INTRODUCTION:
The rising burden of non-communicable diseases (NCDs), particularly hypertension and diabetes, necessitates a robust continuity of care (CoC) to prevent long-term complications. However, health systems in India often face fragmentation that disrupts this continuity. This study aimed to assess the prevalence, care cascade gaps, and process indicators for hypertension and diabetes in the Faridabad district of Haryana, and to identify critical bottlenecks in rural and urban settings.

METHODS:
A cross-sectional community survey was conducted among 1,921 participants (1,143 rural, 778 urban) in Faridabad district, Haryana, from December 2024 to April 2025. We utilised a cascade of care framework—comprising prevalence, diagnosis/awareness, treatment, and control—based on biophysical measurements (blood pressure and HbA1c) and self-reported history.

RESULTS:
The survey revealed a high disease burden, with hypertension prevalence at 48.9% (rural) and 43.8% (urban), and diabetes prevalence at 17.9% (rural) and 24.7% (urban). A sharp decline was observed at the diagnosis stage; only ~17-18% of hypertensive individuals and ~12-16% of diabetics were aware of their condition. While treatment initiation among the diagnosed was high (>90% across groups), disease control remained alarmingly low: effective control was achieved in only 9.8–16.1% of treated hypertension cases and 8.8–12.7% of treated diabetes cases. Adherence was a major barrier, with 38–65% of hypertensive participants reporting missed medications in the last 30 days.

CONCLUSIONS:
The findings indicate a "leaky" cascade of care in Faridabad, characterised by large gaps in screening (low awareness) and poor disease control despite high treatment initiation rates. The high rates of missed medications and short dispensing intervals suggest that system-level inefficiencies—specifically in supply chain management and screening coverage—are hindering effective NCD management.