NCD Situation in Botswana Ministry of Health Department

NCD Situation in Botswana Ministry of Health Department of Public Health Disease Control Division Non-communicable Diseases Program By Bame Punah Shatera

Presentation Layout § Introduction § Situation of NCDs § Strategies/Response to NCDs § Successes and difficulties § Next steps

Switzerland Botswan a

Introduction cont. Demography § Relatively small population estimated in 2008 at 2 million § Population density of 3 persons per sq km § 34% of the population is under the age of 15 years § 6% are over the age of 65 years. § 27% of the total population are women of childbearing age § 12% children under five years § Annual population growth rate 2. 4 % and the total fertility rate is 3. 17.

Introduction Health System § Ministry of Health runs the health care system in the country § It runs the hospitals and provides primary care through network of clinics, health posts, mobile stops as well as community based preventive and promotive services § Ministry of Health currently has 5 Departments § § § Prevention of HIV/AIDS; Corporate Services; Policy Planning and Monitoring and Evaluation; Clinical Services and Care and Public health, where NCD Programme falls.

Introduction cont. § § § The role of NCD Programme: Develop and maintain an effective disease surveillance system Carry out preventive and promotive activities Coordinate and monitor NCD activities

Introduction cont. At the moment NCD focuses on selected diseases • Cancer • Diabetes • Hypertension • Cardiovascular diseases

Situation of NCDs Number of cases and deaths due to NCDs (CSO-HEALTH STATISTICS REPORT 2001 -2005) 2001 NCDs 2002 2003 Cases Deaths DM 1. 042 73 1. 189 74 CVD 13. 325 - 10. 758 Hypertension Neoplasm Cases 2004 2005 Deaths Cases Deat hs 1. 417 81 4. 523 88 5. 388 107 55 12. 676 105 3. 495 305 528 316 150 47. 949 279 410 486 - 107 1. 082 135 6. 729 2. 143 442 1. 198 415 3. 109 13 42. 172 437 8. 939 2. 879

Situation of NCDs cont. § The WHO STEPS survey, Botswana, 2007 revealed that risk factors identified were: • Tobacco use • currently smoking 32%males, 7. 8% females • Alcohol consumption • 54. l% males 51. 8% males(binge drinking) • Inadequate fruits and vegetable intake • 96% of all respondents ate less than 5 servings of fruits and or vegetables on average per day • Physical inactivity • 27% males, 42% females • Raised Blood Pressure • 29% in males, 37% females. • Obesity/overweight • 22% males, 53% females

Situation of NCDs cont. • Global Youth Tobacco Survey (2008)

Strategies/Responses § The NCD program in the Ministry of Health § The National Health Policy revised in 2009 to include Non. Communicable Diseases § A multisectoral and multidisciplinary team set to draft national policy and strategic plan on NCD(end 2009) § BNCR(population based) Identified risk factors are addressed in the following ways: 1. Tobacco use Control of Smoking Amendment Act Cap 2004 • Protection from second hand smoking • Prohibition of marketing, promotion and advertising of tobacco products • Health education campaigns on harmful use of tobacco • Age restriction

Strategies/Response 2. Harmful use of alcohol • Alcohol policy now finalized and ready • Introduction of Levy Fund • Educational campaigns financed from the levy fund to target youths and the community. • Reduction of selling hours • Age restriction • Home brews

Strategies/Response 3. Nutrition • Breast feeding 1 st 6 months(SRH) • School Feeding programs • National action plan on nutrition 4. School Health Program • The National School Health Policy and Procedure Manual revised in 2010 to provide: • Physical examination for primary school pupils from STD 1 -7 which includes: • • BMI-To isolate obesity Oral health Eye examination Mental Health

Strategies/Response to NCDs 5. Physical Activity § Inclusion of safe walk and bicycle lanes in major cities and towns § School Health Policy (revised 2010) which has a provision of safe and sanitary school environment such as: • Playgrounds and large rooms for indoor activities in every school • Adequate sports facilities and equipment in schools • A variety of other recreational activities in schools § Private Sector and NGO • • Other Ministries CAB DAB Private hospitals

Strategies/Response to NCDs § Wellness programmes • Wellness programmes in all government sectors and most of the private sectors

Screening and mgnt programs • Screening for High BP routine • Screening program for cancer of the cervix is run by Sexual Reproductive Health division • Management of High BP and diabetes is integrated in the health care system

Successes • Inclusion of NCDs in the NHP • Completion of draft Strategic Plan and on NCD. • BNCR • Continued advocacy on NCD • Data on risk factors

Challenges • • Inadequate trained personnel Lack of standard management guidelines Inadequate advocacy Poor surveillance system

Next steps § Develop communication strategy § Strengthen partnership § Widen scope of public education § Pilot the WHO package for integrating Essential NCD interventions into Primary Care(WHO-PEN)