The role of CNCD Commissions in tackling chronic diseases by bim75537


									The role of CNCD Commissions
 in tackling chronic diseases –
   The Barbados Experience

Dominica National Commission on CNCDs Capacity Building
              Workshop, 19 January 2010

              Professor Trevor A. Hassell,
       Chairman Commission for CNCDs, Barbados
         The burden of the CNCDs -
 Quarter of men and more than a third of women
  live with one or more CNCD
 Five leading causes of death are CNCDs
 Heart disease and stroke rank among leading causes of
 22% of Barbadian adults are hypertensive and 17.5% are
 Diabetes and hypertension account for 20% of primary care
 Overweight/obesity: 60% of women and 1/3rd men
“ Three primary risk factors ( tobacco, poor
  diet and physical inactivity) and three
  intermediate risk factors (hypertension,
  obesity and diabetes) lead to three diseases
  (heart disease, lung disease and cancer) all
  resulting in some 50% of all deaths.”
approaches to        Individual responsibility
chronic disease

                              Changes to the
                            "toxic" environment

                      POLICY ENACTMENT

 Support for the CNCD Commission -
 The Barbados Strategic Plan for Health, 2002-
 Strategy for the prevention and control of CNCD
  & Cabinet Note (2005) 26/MH.03, Ministry of
  Health, Barbados (2004);
 International Consultation on a Strategy for the
  Prevention and Control of CNCD for Barbados;
  Ministry of Health, Barbados (2005)
 “Healthy Hearts for life”. Report of the Task Force
  on the Development of Cardiovascular Services
  (Jan. 2007); Ministry of Health, Barbados
Support for the CNCD Commission -

 Heads of Government of CARICOM Summit
  and Declaration against CNCDs, 2007

 Healthy Caribbean 2008 Chronic Disease
  Conference: a wellness revolution event
 CARICOM Heads of Government Summit on Chronic
      Non-Communicable Diseases (CNCDs), 15
                    September 2007
adopted a fourteen-point declaration committing the
  region to collective action to stop the epidemic of
 **Infrastructure: Secretariat / CCH3 / Regional
  Plans, M & E;
 **National Commission, NCD Focal Point in MOH
 **Advocacy, Communications, Social marketing
 **Sustainable Financing
 **Surveillance, including Gender dimensions
    Priorities of the Summit
 Tobacco (FCTC)
 Healthy Eating (DPAS):
  – Trans Fat, Trade, Labeling
 Active Living (DPAS)
  – Population-wide activities
  – Schools/workplaces etc.
  – 2nd Saturday in Sept: “Caribbean Wellness
 Screening and integrated management

 To bring together a wide spectrum of
  partners from throughout the CARICOM
  countries – civil society, the business
  community, educators and researchers,
  policy makers to plan civil society’s response
  to the CNCD pandemic
   Agriculture      3         Anguilla
   Business         5         Antigua
   Education        3         Aruba
   Faith Based      4
   Finance          7
                               Bahamas
   Food Industry    2         Barbados
   Gov./Policy      13        Belize
   H C Providers    11        BVI
   Health Finance   3         Cayman islands
   Labour           5         Dominica
   Legal            1
                               Grenada
   Media            9
   NGO/CNCD         35        Guyana
   Pharma           3         Jamaica
   Reg./Pol         6         Montserrat
   Service Clubs    3         St. Lucia
   Sports/PA        3         Trinidad and Tobago
   Urban Dev.       3
                               St. Kitts
   Youth            3
 Active Caribbean Workshop
 Caribbean Civil Society Declaration on CNCDs
 Caribbean Civil Society Action Plan for tackling CNCDs,
 Conference Report produced as a Technical Report of the
  Chronic Disease Research Centre, UWI
 Creation of a Caribbean civil society coalition for tackling
  CNCDs - Healthy Caribbean Coalition
 Website:
 Co-sponsorship of upcoming University Diabetes Outreach
  Conference, Jamaica, 2010
 CNCD media campaign for Barbados and the OECS
      Summary of the Declaration
 10 point preamble and 12 point declaration
 Preamble recognizes the contribution of the CNCDs both to ill
  health & disease and excessive financial burden, but
  appreciates that much can be done
 Declares inter alia:
    Support for Heads of Government of CARICOM Declaration
     on CNCDs
    Need to establish a Caribbean Civil society CNCD coalition
    Stresses the need for increased advocacy
    Promotion of healthy lifestyles
    Public education and media campaigns
    Seeks to hold Governments accountable
    Summary of the Action Plan
 Action lines:
  Establishment of Caribbean CNCD coalition
  Support for Caribbean Wellness Day
  Development of a communication strategy
  Public education programme
  Risk factor reduction
  Support for country level activities
    The National Commission for CNCDs,
 Established January 2007
 Inter-sectoral body
 14 members and 4 ex-officio members
 Volunteers paid small stipend
 Meetings held monthly
 Professional, administrative and secretarial support
  provided by staff of the Health Promotion Unit
 No budget allocated to the Commission at start up
        The Commission’s mandate

 Advise Minister of Health on CNCD policies and legislation
 Broker involvement of all sectors in program implementation
 Assist in mobilisation of resources to facilitate implementation
  of programs
 Recommend relevant research
 Promote collaborations and partnerships
 Monitor regional and international trends
 Facilitate commissioning of audits /evaluation of CNCD
 Recommend to Minister of Health framework that encourages
  and promotes behaviour change to prevent CNCDs
       Membership of NCCNCD, Barbados
•   Professor Trevor Hassell MD., Chairman
•   Professor Henry Fraser MD., Dean Faculty of Medical Sciences
•   Mr. David Neiland , Businessman, the private sector
•   Mr Orlando Scott, trade union movement
•   Mr Wilfred Beckles, Barbados Association of Retired Persons
•   Mr. Michael Gaskin, teacher, physical education
•   Mr Adrian Randall , CEO, Heart & Stroke Foundation of Barbados
•   Dr Elliott Douglin MD., Representing Faith based organisations
•   Mrs. Sophia Cambridge, Advertising and media
•   Ms Candace Waldron, Youth Representative
•   Ms Zonia Phillips, Food and Nutrition advocate
•   Mr Barton Clarke Chief Agricultural Officer, Ministry of Agriculture
•   Mrs Wendy Griffith-Watson, Chief Education Officer
•   Mrs. Ena Harvey, IICA
      Strategic Plan: Objectives
 Internal action:
  Improved management of NCCNCD
  Improved CNCD data management
 External action:
  Health promotion
  Reduction of CNCD risk factors
  Quality CNCD treatment and care
Strategic Plan: Vision, mission and
 Vision: to be a leader in all major national
  developments related to CNCDs in order to
  achieve reduction in CNCDs
 Mission: Advises on, facilitates and promotes
  evidence based best practices in Prevention
  and Control of CNCDs
 Values: Transparency, inclusiveness, respect
  for all views, adoption of evidence based
  practices, accountability, and collaboration
    Strategic plan: key strategies

 Strategic management issues
 Epidemiological data, Health Information
  System and research
 Measures to support reduction of risk factors
 Health promotion
 Quality treatment and care
    Strategic management issues
 Advisory body guiding and assisting a highly
  motivated group of operational partners
 Driving CNCD interventions in collaboration
     Public and private sector
     Government and NGOs
     Professional and voluntary bodies
     Community based organizations
     Regional and international bodies
   Epi- data, Health Information
       Systems and Research
 Increasing access to data on CNCDs
 Strengthening functional links with CDRC/UWI
 Using the BNR as a priority data source to
  inform actions of the CNCD Commission
 Increasing surveillance capacity of Ministry of
 Using Health Information System
Measures to support reduction of
          risk factors
 Declare CNCDs a national priority
 Enhance the role of the commission with the
 Giving the public access to CNCD data
 Inform the public of standards in treatment
  and care
 Support on-going educational programmes
  targeting health care professionals
           Health promotion
 Integrate health promotion strategies in the
  planning process
 Improve inter-sectoral collaboration
 Lobby where necessary for high impact
 Influence legislation and regulation
     Quality treatment and care

 Establish standards for CNCD treatment and
           Indicators of success
 Organizational and management structures
   1. Budgetary funds allocated to CNCDs increased by 10%
   2. Administrative staff added to MOH to support
   3. Secretariat established
 Epi- data, HIS and research
   1. Implementation of annual surveillance reporting system
      for CNCDs
   2. Regular outputs from BNR
   3. Repeat BRFS survey in 2010
   4. Establishment of a web portal for CNCDs
              Indicators of success
 Risk factor reduction
   1. Complete adoption of at least 3 articles of FCTC by end of
   2. National population salt reduction policy articulated and
      programme implemented by 4th quarter of 2009
   3. Support for CME of health professionals
   4. Working relationship with National Nutrition Centre
 Health promotion
   1. Representation of CNCDs at the level of the Social partnership
   2. Sustained highly visible public education programme on CNCDs
 Quality treatment and care
   1. Annual training given to health care professionals in CNCD
              Tobacco exposure
 Significantly increase tax on tobacco products
 Remove duty free concessions on tobacco products at
  the ports of entry
 Ban sale of tobacco products to minors
 Ensure that warning labels on tobacco products meet
  international standards
 Ban smoking in public places
 Prohibit cigarette advertising at point of sale
                Physical inactivity
 Make materials and aids used in exercise and physical
  activity more affordable for personal use….VAT
 Enact policies to facilitate development of small
  community gyms
 Create tax incentives for property developers to create
  safe recreational spaces in communities
 Increase physical activity in schools
 Enact legislation and policies to make the city
  and the country more conducive to walking and
   Hypertension and blood pressure
 Continue to make blood pressure lowering drugs
  available at an affordable cost at point of
  delivery….Drug formulary
 Produce a more cost effective and more rational
  range of antihypertensive drugs
 Seek to provide delivery of care of hypertension
  by primary care doctors using the chronic care
  medical model
 Population salt reduction using a voluntary and
  collaborative approach informed by national
 Diabetes and blood sugar control

Enhance the provision of drugs, syringes,
  needles for diabetics…drug service
Provide blood glucose test strips
 Provide tax concessions or zero rate
   National Chronic Disease Registry
 An initiative of the Ministry of Health, executed on
  contract by the Chronic Disease Research Centre
 Sub-registries of acute myocardial infarction,
  stroke, and cancer, related risk factors and
 Aims to inform and guide prevention and
  intervention strategies, and optimal resource use
 Model for the region
 Complementary to PAHO/STEPS Risk Factor
  surveillance program
  The Commission and the Barbados
         National Registry
 Chairman of the Commission has a “direct
  interest” in the outputs of the Registry
 Commission facilitates and supports the work
  of the Registry
 Commission monitors and evaluates the
  operations of the Registry
 The Registry supports the information needs
  of the Commission
  The Commission and the Barbados
         National Registry

 The Commission in conjunction with the CMO will :
   Provide input to any public health, medical and
    epidemiological issues arising from that work
   Design and implement public awareness and
    communication strategies about the contribution
    of the Registry to population health status
   Design and implement “professional awareness
    strategies” to inform and engage the medical and
    related professions in the activities of the Registry
Barbados Behavioural Risk Factor
Survey (STEPS): 25 years and older

 Tobacco exposure
   8.4% current smokers
 Physical activity
   51% low level of physical activity
 Eating habits/diet
   95% ate less than 5 servings of fruit and
    vegetables per day
         Caribbean Wellness Day
 Introduced by Heads of Government of CARICOM
 Held on the 2nd Saturday in September
 Focus attention throughout the region on the
  chronic diseases
 Coordinated by the CNCD Commission
 All sectors of the community invited to participate,
  private sector, government, trade unions, civil
  society, the academic and educational institutions,
  faith based organisations
    National Nutrition Improvement
      and Salt Reduction Program
   Survey of population salt intake: initial and follow up
   Healthy nutrition policies and actions in schools
   Taxation policy around healthy food and beverages
   Public education campaign on radio, TV, and print
   Reformulation of food and drinks
   “Salt choice the difficult choice”
   Workshops and seminars for health care providers
   Barber shop screening project
The National Chronic Non-Communicable
       Disease Commission Logo
  Nutrition guidelines for schools

 Produced 2009
 A tool for use in schools to assist teachers and
  students in best practice nutrition
 Distribution of guidelines and implementation,
      Activities of the Commission
 Healthy Caribbean 2008 civil society conference
 Initiated service contracts with health NGOs
 Contributed to the Heads of Government of CARICOM
  Summit, 2007
 Contributor and lead role in development of Cabinet
  paper on CNCDs
 Consultation on trans fats / Faith based workshop
 Several lectures and presentations - CMOs and Ministers
  of Health, OECS; New Delhi, India; Washington, USA
 Publication of brochure “Battling the hidden enemy”
 CNCD media campaign for Barbados and the OECS

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