Pan American Health Organization

1
III Meeting of the Global Forum on NCD
Prevention and Control Rio de Janeiro,
Brazil November 2003 Lucimar Coser Cannon, MD
PhD

• Pan American Health Organization
• Pan American Sanitary Bureau
• Regional Office for the Americas for the
• World Health Organization

2
C A R M E N Conjunto de Acciones para la
Reduccion Multifactorial de Enfermedades No
transmisibles Integrated Noncommunicable
Disease Prevention

• Pan American Health Organization
• Pan American Sanitary Bureau
• Regional Office for the Americas for the
• World Health Organization

3
Background

• 1996 PAHO took initial steps to support
  integrated prevention programs in the Americas
• Benefited from the successful experiences and
  collaboration of CINDI
• Adopted to fit the Latin American and Caribbean
  context (more flexible approach)
• September 2002, the Pan American Sanitary
  Conference approved a resolution that endorses
  CARMEN as one of the main strategies for the
  integrated prevention of chronic NCDs.

4
CARMEN INITIATIVE

• Objective
• To promote and support the reduction of NCD risk
  factors and risk conditions in the Americas.

5
Risk-Reduction Component
6
Risk-Reduction ComponentIntegrated Prevention
and Health Promotion

• Simultaneous action at three levels
• Policy building
• Community-based action
• Health care services
• Simultaneous action over a variety of NCD risk
  factors common to major NCDs
• Concomitant use of community and health sector
  resources from other sectors
• Example Colombia

7
Strategies Colombia
Community Participation
Promotion of healthy habits and lifestyles,
communication and education
Surveillance of NCDs and NCD risk factors
Strengthening The CARMEN Initiative
Public Policies
Research
Participation of key actors
Receptive health care services
8
Risk-Reduction ComponentDemonstrative Effect

• Interventions are first introduced in a
  demonstration area so that acceptability, safety,
  and effectiveness can be evaluated in a given
  context.
• Impact on NCD risk factors, morbidity and
  mortality can be measured
• This requires
• Baseline measurements for future comparisons
• Surveillance of risk conditions
• Systematic collection of general information
  related to an implemented intervention

9
Risk-Reduction ComponentPromotion of Health
Equity

• Prevention strategies should consider the
  underlying influences on health inequalities.
• Strategies should reduce overall population risk
  and at the same time reduce the gap among
  different population groups.
• Ex. Brazil - Nutrition Policy

10
Risk-Reduction ComponentPromotion of Health
Equity

• National Food and Nutrition Policy
• To guarantee the quality of foods available for
  consumption in Brazil, to promote healthy
  dietary practices and to prevent and control
  nutritional disorders as well as to stimulate
  intersectoral actions which favor universal
  access to foods.

11
Structure of CARMENNetwork Development
Component The CARMEN Network
Objectives

• Promote and support cost-effective interventions
  for NCD prevention.
• Obtain the support of policy-makers and
  legislators.
• Promote and support community participation in
  NCD prevention initiatives.
• Promote a regional agenda for tackling the NCD
  epidemic.

12
Structure of CARMEN
Network Development Component
Strategy Technical Cooperation Among Countries
Lines of Action
Advocacy
Mobilization of resources
Monitoring Evaluation
Research
Skills-training
Tools
Technical Guidelines
Project Portfolio
13
Composition of the CARMEN Network

• Member Countries
• Collaborative Members
• The CARMEN Network Secretariat (PAHO)

14
Composition of the NetworkMember Countries
Member countries Argentina, Brazil, Canada,
Chile, Colombia, Costa Rica, Cuba, El Salvador,
Guatemala, Panama, Peru, Puerto Rico, Trinidad
Tobago and Uruguay   Prospective countries
Aruba, Belize, Bolivia, Curacao, Honduras,
Nicaragua, Suriname, and Venezuela.   Special
Projects US/Mexico (border) and CARLI  

 
15
Composition of the NetworkCollaborative Members

• The Physical Activity Network of the Americas
  (PANA/RAFA)
• The Produce for Better Health Foundation 5 A Day
  for Better Health
• The Americas Network for Chronic Disease
  Surveillance
• The National Heart Lung and Blood Institute
• The Inter-American Heart Federation

16
Country Contributions to the CARMEN Network

• Brazil Monitoring and Evaluating CARMEN
  Interventions
• Canada Policy Observatory
• Chile CARMEN School
• Panama Small Grants Research Project
• Peru A Proposal for Implementing Integrated NCD
  Prevention Interventions
• Puerto Rico Network Communication

17

CARMEN and Disease Control The VIDA Project
(Veracruz Initiative for Diabetes Awareness)

18
Goal To raise awareness about diabetes among
people with diabetes and health care
professionals in clinics in Veracruz

• Objectives

• Improve capacity and knowledge for diabetes care
  among health providers.
• Introduce strategies to improve diabetes care.
• Evaluate and improve the use of existing
  guidelines for diabetes care.

19
CHRONIC CARE MODEL
ORGANIZATION OF DIABETES CARE
Clinical Information System
COMMUNITY LINKAGES
Self Management Support
Delivery System Design
Decision Support
Prepared Productive Team
Informed Activated Patient
PRODUCTIVE INTERACTION
FUNCTIONAL CLINICAL OUTCOMES
20
PRIORITY SETTING DIABETES CARE MODEL
ORGANIZATION OF DIABETES CARE
SELF MANAGEMENT SUPPORT ESTABLISH PATIENT
GOALS, DM EDUCATION PROGRAM, SUPPORT GRUPS
CLINICAL INFORMATION SYSTEM QUALIDIAB
COMMUNITY LINKAGES
DELIVERY SYSTEM DESIGN REFERENCE SYSTEM,
SPECIALSIT CARE
DECISION SUPPORT MONTLY MEETING TO ENSURE USE OF
GUIDELINES
Prepared Productive Team
Informed Activated Patient
PRODUCTIVE INTERACTION
BETTER HEALTH FOR PEOPLE WITH DIABETES
21
Methodology(6 to 13 months time frame)
Participants
Select Topic (develop mission)
Prework
Closing Event Congress, Guides, Publications Etc.
P
P
Develop Framework Changes
P
AA
D
D
A
A
D
S
S
S
Expert Meeting
LS 2
LS 1
LS 3
Planning Group
Supports E-mail Visits Telephone
Assessments Monthly Team Reports
22
Intervention Plan

• Implement a diabetes education program

• Provide training in diabetes care and education

• Establish a referral mechanism

• Create a patient information system

• Strengthen patient support groups include
  patients in the intervention group

23
Conclusion

• The extension of the CARMEN strategy to disease
  control is being implemented as a diabetes pilot
  in Mexico.
• New site are planning to start in Central America
  and the Caribbean.
• This activities respond to needs identified in
  the region and are another step in tackling the
  burden of NCD.

24

• THANK YOU