LIFESTYLE RELATED DISEASE PROGRAM€¦ · Web viewLIFESTYLE RELATED DISEASE PROGRAM: The interventions for the noncommunicable diseases and their risk factors interventions will be

Life Style Related Diseases Programme document

FOREWORD:

The importance of prevention of noncommunicable diseases (NCDs) cannot be undermined in the light of increasing disease burden and raised exposure to NCD risk factors due to physical inactivity, unhealthy diet, tobacco use and harmful consumption of alcohol in our country.

NCDs have significant impact on health care expenditure of the health system besides being an economic burden on individuals and families. Exposure to NCD risk factors must be prevented through innovative public health approaches to effectively reduce the burden on the health system and socio economic condition of the country.

The Ministry of Health has a critical role as the chief steward in advocating nationwide public health approach to address prevention and control of NCDs as per the national policy and strategic framework for prevention and control of NCD (2009). In order to facilitate, net work and liaise with the stakeholders for multidisciplinary actions that contribute to prevention and control of NCDs, the Health Ministry has instituted Lifestyle Related Disease Program (LSRDP) in October 2009 in the Department of Public Health.

The main goal of the LSRDP is to promote and protect population health by guiding the development of sustainable actions at individuals, community and at the national level that will collectively contribute to reduction of deaths and illnesses due to noncommunicable diseases related to common risk factors: unhealthy diet, physical inactivity, alcohol and tobacco use including adverse health conditions due to injuries.

Taking stock of the enabling political and policy environment, we must aim to jump start a vibrant healthy lifestyle health promotion programme to bring about a health beneficial behavior change among the population.

We must strive to create a Bhutanese population who is physically active, be able to make informed choices of healthy diet, protect from ill effects of tobacco, and decrease harmful use of alcohol to ensure healthy and happy citizens.

Dasho (Dr) Gado Tshering

SECRETARYAugust 2009


BACKGROUND

In pursuit of primary health care services for it’s people, the major focus in Bhutan until recently was on immunization, reproductive health, control of infectious diseases like TB, leprosy and Malaria, HIV/AIDS, rural water supply program, control of diarrhea and improvement of sanitation. As well, there is a growing political commitment and leadership actions towards the control of noncommunicable diseases in the country. Although noncommunicable and chronic diseases such as diabetes, hypertension, cardiovascular diseases and injury related morbidities is not an epidemic proportion at the moment, with the rapid socio economic and demographic transition, increasingly more people are exposed to risk factors for noncommunicable diseases. Unhealthy lifestyle habits namely: physical inactivity, improper diet, alcohol use and tobacco consumption appears to be prevalent among the Bhutanese population. Therefore, systematic health promotion interventions are necessary to at the population level to prevent the burden of NCDs such as diabetes, CVDs, COPDs, and hypertension.

NATIONAL RESPONSE FOR NCDs

The Bhutanese Health System addresses the health care needs of the population equitably. However, there is a considerable scope for further improving efficiencies and expanding the services in primary health care level to improve the health equity. Firstly, there is an opportunity to strengthen the response of primary health care system to match the rising trends

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of NCDs and their risk factors with a modest increase in capacity of health facilities in terms of equipments, consumables, medicines and skills and competencies of the health work force. Secondly, the current NCD services provided by the health facilities could be upgraded at all level of care with a special focus on BHUs/District Health Services by introducing evidence based NCD intervention prioritized in the context of the status of national health system and the availability of resources.

Available information on the growing trends in NCD and their risk factors and resulting socioeconomic implications in Bhutan need to be appropriately documented and given due priority with special focus on provision of equitable basic NCD services at primary health care level at the BHUs and hospitals.

A national multisectoral response frame work for prevention of NCDs and promotion of healthy lifestyles can be coordinated under the leadership of the health sector drawing on the conducive political will and the epidemiological urgency.

KEY MILESTONES IN HEALTHY LIFESTYLE PROMOTION AND NCD PREVENTION

The multi-sectoral frame work of action for promotion of healthy lifestyle and prevention of NCDs have been embedded in the overarching developmental frame work of the country long ago recognizing the multidisciplinary task of interventions. Following are the key milestones achieved in the past that can

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leverage future public health response to addressing NCDs and their risk factors:

Alcohol: Initiatives to involve communities to reduce alcohol use and brewing of local alcohol products to alleviate poverty and improve food sufficiency have been implemented in many communities around the country. Besides, government rules and circulars have been issued as early as 1980’s to reduce alcohol use by controlling alcohol outlets, trading hours and legal age for drinking.

Tobacco: The nation wide ban of sale of tobacco products in the country was eventually enforced in 2004 based on the proposals of the grass root communities to create “tobacco free” districts.

Diet: The Ministry of Agriculture’s policies to improve kitchen garden in schools through the school agriculture programme have opportunity to improve the access to green vegetables in the schools.

Physical activity: The Ministry of Education has followed an integrated approach to games and sports in the school to promote physical activity for in youths in school.

Strengthening NCD in primary health care: National capacity strengthening workshop on integrated prevention and control of noncommunicable diseases September 17-21, 2007, Paro and National Workshop on integration of essential NCDs in the primary health care March 11-13, 2009, Paro, have invigorated health sector commitment to pursue nationwide NCD prevention programmes.

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Disease management

Diabetic management and screening programs were established in the Jigme Dorji Wangchuck National Referral Hospital and Mongar Regional Referral Hospital established with the support of the World Diabetic foundation project in 2007.

Cancer registry is piloted in the Jigme Dorji Wangchuck National Referral Hospital in 2009.

Improving built environment: (Consult Urban Planning on standards)

Injury prevention: Road Safety and Transport Act of (1999) provides clear implementation guide to reduce road traffic injuries. The newly established Occupational Health programme in the Department of Public Health would reinforce public health interventions for injury prevention and health promotion at workplace through multisectoral partnerships.

Research: The first STEP survey was conducted in 2007 in Thimphu city to assess lifestyle related parameters and practices through the three step survey assessment of practices, physical and biochemical measurements. This provides a baseline to study the future trends for risk factors and NCD prevalence.

CURRENT GAPS

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The multisectoral implementation approaches to NCDs is still in infancy to attain population wide positive health impacts. Besides, funding for NCD interventions are also inadequate to support a comprehensive healthy lifestyle promotion.

The current initiatives to address NCD interventions lack a coordinated national frame work of actions to address the key risk factors. There is no harmonized action in the Ministry of Health to aspire for a common goal as programmes are implemented various silos without a common frame work. Various units in the Ministry of Health could be efficiently coordinated to improve the efficiency (See figure 1).

Public health interventions to promote healthy lifestyle through increase in physical activity and healthy diet are grossly inadequate. There is neither national recommendation on health enhancing physical activity nor on diet on which health messages could be promoted.

Research and evidence from Bhutan is minimal. We need to rely on the findings from other countries whose socio-culture and economic determinants are not necessarily comparable.

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Figure 1: Units of the MoH contributing to NCD control and prevention

ICB, MoH

Mental

Health Program

Diabetes program

Nutrition program

Environmental

/Religion and Health Health program

Care, treatment

Reduce risk factor exposure

tobacco, alcohol, physical activity

Prevention of NCD

Rehabilitation

LSRDReproductive health/VHW

PUBLIC HEALTH PROGRAMMES

CBR/Oral Health

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RENEWED FOCUS ON NCD PREVENTION:

The Ministry of Health will play a lead role to scale up public health interventions on non-communicable diseases. The National Policy and Strategic Framework on Prevention and Control of NCDs (2009) provide clear directions for a national multi-sectoral response to promote healthy lifestyle practices in the country.

LIFESTYLE RELATED DISEASE PROGRAM:

The interventions for the noncommunicable diseases and their risk factors interventions will be coordinated under the national public health program. The unit will function as “Lifestyle related disease program” (LSRDP) as stated in the National Policy and Strategic Framework for Prevention and Control of noncommunicable in Bhutan. The Lifestyle Disease Program (LSRD) was created in the Department of Public Health of the Ministry of Health in October 2008.

SCOPE OF PROGRAM INTERVENTION:

The scope for the LSRD Program will be holistic as mentioned under:

“….prevention and control of NCDs will focus on the risk factors and their underlying determinants, while also providing an equitable, quality treatment and care services for those living with NCDs. The interventions will not be limited to traditional defined list of NCDs but also address life style related factors, biological and chemical hazards, physical and built environments

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(for example work place, air quality and planning decisions that affect our health) all of which influence the development of NCDs. Injury (intentional and unintentional) and related public health problems which pose an increasing challenge to the country, will also be included in this strategy”.( NPSF for control and prevention of NCDs, page 12 )

COMPREHENSIVE APPROACH TO NCD PREVENTION:

The Lifestyle Disease Program will implement the prevention and control of NCDs addressed through a “comprehensive approach” by:

Enhancing political commitment and multi-sectoral responsibility to healthy lifestyle promotion to address prevention of exposure to key risk factors (physical inactivity, unhealthy diet, tobacco, alcohol)

Strengthening health services to provide timely management of common non-communicable diseases (diabetes, COPD/asthma, CVDs, Cancers, Injuries, etc) and provide continuum of care.

Focusing interventions on general population as well as those at higher risk groups and individuals

Facilitating lifestyle health promotion by the communities and individuals by providing adequate financing and technical support to them.

PROGRAM MANDATES:

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The following are the mandates of the lifestyle related disease (LSRD) program (Page 13, NPSF):

1. Institute a surveillance system for risk factors of NCDs;

2. Develop relevant and measurable indicators at input, process and outcome levels for periodic monitoring and evaluation;

3. Strengthen health services and human resource capacity at all levels to effectively control, prevent and manage NCDs and their risk factors;

4. Formulate standard guidelines and other health care materials on NCDs and their risk factors;

5. Promote early detection and appropriate care of NCDs;

6. Conduct operational, analytical research on NCDs and their risk factors;

7. Coordinate action of different players within the health sector involved in implementing NCD related activities, and

8. Institute a national program for injury prevention and safety.

PROGRAM GOAL:

To promote and protect population health by guiding the development of sustainable programmes at individuals, community and at the national level that

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will collectively contribute to reduction of deaths and illnesses due to noncommunicable diseases focussing on common risk factors: unhealthy diet, physical inactivity, alcohol and tobacco use including adverse health conditions due to injuries.

PROGRAM OBJECTIVES:

The LSRD program will work towards achievement of the six goals:

1. To reduce the risk factors for noncommunicable disease that stem from unhealthy diets and physical inactivity, alcohol consumption and tobacco use by means of essential public health action and health promoting and disease preventing measures;

2. To increase the awareness and understanding of the influences of diet, physical activity, alcohol, tobacco use, and other risk factors on health and of positive impact of preventive interventions;

3. To encourage national and community based local action plans to control NCD risk factors that are sustainable, comprehensive and actively engage all sectors including the private sector and the media.

4. To encourage early detection and offer a good quality of disease management of the common noncommunicable diseases namely: Diabetes, Hypertension, Cerebrovascular diseases, chronic pulmonary obstructive diseases and asthma,

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cancers and other NCDs in an integrated approach in the primary health services.

5. To reduce deaths, sickness and disabilities due to intentional and unintentional injuries by raising awareness to preventable injuries such as road traffic accidents, occupational injuries and promoting partnerships to address other forms of injuries related to violence and self inflicted injuries.

6. To monitor and generate scientific data on risk factors for noncommunicbale diseases and to support research and evaluation in other sectors

CORE FUNCTIONS OF THE LSRD PROGRAM:

1. 12.1 General functions:

2. Inter-sectoral collaboration and oversight:

3. To coordinate actions of different stakeholders;

4. To create an environment for stakeholders to pursue their strategies and actions

5. To facilitate the development and implementation of a national action plan and programmes

6. To coordinate among implementing agencies within the health sector( need a diagrammatic presentation)

7. Technical support to the stakeholders

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8. Provide technical support through trainings, workshops for capacity building of the other partners and stakeholders

9. Development of information and training tools related to risk factors such as physical inactivity, unhealthy dietary consumption, alcohol and tobacco use

10.Updates the stakeholders on latest scientific evidence on healthy lifestyle practices and NCDs

11.Provide training of the health professionals on interventions for NCDs

Resource mobilization

Facilitate resource mobilization for the health sector and other implementing partners through engagement in grant and proposal development

Monitoring and evaluation

Track the chronic diseases and their risk factors through routine surveillance system, eg, WHO STEP survey,

Monitor execution of the activities and evaluate the outcome and impact of the interventions

Secretariat to the National Steering Committee

Coordinate meetings of the national steering committee and subcommittees instituted to review NCD interventions and strategies

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12.2 . Program organogram

The lifestyle related disease program shall be operated under three sub units:

Healthy lifestyle unit:

Be responsible for development of media campaigns for active lifestyle, heart healthy diet, through physical activity promotion and public education on good diets and harmful effects of alcohol, tobacco and other risk factors of NCDs.

Collaborate with key stakeholders who are implementing the agency work plans

Disease management and care unit:

Integrate prevention of NCDs into primary health care services

Integrate treatment of NCDs into primary health care services

Facilitate standard care (acute and chronic) of all NCDs and CVDs, Diabetes, Hypertension, Cancers and COPDs in particular in hospital services

NCD surveillance unit:

Develop tools for surveys and surveillance of NCDs and health risks among targeted populations such as schools, urban population, and monastic institutions

Act as public health surveillance unit for injuries such as road safety, occupational injuries

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Organize routine surveys such as STEP survey, GPAQ/IPAQ, Global school Health based surveys

Provide epidemiological evidence on NCD trends and lifestyle patterns among the Bhutanese population

Initiate research in community based lifestyle promotion interventions

Core competencies of the program personnels

The units should have a minimum of one full time focal official for each unit with appropriate technical background to effectively manage the units.

Broadly the core competencies required for the program management staffs are:

Analysis and assessment

Policy development and program planning

Communication

Basic public health science

Financial planning and management

Leadership and system thinking

Additional competencies:

Transformational competencies to better visioning, creating missions and developing strategies for the lifestyle related interventions

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Political competencies to work within the dynamic political structure of the community and the state

Trans-organizational competencies focusing on inter-organizational collaboration techniques

Team building competencies to develop coalitions and alliances among the multistakeholders participating in the NCD interventions.

PRINCIPLE APPROCHES:

Multisectoral mobilization

The national program (LSRD) will support with funds and technical support to communities to design and implement community based healthy lifestyle promotion among the people at the grass root level and those communities at higher need for lifestyle promotion.

The nationwide response of healthy lifestyle promotion will be coordinated under the leadership of multisectoral net work and their coordination teams. At the national level, the national steering committee who act as advisory body for the stakeholders on broad national response. At the district level, local leadership and multisectoral organizations will be mobilized to support public health advocacy for healthy lifestyle promotion. Community representatives and members of the community will mainstream the relevant areas of healthy lifestyle promotion.

Building Leadership and workforce development:

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Leadership can come from individuals from organizations, stakeholders or local programme coordinators and community members. Endorsement of respected national personalities and role models will be sought to advocate healthy lifestyle practices. Workforce development is required for development of relevant skills in the area of healthy lifestyle promotion and development of different risk factor interventions among all stakeholders.

Target whole population as well as specific population groups:

The national action plan for healthy lifestyle promotion will aim at educating the whole Bhutanese population as well as specific population groups.

Good environment and supportive infrastructures are necessary to facilitate physical activity promotion, availability of healthy diet, observing control of alcohol and exposure to smoking through tobacco. The LSRD program will take the lead in building partnerships with the communities and government stakeholders to build enabling environment for prevention of NCDs.

Funding:

Lifestyle promotions have sector wide stake and collective benefits for the health and economy of the whole population. Allocation of the financial resources to implement lifestyle promotions is an indication of the national and organizational commitment. Dedicated and adequate fundings for reduction of alcohol and tobacco use, promotion of physical activity and improvement of diet will be secured from the

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government. Other nongovernmental funding sources will also be explored as when the government sources have limited funding.

Program communication:

The national and local action plans for improvement of lifestyle promotions will be linked to clear programme identity. This will be achieved such as through use of a common programme name, a logo, a mascot and /or other sorts of branding which will aim at promotion of healthy lifestyle themes across the communities.

Local reality and cultural sensitivity:

The programme will consider the implementation from the perspective of the regional, district and local communities at the local level. The implementation will be based on local reality and draw upon the grass root experiences and knowledge of what works in the community setting. Local communities will be engaged as equal partners of the programmes and participate in planning, decision making and implementation of the healthy lifestyle programmes.

Life-course perspective:

The approach to NCD intervention will take a life course approach which includes maternal health, prenatal nutrition, pregnancy outcomes, exclusive breast feeding policies, child and adolescent health, children at schools, adults at work sites and other settings, elderly and encourage healthy lifestyle from youth into old age.

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PROGRAM ELEMENTS:

LSRD will focus on the following key elements:

Element one: Play a leadership role in building multi-sectoral partnership and commitment to prevent and control NCDs among the stakeholders

Conduct advocacy sessions among the parliamentarians, bureaucrats of the implementing organizations.

Conduct annual review meeting of the religious bodies, Lam Naitens and Head Lamas of the monastic institutions.

Coordinate joint sectoral reviews of stakeholders who are implementing NCD interventions.

Advocate among private and government sectors to establish organizational policies and facilities for work places that promote physical activity, smoke free environment and access to healthy diet.

Conduct advocacy for local leaders including Gups and other leaders at the geog level.

Element two: Promoting healthy lifestyles in the general population and groups exposed to higher risk factors:

General population:

Mobilize a high level role model advocate for healthy lifestyle promotion in Bhutan.

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Implement health promotion through structured mass media campaigns on major modifiable risk factors: alcohol, tobacco, physical inactivity and unhealthy diet.

Integrate brief intervention on prevention to exposure to NCD risk factors (alcohol, tobacco, physical activity and diet) for all people seeking health services across health facilities.

Integrate education on NCD risk factors (alcohol, tobacco, physical activity and diet) at community sites during the visit of the health workers.

Institution based health literacy:

Assist the Royal Institute of Health Sciences to incorporate NCD prevention and management at the primary health care level.

Collaborate with the Ministry of Education to develop curriculum for incorporating diet, physical activity and prevention of NCD in the school curriculum.

Train the monastic institutions on heart- healthy-diet, benefits of physical activity and prevention of NCDs.

Specific population groups:

Facilitate networking of people living with NCDs for health promotion and social mobilization.

Develop international network with the ALL groups and facilitate formation of Alcohol Anonymous (ALL) among alcohol addicts.

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Establish NCD and diabetic clinics in high prevalent areas and facilitate peer support programmes.

Establish tobacco cessation programmes for tobacco users and smokers.

Element three: Improving NCD management of NCD at the health facility and primary care level

Train health care workforce on the WHO package of essential NCD interventions.

Support additional medicines and equipments required for implementing essential NCD interventions at the BHU and hospitals.

Strengthen medical record keeping and information collection for follow up and care of people with chronic diseases.

Establish a team of national trainers for upgrading the knowledge and skills of the health workforce on NCDs with a special focus on primary health care.

Strengthen rehabilitation facilities for those living with NCD disabilities.

Train communities and families for chronic care and rehabilitation in the households.

Establish facilities at hospitals and BHUs to measure key biological risk factors such as blood pressure, serum cholesterol and body weight that helps to informed decision for the patients.

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Prescribe brief interventions and practical advice to patients and families on benefits of increased level of physical activity and healthy diet as per their endorsed national recommendations during the stay in the hospital or at the time of discharge.

Health workers conduct nutritional assessment among children, pregnant mothers and provide brief interventions to improve the nutritional status by providing supportive services for balanced diet and promote breast feeding practices.

Element four: Strengthening continuum of care for people living with NCDs and empower families and communities:

Advocate national forums for people living with the NCDs to discuss issues and find practical solutions for themselves.

Support formation of neighbourhood associations for physical activity promotion.

Element five: Enhance early detection of NCD in the communities:

Develop cancer policy for Bhutan and institute cancer screening programs for breast and oral cavity.

Establish cancer registry at the Jigme Dorji Wangchuck National Referral Hospital initially and extend regional referral hospitals.

Establish alcohol dependency & liver disease registry in all the hospitals.

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Strengthen existing registry for diabetes.

Initiate screening for impaired sugar through outreach clinics /community approaches.

Element six: Strengthen health diagnostic and human resource capacity;

Support long term training courses for dieticians, physical activity experts, professionals for sports medicine, researchers and epidemiologists in NCDs.

Expand the basic diagnostic services for noncommunicable diseases provision of diagnostic facilities at the hospitals and BHU.

Element seven: Establishing surveillance and research for evidence based planning:

Conduct surveys every 3-5 years using STEP methods, Global School Health Survey and Global Physical Activity Questionnaire.

Analyze and disseminate reports of alcohol related diseases and cancers collected through hospital registries.

Element eight: Strengthen supportive monitoring and supervision

Develop M and E tools for NCDs for health facilities and other stakeholders

Publish and disseminate annual national status report for implementing that focuses on interventions in NCDs by the stakeholders.

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Evaluate outcomes and impact of integrated prevention and control of NCD at the primary health care level.

Facilitate internal evaluation and external evaluation of the program implementation on the recommended schedules.

Element nine: Act as key advocate to frame legislations and regulations to support healthy lifestyle promotion

Be the lead stakeholder to develop Public Health bill of Bhutan.

Participate in drafting bills on alcohol and submit to the parliament.

Participate in drafting bills to improve built environment that promotes physical activity.

Participate to develop regulations on marketing and advertisement of health harming food products.

Engage to develop regulations on road safety and work place safety issues.

AREA OF COLLABORATION WITH THE KEY STAKEHOLDERS:

“The NCD policy will be supported by strategies, programmes and projects for NCD prevention and control which will be developed, instituted and implemented by relevant stakeholders.

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NCD prevention activities will involve a multidisciplinary approach that engages, but is not limited to, key ministries and departments including Education, Agriculture, Trade and Industries, Finance, National Provident Fund, Royal Bhutan Police, Home Ministry, Judiciary, Army Welfare Project, Department of Urban Development, Home Ministry, RSTA, BICMA, BCCI as well as private institutions and non-governmental organizations” (NPSF on prevention and control of NCDs, Page 12 &1 3).

LSRD Program will collaborate in the following key area of sectoral response with the stakeholders:

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Table 1: Organization and key area of collaboration

Parent Organizations

Specific organization

Major area of collaboration

Ministry of Education

Dept. of Youth and Sports

Physical activity promotion

Dept. of Curriculum

Curriculum development for NCDs

Dept. of School Services

Ministry of Economic Affairs

Department of Trade

Alcohol and tobacco trading surveillance

Ministry of Finance

Department of revenue and customs

Alcohol and tobacco trade, work place programs

Ministry of Home and cultural Affairs

Department of local governance

Dzongkhag based prevention programmes

Royal Bhutan Police

Road safety and alcohol and tobacco policy enforcement

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Safe road traffic

Ministry of Agriculture

BAFRA Food safety, labeling of products

Department of Agriculture

Promotion of organic food /fruits and promotion of kitchen garden

Ministry of Labour and Human Resources

Department of Labour

Injury prevention in occupational settings

Ministry Works and Human Settlement

Department of urban planning

Enabling built environment and health friendly design

Thromdey Improving built environment

Standard & Quality Control Authority

Improving built environment

Ministry of Information & Communication

Road Safety and Transport Authority

Promotion of road safety and injury prevention

BICMA Media Media

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organizations campaigns

Dratsang Lhentshog

Monastic institutions

Physical activity and healthy diet

Environment Commission

Waste management

Private organizations

Financial institutions, corporate bodies, NGOs

Healthy diet, physical activity, smoke free work places

RESOURCE MOBILIZATION:

The LSRD program would rely on the funds from the government sources to implement interventions for physical activity, and pursue for incremental resources to fill the gaps in programmes.

External funding opportunities for research grants and pilots projects will be explored from nongovernmental and international sources to cover the implementation gaps that may arise due to limited funding sources of the government.

The budget allocated for NCDs through the Health Ministry is traditionally dedicated to the support care, treatment and prevention components that are specific to health roles. Lifestyle related disease program, will therefore, advocate other stakeholders to incorporate budgeted work plans to integrate

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strategies that has organizational relevance and feasibility in their annual plan.

MONITORING AND EVALUATION

Monitoring and evaluation of the programme will be guided by the conceptual model shown in figure 2. The LSRD programme will monitor process and outputs of the policies, performance of implementation; and assess outcome of interventions on behavior and evaluate long term social, environmental, health and economic benefits.

Research, monitoring and evaluation and surveillance will continue throughout the process so that feed back on the modifications can be provided to the stakeholders involved.

LSRD will collect information on progress of NCD related implementation from the stakeholders on a half yearly basis, and analyze their annual performance. Annual report will be compiled and disseminated to the stakeholders and relevant organizations after the endorsement by the national steering committee.

Figure 2: Conceptual model for M and E

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17.1 Process and output indicators:

1. Existence of resource mobilization plan for diet, physical activity, alcohol and tobacco.

2. Existence of clear and sustainable national budget for action on physical activity, diet promotion, tobacco and alcohol control.

3. National document on diet and physical activity with specified funding sources and published timeline

4. Existence of multi-sectoral work plans for physical activity and heart healthy diet promotion

5. Number of schools with activities promoting healthy diet and physical activity in schools

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6. Number of large monastic institutions promoting physical activity and healthy diet

7. Number of work places with activities promoting healthy diet and physical activity in work place

8. Number of alcohol outlets observing the proper timing for the sale of alcohol such as on dry day and alcohol free before noon, restricting sale of alcohol for under age

9. Number of full time staff dedicated to working on diet and physical activity within the MoH, and /or other ministries

10.Number of work places and enclosed public areas observing smoke free rules

11.Percentage of population aware of the health risks of high intake levels of total fat, saturated fats, salts and sugars

12.Global school based Health survey (GSHS)/ Health behavior in school children (HBSC) conducted every 3-5 years by the MoH

13.STEP survey conducted every 3-5 years by the MoH

14.GPAQ /IPAQ survey conducted every 3-5 years by the MoH

15.Mortality and morbidity statistics on NCDs including the cancers are analyzed routinely to determine the trends

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17.2 Outcome indicators:

Percentage of adults physically active on a level of moderate intensity of at least 30 minutes per day

Percentage of children and adolescents with low level of physical activity

Percentage of adults eating fewer than five servings of fruit and vegetables per day, or proportion of adults eating less than 400 g of fruits and vegetables per day

Percentage of people with dietary sugar intake < 10 % of the total energy daily consumed

Percentage of overweight or obese adults

Percentage of overweight or obese children and adolescents (weight for height)

Percentage of children exclusively breast fed for last 4-6 months

References:

Louis Rowitz, Public Health for 21st century-The prepared leader

Alma-Ata Declaration, International Conference on primary health care, Alma-Ata, USSR, 6- 12 September, 1978

School Policy framework, Implementation of the WHO global strategy on diet, physical activity and health, WHO 2008

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Preventing Noncommunicable Diseases in the Workplace through Diet and Physical Activity, WHO /World Economic Forum Report of a Joint Event 2008

A Framework to monitor and Evaluate Implementation, WHO global strategy on diet, physical activity and health, WHO 2008

Global Strategy on diet, physical activity and health, WHO 2004

A guide for increasing levels of physical activity, WHO 2007

Reducing salt intake in populations, Report of a WHO Forum and Technical meeting, WHO 2007

Child and adolescent physical activity and nutrition survey 2003 (CAPANS)

Physical Activity Levels of Western Australian Adults 2002, premier’s physical activity taskforce

Tobacco Control Bill, Bhutan 2009

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Documents

LIFESTYLE RELATED DISEASE PROGRAM€¦ · Web viewLIFESTYLE RELATED DISEASE PROGRAM: The interventions for the noncommunicable diseases and their risk factors interventions will be