Project Title
Strengthening Ambulatory caRe for Non Communicable Diseases- STAR NCD
Program Officer
Dr. Roopa Shivashankar | Scientist E Division of Delivery Research
NHRP Area
Ambulatory Non-Communicable Disease (NCD) Care
Project Status
Currently ongoing- Model-1 implementation phase
Date of Start
1st March 2024
Duration
36 months
Summary
- Non-communicable diseases (NCDs) are the leading cause of death and disability globally, with nearly 80% of the burden occurring in low- and middle-income countries such as India. In India, NCDs account for approximately two-thirds of all deaths and 70% of premature mortality. Cardiovascular diseases and chronic respiratory diseases are among the major contributors. Despite national efforts, significant gaps remain in the prevention, diagnosis, treatment, and long-term management of common NCDs, particularly hypertension and diabetes. The National Noncommunicable Disease Monitoring Survey highlighted poor awareness, treatment, and control rates for both conditions.
- India has implemented several initiatives, including the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) and the India Hypertension Control Initiative (IHCI). However, challenges such as inadequate models of care, limited monitoring systems, poor integration of services, and insufficient support for chronic disease management continue to affect outcomes. Similar gaps exist in the management of chronic respiratory diseases and secondary prevention of coronary artery disease within public health systems.
- This implementation research study aims to strengthen ambulatory care services for common NCDs across four geographically diverse districts in India. Through a co-designed district-wide implementation model, the study will improve the coverage, quality, and equity of services for hypertension, type 2 diabetes mellitus, chronic respiratory diseases (COPD and asthma), and secondary prevention of coronary artery disease. The findings will inform scalable strategies for strengthening NCD care under the National Programme for Non-Communicable Diseases.
Public Health Relevance
- This study addresses a critical public health need by developing and evaluating a district-wide implementation model to strengthen ambulatory care services for common NCDs within the existing public healthcare system. By focusing on improving service delivery, care coordination, disease monitoring, and patient retention in care, the study aims to enhance the quality, coverage, and equity of NCD services.
- The study is particularly relevant to India’s commitment towards achieving Universal Health Coverage and Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality from NCDs by one-third by 2030. The findings will generate implementation evidence on scalable and sustainable strategies for integrating hypertension, diabetes, chronic respiratory disease, and secondary cardiovascular disease prevention services into routine primary healthcare. The lessons learned can inform policy and programme strengthening under the National Programme for Prevention and Control of Non- Communicable Diseases (NP-NCD) and contribute to improved health outcomes for millions of people living with chronic diseases across India.
Problem Statement
- Despite the expansion of the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD), significant gaps remain in the continuum of care for common NCDs in India. Low rates of awareness, treatment, follow-up, and disease control for hypertension and diabetes, along with limited integration of services for chronic respiratory diseases and secondary prevention of coronary artery disease, continue to contribute to preventable morbidity and premature mortality. Health system challenges, including inadequate human resources, inconsistent availability of medicines and diagnostics, weak information systems, and fragmented service delivery, further limit the effectiveness of NCD care. There is a need for scalable and sustainable models of ambulatory care that strengthen the quality, coverage, continuity, and equity of NCD services within the public healthcare system.
Objectives
- Primary Objective:
- 1. To assess the status of implementation of the NCD program in terms of its coverage, quality of service delivery and equity for major NCDs at different levels of the health care delivery system and assess readiness to implement strategies for improving ambulatory NCD care.
- 2. To co-design the implementation strategies, develop a model for improved delivery of NCD care at selected districts and iteratively implement the model and refine for scaling to the district
- 3. To implement the model and study implementation outcomes of coverage, quality of service delivery, and equity and determine the incremental cost implication for the health care delivery system in the context of the national program for NCDs.
Project Sites
- 1. AIIMS, Madurai
- 2. AIIMS, Nagpur
- 3. AIIMS, New Delhi
- 4. CCDC, New Delhi
- 5. Christian Medical College , LudhianaCMC, Vellore
Anticipated Outcomes
- 1. Hypertension (WHO global target)
- • Blood pressure control of < 140/90 mmHg in at least 50% of adults having high blood pressure
- 2. Diabetes (WHO global diabetes compact)
- • 80% of people to be tested for diabetes
- • 80% of those on treatment to achieve blood glycemic control
- 3. Coronary artery disease (CAD)
- • To assess the feasibility of implementing secondary prevention of CAD care at primary care facilities
- 4. Chronic Respiratory Disease (CRD)
- • Operationalize diagnosis and follow up care for CRD at primary care facilities
Activities
- Year 1 Liaising activities:
- 1. DG ICMR letter to all the state health secretaries before proposal development
- 2. DG ICMR held a meeting with all the Mission Directors of NHM
- 3. Meetings-MDs NHM of Tripura, Maharashtra, Andhra Pradesh and CHO Faridabad
- Year 1 Technical Support Activities:
- 1. Finalization of study tools (2-days meeting in ICMR)
- 2. Organized training on the NCD portal (MoHFW) and e-sanjeevini platform (CDAC) for a better understanding of digital technology
- 3. Convened the expert committee group to help operationalize the CRD
- 4. Organized expert meeting to draft model-0 implementation strategies
- 5. Online and in-person RAPID Qualitative Analysis workshop organized
- 6. Review of Cost Evaluation part of the proposal by DG ICMR meeting
- 7. Weekly investigators meeting
- 8. 1st Annual Progress Review Meeting at ICMR HQs
- Year 2 Liaising Activities:
- 1. Meeting with Health Secretary, Tripura in Agartala (Tripura)
- 2. Meeting with Director General Health Services (DGHS), Haryana and Mission Director National Health Mission (MD-NHM), Haryana
- 3. Meeting with Additional Chief Secretary (ACS), Haryana in Faridabad (Haryana)
- 4. Meeting with Deputy Commissioner, Faridabad (Haryana)
- 5. Meeting with Chief Secretary (Health), Maharashtra with DG- ICMR to present the NHRP project- STAR-NCD and other ICMR activities in Mumbai
- 6. Meeting with District Magistrate of Chittoor
- 7. Meeting with Commissioner, Health Services and MD-NHM, Maharashtra to discuss two ongoing National Health Research Priority (NHRP) Projects in Maharashtra- STAR NCD and STEPS-India
- 8. Meeting with TSU members along with STAR-NCD experts
- Year 2 Technical Support Activities:
- 1. Weekly investigators meetings
- 2. Support in Supply chain and management-related meetings for STAR-NCD in Tripura
- 3. Support in co-design and meeting with STAR-NCD Tripura Team & NHM Tripura in Agartala (Tripura)
- 4. Field Monitoring and support visit with experts- Chittoor (Andhra Pradesh)
- 5. Field Monitoring and support visit with experts- Faridabad (Haryana)
- 6. Field Monitoring and support visit with experts- Nagpur (Maharashtra)
- 7. Site implementation research support online meeting with experts for Gomati (Tripura)
- 8. 2nd Annual Progress REview Meeting
Policy Implications & Public Health Impact
- This study will generate actionable evidence on the implementation of integrated, people-centered ambulatory care models for common non-communicable diseases within India's public health system. The findings will inform policy decisions related to strengthening service delivery under the National Programme for Prevention and Control of Non-Communicable Diseases (NP- NCD), particularly in the areas of screening, treatment protocols, follow-up care, human resources, supply chain management, and health information systems.
- By identifying effective and scalable strategies to improve the continuum of care for hypertension, diabetes, chronic respiratory diseases, and secondary prevention of coronary artery disease, the study has the potential to enhance service coverage, quality, equity, and treatment outcomes.
- The evidence generated can support national and state governments in optimizing resource allocation, strengthening primary healthcare systems, and accelerating progress towards Universal Health Coverage and Sustainable Development Goal 3.4, ultimately contributing to reduced morbidity, premature mortality, and disability due to NCDs in India.
Publications
- 1. Haryana government issued a letter for AYUSH Medical Officers (AMOs) of the State to actively participate in NPNCD programme activities at AAMs-such as health promotion, early detection, patient follow-up, and dispensing of medicines prescribed by the Medical Officer In-Charge (Health)
- 2. District Health Administration of Gomati district, Tripura, issued a letter for implementation of Standard Operating Procedure (SOP) for Model Intervention under STAR NCD Project
- Government of Tripura under Mukhya Mantri Niramay Arogya Abiyaan, the Chief Minister Lifestyle Disease Priority Initiative, plan for conducting 14 days Special Comprehensive NCD (Non-Communicable Disease) screening, Detection and Treatment for individuals aged 30 and above. This will be done Bi-annually in campaign mode till 2028
Achievements
Resources
Media