Development and Implementation of National NCD Programme

1. Development and Implementation of National NCD Programme Dr Lal Panapitiya Director / NCD P & C Unit Ministry of Healthcare & Nutrition, Sri Lanka

3. Demographic Details Sri Lanka * Registrar General’ Department 2006 ** Survey General’s Department 1988 *** Department of Census and Statistics 2006 **** Population census 2006 ***** Demographic Survey 1994

4. Health and Nutrition Indicators *Department of Census and Statistics 2001-2006 **Registrar General’s Department ***Medical Statistical Unit 2006 ****Demographic and Health Survey 2006/07

5. Situational Analysis Sri Lanka

6. Demographic transition in Sri LankaPopulation pyramids 1981 and 2001 WHO Country Cooperation Strategy 2006 – 2011: Democratic Socialist Republic of Sri Lanka(WHO, 2006)]

7. NCDs as a highest priority in Sri Lanka Source: WHO Country Cooperation Strategy 2006 – 2011: Democratic Socialist Republic of Sri Lanka (WHO, 2006)]

9. Mortality by major Disease category

10. Trends of hospital deaths due to NCD Vs CD in years 1985- 2007 Source: Annual Health Bulletin

11. Morbidity – Prevalence of major NCDs

12. Male Female Source- WHO Present situation of major risk factors

13. D/Training D/E&OH D/LS D/ Finance D/Planning& Research D/NCD Structure and organization of health services (In relation to NCD) D/E&UHMS D/Nurse Education D/MH D/ Cancer Control /MS D/IH D/YED&D Central level structure D/MS D/ Policy Analysis D/PH Nursing D/TCS D/Inform D/PCS D/Org Develop

14. PHNS Provincial level structure PHM PHI Volunteers / Volunteer organizations Community

15. PHM / PHI MOH PC / SC Hospitals TC / Special Hospitals Preventive programmes Provincial institutions MoH institutions RD (Planning Unit) PD (Planning Unit) Director / Information (MoH) National / International organizations NCD unit (MoH) Annual Dissemination Directorates/ Sections Provincial authorities Information system

16. Health Expenditure Source: Statistic Unit / MSD, 2008 and Annual Health Bulletin 2007& Ministry of Finance

17. Existing Measures in NCD Prevention & Control

19. Achievements In legislation Tobacco Control Act and proper implementation In the system Identification of NCD as a priority in Health Policy and Health Master Plan Development of policy and strategic plan and district level implementation plans Pilot projects are being completed Coordination of other stakeholders – in the MoH as well as outside Advocacy and cooperation from other sectors to make their policy and environment healthy

20. In the structure • Strengthening the Central Level structure • Appointing D/ NCD with a facilitated unit and staff • Approval to appoint DDG/ NCD in order to coordinate all relevant directorates • National Steering Committee for proper intesectoral collaboration • National Advisory Board and National Working Group for technical matters • In the provincial level • Appointing MO/NCDs in each district to coordinate all NCD prevention activities • District Coordinating Committees for operational level intersectoral coordination

22. Vision: A country that is not burdened with avoidable NCD deaths and disabilities. Mission: The underlying mission of the national NCD policy of Sri Lanka is to reduce the burden due to chronic NCDs by promoting healthy lifestyles, reducing the prevalence of common risk factors, and providing integrated evidence based treatments for diagnosed patients. Goal: The overall goal of the National NCD Policy of Sri Lanka is to reduce the burden due to chronic NCDs by promoting healthy lifestyles, reducing the prevalence of common risk factors, and providing integrated evidence based treatments for diagnosed patients.

23. Policy Objective To reduce premature mortality due to chronic NCDs by 2% annually through expansion of evidence based curative services and to reduce the prevalence of risk factors, through individual and community wide health promotion measures.

24. NCD Policy Key Strategies

26. National Health Council National Advisory Board Chaired by DGHS National Steering Committee Chaired by Secretary / Health MOH PHNS PHM / PHI MDT/ HPO/ Volunteers Community District Advisory Committee Chaired by RDHS Sec by MO/ NCD National Technical Working group NCD unit MoH PDHS RDHS Stakeholders / Pilot projects Coordination of National NCD Programme

27. Inter Ministerial Collaborations

28. Health Ministry inter departmental collaboration

29. Funding Agencies

30. Coordination of current pilot projects • NCD Prevention Project (NPP) – JICA • PEN (Package of Essential NCD Interventions) – WHO • NATA – Bloomberg Fund • SLMA – MoH – WDF Diabetes Prevention project (NIROGI Lanka) • Quality Improvement in Clinical Care - WB ( HSDP) - MoH • Curative Care Survey - WB

32. Activities • Management Protocols for NCD at primary care – piloted through WHO PEN / JICA

33. Objectives Non-communicable diseases Prevention Project • Development objective (overall goal) • Effective & efficient strategies of controlling chronic NCDs developed in the project are implemented in districts other than the project target areas • Actions are initiated regarding the appropriate deployment of human resources and infrastructure of medical institutions for the NCD prevention at the national level • Immediate objective (project purpose) • Effective and efficient implementation strategies for controlling chronic NCDs and the resultant cardiovascular diseases are developed through pursuing the evidence for chronic NCDs 33

34. Future Plans

35. Further strengthening the coordination of interventions with other ministries through the National Advisory Board (NAB) & National Technical Working Group (NTWG) for NCD • Formulation of an Ideal Primary Health care model to capture the increased burden of NCDs • Sensitizing and creating awareness on major NCD (using IEC approach ) and other interventions - At Central level / District level • Quality improvement measures in clinical care -revision of National Treatment Guidelines for Primary, Secondary & Tertiary Care • Management Protocols for NCD care at primary care – piloted through WHO PEN • Training of MOs / nurses involved in follow up care for proper NCD (DM) care • Advocacy for legislation / policy changes and enhanced financial allocations

37. Challenges in Implementing National NCD Programme

38. Challenges in the System : • Lack of adequate NCD /risk factor surveillance system • Quality improvement in clinical care based on standard guidelines • Maintaining coordination between all sectors & stakeholders • Behavioral change among the public • Lack of adequate Monitoring & Evaluation system • Lack of Policy decision on model of primary health care set up • Multinational company involments

39. Challenges in Human Resources: • HR constraints for providing optimal care for NCDs • Gaps in recruiting and training of staff for NCD care at primary and secondary care • Capacity building in central / district level • Lack of policy decision on involvement of field officers (PHI & PHM) for community level health promotion, basic screening and follow up for NCDs

40. Challenges in Funding: • Lack of funding for development of district level NCD implementation units • Lack of funding for district level activities • Lack of funding for social marketing campaign

41. lessons learnt over the last 5 yrs • Priority on Iry prevention but IIry prevention also needed • Need dedicated leadership • Intersecoral coordination and collaboration is a must

42. Thank You