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The Global Alliance against Chronic Respiratory Diseases

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					 The Global Alliance against
Chronic Respiratory Diseases



                                          Dr Nikolai Khaltaev
                  "Global lung health in 2000's"
             Antalya, Turkey, 25 – 26 April 2007
      Global Alliance against Chronic Respiratory Diseases
                        www.who.int/gard
                          Overview
• The global burden of chronic respiratory diseases
  – Chronic obstructive pulmonary disease (COPD)
  – Asthma
• WHO global approach to control chronic
  respiratory diseases
• The Global Alliance against Chronic Respiratory
  Diseases (GARD): a new way to prevent and
  control chronic respiratory diseases
• GARD country activities


              Global Alliance against Chronic Respiratory Diseases
                                www.who.int/gard
       The global burden
of chronic respiratory diseases




      Global Alliance against Chronic Respiratory Diseases
                        www.who.int/gard
Did you know??

                                4 000 000
                            PEOPLE DIED FROM
                                        CHRONIC
                                      RESPIRATORY
                                       DISEASES

                               IN 2005
Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
  Some widespread misunderstandings about chronic
        respiratory diseases - and the reality
                                            Projected global distribution of
MISUNDERSTANDING                            chronic respiratory disease deaths
                                            By World Bank income group, all
CHRONIC RESPIRATORY
                                            ages, 2005
DISEASES MAINLY AFFECT
HIGH INCOME COUNTRIES                                               High income
                                                                     countries
                                                                       13%
                                            Low income
                                             countries                            Upper middle
                                               34%                                  income
                                                                                  countries 5%


REALITY
87% OF CHRONIC
RESPIRATORY DISEASES
DEATHS OCCUR IN LOW &                                                           Lower middle
                                                                              income countries

MIDDLE INCOME COUNTRIES                                                            48%




             Global Alliance against Chronic Respiratory Diseases
                               www.who.int/gard
 Some widespread misunderstandings about chronic
       respiratory diseases - and the reality

MISUNDERSTANDING                             Projected global distribution of
                                             chronic respiratory disease deaths
CHRONIC RESPIRATORY                          all ages, 2005
DISEASES MAINLY
AFFECT MEN



REALITY
                                                        women       men
                                                         48%        52%
CHRONIC RESPIRATORY
DISEASES AFFECT WOMEN AND
MEN ALMOST EQUALLY



             Global Alliance against Chronic Respiratory Diseases
                               www.who.int/gard
Chronic respiratory diseases worldwide

                        Main chronic diseases include:

                            Cardiovascular diseases mainly
                             heart disease and stroke
                            Cancer
                            Chronic respiratory diseases
                            Diabetes



         Global Alliance against Chronic Respiratory Diseases
                           www.who.int/gard
    Chronic respiratory diseases worldwide
   Hundreds of millions of people have
      chronic respiratory diseases,
• including 300 million people with
  asthma,
• 80 million people with moderate to
  severe chronic obstructive pulmonary
  disease (COPD)
• and millions of others with
  mild COPD, allergic rhinitis, and other
  chronic respiratory diseases, which are
  often undiagnosed.


                          Global Alliance against Chronic Respiratory Diseases
                                            www.who.int/gard
Chronic respiratory diseases in Turkey




   In Turkey, chronic respiratory diseases accounted for
        6% of all deaths or 26 220 deaths in 2002.
            Global Alliance against Chronic Respiratory Diseases
                              www.who.int/gard
What are the causes of chronic respiratory diseases?




             Global Alliance against Chronic Respiratory Diseases
                               www.who.int/gard
 Burden of Major Respiratory Conditions

  Condition                                                             Deaths DALYs*
                                                                           %     %
  Lower Respiratory Infections                                            6.6   5.8
  COPD                                                                    4.8   1.9
  Tuberculosis                                                            2.8      2.4
  Lung/ Bronchus /Trachea Cancer                                          2.2      0.8
  Asthma                                                                  0.4      1.0
  Total                                                                  16.8    11.9
                                                               Source: World Health Report 2003
*DALYs = Disability-Adjusted Life-Years

                 Global Alliance against Chronic Respiratory Diseases
                                   www.who.int/gard
          What are DALYs?
                    Disability
                    Adjusted
                    Life
                    Years
One DALY: one lost year of “healthy” life

      DALY = YLD + YLL
      COPD                                                          expected
                                           death
      onset                                                           death
         55                                  65                         75 age (years)
50                        YLD                           YLL
                       Years of Life               Years of Life Lost
                       with Disability
      Global Alliance against Chronic Respiratory Diseases
                        www.who.int/gard
                  Increasing Burden of Diseases and Injuries:
                       Change in Rank Order of DALYs*
*DALYs = Disability-Adjusted Life-Years                        Source: WHO Evidence, Information and Policy, 2005




    *DALYs: Disability Adjusted Life Years




                              Global Alliance against Chronic Respiratory Diseases
                                                www.who.int/gard
Chronic obstructive pulmonary disease (COPD)

      "When I was 16 years old, my primary doctor told me
      that smoking would help me lose weight, so every
      time I started a diet, I also started to smoke.
      Now I am an invisible picture of COPD disability. I am
      not yet using oxygen, but I know that day will come. I
      am unable to do many of the things I love. I cannot
      dance. I cannot do my own food shopping. I cannot
      take long walks along the river at sunset with my
      husband."

      Elaine L. Ackley, 58 years, New York, United States
      of America
          Global Alliance against Chronic Respiratory Diseases
                            www.who.int/gard
                   Burden of COPD
• COPD is a major cause of morbidity, death and disability

• The main cause for developing COPD is tobacco smoking

• COPD is not just simply a "smoker's cough", but a disease
  that kills per year 3 million people worldwide

• Despite its ease of diagnosis, COPD remains an under-
  diagnosed disease, chiefly in its milder and more treatable
  form


               Global Alliance against Chronic Respiratory Diseases
                                 www.who.int/gard
       World map COPD - Deaths / 1000
                 year 2000




<6.2
6.2-9.7
     .
9.7-15.7
15.7-18.1
18.1-19.9
19.9-22.1
22.1-35.5
35.5-38.1
>38.1
no data

            Global Alliance against Chronic Respiratory Diseases
                              www.who.int/gard
      World map COPD – DALYs* / 1000
                year 2000




<0.10
0.10-0.79
0.80-2.19
2.20-2.59
2.60-3.49
3.50-3.89
3.90-4.399
4.40-6.69
>6.70
no data
                                        *DALYs: disability-adjusted life year
             Global Alliance against Chronic Respiratory Diseases
                               www.who.int/gard
Prevalence of COPD in Europe




    Global Alliance against Chronic Respiratory Diseases
                      www.who.int/gard
        Risk factors

                                                       Passive smoking




                                                       "Keep it funny, Keep it
                                                       smoke free"




                                                       Anti smoke campaign,
                                                       The Netherlands




Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
 The relative importance of Tobacco Smoke
  and other risk factors relevant for COPD

Opposite patterns in different geographic areas




   EUROPE versus AFRICA
                                             Source: World Health Report 2002
       Global Alliance against Chronic Respiratory Diseases
                         www.who.int/gard
                                                 EUROPE
            Disease burden (DALYs) in 2000 attributable to selected risk factors


                       Blood pressure
                               Tobacco
                                Alcohol
                           Cholesterol                                                       Tobacco
               High Body Mass Index
           Fruit and vegetable intake
                   Physical inactivity
                           Illicit drugs
                       Lead exposure
                           Unsafe sex
                       Iron deficiency
  Occupational risk factors for injury
                   Urban air pollution
                                                          Urban air
             Childhood sexual abuse                       pollution
                          Underweight
Unsafe water, sanitation, and hygiene
       Indoor smoke from solid fuels
                                           0            5000           10000         15000          20000
                                                  Number of Disability-Adjusted Life Years (000s)
                              Global Alliance against Chronic Respiratory Diseases
                                                www.who.int/gard
                                                 AFRICA
            Disease burden (DALYs) in 2000 attributable to selected risk factors


                           Unsafe sex
                          Underweight
Unsafe water, sanitation, and hygiene
                 Vitamin A deficiency
                       Zinc deficiency
       Indoor smoke from solid fuels
                       Iron deficiency
                                                                 Indoor air pollution
                              Alcohol
                       Blood pressure
               Lack of contraception
                             Tobacco                    Tobacco
                           Cholesterol
        Unsafe health care injections
               Global climate change
                       Lead exposure
  Occupational risk factors for injury
           Fruit and vegetable intake
                                         0     10000   20000     30000     40000     50000     60000   70000
                                                    Number of Disability-Adjusted Life Years (000s)

                             Global Alliance against Chronic Respiratory Diseases
                                               www.who.int/gard
Risks are increasing: burden of disease attributable to
        tobacco (% DALYs in each subregion)
  Source: World Health Report, 2002




                     Global Alliance against Chronic Respiratory Diseases
                                       www.who.int/gard
Risks are increasing: burden of disease attributable to indoor smoke
            from solid fuels (% DALYs in each subregion)




                                                            Source: World Health Report, 2002
                  Global Alliance against Chronic Respiratory Diseases
                                    www.who.int/gard
Risks are increasing: burden of disease attributable to urban air
             pollution (% DALYs in each subregion)




                                                             Source: World Health Report, 2002
                 Global Alliance against Chronic Respiratory Diseases
                                   www.who.int/gard
                  Burden of asthma
                                    •      Asthma is not just a public health
                                           problem for high income countries: it
                                           occurs in all countries regardless of
                                           level of development. Over 80% of
                                           asthma deaths occurs in low and lower-
                                           middle income countries.
                                    •      Asthma deaths will increase by almost
                                           20% in the next 10 years if urgent
                                           action is not taken.
•   According to WHO estimates, 300 million people suffer from asthma
    and 255 000 people died of asthma in 2005.
•   Asthma is the most common chronic disease among children.
               Global Alliance against Chronic Respiratory Diseases
                                 www.who.int/gard
                                                       Global Burden of Asthma 2004


Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
                                                       Global Burden of Asthma 2004



Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
                                                       Global Burden of Asthma 2004


Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
WHO global approach to control
 Chronic Respiratory Diseases




      Global Alliance against Chronic Respiratory Diseases
                        www.who.int/gard
Framework Convention on Tobacco Control (FCTC)

          As for 17 December 2004: 47 countries have
             ratified the treaty. On 27 February 2005:
        the FCTC has entered into force and has become
                         an International law.




              Today the FCTC has 146 parties
                      (16 April 2007)
             Global Alliance against Chronic Respiratory Diseases
                               www.who.int/gard
Framework Convention on Tobacco Control (FCTC)
• Taxes – tax and price measures are an important way of reducing tobacco
  consumption, particularly in young people, and requires signatories to
  consider public health objectives when implementing tax and price policies on
  tobacco products.

• Labelling – The text requires that at least 30 per cent of the display area on
  tobacco product packaging is taken up by clear health warnings in the form of
  text, pictures or a combination of the two. Packaging and labelling
  requirements also prohibit misleading language such as “light”, “mild” or “low
  tar”.

• Advertising –The final text requires parties to move towards a
  comprehensive ban within five years of the convention entering into force.

                     Global Alliance against Chronic Respiratory Diseases
                                       www.who.int/gard
Framework Convention on Tobacco Control (FCTC)

• Liability – Parties to the convention are encouraged to pursue legislative
  action to hold the tobacco industry liable for costs related to tobacco use.
• Financing – Parties are required to provide financial support to their national
  tobacco control programmes. A number of countries and development
  agencies, have already pledged their commitment to include tobacco control
  as a development priority.
• Other issues - The text also requires countries to promote treatment
  programmes to help people stop smoking and education to prevent people
  from starting, to prohibit sales of tobacco products to minors, and to limit
  public exposure to second-hand smoke.




                      Global Alliance against Chronic Respiratory Diseases
                                        www.who.int/gard
        WHO/NHLBI                                                 WHO/ARIA




                                        1995                                                 2001
One of the first examples of worldwide used                     Including adaptation to developing
        disease-specific guidelines                                          countries:
        and the 1st one on Asthma                                               EBM
                                                             low drug cost affordable for most patients
           Project coordinators                                     WHO essential list of drugs
         Nikolai Khaltaev (WHO)
         Claude Lenfant (NHLBI)


                           Global Alliance against Chronic Respiratory Diseases
                                             www.who.int/gard
WHO/NHLBI

                             2001
                                         The first worldwide
                                          used guidelines
                                             on COPD
                                      NHLBI/WHO Workshop Report:
                                     Global Strategy for the Diagnosis,
                                  Management, and Prevention of COPD.
                                         Scientific information and
                                  recommendations for COPD programs.


     Global Alliance against Chronic Respiratory Diseases
                       www.who.int/gard
                             Practical
                             Approach to                        2003
                             Lung health
                            A primary health care strategy for a coordinated and
                            standardized approach
                            for an integrated management of the patient with
                            respiratory symptoms in countries with
                            epidemiological transition.

                            Targets
                            Improve diagnostic strategies,
                            reduce inappropriate care,
                            foster cost reduction strategies,
                            savings in antibiotic usage and
                            increase appropriate CS usage
                            Tested in 15 different countries
                                                                 Source : WHO/STB

Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
STEP


       SuRF
                                            WHO/MNC/CRA/03.2




            Prevention of
            Allergy and
            Allergic Asthma
            Based on the WHO/WAO Meeting on the
            Prevention of Allergy and Allergic Asthma
            Geneva,8-9 January 2002




FCTC
        Global Alliance against Chronic Respiratory Diseases
                          www.who.int/gard
A new way to prevent and control
  chronic respiratory diseases




Global Alliance against Chronic
    Respiratory Diseases
       Global Alliance against Chronic Respiratory Diseases
                         www.who.int/gard
               The enormous human suffering caused by
     chronic respiratory diseases (CRD) has been recognized by the

             53rd World Health Assembly (May 2000)
                which requested the Director General to:

•   To continue giving priority to prevention and control of
    noncommunicable diseases, including CRD, with special emphasis
    on developing countries and other deprived populations;

•   To coordinate, in collaboration with the international community,
    global partnerships and alliances for resource mobilization,
    advocacy, capacity building and collaborative research




                    Global Alliance against Chronic Respiratory Diseases
                                      www.who.int/gard
What is the value added
  of this new way?
                        The value added of developing an alliance
                        with specialized national and international
                        NGOs is to:
                      • To share responsibilities and building on each
                        partner's expertise
                      • To combine the partners' strengths and
                        knowledge, thereby achieving results that no
                        one partner could attain alone.
                      • To improve coordination between existing
                        governmental and nongovernmental
                        programmes, which avoids duplication of
                        efforts and wasting of resources.


Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
Before GARD = lack of coordination, competition




         Global Alliance against Chronic Respiratory Diseases
                           www.who.int/gard
WHO calls for a global and coordinated effort
   to fight Chronic Respiratory Diseases




      Global Alliance against Chronic Respiratory Diseases
                        www.who.int/gard
GARD Global Launch, 28 March 2006, Beijing,
       People's Republic of China

                                             "GARD will provide an effective
                                             form in which health care workers,
                                             institutions and governments from
                                             all countries may jointly work to
                                             mobilize the entire population in
                                             efforts to prevent and control
                                             chronic respiratory diseases".

                                             Dr Longde Wang
                                            Vice Minister of Health, People's
                                            Republic of China




        Global Alliance against Chronic Respiratory Diseases
                          www.who.int/gard
                                          GARD
                                    “I am happy to hear that the Global Alliance
                                    against Chronic Respiratory Diseases is now in
                                    place as a global team. As a team, each
                                    member will contribute his or her unique
                                    strengths, just like in football. Together, the
                                    Alliance's teamwork will provide help to the
                                    hundreds of millions of people who suffer from
                                    chronic respiratory diseases, including those in
                                    my country who do not have access to essential
                                    treatments.”
Pele, soccer legend




                      Global Alliance against Chronic Respiratory Diseases
                                        www.who.int/gard
                                      GARD
"Reaching a major goal like conquering
chronic respiratory diseases is similar to a
marathon run: it's a big effort but with
energy, knowledge, support and the will to
win, it can be done. I am convinced that the
Global Alliance for Respiratory Diseases will
win the battle against chronic respiratory
disease, which kills four million people a
year"

Rosa Mota, former Portuguese marathon runner
and Olympic champion


                  Global Alliance against Chronic Respiratory Diseases
                                    www.who.int/gard
                   GARD Vision
A world where all people breathe freely




        Global Alliance against Chronic Respiratory Diseases
                          www.who.int/gard
                 GARD Goal and Objective
Goal
To reduce the global burden of chronic respiratory diseases

Objective
To initiate a comprehensive approach to fight chronic respiratory diseases through:

• developing a standard way of obtaining relevant data on chronic respiratory
  disease risk factors;
• encouraging countries to implement health promotion and chronic disease
  prevention policies; and
• making recommendations of simple strategies for management of chronic
  respiratory diseases.



                      Global Alliance against Chronic Respiratory Diseases
                                        www.who.int/gard
                                                                                March 2007
                                          Jan 2005            WHO                           GINA (P. O’Byrne, CAN)
                      June 2004                               AAA (D. Vervloet, France)     GOLD (L. Fabbri, ITA)
                                          WHO                 AAAAI (E. Simon, CAN)         ICC (L. Grouse, USA)
           Jan 2003   WHO                 AAAAI               AAAF (R. Pawankar, JAP)       INTERASMA (I. Ansotegui,
                                          AAAF
Oct 2002   WHO        ACAAI                                   ACAAI (M. Blaiss, USA)        SPA)
                      ALAT                ACAAI               AIMAR (C. Donner, ITA)        IPCRG (A. Ostrem, UK)
           EFA                            ARIA
 WHO                  ARIA                                    ALAT (C. Luna, ARG)           IPRAIS (J. Warner, UK)
           ARIA                           ATS
 EFA                  ATS                                     ALLERG.O.S (P. Demoly, FRA)   IUATLD (N. Billo, FRA)
                      EAACI               EAACI               APAACI (T. Fukuda, JAP)       KAF (Y. Kim, KOR)
            3         EFA                 EFA                 APRS (Y. Fukuchi, JAP)        KTL (P. Puska, FIN)
  2                   ERS                 ERS                 ARIA (J. Bousquet, FRA)       NHLBI (B. Alving, USA)
                      FILHA               FILHA               ATS (P. Wagner, USA)          PSA (M. Kowalski, POL)
                      FIRS                FIRS                CCM (D. Greco, ITA)           RSP (A. Chuchalin, RUS)
                      GA2LEN              GA2LEN              CNR-INMM (G. Rasi, ITA)       SIMER (G. D'Amato, ITA)
                      GINA                GINA                DLHA (DK)                     SFAIC (G.Pauli, FRA)
                      GOLD                GOLD                EAACI (U. Wahn, GER)          SPAIC (M. Morais de Almeida)
                      NHLBI               ICC                 ECARF (T. Zuberbier, GER)     SPLF (B. Housset, FRA)
                      WAO                 INTERASMA           EFA (S. Palkonen, FIN)        TTS (A. Kocabas, TUR)
                      WHO-CC DU           KAF                 ERS (R. Dahl, DK)             TNSACI (O. Kalayci, TUR)
                                          NHLBI               FEMTEC (U. Solimene, ITA)     WAO (C. Baena-Cagnani, ARG)
                                          WAO                 FILHA R. Kauppinen, FIN)      WHO-CC DU (S. Makino, JAP)
                        15                WHO-CC DU                                         WHO-CC GU (G. Joos, BEL)
                                                              FIRS (A. Turnbull, SWI)
                                          WHO-CC UCM          GA2LEN (P. Van Cauwenberge,   WONCA (A. Loh, SIN)
                                          WONCA               BEL)
 Participants                                                                                        45
                                           21
                             Global Alliance against Chronic Respiratory Diseases
                                               www.who.int/gard
GARD is part of WHO's work to prevent
   and control chronic diseases


                                          Comprehensive
                                          and integrated
                                          action is the
                                          means to prevent
                                          and control chronic
                                          diseases

       Global Alliance against Chronic Respiratory Diseases
                         www.who.int/gard
    A global alliance working at country level

• GARD focuses on the needs of countries

• and fosters country-specific initiatives tailored to
  local conditions.




               Global Alliance against Chronic Respiratory Diseases
                                 www.who.int/gard
            Desired outcome at country level:
                   initiated or upgraded
     programme on surveillance, prevention and control of
               chronic respiratory diseases

                                                         HOW?

                             Approach:
         Alliances against Chronic Respiratory Diseases
are established at country level (GARD Country), in order for the
activities of the Alliance to meet the specific needs of countries.

                Global Alliance against Chronic Respiratory Diseases
                                  www.who.int/gard
     What does GARD Country do?

1. Coordinating already existing activities and
   exchanging relevant information
2. Analysing the situation of chronic respiratory
   diseases in the country
3. Raising greater awareness on chronic respiratory
   diseases and their risk factors
4. Running intervention projects on chronic
   respiratory diseases prevention and control
5. Generating political commitment
           Global Alliance against Chronic Respiratory Diseases
                             www.who.int/gard
      Who guides the process to explore and
             build GARD Country?

• GARD Country Initiator is a person or an
  organization that develops the initial idea and takes
  the first step in formulating the apporach of building
  an alliance at country level

• The Core Group of interested parties is a group
  of interested parties which gathers with GARD
  Country Initiator

              Global Alliance against Chronic Respiratory Diseases
                                www.who.int/gard
                     Prerequisites
1. The situation of chronic respiratory disease
   surveillance, prevention and control programme in
   the country is analysed.
2. The Ministry of Health is informed about GARD
   Country and invited to be involved in its
   development.
3. WHO Regional Office and WHO Representative are
   informed about GARD Country and invited to be
   involved in its development.

             Global Alliance against Chronic Respiratory Diseases
                               www.who.int/gard
          Situation analysis…
GARD runs pilot projects on surveillance of chronic
respiratory diseases at primary health care level

– Georgia
– Russian Federation
– Cape Verde
– Philippines


          Global Alliance against Chronic Respiratory Diseases
                            www.who.int/gard
                            … in Georgia




 Firstly, patients fill in a WHO                   Secondly, patients are screened
questionnaire on symptoms of                        by doing a spirometry test that
 chronic respiratory diseases,                       measures the lung capacity
 environmental exposure and
         smoking habits
                  Global Alliance against Chronic Respiratory Diseases
                                    www.who.int/gard
   …. in Ryazan, Russian Federation


A patient is
screened by
doing a
spirometry
test



               Global Alliance against Chronic Respiratory Diseases
                                 www.who.int/gard
     …in Cape Verde and the Philippines
Cape Verde (Praia and Sao                                    Philippines (Guimaras): data on
Vincente): data on the prevalence                            the prevalence of CRD have
of CRD have been collected and                               been collected and are being
are being processed                                          processed




                    Global Alliance against Chronic Respiratory Diseases
                                      www.who.int/gard
Involvement of the Ministry of Health

                                       • Poland:
                                         GARD Symposium for
                                         Eastern European
                                         countries under
                                         auspices of Professor
                                         Zbigniew Religa,
                                         Minister of Health,
                                         Republic of Poland,
                                         Zakopane, Poland,
                                         23-24 March 2007


        Global Alliance against Chronic Respiratory Diseases
                          www.who.int/gard
       Involvement of the Ministry of Health
• Algeria: Meeting between                 • Turkey: participation of GARD
  GARD Chairman and                          initiator in a meeting on
  Minister of Health,                        chronic diseases organized by
  Dr Amar Tou, Alger, 23                     the Ministry of Health,
  July 2006                                  Istanbul, 16 January 2007

                                                    GARD Focal Point appointed
                                                    within the Ministry of Health




               Global Alliance against Chronic Respiratory Diseases
                                 www.who.int/gard
Involvement of the Ministry of Health

                                                        • Brazil:
                                                          Meeting with Dr
                                                          Luis Fernando
                                                          Sampaio,
                                                          Director of Primary
                                                          Care, Ministry of
                                                          Health
                                                          April 2006



       Global Alliance against Chronic Respiratory Diseases
                         www.who.int/gard
Involvement of the Ministry of Health
                                       • China: Dr Longde Wang, Vice
                                         Minister of Health, opening
                                         GARD Global Launch, 28
                                         March 2006, Beijing

                                            "GARD will provide an effective
                                            form in which health care
                                            workers, institutions and
                                            governments from all countries
                                            may jointly work to mobilize the
                                            entire population in efforts to
                                            prevent and control chronic
                                            respiratory diseases".

       Global Alliance against Chronic Respiratory Diseases
                         www.who.int/gard
     Steps to develop a GARD Country

1.   Agreeing on a definition of Alliance
2.   Nominating a GARD Country Coordinator
3.   Identifying other partners
4.   Running an exploratory workshop
5.   Defining the Terms of Reference
6.   Defining the structure
7.   Identifying outcomes

           Global Alliance against Chronic Respiratory Diseases
                             www.who.int/gard
              1. Agreeing on a definition of Alliance
PROPOSED DEFINITION                                                            GARD COUNTRY

A strategic alliance                                                          GARD Country shall act
                                                                              as a coordination and
                                                                              creation of a momentum
between organizations drawn
from different sectors of                                                     that invites new inputs
societies                                                                     from various interested
(government, business,                                                        parties
NGOs)

who commit to work                                                             in order to strengthen
collaboratively towards a                                                      the national capacity
common goal.                                                                   to face the increasing
                                                                               impact of CRD.
                       Global Alliance against Chronic Respiratory Diseases
                                         www.who.int/gard
  2. Nominating a GARD Country Coordinator
                                                       Ministry of Health
 WHO on behalf of
 GARD Executive                                        GARD Country initiator
 Committee
                                                       Core group of interested parties
 NOMINATES
                                                       ENDORSE




               GARD Country Coordinator
• International recognition of his/her capabilities in surveillance,
  prevention and control of CRD
• Entrusted by Ministry of Health, GARD Country initiator and other
  interested parties
• Committed to the public health system of the country
• Good communication and diplomatic skills
               Global Alliance against Chronic Respiratory Diseases
                                 www.who.int/gard
   Faces of GARD Country Coordinators




 Prof Tamaz Maglakelidze                             Prof Paulo Camargos
GARD coordinator Georgia                            GARD coordinator Brazil

            Global Alliance against Chronic Respiratory Diseases
                              www.who.int/gard
         3. Identifying other potential partners
   GARD Country Coordinator shall make an inventory of the various
   interested parties:
                             Within Ministry of Health:
• Between specific programmes on chronic respiratory diseases
• Between supporting programmes, services, departments at national and regional
  level:
    – Human Resources Development Department
    – Health Statistics Department
    – Health Finance Department
    – Drug Control Department
    – Health Education Programme
    – Health Care Reforms
    – Environmental Health Unit

                    Global Alliance against Chronic Respiratory Diseases
                                      www.who.int/gard
           Multilateral   Educational
            Bilateral       Sector
           Agencies
                                      Professional
Communities,                          Associations
 churches,          Identifying
  religious
   leaders            partners
                  outside Ministry        Patient
Private sector,      of Health            Groups
    media

                                     CRD and
          Related                      public
          Ministries                   health
                          NGOs
                                      experts
       4. Running an exploratory workshop
The country coordinator and the Ministry of Health focal point call a workshop
with the core group of interested parties and the short listed potential partners.
                             During this workshop:

• a vision for the alliance is agreed upon
• the purpose and shared objectives of the alliance are agreed
• the interest and expected benefit of each single partners are identified
• the resources and competencies that each partner could bring to the alliance are
  mapped
• roles and responsibilities of each partner are decided
• project ideas are that could be carried out collaboratively are outlined
• options for management mechanisms are explored



                     Global Alliance against Chronic Respiratory Diseases
                                       www.who.int/gard
Exploratory workshop in Brazil, April 2006




         Global Alliance against Chronic Respiratory Diseases
                           www.who.int/gard
Exploratory workshop for Eastern European Countries,
              Poland, 23-24 March 2007




                              4




            Global Alliance against Chronic Respiratory Diseases
                              www.who.int/gard
     5. Defining the Terms of Reference
     A sub-committee is appointed by GARD Country Coordinator to draft
               the Terms of Reference of GARD Country


a.   General Purpose: to reduce the burden of CRD at national level
b.   Technical Objectives: different according to the products of GARD
     action plan that best suit the country
c.   In general:

        Coordinating existing activities related to CRD
        Exchanging relevant information
        Raising greater awareness on CRD and their risk factors as well as on
         prevention and treatment
        Running intervention projects on CRD surveillance, prevention and control
        Generating political commitment at country level
        Raising additional resources
                   Global Alliance against Chronic Respiratory Diseases
                                     www.who.int/gard
    Raising greater awareness on chronic respiratory
                    diseases in China


The Launch
Meeting of China
COPD Alliance in
Guangzhou,
4 November 2006




                   Global Alliance against Chronic Respiratory Diseases
                                     www.who.int/gard
    Raising greater awareness on chronic respiratory
                    diseases in China

The Launch
Meeting of
Asthma Alliance in
Zhengzhou,
Henan
4 June 2005




                     Global Alliance against Chronic Respiratory Diseases
                                       www.who.int/gard
     Running intervention projects

GARD has started to run intervention projects
on chronic respiratory diseases prevention
and control:
– Brazil
– Tunisia




            Global Alliance against Chronic Respiratory Diseases
                              www.who.int/gard
                                 … in Brazil
Brazil (Belo Horizonte):
Programme Criança que
Chia (Wheezing Child)




                                                            Brazil (Bahia): Pilot project
                                                            on control of severe asthma


                  Global Alliance against Chronic Respiratory Diseases
                                    www.who.int/gard
            … in Tunisia

                                           Tunisia (since 2002):
                                           Pilot project on control of
                                           CRD:
                                           • Practical Approach to Lung
                 TUNISIA
                                           Health (PAL) implemented
                                           • Increased diagnosis
                                           • Reduction of prescription of
                                           antibiotics
                                           • Reduction of medication
                                           costs per patient


Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
                     6. Defining the structure
A proposal:




                                              Planning Group
                     GARD Country



                                              GARD Country



                                                                      GARD Country
                                                                      secretariat
                     Council



Plenary body of all GARD                                                             It supports GARD Country
Country partners                        Driving force of the Alliance                and assists the partners
Chaired by GARD Country                 Composed of partners                         Managed by GARD
Coordinator                             elected by the Council                       Country Coordinator
                           Global Alliance against Chronic Respiratory Diseases
                                             www.who.int/gard
GARD Brazil Council




Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard
                7. Identifying outcomes
• Are you doing things right?
• What have you learnt from building the alliance?
• Has the alliance been effective to achieve its aims?
• Have the partners all benefited from their involvement?
• How much has GARD Country achieved in the country (process and
  output)?
• Has GARD Country brought any change in CRD surveillance,
  prevention and control in he country (outcome)?




          If not, EXIT STRATEGY


                 Global Alliance against Chronic Respiratory Diseases
                                   www.who.int/gard
                           Overview

• A global alliance working at country level
• Who guides the process?
• Prerequisites to develop an alliance at country
  level
• Steps to develop an alliance at country level
• Current activities countries

            Global Alliance against Chronic Respiratory Diseases
                              www.who.int/gard
Overview of GARD in countries




      Global Alliance against Chronic Respiratory Diseases
                        www.who.int/gard
   Overview of GARD in countries
• Pilot projects in:                        • Other interested countries:
   – Algeria                                   – Argentina
   – Brazil                                    – Bulgaria
   – Cape Verde                                – France
   – China                                     – Greece
   – Georgia                                   – Italy
   – Republic of Korea                         – Kazakhstan
   – Philippines                               – Norway
   – Russian Federation                        – Paraguay
   – Tunisia                                   – Poland
   – Turkey                                    – Portugal
                                               – South Africa
                                               – Vietnam

               Global Alliance against Chronic Respiratory Diseases
                                 www.who.int/gard
Global Alliance against Chronic Respiratory Diseases
                  www.who.int/gard

				
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