National health programmes for non communicable disease

Presented by Dr Khyati Boriya

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OBJECTIVES

• To know about the national health programs for non communicable diseases• Understand relevance of NHP• Description of NHP for non

communicable diseases

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Content

• Introduction- Noncommunicable diseases,risk factors of NCDs, %deaths internationally and nationally due to NCDs.

• National mental health programme- Aims, objectives, strategies,mental health care, district mental health programme , thrust areas and limitations.

• National programmes for control of blindness-, National and international WHO definition for blindness ,types of blindness, causes of blindness ,national programme for blindness, revised stratigies,objectives,organizational structure of NPBC,service delivery and referral system,activities of programme, new initiatives, vision 2020,prevention of blindness.

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Content

• National programmes for the control of cancer– About cancer ,causes of cancer ,cancer problems worldwide and in India ,control, methodology of cancer registration ,goals and objectives of NCCP ,national cancer control programme,existing schemes, recent news of cancer.

• National programmes for the control of diabetes-overview of the diabetes disease,diabetes control programme,objectives of programme,stretegies of programme, scheme.

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Introduction• Non communicable disease(NCD) is a

medical condition or disease that is non infectious or nontransmissible .

• Chronic noncommunicable diseases are assuming increasing importance among the Adult population in both developed and developing countries. Cardiovascular diseases and cancer are at present the leading causes of death in developed countries .

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Noncommunicable diseases include-• Cardiovascular diseases• Renal diseases• Nervous disorders• Mental disorders• Musculoskeletal conditions such as arthritis and allied diseases • Chronic non specific respiratory diseases for e.g chronic

bronchitis ,emphysema ,asthma.• Permanent results of accidents • Blindness• Cancer• Diabetes• Obesity• Various metabolic and degenerative diseases• Chronic results of communicable diseases

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• Of the 57 million global deaths in 2008 , 36 million or 63% were due to non-communicable diseases (NCDs)

• By the cause ,cardiovascular diseases were responsible for the largest proportion of NCD deaths - 47.9%

• Followed by cancers- 21%• Chronic respiratory diseases -11.72 %• Digestive diseases-6.1%• Diabetes-3.5%• And rest NCDs were responsible for- 9.78%• As population will age ,annual NCD deaths are projected

to rise substantially , to 52 billion in 2030.

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• India is experiencing a rapid health transition with a rising burden of NCDs causing significant morbidity and mortality ,both in urban and rural population ,with considerable loss in potentially productive years (age 35-64 years) of life . NCDs are estimated to a account for about 53% of all deaths

• Pie chart showing proportional mortality (% of all deaths all ages)

37%

24%11%

10%6%

2%10%

% of total deaths ,all agescommunicable,maternal,perinatal,and nutritional conditions

CVD

respiratory diseases

others NCDs

cancers

diabetes

injuries

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Non communicable diseases risk factors

• Tobacco• Insufficient physical activity• Harmful use of alcohol• Unhealthy diet• Raised blood pressure• Overweight and obesity• Raised cholesterol• Cancer associated infections• Environmental risk factors

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National mental health programme

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National mental health programme

• The national mental health programme(NMHP) was launched during 1982 with a view to ensure availability of mental health care services for all ,especially the community at risk and underprivileged section of population.

• Eleven institutions have been identified for imparting basic knowledge and skills in the field of mental health to the primary health care physicians and paramedical personnel,at present this programme covers 94 districts.

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AIMS OF NMHP

• Prevention and treatment of mental and neurological disorders and their associated disabilities

• Use of mental health technology to improve general health services

• Application of mental health principles in total national development to improve quality of life

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Objectives of NMHP

• To ensure availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of population

• To encourage application of mental health knowledge in general health care and in the social development

• To promote community participation in the mental health services development and to stimulate efforts towards self-help in the community

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NMHP STRATEGIES

• Integration of mental health with primary health care through the NMHP

• Provision of tertiary care institutions for treatment of mental disorders

• Eradicating stigmatization of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority and State Mental Authority.

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Mental health care• The mental morbidity requires priority in mental

health treatment • Primary health care at village and subcentre level • At primary health centre level• At district hospital level• Mental hospital and teaching psychiatric units

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District mental health programme components

• Training programmes of all workers in the mental health team at the identified nodal institute in the state

• Public education in mental health to increase awareness and to reduce stigma

• For early detection and treatment , the opd and indoor services are provided

• Providing valuable data and experience at the level of community to the state and centre for future planning , improvement in service and research.

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• District mental health programme has now incorporated promotive and preventive activities for positive mental health which includes :

• School mental health services :life skills education in schools ,counseling services.

• College counseling services: through trained teachers /councellors.

• Work place stress management :formal and informal sectors ,including farmers ,women,etc

• Suicide prevention services :counseling centre at district level ,sensitization workshops, IEC,help lines etc.

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Thrust areas• District mental health programme in an enlarged and more

effective form covering the entire country.• Modernization of mental hospitals in order to modify their

present custodial role.• Upgrading dept. of psychiatry in medical colleges and enhancing

the psychiatric content of medical curriculum at undergraduate and post graduate level.

• Strengthening the central and state mental health authorities with a permanent secretariat. Appointment of medical officers at state head quarters in order to make monitoring role more effective.

• Research and training in the field of community mental health, substance abuse and child adolescent psychiatric clinics.

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Limitations of NMHP• There is no initiative from the mental health professional to take

active part in this programme.most of them are not aware of the programme.

• There is shortage of professional manpower and training programmes are not able to meet the demand in providing all medical private practitioner and medical officers

• The targets set for the programme are not achieved till today after lapse of more than one decade.this indicates that there is a poor commitment of the government,psychiatrists and community at large.

• The programme has given more emphasis on the curative services to the mental disorders and preventive measures are largely ignored . More public awareness programme are required.

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• WHO defines blindness as “visual acuity of less than 3/60 (snellen) or its equivalent”

• Simple Definition: Inability of a person to count fingers from a distance of 6 meters or 20 feet

• Technical Definition: Vision 6/60 or less with the best possible spectacle correction

Causes of blindness

64%

20%

6%5%

1% 1% 1% 1%

Cataract

refractive errors 20%

glucoma

posterior segment dis-order

surgical complication

posterior capsular opaci-fication

corneal blindness

Other

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Types of blindness• Curable blindness: That stage of blindness where the

damage is reversible by prompt management e.g. cataract

• Preventable blindness: The loss of blindness that could have been completely prevented by institution of effective preventive or prophylactic measures e.g. xerophthalmia, trachoma, and glaucoma

• Avoidable blindness: The sum total of preventable or curable blindness is often referred to as avoidable blindness.

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• Magnitude of Problem in IndiaEstimated prevalence of blindness :

• 11.2 per 1000 population• 0.1 per 1000 population : 0 14 years‐• 0.6 per 1000 population: 15 49 years‐• 77.3 per 1000 population: 50 years & above

• Female (12.2 per 1000 population) > Male (10.2 per 1000 population)

• 15 millions are suffered with blindness in India.

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National Programme for Control of Blindness• Launched in year 1976 • 100% centrally sponsored programme• Incorporates the earlier Trachoma Control Programme (started in

1968)• Goal: To reduce the prevalence of blindness from 1.4 to 0.3%World Bank assisted cataract blindness control project (1994 2002):‐• Implemented in 8 states. • 15.35 million operations had been done against 11 million target.• IOL implantation had been increased from 3% in 1993 to 75% in 2002.DANIDA assistance to NPCB (1998 2003) :‐• Funds were utilized for the training , development of MIS, supply of

equipment.WHO assistance for prevention of blindness:• Development plan for“Vision 2020:the right to sight ”initiative.

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Revised strategiesBased upon the finding of survey conducted during 1998-99 &

1999-20001.To make the NPCB more comprehensive by:• Strengthening services for other blindness like corneal

blindness• Refractive errors in school going childrens• Improved follow up services for cataract operated persons.• Treating other causes of blindness like glaucoma .2.To shift• Eye camp approach to a fixed facility.• From conventional surgery to IOL implantation for batter

quality post operative vision.

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3. To expand the world bank project activities like constructions of eye OTs, eye wards at dist. Level, training

of eye surgeons, modern cataract surgery & supply of eye equipments.

4. To strengthen participation of voluntary organizations in the programme & to earmark geographic areas to NGOs and govt. hospital & improve the performance of govt. units.

5. To enhance coverage of eye care services in tribal & underserved areas through identification of bilateral blind patients, preparation of village wise blind register & giving preference to bilateral blind patients for cataract surgery .

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Objectives• To reduce backlog of blindness through

identification & treatment of blind.• To develop eye care facility for every district.• To develop human resources for eye care

services.• To improve quality of service delivery.• To secure participation of civil society & private

sector.

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Infrastructure Development for Eye Care • Item Current achievement• Strengthening of PHCs 5,633• Centre Mobile Units 80• Strengthening of District Hospitals 445• Upgrading of Dept. of Ophthalmology in Medical Colleges 82• Establishment of Regional Institutes 11• Ophthalmic Assistant training centers 39• District Mobile Units 341• State Ophthalmic Cells 21• Establishment of DBCSs 604• Eye Bank (Govt.) 166• Paramedical Ophthalmic Assistants posted 4,881

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Organizational Structure for NPCB

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Service Delivery & Referral System

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Activities• Cataract operation: IOL implantation has been emphasized. • Involvement of NGOs.• Civil works: Construction of eye wards, OTs & dark room were

undertaken in 7 states under World Bank assisted project.• Training to eye surgeons, PHC MO, ophthalmic assistant,

ophthalmic HWs.• Commodity assistant like sutures & IOLs, slit lamps, A scans, ‐

Yag lasers, keratometres are procured centrally & distributed to states & DBCS.

• IEC• MIS• Monitoring & evaluation rapid assessment surveys, beneficiary

assessment survey, visual outcome surveys

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• Collection & utilization of donated eyes: Nearly 20,000 donated eyes are collected per annum• School Eye Screening Programme : First screening by trained teachers. Children suspected to have refractory errors are confirmed by

ophthalmic assistants. Corrective spectacles are prescribed or provided free of cost to

poor.

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New Initiatives• Dedicated eye wards & eye OTs in DH & SDH as per demand.• Appointment of Ophthalmic surgeons & O.A. in new DHs &

SDHs.• Appointment of O.A. in PHCs• Appointment of Eye Donation Counselors in eye banks• Grant in aid for NGOs for management of various eye ‐ ‐

diseases• PPP• Special attention to NE States• Telemedicine in Ophthalmology• Vitamin A supplement and MMR vaccination through DBCS

funds.

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Vision 2020: Right to Sight• A global initiative has been taken to reduce avoidable • blindness by 2020. • India also has committed to this initiative.

Plan of action1.Target diseases: • Cataract, Refractive Errors, Childhood Blindness, Glaucoma, Diabetic

Retinopathy.2.Human resource development3.Infrastructure development: • Proposed 4 tier structure includes:‐• Centres Of Excellence (20)• Training Centres(200) • Services Centres(2000)• Vision Centres(20,000)

Tertiary

• Centers of excellence 20: Professional leadership, strategy development, continued medical education, laying of standards and quality assurance,reasearch.

• Training centers 200:Tertiary eye care including retinal surgery, corneal implantation,glacoma surgery ,training etc.

Secondary• Service centers 2000:Cataract surgery, other

common eye surgeries, facilities for refraction, referral services

Primary• Vision centers 20000:Refraction and

prescription of glasses, primary eye care, school eye screening programme,screening and referral services.

Proposed structure for vision 2020 : the right to sight

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Prevention & control of blindness: 1. Initial assessment.2. Methods of interventions.• Primary eye care.• Secondary eye care.• Tertiary eye care.• Specific programmes.Trachoma control.School eye health services.Vit.A prophylaxisOccupational eye health services.3.Long term measures4.Evaluations.

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• Global Elimination of Blinding Trachoma: Trachoma still endemic in 46 countries. There are 146 million active cases of the disease.

• Almost 6 million people are blind or visually disabled as a result of trachoma.

• SAFE strategy: S –Surgery A Antibiotic use‐ F Facial cleanliness‐ E Environment improvement‐

CANCER

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ABOUT CANCER

• Cancer may be regarded as group of diseases characterized by an :

• (1)abnormal growth of cells• (2)ability to invade adjacent cells & even distant

organs• (3)the eventual death of the affected patient if

the tumour has progressed.• Cancer can occur at any site or tissue of the body

& may involve any type of cells.

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CAUSES OF CANCER

(1)ENVIROMENTAL FACTORS : responsible for 80 to 90% of all human cancers.

(a)tobacco (b)alcohol (c)dietary factors (d)occupational exposures (e)viruses (f)parasites (g)others(2)GENETIC FACTORS

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CANCER PROBLEM WORLDWIDE

CANCER afflicts all communities worldwide; approx. 12.7 million people are diagnosed with

cancer in 2008 14.1 million cancer cases around the world in 2012Lung cancer is the most common cancer

worldwide contributing 13% of the total number of new cases diagnosed in 2012 while breast cancer is the second most common & colorectal cancer is third most common in 2012.

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CANCER PROBLEM IN INDIA

• It is estimated that during the year 2008, • 9.4 lakhs new cancer cases ; of these 4.3 lakhs

were males & 5.1 lakhs were females.• Incidence rates 98.5 per one lac population• Same year 6.3 lac persons died of cancer out of

which 3.21 lac males & 3.12 lacs females• Mortality rate is 68 per lac population.• More than 2/3rd of cancer patients are already in

an advanced & incurable stage when diagnosed.

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CANCER CONTROLPRIMARY PREVENTION : Control of tobacco & alcohol consumption Personal hygiene Radiation Occupational exposures Immunization Foods, drugs & cosmetics Air pollution Treatment of precancerous lesions Cancer education

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NATIONAL CANCER CONTROL PROGRAMME

i. For data base of cancer cases, national cancer registry programme (ncrp) was initiated in 1982.

• There are 2 types of registries :• (a)population based cancer registry• (b)hospital based cancer registry• At present 25 population based registry & 6

hospital based registry.

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METHODOLOGY OF CANCER REGISTRATION

o In developed countries like USA notification of cancer is compulsory for every hospitals.

o The hospitals in areas with compulsory notification & the hospitals cancer registries, abstract the information from the patient records on a specified proforma & send it to the registry(passive method). This is known as HOSPITAL-BASED REGISTRIES.

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o However, where trained staff for abstracting the records is not available with the individual hospital, the workers from registry scan through the patient records from different hospitals, clarify incomplete or contradictory information, & abstract data(active method).

o In India, cancer registry is through the active methodology.

o Known as POPULATION-BASED REGISTRIES

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GOALS & OBJECTIVES OF NCCP

1. Primary prevention of cancers by health education.

2. Secondary prevention by early detection & diagnoses of cancers.

3. Strengthening of existing cancer treatment facilities, which are inadequate.

4. Palliative care in terminal stage of cancer.

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EXISTING SCHEMES UNDER NCCP AS ON 1ST JUNE 2008

i. Recognition of NEW REGIONAL CANCER CENTRES(RCCs)

ii. Strengthening of existing RCCiii. Development of ONCOLOGY WINGiv. District Cancer Control Programmev. Decentralized NGO Scheme

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RECENT NEWS OF CANCER• By 2025, cancer is estimated to cross 15 lakh in

INDIA, which is 35% higher than the 2014• Increase in number of cancer cases may be

attributed to larger number of ageing population, unhealthy lifestyles, use of tobacco, unhealthy diet & others

• Mortality due to cancer in 2015 is 5,05,428 while in 2014 it was 4,91,598 acc. to NCRP

• Based on NCRP data, while 1 in 14 women in India have a chance of developing cancer, 1 in 16 for men.

NATIONAL CONTROL PROGRAMME FOR THE

DIABETES

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Over view of diabetes disease• DEFINITION:-• It is a metabolic disease in which there is high blood

sugar levels(more than 160mg/dl) over the prolonged period.

• Sign& symptoms:-• Weigh loss• Polyuria• Polydipsia• Polyphagia ect….

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DIABETES..CONTROL PROGRAMME.

This programme is focus on the health promotion, capacity building including human resources development, early diagnosis and management of this disease with integration with primary health care system

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objectives

• Prevent & control of diabetes through lifestyle changes.

• Provide early diagnosis &treatment for the diabetes.• Buildup the capacity at various level of health care

that is primary level, secondary level, tertiary level.• Train human resource that is doctors, nursing staff

and paramedics to cope with the incresing burden of diabetes.

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• Establish and develop capacity for palliative & rehabilitation centers.

• Reduce the risk of gestational diabetes and reduce the risk of MMR, IMR

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Strategies

• It include healthy life style through health education and mass media effort at district , state, & country level

• Opportunistic screening of persons above the age of 30 year.

• Establishment of health centers like PHC, CHC, district level.

• Strengthening of tertiary level health care facilities.

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• Long term sustainability of the programme. • Services delivery will be through existing public

health infrastructure and system.• The various approaches such as mass media,

community health education, interpersonal communication will be used for life style changes.

• Increases physical activites .• Stress management.• Regular blood sugar testing.

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scheme

• Urban health check up scheme for the diabetes.

Objectives:-• To screen urban slum population for the diabetes.• To create data-base information for the prevalence

of diabetes.• To sensitize the urban slum population about healthy

life style.• Blood sugar will be checked for all >_ 30 years and all

pregnant women to all age .

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References

• Wikipedia

• K.park

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THANK YOU