Strengthening NCD and RF surveillance Strengthening NCD and RF surveillance in the Americasin the Americas

Branka Legetic.

PAHO-WHO Regional adviser,

Workshop on STEPS Stoke ,Curacao, Nov 2010

Strategic Plan 2008-2012 Surveillance & policy of NCDs & RF

• SO 3: To prevent and reduce disease, disability and premature death of chronic non communicable diseases, violence and injuries

• SO6: To promote health and development and prevent and reduce RF such as use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex

• SO 6; SO9;SO11;SO15

PAHO Regional Strategy and PAHO Regional Strategy and Plan of Action on an Plan of Action on an Integrated Approach to the Integrated Approach to the Prevention and Control of Prevention and Control of Chronic DiseasesChronic Diseases

WHO 2008-2013 Action Plan WHO 2008-2013 Action Plan for the Global Strategy for for the Global Strategy for the Prevention and Control the Prevention and Control of Non communicable of Non communicable DiseasesDiseases

http://www.paho.org/cncd_surveillance

Development and strengthening of Country capacity for surveillance of chronic diseases, their consequences, RF, and impact of PH interventions

Monitoring NCDs and their determinants and evaluate progress at the national, regional and global levels

Surveillance line of Action

To encourage and support the development and strengthening of countries’ capacity for better surveillance of chronic diseases, their consequences, their risk factors, and the impact of public health interventions.

Development & strengthening of chronic disease and risk factor surveillance systems

Focus on the following in the countries, sub regions and the Region:

• Capacity assessment, use for monitoring & evaluation

• Ongoing collection of reliable, comparable, and quality data;

• timely and advanced analysis;

• dissemination and use of analysis results for national policy and program planning & evaluation,

• technical competency of the surveillance workforce • novel thinking and innovation

Available documents and tools

http://www.paho.org/cncd_surveillance

TOOL: Country Profile of Capacity and Response to NCDs

http://www.paho.org/cncd_surveillance/countrycapacityandresponse

TOOL: Minimum dataset for NCDs

http://paho.org/cncd_surveillance/minimumdataset

Purpose:• to combine multiple data sources in one functional annual reporting system as a foundation for CNCD surveillance.• to remedy the fragmentation of traditional country surveillance systems• to facilitate further analysis on a national, sub Regional, and Regional level and the generation of more complex indicators for NCDs.

In 2010

Assessment of capacity: • Country capacity to respond to NCDs : instrument in Excel

available on www.paho,org/cncd_surveillance

• PROGRES REPORT for Directing Council

Ongoing collection of reliable, comparable and timely data

• Implementation of Minimum data set in implementation in 20 countries

• Support RF studies

• Pan Am STEPS & introducing new methods

TOOLS: Methodology for Risk Factor Surveillance

Disease, risk and protective factors in adults:

Pan Am STEPS-

New fact sheet on Determinants & RF

E STEPS

Additional modules

MULTIMOD: Methodology for use of land and cell phones

Pan American STEPS-UPDATEJanuary 2008 Presently in the Field:

Paraguay

Published and promoted for policy purposes: Aruba, Bahamas, St Kitts

Attended II Level training & completed data processing : Aruba, Bahamas, Uruguay, St Kits, Barbados, BVI, Dominica

Trained level 1 and in preparatory phase: Dominican Republic, Cuba, T&T, Curacao,Turks & Cayucos

Planning I Level training in 2008: St Lucia, St Vincent, Panama, C Rica, Grenada

Chile, Argentina, Brazil, Mexico, Colombia, Jamaica are in process of mapping and harmonization of data with Pan Am STEPS

Advances in 2010

Dissemination and use of analysis results for national policy and program planning & evaluation

• Workshops for STEPS advanced analysis CAREC Feb 2010• Policy and program implementation based on data analysis • Caribbean Portal as part of PAHO health observatory CAREC 2010

Technical competency of the surveillance workforce • FETP including NCDs, in collaboration with Brazil, Colombia &

CDC • Training for cancer registry: in collaboration with IARC,• Guayaquil 2010; Port of Spain 2010,

2010 cont

Novel thinking and innovation• Training & pilot of Multi Mod surveillance

Miami Sept 2010• Mini STEPS as part of census, labor or other

studies for annual updates on behavioral RF, Caribbean

• Use of Sentinel sites for PHC and hospital performance monitoring C Rica pilot

Cancer incidence/ cancer registers – geographic coverage in LAC based on CI5 IX

Improving information on incidence, prevalence and survival of CVD

WHOs STEPwise Aapproach to Stroke Surveillance, STEPS Stroke (based on WHO MONICA Project)

TOOLS: STEPS Stroke methodology

http://www.paho.org/cncd_surveillance/stepsstroke

Stroke as one of the 3 main causes of death in the Americas

1st % 2nd % 3rd %Anguilla 14.7 Argentina 8.2 Antigua and Barbuda 8.3

Brazil 10.7 Belize 6.7 Canada 7

French Guyana 8.7 Barbados 8.8 Colombia 7.4

Guadeloupe 11.9 Bermuda 7.4 Haiti 8.6

Guyana 10.9 Cayman Islands 6.4 Montserrat 8.8

Martinique 12.2 Chile 9.6 Nicaragua 7.7

Panama 11.2 Costa Rica 6.3 Puerto Rico 5.8

Paraguay 10.6 Cuba 10.4 Trinidad and Tobago 10.7

Suriname 12.9 Dominican Republic 10

St. Kitts and Nevis 10.1 Ecuador 6.2

Uruguay 12.4 Peru 4.8

St. Lucia 12.1

United States 6.9

Venezuela 7.2

    Virgin Islands (US) 7.6    

STEPS Stroke in LAC – State and Perspectives 

  Countries that have implemented STEPS stroke, 1,2, 3 step : Chile, Mexico, Brazil (Sao Paulo + 5 regions), Barbados, Countries interested in implementing STEPS Stroke: Colombia, Uruguay, Argentina,  Honduras, Curacao

STEPS Stroke Instrument available on PAHO WEB:  in English, Spanish and soon in PortugueseSTEPS Stroke supported by: World Stroke organization, World Federation of Neurology, PAHO-WHO

EMMA: Estudo de Mortalidade e Morbilidade do Acidente Vascular Cerebral

STROQUE: Stroke Register of Queretaro. Municipio Queretaro

TAURUSs: Talca Urban & Rural Stroke Study

Barbados, MI & Stroke register

STEPS STROKE initiatives in Latin America and Caribbean

Acronym Name City,

Country

Population STEPS P.I Funding Agency

EMMA Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral

Sao Paulo, Brazil

10 Million 1-2-3 Dr. P.A Lotufo

CNP

STROQUE Stroke Register of Queretaro, Municipio Queretaro

Municipio Queretaro, Mexico

725,000 1-2-3 Dr. F. Barrinagarre menteria

CONCYTEQCONACYT

TAURUSs Talca Urban & Rural Stroke Study

Provincia Talca, Chile

390,000 1-2-3 Dr. P.M Lavados

CONICYT

National population Register of Barbados

Barbados 300,000 1-2-3 Dr. Anselm Hennins

MOH Barbados

STEPS Stroke...what it offers

• Study Protocol and Instrument

• Data Entry Tool

• International Comparisons

Advances in 2010• Cancer Registry: Brasilia Declaration on improving

information on cancer signed by 19 countries• Training for cancer registry: in collaboration with

IARC: Guayaquil 2010; Port of Spain 2010• Stroke registry: Manual STEP STROKE in en, Sp &

Portuguese on the WEB• Temporary advisers to support countries• Training for Step Stroke: Curacao 2010

SUBREGIONAL Support

• MERCOSUR: Common Market of the South- VENT working group

• 2008, 2009,2010

• Andean - VENT working group

• 2009, 2010

Chile

English Speaking Caribbean

• Declaration of Port of Spain (2007)

• To be established, as a matter of urgency, the programs necessary for research and surveillance of the risk factors for NCDs with the support of our Universities and the Caribbean Epidemiology Centre/Pan American Health Organization (CAREC/PAHO);”

• EPI meetings :• 2006,• 2007,• 2008,• 2010

PHIP Architecture

Use of results for national policy

Policy ObservatoryProject

Policy Development

Policy Development

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Polic

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Capacity BuildingCapacity Building

Policy ResearchPolicy Research

Advoca

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NCD POLICYNCD POLICYOBSERVATORYOBSERVATORY

Policy DialoguePolicy Dialogue

Operationally the Observatory will support and promote a number of functions, at regional, sub-regional and country levels:

Advances in use of results for national policy

Case study methodology:

• Brazil

• C Rica

• Canada

National NCD policies• Chile

• Uruguay

• Aruba,

• Dominica

• Bahamas,

• St Kits & Nevis

Policy dialogues

Support Sub regional or Regional policy planning process

Caribbean –Summit &

follow up

Advances in 2010

• Policy Observatory project meeting

Port of Spain, November 17,18 2010

Purpose: Discus and prepare governments for UN Special Session on NCD September 2011

Conclusions

NCD and RF surveillance are of importance for political and technical agenda

Secures commitment for strengthening capacity at national and sub regional level

Jointly developed & implemented standardized instruments:

1. Shorten the process of obtaining reliable timely information

2. Secure inter-country comparability and comparability over time

3. Secures sustainability of collection and analysis

4. Strengthen partnerships

Please visit:

www.paho.org/cncd_surveillance

Thank You