1. NCD policy and programming Bangladesh
Dr A. K. M. Jafar Ullah DPM (Arsenic & NCD), DGHS, Bangladesh and NCD Focal Point, WHO, Bangladesh
Bangladesh

2. Outline of the presentation
Introduction
Situation of NCDs
Achievements in tackling NCDs and their Risk Factors
Challenges
Lesson learnt
Next steps

3. Introduction (Demography)
Population size 156 million
Population density of 979 persons/Km2
One-third of the population is under 15 years
Around 61.4% are aged years
Around 4.5% are aged 65 or older. (Rapidly rising)
Urban population 27% (Rapidly increasing )
Population growth 1.292%
Life expectancy at birth years

4. Situation of NCDs Prevalence of major NCDs Diabetes 3.9% (2010)
CVD 12% (2004)
Hypertension 17.9% (2010)
Neoplasm 3.7% (2009)
COPD /Asthma 3.0% (2007)
Stroke 2.4% (2009)
Diabetes prevalence trend
Hypertension prevalence trend

5. Death due to selected NCDs

6. Bangladesh NCD risk factor Survey 2010
Number of people (in million ) with selected risk factors among the adult population aged ≥25 years
Risk factor
Men
Women
Both sexes
Current smoker
17.3
0.4
17.7
Smokeless tobacco user
09.3
10.4
19.7
Tobacco user (any form)
22.1
10.7
32.8
Low vegetable/Fruit intake a
30.8
29.2
60.0
Low physical activity b
03.3
12.8
16.1
Overweight (BMI > 25 kg/m2)
04.1
06.7
10.8
Large waist circumference c
02.5
10.5
13.0
Hypertension d
05.8
05.4
11.2
Diabetes Mellitus e
01.4
01.1
a< 5 serving/day b < 600 MET c men ≥ 94 cm women ≥ 80cm d (≥ 149 /90 mmHg) e documented

7. Achievements
Logistics and skilled human resource are available at medical colleges and tertiary hospitals for management of NCDs
Diagnosis and management facility for major NCDs are made available at public and private primary care health facilities
Health manpower at different level were oriented and trained about NCD and its prevention
Bangladesh Global Adult Tobacco Survey 2009
Bangladesh NCD Risk factor survey 2010
Development of guideline/manual for management of selected NCDs

8. Achievements contd.
Piloting of selected NCD prevention and control is under way at primary care level. (Along with awareness raising campaign, manpower were trained and following logistics were provided )
Diabetes : Gluco-meter
CVD : BP machine , ECG machine
COPD/asthma : Nebulizer
Cancer : VIA kit
Interim assessment shows 60% increase in awareness level on NCDs

9. Strategies/Response
National Strategic Plan for Surveillance and Prevention of NCD developed
Current health sector plan identifies CVD, Cancer and Diabetes as major public health problems.
Ratified the Framework Convention on Tobacco Control (FCTC)
National essential drugs policy and a list of essential drugs is developed
Strategies developed for responding to specific NCDs
The National Cancer Control Strategy
Injury Prevention Strategy
Deafness Prevention Strategy
National Eye Care Plan .
Legislative initiatives related to NCDs
Amendment of Mental Health Act; ; in the process of enactment,
Review of tax policy, Increase of tobacco tax by NBR and amendment of Tobacco Control Law.

10. Challenges of NCD Prevention and control
Unplanned rapid urbanization
Translation of NCD strategies into activities and implementation
Social custom
Generally women are not encouraged to go out for physical activity
Dietary
High carbohydrate diet may result dislipidemia
Westernized Junk food is popular among wealthy population
Health seeking
People seek health care mostly at advance stage of the disease
Out of pocket expenditure of clients

11. Lesson learnt over last 5 years
If mass awareness could be raised most of the major NCDs could be prevented like CDs in Bangladesh
Strategies and laws are not enough unless adequate enforcement is done
Establishment and maintenance of NCD Health Information System is essential for generation of data
Capacity development of service providers is mandatory for attracting people for health care
NCDs are disease of rich is not true, poor are also vulnerable to several NCDs

12. Next Steps
Inclusion of country specific NCD prevention program in the upcoming new health sector program ( )
Updating of the NCD strategic plan of action
Scaling up of the injury prevention piloting throughout the country
Preparation for the Decade of Action for Road Safety( )
Establishment of population based Surveillance system and registries for major NCDs
Development of National Communication Strategy for Health Promotion on NCDs

13. Thank You