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National Action Plan on Ncds and Health Promotion in Pakistan

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National Action Plan on Ncds and Health Promotion in Pakistan National Action Plan – NCDs – Pakistan i National Action Plan – NCDs – Pakistan National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan A Public-Private Partnership in Health The cover design, in addition to highlighting the public-private partnership dimension of this work, depicts an eccentrically placed watermark symbolizing movement as manifested by the circular brush strokes. This logo delineates the circle of health surrounding the human body. i National Action Plan – NCDs – Pakistan National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan With accompanying CD-ROM A joint publication of the Ministry of Health, Government of Pakistan; the World Health Organization, Pakistan office, and Heartfile Produced as part of a formal collaborative arrangement (http://heartfile.org/napmou.htm) Further information or free copies of this publication can be obtained by sending an e-mail to [email protected]; calling 0092 51 2243580; faxing a request at 0092 51 2240773 or by writing to the Heartfile central office, 1- Park Road, Chak Shahzad, Islamabad, Pakistan. Suggested citation: National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan. Islamabad, Pakistan: tripartite collaboration of the Ministry of Health, Government of Pakistan; WHO, Pakistan office, and Heartfile; 2004. This report was produced under the overall direction of Dr. Sania Nishtar, who also contributed her time as the principal author. The report received inputs from panels of experts constituting the National NCD Forum and the International Advisory Board. Members have played a participatory role through representation in working groups, attending meetings, contributing to discussions and providing inputs to the consultative process; details have been appended. The consensus building effort was led by Dr. Khalif Bile Mohamud (WHO Representative in Pakistan) on behalf of the World Health Organization; Dr. Ashfaq Ahmed (Deputy Director General, Health) on behalf of the Ministry of Health and Dr. Sania Nishtar on behalf of Heartfile. Mohammad Nasir Khan (Federal Minister for Health); Mr. Hamid Yar Hiraj (State Minister for Health); Mr. Tariq Farook (Secretary Health) Mr. Ejaz Rahim (Former Secretary Health) and Maj. Gen. (R) Mohammad Aslam H.I. (M) (Director General Health) provided support for this initiative. Heartfile took a lead role in the development of the Action Plan and contributed resources and technical expertise; WHO provided resources for the consultative process whereas the Ministry of Health provided policy and logistic support for the development of the Action Plan. Layout: Yasir A. Mirza, Heartfile Cover: Ideas Workshop – inspired by a Shazad Nawaz design © Tripartite collaboration on NCDs in Pakistan 2004. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, for any purpose, without the written permission of Heartfile. The copyright notice applies to the printed text, graphics and other illustrations of this document monograph. The CD ROM accompanying this document is covered by its own copyright notice. Heartfile is a non-profit NGO registered under the Societies Registration Act of 1860 in Pakistan. (http://heartfile.org) ii National Action Plan – NCDs – Pakistan Contents Pages Précis 1 Section1: Prelude and Finale 5 1.1 Strengths of the Action Plan 6 1.1.1 Public-private partnership dimension 6 1.1.2 Integrated approach to NCDs 7 1.1.3 An evidence-based approach 8 1.1.4 Maximizing on strengths of partnerships 8 1.1.5 Linkage with national health policies 9 1.1.6 Relationship with development agenda 10 1.1.7 Unrealized ancillary benefits 11 1.2 Action Plan-specific descriptions and clarifications 11 1.2.1 Definition of NCDs 11 1.2.2 Focus of the Action Plan 11 1.2.3 What constitutes evidence? 12 1.2.4 Relationship with health systems structure in Pakistan 12 1.2.5 Priority setting 13 1.3 Challenges, risks and mitigates 14 Section 2: Common Action Areas 17 2.1 Context: paradigm of NCD prevention, control and health promotion 17 2.2 Common action areas in the IFA 18 2.2.1 Behavioural change communication strategy 18 2.2.2 Reorientation of health services 19 2.2.3 Research 22 Section 3: Cardiovascular Diseases 25 3.1 Context 25 3.2 Data on cardiovascular diseases in Pakistan 26 3.2.1 Data on coronary artery disease 26 3.2.2 Data on stroke 26 3.2.3 Data on biological risk factors of coronary heart disease and stroke 27 3.2.4 Data on lifestyle-related risk factors common to major NCDs 28 3.2.5 Gender and rural-urban differences in risk factors 29 3.2.6 Risk factor causal associations 30 3.3 Preventive strategies: atherosclerotic and hypertensive heart disease 31 3.3.1 Mitigating modifiable lifestyle-related risks 31 3.3.2 Approaches to address risks in populations – existing models in Pakistan 35 3.3.3 Screening, risk assessment and management in primary prevention settings 36 3.3.4 Secondary prevention of cardiovascular diseases 37 3.4 Preventive strategies: rheumatic fever and rheumatic heart disease 39 3.4.1 Background to RF/RHD prevention and control efforts in Pakistan 40 3.4.2 Approaches to prevention and control of RF/RHD 41 3.5 Action Agenda – Cardiovascular Diseases 42 Section 4: Diabetes 43 4.1 Context 43 4.2 Data on diabetes in Pakistan 43 4.3 Prevention and control of diabetes 45 4.3.1 Approaches to diabetes prevention 46 4.3.2 Diabetes prevention and control-related efforts in Pakistan 48 iii National Action Plan – NCDs – Pakistan 4.4 Action Agenda – Diabetes 49 Section 5: Tobacco Use 51 5.1 Context 51 5.2 Data on tobacco use in Pakistan 53 5.3 Tobacco production in Pakistan 54 5.4 Tobacco control strategies 54 5.4.1 Restricting youth’s access to tobacco 55 5.4.2 Clean air policies 56 5.4.3 Tobacco cultivation 57 5.4.4 Public and professional education 58 5.4.5 Advertising promotion and sponsorship 60 5.4.6 Warnings 61 5.4.7 Price, excise and taxation 62 5.4.8 Dependence and cessation 63 5.4.9 Illicit trade 63 5.4.10 Liability and compensation 64 5.4.11 Research and surveillance 65 5.5 Action Agenda – Tobacco 66 Section 6: Chronic Respiratory Diseases 67 6.1 Context 67 6.2 Data on chronic respiratory diseases in Pakistan 67 6.3 Risks for chest diseases and their prevention 68 6.4 Action Agenda – Chronic Respiratory Diseases 69 Section 7: Cancer 71 7.1 Context 71 7.2 Data on cancers in Pakistan 72 7.2.1 Data on adults 72 7.2.2 Paediatric data 72 7.2.3 Regional data on specific cancers 73 7.2.4 Trends in cancer pattern 73 7.3 Cancer registration in Pakistan 73 7.4 Cancer prevention and control 76 7.4.1 Risks for cancers 78 7.4.2 Lifestyle-related risks for cancer 79 7.4.3 Occupational and environmental risks for cancer 80 7.4.4 Early detection programmes 83 7.5 Action Agenda – Cancer 87 Section 8: Injuries 89 8.1 Context 89 8.2 Data on injuries in Pakistan 89 8.3 Road traffic crashes 92 8.3.1 Burden of road traffic crashes in Pakistan 92 8.3.2 Road user 94 8.3.3 Roads 95 8.3.4 Vehicle 96 8.3.5 Legislative measures 98 8.3.6 Enforcement of rules and standards – policing 98 8.4 Occupational injuries 100 8.4.1 Social Security Department 101 8.5 Falls 102 8.6 Violence 103 8.7 Burns 104 8.8 Other injuries 104 8.8 Action Agenda – Injuries 106 iv National Action Plan – NCDs – Pakistan Section 9: Mental Illnesses 107 9.1 Context 107 9.2 Data on mental illnesses in Pakistan 108 9.2.1 Population-based data on major and minor mental illnesses 108 9.2.2 Facility-based data 110 9.2.3 Data on substance abuse 110 9.3 Framework for prevention of mental illnesses and promotion of mental health 110 9.4 Action areas within the framework 111 9.4.1 National policies, programmes and legislation 111 9.4.2 Community care, information dissemination and reduction in stigma and discrimination 113 9.4.3 Provision of treatment as part of primary care 115 9.4.4 Human resource and infrastructure development 116 9.4.5 Availability of psychotropic drugs 118 9.4.6 Linking with other sectors 118 9.5 Action Agenda – Mental Illnesses 120 References 121 Integrated Framework for Action 135 Appendices Acronyms Glossary National NCD Forum International Advisory Board Tables Table 3.1 Prevalence of CAD and common risk factors for NCDs in Pakistan 29 Diabetes and impaired glucose tolerance in Pakistan: regional prevalence data Table 4.1 44 from DAP-WHO Surveys (1994-1998) Table 7.1 Strategies for the eight most common cancers in Karachi – females 77 Table 7.2 Strategies for the eight most common cancers in Karachi – males 77 Table 7.3 Factors epidemiologically associated with cancers 78 Table 8.1 Distribution of injuries by causes 90 Table 9.1 Prevalence of mental disorders in Pakistan 109 v National Action Plan – NCDs – Pakistan vi National Action Plan – NCDs – Pakistan Précis By convention, the term ‘non-communicable’ diseases (NCDs) refers to major chronic diseases inclusive of cardiovascular diseases, diabetes, cancer NCDs are being and chronic respiratory diseases and their risk factors. As part of this initiative, however, the chronic conditions of mental illnesses and injuries addressed have also been grouped alongside as country requirements necessitated that these be addressed through synchronized public health measures within a within a combined strategic framework.
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