1. Chronic Diseases Program of Medical Relief Society

2. PMRS (UPMRC) Heritage A grassroots, community- based, non-profit Palestinian health organization Founded in 1979 Our health programs emphasize prevention, education, community participation, and the empowerment of people

3. PMRS (UPMRC) Mission PMRS seeks to improve the overall physical, mental, and social wellbeing of all Palestinians Focuses on the needs of the poor in villages, refugee camps, and in the urban areas. Focuses on the needs of women, children, elderly, disabled, and others marginalized groups Looks to provide the quality of care in 400 Palestinian communities

4. PMRS (UPMRC) Vision PMRS follows the principles and practice of Primary Health Care in the provision of preventive, curative, and promotive health services

6. Map of UPMRC activities in the West Bank and Gaza Strip

7. The Need for this Program Epidemiologic and demographic transition –Rapid aging –Progressive urbanization –Socioeconomic transformation Changes in nutritional patterns: –Less proportion of complex carbohydrates –More sugar –More animal fat Obesity becomes more prevalent Less physical activity Increased cigarette consumption

8. Why chronic diseases? The disease burden has moved towards chronic diseases as a result of the epidemiological transition The leading causes of mortality, the leading causes of morbidity (including disability), and impose an enormous financial and societal burden on the country Chronic diseases account for one-third of the years of potential life lost before age 65. They are preventable.

9. NCDs of Interest.. Heart HTN Diabetes CVD Cancer (Breast) Dyslipidemia Obesity ?!

10. Targeted Diseases High prevalence An increasing morbidity and mortality burden An increasing economic, social, and psychological burden Early detection improves prognosis Public awareness is crucial for prevention Comprehensive management is generally absent

11. How High is the Risk ? After the age of 35 years: –1 out of six may develop diabetes –1 out of 3 may develop hypertension –1 out of 2 have dyslipidemia –2 out of 3 are overweight –2 out of 5 are obese –1 male out of 3 is a smoker

12. Leading causes of death among the Palestinian population in – 2002 (MoH)

13. History

14. Purpose Developing a model that focuses on prevention methodology Alleviating some pressure on curative treatment Early detection of diseases and proper management Preventing disability and loss of labor power Using of data collected to advocate reformation of health care policies Reaching the marginaliyed people

15. Components Prevention, Early Detection And Health Promotion Surveillance, Data Collection, And Research Proper Management

16. Mobile Clinic More than 11,000 people screened fpr NCDs 68% were women 7800 women were screened for breast abnormalities All of them know how to do self breast examination

17. Diagnostic Procedures Patient’s and family history Blood pressure Weight and height Dr’s examination Upon need: –ECG –Echocardiography –Treadmill –Holter Counseling

18. Integration with PHC clinics An important goal for a successful program Started with 6 villages in Ramallah area, and will continue to cover all clinics The aim is to reach a common vision towards the management of NCD

19. Preliminary results (%) from different locations been screened by the mobile clinic (2003) OverweightDyslipidemiaHypertensio n DiabetesLocation 72432111.6Abud 67423712.5An Nabi Saleh 69572511.5CHF (work org) 68434421Deir Ghassaneh 71573814.7Kobar 74523117Qarawat BZ 78542518Sinjil 81613818Turmus Ayya 75543317.5Abu Qash 75523018Total Average

20. Data Collection & Research First national data base on chronic diseases and their risk factors Data are used to evaluate the burden of diseases and the quality of medical care Information gathered is used in lobbying and advocacy to raise the problem of NCD Call for reformation of health policy

21. Health Promotion Different methods used: –Health education booklets (diabetes, HTN, Heart disease, smoking, breast cancer…) –Posters and flyers –TV and radio spots –Group and individual counseling – Radio and TV programs

22. Comprehensive Management Management of NCDs is of a holistic approach: –Assessment of risk factors –Early detection of the disease –Diagnostic procedures –Life style modification –Pharmaceutical intervention –Follow up of the patients –Referrals

23. Training A well trained team in NCDs Team building of health professionals to deal with NCDs Training of Teams including representatives of health providers: UPMRC, MOH, UNRWA, UHWC, and private doctors The aim is to transfer the model to other sites.

24. Lobbying and Advocacy Cooperation and consultations with other health providers Using the media to raise the burden of NCDs Using the media to call for national efforts to provide quality of care Meetings with representatives of local communities, youth clubs, and people of different activities to alert the issue on NCDs.

25. Building a model The comprehensive approach in management Capacity building Transfer of knowledge and experience Connect the center with the periphery Rational use of technology Emphasizing the importance of prevention in combating NCDs

26. A Different Approach A comprehensive approach in the management of diseases: Prevention –Life style modification –Health promotion Early detection Proper treatment Train and support management at PHC level Establish a good referral system