NCD in Uzbekistan Zulfia Atadjanova 6th WHO-IUMSP international course on public health aspects of NCD Lausanne, May 7-12, 2012

The total area - ​​447.4 km2 Population – 28 mln Urban 51.4% and 48.6% rural 0-14 years - 26.5% 15-64 years - 68.8% > 65 years - 4.7% Life expectancy – 73 years

Health system Structure and organization of prevention and care services: Health care system is the main player in prevention and health promotion Current reforms of Primary health care Inefficient surveillance system for risk factors

Incidence of key disease classes registered in the Republic of Uzbekistan in 1991-2010 (per 100,000 population). Groups of Diseases 1991 1995 2000 2004 2008 2009 2010 Respiratory Diseases 17940.9 15215.1 11040.22 12029.45 12055.61 11804.95 11950.90 Cardiovascular Systems 1014.3 1076.7 1193.43 1410.24 1543.16 1545.07 1616.46 Bone and Muscle System 747.8 570.1 765.30 841.63 868.53 842.44 814.85 Blood and Circulatory System Disorders 5897.7 7823.3 8567.1 9111.94 8872.00 8166.75 Digestive Disorders 3996.4 5360.1 4528.22 5760.97 6441.87 5790.44 5607.14 Malignant Growths 76.2 68.5 70.8 67.7 68.1 68.4 Urinary System 1617.0 1814.0 2194.61 2549.26 2693.79 2631.85 2753.01 Injuries and Poisoning 3903.4 3258.9 2804.96 3377.41 3268.74 3077.00 3255.06 Mental Disorders 257.3 232.1 267.81 213.70 194.13 190.39 183.83 Endocrine Disorders 865.6 1330.1 2472.85 2982.15 2685.30 2891.69 2857.06 TOTAL 42979.7 42539.0 40264.32 46938.28 48380.86 46971.35 46804.82 Source: Institute of Health and Medical Statistics of the MOH of the Republic of Uzbekistan

NCD situation in Uzbekistan Top 10 groups of permanent health problems and disability for males and females in Uzbekistan (2002) according their weight in the total DALY number Rank Men Women Groups of permanent health problems Total DALY (%) 1 Cardiovascular diseases 18.7 Neuropsychiatric disorders 21.9 2 16.6 18.3 3 Unintended injuries 12.5 Respiratory infections 7.4 4 9.1 Digestive diseases 6.3 5 6.2 Infectious and parasitic diseases 5.3 6 6.1 Sense organs diseases 4.7 7 Perinatal conditions 5.4 Malignant neoplasms 4.6 8 3.7 4.5 9 Respiratory diseases 3.6 Malnutrition 4.2 10 3.4

Main achievements National strategy on NCD prevention and control and action plan with inter-sectoral consultations; Law against tobacco/smoking and alcohol endorsed by government; President signed decree for joining FCTC National nutirtion investment strategy

Main challenges Inter-sectoral collaboration Ministry of Finance is against tobacco and alcohol taxation NGOs and community involvement into policy development and implementation; NCD risk factors surveillance system is not in place; Mechanism for financial allocation for NCDs not developed

Lessons learnt Involvement of all key sectors into NCD policy development and capacity building makes a big difference in further commitment and decision-making Good cost-benefits analysis and implementation of good risk factors surveillance system should be conducted and results presented to politicians

Lessons learnt (2) Reforms/initiatives can fail if they do not include such components as creation of supportive environment, self-managing and good monitoring/quality improvement mechanisms Pilot projects showed that community leaders can play a great role and influence on behavior change

Next steps Endorsement of the National NCD prevention and control strategy and action plan at intersectoral level Endorsement of the Law against tobacco and alcohol Launch piloting implementation of some strategic approaches in 3 provinces of the country

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