Is managerial convergence sufficient for implementing stroke services within the NPCDCS program in India?-a critical appraisal

Abstract

Background: The National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) is a program concentrating on delivering high-quality services for non-communicable diseases especially in the rural areas of India. By integrating this program with the comprehensive National Health Mission (NHM) the Government ambitiously aims to cover the vast rural population, which constitutes about 70% of the total population. However eight years since its launch, the program has not been able to expand significantly. Our critical appraisal of the program highlights multiple deficits in its conception, planning and implementation. Method(s): Literature from peer-reviewed journals and gray literature like government reports were considered for review. In-depth interviews with experts from the NPCDCS program were conducted and consolidated for discussion. Finding(s): Managerial convergence appears to be an important strategy to enhance efficiency in the NPCDCS program. However, it is not feasible to converge, medical and therapeutic management of four chronic conditions that are very different to each other in terms of their manifestation, diagnosis and management. There isn't any specific plan for implementation of stroke services within the NPCDCS program. The NCD cells which are described to be the heart of the program seems more like a program management unit. Allied health professionals who form the backbone of this program are invisible especially at the grass root level. Conclusion(s): A critical revision of the program with sustainable strategies for effective implementation is highly pertinent. Involvement of allied health professionals in program conceptualization, planning and implementation is recommended.