NCD policy and programming Bangladesh Dr A K

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NCD policy and programming Bangladesh Dr A. K. M. Jafar Ullah DPM (Arsenic &

NCD policy and programming Bangladesh Dr A. K. M. Jafar Ullah DPM (Arsenic & NCD), DGHS, Bangladesh and NCD Focal Point, WHO, Bangladesh

Outline of the presentation • Introduction • Situation of NCDs • Achievements in tackling

Outline of the presentation • Introduction • Situation of NCDs • Achievements in tackling NCDs and their Risk Factors • Challenges • Lesson learnt • Next steps

Introduction (Demography) • • Population size 156 million Population density of 979 persons/Km 2

Introduction (Demography) • • Population size 156 million Population density of 979 persons/Km 2 One-third of the population is under 15 years Around 61. 4% are aged 15 -64 years Around 4. 5% are aged 65 or older. (Rapidly rising) Urban population 27% (Rapidly increasing ) Population growth 1. 292% Life expectancy at birth 60. 25 years

Situation of NCDs • Prevalence of major NCDs – – – Diabetes 3. 9%

Situation of NCDs • Prevalence of major NCDs – – – Diabetes 3. 9% (2010) CVD 12% (2004) Hypertension 17. 9% (2010) Neoplasm 3. 7% (2009) COPD /Asthma 3. 0% (2007) Stroke 2. 4% (2009) Diabetes prevalence trend Hypertension prevalence trend

Death due to selected NCDs

Death due to selected NCDs

Bangladesh NCD risk factor Survey 2010 Number of people (in million ) with selected

Bangladesh NCD risk factor Survey 2010 Number of people (in million ) with selected risk factors among the adult population aged ≥ 25 years Risk factor Men Women Both sexes Current smoker 17. 3 0. 4 17. 7 Smokeless tobacco user 09. 3 10. 4 19. 7 Tobacco user (any form) 22. 1 10. 7 32. 8 30. 8 29. 2 60. 0 03. 3 12. 8 16. 1 Overweight (BMI > 25 kg/m 2) 04. 1 06. 7 10. 8 Large waist circumference 02. 5 10. 5 13. 0 05. 8 05. 4 11. 2 01. 4 01. 1 02. 5 Low vegetable/Fruit intake Low physical activity Hypertension a < 5 serving/day b d Diabetes Mellitus b a e < 600 MET c c men ≥ 94 cm women ≥ 80 cm d (≥ 149 /90 mm. Hg) e documented

Achievements • Logistics and skilled human resource are available at medical colleges and tertiary

Achievements • Logistics and skilled human resource are available at medical colleges and tertiary hospitals for management of NCDs • Diagnosis and management facility for major NCDs are made available at public and private primary care health facilities • Health manpower at different level were oriented and trained about NCD and its prevention • Bangladesh Global Adult Tobacco Survey 2009 • Bangladesh NCD Risk factor survey 2010 • Development of guideline/manual for management of selected NCDs

Achievements contd. • Piloting of selected NCD prevention and control is under way at

Achievements contd. • Piloting of selected NCD prevention and control is under way at primary care level. (Along with awareness raising campaign, manpower were trained and following logistics were provided ) – – Diabetes : Gluco-meter CVD : BP machine , ECG machine COPD/asthma : Nebulizer Cancer : VIA kit • Interim assessment shows 60% increase in awareness level on NCDs

Strategies/Response • National Strategic Plan for Surveillance and Prevention of NCD developed • Current

Strategies/Response • National Strategic Plan for Surveillance and Prevention of NCD developed • Current health sector plan identifies CVD, Cancer and Diabetes as major public health problems. • Ratified the Framework Convention on Tobacco Control (FCTC) • National essential drugs policy and a list of essential drugs is developed • Strategies developed for responding to specific NCDs – – The National Cancer Control Strategy Injury Prevention Strategy Deafness Prevention Strategy National Eye Care Plan. • Legislative initiatives related to NCDs – Amendment of Mental Health Act; ; in the process of enactment, – Review of tax policy, Increase of tobacco tax by NBR and amendment of Tobacco Control Law.

Challenges of NCD Prevention and control – Unplanned rapid urbanization – Translation of NCD

Challenges of NCD Prevention and control – Unplanned rapid urbanization – Translation of NCD strategies into activities and implementation – Social custom • Generally women are not encouraged to go out for physical activity – Dietary • High carbohydrate diet may result dislipidemia • Westernized Junk food is popular among wealthy population – Health seeking • People seek health care mostly at advance stage of the disease • Out of pocket expenditure of clients

Lesson learnt over last 5 years – If mass awareness could be raised most

Lesson learnt over last 5 years – If mass awareness could be raised most of the major NCDs could be prevented like CDs in Bangladesh – Strategies and laws are not enough unless adequate enforcement is done – Establishment and maintenance of NCD Health Information System is essential for generation of data – Capacity development of service providers is mandatory for attracting people for health care – NCDs are disease of rich is not true, poor are also vulnerable to several NCDs

Next Steps • Inclusion of country specific NCD prevention program in the upcoming new

Next Steps • Inclusion of country specific NCD prevention program in the upcoming new health sector program (2011 -2016) • Updating of the NCD strategic plan of action • Scaling up of the injury prevention piloting throughout the country • Preparation for the Decade of Action for Road Safety( 2011 -2020) • Establishment of population based Surveillance system and registries for major NCDs • Development of National Communication Strategy for Health Promotion on NCDs

Thank You

Thank You