NCD Prevention and Control

Experience in North Africa

Pr Habiba Ben Romdhane

Cardiovascular Epidemiology & Prevention Resarch Laboratory

Tunisia

International Conference on Healthy Lifestyles and Non Communicable Diseases (NCD)

In the Arab World and the Middle-East(Riyadh, KSA, 9-12 September 2012)

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 .

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

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 and specialist clinics

NGOs play virtually no role in providing health care

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 .

2008-2013 Action Plan: what has it achieved ?

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.

NCDs Surveillance

Death certificatio

nQuality

Important issue

Registry Risk factors surveyCancer CHD

Algeria Yes 3 - Yes

Morocco Yes - - Yes

Tunisia Yes 3 1 Yes

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 .

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

Reduction of risk factors

Gaps in implementing “best buys” : FCTC and tobacco control measures

salt reduction programmes marketing of foods

physical activities programmes

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.

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

EEpidemiological TTransition AAnd HHealth IImpact IIn NNorth AAfrica (TAHINA)

MEDiterranean studiesMEDiterranean studies of of CCardiovascular disease andardiovascular disease and HHyperglycaemia:yperglycaemia: AAnalyticalnalytical MModellingodelling ofof PPopulationopulation SSocio-ocio-economic transitionseconomic transitions (MedCHAMPS)

NCDs & their social determinants in Mediterranean : building sustainable RESearch CAPacity for effective policy intervention (RESCAP-MED)

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

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.

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 .

CHD Mortality Trends in Tunisia 1997-2009: additional deaths attributable to risk factor

changes & deaths prevented or postponed by treatments*

* MedCHAMPS Project

Forecasting Tunisian Type 2 Diabetes Prevalence to 2027

*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.

Forecasting Tunisian Type 2 Diabetes Prevalence to 2027 and Scenario Projections

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

Thank you for your attention