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NCD Experience in PHC in Bahrain Dr. A. Hussain Al- Ajmi COMS/PHC Head of NCDC Jan 2010

NCD Experience in PHC in Bahrain Dr. A. Hussain Al- Ajmi COMS/PHC Head of NCDC Jan 2010. Distribution of health Institutions in Bahrain Governorates. NCD in Bahrain: Size of the Problem.

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NCD Experience in PHC in Bahrain Dr. A. Hussain Al- Ajmi COMS/PHC Head of NCDC Jan 2010

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  1. NCD Experience in PHC in Bahrain Dr. A. Hussain Al-Ajmi COMS/PHC Head of NCDC Jan 2010

  2. Distribution of health Institutions in Bahrain Governorates

  3. NCD in Bahrain: Size of the Problem • 1- Cardiovascular and circulatory diseases are considered the main cause of death in the kingdom of Bahrain. • 86.6% in 2003 • 60.5% in 2006 • 43% in 2007 • 2- Hypertension, hyperlipideamia, diabetes, smoking and obesity were the main risk factors causing these diseases.

  4. Risk Factors & Morbidity 1- Smoking Prevalence of smoking all kinds of tobacco in Bahrain compared to other gulf countries.

  5. Risk Factors & Morbidity 2-Obesity as defined by BMI => 30 Shown as % of local population

  6. Risk Factors & Morbidity 3-Hypertension Prevalence of hypertension

  7. Risk Factors & Morbidity 4- Practice of Physical Exercise Regularly During own free time presented as % of local population

  8. Risk Factors & Morbidity 5- Diabetes Mellitus Prevalence of Diabetes according to the geographic distribution

  9. MOH Mission To reduce morbidity, disability and premature mortality resulting from non-communicable diseases and to improve the quality of life of people with NCD through the development of comprehensive prevention and control programmes and strengthened surveillance and management .

  10. MOH Strategy • Assess the epidemiology of NCD, their associated risk factors and environmental determinants, evaluate provision of services and establish an appropriate monitoring system • Obtain strong political commitment and provide support for the development of public policies and evidence-based NCD prevention and control programmes as a priority in national health planning • Integrate NCD control in primary health care • Emphasize primary prevention through increasing awareness of NCD and their risk factors; carry out information and education campaigns through the media, advocating adoption of healthy lifestyles and stressing the need to maintain a healthy social, economic and physical environment.

  11. MOH Strategy • Facilities/infrastructure to expand coverage of secondary and tertiary programmes, particularly hypertension and diabetes, and establish a referral system. • Develop an integrated approach to NCD prevention and control within the framework of primary health care. • Strengthen implementation of WHO cancer control strategies such as risk reduction through Hepatitis B vaccination for prevention of liver cancer, tobacco control for prevention of lung cancer and safe sex for prevention of cervical cancer; promote early detection and screening for cervical cancer and breast cancer; support palliative care and cancer pain relief.

  12. NCDC Announcement Objectives • To reduce the incidence of risk factors leading to the NCD. • To reduce the NCD among people in the community. • To reduce complications caused by NCD. • Improve the quality of services provided to patients with NCD

  13. Chronic Diseases Commitee Opportunistic Age screening Team Obesity & Life style Team Monitering & Evaluation Team Monitering & Evaluation Team Medication & equipment Team Dyslipideamia Team Medication & equipment Team IT Team Asthma & Resp Team CVS Team Cancer Team Diabetic clinic Team Mental Health Team Dyslipideamia Team Osteoporosis Team Training Team Chronic Disease Committee Teams

  14. Achievements: 1- NCD Registry NCD registry programme was designed with HID to collect data from each HC and use it to get reports and indicators that shows the quality of services given to the NCD and burden of work. The patient’s prescription is the main source to capture data around NCD where it will be coded by doctors and entered to the system.

  15. Achievements: 2- NCD Guidelines All guidelines were finalised in 2008 and disseminated 1- Diabetes guidelines 2- Dyslipideamia guidelines 3- Cardiovascular guidelines 4- Screening guidelines 5-Obesity clinics guideline 6- Osteoporosis guidelines 7- Bronchial Asthma guidelines 8- Sickle Cell Disease guidelines.

  16. Achievements: 3- Clinics Development 1- Diabetes Clinics started in 1997 in few HC ,generalised in all health centres in 2006 2- Obesity clinics in region1 since 2008 and will be extended to region4 on trial basis Dec 2009. 3- Smoking Cessation Clinics (Hoora HC) since 2007. 4- NCD pilot clinics in 4 HCs in 2009.

  17. Achievements: NCD Clinics Integration • NCD clinics integration in PHC in coordination with WHO was established in 2009 in 4 health centers in Bahrain. • WHO protocols were adapted and integrated with the national guidelines. • Education and changing life style is the main aim of this project were patients will be referred to this clinic depending of their CV risk factor • A trained nurse, health educator and a doctor are working in this integrated clinic. • Training of staff in the four health centers.

  18. Achievements: NCD Clinics Integration

  19. NCD Risk calculation Tables

  20. NCD clinics: Assessment & Follow up Sheet

  21. Achievements: 4- CME & Training c A- Awareness workshop on national guidelines B- Awareness workshop on tools for guidelines implementation & performance indicators for HCPS C- CME workshops for HCPs on 1- ABC of Diabetes Care 2- Foot Care 3- Cardiovascular Risk Prevention

  22. NCD Manpower: Number & Training

  23. Achievements: 5- Community Awareness Campaigns 1- Marking World Diabetes day (WDD 2008) celebration in liaison with Bahrain Diabetes Society 2008 ( Monumental blue lighting & Screening campaign) 2- Several screening Campaigns in malls and civil societies

  24. Achievements: 6- National Diabetes Awareness Campaign WDD 2009 NCDC LOGO 2009

  25. Components of National DiabetesAwareness Campaign: WDD 2009 These include: 1- Sending consecutive bulk SMS messages ( >100,000 SMS x4 wks) 2- Sending Bulk emails (100,000 emails per week) 3- Sending email to all government emails through E-Government electronic gate. 4- Distribution of educational leaflets (60,000 copies/wk x 4wks) through the news paper on weekly basis for one month (Distribution is sponsored fully by Al-wasat publishing and distribution)  5- Coordinating with the ministry of education an art competition at a national level on “Diabetes Education and prevention”. Winners will be awarded on a special arrangement next April 2010. Three wards will be given to the three best drawings.   6- Scientific workshop for HCP .

  26. Achievements: 6- National Diabetes Awareness Campaign WDD 2009 W1 W2 W3 W4 26

  27. Achievements: 7- National & GCC Diabetes (NCDs) Plan 1- GCC plan for diabetes control - 2007 2- National plan for diabetes control- 2007 ( Taken from GCC plan) 3- National committee for Diabetes control- 2007 4- GCC Non- Communicable Diseases Plan (Draft 2009) ,taken from Diabetes plan. • Overall objective: • حماية المجتمع البحريني(الخليجي) من الداء السكري(الامراض المزمنة) ومضاعفاته كمسئولية مشتركة بين جميع فئات المجتمع • Protection of the GCC (Bahraini) community of diabetes (NCDs) and • its complications as a shared responsibility between all segments of society.

  28. NCD Programme: Challenges & Obstacles • Lack of the suitable infrastructure for NCDs care in some health centres. • Manpower. • Escalating financial cost for chronic diseases which support the need for social protection schemes. • Training of the NCDs team. • (Counselling in diet , lifestyle, etc)

  29. Future Plan & Vision • Integration of the health care system for NCDs Care (Insurance System) • Generalizing the NCDs clinics toll all health centres • IT health Project ( Will start in 2010)

  30. Future Plan & Vision: Core Steps for Integration Screening Feet, eyes Renal User Expectation Audit (PI) Guidelines Protocol Multi -disciplinary Infrastructure& manpower Secondary care Lifestyle Clinics Tools & Resources (Projects) Registry &Database

  31. ……………………. Palliative …………………… Renal replacement ………………….. Amputation …………………. Rehabilitation ………………… PCI / CABG Tertiary ……………….. Advancedeye surgery ……………… DKA …………….. Secondary care Infections …………..... …………... CVD CVD Risk …………... Primary Insulin start ………….. Screening eyes Interface …………. Experts Visitors Consultant Clinics Screening feet …………. Secondary Screening renal …….…... Complex cases ………... Screening & Diagnosis ………. Primary General treatment ……… Review screening ….… …… Healthy eating Public Health & Prevention …… Exercise …… Weight care Chronic Diseases Management Single Team

  32. Thank you for your attention

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