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Transcript of The role of CNCD Commissions in tackling chronic diseases – The Barbados Experience Dominica...
The role of CNCD Commissions in tackling chronic diseases –
The Barbados Experience
Dominica National Commission on CNCDs Capacity Building Workshop, 19 January 2010
Professor Trevor A. Hassell, Chairman Commission for CNCDs, Barbados
The burden of the CNCDs - Barbados
Quarter of men and more than a third of women live with one or more CNCD
Five leading causes of death are CNCDs Heart disease and stroke rank among leading causes of death 22% of Barbadian adults are hypertensive and 17.5% are
diabetic Diabetes and hypertension account for 20% of primary care
consultations Overweight/obesity: 60% of women and 1/3rd men
“ Three primary risk factors ( tobacco, poor diet and physical inactivity) and three intermediate risk factors (hypertension, obesity and diabetes) lead to three diseases (heart disease, lung disease and cancer) all resulting in some 50% of all deaths.”
4
Individual responsibility
Changes to the "toxic" environment
COMMUNITY AND CIVIL SOCIETY
Complementary Complementary approaches to approaches to chronic disease chronic disease preventionprevention
Complementary Complementary approaches to approaches to chronic disease chronic disease preventionprevention
POLICY ENACTMENTHEALTH CARE AND DOCTOR
Support for the CNCD Commission -local
The Barbados Strategic Plan for Health, 2002-2012
Strategy for the prevention and control of CNCD & Cabinet Note (2005) 26/MH.03, Ministry of Health, Barbados (2004);
International Consultation on a Strategy for the Prevention and Control of CNCD for Barbados; Ministry of Health, Barbados (2005)
“Healthy Hearts for life”. Report of the Task Force on the Development of Cardiovascular Services (Jan. 2007); Ministry of Health, Barbados
Support for the CNCD Commission - regional
Heads of Government of CARICOM Summit and Declaration against CNCDs, 2007
Healthy Caribbean 2008 Chronic Disease Conference: a wellness revolution event
CARICOM Heads of Government Summit on Chronic Non-Communicable Diseases (CNCDs), 15
September 2007adopted a fourteen-point declaration committing the
region to collective action to stop the epidemic of CNCDs
**Infrastructure: Secretariat / CCH3 / Regional Plans, M & E;
**National Commission, NCD Focal Point in MOH **Advocacy, Communications, Social marketing **Sustainable Financing **Surveillance, including Gender dimensions
Priorities of the Summit
Tobacco (FCTC) Healthy Eating (DPAS): – Trans Fat, Trade, Labeling
Active Living (DPAS)– Population-wide activities – Schools/workplaces etc.– 2nd Saturday in Sept: “Caribbean Wellness
Day” Screening and integrated management
Purpose
To bring together a wide spectrum of partners from throughout the CARICOM countries – civil society, the business community, educators and researchers, policy makers to plan civil society’s response to the CNCD pandemic
Participants Agriculture 3 Business 5 Education 3 Faith Based 4 Finance 7 Food Industry 2 Gov./Policy 13 H C Providers 11 Health Finance 3 Labour 5 Legal 1 Media 9 NGO/CNCD 35 Pharma 3 Reg./Pol 6 Service Clubs 3 Sports/PA 3 Urban Dev. 3 Youth 3
Anguilla Antigua Aruba Bahamas Barbados Belize BVI Cayman islands Dominica Grenada Guyana Jamaica Montserrat St. Lucia Trinidad and Tobago St. Kitts
Outcomes Active Caribbean Workshop Caribbean Civil Society Declaration on CNCDs Caribbean Civil Society Action Plan for tackling CNCDs, Conference Report produced as a Technical Report of the
Chronic Disease Research Centre, UWI Creation of a Caribbean civil society coalition for tackling CNCDs
- Healthy Caribbean Coalition Website: www.healthycaribbean.org. Co-sponsorship of upcoming University Diabetes Outreach
Conference, Jamaica, 2010 CNCD media campaign for Barbados and the OECS
Summary of the Declaration 10 point preamble and 12 point declaration Preamble recognizes the contribution of the CNCDs both to ill
health & disease and excessive financial burden, but appreciates that much can be done
Declares inter alia: Support for Heads of Government of CARICOM Declaration on
CNCDsNeed to establish a Caribbean Civil society CNCD coalition Stresses the need for increased advocacyPromotion of healthy lifestyles Public education and media campaigns Seeks to hold Governments accountable
Summary of the Action Plan
Action lines:Establishment of Caribbean CNCD coalitionAdvocacySupport for Caribbean Wellness DayDevelopment of a communication strategyPublic education programmeRisk factor reductionSupport for country level activities
The National Commission for CNCDs, Barbados
Established January 2007 Inter-sectoral body 14 members and 4 ex-officio members Volunteers paid small stipend Meetings held monthly Professional, administrative and secretarial support
provided by staff of the Health Promotion Unit No budget allocated to the Commission at start up
The Commission’s mandate
Advise Minister of Health on CNCD policies and legislation Broker involvement of all sectors in program implementation Assist in mobilisation of resources to facilitate implementation
of programs Recommend relevant research Promote collaborations and partnerships Monitor regional and international trends Facilitate commissioning of audits /evaluation of CNCD
programs Recommend to Minister of Health framework that encourages
and promotes behaviour change to prevent CNCDs
Membership of NCCNCD, Barbados• Professor Trevor Hassell MD., Chairman• Professor Henry Fraser MD., Dean Faculty of Medical Sciences • Mr. David Neiland , Businessman, the private sector• Mr Orlando Scott, trade union movement• Mr Wilfred Beckles, Barbados Association of Retired Persons• Mr. Michael Gaskin, teacher, physical education • Mr Adrian Randall , CEO, Heart & Stroke Foundation of Barbados• Dr Elliott Douglin MD., Representing Faith based organisations• Mrs. Sophia Cambridge, Advertising and media• Ms Candace Waldron, Youth Representative• Ms Zonia Phillips, Food and Nutrition advocate• Mr Barton Clarke Chief Agricultural Officer, Ministry of Agriculture• Mrs Wendy Griffith-Watson, Chief Education Officer• Mrs. Ena Harvey, IICA
Internal action:Improved management of NCCNCD Improved CNCD data management
External action:Health promotionReduction of CNCD risk factorsQuality CNCD treatment and care
Strategic Plan: Objectives
Vision: to be a leader in all major national developments related to CNCDs in order to achieve reduction in CNCDs
Mission: Advises on, facilitates and promotes evidence based best practices in Prevention and Control of CNCDs
Values: Transparency, inclusiveness, respect for all views, adoption of evidence based practices, accountability, and collaboration
Strategic Plan: Vision, mission and values
Strategic plan: key strategies
Strategic management issues Epidemiological data, Health Information
System and research Measures to support reduction of risk factors Health promotion Quality treatment and care
Strategic management issues
Advisory body guiding and assisting a highly motivated group of operational partners
Driving CNCD interventions in collaboration with:
Public and private sectorGovernment and NGOsProfessional and voluntary bodiesCommunity based organizationsRegional and international bodies
Epi- data, Health Information Systems and Research
Increasing access to data on CNCDs Strengthening functional links with CDRC/UWI Using the BNR as a priority data source to
inform actions of the CNCD Commission Increasing surveillance capacity of Ministry of
Health Using Health Information System
Measures to support reduction of risk factors
Declare CNCDs a national priority Enhance the role of the commission with the
public Giving the public access to CNCD data Inform the public of standards in treatment
and care Support on-going educational programmes
targeting health care professionals
Health promotion
Integrate health promotion strategies in the planning process
Improve inter-sectoral collaboration Lobby where necessary for high impact Influence legislation and regulation
Quality treatment and care
Establish standards for CNCD treatment and care
Organizational and management structures1. Budgetary funds allocated to CNCDs increased by 10%2. Administrative staff added to MOH to support Commission3. Secretariat established
Epi- data, HIS and research1. Implementation of annual surveillance reporting system
for CNCDs2. Regular outputs from BNR3. Repeat BRFS survey in 20104. Establishment of a web portal for CNCDs
Indicators of success
Risk factor reduction1. Complete adoption of at least 3 articles of FCTC by end of
20092. National population salt reduction policy articulated and
programme implemented by 4th quarter of 20093. Support for CME of health professionals4. Working relationship with National Nutrition Centre
Health promotion1. Representation of CNCDs at the level of the Social
partnership2. Sustained highly visible public education programme on CNCDs
Quality treatment and care1. Annual training given to health care professionals in CNCD
protocols
Indicators of success
Tobacco exposure
Significantly increase tax on tobacco productsRemove duty free concessions on tobacco products at
the ports of entryBan sale of tobacco products to minors Ensure that warning labels on tobacco products meet
international standards Ban smoking in public places Prohibit cigarette advertising at point of sale
Physical inactivity Make materials and aids used in exercise and physical
activity more affordable for personal use….VAT exemption
Enact policies to facilitate development of small community gyms
Create tax incentives for property developers to create safe recreational spaces in communities
Increase physical activity in schools Enact legislation and policies to make the city
and the country more conducive to walking and riding
Hypertension and blood pressure control
Continue to make blood pressure lowering drugs available at an affordable cost at point of delivery….Drug formulary
Produce a more cost effective and more rational range of antihypertensive drugs
Seek to provide delivery of care of hypertension by primary care doctors using the chronic care medical model
Population salt reduction using a voluntary and collaborative approach informed by national policy
Diabetes and blood sugar control
Enhance the provision of drugs, syringes, needles for diabetics…drug service
Provide blood glucose test strips Provide tax concessions or zero rate
glucometers
National Chronic Disease Registry An initiative of the Ministry of Health, executed on
contract by the Chronic Disease Research Centre Sub-registries of acute myocardial infarction, stroke,
and cancer, related risk factors and outcomes Aims to inform and guide prevention and
intervention strategies, and optimal resource use Model for the region Complementary to PAHO/STEPS Risk Factor
surveillance program
The Commission and the Barbados National Registry
Chairman of the Commission has a “direct interest” in the outputs of the Registry
Commission facilitates and supports the work of the Registry
Commission monitors and evaluates the operations of the Registry
The Registry supports the information needs of the Commission
The Commission and the Barbados National Registry
The Commission in conjunction with the CMO will : Provide input to any public health, medical and
epidemiological issues arising from that work Design and implement public awareness and
communication strategies about the contribution of the Registry to population health status improvement
Design and implement “professional awareness strategies” to inform and engage the medical and related professions in the activities of the Registry
Barbados Behavioural Risk Factor Survey (STEPS): 25 years and older
Tobacco exposure8.4% current smokers
Physical activity51% low level of physical activity
Eating habits/diet95% ate less than 5 servings of fruit and
vegetables per day
Caribbean Wellness Day Introduced by Heads of Government of CARICOM Held on the 2nd Saturday in September Focus attention throughout the region on the
chronic diseases Coordinated by the CNCD Commission All sectors of the community invited to participate,
private sector, government, trade unions, civil society, the academic and educational institutions, faith based organisations
National Nutrition Improvement and Salt Reduction Program
Survey of population salt intake: initial and follow up Healthy nutrition policies and actions in schools Taxation policy around healthy food and beverages Public education campaign on radio, TV, and print
media Reformulation of food and drinks “Salt choice the difficult choice” Workshops and seminars for health care providers Barber shop screening project
The National Chronic Non-Communicable Disease Commission Logo
Nutrition guidelines for schools
Produced 2009 A tool for use in schools to assist teachers and
students in best practice nutrition Distribution of guidelines and implementation,
2010
Activities of the Commission Healthy Caribbean 2008 civil society conference Initiated service contracts with health NGOs Contributed to the Heads of Government of CARICOM
Summit, 2007 Contributor and lead role in development of Cabinet paper
on CNCDs Consultation on trans fats / Faith based workshop Several lectures and presentations - CMOs and Ministers of
Health, OECS; New Delhi, India; Washington, USA Publication of brochure “Battling the hidden enemy” CNCD media campaign for Barbados and the OECS