Guidelines-NPCDCS - NCD PDF

NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER,
DIABETES, CARDIOVASCULAR DISEASES & STROKE (NPCDCS)
OPERATIONAL GUIDELINES
Directorate General of Health Services

Ministry of Health & Family welfare
Government Of India
NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER,

DIABETES, CVD AND STROKE (NPCDCS)
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1. POLICY & STRATEGIC FRAMEWORK FOR MPLEMENTATION
1.1 Introduction
India is experiencing a rapid health transition with a rising burden of Non Communicable
Diseases (NCDs). According to a WHO report (2002), cardiovascular diseases (CVDs) will be
the largest cause of death and disability in India by 2020. Overall, NCDs are emerging as the
leading cause of deaths in India accounting for over 42% of all deaths (Registrar General of
India). NCDs cause significant morbidity and mortality both in urban and rural population,
with considerable loss in potentially productive years (aged 35–64 years) of life
It is estimated that the overall prevalence of diabetes, hypertension, Ischemic Heart Diseases
(IHD) and Stroke is 62.47, 159.46, 37.00 and 1.54 respectively per 1000 population of India.
There are an estimated 25 Lakh cancer cases in India. According to the National Commission
on Macroeconomics & Health (NCMH) Report (2005), the Crude Incidence Rate (CIR) for
Cervix cancer, Breast cancer and Oral cancer is 21.3, 17.1 and 11.8 (among both men and
women) per 100,000 populations respectively.
The main preventable risk factors for NCDs are tobacco consumption; poor dietary habits,
sedentary life style, stress etc. National Family Health Survey III (2005-06), reported that the
prevalence of current tobacco use was 57·0 % among men and 10.8% among women. Over 8
lakh deaths occur every year due to diseases associated with tobacco use. The cancer registry
data reveals that 48% of cancers in males and 20% in females are tobacco related and are
totally avoidable. Common cancers caused by smoking tobacco are lung, larynx, pharynx and
oesophagus, while cancers of the mouth, tongue and lip are due to chewing and smoking
tobacco.
States have already initiated some of the activities for prevention and control of non
communicable diseases (NCDs) especially cancer, diabetes, CVDs and stroke. The Central
Govt. proposes to supplement their efforts by providing technical and financial support through
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stroke
(NPCDCS). The NPCDCS program has two components viz. (i) Cancer & (ii) Diabetes, CVDs
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& Stroke. These two components have been integrated at different levels as far as possible for
optimal utilization of the resources. The activities at State, Districts, CHC and Sub Centre level
have been planned under the programme and will be closely monitored through NCD cell at
different levels.
The Government of India launched a flagship programme called the NRHM in 2005 with the
objective of expanding access to quality health care to rural populations by undertaking
architectural corrections in the institutional mechanism for health care delivery. The crucial
strategies under NRHM have been the integration of Family Welfare and National Disease
Control Programmes under an umbrella approach for optimization of resources and
manpower; strengthening of outreach services by incorporation of village health worker called
ASHA; efforts for communitization of services through formation of Health and Sanitation
Committees at village, block and district level; registering Rogi Kalyan Samities for
improving hospital management; strengthening and upgrading the public health infrastructure
to Indian Public Health Standards (IPHS); and consolidation of the District Level Programme
Management Unit through the induction of professionals.
The NPCDCS aims at integration of NCD interventions in the NRHM framework for
optimization of scarce resources and provision of seamless services to the end customer /
patients as also for ensuring long term sustainability of interventions. Thus, the
institutionalization of NPCDCS at district level within the District Health Society, sharing
administrative and financial structure of NRHM becomes a crucial programme strategy for
NPCDCS. The NCD cell at various levels will ensure implementation and supervision of the
programme activities related to health promotion, early diagnosis, treatment and referral, and
further facilitates partnership with laboratories for early diagnosis in the private sector.
Simultaneously, it will attempt to create a wider knowledge base in the community for
effective prevention, detection, referrals and treatment strategies through convergence with
the ongoing interventions of National Rural Health Mission (NRHM), National Tobacco
Control Programme (NTCP), and National Programme for Health Care of Elderly (NPHCE)
etc.and build a strong monitoring and evaluation system through the public health
infrastructure.
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1.2 Objectives of NPCDCS
1) Prevent and control common NCDs through behaviour and life style changes,
2) Provide early diagnosis and management of common NCDs,
3) Build capacity at various levels of health care for prevention, diagnosis and treatment
of common NCDs,
4) Train human resource within the public health setup viz doctors, paramedics and
nursing staff to cope with the increasing burden of NCDs, and
5) Establish and develop capacity for palliative & rehabilitative care.
Fig. 1 Risk factors (RF) and level of NCD

Prevention and Management
The causal chain
Behavioral Disease
RF Physiological RF Outcomes
• Tobacco • BMI (obesity) • Heart disease
• Alcohol • Blood pressure • Stroke
• Physical • Blood glucose • Diabetes
inactivity • Cholesterol • Cancer
• Diet • Chronic resp.
disease
Primary Prevention Secondary Prevention Tertiary Care

(Health Promotion) (Early Diagnosis and (Case Management &
Case management Rehabilitation)
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1.3 Strategies
The Strategies to achieve above objectives are as follows:
1) Prevention through behaviour change

2) Early Diagnosis
3) Treatment
4) Capacity building of human resource
5) Surveillance, Monitoring & Evaluation
1.3.1 Prevention through behavior change
The major risk factors to cancer, hypertension, obesity, diabetes and cardiovascular diseases
are unhealthy diet, physical inactivity, stress and consumption of tobacco & alcohol. Attempts
will be made to prevent these risk factors by creating general awareness about the Non
Communicable Diseases (NCD) and promotion of healthy life style habits among the
community. Such interventions will be done through the peripheral health functionaries and
NGOs.
The various approaches such as mass media, community education and interpersonal
communication will be used for behavior change focusing on the following five messages:
increased intake of healthy foods

increased physical activity through sports, exercise, etc.;
avoidance of tobacco and alcohol;
stress management
warning signs of cancer etc.
Interpersonal communication will be carried out through ASHAs/ AWWs/ SHGs/ Youth clubs,
Panchayat members etc. for which education material will be developed at central / State level
to facilitate IEC/ BCC activities. These workers / groups will also help in Social mobilization
for diagnostic camps. Targeted intervention programmes will be designed to bring awareness
in schools and workplaces.
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1.3.2. Early diagnosis
Strategy for early diagnosis of chronic non-communicable diseases will consist of
opportunistic screening of persons above the age of 30 years at the point of primary contact
with any health care facility, be it the village, CHC, District hospital, tertiary care hospital etc.
Opportunistic screening will have in built components of mass awareness creation, self
screening and trained health care providers.
Such screening involves simple clinical examination comprising of relevant questions and
easily conducted physical measurements (such as history of tobacco consumption and
measurement of blood pressure etc.) to identify those individuals who are at a high risk of
developing diabetes and CVD, warranting further investigation/ action. The investigations
which may not be carried out in the health facilities can be outsourced.
1.3.3. Treatment
“NCD clinic’’ will be established at CHC and District Hospital (NCD here refers to Cancer
Diabetes, Hypertension, Cardiovascular diseases and Stroke) where comprehensive
examination of patients referred by lower health facility /Health Worker as well as of those
reporting directly will be conducted for ruling out complications or advanced stages of
common NCDs. Screening, diagnosis and management (including diet counseling, Lifestyle
management) and home based care will be the key functions.
1.3.4 Capacity building of human resource
Health personnel at various levels will be trained for health promotion, prevention, early
detection and management by a team of trainers at identified Training Institutes/Centres. These
Training Institutes/Centres will be identified by the State in consultation with the Centre.
1.3.5 Supervision, monitoring and evaluation

Regular monitoring and review of the scheme will be conducted at the District, State and
Central level through monitoring formats and periodic visits and review meetings. For the
purpose, NCD cell at different levels is envisaged to supervise and monitor the programme and
also other NCD programmes. The evaluation is the integral part of the programme and will be
carried out concurrently and periodically, as & when required.
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The strategies proposed will be implemented in 20,000 Sub Centres and 700 Community
Health Centre in 100 Districts across 21 States during 2010-12.
The guidelines on operational aspects and financial norms of the programme have been given
in details to facilitate the effective implementation of the programme.
Figure 2: India Map showing the States to implement NPCDCS
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2. OPERATIONAL GUIDELINES
2.1 Package of Services
In the programme, it is envisaged providing preventive, promotive, curative and supportive

services (core and integrated services) in Cancer, Diabetes, Cardio-Vascular Diseases (CVD)
& Stroke at various government health facilities.
The package of services would depend on the level of health facility and may vary from
facility to facility. The range of services will include health promotion, psycho-social
counseling, management (out-and-in-patient), day care services, home based care and
palliative care as well as referral for specialized services as needed. Linkages of District
Hospitals to private laboratories and NGOs will help to provide the additional components of
continuum of care and support for outreach services. The district will be linked to tertiary
cancer care health facilities for providing comprehensive care.
The Non Communicable Diseases are expensive to treat. National strategies have to focus on
prevention and health promotion as key to reduce disease burden. Health education programme
that promote exercise, weight reduction, early diagnosis, screening are some of the key
interventions that need to be promoted at various levels of heath facilities.
The services under the programme would be integrated below district level and will be integral
part of existing primary health care delivery system, and vertical at district and above as more
specialized health care are needed both for cancer component and diabetes, CVD, and stroke.
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Packages of services to be made available at different levels under NPCDCS
Health Facility Packages of services

Sub centre 1. Health promotion for behavior change
2. ‘Opportunistic’ Screening using B.P measurement and blood glucose
by strip method
3. Referral of suspected cases to CHC
CHC 1. Prevention and health promotion including counseling
2. Early diagnosis through clinical and laboratory investigations
(Common lab investigations: Blood Sugar, lipid profile, ECG,
Ultrasound, X ray etc.)
3. Management of common CVD, diabetes and stroke cases (out patient
and in patients.)
4. Home based care for bed ridden chronic cases
5. Referral of difficult cases to District Hospital/higher health care facility
District Hospital 1. Early diagnosis of diabetes, CVDs, Stroke and Cancer
2. Investigations:
Blood Sugar, lipid profile, Kidney Function Test (KFT),Liver Function
Test ( LFT), ECG, Ultrasound, X ray, colposcopy , mammography etc.
(if not available, will be outsourced)
3. Medical management of cases (out patient , inpatient and intensive
Care )
4. Follow up and care of bed ridden cases
5. Day care facility
6. Referral of difficult cases to higher health care facility
7. Health promotion for behavior change
Tertiary Cancer Comprehensive cancer care including prevention, early detection,

Centre diagnosis, treatment, minimal access surgery after care, palliative care and
rehabilitation
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Figure 3: Services available under NPCDCS at different levels
Institutional Frame Work Public Health Infrastructure Services
National NCD
Tert. [Tertiary Cancer Care Centres

State NCD cell
Level in Medical Colleges/RCC
District Hospital [Health Promotion; Early

District NCD cell NCD Clinic diagnosis. & Management;
Cardiac Care Unit Home Based Care;
Cancer Care Facility Day Care Facility] Ref.
Block CHC
(Rogi Kalyan CHC
Samiti) NCD Clinic
[Early diagnosis & Management; Laboratory
Investigations, Home Based Care, Referral]
Village
Health
Committee Sub Centre
Screening Facility
[Health Promotion; Opportunistic Screening; Referral]
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2.2 Institutional framework for the implementation of NPCDCS activities
2.2.1 Program Structure-Integration with NRHM:

Financial management group (FMG) of Programme Management support units at state and
district level, which is established under NRHM, will be responsible for financial management
(maintenance of accounts, release of funds, expenditure reports, utilization certificates and
audit arrangements). Financial monitoring format for the programme developed by the
programme division will be communicated to the FMG for this purpose.
Funds from Government of India will be released to the State Health Society. State Health
Society will retain funds for state level activity and release GIA to the District Health
Societies. NPCDCS would operate through NCD cells under the programme constituted at
State and District levels and also maintain separate bank accounts at each level. Funds from
Health Society will be transferred to the Bank accounts of the NCD cell after requisite
approvals at appropriate stage. This system will ensure both convergence as well as
independence in achieving programme goals through specific interventions.
It is envisaged to merge the programme at State and District into the SHS and DHS
respectively in order to ensure sustaining the current momentum and continued focus.
2.2.2 State Health Society (SHS):
Under the NRHM framework different Societies of national programmes such as Reproductive
and Child Health Programme, Malaria, TB, Leprosy, National Blindness Control Programme
have been merged into a common State Health Society is chaired by Chief
Secretary/Development Commissioner. Principal/Secretary (Health & Family Welfare) is the
vice chair person and mission director is the Member -Secretary of the State Health Society.
2.2.3 District Health Society (DHS)
At the district level all programme societies have been merged into the District Health Society
(DHS).The Governing Body of the DHS is chaired by the Chairman of the Zila Parishad /
District Collector. The Executive Body is chaired by the District Collector (subject to State
specific variations).The CMHO is the Member -Secretary of the District Health Society.
District health society will pass on the funds to the Rogi Kalyan Samities of Block level for the
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activities under the programme. District Health society will monitor the utilization of funds and
submit quarterly the financial management report (FMR) of the programme to State Health
Society.
2.2.4 Technical Resource Groups
To provide technical guidance, advice and review the progress of the programme for enhancing
the quality of implementation of NPCDCS, twoTechnical Resource Groups (TRG) have been
constituted, one for cancer component and other for Diabetes, Cardiovascular Diseases and
Stroke with following term of references (TORs).
2.2.4.1 Terms of references for TRG on cancer
i. To provide technical inputs for enhancing the quality of implementation of NPCDCS
related to cancer.
ii. To review the operational guidelines from time to time.
iii. To identify resource centres for providing training to various health professionals.
iv. To advice about training material, strategy and preparation of training plan.
v. To advice in preparation of health education material and review the existing material.
vi. To advice in formulation of protocols and tools for monitoring and evaluation.
vii. To assess the human resource requirement and advice on fill up the deficiencies.
viii. To develop strategy for integration with NRHM and other NCDs.
ix. To review the functioning and operational problems regarding radiotherapy units
already installed including the trained manpower, infrastructure and radiation safety.
x. To act as technical advisory body to assess and project the present and the future
demand for indigenous manufactured units and their acceptable standards or
specifications.
xi. Any other issue related to Cancer.
2.2.4.2 Terms of references for TRG on Diabetes, CVD & Stroke
i. To provide technical inputs for enhancing the quality of implementation of NPCDCS.
ii. To review the operational guidelines from time to time.
iii. To identify resource centres for providing training to various health professionals.
iv. To advice about training material, strategy and preparation of training plan.
v. To advice in preparation of health education material and review the existing material.
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vi. To advice in formulation of protocols and tools for monitoring and evaluation of
NPCDCS.
vii. To assess the human resource requirement and advice on filling up the deficiencies.
viii. To develop strategy for integration with NRHM and other NCDs.
ix. To recommend the proposals for financial assistance under various schemes.
x. Any other issue related to NCDs.
Analogous to the presence of dedicated structure for all National programmes under the
NRHM framework, NCD Cells will be constituted at various levels for effective ownership,
implementation, supervision, monitoring and mainstreaming of the NPCDCS activities.
2.2.5 Management Structure:
2.2.5.1 National NCD Cell

A. Organization Structure
National NCD Cell will be responsible for overall planning, implementation, monitoring and
evaluation of the different activities and achievement of physical and financial targets planned
under the programme. The National NCD cell shall function under the guidance of Programme
in-charge from the Ministry of Health & Family Welfare and will be supported by the
identified officers/officials from the Directorate General of Health Services.
Organization Structure of National NCD Cell

Technical Wing Administrative Wing
Deputy Director General Additional Secretary /Joint Secretary
CMO (Cancer ) Director (NCD)
CMO ( Diabetes & CVD ) Under Secretary (NCD)
CMO (Geriatric care ) Under Secretary (NCD)
Consultants Section officer
The National NCD Cell will be supported by following contractual staff.
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S. No. Name of post No. of posts
1. National Program Officer (NCD) 1
2. National Program Officer (Training & Coordination) 1
3. National Program Officer (M& E and Surveillance) 1
4. National Epidemiologist 1
5. Financial Consultant 1
6. Technical Officer (Health Management) 1
7. Technical Officer (Nutrition) 1
8. Technical Officer (Physiotherapy) 1
9. Technical Officer (IEC) 1
10. Logistic Coordinator 1
11. M& E Officer 1
12. Data Manager 1
13. Computer Assistant 2
14. Technical Assistant 2
TOTAL 16
B. Role and responsibilities of the National NCD Cell is as under:

• Nodal body to roll out NPCDCS in the country
• Plan, Coordinate, and Monitor all the activities at National and State level.
• Develop operational guidelines, Standard Operating Procedures (SOP), Training
modules, Quality benchmarks, Monitoring and reporting systems and tools.
• Monitoring and evaluation of the programme through HMIS, Review meetings, Field
observations, surveillance, operational research and evaluation studies.
• Prepare National Training Plan: Curriculum, Training resource centres, training modules
and organize national level training programmes
• Procurement of equipment and supplies for items to be provided as commodity assistance;
• Release of funds and monitoring of expenditure
2.2.5.2 State NCD cell

State NCD Cell will be established preferably in the Directorate of Health services or any other
space provided by the State Government. The NCD Cell will be responsible for overall
planning, implementation, monitoring and evaluation of the different activities, and
achievement of physical and financial targets planned under the programme in the State. The
Cell shall function under the guidance of State programme Officer (SPO NCD) and will be
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supported by the identified officers/officials from the Directorate /Director General of Health
Services. SPO (NCD) will be a State level health official identified by the State government.
A. Composition: State NCD Cell will be supported by following contractual staff

1. State Programme Officer
2. Programme Assistant
3. Finance cum Logistics Officer
4. Data Entry Operators (2)
Terms of Reference of these posts are given at Annexure 1.
B. Role and responsibilities of the State NCD Cell is as under:
1. Preparation of State action plan for implementation of NPCDCS strategies.
2. Develop district wise information of NCD diseases including cancer, diabetes,
cardiovascular disease and stroke through health facilities including sentinel sites.
3. Organize State & district level trainings for capacity building
4. Ensure appointment of contractual staff sanctioned for various facilities
5. Release of funds to districts for continuous flow of funds and submit Statement of
Expenditure and Utilization Certificates
6. Maintaining State and District level data on physical, financial, epidemiological profile
7. Convergence with NRHM activities and other related departments in the State / District
8. Ensure availability of palliative and rehabilitative services including oral morphine
9. Monitoring of the programme through HMIS, Review meetings, Field observations.
10. Public awareness regarding health promotion and prevention of NCDs through
following approaches:
Development of communication messages for audio-visual and print media
Distribution of pamphlets and handouts
Campaigns through mass media channels (electronic and print media)
Social mobilization through involvement of women’s self help groups,
community leaders, NGOs etc.
Advocacy and public awareness through mid-media (Street Plays, folk methods,
wall paintings, hoardings etc.)
Flip charts to ground level workers for health education in the community.
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2.2.5.3 District NCD Cell
District NCD Cell will be established preferably in the Directorate of Health services or any
other space provided by District head quarter. The NCD Cell will be responsible for overall
planning, implementation, monitoring and evaluation of the different activities and
achievement of physical and financial targets planned under the programme in the District. The
Cell shall function under the guidance of District programme Officer (DPO NCD) and will be
supported by the identified officers/officials from the District health system.DPO NCD shall be
a district level health official and be identified by the State government.
A. Composition: District NCD Cell will be supported by following contractual staff:

1. District Programme Officer
2. Programme Assistant
3. Finance cum Logistics Officer
4. Data Entry Operator
Terms of Reference of these posts are given at Annexure 1.
B. Role and responsibilities of the District NCD Cell

1. Preparation of District action plan for implementation of NPCDCS strategies.
2. Maintain and update district database of NCD diseases including cancer, diabetes,
cardiovascular disease and stroke.
3. Conduct sub-district/ CHC level trainings for capacity building
4. Engage contractual personnel sanctioned for various facilities in the district
5. Maintain fund flow and submit Utilization Certificates
6. Maintaining District level data on physical, financial, epidemiological progress
7. Convergence with NRHM activities; and
8. convergence with the other related departments in the States/ District
9. Ensure availability of palliative and rehabilitative services including oral morphine
2.3 Activities under NPCDCS at various levels
2.3.1 Sub Centre
Under the NPCDCS Sub Centers shall perform following activities:

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A. Health promotion:
Behaviour and life style changes through health promotion is an important component of the
programme at sub centre level and would be carried out by the front line health workers- ANM
and (or) Male Health Worker. Various approaches can be used such as camp, interpersonal
communication (IPC), posters, banners etc. to educate people at community/school/workplace
settings. Camps may be organized for this activity in the village onVillage Health and
Nutrition Days when the Health Worker goes to the village for immunization and other health
services. During the camps/days these health workers will discuss the various approached of
healthy life style and its benefits with the target groups and motivate them to adopt healthy
lifestyle and to practice regularly prevention of common NCDs. Key messages that need to be
conveyed to the public include:

stress management
warning signs of cancer etc.
B Opportunistic Screening
During the camps/ designated day ANM and (or) Male Health Worker shall also examine
persons at and above the age of 30 years for alcohol and tobacco intake, physical activity,
blood sugar and blood pressure. During the examination, health worker shall also carry out the
measurement of weight, height, and Body Mass Index (BMI) etc. For blood sugar
measurement, blood glucose strip will be provided to Health Worker. ANM and (or) Male
Health Worker will be trained for such screening. Method for measurement of blood sugar by
strip method and blood pressure is described in the following paragraph.
Method of Screening of Diabetes by Strip method
Things Needed:
• A glucometer
• Test strips
• A lancet
• A notebook & pen
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Figure 4: Diabetic Check up.
Step 1
Take out the glucometer and place on a flat surface
Step 2
Remove a test strip from the container and place in the glucometer. One end will need to face
the top of the glucometer; usually it has a darker colored line on it. This is where the blood will
be placed for testing.
Step 3
Turn on your glucometer.
Step 4
Use a lancet to pierce the skin and obtain blood from the tip of a finger.
Step 5
Place the blood sample on the test strip. The test strip package will have exact instructions,
including blood sample size. Usually, this is accomplished by placing the blood drop against
the edge or top of the strip.
Step 6
Watch the glucometer screen. It should show a "waiting" or "processing" symbol, and will emit
a beep when the sample has been tested. The results will be displayed as a number on the
screen.
Record your test results in your notebook and pass this information to Medical officer.
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Criteria for diagnosing Diabetes
Fasting Glucose 2-hour Post-Glucose Load

Diagnosis
(mg/dl) (mg/dl)
Diabetes Mellitus >=126 >=200
Impaired Glucose Tolerance < 110 >140 to <200
Impaired Fasting Glucose >=110 to <126

*WHO Definition 1999
Steps for measuring Blood pressure
Step 1.
Rest the arm of the person on table so that the elbow of the person is parallel to heart. Wrap the
blood pressure cuff around the arm slightly above the crease of forearm. Place the stethoscope
on the crease of the forearm and pump the blood pressure cuff up to 160. The metal attachment
on the side of the pump allows you to inflate and deflate the cuff.
Step 2.
Listen for two different sounds with the stethoscope as you slowly deflate the cuff. The first
sound will be strong and the second sound lighter. At the start of each new sound, look at the
reading on the cuff to see the numbers with the first and stronger sound representing the top
systolic number and the second, softer sound is representing the diastolic number.
Step 3.
Repeat the blood pressure reading. Results will vary from arm to arm. Ideal blood pressure is
120/80. Take three or four readings and average the results.
C. Referral
ANM and (or) Male Health Worker will refer the suspected case of Diabetes and Hypertension
to the CHC or higher Health Facility for further diagnosis and management.
D. Data recording and reporting

ANM and (or) Male Health Worker at Sub Centre will maintain in prescribed format to related
CHC under the programme and will submit the report monthly to CHC.
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2.3.2 Activities at Community Health Centre
Under NPCDCS 7000 CHCs shall be selected in total for programme implementation in two
years. Each selected CHC shall establish a ‘NCD clinic’ for comprehensive examination of
patients referred by the Health Worker as well as reporting directly to rule out complications or
advanced stages of common NCDs. The clinic shall run on all working days of the weak.
Following activities will be performed by a CHC under the NPCDCS:
A. Screening
Opportunistic screening of persons above the age of 30 years shall be carried out at CHC by
the appointed doctor under the programme which will be assisted by a nurse. Such screening
will involve simple clinical examination comprising of relevant questions and easily conducted
physical measurements (such as history of tobacco consumption and measurement of blood
pressure, blood sugar estimation etc.) to identify those individuals who are at a high risk of
developing cancer, diabetes and CVD, warranting further investigation/ action.
B. Prevention and health promotion
Apart from clinical services CHC shall be involved in promotion of healthy lifestyle through health
education and counseling to the patients and their attendants at the time of their visit to health
facility about the benefit in prevention of NCDs. Key messages that need to be conveyed to the
public include:

stress management
warning signs of cancer
Medical officer and a nurse shall impart the health education during the OPD as well as to the
inpatients if any. Counsellor appointed under the programme shall counsel on diet, nutrition
and tobacco, alcohol, warning signs of cancer etc.
C. Laboratory investigations
CHC shall do the required investigations/tests for comprehensive examination for NCDs like
Blood Sugar measurement, lipid profile, Ultrasound, X- ray and ECG etc. In case there is no
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facility for particular investigations/tests it may be referred to District Hospital. Provision of
out sourcing of required investigations to some extent can be done where investigations are not
available at the hospital.
D. Diagnosis and Management

The unit of NCD clinic at CHC which involves doctor and paramedical personnel will do the
diagnosis, management and stabilization of common CVD, diabetes and stroke cases (out
patient as well as in patients.)
E. Home based care
One of the Nurses appointed under the programme shall undertake home visits for bedridden
cases, supervise the work of Health workers and attend monthly clinics being held in the
villages on a random basis. She shall visit one village/week for home visits and advise the bed
ridden patient with diabetes, stroke etc. about the care and will refer the case to the
CHC/District hospital if required. In total she shall visit 4 times in a month.
F. Referral
Complicated cases of diabetes, high blood pressure etc. shall be referred from CHC to the
District Hospital for further investigations and management on the prescribed format.
G. Data recording and reporting
“NCD Clinic” at CHC shall maintain individual diagnosis, treatment and referral records on
the patient chronic disease card, with verbal and pictorial advice for the patient. This record
shall be send monthly to the District NCD Cell set up under National Cancer Control
Programme.
2.3.2.1 Human Resources for CHC NCD services

For providing effective comprehensive care at CHC, following staff shall be appointed on
contract basis by the State Government:
a. Doctor (1)
b. Nurses (2)
c. Counselor (1)
d. Data Entry Operator (1)
2.3.2.2. Role of NCD Clinic at CHC
a. Provide opportunistic screening
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b. Investigate for Blood sugar, ECG, Blood cholesterol etc.
c. Diagnose and treat Diabetes and Hypertension
d. Provide education to the patients
e. Refer the difficult or complicated cases to district hospital
A. Role of Doctor
• To conduct comprehensive examination to diagnose, investigate and manage the cases
appropriately.
• To rule out complications or advanced stage.
• To refer complicated cases to higher care facility
• To provide follow up care to the patients
B. Role of Nurse
• To assist in examination and investigation
• To teach the patient and family about risk factors of NCDs and promote patients well
being
• To assist in follow up and care
C. Role of Counselor
• To provide counseling on diet and life style management
• To assist in follow up care and referral
2.3.3. Activities at District Level

The selected district shall provide the full complement of preventive, supportive and curative
services for cancer diabetes, hypertension and cardio vascular diseases including stroke
through the selected District Hospital. Following services will be provided by district hospital
District shall identify a district hospital to be strengthened under NPCDCS for providing NCD
services. The hospital shall have an ICU and basic laboratory facilities available attached to it.
A‘NCD clinic’ will be established at the identified district hospital to provide emergency care
and management of cancer, diabetes, hypertension and acute cardiovascular diseases. The
clinic shall run on all working days of the weak. ICU of the district hospital will be upgraded/
strengthened with a cardiac care unit (2-4 beds) with ventilator and other necessary
equipments. Following activities will be performed by a District under the NPCDCS:
A. Opportunistic screening
NCD clinic at district hospital shall screen persons above the age of 30 years for diabetes,
hypertension, cardiovascular diseases etc. to identify individuals who are at a high risk of
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developing diabetes, hypertension and CVDs warranting further investigation/ action.Such
screening shall involve simple clinical examination comprising of relevant questions and easily
conducted physical measurements (such as history of tobacco consumption and measurement
of blood pressure, blood sugar estimation etc.)
District NCD clinic shall also screen women of the age group 30-69 years approaching to the
hospital for early detection of cervix cancer and breast cancer. District hospital would be
assisted to purchase the required equipments like colposcope and mammography etc.
B. Detailed investigation
Detailed investigation of persons those who are at high risk of developing NCDs on screening
and those who are referred form CHCs will be done at district hospital. Laboratory services at
district hospital will be strengthened/established to provide necessary investigations for cancer,
diabetes, hypertension and cardiovascular diseases like Cardiac Enzymes, Lipid Profile
Coagulation parameters, ECG, ECHO, CT Scan, MRI and other laboratory investigations.
C. Outsourcing of certain laboratory investigations
District hospital may outsource certain laboratory investigations that are not available at
district hospitals including mammography.
Financial assistance will be provided (details are in financial guidelines) under Public Private
Partnership (PPP) mode will be granted for the purpose. It is expected that district hospital
shall have X-ray and ultrasound facilities; however, in places where it is not available these
shall be outsourced. The District Hospital shall display the list of Laboratories in which these
investigations would be outsourced.
D. Out-patient and In-patient Care
NCD Clinic at District Hospital shall provide regular management and annual assessment of
persons suffering from cancer, diabetes and hypertension. People with established
cardiovascular diseases shall also be managed at district hospital. Cardiac care unit established
at hospital shall manage acute and emergent cases of cardiovascular diseases. The hospital
23
shall ensure the availability of essential drugs. In case of Cancer support shall be provided for
common chemotherapy drugs to treat about 100 cases, from the poor category only.
E. Day Care Chemotherapy Facility

Identified district hospital shall provide a day care chemotherapy facility for patients on
chemotherapy regimens. The day care facility shall have 4 beds along with necessary
equipments such as IV stands, BP instruments, sterilizer etc. A medical oncologist and two 2
Nurses shall be appointed on contractual basis for smooth functioning of the centre.
F. Home Based Palliative Care

District hospital shall provide Home based palliative care for chronic, debilitating and
progressive patients. A team consisting of nurse and counsellor shall be trained in identifying
symptoms, pain management, communication, psychosocial & emotional care, nursing needs
of the terminally ill and ethics of palliative care. The nurse shall be trained in wound dressing,
mouth care, oral morphine use, diet, hygiene etc. Home care kit containing stethoscope, BP
apparatus, torch, thermometer, tongue depressor, forceps, and common medicines etc. shall be
provided to this team.
G. Referral & Transport facility to serious patients

To ensure timely and emergent care to the patient at distant CHC or below, district hospital
shall make provision for transporting the serious patients to the hospital or at nearest tertiary
level facility.
Complicated cases shall be referred to nearest tertiary health care facility with a referral card.
Patients suffering from lymphomas and leukaemias shall be referred to tertiary care centres
(TCC) for Chemotherapy as blood bank facilities and required human resources are available
there.
H. Health promotion
Apart from clinical services district hospital shall be involved in promotion of healthy lifestyle
through health education and counseling to the patients and their attendants regarding
24
stress management
warning signs of cancer etc
I. Training
District Hospital shall impart training to the health personnel of Community Health Centre as
per guidelines issued by National NCD Cell.
J. Data recording and reporting

Data shall be collected in prescribed formats and monthly report shall be sent to the District
NCD Unit of the programme
K. Human Resources at District Hospital

Following additional staff will be recruited on contract basis by the State Government to
manage NCD clinic and to provide acute and chronic care services.
a. Doctor (specialist in Diabetology/Cardiology/M.D Physician)
b. Medical Oncologist
c. Cyto-pathologist
d. Cytopathology Technician
e. Nurses (4): 2 for Day Care, one for Cardiac Care Unit, one for O.P.D
f. Physiotherapist
g. Counselor
h. Data Entry Operator
i. Care coordinator
2.3.4. Activities at State level
The selected state will be provided support to develop capacity for providing the full
complement of preventive, supportive and curative services for cancer, diabetes, hypertension
and cardiovascular diseases including stroke through various facilities strengthened under the
programme. Following activities will be performed at the State level:
A. Community awareness
Public awareness through various channels of communication will be organized by the State
NCD cell to sensitize public about the risk factors, promotion of healthy life style and services
25
made available under the programme. Key messages that need to be conveyed to the public
include:

stress management
warning signs of cancer etc
Mass media through Radio, Television, Print media will be used for public awareness using the
most effective channels that have reach to the community. Mid media and locally prevalent
folk media may also be used to reach the targeted population, particularly in rural and urban
deprived population.
B. Planning, Monitoring and Supervision:

The State NCD cell will undertake situational analysis and prepare State Plan that spells out
physical targets, means of coordination, supervision and monitoring related to various
components of NPCDCS in the State. Formats prescribed for reporting to Central NCD Cell
will be used to report physical and financial progress made under the programme.
C. Training of Human Resources
Under NPCDCS approximately 32 thousand personnel need to be under the programme in

100 districts at various levels. Key areas of training will be health promotion, NCD
prevention, early detection and management of Diabetes, CVD and Stroke. Prototype of
training kits for each category of trainee will be prepared by Central NCD Cell. Following
categories of personnel will be trained under the programme for this component:
a. Doctors
b. AYUSH Practitioners
c. Nurses
d. Physiotherapist
e. Counselor/Care coordinator
f. Laboratory Technician
26
g. Data Entry Operator/Assistant
h. ANM, and Male Health Worker
Detailed training plan of staff is to be prepared based on following norms:
AYUSH Physio- Counselor/ Lab. DEO/ ANM/

Facility Doctor Nurse
Practitioner therapist Care Coord. Tech. Assistant MHW
Sub-Centres 2
NCD Clinic CHC 1 2 1 1 1
NCD Clinic Distt. Hosp. 1 2 1 3 2 1
Duration (Days) 15 21 15 15 15 5 5 3
Selected Selected
Medical Nursing Medical Medical Med. CHC/
Training Institute Training Training
Colleges Colleges Colleges Colleges Coll. DH
Institutes Institutes
Training plan for various personnel on Cancer related services need to be prepared based on
following norms:
No. of Trainee
S.No. Category of Trainee Duration Venue of Training
per District
1. Medical Oncologist 1 1 Day Medical Colleges
2. Cytopathologist 1 2 weeks Medical Colleges
3. Cytopathology technician 1 4 weeks Medical Colleges
4. Nurses for Day care 2 2 weeks Nursing Colleges
5. District Surgeons 1 2 weeks Medical Colleges
6. District Physicians 1 2 weeks Medical Colleges
7. District Gynecologists 1 2 weeks Medical Colleges
8. District Radiotherapist 1 3 weeks Medical Colleges
9. District Medical Physicist 1 2 weeks Medical Colleges
10. District Programme Coordinator 1 2 weeks NIHFW
11. Programme Assistant 1 2 weeks NIHFW
12. Finance cum logistics officer 1 2 weeks NIHFW
13. Data entry operator 1 2 weeks NIC
D. Financial Management:
State will monitor release of funds and expenditure incurred under various components of the
programme in the State. State NCD Cell will submit monthly statement of expenditure in the
prescribed format to the State Health Society and National NCD Cell
27
2.3.5.Activities at Central level
The Government of India will facilitate implementation of the programme in selected districts
and States for prevention and control of non communicable diseases. Following will be key
activities coordinated by the NCD cell in the Directorate General of Health Services, Ministry
of Health and Family Welfare:
A. Selection of States and Districts
The programme would be implemented in the country in phased manner. During the
remaining period of 11th Five Year Plan, 100 districts in 21 states will be selected. Further
expansion will be undertaken during the 12th Five Year Plan. Districts and States that will be
covered during 2010-12 are given at Annexure V.
B. Information, Education & Communication
Central will prepare prototype IEC material on cancer, diabetes, hypertension and cardio
vascular diseases including stroke to sensitize community about risk factors, to promote
healthy life style and inform about services available through various electronic, print media,
and other channels. These will be disseminated to States for translation, adoption and
dissemination. Messages through mass media will also be organized centrally through Radio,
Television, Internet and Print media.
C. Tertiary Level Care

Central NCD cell will seek proposals from all the States/UTs and not restricted to only 21
States selected during 2010-12 though preference would be given to these 21 states. State
Govt. shall identify the Government Medical Colleges/ District Hospital/ Govt. Institution for
financial assistance under Tertiary Cancer Centre (TCC) scheme. Sixty five (65) TCCs shall be
identified throughout the country. The funds will be released after examining the proposals
from the States/UTs, followed by scrutiny by an inspection team from the Dte.GHS and
recommendation by the Standing Committee. Detailed guidelines for TCC are given at
Annexure IV.
28
D. Training
Central NCD cell will prepare a plan for central level training programmes.. A pool of master-
trainers will be generated with capacity to organize and impart training at State and district
levels. Training will comprise of didactic sessions, e–education and hands-on training
approaches at selected Institutions, Medical and Nursing Colleges fulfilling following criteria
• Central/State Government Medical College/Institute or Autonomous institutes
supported by State or Central Government. Institutions of repute in non-government
and private sector will also be considered.
• Adequate infrastructure for training which includes the seminar room with capacity of
30 to 50 trainees, projector/LCD, screen, laptop/computer and other audiovisual aids.
• Availability of subject specialists for clinical/laboratory training in the fields of Cancer,
Diabetes, Hypertension, Cardiovascular diseases. Resource persons for training in
programme management, monitoring and health promotion would be required.
• Experience and good track record in providing training to Health Professionals.
Training of State and District Programme Officers, Finance Consultants, Specialists and
Trainers will be organized centrally. Plan for their training will be based on following norms:
Programme Finance
Facility Specialists Trainers DEO
Officers Consultant
Each District NCD Cell 1 1 2
Each District NCD Clinic 1
Training Institutes (10) 40
Each State NCD Cell 1 1 1
Central NCD Cell 9 1 4
Duration (days) 2 3 15 3 3
NIHFW/ NIHFW/ Medical Medical NIHFW/
Place of Training
SIHFW SIHFW Colleges Colleges SIHFW
29
E. Monitoring, Evaluation, Surveillance and Research
Standard formats for recording and reporting will be prescribed by the Central NCD Cell and
will be used by various facilities, District and State NCD Cell. A Management Information
System will also be developed to computerize the information. Review meetings of State
Programme Officers (NCD) will be organized on a quarterly progress to assess physical and
financial progress and discuss constraints in implementation of the programme. Formats to be
used by various facilities and cells are given at Annexure VI. Responsibility of reporting, flow
of information and frequency of reporting is summarized below:
Frequency of
Level Reporting Form Person in charge Reporting to:
submission
Sub-centre Form 1 ANM/MHW MO I/c NCD Clinic CHC Monthly
Form 2 A MO I/c NCD Clinic District NCD cell Monthly

CHC
Form 2 B MO I/c NCD Clinic District NCD cell Monthly
Form 3 A DPO (NCD) State NCD cell Monthly

District Form 3 B MO I/c NCD Clinic District/ State NCD cell Monthly
Form 3 C DPO (NCD) State NCD cell Monthly
Form 4 A SPO (NCD) National NCD cell Quarterly

State
Form 4 B SPO (NCD) National NCD cell Quarterly
Independent evaluation of various components of the programme and surveillance of NCD risk
factors will also be planned and organized by the Central NCD cell. Key gaps identified during
implementation of the programme and innovative interventions will be addressed through
planned operational research.
30
3. FINANCIAL GUIDELINES
3.1 Financial Provision for State & District under NPCDCS

Financial management groups (FMG) of Programme Management support units at state and
district level, which are established under NRHM, will be responsible of maintenance of
accounts, release of funds, expenditure reports, utilization certificates and audit arrangements.
The funds will be released to States/UTs under two separate components of the NPCDCS i.e.
(i) Cancer and (ii) Diabetes, Cardiovascular Diseases & Stroke (DCS) through the State Health
Society to carry out the activities at different levels as envisaged in the operational guidelines.
Funds release from State to District Health Society would inter alia include funds for CHCs
and Sub- centres to cover the entire District.
State shall have the flexibility for inter-usability of funds from one component to another
within the same group of diseases i.e. (i) Cancer and (ii) DCS, under intimation to the GOI,
limited to a ceiling of 10%, in order to impart operational flexibility in implementation of these
programmes. NPCDCS would operate through NCD cells constituted under the programme at
State and District levels. A separate bank account in a nationalized bank should be opned for
each components of programme i.e. (i) Cancer and (ii) DCS for appropriate utilization of
funds.
The Statement of Expenditure (SOE) and Utilization Certificate (UC) as per GFR shall be
submitted separately for both the components; (i) Cancer and (ii) Diabetes, Cardiovascular
Diseases & Stroke. Formats for SOE and UC are given at Annexure VII & VIII.
3.2 Financial Assistance under NPCDCS

The funds will be released to Sub-Centre (SC), Community Health Centre (CHC), District and
State facilities through NRHM structure. The details are given in these guideline as per unit
cost at various levels. The total funds to be released to each State would be based on number
of units to be taken up at different levels. Assistance to various facilities/units is summarized
below:
31
3.2.1 Assistance for Sub Centre (Under DCS Component)
Heads No./Grant
Commodity Assistance
Glucometer 1
Glucostrips and Lancets (for population above As per
30 years & pregnant women) requirement
Recurring grant: Health promotional activities,
Rs. 2000 p.a
Patient Referral Cards, Spirit swabs
80% of grant will be Central share and 20% State share
3.2.2 Assistance for Community Health Centre (Under DCS Component)
Heads Amount
Rs. lakh
Non-recurring grant 1.00
NCD Clinic: Furniture, Equipment, Computer etc.
Recurring grant
Human Resources (on contract) 11.76
a) 1 Doctor @ Rs. 40000/month [Rs. 4.80 lakh/ year]
b) 2 Nurses @ Rs. 18000/month/nurse [Rs. 4.32 lakh/ year]
c) 1 Counselor @ Rs. 12000/month [Rs.1.44 lakh/ year]
d) 1Data Entry operator @Rs.10000/month [ Rs.1.20 lakh/year]
Laboratory tests & consumables 10.00

Home based care @ Rs. 250/visit 0.12
Local IEC material 0.05
Transport of referred cases 0.10
Miscellaneous cost for communication, TA/DA, contingency 1.00
Sub-total Recurring Grant per year 23.03
Total Grant in Year 1 24.03
3.2.3 Assistance for District Hospital (under DCS Component)
Districts covered under NPCDCS will be provided assistance to create and maintain facilities
and services for patients suffering from cancer, diabetes, cardiovascular diseases and Stroke.
32
A. NCD Clinic & CCU:
Heads Amount
Rs. lakhs
Non-Recurring Grant
a) Developing/Strengthening and equipping Cardiac Care Unit (CCU) 150.00
b) Strengthening of laboratory 10.00
c) NCD Clinic: Furniture, Equipment, Computer etc. 1.00
d) Cell (Renovation/office equipments/photocopier/internet etc.- Rs.1 lakh
Sub-total Non-recurring 161.00
Recurring Grant per annum
Human Resources on contract 18.12
a) Doctor (specialist in Endocrinology/Cardiology/M.D General Medicine)
@ Rs. 55000/month [ Rs.6.6 lakh/year]
b) Nurses (2) @ Rs. 18000/month/Nurse [Rs.4.32 lakh/year]
c) Physiotherapist @ Rs. 20000/month [ Rs. 2.40 lakh/year]
d) Counselors (2) @ Rs. 12000/month [Rs. 2.88 lakh/year]
e) Data entry operators @ Rs.10000/month [Rs. 1.20 lakh/year]
f) Care Coordinator @ 6000/month [Rs. 0.72 lakh/year]
Miscellaneous cost for communication, TA/DA, POL, contingency etc. 3.00
Drugs and consumables @ Rs. 50000/month (As per Annexure II) 6.00
IEC material 0.10
Transport of Referred/Serious patients 2.50
Sub-total Recurring Grant per annum 29.72
Total Grant in year 1 190.72
Equipments for strengthening CCU are as under:
1. ECG machine computerized
2. ECG machine ordinary
3. 12 Channel stress ECG test equipments Tread Mill *
4. Cardiac Monitor
5. Cardiac Monitor with defibrillator
6. Ventilators (Adult)
7. Pulse Oximeter
Ventilator shall be Portable cum bedside fixed with turbine /jet-mixing technology for
supplying air- oxygen mixture. It should have battery backup for minimum 1 hour and should
fix on rails of transport trolley and on stand with wheels. It shall meet IEC-60601-1-2:200 (or
Equivalent BIS) General Requirement of Safely for Electromagnetic Compatibility.
33
Manufacturer should have ISO certificate for quality standards. Comprehensive warranty for 5
years and 5 years CMC/AMC after warranty should be stipulated.
Specification for Computer: Microsoft Windows XP, SP 3, Intel ®, Pentium 5 with 1 GB
RAM with multimedia key board, optical mouse, DVD writer, TFT Monitor 18.5”; Pen Drive
4 GB; Laser printer.
B. District Cancer Care Facility

Heads Amount
Rs. lakhs
Non-Recurring Grant
Day Care Chemotherapy facility 1.00
Colposcope 4.00
Sub-total Non-recurring 5 .00
Human Resources on contract 19.92
a) Medical Oncologist @ Rs.55000/month (Rs.6.6 lakh/year)
b) Cytopathologist @ Rs.55000/month (Rs. 6.6 lakh/year)
c) Cytopathology technician @ Rs.20000/month (Rs.2.4 lakh/year)
d) Nurses (2) for Day care @ Rs.18,000/month (Rs.4.32 lakh/year)
Chemotherapy drugs for 100 pts@ Rs.1 lakh/year (As per Annexure III) 100.00
Education materials 1.00
Misc. incl. Office/administrative expenses @ Rs. 25,000 p.m. including TA/DA, 3.00
home based palliative care @ Rs. 10,000 p.m incl. honorarium, if any
Consumables &/ or other investigations outsourced (2000 cases @ Rs.1500)* 30.0
Mammography @ Rs.1500 for 500 cases 7.50
Sub-total Recurring 161.42
District hospital laboratory will be utilised for diagnostic procedures. The provision for
consumables has been kept. An indicative list of required investigations is as under:
1. Hb, TLC, DLC, Platelet count
2. Bleeting Time, Clotting time
3. Fasting /PP blood sugar
4. Lipid profile
5. Blood Urea
6. Liver Function Test
7. Kidney Function Test
8. Urine routine & Urine Sugar
9. X-ray
10. Ultrasound
34
3.2.4 Tertiary Cancer Centres (TCCs) – (Under Cancer Component)
State Govt. shall identify the Government Medical Colleges/ District Hospital/ Govt.
Institution for financial assistance under Tertiary Cancer Centre (TCC) scheme. The funds will
be released after examining the proposals from the States/UTs, followed by scrutiny by an
inspection team from the Dte.GHS and recommendation by the Standing Committee.
Each Centre will be eligible for the financial support of a one-time financial assistance of
maximum Rs. 6 crore with the Central and the State share of 80:20. The selected institute will
submit the proposal based on gaps in cancer care services at their institute duly recommended
by the State Government. The selected institute is permitted to procure one or more
equipments related to cancer care e.g. Radiotherapy, Surgical Oncology, Medical Oncology,
pain and palliative care services, cancer diagnostics equipments, CT scan, other related
departments etc including Cobalt Source. Detailed guideline for TCC is annexed at Annexure-
IV.
3.2.5 District NCD Cell (Funded under Cancer Component)

A District NCD Cell will be constituted in each district covered under NPCDCS. Assistance
for this cell will be 100% by Government of India as per following norms:
Heads Amount
Rs. lakhs
Non-Recurring Grant
District NCD Cell 5.00
Renovation and furnishing, furniture, computers, office equipments (fax,
phone, photocopier etc.)
Human Resources on contract
a) District Programme Officer @ Rs. 40,000/month (Rs. 4.8 lakh/year) 12.24
b) Programme Assistant @ Rs. 20,000/month (Rs. 2.4 lakh/year)
c) Finance cum logistics officer @ Rs.30,000/month (Rs. 3.6 lakh/ year)
d) Data entry operators @ Rs.12000/month (Rs.1.44 lakh/year)
Training of district teams, DA for attending state meetings, travel to CHCs 3.00
Miscellaneous Expenses including admn. Expenses, communication, 1.20
internet etc. @ Rs. 10,000 p.m.
35
3.2.6 State NCD Cell (Funded under Cancer Component):

The State will monitor the programme activities through a State NCD cell. The State NCD cell
will be supported through the funding of cancer component. Assistance for this cell will be
100% by Government of India as per following norms:
Heads Amount
Rs.lakh
Non-Recurring Grant
State NCD Cell (Renovation and furnishing, computer, office equipments, fax, 5.00
phone, photocopier etc)
Human Resources on Contract 15.48
a) State Programme Officer @ Rs. 55,000/month (Rs. 6.lakh/year)
b) Programme Assistant @ Rs. 20,000/month (Rs. 2.4 lakh/year)
c) Finance cum logistics officer @ Rs.30,000/month (Rs. 3.6 lakh/year)
d) Data Entry Operators (2) @ Rs.12000/month (Rs. 2.88 lakh/year)
Misc. incl. Office/admn. expenses. including TA/ DA, communication, internet 3.0
etc. @ Rs. 25,000 p.m

4 GB; Laser printer.
3.2.7 Financial Guidelines for Training

Training of personnel involved under NPCDCS at various levels is to be organized as per
curriculum, training methods and guidelines prescribed for each training activity. Funding and
expenditure incurred on training will be governed by the approved guidelines under NRHM.
Based on existing financial guidelines, estimated costs of various training programmes are
given below:
36
A. Training Programme at District/State level
AYUSH Counselor/
Details of Physio- Lab. DEO/ ANM/
Doctors Nurse Practi Care
Training therapist Tech. Assistant MHW
-tioner Coord.
Average No. of
20 20 20 10 20 15 20 25
Trainees/batch
Duration (days) 15 21 15 15 15 5 5 3
Trainers 5 5 5 2 2 2 2 2
Medical Nursing Medical Medical Selected Medical Selected CHC/

Place of Training
Colleges Colleges Colleges Colleges Institutes Colleges Institutes DH
Financial Norms for Training at District Level
Unit Cost of Training /batch

Component
AYUSH Counselor/
Physio- Lab. DEO/ ANM/
Doctors Nurse Practi- Care
therapist Techn. Assistant MHW
tioner Coord.
Travel Cost
40000 40000 40000 20000 40000 30000 20000 5000
(on actuals)
Per diem Trainees 210000 168000 210000 60000 120000 30000 40000 30000
Honorarium to
30000 25200 18000 9000 9000 6000 6000 3600
Trainers
Training Kit &
6250 6250 6250 3000 5500 4250 5500 4050
Stationery
Refreshments 75000 105000 75000 36000 66000 17000 22000 16200
Incidental Expenses 5000 3000 5000 1500 3000 2250 3000 3750
Institutional
54938 52118 53138 19425 36525 13425 14475 9390
Overheads -15%*
Estimated
421188 399568 407388 148925 280025 102925 110975 71990
Cost/batch
Unit Cost/trainee 21059 19978 20369 14893 14001 6862 5549 2880
*includes Rental of venue
37
B. Training Programme at Central Level:
Programme Finance MEO/

Details of Training Specialists Trainers
Officers Consultant DEO
Average No. of Trainees/batch 20 15 10 20 20
Duration (days) 2 3 15 3 3
Trainers/Resource Persons 3 3 3 3 3
NIHFW/ NIHFW/ Medical Medical NIHFW/

Place of Training
SIHFW SIHFW Colleges Colleges SIHFW
Cost per batch

Component
Programme Finance MEO/
Specialists Trainers
Officers Consultant DEO
Travel Cost (on actuals) 200000 150000 100000 200000 100000
Per diem Trainees 28000 31500 105000 42000 24000
Honorarium to Trainers 6000 9000 45000 9000 9000
Training Kit & Stationery 5750 4500 3250 5750 5750
Refreshments 9200 10800 39000 13800 13800
Incidental Expenses 5000 3750 2500 5000 5000
Institutional Overheads (15%)* 38093 31433 44213 41333 23633
Estimated Cost/batch 292043 240983 338963 316883 181183
Unit Cost per trainee 14602 16066 33896 15844 9059

*includes Venue Rental
38
Annexure –I
Term of references of staff in State NCD Cell / District NCD Cell
1. Job title: State Programme Officer (SPO) /District Programme Officer (DPO)
Qualifications:
Essential
1) MBBS or equivalent degree from institution recognized by Medical Council of India.
2) Must have completed compulsory internship.
3) Diploma /Masters in Public Health or MD/DNB in Preventive & Social
Medicine/Community Medicine/ Community Health Administration/MBA (Health
Care Administration).
4) At least 5 years experience in Health Management/ Public Health Programme/ Health
Services after obtaining post graduate degree. For DPO minimum 3 years experience.
Desirable: Experience in Non Communicable Disease control program/projects.

Age Limit: Up to 50 years. Retired Govt./Public Sector officers up to the age of 62
years are eligible to apply.
Job requirements/responsibilities:
1) Preparing Programme Implementation Plan.
2) Organizing State level review meetings and orientation workshops.
3) Organizing training program for Medical Officers including AYUSH Practitioners,
nurses and health workers.
4) Visiting districts to monitor the NCD activities.
5) Reviewing program implementation at district and below district levels.
6) Collaborating with Centre, Medical colleges, Districts, NGOs and other sectors.
7) Preparing and submitting quarterly progress report for NPCDCS to SNO (NCD).
8) Any other job assigned by concerned officers.
Remuneration: Up to Rs. 55,000/month (consolidated); for DPO: Rs. 40,000/month
39
2. Job title: One Finance cum Logistics Officer
Qualifications: Essential
1. Inter CA/Inter ICWA/M.Com or MBA (Finance/ Material Management) with
knowledge of computer
2. At least 3 years experience in supervisory capacity and knowledge of popular
accounting software packages.
Age Limit: Up to 40 years.
General:-
1) All matters relating to accounts, budgeting and financial matters and management of
accounting procedure pertaining to NPCDCS in the State/ District.
2) To maintain the fund flow mechanism from State to Districts and Districts to below.
3) Accurate and timely submission of quarterly report on expenditure to Centre/State,
annual audited statement of accounts and intensively monitoring the financial
management in State/ District Health Society.
4) Any other job assigned by concerned officers.
Specific:
5) Preparing annual and quarterly budgets for the State/ District.
6) Ensuring that adequate internal controls are in place to support the payments and
receipts.
7) Ensuring timely consolidation of accounts/financial statements at the State/ District.
8) Monitoring expenditure and receipt of Utilization Certificate (UC) & Statement of
Expenditure (SOE) from the State /District.
9) Coordinating with District and below to address the audit objection/internal control
weaknesses, issues of disallowances, if any.
Remuneration: Up to Rs. 30,000/month (consolidated)
40
3. Job title: Programme Assistant
Qualifications:
Essential
1) Graduate in any stream
2) Knowledge and experience in office work
3) Course in shorthand, typing, computer applications desirable.
Age Limit: Up to 4o years.
Assistance to State/District Programme coordinator in all his job responsibilities
Correspondence with District NCD Unit, State Government, Govt.of India
Assistance in organizing review meetings and official tours
Maintenance of files and correspondence
Assistance in preparation of reports
Any other job assigned as per program need.
Remuneration: Up to Rs. 20,000/month (consolidated)
4. Job title: Data Entry Operator

Qualification & Experience
Graduate
Diploma in Computer Applications
Experience in database designing, excel sheet desirable
Minimum one year of relevant working experience.
Age Limit: Up to 40 years.
Ensure regular entry of all relevant data in the computer pertaining to various
aspects of NPCDCS in a systematic manner to facilitate its analysis.
Compile the reports.
Maintenance and up keep of the computer and its accessories.
Any other job assigned as per program need.
Remuneration: Up to Rs. 12,000/month
41
Annexure –II
Indicative List of Drugs for Diabetes, CVD & Stroke.
S.no Drugs
1 Tab Aspirin
2 Tab .Atenolol
3 Tab.Metoprolol
4 Tab. Amlodipine 10mg
5 Tab Hydrochlorthiazide 12.5, 25 mg
6 Tab.Enalapril 2.5/5mg
7 Tab Captopril
8 Tab. Methyldopa
9 Tab Atorvastatin 10mg
10 Tab Clopidogrel
11 Tab.Frusemide 40mg
12 Inj.Streptokinase 7.5 lac vial
13 Inj.Streptokinase 15 lac vial
14 Inj.Heparin sod.1000 IU
15 Tab.Isosorbide Dinitrate (Sorbitrate)
16 Glyceryl Trinitrate Inj, Sub lingual tabs
17 Diazepam Inj & Tab
18 Inj.Adrenaline
19 Inj.Atropine sulphate
20 Inj.Digoxin
21 Tab.Digoxin
22 Tab.Verapamil(Isoptin)
23 Inj.Mephentine
24 Tab Potassium IP (Penicilliln V)
25 Inj. Normal saline (Sod chloride) 500ml
26 Inj.Ringer lactate 500ml
27 Inj.Mannitol 20% 300ml
28 Inj.Insulin Regular
29 Insulin Intermediate
30 Tab. Metformin
31 Inj. Aminophylline
32 Tab Folic Acid
33 Inj Benzathine Benzyl penicillin
34 Carbamazepine tabs, syrup
35 Inj Lignocaine hydrochloride
36 Inj.Dexamethasone 2mg/ml vial
37 Tab Prednisolone
38 Promethazine Tab, Syrup , Caps, Inj
42
Annexure –III
Indicative List of Drugs for Treatment of Cancer
1 Inj Doxorubicin
2 Inj Cisplatin
3 Inj Carboplatin
4 Inj Paclitaxel
5 Inj Docetaxel
6 Inj Gemcitabine
7 Inj Oxaliplatin
8 Inj Herceptin
9 Inj Mabthera
10 Inj Velcade
11 Inj Avastin
12 Inj 5 FU
13 Inj Vincristine
14 Inj & tab Endoxan (Cyclophosphamide)
15 Tab Tamoxifen
16 Cap Temozolimide
17 Cap Procarbazine
18 Cap CCNU (lomustine)
19 Inj Epirubicin
20 Inj & tab Methotraxate
21 Inj Vinblastine
22 Inj Etoposide
i.
43
Annexure IV
GUIDELINES FOR ‘TERTIARY CANCER CENTRE’ SCHEME OF NPCDCS
(A) Introduction:
Since 1975, the National Cancer Control Programme provided recognition of certain health
care centers as Regional Cancer Centers so that these could become nodal centers to support
the Programme. Under the 10th Five Year Plan, these centers were given grant-in-aid under the
Regional Cancer Centre (RCC) Scheme or the Development of Oncology wing Scheme. Under
the RCC scheme, the old and new RCCs were eligible for grant in aid of Rs. 3 crores & Rs. 5
Crores respectively. Government Medical College Hospitals were also eligible for Rs. 3.00
crores under Oncology Wing Scheme of NCCP. In all, 27 RCCs and 50 Govt. Medical
College Hospitals were supported to provide super specialty cancer care in the Government
sector.
The National Programme for Prevention and control of Cancer, Diabetes and Cardio
Vascular Diseases (NPCDCS) is formulated after merging the National Cancer Control
Programme (NCCP) and National Program of Prevention & Control of Diabetes, CVD and
Stroke (NPCDCS). The programme has two components: Cancer component and Diabetes,
Cardiovascular Disease and Stroke (DCS) component. In the NPCDCS, there is a provision to
provide support to 65 health care centers. Each centre will now be known as a Tertiary Cancer
Centre (TCC) and shall be supported by up to Rs. 6 crores with the Central and the State share
of 80:20.
(B) Objectives of TCC Scheme:

1. To develop regional referral cancer centers to provide specialized and
comprehensive cancer care,
2. To provide training and research facilities in all types of cancer with focus on oral,
cervix and breast cancer.
(C) Eligibility Criteria for TCCs:

1. The institute should be a Government Medical College Hospital or erstwhile RCCs.
2. The focus of funding should be the Government Medical College, who were earlier
supported under “Oncology Department” component of the scheme
3. The institute should have at least three years of experience in cancer treatment.
4. The Tertiary Cancer Centres should be well within 300 km of identified districts
under NPCDCS
5. The institute should have well equipped and functional departments of Medicine,
Surgery, Gynecology & Obstetrics, ENT, Anesthesia, Pathology and Radiology.
These departments can be part of the institute or part of hospital attached with a
44
Government Medical College in near vicinity in the same city which has entered
into a formal understanding with TCC.
(D) Procedure of application:

1) Based on the gaps identified by the grantee institute, the institute shall submit the
Proposal as per the format (Annexure I – Part I & II) and include action plan for
a. Procurement of equipment/instruments related to cancer treatment and research
b. Construction of the building (if required)
2) The application should indicate separately the amount of grant required for equipment
and construction work.
3) The state government shall forward the Proposal with necessary undertaking to the
Government of India and recommendation as per format (Annexure I – Part III) duly
approved by a competent authority.
4) If the institute requires Radiotherapy equipments, a letter of approval and approved
layout map of the Center from AERB will be submitted along with the Proposal.
5) The detail of previous grant(s) received under the erstwhile National Cancer Control
Programme, if any and Utilization Certificate(s) thereof should be annexed with the
Proposal
6) The proposal should be addressed to Under Secretary (Cancer Desk), Ministry of
Health & Family Welfare, Nirman Bhawan, New Delhi- 110108.
(E) Procedure for approval:

1. The proposals shall be examined in the Directorate and an expert/ team, consisting of at
least one expert and one senior officer of the central government including the Regional
Directors (H&FW), shall be nominated to make an assessment of the applicant
institution. The expert/team shall assess the eligibility criteria and evaluate the gaps in
the availability of the cancer treatment facilities in various disciplines. The assessment
shall be carried out as per Annexure I – Part V. Since TCC are linked to already
identified districts under the programme, it is necessary to ensure that TCC identified
should be well within 300 km of district already identified under the programme in
order to ensure effective referral care.
2. The proposals shall be considered by the ‘Standing Committee on Radiotherapy
Development Program’ and recommend the same to the Ministry of Health & Family
Welfare for financial assistance.
3. The grant amount shall be released to the institute through the State Health Society by
the Ministry of Health & Family Welfare with information to State government
/NRHM after the signing of a tripartite Memorandum of Understanding (MOU).
4. The three parties signing the MoU shall be the authorized signatories of (i) Grantee
institute; (ii) State Government; and (iii) Ministry of Health & Family Welfare,
Government of India.
45
(F) Financial Provisions:
1) The selected institute shall be provided non-recurring financial assistance upto Rs. 6
crores for procurement of any equipment or construction of the building related to
cancer care or HR Recruitment. The Central Government’s share shall be 80% of the
grant requested and remaining assistance shall be the States’s contribution.
2) The State Government shall ensure that the erstwhile NGO RCC institutions and TCCs
provide free treatment to cancer patients below poverty line (BPL).
3) The selected institute shall be permitted to procure one or more equipment related to
cancer care. The list of equipments/instruments is at Annexure – II.
4) A portion of the grant not exceeding 30% can be utilized for construction activities.
5) The Utilization Certificate of the grant sanctioned should be settled by the grantee
institute within one year’s time.
6) The grant shall be deposited in a joint Savings Bank Account of a Nationalized Bank.
The Account shall be operated by two persons of the institute. The interest accrued
thereon should also be reflected in the Utilization Certificate.
7) There would be no claim for the recurrent grant in the future over and above envisaged
under the 11th five year plan. However, Govt. of India at its own discretion may
consider providing more grants to TCCs.
8) The maintenance cost of equipment(s) procured shall be borne by the grantee
institute/respective state government.
Activities:
The Tertiary cancer centre shall provide cancer care ranging from cancer prevention, early
detection, diagnosis, provision of therapy, after care, palliative care and rehabilitation. The
TCCs would do the following activities:
1. The TCCs will provide comprehensive care, training and research in all types of cancers
with focus on oral cancer, cervix cancer and breast cancer. The comprehensive care
includes cancer prevention, early detection, diagnosis, provision of therapy, after care,
palliative care and rehabilitation.
2. The TCCs will act as a regional referral center for the comprehensive management
(treatment) of difficult cancer cases.
3. The TCCs will provide pain and palliative care and ensure availability of opioids drugs
for cancer patients.
4. The TCCs will function as a centre for creating/ imparting training of different health
professionals (Doctors, Nurse, technologists, technicians) where possible.
5. The TCCs will facilitate in organizing workshops/training programmes for human
resource development
6. The TCCs will facilitate in developing modules/standard treatment protocols for the
common cancers.
46
7. The TCCs will coordinate with other institutions, NGOs, medical colleges and the
general health care delivery infrastructure in conduction of cancer related activities
including peripheral outreach services in their respective geographical areas/ region.
PROFORMA FOR TERTIARY CANCER CENTRE
THIS PROFORMA IS IN FIVE PARTS:

I. Detailed information about the Institution,
II. Application for grant-in-aid (Action Plan)
III. State Govt. Recommendation
IV. Memorandum of Understanding
V. Inspection report (to be completed by the nominated Expert/Team)
47
PART- I
1. Name and address of Institute:
1.1. Nature of the Institute: Government Institution/ NGO (only for existing RCC)
2 Details of infrastructure:
2.1 Existing Indoor-beds: Total __________ For Cancer Patients___________
2.2 Additional Beds proposed for Cancer Patients:________
2.3 Day Care Facilities: Chemotherapy/Palliative Care/Others
3. Facilities for management of cancer patients*
____________________________________________________________________
Department Existing Proposed Head of Department
(Name & designation)
1. Pathology
- Histopathology
- Cytology
- Haematology
- Blood Bank
2. Microbiology
3. Biochemistry
4. Radio-diagnosis
- X Ray
- Ultrasound
- CT scan
5. Surgical Oncology
6. Gynae- Oncology
7. Medical Oncology
8. Paediatric Oncology
9. Palliative
& Rehabilitative Care
10. Radiotherapy
-Radiation Physics
11. Anaesthesiology
12. Cancer Registry
13. Medical Records
14. Any other (specify)
* The TCC should ensure the services of histopathology, cytology, haematology, biochemistry and
radio-diagnosis. The comprehensive TCC consists of surgical oncology, radiotherapy, medical
oncology, Palliative care specialities with medical record section.
48
4. Patient population Data
4.1 Districts and region covered/proposed to be covered by the institute (give details):
4.2 Population in the above mentioned districts
4.3 Expected number of new cases of cancer per year:
4.4 Registered new cancer cases/year in the last 3 years
4.5 User charges levied or not : Yes/No
(if yes give details)
5. Radiotherapy Facilities
Equipments Existing Number* Additional No.

Proposed#
- Cobalt
- Linear Accelerator
- Manual Brachytherapy
- Remote A/L Brachytherapy
- Simulator
- Treatment Planning System
- Radiation Physics
• Survey meter
• Other instrument
*Existing Equipments : mention number, make, source, source strength, Xray/electron
energies, accessories, year of purchase etc. in separate page.
# Proposed Equipments : mention proposed number of equipment (s) and the year by which it
will be acquired.
No. of Operation Theatres

General Surgery
Cancer Surgery
Details of major surgical equipments
No. of beds in Surgical Oncology
No. of Cancer Surgeries done in the last three years
49
7. Medical Oncology
No. of beds in Medical Oncology
No. of new patients treated with Chemotherapy during the last 3 years
8. Teaching Programme
Speciality Course Duration Seats/Year Affiliation Existing/ Proposed
___________________________________________________________________________
- Radiotherapy
- Surgical Oncology
- Medical Oncology
- Palliative Care
- Cancer Epidemiology
- Radiation Physics
- Technologist
(specify)
- Nursing
- Other (specify)
9. Research and Training Activities
9.1 Mention in Brief Continuing/proposed research works in cancer epidemiology, basic

sciences, clinical sciences etc.
9.2 Mention in brief training activities and community oriented programmes (within and
outside the RCC).
9.3 Research Publications already carried out (attach separate list, if any)
50
PART-II
PROPOSAL FOR OBTAINING GRANT-IN-AID (ACTION PLAN)
Equipments can be procured for Radiotherapy/Surgical Oncology/Medical Oncology/

Pathology/Radio-diagnosis/Nuclear Medicine etc. (refer annexed indicative list)
10. Radiotherapy (Teletherapy/Brachytherapy) Equipment

10.1 Estimated cost of Equipment
10.2. Building for Equipment : Ready / under construction
10.3 Approval by AERB/BARC : Obtained / not obtained
10.4 Building Plan for proposed TCC : Attached / not attached
10.5 Building Plan for Proposed Equipment : Attached / not attached
11. Medical Oncology/Palliative care
11.1 Medical Oncologist/dedicated physician or surgeon
11.2 Palliative Care Physician/Surgeon or PMR specialist
11.3 Dedicated day care ward/facility for chemotherapy
11.4 Dedicated palliative Care ward or Rehabilitation ward
11.5 Chemotherapy drugs/consumables
12.1 Surgical Oncologist/Trained Surgeon
12.2 Dedicated Operation Theatre/OT table
12.3 Special Surgical equipments like endoscopy/knife etc.
13. Diagnostic/pathology/other equipments
13.1 Estimated cost
13.2 Other details
14. Timelines (Gantt Chart) for different stages of completion of action plan
Mention details of any previous grants taken earlier and the status of its Utilization
Certificate.
Date: _____________
Name and Seal of Head of TCC/Institution
P.S. If it is a Government institution, the proforma should be forwarded by the competent

authority.
Attach separate sheets to provide information wherever necessary.
51
PART – III
CERTIFICATE & RECOMMENDATIONS OF THE STATE GOVT./U.T. ADMINISTRATION
No………Station and date…………..Government of ……………Department of …………….
1. The Institution is a Govt. Medical College/Hospital and is involved in cancer treatment

activities.
2. The State Government has examined the audited accounts of the Institution and is satisfied
that their financial position is sound
3. The State Government is satisfied about the soundness of the project and that the institution
is of proven capability for undertaking the project.
4. The information furnished by the Institution is correct.
5. The State-Government recommends the proposal for a total grant of Rs…………
(Maximum grant amount Rs. 6 crores with Rs. 4.8 Crores by Central Govt.) to be utilized
in ________________________________(name of the institution) for the purpose of
________________________________.
6. State Govt. agrees to make contribution to the development of TCC in the institution
through grant-in-aid and/or any other assistance required.
7. The State Govt. will ensure that the institution (including erstwhile private NGO RCCs
only) shall provide free treatment to BPL cancer patients.
Signature, Name & Designation
(To be signed by an officer of the State Govt. not

below the rank of Dy. Secretary)
52
Part IV
Memorandum of Understanding
[Between Tertiary Cancer Centres, State Govt & Ministry of Health & Family Welfare, GOI]
1. Parties
The Department of Health (National Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular Disease and Stroke, NPCDCS), the State Government and
____________________________________ (name of Tertiary Cancer Centre) hereinafter
referred to as ‘designated agency’ agree to cooperate in the implementation of Cancer control
activities to patients who require Cancer care.
The NPCDCS aims to improve cancer care facilities for cancer patients. To make the
programme more effective, wider participation of health care providers in Cancer control is
required.
2. Objectives of the MoU:
1. Identify and establish the roles and responsibilities of the partner institution and
delivery of Cancer care.
2. Provide diagnosis and treatment services to the cancer cases in the general population
in the region.
3. To undertake capacity building training programs for doctors, nurses and other health
personnel under the Programme.
4. To undertake health education and awareness programs for prevention and early
detection of cancer cases.
3. Terms, conditions, and specific services under the MoU.
A. THE MINISTRY OF HEALTH & FAMILY WELFARE, GOVERNMENT OF INDIA

SHALL
(i) Provide financial assistance towards construction for housing the equipments &
cancer wards and for purchase of equipments for cancer care up to a maximum of
Rs. 4.8 crore through the State Health Society The Ministry will assess the action
plan and decide on the quantum of grant to be released. The amount of the grant
may be released in installments and in a phased manner depending on the
availability of funds.
(ii) Provide the technical support in implementation of action plan.
(iii) Provide operational and technical guidelines and updates (manuals, circulars, etc.)
to the TCC
53
(iv) Monitor and evaluate Cancer Care services being provided by the TCC
B. THE STATE GOVERNMENT SHALL
(i) Examine and verify the facts of the proposal submitted by the institution;
(ii) Make recommendation on the proposal after having got satisfied on each
parameter contained in Part III
(iii) Agree to make contribution to the development of TCC in the institution through
grant-in-aid and/or any other assistance required.
(iv) Release grant received from the Government of India and release to the grant
institution for setting up/development of TCC
(v) Monitor expenditure incurred by the TCC; obtain and forward Statement of
Expenditure and Utilization certificate to the Ministry of Health &FW.
(vi) Ensure that the institution (including erstwhile private NGO RCCs only) shall
provide free treatment to BPL cancer patients
C. THE INSTITUTE (TCC) SHALL
(i) Prepare an action plan for development of infrastructure, indicating the

equipment proposed to be purchased and project the activities proposed to be
undertaken
(ii) Execute the project according to the policy outlined in NPCDCS.
(iii) Undertake cancer treatment activities and act as a nodal centre for the Health
Education, prevention and early detection in the district/s.
(iv) Extend cancer treatment facilities to all types of patients irrespective of the
caste, creed and religion.
(v) Maintain medical records of patients treated in the institutions as per prescribed
formats in the MIS/Cancer Registry
(vi) Timely submit physical and financial progress reports in the prescribed formats
(vii) Undertake capacity building training programs for doctors, nurses and other
health personnel.
(viii) Utilize the grant as per operational guidelines, terms in the sanction letter and
provisions under GFR and submit SOE and UC to the State Health Society.
(ix) Provide treatment free of cost to cancer patients below poverty line (BPL)
(x) Ensure proper upkeep and maintenance of the equipment, for which the
financial assistance has been granted
54
4. Duration and Renewal
This MOU shall be valid for ____years from the date of signing the agreement.
5. Penalty clause
In case of violation of any of the provisions of this agreement by the grantee institution, the
Ministry of Health & FW will be at liberty to terminate the contract and the concerned
institution will have to refund the entire grant money along with interest.
_____________________ ______________________________
Signature by authorized signatory Signature by authorized signatory

of Grantee Institution (TCC) of the State Government
Stamp Stamp
_____________________
Signature by authorized signatory

of the Ministry of Health & Family Welfare
Government of India
Stamp
55
PART V
INSPECTION REPORT
15.1. Name & Address of the Institution Inspected :
15.2 Date/s of Inspection
15.3. Inspection Team
Member’s Name Designation Address Phone/Fax
1.
2.
3.
15.4 Inspection Report: (As per check-list)
15.5 Recommendation: Recommended/Not Recommended
_____________ ______________ ____________
Signature Signature Signature
56
Guidelines for INSPECTION TEAM:
Issues/matters other than the points mentioned below may also be identified and looked into by
the inspecting members.
1. To physically verify Institution’s area, space allocations for specialities, OPD, beds,
and laboratories.
2. The medical and other staff strength of the Institution.
3. Obtain documents about the official status/governing body/annual report/financial

position/other sources of grant etc.
4. Records on Patient Population data, cancer treatment facility, teaching and training
activities should be obtained.
5. Details need to be provided in separate sheets as per existing Performa/ format.
Check list for Financial Assistance to TCCs
1. Filled up proposal as per format containing availability of infrastructure, manpower and

action plan including construction plan.
2. Availability of Radiotherapist & Medical Physicist in case of request for Radiotherapy
Equipment.
3. Details of the previous grants received & Utilization certificate/s
4. Copies of AERB/BARC lay out plan and letter in case of radiotherapy equipments.
5. State Government Recommendation as per the format.
57
Part VI
List of equipments for Cancer Care Services at TCC
1. Teletherapy:
• Cobalt radiotherapy machine
• Low Energy LINAC or High Energy LINAC (Linear accelerator)
• Mould room facility
• Gamma Knife
2. Brachytherapy
• High-dose rate brachytherapy system or LDR
3. Planning
• Simulator or CT Simulator with Virtual Simulation facility
• Treatment Planning System
4. Verification (Physics accessories for comprehensive QA)
• Secondary Standard Dosimeter

• Gamma Zone monitor
• Survey Meter (Ion chamber based)
• Radiation Frequency Analyzer
5. Surgical Oncology equipments
6. Medical Oncology related equipments
• X- ray Machines
• Ultrasound Equipment
• CT Scan Machine
• PET
• Fibre Optic Endoscopes
• Mammography Machine
• Gamma camera and other Nuclear Medicine Equipment
• Pathology and Cytology microscope and other related equipment
• Equipment for Operation theatre/ Anaesthesia
Note:
1. List is indicative only
2. Indigenous machines, if available, should be preferred by the institutions
58
GFR 19-A
Form of Utilization Certificate
Sl. No. Letter No. and Date Amount
Total
Certified that out of Rs. ________ of grants-in-aid sanctioned during the year _________ in
favour of ___________ under this Ministry / Department Letter No. given in the margin and
Rs. _______ on account of unspent balance of Rs. _______ on account of unspent balance of
the previous year, a sum of Rs. _______ has been utilized for the purpose of ________ for
which it was sanctioned and that the balance of Rs. _____ remaining unutilized at the end of
the year has been surrendered to Government (vide No. _______, dated_________)/will be
adjusted towards the grants-in-aid payable during the next year ________.
2. Certified that I have satisfied myself that the conditions on which the grants-in-aid was
sanctioned have been duly fulfilled/are being fulfilled and that I have exercised the following
checks to see that the money was actually utilized for the purpose for which it was sanctioned.
Kinds of checks exercised
1.
2.
3.
4.
5.
Signature___________
Designation __________
Date________________
59
Annexure V
National Programme for Prevention & Control of Cancer, Diabetes,

Cardiovascular Diseases and Stroke (NPCDCS)
Districts Covered during 2010-11
S.No. States Distt. S.No. Disricts CHCs Sub Centres

1 Andhra Pradesh 1 Nellore 6 481
2 Vijayanagaram 7 470
2 Assam 3 Dibrugarh 6 240
4 Jorhat 4 142
3 Bihar 5 Vaishali 2 336
6 Rohtas 1 186
4 Chhattisgarh 7 Bilaspur 10 379
5 Gujarat 8 Gandhi Nagar 6 171
9 Surendranagar 11 200
6 Haryana 10 Mewat 3 102
7 Himachal Pradesh 11 Chamba 7 170
8 Jammu & Kashmir 12 Leh (Ladakh) 3 24
13 Udhampur 2 97
9 Jhankhand 14 Bokaro 8 116
10 Karnataka 15 Shimoga 11 307
16 Kolar 6 201
11 Kerala 17 Pathanathitta 13 230
12 Madhya Pradesh 18 Ratlam 5 158
13 Maharashtra 19 Washim 7 153
20 Wardha 6 181
14 Sikkim 21 East Sikkim 0 48
15 Orissa 22 Naupada 4 95
16 Punjab 23 Bhatinda 9 136
17 Rajasthan 24 Bhilwara 16 415
25 Jaisalmer 6 136
18 Uttrakhand 26 Nainital 4 136
19 Tamil Nadu 27 Theni 6 162
20 Uttar Pradesh 28 Rae Bareli 11 377
29 Sultanpur 14 403
21 West Bengal 30 Darjeeling 11 230
21 TOTAL 30 205 6482
60
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NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER,

DIABETES, CARDIOVASCULAR DISEASES & STROKE (NPCDCS)

Directorate General of Health Services

NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER,

Fig. 1 Risk factors (RF) and level of NCD

Primary Prevention Secondary Prevention Tertiary Care

1) Prevention through behaviour change

1.3.1 Prevention through behavior change

increased intake of healthy foods

1.3.4 Capacity building of human resource

1.3.5 Supervision, monitoring and evaluation

Figure 2: India Map showing the States to implement NPCDCS

2.1 Package of Services

In the programme, it is envisaged providing preventive, promotive, curative and supportive

Health Facility Packages of services

Tertiary Cancer Comprehensive cancer care including prevention, early detection,

Institutional Frame Work Public Health Infrastructure Services

Tert. [Tertiary Cancer Care Centres

District Hospital [Health Promotion; Early

2.2.1 Program Structure-Integration with NRHM:

2.2.2 State Health Society (SHS):

2.2.4 Technical Resource Groups

2.2.5 Management Structure:

2.2.5.1 National NCD Cell

Organization Structure of National NCD Cell

The National NCD Cell will be supported by following contractual staff.

B. Role and responsibilities of the National NCD Cell is as under:

2.2.5.2 State NCD cell

A. Composition: State NCD Cell will be supported by following contractual staff

A. Composition: District NCD Cell will be supported by following contractual staff:

B. Role and responsibilities of the District NCD Cell

2.3.1 Sub Centre

Under the NPCDCS Sub Centers shall perform following activities:

increased intake of healthy foods

Fasting Glucose 2-hour Post-Glucose Load

Diabetes Mellitus >=126 >=200

Impaired Glucose Tolerance < 110 >140 to <200

Impaired Fasting Glucose >=110 to <126

Steps for measuring Blood pressure

D. Data recording and reporting

increased intake of healthy foods

D. Diagnosis and Management

2.3.2.1 Human Resources for CHC NCD services

2.3.2.2. Role of NCD Clinic at CHC

a. Provide opportunistic screening

2.3.3. Activities at District Level

C. Outsourcing of certain laboratory investigations

D. Out-patient and In-patient Care

E. Day Care Chemotherapy Facility

F. Home Based Palliative Care

G. Referral & Transport facility to serious patients

J. Data recording and reporting

K. Human Resources at District Hospital

increased intake of healthy foods

B. Planning, Monitoring and Supervision:

Under NPCDCS approximately 32 thousand personnel need to be under the programme in

AYUSH Physio- Counselor/ Lab. DEO/ ANM/

NCD Clinic CHC 1 2 1 1 1

NCD Clinic Distt. Hosp. 1 2 1 3 2 1