NCD in Islamic Republic of Iran Dr Behzad Damari Director of NCD(MOH) Assistant Professor of Tehran University of Medical Sciences (TUMS)

General Aspects population : 76000.000 31 provinces and 420 districts 30% for Rural area 70% for Urban area (10% Suburb) PHC in rural area developed 4000 health centers in urban 100 research center related NCD

National Average of inactivity in IRI Based on STEPs 2011 : 33% <600 MET-minutes/week

High Health and Food Security Council (HHFSC) According 4th development plan of country established. 10 year experience with 80 policy statements on : Food security e.g. Fatty acid Environmental issue e.g. air pollution President is head of council and health minister responsible for secretariat. All notifications order by president. Secretariat in health ministry established as Health Policy Unit(HPU).

Country profile for NCD Smoking: 5.300.000(10%) + 5000.000 water pipe High Cholesterol: 15.000.000(28%) IPA: 18.000.000(33%) High Blood Pressure :10.000.000(19%) Diabetes :7.300.000(14%) Obesity :9.000.000(17%) Overweight :15.000.000(28%) Fruits and vegetables(5 units not consume): 47.000.000(88%) Mental Disorder prevalence : 23.6%

Key achievements Integrating blood pressure and diabetes care in PHC (8 years) Intersectoral collaboration for fatty acid Genetics programs especially for Thalassemia STEPs survey : 5 times Advocacy initiatives from 2013 : NCD Policy approved by Health Policy Council : 2014 2.000.000 $ for integration NCD to PHC Recommend healthy life style by supreme leader Establish Risk Factor Taskforce under HH&FSC MoUs with food industry (40 societies) for decreasing fat ,salt and sugar

Challenges Fragmented initiations on NCD Large service gaps in PHC level for NCD, mental health and social problem Weakness in CP and IA link to PHC Budgets and human recourses especial for NCD

Future directions 3 major interventions Heath Literacy PHC(each heath center cover and care 12500 people ) Intersectoral action: policy for IPA SMOKING FOOD AND NUTRITION

Community participation and selfcare unit Health Center Basic level Level 1 Behzad Damari.New PHC direction based on NCD mental health unit SCREENING NCD RF COMMUNITY NURSE 12500 PEOPLE With health messengers Care for nutrition and PA MIS Social health care unit Refer to GP or FP Communicable care unit Mother and child Care unit Start treatment of NCD Level 3 Oral health Unit Lal Community participation and selfcare unit Refer to second level پزشک درمانی را باید از پزشک مراقبت مزمن جدا دید و یا فکری برای حجم کار کرد غربالگر باید یک نفر باشد تا سیستم را بشود نظارت کرد Health protection unit Second level Model for integrating NCD to PHC General hospital

Risk Factor card

Individual Risk Factors Profile

Risk factor Card

Thanks for your attention bdamari@gmail.com For further information Thanks for your attention