1. 1 Integration of Noncommunicable Diseases into PHC in low-resource settings Lessons learned Dr Shanthi Mendis Chronic Disease Prevention and Management World Health Organization

2. 2 PHC Reforms proposed (WHR 2008) l Universal coverage l Service delivery l Leadership reforms l Public policy reforms

3. 3 WHO provides Technical support for National Health Development process (Driven by country needs) WHO provides Technical support for National Health Development process (Driven by country needs) l Bhutan l Eritrea l Sri Lanka l Sudan l Syria

4. 4 LessonsLessons l Challenges l Opportunities l Capacity l Sustainability l Affordability l Balance l Evaluation

5. 5 Per capita expenditure on health Less than 50 $ 50 – 99 100-499 500-999 1000-1999 >2000 33 25 72 24 19 18 ExpenditureNumber of countries

6. 6 Setting priorities l Contribution to morbidity and mortality (Cardiovascular diseases, diabetes, Cancer, CRD) l Availability of cost effective interventions l Feasibility of implementing in primary care

7. 7 PC(NPHW) Very low risk Manage in PC Next level Back referral Referral 10-<20% 30-<40% >40% 20-<30% Low Medium High Very high Service delivery

8. 8 WHO/ISH charts To screen for risk of heart attacks and strokes Using simple variables Age Smoking Sex Blood pressure Blood cholesterol Blood sugar AGEAGE MALE FEMALE SBP Non-Smoker Smoker Non-Smoker Smoker 180 160 70 140 120 180 160 60 140 120 180 160 50 140 120 180 160 40 140 120 45678 45678 45678 45678 Cholesterol

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10. 10 PHC based Health System l Define functions of all levels of the health system based on PHC: skills, requirements, equipment, medicines, interactions between levels and sectors l Financing models for different social and economic contexts and health systems l Service delivery models that promote continuity of care across different NCDs, levels and sectors of care l Type of training, support and supervision needed for delivery of interventions by physician/ non-physician

11. 11 Integration of NCD into PHC 1. Per capita health expenditure in many LMIC countries is inadequate to provide universal coverage 2. Range of cost effective NCD interventions can be integrated into PHC, even in low resource settings. 3. If sustainable approaches are used they can reduce morbidity and premature mortality due to NCDs. 4. PHC has the potential to reduce suffering from preventable NCDs and reduce health-care costs.

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