بسم الله الرحمن الرحيم

6th NCD Seminar lausanne,7-12may,2012 country presentation SAUDI ARABIA By Dr. Mohammad. Al hamid Family Medicine Consultant ,SBFM,ABFM, Director of Diabetes Control Program,GDNCD,MOH,Saudi Arabia.

Main Headlines Introduction. General Information. Magnitude of the problem. Achievements. WHAT IS NEXT.

Introduction Success of any program depends on: 1- clarity of epidemiological situation. 2- Putting clear, measurable and achievable goals and objectives and strategies within time limit. 3- sharing and adapting of the goals objectives and strategies at all levels. 4- the proper implementation of mechanisms that should be followed to reach these goals and objectives.

Introduction General Directorate for Control of Hereditary and chronic Diseases was established in 2004 Aim: To prevent occurrence of chronic Diseases and its morbidity and mortality, and to improve the quality of patient's life and empowering him and his family to share in the care process.

General Information General Information Population: 24,293,844 Includes 5,576,076 non-nationals 0-14 years: 42.3% 15-64 years: 54.8% 65 years and over: 2.9% Birth rate: 37.2 births/1,000 population .

General Information General Information Life expectancy at birth: total population: 68.73 years male: 66.99 years female: 70.55 years Total fertility rate: 6.15 children born/woman . Ethnic groups: Arab 90%, Afro-Asian 10%

General Information General Information Death rate: 5.79 deaths/1,000 population . Growth rate : 3.7% Net migration rate: 1.23 migrant(s)/1,000 population . GDP per capita is $ in 2011 24,237 With order of 39 from 42

General Information General Information The country is divided into 13 administrative regions - Pop ( 1 – 5 ) million - Urbanization ( 50 – 90 %) The health system 3 levels: 1ry – 2ry and 3ry provided by 2200 PHC - 240 hospitals – general( 100 - 300 beds capacity) and specialized (subspecialty and child and maternity ( one for each region)

General Information General Information Care is provided by: Mini clinics in primary health care centers General general hospitals (240) Referral subspeciality hospital - 20 Integration between the three levels is facilitated by referral policies.

Health system 60 – 70 % of health services is provided by MoH. 30 – 40% is provided by the other gov and private Health sectors. The other Gov H sectors have in most of them the care at the 3 levels controlled by regulations. In the private sector, there is variability in the level of the service provided

Magnitude of the problem In the last three decades, the region has experienced significant social and economic changes. The non-infectious diseases start to climb the list of health problems.

Magnitude of the problem Adoption of unhealthy behavior and lifestyle, reflected by the changes in nutritional pattern, increasing rates of obesity, less physical activity and increase in cigarette smoking.

Overview on behavior of DM over the last 30 years. in Saudi Arabia Type 2 Diabetes Mellitus Annual change of prevalence. Incidence is  1%. Increase in the risk factors: Obesity: the most important. Diet: More data needed. Activity: No data. Diabetes Care Vol,10 1987 Annals of Saudi Medicine Vol,12 1992 Acta Diabetol Vol, 1999 Diabetes Care, Vol, 26 2003 > 20% 2000’S 10-20% 1990’S 1970’S < 5% 1980’S 5-10%

28% Diabetes Prevalence Targeted Population (> 30 years of age) 25.9% 34.7% 20.2% 26% 22.9% 22.8% 25.2% 28.7% 25.5% 33.7% 31.2% 32.7% Targeted Population (> 30 years of age)

14.1% Diabetes Prevalence Total Population (All age group) 7.5% 15.7% 13.8% 15.7% 7.5% 12.9% 11.3% 9.4% 11.2% 14% 12.3% 10.1% 18.8% 15.3% Total Population (All age group)

CONT… DIABETES DIRECT COST CALCULATION IN SAUDI ARABIA: Diabetes Expected Annual Total cost Number expenses Type 1 250,000 8324 SR 956,600,000 SR Type 2 2,099,000 3433 SR 7,634,550,000 SR Total cost 2,100,000 8,591,150,000 SR Diabetes Impact in Saudi Health, Health minister,,Alruba,an et al - initial results

Step wise - surveillance for NCDs 2005, Age (15 – 64 ),(n = 5000) Total (%) Women (%) Men (%) prevalence 26 24.4 27,7 hypertension 17.9 16.6 19,2 Hyperglycemia 19.3 19.9 18.7 hyperlipedeamia 36.1 43.3 28.6 obesity 29.4 31.9 27 Central obesity 12.9 1.4 24.7 smoking 33.8 33.2 34.4 Physical inactivity

Achievements Establishment of National plans for Prevention and Control of NCDs, Diabetes,CVD ,Cancer,premarital ,neonatal screening,COPD and Strstegy for Diet and Physical activity. National committees. Stepwise surveillance for NCDs R Fs 2005 - 2012. National Community based study on the impact of Diabetes on Saudi Health including economic burden. Registry for DM 2009 1st step ,Cancer …premarital… . NCDs Screening program pilot in Aljouf Region. Integration of NCDs care in 1ry HCCs through mini clinics. Tobacco control program as separate national program legsilations and taxations. Mental Health program as separate national program integration of mental care in the primary care.

Achievements Improving quality of care for NCDs and detection of R Fs. Infrastructur and facilities. Referral System between the 3 health care levels. 20 specialized centers Ongoing training and qualification of health personnels . Yearly multiple campaigns with screening.

Achievements Adopting Evidance – based clinical guidelines. Conducting National campaigns for Community awareness and screening. Strengthening of cooperation and coordination with governmental and non- governmental health sectors and related ones such ministry of education Assignment of 20 NCDs control program coordinators in regions and provinces.

Challenges Shortage of qualified personnels at planning and executive levels Lack of coordination and cooperation among Departments at ministry levels and related sectors. Difficultie in changing behavioral Risk Factors especially , dit and P A in community among those who physically inactive and having unhealthy diet. Building health system capacity ,especially human resources. Unavailability of Healthy Choices and environmen Social and Cultural fators Resistant to providing sport environment in females educational institutions( schools and universities)

Lessons Learnt Diet,PA,Smoking,and overweight and obesity are common risk factors for the four main NCD’s. The prevention and control of these diseases should focus on the identification and control of these risk factors in an integrated ,population – based manner. Best approach is population based preventive strategies including increasing awareness, health promotion, and legislations in an effective cooperative manner with other related governmental sectors and community participation. Important target population is children and mothers or housewives Parallel to that, we should improve quality of care to NCDs through building capacity of health system.

What is next Gradual Expansion in the screening programs for Ncds and control of behavioral and physiological risk factors. Increasing and activating the intersectoral collaboration for providing healthy Choices ,environment and diet, in addition to Health promotion. Development and expansion in registries by adding new NCDs and new variables Foundation of high authority council for health promotion including all related sectors Monitoring and evaluation of : 1- NCDs and its RFs 2- quality of provided care 3- how far was applied of the action plans of different programs in term of time frame and goals Conducting STEP wise Surveillance for Ncds RFs

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