Capacity-building Initiatives in Non-Communicable Diseases in India

Abstract

Non-communicable diseases (NCD) are reaching epidemic proportions in India and the escalating burden is expected to deepen economic load by putting further pressure into an already constrained health system. One of the serious constraints of the health systems is poorly skilled staff widening the gap between the demand and supply of healthcare professionals trained in NCDs. The current article reviews efforts made towards capacity building initiatives undertaken in India to address the limited human resources to counter the emerging burden posed by NCDs. This paper reviews existing literature on capacity building efforts on NCDs in India through gathering information from search engines such as Google Scholar and PubMed and other relevant websites. Even though health care professionals across all levels of health care have a critical role in prevention and control of NCDs, this review suggests minimal consolidated efforts at capacity building in the area of NCD within the health systems in India, albeit isolated efforts identified from different sectors. This review makes a case to upgrade and advance sustained efforts to enhance and improve capacity of workforce and to incorporate a component of NCD training into medical curricula.

Keywords

Capacity building NCDs trainings health professionals workshops continuing medical education India

Introduction

Non-communicable diseases (NCDs) are no longer a health priority of only the affluent countries but are increasingly recognised as major public health challenge in low- and middle-income countries (LMICs) and are expected to rise disproportionately in these countries over the next 20 years (Boutayeb & Boutayeb, 2005). India is currently undergoing an epidemiological transition and is faced with a dual burden of both communicable diseases and NCDs. A rising economy and increasing globalisation leading to unhealthy lifestyle changes in people have prompted an increasing trend in NCDs and its risk factors. NCDs are emerging as the leading cause of death in the country accounting for 53 per cent of all deaths and 44 per cent of disability adjusted life years (DALYs) lost. This is further projected to increase to 67 per cent of all deaths by 2030 (Reddy & Mohan, 2014). According to the WHO, cardiovascular diseases (CVD) will be the leading contributor to death and disability in India by 2020 (World Health Organization, 2002). As noted by Patel et al. (2011), CVD accounts for 29 per cent of all deaths and 52 per cent of NCD-related deaths. The overall prevalence of major NCDs including diabetes, hypertension, ischemic heart diseases and stroke is estimated to be 62.47, 159.46, 37.00 and 1.54 respectively per 1,000 population of India (Kumar & Kaushik, 2012).

Considering the major threat that NCDs poses on the health systems and anticipated escalation of the problem in future, it is high time to initiate strategies and coordinate efforts to prepare to meet the rising demand for qualified health professionals in NCDs management at all levels of healthcare. The current article seeks to examine the capacity development initiatives for different categories of healthcare professional that are presently undertaken in the country as an effort to address the capacity constraints in NCD prevention and control.

A thorough search of web-based engines such as Google Scholar and PubMed was carried out to identify institutions/organisations offering NCD-related trainings and courses. A set of keywords in combination was used for the purpose of the search. These keywords included capacity building; trainings; distance learning; medical curricula; courses; public health; NCDs; chronic diseases; health professionals; doctors; nurses; paramedical; Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH); diabetes; CVD; stroke; hypertension; cancer; mental health. The websites of the Medical Council of India, the Ministry of Health and Family Welfare, Indian Council of Medical Research (ICMR), the Indian Nursing Council and the All India Institute of Medical Sciences (AIIMS) were also searched to find out about the courses offered in NCDs. A similar search was made in the websites of the Indira Gandhi National Open University, World Health Organization (WHO) and various institutes associated with NCD. The search was limited to the capacity-building initiatives being offered in India and collaborations centring on NCD-related capacity building between Indian and foreign organisations. The current article focused on capacity-building initiatives such as diploma programmes, certificate courses, short-term workshops, trainings, continuing medical education/professional development, seminars and fellowships. A search of the NCD initiatives undertaken for various health professionals cadres, namely doctors, nurses, allied health professionals such as physiotherapy & speech therapy and AYUSH was conducted to understand the extent to which the NCD trainings are being conducted. The syllabi in undergraduate courses of medicine, nursing and allied health sciences were also reviewed to gauge the depth of NCD teaching in India. This search was intended to give an overview in the larger context of the health systems, and we did not cover postgraduate trainings in NCD-related domains for medical students such as MD, MS, DM, MCh and PhD as a part of this study.

Ongoing Efforts Adopted to Tackle NCDs in India

The growing awareness and concern about the escalating burden of NCDs have impelled the government to recognise NCDs as a health emergency and to launch efforts to tackle the burgeoning problem. The Government of India in 2010 integrated the two separate programmes for prevention and control of (a) cancer and (b) diabetes, CVD & stroke into a coordinated National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS), implemented within the National Health Rural Mission framework, focuses on strengthening of infrastructure, human resource development, health promotion, early diagnosis, treatment and referral (Directorate General of Health Services). Other national programmes or policies for NCDs in India include National Mental Health Programme; National Programme for Control of Blindness; National Programme for Prevention and Control of Deafness and National Trauma Care Programme under the 11th Five-year Plan. India is also a signatory to the WHO’s Framework Convention on Tobacco Control and implemented the Indian Tobacco Control Act 2003 which bans smoking in public places, increasing taxation on tobacco products, issuing pictorial warnings on tobacco product packages, etc. In addition, government institutions such as ICMR, National Center for Disease Control (NCDC) and National Institute of Health and Family Welfare (NIHFW) are key agencies dealing with NCD at the national level.

Current Capacity-building Initiatives on NCDs for the Various Levels of Healthcare Professionals

At the national level, the Government of India has undertaken some activities within the framework of the various national health programmes. Through training human resource within the public health setup to include doctors, paramedics and nursing staff, the National Programme on Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS) envisages to strengthen the capacity to cope with the escalating burden of NCDs and to provide the much-needed support to the overstrained health systems. One of the strategies devised to be implemented under this programme to effectively manage and prevent NCDs is the creation of NCD clinics at 100 district hospitals and 700 community health centres (CHCs) for diagnosis and management of CVD, diabetes & stroke. As a part of this agenda, some of the initiatives undertaken by the NPDCS so far has been the development of Training Modules for Health Workers and Medical Officers and release of funds to NIHFW and Indian Nursing Council for conducting training workshops (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, 2014).

Another such effort documented in the literature is the initiative undertaken by the NRHM as an effort to integrate alternative systems of medicine, AYUSH into the health system considering the potential role of these practitioners in providing healthcare services. Although a comprehensive structured course/curriculum has not been developed so far, an evaluation of a curriculum for a three months short course in public health principals and methods in the prevention and control of NCDs among AYUSH practitioners in India has shown success and reiterates the fact that a more formal training course can help bridge the demand gap for public health professional in an important domain in a resource-poor setting such as India (Kumar et al., 2012). Again, the Integrated Disease Surveillance Programme launched in 2004 in collaboration with ICMR and NICD in India has extended its training agenda to include one on surveillance of risk factors for NCDs as a part of the training programme for state and district surveillance officers employed under the programme.

Another NCD training initiative was launched in India in 2009 under the assistance of National Institutes of Health, the USA. This is a partnership between Emory University and the Centre for Chronic Disease Control (CCDC), a Delhi-based non-profit organisation, working in close association with Public Health Foundation of India (PHFI), AIIMS, Madras Diabetes Research Foundation (MDRF) and the South Asia Network of Chronic Diseases (SANCD) (Millennium Promise Awards). This initiative focuses on capacity building in NCD prevention and control in India. Through short-term and long-term trainings, this programme is committed to training a select few young scientists, who in turn will facilitate the capacity building of other researchers at in-country institutions with the long-term goal of creating a pool of NCD researchers and to incorporate them within integrated NCD research programmes in India.

Capacity-building Initiatives for the Different NCD Risk Factors

Efforts in the form of short-term trainings/courses for individual NCD conditions including diabetes, stroke, mental health, hypertension, CVDs, etc., by both government and private agencies including non-profit organisations have been initiated for the different levels of healthcare professional. The Medtronic Foundation for one has taken a particular interest in the NCD cause, being actively involved in activities including training diabetes healthcare providers and developing paediatric cardiac Centres of Excellence (Medtronic, 2012). Similarly, the PHFI, a public–private initiative, is also tailoring its efforts to address the limited capacity of health professionals in the area of NCDs. One of the initiatives that it has undertaken is to train primary care physicians with latest knowledge and guidelines in diabetes care management. In this context, the PHFI in collaboration with Dr. Mohan’s Diabetic Education Academy has jointly developed a one-year certification programme, Certificate Course in Evidence Based Diabetes Management (CCEBDM), with unrestricted educational grants from MSD Pharmaceuticals Pvt Ltd, India.¹

See www.phfi.org

Likewise, the Certificate Course in Gestational Diabetes Mellitus, an executive on-job training programme, was initiated with the purpose of enhancing core skills and need-based competencies in primary care physicians, obstetricians and gynaecologists for the practice of gestational diabetes mellitus management and to establish their networks with existing specialised diabetes care centres, eminent obstetricians and gynaecologists for improving patient outcomes in gestational diabetes.²

See http://www.projecthope.org/where-we-work/southeast-asia-middle-east/india.html (accessed on 1 September 2014).

Similarly, for diabetes, a number of other initiatives and trainings are currently underway.

Project HOPE, an international healthcare organisation dedicated to medical training and health education, initiated the ‘India Diabetes Educator Project’ in 2007 to train and educate healthcare professionals on best practices for diabetes prevention and management.³

See http://www.projecthope.org/what-we-do/chronic-diseases/

Soon after in 2013, they launched the ‘India Diabetes Educator E-learning Program (IDEEL)’, an online learning programme with a short clinical internship under the guidance of an endocrinologist and a diabetes educator.⁴

See http://www.indiadiabetesfoundation.org/idrf.aspx (accessed on 1 September 2014)

The India Diabetes Research Foundation (IDRF) undertook a project (2007–2011) to support the strengthening of national diabetes delivery services by enhancing the capacity of doctors, health educators and other paramedical staff through short trainings (IDRF-WDF).⁵ Through Dr. Mohan’s Diabetes Education Academy and MDRF, Dr Mohan has started several training courses (diplomas, certificate courses and fellowships) for physicians and non-physicians in the different aspects of management of diabetes and its complications (Dr. Mohan’s Diabetes Education Academy). To provide exposure to research in the area of diabetes, short-term training under this programme extends to undergraduate, graduate and other health professions students. An intensive training course in diabetes prevention and management for nurses is currently underway in Chennai provided by the M.V. Hospital and Prof. M. Viswanathan Diabetes Research Centre. In addition, a few other education programmes have also been identified as reviewed by Hasan et al. (2011).

In the field of cancer, capacity building in the form of training workshops and short-term courses have been initiated by a quite a few institutes/NGOs including the Tata Memorial Centre, Cancer Foundation of India, Indian Cancer Society, Regional Cancer Centre (Thiruvananthapuram), etc., for medical and paramedical staff. Similarly, the National Cancer Registry Programme under the ICMR is involved in developing training programmes in cancer registration and epidemiology (Indian Council of Medical Research).

Fewer capacity-building initiatives were observed for CVDs. One such effort is Advanced Certificate Course in Prevention and Management of Diabetes & Cardiovascular Disease. It is a joint certification course designed and delivered by PHFI, CCDC, World Heart Federation (WHF), Chellaram Diabetes Institute and supported by an unrestricted education grant from Abbott Healthcare Private Limited. It aims to train primary care physicians across the country with an ultimate objective to improve patient outcomes by enabling early diagnosis and evidence-based treatment and establishing a robust referral linkage.⁶

In the field of stroke, few short-term training programmes are being conducted sporadically by organisations such as All India Institute of Speech and Hearing and Neuro Developmental Treatment Association (NDTA). All India Institute of Speech and Hearing mainly conducts stroke-related workshops on assessment and management of stroke patients (All India Institute of Speech and Hearing) and NDTA runs a three week NDT/Bobath Certificate Course in the Management of Adults with Stroke and Brain Injury mainly for allied health professionals, namely physiotherapists and speech therapists (Neuro-Developmental Treatment Association).

Mental health has often been a neglected area for long and not a priority in terms of investment in poor and middle country settings. Fewer efforts are being directed for capacity building in this area. Under the District Mental Health Programme (DMHP) launched within the National Health Mental Programme in the year 1996, imparting short-term trainings to general physicians for diagnosis and treatment of common mental illnesses, was one of the important components of the programme. In addition, it envisaged the training of health workers in identifying mentally ill persons and strengthening of training facilities for undergraduates and postgraduates at the psychiatry wings of government medical colleges/hospitals. The other initiative we found was a distance learning programme on International Diploma on Mental Health Law and Human Rights, a collaboration between WHO and the ILS Law College in Pune, India to build the capacity in issues related to human rights violations and to promote the rights of persons with mental disabilities in accordance with the United Nations Convention on the Rights of Persons with Mental Disabilities and other international human rights standards (Centre for Mental Health Law and Policy).

Medical Curriculum

There are approximately 398 medical colleges in India producing 49,930 medical graduates every year (Medical Council of India, 2016) Considering the changing pattern of disease burden with the NCDs reaching epidemic proportions in India and the onus falling on medical professionals to play a critical role in NCD prevention and control, there has not been much attempts at revising the medical and nursing curriculum to incorporate a component on NCD as a part of the clinical course. Presently, the curriculum focuses more on curative model than on a holistic public health approach. This brings to light the fact that the teaching standards are not in line with changing dynamics in health patterns and the current needs of the community. This is further corroborated by an inter-country consultation by WHO highlighting that such gaps in medical education make a strong case to consider the inclusion of this component into the medical curriculum (World Health Organization, 2011). Similar recommendations that ‘medical education also requires greater orientation of providers to the social determinants of health as well as to gender and equity issues’ were endorsed by a High Level Expert Group on Universal Health Coverage for India by Planning Commission of India (Planning Commission of India, 2011). Talwar et al. (2011) in a recent review rightly concluded that ‘medical education and training should be reoriented by introducing competency-based, health system connected curricula, and continuous education’ and further lessons from Africa do suggest that medical training should incorporate a focused component of NCDs at both undergraduate and postgraduate levels through an approach that involves community-based learning (Shendell & Ana, 2011).

Implications

Evidences highlight that NCD burden in India has clearly reached substantial proportion and is emerging as a major cause of morbidity and mortality. It has extended beyond the affluent societies to affect the India’s poor who are at a heightened risk of acquiring NCDs because of high prevalence of smoking and tobacco use, poor living conditions, poor awareness of the consequences of risk factors, lack of access to subsidised healthcare, etc. Further, NCDs constitute a significant economic burden on India. The high levels of out of pocket spending incurred by households having someone with NCDs and loss of income of affected families will have catastrophic economic implications in the long run. Evidence suggests that a strategic shift in spending towards preventive health efforts is the most cost-effective solution, particularly when a long-term horizon and societal perspective are adopted. However, the present capacity and skills of health professionals are inadequate to meet the enormous demands with which the morbidity and mortality trends of NCD are progressing across the country. The already limited qualified workforce is again mostly concentrated in urban areas, while those in rural areas have to depend on unqualified providers. The acute shortage of adequately trained healthcare professionals, in particular with a public health approach to NCDs, is one of the major shortcomings towards achieving sustainability of efforts in the control and prevention of NCDs.

Future Directions

Tackling the increasing NCD burden would require significant efforts to develop a qualified workforce and training would need to extend across all healthcare professionals to include frontline health workers, namely ASHA, ANMs and allied health professionals besides doctors and nurses. Although the Government of India has already initiated some actions within the agenda of various national health programmes to address the problem of NCDs in India, the lack of an integrated formal and structured model for capacity development of the over-stretched human resources is an obstacle that clearly warrants immediate focus. The pieces of evidence that are available suggest that most of the current capacity-building activities are intermittent and isolated and deficient to equip healthcare professionals with the necessary competencies to deal with NCDs. It is imperative that these initiatives are integrated and implemented more intensively.

There is an urgent need to create a comprehensive policy at the national level for developing capacity of healthcare professionals in NCD at the different levels and to deal with the shortfall of human resources. Little attention is paid during medical education to the medical and public health needs of the population. Considering the economic and social impact that NCD will have on the society in the years to come, it is pertinent to develop and incorporate teaching and training modules specific to the prevention and control of NCDs within the medical curriculum to adequately train our healthcare workforce. The training programme for providers should be re-visited and modified to accommodate community-based needs in order to ensure that knowledge and skills in NCD prevention, surveillance and management are relevant to current and local context. Similarly, grassroots workers should also be targeted for NCD training considering the lack of doctors at the primary level and the fact that they are an integral part of healthcare delivery and often the first point of contact for the population. Capacity building of nurses and practitioners of alternative Indian medicine in the management of NCD to enable them to work in this area is another innovative way of augmenting human resources for alleviating NCD burden. Further, the untapped potential of distance learning initiatives in NCDs to expand access to busy and out-of-reach professionals should be exploited. In conclusion, a programme focussed in building health system capacity in NCD through strengthening medical education and capacity development initiatives will, in the long run, be more cost effective and also reach out to the community in a more efficient manner.

Table 1.

NCD Courses

Disease	Name of the initiative	Type (National Programme/Training)	Remarks
Cancer, diabetes,cardiovascular disease; mental health; blindness; deafness	National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS)National Mental Health ProgrammeNational Programme for Prevention and Control of DeafnessNational Trauma Care Programme	National programme	The growing awareness and concern about the escalating burden of NCDs impelled the government to recognise NCDs as a health emergency and to launch efforts to tackle the burgeoning problem. The Government of India in 2010 integrated the 2 separate programmes for prevention and control of (a) cancer and (b) diabetes, CVD & stroke into a coordinated National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke. The NPCDCS, implemented within the National Health Rural Mission framework, focuses on strengthening of infrastructure, human resource development, health promotion, early diagnosis, treatment and referral.
Diabetes, CVD and stroke	National Programme on Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS)	National programme	Through training human resource within the public health setup to include doctors, paramedics and nursing staff, the NPDCS envisages to strengthen the capacity to cope with the escalating burden of NCDs and to provide the much-needed support to the overstrained health systems. One of the strategies devised to be implemented under this programme to effectively manage and prevent NCDs is the creation of NCD clinics at 100 district hospitals and 700 community health centres (CHCs) for diagnosis and management of CVD, diabetes & stroke. As a part of this agenda, some of the initiatives undertaken by the NPDCS so far has been the development of Training Modules for Health Workers and Medical Officers and release of funds to National Institute of Health and Family Welfare (NIHFW) and Indian Nursing Council for conducting training workshops.
NCDs	National Health Mission	National programme	An effort to integrate alternative systems of medicine, AYUSH into the health system considering the potential role of these practitioners in providing healthcare services. Although a comprehensive structured course/curriculum has not been developed so far, an evaluation of a curriculum for a 3 months short course in public health principals and methods in the prevention and control of NCDs among AYUSH practitioners in India has shown success and reiterates the fact that a more formal training course can help bridge the demand gap for public health professional in an important domain in a resource-poor setting such as India.
	Integrated Disease Surveillance Programme	National programme	Launched in 2004 in collaboration with ICMR and NICD in India, ICDS has extended its training agenda to include one on surveillance of risk factors for NCDs as a part of the training programme for state and district surveillance officers employed under the programme.
NCD	Partnership between Emory University and the Centre for Chronic Disease Control (CCDC), a Delhi-based non-profit organisation, working in close association with Public Health Foundation of India (PHFI)All India Institute of Medical Sciences (AIIMS), Madras Diabetes Research Foundation (MDRF)the South Asia Network of Chronic Diseases (SANCD)	Training	Through short-term and long-term trainings, this programme is committed to training a select few young scientists, who in turn will facilitate the capacity building of other researchers at in-country institutions with the long-term goal of creating a pool of NCD researchers and to incorporate them within integrated NCD research programmes in India.
Diabetes	The Medtronic Foundation	Training	Involved in activities including training diabetes healthcare providers and developing paediatric cardiac Centres of Excellence
Diabetes	PHFI	Training	One of the initiatives that this public–private initiative has undertaken is to train primary care physicians with latest knowledge and guidelines in diabetes care management in collaboration with Dr. Mohan’s Diabetic Education Academy. It has jointly developed a 1-year certification programme, Certificate Course in Evidence Based Diabetes Management (CCEBDM), with unrestricted educational grants from MSD Pharmaceuticals Pvt. Ltd, India.The Certificate Course in Gestational Diabetes Mellitus, an executive on-job training programme, was initiated with the purpose of enhancing core skills and need-based competencies in primary care physicians, obstetricians and gynaecologists for the practice of gestational diabetes mellitus management and to establish their networks with existing specialised diabetes care centres, eminent obstetricians and gynaecologists for improving patient outcomes in gestational diabetes.
Diabetes	Project HOPE	Research and education	An international healthcare organisation dedicated to medical training and health education, initiated the ‘India Diabetes Educator Project’ in 2007 to train and educate healthcare professionals on best practices for diabetes prevention and management. Soon after in 2013, they launched the ‘India Diabetes Educator E-learning Program (IDEEL)’, an online learning programme with a short clinical internship under the guidance of an endocrinologist and a diabetes educator
Diabetes	India Diabetes Research Foundation (IDRF)	Research	Undertook a project (2007–2011) to support the strengthening of national diabetes delivery services by enhancing the capacity of doctors, health educators and other paramedical staff through short trainings.
Diabetes	Dr. Mohan’s Diabetes Education Academy and MDRF	Education and research	Dr Mohan has started several training courses (diplomas, certificate courses and fellowships) for physicians and non-physicians in the different aspects of management of diabetes and its complications. To provide exposure to research in the area of diabetes, short-term training under this programme extends to undergraduate, graduate and other health professions students.
Diabetes	M.V. Hospital and Prof. M.V. Diabetes Research Centre	Education	An intensive training course in diabetes prevention and management for nurses is currently underway in Chennai provided by the M.V. Hospital and Prof. M.V. Diabetes Research Centre.
Cancer	Tata Memorial CentreCancer Foundation of IndiaIndian Cancer SocietyRegional Cancer Centre, Thiruvananthapuram	Education and training	Capacity building in the form of training workshops and short-term courses have been initiated for medical and paramedical staff.
Cancer	Indian Council of Medical Research	Developing training programmes	The National Cancer Registry Programme under the ICMR is involved in developing training programmes in cancer registration and epidemiology
CVDs	PHFI	Education	Advanced Certificate Course in Prevention and Management of Diabetes & Cardiovascular Disease—a joint certification course designed and delivered by PHFI, CCDC, World Heart Federation (WHF), Chellaram Diabetes Institute and supported by an unrestricted education grant from Abbott Healthcare Private Limited. It aims to train primary care physicians across the country with an ultimate objective to improve patient outcomes by enabling early diagnosis and evidence-based treatment and establishing a robust referral linkage
Stroke	All India Institute of Speech and Hearing		All India Institute of Speech and Hearing mainly conducts stroke-related workshops on assessment and management of stroke patients
Stroke	Neuro Developmental Treatment Association (NDTA)	Education	Conducts a 3 week NDT/Bobath Certificate Course in the Management of Adults with Stroke and Brain Injury mainly for allied health professionals, namely physiotherapists and speech therapists
Mental health	District Mental Health Programme (DMHP) launched within the National Health Mental Programme	Training	Under the District Mental Health Programme (DMHP) launched within the National Health Mental Programme in the year 1996, imparting short-term trainings to general physicians for diagnosis and treatment of common mental illnesses, was one of the important components of the programme. In addition, it envisaged the training of health workers in identifying mentally ill persons and strengthening of training facilities for undergraduates and postgraduates at the psychiatry wings of government medical colleges/hospitals.
Mental health	WHO and the ILS Law College in Pune	Distance learning programme	A distance learning programme on International Diploma on Mental Health Law and Human Rights, a collaboration between WHO and the ILS Law College in Pune, India, to build the capacity in issues related to human rights violations and to promote the rights of persons with mental disabilities in accordance with the United Nations Convention on the Rights of Persons with Mental Disabilities and other international human rights standards.

Source: The authors.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

References

All India Institute of Speech and Hearing. (n.d.). Speech language pathology: Short term training programs . http://aiishmysore.in/en/departments_patho_shortterm.html

Boutayeb

, & Boutayeb

(2005). The burden of non-communicable diseases in developing countries. International Journal for Equity in Health , 4(1), 2.

Centre for Mental Health Law and Policy. (n.d.). International diploma in mental health law and human rights . http://cmhlp.org/diploma

Directorate General of Health Services. (n.d.). Operational guidelines for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) . Ministry of Health and Family Welfare, Government of India. http://health.puducherry.gov.in/ACTS%20AND%20MANUALS/Operational_Guideline_NPCDCS.pdf

Dr. Mohan’s Diabetes Education Academy. Non-physician courses . http://diabetescourses.in/non_physicican.html

Hasan

, Zodpey

, & Saraf

(2011). Diabetes care in India: Assessing the need for evidence-based education. South-East Asian Journal of Medical Education , 5(2), 15–18.

Indian Council of Medical Research. (n.d.). National Cancer Registry Programme . http://www.ncrpindia.org/

Kumar

, & Kaushik

(2012). Non-communicable diseases: A challenge. Indian Journal of Community Health , 24(4), 252–254.

Kumar

, Raina

S. K.

, Bhardwaj

A. K.

, & Chander

(2012). Capacity building of AYUSH practitioners to study the feasibility of their involvement in non-communicable disease prevention and control. Ancient Science of Life , 32(2), 116–119.

10.

Medical Council of India. (2016). List of colleges teaching MBBS . https://www.mciindia.org/CMS/information-desk/for-students-to-study-in-india/list-of-college-teaching-mbbs

11.

Medtronic. (2012). Expanding access to NCD care in India . http://www.citizenshipreport.medtronic.com/wcm/groups/mdtcom_sg/@mdt/documents/documents/ncd_india_grants_review.pdf

12.

Millennium Promise Awards: Non-communicable Chronic Diseases Research Training Program . (n.d.). http://www.ccdcindia.org/projects.php

13.

Neuro-Developmental Treatment Association. (n.d.). Education . https://www.ndta.org/education.php

14.

NPCDCS. Managing non-communicable diseases . (n.d.). http://pib.nic.in/newsite/efeatures.aspx?relid=76249

15.

Patel

, Chatterji

, Chisholm

, Ebrahim

, Gopalakrishna

, Mathers

, Mohan

, Prabhakaran

, Ravindran

R. D.

, & Reddy

K. S.

(2011). Chronic diseases and injuries in India. Lancet , 377(9763), 413–428.

16.

Planning Commission of India. (2011). High level expert group report on universal health coverage for India Instituted by Planning Commission of India . https://ideas.repec.org/p/ess/wpaper/id4646.html

17.

Prof. M. Viswanathan Diabetes Research Centre. (n.d.). Intensive foot care training for doctors . http://whoccdindia.com/courses.htm

18.

Public Health Foundation of India. Advanced Certificate Course in Prevention and Management of Diabetes and Cardiovascular Disease . http://www.diabetescare.co.in/acmdc/.

19.

Reddy

K. S.

, & Mohan

(2014). Chronic diseases in India: Burden and implications . https://www.swissre.com/dam/jcr:1980728e-e364-421d-8174-2795164a403b/RDS_HealthRiskFactors_India_WEB.pdf

20.

Shendell

D. G.

, & Ana

G. R.

(2011). Promoting environmental public health in rapidly urbanizing areas of less-developed countries in Africa: A collaborative interdisciplinary training in Ibadan, Nigeria. Journal of Environmental Health , 74(1), 26–35.

21.

Talwar

, Grover

, & Thakur

(2011). Role of medical education in preventing and control of noncommunicable diseases in India? Indian Journal of Community Medicine , 36(Suppl. 1), S63–S66.

22.

World Health Organization. (2002). The World Health Report 2002 . Author.

23.

World Health Organization, Regional Office for South-East Asia. (2011). Injury prevention and control: A handbook for undergraduate medical curriculum (p. 152). https://apps.who.int/iris/handle/10665/205348