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Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH,FRCP (UK) Director General - GCC

Strategic Approaches In Combating Diabetes Mellitus Among GCC Countries. Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH,FRCP (UK) Director General - GCC. Riyadh 11/1/1430H - 8/1/2009. ” أَفَمَن يَمْشِي مُكِبًّا عَلَى وَجْهِهِ أَهْدَى أَمَّن يَمْشِي سَوِيًّا عَلَى صِرَاطٍ مُّسْتَقِيمٍ ”.

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Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH,FRCP (UK) Director General - GCC

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  1. Strategic Approaches In Combating Diabetes Mellitus Among GCC Countries Dr. Tawfik A. M. Khoja MBBS, DPHC, FRCGP, FFPH,FRCP (UK) Director General - GCC Riyadh 11/1/1430H - 8/1/2009 Dr. Tawfik A. Khoja

  2. ” أَفَمَنيَمْشِيمُكِبًّاعَلَىوَجْهِهِأَهْدَىأَمَّن يَمْشِيسَوِيًّا عَلَىصِرَاطٍمُّسْتَقِيمٍ ” سورة الملك (آية 22) “ Is then one who Walks headlong, with his face Grovelling, better guided, Or one who walks Evenly on a Straight Way ? ” Dr. Tawfik A. Khoja Holy Quran

  3. MISSIONOF THE COUNCIL OF MINISTERS OF HEALTH FOR GCC SINCEthe GCC States constitute one regional community in its Islamic religion, Arabic language, population, similarity in geography, and values history, traditions, economic sources, social and cultural circumstances. THEREFOREthey had to unify their efforts in different fields of life to face the quick changes, and the overall development requirements. Dr. Tawfik A. Khoja

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  5. The Health Minister's Council for Cooperation Council States , was established in 1397 H (1976G. ) for coordination between the GCC States in the fields of health to join the common world efforts symbolizing one goal for better achievement of health and expectation for health. MISSIONin the Gulf States based on these principles:- • Commondevelopment & coordinationbetween the Members States in the preventive, curative and rehabilitation fields. Dr. Tawfik A. Khoja

  6. Identify the concepts and directions of the differenthealth and scientific issues . • Unify and arranging the priorities as well as adopting the common executive programs in Gulf States. • Assessment of the existing systems and strategiesin the health fields and supporting the successful experiences in the Gulf States to exchange such achievements in other Member State. Dr. Tawfik A. Khoja

  7. Since Alma Ata in 1978 • Dramatic changes have occurred: • * In the pattern of diseases. • * In demographic profiles. • In socioeconomic environment. • Growing demand on health services. • Rising costs. • Public needs for better quality services. • Which present new challenges to PHC. • These changes are seen globally: • For example: • Increase in the prevalence of preventable risks • In crease in the prevalence of chronic non-communicable disease. Dr. Tawfik A. Khoja

  8. Introduction The GCC is witnessing the last few years huge changes in the health needs of its population. MANY countries are suffering from the effects of the double burdendue to infectious and non-communicable diseases (NCD). NCDs forms the main causes of premature deaths and disability where it forms around 60%of the overall mortality and47%of the global burden of diseases. These two rates are expected to jump into 73%and62%respectively by the year 2020. Dr. Tawfik A. M. Khoja

  9. The epidemiologic transition in the GCC : • The quick ageingof the population the steadily increasing urbanizationwith consequent social and economic impact. • Important behavioral factors related to the dietary pattern, physical inactivity leading to overweight and obesity and thus increasing rates of cardiovascular diseases, diabetes, hypertension, some types of cancer.. etc. The effects of this epidemiologic transition is far more than expected by the health policy makers. Dr. Tawfik A. M. Khoja

  10. The burden of NCD: • Has major adverse effects on the quality of life of affected individuals; • Causes premature death; • Creates large adverse – and under appreciated – economic effects on families, communities and societies in general. Dr. Tawfik A. M. Khoja

  11. CVD and diabetes are emerging as the single leading cause of mortality in the Gulf. The enormous burden caused, in terms of suffering and health costs is escalating. NCDs present mainly at the primary health care (PHC) level and will therefore need to be handled principally in these settings. Yet, most primary health care has developed in response to acute problems and the urgent needs of patients. Health care workers need the skills and practical tools to manage these chronic conditions and to ensure that patients receive comprehensive, coordinated care. Dr. Tawfik A. Khoja

  12. Health care systems must guard against the fragmentation of services. Care for NCDs needs integration to ensure shared information across setting and providers, this means setting priorities for screening, early detection prioritising surveillance, and management to be applied and followed among Gulf area, through community - based programme as well as health team training on: • Evidence-based, clinical management of chronic conditions. • Organizational factors that support the provision of care for patients with chronic conditions. • A proven methodology for accelerating health care improvement in PHC. Dr. Tawfik A. Khoja

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  14. Prevalence of Physical Inactivity GCC mean of Physical inactivity is 71.4% Dr. Tawfik A. M. Khoja

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  16. Global effect of Over weight & Obesity on developing NCDs • In WHO analysis: • 58% of Diabetes Mellitus • 21% Ischemic heart diseases • 4-42% of certain cancer • Were attributable to BMI above 21 kg/m2 Dr. Tawfik A. M. Khoja

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  18. د. توفيق بن أحمد خوجة

  19. Current Situation in the GCC States The GCC countries lie in the center of these epidemiologic transitions. Statistical studies affirms that more than (40-50%) of the Gulf community are suffering high rates of overweight (which increases with age) in addition to the high prevalence of risk factors; namely high lipids and cholesterol in blood – smoking and others. The studies emphasized as well the aggravation of this health phenomenon and its consequent economic burden. Dr. Tawfik A. M. Khoja

  20. Chronic conditions Among person aged 15 years and over, the percentage reported of have ever had specific chronic conditions confirmed by a doctor, by sex, GCC Family Health Survey Dr. Tawfik A. Khoja

  21. Risk factors in the GCC States Many studies affirmed the high prevalence of the risk factors in the Gulf region for the age group 25-65, as follows: • - Smoking 16- 46% • - Hypertension 15- 35% • - Fats and lipids 20- 45% • - Physical Inactivity 80 - 90% • Diabetes 12 - 25% • - Overweight and obesity 40-70% Dr. Tawfik A. Khoja

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  23. Diabetes - an escalating problem in the Kingdom of Saudi Arabia Dr. Tawfik A. M. Khoja

  24. Diabetes in the Gulf Region Dr. Tawfik A. Khoja

  25. GCC challenges for Non-communicable Diseases Control Dr. Tawfik A. Khoja

  26. Hence, it became mandatory for the Health Ministers’ Council for the Cooperation council States to confront this problem, through a number of strategic directions: I- Establishing Specialized Consultative National Committees • Control of Cardiovascular Diseases. • Control of Diabetes. • Cancer Control and Registration. • Health Education and Information. • School Health. • Mental Health. • Strengthening the Role of PHC in Prevention and Control. Dr. Tawfik A. Khoja

  27. II- Strategic Resolutions by the Health Ministers’ Council for Cooperation Council States Dr. Tawfik A. Khoja

  28. The following Health Ministers’ resolutions were issued Dr. Tawfik A. Khoja

  29. Resolution # 3/50 (Kuwait, Shawwal 13-15, 1421H /Jan. 8-10, 2001). It decided the following: a: 1- Establish diabetes epidemiological screening program, collect information and prepare diabetes health indicators in the Gulf States. 2- Coordinate, follow-up and communicate in the field of dissemination of information and develop preventive, educational, and treatment programs to control this disease, and help individuals to lead a healthy life. 3- Supervise the training programs and train workers in the field of healthcare for Diabetes mellitus. Dr. Tawfik A. Khoja

  30. b. Adopt new methods in the health care service of diabetes,i.e. specialized primary healthcare clinics for diabetic patients, adoption of shared care for chronic diseases, and reinforce the referral system within the different levels of health care services. c. Adopt national diabetes registration system to register all the diabetes cases in each country of the Gulf States. It should possess very clear views and methodology to achieve each goal. Dr. Tawfik A. Khoja

  31. Resolution # 2/51 (Geneva, Safar 1422H /May 2001) It affirmed the following: 1- Approve the "Gulf Plan of Action" (2001 — 2002) which has been suggested by the referenced taskforce team, as a guiding plan for the rest of the Gulf countries. 2- Take the initiative of forming the "National Committee for the Control of Diabetes" in member countries where these committees have not been formed yet. 3- Incorporate diabetes control programs in the other programs that are related to chronic noncommunicable diseases i.e. high blood pressure (hypertension), obesity, etc… within the healthcare joint systems for chronic diseases, and the specialized clinics in the primary health care sector. Dr. Tawfik A. Khoja

  32. Resolution # 8/52 (Riyadh, 24-25 Shawwal, 1422H / 8-9 Jan. 2002) It adopted the following: 1 - Member countries should submit their suggestions for the activation of the “Gulf Diabetes Control Plan”. These suggestions should indicate a phased goals plan, and a specific timetable, taking into consideration that special emphasis should be made on preventive measures in controlling diabetes. 2- Instruct the “Health Education and Information Committee” of the executive board, to prepare a special program to enhance positive healthy life style approach and encourage the change of individual attitudes and behavior to go alongside with this concept. Dr. Tawfik A. Khoja

  33. Resolution # 5, conference 58 HMC (Muscat, 5-6/1/1426 H – 14-15/2/2005) Which affirmed the following: A- Giving effect to the “global strategy on diet, physical activity and health” within the related programs and departments in the Ministries of Health. Dr. Tawfik A. Khoja

  34. Resolution # 4 Conference 60 (Feb., 2006) - Reaffirming the previous endorsed resolutions of the Council concerning the importance of supporting and promoting the role of control of non-communicable diseases and positioning the extended medical care as one of the priorities in the strategies of the ministries of health, with emphasis on: • Adopting new approaches to evaluate medical services for the care of patients of such diseases and giving effect to and developing the role of health centers in this respect (prevention, cure, and rehabilitation). • B) Giving effect to the concept of health promotion within the Healthy Lifestyle, prevention and control of chronic and non-Infectious diseases. Dr. Tawfik A. Khoja

  35. Recent Strategic Directions of HMC / GCC Dr. Tawfik A. Khoja

  36. Developments of the Gulf Program for Diabetes Control Resolution # 2 the 61st conference of the Health Ministers (held in Geneva on 26//4/1427 H / 24/5/2006), which assigned the specialized Gulf committee to undertake the process of development and update of the programme through the following: 1- Review of the Gulf plan for Diabetes Control in the light of the recent scientific updates, and after evaluation of the achievements made in various stages, and hence setting an executive workplan including preventive and promotive aspects. Dr. Tawfik A. M. Khoja

  37. 2- Studying the current situation of the diabetes problem in the Council States and the objectives realized in the Gulf programme for Diabetes Control, reduction of diabetes incidence and its complications along 10 years. Dr. Tawfik A. M. Khoja

  38. The Director General of the Executive Board submitted a proposed working paper to update and develop the Gulf plan for Diabetes Control. The working paper included a number of very important items: 1) Evaluation of what has been achieved in the Gulf plan (infrastructure – training, learning and development of health caders - prevention programmes – scientific research). 2) Determinants of the Gulf plan which is considered so far a general framework for a comprehensive plan, especially after defining weaknesses and shortcomings. Dr. Tawfik A. M. Khoja

  39. Methods of realizing the strategic objectives of the Gulf plan guided with the leading international experiences. • Proposed developmental steps – emphasis on the community dimension – preventive aspect - scientific research. • 5) Guarantees of success and continuity – at all levels in (MOH – related authorities – political level and decision making). Dr. Tawfik A. M. Khoja

  40. Resolution # (1) 63rd conference (Geneva, 29/4/1428 H – 16/5/2007) which is considered an applied approach to the directives of the Ministers of Health in their 62nd conference in Kuwait which was named (The conference of diabetes control) and included a number of key directions, on top of which come the following: 1- Signing the “joint statement for the Health Ministers’ of the Cooperation Council States about Diabetes” and its endorsement as a commitment to improve public health and confront the diabetes epidemic. Dr. Tawfik A. M. Khoja

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  42. 2- Endorsement of the updating Integrated Executive Gulf plan (2008/2018) set by the specialized technical committees, which included the vision, mission and strategic objectives – mechanisms of implementation as well as indicators of follow up and improvement. 3- Selection of a work team at the highest technical and leading level from the ministry of health to undertake the process of follow up of implementation of the plan and developing it according to the needs and the stages of progress. Dr. Tawfik A. M. Khoja

  43. 4- Calling upon the Council States to establish a supreme national council for control of diabetes, on the basis that control of diabetes is a case of nation and the responsibility of all community classes. 5- Each member state shall propose the “national executive plan for control of diabetes “based on the general framework for the Gulf executive plan (2008-2018). 6- Approval on establishing a “Gulf Central Supervisory Team”. The team is assigned to set protocol for a Gulf study with unified methodology to deal with epidemiology, burden of disease and economics of diabetes. Dr. Tawfik A. M. Khoja

  44. It is worthy to mention that the “joint statement for diabetes” document had been circulated to all related bodies, organizations, scientific institutes local, regional and international. The joint statement had a very resonant impact in all those institutions. The most prominent is the message received from the Secretary General / Arab League office (188/5 dated 19/6/2007) in which HE the Secretary General expressed his appreciation and acknowledgement of this important strategy and he proposed establishing an umbrella for protection of diabetic patients at the Arab level. In addition, HE called upon considering this declaration a statement among the formal documents and it had been registered under the number (400) and a copy of this document was put on the website of the Arab League and it had been circulated to the Arab Countries. Dr. Tawfik A. M. Khoja

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  46. The Assistant Secretary General – Chairman of social affairs – General Secretary for the Arab League has been addressed to take the executive actions to include this Gulf document as well as the Gulf Executive plan for Diabetes Control (2008/2018) on the agenda of such meeting. And, to give effect to resolution # (1) for the 63rd conference, and put it into action. Dr. Tawfik A. M. Khoja

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  48. The proposed Interim Operational Plan (2008- 2009) Based on the request of the Director General of the Executive Board, the meeting for the Specialized Technical Committee was held alongside the Diabetes Economics Conference “Diabetes Economics – Vital Investment”). The main question was what next? and what are the next steps to combat diabetes. It was agreed on dividing the Gulf plan into 5 stages, where each stage is evaluated, reviewed and the progress assessed as well as shortcomings. Thereafter, a plan for the next stage is set. Dr. Tawfik A. M. Khoja

  49. It was agreed to put an interim operational plan (2008/2009) as follows: • it represent the (first ) executive stage of the endorsed Gulf Executive plan. • It involves the minimum amount of strategies to be implemented. • - Mechanisms and requirements for starting implementation of the plan were selected. Dr. Tawfik A. M. Khoja

  50. What has been achieved during 2007 ( the year of control of diabetes) has been presented and reviewed by the Health Ministers’ Council in the 64th conference (held in Riyadh, Muharam 1429 H – February 2008) where resolution # (3-A) was issued. The resolution defined the path of the new Gulf programme through the following: I- Appreciation of the initiative of presenting the joint statement for the Health Ministers’ in the Cooperation Council States about Diabetes, and the endorsed Gulf Executive plan for diabetes control to the next Arab Health Ministers. This is starting from the joint Arab Cooperation principle which was crowned by the proposal of HE the Secretary General of the Arab League concerning “Establishing an umbrella of protection for diabetic patients at the Arab level. Dr. Tawfik A. M. Khoja

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