This document summarizes an experience in managing non-communicable diseases (NCDs) in North Africa. It examines preparedness in Algeria, Morocco, and Tunisia to address rising NCD rates due to similar cultures, lifestyles, and health systems following French colonization. NCDs cause over half of deaths in the region. While national NCD programs were implemented in the 1990s, 2008-2013 action plans were not fully realized. Surveillance and risk factor data exist but health systems remain fragmented. Multisector collaboration and sustainable financing models are needed to curb NCDs in Northern Africa through strengthened regional partnerships.

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 - Yes
Morocco Yes - - Yes
Tunisia 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