1. Palestinian National Authority Ministry of Health Towards Better Prevention and Management of Non Communicable Diseases (NCDs)
Prepared by: Dr. Faisal A/Latif
Director NCDs Programs
January 2010
Lausanne
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2. Jerusalem – The holy city
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3. Presentation outlines
Background and Demography
Why NCDs?
NCDs magnitude Global Vs. Local
National facts on NCDs
Challenges, opportunities and constrains
Commitments
Specific MOH interventions:
NCDs Department
National Center for Prevention and Management of NCDs funded by the Austrian Government Establishment of thematic working group
Integration of programs
Conclusions and recommendations
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4. Background Longstanding conflict and ongoing occupation
Challenges to maintain up to date knowledge and skills and continuous education programs
Ministry of Health responsibility, efforts and coordination
The separation wall and its negative impact
Trends of care and raised hospital orientation
Services offered in PHC centres
Population: 3.9 million; 2.4 million in the West Bank and 1.4 million in Gaza (Palestinian Central Bureau for Statistics (PCBS), Palestine in Figures 2007)
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5. Why focus on NCDs?
Rise in life expectancy, gradual adoption of unhealthy behaviors including tobacco use, physical inactivity and unhealthy diet, aggravated by poor psychosocial wellbeing due to a longstanding political conflict has resulted in a growing burden of NCDs in Palestine.
50 % of deaths is attributed to cardiovascular disease, cancer, DM and COPD
This represents a major public health challenges to the national economy and social development as well as lives and health of people
Palestine is witnessing a status of epidemiological transition that shaped the national task to address simultaneously both: “diseases of underdevelopment“ as well as "diseases of development,“
The NCDs rate in the Middle East including Palestine is considered as the highest in the world
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6. Burden of NCDs “The World Health Report 2006” Global
60% of all deaths over the world
75% in the developing countries
25% in the developed world
47% of the burden of diseases
Regional - Middle east
52% of all Deaths
47% of the Burden similar of the global figure
“The World Health Report 2006” 
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7. Burden of NCDs in the developing countries 1995 - 2020
1990
2020 )
Communicable diseases, maternal
conditions and nutritional deficiencies
Non Communicable Diseases
Neuro psychiatric and OA Disorders
Injuries
Extracted from WHO reports
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8. Where are we in Palestine ? Prevalence of NCDs – Estimation
NCDs Prevalence
Cardiovascular Diseases 14% above 18 years
Diabetes mellitus % all ages (old study 2000)
Neoplasm %
COPD %
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9. Where are we in Palestine ? Leadings causes of death – Estimations
Causes of Death Rate
Cardiovascular Diseases %
Malignancies %
Accidents %
Diabetes Mellitus %
All others %
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10. Where are we in Palestine
Where are we in Palestine ? Prevalence of Major NCDs Risk Factors- Estimation
Risk Factor Percentage
Modifiable:
Low fruit and vegetable % - (relatively low)
Tobacco use %
Physical Inactivity % - (urbanization)
Intermediate:
Overweight &Obesity %
Abnormal lipids Profile %
Hypertension %
Diabetes Mellitus % - (old studies (2000)
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11. Facts on NCDs in Palestine (PCBS)
Prevalence:
One out of every ten has at least one NCD
25% of citizens above 60 are diabetics
Expenditure : 45% of health expenditure goes on NCDs
Health insurance: 60% of the Palestinian population is covered by the existing insurance system and those not covered usually register for coverage upon diagnosis of NCDs in order to obtain subsidized prescriptions and other implications
Quality of care: at this point, no consistent implementation of service delivery protocols
Tracking of the clinical indicators and risk factors not available
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12. Studies related to NCDs
Only two and old : one by Birzeit university in cooperation with Oslo university and the other is by Al-Quds university in cooperation with MOH and PCBS
Findings :
Prevalence:
DM was approximately 10 % ? ( projecting to ----?)
Heart diseases was approximately 8 % ( doubled now16%)
Comparing to regional finding :
Close to reported results in Jordan, Iraq and Tunisia
Less than in Saudi Arabia and Oman
Under reporting:
Big and significant gap between the expected prevalence of DM and cases under supervision
Recommendations:
Screening and consequently early detection would allow more realistic estimation of the prevalence of the disease and insure appropriate evaluation and management of the problem.
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13. Challenges and Opportunities in the developing world
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14. Double burden of diseases in low income countries
DALYs
High income Low income
Communicable, Maternal and Peri-natal Conditions Nutritional Deficiencies
Non Communicable Diseases
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15. Cardiovascular Deaths Projected to 2020
Millions
Non Communicable Diseases
Communicable, MCH Conditions and Nutritional Deficiencies
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16. Challenges Vs. Opportunities GAPS
Adequate scientific knowledge but not sufficient information , policies, strategies and actions
Limited resource and actual need to invest in NCDs prevention and health promotion
Knowledge E
Action TION
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17. Main and progressing constraints
Resource limitation
Confusions: (Behaviours Vs. Public Health problem, Treatment Vs. Prevention, Modernization, globalization Vs. local problem )
Myths about the nature and impact of NCDs
Lack of surveillance system
Fragmented and uncoordinated care
Few clear policies and strategies
Inadequate adherence to standardized guidelines
Severe lack of investment in research
Political instability
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18. Our commitment Addressing NCDs risk factors: Preventive measures:
Conduct STEP wise risk factors surveillance
Targeting the modifiable risk factors: unhealthy food, obesity, smoking and physical inactivity
Preventive measures:
Health education and promotion , screening and early detection , counseling and messages smoking cessation, obesity control, breast feeding promotion. and retinopathy screening has been recently considered
Curative measures:
PHC Clinics, guidelines, training of service providers ,
Referral policies
Secondary care settings
Cooperation at national and international levels:
We in the MOH work with stakeholders at all levels and provide national leadership in prevention and control of NCDs through an effective and functioning NCDs thematic working group
Focus on the role of PHC and the importance of integration:
The MOH gave special attention to PHC in prevention, control of NCDs and proceeding in further integration of all NCD's programs
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19. Thematic Working group
Purpose:
“The NCDs thematic working group has been established by a Minister decision mainly for the Development of the National Policy and Strategy for Prevention and Management of NCDs aiming improving the health status of Palestinian population”
Structure:
Chair by the MOH
Co-chaired by the Austrian Development Agency (ADA) - main donor
WHO: technical advisor
Members: UNRWA, NGOs, donors community and academic institutions
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20. Specific Intervention
Establishment of NCDs cells and bodies ( )
Department for NCDs/ PHC :
Works with other departments and stakeholders at all levels and provide national leadership in prevention and control of NCDs through:
Leading the work of the thematic group
Development of surveillance system
Upgrade and disseminate knowledge and skills of service providers with focus on the preventable nature of NCDs and importance of early detection of cases
Integrating programs
National Center for Prevention and Management of NCDs – funded by ADA
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21. National Center for Prevention and Management of NCDs – Austrian Fund Site: Ramallah City
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22. Center for Prevention and Management of NCDs
Vision
“Palestinian people living healthy and free from the devastation of NCDs”
Mandate
Support the Development of the National Policy and Strategic Plan for Prevention and Management of NCDs
Lead the implementation of quality prevention and care programs utilize evidence based practices
Expected ultimate impacts of the project interventions
Prevalence of NCDs - Decreased
Early detection of cases - Enhanced
Quality of life of sick people - Improved
Number of referrals abroad - Reduced
Economic burden and cost of management of NCDs – Reduced
Partnership among stakeholders- Enhanced
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23. Work done so far:
Developed the process for the development of the National Policy and Strategy for NCDs as follows:
Situation analysis and data collection – done
Identification of gaps – done
Setting priorities – done
Formulate objectives - done
Develop strategies that achieve objectives – done
Develop action plans – ongoing
Monitoring and evaluation - ongoing
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24. Situation Analysis and Data Collection
First step
Situation Analysis and Data Collection
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25. Situation analysis and data collection
Scope of work :
Health information, research, surveys related to NCDs
Organization, delivery, quality and costing of services related to NCDs
Community based interventions and empowerment and legislative, regulatory and inter-sectoral measures related to NCDs
Surveys:
Health Facility Assessment – Done
NCDs risk factors surveillance – ongoing
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26. Health Facility Assessment
Purpose:
“Assess the capacity of identified health facilities to prevent and manage major NCDs in primary care centres”
Tool :
“WHO global assessment tool”
Steps undertaken:
60 PHC randomly selected representing all care providers
An assessment team assigned representing care providers
Orientated the team on the tool content , data needed and reporting mechanisms
All centers were visited , assessed and questionnaire filled in
Data collected were downloaded
Downloaded submitted to WHO for analysis
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27. NCDs Risk Factors Surveillance
Rational:
Huge burden of NCDs on the care system as well the national economy and social development in Palestine
Lack of reliable information on the level of NCDs and its risk factors hinders successful planning, intervention and consequently the control of NCDs
Goal: Assess the magnitude of risk factors among population
Behavioral factors: tobacco consumption ,unhealthy food habits , physical inactivity and obesity
Biological factors: raised blood sugar , B.P and cholesterol
Approach: STEP wise global approach adopted by WHO as a flexible tool that consist of three main steps and each include core and expanded items in cooperation with PCBS
Step I: key information on risk factors
Step II: simple physical measurements
Step III: blood sampling for biological analysis
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28. NCDs Risk Factors Surveillance
Sampling:
Target: age groups15 to 64 years
Size: 7200 citizens
Data manipulation:
Collecting downloading and analyzing data
Results and reports would be used by the ministry for the purpose of developing the final National Policy and Strategy for NCDs and then for continues monitoring
Resources allocated:
National NCDs center project budget – Austrian fund
Ministry of Health capacities
Technical support from WHO
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29. Conclusion
NCDs issue is a top priority: CVD- Cancer- COPD and DM
These major NCDs share common risk factors: tobacco use, unhealthy diet, physical inactivity, alcohol abuse
Reliable information and surveillance is power
Prevention , integration of programs and population approach are the keys
No nation is immune to the rising burden of NCDs
Their burden can be dramatically reduced but ONLY if governments and health care leaders decide to do so.
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30. Recommendations It is time to take action Increasing awareness
Marketing and advocacy of NCDs prevention
Developing National Policy and Strategy
Integrating , further cooperation
Capacity building and training
Enhancing research
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31. Thank you
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