1. Package of Essential NCD (PEN) interventions for primary health care in low-resource settings.
Dr. Sevil Huseynova
World Health Organization
Country Liaison Officer for Northern Micronesia
(Republic of Palau, Federated States of Micronesia, Republic of the Marshall Islands)

2. 50% of eligible people (high risk)
Links to mental health

3. NCD progression and implications for prevention and control
Health and economic burden
Healthy
Population to be covered
Risk factors
Health promotion
High risk
Risk reduction
NCD
Complications
Treatment
Rehabilitation
Psycho-social support
Progression of NCD

4. NCD ROADMAP REPORT
Strengthened tobacco control
Policies on reducing consumption of food and drink products
Improved efficiency and impact from the existing health dollar by reallocating resources to targeted primary and secondary prevention of NCDs including scaling up of PEN and better drug prices;
Strengthening the evidence base

6. Objectives of WHO PEN
Assist low resource settings to address NCDs in the context of health system strengthening in an affordable and sustainable manner
Assist low resource settings to address NCDs through a PHC approach
Support countries in attaining NCD targets (1, 8 and 9)
Objectives

7. Health services- limitations
Infrastructure
Lack of diagnostics/drugs
No tracking of patients
Not enough to manage chronic conditions
Service delivery
Acute, episodic
Responding to outbreaks
No care continuum
No systematic referrals
Work force
Trained in CD
Not adequate to manage CD and MCH

8. Many risk factors coexist in the same individual
Smoker
Ischaameic heart disease
High BP
High Uric acid
Fatty liver
Dyslipidaemia
High Blood Sugar

10. Better yield… (get most of the red balls) 10 $ for one scoop
30-40 years
40-50 years
50-60 years

11. Less heart attacks, strokes, renal failure and amputations
Better management of those at high absolute risk and prevent complications
Less heart attacks, strokes, renal failure and amputations
Medication, counseling, foot care, periodic check up for urine protein, compliance…

13. Approach to NCDs Diagnosis Honesty in communication
CHAT Scan and not CAT Scan
Honesty in communication
‘Low tech’ and ‘high touch’ therapy
Involvement of family
Realistic goals

14. Continuing Care in the Community (Volunteers linked to health system)
Emotional support
Basic nursing
Diabetic foot care
Follow up
Linking up with the professional team
Social support to the affected family by way of
Helping with transport to hospital
Linking with other support groups
Helping to get benefits from various sources
Rehabilitation

15. The cycle of health systems for NCD
Rehabilitation
Care in the
community
Risk identification
and reduction
in the community
Overall risk reduction
and health promotion through
population based policies
and programmes
Referral care and
Specialized
management
Risk and disease
Management in
the health centre

16. ADAPTING WHO PEN IN THE PACIFIC
15 PICs have started the adaptation.
Demonstration phase indicates the need for
service delivery model, screening thresholds, drugs, equipment and skill building of personnel.
Skill building is feasible
STEPS surveys
are providing an indication of the number of people at high risk for CVD
Support for costing of PEN has begun with studies in 5 PICs
and development of tool for costing

17. Factors affecting PEN implementation