NON-COMMUNICABLE DISEASES IN BHUTAN TANDIN DORJI CHIEF NON-COMMUNICBLE DISEASES DIVISION DEPARTMENT OF PUBLIC HEALTH MINISTRY OF HEALTH

Country Profile Area: 38,394 Km2 Population: 0.74 mill. (current) Life Expectancy: 68.9 (2005) IMR: 60.5/1000LB (2000) MMR: 255/100,000 LB (2000)

Alcohol Liver Diseases Disease incidence per 10,000 population NCD Situation Disease incidence Year 2007 2008 2009 2010 2011 Alcohol Liver Diseases 22 20 23 28 29 Cancer 13 10 17 15 14 Diabetes 26 38 47 53 Hypertension 294 303 310 343 325 Disease incidence per 10,000 population

Multi-Sectoral Intervention Tobacco Control Act 2010 - Ban on Sale of Tobacco products - No smoking in public places - Numerous stakeholders

Introduction of PEN Adoption of WHO proposed Package of Essential NCD (PEN) interventions Piloted in 2 districts in 2009 for 6 months Reviewed in 2011 Early detection and management of individuals having higher level of risk factors for NCDs, to reduce NCD disease burden and complications, improving the survival and quality of life

PEN contd. All NCD patients attending OPDs in the health institutions registered. All patients >40 years counseled for smoking cessation, alcohol harm reduction, healthy diet and physical activity screened for high BP and overweight/obesity; those having over-weight/obesity tested for blood sugar registered if found to have hypertension or glucose intolerance or diabetes A clinical record form was used for registration & follow-up; it was kept in a folder or registers

PEN Review 2011 PEN intervention successfully implemented PEN protocols user friendly; most of the health workers could follow Capacity of health workers (knowledge and skills) enhanced Community awareness on major NCD risk factors increased Glucometers and peakflow meters supplied to the health facilities

Successes and Challenges Awareness on NCDs Adoption of PEN in all health centres National Policy and strategy Challenges Enabling environment Double burden of disease Information Resource constraints

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