Regional Strategy

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Regional Strategy Plan of Action on an
Integrated Approach to the Prevention and Control
of Chronic Diseases Line of ActionSurveillance
of CNCDs and RFs
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The Growing Epidemic of Chronic Diseases, Driving
Factors, and What They Contributed to

• Driving factors
• Urbanization
• Globalization
• Technology
• Aging

• Behavioral risk factors
• Unhealthy diet
• Physical inactivity
• Tobacco and alcohol use
• Social and economic burden
• Disproportionate burden of chronic diseases on
  the poor

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WHO and PAHO Resolutions Supporting Integrated
CNCD and RF Prevention and Control

• WHO Resolution on Integrated prevention and
  control of non communicable diseases (2000)
• Framework convention for Tobacco control ( 2003)
• Global Strategy on Diet Physical activity and
  health (2004)
• Global Resolution on Alcohol (2005)
• Global Resolution on prevention on cancer ( 2005)
• PAHO Resolution on Cardiovascular diseases and
  Hypertension (2 000)
• PAHO resolution on Public Health response to
  chronic diseases (2002)

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Type of information Related to Health

• Environment
• Socioeconomic and political
• Health situation
• Health services
• Health determinants
• Health-promotion strategies
• Health-related policy info

Adapted from Parrish y MC Donnell
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Scenarios

• Integrated information systems
• Mortality
• Morbidity
• Health services (PHC and hospital)
• Programs
• Other sectors
• Public Health Surveillance
• CD and CNCD
• Sentinel sites
• Population Health studies
• Developed units for analysis of health situation
• Use of GIS
• Information used for decision-making

• Information systemsdisconnected and undeveloped
• Mortality
• Programs
• Routine surveillance
• CD
• Analysis poor and fragmented
• Decision-making regardless to available
  information

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Situation Today in LAC Related to Surveillance
Systems and CNCDs
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• National Health Reporting System, Survey and
  Surveillance
• Health Information System 25
• Chronic diseases included 17
• Risk factors included 17
• Mortality included 25
• Morbidity included 20
• Routine surveillance system 8

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Brazil CNCD Surveillance System
Information
Risk factors, protection
Morbidity
Mortality
Population-based survey Use of Services (PNAD)
Population-based cancer registry
Basic cause
Hospital information system Authorization for
hospital stays
Specific population Schoolchildren (PNAD)
Hospital cancer registry
Ambulatory Information System (APAC)
Multiple causes
Other Phone, users
PNAD Pesquisa Nacional por Amostras de
Domicílios APAC Autorização de
Procedimentos de Alta Complexidade
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Data Used for Policy- and Program- Planning
Purposes
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Regional Strategy and Plan of Actionapproved in
September 2006

• Goal To prevent and reduce the burden of chronic
  diseases and related risk factors in the Americas
• Integrated Approach
• Common risk factors
• Life course perspective
• Comprehensive approach
• Multisectoral
• Multilevel that includes promotion, prevention
  and control

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Regional Strategy (contd)

• Within public-health response to chronic
  diseases,
• Surveillance is stated as a necessary element
  for further development and expansion of a
  comprehensive approach that would allow countries
  to address chronic noncommunicable diseases from
  a public-health perspective.

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Regional Strategy Lines of Action

• Health Promotion
• To reduce the burden of chronic disease through
  support, and promotion of social and economic
  conditions that address the determinants of
  chronic diseases and empower people to increase
  control over their health, especially the
  adoption of sustained healthy behaviors.
• Surveillance
• To encourage and support the development and/or
  strengthening of countries capacities to better
  monitor chronic diseases, their impacts, their
  risk factors, and the impact of interventions as
  part of the integrated strategy on chronic
  disease prevention.
• Integrated Management of Chronic Diseases and
  Risk Factors
• To facilitate and support the strengthening of
  the capacity and competencies of the health
  system for prevention and control in the
  integrated management of chronic diseases and
  their risk factors.
• Public Policy and Advocacy
• To ensure and promote the development and
  implementation of effective, integrated,
  sustainable, and evidence-based public policies
  on chronic disease, their risk factors and
  determinants.

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Regional Strategy (contd)

• The Strategy and action plan is guided first and
  foremost by the expressed interests and needs of
  counties.
• It is based on WHO Global surveillance strategic
  directions.
• It is in coherence and continuity with previous
  work within PAHO, WHO, national and international
  community
• Data selection, indicators, instruments for
  analysis are based on existing WHO and PAHO
  health information and health statistics
  initiatives (PAHO Basic data, Healthy metrics,
  Global Info base).

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Line of Action Surveillance Outcome Goal

• To encourage and support the development and the
  strengthening of countries capacity to better
  monitor chronic diseases, their consequences,
  their risk factors, and the impact of
  public-health interventions as part of the
  integrated strategy on NCD prevention and
  control.

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Line of Action Surveillance Sub-goals

• Focus on strengthening the following capacities
  in the countries
• Strengthening or building CNCD surveillance
  system as part of country health inf. System.
• Ongoing systematic collection of reliable,
  comparable, and quality data.
• Timely and advanced analysis.
• Dissemination and use of analysis results for
  national policy and program planning and
  evaluation.
• Technical competency of the surveillance
  workforce.
• Monitoring and continuous Evaluation of system
  itself.
• Novel thinking and innovation.

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The Regional Strategy and Action Plan
promote the following

• Gradual/STEPwise approach through 3 levels
• Minimum /basic /core requirements for
  surveillance of CNCDs and RF
• Expanded /optimum requirements for surveillance
  of CNCDs and RF
• Desirable requirements for surveillance of CNCDs
  and RF
• This approach enables insight of the entire
  framework, so that counties can move from one
  level to another as their capacities grow over
  time.

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• Core level The existing resources will be in
  use and will include the collection, analysis of
  core/existing information strengthening quality,
  reliability and timeliness.
• Content of this level will be developed in
  collaboration with key countries and those that
  are part of the unfinished agenda.
• Expanded level is focused on obtaining and
  analyzing the information that will be collected
  with realistic projection of increase or
  reallocation of resources.
• Content of this level will include regular and
  periodic data collection of health determinants
  and biological RF using PAHO/WHO instrument(s)
  and methodology.
• Desirable level includes obtaining and analyzing
  the desired information that remains beyond the
  reach of most countries and their available
  resources.
• Content of this level will include data on health
  determinates, policy and program evaluation,
  information and analysis for fine-tuning of
  intervention programs.
• This approach facilitates collection of selected
  data, production of reliable indicators, levels
  of analysis to establish groups or areas of
  priority for NCD control, development of national
  infobases, participation in global regional
  infobases.

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Implementation

• Activities to follow
• Consensus-building of gradual /STEPwise approach
• Production of guidelines for each level
• Building infrastructure and resources
• Provision of adequate tools and training
• Development of academic centers to support
  capacity building
• Building national, subregional and regional
  infobases

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On what are we building the implementation plan
for surveillance?

• Situation analysis (country capacity,
  availability of data, integration of the
  national or local system, etc.).
• PAHO Interprogrammatic Working Group in formation
  Tasks Proposal of core and expended set of
  indicators( Caribbean proposal for core a
  starting point) PAHO Basic Data initiative,
  guidelines for each level of system.
• RF surveillance modalities Pan American version
  of STEPS (Aruba and Grenada trained) CAREC
  Workshop, BRFS tested in Trinidad.
• Infobase WHO infobase decentralization.
• Quality, under-reporting, timelines Part of PAHO
  program for quality improvement of vital
  statistics.