5 habiba ben romdhane
TRANSCRIPT
NCD Prevention and Control
Experience in North Africa
Pr Habiba Ben Romdhane
Cardiovascular Epidemiology & Prevention Resarch Laboratory
Tunisia
International Conference on Healthy Lifestyles and Non Communicable Diseases (NCD)
In the Arab World and the Middle-East(Riyadh, KSA, 9-12 September 2012)
This presentation examines the preparedness of three of the Northern Africa countries (Algeria, Morocco and Tunisia) to manage the challenge posed by the increase of NCDs.
The choice of these countries is motivated by their similarity in culture and lifestyle , and health sector organization , heritage of the French colonisation .
Their total population is almost 25% of the Arab population .
Burden of NCDs NCD are the causes of deaths:
56% in Morocco, 58% in Algeria and 62% in Tunisia
Tunisia has the highest prevalence of tobacco and obesity
There is a gender specificity on risk factors prevalence : highest prevalence of tobacco smoking on men and obesity on women
NCDs Management MoH is the key strategic and delivery
institution, overseeing the planning and provision of the bulk of health services.
Within the MoH, NCDs responsibility lies with the Department of Primary Health Care where are established NCDs Unit /Department
Steering committees are established in the MoH
A growing private sector exists in the main urban centres, offering diagnostic services and specialist clinics
NGOs play virtually no role in providing health care
NCDs Management Early in the 1990’s , national
programs on hypertension and diabetes were implemented;
In Tunisia CVDs strategy document was elaborted since 1999.
During the 2000’s were elaborated :
Plans on Cancer,on Mental Health and on Tobacco
Ariana Healthy Urbanization Project (Tunisia). This project was based on multisectorial approach .
2008-2013 Action Plan: what has it achieved ?
Plans of action for the period (2008-2013) are elaborated. However, in the three countries, the plans are not really implemented . They are not endorsed by the different departments and stakeholders.
NCDs Surveillance
Death certificatio
nQuality
Important issue
Registry Risk factors surveyCancer CHD
Algeria Yes 3 - Yes
Morocco Yes - - Yes
Tunisia Yes 3 1 Yes
Health information systems are fragmented and ill-suited to the task of monitoring patient treatment, at either an individual or a population level, or resources .
Health care
Integration in PHC (Hypertension and diabetes)
Absence of coherent – indeed any – referral pathways between primary and secondary health services
inadequate access to essential health technologies and medicines
Inequalities
Reduction of risk factors
Gaps in implementing “best buys” : FCTC and tobacco control measures
salt reduction programmes marketing of foods
physical activities programmes
Multisectorial Actions
A lack of coordination within the health sector is perceived to be worsening with the growth of a private sector .
The need to be tackling such a major public health concern through collaboration outside the health sector is subordinated to the more pressing issue of collaboration within the health sector itself.
Financing The economic implications of
rising NCD levels is an adding urgency to the search for alternative financial models of health care
The private sector is seen as almost a parallel health economy, NCDs are “an abyss of money”
Out-of-pocket and catastrophic expenditure due to NCDs are source of inequality
EEpidemiological TTransition AAnd HHealth IImpact IIn NNorth AAfrica (TAHINA)
MEDiterranean studiesMEDiterranean studies of of CCardiovascular disease andardiovascular disease and HHyperglycaemia:yperglycaemia: AAnalyticalnalytical MModellingodelling ofof PPopulationopulation SSocio-ocio-economic transitionseconomic transitions (MedCHAMPS)
NCDs & their social determinants in Mediterranean : building sustainable RESearch CAPacity for effective policy intervention (RESCAP-MED)
Key Outcomes
Determinants , trend and impact of the Epidemiological transition in North Africa
Epidemiological modelling (IMPACT CHD mortality model)
Diabetes projection and policy modelling tool
Stroke modelling
Key Outcomes
Health system analysis : how is it organised to manage the care of those with CVD or diabetes and what are key concerns about the institutional capability to address these challenges.
A ‘policy effectiveness-feasibility loop’ designed to foster collaboration between researchers and policy makers.
Key Outcomes
Cost effectiveness analysis of salt reduction policies to reduce coronary heart disease
Policy options beyond salt reduction
Building research capacity in several disciplines which must work together to improve health care policies for NCDs .
CHD Mortality Trends in Tunisia 1997-2009: additional deaths attributable to risk factor
changes & deaths prevented or postponed by treatments*
* MedCHAMPS Project
Forecasting Tunisian Type 2 Diabetes Prevalence to 2027
*Reduce the smoking prevalence by 20% in 10 years starting in
2009
*Reduce the prevalence of obesity by 20% in 10 years will start in
2013 A 3.3% reduction in diabetes prevalence would
be reach in 2027 (1.6% in men and 4.1% in women) (Figure 5), this
corresponds to 61321 of postponed case of diabetes.
Forecasting Tunisian Type 2 Diabetes Prevalence to 2027 and Scenario Projections
What is the way forward in NA
Northern Africa countries are facing many challenges to achieve the objectives of Global Action Plan for the Prevention and Control of NCDs
Regional partnership for capacity building is one of the strategic areas to bridge the gap
Thank you for your attention