Package of Essential NCD (PEN) interventions for primary health care in low-resource settings. Dr. Sevil Huseynova World Health Organization Country Liaison Officer for Northern Micronesia (Republic of Palau, Federated States of Micronesia, Republic of the Marshall Islands)

50% of eligible people (high risk) Links to mental health

NCD progression and implications for prevention and control Health and economic burden Healthy Population to be covered Risk factors Health promotion High risk Risk reduction NCD Complications Treatment Rehabilitation Psycho-social support Progression of NCD

NCD ROADMAP REPORT Strengthened tobacco control Policies on reducing consumption of food and drink products Improved efficiency and impact from the existing health dollar by reallocating resources to targeted primary and secondary prevention of NCDs including scaling up of PEN and better drug prices; Strengthening the evidence base

Objectives of WHO PEN Assist low resource settings to address NCDs in the context of health system strengthening in an affordable and sustainable manner Assist low resource settings to address NCDs through a PHC approach Support countries in attaining NCD targets (1, 8 and 9) Objectives

Health services- limitations Infrastructure Lack of diagnostics/drugs No tracking of patients Not enough to manage chronic conditions Service delivery Acute, episodic Responding to outbreaks No care continuum No systematic referrals Work force Trained in CD Not adequate to manage CD and MCH

Many risk factors coexist in the same individual Smoker Ischaameic heart disease High BP High Uric acid Fatty liver Dyslipidaemia High Blood Sugar

Better yield… (get most of the red balls) 10 $ for one scoop 30-40 years 40-50 years 50-60 years

Less heart attacks, strokes, renal failure and amputations Better management of those at high absolute risk and prevent complications Less heart attacks, strokes, renal failure and amputations Medication, counseling, foot care, periodic check up for urine protein, compliance…

Approach to NCDs Diagnosis Honesty in communication CHAT Scan and not CAT Scan Honesty in communication ‘Low tech’ and ‘high touch’ therapy Involvement of family Realistic goals

Continuing Care in the Community (Volunteers linked to health system) Emotional support Basic nursing Diabetic foot care Follow up Linking up with the professional team Social support to the affected family by way of Helping with transport to hospital Linking with other support groups Helping to get benefits from various sources Rehabilitation

The cycle of health systems for NCD Rehabilitation Care in the community Risk identification and reduction in the community Overall risk reduction and health promotion through population based policies and programmes Referral care and Specialized management Risk and disease Management in the health centre

ADAPTING WHO PEN IN THE PACIFIC 15 PICs have started the adaptation. Demonstration phase indicates the need for service delivery model, screening thresholds, drugs, equipment and skill building of personnel. Skill building is feasible STEPS surveys are providing an indication of the number of people at high risk for CVD Support for costing of PEN has begun with studies in 5 PICs and development of tool for costing

Factors affecting PEN implementation