NCD multisectoral plans-moving to implementation.

Cherian Varghese

Coordinator, Management of NCDs

WHO, Geneva.

NCD MSAP

• MSA-NCD plan is the national roadmap for activities by all relevant ministries/sectors in the country for NCD prevention and control

National MSA plans

• Essential, but not sufficient

• Helps to position NCDs as a national agenda

• Engagement of relevant sectors

• Broad contours

• ‘Good to have’ actions

Percentage of countries with a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors

and their level of plan integration, by WHO region

0

10

20

30

40

50

60

70

80

90

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AFR AMR EMR EUR SEAR WPR

% o

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Health plan Development agenda Indicators Targets

Framing a national MSA plan

What are the best buys?

Minimum set of actions (‘Best Buys’)Tobacco use Reduce affordability of tobacco products by increasing tobacco excise

taxes;

Create by law completely smoke-free environments in all indoor

workplaces, public places and public transport;

Warn people of the dangers of tobacco and tobacco smoke through

effective health warnings and mass media campaigns;

Ban all forms of tobacco advertising, promotion and sponsorship

Harmful alcohol use Excise tax increases on alcoholic beverages;

Comprehensive restrictions and bans on alcohol advertising and

promotion;

Restrictions on the availability of retailed alcohol

Unhealthy diet and

physical inactivity

Salt reduction through mass media campaigns/reduced salt content in

processed foods;

Replacement of trans-fats with polyunsaturated fats;

Public awareness programme about diet and physical activity

Cardiovascular disease

and diabetes

Multi-drug therapy (including glycaemic control for diabetes mellitus)

to individuals who have had a heart attack or stroke, and to persons

with a high risk (> 30%) of a CVD event in the next 10 years

Providing aspirin to people having an acute heart attack

Cancer Prevention of liver cancer through hepatitis B immunization;

Prevention of cervical cancer through screening (visual inspection with

acetic acid [VIA]) and treatment of pre-cancerous lesions

Package for NCD management• A cost effective set of

interventions as a package

• Consider WHO Package of Essential NCD interventions and adapt as needed

• Define a service delivery model

• Task sharing and redefining roles of health providers

• Electronic records, automation, coverage

Service delivery – depending on resources

CHWsHealth Education

PHC (no MD)

PHC (with MD)

District Hospital

Risk screening procedures

Risk Assessment

Risk assessment Risk Management

Comprehensive NCD Management

Specialist availability

Bankable document• MSA -Large number of actions (200 to 300)

• Prioritized and costed plan

– Impact and feasibility

• Move towards a prioritized and costed set of actions with well defined outputs and outcomes

• Appendix 3 of the NCD GAP provides cost effective interventions

• Consider a package

– Primary care package

– Policy package

Cross over

• Health in all policies

– Transport

– Urban planning

– Food processing

– Tobacco/Alcohol sales and

promotions

– Education

– Industry

MSA-Entry Points

National multi-ministerial forumNational

• Effective only with commitment at the highest level, need a good driver, Health in All Policies

City/District/Village levelSubnational

• More feasible, leverage local government, collective voice of community, government closer to the community, local ordinances

Tobacco/Alcohol/Physical ActivityRisk factor

• Facilitators-activism, pressure groups, champions, international agreements (FCTC), global reporting, more palpable interventions, common good /common enemy

Inter

ministerial

Local

Government

Cross sector

working groups

Meet their primary interest-NCD prevention can be a co-benefit

EducationImproved scholastic outcome

Improved health of children

AgricultureImproved

production of fruits and vegetables

Improved consumption of

f&v in population

Industries

Improved productivity

Less expenses on sickness of

employees

Healthier people

Urban planning

Beautiful city, more tourists, more money

More physical activity

Settings based approach

• Smokefree environments (eg Japan, Philippines)

• Promoting active transport

Healthy Cities

Healthy Villages

Community based

eg Lao PDR – could consider NCD

eg “Let’s Beat Diabetes” Auckland

Sub-national & local approaches

What can local Governments do?• Show leadership-set an example• Collaboration within local govt-

Transport/Health/Public Safety/Parks/Recreation/Education etc

• Partner with voluntary organizations

• Partner with private sector• Share information• Encourage public participation• Implement a communication

strategy

• Health Promoting Environment (Malaysia)

• Health promotion (Brunei Darussalam)

• Tobacco, environmental health (Cambodia)

National inter-sectoral committees Health in All

Policies

National NCD Plans

Eg Adelaide HiAP •All sectors jointly accountable for goals in high-level strategic plan•Not “health” issues (migrant settlement, educational achievement, indigenous road safety)

eg Mongolia, Hong Kong SAR

National level approaches

Progressive expansion

Early

•Across programmes in MoH-Nutrition, environment, food safety, TB, HIV,ANC

Settings

One other ministry

Intermediate• Local governments

Two or three ministries on a particular issue

Advanced

• Multiple ministries

Specialized agencies and platforms

Key messages

• And it is happening now; Level of entry, topic, scope, sectors.

Many barriers but also many opportunities

• Learning by doing, and learn from each other

“MSA” describes a process not a thing

• Build upon what you already have (structures & relationships)

• Be opportunistic , events and non NCD events

No one starting point or approach

• Do not expect other sectors to make the connection between NCD and their goals

Data will not speak for itself

EARLY EASY

ENJOYABLE EVERYONE

Promoting health is

EVERYBODY’S BUSINESS