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Thursday, January 10, 2019

Winning the War on NCDs in Rural India

ACF's Sakhis during training on NCDs in Chandrapur, Maharashtra

The evidence to mount strong interventions against Non-communicable diseases (NCDs) in India, is compelling - a recent Harvard University and World Economic Forum Report on NCDs claimed that India stands to lose $4.5 trillion before 2030 due to NCD’s alone.

Whilst India has a national action plan on NCDs (NPCDCS), much more work and investment is needed to strengthen the health infrastructure and interventions supporting that effort.  The government-run healthcare system in rural India largely focuses on maternal and child health and infectious disease; for instance, of the total health budget of Rs47,343 crore in 2017-18, only Rs955 crore was allotted to the NCD programme. The system now faces the dual burden of tackling not just infectious diseases, but that of NCDs as well.

Similarly, private sector efforts to promote preventive healthcare through corporate social responsibility (CSR) and other philanthropic initiatives, have largely been focused on maternal and child health. Whilst this investment has been necessary, it is important to recognize that the disease pattern in India has undergone a significant shift over the last 15 years.

In 2001-2003 a Government of India report on the causes of death in India revealed that the deaths in rural India due to communicable diseases (41 percent) were almost matched by those due to NCDs (40 percent). A follow-up study on the causes of death in rural India for the years 2010-13 showed that NCDs accounted for 47 percent of all deaths, while communicable, maternal, perinatal and nutritional conditions together accounted for 30 percent, indicating that NCDs have unquestionably become a healthcare priority.

Now more than ever, there is a need to bring NCDs into focus and simultaneously work on addressing them.  Both Government and Private investors need to bring NCDs into the spotlight and invest in tackling them for the long term.


There are a number of priority areas for investment, in tackling NCD’s in rural India:

  • Promotion of Well-being & Healthy Lifestyles as Preventative Measures.  Education and awareness in encouraging modification of lifestyle and high-risk behaviour, needs to be enhanced - promoting proper nutrition and developing healthy dietary habits.
  • Early Detection - Early screening of all adult population above the age of 30, would help highlight high-risk populations.  This provides a platform for early preventive management and behaviour change through health awareness and sensitization. This will help reduce untimely deaths and in the long run, reduce NCD prevalence.
  • Access to Diagnostics & Drugs - Upgrading the Primary Health care centres (PHC’s) with equipment for early screening and diagnosis and management of NCDs. Availability of drugs and essential diagnostic equipment at the primary care level is an essential prerequisite. 
  • Appropriate Treatment - Secondary and Tertiary Care is necessary. Recognizing the looming supply side issues in this area, Niti Aayog has recently recommended a public-private partnership model for setting up additional infrastructure for treatment of non-communicable diseases (NCDs) at district hospitals at reasonable costs. Under the PPP model, the private sector would be provided space for setting up facilities for treatment of cardiac, oncological, and pulmonary diseases by the state governments within the premise of existing district hospitals.  50% of NDCs can be treated effectively in primary healthcare.

Creating a cadre of trained community-based health workers, as the first crucial point of contact for health interventions in the rural communities is one impactful solution and area for enhanced investment. India paints a dismal picture in terms of the density of health workforce per 10,000 populations in comparison to global scenario. Only 20.9 health personnel were available per 10,000 population in India, of which 56.4% of all health workers were found to be in need of additional capacity building to effectively address NCDs.  Out of all qualified workers, 77.4% were located in urban areas, even though the urban population is only 31% of the total population of the country.


ACF is working towards developing a collaborative model that addresses the highlighted gaps in the current public health system in rural India, that would provide an effective, scalable model to tackle NCD’s, nationally.  The intervention Strategy focuses on 3 key aspects:

  • Creating awareness, lifestyle changes and health-seeking behaviour in rural communities, via a cadre of trained Sakhis (health workers) who provide the frontline interface with the community. This includes creating community awareness on NCD risk factors, high-risk profiling via home to home visits, conducting assessments, and providing education about nutrition and various risk factors of NCD and their prevention.
  • Strengthening the capacity of key stakeholders to help deliver primary care - This includes the promotion of interface between community and service providers.  
  • ACF strengthens linkages with Government health systems to maintain a continuum of care and provides capacity building of frontline workers. Additionally, ACF ensures availability of diagnostics, screening and treatment - including a referral mechanism to maintain the continuum of care and make health schemes accessible to the community.

India’s present health system lacks preparedness in tacking the NCD burden. Pivotal to winning the war on NCD’s are increased investments in this area, to empower both communities and the primary health care system. 


1. Dr Yogesh Kalkonde: Rural India faces an epidemic of non-communicable diseases; March 15, 2018; IDR Online

2. Sinha R, Pati S. Addressing the escalating burden of chronic diseases in India: Need for strengthening primary care. J Family Med Prim Care 2017;6:701-8.

3. R K Srivastava and D Bachani: Burden of NCDs, Policies and Programme for Prevention and Control of NCDs in India; Indian J Community Med. 2011 Dec; 36(Suppl1): S7–S12.

In Conversation: Harvard's Dr. Lindsay Jaacks on NCDs in India

Dr. Lindsay Jaacks, Assistant Professor, Harvard Chan School of Public Health

Dr. Lindsay Jaacks, Assistant Professor at the Harvard Chan School of Public Health, will be participating in a Symposium on 'Models for Control of Non-Communicable Disease in Global Health.'  In this candid conversation, she sheds light on Non-Communicable Disease in India in the context of global trends.

Why is ‘NCDs in India’ an interesting issue for Harvard to explore?

Many students in our school are unaware of the great improvements in maternal and infant mortality that have been achieved by India over the past decades, and the huge gains in life expectancy that have resulted. As such, India is rapidly progressing through what has been called the “epidemiological transition,” a theory that is taught in our classrooms in Cambridge.
We are eager to learn about this transition first-hand, learning from patients in India with NCDs, what it means to them to have a chronic disease, what treatment and health care look like in this context, what the challenges are and what strategies are being used to overcome them.
The disease patterns in India and the US are converging on diet-related NCDs like diabetes, hypertension and cardiovascular disease as well as some cancers, and so I hope that the tips and lessons learned from India will provide new ideas for innovations back home in the US.

What do you hope to learn from India, and specifically ACF’s health interventions?

We were first drawn to ACF’s health interventions by mention of the ‘tobacco-free village’ model, which is very unique to the India scene and has the potential for huge global health impact if successfully scaled up. Our first objective is really to learn more about the interventions and hear about their experiences with implementation and their impression of the local impact.
Secondly, given our expertise in NCDs and ACF’s growing interest in NCDs, we hope to provide some inputs from our research elsewhere on what might be done to address NCDs in these villages, with a focus on primary prevention.

How do you think partnerships between Academic Institutions (like Harvard) and Foundations (like Ambuja) can help address global health challenges?

Academic institutions like Harvard bring important expertise in program measurement and evaluation to the table. This is absolutely essential to know whether or not a program has worked - and if so, why, and how can it be scaled up. They are also a resource for results from other countries on what has worked and what hasn’t worked, and can facilitate capacity-building through scholar exchanges.
With these inputs, I see academic institutions as a sort-of ‘booster’ to existing programs being implemented by foundations like Ambuja who are striving to improve global health. Together with the know-how on program implementation from foundations, the know-how on program measurement and evaluation from academic institutions can ensure that the best programs are run and that they are achieving the improvements we all seek in doing this work.

Is India’s NCD situation similar to other countries around the world that Harvard Studies?

Yes, India is quite similar in that the top killer is cardiovascular disease, but the onset of disease is at much younger ages in India compared to, for example, the US. Another unique aspect in India and many other countries in South and Southeast Asia and Sub-Saharan Africa as compared to the US is that these diseases are more common in urban areas and in high-SES people (e.g., those with higher educational attainment), whereas in the US they are more common in rural areas and lower-SES people – but we predict that this will soon be the case in India as well.
We have also found much greater state-to-state variation in India as compared to the US, but that likely reflects the huge diversity of cultures (e.g. dietary patterns), climate (which can influence physical activity patterns), environmental exposure (for example, air pollution is much higher in northern India), and the fact that health care is a state matter in India.
Similar to most countries around the world, tobacco and alcohol use among men is commonplace, unhealthy diets high in refined carbohydrates and trans-fat, and low in fruits, vegetables, nuts and seeds are common across socio-demographic strata, physical activity levels are low and environmental pollutants are pervasive. These are all shared risk factors for the top NCDs – cardiovascular disease, diabetes, cancer, and respiratory disease – and must be addressed all across the world if we are to tackle this pressing global health challenge.

Monday, January 07, 2019

Harvard & ACF Partner for Symposium on NCDs

The Harvard T H Chan School of Public Health, the Harvard Chan India Research Center and Ambuja Cement Foundation will engage through a Symposium on Non-Communicable Disease in Mumbai on the 17th of January 2019. 

The Symposium will focus on sharing models that have been implemented globally for the control of Non-Communicable Diseases and explore ways of developing a strategy for the Indian context. 
Working in collaboration, the event provides a platform to share experiences and gain insights into the work being done by ACF, and to facilitate possibilities of further engagement and collaboration between the School and ACF.

The disease pattern in India, particularly rural India, has undergone a significant shift over the last 15 years.  A 2001-2003 Government of India report on the causes of death revealed that the deaths in rural India due to communicable disease (41%) were almost matched by those due to Non-Communicable Diseases (40%).

Non Communicable Diseases (NCDs) have unquestionably become a healthcare priority in India.  The pattern of NCDs in rural India looks largely similar to that of urban India.  High blood pressure, the biggest risk factor for death worldwide, now affects one in five adults in rural India, while diabetes affects about one in 20 adults.

There is also a significant economic threat posed by NCDs.  NCDs not only affect health, but also productivity and economic growth. The probability of dying during the most productive years (ages 30-70) from one of the four main NCDs is a staggering 26%.  As such, India stands to lose $4.58 trillion before 2030 due to NCDs and mental health conditions.

Diagnosis & Treatment Helps Fight the Scourge of Diabetes & Other NCDs

At the ripe old age of 80, Sonubai Haridas Pote still manages the household and supports her husband in farming. But her ability had been hindered since the advent of Diabetes and Hypertension 6 years ago, and for the last 2 years had found it difficult to visit the hospital for her routine treatment. 

Without regular treatment and medicines, Sonubai’s blood pressure spiked abnormally, putting her at high risk of death. In fact, 62% of all deaths in India (or a staggering 6.4 million deaths), can be attributed to Non-Communicable Diseases.

Recognising the rise of Non-Communicable Diseases (NCD) in rural areas, ACF launched interventions for NCDs in 2016, harnessing the power of their community Sakhis, who form the backbone of the program. 

As part of the NCD outreach to households in Isapur, when a Sakhi checked Sonubai’s BMI, she found it to be abnormal. On further investigation, it was discovered that her BP was 150/70 while her sugar was at 130. Concerned, the Sakhi convinced Sonubai to visit the Government hospital which verified the readings and put her on a treatment schedule.

Back from the hospital, the Sakhi suggested that Sonubai make some changes in her diet and motivated her to take regular walks in the mornings and evenings. Wanting to live a fuller life, Sonubai listened and decided to make changes to her lifestyle. 

Today, Sonubai is a much healthier, and happier lady. Her BP has gone down to 130/70 and her sugar levels are at 93. She doesn’t drink tea and avoids sweets altogether. In her opinion, getting doorstep services for Diabetes and Hypertension has been a life saver for the entire village as it avoids unnecessary medical expenditure and hospital visits. 

ACF’s NCD program commenced with just 48 villages, 7069 households and a population of 31553 adults above 30 years. Within 2 years itself, the program has now expanded to 4 states, 101 villages, 18464 households and a population of 97960 adults.

ACF Wins 4 x CII-ITC Sustainability Awards

Not one, not two, but four locations of ACF have won the CII-ITC Sustainability Award 2018 for Excellence in CSR. Ambujanagar (Gujarat), Chandrapur (Maharashtra), Farakka (West Bengal) and Bhatapara (Chhattisgarh) were awarded for their outstanding work among a candidate pool of 29 applicants.

Instituted in 2006, the CII-ITC Sustainability Awards recognise and reward excellence in businesses that are seeking ways to be more sustainable and inclusive in their activities. Winners of the Awards are role models that inspire others to follow suit. The Awards are a part of the continued efforts of CESD to create awareness on sustainability practices and to create capacities in business. More than recognition, the Awards measure performance and provide detailed feedback for opportunities to excel. 

The award ceremony was conducted on 12th December 2018 at the Pravasi Bharatiya Kendra Chanakyapuri, New Delhi, with Chief Guest Mr. Amitabh Kant (CEO- NITI AYOOG) presenting the awards. 

Each location was awarded based on scores received, which help them assess their progress from year to year. 

  • Ambujanagar - 96/100 
  • Chandrapur - 96.25 /100 The scores increased by 3% compared to last year. 
  • Farakka - 93.25/100 
  • Bhatapara - 88.38/100. The scores increased by 3% compared to last year

AMK Champions Reign at the Punjab Special Olympics

AMK athletes won 30 Medals at the 21st Punjab State Special Olympic Games, and AMK won the Overall Championship Trophy for Best Institute of the State in Sports, for the 13th year in a row. 

Held from 7th to 9th December 2018 at Guru Nanak Public School, Ludhiana (Punjab) and organized by Special Olympics Bharat (Punjab Chapter) the event saw 550 athletes from 59 Special Schools of Punjab participate.

It is a matter of great honour & pride that a contingent of 24 members including 19 Special athletes from AMK participated in 21st  Punjab State Special Olympics and Won 22 Gold Medals, 07 Silver Medals and 1 Bronze Medal in athletics.

All the athletes were welcomed home by the AMK staff and students where a celebration, including bhangra and sweets, took place to mark the occasion.

These results are a reflection of all the hard work and commitment of our athletes and TEAM AMK.  The athletics results are as follows:

Name of the students
     Athletic Event & Position
100 M Walk –   1st (Gold)
200 M Dash–   1st (Gold)
Amanjot Kaur
25  M Walk –   1st (Gold)
SLJ              –   1st (Gold)
Gurinder Singh
25  M Walk –   1st (Gold)
50  M Walk –   2nd  (Silver)
Tanveer Kaur
25  M Walk –   2nd  (Silver)
50 M Walk --    1st (Gold)
Arshdeep Kaur
25  M Walk –  2nd   (Silver)
 50 M Walk --  3rd (bronze)
Jashanpreet Kaur
100 M Walk --  1st (Gold)
100 M Dash –   1st (Gold)
Aditya Kaushal
100 M Walk –   1st (Gold)
200 M Walk –   1st (Gold)
Ravijeet Singh
25 M Walk  – 1st (Gold)
50 M Walk  – 1st (Gold)
Dev Kumar
Shot Put     –   1st  (Gold)
RLJ            –   1st  (Gold)
Ravi Puri
     200 M Walk  – 2nd (Silver)
     400 M Walk  – 1st  (Gold)
     100 M Walk  – 1st  (Gold)
     400 M Walk  – 1st  (Gold)
Jaskaran Kaur
25 M Walk   – 1st  (Gold)
SLJ               – 1st  (Gold)
Dilpreet singh
      100 M Walk  – 1st  (Gold)
      200 M Walk  – 1st  (Gold)
Amanpreet Singh
     100 M Walk  –  2nd (Silver)
     Shot Put       – 1st  (Gold)
Vikas Kumar
     25  M Walk –   2nd (Silver)
     50  M Walk –   2nd (Silver)
Amanpreet Singh
Bocce (Team Game- Male) – Participation
Anmol Mittal
     Bocce (Team Game- Male) -     Participation
Naresh Kumar
      Bocce (Team Game- Male) -  Participation
Dharampreet Singh
      Bocce (Team Game- Male) -  Participation