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5 habiba ben romdhane


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  • Few data on local initiatives targeting NCDs are available. A successful examples come from Tunisia : Ariana Healthy Urbanization Project
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    • 1. 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
    • 2.  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 .
    • 3. 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
    • 4. 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
    • 5. 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 .
    • 6. 2008-2013 Action Plan: what has it achieved ?
    • 7.  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.
    • 8. NCDs Surveillance Death Registry Risk certification factors Quality survey Important Cancer CHD issue Algeria Yes 3 - YesMorocco Yes - - YesTunisia Yes 3 1 Yes
    • 9.  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 .
    • 10. 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
    • 11. Reduction of risk factors Gaps in implementing “best buys” : FCTC and tobacco control measures salt reduction programmes marketing of foods physical activities programmes
    • 12. 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.
    • 13. 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
    • 14.  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)
    • 15. 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
    • 16. 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.
    • 17. 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 .
    • 18. CHD Mortality Trends in Tunisia 1997-2009: additional deaths attributable to risk factor changes & deaths prevented or postponed by treatments* * MedCHAMPS Project
    • 19. Forecasting Tunisian Type 2 Diabetes Prevalence to 2027
    • 20. 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.
    • 21. 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
    • 22. Thank you for your attention