Non Communicable Diseases in the Region: Way Forward

1. MEETING OF AFRICAN MINISTERS OF HEALTH OF ISLAND DEVELOPING STATES Praia, Cape Verde, 18 – 20 March 2009 Non Communicable Diseases in the Region: Way Forward

2. Seychelles, 23rd to 25th of October 2006 • Global burden of diseases estimates • Double burden • 8 common risk factors • Integrated approach • Surveillance • Primary Prevention • Prevention secondary and tertiary • Evidence based • Local needs

3. STEP Survey Stage of development February 2009 Algeria Mali Senegal Mauritania Niger Cape Verde Chad Eritrea Gambia Burkina Faso Guinea Benin Nigeria Guinea Bissau Ethiopia Ghana Cote d'Ivoire DNC AFRO CentralAfricanRepublic Sierra Leone Cameroon Liberia Togo Uganda Kenya Congo Sao Tome & Principe Democratic Republic of Congo Gabon Rwanda Equatorial Guinea Burundi Seychelles United Republic of Tanzania Comoros Angola Malawi Zambia Madagascar Atlantic Ocean Zimbabwe Mauritius Namibia Most advanced Botswana Mozambique Survey with data Survey in field Swaziland Trained South Africa Lesotho Indian Ocean

4. Regional Database on Rsk Factors

11. Summary of combined risk factors • current daily smokers • less than 5 servings of fruits & vegetables per day • low level of activity (<600 MET -minutes) • overweight or obese (BMI ≥ 25 kg/m2) • raised BP (SBP ≥ 140 and/or DBP ≥ 90 mmHg or currently on medication for raised BP)

13. Tobacco: key driver of NCD increase 80% of projected 8.3m tobacco-attributable deaths up to 2030 will occur in low- & middle-income countries

14. % currently use any form of tobacco • Cape Verde 2007 • 13.4 • Comoros 2007 • 18.1 • Mauritius 2008 • 13.7 • Seychelles 2007 • 26.6

15. % live in homes where others smoke in their presence • Cape Verde 2007 • 13.9 • Comoros 2007 • 35.2 • Mauritius 2008 • 36.1 • Seychelles 2007 • 42.3

16. % think smoke from others is harmful to them • Cape Verde 2007 • 63.3 • Comoros 2007 • 62.9 • Mauritius 2008 • 70 • Seychelles 2007 • 55.5

17. % think smoking should be banned from public places. • Cape Verde 2007 • 78.9 • Comoros 2007 • 78.8 • Mauritius 2008 • 75 • Seychelles 2007 • 62.7

18. % students saw anti-smoking messages (30days) • Cape Verde 2007 • 74.5 • Comoros 2007 • 76.6 • Mauritius 2008 • 84.9 • Seychelles 2007 • 84.3

19. % saw pro-cigarette ads in newspapers or magazines (30days) • Cape Verde 2007 • 53.2 • Comoros 2007 • 48.3 • Mauritius 2008 • 51.4 • Seychelles 2007 • 49.4

20. Global school-based student health survey (GSHS)

21. Percentage of students who drank so much alcohol that they were really drunk one or more times during their lives

22. Percentage of students who spent three or more hours per day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities

23. Way Forward

24. The global response to address NCDs: overview Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases Global Strategy for the Prevention and Control of Noncommunicable Diseases 2003 2004 2007 Global Strategy on Harmful Use of Alcohol WHO Framework Convention on Tobacco Control A six-year Global Action Plan to address cardiovascular disease, cancer, respiratory disease and diabetes was endorsed by the WHO World Health Assembly on 24 May 2008. 2000 2013 2008 Prevention and Control of Noncommunicable Diseases: Implementation of the Global Strategy Global strategy on Diet, Physical Activity and Health implementation in countries

25. The regional response to address NCDs: overview WHO AFRO strategy on NCD RC50 2001 2008 2013 2000 WHO AFRO strategy on Health PromotionRC51 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases implementation in countries 2005 2007 Cardiovascular diseases RC55 Tobacco RC55 Diabetes Strategy RC57 Alcohol RC57 Cancer Strategy RC58

26. NCD Action Plan: 6 objectives • Raise the priority accorded to NCDs in development work • Establish/strengthen national policies and plans for prevention and control of NCDs • Promote interventions to reduce the risk factors for NCDs • Promote research for the prevention and control of NCDs • Promote partnerships for the prevention and control of NCDs • Monitor NCDs and their determinants & evaluate progress

27. Regional Priorities • Primary Prevention • NCD Management at PHC

28. 1. Primary Prevention To promote interventions to reduce the main shared modifiable risk factors for noncommunicable diseases: tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol

29. Tobacco control The MPOWER package, • Monitor tobacco use and tobacco-prevention policies • Protect people from tobacco smoke in public places and workplaces • Offer help to people who want to stop using tobacco • Warn people about the dangers of tobacco • Enforce bans on tobacco advertising, promotion and sponsorship • Raise tobacco taxes and prices.

30. Promoting healthy diet • Exclusive breastfeeding & ensure optimal feeding for all infants and young children; • Develop a national policy and action plan on food and nutrition, including the control of diet-related noncommunicable diseases; • Establish and implement food-based dietary guidelines • reducing salt levels • eliminating industrially produced trans-fatty acids • decreasing saturated fats • limiting free sugars • responsible marketing of foods and non-alcoholic beverages to children, • Provide accurate and balanced information for consumers

31. Promoting physical activity • Develop and implement national guidelines on physical activity for health; • Implement school-based programmes in line with WHO’s health-promoting schools initiative; • Ensure that physical environments support safe active commuting, and create space for recreational activity, by the following: • ensuring that physical activity are accessible to and safe for all; • introducing transport policies that promote active and safe methods of travelling • improving sports, recreation and leisure facilities; • increasing the number of safe spaces available for active play.

32. Reducing the harmful use of alcohol • Under-age drinking • The harmful use of alcohol by women of reproductive age; • Driving or operating machinery while under the influence of alcohol (including all traffic-related injuries involving alcohol); • Drinking to intoxication; • Alcohol-use disorders; • The consumption of alcoholic beverages that have been illegally produced and distributed;

33. 2. NCD Management at PHC to implement and monitor cost-effective approaches for the early detection of cardiovascular diseases, cancers, diabetes, CRD and establish standards of health care for common conditions integrating, whenever feasible, their management into primary health care.

34. NCD Management at PHC • In line with the Ouagadougou declaration on PHC • WHO has developed a package of essential NCD (WHO-PEN) interventions to integrate cost-effective interventions for the prevention and control of major NCDs into primary care level. • These protocols have been selected for the delivery of a minimum set of essential interventions addressing the four major NCDs (CVD, cancer, diabetes and chronic respiratory diseases) at PH level. • Protocols have been prepared taking into consideration the limitations in low resource settings.

35. Application of Protocols • For Scenario 1 (Non Physicians) • For Scenario 2 (Physicians)

37. Assessment and management of cardiovascular risk in primary health care • WHO/ISH Pocket guidelines for predicting 10-year risk of a fatal or non-fatal major heart attack and stroke risk based on • Age • Sex • Blood pressure • Smoking status • Blood cholesterol • Presence or absence of diabetes • and appropriate interventions for each.

41. NCD Management • The implementation of the WHO PEN interventions • requires training, • adequate financing, • provision of essential medicines and equipment, • Generic protocols to be adapted

42. NCD national capacity survey2010 - 2013 • Institutional Capacity • Status of CNCD relevant policies, strategies, action plans • Health Information Systems, surveillance and surveys • Health Promotion & Primary Prevention • Health services for CNCD Screening, treatment and care

43. Thank you