1. COMMUNITY INTERVENTIONS AND CAPACITY BUILDING FOR NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL IN TUNISIA AND NORTH AFRICA Pr Hassen Ghannem Department of Epidemiology & COHRED North Africa University Hospital Farhat Hached Sousse, Tunisia

2. TUNISIA

4. RESEARCH & NCD HOW TO PUT NCD ON NATIONAL RESEARCH AGENDA? HOW TO PUT NCD ON NATIONAL RESEARCH AGENDA? HOW TO MOBILIZE LOCAL RESOURCES? HOW TO MOBILIZE LOCAL RESOURCES? HOW TO CREATE A TEAM? HOW TO CREATE A TEAM? HOW TO CREATE A COALITION? HOW TO CREATE A COALITION?

5. FORWARD STEPWISE APPROACH Document / Analyse the problem Document / Analyse the problem Sensitise politicians and health professionals Sensitise politicians and health professionals Create partnerships (TEAM) Create partnerships (TEAM) Start demonstration project of global intervention Start demonstration project of global intervention Proceed to generalisation Proceed to generalisation

6. TEAM: NATIONAL PARTNERS IN TUNISIA Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia Department of Epidemiology, University Hospital Farhat Hached, Sousse, Tunisia Department of Cardiology, University Hospital Farhat Hached, Sousse, Tunisia Department of Cardiology, University Hospital Farhat Hached, Sousse, Tunisia Departments of Peadiatrics, University Hospital F Hached & Sahloul, Sousse, Tunisia Departments of Peadiatrics, University Hospital F Hached & Sahloul, Sousse, Tunisia Department of Endocrinology & Diabetology, University Hospital Farhat Hached, Sousse, Tunisia Department of Endocrinology & Diabetology, University Hospital Farhat Hached, Sousse, Tunisia Department of Occupational Health, University Hospital Farhat Hached, Sousse Department of Occupational Health, University Hospital Farhat Hached, Sousse Department of Biochemistry, Faculty of Medicine of Sousse Department of Biochemistry, Faculty of Medicine of Sousse Regional Direction of Health of Sousse, Primary Health Care, School Medicine Unit Regional Direction of Health of Sousse, Primary Health Care, School Medicine Unit Regional Direction of Education of Sousse Regional Direction of Education of Sousse Regional Direction of Youth, Sport of Sousse Regional Direction of Youth, Sport of Sousse Tunisian Heart Foundation Tunisian Heart Foundation Tunisian association of life and earth sciences Tunisian association of life and earth sciences

7. TEAM International Partners Department of Chronic Disease Prevention and Health Promotion, National Public Health Institute of Helsinki, KTL, Finland Department of Chronic Disease Prevention and Health Promotion, National Public Health Institute of Helsinki, KTL, Finland Isfahan Cardiovascular Research Centre, Isfahan University of Medical Sciences, Iran Isfahan Cardiovascular Research Centre, Isfahan University of Medical Sciences, Iran Duluth Medical Research Institute Duluth Medical Research Institute University of Minnesota Medical School, USA

8. ADDITIONAL SUPPORTERS AND COLLABORATORS Oxford Health Alliance Oxford Health Alliance MATRIX Public Health Solutions, Inc, MATRIX Public Health Solutions, Inc, WHO Office in Tunisia WHO Office in Tunisia

9. THIS PROGRAM IS CURRENTLY FUNDED BY THE OVATIONS CHRONIC DISEASE INITIATIVE THE OVATIONS CHRONIC DISEASE INITIATIVE Ovations UnitedHealth Group With a strong interest from NHLBI (NIH)

10. The specific aims of the programme are to: determine the effectiveness, feasibility and necessary cultural adaptations of evidenced-based interventions directed at tobacco use, diet, and physical inactivity in adults and children (known as the Community Intervention for Health). determine the effectiveness, feasibility and necessary cultural adaptations of evidenced-based interventions directed at tobacco use, diet, and physical inactivity in adults and children (known as the Community Intervention for Health).

11. The specific aims of the programme are to: Develop a model for implementing, monitoring and assessing sustainable comprehensive community interventions in Tunisia, and across North African countries with similar socioeconomic and cultural situations. Develop a model for implementing, monitoring and assessing sustainable comprehensive community interventions in Tunisia, and across North African countries with similar socioeconomic and cultural situations.

12. The specific aims of the programme are to: Train health officials from other countries in the Eastern Mediterranean region who are interested in planning, implementing or evaluating programmes for chronic disease prevention and control. Train health officials from other countries in the Eastern Mediterranean region who are interested in planning, implementing or evaluating programmes for chronic disease prevention and control.

13. CHALLENGES TO NCD PREVENTION CHALLENGES TO NCD PREVENTION The challenge facing policymakers in low and middle income countries is the "wide range of possible effective and cost- effective interventions (population based approach, high risk approach)

14. CHALLENGES TO NCD PREVENTION CHALLENGES TO NCD PREVENTION How to apply evidence on policy: What are the interventions that effectively reduce the risk of burden of chronic disease and alleviate the existing burden? Which of these are cost-effective in a low resource setting?

15. ENVIRONMENT HEALTH SYSTEM HEALTH LIFESTYLE BIOLOGY HEALTH DETERMINANTS HEALTH DETERMINANTS

16. What is the way forward? Mobilize the public Mobilize the public Strengthen public health capacity Strengthen public health capacity Develop vision for national & international action and corresponding strategies that work Develop vision for national & international action and corresponding strategies that work Engage the health professionals and other key leaders to change course Engage the health professionals and other key leaders to change course Monitor progress Monitor progress Cooperate with regional and international partners Cooperate with regional and international partners

17. PROGRAMME OVERVIEW FOR TUNISIA 1.COMMUNITY BASED INTERVENTION PROGRAM 2.CAPACITY BUILDING

18. Our design will employ rigorous scientific research methodology, including: STUDY DESIGN Quasi - experimental design (matched intervention- control communities) randomised sampling procedures Power - based sample sizes standardised operations protocols standardised instrumentation (e.g., surveys, environmental scans)

19. The coordination of all the research team is under the responsibility of the principal investigator Research Team

20. CAPACITY BUILDING

21. The expected plan of actions and main achievements for the first year are: Strategic plan development for the programme with Short Term Consultants to assist in planning interventions & a communication strategy Strategic plan development for the programme with Short Term Consultants to assist in planning interventions & a communication strategy Training of the operational teams to prepare the start of planned interventions for schools, work settings, community and health professionals Training of the operational teams to prepare the start of planned interventions for schools, work settings, community and health professionals

22. The expected plan of actions and main achievements for the first year are: Pre assessment of the three main risk factors and environmental situation in schools, work settings, Health centers and the community for the intervention sites and control group sites Pre assessment of the three main risk factors and environmental situation in schools, work settings, Health centers and the community for the intervention sites and control group sites

23. THANK YOU