January 10, 2019

Winning the War on NCDs in Rural India

ACF's Sakhis during training on NCDs in Chandrapur, Maharashtra

The evidence to mount strong interventions against Non-communicable diseases (NCDs) in India, is compelling - a recent Harvard University and World Economic Forum Report on NCDs claimed that India stands to lose $4.5 trillion before 2030 due to NCD's alone.

Whilst India has a national action plan on NCDs (NPCDCS), much more work and investment is needed to strengthen the health infrastructure and interventions supporting that effort.  The government-run healthcare system in rural India largely focuses on maternal and child health and infectious disease; for instance, of the total health budget of Rs47,343 crore in 2017-18, only Rs955 crore was allotted to the NCD programme. The system now faces the dual burden of tackling not just infectious diseases, but that of NCDs as well.

Similarly, private sector efforts to promote preventive healthcare through corporate social responsibility (CSR) and other philanthropic initiatives, have largely been focused on maternal and child health. Whilst this investment has been necessary, it is important to recognize that the disease pattern in India has undergone a significant shift over the last 15 years.

In 2001-2003 a Government of India report on the causes of death in India revealed that the deaths in rural India due to communicable diseases (41 percent) were almost matched by those due to NCDs (40 percent). A follow-up study on the causes of death in rural India for the years 2010-13 showed that NCDs accounted for 47 percent of all deaths, while communicable, maternal, perinatal and nutritional conditions together accounted for 30 percent, indicating that NCDs have unquestionably become a healthcare priority.

Now more than ever, there is a need to bring NCDs into focus and simultaneously work on addressing them.  Both Government and Private investors need to bring NCDs into the spotlight and invest in tackling them for the long term.


There are a number of priority areas for investment, in tackling NCD's in rural India:

  • Promotion of Well-being & Healthy Lifestyles as Preventative Measures.  Education and awareness in encouraging modification of lifestyle and high-risk behaviour, needs to be enhanced - promoting proper nutrition and developing healthy dietary habits.
  • Early Detection - Early screening of all adult population above the age of 30, would help highlight high-risk populations.  This provides a platform for early preventive management and behaviour change through health awareness and sensitization. This will help reduce untimely deaths and in the long run, reduce NCD prevalence.
  • Access to Diagnostics & Drugs - Upgrading the Primary Health care centres (PHC's) with equipment for early screening and diagnosis and management of NCDs. Availability of drugs and essential diagnostic equipment at the primary care level is an essential prerequisite. 
  • Appropriate Treatment - Secondary and Tertiary Care is necessary. Recognizing the looming supply side issues in this area, Niti Aayog has recently recommended a public-private partnership model for setting up additional infrastructure for treatment of non-communicable diseases (NCDs) at district hospitals at reasonable costs. Under the PPP model, the private sector would be provided space for setting up facilities for treatment of cardiac, oncological, and pulmonary diseases by the state governments within the premise of existing district hospitals.  50% of NDCs can be treated effectively in primary healthcare.

Creating a cadre of trained community-based health workers, as the first crucial point of contact for health interventions in the rural communities is one impactful solution and area for enhanced investment. India paints a dismal picture in terms of the density of health workforce per 10,000 populations in comparison to global scenario. Only 20.9 health personnel were available per 10,000 population in India, of which 56.4% of all health workers were found to be in need of additional capacity building to effectively address NCDs.  Out of all qualified workers, 77.4% were located in urban areas, even though the urban population is only 31% of the total population of the country.


ACF is working towards developing a collaborative model that addresses the highlighted gaps in the current public health system in rural India, that would provide an effective, scalable model to tackle NCD's, nationally.  The intervention Strategy focuses on 3 key aspects:

  • Creating awareness, lifestyle changes and health-seeking behaviour in rural communities, via a cadre of trained Sakhis (health workers) who provide the frontline interface with the community. This includes creating community awareness on NCD risk factors, high-risk profiling via home to home visits, conducting assessments, and providing education about nutrition and various risk factors of NCD and their prevention.
  • Strengthening the capacity of key stakeholders to help deliver primary care - This includes the promotion of interface between community and service providers.  
  • ACF strengthens linkages with Government health systems to maintain a continuum of care and provides capacity building of frontline workers. Additionally, ACF ensures availability of diagnostics, screening and treatment - including a referral mechanism to maintain the continuum of care and make health schemes accessible to the community.

India's present health system lacks preparedness in tacking the NCD burden. Pivotal to winning the war on NCD's are increased investments in this area, to empower both communities and the primary health care system. 


1. Dr Yogesh Kalkonde: Rural India faces an epidemic of non-communicable diseases; March 15, 2018; IDR Online

2. Sinha R, Pati S. Addressing the escalating burden of chronic diseases in India: Need for strengthening primary care. J Family Med Prim Care 2017;6:701-8.

3. R K Srivastava and D Bachani: Burden of NCDs, Policies and Programme for Prevention and Control of NCDs in India; Indian J Community Med. 2011 Dec; 36(Suppl1): S7-S12.

Tags: Health
January 10, 2019

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