1. Present NCDI situation in Mongolia
Kh.Altaisaikhan /Professor of Medicine, Vice president of HSUM/

2. Mongolian step survey on non-communicable disease risk factors 2006

3. Mongolian step survey on non-communicable disease risk factors 2006
The Mongolian NCD – STEPs survey is a nationwide cross–sectional survey, carried out throughout Mongolia in 2005.
The goal of the survey was to determine the prevalence of major NCD risk factors and to establish the baseline information for the surveillance of NCDs prevention and control.
The survey was conducted through three subsequent steps with the concept of the WHO Stepwise approach for NCD surveillance and data obtained from 3411 participants aged years.

4. Mongolian step survey on non-communicable disease risk factors 2006
Questionnaire method
Step 2
Physiological measurements
Step 3
Laboratory analysis

5. Survey results: Behavioral risk factors
1. Tobacco use
The prevalence of daily smokers was 24.2 % of the surveyed population aged years.
There was a marked gender difference noted in the prevalence of daily smokers. The proportion of daily smokers in males (43.1%) were higher by 10 times as compared to that of females (4.1%).
An average age of initiation to smoking was 20 years.

6. Survey results: Behavioral risk factors
2. Alcohol consumption
30.2% of the surveyed population aged years consumed alcoholic beverages on a regular basis in the past 30 days; and in terms of gender, 44% of the surveyed male respondents and 15% of the surveyed female respondents consumed alcoholic beverages on a regular basis.
In the past 30 days, 2.2% of the surveyed population who consumed alcohol on a regular basis were drinking alcohol on 4 and more days a week thus presenting to be at high risk; and in regard to gender, 2.5% of male regular drinkers and 1.2% of female regular drinkers were at high risk.
There was a gender difference in alcohol consumption. The proportion of alcohol consumption on a regular basis and binge drinking were 3 times higher in males as compared to females.

7. Survey results: Behavioral risk factors
3. Fruit and vegetable intake

8. Survey results: Behavioral risk factors
4. Physical inactivity

9. Survey results: Health indicators
1. Overweight and obesity

10. Survey results: Health indicators
2. Diabetes mellitus
Prevalence of diabetes was 9.3% and this proportion was much higher as compared to 3.1% of the data from the survey conducted in 1999.
A proportion of impaired fasting glucose was found in 10.3% and there was no remarkable difference compared to the prevalence of 9.2% in 1999.

11. Survey results: Health indicators
3. Hypertension and blood pressure
The prevalence of hypertension 28.1 (+0.1)%.
With increased age the prevalence of hypertension was higher in both sexes.

12. Survey results: Conclusion
Smoking %
Alcochol in moderate use 5%
Current use of alcochol %
Unhealthy diet %
Physical inactivity %
Hypertension %
Diabetes %
Obesity %

13. Survey results: Conclusion
9 in every 10 people (90.6% of the surveyed population) had at least one risk factor for developing NCDs.
One in every five people (20.7% of the surveyed population) had three or more risk factors or were at HIGH risk and in particular,
One in every two males aged 45 years and above were at high risk in developing NCDs.

14. National programme on prevention and control of non-communicable disease

15. National programme on prevention and control of non-communicable disease
1. Goal
Reduce deaths caused by major NCDs through improving control and surveillance of NCDs and their risk factors and through effective health promotion action
The program will be implemented in two stages splitting into stage one as to be implemented during and two as for

16. National programme on prevention and control of non-communicable disease
Objectives
Objective 1. To create sustainable mechanism for coordination on prevention and control of major NCDs such as cardiovascular diseases, cancer and diabetes mellitus
Objective 2. To reduce risk factors of major NCDs by promoting healthy lifestyles and supportive environment
Objective 3. To make reorientation of health services (towards community-based, appropriate, accessible and effective) for major NCD-s

17. Non-communicable disease related our experience

18. Non-communicable disease related our experience
National survey on diabetes prevalence /2002/ Diabet Med June;19 (6):502-8
Mongolian NCD STEPS risk factors survey /2005/
Development of national program on NCD prevention and control /2005/
WHO Local fellowship on NCD prevention and control for primary health workers
NCD Regional Center establishment /2005/ (Khovd, Uvurkhangai, Dornod)
Essential emergency surgical care WHO Local fellowship WHO Local fellowship training on primary health care
Distance learning training program for primary health providers

19. The Diabetes Center in Ulaanbaatar, 2005

20. The Diabetes Center in Erdenet, 2005
New diabetes center was established with 3 rooms at out-patient clinic in Erdenet cities Central Hospital with necessary equipments

21. World Diabetes Day since 2001

22. Diabetes Educator Training May 2005
31 Mongolian health professionals were certified as Diabetes Educators

23. The incidence of diabetes in Mongolia

24. Global strategy of non-communicable disease prevention and control

25. Noncommunicable Diseases 4 Diseases, 4 Modifiable Shared Risk Factors
Tobacco
Use
Unhealthy diets
Physical
Inactivity
Harmful
Use of
Alcohol
Cardio-vascular
Diabetes
Cancer
Chronic
Respiratory

26. Total deaths around the world:
58 million

27. Total deaths around the world:
58 million
Deaths from noncommunicable diseases around the world:
35 million

28. Total deaths around the world:
58 million
Deaths from noncommunicable diseases around the world:
35 million
Deaths from noncommunicable diseases in developing countries:
28 million

29. Total deaths around the world:
58 million
Deaths from noncommunicable diseases around the world:
35 million
Deaths from noncommunicable diseases in developing countries:
28 million
Deaths from noncommunicable diseases in developing countries which could have been prevented: an estimated
14 million

30. Noncommunicable Diseases Mortality among men and women aged 15-59 years (2004)

31. Noncommunicable Diseases Projected Deaths in 2015 and 2030
Intentional injuries
Other unintentional
Road traffic accidents
Other NCD
Cancers
CVD
Mat//peri/nutritional
Other infectious
HIV, TB, malaria

34. WPRO Pattern of Morbidity is Similar to EURO and AMRO Distribution of DALYS, by broad cause group and WHO Region, 1999 % 75
Noncommunicable
conditions
Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50 25
Injuries
AFR
EMR
SEAR
WPR
AMR
EUR
DALY = Disability-Adjusted Life Year
Source: World Health Report, 1999

35. Noncommunicable Diseases Global Action Plan 2008-2013: Six Objectives
1. Integrating NCD prevention into the development agenda, and into policies across all government departments
2. Establishing and strengthening national policies and programmes
3. Reducing and preventing risk factors
4. Prioritizing research on prevention and health care
5. Strengthening partnerships
6. Monitoring NCD trends and assessing progress made at country level
Here are the objectives of the plan. Under each of the six objectives there are three sets of actions to be iplemented during the six year period, one set for member sates, another for WHO and a third for international partners
Under each of the 6 objectives, there are sets of actions for member states, WHO Secretariat and international partners

36. Noncommunicable Diseases Why working in partnership?
Consolidate fragmented efforts
Promote results-oriented collaborative efforts
Engage partners outside the health sector
Scale up by pooling limited resources

37. Noncommunicable Diseases Global NCD Network
Mission:
Help implement the NCD Action Plan by catalyzing an multi-sectoral, multi-level response, with a particular focus on developing countries
Goals:
Increase focus on NCD prevention and control through collective advocacy
Increase resource availability (both financial and human capital)
Catalyze effective multi-stakeholder action with a focus on country-level implementation

38. Noncommunicable Diseases Global NCD Network: Stakeholders
Stakeholders from the disease and risk factor community:
Stakeholders outside the health sector:
Ministries of Finance, Trade, Education, Social Affairs
Development donors (e.g. Austrian Development Agency, Ministry of Foreign Affairs)
International Financial Institutions
Intergovernmental Organizations
Private sector
Here are the objectives of the plan. Under each of the six objectives there are three sets of actions to be iplemented during the six year period, one set for member sates, another for WHO and a third for international partners

39. Noncommunicable Diseases Global NCD Network: Structure
Implemented in 2009
WHO
Implemented in 2010
International Advisory Council
Staff
Funding Mechanisms
Global/Regional Forum Meetings
Working Group
Working Group
Working Group

40. Core competencies for caring for patients with chronic conditions
Patient-centred care
Partnering
Quality improvement
Information and communication technology
Public health perspective

41. 1. Patient-centred care Interviewing and communicating effectively
Assisting changes in health-related behaviors
Supporting self-management
Using a proactive approach

42. 1. Patient-centred care 5 as approach: Assess Advice Agree Assist
Interviewing and communicating effectively
5 as approach:
Assess
Advice
Agree
Assist
Arrange

43. Supporting self-management
1. Patient-centred care
Supporting self-management

44. 2. Partnering Partnering with patients Partnering with other providers
Partnering with communities

45. 3. Quality improvement Measuring care delivery and outcomes
Learning and adapting to change
Translating evidence into practice

46. 4. Information and communication technology
Designing and using patient registries
Using computer technologies
Communicating with partners

47. 5. Public health perspective
Providing population-based care
Systems thinking
Working across the care continuum
Working in primary health care-led systems

48. Partnerships, Collaboration
NGOs
CCs
UN agencies