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International Conference on Healthy Lifestyles and Non Communicable Diseases (NCD) In the Arab World and the Middle-East (Riyadh, KSA, 9-12 September 2012) NCD Prevention and Control Experience in North Africa Pr Habiba Ben Romdhane Cardiovascular Epidemiology & Prevention Resarch Laboratory Tunisia
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
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 Registry Risk certification factors Quality survey Important Cancer CHD issue Algeria Yes 3 - YesMorocco Yes - - YesTunisia 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
Epidemiological Transition And Health Impact In North Africa (TAHINA) MEDiterranean studies of Cardiovascular disease and Hyperglycaemia: Analytical Modelling of Population Socio- economic 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
Forecasting Tunisian Type 2 Diabetes Prevalence to 2027 and Scenario Projections *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.
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