NCD policy and programming in Georgia Lela Sturua Head, NCD Division/NCDC WHO counterpart on NCDs

Geopolitical Context Georgia is located at the geographical and political border of Europe and Asia Population – 4 million

Structure and organization of prevention and care services and resources available Ministry of Labour, Health and Social Affaires National Center for Disease Control and Public Health Primary Healthcare (public/private) Hospital Sector (public/private) Insurance companies NGOs Resources State budget International Donations

NCDs accounted for 94% of all deaths; CVD – 75%

Main achievements Legislation documents Laws: on Healthcare; on Public Health; on Medical Insurance; on Prevention of Iodine and other Microelements & Vitamins Deficiency; on Tobacco Control; on Protection and Promotion of Natural Feeding of Children; etc. Normative decrees Strategic documents (Food based dietary guidelines dissemination package, Assessment of NCD Prevention and Control in Primary Health Care, etc.) Establishing alliances and joint committees (ESAN, NFSI, WASH, etc.) Public educational materials Preventive practice guidelines Professional education

Main achievements NCD Division at the NCDC Surveys: WHO-STEP (2010); GNNS (2009); GeoRHS (2000-05-10) Breast cancer and cervical cancer screening programs Flour/bread fortification Salt is well iodized Presidential program “equipping stadiums”; schools are equipped with sports inventory First sketch of the Concept Paper on Prevention, Early Detection and Treatment of Most Prevalent Non-Communicable Diseases

Main challenges Lack of finances Main Diseases: IHD (42%); CVD (26%) Main risk-factors: hypertension (49%), high cholesterol (23%), high BMI (17%) Georgia belongs to TOP 5 WHO Member Countries with the highest mean blood pressure No information available on salt consumption, etc. Half of newly diagnosed cancer cases are on IV stage Limited finances, adequate trained human resources and technical capacity Lack of standard management guidelines, strategic documents Inadequate advocacy & political commitment Poor surveillance system

Main challenges The proportion of 16 y. students who had tried cigarettes at the age of 13 or younger is 30% (10% started smoking at the age ≤9 years old) On the last occasion 43% had alcohol at home and 27% at friend’s home 87%’s friend smokes; 86%’s friend drinks (ESPAD) 35% of healthcare professionals smoke 33% of adult population smokes (56%-man) (STEPS, 2010) 56% are overweight (man–58%); 25% - obese (women-28%) 35% of 18-64 y. have 3 or more risk-factors (man-46%) 27% of 18-44 y. have 3 or more risk-factors (man-39%)

Main challenges NCD Risk Factors Survey, Georgia 2006-2007 Recommendations Against Unhealthy Habits

Main lessons learnt over the last 5 years Low Budget allocation Lack of strategic documents Cultural sensitive intervention Advocacy & political commitment Surveillance system

Plans for the next 12 months 2011 State programs Cancer screening programs: breast cancer, cervical cancer, prostate cancer, colorectal cancer CVD program; etc. Cancer registry/stroke registry? International donor funded projects Concept Paper on Prevention, Early Detection and Treatment of Most Prevalent Non-Communicable Diseases National strategy on NCDs National HP strategy Communication strategy Strengthen partnerships