Mapping of Roles and Responsibilities of NCD (Non-Communicable Diseases) Staff Nurses at Primary Health Centres in India: A Multi-State Job Analysis

Ponnambily Chandy^1,2, Vathsala Sadan^3,4, Imnainla K Walling⁵

¹Ph.D. Scholar, 17^th Batch, National Consortium for Ph.D. in Nursing by Indian Nursing Council, New Delhi.

²Associate Professor, Sathyabama College of Nursing,

Sathyabama Institute of Science and Technology, Chennai.

³Ph.D Guide, National Consortium for Ph.D. in Nursing by Indian Nursing Council, New Delhi.

⁴Former Dean and Professor, College of Nursing, Christian Medical College, Vellore.

⁵Quality Assurance Consultant, Sathyabama Institute of Science and Technology, Chennai.

*Corresponding Author Email: ponnambily.ponnu@gmail.com

ABSTRACT:

Background: Non-Communicable Diseases (NCDs) are the leading cause of morbidity and mortality in India, necessitating a strong primary care response. Staff nurses at Primary Health Centres (PHCs) play a critical role in population-based screening and management of NCDs. However, their roles and responsibilities remain inconsistently defined across states, limiting effective implementation. Objective: To map and categorize the roles and responsibilities of NCD staff nurses at PHCs in India through a multi-state job analysis. Methods: A document review was conducted using job descriptions, national operational guidelines, and training manuals from ten Indian states—Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, West Bengal, Gujarat, Odisha, Rajasthan, Madhya Pradesh, and Meghalaya—along with four national guidelines and one training module issued by the Ministry of Health and Family Welfare (MoHFW). Documents were sourced from official government websites and analyzed using content analysis to identify and categorize roles and responsibilities. Results: Six major roles and 37 specific responsibilities were identified for NCD staff nurses. The roles include: (1) NCD Clinical Care Provider (2) NCD Patient Counseling and Health Promotion Coordinator (3) NCD Referral Service Coordinator (4) NCD Data Management and Reporting Coordinator (5) NCD Administrative and Logistics Coordinator and (6) NCD Training, Supervision, and Capacity Building Coordinator. These roles reflect the broad scope of nursing practice required for comprehensive NCD service delivery at the primary care level. Conclusion: This study provides a structured mapping of the expanded roles of NCD staff nurses at PHCs, highlighting their integral contribution to screening, clinical care, referral, health counselling, data management, and community engagement. The findings support the need for standardized role definitions, competency-based training and supportive policies to strengthen the nursing workforce of NCD response in India.

KEYWORDS: NCD staff nurse, Primary Health Centres, India, job Analysis, Population-Based Screening, Nursing Roles, Content Analysis, non-Communicable Diseases, Primary Healthcare.

INTRODUCTION:

Non-communicable diseases (NCDs) such as Diabetes Mellitus (DM), Hypertension (HTN), and Cancer (Oral, Breast, And Cervical) have emerged as the predominant cause of mortality and morbidity globally and in India. These chronic conditions account for nearly two-thirds of all deaths in the country, imposing a significant burden on the health system and the economy. In response, the Government of India has launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), with a strong focus on integrating population-based screening, early detection, and management of NCDs within primary healthcare settings. Primary Health Centres (PHCs) serve as the first point of contact for individuals in rural and underserved areas, making them central to the success of NCD interventions. Staff nurses, who are often the only consistent healthcare providers at PHCs, play a crucial role in this model by conducting screening, providing basic clinical care, counseling patients, maintaining records, and ensuring timely referral to higher facilities when needed^1,2. However, despite their pivotal role, the responsibilities of staff nurses in NCD care are often vaguely defined and vary across states, resulting in inconsistency in service delivery.

There is a growing consensus that clearly defined roles and responsibilities for nurses in NCD care are essential to improving the quality and efficiency of healthcare delivery at the primary level. The World Health Organization (WHO) and other global agencies advocate for task shifting and the empowerment of nurses to address the growing burden of chronic conditions, particularly in resource-constrained settings ^3,4. In India, the complexity of NCD care requires that nurses take on expanded responsibilities beyond routine clinical tasks, including patient education, follow-up, lifestyle counseling, and community engagement. Despite the development of national guidelines such as those by the Ministry of Health and Family Welfare and training modules by state governments like West Bengal ^2,5, there remains considerable variation in how these roles are understood and executed in practice. Research indicates that nurses often lack clarity regarding their scope of work in NCD screening and management, leading to underutilization of their skills and potential⁶. Furthermore, nurses are expected to balance multiple roles, often without formal job descriptions or sufficient training, which can lead to job dissatisfaction and suboptimal patient outcomes^7,8.

In this context, defining a standardized and evidence-based framework for the roles and responsibilities of staff nurses in NCD care becomes not only relevant but necessary. Role clarity enhances nurses’ confidence, improves interdisciplinary collaboration, and fosters accountability within the health system⁹. A focused role definition also helps in workforce planning, curriculum development, supportive supervision, and performance evaluation. Moreover, as social determinants increasingly influence NCD outcomes, nurses are expected to engage with communities and provide patient-centered, holistic care that goes beyond the biomedical model^10,11. Understanding and documenting the real-world responsibilities undertaken by NCD staff nurses across different states can bridge the gap between policy and practice. Through this study, we conducted an analysis of job descriptions from ten Indian states to identify and categorize the roles and responsibilities of staff nurses engaged in NCD population screening and care at PHCs. The findings aim to inform policy formulation, guide capacity-building initiatives, and ultimately contribute to the development of a robust, responsive, and equitable primary healthcare system for NCDs in India.

METHODS:

Study Design:

This study adopted a document analysis to identify and map the roles and responsibilities of staff nurses involved in non-communicable disease (NCD) screening and management at Primary Health Centres (PHCs) across India. A content analysis approach was employed to systematically examine official job descriptions and guideline documents related to the scope of work for NCD staff nurses.

Data Sources and Collection:

Relevant documents were identified and collected through a structured web-based literature search conducted from January 2025 to March 2025. We systematically searched the official websites of State Health Departments and the Ministry of Health and Family Welfare (MoHFW), Government of India, including the National Health Systems Resource Centre (NHSRC) and the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS).

The search targeted publicly available government-issued documents outlining job roles, responsibilities, and operational guidance for NCD-related nursing services. A total of 15 documents were included: job descriptions from 10 states (Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, West Bengal, Gujarat, Odisha, Rajasthan, Madhya Pradesh, and Meghalaya), four national operational guidelines (including NPCDCS and Comprehensive Primary Health Care documents), and one NCD nurse training module developed by NHSRC under MoHFW.

Inclusion criteria for documents were: (1) published or endorsed by state or national health authorities (2) related specifically to NCD screening or management at PHCs and (3) including designated responsibilities for nurses. Drafts, unofficial publications, or documents with no clear description of staff nurse roles were excluded (see figure 1).

Data Analysis:

All selected documents were downloaded and manually reviewed. A conventional content analysis approach was employed to identify recurring themes, roles and responsibilities.

The analysis process followed three key steps:

1. Open Coding – Relevant texts related to staff nurses’ tasks in NCD screening and care were extracted and coded line by line using an inductive approach.

2. Categorization – The initial codes were grouped based on similarity and thematic relevance into broader categories.

3. Role Mapping – The categories were synthesized to identify distinct functional roles. This resulted in the formulation of six overarching roles under which 37 specific responsibilities were organized.

Two researchers independently coded the documents and reconciled any discrepancies through discussion to ensure reliability and consistency. Manual coding sheets were used for organizing and managing the data.

Ethical Considerations:

The study has used publicly available documents, no human subjects were involved and formal ethical approval was not required. The analysis was conducted in accordance with academic standards for secondary data research.

Figure 1: Flowchart illustrating the document selection process

RESULTS:

The content analysis of job descriptions and official guidelines from ten Indian states and four national operational documents revealed a comprehensive profile of roles and responsibilities for Non-Communicable Disease (NCD) staff nurses at Primary Health Centres (PHCs). A total of 37 discrete responsibilities were identified, which were thematically grouped into six major roles based on similarities in purpose and function. These roles collectively represent the scope of work expected from NCD staff nurses involved in population-level screening and management of common NCDs such as hypertension, diabetes, and cancers (oral, breast, and cervical).

I. NCD Clinical Care Provider:

This role encompasses core clinical functions performed by the staff nurse, such as screening for common NCDs, assisting physicians in diagnosis and treatment, providing home-based care, documenting treatment history, and monitoring follow-up care. Responsibilities under this role emphasized early detection, continuity of care and collaboration with PHC-MO to ensure optimal clinical outcomes.

Key responsibilities included:

· Conducting NCD screening.

· Assisting in diagnosis and management.

· Supporting treatment plan implementation.

· Ensuring documentation and follow-up care.

II. NCD Patient Counseling and Health Promotion Coordinator:

Nurses played a critical role in educating patients and communities about risk factors, lifestyle changes treatment adherence and complications. This role focuses on behavior change communication, awareness generation and promotion of self-care practices.

Key responsibilities included:

· Patient, family and community education on NCDs

· Organizing health promotion activities.

· Collaboration with health workers like ASHAs and ANMs.

III. NCD Referral Service Coordinator:

This role involved identifying cases requiring higher-level care, coordinating with referral centers, and ensuring follow-up continuity. Emphasis was placed on accurate documentation and stakeholder engagement to streamline referral pathways.

Key responsibilities included:

· Identifying complicated NCD cases for referral

· Coordinating referrals and maintaining documentation.

· Engaging with PHC teams and community leaders.

IV. NCD Data Management and Reporting Coordinator:

Data-driven decision-making was supported through this role, which involved maintaining records on the National NCD Portal, submitting reports to district authorities and ensuring data quality.

Key responsibilities included:

· Maintaining electronic and manual records.

· Submitting monthly reports to PHC-MO.

· Tracking treatment adherence and patient outcomes.

V. NCD Administrative and Logistics Coordinator:

Nurses also managed essential logistics for service delivery, such as ensuring drug availability, emergency preparedness, and supply chain maintenance. This role highlights the operational backbone required for uninterrupted NCD services.

Key responsibilities included:

· Managing drug and diagnostic inventories.

· Ensuring availability of emergency care protocols.

· Supporting service integration with broader PHC programs.

VI. NCD Training, Supervision and Capacity Building Coordinator:

This role reflects the evolving leadership of staff nurses in mentoring other healthcare workers, conducting field supervision, and participating in skill development activities. Nurses were found to play an integral role in strengthening the capacity of PHC-level teams.

Key responsibilities included:

· Mentoring ASHAs and ANMs.

· Supporting and conducting training programs.

· Supervising field-level activities and service quality.

The Table 1 Summarizes the Role-Wise Distribution of Responsibilities for Ncd Staff Nurses at Phcs, As Identified Through the Content Analysis.

Role (n=6)	Role Description	Responsibilities (n=37)	Key Functions
NCD Clinical Care Provider	Provides direct clinical services including screening, diagnosis support, referral and follow-up.	1. Conduct screening for common NCDs such as hypertension, diabetes, and cancers (oral, breast, cervical). 2. Assist PHC-MO in examination, diagnosis, and management of NCD patients. 3. Support PHC-MO in developing and implementing treatment plans. 4. Ensure proper documentation of patient history, treatment plans, and medication adherence. 5. Provide home-based care and follow-up for bedridden or chronic NCD patients. 6. Ensure timely follow-up care and monitor patient progress. 7. Identify complications or advanced NCD stages and ensure referral to higher healthcare facilities.	Screening, diagnosis support, documentation, home-based care, referral and monitoring patient progress.
NCD Patient Counseling and Health Promotion Coordinator	Educates patients and communities on NCD risk factors, lifestyle changes, health seeking behaviour and adherence.	1. Educate patients and families on NCD risk factors and lifestyle modifications, including healthy diet, physical activity, tobacco cessation, and alcohol reduction. 2. Conduct health promotion activities, such as awareness campaigns and education sessions at both community and facility levels. 3. Use IEC materials to support behavior change communication. 4. Promote treatment adherence and self-management of chronic conditions. 5. Collaborate with ASHAs and ANMs to promote early detection and health-seeking behavior for NCDs.	Health education and health seeking behaviour in collaboration with ASHAs/ANMs.
NCD Referral Service Coordinator	Manages referral of complex cases and coordinates continuity of care.	1. Identify and facilitate referral of complicated NCD cases to secondary or tertiary care facilities. 2. Maintain accurate referral records and ensure proper tracking of follow-up care. 3. Coordinate with PHC-MO, health workers, and community leaders to ensure continuity of care. 4. Ensure timely completion of referral forms, especially for suspected cancer cases. 5. Collaborate with secondary/tertiary care team to optimize patient's health seeking behaviour and improve service delivery.	Case identification, documentation, follow-up tracking, coordination with higher-level facilities.
NCD Data Management and Reporting Coordinator	Ensures accurate data entry, report generation and record keeping.	1. Maintain accurate and updated records of screening, diagnosis, treatment, and follow-up using the National NCD Portal. 2. Ensure completeness of referral cards and follow-up documentation. 3. Submit monthly progress reports to the District NCD Cell or designated authorities as per national protocols in coordination with PHC-MO. 4. Track individual patient adherence and outcomes. 5. Support real-time data entry and quality assurance in record maintenance.	Use of NCD portal, patient tracking, monthly reporting, data quality assurance.
NCD Administrative and Logistics Coordinator	Manages logistics, inventory and service readiness for NCD service delivery.	1. Ensure the availability of essential drugs, diagnostics, and equipment needed for NCD management. 2. Maintain inventory of medical supplies and assist in procurement planning. 3. Collaborate with the PHC team to improve service delivery and clinic preparedness. 4. Maintain emergency protocols and ensure readiness for acute NCD events (e.g., hypertensive crisis). 5. Support integration of NCD services with other health programs at PHC.	Drug and diagnostic supply, emergency preparedness, program integration.
NCD Training, Supervision, and Capacity Building Coordinator	Guides and supports training and capacity building of health workers.	1. Mentor and guide ASHAs and ANMs on population-based screening and community-level NCD interventions. 2. Participate in and assist with training sessions, refresher courses, and workshops on NCD prevention and management. 3. Provide hands-on training for BSA/VIA screening, NCD diagnostic tools, and counseling techniques. 4. Conduct field supervision and review meetings to monitor service quality and support continuous learning. 5. Act as a resource person for ongoing capacity-building initiatives within the PHC team.	Mentoring, skill development, supervision, training facilitation

DISCUSSION:

This study systematically mapped the roles and responsibilities of Non-Communicable Disease (NCD) staff nurses at Primary Health Centres (PHCs) across ten Indian states, identifying six primary roles encompassing 37 specific responsibilities. These roles include Clinical Care Provider; Patient Counseling and Health Promotion Coordinator; Referral Service Coordinator; Data Management and Reporting Coordinator; Administrative and Logistics Coordinator; Training, Supervision, and Capacity Building Coordinator. The findings underscore the multifaceted contributions of nurses in NCD management within the primary healthcare framework in India.

The role of nurses as Clinical Care Providers is pivotal, involving the screening and management of prevalent NCDs^13,14 such as hypertension^15,16, diabetes^17,18, and certain cancers. This aligns with the National Programme for Prevention and Control of Cancer^19,20, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), which emphasizes the importance of early detection and management at the primary care level. A study by Bassi et al. highlighted that nurses in primary care facilities dedicate a significant portion of their time to hypertension-related activities, underscoring their central role in NCD management¹².

In their capacity as Patient Counseling and Health Promotion Coordinators, nurses are instrumental in educating patients and communities about NCD risk factors and lifestyle modifications. This function is crucial for the prevention and control of NCDs, as effective health education interventions have been shown to significantly improve patient outcomes and promote healthier lifestyles.²¹

The Referral Service Coordinator role involves identifying patients requiring advanced care and ensuring seamless referrals to higher-level facilities. Maintaining accurate referral records and coordinating with other healthcare providers are essential for continuity of care, as emphasized in the operational guidelines for comprehensive primary healthcare.²²

As Data Management and Reporting Coordinators, nurses are responsible for maintaining precise records of NCD screenings, diagnoses, treatments, and follow-ups. The introduction of digital health records has been shown to enhance nurses' productivity by reducing the time spent on indirect hypertension activities, thereby allowing more focus on patient care.¹²

The Administrative and Logistics Coordinator role encompasses ensuring the availability of essential medications, diagnostic tools, and equipment necessary for NCD management. Effective inventory management and procurement planning are vital for uninterrupted service delivery, as highlighted in the NCD module for staff nurses.

Finally, as Training, Supervision, and Capacity Building Coordinators, the nurses mentor and guide community health workers such as Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs). This mentorship is crucial for population-based screening and community-level NCD interventions, reinforcing the importance of capacity building within the healthcare workforce.²³

The identified roles are consistent with findings from other studies. For instance, a study conducted in South India reported that nurses frequently assume roles as educators, rehabilitators, care providers, and supervisors in community settings. Additionally, the importance of task-sharing and the expanded role of nurses in NCD management have been recognized as effective strategies in resource-constrained settings.^24,25

However, challenges persist. The shortage of trained nursing personnel in India has been a longstanding issue, impacting the quality of care and the effective implementation of NCD programs. Furthermore, while nurses are tasked with extensive responsibilities, adequate training and support are essential to equip them with the necessary knowledge, skill, and attitude. A situational analysis in Chengdu highlighted the need for continuous NCD-related training among community health workers to address existing gaps.^26,27

CONCLUSION:

This study provides a comprehensive mapping of the roles and responsibilities of NCD staff nurses at PHCs in India, highlighting their integral contributions to NCD prevention and management. The six identified roles underscore the multifaceted nature of nursing responsibilities in the primary healthcare setting. To optimize the effectiveness of NCD programs, it is imperative to address challenges related to workforce shortages and to invest in continuous training and capacity-building initiatives for nurses. Standardizing these roles across states and ensuring adequate support can significantly enhance the quality of NCD care delivery in the primary healthcare system in India.

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Received on 23.05.2025         Revised on 02.07.2025

Accepted on 05.08.2025      Published on 25.10.2025

Available online from November 04, 2025

Asian J. Nursing Education and Research. 2025;15(4):235-240.

DOI: 10.52711/2349-2996.2025.00048

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