NCDs & Eye Health
Converging interests and opportunities for
collaboration
Course 17: Neglected Tropical Diseases & NCDs
9th GA of IAPB
Hyderabad; 19th September 2012
Dr. Damodar Bachani, MD
Percentage of NCD deaths, by cause
in WHO Regions, 2008
100%
Other NCDs
% of Death
80%
Diabetes
60%
Respiratory
diseases
40%
Cancers
20%
Cardiovascular
diseases
Ea
s
te
Source: WHO global Health observatory 2011 http://apps.who.int/ghodata/
cif
ic
sia
W
es
t
er
n
Pa
tA
So
ut
hEa
s
rn
M
Eu
ro
pe
n
ed
ite
rr
an
ea
ica
Am
er
Th
e
Af
ric
s
a
0%
Four major NCDs
cause 80% of deaths
due to NCDs in all
WHO Regions
Distribution of deaths by major causeIndia 2001-2003
Others
9.9% (N=11,242)
Injuries
9.6%
(N=10,890)
Noncommunicable
disease
42.4%
(N=48,170)
Communicable
disease, maternal
& perinatal
conditions,
nutritional
deficiencies
38.2%
(N=43,390)
Deaths due to NCDs outnumber deaths due to
communicable diseases, maternal and perinatal causes
and nutritional conditions combined
Source: RGI-CGHR Million Death Study
Causes of Death (%) in Urban Population
(25 to 69 years) India: 2001-2003
Cardiovascular Diseases
17
32.8
Malignant & other
Neoplasms
COPD, Asthma & other
Respiratory Diseases
Diabetes Mellitus
4.3
Motor vehicle accidents
7.7
Unintentional Injuries
3.3
Digestive Diseases
5.8
Genito-urinary diseases
3.6
11.3
3.7
2.8
7.7
Tuberculosis
Symptoms, signs & ill
defined conditions
Other causes
4 major NCDs- Cardiovascular diseases, Malignant & other
Neoplasms, COPD, Asthma & other respiratory diseases &
Diabetes Mellitus contributes to 55% of the total reported
deaths in urban area
Source :Special Survey of Deaths,
Registrar General of India
Causes of Death (%) in Rural Population
(25 to 69 years) India: 2001-2003
Cardiovascular Diseases
19.6
COPD, Asthma, other
Respiratory Diseases
22.9
Malignant & other
Neoplasms
Unintentional Injuries
Intentional Self harm
5.5
Digestive Diseases
5.5
10.9
3.1
Tuberculosis
Malaria
Diarrhoeal Diseases
10.7
8.9
4.9
3.1
4.9
Symptoms, signs & ill
defined conditions
Other Causes
3 major NCDs-Cardiovascular diseases, COPD,
Asthma & other respiratory diseases, Malignant &
other Neoplasms contributes to 43% of the total
reported deaths in rural area
Source :Special Survey of Deaths,
Registrar General of India
National Health Programs for
NCDs initiated before 2007
 National Cancer Control Program
 National Blindness Control Program
 National Mental Health Program
 National Iodine Deficiency Disorders Control
Program
 National Tobacco Control Program
 Trauma Care Facility on National Highways
 National Deafness Control Program
National Health Programs initiated
since 2007
 National Program for Prevention and Control of Fluorosis
 Pilot Project on Oral Health
 National Program for Prevention and Control of Cancer,





Diabetes, CVD, Stroke
National Program for Health Care of the Elderly
Pilot Program for Prevention of Burn injuries
Upgradation of Department of PMR in Medical Colleges
Disaster Management/Mobile Hospitals/ CBRN
Organ and Tissue Transplant
Strategies to address NCDs 2012-17
1.
2.
3.
4.
5.
6.
7.
8.
9.
Health Promotion for healthy life styles that preclude NCDs and their
risk factors
Specific prevention to reduce exposure to risk factors
Early Diagnosis through periodic/opportunistic screening of population
and better diagnostic facilities
Infrastructure Development and facilities required for management of
NCDs
Human Resources and their capacity building for prevention and
treatment of NCDs
Establish Emergency Medical Services with rapid referral systems to
reduce disability and mortality due to NCDs
Treatment and care of persons with NCDs including rehabilitation and
palliative care
Health Legislation and population and evidence based interventions
wherever applicable through multisectoral approach for prevention of NCDs
Building evidence for action through surveillance, monitoring and
research.
Services in Public Sector Health System
Tertiary level Institute
Medical Colleges, Tertiary Cancer Centres,
Regional geriatric Centres, Centres of Excellence
[Tertiary care, Training, Research]
District Hospital
NCD Clinic, Geriatric Clinic, Cardiac Care Unit,
Cancer Care Facility etc.
[Health Promotion; Early diagnosis & Management; Home Based Care; Day Care
Facility]
Community Health Center
NCD Clinic, Geriatric Clinic
[Health Promotion, Early diagnosis & Management; Laboratory Investigations, Home Based Care,
Referral]
Sub Center
Screening Services
[Health Promotion; Opportunistic Screening; Referral]
Referral
National Health Programmes
A. Life Style Chronic Diseases
Cancer
2. Tobacco Control
3. Diabetes, Cardiovascular Diseases (CVD) & Stroke
4. Chronic Obstructive Pulmonary Diseases*
5. Chronic Kidney Diseases*
6. Organ and Tissue Transplant
7. Mental Disorders
8. Prevention and Management of Nutritional Disorders &
Obesity*
9. Iodine Deficiency Disorders
10. Fluorosis
11. Oro-dental disorders*
* New
1.
B. Disability Prevention & Rehabilitation
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
Trauma (including Road Traffic Accidents)
Burn Injuries
Disaster Response*
Emergency Medical Services*
Musculo-skeletal (Bone and Joint) Disorders*
Physical Medicine & Rehabilitation
Blindness
Deafness
Health Care of the Elderly (Geriatric Disorders)
Neurological Disorders (Epilepsy, Autism, Dementia)*
Congenital Diseases*
Hereditary Blood Disorders (Sickle Cell Anaemia,
Thalassemia, Haemophilia)*
* New
Experiences & Issues for Effective
Implementation



Health promotion and prevention need to be given
more attention to reduce the incidence of NCDs and
their risk factors.
As NCDs are prevalent across the country, the
programmes need to be expanded to the entire
country to cover urban, rural and slum population
The States need to be given flexibility in
implementation of the programmes based on their
public sector health system, prevalence and needs. The
flexibility would be within broad policy framework.
Experiences & Issues… (contd.)


Convergence and integration would be critical in
implementation of large number of interventions with a
unified management structure at various levels
Integration of cross cutting components like health
promotion, prevention, screening of population,
training, referral services, emergency medical services,
public awareness, programme management, monitoring
& evaluation etc. would save on costs and make
implementation more effective.
Opportunities & Challenges








Political will
Healthy Public Policy
Resource Mobilization
Sustainable Infrastructure & Systems
Human resources & their capacity building
Convergence & Integration
Partnership & Collaboration
Quality assurance, M&E for evidence
Thanks