NCD policy and programming Bangladesh

1. Dr A. K. M. Jafar UllahDPM (Arsenic & NCD), DGHS, Bangladesh and NCD Focal Point, WHO, Bangladesh NCD policy and programming Bangladesh Bangladesh

2. Outline of the presentation • Introduction • Situation of NCDs • Achievements in tackling NCDs and their Risk Factors • Challenges • Lesson learnt • Next steps

3. Introduction (Demography) • Population size 156 million • Population density of 979 persons/Km2 • One-third of the population is under 15 years • Around 61.4% are aged 15-64 years • Around 4.5% are aged 65 or older. (Rapidly rising) • Urban population 27% (Rapidly increasing ) • Population growth 1.292% • Life expectancy at birth 60.25 years

4. Situation of NCDs • Prevalence of major NCDs • Diabetes 3.9% (2010) • CVD 12% (2004) • Hypertension 17.9% (2010) • Neoplasm 3.7% (2009) • COPD /Asthma 3.0% (2007) • Stroke 2.4% (2009) Diabetes prevalence trend Hypertension prevalence trend

5. Death due to selected NCDs

6. Bangladesh NCD risk factor Survey 2010

7. Achievements • Logistics and skilled human resource are available at medical colleges and tertiary hospitals for management of NCDs • Diagnosis and management facility for major NCDs are made available at public and private primary care health facilities • Health manpower at different level were oriented and trained about NCD and its prevention • Bangladesh Global Adult Tobacco Survey 2009 • Bangladesh NCD Risk factor survey 2010 • Development of guideline/manual for management of selected NCDs

8. Achievements contd. • Piloting of selected NCD prevention and control is under way at primary care level. (Along with awareness raising campaign, manpower were trained and following logistics were provided ) • Diabetes : Gluco-meter • CVD : BP machine , ECG machine • COPD/asthma : Nebulizer • Cancer : VIA kit • Interim assessment shows 60% increase in awareness level on NCDs

9. Strategies/Response • National Strategic Plan for Surveillance and Prevention of NCD developed • Current health sector plan identifies CVD, Cancer and Diabetes as major public health problems. • Ratified the Framework Convention on Tobacco Control (FCTC) • National essential drugs policy and a list of essential drugs is developed • Strategies developed for responding to specific NCDs • The National Cancer Control Strategy • Injury Prevention Strategy • Deafness Prevention Strategy • National Eye Care Plan . • Legislative initiatives related to NCDs • Amendment of Mental Health Act; ; in the process of enactment, • Review of tax policy, Increase of tobacco tax by NBR and amendment of Tobacco Control Law.

10. Challenges of NCD Prevention and control • Unplanned rapid urbanization • Translation of NCD strategies into activities and implementation • Social custom • Generally women are not encouraged to go out for physical activity • Dietary • High carbohydrate diet may result dislipidemia • Westernized Junk food is popular among wealthy population • Health seeking • People seek health care mostly at advance stage of the disease • Out of pocket expenditure of clients

11. Lesson learnt over last 5 years • If mass awareness could be raised most of the major NCDs could be prevented like CDs in Bangladesh • Strategies and laws are not enough unless adequate enforcement is done • Establishment and maintenance of NCD Health Information System is essential for generation of data • Capacity development of service providers is mandatory for attracting people for health care • NCDs are disease of rich is not true, poor are also vulnerable to several NCDs

12. Next Steps • Inclusion of country specific NCD prevention program in the upcoming new health sector program (2011-2016) • Updating of the NCD strategic plan of action • Scaling up of the injury prevention piloting throughout the country • Preparation for the Decade of Action for Road Safety( 2011-2020) • Establishment of population based Surveillance system and registries for major NCDs • Development of National Communication Strategy for Health Promotion on NCDs

13. Thank You