NCDS PROGRAM

NCDS PROGRAM




Non-Communicable Diseases (NCDs) refers to a group of conditions that are not mainly caused by an acute infection, result in long-term health consequences and often create a need for long-term treatment and care. Prevention and Control of Non-Communicable Disease Program covers diabetes, cardiovascular diseases, chronic respiratory diseases (asthma & COPD), cancers and hypertension. NCDs Program strategically emphasizes the use of innovative approaches for prevention, diagnosis and treatment.

 

Brief History:

The Primary & Secondary Healthcare Department (P&SHD), Government of the Punjab launched “Prevention and Control of Non-Communicable Diseases Program, Punjab” in 2016 to mobilize the provincial financial resources required for implementation of NCDs screening, awareness and continuity of care interventions. 

First PC-1:

(July 2016-June 2018) was approved by DDSC on 29-06-2016.

1st Revision:

 (July 2016-June 2018) was approved by DDSC on 27-03-2017 to Incorporate logistics (District Hardware and Furniture etc.)

2nd Revision:

 (July 2016-June 2018) was approved by DDSC on 25-10-2017 to redesign the NCDs care model with population based screening, follow up care at NCDs clinics with revised structure of the Program Management. 

rd Revision:

 (July 2016-June 2021) was approved by PDWP, P&D Department Punjab on 29-05-2018 to remodel the program as WHO NCDs Global Action Plan and PEN Framework. 

4th Revision:

 (July 2016-June 2023) was approved by PDWP, P&D Department Punjab 3rd September 2021. Revised to include: Mental Health component (Depression & Anxiety), Type 1 Diabetes, Diabetes in Pregnancy & Screening of complications associated with Diabetes. 
 130 more service delivery points with name of Well Woman Clinics (for CA Breast and CA Cervix Screening)

 

Vision

Enhance access to NCDs prevention, control & management through innovation and technology to reduce disease burden and avertible complications. 

Goal

To reduce burden of morbidity and premature mortality related to NCDs.

 

Objectives

  1. To prevent NCDs by risk factor modifications through health promotion and multi-sectoral action following a life-course approach.

 

  1. To provide access to the population for NCDs care through early detection and management by strengthening existing health systems.

 

  1. To assess and monitor NCDs and risk factor situation in Punjab through Case Registries, Operational Research and Surveys.

Program Manager: 

Dr. Faisal Masood (M.B.B.S, PAAS-18) is working as Program Manager NCDs. 

 

To Contact: Office of the Program Manager NCDs, 24-Cooper Road Lahore. Tel: 99206293-94

 

Non-Communicable Diseases:

NCDs, are by far the leading cause of death in the world, representing 71% of all annual deaths comprising mainly cardiovascular diseases (17.1 M), cancers (9.0 M), chronic respiratory diseases (3.9 M) and diabetes (1.6 M). Some 85% of “Premature” deaths occur in low- and middle-income countries.  In Pakistan, NCDs are estimated to account for 58% of total deaths. (World Health Organization)

The percentage mortality. In Pakistan for cardiovascular diseases is 29%, Cancers 8%, CRDs 5% and Diabetes is 3%, other NCDs 12%, Communicable maternal, perinatal and nutritional conditions 35% and Injuries 7 %. (World Health Organization-Noncommunicable Diseases (NCD) Country Profiles, 2018)

Figure 1: WHO, country profiles, Non-Communicable Diseases (2018)

By 2030, deaths caused by NCDs are expected to increase to 52 million while deaths caused by infectious diseases, maternal and perinatal conditions and nutritional deficiencies are expected to decline by 7 million over the same time period 3. 

Working Mechanism

OPERATIONAL MODEL FOR NCD SCREENING DESK AND CLINICS

OPERATIONAL MODEL FOR BREAST CANCER SCREENING AT WELL WOMEN CLINIC

               Female Patients visiting Gynecology Department

OPERATIONAL MODEL FOR CERVICAL CANCER SCREENING AT WELL WOMEN CLINIC

Operational Model for Diabetes in Pregnancy
 

Annotations

  1. Standard (non-pregnant) Diagnostic Criteria for Diabetes (mg/dl): (For 1st Trimester)

Normal: - BSF < 100; or 2 hrs. after 75 gm glucose < 140; or HbA1C <5.7 % or BSR <140

Impaired: - BSF 100-125; or 2 hrs. after 75 gm glucose 140-199; or HbA1C: 5.7–6.4% or BSR 140-199

Diabetes: - BSF = 126; or 2 hrs. after 75 gm glucose load = 200; or HbA1C =6.5% or BSR =200

  1. At every contact, counsel women about healthy lifestyle and risk modulation even if results of testing are normal
  2. 75 gm Gestational OGTT, Diagnostic Criteria (mg/dl): (For 2nd and 3rd Trimester)

Normal: - BSF mg/dl < 92; OR (1 hour < 180); OR (2 hours <153), OR (BSR <180), OR (HbA1C<6.5)

Gestational Diabetes: BSF = 92; OR 1 hour =180; OR 2 hours =153, OR BSR =180, OR HbA1C =6.5

  1. If the mother is at high risk for GDM (e.g., H/O GDM in previous pregnancy), consider repeat testing at monthly intervals till delivery.

Note: Only for married females and age >12 or <50

Screen 1: Search with CNIC, Token and mobile number

 

                 Screen 2: Demographic

              Calendar (Heading: LMP date)

               Show pop up message about Trimester (1,2 or 3)

1st Trimester                                                     2nd Trimester                                                    3rd Trimester

Selected date = 12 weeks                             (>12 or <24 weeks)                                         (= 24 weeks)

  

Services

NCDs Program is providing the following services FREE OF COST at its service delivery points across Punjab.

               NCDs Care at Different Level of Healthcare Facilities 

                          For Elaboration of Referral Linkages

 

Primary & Secondary Health Care Department

SH&ME

 

BHU

RHC

THQ

DHQ

Tertiary Care Hospitals

Health Education and Counselling

Health Education and awareness for NCDs and their risk factors with counselling for risk factor modification

Health Education and awareness for NCDs and their risk factors with counselling for risk factor modification

Health Education and awareness for NCDs and their risk factors with counselling for risk factor modification

Health Education and awareness for NCDs and their risk factors with counselling for risk factor modification

Nil

Early Detection and Diagnosis 

A:

  • BP 
  • BSR 
  • Weight
  • Height
  • Waist-hip ratio
  • Clinical breast examination

 

B:

Additional to A

  • Urine dip stick for sugar
  • Chest X-rays

 

C:

Additional to A&B

  • Lipid Profile
  • HbA1C
  • PEFR
  • CBE
  • USG/FNAC
  • Per-speculum
  • Pap Smear
  • VIA for CA-Cervix screening
  • Risk Assessment of mental health disorders

D:

Additional to A, B&C

  • Mammography in Selected DHQs
  • CBE
  • FNAC/USG
  • Pap Smears
  • Glucose tolerance test

 

E:

Additional to A, B, C&D

  • Spirometry 
  • Angiography
  • CT scan
  • MRI etc.

 

Treatment

Medication from EDL for BHU

*List below

Medication from EDL for RHC

*List below

  • Basic management of mild cardiac event
  • Medication from EDL for THQ

*List below

  • Diagnosis and treatment of Mild to moderate cases of prioritized mental health disorders
  • Mastectomy
  • Lobectomy
  • Cryotherapy
  • Basic management of Acute Cardiac event 
  • Medication from EDL for DHQ

*List below

  • Diagnosis and treatment of Mild to moderate cases of prioritized mental health disorders
  • Referral to psychiatrics or tertiary care hospital (when needed)
  • Angioplasty
  • Chemotherapy
  • Radiotherapy
  • Advanced surgery for CA-Breast, CA-Cervix
  • Treatment of moderate to severe mental health disorders

 

Identification and Management of complications

Physical examination and referral to secondary care health facility

Physical examination and referral to secondary care health facility

Renal Function tests

 

  • Fundoscopy
  • Dialysis
  • Amputation

 

  • EMG
  • Doppler imaging for neuropathy
  • Cardiothoracic Surgery
  • Photocoagulation
  • Reconstructive surgery etc.

Centers

 

District

Facility Name

NCD Screening Desk

NCD Clinic



Attock

DHQ, Attock

1

1


Attock

THQ Hazro, Hazro, Attock

1

1


Attock

THQ, Fateh Jang, Attock

1

1


Attock

THQ, Hassanabdal, Attock

1

1


Attock

THQ, Jand, Attock

1

1


Attock

THQ, Pindi Gheb, Attock

1

1


Bahawalnagar

DHQ, BWN

1

1


Bahawalnagar

THQ, Chishtian, BWN

1

1


Bahawalnagar

THQ, Fortabbas, BWN

1

1


Bahawalnagar

THQ, Haroonabad, BWN

1

1


Bahawalnagar

THQ, Minchanabad, BWN

1

1


Bahawalpur

THQ, Ahmedpur East, BWP

1

1


Bahawalpur

THQ, Hasilpur, BWP

1

1


Bahawalpur

THQ, Khairpur Tamewali, BWP

1

1


Bahawalpur

THQ, Yazman, BWP

1

1


Bhakkar

DHQ, Bhakkar

1

1


Bhakkar

THQ , Mankera, Bhakkar

1

1


Bhakkar

THQ, Darya Khan, Bhakkar

1

1


Bhakkar

THQ, Kallurkot, Bhakkar

1

1


Chakwal

DHQ , Chakwal

1

1


Chakwal

THQ , Kallar Kahar, Chakwal

1

1


Chakwal

THQ , Talagang, Chakwal

1

1


Chakwal

THQ City, Talagang, Chakwal

1

1


Chakwal

THQ, Choa Saidan Shah, Chakwal

1

1


Chiniot

DHQ Chiniot

1

1


Chiniot

THQ, Lalian, Chiniot

1

1


Dera Ghazi Khan

THQ, Taunsa Sharif, DGK

1

1


Faisalabad

THQ , Jaranwala, FSD

1

1


Faisalabad

THQ , Samundri, FSD

1

1


Faisalabad

THQ , Tandlianwala, FSD

1

1


Faisalabad

THQ Samanabad, FSD

1

1


Faisalabad

THQ, Chak Jhumra, FSD

1

1


Gujranwala

THQ Wazirabad, GRW

1

1


Gujranwala

THQ, Kamoke, GRW

1

1


Gujranwala

THQ, Nowshera Virkan, GRW

1

1


Gujrat

THQ Dinga, Kharian, Gujrat

1

1


Gujrat

THQ Kunjah, Gujrat

1

1


Gujrat

THQ, Kharian, Gujrat

1

1


Gujrat

THQ, Sarai Alamgir, Gujrat

1

1


Hafizabad

DHQ, Hafizabad

1

1


Hafizabad

THQ, Pindi Bhattian, Hafizabad

1

1


Jhang

DHQ , Jhang

1

1


Jhang

THQ, 18-Hazari, Jhang

1

1


Jhang

THQ, Ahmadpur Sial, Jhang

1

1


Jhang

THQ, Shorkot, Jhang

1

1


Jhelum

DHQ, Jhelum

1

1


Jhelum

THQ, Pind Dadan Khan, Jhelum

1

1


Jhelum

THQ, Sohawa, Jhelum

1

1


Kasur

DHQ, Kasur

1

1


Kasur

THQ, Chunian, Kasur

1

1


Kasur

THQ, Pattoki, Kasur

1

1


Khanewal

DHQ, Khanewal

1

1


Khanewal

THQ, Jahanian, Khanewal

1

1


Khanewal

THQ, Kabirwala, Khanewal

1

1


Khanewal

THQ, Mian Channu, Khanewal

1

1


Khushab

DHQ, Khushab

1

1


Khushab

THQ, Khushab

1

1


Khushab

THQ, Noorpur Thal, Khushab

1

1


Khushab

THQ, Quaidabad, Khushab

1

1


Lahore

THQ Ghaziabad, LHR

1

1


Lahore

THQ Mian Meer, LHR

1

1


Lahore

THQ Samanabad, LHR

1

1


Lahore

THQ Shahdara Town, LHR

1

1


Layyah

DHQ, Layyah

1

1


Layyah

THQ Thal, Layyah

1

1


Layyah

THQ, Chaubara, Layyah

1

1


Layyah

THQ, Chowk Azam, Layyah

1

1


Layyah

THQ, Fatehpur ,Layyah

1

1


Layyah

THQ, Karor Lal-E-Son, Layyah

1

1


Layyah

THQ, Kot Sultan, Layyah

1

1


Lodhran

DHQ, Lodhran

1

1


Lodhran

THQ, Duniapur, Lodhran

1

1


Lodhran

THQ, Kahror Pacca, Lodhran

1

1


Mandi Bahuddin

DHQ, Mandi Bahuddin

1

1


Mandi Bahuddin

THQ, Malikwal, Mandi Bahuddin

1

1


Mandi Bahuddin

THQ, Phalia, Mandi Bahuddin

1

1


Mianwali

DHQ, Mianwali

1

1


Mianwali

THQ, Esa Khel, Mianwali

1

1


Mianwali

THQ, Piplan, Mianwali

1

1


Multan

DHQ Multan, Multan

1

1


Multan

THQ, Jalalpur Pirwala, Multan

1

1


Multan

THQ, Shuja Abad, Multan

1

1


Muzaffargarh

DHQ, Muzaffargarh

1

1


Muzaffargarh

THQ, AliPur, Muzaffargarh

1

1


Muzaffargarh

THQ, Jatoi, Muzaffargarh

1

1


Muzaffargarh

THQ, Kot Adu, Muzaffargarh

1

1


Nankana Sahib

DHQ, Nankana Sahib

1

1


Nankana Sahib

THQ, Sangla Hill, Nankana Sahib

1

1


Nankana Sahib

THQ, Shah Kot, Nankana Sahib

1

1


Narowal

DHQ, Narowal

1

1


Narowal

THQ, Shakargarh, Narowal

1

1


Okara

DHQ South City, Okara

1

1


Okara

DHQ, Okara

1

1


Okara

THQ , Depal Pur, Okara

1

1


Okara

THQ Haveli Lakha, Okara

1

1


Pakpattan

DHQ, Pakpattan

1

1


Pakpattan

THQ, Arifwala, Pakpattan

1

1


Rahim Yar Khan

THQ, Khanpur, RYK

1

1


Rahim Yar Khan

THQ, Liaqatpur, RYK

1

1


Rahim Yar Khan

THQ, Sadiqabad, RYK

1

1


Rajanpur

DHQ, Rajanpur

1

1


Rajanpur

THQ, Jampur, Rajanpur

1

1


Rajanpur

THQ, Rojhan, Rajanpur

1

1


Rawalpindi

THQ, Gujar Khan, Rawalpindi

1

1


Rawalpindi

THQ, Kahuta, Rawalpindi

1

1


Rawalpindi

THQ, Kallar Syedan, Rawalpindi

1

1


Rawalpindi

THQ, Kotli Sattian, Rawalpindi

1

1


Rawalpindi

THQ, Murree, Rawalpindi

1

1


Rawalpindi

THQ, Taxila, Rawalpindi

1

1


Sahiwal

THQ , Chichawatni, Sahiwal

1

1


Sargodha

THQ, Bhalwal, Sargodha

1

1


Sargodha

THQ, Bhera, Sargodha

1

1


Sargodha

THQ, Kot Momin, Sargodha

1

1


Sargodha

THQ, Sahiwal, Sargodha

1

1


Sargodha

THQ, Shahpur, Sargodha

1

1


Sargodha

THQ, Sillanwali, Sargodha

1

1


Sheikhupura

DHQ, Sheikhupura

1

1


Sheikhupura

THQ, Ferozewala, Sheikhupura

1

1


Sheikhupura

THQ, Muridkey, Sheikhupura

1

1


Sheikhupura

THQ, Safdar Abad, Sheikhupura

1

1


Sheikhupura

THQ, Sharaqpur, Sheikhupura

1

1


Sialkot

THQ, Daska, Sialkot

1

1


Sialkot

THQ, Pasrur, Sialkot

1

1


Sialkot

THQ, Sambrial, Sialkot

1

1


T.T Singh

DHQ, T.T Singh

1

1


T.T Singh

THQ, Gojra, T.T Singh

1

1


T.T Singh

THQ, Kamalia, T.T Singh

1

1


Vehari

DHQ, Vehari

1

1


Vehari

THQ, Burewala, Vehari

1

1


Vehari

THQ, Mailsi, Vehari

1

1


Total

130

130


Achievements

  • Establishment of NCDs Service Delivery Points at Secondary Level Hospitals (THQs & DHQs),130 Screening Desks & 130 NCDs Clinics.  

 

  • Screening & Registered Patients – Till 21-03-2022

NCDs

Screening

Clinic Registration

Diabetes

988901

Hypertension

4303417

635359

Chronic Respiratory Diseases

206940

187462

 

  1. Digitalization of record – Development of Android app for Screening Desks, Web Portal for NCDs Clinics, Well-Woman Clinics & Dashboard for online monitoring.

 

  1. Establishment of Well-Woman Clinic for early detection of Breast & Cervical Cancer and Diabetes in Pregnancy as a pilot project. 

 

  1. Capacity building Training of more than 600 medical staff (Gynecologists, Radiologists, WMOs, Staff Nurses and LHVs) on CA Breast, CA Cervix and Diabetes in Pregnancy. 

 

  1. Development of intervention package (training manuals, doctors’ manual, desk guides, counselling tools) for the management of NCDs followed by Training of more than 1500 Health Professionals. 

 

 

  1. Organization of First Health Week (August 2017) – Total 362,017 people were screened against prioritized conditions including Viral Hepatitis (B&C), TB, Malaria and Non-Communicable Diseases such as Hypertension, Diabetes Mellitus, Asthma and COPD from all 36 districts of Punjab.

 

  1. Organization of Second Health Week (February 2018) – A total of 846,343 were screened from all 36 districts of Punjab, out of which 799,547 were adults above age 14 and 46,796 children of age 14 and below.

 

  1. Screening of more than 4.5 million people for NCDs through Screening Desks, Screening Camps and Health Weeks. 

 

 

Planned initiatives:

  1. Establishment of Well Women Clinics at 130 Secondary healthcare Facilities across Punjab for early detection of CA Breast and CA Cervix & early detection & management of diabetes in pregnancy.
  2. Scholarship for M.Phil. and PhD in medical Disciplines. 

 

IEC Material 

 

 

 

 

Links

  1.       
  2. ncd.punjab.gov.pk