Presented by: Dr. Lamia Mahmoud Technical Officer for NCDs WHO Sudan NCDs in Sudan Presented by: Dr. Lamia Mahmoud Technical Officer for NCDs WHO Sudan

Where are we? NCDs addressed in country directives 25 years country strategy (2007-2031) 5 year health strategy (2012-2016) NCDs strategy (2011-2015) Absence of updated NCDs prevalence data- 41% of all deaths (2005, Krt steps) Life expectancy 61.8 Health expenditure 6% of GDP Sudan is not an exception from the international trend of transition of disease pattern from predominantly communicable to non-communicable diseases. It falls within the EMR where currently 47% of the region’s burden of disease is due to non-communicable diseases and it is expected that this will rise to 60% by the year 2020. Prevention and control of NCDs is one of the policy foundations of Sudan’s National Strategic plan for the health sector (2003-2027) reflecting a strong political commitment towards NCDs. However, data on the disease burden of NCDs in Sudan is scarce and deficient. Prevailing data somewhat illustrates the problem, revealing that diabetes mellitus, asthma, cardiovascular disease, and cancers, accounted for 41% of all deaths in 2005 (step wise survey, Khartoum). Hypertension has been shown to have the highest prevalence, accounting for 22% of the major NCDs in Sudan. Moreover, Sudan rates as the second country in Africa regarding prevalence of hypertension. Hospital admission rates due to heart disease and prevalence of heart disease among outpatients have experienced a considerable increase since 2002; deaths due to cardiovascular disease represented 20%. Moreover, Sudan has the highest prevalence of rheumatic heart disease (RHD) in the African and Arab region (100 per 100,000 annually) and the prevalence has been reported as 10.2 per 1000. In the main Children's Hospital (Gaafar Ibn Auf), RHD represents the most common cause of admission to the cardiology ward and the commonest cause of death due to cardiac disease. Poverty and overcrowded living conditions are main features of most patients. There is currently no active program for control of RHD in Sudan. Diabetes Mellitus ranks second among the major NCDs representing an estimated prevalence of 12% of all NCDs. Asthma ranks third among the major NCDs representing an estimated prevalence of 9.2%. Data from 2003 onwards is reflecting very high hospital admission rates for asthma; in fact, they are the highest among the major NCDs.

NCDs within PHC Currently, no special care for NCDs at PHC level (70% rural pop) Main feature of the NCDs strategy- integration of prevention and early diagnosis within PHC Opportunity- National commitment to PHC expansion plan, supported by parliament Despite their importance, the needed support in tackling NCDs is not properly allocated; patients receive no special care at primary health care level when it comes to early diagnosis and management. Education for patients and public awareness are almost nonexistent. In general, the overall health care provided to these patients and to communities is far from optimum.  

Multisectoral response Absence of a national multi-sectoral plan for NCDs WHO lead in-country coordination processes for NCDs- 2012 Stakeholder analysis First NCDs multi-sectoral meeting conducted in April 2013 Lesson learned- partners are not aware of the role that they DO play, and CAN play, for NCDs Control NCD prevention is recently becoming viewed as an all-government responsibility, and in line with this, Sudan is in the process of launching an inter-sectoral committee for supporting NCDs control. Given WHO’s comparative advantage in leading the in-country coordination process for NCDs, this process has been initiated and supported by WHO country office (current biennium). This will pave the way to develop National multi sectotral NCD plan. The project funds will be used for development of the NCD multi sectoral national action plan for the prevention and control of Non-Communicable diseases in Sudan. Establishing & sustaining commitment to NCDs at national & state levels, setting an inter sector working group to draft the new plan, organizing the broad discussion of the draft and finalization of the national Action Plan for the next period with national targets and indicators.

Addressing risk factors- smoking High level committee for tobacco control High committee from all sectors (MoHealth, MOTrade, SSMO, Consumer protection, Parliament) Revision of the National Tobacco Law 2005 Khartoum state:one year campaign for tobacco control, revised state law endorsed in 2012

Lesson learned- Champion needed lobbying

Focus on Darfur Decentralized health system Funds mobilized from humanitarian resources (323,000 US$)for role out of NCDs within PHC Target 2 states in Darfur Addressing capacity building, and strengthening NCDs patient pathway within PHC Develop a model for replication in other states Lesson learned- Strong commitment at state level & greater coordination mechanisms in place Emergency prone zone, with greater stress, mobility problems, lless access to 2 & 3 care Countries like sudan, with greater emerging priorities, focus should be taken lower down