Common Review Mission, 2019

1. Common Review Mission, 2019

2. National Programmes for :1. Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)2. Dialysis (PMNDP)3. Palliative Care4. Control of Blindness and Visual Impairment5. Health Care of Elderly6.Mental Health

3. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)

4. Epidemiological transition • Communicable to non communicable ICMR. India: Health of the Nation’s States, 2017.

5. Programme Components: NPCDCS

6. Population-based Screening • Rolled out in 219 districts – more than 1.39 crore persons screened till date • Persons above 30 years of age are targeted for screening of common NCDs – Hypertension, Diabetes and common cancers • Community Based Assessment Checklist (CBAC) • Referral of suspected cases of DM/HTN/Cancer to higher facilities

7. Infrastructure under NPCDCS • Setting up of NCD Clinics an the District and CHC levels • Setting up of Cardiac Care Units at District level • Setting up of Day Care Centres at District level • Support to States/UTs under NHM for infrastructure strengthening, manpower, equipment drugs & diagnostics

8. Checklist – CRMCommunity • Have you been screened for diabetes, hypertension and cancer recently? • Do you know about your health status? What motivates you to follow a healthy lifestyle? • When was the last camp for screening diabetes, hypertension and cancer conducted in your area? • What do you think causes cancer? • What is your idea of healthy diet?

9. Sub Centre/ Health Wellness Centre • Is there line list available with ANM & ASHA of patients with Hypertension, Diabetes & Cancer? Number of cases referred to Medical Officer • Total Individuals screened, diagnosed and treated for • Hypertension • Diabetes • Oral Cancer • Breast Cancer • Cervical Cancer • Number of cases who are receiving treatment

10. Sub Centre/ Health Wellness Centre • Availability of fixed days for Clinics at health facilities • Availability of lifestyle and diet counseling services at the facilities • Availability of drugs • In case the SHC are yet to be upgraded as HWC – • Medicines- Check for Anti-hypertensives and Antidiabetics • Diagnostics- • Is there any follow up of the patients who were referred to higher centers?

11. PHC • Facility of OPD clinics at health facility? • Availability of lifestyle and diet counseling services at the facilities • Availability of drugs • Is there any follow up of the patients who were referred to higher centres?

12. CHC • Does the facility have NCD Clinic? • Availability of drugs • Facility of lifestyle and diet counseling services at the CHC • Is there any follow up of the patients who were referred to higher centres?

13. District Hospital • Total Individuals screened, diagnosed and treated for • Hypertension • Diabetes • Oral Cancer • Breast Cancer • Cervical Cancer • Availability of lifestyle and diet counseling services at the facilities

14. District Hospital • Availability of drugs • VIA Training: • Number of Doctors trained • Number of Staff Nurses trained

15. State • Number of HWCs/SHCs/ PHCs where Universal Screening of NCDs has started

16. PRADHAN MANTRI NATIONAL DIALYSIS PROGRAM (PMNDP)

17. PMNDP • To improve access to dialysis services • Being implemented in PPP / in-house mode. In case of PPP mode : • Water, Electricity and space to be provided by the District hospital • HR, dialysis machine, RO plant infrastructure, dialyser, consumable by the private partner • Dialysis services to be provide free of cost to BPL patients under PMNDP – support provided under NHM to States / UTs

18. Checklist – CRM Community • Are you aware of dialysis service in government hospitals?

19. State • Status of PM National Dialysis Program in State; • Is it completely free to BPL patients? • Are patients charged for drugs, consumable and lab test related to dialysis? • Mode of dialysis service delivery (PPP / In-house) • Is there any real-time dashboard indicating activity of service provider (PPP)? • Number of patients waitlisted in each facility • Patients died in last year due to infection or cross contamination

20. State • How many dialysis machines are available in the entire State? • What is the utilization rate of the machine? • What is the average waiting time (in days) for receiving of dialysis services

21. District Hospital/ SDH • Does facility reuse the dialyser and other consumables? • Provision of dialysis for sero-positive patients • Is there any checklist available at dialysis center for ensuring quality • Record of activity conducted i.e. patients’ clinical data and diagnostic test results. • Record on medical equipment maintenance, quality checks on RO water and other microbial growth surveillance. • Is dialysis adequacy determined for each dialysis cycle by Kt/V technique or URR ratio?

22. District Hospital/ SDH • The frequency of Nephrologists’ visit to the dialysis center.(Daily/Weekly/Fortnightly/Monthly) • Is staff appointed for dialysis services vaccinated? • Is there any IT based software/Patient registry in place for capturing the patient data? • Is there a nodal officer to for monitoring dialysis services? • Is there a periodic monitoring at facility level by nodal officer? • Approx. number of patients provided dialysis service in a day.

23. State/ District • Monitoring and evaluation: • Is there a nodal officer for monitoring dialysis services? • Is there a periodic monitoring at state level, district level, facility level by nodal officer? • Approximate utilization: • Approx. number of patients provided dialysis service in a day. • Whether fund allotted in PIP is fully utilized

24. National Program for Palliative Care

25. Components of Program 1. Establishment of State Palliative Care Cell: (a) Co-ordinator (1) (b) Data Entry Operator (1) • 2. Palliative Care Unit at District Hospital: • (a) Physical infrastructure (renovation, equipment etc.) • (b) Human resource (1 Physician; 4 Nurses; 1 Multi-task worker) • (c) Training • (d) Miscellaneous (Drugs, Home-based PC etc.)

26. Palliative Care Activities At State level: • a) Training • b) IEC • c) Monitoring At SDH/DH level: a) OPD/IPD services b) Referral services c) Home-based palliative care • At HWC/PHC/CHC level: • a) Identification/Line-listing of patients with palliative care needs • b) Basic nursing procedures • c) Psycho-social & spiritual support • d) Home-based palliative care • e) Referral services • f) Bereavement support • g) Community awareness

27. Check-list For Community: • Any visit by healthcare provider to terminally ill person. • Any sensitization/training on basic nursing/palliative care skills given to care-givers. For SC/ HWCs: • Any line list available of persons requiring palliative care • Availability of Home-Care Kit • Availability of essential drugs • Training of MLHP/Nurses/ASHA/ ANM on palliative care • Any sensitization/training given to care-giver on basic nursing/palliative care

28. Check-list For PHC/ UPHCs: • Any line list available of persons requiring palliative care • Availability of Home-Care Kit • Availability of essential drugs for patient requiring palliative care • Training of staff on palliative care • Carrying out basic procedures like Ascites tapping, Complex wound dressing, etc. For CHC/UCHC: • Any line list available of persons requiring palliative care • Availability of Home-Care Kit • Availability of essential drugs for patient requiring palliative care • Training of staff on palliative care • Carrying out basic procedures like Ascites tapping, Complex wound dressing, etc. • Beds earmarked for palliative care patients

29. Check-list For SDH/District Hospital: • Identification of District Program/Nodal Officer • Recruitment of staff sanctioned • OPD & Referral services • Any line list available of persons requiring palliative care • Availability of Home-Care Kit • Availability of essential drugs for patient requiring palliative care • Training of staff on palliative care • Carrying out basic procedures like Ascites tapping, Complex wound dressing, etc. • Beds earmarked for palliative care patients For State: • Identification of State Program/Nodal Officer • Training workshops conducted for different categories of trainees (doctors, nurses etc) • IEC activities conducted for generating community awareness • Availability of continuum of care to palliative patients

30. NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS AND VISUAL IMPAIRMENT (NPCB&VI)

31. Introduction • Prevalence of Blindness - 1.1%. (Survey 2001-02 ) • Prevalence of Blindness - 1. %. (Survey 2006-07) • Prevalence of Blindness - 0.36% (Survey 2015-19) • WHO Goal is to reduce the prevalence of avoidable blindness to 0.3% by 2020.

32. Objectives • Reduce the backlog of blindness through identification and treatment of blind. • Develop comprehensive eye-care facilities at each level i.e. PHCs, CHCs, Dist. Hospitals, Medical Colleges and Regional Institutes of Ophthalmology. • Develop human resources for providing Eye Care Services. • Improve quality of service delivery. • Secure participation of Voluntary Organizations/Private Practitioners in eye care services. • Enhance community awareness on eye care.

33. Checklist - CRM Team • Community level • 1. Awareness regarding availability of eye care facilities/centres. • 2. Awareness regarding eye care services at Govt. facilities. • 3. Health seeking behaviour, in case of vision/eye related problems. • SC/HWC • 1. Documentation of follow up of cataract cases • 2. Village blind/visual impairment registry. • 3. Documentation of School eye screening camps.

34. PHCs/UPHCs • 1. Documentation for village blind/visual impairment registry. • 2. Documentation of school eye screening camps. • 3. Documentation of refraction cases, cataract follow up and referred cases. • CHC/UCHS • 1. Documentation for follow up of cataract and glaucoma cases. • 2. Documentation of OPD and refraction cases. • 3. Check for availability of ophthalmologist on fixed days. • 4. Availability of functional eye equipments and eye drops.

35. District/Sub-District Hospital level • Whether documentation of follow up of cataract, glaucoma and Diabetic Retinopathy cases and refraction are available or not? • Separate functional Eye OT and equipments. • Record of surgeries performed for cataract, glaucoma and others. • Record for sterilization of OT and equipments. • Documentation for outreach camps in the community. 6. Does district have any backlog cases of cataract?

36. National Program for Health Care of Elderly (NPHCE)

37. Burden of Disease in Elderly • Morbidity profile • 75% of the elderly are suffering from more than one chronic disease • Approximately 50% have two at-least two chronic diseases • 25 % elderly have 3 or more chronic diseases • Disability profile • 25 % elderly suffer from visual disabilities • 13% of elderly suffer from Hearing disabilities • 10 % of elderly suffers from Locomotors disability Source of Data: NSSO MoSPI

38. Magnitude of the Problem • 2011 census: • Elderly Population - 10.38 Crore • Percentage of elderly - 8.6% • 2050 Projections: • Elderly Population - 32.43 crore • Percentage of elderly - 20.6% • Elderly growth much faster • Population growth rate (2001-2011) = + 18% • Elderly population growth rate (2001-2011) = + 36%

39. NPHCE • Initiated in 2010-11 • Objectives of the NPHCE • To provide accessible, affordable, and high-quality long-term, comprehensive and dedicated care services to an Ageing population; • Creating a “new architecture" for Ageing; • To build a framework to create an enabling environment for "a Society for all Ages"; • To promote the concept of Active and Healthy Ageing; • Convergence with National Rural Health Mission, AYUSH and other line departments like Ministry of Social Justice and Empowerment.

40. Package of services : sub-district level to DH • Sub Centre: • Health Education related to healthy ageing, environmental modifications, nutritional requirements, life styles and behavioral changes. • Special attention to home bound / bedridden elderly persons and provide training to the family health care providers in looking after the disabled elderly persons. • Primary Health Centre: • A weekly geriatric clinic at PHC level by trained Medical Officer, Conducting Health assessment of the elderly persons and simple investigation including blood sugar, etc. • Community Health Centre • Biweekly geriatric Clinic and Rehabilitation services to be arranged by trained staff and rehabilitation worker at CHCs. • Domiciliary visits by the rehabilitation worker will be undertaken for bed-ridden elderly and counseling to family members for care such patients. • District Hospitals: • Dedicated Geriatric OPD services, In-door admissions through 10 bedded geriatric ward, laboratory investigations and rehabilitation services. • Provide services for the elderly patients referred by the CHCs/PHCs etc and refer severe cases to tertiary level hospitals

41. Checklist – CRM Community • From where do you seek treatment for any health issue? • Has any health provider visited your home for care to home bound elderly (esp. bedridden conditions)? • Has any of your family members received training to look after the disabled elderly persons by ASHA/ANM? Sub Centre/Health & Wellness Centres • Availability of information in Standard Health Card for the elderly? • Availability of supportive devices (Wheel chair, walkers etc. at the Sub centre/ HWC • Health assessment conducted based on clinical examination relating to vision, joints, hearing, chest and BP.

42. CRM Checklist–NPHCE PHCs/UPHCs • Is facility for clinical examination of elderly available at PHC or not? • Availability of supportive devices (Wheel chair, walkers etc. at the Sub centre/ HWC CHCs/UCHCs • Availability of Bi-weekly OPD • Availability of Physiotherapy unit SDH/DH • Availability of Ten-bedded Geriatric Ward for in-patient care of the Elderly. • Availability of dedicated daily NPHCE clinic • Availability of Physiotherapy unit with specialized equipment (like TENS, CRM apparatus etc.)? • No of Doctors and Staff Trained to provide geriatric care.

43. National Mental Health Program

44. Burden of Mental Disorders • Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychosis, dementia, intellectual disabilities and developmental disorders. • Key findings of the National Mental Health Survey , 2016 • Common mental disorders (CMDs), including depression, anxiety disorders and substance use disorders affect nearly 10.6% of the population • 150 million people in India are in need of intervention for mental disorders. • 1 in 20 person in the country currently suffers from depression out of which 39% suffer from Severe Depression • 0.9 % of the population at high risk of suicide • 3 out of 4 persons with mental disorders had disabilities affecting their work, family, education and other aspects of life.

45. District Mental Health Programme (DMHP) • Support is provided for making provision of basic mental health services to the community for early detection & treatment of mental illness at the District Hospital Level and below (OPD/ Indoor & follow up) • Core Components of DMHP: • Human Resource Support – engagement of Psychiatrists, Clinical Psychologists, Psychiatric Social Workers, Medical Officer, Psychiatric and Community Nurse, Monitoring & Evaluation Officer, Case Registry Assistant and Ward Assistant • Training of Medical Officers, Community Health Workers, Nurses, Pharmacists of CHC and PHC • Community awareness- Awareness generation to increase help seeking behaviour and address stigma and discrimination faced by mentally ill people. • Inter-sectoral linkages- with schools and colleges and Outreach clinics and camps • Psychotropic drugs, equipment, IPD services and ambulatory support

46. Check-list

47. Check-list

48. Thank You

49. Contribution of disease groups to deaths in India: 2016 (in %) ICMR. India: Health of the Nation’s States, 2017.

50. Prevalence of common NCDs: India • Estimated cases of diabetes in India in the age group of 20-70 years were 730 lakh in 2017. (International Diabetes Federation) • Prevalent cases of cardiovascular disease – 54.5 million, ischemic heart diseases – 23.8 million, stroke – 6.5 million, COPD – 55 million, asthma – 38 million, diabetes – 65 million in 2016. (GBD study) • India sees nearly 1.5 million cases of stroke each year (Lancet, 2018)