1. How does teamwork improve value. Dr Nils E
How does teamwork improve value? Dr Nils E. Billo Medical Officer 8th IPCRG World Conference, Amsterdam, 2016

2. Outline Burden Challenges WHO Global Action Plan 2013-2020
Sustainable Development Goals
Teamwork
Framework Convention on Tobacco Control
Global Alliance against Chronic Respiratory Diseases (GARD)

3. Chronic Respiratory Diseases (CRDs) A major public health problem??
1 billion people suffer from CRDs including asthma, respiratory allergies, COPD, occupational lung diseases, sleep apnea and pulmonary hypertension
CRDs account for about 5 million deaths annually
COPD to become the 3rd leading cause of death by 2030
Indoor air pollution kills more than 4 million people each year

4. Indoor air pollution 4.3 million people die prematurely:
12% are due to pneumonia
34% from stroke
26% from ischaemic heart disease
22% from chronic obstructive pulmonary disease (COPD), and
6% from lung cancer.

5. Global challenges
CRDs not high on global health agenda, lack of funding at all levels, in particular in LMIC
Lack of reliable data on CRDs
30% of patients at PHC present with cough but
Prevention and treatment opportunities missed
Effective treatment not available or not accessible
Medicines not affordable

6. Global challenges Many guidelines available at PHC level: National
WHO PEN guidelines
International Professional Societies
Industry sponsored
Mixed
Lack of simple, standardized guidelines which are implementable by small teams

7. How can we overcome these challenges?
With hard teamwork

8. WHO Global Strategy for the Prevention and Control of NCDs
GARD

9. 9 global NCD targets to be attained by 2025 (against a 2010 baseline)
A 25% relative reduction in risk of premature mortality from cardiovascular disease, cancer, diabetes or chronic respiratory diseases
At least a 10% relative reduction in the harmful use of alcohol
A 10% relative reduction in prevalence of insufficient physical activity
A 25% relative reduction in prevalence of raised blood pressure or contain the prevalence of raised blood pressure
A 30% relative reduction in prevalence of current tobacco use
A 30% relative reduction in mean population intake of salt/sodium
At least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes
An 80% availability of the affordable basic technologies and essential medicines, incl. generics, required to treat NCDs
Halt the rise in diabetes and obesity

11. Global challenges (2)
Most of CRD related deaths occur in low-and middle income countries
Country NCD plans seldom include good plans for prevention and management of CRDs
Lack of political commitment
Many competing priorities

12. Teamwork works and has impact if
Common goal
Good communication with all partners (governmental and non-governmental)
At local level
National
Global level
Agreement on goals and milestones
Concrete tasks to be completed

13. Teamwork works and has impact if
Good communication
Monitoring and evaluation of progress
Interpretation of results
Fight for the cause and not for personal glory

14. Teamwork is hard work at many levels
In the community
Among primary health care personnel
Between the subnational and national level
Within countries (Ministries, Civil Society, private sector, professional societies etc)
Between countries
Between countries and WHO
With donor agencies
Within Global Alliances

18. What does the Global Alliance against Respiratory Diseases (GARD) offer?

19. GARD
GARD provides a network through which collaborating parties can combine their strengths and knowledge, thereby achieving results that no single partner could attain alone. GARD also improves coordination between existing governmental and nongovernmental programmes, which avoids duplication of efforts and wasting of resources.

20. GARD strategic objectives
Advocacy
Partnership
National Plans on Prevention and Control
Surveillance

21. GARD achievements since 2006
GARD has been introduced in 21 high and 24 low and middle income countries
Considerable progress in countries where government involvment is strong (Turkey, Portugal, Netherlands, Brazil and others)
GARD has contributed in developing national CRD programmes
Dutch GARD leadership contributed to a collaborative National Action Plan on CRDs in NL

22. GARD in the future
Reinforced teamwork needed to maintain and improve integrated national CRD programmes both in high and low income countries
GARD collaboration in low income countries will be key to reduce the burden of CRDs in high prevalence areas (example: FRESH AIR Uganda project supported by IPCRG)
GARD needs to contribute to pragmatic and effective teamwork between all major stakeholders interested in CRDs and global health

23. Health systems
Work with Essential Medicines & Technologies on essential list, access, affordability and availability
Contribute case studies of people-centred care and service delivery that are relevant not just for CRD but also for other diseases
Develop further and provide case studies on the care of people with co-morbidities
Assist in the implementation and further development of PEN in resource- /setting-appropriate ways

24. Teamwork: who cares?
Teamwork: WHO cares

25. Thank you!