India’s rapid demographic and epidemiological transitions have led to a steep rise in the burden of lifestyle-related chronic non-communicable diseases (NCDs). As per the national NCD monitoring survey (2017–2018), the prevalence of hypertension associated with NCDs among adults (18–69 years) is 28.9%, of which 27.9% were aware of their raised blood pressure status. Of those who were aware, 52.1% were on treatment and of those who were on treatment, 44.4% had their blood pressure in control.[1]
In order to cater to the huge need for the prevention and control of NCDs including hypertension, India has established NCD clinics in the districts (640 district NCD clinics, 5148 community health center (CHC) NCD clinics and 194 district cardiac care units) under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). These units, inter alia, provide screening and management of hypertension cases.[2] To leverage and strengthen the ongoing efforts of hypertensive control interventions by the NPCDCS under the National Health Mission (NHM) and improve the linkages between population-based screening initiative with health care, India Hypertension Control Initiative (IHCI), a collaborative project of ministry of health and family welfare (MoHFW), Indian council of medical research (ICMR), state governments and the World Health Organization (WHO) India, has been implemented in 87 districts of 18 states. The initiative mainly focuses on five critical components of effective hypertensive care, which include standard treatment protocol, continuous medication supply, community-based treatment, patient-centred care and a strengthened information system to ensure follow-up and patient tracking. Till 31 July 2021, the IHCI has been implemented in nearly 9908 health facilities, with over 15,34,862 patients being registered.
For the preventive aspect, population-based screening for common NCDs (diabetes, hypertension and common cancers [oral, breast and cervical]) targets the population above 30 years of age. The NCD application has been developed for implementation of population based screening (PBS) for prevention, control, screening and management of common NCDs as a part of Comprehensive Primary Health Care under Ayushman Bharat – Health and Wellness Centres (AB-HWC).[3]
Furthermore, healthy eating is also promoted through food safety and standards authority of India (FSSAI).[4] Fit India movement is being implemented by the Ministry of Youth Affairs and Sports, and various Yoga-related activities are being carried out by the Ministry of AYUSH.[5]
National Multi-sectoral Action Plan (NMAP) is an envisaged platform for roping in all other stakeholder departments, which offers a road map and menu of policy options to guide multi-sectoral efforts towards attaining the NCD targets mentioned in the National Health Policy, 2017 and National NCD Monitoring Framework.[6]
The NPCDCS programme division periodically reviews the performance of the states/union territories (UTs.) Further, the programme, along with all other programmes, gets reviewed annually through the Common Review Missions (CRM) of the NHM.
For safeguarding the beneficiaries from the catastrophic expenditure of treatment of hypertension-related diseases, the Pradhan Mantri Jan Arogya Yojana (PMJAY) is being implemented. Health insurance cover of Rs. 5 lakhs to over Rs. 10.75 crore are being provided to poor and vulnerable families for secondary or tertiary care hospitalisation. It provides treatment corresponding to a total of 1669 procedures under 26 different specialities.[7] Other novel initiatives, Affordable Medicines and Reliable Implants for Treatment (AMRIT) and Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana (PMBJP), aim at providing affordable lifesaving medicines and medical disposables to patients.[8]
Conclusion and Way Forward
India’s plan for tackling the NCDs is robust and designed correctly by involving all relevant stakeholders and is in sync with global guidelines. Currently, the focus is slowly shifting towards healthy living and prevention of NCDs. However robust the NPCDCS programme may be, proper implementation at the various levels will bear healthy results in decreasing NCD-related morbidity and mortality. Integration with relevant programmes within and beyond health is the key game changer.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- 1.National NCD Monitoring Survey;National Centre for Disease Informatics and Research. [Last accessed on 2021 Nov 14]. Available from:https://ncdirindia.org/nnms/resources/NNMS%202017-18%20-%20Report.pdf .
- 2.National Programme for Prevention and Control of Cancer Diabetes Cardiovascular Diseases and Stroke;Ministry of Health &Family Welfare. [Last accessed on 2021 Nov 14]. Available from:https://main.mohfw.gov.in/sites/default/files/Operational%20Guidelines%20of%20NPC DCS%20%28Revised%20-%202013-17%29_1.pdf .
- 3.Ayushman Bharat –Health &Wellness Centre. Ministry of Health &Family Welfare. [Last accessed on 2021 Nov 14]. Available from:https://main.mohfw.gov.in/sites/default/files/Operational%20Guidelines%20on%20Preve ntion%2C%20Screening%20and%20Control%20of%20Common%20NCDs_1.pdf .
- 4.FSSAI. [Last accessed on 2021 Nov 14]. Available from:https://www.fssai.gov.in .
- 5.Fit India –be fit. [Last accessed on 2021 Nov 14]. Available from:https://fitindia.gov.in .
- 6.National Multi-sectoral Action Plan;Ministry of Health &Family Welfare &WHO. [Last accessed on 2021 Nov 14]. Available from:https://main.mohfw.gov.in/sites/default/files/National%20Multisectoral%20Action%20Plan%20%28NMAP%29%20for%20Prevention%20and%20Control%20of%20Common% 20NCDs%20%282017-22%29_1.pdf .
- 7.Ayushman Bharat –Pradhan Mantri Jan Arogya Yojana. [Last accessed on 2021 Nov 14]. Available from:https://pmjay.gov.in/
- 8.Pradhan Mantri Bhartiya Janaushadhi Pariyojana. Bureau of Pharma PSUs of India (BPPI), Government of India. [Last accessed on 2021 Nov 14]. Available from:http://janaushadhi.gov.in/pmjy.aspx .