Belize’s NCD Experiences “7th WHO – IUMSP International Seminar on the Public Health Aspects of Noncommunicable Diseases Hotel Aulac, Lausanne Switzerland 3 – 8 June 2013

Belize – Basic Facts/Info. 8,867 sq. miles in Central America & Caribbean Multiethnic population 340,7921 Population density 15.6/km2 – 5% over 65+ HDI #96 (187) estimated 75% of population access via public system 1Statistical Institute of Belize - 2012 mid-year estimate

NCD Burden Mortality due to NCDs >30%: 10% Cancer; 9%DM; IHD 8%; CVD HTN 4%... Risk Factors – population-based survey of 2006 in persons aged 20-65: DM prevalence of 13.1% (5.6% newly diagnosed and 7.7%, with the prevalence among females (17.6%) double that of the males prevalence of hypertension 28.7% (12.1% newly diagnosed and 16.6% known) this was slightly higher in males (28.6%) than females (24.4%) (8.3%)overweight, obesity and high cholesterol were 33.2%, 32.5%, and 5.1% respectively and sedentarism, assessed as getting less than 60 minutes of exercise per week was almost 78%. 

2013 Country Profile Capacity & Response to NCDs Public Health Infrastructure, Partnerships and Multisectoral Collaboration for NCDs - no unit / branch / department in the ministry of health or equivalent with responsibility for NCDs; funding available for primary prevention & health promotion, healthcare & treatment, rehabilitation services, early detection / screening II. Status of NCD-Relevant Policies, Strategies and Action Plans integrated NCD policy / strategy / action plan, but it is not operational; addresses harmful use of alcohol, physical inactivity, unhealthy diet, tobacco

III. Health Information Systems, Surveillance and Surveys for NCDs- system for generating mortality by cause of death on a routine basis; no cancer registry; risk factor surveys conducted on the following: harmful alcohol use; tobacco use; low fruit and vegetable consumption; physical inactivity; raised total cholesterol, blood glucose/diabetes, blood pressure/hypertension; overweight & obesity IV. Capacity for NCD Prevention, Early Detection, Treatment and Care Within the Health System - following components related to NCDs are integrated into the health care system:primary prevention and health promotion; risk factor detection; risk factor and disease management; support for self help and self care; support for home-based care CARICOM_NCD_grid_2011_update_11 countries(3).doc

Multisectoral Intervention - NCD Strategy/Strategic Plan – October 2011 NCD Commission at core & >30 persons across several governmental sectors (Health, Education, Agriculture, Economic Development); Non-governmental Organizations and the private sector - consistent with the WHO and CARICOM directions/frameworks but also reflects the unique Belizean context. Incorporates situational analysis on policies, procedures , programmes initiatives; identifies issues, unmet needs, gaps strategic interventions based on an integrated approach while non-prescriptive & meant to enable flexibility

Strategic Lines/Areas Risk Factor Reduction, Health Promotion and Communications Integrated Disease Management & Patient Self Management Surveillance, Monitoring and Evaluation Emphasis on improving evidence Programme Management, Policy &Advocacy “To reduce the chronic disease burden by combining integrated action on NCDs risk factors and their underlying determinants, and strengthen health systems so as to reduce the NCDs morbidity and mortality.”

Observations/Challenges Key next step is to operational plan & develop M&E framework NCD commission – dormant no political clout & still not representative enough of key sectors e.g business/private sector & economic development Inability to account for matters outside of the realm of heath for some of the key points of action of the strategy e.g cost & quality of food, exercise equipment: import duties; trade policy, pricing of goods at the table; trans fat policy

Primary Care Initiatives Health Education and Community Participation Bureau (HECOPAB) - health promotion arm of the Ministry of Health Backbone of HECOPAB is a network of Community Health Workers (CHWs) - >300 in communities countrywide Traditionally pulse of the communities working mainly in CD; surveillance, basic health care services Community-based intervention – revision of terms of reference & development of teaching manuals for community-health workers – in collaboration with USA Peace Corps to incorporate NCDS – primary & secodary prevention

Observations/Challenges Programme needs to be carefully planned, structured, run & evaluated according to clearly defined goals, objectives, outputs, outcomes etc. complete shift in their traditional work purview – very slow to develop & implement New cadre of low-literacy personnel

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