Country Capacity and Accomplishments and Application of the Policy Options Framework(cont...)

India

Key Policy Options and Strategic Actions

Assess

* Create a national NCD surveillance system. A national surveillance system is needed for strategic planning and policy development. The IDSP is a good effort to develop a national ongoing risk factor surveillance system but is now stalled. Using a state-based approach is reasonable but national and regional funding and technical support will be needed. In addition, systematic surveillance of morbidity and mortality will be needed. With regional
variations in disease burden likely an issue, assessments can be done in representative subsamples.

Surveillance must be designed to meet planning and policy development needs. It will be important to link institutions with NCD research capacity to create a disease burden evidence base but also one for population- and individual-based interventions. Expanding surveillance outside the health sector for exposure to harmful products and foods (tobacco, processed foods, edible oils, etc.), will be needed for health policy planning.

Plan

* Coordinate national NCD efforts. India already has many NCD policies and stakeholders, and

much progress has been made. The current challenge is coordinating efforts in many areas to

improve efficiencies and to assure that resources will have the largest impact. Currently, there is

no overarching policy, strategy, or coordinating body to make sure that key opportunities are

taken.

Develop and Implement

* Strengthen tobacco control policies. Prevention efforts for tobacco are reasonably well

developed and planned for integration into the NRHM and NPDCS. However, prevention and

control efforts outside the health sector, while substantial, could be enhanced. Specifically,

considering a tax framework that includes all major tobacco products (including bidis) could

have a large impact. This strategy would need to include the tax impact outside the sector on

finance, agriculture, commerce, and labor.

* Strengthen injury control policies with a focus on road traffic injuries. This is an area where

surveillance data are still not well developed. However, prevention policy, especially for road

traffic injuries, is badly needed.

* Implement clinical standards and guidelines developed under the India Public Health Standards and integrate NCD training into human resources for health (HRH) curricula. With the NRHM and the NPDCS both coming on line, this aspect will be critically important.

* Develop financing strategies for NCD prevention and control efforts. Most clinical prevention and treatment services are from private out-of-pocket sources, and impose a large burden on the poor and lead to both poverty induction and catastrophic spending. The priority is for financing schemes to protect the poor. However, a substantial proportion of the total population will also be susceptible to financial stress from health care costs from NCDs. Thus, schemes suitable for those with some means that can use risk pooling and expenditure smoothing will be of great benefit. Some models are currently being examined but a strategic plan is not evident. Finally, a strategy to finance population-based prevention interventions within and outside the health sector is needed.

Evaluate

* Evaluate NCD programs and policy initiatives. Few evaluations have been done and there is little demand for them. As more and more resources are targeted toward NCDs and policies and

programs are scaled up, understanding the benefits of such programs and initiatives provides

critical input. Areas that might greatly benefit from evaluations include tobacco control, NRHM,

and NPDCS.