1. NCD Prevention & Control Programme SRI LANKA

2. Country Background
Health System
Disease Burden & Risk factors
What is in place for NCD Prevention & Control
What we need for NCD Control & Prevention

3. Country Background Land Area – 65,000 sq km Population 21 million
GDP – Per Capita (PPP) USD 4500
Health Care financing – 4.2% GDP

4. Organization of the Health System
Ministry of Healthcare & Nutrition
Provincial Health Ministry (9 provinces)
Regional Director of health services
Preventive Services
Curative Services
District Base Hospital
Teaching Hospitals
Organization of the Health System
MOH 50 – 100,000 population
MOH
Primary Care Institutions 1: 22,000
No defined population
Primary Care Institutions DH RH PU CD

5. Evolving Disease Burden & Risk factors
Demographic Trends & Population Ageing
Growth in percentage of population aged 60 years and above, Sri Lanka and world regions, 2000–2050
Source: World Bank Sri Lanka Aging Survey (SLAS) 2008

6. Mortality Trends & the problem of Adult Mortality
Changes in life expectancy at age 60 years, Sri Lanka and the United States, 1921–2001
Source: Source: Sri Lanka from Sarkar (1951), Department of Census and Statistics (1970), De Silva (2007), and Institute for Health Policy’s computations from the same sources, and the United States from Bell and Miller (2005).

7. NCD Mortality

8. NCD Mortality

9. NCD Morbidity
* Katulanda unpublished data

10. Prevalence of Major NCD Risk factors
Male
Female
*Smoking (Adults)
22.8%
0.3%
*Obesity (BMI>=25)
19.6%
30.4%
**Lipid Levels (Total Cholesterol)
19.4%
28.7%
***Hypertension (Systolic BP>140mmHg & Diastolic > 90mmHg)
13%
14%
Physical Inactivity (<600MET minutes / week)
17.9%
31.9%
Fruit & Vegetable Consumption(<5 fruits/vegetable servings)
81.4%
83.3%
*Sri Lanka STEPS survey 2007
**Ragama Risk Factor Study 2007
***Katulanda et al 2005

11. WHAT IS IN PLACE 1. Political Will Mahinda Chinthana ++
National Health Policy +
National NCD Policy and Strategic Framework+++
Cancer Control Policy???
Medium term NCD Operational Plan ++
National Health Council???
National Authority on Tobacco & Alcohol+++
National NCD Steering Committee ???
National Nutrition Advisory Group???
National Cancer Advisory Group ???
National NCD Working Group

12. NCD Policy Objective (2009)
To reduce premature mortality (less than 65 years ) due to chronic NCDs by 2% annually over the next 10 years through expansion of evidence- based curative services, and individual and community-wide health promotion measures for reduction of risk factors.

13. 1
Support prevention of chronic NCDs by strengthening policy, regulatory and service delivery measures for reducing level of risk factors of NCDs in the population 2
Implement a cost-effective NCD screening program at community level with special emphasis on cardiovascular diseases 3
Facilitate provision of optimal NCD care by strengthening the health system to provide integrated and appropriate curative, preventive, rehabilitative and palliative services at each service level 4
Empower the community for promotion of healthy lifestyle for NCD prevention and control 5
Enhance human resource development to facilitate NCD prevention and care 6
Strengthen national health information system including disease and risk factor surveillance 7
Promote research and utilisation of its findings for prevention and control of NCDs 8
Ensure sustainable financing mechanisms that support cost-effective health interventions at both preventive and curative sectors 9
Raise priority and integrate prevention and control of NCDs into policies across all government ministries, and private sector organisations

14. Medium Term Operational Plan
Strategies Identified under each objective.
Eg:
Policy priority 1:
To establish and strengthen national policies and plans for the prevention and control of NCD
Strategies
Major Activities
Expected output
Key progress indicators
Responsible institutions/
Organizations
Implement district NCD and strategic plan
1.District NCD working committees
Improve implementation of NCD policy and strategic plan at district level
.% meeting held in each Year/ quarter
at district level
PD/RDHS
Monitoing of the NCD program at provincial and district level
2. Develop program indicators for provincial and district level
Improve implementation and monitoring of national NCD policy and strategic plan
% planned activities carried out during the year
DDG(MS1)
NCD unit
M&E unit

15. National NCD Program Colleges (Physicians, GPs) Health Ministry
Sri Lanka Medical Association (SLMA)
Other Ministries
NGOs
Media
NCD Unit
Mental Health Unit
Planning Unit
Nutrition Division
NATA
Youth / Elderly & Disability Unit
Trauma Secretariat
Health Education Bureau
Epidemiology Unit
Family Health Bureau
Ministry of Education
Health & Nutrition Ministry
Ministry of Agriculture
Ministry of Public administration & Home Affairs
Ministry of Social Services
Ministry of Media & Mass Communication

16. National Authority on Tobacco & Alcohol (NATA)
Tobacco Control ( NATA ) Act include: 2006
Sales & promotion of tobacco products to minors prohibited (Minor defined as below 21 years of age).
Advertising, Promotions & Sponsorship prohibited.
Vending machines prohibited.
Health warnings compulsory.
Smoking in indoor places prohibited with exceptions.
Sri Lanka is the fifth country in Region to sign and first country in the Region to ratify.
Its position comes third globally in ratifying the WHO FCTC after FIJI (3 October 2003) and Malta (24 September 2003)
Health Promotion Fund
Tobacco Cessation Counselling
Tobacco Quit Line
DTCC Cells

17. Coordinating Mechanism
National Steering Committee for NCDs
National Steering Committee for NCDs
National Health Council
National Advisory Council for Cancer
NCD Working Groups
Chairman
Social Marketing and Advocacy
Population Screening & Health Checks
Législation
Programmatic and System Issues

18. WHAT IS IN PLACE 2. Situation Analysis and Projections
World Bank NCD Report ++
World Bank Sri Lanka Ageing Survey ++
PEN Costing
JICA Costing
Ragama Risk Factor Survey ++
Other Studies (Katulanda)++

19. WHAT IS IN PLACE 3. Human Resources Central Level Leadership ??
NCD Director ??
DTCC (District Tobacco Control ) Cells in all districts
District Level – 16 MO NCDs ++

21. WHAT IS IN PLACE . Programmatic Pilots / Initiatives
JICA funded NCD Prevention Project+
WDF Funded NIROGI Lanka +
WHO Funded PEN (Package of Essential NCD Interventions for Primary Care in Low Resource Settings) +++

22. PEN Assess Capacity & Coverage Identify Needs
Essential Equipments
Essential
Medicines
Essential Recording Tools/MIS
WHO/ISH Risk Charts
Protocols for primary Care

23. Assess Capacity & Coverage
(Facility Assessment)
Population Size & Geographical Area covered
Human Resources
Equipment
Infrastructure & Services
Medicines
Utilization of Services
Referral of Patients
Financing Administration
Community Links

24. Essential Equipment Measurement Tape Stethoscope
Thermometer
Measurement Tape
Stethoscope
BPMD with digital reading
Weighing Machine
Peak Flow Meter
Nebulizer
Glucometer & Glucose Test strips
Urine Protein Test Strips
ECG Machine

25. Hydrocortisone Injection
Essential Medicines
Aspirin
ISDN
GTN
Atorvastatin
HCT
Nifedepine SR
Atenolol
Enalapril
Frusemide
Beclamethasone
Inhaler*
Prednisolone
Hydrocortisone Injection
Chlorpheniramine
Glibenclamide
Metformin
Insulin
Amoxycillin

26. Essential Recording Tools / MIS
Medical / Out Patient Information Register
Patient Clinic Book / Clinic Record
Drug Dispensing covers

27. Protocols for Primary Care
Screening
Prevention & Early detection of cancers
Health Education & Counselling
Tobacco Cessation Counselling
Angina, MI, Cardiac Failure
Asthma / COPD / LRTI
TIA / Stroke

29. Community Mobilisation through NGOs and Community Leaders
Partnerships

30. WHAT IS NEEDED Address Human Resources issues at National and
District Levels
Strengthen Inter-Sectoral Collaboration
Population-Based Interventions - Legislation on Salt,
Fats and Import of Cooking Oil
Expedite Revision to NATA Legislation
Incorporate Pictorial Health Warnings
Expansion of Pilots / Initiatives to other Districts
and engagement of Provincial Councils
Workplace Engagement
Physical Activity
Tobacco Free
Healthy Canteens
School Engagement
Include in Curriculum
Increase Physical Activity
Healthy Canteens / Food
Students as Agents of Change
Teachers as Catalysts

31. Healthy Meeting Menus
Health Check Up

32. Celebration of Theme Days
World No Tobacco Day
Gold Winners Award for World Stroke Day activities (2009)
World Stroke Day
World Heart Day
World Health Day
World Diabetes Day

33. Thank You
Thank You…