Chronic Diseases Programof

Medical Relief Society

PMRS (UPMRC)

Heritage• A grassroots, community- based, non-profit

Palestinian health organization• Founded in 1979• Our health programs emphasize prevention,

education, community participation, and the empowerment of people

PMRS (UPMRC)

Mission• PMRS seeks to improve the overall physical,

mental, and social wellbeing of all Palestinians• Focuses on the needs of the poor in villages,

refugee camps, and in the urban areas.• Focuses on the needs of women, children,

elderly, disabled, and others marginalized groups

• Looks to provide the quality of care in 400 Palestinian communities

PMRS (UPMRC)

Vision

• PMRS follows the principles and practice of Primary Health Care in the provision of preventive, curative, and promotive health services

Map of UPMRC activities in the West Bank and Gaza Strip

The Need for this Program

• Epidemiologic and demographic transition– Rapid aging– Progressive urbanization– Socioeconomic transformation

• Changes in nutritional patterns:– Less proportion of complex carbohydrates– More sugar– More animal fat

• Obesity becomes more prevalent• Less physical activity • Increased cigarette consumption

Why chronic diseases?

• The disease burden has moved towards chronic diseases as a result of the epidemiological transition

• The leading causes of mortality, the leading causes of morbidity (including disability), and impose an enormous financial and societal burden on the country

• Chronic diseases account for one-third of the years of potential life lost before age 65.

• They are preventable.

NCDs of Interest..

• Heart

• HTN

• Diabetes

• CVD

• Cancer (Breast)

• Dyslipidemia

• Obesity ?!

Targeted Diseases

• High prevalence• An increasing morbidity and mortality

burden• An increasing economic, social, and

psychological burden• Early detection improves prognosis• Public awareness is crucial for prevention• Comprehensive management is generally

absent

How High is the Risk?

• After the age of 35 years:– 1 out of six may develop diabetes– 1 out of 3 may develop hypertension– 1 out of 2 have dyslipidemia– 2 out of 3 are overweight – 2 out of 5 are obese– 1 male out of 3 is a smoker

Leading causes of death among the Palestinian population in – 2002

(MoH)

19.4

12.5 11.7

9 8.2

65.1 4.9

3.8 3.6

0

5

10

15

20

25

heart disease

accidents

condition in

the perin

atal perio

d

cerebrovascular disease

malignant n

eoplasm

hypertension

senility

diabetes

Infectious diseases

congenital m

alform

ation

% o

f T

ota

l D

ea

th

History

Purpose

• Developing a model that focuses on prevention methodology

• Alleviating some pressure on curative treatment• Early detection of diseases and proper

management• Preventing disability and loss of labor power • Using of data collected to advocate reformation

of health care policies• Reaching the marginaliyed people

Components

Prevention, Early DetectionAnd

Health Promotion

Surveillance, Data Collection,

And Research

Proper Management

Mobile Clinic

• More than 11,000 people screened fpr NCDs

• 68% were women• 7800 women were

screened for breast abnormalities

• All of them know how to do self breast examination

Diagnostic Procedures

• Patient’s and family history• Blood pressure• Weight and height• Dr’s examination• Upon need:

– ECG– Echocardiography– Treadmill– Holter

• Counseling

Integration with PHC clinics

• An important goal for a successful program

• Started with 6 villages in Ramallah area, and will continue to cover all clinics

• The aim is to reach a common vision towards the management of NCD

Preliminary results (%) from different locations been screened by the mobile clinic (2003)

LocationDiabetesHypertension

DyslipidemiaOverweight

Abud11.6214372

An Nabi Saleh12.5374267

CHF (work org)11.5255769

Deir Ghassaneh21444368

Kobar14.7385771

Qarawat BZ17315274

Sinjil18255478

Turmus Ayya18386181

Abu Qash17.5335475

Total Average18305275

Data Collection& Research

• First national data base on chronic diseases and their risk factors

• Data are used to evaluate the burden of diseases and the quality of medical care

• Information gathered is used in lobbying and advocacy to raise the problem of NCD

• Call for reformation of health policy

Health Promotion

• Different methods used:– Health education booklets (diabetes, HTN,

Heart disease, smoking, breast cancer…)– Posters and flyers– TV and radio spots– Group and individual counseling– Radio and TV programs

Comprehensive Management

• Management of NCDs is of a holistic approach:– Assessment of risk factors– Early detection of the disease– Diagnostic procedures– Life style modification– Pharmaceutical intervention– Follow up of the patients– Referrals

Training

• A well trained team in NCDs• Team building of health professionals to

deal with NCDs• Training of Teams including

representatives of health providers: UPMRC, MOH, UNRWA, UHWC, and private doctors

• The aim is to transfer the model to other sites.

Lobbying and Advocacy

• Cooperation and consultations with other health providers

• Using the media to raise the burden of NCDs• Using the media to call for national efforts to

provide quality of care • Meetings with representatives of local

communities, youth clubs, and people of different activities to alert the issue on NCDs.

Building a model

• The comprehensive approach in management

• Capacity building

• Transfer of knowledge and experience

• Connect the center with the periphery

• Rational use of technology

• Emphasizing the importance of prevention in combating NCDs

A Different Approach

• A comprehensive approach in the management of diseases:

• Prevention– Life style modification– Health promotion

• Early detection• Proper treatment

• Train and support management at PHC level

• Establish a good referral system