Background
Conceptual framework
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Governance structures: The roles and responsibilities, inter-relationships, and architecture of the institutional structures within Ministries of Health (MOH) that are involved in oversight, management, and planning for NCDs were examined. We conceptualize the institutional structures in two categories: NCD –specific structures whose remit is confined to NCDs only, and the ‘sector-wide’ structures responsible for ‘shared’ health functions across different diseases and programs (e.g. human resource development, health planning, information, etc.).
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Policy development and planning: Policies and plans may be NCD-specific and ‘sector-wide’ (i.e. national health plans) covering all the programs and diseases and other sector-wide issues (e.g. human resources, health financing, information, etc.). We examine the extent to which the content, and processes for development of NCD-specific and sector-wide health policies and plans are aligned.
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Multisectoral coordination, building coalitions and partnerships: Effective regulation of and influence over the life-style and other environmental determinants of NCDs require interventions across multiple sectors and stakeholders increasing the salience of multi-sectoral coordination. We examine the status, nature, roles and responsibilities, and outcomes of multisectoral coordination mechanisms, coalitions and partnerships both within and outside government.
Methods
Results
Governance of NCDs: the current situation
Governance structures
Country | Location of NCD unit1
| Total staffing2(2010) | Year of creation2
| Reported role and responsibilities2
|
---|---|---|---|---|
Cambodia | Department of Preventive Medicine | 4 full time, 2 part-time | 1998 | Planning, coordination of implementation, policy development, Monitoring and evaluation (M&E) |
Fiji | NCD advisor under Director, Public health | 2 | 2004 | Policy development, planning, M&E, implementation |
Malaysia | Separate section in overall disease control division | 11 | 1996 | Planning, coordination of implementation, M&E |
Mongolia |
Officer-in-Charge of NCD prevention policy implementation and coordination in the Department of Public Health Policy Implementation and Coordination in MOH | 4 | 1997 | Planning, coordination of implementation, M&E |
Philippines | Degenerative disease division of National Center for Disease control and Prevention | 13 | 1998 | Policy development, coordination of implementation, M&E. |
An integrated NCD technical team or organizational structures by specific diseases or risk factors?
Inter-relationships among multiple organizational structures with NCD related functions and with structures responsible for sector-wide health system functions
Policy development and planning
Country | Sector-wide health plan/policy | NCD specific plan/policy | Baseline expenditure levels given | Sources of financing defined | Potential gaps in financing identified |
---|---|---|---|---|---|
Costing and financing of reproductive health and child survival interventions but not NCD ([13] | No costing/budget for the proposed activities provided. | Overall public spending on health accounted for 12% of national budget, 1% GDP | Proposes an increase in government budget, no specific financing sources for NCDs. | Identifies need to mobilize additional resources for NCD, health promotion, traffic injuries, but with no quantification ([13] | |
No costing provided [15] | Annual budget provided: $226199 $0.27 per capital [14] | For overall health systems (2.87% of GDP for MoH), but no NCD-specific budget [15] | Annual Increase to health budget by 0.5% for 5-7 yrs; no specific financing for NCDs [15] | Establish Health Care Financing Unit to identify gaps in the system, not specifically for NCDs [15] | |
No costing/Budget provided | No costing/ budget provided | No | No | No | |
Medium-term expenditure framework, but no clear costing linked to proposed activities[18] | No costing/ budget provided [19] | For overall health systems, but no NCD-specific[18] | No | notices additional resources need to implement the Health Sector Strategic Master Plan [18] | |
Allocates budget for Health Promoting activities for 2006–2007 [21] | No costing/ budget provided, asks the local government units to establish effective financing schemes at provincial and local level [[20] | Not given | Sources of funding identified[21] | Identifies a gap of 11% of the required costs for overall health systems (PhP3.9 Billion) [21]. |
Country | Sector-wide health plan/Policy | NCD-specific plan/policy | Baseline levels |
---|---|---|---|
Cambodia
|
Reduce between baseline (2005-08) and 2015,
| Sample indicators to monitor progress mentioned, but no targets specified.
| ■ Average baseline given for 2005-2008 ([13]; data from existing literature summarized in NCD-specific plan |
■ the adults smoking prevalence% (male/female) from 54/9 to 44/2 | ■ Proposes monitoring through national STEP surveys | ||
■ Incidence of hypertension per 1000 population from 20 to 15 | |||
■ Prevalence of adults with diabetes reported from public facilities from 2 to <2 | |||
■ Incidence of cervical cancer per 10,000 population reported from public facilities from 25 to 12.5 [13] | |||
By 2015, reduce prevalence of
|
By 2014, reduce prevalence of
| ■ Baseline from National NCD STEPS Survey 2002, no progress reported from prior National NCD Strategic Plan 2004-2008 | |
■ Diabetes (25-64 yr) from 16% to 14% | ■ Diabetes by 5% | ■ Proposes monitoring through National NCD STEPS Survey and National Nutrition Survey. | |
■ Alcohol related injuries to less than 5% | ■ Common risk factors by 5% | ■ No periodicity/monitoring agency defined. | |
■ moderate physical activity by 5% | ■ Intermediate risk factors by 5% | ||
■ fruing/vegetable intake (Adults) by 5% | ■ Major NCDs by 5% | ||
■ Current smoking (15-65yrs) from 37% to 33% | ■ Tobacco use: 10% from baseline | ||
■ reduce obesity by 6.2% | ■ Improve nutrition: No target | ||
■ Increase HPV vaccine coverage by 5% | ■ Alcohol related harm: No target | ||
■ Cardiovascular diseases by 5% | |||
■ Improve national NCD status by 5% | |||
■ Indicators are listed as prevalence of Ischemic heart disease, mental illness, CVD, Diabetes, cancer and chronic obstructive respiratory disease but with no specific targets. |
By 2016, Reduce Prevalence of
| ■ Baseline Data from National Health and Morbidity Survey 2006 | |
■ Diabetes from 11.6 to <13.6% | ■ Proposes monitoring through Behavioural Surveillance Survey, NCD Risk Factor Surveillance | ||
■ Obesity from 26.2% to <33.7% | ■ Periodicity/Monitoring agencies identified | ||
■ Healthy Eating – no target given | ■ No past progress reported | ||
■ Physical Activity – no target given | |||
Between 2010 and 2015, Reduce prevalence of
|
Between 2009 and 2013, Reduce prevalence of
| ■ Some baseline data given from 2004-2005 | |
■ Daily Smoking from 37% to 31% | ■ Smoking from 23.4% to 20.4% | ■ Mechanism to collect data and its periodicity not defined | |
■ Daily salt intake (gm/day) from 13g to 12g | ■ Daily salt intake (gm/day) from 9.6 to 9.1 | ■ No achievements or rate of progress described in the immediate past to inform the current target setting | |
■ Increase the percentage of adult population that reduce alcohol intake to 2-3 std /wk from 30% to 40% | ■ Alcohol use among population (last month) from 29% to 27% | ||
■ Increase population doing fitness activities at least 3 times/wk from 20% to 25% | ■ Increase in population with active life-style on regular basis with minimum of 30 minutes from 18.4% to 23.4% | ||
Between 2006 & 2010, reduce prevalence% of
| This is an operation manual. Indicators to be monitored are outlined but no quantified national targets for these indicators are given | Some baseline data 2000/2003 | |
■ Obesity from 4.3 to 3 | Proposes Behavioural Risk Factor Surveillance System including Adult | ||
■ Smoking from 34.8 to <34.8 | National Nutrition and Health Survey to monitor the progress. | ||
■ Alcohol from 46 to <46 | No reporting of past progress | ||
■ Inactivity from 60.5% to 50.8% | |||
By 2010, reduce mortality rates (per 100 000) to less than the baseline level in 2006 for | |||
■ CVD < 79.1 | |||
■ COPD<63.2 | |||
■ Diabetes <20.8 | |||
■ Cancer <47.7 [22] |
Multisectoral coordination, building coalitions and partnerships
Multisectoral coordination
Country | Name of intersectoral mechanism | Chair | Membership | Year of establishment | Comments |
---|---|---|---|---|---|
Cambodia | Inter-ministerial committee for education and reduction of tobacco use; | Minister of Health | 12 government ministries and institutions | June 2001 | plays a major role in |
formulating the National Strategic Plan on tobacco control, law and legislation fortobacco control. | |||||
NCD plan mentions about establishment of inter-ministerial working group by 2009, but status is not known at the time of study. | |||||
Fiji | National NCD committee (similar multisectoral committee for health promotion, HIV/AIDS and suicide prevention. | Minister of Health | permanent secretary or directorate level of government, non-state actors and civil society groups, including faith-based groups | 2004 | Coordinate national implementation of the respective strategic plans developed by the same multi-stakeholders. |
Mongolia | National Council for public health | Prime-minister | Minister-level member ship from 8 line ministries (health, education, justice, infrastructure, food and agriculture, environment, foreign affairs and defence), the National Statistical Office, the HSUM and the Ulaanbaatar City Government | 2002 | Another multi-sectoral structure is Health Promotion Foundation headed by Minister of Health with membership from director, taxation office, Ministry of Finance. |
Malaysia | Cabinet Committee for a health promoting environment proposed in the National Strategic plan for NCD (2010–2014) | Deputy Prime-minster | Minister-level membership from 10 line ministries | 2011 | Has clear terms of reference to determine policies that support positive behavioural changes towards healthy eating and living. The Committee held its first meeting in April 2011. |
Philippines | Philippine coalition for prevention and control of NCD It institutionalized the annual public health forum on NCD prevention and control since 2006. | NA | Initial membership has 44 organizations including various medical specialty organizations and societies, professional organizations, non-government organizations, government agencies, academe. | 2004 | Each member organization signs an Memorandum of understanding that it will contribute to the programs and activities approved by the Coalition Council in consonance with its mandate, while maintaining its own independent programs and avoid open conflict with similar actions of the Coalition. |