1. NCD Experience in PHC in Bahrain
Dr. A. Hussain Al-Ajmi
COMS/PHC
Head of NCDC
Jan 2010

2. Distribution of health Institutions in Bahrain
Governorates 2

3. NCD in Bahrain: Size of the Problem
1- Cardiovascular and circulatory diseases are considered the main cause of death in the kingdom of Bahrain.
86.6% in 2003
60.5% in 2006
43% in 2007
2- Hypertension, hyperlipideamia, diabetes, smoking and obesity were the main risk factors causing these diseases.

4. Risk Factors & Morbidity
1- Smoking
Prevalence of smoking all kinds of tobacco in Bahrain compared to other gulf countries.

5. Risk Factors & Morbidity
2-Obesity as defined by BMI => 30
Shown as % of local population

6. Prevalence of hypertension
Risk Factors & Morbidity
3-Hypertension
Prevalence of hypertension

7. Risk Factors & Morbidity
4- Practice of Physical Exercise Regularly
During own free time presented as % of local population

8. Prevalence of Diabetes according to the geographic distribution
Risk Factors & Morbidity
5- Diabetes Mellitus
Prevalence of Diabetes according to the geographic distribution

9. MOH Mission
To reduce morbidity, disability and premature mortality resulting from non-communicable diseases and to improve the quality of life of people with NCD through the development of comprehensive prevention and control programmes and strengthened surveillance and management .

10. MOH Strategy
Assess the epidemiology of NCD, their associated risk factors and environmental determinants, evaluate provision of services and establish an appropriate monitoring system
Obtain strong political commitment and provide support for the development of public policies and evidence-based NCD prevention and control programmes as a priority in national health planning
Integrate NCD control in primary health care
Emphasize primary prevention through increasing awareness of NCD and their risk factors; carry out information and education campaigns through the media, advocating adoption of healthy lifestyles and stressing the need to maintain a healthy social, economic and physical environment.

11. MOH Strategy
Facilities/infrastructure to expand coverage of secondary and tertiary programmes, particularly hypertension and diabetes, and establish a referral system.
Develop an integrated approach to NCD prevention and control within the framework of primary health care.
Strengthen implementation of WHO cancer control strategies such as risk reduction through Hepatitis B vaccination for prevention of liver cancer, tobacco control for prevention of lung cancer and safe sex for prevention of cervical cancer; promote early detection and screening for cervical cancer and breast cancer; support palliative care and cancer pain relief.

12. NCDC Announcement Objectives
To reduce the incidence of risk factors leading to the NCD.
To reduce the NCD among people in the community.
To reduce complications caused by NCD.
Improve the quality of services provided to patients with NCD

13. Chronic Disease Committee Teams
Diabetic clinic Team
Asthma & Resp Team
CVS Team
Cancer Team
Opportunistic Age
screening Team
Osteoporosis Team
Training Team
Obesity & Life
style Team
Dyslipideamia Team
Medication & equipment
Team
Monitering & Evaluation
Chronic Diseases Commitee
IT Team
Mental Health Team

14. Achievements: 1- NCD Registry
NCD registry programme was designed with HID to collect data from each HC and use it to get reports and indicators that shows the quality of services given to the NCD and burden of work. The patient’s prescription is the main source to capture data around NCD where it will be coded by doctors and entered to the system.
Health Center
ARTH BA BP
COPD
DM1
DM2
G6PD
HYPOTHYR
IHD
LPDS
OSTEOP
OTHERS
PSY
SCD
SMOK
THYR
Total
A'ALI HC 38
307
300 4 15 28
105 80 3 16 42
938
ALHOORA HC
153 76
550
229 10
273
219 6 60
1612
ALNAIM HC 13
149
1592 2
1132
677 17 86
124
792
505 48 33
197
5367
HAMAD KANOO HC 8 5
128
HAMAD TOWN HC 44
589
125
386 20
269
187 27 92
1767
IBN SINNA HC 50
555
282 98 40
208 67
1691

15. Achievements: 2- NCD Guidelines
All guidelines were finalised in 2008 and disseminated
1- Diabetes guidelines 2- Dyslipideamia guidelines
3- Cardiovascular guidelines 4- Screening guidelines
5-Obesity clinics guideline 6- Osteoporosis guidelines
7- Bronchial Asthma guidelines 8- Sickle Cell Disease guidelines.

16. Achievements: 3- Clinics Development
1- Diabetes Clinics started in 1997 in few HC ,generalised in all health centres in 2006
2- Obesity clinics in region1 since 2008 and will be extended to region4 on trial basis Dec 2009.
3- Smoking Cessation Clinics (Hoora HC) since 2007.
4- NCD pilot clinics in 4 HCs in 2009.

17. Achievements: NCD Clinics Integration
NCD clinics integration in PHC in coordination with WHO was established in 2009 in 4 health centers in Bahrain.
WHO protocols were adapted and integrated with the national guidelines.
Education and changing life style is the main aim of this project were patients will be referred to this clinic depending of their CV risk factor
A trained nurse, health educator and a doctor are working in this integrated clinic.
Training of staff in the four health centers.

18. Achievements: NCD Clinics Integration

19. NCD Risk calculation Tables

20. NCD clinics: Assessment & Follow up Sheet

21. Achievements: 4- CME & Training
A- Awareness workshop on national guidelines
B- Awareness workshop on tools for guidelines implementation & performance indicators for HCPS
C- CME workshops for HCPs on
1- ABC of Diabetes Care
2- Foot Care
3- Cardiovascular Risk Prevention c 21

22. NCD Manpower: Number & Training

23. Achievements: 5- Community Awareness Campaigns
1- Marking World Diabetes day (WDD 2008) celebration in liaison with Bahrain Diabetes Society 2008 ( Monumental blue lighting & Screening campaign) 2- Several screening Campaigns in malls and civil societies

24. Achievements: 6- National Diabetes Awareness Campaign WDD 2009
NCDC LOGO 2009

25. Components of National Diabetes Awareness Campaign: WDD 2009
These include:
1- Sending consecutive bulk SMS messages ( >100,000 SMS x4 wks)
2- Sending Bulk s (100,000 s per week)
3- Sending to all government s through E-Government electronic gate.
4- Distribution of educational leaflets (60,000 copies/wk x 4wks) through the news paper on weekly basis for one month (Distribution is sponsored fully by Al-wasat publishing and distribution) 
5- Coordinating with the ministry of education an art competition at a national level on “Diabetes Education and prevention”. Winners will be awarded on a special arrangement next April Three wards will be given to the three best drawings.  
6- Scientific workshop for HCP .

26. Achievements: 6- National Diabetes Awareness Campaign WDD 2009
2626

27. 7- National & GCC Diabetes (NCDs) Plan
Achievements:
7- National & GCC Diabetes (NCDs) Plan
1- GCC plan for diabetes control
2- National plan for diabetes control ( Taken from GCC plan)
3- National committee for Diabetes control
4- GCC Non- Communicable Diseases Plan (Draft 2009) ,taken from
Diabetes plan.
Overall objective:
حماية المجتمع البحريني(الخليجي) من الداء السكري(الامراض المزمنة) ومضاعفاته كمسئولية مشتركة بين جميع فئات المجتمع
Protection of the GCC (Bahraini) community of diabetes (NCDs) and
its complications as a shared responsibility between all segments of society. 27

28. Challenges & Obstacles
NCD Programme:
Challenges & Obstacles
Lack of the suitable infrastructure for NCDs care in some health centres.
Manpower.
Escalating financial cost for chronic diseases which support the need for social protection schemes.
Training of the NCDs team.
(Counselling in diet , lifestyle, etc)

29. Future Plan & Vision
Integration of the health care system for NCDs Care (Insurance System)
Generalizing the NCDs clinics toll all health centres
IT health Project ( Will start in 2010)

30. Infrastructure& manpower Clinics Tools & Resources
Future Plan & Vision: Core Steps for Integration
Screening
Feet, eyes
Renal
User Expectation
Audit (PI)
Guidelines
Protocol
Multi -disciplinary
Infrastructure& manpower
Secondary
care
Lifestyle
Clinics Tools & Resources
(Projects)
Registry &Database

31. Chronic Diseases Management
Palliative
…………………….
……………………
Renal replacement
…………………..
Amputation
………………….
Rehabilitation
…………………
PCI / CABG
………………..
Advanced eye surgery
Public Health & Prevention
Primary
Experts
Visitors Consultant
Clinics
Secondary care
Tertiary
Single Team
………………
DKA
……………..
Infections
………….....
CVD
…………...
CVD Risk
Insulin start
…………..
Screening eyes
………….
Screening feet
Screening renal
…….…...
Complex cases
Secondary
Primary
Interface
………...
Screening & Diagnosis
……….
General treatment
………
Review
screening
….… ……
Healthy eating
Exercise
Weight care

32. Thank you for your attention