Dominica CNCDs- Current Situation

Dr. David JohnsonMinistry of Health and Environment

CARMEN OBSERVATORY MEETING

May 12, 2008

Ministry of Health & Environment

Demographic dataDemographic data

Total population = 68,635 (2001 census)• Males = 50.3%

• population <25 years = 45.4%

• population >60 years = 13.4%

Population Age Structure, Dominica 2001

0500

1000150020002500300035004000

0 - 4

5 - 9

10 -

1415

- 19

20 -

2425

- 29

30 -

3435

- 39

40 -

4445

- 49

50 -

5455

- 59

60 -

6465

- 69

70 -

7475

- 79

80 -

84 85+

Male

Female

Ministry of Health & Environment

• 790 square kilometers

• 7 health districts

•52 health centre/clinics

•2 district hospitals

•Main hospital in Roseau (secondary care)

Ministry of Health & Environment

Trend in Crude Birth Rate and Infant Trend in Crude Birth Rate and Infant Mortality Rate, 2001-2006Mortality Rate, 2001-2006

Ministry of Health & Environment

Trend in Life Expectancy, 1995-2010Trend in Life Expectancy, 1995-2010

Ministry of Health & Environment

0

5

10

15

20

25

30

35

40

45

2001 2002 2003 2004 2005

Nu

mb

er

Ischaemic Heart Disease Mortality in Dominica

Males

Females

Both sexes

Chronic Non-communicable DiseasesChronic Non-communicable Diseases

Ministry of Health & Environment

Chronic Non-communicable DiseasesChronic Non-communicable Diseases

Ten Most Frequent Diagnoses at PMH per 1000 Registered Patients

0

5

10

15

20

25

30

35

40

2004 2005 2006 2007

Nu

mb

er o

f P

atie

nts

Deep Vein Thrombosis

Hypertension

Diabetes Mellitus

Diarrhoea and Gastroenteritis

Uterine Fibroid

Bronchopneumonia

Ischemic Heart Disease

Congested Heart Failure

Cancer

Cerebrovascular Accident

Ministry of Health & Environment

Leading Causes of Death RankingLeading Causes of Death Ranking2002-20062002-2006

2002 2003 2004 2005 2006

Rank Disease Rank Disease Rank Disease Rank Disease Rank Disease

1 Heart d 1 Heart d 1 Htn 1 Heart d 1 Heart d

2 Htn 2 Htn 2 Heart d 2 Stroke 2 Stroke

3 DM 3 Ca pros 3 DM 3 DM 3 DM

4 Ca pros 4 DM 4 Ca pros 4 ARI 4 Ca pros

5 Stroke 5 Stroke 5 Stroke 5 Ca pros 5 ARI

6 Ca stomach

6 Ca stomach

6 ARI 6 Septicemia

6 Htn

7 ARI 6 ARI 7 Ca Dig 7 Ca dig 7 CLRD

8 Ca lung 8 Perinat 7 Ca stomach

7 CLRD 8 Nerv S

9 Homicide 9 Ca breast

9 Urinary 9 Htn 9 Ca breast

10 Urinary 10 Nerv S 10 Perinat 10 Nerv S 10 Ca dig

Ministry of Health & Environment

Leading Causes of death by both sexes 1991 -1995 vs 2001-2005

Ministry of Health & Environment

Percentage Obesity Among 0-5 Year Old Percentage Obesity Among 0-5 Year Old Children, 2001-2005Children, 2001-2005

Ministry of Health & Environment

Relationship between NSPH & Other Policies/Plans

National Strategic Plan for Health

CNCD Strategic Plan/Corporate Plan

CNCD Program Dept/Prgm Plans Dept/Prgm Plans

National Development Plans(Growth & Social Protection Strategy)

Regional plansInt’l Agreements

Work Plans Work Plans Work Plans

Ministry of Health & Environment

Research Field Work of PAN American Version of WHO

STEPS CNCD Risk Factor Surveillance completed May 10, 2007

Data Processing is ongoing

Data Analysis- June 2008

Dominica will be among 4 countries, with CAREC, PAHO Washington and WHO- Geneva in Videoconference- May 15, 2008.

Ministry of Health & Environment

NCD Risk Factor Surveillance

This surveillance will include the incidence and prevalence rates of NCDs as well as their risk factorswhich will be used to:

Develop and National NCD Strategic Plan

Complete National Policy on NCD

inform NCDs programmes.

Ministry of Health & Environment

Policy and Advocacy.

The response to NCDs is guided by policy documents

which include:

The National Strategic Plan for Health The National Policy for Chronic Non-communicable

Diseases (draft) National Dietary Guidelines, 2007 Food and Nutrition Policy( to be finalized in Before

end of 2008

Ministry of Health & Environment

Policy/Advocacy Dialogues

On the initiative of the Hon. Prime Minister, a National

Summit on CNCDs held – December 14, 2007.

The theme of Summit:

“ Investing in health, Combating CNCDs”

Ministry of Health & Environment

National Summit- Purpose

To sensitize the Cabinet and other key stakeholders on

the situation of CNCDs and the need for:

collective policies and

comprehensive program for management of and prevention of their risk factors

Ministry of Health & Environment

National Summit- Objectives Present Dominica’s health profile, its position and

response to CARICOM Heads of Government Summit on management & control of NCDs

Strengthen political support and obligation for the management and prevention of NCDs and their risk factors.

Foster inter-institutional and inter-sectoral actions for management and prevention of NCDs and their risk factors.

Ministry of Health & Environment

National Summit- Objectives

Advocate for strengthening social network for prevention and management of NCDs and their risk factors.

Discuss and agree on the need for collective policies for prevention of risks for NCDS.

Ministry of Health & Environment

National Summit- Outcome

Clear statements on Dominica’s commitment to NCDs

A deeper sense of joint collaborative commitment among stakeholders for the need to implement the necessary actions to manage and control NCDs

Commitment to establishment of Dominica National Commission on NCDs

Ministry of Health & Environment

Dominica National Commission NCD To monitor conformity of Dominica’s policies, laws

and programmes with regards to its obligations arising from CARICOM Heads of Government “Declaration NCDs”.

To advise Cabinet on the State’s policies, laws and programmes with regards the its obligations arising from the Declaration.

To foster a multi-sectoral approach for addressing of epidemic of the CNCDs

Ministry of Health & Environment

Community based- initiatives

The Antihypertensive/Diabetes Project Woodford Hill,

The Calibishie Healthy Lifestyle Group Weight Watchers Project Laplaine The school health and family life education diet and

exercise healthy communities initiatives, screening prostate cancer among farmers

Ministry of Health & Environment

Thank you

Ministry of Health & Environment

Capacity Building- Workshop on Asthma Clinical Guidelines for

Caribbean

Sickle Cell Anaemia Capacity Building Workshop CARMEN Biennial Meeting in Bahamas- November

2007 PAHO/WHO Policy Analysis and Decision Making

Workshop Emphasis on NCD- Barbados Oct. 2007 Meeting of Expertise

Ministry of Health & Environment

Capacity Building-

Strengthening the cervical cancer Prevention/Screening and Management Programme

Development of Men’s Health Program- emphasis on Prostate cancer.