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MULTI-STAKEHOLDER Book 18 Feb 2020.Cdr WHO's Role in Multisectoral Response to Noncommunicable Diseases in India Evaluation Report WHO's Role in Multisectoral Response to Noncommunicable Diseases in India Evaluation Report TABLE OF CONTENT List of Annexes, Tables, Figures, Boxes i List of Abbreviations ii Acknowledgements iv cc 1 A. Overview of the NCD issue 10 A.1. WHO's Global and Regional Mandate for NCD 10 A.2. NCDs and SDGs 10 A.3. National Situation on NCDs in India 11 A.3.1. Disease-wise mortality 11 A.3.2. Major risk factors of NCDs in India 12 a. Widespread prevalence of Tobacco use 12 b. Decreasing Physical Inactivity 12 c. Increase in Air Pollution related diseases 12 d. Very High Road Accident Fatalities 13 e. Drastic increase in alcohol abuse 13 f. Poor food safety 13 A.3.3. Implications of NCDs in India 13 a. Rising mortality die to Cardio-vascular Diseases 13 b. Burden of treatment on poor 13 c. Inadequate public investments and infrastructure 13 d. Resource Crunch in the States for NCDs 13 e. Alarming situation on Mental health 14 B. Evaluation Framework 15 B.1. Context of this evaluation 15 B.2. Objectives of this Evaluation 15 B.3. Our approach to this evaluation 16 B.4. Key Stakeholders of this evaluation 16 B.5. The Evaluation Design 16 B.6. Theoretical Framework for the Evaluation 16 B.6.1. Results Based Management and Evaluation Frameworks of UNEG and OECD-DAC 17 B.6.2. Process Tracing Framework 17 B.6.3. Advocacy Evaluation Framework 17 B.7. The Evaluation Instruments 18 B.7.1. Documentation Review 18 B.7.2. Key Informant Interviews 18 B.7.3. Focus Groups 18 B.7.4. Visits to Five States 18 B.7.5. Media Analysis 18 B.7.6. Case Studies 19 B.8. Limitations faced during this evaluation 19 B.9. Key Evaluation Questions vs Tools 19 C. Major Findings from the Evaluation 20 C.1. Question 1 : Relevance of response of WHO India 20 C.1.1. Research and evidence generation for multi-stakeholder action on NCDs 20 C.1.2. Working closely with Government of India in formulating the NMAP 21 C.1.3. Process Learnings 22 a. Process learning from Tobacco control about advocacy for NCDs 22 b. Inclusion of other suggested stakeholders 24 C.2. Question 2. Effectiveness of WHO India in fostering multi-stakeholder collaboration 24 C.2.1. Steps taken for supporting Multi-stakeholder response on NCDs 25 C.2.2. WHO-UNDP new initiative to support GoI for enhanced coordination on NMAP 27 C.2.3. WHO India’s role in building a multi-stakeholder Response to Air Pollution in India 27 C.2.4. Multi-stakeholder response to Road Safety in India 29 C.2.5. Government Programmes for prevention and control of NCDs 30 a. National Programme for Prevention & Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke 30 b. National Non-communicable Disease Monitoring Survey 31 c. National Mental Health Programme 31 C.2.6. Role of WHO India in support to National Mental Health Programme 31 C.3. Question 3. Support to evidence generation and implementation by WHO India for Best Buys 32 C.3.1. Reduce Tobacco Use 32 C.3.2. Reduce the Harmful Use of Alcohol 35 C.3.3. Reduce Unhealthy Diet 36 C.3.4. Reduce Physical Inactivity 38 C.3.5. Manage Cardiovascular Disease and Diabetes 38 C.3.6. Manage Cancer 39 C.4. Question 4. Results of support to Health Systems Strengthening and Health Promotion by WHO India 40 C.4.1. Health Promotion 40 C.4.2. Health System Strengthening 45 C.4.3. Surveillance, Monitoring, Evaluation and Research 50 a. National Non-communicable Disease Monitoring Survey 51 b. Population based screening for NCDs 51 c. Health Management Information Systems 52 C.5. Question 5. Work by WHO India with UN Partners, CSOs and Academia 53 C.5.1. Joint Programming with UNDP on NCDs 53 C.5.2. WHO India’s partnerships with Civil Society to address NCDs 53 C.5.3. Results of qualitative analysis of interview data 56 C.6. Question 6. Lessons Learnt 57 C.6.1. Main Strengths, Weaknesses, Opportunities and Threats for NCDs which WHO India needs to address 57 a. Strengths in the Current NCD Scenario 57 b. Challenges/Weaknesses/Gaps in the current NCD Scenario 57 c. Opportunities for NCDs in India 60 d. Threats in the area of NCDs 61 C.7. Question 7. Recommendations 61 C.7.1. Widen WHO India’s current targeting and partnership strategy on NCDs 61 C.7.2. Continue supporting GOI and State Governments for strengthening health management systems 62 C.7.3. Continue supporting GOI and State Governments to strengthen capacity building processes for NCDs 63 C.7.4. Support and undertake advocacy in multiple areas on NCDs 64 C.7.5. Explore areas for supporting further research on NCDs 65 D. Bibliography 67 E. Notes and References 72 LIST OF ANNEXES, TABLES, FIGURES, BOXES Annexes Annex 1: Multi stakeholder (GoI's Ministries) responses on NCD prevention Annex 2: National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) Annex 3: The National Multisectoral Action Plan on NCDs Annex 4: List of persons interviewed Annex 5: Results of Media Analysis Annex 6: Tobacco Control and CSO actions on Diabetes and Cancer in Mizoram Annex 7 : Major CSOs working on NCDs in India and their contributions Annex 8: Timeline of efforts to control Tobacco in India Annex 9: Overview of Mental Health Issues in India Tables Table 1: National NCD Monitoring Framework Table 2: Key Stakeholders in the Evaluation Table 3: Key Evaluation Questions Table 4: Comparative Analysis of factors for success of multi-stakeholder mechanisms on Tobacco and NCDs Figures Figure 1: Contribution of major disease groups to total deaths in India, 2016 Figure 2: Structure for implementing NCD interventions from national to Sub-Centre level Figure 3: Contribution of major disease groups to total deaths in India, 1990 and 2016 Figure 4: Death Rate per 100,000 from various diseases in 2016 Figure 5: Contribution of Disease Categories to deaths, 2016 Figure 6: Survey – Attitude towards Mental Illness in India, 2016 Figure 7: Structure of Tobacco Control in India Figure 8: National Health Portal Figure 9: Number of Newspaper per sample month analysed Figure 10: Average number of stories on health in sample months Figure 11: Distribution of Newspaper stories by category Figure 12: Trends in number of media articles Figure 13: Trends in visibility of stories on communicable versus non-communicable diseases Figure 14: Breakdown of trends in stories by NCD Figure 15: Flowchart for Population based screening Figure 16: Information flow in Integrated Health Information Platform Figure 17: Health Management Information System Website Figure 18: Number of CSOs in India working on NCDs 1 Boxes Box 1: NCD-related targets in SDG 3 Box 2: Process Tracing Approach Box 3: “BEST BUYS” on NCDs Box 4: Tobacco control program becomes a movement in Mizoram Box 5: Regulations, Guidance and Notifications by FSSAI on Food Safety Box 6: Mentor Nurse Training Program in Chhattisgarh Box 7: The United Nations Interagency Task Force on the Prevention and Control of Non- communicable Diseases Box 8: Key Recommendations from CSO Consultations on NCDs Box 9: Standing Up to Industry to Secure Higher Sugar-Sweetened Beverage Taxes Box 10: Key facts about NCD prevalence in India Box 21: Funding for NCDs Cover picture: Pinkathon, Guwahati 2 2 LIST OF ABBREVIATIONS ACS : American Cancer Society AFTP : Advocacy Forum on Tobacco Control AHWC : AYUSH Health and Wellness Centres AIIMS : All India Institute of Medical Science AMRIT : Affordable Medicines and Reasonable Implants for Treatment AMRUT : Atal Mission for Rejuvenation and Urban Transformation ANM : Auxiliary Nurse Midwifery APL : Above the poverty line AQ : Air Quality ASHA : Accredited Social Health Activist AYUSH : Ayurvedic, Yoga and Naturopathy, Unani, Siddha and Homeopathy BCC : Behaviour Change Communication BMGF : Bill and Melinda Gates Foundation BMI : Body Mass Index CBAC : Community based Assessment Checklist CBSE : Central Board for Secondary Education CD : Communicable Diseases CDP : Crop Diversification Programme CERC : Consumer Education & Research Centre CHC : Community Health Centre CHIS : Comprehensive Health Insurance Scheme CMNNDs : Communicable, Maternal, Neonatal, and Nutritional Diseases CNC : Central NCD Cell COPD : Chronic Obstructive Pulmonary Disease COTPA : Cigarettes and Other Tobacco Products Act. CRD : Chronic Respiratory Disease CRISIL : Credit Rating Information Services of India Limited CSE : Centre for Science and Environment CSI : Civil Society Initiative CSO : Civil Society Organisation CSR : Civil Society Responsibility CVD : Cardiovascular Disease 3 DGHS : Directorate General for Health Services DH : District Hospital DMHP : District Mental health Programme DTCC : District Tobacco Control Cell ENDS : Electronic Nicotine Delivery System FBD : Food Borne Disease FCA : Framework Convention Alliance for Tobacco Control FCTC : Framework Convention on Tobacco Control FCV : Flue Cured Virginia tobacco FRU : First Referral Unit FSSAI : Food Safety and Standards Authority of India GCM : Global Coordination Mechanism on Prevention and Control of NCDs GDP : Gross domestic products ( GoI : Government of India HFSS : High Fat Sugar & Salt HH : Household HIA : Health Impact Assessment HIV : Human Immunodeficiency Virus HLSC : Health Sciences Learning Centre HMIS : Health Monitoring Information System HOT : Health-Oriented Telecommunications HRD : Human Resource Development HRIDAY : Health Related Information Dissemination Amongst Youth HWCs : Health and Wellness Centres ICMR : Indian Council of Medical Research IDSP : Integrated Disease Surveillance Program
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