Critical appraisal of the national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) for stroke in India

Introduction: India's National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is an ambitious venture by the government that integrates with the flagship National Health Mission (NHM); aiming to deliver quality services for non-communicable diseases to 80% of India's population residing in the rural areas. However, since its inception as a pilot project in selected states four years back, the program hasn't expanded significantly. Aim(s): Our critical appraisal aims to identify potential fallacies in planning and implementation of the NPCDCS for stroke. Discussion(s): Combined focus on all non-communicable diseases necessitates managerial convergence of resources rather than a separate policy or program for every disease. Inadequately defined screening criteria for stroke, lack of well-defined referral pathways and underutilization of public-private partnership compromise the efficacy of acute care, including thrombolysis. Lack of workforce (neurologists, occupational, speech and physiotherapists), insufficient supplies for rehabilitation technology (wheel chair, orthotics) and lesser involvement of existing allied health workforce in post-discharge care makes focus on rehabilitation (tertiary prevention) grossly inadequate. These shortcomings make the decision to integrate with the already bulky NRHM questionable. We also evaluated the scope of stroke units, affordable generic drugs, early involvement of caregivers for rehabilitation and impedance caused by patients shifting to alternative medicine; to fortify the stroke prevention policy. Conclusion(s): A critical revision of program with an independent stroke policy, substantial inclusion of stroke specific strategies, emphasis on public-private partnership and greater involvement of allied health professionals in planning and implementation is advised.