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CONCEPT – NPCDCS
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- NCDs : The Non-communicable Diseases are rightly called ‘Silent’ diseases as they may not cause any symptoms for many years. The dilemma is that general public perception for diseases is related with appearance of symptoms and well-being with absence of symptoms. Unfortunately, even in the absence of symptoms, disease progression continues unabated leading to complications. It was with this background that the Ministry of Health & FW decided to give opportunity to people to get themselves screened for common NCDs like Diabetes and Hypertension periodically to detect them early and manage them with lifestyle modifications and treatment.
- Silent killer : Nearly half of population with diabetes and hypertension is estimated to be undetected in India and with screening programmes, they are likely to be identified and appropriately treated. Early diagnosis and treatment would avert complication like heart attacks, stroke, kidney diseases, blindness etc. which are not only life threatening but also expensive to manage. An additional benefit of population based screening is to assess risk profile of every individual including tobacco and alcohol use, unhealthy diet, lack of physical activity etc. This information needs to be used to educate people regarding consequences of unhealthy practices and to motivate them for adopting healthy lifestyle.
- NPCDCS : The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) provides comprehensive services for early diagnosis, treatment, follow up and referral etc. The existing protocol, being followed is opportunistic screening. As the programme has expanded considerably, it is envisaged that the package of services for these Non-Communicable Diseases can be ascertained only when the primary health care delivery system is geared-up for the screening of all the people in the community in the age group of 30 years and above.
- Indian case : Non-communicable Diseases (NCDs) are currently the leading cause of preventable deaths and disability in India. The four identified major NCDs are Cardiovascular Diseases (CVD) such as heart attacks and stroke, Diabetes, Chronic Respiratory Diseases (Chronic Obstructive Pulmonary Diseases and Asthma) and Cancer. They are the leading cause of death, accounting for over 60% of premature mortality, placing them ahead of Communicable diseases, Maternal, Prenatal, and Nutritional conditions (WHO 2014).
- Risk factors : Risk factors are cumulative and operate on a life course perspective. It is important to note that all these risk factors are amenable to modification through lifestyle changes. In nutshell, today’s risky behaviours are tomorrow’s risk factors. Today’s risk factors are tomorrow’s disease. Thus, primary and secondary prevention of chronic diseases and their common risk factors provide the most sustainable and cost-effective approach to chronic disease prevention and control.
- Objectives of NPCDCS : The various objectives are
- Health promotion through behaviour change with involvement of community, civil society, community based organizations, media etc.
- Population based screening and Opportunistic screening at all levels in the health care delivery system from sub-centre and above for early detection of diabetes, hypertension and common cancers.
- To prevent and control chronic Non-Communicable Diseases, especially common Cancer, Diabetes and Hypertension.
- To build capacity at various levels of health care for prevention, early diagnosis, treatment, rehabilitation, IEC/BCC and 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 NCDs through Surveillance System and to monitor NCD morbidity and mortality and risk factors.
- The rationale : Under NHM, population based screening for NCDs including the three common cancers is being initiated as a part of comprehensive care which would complement the NPCDCS. In India, due to low levels of health awareness and significant information asymmetry that exists, screening for diseases where there are no obvious symptoms is perceived to be an unnecessary process, particularly so, amongst the poor, for whom a day’s visit to the secondary or tertiary facility for screening, might mean the loss of a day’s wages. Instituting population based screening at the sub-center for common NCDs (diabetes, hypertension and breast, cervical and oral cancers) would be particularly beneficial to women, given current low levels of care seeking among them and limited access to health services. Such screening would also address the issue of equity, since population based screening would also enable reach to the marginalized, who are also excluded from health care services on account of poverty and other forms of marginalization. Thus in order for screening programmes to be easily accessible, particularly for women and other vulnerable groups, they need to be decentralized to a level of care as close as possible, and be undertaken on a population wide level for particular age categories. The principle of screening at the community level is that no individual should need to travel more than half an hour to be screened. Population based screening will also serve the purpose of increasing awareness in the community about NCDs/ risk factors and the need for periodic screening. It also enables an understanding of better health and avoidance of risk factors in the general community. Effective and accessible screening program for NCDs and common cancers ensure early detection and increase in survival rates. However, screening for NCDs and their risk factors is not an end unto itself. It needs to be linked to accessible high quality treatment at affordable costs, regular follow up and management as and when required.
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