Dr Prak Piseth Raingsey Director Department of Preventive Medicine KINGDOM OF CAMBODIA MINISTRY OF HEALTH 6th WHO-IUMSP International Seminar on the Public Health Aspects of NCDs Hotel Aulac, Lausanne 7- 12 May, 2012 Dr Prak Piseth Raingsey Director Department of Preventive Medicine

NCD SITUATION Area 181,040 sq. km Population 13.4 Million (2008) Per capita GDP USD 776 (2010) Total National Budget on Health USD 106.49 Million RGC spends 6% of GDP on health Diabetes prevalence 2.9% (STEPS 2010) Hypertension prevalence 11.2% (STEPS 2010) Cancer new cases 12,900 (Globocan 2008) NCD mortality 46% (WHO estimate)

NCD Prevention & Control NCD STRUCTURE NCD Bureau/MoH Policy and strategic plan Resource allocation Capacity building Monitoring & Evaluation National Multisectoral Collaboration Provincial Health Department/NCD focal point NCD primary prevention through reduction of NCD risk factors NCD care ( eg. diabetes clinics) Provincial NCD Prevention & Control Operational District NCD primary prevention NCD screening, treatment, and refer District NCD screening Health Center NCD primary prevention NCD screening, treatment and refer PHC PHC PHC PHC Communities: peer education COMMUNITIES

ACHIEVEMENT National Strategy for Prevention and Control endorsed NCD program prioritized in Health Strategic Plan 2008-2015 WHO STEPS Surveillance for chronic disease risk factors including diabetes, and high blood pressure conducted and published National Cancer Program established and National Strategy for Cancer Prevention and Control drafted FCTC implementation enforced (IMC for tobacco control established, Sub-Decree on Printing Health Warning on Cigarette Packs, and the measures for banning of Tobacco Product advertising approved, 14 government ministries issued smoke-free circulars ban indoor smoking) Reduction of harmful use of alcohol in progress Treatment services for diabetes, cardiology, and oncology established Peer education for diabetes in communities established

CHALLENGES Mobilization of non-health sectors to engage in NCD prevention and control National budget allocated for NCD intervention is limited Human resources, drug and other medical supplies for NCD program is another challenged Competencies of staff working for NCD program is limited Limited capacity for enhancing NCD-related data in existing Health Information System contributing to difficult in monitoring and evaluation of NCD program

LESSON LEARNT Tobacco smoking has realized by RGC ( smoke-free indoor workplaces and public place, health information and warnings about tobacco and bans on advertising and promotion) Population based intervention addressing NCD prevention in PHC ( screening for diabetes, high blood pressure, cervical cancer) Reduction of alcohol harmful use - traffic land law in drink driving ( 0.25mg/ l breath & 0.050mg/l BAC) Bans mass media advertizing on lucky draw Bans alcohol selling at school & university Community awareness on NCD risk factors

NEXT STEP Develop National Multisectoral Plan for NCD Prevention and Control Advocate for engagement from relevant ministries contributing NCD prevention Scale up healthy cities addressing on NCD prevention ( healthy school, healthy work place, healthy market, etc.) Build capacity of health workers on NCD prevention and management Strengthen the quality of health services for people with chronic diseases Priority NCD research agenda

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