By Arunima Rajan

For decades, India’s public health system has fought its biggest battles against infectious diseases. But a different kind of crisis has been brewing—one that moves slowly, quietly, and often unnoticed until it’s too late. Non-communicable diseases (NCDs) like diabetes, hypertension, and heart disease are rising at an alarming rate, slipping past undiagnosed until they turn life-threatening. In response, the government has launched an ambitious screening drive, pledging to test every Indian over 30. The screenings, part of the National Programme for Prevention and Control of NCDs, are being conducted at Ayushman Arogya Mandirs and other health facilities across the country.

But what does this massive exercise mean in practice? Will it create real change, or will it become another well-intentioned but ineffective intervention? Sudheer Kumar Shukla, a specialist in monitoring, evaluation, and data analysis at the Health Systems Transformation Platform, has been following the rollout closely. He unpacks the challenges, the scale of the effort, and whether this initiative can meaningfully shift the trajectory of India’s NCD crisis.

How do you see this 100% Non-Communicable Diseases (NCDs) screening drive changing the conversation around preventive healthcare in India?

The 100% NCD screening drive signifies a transformative shift in India's healthcare paradigm, embedding preventive strategies at the core of primary care. By systematically screening individuals aged 30 and above for hypertension, diabetes, and prevalent cancers—oral, breast, and cervical—the initiative aims to curtail the progression of non-communicable diseases (NCDs) through early detection and timely intervention. As of 19th March 2025, the National NCD Portal reports that approximately 630 million beneficiaries have been enrolled, with over 107 million Ayushman Bharat Health Account (ABHA) numbers generated or linked, facilitating seamless patient tracking and continuity of care. Notably, over 60 million patients are currently receiving treatment for hypertension and diabetes, underscoring the programme's expansive reach and impact. The initiative's integration with Ayushman Arogya Mandirs (AAMs) enhances community-level engagement, making preventive screening a fundamental healthcare service. The digital infrastructure, exemplified by the National NCD Portal and ABHA IDs, enables real-time data monitoring and efficient referral systems, ensuring sustained follow-up and adherence to treatment protocols. By mobilizing frontline health workers, such as Accredited Social Health Activists (ASHAs), Multi-Purpose Workers (MPWs) and Community Health Officers (CHOs) (also known as mid-level health providers-MLHP), the program fosters community-based risk assessments and heightens awareness, particularly in underserved regions, thereby addressing healthcare disparities and promoting equitable access. This comprehensive approach aligns with global health commitments under Sustainable Development Goal 3.4, reflecting a decisive move towards a data-driven, technology-enabled, and community-centric healthcare system. The program's success hinges on robust implementation, continuous monitoring, and the seamless integration of screening, diagnosis, and management into routine primary healthcare services.

**Dr. Sudheer Kumar Shukla**, Specialist - Health Financing, M&E, and Data Analysis, NP-NCD Vertical, Health Systems Transformation Platform (HSTP), New Delhi.

When healthcare comes to your doorstep, what are the hidden challenges that could make reaching every person over 30 more difficult than we imagine?

Delivering doorstep healthcare for universal NCD screening presents critical challenges. Geographical barriers hinder outreach in remote, tribal, and urban slum areas, while workforce shortages overburden ASHAs, ANMs, MPWs and CHOs/MLHP at SHCs, PHCs and CHCs affecting screening efficiency and follow-up adherence. Sociocultural resistance, particularly among women and marginalized communities, hampers participation. Health system inefficiencies, such as irregular medicine supplies, referral delays, and inadequate digital infrastructure, disrupt care continuity. Digital infrastructure gaps, including ABHA ID interoperability and poor internet connectivity, limit real-time data tracking. Economic constraints, including out-of-pocket costs for follow-up diagnostics and treatment, deter adherence despite free screening. Strengthening digital health, workforce capacity, and financial risk protection is crucial to ensuring equitable and effective preventive healthcare access.

Bringing healthcare right into communities seems revolutionary-what surprising shifts in local engagement are you witnessing on the ground?

The universal NCD screening drive is transforming local healthcare engagement, fostering proactive health-seeking behaviour and community participation. ASHAs, ANMs, MPWs and CHOs/MLHPs are pivotal in mobilizing individuals, increasing screening uptake, particularly in underserved regions. Women’s participation in cancer screening has risen due to gender-sensitive IEC campaigns, reducing stigma and promoting early detection. Digital health integration through ABHA IDs and the National NCD Portal enhances patient tracking, though interoperability issues and digital literacy gaps persist. Community-led fitness initiatives, tobacco cessation efforts, and alcohol reduction programmes reinforce a preventive health culture. The initiative is shifting healthcare perceptions from reactive treatment to routine check-ups, but disparities persist in lower-performing areas, necessitating sustained outreach, workforce expansion, and robust referral systems.

With real-time monitoring through the NP-NCD portal, how is technology quietly rewriting the rules of public health?

The NP-NCD portal is redefining public health by embedding real-time monitoring, digital health records, and data-driven decision support into routine care. ABHA ID-linked records enable seamless patient tracking, improving continuity of care and referrals. Integrated decision-support tools for hypertension and diabetes enhance evidence-based treatment, while automated risk stratification and alerts facilitate early detection of high-risk cases. However, interoperability challenges, disparities in SHC, PHC and CHC level staffs’ portal usage, and digital literacy gaps persist. Strengthening data governance, workforce training, and system integration is essential for optimizing digital transformation in public health.

Can you take us behind the scenes on how coordination from the facility level all the way to the state level is being orchestrated for this campaign?

The NP-NCD campaign follows a multi-tiered coordination system, ensuring seamless integration from SHCs to the state level. ASHAs, ANMs and MPWs use the Community-Based Assessment Checklist (CBAC) tool for risk assessment, referring high-risk individuals to AAMs for further evaluation. CHOs/MLHPs at PHCs oversee treatment initiation, while CHCs and district hospitals manage advanced cases. District NCD Divisions, led by District Nodal Officers, monitor programme performance, ensure seamless data integration with the NP-NCD portal, facilitate workforce training, and ensure drug supply continuity. At the state level, NHM-led NCD Divisions conduct training, performance reviews, and resource allocation, ensuring alignment with national goals. Monthly and quarterly review meetings at district and state levels enhance data-driven course corrections, improving programme efficiency and accountability.

This drive aims for 100% coverage-what are some of the real-life obstacles that might prevent us from reaching that ambitious goal?

Achieving 100% coverage presents multiple hurdles, including population movement, resistance to screening, and infrastructure gaps. Shortages of Multi-Purpose Workers (MPWs) at AAMs affect service delivery. Certain areas report lower participation due to cultural hesitancy or lack of awareness. Additionally, data integration challenges arise from inconsistent portal usage. Overcoming these barriers requires targeted awareness campaigns, expanded workforce training, and strengthened digital engagement strategies.

The 100% NCD screening drive faces multiple systemic, logistical, and behavioural barriers that could hinder universal coverage. Geographical inaccessibility remains a significant challenge, with remote, tribal, and conflict-prone regions having limited health infrastructure and trained workforce availability. Workforce shortages, particularly among ASHAs, ANMs, MPWs and CHOs/MLHPs, strain implementation efforts, reducing screening efficiency and follow-up adherence. Migration and sociocultural resistance, including stigma around cancer screening, especially among women and marginalized communities, reduces participation. Health system inefficiencies and operational gaps, such as irregular medicine supplies, referral delays, and weak digital infrastructure, disrupt continuity of care. Digital literacy gaps among frontline workers further impede real-time data tracking through the NP-NCD portal. Additionally, economic constraints, including out-of-pocket costs for follow-up diagnostics and treatment, deter adherence despite free screening.

Early detection is key, but what steps are in place to ensure that once someone is diagnosed, they receive the timely and effective treatment they need?

The NP-NCD programme ensures timely and effective treatment through a structured referral and follow-up system, real-time patient tracking, and free essential NCD care. ASHAs and ANMs conduct screenings, referring high-risk individuals to AAMs (SHCs, PHCs) for evaluation. Bi-directional referrals link complex cases to CHCs and district hospitals. ABHA-linked EHRs, teleconsultation services, and ASHA-led adherence monitoring improve care continuity. Ensuring uninterrupted medicine supply, monthly reviews, and financial risk protection mechanisms mitigate barriers, enhancing long-term disease management.

Shifting from reactive treatments to a preventive mindset sounds promising-how do you think this proactive approach will reshape how people view their own health?

The NP‐NCD programme is shifting healthcare from reactive treatment to a preventive paradigm, empowering individuals to actively manage their health. Enhanced participation in screenings and lifestyle interventions—facilitated by robust health promotion campaigns—has heightened awareness of NCD risk factors. Integration of Ayushman Arogya Mandirs with digital tracking via the NP‐NCD portal enables early intervention and sustained follow-up. Social media and community networks reduce stigma and normalize routine check-ups, promoting healthier lifestyles, decreasing tobacco and alcohol use, reducing the long-term disease burden and ultimately reducing reliance on tertiary care.

Trust is essential in healthcare-what measures are being taken to build and sustain trust between healthcare providers and communities, especially in underserved areas?

The NP-NCD programme fosters community trust through ASHAs, ANMs, and local governance partnerships, ensuring culturally sensitive outreach, mobilizing communities, providing counselling, and addressing misconceptions about NCDs. Social mobilization strategies, including patient support groups and local partnerships with Panchayati Raj institutions, enhance participation. Free screenings and follow-ups alleviate financial concerns, while targeted women’s health screenings enhance gender-inclusive care. Digital integration via the NP-NCD portal and ABHA IDs strengthens care continuity and accountability. Patient support groups, grievance redressal mechanisms, and workforce regular training further build provider-community relationships. Health system responsiveness and sustained engagement remain critical for long-term community trust in preventive healthcare.

The Ayushman Bharat Arogya Mandirs are set to play a crucial role-how do you see these centers uniquely contributing to widespread access to primary and preventive care?

The Ayushman Arogya Mandirs (AAMs) are redefining access to primary and preventive care by serving as decentralized hubs for early detection, treatment, and health promotion. As the first point of contact for NCD screening, AAMs facilitate community-based risk assessments through ASHAs and ANMs, ensuring early identification of hypertension, diabetes, and common cancers. Integrated with digital health tools, AAMs streamline patient tracking via ABHA IDs and the NP-NCD portal, enhancing continuity of care. Their role extends to lifestyle counselling, tobacco cessation programs, and referral linkages to CHCs and district hospitals for advanced management. Telemedicine services, including e-Sanjeevani, bridge specialist gaps in underserved regions by embedding prevention into routine care and leveraging digital platforms, AAMs strengthen health system responsiveness, reduce tertiary care dependency, and drive a paradigm shift towards proactive health management.

Looking forward, if these initiatives reach their full potential, what lasting impact do you believe they’ll have on India’s overall healthcare landscape?

The NP-NCD programme and Ayushman Arogya Mandirs (AAMs) are poised to transform India’s healthcare landscape by institutionalizing preventive and primary care within the broader framework of Universal Health Coverage (UHC). By integrating real-time surveillance, digital health tracking, and population-based screening, the programme is expected to reduce the burden of late-stage NCDs, lowering hospital admissions and healthcare costs. Strengthened referral linkages, teleconsultation services, and financial risk protection mechanisms will improve access to specialized care, particularly in underserved areas. Long-term impacts include increased life expectancy, reduced premature mortality from NCDs, and a shift toward a community-driven, technology-enabled, and cost-effective public health model.

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