Developments of the Gulf Program for Diabetes Control

Dr. Tawfik A. Khoja 1

Resolution # 2 the Resolution # 2 the 61st conference 61st conference of the Health of the Health Ministers (held in Geneva on 26//4/1427 H / 24/5/2006), Ministers (held in Geneva on 26//4/1427 H / 24/5/2006), which assigned the specialized Gulf committee to which assigned the specialized Gulf committee to undertake the process of development and update of undertake the process of development and update of the programme through the following:the programme through the following:

Developments of the Gulf Program for Diabetes Control

2Dr. Tawfik A. M. Khoja

1- Review of the Gulf plan for Diabetes Control in the 1- Review of the Gulf plan for Diabetes Control in the light of the recent scientific updates, and after light of the recent scientific updates, and after evaluation of the achievements made in various evaluation of the achievements made in various stages, and hence setting an executive workplan stages, and hence setting an executive workplan including preventive and promotive aspects.including preventive and promotive aspects.

2- Studying the current situation of the diabetes 2- Studying the current situation of the diabetes problem in the Council States and the objectives problem in the Council States and the objectives realized in the Gulf programme for Diabetes realized in the Gulf programme for Diabetes Control, reduction of diabetes incidence and its Control, reduction of diabetes incidence and its complications along 10 years.complications along 10 years.


The Director General of the Executive Board The Director General of the Executive Board submitted a proposed working paper to update and submitted a proposed working paper to update and develop the Gulf plan for Diabetes Control. The develop the Gulf plan for Diabetes Control. The working paper included a number of very important working paper included a number of very important items: items:


1) Evaluation of what has been achieved in the Gulf 1) Evaluation of what has been achieved in the Gulf plan (infrastructure – training, learning and plan (infrastructure – training, learning and development of health caders - prevention development of health caders - prevention programmes – scientific research).programmes – scientific research).

2) Determinants of the Gulf plan which is considered 2) Determinants of the Gulf plan which is considered so far a general framework for a comprehensive so far a general framework for a comprehensive plan, especially after defining weaknesses and plan, especially after defining weaknesses and shortcomings.shortcomings.

3)3) Methods of realizing the strategic objectives of the Methods of realizing the strategic objectives of the Gulf plan guided with the leading international Gulf plan guided with the leading international experiences.experiences.

4)4) Proposed developmental steps – emphasis on the Proposed developmental steps – emphasis on the community dimension – preventive aspect - community dimension – preventive aspect - scientific research. scientific research.

5) Guarantees of success and continuity – at all levels 5) Guarantees of success and continuity – at all levels in (MOH – related authorities – political level and in (MOH – related authorities – political level and decision making).decision making).


Resolution # (1) Resolution # (1) 63rd conference 63rd conference (Geneva, (Geneva, 29/4/1428 H – 16/5/2007) which is considered an 29/4/1428 H – 16/5/2007) which is considered an applied approach to the directives of the Ministers of applied approach to the directives of the Ministers of Health in their 62nd conference in Kuwait which was Health in their 62nd conference in Kuwait which was named (The conference of diabetes control) and named (The conference of diabetes control) and included a number of key directions, on top of which included a number of key directions, on top of which come the following:come the following:


1-1- Signing the “Signing the “joint statement for the Health Ministers’ of the Cooperation Council States about Diabetes” ” and its endorsement as a commitment to improve and its endorsement as a commitment to improve public health and confront the diabetes epidemic.public health and confront the diabetes epidemic.

1-1- Signing the “Signing the “joint statement for the Health Ministers’ of the Cooperation Council States about Diabetes” ” and its endorsement as a commitment to improve and its endorsement as a commitment to improve public health and confront the diabetes epidemic.public health and confront the diabetes epidemic.


2- Endorsement of the updating Integrated Executive 2- Endorsement of the updating Integrated Executive Gulf plan (2008/2018) set by the specialized technical Gulf plan (2008/2018) set by the specialized technical committees, which included the vision, mission and committees, which included the vision, mission and strategic objectives – mechanisms of implementation strategic objectives – mechanisms of implementation as well as indicators of follow up and improvement. as well as indicators of follow up and improvement.

3- Selection of a work team at the highest technical and 3- Selection of a work team at the highest technical and leading level from the ministry of health to undertake leading level from the ministry of health to undertake the process of follow up of implementation of the plan the process of follow up of implementation of the plan and developing it according to the needs and the and developing it according to the needs and the stages of progress.stages of progress.


4-4- Calling upon the Council States to establish a Calling upon the Council States to establish a supreme national council for control of diabetes, on supreme national council for control of diabetes, on the basis that control of diabetes is a case of nation the basis that control of diabetes is a case of nation and the responsibility of all community classes. and the responsibility of all community classes.

5-5- Each member state shall propose the “national Each member state shall propose the “national executive plan for control of diabetes “based on the executive plan for control of diabetes “based on the general framework for the Gulf executive plan general framework for the Gulf executive plan (2008-2018). (2008-2018).

6-6- Approval on establishing a “Gulf Central Approval on establishing a “Gulf Central Supervisory Team”. The team is assigned to set Supervisory Team”. The team is assigned to set protocol for a Gulf study with unified methodology protocol for a Gulf study with unified methodology to deal with epidemiology, burden of disease and to deal with epidemiology, burden of disease and economics of diabetes. economics of diabetes.


It is worthy to mention that the “joint statement for It is worthy to mention that the “joint statement for diabetes” document had been circulated to all related diabetes” document had been circulated to all related bodies, organizations, scientific institutes local, regional bodies, organizations, scientific institutes local, regional and international. The joint statement had a very resonant and international. The joint statement had a very resonant impact in all those institutions. The most prominent is the impact in all those institutions. The most prominent is the message received from the Secretary General / Arab message received from the Secretary General / Arab League office (188/5 dated 19/6/2007) in which HE the League office (188/5 dated 19/6/2007) in which HE the Secretary General expressed his appreciation and Secretary General expressed his appreciation and acknowledgement of this important strategy and he acknowledgement of this important strategy and he proposed establishing an umbrella for protection of proposed establishing an umbrella for protection of diabetic patients at the Arab level. In addition, HE called diabetic patients at the Arab level. In addition, HE called upon considering this declaration a statement among the upon considering this declaration a statement among the formal documents and it had been registered under the formal documents and it had been registered under the number (400) and a copy of this document was put on the number (400) and a copy of this document was put on the website of the Arab League and it had been circulated to website of the Arab League and it had been circulated to the Arab Countries. the Arab Countries. 10Dr. Tawfik A. M. Khoja


The Assistant Secretary General – Chairman of social The Assistant Secretary General – Chairman of social affairs – General Secretary for the Arab League has affairs – General Secretary for the Arab League has been addressed to take the executive actions to include been addressed to take the executive actions to include this Gulf document as well as the Gulf Executive plan this Gulf document as well as the Gulf Executive plan for Diabetes Control (2008/2018) on the agenda of such for Diabetes Control (2008/2018) on the agenda of such meeting. And, to give effect to resolution # (1) for the meeting. And, to give effect to resolution # (1) for the 63rd conference, and put it into action. 63rd conference, and put it into action.



Based on the request of the Director General of the Based on the request of the Director General of the Executive Board, the meeting for the Specialized Executive Board, the meeting for the Specialized Technical Committee was held alongside the Diabetes Technical Committee was held alongside the Diabetes Economics Conference “Diabetes Economics – Vital Economics Conference “Diabetes Economics – Vital Investment”). The main question was what next? and Investment”). The main question was what next? and what are the next steps to combat diabetes. It was what are the next steps to combat diabetes. It was agreed on dividing the Gulf plan into 5 stages, where agreed on dividing the Gulf plan into 5 stages, where each stage is evaluated, reviewed and the progress each stage is evaluated, reviewed and the progress assessed as well as shortcomings. Thereafter, a plan assessed as well as shortcomings. Thereafter, a plan for the next stage is set.for the next stage is set.


The proposed Interim Operational Plan (2008- 2009)

- it represent the (first ) executive stage of the it represent the (first ) executive stage of the endorsed Gulf Executive plan. endorsed Gulf Executive plan.

- It involves the minimum amount of strategies to be It involves the minimum amount of strategies to be implemented.implemented.

- Mechanisms and requirements for - Mechanisms and requirements for starting implementation of the plan were selected. starting implementation of the plan were selected.


It was agreed to put an interim It was agreed to put an interim operational plan (2008/2009) as operational plan (2008/2009) as follows:follows:

I-I- Appreciation of the initiative of presenting the joint Appreciation of the initiative of presenting the joint statement for the Health Ministers’ in the Cooperation statement for the Health Ministers’ in the Cooperation Council States about Diabetes, and the endorsed Gulf Council States about Diabetes, and the endorsed Gulf Executive plan for diabetes control to the next Arab Health Executive plan for diabetes control to the next Arab Health Ministers. This is starting from the joint Arab Cooperation Ministers. This is starting from the joint Arab Cooperation principle which was crowned by the proposal of HE the principle which was crowned by the proposal of HE the Secretary General of the Arab League concerning Secretary General of the Arab League concerning “Establishing an umbrella of protection for diabetic patients “Establishing an umbrella of protection for diabetic patients at the Arab level. at the Arab level.


What has been achieved during 2007 ( the year of control What has been achieved during 2007 ( the year of control of diabetes) has been presented and reviewed by the of diabetes) has been presented and reviewed by the Health Ministers’ Council in the 64th conference (held in Health Ministers’ Council in the 64th conference (held in Riyadh, Muharam 1429 H – February 2008) where Riyadh, Muharam 1429 H – February 2008) where resolution # (3-A) was issued. The resolution defined the resolution # (3-A) was issued. The resolution defined the path of the new Gulf programme through the following: path of the new Gulf programme through the following:

II- Work towards putting resolution # 4 / 62 and 1 / 63 II- Work towards putting resolution # 4 / 62 and 1 / 63 into action and the Council States shall provide the into action and the Council States shall provide the Executive Board with a periodic interim follow up Executive Board with a periodic interim follow up report every 6 months, and specifically the report every 6 months, and specifically the following:following:


1- Giving effect to the items in the “ joint 1- Giving effect to the items in the “ joint statement of the Health Ministers about statement of the Health Ministers about Diabetes” into work executive programmes. Diabetes” into work executive programmes.

2-2- Giving effect to the Integrated updated Giving effect to the Integrated updated executive Gulf plan (2008/2018) according to the executive Gulf plan (2008/2018) according to the approved mechanisms and indicators.approved mechanisms and indicators.

III- Approval on starting giving effect to and III- Approval on starting giving effect to and implementing the interim operational aplan implementing the interim operational aplan (2008-2009) proposed by the technical sub-(2008-2009) proposed by the technical sub-committee, which is considered the first statge of committee, which is considered the first statge of the endorsed executive plan for control of the endorsed executive plan for control of diabetes.diabetes.

IV- Finalizing the unified Gulf research project on IV- Finalizing the unified Gulf research project on diabetes according to the following: diabetes according to the following:


A- Endorsing establishment of the Central A- Endorsing establishment of the Central Gulf Supervisory Team. Gulf Supervisory Team.

B- Finalizing preparation of the estimated budget B- Finalizing preparation of the estimated budget for the unified Gulf research on diabetes.for the unified Gulf research on diabetes.

خوجة. أحمد بن توفيق د 19

pproper (effective) promotion, roper (effective) promotion,

prevention and treatment not to prevention and treatment not to

be seen as abe seen as a costcost but as anbut as an

investment investment in ’health capital’in ’health capital’

Professor Professor David CutlerDavid Cutler, ,

Harvard UniversityHarvard University

Dr. Tawfik A. M. Khoja 20


FROM ILLNESS TOWELLNESS

LOOKING AHEAD-LOOKING AHEAD-PRIORITY CHOICESPRIORITY CHOICESLOOKING AHEAD-LOOKING AHEAD-

PRIORITY CHOICESPRIORITY CHOICES


In the 64th conference held in Riyadh throughout the In the 64th conference held in Riyadh throughout the period (Muharram 1429 H / February 2008) the Health period (Muharram 1429 H / February 2008) the Health Ministers affirmed the importance of putting the criteria Ministers affirmed the importance of putting the criteria and standards of healthy diet as an entrance in the and standards of healthy diet as an entrance in the Control of NCDs programme, and resolution # (6-C) was Control of NCDs programme, and resolution # (6-C) was issued which included the following:issued which included the following:

1- The Council affirms the importance of the issue of 1- The Council affirms the importance of the issue of healthy diet, physical activity in the prevention of NCDs healthy diet, physical activity in the prevention of NCDs and the serious role played by the unhealthy and the serious role played by the unhealthy components and fast food industries in the increased components and fast food industries in the increased rates of risk factors leading to such group of diseases rates of risk factors leading to such group of diseases which extended its effect to children and youngsters.which extended its effect to children and youngsters.


2- Urging the Council states to 2- Urging the Council states to establish public health committees establish public health committees in coordination with concerned in coordination with concerned ministries; industry, commerce, ministries; industry, commerce, agriculture and other concerned agriculture and other concerned bodies such as standardization bodies such as standardization and specifications organization, and specifications organization, municipalities, and food industries municipalities, and food industries as well as consumer protection as well as consumer protection societies to work towards setting societies to work towards setting national strategic plans for healthy national strategic plans for healthy diet, guided with the international diet, guided with the international strategy for diet, physical activity strategy for diet, physical activity and health.and health.


3- Intensifying constructive cooperation with 3- Intensifying constructive cooperation with related authorities especially ministries of information, related authorities especially ministries of information, education, industry, agriculture and endowment education, industry, agriculture and endowment towards setting a national alliance for health education towards setting a national alliance for health education to confront these deleterious community phenomena.to confront these deleterious community phenomena.

4- Giving effect to the 4- Giving effect to the “International Strategy on “International Strategy on Diet, Physical Activity and Diet, Physical Activity and Health” and working towards Health” and working towards putting it into action through putting it into action through various programmes and health various programmes and health departments in cooperation departments in cooperation with governmental and non-with governmental and non-governmental authorities in a governmental authorities in a comprehensive national comprehensive national framework.framework.


Current Situation Follow up of Implementation Current Situation Follow up of Implementation of the Gulf Plan for Diabetes Controlof the Gulf Plan for Diabetes Control



Dr. Tawfik A. Khoja28

Strategic Directions The HMC has to adopt

• • Networking with EMAN and carrying out the Networking with EMAN and carrying out the STEPwise approach.STEPwise approach.

• • Making full use of the Gulf plan for health Making full use of the Gulf plan for health education of Non-communicable education of Non-communicable diseases.diseases.

• • Giving effect to the “Global Giving effect to the “Global Strategy on Diet, Physical Strategy on Diet, Physical Activity and HealthActivity and Health

• • Implementation of the World Implementation of the World Health survey.Health survey.

• • Conduction of the Burden of Conduction of the Burden of Diseases Research.Diseases Research.

• Issuance of the Book Entitled• “Facts for Life”


• Health promoting schools (United Arab Emirates)

• Health Promotion Council in the Kingdom of Bahrain (National Plan for Control of Chronic Diseases).

• Specialized clinics Initiatives (Kingdom of Saudi Arabia)

• NIZWA project for Healthy Life Style (Sultanate of Oman)

• Facts for Life “ Book (Cooperation Council States).

Examples of some leading gulf Achievements


1- 1- Unifying methods of treatment and Unifying methods of treatment and follow up of chronic diseases in H C follow up of chronic diseases in H C according to evidence-based scientific according to evidence-based scientific methods towards the optimal use of methods towards the optimal use of available resources to reduce available resources to reduce morbidity and mortality as well as morbidity and mortality as well as disability rates.disability rates.

Mechanisms of implementation of concept of specialized clinics initiative

2- 2- Prevention of diseases, through:Prevention of diseases, through:

a)a) Minimizing the risk factors such Minimizing the risk factors such as obesity, and others.as obesity, and others.

b)b) Early detection of cases.Early detection of cases.

c) c) Early detection of complications.Early detection of complications.

d)d) Increasing of health education Increasing of health education and awareness and development and awareness and development healthy attitudes.healthy attitudes.





Control of Non-communicable Diseases (DM) and its

prevention is POSSIBLE

The rapid changes that threaten health in the Arab world require a speedy response, it must be proactive first and beforehand. It is unlikely that epidemics of today are similar to those that happened in the past. This is due to the progress made in controlling infectious diseases.If full alertness should be given to new outbreaks such as Avian influenza, the concealed epidemics e.g. cardiac diseases, stroke, diabetes, cancer and others… will result in the future in the largest number of victims whether victims of death or disability.




Requirements forDevelopment in the Current Stage

1- Support promotion and development of optimal methods of health programs for such group of diseases and implementing programs of prevention and control of infectious and noninfectious diseases within a comprehensive and integrated health system in the primary health care in various sectors of health service, (e.g: school health) based on the concept of double burden.

2- Giving effect to the “Global Strategy on Diet, physical Activity and Health through the various programmes and health departments and in collaboration with the related governmental and non-governmental agencies and bodies within a comprehensive national conceptual framework.


3- Establishing a reliable and accurate data base about the patterns of prevalence rates of these diseases and their determinants as well as preparing a dynamic health information program for collection and analysis of data in addition to networking and evaluation. Work should be done to formulate document based health system and plans.

4- Investment in health system research and implementing community health research models which have to be realistic and comparable .

5- Unifying all related activities and programs in the fields of control of non communicable diseases in a unified national/Gulf / Arab frame for “Health Promotion” guided by the successful experiences such as:


a) Experience of the Kingdom of Bahrain concerning the “Health Promotion Council and its role in the control of chronic diseases.

b) Kuwait program about the (health promotion as a comprehensive umbrella for all programs of control of chronic diseases.

c) Specialized clinics program in the health centers in the Kingdom of Saudi Arabia.

d) Community intervention program for prevention of cardiac diseases in Lebanon.

e) MONICA project for smoking and Myocardial infarction.f) Prevention of cardiovascular diseases project (U.K.)g) Prevention of Diabetes project (USA)h) North Carlina Project


Primary prevention, based on comprehensive _population-based programmes, is the most cost-effective approach to contain this emerging epidemic. Therefore, action to reduce these major NCDs and mainly (DM) should focus on preventing and controlling the risk factors in an integrated manner. Intervention at all levels of society, from communities to governments, private organizations and nongovernmental groups, is essential for prevention since the risk groups are entrenched in the framework of society influenced by many areas of national policy.

COLLABORATION AMONG COLLABORATION AMONG GCC COUNTREIS AND GCC COUNTREIS AND SHARING COMMUNITY-SHARING COMMUNITY-BASED PROGRAMMES & BASED PROGRAMMES & SUCCESSFUL INITIATIVESSUCCESSFUL INITIATIVES

COLLABORATION AMONG COLLABORATION AMONG GCC COUNTREIS AND GCC COUNTREIS AND SHARING COMMUNITY-SHARING COMMUNITY-BASED PROGRAMMES & BASED PROGRAMMES & SUCCESSFUL INITIATIVESSUCCESSFUL INITIATIVES

41Dr. Tawfik A. Khoja



Thank you for your kind attention

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Developments of the Gulf Program for Diabetes Control