and follow-up care.
5.1. Cancer Prevention and Control
Cancer is a leading cause of mortality in India with oral, breast, and cervical cancers being most prevalent. The NPCDCS cancer component focuses on:
- Prevention: Reducing exposure to risk factors like tobacco, alcohol, unhealthy diet, and physical inactivity
- Early Detection: Screening for common cancers – oral, breast, and cervical cancer
- Diagnosis and Treatment: Strengthening infrastructure for cancer diagnosis and treatment
- Palliative Care: Supporting end-of-life care for advanced cancer patients
Screening Protocols for Common Cancers
| Cancer Type | Screening Method | Target Population | Frequency |
|---|---|---|---|
| Oral Cancer | Visual examination of oral cavity | Adults ≥30 years, especially tobacco users | Once every 5 years |
| Breast Cancer | Clinical Breast Examination (CBE) | Women ≥30 years | Once every 5 years |
| Cervical Cancer | Visual Inspection with Acetic Acid (VIA) | Women ≥30 years | Once every 5 years |
Mnemonic: “ABCD” for Oral Cancer Warning Signs
- Asymmetry in mouth lesions
- Bleeding and/or pain in the mouth
- Color changes (red, white patches)
- Duration (lesions persisting beyond 2 weeks)
5.2. Diabetes Management
Diabetes has reached epidemic proportions in India with over 74 million adults affected. The NPCDCS diabetes component includes:
- Risk Assessment: Identifying individuals at high risk for developing diabetes
- Screening: Blood glucose testing for early detection
- Management: Lifestyle modifications, medication, and regular follow-up
- Prevention of Complications: Regular examinations for early detection of complications
Diabetes Screening and Diagnosis
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| Fasting Plasma Glucose (FPG) | <100 mg/dL | 100-125 mg/dL | ≥126 mg/dL |
| 2-hour Post-Glucose Load | <140 mg/dL | 140-199 mg/dL | ≥200 mg/dL |
| Random Blood Glucose with symptoms | – | – | ≥200 mg/dL |
| HbA1c | <5.7% | 5.7-6.4% | ≥6.5% |
Mnemonic: “DIABETES” for Patient Education
- Diet control (balanced, low carbohydrate)
- Insulin or medication adherence
- Activity and regular exercise
- Blood glucose monitoring
- Education about the condition
- Toeing care (foot care)
- Eye examination regularly
- Screening for complications
5.3. Cardiovascular Diseases
Cardiovascular diseases (CVDs) are the leading cause of mortality in India. The NPCDCS CVD component focuses on:
- Risk Factor Identification: Screening for hypertension, dyslipidemia, obesity
- Prevention: Lifestyle interventions, smoking cessation, healthy diet
- Early Diagnosis: Regular blood pressure monitoring, cholesterol checks
- Management: Medication, lifestyle modifications, regular follow-up
- Emergency Care: Strengthening cardiac care units at district hospitals
Blood Pressure Classification
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Normal | <120 | and <80 |
| Elevated | 120-129 | and <80 |
| Hypertension Stage 1 | 130-139 | or 80-89 |
| Hypertension Stage 2 | ≥140 | or ≥90 |
| Hypertensive Crisis | >180 | and/or >120 |
Mnemonic: “HEARTS” for CVD Risk Factors
- Hypertension
- Elevated cholesterol
- Age (increasing risk with age)
- Race (higher risk in certain ethnic groups)
- Tobacco use
- Sedentary lifestyle
5.4. Stroke Management
Stroke is a leading cause of disability and death in India. The NPCDCS stroke component addresses:
- Prevention: Control of risk factors like hypertension, diabetes, smoking
- Early Recognition: Community awareness about stroke warning signs
- Emergency Response: Prompt medical attention within the “golden hour”
- Rehabilitation: Physical, occupational, and speech therapy
Mnemonic: “FAST” for Stroke Recognition
- Face drooping on one side
- Arm weakness or numbness
- Speech difficulty or slurring
- Time to call emergency services
Stroke Types and Characteristics
| Type | Cause | Characteristics | Management |
|---|---|---|---|
| Ischemic Stroke | Blood clot blocking blood flow | More common (80-85% of strokes) | Thrombolytics, antiplatelet therapy |
| Hemorrhagic Stroke | Ruptured blood vessel | More severe, higher mortality | Blood pressure management, surgery if needed |
| Transient Ischemic Attack (TIA) | Temporary blockage | Symptoms resolve within 24 hours | Risk factor management, prevention of full stroke |
6. Screening Protocols under NPCDCS
Screening is a cornerstone of the NPCDCS program, enabling early detection and timely intervention for non-communicable diseases. The program employs two primary screening approaches:
Opportunistic Screening
This type of screening is conducted when individuals visit health facilities for any health-related issue. Under NPCDCS:
- NCD clinics at district hospitals and CHCs screen all individuals aged 30 years and above
- Screening includes basic measurements and tests for diabetes, hypertension, and common cancers
- Healthcare providers use the opportunity of any patient visit to conduct NCD screening
Population-Based Screening (PBS)
This is a more proactive approach where screening services are taken to the community:
- Target population: All individuals aged 30 years and above
- Conducted through outreach camps, health melas, and door-to-door visits
- Involves ASHAs, ANMs, and other community health workers
- Aims to reach individuals who may not visit health facilities regularly
NCD Screening Process
| Step | Activity | Responsible Personnel | Tools/Methods |
|---|---|---|---|
| 1 | Line listing of target population | ASHA, ANM | Community survey, household register |
| 2 | Risk assessment using CBAC form | ASHA | Community-Based Assessment Checklist |
| 3 | Physical measurements | ANM, Staff Nurse | Height, weight, waist circumference, BP measurement |
| 4 | Blood glucose testing | ANM, Lab Technician | Glucometer, lab tests |
| 5 | Oral, breast, cervical cancer screening | ANM, MO | Visual examination, VIA/VILI, CBE |
| 6 | Referral of suspected cases | ANM, MO | Referral slips, follow-up register |
Screening Achievements
As per recent evaluations of NPCDCS:
- Over 64,000 people were screened across 36 sub-centers in one district study
- Average coverage rate was 25.77% of the eligible population
- Diabetes prevalence was found to be 4.87% among those screened
- Hypertension was detected in approximately 8.4% of screened individuals
7. Role of Community Health Nurses in NPCDCS
Community health nurses play a pivotal role in the successful implementation of the NPCDCS program, serving as the bridge between the healthcare system and the community. Their roles span across prevention, screening, management, and follow-up care.
Core Nursing Responsibilities in NPCDCS
- Conducting screening for diabetes, hypertension, and common cancers
- Assisting physicians during examinations and procedures
- Providing health education to patients and communities
- Maintaining records and registers for NCD patients
- Conducting home visits for follow-up care
- Coordinating with ASHAs and other community health workers
- Organizing health camps and awareness programs
- Monitoring treatment adherence among NCD patients
7.1. Collaboration with ASHAs and ANMs
Community health nurses work closely with Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) to extend NPCDCS services to the community level:
| Healthcare Worker | Role in NPCDCS | Activities |
|---|---|---|
| Community Health Nurse | Supervisor and care provider | Screening, patient education, clinical care, supervision of ASHAs and ANMs |
| ANM | Primary screener and field worker | BP monitoring, blood glucose testing, cancer screening, referrals, follow-up |
| ASHA | Community mobilizer | Risk assessment using CBAC, community mobilization, follow-up, health education |
The collaborative approach ensures comprehensive coverage of the target population and effective implementation of NPCDCS activities at the grassroots level.
7.2. Health Promotion and Education
Community health nurses lead health promotion activities to address modifiable risk factors for NCDs:
- Individual Counseling: Personalized guidance on lifestyle modifications
- Group Education: Conducting sessions on NCD prevention in community settings
- IEC Material: Developing and distributing information, education, and communication materials
- School Health Programs: Promoting healthy habits among children and adolescents
- Community Events: Organizing health melas and awareness campaigns
Mnemonic: “TEACH” for Health Education
- Tailor the message to audience needs
- Engage using interactive methods
- Assess understanding regularly
- Clarify misconceptions promptly
- Highlight actionable steps
7.3. NCD Screening and Referral
Community health nurses are at the forefront of NCD screening activities under NPCDCS:
- Physical Measurements: Blood pressure, height, weight, BMI, waist circumference
- Blood Glucose Testing: Using glucometers for random and fasting blood glucose
- Cancer Screening: Clinical breast examination, visual inspection of oral cavity, VIA for cervical cancer
- Risk Assessment: Evaluating lifestyle factors, family history, and clinical indicators
- Referral: Identifying cases requiring further evaluation and linking them to appropriate healthcare facilities
Screening Targets
Under NPCDCS, community health nurses aim to:
- Screen at least 80% of the population aged 30 years and above in their service area
- Refer 100% of individuals with abnormal findings for confirmation and management
- Maintain complete documentation of all screenings conducted
7.4. Follow-up and Continuity of Care
Ensuring continuity of care is a critical aspect of NCD management in NPCDCS:
- Maintenance of Registers: Recording patient information and follow-up details
- Reminder Systems: Ensuring patients return for scheduled appointments
- Home Visits: Following up with patients who miss appointments
- Medication Adherence: Monitoring and promoting compliance with prescribed treatments
- Complication Monitoring: Regular assessment for early signs of complications
- Lifestyle Modification Support: Ongoing guidance and motivation for sustaining healthy behaviors
| NCD | Follow-up Frequency | Key Monitoring Parameters |
|---|---|---|
| Diabetes | Every 3 months (stable cases) | Blood glucose, HbA1c, foot examination, blood pressure |
| Hypertension | Every 1-3 months (based on control) | Blood pressure, adherence, lifestyle changes |
| Cancer (post-treatment) | As per oncologist’s recommendation | Symptoms, recurrence, palliative care needs |
| Stroke (recovery) | Monthly for first 6 months | Functional ability, BP control, rehabilitation progress |
8. Useful Mnemonics for Community Health Nursing in NPCDCS
Mnemonics serve as valuable tools for nursing students and practitioners to remember important aspects of NCD management. Below are additional mnemonics specific to NPCDCS implementation:
Mnemonic: “SCREEN” for NCD Screening Approach
- Systematic assessment of risk factors
- Clinical examination tailored to specific NCDs
- Record findings accurately and completely
- Educate about findings and next steps
- Ensure appropriate referral when needed
- Note follow-up plan clearly
Mnemonic: “CARES” for Diabetes Foot Care Education
- Clean feet daily with mild soap and water
- Assess for injuries, blisters, or discoloration daily
- Regular trimming of nails straight across
- Ensure proper footwear that fits well
- Seek medical attention for any foot problems
Mnemonic: “HELP” for Hypertension Management
- Healthy diet (low sodium, DASH diet)
- Exercise regularly (30 minutes daily)
- Limit alcohol and avoid tobacco
- Prescription medications taken regularly
Mnemonic: “NCD CARE” for Community Nursing Approach
- Needs assessment of the community
- Collaboration with stakeholders (ASHAs, ANMs, physicians)
- Documentation of all activities
- Counseling on lifestyle modifications
- Assessment of risk factors
- Referral of high-risk cases
- Evaluation of program outcomes
Mnemonic: “OLD CLASS” for Chronic Disease Management
- Optimal nutrition
- Lifestyle modifications
- Disease monitoring
- Consistent medication adherence
- Limiting risk factors
- Appropriate physical activity
- Stress management
- Support system engagement
9. Challenges in NPCDCS Implementation
Despite its comprehensive design, the NPCDCS program faces several challenges in implementation. Community health nurses should be aware of these challenges to develop effective strategies to address them:
Key Implementation Challenges
- Human Resource Shortage: Studies have found that over 60% of sanctioned posts under NPCDCS remain vacant in many districts
- Inadequate Infrastructure: Limited availability of essential equipment and diagnostic facilities at primary care levels
- Insufficient Training: Only 69% of ANMs in one assessment had received training for NPCDCS implementation
- Financial Constraints: Low central budget allocation and under-utilization of allocated funds
- Weak Referral Systems: Poor linkages between different levels of healthcare facilities
- Limited Community Awareness: Inadequate health education and behavior change communication activities
- Poor Documentation: Incomplete records and registers affecting continuity of care
Nursing-Specific Challenges
Community health nurses face specific challenges in implementing NPCDCS activities:
- Work Overload: Multiple program responsibilities leading to burnout
- Inadequate Supervision: Limited guidance and support from higher levels
- Knowledge Gaps: Insufficient training on evolving NCD management guidelines
- Limited Decision-Making Authority: Restricted scope of practice in certain interventions
- Logistical Issues: Difficulty in reaching remote areas for screening and follow-up
- Cultural Barriers: Overcoming traditional beliefs that hinder NCD prevention and management
Strategies to Address Challenges
| Challenge | Strategy | Nursing Role |
|---|---|---|
| Human Resource Shortage | Task-sharing, capacity building of existing staff | Training ASHAs and volunteer health workers |
| Inadequate Infrastructure | Innovative use of available resources, mobile health units | Adapting screening protocols to available resources |
| Insufficient Training | Peer learning, online resources, on-the-job training | Creating learning opportunities within the team |
| Poor Community Awareness | Engaging local leaders, culturally appropriate messaging | Developing context-specific IEC materials |
| Weak Referral Systems | Strengthening communication between facilities | Maintaining detailed referral documentation |
10. Best Practices and Success Stories
Several states and districts have demonstrated effective implementation of NPCDCS, offering valuable lessons for community health nursing practice. These success stories highlight innovative approaches that can be adapted to various settings:
Successful Implementation Models
- Integration with Existing Programs: States that have effectively integrated NPCDCS with other health programs like the National Health Mission have shown better outcomes
- Technology Utilization: Districts using mobile health technology for screening and follow-up have improved coverage and continuity of care
- Community Participation: Engaging local community organizations and leaders has enhanced program acceptance and participation
- Public-Private Partnerships: Collaboration with private healthcare providers has expanded program reach and resource availability
- Comprehensive Training Approaches: Regular capacity building of all cadres of healthcare providers has improved service quality
Nursing Best Practices in NPCDCS
Evidence-Based Nursing Interventions
- Group-Based Education: Conducting structured group sessions for patients with similar conditions has shown better knowledge retention and behavior change
- Family-Centered Approach: Involving family members in patient education and care planning improves adherence
- Peer Support Groups: Facilitating patient peer groups for mutual support and motivation enhances self-management
- Standardized Protocols: Using checklist-based approaches for screening ensures comprehensive assessment
- Home-Based Monitoring: Training patients in self-monitoring with regular nurse-led follow-up improves disease control
Case Study: Successful NPCDCS Implementation
Case Example: Comprehensive NCD Management in Kerala
Kerala’s approach to NPCDCS implementation stands out for its comprehensive community-based strategies:
- Approach: Integration of NCD clinics with primary healthcare centers and community outreach
- Innovation: Electronic health records for NCD patients ensuring continuity of care
- Community Engagement: Involvement of local self-government institutions in program implementation
- Results: Over 85% screening coverage of target population, improved follow-up rates
- Nursing Role: Community health nurses led screening camps and coordinated care between levels
Global Best Practices Adaptable to NPCDCS
| Global Practice | Country/Region | Application to NPCDCS |
|---|---|---|
| Nurse-led NCD clinics | Thailand | Expanding scope of practice for nurses in primary care settings |
| Community health worker model | Brazil | Enhanced training for ASHAs to provide basic NCD management |
| Mobile health screening units | South Africa | Reaching remote populations with screening services |
| Self-help groups for chronic disease management | United Kingdom | Formation of community-based support groups for NCD patients |
11. Future Directions
The NPCDCS program continues to evolve to address the growing burden of NCDs in India. Community health nurses need to stay informed about emerging trends and future directions:
Recent Updates and Future Plans
- Program Expansion: Inclusion of additional NCDs such as chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)
- Strengthening Primary Care: Greater emphasis on NCD management at primary health centers and health and wellness centers
- Digital Health Integration: Implementation of electronic health records and telemedicine for NCD care
- Life-Course Approach: Expanding focus to include adolescent and young adult populations for early prevention
- Multi-sectoral Collaboration: Engaging sectors beyond health for addressing social determinants of NCDs
Emerging Role of Community Health Nurses
The future of NPCDCS envisions an expanded role for community health nurses:
- Nurse-Led NCD Clinics: Greater autonomy in managing stable NCD patients
- Telehealth Coordinators: Facilitating remote consultations and monitoring
- Research Participation: Engagement in community-based research on NCD prevention and management
- Program Leadership: Taking on coordination and management roles within NPCDCS
- Policy Advocacy: Contributing to policy development based on field experiences
Innovations in NPCDCS
Recent innovations being piloted or planned include:
- AI-based Risk Prediction: Using artificial intelligence to identify high-risk individuals for targeted interventions
- Point-of-Care Testing: Deployment of advanced portable diagnostic tools at community level
- Mobile Applications: Smartphone apps for patient self-management and provider decision support
- Precision Public Health: Tailoring interventions based on community-specific NCD risk profiles
12. Conclusion
The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) represents India’s comprehensive response to the growing epidemic of non-communicable diseases. With its multi-tiered implementation structure and focus on prevention, early detection, and management, NPCDCS aims to reduce the burden of NCDs and their impact on individuals, communities, and the healthcare system.
Community health nurses serve as the backbone of NPCDCS implementation at the grassroots level, bridging the gap between communities and healthcare facilities. Their multifaceted role encompasses health promotion, screening, patient education, follow-up care, and program coordination. By understanding the program’s components, implementing evidence-based interventions, and addressing implementation challenges, community health nurses can significantly contribute to the success of NPCDCS.
As NPCDCS continues to evolve, staying updated with the latest guidelines, best practices, and emerging trends will enable community health nurses to provide high-quality care and contribute to the national goal of reducing premature mortality from non-communicable diseases.
Final Mnemonic: “NPCDCS” for Program Implementation
- Needs assessment of the community
- Prevention through health promotion activities
- Comprehensive screening of target population
- Diagnosis and timely referral
- Continuity of care through follow-up
- Support for self-management