Associate Professor & HOD Department of .... services provided as planned under the program, at the sub centre, CHC, district and state levels. .... State NCD Cell will be established preferably in the Directorate of Health services (DHS) or any ...
NHPP26- Non-Communicable Disease Control Programme I Quadrant – I Personal details: Role Principal Investigator
Name Dr. C.P. Mishra
Paper Coordinator
Dr. Davendra Kumar Taneja
Content Writer/Author
Dr. Sarbjeet Khurana,
Content Reviewer
Dr. Shweta Sharma Dr. Bratati Banerjee
Affiliation Professor Department of Community Medicine Banaras Hindu University, Varanasi Uttar Pradesh, India Director Professor Department of Community Medicine Maulana Azad Medical College New Delhi, India Associate Professor & HOD Department of Epidemiology Institute of Human Behavior and Allied Sciences, Delhi, India Professor Department of Community Medicine Maulana Azad Medical College New Delhi, India
Description of Module: Items Subject Name Paper Name Module Name/Title
Description of Module Community Medicine National Health Policies and Programmes Non-communicable Diseases Control Programme (I) – Diabetes, cardiovascular Diseases and Stroke
Module Id Pre-requisites
NHPP26 Knowledge on non-communicable diseases; Knowledge on national progammes in general At the end of this module the students will be able to: • Describe the problem of non-communicable diseases. • Describe the objectives and strategies of the national programme on non communicable diseases regarding diabetes, cardiovascular diseases and stroke National Programme, diabetes, cardiovascular diseases, stroke, noncommunicable diseases
Objectives
Key words
Introduction The spectrum of chronic, non- communicable diseases encompasses cardiovascular diseases (CVDs), stroke, type- II diabetes and several cancers which affect people across all ages and nationalities. This epidemic of NCDs is on the rise in the developed countries and at a faster pace in the low and middle income countries. NCDs are like a double edged sword, as on one hand they are a set back to the economy of a nation by being a burden on the health system, also they reduce the working efficiency of the patient and afflict the family with long term health care expenditure. Heart diseases, Stroke and Diabetes are projected to increase cumulatively and India would suffer loss of 237 billion dollars during the decade 2005-2015 (Planning Commission 12th Five year Plan).1 Taking into consideration this slow percolation of NCDs into the Indian population the Government of India had launched various vertical programmes such as National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS), National Cancer Control Programme, National Tobacco Control Programme, etc.2 The NPCDCS is a multidimensional approach which addresses health promotion, prevention and control of various NCDs.
Learning Outcomes At the end of this module the students should be able to:
Describe the problem of non-communicable diseases.
Describe the national programme on non communicable diseases regarding diabetes, cardiovascular diseases and stroke in terms of:
NPCDCS program.
Objectives of the programme.
Program components.
Strategies.
Management Structure.
Services offered.
Achievements.
Main Text 1. Burden 1.1. Global Burden 1
As mentioned in the Global Status report on NCDs 2014, the NCDs are causing more number of deaths as those compared to all other causes combined together.
As a projection the NCD deaths would increase from 38 million (2012) to 52 million by 2030.
More than 40% of the deaths from the 38 million deaths due to NCDs in 2012 were premature and affected people under 70 years of age.3
There has been an upsurge in NCD deaths in WHO South-East Asia Region from 6.7 million in 2000 to 8.5 million in 2012, and in the Western Pacific Region, from 8.6 million to 10.9 million.
PROPORTION OF GLOBAL DEATHS UNDER AGE OF 70, (2012) 14%
34%
NCDs
Communicable, Matern al, Perinatal and Nutritional conditions Injuries
52%
2
1.2. National Burden:
India is facing a growing burden of non-communicable diseases, over the decades towards which socio-economic development, industrialization, rapid urbanization, demographic changes and changing lifestyles have all slowly contributed.
The four leading chronic diseases in India, according to their prevalence, are in descending order: cardiovascular diseases (CVDs), diabetes mellitus, chronic obstructive pulmonary disease (COPD) and cancer. All of them are projected to continue to increase in prevalence in the near future.4
India is often referred to as the diabetes capital of the world. It is currently experiencing an epidemic of Type 2 diabetes mellitus (T2DM) and has the largest number of diabetic patients.5
Indians seem to have a genetic predisposition towards diabetes. This become manifest on exposure to richer diet and consequent increase in body weight.6
In India, non-communicable diseases (NCDs) were responsible for 40% of all hospital stays and 35% of all outpatient visits in 2004.5
As of 2005, India experienced the “highest loss in potentially productive years of life” worldwide.4
Based on latest research about one million cases of stroke occur every year in the country, of which more than 100,000 die. This could be an underestimate as not all strokes are recognised and treatment sought for it.6
In a study conducted as a part of the National non-communicable diseases (NCD) risk factor surveillance, in different geographical sites (North, South, East, West/Central) in India. The major risk factors were studied using modified WHO STEPS approach and diabetes was diagnosed based on self-reported diabetes diagnosed by a physician, it was found that the overall prevalence of selfreported diabetes was highest in Trivandrum in Kerala (9.2%), followed by Chennai in Tamilnadu (6.4%) and Delhi (6.0%). This was followed by Ballabgarh in North India (2.7%), Dibrugargh in East India (2.4%) and the lowest was observed in Nagpur in West/Central India (1.5%) (7)
1.3. Economic Burden:
During 2011–2025, economic losses owing to NCDs under a “business as usual” scenario in low- and middle-income countries have been estimated to be US$ 7 trillion. The figure outweighs the annual US$ 11.2 billion cost of implementing a set of high-impact interventions to reduce the NCD burden.3
The projected cumulative loss of national income for India due to non-communicable disease mortality for 2006-2015 is expected to be USD237 billion. By 2030, this productivity loss is expected to double to 17.9 million years lost.4 3
As for the out of pocket expenditure involved for NCDs,there has been an increase of nearly 50% i.e. from 31.6% in 1995-96 to 47.3% in 2004.The major portion of the money is used for diagnostic tests, purchasing of medicines, and medical equipments.5
2. Introduction to the NPCDCS programme The Government of India had launched a flagship programme called the NRHM in 2005. The objective of the program was to expand access to quality health care to rural populations by improving the institutional mechanism for health care delivery, integrating the Family Welfare and National Disease Control Programmes under an umbrella approach for optimisation of resources and manpower, involving the various stakeholders such as the public and strengthening and upgrading the public health infrastructure to Indian Public Health Standards (IPHS). The aim of the NPCDCS was to integrate the interventions designed for NCDs into NRHM. This integration would result in optimum use of scarce resources, thus ensuring the sustainability of the program. The Central Government thus proposed to supplement the efforts of the states for prevention and control of non communicable diseases (NCDs) especially cancer, diabetes, CVDs and stroke, by offering technical and financial support through the National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS).
2.1. Objectives of the program 2.1.1 To prevent and control common NCDs through behavioural and life style changes, 2.1.2 To provide early diagnosis and management of common NCDs, 2.1.3 Capacity building at different levels of health care for prevention, diagnosis and treatment common NCDs, 2.1.4 To train human resource within the public health setup (doctors, paramedics and nursing staff) to cope with the increasing burden of NCDs, and 2.1.5 To establish and develop capacity for palliative &and rehabilitative care
2.2. Program Component The NPCDCS program has two components: (i) Diabetes, CVDs and Stroke (ii) Cancer
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of
These two components have been integrated at different levels of the public health care system as far as possible for optimal utilization of the resources. The NCD cell would closely monitor the activities and services provided as planned under the program, at the sub centre, CHC, district and state levels. Cardiovascular, Diabetes and Stroke component of the program: - NCD clinic at 100 district hospitals and 700 Community Health Centre (CHCs) for diagnosis and management - Provision for availability of life saving drugs in 100 districts - Cardiac Care Unit (CCU) at each of the 100 district hospitals - Opportunistic screening for high blood pressure and diabetes to all people above 30 years including pregnant women of all age groups at all 20,000 sub centers. Home based care for bed ridden patients in all 100 districts.
2.3. Strategies The strategies proposed will be implemented in 20,000 Sub Centers and 700 Community Health Centres in 100 Districts across 21 States during 2010-12.
2.3.1 Prevention through behavior changeAs an approach of primary prevention, when the disease has yet not manifested itself in the individual and not even in the healthy masses, behaviour change is a tool of use. For this approach the prerequisites necessarily to be known are the risk factors of cancer, hypertension, obesity, diabetes and cardiovascular diseases which are namely:
unhealthy diet,
physical inactivity,
stress and
consumption of tobacco and alcohol
Through this strategy of behavior change, attempts will be made to create awareness about NCDs and promote healthy lifestyle habits in the community members. -These interventions will be carried out through the peripheral health functionaries and NGOs. The various tools such as mass media, community education and interpersonal communication will be used for behavior change. Five main messages will be emphasized:
increased intake of healthy foods
increased physical activity through sports, exercise, etc. 5
avoidance of tobacco and alcohol
stress management
Warning signs of cancer
The task of Interpersonal communication will be carried out through ASHAs/ AWWs/ SHGs/ Youth clubs, Panchayat members etc. These workers/groups will also help in Social mobilisation for diagnostic camps. Education material will be developed at central/State level to facilitate IEC/BCC activities. In various institutions such as schools and workplaces targeted intervention programmes relevant to the individuals as per the age group will be designed.
2.3.2 Early Diagnosis Opportunistic screening: As a response of secondary level of prevention early diagnosis of NCDs will comprise of opportunistic screening of persons above the age of 30 years at the point of primary contact with any health care facility. Opportunistic screening will have in built elements of: mass awareness, self-screening Trained health care providers. Such screening aims to identify those who are at a high risk of developing diabetes and CVD and suggesting further investigations. It involves simple clinical examination comprising of relevant questions and easily conducted physical measurements (such as history of tobacco consumption and measurement of blood pressure etc.). If the investigations cannot be performed at the health facilities these can be outsourced.
2.3.3 Treatment A special clinic termed as “NCD clinic’’will be set up at CHCs and District Hospitals. These clinics will undertake complete examination of patients referred by lower health facility/Health Worker as well as of those reporting directly. The key functions would include screening, diagnosis and management (including diet counseling, lifestyle management) and home based care
2.3.4 Capacity building of human resource
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The state will identify Training Institutes/Centers in consultation with the Centre. A team of trainers at identified Training Institutes/Centers will train the Health personnel at various levels for health promotion, prevention, early detection and management of NCDs.
2.3.5 Surveillance, Monitoring and Evaluation At regular intervals the programme will be monitored and evaluated at all levels i.e. District, State and Central levels by the process of periodic visits and review meetings. A NCD cell will supervise and monitor the programme including other NCD programmes. During the period of 2010-2012 the program strategies swill be implemented in 20,000 Sub Centers and 700 Community Health Centre in 100 Districts across 21 States. The strategies proposed will be implemented during 2010-12.
2.4. Management Structure 2.4. 1 National NCD Cell National NCD Cell will be responsible for overall planning, implementation, monitoring and evaluation process and also for the achievement of physical and financial targets planned under the programme. It will function under the guidance of Programme in-charge from the Ministry of Health and Family Welfare along with the identified officers/officials from the Directorate General of Health Services.
Organization Structure of National NCD Cell TECHNICAL WING
Deputy Director General CMO (Cancer) CMO (Diabetes & CVD) CMO (Geriatric Care) Consultants
ADMINISTRATIVE WING
Additional Secretary/Joint Secretary Director (NCD) Under Secretary (NCD) Under Secretary (NCD) Section officer
Role and responsibilities of the National NCD Cell is as under: • Nodal body to roll out NPCDCS in the country. • Plan, Coordinate, and Monitor all the activities at National and State level. • Develop operational guidelines, Standard Operating Procedures (SOP), Training modules, Quality benchmarks, Monitoring and reporting systems and tools. • Monitoring and evaluation through HMIS, Review meetings, Field observations, surveillance, operational research and evaluation studies. 7
• Prepare National Training Plan: Curriculum, Training resource centres, training modules and organise national level training programmes. • Procurement of equipment and supplies for items to be provided as commodity assistance. • Release of funds and monitoring of expenditure.
2.4.2 State NCD cell State NCD Cell will be established preferably in the Directorate of Health services (DHS) or any other space as provided by the State Government. The NCD Cell will be responsible for overall planning, implementation, monitoring and evaluation of the different activities, and achievement of physical and financial targets planned under the programme in the State. The Cell shall function under the guidance of State programme Officer (SPO NCD). SPO (NCD) will be a State level health official identified by the State government. A. Composition: State NCD Cell will be supported by following contractual staff 1. State Programme Officer 2. Programme Assistant 3. Finance cum Logistics Officer 4. Data Entry Operators (2) B. Role and responsibilities of the State NCD Cell is as under: 1. Preparation of State action plan for implementation of NPCDCS strategies. 2. Organize State and district level trainings for capacity building. 3. Develop district wise information of NCD diseases including cancer, diabetes, cardiovascular disease and stroke through health facilities including sentinel sites. 4. Ensure appointment of contractual staff sanctioned for various facilities. 5. Maintaining State and District level data on physical, financial, epidemiological profile. 6. Convergence with NRHM activities and other related departments in the State/District. 7. Release of funds to districts for continuous flow of funds and submit Statement of Expenditure and Utilization Certificates. 8. Ensure availability of palliative and rehabilitative services including oral morphine. 9. Monitoring of the programme through HMIS, Review meetings, Field observations. 10. Public awareness regarding health promotion and prevention of NCDs through following approaches: ∙ Development of audio-visual and print media messages ∙ Social mobilization through involvement of community leaders, NGOs ∙ Mass media Campaigns ∙ Distribution of pamphlets and handouts ∙ Flip charts to ground level workers for health education in the community ∙ Advocacy and public awareness through Street Plays, folk methods,wall paintings,hoardings 2.4.3 District NCD Cell
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The Cell will be guided by the District programme Officer (DPO NCD) and will be supported by the officials from the District health system. DPO NCD shall be a district level health official identified by the State government. A. Composition: District NCD Cell will be supported by following contractual staff: 1. District Programme Officer 2. Programme Assistant 3. Finance cum Logistics Officer 4. Data Entry Operator B. Role and responsibilities of the District NCD Cell 1. Preparation of District action plan 2. Engaging contractual personnel for the programme 3. Capacity building at sub-district/CHC level trainings 4. Maintain and update district database of NCDs 5. Maintain fund flow and submit Utilisation Certificates 6. Maintain District level data on epidemiological and financial progress 7. Convergence with NRHM activities and with the other related departments in the States/Districts 9. Ensure availability of palliative and rehabilitative services
2.5 SERVICES It is envisaged to providing preventive, promotive, curative and supportive services (core and integrated services) for Diabetes, Cardio-Vascular Diseases (CVD) and Stroke at different levels of health care The package of services would depend on the level of health facility.The range of services will include ∙ health promotion ∙ psycho-social counseling ∙ management (out-and-in-patient) ∙ day care services, home based care ∙ palliative care ∙ referral services ∙ linking the District Hospitals to private laboratories ∙ Outreach services- NGOs will help to provide the additional components of continuum of care and support The Non Communicable Diseases are financial challenges to both the individual and the health care authorities. National strategies have to focus on prevention and health promotion as key tools to reduce disease and economic burden. Health education programmes which are inclusive of daily routine of exercise, weight reduction, early diagnosis and screening are some of the key interventions that need to be promoted at various levels of health facilities. The services under the programme would be integrated below district level and will be integral part of existing primary health care delivery system.
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Packages of Services to be made available at different levels under NPCDCS
HEALTH FACILITY
PACKAGE OF SERVICES
Sub-centre
1. Health promotion for behavior change 2. ‘Opportunistic’ Screening using B.P measurement and blood glucose by strip method 3. Referral of suspected cases to CHC
CHC
1.Prevention and health promotion including counseling 2. Early diagnosis through clinical and laboratory investigations (Common lab investigations: blood sugar, lipid profile, ECG, ultrasound, X ray etc.) 3. Management of common CVD, diabetes and stroke cases (out patient and in patients.) 4. Home based care for bed ridden chronic cases 5. Referral of difficult cases to District Hospital/higher health care facility
District Hospital
1. Early diagnosis of diabetes, CVDs, Stroke and Cancer 2. Investigations: Blood sugar, lipid profile, Kidney Function Test (KFT), Liver Function Test (LFT), ECG, ultrasound, X ray, colposcopy, mammography etc. (if not available, will be outsourced) 3. Medical management of cases (out-patient, inpatient and intensive Care ) 4. Follow up and care of bed ridden cases 5. Day care facility 6. Referral of difficult cases to higher health care facility 7. Health promotion for behavior change
2.6 Achievements ∙
Operational guidelines have been developed
∙
Training modules have been developed for medical officers and healthcare workers
∙
Human resource under state and district level in process
∙
Signed MOU received from 11 States
∙
Setting up of State and district NCD cells in process
∙
Proposal for surveillance of NCD risk factors is under submission.
The program has an aim to achieve behavior change in the individuals so that they adopt healthy dietary choice, incorporate physical activity and keep a check on the various risk factors such as tobacco, alcohol, refined food etc. associated with common NCDs.
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Summary Noncommunicable diseases (NCDs) pose a major health challenge to the individuals and the authorities, in terms of both the human misery they cause and the harm they inflict on the socioeconomic fabric of countries, with no distinction across developed or developing nations. NCDs will not only be the foremost cause of disability globally by the year 2020 also if not effectively managed, they will become the most expensive problems faced by our health care systems. Growing evidence suggests that when patients receive early diagnosis, effective treatments, self-management support, and regular follow-up timely, the results are better. Evidence also suggests that organized systems of care, including individual health care workers, are essential in producing positive consequences. Keeping in view the increasing burden of chronic non communicable diseases, Ministry of Health and Family Welfare, Government of India, launched the National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPPCDCS) on the 4th January, 2008 on a pilot basis. Macro, meso, micro levels of health care refer to the health care organization and community level, the policy level and patient interaction level respectively same as the three tier system of public health in our nation. Evolution at each step is necessary. Health care interventions are to be coordinated for chronic conditions using scientific evidence to guide the program strategies. Every decision-maker in the process of planning and designing the various program components has the potential to improve his or her health care system’s ability to address the growing problem of chronic conditions because today’s choices will influence the future scenario of chronic diseases.
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Refrences 1. Alwa Ala (ed), Global Status report on Noncommunicable diseases 2010. World Health Organization, Geneva. 2010. 2. Sharma K. Burden of non communicable diseases in india: setting priority for action . International Journal of Medical Science and Public Health.2013;2(1):7-11 3. Shanthi M, Anarfi BA, Chris D, Ian S. Global Status Report on non-communicable diseases 2014. World Health Organization, Geneva. 2014. 4. Reddy KS, Shah B, Varghese C, Ramdoss A. Responding to the threat of chronic diseases in India. The Lancet.2005;366(9498):1746-51 5. Upadhyay RP. An Overview of the Burden of Non- Communicable Diseases in India. Iranian J Publ Health.2012;41(3):1-8 6. Nongkynrih B, Patro BK, Pandav CS. Current Status of Communicable and Noncommunicable Diseases in India. Journal of The Association of Physicians of India.2004;52(February):118-123 7. Mohan V, Mathur P, Deepa R, Deepa M, Shukla DK, Menon GR et al. Urban rural differences in prevalence of self-reported diabetes in India--the WHO-ICMR Indian NCD risk factor surveillance.Diabetes Res Clin Pract.2007;80(1):159-68 8. Directorate General of Health Services, Operational Guidelines: National Programme for Prevention and Control of Diabetes, Cardiovascualr Disease and Stroke (NPCDCS). Ministry of Health and Family Welfare Government of India. 9. Bhatia V, Sahoo J, Subba SH, History P. Epidemic of Non Communicable Diseases: its burden and implications on India.The International Weekly Journal for Medicine. PERSPECTIVE @BULLET COMMUNITY & FAMILY MEDICINE Medical Science [Internet]. 2014;6(19). Available from: www.discovery.org.in 10. Press Information Bureau, Government of India. NPCDCS : Managing Non-Communicable Diseases. http://pib.nic.in/newsite/efeatures.aspx?relid=76249 (accessed 22/5/15). 11. World Health Organization. CARDIOVASCULAR DISEASES. http://www.who.int/nmh/publications/fact_sheet_cardiovascular_en.pdf (accessed 31/5/2015). 12. Vikaspedia. NPCDCS. http://vikaspedia.in/health/nrhm/national-health-programmes-1/npcdcs (accessed 27/5/2015). 13. Report by Director General. Global strategy for the prevention and control of noncommunicable diseases. World Health Organization, Geneva. Report No. A53/14,2000. 14. Jordan Epping Anne Jo, Innovative care for Chronic conditions: Building Blocks for Action, Global Report. Noncommunicable Disease and Mental Health World Health Organization, Geneva. 2002.
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Quadrant. III. Self-Assessment MCQs 1.
STEPS done for a) Surveillance of risk factors of non-communicable disease b) Surveillance of incidence of non-communicable disease c) Surveillance of evaluation of treatment of non-communicable disease d) Surveillance of mortality from non-communicable disease ANS: (a)
2. NPCDCS is presently being implemented in a) 35 states only b) 35 states/UTs c) 20 states d) All over the country ANS: (a) 3. The diseases under target of NPCDCS are: a) Cardiovascular diseases, Diabetes, COPD, Injuries b) Asthma, Diabetes, Cardiovascular diseases, Cancers c) Blindness, Cancers, Injuries, Stroke, Cardiovascular diseases d) Cancers, Cardiovascular diseases, Stroke, Diabetes ANS: (d)
4. Which one of the following best explains the objective of the Global NCD action plan: a) To raise the priority accorded to the prevention and control of NCDs in global, regional and national agendas b) To reduce modifiable risk factors for NCDs and underlying social determinants c) To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control d) All of the above ANS: (d) 5. Which of the following NCDs was responsible for largest proportion of deaths in 2012: a) Cardiovascular diseases b) Malignant neoplasm c) Diabetes mellitus d) Respiratory diseases ANS: (a)
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True and False 1 2 3 4
5 6
Four major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) are responsible for 82% of NCD deaths NCD clinics have been established only at tertiary healthcare facilities in India Premature deaths is not an implication of suffering from non communicable diseases The Life Course approach aims to identify the underlying biological, behavioral and psychosocial processes that operate across the life span and affect chronic disease risk and health outcomes in later life. The tool used for primary prevention of NCD is Health Promotion, in order to change the behavioral risk factors Mass and trained heath care workers are the elements of opportunistic screening except for self-screening
TRUE FALSE FALSE TRUE
TRUE FALSE
Match the following Correct Answers PHC AND Sub-center level
Services for Opportunistic screening for CVD and 1 Diabetes are available 2 National NCD cell 3 Secondary prevention Modifiable risk factor 4
Nodal body to roll out NPCDCS in the country Physiological risk factors Dyslipidemia, Inability to avail preventive health care services
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Quadrant – IV Learn more/Web Resources/Supporting Materials/Interesting Facts: S.NO. 1
2
3
4
5
FACTS WHO has strengthened its efforts to promote population-wide primary prevention of noncommunicable diseases, through the Framework Convention on Tobacco Control and the Global Strategy for Diet, Physical Activity and Health This guide was developed on the basis of the total risk approach to prevention of cardiovascular disease, elaborated in the World Health Report 2002. Development of the risk prediction charts started in 2003, followed by preparations for the development of this guide in 2004, using an evidence-based methodology. .[3]CHECK FROM REFERENCE NCDnet creation: The creation of the Global Non-communicable Disease Network (NCDnet ) is in direct support of the Objective 5 of the NCD Action Plan that specifically calls upon Member States, WHO, and international partners and other stakeholders to promote partnerships for the prevention and control of non-communicable diseases To accelerate national efforts to address NCDs, in 2013 the World Health Assembly adopted a comprehensive global monitoring framework with 25 indicators and nine voluntary global targets for 2025 (Annex 1).(6) In line with WHO’s Global action plan for the prevention and control of NCDs 2013-2020, India is the first country to develop specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025
TIME LINE 2000 2003
GLOBAL STRATEGY FOR PREVENTION AND CONTROL OF NCDS FCTC
2010
FIRST WHO Global Status Report on NCDs
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2011
UN Political declaration on NCDs. In July 2014, the United Nations General Assembly conducted a review to assess progress in implementing the 2011 Political Declaration, and recognised the progress achieved at national level since September 2011
2013
UN Task Force on NCDs
2013
WHO Global NCD Action Plan 2013-2020, including 9 global targets and 25 indicators One of them was the development of the WHO Global action plan for prevention and control of noncommunicable diseases 2013–2020 (known as the Global NCD Action Plan), including nine voluntary global targets and a global monitoring framework. The Global NCD Action Plan and the voluntary global targets were adopted by the World Health Assembly in 2013
Extra links: 1. 2. 3. 4. 5. 6. 7.
http://www.searo.who.int/india/publications/JMM_2015/en/ http://www.cdc.gov/globalhealth/ncd/ http://www.mohfw.nic.in/index1.php?lang=1&level=2&sublinkid=659&lid=651 planningcommission.gov.in/aboutus/.../WG_3_2non_communicable.pdf http://www.healthissuesindia.com/noncommunicable-diseases/ http://www.who.int/nmh/en/ http://www.who.int/nmh/events/un_ncd_summit2011/en/
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