INTEGRATED NONCOMMUNICABLE DISEASE PREVENTION AND CONTROL POLICY: IMPLICATIONS FOR LOCAL IMPLEMENTAT

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INTEGRATED NON-COMMUNICABLE DISEASE PREVENTION
AND CONTROL POLICY IMPLICATIONS FOR LOCAL
IMPLEMENTATION

• DR. YOLANDA E. OLIVEROS
• Director IV
• National Center for Disease Prevention and
  Control
• Department of Health

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Non-Communicable Diseases

• Interchangeably use chronic diseases,
  degenerative diseases, lifestyle related diseases
• 4 major NCDs CVDs, CA, COPDs, DM
• Linked by four most common preventable risk
  factors related to lifestyle
• Tobacco use
• Unhealthy diet
• Physical inactivity
• Alcohol use

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Country NCD Situation

• The Philippines is one of the 23 selected
  countries contributing to around 80 of the
  total mortality burden attributable to chronic
  diseases in developing countries, and 50 of the
  total disease burden caused by non-communicable
  diseases worldwide.

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MORTALITY TEN LEADING CAUSES BY SEXNumber,
Rate/100,000 Population and Percent
DistributionPhilippines, 2004
Source  The 2004 Philippine Health Statistics
percent share from total deaths, all causes,
Philippines External Causes of MortalityLast
Update February 11, 2008
 
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Top Ten Leading Causes of Morbidity 2006

• Overall both sexes
• 4.Hypertension
• 7.Diseases of the Heart
• Source FHSIS, 2006

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RISK FACTORS

• 90 of Filipinos has one or more of these 6
  prevalent risk factors (NNHeS, FNRI 2003)
• Physical inactivity 60.5
• Smoking 34..8
• Hypertension 22.5
• Hypercholesterolemia 8.5
• Overweight 20
• Obesity 4.9
• Diabetes 4.6

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Trends in overweight among children 0-10 years old
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Trends in overweight among adolescents
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• Current Use of Tobacco Product Among Adolescents
• Both Sexes 27 (20 in 2003)
• Boys 34 (27 in 2003)
• Girls 14 (13 in 2003)
• (Source GYTS 2007)

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Risk Factors in the Phils

• 11 of Filipinos 15-74 years regularly drink
  alcoholic beverages (gt4 days/week)
• 24 of Filipinos 15-19 years are current drinkers
  (2001 survey n10,240)
• 42 of Filipinos 15-27 years are current drinkers
  (2002 survey n20,000)
• Mean value of pure alcohol consumed per day 4.8
  grams (2003 World Health Survey n4951)

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NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL
SERVICE

• Established 1986 with EO 119 reorganizing the
  Department of Health
• Developed vertical programs in early 1990s
• Cardiovascular Disease Prevention and Control
  Program
• National Cancer Control Program
• Diabetes Prevention and Control Program

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NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL
SERVICE

• LAUNCHED ADVOCACY AND IEC CAMPAIGNS AGAINST KNOWN
  RISK FACTORS
• YOSI KADIRI anti smoking
• EDI EXERCISE/HATAW /THE GREAT
• FILIPINO WORKOUT regular
• physical activity
• TIYA KULIT/ IWAS SAKIT DIET low
• salt, low fat, high fiber diet

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Recent and Current Evidence showed that....

• Preventing and controlling major risk factors in
  an integrated manner and employing health
  promotion across the life course at the level of
  family and community is thus most cost-effective

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WHO-DOH Demonstration Project in Pateros and
Guimaras 2003-2008

• Integrated Community Based NCD Prevention and
  Control Project
• Impact Evaluation
• Has met with some success in effecting lifestyle
  change particularly in Guimaras
• Policies, directives, guidelines should be in
  place to effect more success.
• Need to review implementation strategies and
  share lessons to LGUs for more effective
  implementation in the scale-up

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INTEGRATED NCD POLICY

• GOAL
• To reduce morbidity, disability and premature
  deaths due to NCDs, particularly CVDs, Cancers,
  COPDs and Diabetes Mellitus

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Policy Statement No. 1

• The Integrated NCD Prevention and Control Action
  follows the causation pathway of NCDs as a
  framework for action
• It supports the WHO Global and Regional Strategy
  for NCD Prevention and Control.

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Causation Pathway
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Causation Pathway
Intervention Pathway
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Strategic Approach
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Policy Statement No. 2

• Adoption of an integrated, comprehensive and
  community based response to NCD prevention and
  control
• Focuses on common risk factors guided by a life
  course perspective
• Encompasses the three levels of disease
  prevention primary, secondary and tertiary
  level
• Emphasizes strategies which would benefit entire
  population or large packets of population, but
  also takes care of high-risk populations
• Integrates across settings such as health
  centers, schools, workplaces and communities
• Makes explicit links to other government
  programmes
• Emphasizes intersectoral action

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Policy Statement No. 3

• Intensify health promotion to effect changes that
  lead to significant reduction in mortality and
  morbidity due to NCDs
• Changing lifestyles
• Changing the environment
• Reorienting the health system from the curative
  mode to the preventive or wellness mode

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Policy Statement No. 4

• Foster complementary accountabilities in the
  implementation of an Integrated NCD Prevention
  and control program
• DOH
• LGU
• Other GOs/NGAs
• Other Sectors, including Private sector and other
  stakeholders

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Guiding Principles

• Equity
• Sustainability
• Rights based
• Continuum of care throughout the life cycle
• Evidence based

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Key Strategies for Local Implementation

• Localize healthy public policies
• Build coalitions and partnerships
• Enhance community participation
• Create a supportive organizational and physical
  environment
• Intensify health education and public information

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Key Strategies for Local Implementation

• Institutionalize local assessment and planning
• Build or expand local capacities
• Reinstall supervision
• Establish financing schemes
• Install regulatory mechanisms
• Unify monitoring and evaluation efforts

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Lessons on Local Implementation

• National policies are useless if not locally
  adapted
• Success lies largely in the hands of implementing
  units
• Experience with PIPH-AOPs shows that effective
  strategies for NCDS are not fully utilized.
• Operationalizing this policy at the local level
  will ensure effective prevention and control
  efforts for NCDs

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Thank you.