Critical Appraisal of India's National Stroke Rehabilitation Programme J Ind Fed NR
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Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
INTRODUCTION
Health Systems in India:
India is a federal union with 28 states and eight
union territories.
1
Health is a state subject in India
where the state government takes up the
responsibilities to provide good quality health care
and public good to the people in each state.
2
Organized provision health services in India have
been envisioned since 1946 by the
recommendations from the Bhore committee.
3
Health Systems for Rehabilitaon – Crical Appraisal of the Naonal
Programme for Stroke in India.
Sureshkumar Kamalakannan
1
, Abhishek Srivastava
2
, Manigandan Chockalingam
3
, Dorcas Gandhi
4
, Rajinder K
Dhamija
5
,
John Solomon
6
, Preee Shey Akkunje
7
,Sonal Chitnis
8
, Hitav Someshwar
9
, Nirmal Surya
10
1. Northumbria University, Newcastle Upon Tyne, U.K. & Pragyaan Sustainable Health outcomes Foundaon, Hyderabad, Telangana,
India. 2. Kokilaben Dhirubhai Ambani Hospital & Medical Research Instute, Mumbai, India. 3. Naonal University of Ireland Galway,
Galway, Ireland. 4. Chrisan Medical College and Hospital, Ludhiana, Punjab, India. 5. Instute of Human Behaviour and Allied Sciences,
New Delhi, India. 6. Manipal Academy of Higher Educaon, Manipal, Karnataka, India. 7. Kasturba Medical College, MAHE, Mangalore,
Karnataka, India. 8. Bhara Vidyapeeth Deemed to be University, Pune, Maharashtra, India. 9. Topiwala Naonal Medical College & BYL
Nair Ch. Hospital, Mumbai, India. 10. Bombay Hospital and Medical Research Center, Mumbai, India.
Consorum for Rehabilitaon in Health Systems, The Indian Federaon of Neurorehabilitaon (IFNR), Mumbai, India.
ABSTRACT
The organized provision of health services in India has been envisioned since 1946 by the recommendations from
the Bhore committee. However, the policy and program strategies for the provision of good quality health care still
lack effectiveness. Access to rehabilitation services for persons with disabilities continues to be a significant public
health problem in India. This review intended to identify the barriers to integration and implementation of
rehabilitation services within the national program for stroke in India. The methods involved the critical review and
appraisal of the last five years of the published common review mission reports which report the performance of the
entire health system and national program of the country. All relevant policy and program documents related to the
national program for the prevention and control of cancer, diabetes, cardiovascular diseases, and stroke, were also
reviewed. The World Health Organization, Rehabilitation 2030 recommendations were also cross-compared to
summarize the findings from the critical review. The results revealed that rehabilitation was neglected within the
conceptualization and implementation of the NPCDCS program. Let alone for the Stroke program, there was not
any evidence-based description of the concept of disability management and rehabilitation within the NPCDCS
program. The health system in its current form appears to be a non-inclusive system for disability-inclusive
development. The priority is mainstreaming disability within the agenda for the health of the nation. If disability
could be mainstreamed within the health agenda of India and in LMICs, universal health coverage and disability-
inclusive development can certainly, be achieved.
KEYWORDS- Health Policy; Health Systems; Rehabilitation; Disability; Inclusive Development; Policy Analysis.
CORRESPONDING AUTHOR
Dr. Sureshkumar Kamalakannan
Associate Professor
Department of Social Work Education and
Community Wellbeing
Northumbria University
Newcastle Upon Tyne NE7 7TR
England, U.K.
Phone: +44 7366962444
Email: Sureshkumar.kamalakannan@northumbria.ac.uk
Received on- 4
th
May 2024
Published on
-
2
9
th
July 2024
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Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
However, the policy and program strategies for the
provision of good quality health care still lack
effectiveness.
4
This had in fact led to the emergence
of private health care systems in India which is
currently being utilized by a significant proportion
of the country’s citizens, especially those living in
urban areas.
4-5
India has a health care system where
the public and private sectors work simultaneously
and sometimes in partnership to meet the health
needs of the population.
6
The private health system
is primarily located in urban areas and provides
secondary and tertiary healthcare services.
6
The
government health system is three-tiered covering
primary, secondary, and tertiary level care and
health services for the entire state supported by the
national ministry of health and family welfare
(MoHFW) (Figure -1).
2,7
This system has improved
significantly in the past two decades in terms of its
approach to meet the increasing health needs of
people in the country.
8
Given the epidemiological
transition in the second-most populous country in
the world, there have been several strategic re-
organization of the health system with new national
programs for non-communicable diseases, mental
health, elderly care, as well as health insurance
policies converged under the new National Health
Mission (NHM).
2, 7-8
However, the tertiary prevention aspects such as
disability and rehabilitation have been neglected
and are hardly visible in any of this strategic
reorganization.
9-11
Access to rehabilitation services
for persons with disabilities is an important public
health problem in India.
7, 12
Comprehensive
rehabilitation services are available only in tertiary
care hospitals situated in urban areas and they are
predominantly run by physicians and
physiotherapists.
12 -16
Disability and rehabilitation
are viewed only from a charity model especially by
the government systems through the ministry of
social justice and empowerment and it is restricted
to the provision of monthly pension and livelihood
opportunities.
12-16
The health system in its current
form appears to be a non-inclusive system for
disability-inclusive development.
National Program for Stroke in India:
The National Programme for Prevention and
Control of Cancer, Diabetes, Cardiovascular
Diseases and Stroke (NPCDCS) is the only
program that was designed to cover Stroke or
cerebrovascular disease initiatives in the country.
17
The NPCDCS was launched in 2006 and was
piloted in 2008 in selected states and then rolled out
to all states a decade ago. The objective of this
program was to prevent and control non-
communicable diseases (NCDs) including stroke
through the establishment of NCD clinics at the
community level and opportunistic screening for
NCDs at the primary health centers (PHCs) and
Sub-health centers (SHCs) in the villages.
Screening, capacity building, community
awareness, treatment, and management of
complications were the core program activities
within the government health facilities and NCD
clinics in the community.
17
However, there is very
little understanding and effort on the impact of
these activities on the stroke survivors
experiencing disabilities and the consequences
leading to their poor quality of life. Although more
than a decade and a half since its inception, the
NPCDCS program has still not been effective
enough to reduce the growing burden of stroke and
stroke-related disabilities in India.
18-20
Recent
evidence on the magnitude of stroke in India very
clearly highlights the unchanging and rather
increasing incidence and prevalence of stroke.
21
This implies the importance of identifying the
barriers to effective implementation of the
NPCDCS program and developing scalable
solutions to address the disability burden imposed
by stroke and other NCDs in India.
Common Review Mission:
The Common Review Mission (CRM) is an
extensive national monitoring exercise of the
national health mission. This initiative has been in
place since 2007.
22-23
The primary objective of the
CRM is to enhance the focus of the NHM on a fully
functional health system at all levels in the country.
The CRM reviews all the national health programs,
policies, and strategies of the NHM from the
perspectives of the community to ensure people
with health needs can access good quality service,
free of cost in any place within the country.
22-23
The
CRM reviews have been even more rigorous since
within the expanded service delivery package of
the health systems.
22
Having been scaled up in all
2018 particularly because, most of the national
programs have been operationally strengthened
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Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
Figure-1: Health systems in India
2
the states since 2015, the NPCDCS program has
been reviewed majorly as a part of the CRM. Hence
this review includes all the program evaluation
reports of the NPCDCS program within the CRM
reports from 2015 to 2019 until the last review
mission, published by the MoHFW.
Objectives:
To review the barriers to integration and
implementation of rehabilitation services
within the national program for stroke in
India.
METHODOLOGY
The methods involved the critical review and
appraisal of the last five years of published CRM
Reports and all relevant and published policy as
well as program documents related to NPCDCS
from MoHFW. CRM Reports from 2015 – 2019
were reviewed to understand the barriers to
integration and implementation of the disability
and rehabilitation aspects of the stroke program
within the NPCDCS evaluation summaries in the
reports.
24-28
Some of the findings from the
evaluation reports are presented as it is in boxes for
the purpose of description. The World Health
Organization (WHO) Rehabilitation 2030 action
plans were also cross-compared to summarize the
findings from the critical review.
29
Health System Barriers for Rehabilitation
within the NPCDCS Program:
The review of the programs and policy documents
related to the NCDs and NPCDCS was useful to
identify the Barriers to integration and
implementation of rehabilitation within the
national program for stroke in India. The Details
are provided below.
Non-Inclusive development of the NPCDCS
Program: The review identified that the NPCDCS
Critical Appraisal of India's National Stroke Rehabilitation Programme J Ind Fed NR
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Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
program development was non-systematic and
non-inclusive in its approach. Rehabilitation was
neglected within the conceptualization of the
NPCDCS program.
24-28
Let alone for the Stroke
program, there was not any evidence-based
description of the concept of disability
management and rehabilitation within the
NPCDCS program covering all NCDs.
17-19
A review of the operational guidelines of NPCDCS
clearly indicated that the program was developed
primarily for addressing the cancer burden in the
country.
30
Incorporation of stroke and other
NCDs appears to be deliberate and for reducing
managerial and administrative bottlenecks.
30
The program was piloted in 100 districts in 21
states between the period of 2010-2012 in India.
Bottlenecks were identified and the program was
re-strategized as well as scaled up to the entire
country.
17-19
A total amount of INR 80960 million
was allocated for implementing these strategies
between 2012 – 2017.
31
This is excluding the cost
it might incur for managing disability and
rehabilitation of those experiencing disabilities due
to NCDs and especially after a stroke which results
in various neurological disabilities.
Table:1 Comparison of the review findings with
the WHO Rehabilitation in Health systems
recommendations
A new guideline exclusively for stroke had been
published under the NPCDCS program in 2019.
32
There were about 12 pages within the document on
rehabilitation, describing the role of
physiotherapists and envisioning recruitment of
one physiotherapist at the tertiary level in the
districts to meet the growing need for stroke
rehabilitation.
32
Overall, it is evident that none of
those who are involved in the rehabilitation of
persons with disabilities were included in
conceptualizing the national program. Although the
2019 document exclusive for stroke starts with an
inclusive statement on the need for multi-
disciplinary rehabilitation, conceptualization
strategies and operational plans exclude the entire
system for disability and rehabilitation required to
implement this program effectively. A cross-
comparison of the recommendations from the
WHO rehabilitation 2030 against the existing
situation of the NPCDCS program is provided in
Table – 1.
“In no state was there an understanding that public
health facilities at primary health care level offered
services, be it screening, examination or treatment,
with the result that those who sought care at public
health facilities tended to access CHC or DH
incurring higher cost, and the possibility of poor
treatment adherence and lack of follow up, resulting
in fragmentation of care” CRM 2018
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Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
Lack of health systems for rehabilitation:
A review of the CRM reports in the past five years
reveals that even the existing strategies lack the
system that is required for the rehabilitation of
persons with disabilities following a stroke.
Human resources:
The first and foremost issue reported in the CRM
evaluation was the lack of human resources for the
entire program.
24-28
Even in the 2019 guidelines for
stroke, opportunistic screening and case detection
outside the hospital setting and, in the
communities, especially at the primary level care
(PHCs and SHCs) were envisioned only through
Accredited Social Health Activists (ASHAs) and
Anganwadi Workers (AWWs).
32
Although AWWs
and ASHAs play a crucial role in primary care, they
are non-qualified, non-permanent government
healthcare workers, already implementing close to
20 national programs apart from the NPCDCS.
2
Even specific training related to disability
management and rehabilitation for those involved
in NPCDCS was not reported in any of the CRM
evaluations.
24-28
The NHM is reforming the PHCs
into Health and Wellness Centres (HWCs) to
accommodate the management of NCDs and there
isn’t any dedicated, qualified rehabilitation
workforce such as physiotherapists, occupational
therapists, rehabilitation nurses, clinical
psychologists, speech-language pathologists,
orthotist in these HWCs.
Health Management Information Systems
(HMIS):
Enumeration of those detected with high risk for
NCDs including stroke was not able to be followed
up in the absence of health records.
24-28
Although a
surveillance system is envisioned for the entire
NPCDCS program, there are issues reported in
relation to the absence of health records to enable
service providers to follow up and ensure
compliance. Organized HMIS systems and
effective follow-up mechanisms have been in place
within the national programs for HIV/AIDS and
Tuberculosis in NHM previously.
24-28
However, it’s
surprising to see such systems either integrated or
newly established for NPCDCS within the NHM to
date. Without the HMIS for identifying individuals
who need rehabilitation, it is impossible to ensure a
continuum of care to those who need it most and
reduce the disability burden in India.
Health Financing:
There was an absence of any funding allocation or
expenditure for rehabilitation-related activities in
the INR 85000 million rupees allotted between
2012-2017 for the NPCDCS program.
31
This needs
to be critically looked at because there is a lack of
insurance coverage for stroke rehabilitation
especially outside the institutional settings such as
tertiary care hospitals even within the Ayushman
Bharat program as well as from the private
sector.
24-28
Each year, 55 million people in India
become poorer in order to pay healthcare costs, and
38 million falls below the poverty line due to
spending on medications alone.
33
The situation is
very similar
for those individuals diagnosed with
stroke or other NCDs. The prescription for
medicines to these group individuals was only
dispensed for a week to 10 days maximum at the
public facilities at all levels in India. The affected
individuals are expected to travel to these health
facilities once in 10 days and request for a repeat
prescription or wait in the long queue for a
significant amount of time to get this medicine free
of cost. If not, these diagnosed individuals
generally get the medicines from the nearest private
pharmacy paying for them.
24-28
This implies a
significant Out Pocket Expenditure (OOPE) or
opportunity cost on the affected individuals to get
their medicines to protect themselves from the risk
“Human Resource shortages in NCD cells at district
and state levels service delivery at the secondary
level of health care facilities constrain continuum of
care
”
.
CRM 2019
“Lack of follow up mechanisms for positively
diagnosed case is a critical challenge, and in
absence of records for identified cases it is difficult
for service providers to follow up for treatment
compliance
”
.
CRM 2019
“It is not surprising that in all states, Out of Pocket
Expenditures for those with hypertension and
diabetes was largely on medicines, transport with
multiple visits to the health care facility”. CRM
2018
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Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
of a stroke or NCDs and manage the complications
of it.
Equipment and Supplies: Given the issues related
to medicine, it must be assumed that the equipment
and supplies related to disability and rehabilitation,
such as orthotics, wheelchairs, assistive devices,
supports, and splints remain unavailable in the
government health supplies.
27-28
These
rehabilitation supplies and equipment might be
unavailable at the pharmacies of MoHFW. They
might be expensive even if available and non-
specific to the needs of the affected individual in
private pharmacies and suppliers. There are not any
stroke-specific provisions to receive prescriptions
for devices like a wheelchair, shoulder sling, ankle-
foot orthoses specific to the needs of the stroke
survivors even in the scheme for assistance to
disabled persons for purchase of aids and
appliances (ADIP) by the ministry of social justice
and empowerment.
34
Service Delivery:
There are three ways in which services for the
stroke component of the NPCDCS program were
delivered. First is at the tertiary hospitals where
individuals experiencing a stroke get admitted and
treated for a stroke.
24-28
In these facilities, stroke
survivors might be able to receive physiotherapy
services for 3-5 days within their acute care stay.
Rehabilitation services are restricted primarily to
physiotherapy for these 3-5 days during the acute
care in these facilities. There are very few multi-
disciplinary stroke rehabilitation institutions with
free in-patient facilities in the entire country.
Secondly, the individuals at risk of a stroke can be
screened routinely at the NCD clinic and could
avail prescription for their medicines at NCD
clinics.
24-28
There is a plan since 2019 to integrate
complementary medicine such as Ayurveda, Yoga,
Unani, Siddha, and Homeopathy (AYUSH)
systems of Indian medicine and have these doctors
at NCD clinics.
24-28
This is expected to dilute the
existing evidence for rehabilitation services as well
as compensate for all other required human
resources. Lastly, individuals can be screened in the
community by ASHAs and AWWs. However, in
the absence of any basic rehabilitation service
provision facilities within the health or social care
sector at the villages and blocks, follow-up,
compliance, and continuum of care can only be
dreamt.
Health Policies for rehabilitation:
None of the CRM reports, policy, and program
documents reviewed, reported on policies for
disability and rehabilitation for persons with
disabilities in general, let alone for people affected
by stroke or NCDs.
24-28
This implies that the
evidence of the absence of any policy for
rehabilitation in India is the reason for the absence
of any evidence related to the presence of systems
for disability management and rehabilitation in the
country. It is evident that the NPCDCS as well as
the other national program planners, implementers,
and policymakers are well-aware of the lack of a
health system for rehabilitation and hence the
operational framework or the strategy document
lacks any information about disability and
rehabilitation.
The way forward - Mainstreaming
rehabilitation within the agenda for Health
Comparing the recommendations from WHO on
rehabilitation in health systems with the findings
from this review unveil what’s essential and what
must be prioritized by the national health system
stewards in India and in similar countries. The
priority is mainstreaming disability within the
agenda for the health of the nation. The MoHFW
must take up the responsibility for the rehabilitation
and integrate rehabilitation within its health
system. Currently, the integration is limited to
tertiary hospitals without the conceptualization of
disability as recommended by the International
Classification of Functioning from a bio-psycho-
“In Bihar, the NPCDS programme was reported to
be non-functional, including the availability of
equipment and drugs for hypertension and
diabetes
”
.
CRM 201
“Continuum of care is essential for Non-
Communicable Diseases’ management and control;
however, referral and follow up mechanisms were
weak across the states. None of the states reported
back referral of identified NCD patients
undergoing treatment at higher health care
facilities”
.
CRM 2019
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Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
social perspective.
31
Although the medical model
for rehabilitation is just emerging in the urban areas
of the country. Disability even from a medical
model does not imply impairments alone and
physiotherapists, ASHAs, AWWs cannot be
considered as a comprehensive multi-disciplinary
rehabilitation team for reducing the burden of
disability in any country. This conceptualization
can enable disability-inclusive integration right
from the HWCs in the grass root. There is a high
level of evidence for multi-disciplinary
rehabilitation, especially in tertiary care facilities
for people with complex health and rehabilitation
needs such as stroke survivors.
32
Sufficient
allocation of funding for rehabilitation with
adequate supplies and mechanisms to reduce
OOPE like the insurance for rehabilitation of NCDs
such as stroke must be prioritized. In the absence of
a system for rehabilitation, inclusive development
can only be dreamt. Perhaps this is an important
reason why stroke is still the leading cause of
disability in the past four decades in India. If
disability could be mainstreamed within the health
agenda of India, universal health coverage and
disability-inclusive development can certainly be
achieved.
REFERENCES
1. Data.worldbank.org. 2022. India | Data.
[online] Available at:
<http://data.worldbank.org/country/india?view
=chart> [Accessed 11 February 2022].
2. Chokshi M, Patil B, Khanna R, Neogi SB,
Sharma J, Paul VK, Zodpey S. Health systems
in India. J Perinatol. 2016 Dec;36(s3):S9-S12.
doi: 10.1038/jp.2016.184. PMID: 27924110;
PMCID: PMC5144115.
3. Duggal R. Bhore Committee (1946) and its
relevance today. Indian J Pediatr.
1991;58:395–406.
4. Kasthuri A. Challenges to Healthcare in India -
The Five A's. Indian J Community Med. 2018
Jul-Sep;43(3):141-143. doi:
10.4103/ijcm.IJCM_194_18. PMID:
30294075; PMCID: PMC6166510.
5. Sengupta A, Nundy S. The private health
sector in India. BMJ. 2005 Nov
19;331(7526):1157-8. doi:
10.1136/bmj.331.7526.1157. PMID:
16293815; PMCID: PMC1285083.
6. Bose A. Private health sector in India: is
private health care at the cost of public health
care? BMJ. 2005 Dec 3;331(7528):1338-9.
doi: 10.1136/bmj.331.7528.1338-c. PMID:
16322030; PMCID: PMC1298900.
7. Barik D, Thorat A. Issues of Unequal Access
to Public Health in India. Front Public Health.
2015 Oct 27;3:245. doi:
10.3389/fpubh.2015.00245. PMID: 26579507;
PMCID: PMC4621381.
8. Younger DS. Health Care in India. Neurol
Clin. 2016 Nov;34(4):1103-1114. doi:
10.1016/j.ncl.2016.06.005. PMID: 27719992.
9. Human resources for health. National Rural
Health Mission, Ministry of Health and
Family Welfare, Government of India. Child
Health Division, Ministry of Health and
Family Welfare. 2011. Available at: uhc-
india.org/reports/hleg_report_chapter_4.pdf
(accessed on 12 February 2022).
10. Aggarwal AK. Strengthening health care
system in India: is privatization the only
answer? Indian J Community Med. 2008
Apr;33(2):69-70. doi: 10.4103/0970-
0218.40869. PMID: 19967025; PMCID:
PMC2784627.
11. Government of India. 2014b.National Health
Mission, Ministry of Health & Family Welfare,
New Delhi. Available
from: http://nrhm.gov.in/nhm/about-nhm.html.
(accessed on 12 February 2022).
12. Kumar SG, Roy G, Kar SS. Disability and
rehabilitation services in India: issues and
challenges. J Family Med Prim Care. 2012
Jan;1(1):69-73. doi: 10.4103/2249-
4863.94458. PMID: 24479007; PMCID:
PMC3893941.
13. Janardhana N, Muralidhar D, Naidu DM,
Raghevendra G. Discrimination against
differently abled children among rural
communities in India: Need for action. J Nat
Critical Appraisal of India's National Stroke Rehabilitation Programme J Ind Fed NR
Page | 25
Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
Sci Biol Med. 2015 Jan-Jun;6(1):7-11. doi:
10.4103/0976-9668.149070. PMID:
25810627; PMCID: PMC4367071.
14. Kamalakannan S, Gudlavalleti Venkata M,
Prost A, Natarajan S, Pant H, Chitalurri N,
Goenka S, Kuper H. Rehabilitation Needs of
Stroke Survivors After Discharge From
Hospital in India. Arch Phys Med Rehabil.
2016 Sep;97(9):1526-1532.e9. doi:
10.1016/j.apmr.2016.02.008. Epub 2016 Mar
2. PMID: 26944710; PMCID: PMC5813710.
15. Grills N, Singh L, Pant H, Varghese J, Murthy
GVS, Hoq M, et al. Access to services and
barriers faced by people with disabilities: a
quantitative survey. DCIDJ. 2017;28(2):23–
24.
16. Chavan BS, Rozatkar AR. Intellectual
disability in India: Charity to right based.
Indian J Psychiatry. 2014 Apr;56(2):113-6.
doi: 10.4103/0019-5545.130477. PMID:
24891695; PMCID: PMC4040055.
17. Government of India. National Programme for
Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases, and Stroke.
Operational guidelines (revised 2013-17).
2013. https://mohfw.gov.in/sites/default/files/
Operational%20Guidelines%20of%20NPCDC
S%20%28Revised%20-%202013-17%29.pdf
(Accessed 17th Dec 2021)
18. Thakur JS, Paika R, Singh S. Burden of
noncommunicable diseases and
implementation challenges of National NCD
Programmes in India. Med J Armed Forces
India. 2020 Jul;76(3):261-267. doi:
10.1016/j.mjafi.2020.03.002. Epub 2020 May
18. PMID: 32773927; PMCID: PMC7399556.
19. Pati MK, Swaroop N, Kar A, Aggarwal P,
Jayanna K, Van Damme W. A narrative review
of gaps in the provision of integrated care for
noncommunicable diseases in India. Public
Health Rev. 2020 May 13;41:8. doi:
10.1186/s40985-020-00128-3. PMID:
32435518; PMCID: PMC7222468.
20. Singh Thakur J, Nangia R, Singh S. Progress
and challenges in achieving noncommunicable
diseases targets for the sustainable
development goals. FASEB Bioadv. 2021 Apr
29;3(8):563-568. doi: 10.1096/fba.2020-
00117. PMID: 34377953; PMCID:
PMC8332469.
21. Watts G. Lalit Dandona: surveying the burden
of disease in India. Lancet. 2017 Dec
2;390(10111):2428. doi: 10.1016/S0140-
6736(17)32861-1. Epub 2017 Nov 14. PMID:
29150204.
22. National health systems resource center.
Common review mission. [internet] 2022.
Available from: https://nhsrcindia.org/php-
crm-reports (Accessed 17th Dec 2021)
23. Singh P, Sundararaman T, Ved R, Khanna P.
Common Review Mission: reflections on a
concurrent evaluation measure. BMC Proc.
2012 Sep 28;6(Suppl 5): O20. doi:
10.1186/1753-6561-6-S5-O20. PMCID:
PMC3467688.
24. National health mission. Ministry of health
and family welfare. 9
th
common review
mission report. [internet] 2015. Available
from: https://nhsrcindia.org/php-crm-reports
(Accessed 17th Dec 2021)
25. National health mission. Ministry of health
and family welfare. 10
th
common review
mission report. [internet] 2016. Available
from: https://nhsrcindia.org/php-crm-reports
(Accessed 17th Dec 2021)
26. National health mission. Ministry of health
and family welfare. 11
th
common review
mission report. [internet] 2017. Available
from: https://nhsrcindia.org/php-crm-reports
(Accessed 17th Dec 2021)
27. National health mission. Ministry of health
and family welfare. 12
th
common review
mission report. [internet] 2018. Available
from: https://nhsrcindia.org/php-crm-reports
(Accessed 17th Dec 2021)
28. National health mission. Ministry of health
and family welfare. 13
th
common review
mission report. [internet] 2019. Available
from: https://nhsrcindia.org/php-crm-reports
(Accessed 17th Dec 2021)
Critical Appraisal of India's National Stroke Rehabilitation Programme J Ind Fed NR
Page | 26
Sureshkumar Kamalakannan et al. Journal IFNR Volume 1, Issue 1
29. Gimigliano F, Negrini S. The World Health
Organization "Rehabilitation 2030: a call for
action". Eur J Phys Rehabil Med. 2017
Apr;53(2):155-168. doi: 10.23736/S1973-
9087.17.04746-3. Epub 2017 Apr 4. PMID:
28382807.
30. Kar SS, Thakur JS. Integration of NCD
programs in India: Concepts and health system
perspective. Int J Med Public Health
2013;3:215-8.
31. National health mission. Ministry of health
and family welfare. National programme for
prevention and control of cancer diabetes
cardiovascular diseases & stroke.[Internet]
Available from:
https://nhm.gov.in/index1.php?lang=1&level=
2&sublinkid=1048&lid=604 (Accessed 17th
Dec 2021)
32. Director general of health services. Ministry of
health and family welfare. NPCDCS -
Guidelines for Prevention and Management of
Stroke. 2019. [internet]. Available from:
https://main.mohfw.gov.in/sites/default/files/G
uidelines%20for%20Prevention%20and%20M
anagment%20of%20Stroke.pdf (Accessed
17th Dec 2021)
33. Selvaraj S, Farooqui HH, Karan A.
Quantifying the financial burden of
households’out-of pocket payments on
medicines in India: a repeated cross-sectional
analysis of National Sample Survey data,
1994–2014. BMJ Open. 2018; 8: e018020.
34. Gupta, S., Meershoek, A. and De Witte, L.
orcid.org/0000-0002-3013-2640 (2021) A
narrative review of the government
wheelchair provision system in India.
International Journal of Environmental
Research and Public Health, 18 (10). 5109.
ISSN 1660-4601
CITE THIS ARTICLE:
S Kamalakannan, A Srivastava, M Chockalingam,
Dorcas Gandhi4, R K Dhamija, J Solomon et al, Health
Systems for Rehabilitaon – Crical Appraisal of the
Naonal Programme for Stroke in India. J Ind Fed NR,
2024, Aug 2024; 1 (1): 18-26