National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020

NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 1 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 MINISTRY OF HEALTH, NUTRITION AND INDIGENOUS MEDICINE SRI LANKA NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 2 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 3 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 MINISTRY OF HEALTH, NUTRITION AND INDIGENOUS MEDICINE SRI LANKA NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 4 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 5 Contents Message from the Prime Minister 7 Message from the Minister of Health, Nutrition and Indigenous Medicine 8 Message from the Director General of Health Services 9 Message from the Country Representative for Sri Lanka, World Health Organization 10 List of abbreviations and acronyms 11 Introduction 13 Strategic Priority Action Areas of the National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020 21 Prioritized National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2017 69 Summary of targets and monitoring framework of the Prioritized National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 83 Costs for the implementation of the Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020 117 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 6 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 7 I am pleased to provide a message of felicitations for the National Multi Sectorial Action Plan for The Prevention and Control of Noncommunicable Diseases 2016 - 2020. In today’s technology driven environment, many changes have taken place in society. People are adopting a more sedentary lifestyle with less exercise outdoors. They are also more prone to stress. At the same time, food consumption patterns have changed, with more emphasis on processed food instead of fresh fruits and vegetables; accordingly, the intake of sugar and salt has increased. These variable risk factors have resulted in causing chronic Noncommunicable Diseases (NCDs-) such as high blood pressure, high blood lipid levels, high blood sugar and obesity. The NCDs have been identified as a major cause of mortality in Sri Lanka. The efforts undertaken by the Ministry of Health to minimize the risks of NCDs are commendable and worthy of recognition. These measures, taken in con junction with other Ministries, groups and civil organizations towards the upliftment of health for all, will undoubtedly decrease the cost of secondary care provided for NCDs, palliative care and rehabilitation. On the threshold of being classified as a middle income country, Sri Lanka will certainly benefit tremendously from this action plan which propos es specific direction mechanisms for the healthy sector. I take this opportunity to wish the Ministry of Health and the Noncommunicable Disease Unit all the very best in their quest to achieve proposed targets. Ranil Wickremesinghe Prime Minister Message from the Prime Minister NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 8 Message from the Minister of Health, Nutrition and Indigenous Medicine Since independence, Sri Lanka has achieved much in the control of communicable diseases, virtually eliminating vac cine preventable diseases and became exemplary amongSouth East Asian nations in its achievements in the arena of maternal and child health. Currently,non-communicable diseases are the dominant health problem and are presently the leading cause of mortality, morbidity and disability in the country. Noncommunicable diseases are not just the most pressing health concerns in the country but also is a significant challenge for development. They are driven by underlying social, economic, political, environmental and cultural fac tors, broadly known as ‘social determinants’. Sri Lanka needs to address the social determinants of non-communica ble diseasesthrough health promoting partnerships and coordinated actions of many sectors beyondthe healthsector, partnering with non-governmental sectors and civil society organizations where necessary. This National, Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020 developed with theleadership of theMinistry of Health, Nutrition IndigenousMedicine, in consultation with all other partners,is the guiding tool for such coordinated actions,and will ensure that the country will successfully address the burden of NCDs in the years to come. Dr. Rajitha Senarathne Minister of Health, Nutrition and Indigenous Medicine NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 9 Major noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes, cancer and chronic respiratory diseases account for more than 36 million deaths at the global level. Smoking, alcohol, unhealthy diet and insufficient physical activity have identified as four main modifiable behavioural risk factors for NCDs. Nearly 65% of the hospital deaths in Sri Lanka are due to NCDs. Cardiovascular diseases are the number one lead ing cause of death in Sri Lanka. Sri Lanka is experiencing an increase in trend of morbidity and mortality due to NCDsoverthe past few decades due to the changes in the life styles of the people. Considering the need of contri butions by sectors outside the health in addressing the burden of NCD, the NCD Unit of the Ministry of Health, Nutri tion and Indigenous Medicine developed this National Multi-sectoralAction Plan for Prevention and Control of NCD. Development of this plan was through a consultative process which ensured contributions of the academia, profes sional colleges and officials of the Ministry of Health and other relevant Ministries. I hope that this action plan will generate collaboration between different ministries, authorities and departments to combat the burden incurred by NCDs in Sri Lanka. Dr. P G Mahipala Director General of Health Services Ministry of Health, Nutrition and Indigenous Medicine Message from the Director General of Health Services NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 10 Message from the Country Representative for Sri Lanka, World Health Organization The global burden and threat of noncommunicable diseases constitute a major public health challenge that undermines social and economic development of the countries throughout the world. Realizing the requirement of urgent and concerted action at the global and national levels to overcome the challenge of NCDs, at the 66th World Health Assembly in September 2011, the Heads of State of Governments committed themselves in the United Nations Political Declaration on the Prevention and Control of NCDs. The declaration pledges to establish and strengthen the multisectoral national policies and plans for the prevention and control of NCDs. The National Multisectoral Action Plan for the Prevention and Control of NCDs 2106-2020 is the result of this national commitment. It presents a road map for and calls for the support of whole of government, whole of United Nations and whole of society to achieve its stipulated national voluntary targets on NCDs. Recognizing the role of international cooperation to support this important national effort, the World Health Organization has se lected Sri Lanka as a fast-track country for NCDs. The selected fast-track countries are eligible to receive ‘One-WHO’ integrated technical support for implementation of the plan from the global, regional and national levels of WHO in a coordinated manner. We are looking forward to working with the stakeholders to ensure that the country achieves its targets ensuring that the human and financial burden of NCDs does not undermine the development gains. Dr Jacob Kumaresan World Health Organization Representative to Sri Lanka NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 11 List of abbreviations and acronyms BOI Board of Investment CEA Central Environment Authority DDG Deputy Director General DGH District General Hospital DoP Department of Police E & OH Environment and Occupational Health ET & R Education, Training and Research FAO World Agriculture Organization HEB Health Education Bureau HITA Health Intervention and Technology Assessments ITI Industrial Technology Institute MH Mental Health MoA Ministry of Agriculture MoC Ministry of Cultural Affairs MoE Ministry of Education MoH Ministry of Health, Nutrition and Indigenous Medicine MoI Ministry of Industry and Commerce MoJ Ministry of Justice MoNPEF Ministry of National Policy and Economic Affairs MoS Ministry of Sports MoSRT Ministry of Technology and Research MRI Medical Research Institute MS I Medical Services I MSD Medical Supplies Division NATA National Authority on Tobacco and Alcohol NCCP National Cancer Control Programme NCD Noncommunicable diseases NPTCCD National Programme on Tuberculosis Control and Chest Diseases PDHS Provincial Director Health Services PGIM Postgraduate Institute of Medicine PHC Primary Health Care PHI Public Health Inspector PHM Public Health Midwife NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 12 PHNS Public Health Nursing Sister PMCU Primary Medical Care Unit RDHS Regional Director Health Services UNDP United Nations Development Programme UNICEF United Nations Children’s Funds WB World Bank WHA World Health Assembly WHO World Health Organization List of abbreviations and acronyms (Cont.) NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 13 Introduction Sri Lanka is often cited as an example in the world for achieving high health indices with low health expenditure and is moving towards an upper middle income country. A good political commitment in Sri Lanka throughout the period after independence from British ruling to maintain the free health services has contributed much towards improvements in health condition and the country is proud of its free health system which is accessible to all of its population. Changes in life style in its population associated with improved economic conditions in an open economy have contributed towards epidemiological transition on demographic transition. Similar to global situation, the present burden due to non-communicable diseases (NCD) in Sri Lanka outweighs the burden due to communicable diseases and maternal and child health conditions. While contributing to a huge disease burden, chronic NCDs also have serious socio- economic consequences. NCDs incur a huge cost to individuals, families and the societies due to the need of a lifelong treatment, escalating health care cost and loss of productivity. Total deaths: 138,000 NCDs are estimated to account for 75% of total deaths. Cancers 10% Injuries 14% Other NCDs 10% Diabetes 7% Communicable meter nal, perinatal and nutri tonal condition 11% Cardiovascular diseases 40% Chronic respiratory diseases 8% Figure 1: Cause specific mortality Sri Lanka 2012 Source WHO - NCD Country Profiles, 2014. NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 14 Source WHO country Health profile Sri Lanka 2015 Top ten causes of deaths indicate that Ischemic heart disease was the leading cause of death, killing 32.6 thousand people in 2012 (Figure 2). The data on burden of diseases of Sri Lanka indicate that the burden due to cardiovascular diseases and diabetes is the highest (Figure 3). Use of tobacco, consumption of alcohol, unhealthy dietary practices and physical inactivity are the leading behavioural risk factors for NCDs. Air pollution contributes to a great extent in causing chronic pulmonary diseases. According to the STEPS survey (2008), to assess the NCD behavioural risk factors, 8.4% of males and 10.5% of females had systolic blood pressure more than 160 mmHg and diastolic blood pressure more than 100 mmHg or were on medication at the time of survey. Approximately one fourth of the populations were overweight or obese with the corre sponding figures among males being 19.5% and among females being 30.5%. A great majority (82.4%) of the population consume less than In keeping with the global pattern, cardio-vascular diseases, cancer, chronic pulmonary diseases and diabetes are known to be the major contributors to the NCD burden in the country. Of the annual total deaths of 138,000 in the country in 2012 75% of deaths were due to NCDs and 40% of deaths were due to cardiovascular diseases (Figure 1). Figure 2: Top ten leading causes of deaths in Sri Lanka 2012 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 15 Source WHO country Health profile Sri Lanka 2015 *Other noncommunicable deseases (NCDs) including non-malignant neoplasms; endocrine, blood and immune disorders; sense organs, digestive, genitourinary and skin desease; oral conditions; and congenital anomalies. **Infectious diseases other than accute repiratory diseases, HIV, TB and malaria five servings of fruits and vegetables per day. Among the males, 9.4% re ported to be consuming alcohol daily and around 22.8% of the males were daily smokers. It is proven that primordial and primary prevention plays a major role in reduction in the prevalence of behavioural risk factors and NCDs. Second ary prevention measures to improve the secondary and tertiary care to NCD patients, play a major role in reducing premature mortality of the NCD patients. A programme on prevention and control of NCDs in any country needs a comprehensive approach and contributions of multiple sectors is essential to make it a success. The National Multisectoral Action Plan for the Prevention and Control of NCDs The National Multisectoral Action Plan for the Prevention and Control of Non-communicable diseases 2016- 20120 is a result of untiring efforts of the NCD unit of the Ministry of Health, Nutrition and indigenous Medicine which led the process of consultations with relevent units in the health sector and professional colleges along with the support of the World Health Organization and other stakeholders. This has been developed in order to achieve the ten voluntary targets adopted by Sri Lanka based on the nine Figure 3: Burden of diseases in Sri Lanka 2012 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 16 global targets and the specific regional target identified for the South East Asian region. This plan is composed of four strategic areas, namely; Advo cacy, partnership and leadership; health promotion and risk reduction; strengthen health system for early detection and management of NCDs and their risk factors and surveillance, monitoring, evaluation and research. The strategic area health promotion and risk reduction specifies the plans on reduc tion of tobacco use, reduction of use of alcohol, promotion of healthy diet high in fruit and vegetables and low in saturated fat/ trans-fat free sugar and salt, , promotion of physical ac tivity and promote healthy behaviors and reduce household air pollution. The plan provides a comprehensive description of the out comes to be achieved, specific activities to be implemented, the multi-stakeholder partnership including civil society and the time frame by which the targets are to be achieved. Sim ilar to the contribution in the process of preparation of the plan the maximum corporation of relevant departments of the Ministry of Health, Nutrition and Indigenous Medicine, other ministries, departments, professional colleges, civil societies and other relevant parties is vital in achieving the specified targets of NCD prevention and control in the plan. NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 17 Goal To reduce the preventable and avoidable burden of morbidity, mortality and disability due to noncommunicable diseases by means of multisectoral collaboration and cooperation at na tional level, so that populations reach the highest attainable standards of health and productivity at every age and those diseases are no longer a barrier to well-being or socioeco nomic development. Overarching Principles • Life-course approach • Empowerment of people and communities • Evidence-based strategies • Universal health coverage • Management of real, perceived or potential conflicts of interest • Human rights approach • Equity-based approach • National action and international cooperation and solidarity • Multisectoral action Objectives 1. To raise the priority accorded to the prevent ion and control of noncommunicable diseases in national agenda through strengthened mutltisectoral cooperation and advo cacy 2. To strengthen national capacity, leadership governance, multisectoral action and partnerships to accelerate country response for the prevent ion and control of noncommuni cable diseases 3. To reduce modifiable risk factors for noncommunicable diseases and under lying social determinant s through cre ation of health-promoting environments Vision A country free of the avoidable burden of noncommunicable diseases NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 18 4. To strengthen and orient health systems to address the prevent ion and control o f noncommunicable diseases and the under lying social determinants through people- cent red primary health care and universal health coverage 5. To promote and support national capacity for high-qual ity research and development for the prevent ion and con trol of noncommunicable diseases 6. To monitor the trends and determinants of noncommu nicable diseases and evaluate progress in their prevention and control NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 19 1. A 25% relative reduction in premature mortality from cardiovascular disease, cancer, diabetes, or chronic respiratory diseases 2. A 10% relative reduction in the use of alcohol 3. A 10% relative reduction in prevalence of insufficient physical activity 4. A 30% relative reduction in mean population intake of salt/sodium 5. A 30% relative reduction in prevalence of current tobacco use in persons aged over 15 years 6. A 25% relative reduction in prevalence of raised blood pressure and or contain the prevalence of raised blood pressure 7. Halt the rise in obesity and diabetes 8. A 50% of eligible people receive drug therapy and counseling (including glycaemic control) to prevent heart attacks and strokes 9. An 80% availability of affordable basic technologies and essential medicines including generics, required to treat major noncommunicable diseases in both public and private facilities Sri Lanka aims to achieve the following targets by 2025 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 20 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 21 Strategic Priority Action Areas of the National Multisectoral Action Plan for the Prevention and Control of NCD 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 22 Strategic action area 1: Advocacy, partnership and leadership 1.1 Advocacy Desired outcome Indicator Proposed actions Responsibility Time frame 1.1.1 NCD recognized as a national priority in national agenda in the country Availability of a National NCD council chaired by Hon. President / Prime Minister 1.1.1.a Establish A National NCD council and convene regular meetings bi annually NCD unit 2016 Availability of advocacy package for various stakeholders 1.1.1.b Develop advocacy packages on prevention and control of NCDs for politicians, each levels in the health sector and non- health sectors at national, provincial and district levels HEB NCD unit 2016 1.1.2 NCD recognized as a priority in ministries, authorities and departments outside the Ministry of Health No. of ministries/ authorities/ departments in which NCD included as a priority area in the policy 1.1.2.a Advocacy meetings for the upper level managers of the relevant ministries, authorities and departments at the national, provincial and district levels • twice a year at the national level • twice a year at the provincial level • twice a year at the district level NCD Unit PDHS RDHS 2016 2020 1.1.3 NCD prioritized in national health action plan No. of NCD related decisions/ actions taken by the political authorities 1.1.3.a Advocacy meeting for the political authorities • Once a year at the national level • -Once a year at the district level NCD Unit PDHS RDHS 2016 2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 23 Desired outcome Indicator Proposed actions Responsibility Time frame 1.2.1 National and subnational mechanisms for multisectoral actions established and functioning No. of workshops held at national, provincial and district levels to map stakeholders and to design health promotion activities 1.2.1.a Conduct workshops at National, rovincial and district levels to map stake holders and to design health promotion activities NCD Unit PDHS RDHS 2016-2017 No. of Ministries/ authorities/ departments implementing NCD prevention actions indicated in their policies at national and subnational levels 1.2.1.b Establish provincial and district level multi sectoral committees and monitor implementation of existing policies NCD Unit PDHS RDHS 2016-2020 1.2.2 Place NCDs on broader health and development agenda NCD related targets incorporated into the monitoring framework of the Sustainable Development Goals 1.2.2.a Integrate the prevention and control of NCDs in to national planning processes and broader development agendas Department of National Planning DDG (NCD) 2016-2020 1.2.2.b Share process indicators and global NCD targets with the national team working on Sustainable Development Goals Department of National Planning DDG (NCD) 2016-2017 1.2 Partnership NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 24 Desired outcome Indicator Proposed actions Responsibility Time frame 1.3.1 Health Ministry effectively leading and coordinating the national NCD prevention and control programme Availability of a coordinated mechanism within the Ministry of Health for NCD prevention and control 1.3.1.a Ensure activities relevant to different units of the MoH are coordinated to strengthen the linkages between different units of Ministry of Health for NCD prevention and control DDG (NCD) NCD Unit 2016 2017 Availability of adequate human resources at national, district and grass root levels to perform NCD related activities 1.3.1.b Initiate action to obtain the required human resources for NCD related work • identify a healthcare worker at the grass root level to perform NCD activities • • • proposal for cardre approval to be submitted • provide facilities and staff for the NCD unit to facilitate the monitoring mechanism of the NCD action plan DDG (NCD) Organizatonal and Development Unit Salary and Cadre Commission 2016 2017 DDG (NCD) Organizatonal and Development Unit Salary and Cadre Commission 2016 DDG (NCD) NCD unit Organizatonal and Development Unit Salary and Cadre Commission 2016 Adequate funds allocated for NCD activities from GOSL funds and funds from UN agencies 1.3.1.c Conduct advocacy meetings with the officers in the Ministry of Finance and UN agencies NCD Unit Finance Ministry 2016 2020 1.3 Leadership NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 25 Desired outcome Indicator Proposed actions Responsibility Time frame 1.3.1 Health Ministry effectively leading and coordinating the national NCD prevention and control programme Continued. No. of trained health staff at national and district levels 1.3.1.d Capacity building of relevant staff on NCD Prevention and Control • capacity building of the national programme managers capacity building of the MO(NCD) • capacity building of the MO(NCD) DDG (NCD) NCD unit PDHS RDHS 2016 2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 26 Desired outcome Indicator Proposed actions Responsibility Time frame 2.1.1 Prevalence of tobacco use reduced Age standardized prevalence of current tobacco use among 18yrs and above Prevalence of tobacco use among adolescents No. of provisions of FCTC implemented 2.1.1.a Accelerate full implementation of FCTC • implement pictorial warning (80%) • prohibit elicit trade of tobacco products • ban all forms of advertising • ban point of sale display • ban sponsoring community activities • conduct trade seminars DDG (MS I) DDG (NCD) NATA NCD Unit PDHS RDHS 2016-2020 Availability of an amended NATA Act 2.1.1.b Bring about amendments to NATA Act • ban all forms of advertising • ban point of sale display • prohibiting smoking in outdoor/ public places (100% tobacco free outdoor environment) • bring legislation on retail sales of cigarettes • bring policies on smokeless tobacco use • bring legislation on sales of smokeless tobacco products • surveillance to prevent importation of e-cigarettes DDG (MS I) DDG (NCD) NATA NCD Unit 2016-2018 % of tax increase in comparison to increase in GDP 2.1.1.c Advocate to raise tobacco tax • advocate to raise taxes and inflation adjusted prices on tobacco DDG (MS I) DDG (NCD) NATA Ministry of Finance NCD Unit 2016-2018 Strategic action area 2: Health promotion and risk reduction 2.1 Reduce tobacco use NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 27 2.1.1 Prevalence of tobacco use reduced continued. No. of functioning community based tobacco cessation services available 2.1.1.d Setup tobacco cessation services • review evidence and develop a national programme on tobacco cessation service development in Sri Lanka • establish tobacco cessation clinics • develop training module on smoking cessation • develop tobacco cessation guidelines • conduct International workshop on tobacco cessation • capacity building of the health staff on tobacco cessation • training the health staff on counseling • initiation of community based tobacco cessation services DDG (MS) 1 DDG (NCD) NCD Unit NATA Professional Colleges 2016 2020 Proportion of smokers successfully quitting smoking No. of 24 hour hotlines for tobacco cessation available 2.1.1.e Strengthen the services available for tobacco cessation • set up community based tobacco cessation services • strengthen the tobacco cessation hotline • display the tobacco cessation hot line number in cigarette packets • display tobacco cessation hot line number to display at point of sale DDG (MS) 1 NCD Unit NATA Professional Colleges 2016-2020 Desired outcome Indicator Proposed actions Responsibility Time frame NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 28 2.1.1 Prevalence of tobacco use reduced continued. Propotion of smokers successfully quitting smoking No. of 24 hour hotlines for tobacco cessation available 2.1.1.f Improve community awareness on tobacco use including the use of smokeless tobacco • conduct mass media and social media campaigns • conduct community awareness programmes for o teachers o school children o youth o for different community groups DDG (MS I) NCD Unit NATA Ministry of Mass Media 2016-2020 Ministry of Education National Youth Services Council NATA NCD unit NCCP 2016-2020 No. of trade seminars conducted in view of establishing tobacco free zones 2.1.1.g Conduct trade seminars in view of establishing tobacco free zones NCD Unit NATA Ministry of Trade and Commerce 2016-2020 No. of media workshops conducted 2.1.1.h Conduct awareness programmes for media personnel • conduct media workshop Ministry of Telecommunication and Digital Infrastructure NCD unit 2016-2020 Availability of data on prevalance of use of tobacco and other details related to use 2.1.1.i Conduct tobacco research • conduct tobacco use related surveys NCD Unit NATA 2018 Desired outcome Indicator Proposed actions Responsibility Time frame NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 29 2.1.1 Prevalence of tobacco use reduced continued Availability of a mechanism for NATA to monitor ban on advertising including community activities, illegal tobacco products available in the country and point of sale display 2.1.1.j Strengthen NATA • ensure continuous funds to NATA Increase the capacity of NATA • • conduct once month meetings (multi stake holder)by district NATA cell • • strengthen the activities to detect and eliminate illegal tobacco products in airports and ports • • • • • • setup a mechanism at NATA to monitor ban on advertising including community activities , illegal tobacco products available in the country and point of sale display MOH 2016-2020 RDHS 2016-2020 DDG (MS)1 DDG (NCD) Customs Department NCD unit NATA 2017-2020 NATA 2017-2020 No. of health staff trained on tobacco prevention and control 2.1.1.k Train the health staff on tobacco (including smokeless) prevention and control • conduct training programme for health care workers NCD Unit 2016-2018 Desired outcome Indicator Proposed actions Responsibility Time frame NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 30 Desired outcome Indicator Proposed actions Responsibility Time frame 2.2.1 Prevalence of alcohol use and its harmful effects reduced Availability of a national action plan to implement the policy on reduce alcohol use Total alcohol per capita (aged 15+ years old) consumption within a calendar year Age standardized prevalence of heavy episodic drinking among adolescents and adults 2.2.1.a Implement the National Alcohol Policy • develop a mechanism to monitor social media for on alcohol promotion • establish a mechanism to report violations of laws in alcohol marketing & promotion • enact regulations to eliminate all forms of tax concessions for alcohol production, import, retail and marketing • initiate a system where the NATA Act is taken into consideration by the Ministry of Foreign Affairs when International Treaties are scrutinized • establish a mechanism to monitor production, pricing and sale and income • restrict selling of duty free alcohol Tele Communication Regulatory Commission 2017 NATA 2017 Ministry of Finance Ministry of External Affairs Import & Export Control Commission 2016-2020 NATA Ministry of Foreign Affairs 2018 Department of Excise Ministry of Finance Department of Police NATA 2017 Department of Customs BOI Ministry of Trade 2018 2.2 Reduce alcohol use NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 31 2.2.1 Prevalence of alcohol use and its harmful effects reduced continued. continued. • review and revise the licensing system to control the availability of alcohol products • advocate political leadership and other relevant stakeholders to get their support for law enforcement • • strengthen life skills of school children to resist the influence on alcohol promotion Department of Excise Tourist Board 2020 Mental Health Unit 2017-2020 Mental Health Unit Ministry of Education NYSC Ministry of Child Development 2017-2020 Production and sale of illicit alcohol 2.2.1.b Reduce production and sale of illicit alcohol • establish a mechanism receive information on availability of illicit alcohol products • educate the community on harmful effects of these products and empower to act against illicit alcohol Department of Excise Department of Police 2017 Public Administration Ministry Mental Health Unit Social Service Ministry Ministry of Women’s Affairs District Secretariat 2017 Desired outcome Indicator Proposed actions Responsibility Time frame NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 32 Desired outcome Indicator Proposed actions Responsibility Time frame 2.2.1 Prevalence of alcohol use and its harmful effects reduced Proportion of alcohol related violence and injuries 2.2.1.c Reduce alcohol related violence and injuries • strengthen legal action for alcohol use and violence and accidents • strengthen the service availability of detecting Blood Alcohol Concentration (BAC) including following accidents • increase public awareness on harm due to alcohol, control direct and indirect promotion of alcohol use, and related laws • empower the community to act NATA Ministry of Justice Min. of Social service 2017 Department of Police Mental Health Unit 2017 NATA Mental Health Unit Department of Police Ministry of Education Ministry of Social Services 2017-2020 Department of Police MOH Ministry of Education 2017-2020 Prevalence of alcohol among adults and harmful effects of alcohol 2.2.1.d Monitor prevalence of alcohol among adults and harmful effects of alcohol in the country and share the findings • conduct alcohol prevalence surveys every 3 yrs • establish a surveillance mechanism to report alcohol related violence, accidents and injuries • promote alcohol related research • establish a mechanism to disseminate the evidence Mental Health Unit Department of Police 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 33 Desired outcome Indicator Proposed actions Responsibility Time frame 2.2.1 Prevalence of alcohol use and its harmful effects reduced Availability of treatment and rehabilitation services related to alcohol 2.2.1.e Establish treatment and rehabilitation services related to alcohol • build the capacity of PHC workers & other grass root level field officers in non health sector to screen and refer alcohol dependents & follow-up • establish a mechanism to report alcohol related services available in the government, NGOs and private sector for treatment and rehabilitation • establish alcohol rehabilitation units and Alcohol treatment clinics in all districts at institutional and community settings Mental Health Unit 2017 NATA Mental Health Unit 2017 Mental Health Unit 2017 Availability of a mechanism to implement and monitor the alcohol policy 2.2.1.f Establish a mechanism to implement, monitor and evaluate alcohol policy at national and district levels • establish a sub-committee within National Mental Health Committee to review the implementation of alcohol policy • develop a strategic plan and guidelines for implementation • empower NATA to implement alcohol policy as this is its legitimate role • ensure availability of adequate funding for implementing activities at national and district levels • preparation of documentation for the periodically reporting of the progress to the Presidential Task Force on Prevention of Substance Use MOHD/MH RDHS District Psychiatrist MO/MH (Focal Point) Mental Health Unit 2017 NATA Mental Health Unit 2017-2020 NATA Mental Health Unit 2017-2020 Mental Health Unit NATA 2017 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 34 2.3 Promote healthy diet high in fruit and vegetables and low in saturated fat/trans fat, free sugar and salt Desired outcome Indicator Proposed actions Responsibility Time frame 2.3.1 Increased intake of healthy foods Availability of policies and mechanisms to increase intake of healthy foods Prevalence of persons (aged +18 years ) consuming less than five total servings (400 g) of fruit and vegetables per day 2.3.1.a Accelerate the implementation of the diet component of the Global Strategy on Diet, Physical Activity and Health • create a mechanism for monitoring of food and beverages advertisements and complains • develop national policies on marketing of food and non alcoholic beverages to children • develop policies to promote availability of healthy food • develop policies to increase the affordability of healthy food • set up a committee to review food advertisement before airing • conduct programme to increase the acceptability of healthy food • establish policies on taxes and subsidies to promote consumption of fruits and vegetables E&OH Ministry of Trade Ministry of Consumer affairs Ministry of Agriculture Nutrition Division NCD unit 2017-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 35 2.3.2 Reduced consumption of saturated fats/ trans fats, sugar and salt Availability of fruits and vegetables 2.3.1.b Increase availability of fruits and vegetables • home gardening promotion programme • provide plants and seeds free / low cost • conduct home gardening competitions • establish a mechanism to provide seasonal fruits and vegetables for low cost Nutrition Coordination division Ministry of Agriculture 2017-2020 Availability of policies and mechanisms to increase intake of healthy foods Availability of food composition tables and nutrition profiling 2.3.1.c Make available data and initiate policies to increase intake of healthy foods • nutrition profiling to define unhealthy food and drinks • develop food composition tables • draft a policies to increase intake of healthy foods Nutrition Division MRI NCD unit Nutrition Division 2017-2020 Age-standardized mean population intake of salt (sodium chloride) per day in grams in persons aged 18+ years 2.3.1.d Develop and implement a national salt reduction strategy • advocate recommended salt consumption and define key components of the policy • determine the main sources of sodium chloride in Sri Lanka ( survey) • conduct urinary salt surveys once in every 3 years • Develop and implement a national salt reduction strategy • evaluate locally tailored interventions adopted to reduce the salt consumption E& OH NCD Unit 2016-2017 MRI 2016-2017 Nutrition division 2016-2017 NCD Unit 2016-2017 MRI 2016-2017 Desired outcome Indicator Proposed actions Responsibility Time frame NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 36 2.3.2 Reduced consumption of saturated fats/ trans fats, sugar and salt continued. continued. • strengthen the laboratory facilities at MRI and to check salt, fat content in the diet and urinary sodium concentration • develop the lab at MRI and in a selected hospital • strengthen of MLT schools at MRI MOH 2018-2019 MOH 2018-2019 MOH 2018-2019 Availability of food low in food low in salt, sugar and fats 2.3.2.e.Increase the availability of healthy foods low in salt, sugar and fats • advocacy meeting with food producers, processors, retailers to lobby to change the composition of food • lobby food industry to manufacture healthy food options • motivate food industry to reformulate processed food • conduct award programme for companies who prepare healthy food • establish a mechanism to ensure voluntary reduction of salt, sugar and fat • establish a mechanism to ensure mandatory reduction of salt, sugar and fat • evaluate the effects of major interventions for reducing salt E &OH Nutrition Division NCD Unit Ministry of Trade and Consumer Affairs Food manufacturers Chamber of Commerce 2016-2019 E&OH MRI 2017-2019 E&OH MRI 2017-2019 Desired outcome Indicator Proposed actions Responsibility Time frame NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 37 2.3.2 Reduced consumption of saturated fats/ trans fats, sugar and salt continued. Availability of processed foods with no trans fats 2.3.2f Take measures to reduce trans fat in processed foods • conduct a survey to identify sources of trans fat and base line levels • develop a national strategy to address trans fat • develop a policy to limit use of trans fat and use of PHVO (partially hydrogenated vegetable oil) in all processed food and restaurants MRI ITI 2017 NCD Unit 2017 E&OH, Nutrition Division NCD unit Food manufacturers 2018 Availability of food labeling with nutrition composition and traffic light system No. of food items certified by / given the certification on the contents of the food label 2.3.2.g Introduce food labeling to indicate unhealthy foods • introduce traffic light system for salt, sugar and saturated fat, trans fat, energy content • indicate the nutrition composition of the food in the labels • strengthen laboratory network in the country to certify the contents in the food labels (one per E&OH, NCD Nutrition Division Food manufacturers 2017-2020 E&OH NCD unit MoH Food manufacturers 2018-2020 E&OH NCD unit 2018-2020 Availability of policies on taxing unhealthy diet 2.3.2.h Increase tax for unhealthy food • establish policies on taxes to discourage consumption of unhealthy food high in fat, sugar and salt • impose taxes on un healthy food and beverages E&OH Ministry of Finance Food manufacturers Nutrition Division NCD Unit 2018-2020 Desired outcome Indicator Proposed actions Responsibility Time frame NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 38 2.3.2 Reduced consumption of saturated fats/ trans fats, sugar and salt continued. Availability of a mechanism to monitor compliance of the private sector with reduction of salt, sugar and fat in processed food 2.3.2.i Establish a mechanism to monitor compliance of the private sector with reduction of salt, sugar and fat in processed food E&OH 2016-2020 2.3.3 Reduced cardio metabolic risk of consuming unhealthy foods Knowledge of the public on daily requirement of salt, sugar, fats and cardio metabolic risk of consuming unhealthy foods 2.3.3.a Improve awareness of the public on cardio metabolic risk of consuming unhealthy foods through a mass media campaign • develop IEC materials on salt, sugar, fat • telecast commercials on sugar , salt, fat reduction • develop IEC materials on BMI, obesity, overweight prevention • telecast commercials on fruits and vegetables consumption • publish newspaper advertisement on healthy foods and unhealthy food habits • conduct healthy dish competitions HEB Ministry of Mass communication NCD unit Professional Colleges 2017- 2019 Desired outcome Indicator Proposed actions Responsibility Time frame NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 39 Desired outcome Indicator Proposed actions Responsibility Time frame 2.3.3 Reduced cardio metabolic risk of consuming unhealthy foods continued. % of infants receive complementary feeding after 6 months % of mothers who exclusively breast feed for 6 months and appropriate complementary feeding 2.3.3.b Promote maternal and child nutrition • promote exclusive breast feeding • implement breast feeding code • promote complementary feeding • ensure good maternal nutrition • improve nutrition in malnourished girl children FHB 2016- 2020 No. of schools practicing healthy canteen policy No. of workplaces practicing healthy canteen policy 2.3.3.c Improve availability of healthy foods • implement healthy canteen policy in schools • establish healthy canteens in work places according to the guidelines Ministry of Education FHB PDHS RDHS 2016- 2020 All Ministries NCD Unit Nutrition division E&OH PDHS RDHS 2016- 2020 Availability of locally relevant food based dietary guidelines 2.3.3.d Increase availability of food based dietary guidelines • revise the Sri Lankan food based dietary guidelines • disseminate the food based dietary guidelines Ministry of Education FHB PDHS RDHS 2018 Nutrition division 2016 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 40 Desired outcome Indicator Proposed actions Responsibility Time frame 2.3.3 Reduced cardio metabolic risk of consuming unhealthy foods continued. Knowledge of the public on healthy foods 2.3.3.e Conduct awareness programmes on healthy foods and food based dietary guidelines • conduct programmes for pre school teachers, school children, teachers, parents, youth, university students, community groups on food based dietary guidelines Nutrition division NCD Unit PDHS RDHS 2016 - 2020 No. of staff trained on food based dietary guidelines 2.3.3.f capacity building of health workers on food based dietary guidelines • training programmes on healthy diet for healthcare workers based on food based dietary guidelines Nutrition division NCD Unit 2016 Availability of obesity management guidelines and obesity management clinics 2.3.3.g Improve obesity management • develop a teaching module on obesity management guidelines • establish obesity management clinics NCD Unit Professional Colleges 2017-2018 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 41 Desired outcome Indicator Proposed actions Responsibility Time frame 2.4.1 Physical inactivity reduced Availability of a physical activity guidelines for public Availability of environment conducive to promote physical activity Prevalence of physical inactivity in people 18 yrs and over Availability of policy on doing physical activity during working hours Age standardized prevalence of overweight and obesity among the curative health staff 2.4.1. a Develop physical activity guidelines for public NCD unit Ministry of Sports 2016 2.4.1.b Conduct advocacy meetings for town planners, politicians to improve environmental changes to promote physical activity Ministry of Sports Ministry of Local Government 2016-2018 2.4.1.c Establish / Strengthen the PA programmes in work places • develop policies on supportive environment for physical activity in workplaces • develop an action plan to promote physical activity through sports clubs , other community settings and schools • develop guidelines for physical activity at work places • introduce regulation to establish a place to do exercise in new office buildings • introduce a mechanism to provide membership at sport complexes for a subsidize prize for government workers • bring up policy decision on permitting exercise during working hours • establish a place to do physical activity in hospitals (as a pilot) Ministry of Sports E&OH NCD unit 2017-2020 Ministry of Sports E&OH 2016-2017 Ministry of Sports NCD Unit 2018 E&OH Ministry of Sports 2018-2019 Ministry of Sports E&OH 2018 NCD unit Sports ministry Ministry of Labour 2017 E&OH NCD unit 2017 - 1018 2.4 Promote physical activity NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 42 Desired outcome Indicator Proposed actions Responsibility Time frame 2.4.1 Physical inactivity reduced Prevalence of overweight and obesity in adolescents 2.4.1.d Strengthen the PA programmes in the schools • revise guidelines on physical activity in schools • develop policies on supportive environment for physical activity in schools • ensure mandatory exercise time in the school • establish a mechanism that all children engaged in one type of PA • increase the availability of sports equipment in the schools • increase the availability of spaces to do physical activity in schools • recruit adequate number of teachers for physical education • revise the school curriculum • make health science a compulsory subject Ministry of Education Ministry of Sports HB NCD unit Ministry of Local Government 2016-2020 Venues available to do PA % of towns with a standard play area 2.4.1.e Improve facilities for physical activity for the community • increase venues for (people to do PA (swimming fools, sport fields/ complexes, gym facilities) Ministry of Local Government Ministry of Sports 2018 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 43 Desired outcome Indicator Proposed actions Responsibility Time frame 2.4.1 Physical inactivity reduced continued. continued. • introduce legislation to ensure safe walking paths / cycling paths/ facility to do PA in new town and housing development • introduce legislation to ensure each town has at least one play area • establish a play area in each town1-3 per 50,000 population) Ministry of Local Government 2018 Ministry of Local Government Ministry of Sports 2018 Ministry of Local Government Ministry of Sports 2020 Prevalence of physical inactivity in people 18yrs and over Knowledge of specific groups on the recommendations of physical activity, 2.4.1.f Improve public awareness on physical activity • conduct awareness programmes for pre school teachers, teachers, parents, youth, university students, • develop IEC materials on physical activity • develop paper advertisements and TV commercials • social marketing on physical activity NCD unit PDHS RDHS Ministry of Sports Ministry of Higher Education Ministry of Skills Development 2018 HEB Ministry of Mass Media Ministry of Sports NCD Unit Professional Colleges 2017 - 2018 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 44 Desired outcome Indicator Proposed actions Responsibility Time frame 2.4.1 Physical inactivity reduced continued. Availability of research findings on effective PA interventions 2.4.1.f Conduct a research on effectiveness of physical inactivity among adolescents NCD unit Ministry of Sports 2019 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 45 2. 5 Promote healthy behaviours and reduce NCDs in key settings Desired outcome Indicator Proposed actions Responsibility Time frame 2.5.1 Reduced risk of NCDs among school children/ university students/ students in vocational institutions and among the workforce Availability of a revised NCD communication strategy promoting healthy behaviours 2.5.1.a Design and launch a public education campaign on NCD • revise the NCD communication strategy • conduct mass media campaign through electronic, print and online media HEB NCD Unit 2016-2017 NCD Unit HEB 2016-2020 No. of functioning healthy villages No. of functioning healthy schools No. of functioning healthy work places Availability of guidelines for a healthy village Availability of guidelines for a healthy school Availability of guidelines for a healthy workplace % of work places with inter sectoral working groups 2.5.1. b Establish health promotion settings • establish healthy villages • establish healthy promoting schools • establish healthy workplaces • develop guidelines for a healthy village • conduct workshops at MoH level with other officials to map stakeholders and to design health promotion activities HEB NCD Unit PDHS RDHS 2016-2017 Ministry of Education FHB NCD unit PDHS RDHS 2016-2020 E & OH PDHS RDHS 2016-2020 HEB 2016 HEB NCD unit 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 46 Desired outcome Indicator Proposed actions Responsibility Time frame Continued. • develop guidelines for a healthy school • develop guidelines for a healthy workplace • establishment of inter sectoral working groups in work places to promote healthy behavior • conduct experience sharing events: healthy dish exhibitions, PA competitions Ministry of Education HEB FHB 2016 E&OH NCD unit 2017-2018 Relevant Ministries 2016 NCD unit 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 47 Desired outcome Indicator Activities Responsibility Time frame 2.6.1 Household air pollution due to solid fuel use for cooking is reduced Proportion of households with solid fuel as primary source of cooking Percentage of households using improved cook stoves Percentage of households using LP gas for cooking 2.6.1.a Advocate and introduce a policy to reduce air pollution • advocacy meetings with all relevant stake holders to reduce air pollution • introduce a policy to reduce air pollution • advocacy with stakeholders to promote clean fuel for cooking • introduction of cleaner technologies and ovens with less fume, improved cook stoves Ministry of Environment Central Environmental Authority Department of Sustainable Energy NCD Unit NPTCCD E&OH 2016 – 2017 Ministry of Environment Central Environmental Authority Department of Sustainable Energy 2016 – 2020 2.6.1.b Conduct training programmes for Medical Officers and other health staff on reducing indoor air pollution NCD Unit E&OH NPTCCD 2016- 2020 Availability of indoor air quality guidelines 2.6.1.c Develop indoor air quality guidelines Ministry of Environment Central Environmental Authority Department of Sustainable Energy 2016- 2020 Availability of data on effective interventions to reduce air pollution in local context 2.6.1.d Conduct research on interventions to reduce indoor air pollution in local context Ministry of Environment Central Environmental Authority 2016- 2020 2.6 Reduce household air pollution NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 48 Desired outcome Indicator Activities Responsibility Time frame 2.6.2 Passive smoking is reduced Knowledge on passive smoking, its harm and how to prevent 2.6.2.a Improve public awareness on passive smoking • conduct awareness programmes on second hand smoking at home for School children and for community groups • conduct mass media campaign on passive smoking o telecast commercials on indoor air pollution o develop IEC materials o publish paper advertisements NATA NCD unit NCCP Ministry of Environment Central Environmental Authority Department of Sustainable Energy 2018 – 2020 HEB E&OH NPTCCD NCD Unit Ministry of Environment Central Environmental Authority Department of Sustainable Energy Professional Colleges 2017-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 49 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors Proportion of eligible people screened for NCDs Proportion of screened people assessed for cardiac risk 3.1.1a Increase availability and access to NCD screening services • change the service hours of HLCs • revise the upper age limit for NCD screening • revise the HLC guideline • make available free downloadable application to assess cardiac risk (to be used in electronic devices) • revise the basic package for NCD screening o HLCs o workplaces o mobile clinics • introduce health record for every one above 20 yrs • develop criteria to screen persons 20yrs – 40yrs for diabetes • facilities to perform OGT in screened people with FBG 100- 125 mg/dl NCD unit 2016 NCD unit Professional Colleges 2016 NCD unit 2017 NCD unit 2016-2020 NCD unit 2017 NCD unit 2017 NCD unit Professional Colleges 2017 NCD unit Professional Colleges 2018 Strategic Action Area 3: Health system strengthening for early detection and manage ment of NCDs and their risk factors 3.1 Access to health services NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 50 3.1 Access to health services Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors Percentage availability of essential NCD medicines, including generics, and basic technologies in both public and private facilities Proportion of out of pocket expenditure Availability of national essential NCD drug list Percentage of health institutions having technologies and investigation facilities for primary, secondary and tertiary prevention Availability of a national essential technology list Availability of low cost effective generic products to treat NCDs 3.1.1.b improve availbility and access to essential NCD medicine and technologies • revise the national essential NCD drug list • monitor the availability of essential NCD drugs at central and district levels • develop/ revise then basic essential technology list for management of NCDs • identify the life saving technologies for managing NCD in initial phase of emergency response • improve the Bio medical Engineering network • make availability of services to do Fasting Lipid profile at BH and above • advocacy to make the basic technologies and essential NCD drugs available in the private sector NCD unit MSD PDHS RDHS 2016 NCD unit MSD PDHS RDHS 2016 NCD unit MSD Biomedical Engineering Dept (BMED) 2016 NCD unit MSD Professional Colleges Biomedical Engineering Dept (BMED) 2017 MoH 2018-2019 NCD unit MSD 2016-2020 MSD Director private health 2016 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 51 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors Continued. • Promote procurement and use of generic medicine for prevention and control of NCDs o establish a mechanism to assure the quality of generic products o educate the prescribers o educate the consumers • post marketing surveillance for essential NCD drugs • develop MRI and lab facilities in other districts MSD National Medicine Regulatory Authority Professional Colleges 2016 National Medicine Regulatory Authority RDHS 2017 MRI PDHS RDHS 2017 Availability of revised NCD management guidelines to be used in PHCs Availability of a referral and back referral system Accredited quality assurance system is available Availability of a training module on management of NCDs at the PMCU 3.1.1.c Improve NCD management at Primary Health Care level • revise NCD management guidelines to be used in PHCs • reduce risk threshold for starting statins • integrate NCD management in to the PHC system and identify basic primary care package for NCD management at PHC • establish a referral and back referral system at PMCU for NCDs NCD Unit PHC unit 2016 NCD Unit Professional colleges 2016 NCD Unit PHC unit 2016 NCD Unit PHC unit Quality Assurance Unit 2019 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 52 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors No. of MOO practice NCD management guidelines at PMCU Availability of guidelines on tools/ guidelines for self- care of major NCDs • establish a quality assurance system for PMCU to improve the quality of care with focus on clinical services quality standards , management systems and risk management • develop a training module on management of NCDs at the PMCU • training of the MOO on NCD management at PMCU • develop tools/ guidelines for self- care of major NCDs NCD Unit PHC unit Quality Assurance Unit 2019 Professional Colleges NCD Unit 2017 NCD Unit 2016 Professional Colleges NCD Unit 2017 Availability of guidelines on the palliative care in NCDs No. trained on palliative care in NCDs 3.1.1.d Improve availability and access to palliative care • develop guidelines on the palliative care in NCDs • develop terminal and palliative care protocols for cancers , CVDs , COPDs, diabetes • Training of the MOO on palliative care in NCDs Professional Colleges NCD Unit NCCP YED 2017 Professional Colleges NCD Unit NCCP 2018 Professional Colleges NCD Unit Cancer control unit 2016 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 53 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved ac cess to services for early detection and management of NCDs and their risk factors Continued. No. of trained healthcare workers to manage NCDs 3.1.1.e Capacity building of healthcare workers to manage NCDs NCD Unit 2016 Availability of separate budget allocated for NCD 3.1.1.f Develop policies for sustainable health financing for NCD NCD Unit Ministry of Finance 2017 No. of TV commercials aired on screening No. of TV commercials aired on HLCs No. of paper advertisements published 3.1.1.g Publicize screening services through a mass media campaign • telecast commercials to promote screening • telecast commercials to promote utilizing HLCs • publish Paper advertisements on HLCs • conduct social media campaign on screening • develop IEC materials on screening and HLCs NCD unit Ministry of Mass Media Professional Colleges 2016-2017 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 54 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors Continued. Availability of a standardized and efficient system to produce clinical guidelines 3.1.1.h Establish a Council to produce clinical guidelines on NCDs Professional Colleges Academia NCD unit 2019 Availability of a well equipped PCI centre at NHSL %. of trained staff available at PCI centres % of provinces with at least one PCI centre Availability of equipment for emergency management services Availability of emergency management services with ambulance facilities to manage AMI patients at cardiology unit, Colombo Availability of emergency management services with ambulance facilities to manage AMI patients in other provinces 3.1.1.i Improve access to services to manage Cardiovascular Diseases • provide dug therapy and counseling (including gly caemic control) for eligible people to prevent heart attack and stroke • strengthen the PCI centre at NHSL with provision of equipment and human resources • ensure provision of adequate human resources, tec nologies and other resources to function cardiac cath eterization lab at NHSL for 24 hours in a phased out manner • establish PCI (per cutaneous coronary intervention) centres one per province in a phased manner • strengthen the transport system and train a team to manage AMI at provincial level • improve availability of equipment to Cardiology Units in selected hospitals • improvements to the cardiology units of selected hos pitals • construction of cardiac operation theatres, procurement of equipment, development and provision of equipment to cardiac ICUs in selected hospitals NCD unit MSD 2016 MoH 2017 - 2019 MoH 2017 - 2020 MoH 2017 - 2020 MoH 2016 MoH 2018 - 2019 MoH 2018 - 2019 MoH 2018 - 2019 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 55 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved ac cess to services for early detection and management of NCDs and their risk factors Continued. Availability of criteria to do HbA1C in medical clinics Availability of updated Diabetes management guidelines % of diabetes patients investigated for HbA1C once in three months Availability of a updated / revised diabetes management guidelines % of diabetes patients examined for yearly podiatry review % of diabetes patients examined for two yearly ophthalmology review % of diabetes patients on statin % of gestational diabetes mothers screened for DM after the pregnancy 3.1.1.j Improve access to services to manage Diabetes Mellitus • develop criteria to do HbA1C in medical clinics • provide facilities to do HbA1C in medical clinics • • develop / update the diabetes management guidelines • services to perform monthly FBS or RBC in diabetes patients in medical clinics • services to perform HbA1C once in three months until the target is achieved. Once a year after that • services for yearly 24 urinary protein check in diabetes patients • services yearly podiatry review of diabetes patients • services for two yearly ophthalmology review of diabetes patients • provisions for all diabetes patients to get statins • screening of mothers who had gestational diabetes • strengthen post natal programmes to target gestational diabetes women • conduct programmes to reduce gestational diabetes- pre conception screening for overweight and obesity • conduct programmes to reduce low birth weight Professional Colleges NCD unit 2017 MOH 2019 Professional Colleges NCD unit 2016 MOH 2017 MOH 2018-2020 MOH 2017-2020 MOH 2017 MOH 2016 MOH 2018 MOH 2017 FHB 2016 NCD unit 2017 FHB 2016 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 56 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors Continued. % school children screened for asthma % of work places where workforce is screened for asthma 3.1.1.k Improve access to services to screen Chronic Respiratory Diseases (CRD) - Asthma and chronic obstructive Pulmonary Disease (COPD) • screening for CRD in the schools • screening for CRD in the workplaces • screening adults > 40 years for CRD NPTCCD NCD unit 2016 E&OH NPTCCD NCD unit 2017 NPTCCD NCD unit 2017 % of asthma patients managed according to asthma guidelines % of asthma patients receiving essential drugs % of medical / chest clinics with essential equipment to manage asthma 3.1.1.l Improve access to services to manage CRD • print and disseminate guidelines for the management of CRD • improve the knowledge of the patients on asthma and using inhalers • introduce self management plans for CRD patients NPTCCD NCD unit Professional College 2016 Professional Colleges 2017 Professional Colleges 2016 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 57 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved ac cess to services for early detection and management of NCDs and their risk factors Continued. % of asthma patients managed according to asthma guidelines % of asthma patients receiving essential drugs % of medical / chest clinics with essential equipment to manage asthma Continued. • increase the availability of equipment for the diagnosis and assessment of CRD patients o Peak flow meters o Pulse oximeters o Spirometers • establish community based palliative care for end stage COPD patients • develop guideline on management of COPD o Pneumococcal and influenza vaccination for COPD patients o referral of COPD patients • training of health staff on CRD o develop a training module o conduct training • improve services for recognizing and managing asthma in schools o training of teachers and students MSD NPTCCD PDHS RDHS NCD unit 2016 Professional Colleges 2019 Professional Colleges 2017 NPTCCD Professional Colleges 2017 NPTCCD Professional Colleges 2017 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 58 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors Continued. Availability of a documentation procedure on asthma patients Availability of data collection system of the asthma patients 3.1.1.m Improve availability of data on CRD • establish a standardized documentation procedure for the CRD patients • develop a data collection system of the CRD patients NPTCCD NCD unit Professional College 2018 NPTCCD NCD unit Professional College 2017 Knowledge of different community category on risk factors for asthma 3.1.1.n Increase public awareness on CRD • develop IEC materials on CRD o TV commercials on CRD o paper advertisements on CRD • conduct awareness programmes at the community, schools and work places on CRD NPTCCD NCD unit Professional College 2017 NPTCCD NCD unit Professional College 2017 Availability of data on epidemiology of CRD in Sri Lanka and occupational hazards 3.1.1.0 Conduct Research to identify epidemiology of CRD in Sri Lanka and occupational hazards NPTCCD MSD NCD unit 2017 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 59 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors Continued. No. of provinces having at least one comprehensive cancer screening service out of all provinces No. of provinces having at least one mammography facility out of all provinces No. of provinces having at least one colposcopy service out of all provinces Coverage of cervical cancer screening out of target population 3.1.1.p Improve Cancers screening services • establish comprehensive cancer screening service at each province • increase mammography capacity • ensure colposcopy services are available at provincial level • expand the coverage of Well Women Clinic Services for cervical cancer screening & breast cancer early diagnosis at MoH level • pilot HPV testing for cervical cancer screening • strengthen Oral potentially malignant disorders /Oral cancer screening at MoH level • introduction of HPV vaccination for cervical cancer prevention NCCP Hospital Directors of Teaching / Provincial General Hospitals 2016 - 2020 FHB NCCP NCD Unit PDHS 2016 - 2020 FHB NCCP 2016 - 2017 NCCP 2016 Epidemiology Unit 2017 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 60 Desired outcome Indicator Proposed actions Responsibility Time frame 3.1.1. Improved access to services for early detection and management of NCDs and their risk factors Continued. Percentage of cancers detected at an early stage out of all cancers for breast, oral & cervical 3.1.1.q Improve the diagnostic and treatment facilities for cancer • develop clinical management guideline for common cancers Breast & Oral cancer NCCP Professional Colleges including College of Oncologists 2016-2018 3.1.1.r Strengthen radiotherapy facilities at nine cancer treatment centres MoH 2016-2020 No. of cancer treatment centres having palliative care consult service out of all cancer centres 3.1.1.s Improve palliative care for cancer patients • development of palliative care consult services at cancer treatment centres in phased out manner • training of health staff on palliative care for cancer patients NCCP Hospital Directors of Teaching / Provincial General Hospitals 2016-2020 NCCP Professional colleges 2016-2020 3.1.1.t Improve public awareness on cancer • develop and disseminate audio / video campaigns • develop & disseminate IEC materials NCCP 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 61 Desired outcome Indicator Proposed actions Responsibility Time Frame 3.2.1 Availability of adequate competent health workforce for prevention, diagnosis and management of NCD Availability of a healthcare worker in the field to do NCD activities 3.2.1.a Improve availability of human resources • increase the No. of PHMM or identify a new cadre to perform NCD activities at the field level and project the required cadre MOH 2017 Availability of a training curriculum for other health staff in NCD No. of different staff categories trained on NCD 3.2.1.b Capacity building of the health workers • development of a training curriculum for MO(NCD) in NCD • conduct two weeks training programme for MOO(NCD), annually • develop a training curriculum for other health staff in NCD • introduce in service training programme on NCD of for all health category; PHNS,PHM,PHI • revise the available NCD modules in basic training programme of health care workers • training the paramedics attached to emergency care services NCD unit 2016 NCD unit 2016-2020 NCD unit 2017 NCD unit 2016-20 ET&R unit NCD unit 2016 Academia Colleges NCD unit 2016-2020 3.2.1.c improve training facilities to train the health workers • Construction of new Provincial training centres • Improvement of equipment in regional train ing centres NCD unit 2018-2019 NCD unit 2018 - 2019 3.2 Health workforce NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 62 3.3 Community based approaches Desired outcome Indicator Proposed actions Responsibility Time 3.3.1 Community is empowered for prevention and control of NCD Availability of empowered community groups on NCD prevention 3.3.1.a Establish community groups to be involved in NCD activities Provincial and district health staff HEB 2016 3.3.1.b Formation of community/ patient groups HEB NCD unit 2017 3.3.1.c Build the capacity of the patient groups Professional Colleges 2016 3.3.1.d Develop an effective model to care for patients who need long term care in NCDs Professional Colleges 2016 3.3.1.e.Develop guidelines to monitor community based approaches HEB 2016 3.3.1.f Monitor community based approaches HEB 2017 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 63 Desired outcome Indicator (The section on Aligning National NCD MSAP with Global Monitoring Framework specifies the relevant global impact indicators) Activities Responsibility Time frame 4.1.1 Availability of data on relationship of one risk factor and economical burden / year Availability of timely and quality data on NCD and risk factors Availability of trained staff for data management Availability of timely and quality data on risk factors and economic burden 4.1.1.a Improve staff and resources dedicated for data management in NCD • establish national surveillance and monitoring framework for NCD prevention and control • provide adequate human resourcesto manage data at the medical Statistics Unit • initiate a web based data collection system for morbidity data • improve the quality of returns from HLCs • obtain a software to monitor availability of drugs and equipment • develop an IT system to capture the OPD data as a pilot project • establish a web based data system in each HLC • conduct STEP survey every 4- 5 yrs • improve the quality of IMMR data (diagnosis and COD) • improve the quality of Registrar General ‘s death data NCD unit 2016 MOH NCD unit Medical Statistics unit NCD unit 2016 MSD 2016 NCD Unit Medical Statistics Unit 2016 NCD unit 2016 2018 NCD unit 2019 Medical Statistics Unit 2016 2020 Registrar General’s dept Medical statistics unit 2016 2020 Strategic action area 4: Surveillance, monitoring, evaluation and research 4.1 Strengthen surveillance NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 64 Desired outcome Indicator Proposed actions Responsibility Time frame 4.1.1 Availability of data on relationship of one risk factor and economical burden / year Continued. Availability of timely and quality data on NCD and risk factors Availability of trained staff for data management Availability of timely and quality data on risk factors and economic burden Continued • integrate surveillance of NCD in other national surveys o DHS o Census • training of MRO • training of pre intern doctors • conduct workshops to strengthen the vital registration system • conduct workshops to improve the medical cause of death reporting • carry out national school health survey • capacity building for data analysis • capacity building for data use • disseminate the results of surveillance • update cause specific mortality statistics by sex and age for the latest available year • review the current cancer registry and establish cancer registries in 2 regional referral hospitals Medical statistics unit 2016-2020 Medical Statistics Unit 2016-2020 PHC unit 2016-2020 Medical Statistics Unit PHC unit 2016-2020 Registrar General’s Dept 2016-2020 NCD Unit 2018 Medical Statistics Unit 2016 Medical statistics unit 2016 Relevant units 2016 Medical Statistics Unit NCD unit 2016 NCCP 2017 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 65 Desired outcome Indicator Proposed actions Responsibility Time frame 4.2.1 Timely reporting of information and timely review of the NCD programmes Availability of a monitoring framework to assess progress towards the goal 4.2.1.a Develop a monitoring framework to assess progress towards the goal NCD Unit 2016 Reports of periodic NCD programme evaluation 4.2.1.b Conduct periodic NCD programme evaluation NCD unit 2016 Availability of an integrated NCD monitoring system into HMIS 4.2.1.c Integrate NCD monitoring into HMIS Medical Statistic Unit 2017 4.2.1.d Conduct national review meetings NCD unit 2016 4.2.1.e Conduct district review meetings RDHS 2016 Availability of a mechanism to disseminate results – Quarterly NCD Bulletin 4.2.1.f Develop a mechanism to disseminate results – Quarterly NCD Bulletin NCD Unit 2016 Annual report on NCD prevention and control 4.2.1.g Publish a yearly report NCD unit 2017 An improvea system to monitor activities in the MSAP at national, provincial and district level 4.2.1.h Monitoring and evaluation framework for health system intervention • clinical audits to assess the adherence to guidelines • assess the health impact of policies in non- health sectors • conduct Capacity assessment survey NCD unit Academia 2018 2020 Availability of a report on the health impact of policies in non health sector HITA team 2020 Availability of a capacity assessment survey report NCD unit WHO 2016 4.2 Improve monitoring and evaluation NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 66 4.3 Strengthen research Desired outcome Indicator Proposed actions Responsibility Time frame 4.3.1 Evidence generated and used for national policy and programmedevelopment Availability of a mechanism to generate research evidence for NCD policy and programming 4.3.1 .a Establish a national multi -disciplinary research committee Planning Unit NCD Unit Academia 2016-2017 4.3.1.b Prepare a national research agenda for NCD 4.3.1.c Conduct priority research 4.3.1.d Capacity building of officers on research 4.3.1.eEstablish a forum / committee to translate research in to policy action 4.3.1.f Identify the country / region specific cut - off points Eg: cut -off for the overweight and obesity, Total Cholesterol level 4.3.3.g Identify research questions to support the implementation, monitoring and evaluation of the NCD action plan PGIM Academia 2016 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 67 Prioritized National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2017 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 68 Strategic area 1: Advocacy, partnership and leadership 2016-2017 NCD recognized as a priority in the national agenda Advocacy to recognize NCD as a priority and to take up prevention and control of NCDs and its risk factors Strengthen national coordina tion for multisectoral actions on the prevention and Control of NCDs Place NCDs on broader health and development agenda 1.1.a Establish national NCD Council and convene regular meetings to coordinate and supervise, including twice a year meetings to review progress and to facilitate the implementation of the national NCD MSAP 1.1.b Develop advocacy packages on prevention and control of NCDs for politicians and for the health sector and non- health sec tors at national, provincial and district levels. 1.2.a Establish provincial and district level a multi-sectoral commit tees to implement and monitor the policies and interventions. 1.2.b Integrate the prevention and control of NCDs into national and provincial health planning processes and broader development agendas. 1.2.c Share global NCD targets and process indicators with the national and provincial team working on SDGs • MoH • NCD Unit • Department of National Plan ning • HEB • NCD unit • PDHS • RDHS • Department of National Plan ning • NCD Unit • Department of National Plan ning • NCD unit Establishment of a National NCD Council Availability of advocacy packages for various stakeholders, covering major NCDs and NCD risk factors Committees established in all Districts Integration of NCDs as one of the crite ria to assess new national and provincial level projects National and provincial committee accepted the indicators identified by the NCD MSAP Detailed activities Lead agency Milestones 2018 1.1 Advocacy 1.2. Partnership Prioritized actions NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 69 Strategic area 1: Advocacy, partnership and leadership 2016-2017 Prioritized actions Enhance the human resources at national, regional and grass root levels to perform NCD related activities 1.3.a Identify the cadre and fill the identified cadres of staff mem bers at NCD Unit 1.3.b Capacity building of the relevant staff 1.3.c Provide infra structure facilities 1.3.d Provide facilities and staff for the NCD unit to support and monitor the implementation of the NCD MSAP • Organizational and Develop ment unit • Planning unit • Organizational and Develop ment unit • Planning Unit Fully staffed NCD unit A mechanism to monitor and coordinate the NCD MSAP established Detailed activities Lead agency Milestones 2018 1.3 Leadership NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 70 Strategic area 2: Health promotion and risk reduction 2016-2017 Prioritized actions Raise taxes and inflation ad justed prices on tobacco Strengthen the governance and legal frame work for tobacco control Strengthen the services avail able for tobacco cessation 2.1.a Establish a taxation mechanism for tobacco 2.1.b Ban of tobacco smoking in outdoor/public places 2.1.c Bring legislation on retail sales cigarettes 2.1.d Bring policies on smokeless tobacco use 2.1.e Surveillance to prevent importation e-cigarettes 2.1.f Set up a mechanism at NATA to monitor ban on advertising including community activities, illegal tobacco products available in the country and point of sale display 2.1 g Review evidence and prepare a technical report on tobacco cessation service development in SL 2.1.h Strengthen and build the capacity of the tobacco cessation hotline • NATA • NATA • NATA • NATA Establishment of a taxation mechanism for tobacco Draft legislation available Technical report on tobacco cessation service development Availability of an effective tobacco cessation hotline Detailed activities Lead agency Milestones 2018 2.1 Reduce tobacco use NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 71 Prioritized actions Update guidelines on drink driving and ensure enforce ment Taxation mechanism for alcohol Implement national policy to reduce alcohol use Policy to promote healthy diets and to reduce exposure to unhealthy foods through mass media and all forms of advertising 2.2.a Conduct workshop with relevant stakeholders to update the guidelines 2.2.b Develop strategy with stakeholders for developing taxation mechanisms 2.2.c Develop a national plan to implement the policy to reduce alcohol use 2.3.a Develop policies and guidelines to reduce marketing of un healthy foods to children 2.3.b Conduct nutrition profiling workshop to create a nutrition profile 2.3.c Develop food composition tables 2.3.d Set up a committee to review food advertisement • NATA • NATA • Mental Health Unit • NCD Unit • Nutrition Division • MRI • E & OH Guidelines on drink driving available Relevant taxation strategy available National implementation plan of policy on alcohol control available Guideline to reduce marketing of un healthy food and drinks for children Food composition tables available Detailed activities Lead agency Milestones 2018 2.2 Reduce alcohol use 2.3 Promote healthy diet high in fruit and vegetables and low in saturated fat/trans-fat, free sugar and salt NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 72 Prioritized actions Policy to promote healthy diets and to reduce exposure to unhealthy foods through mass media and all forms of advertising Develop and implement a na tional salt reduction strategy Nutrition labeling and infor mation Taxation mechanism to re duce unhealthy foods Subsidies for fruits and veg etables 2.3.e Create a mechanism for monitoring of unhealthy food and drink advertisements and complaints 2.3.f Conduct a national survey to identify common sources of salt in SL diet and salt intake levels 2.3.h Introduce traffic light system for salt, sugar and saturated fat, trans fat, energy content 2.3.i Establish policies on taxes to discourage consumption of unhealthy food high in fat, sugar and salt 2.3.j Measures to increase production, access and availability of fruits and vegetables 2.3.g Develop national salt reduction strategy and advocate rec ommended salt consumption • E & OH • Nutrition Division • E & OH • E & OH • Ministry of Agriculture • NCD Unit Having a functional process in place to handle complaints Mean pop salt intake level available Nutrition labeling guideline available Availability of the Sri Lankan taxation policy to discourage unhealthy foods Economic subsidies are available to increase the availability and access to fruits and vegetables Draft national salt reduction strategy available Detailed activities Lead agency Milestones 2018 2.3 Promote healthy diet high in fruit and vegetables and low in saturated fat/trans-fat, free sugar and salt NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 73 Prioritized actions Develop a strategy to address trans-fats Policies with local governments to include space for physical activity Facilities at schools, work places, schools and communi ties for physical activity Promote healthy lifestyle to control obesity among school children 2.3.k Conduct a survey to identify sources of trans-fat and baseline levels 2.4.a Develop policies , guidelines and provide facilities to do PA in workplaces 2.4.b Improve availability of sports equipment in schools and avail ability of facilities to do PA in schools 2.4.c Improve awareness and availability of facilities to do PA in the community 2.4.d Develop a teaching module on obesity management guide lines and establish obesity management clinics 2.3.l Develop a national strategy to address trans-fats • MRI • Ministry of Sports • Local Governments • E & OH • Ministry of Education • Ministry of Sports • Local Governments • Ministry of Sports • NCD Unit • Professional Colleges • NCD Unit Report on sources of trans-fat and baseline levels Policies available Facilities available in schools and work places Availability of facilities to do PA in the community Health-promoting School initiative addressing obesity among school children National strategy on trans fats available Detailed activities Lead agency Milestones 2018 2.3 Promote healthy diet high in fruit and vegetables and low in saturated fat/trans-fat, free sugar and salt 2.4 Promote Physical activity NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 74 Prioritized actions Mapping community based multisectoral interventions to promote healthy lifestyles Community based multisectoral interventions to promote healthy lifestyles Mass media campaign for NCD risk factors Strategy to increase the up take of improved cook stoves Subsidize the clean fuel for cooking 2.5.a Workshops at MOH level with other officials to map stake holders and to design health promotion activities 2.5.b Establish health promotion settings • establish healthy villages • establish healthy promoting schools • establish healthy workplaces 2.5.c Revise the NCD communication strategy 2.5.d Conduct mass media campaign through electronic, print and online media 2.6.a Develop a strategy to increase the uptake of improved cook stoves 2.6.b Advocacy with stakeholders to promote clean fuel for cooking • HEB • HEB • HEB • NCD Unit • HEB • NCD Unit • Ministry of Environment • Department of Sustainable Energy Workshop report available Guide on community based health promotion at village level. Finalized NCD communication strategy Evaluation report of the mass media campaign for first 2 years Detailed activities Lead agency Milestones 2018 2.5 Promote healthy behaviors and reduce NCDs in key settings 2.6 Reduce Household air pollution NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 75 Strategic area 3: Health system strengthening for early detection and management of NCDs and their risk factors 2016-2017 Prioritized actions Improve early detection of NCDs and risk factors and provide counseling Improve management of NCDs 3.1.a Review the Healthy Lifestyle centre guidelines 3.1.b Revise the basic package for NCD screening o HLCs o Workplaces o mobile clinics 3.1.c Expand screening programme for cervical cancer, breast cancer, and oral cancer hepatitis B specific popula tion groups 3.1.d Revise NCD management guidelines to be used in PHCs 3.1.e Provide drug therapy and counselling (including glycaemic control) for eligible people receive to prevent heart attacks and strokes 3.1.f Integrate the NCD management into the PHC system • NCD Unit • NCD Unit • NCD Unit • MSD • PHC unit • NCCP Revised guidelines for NCD screening available The basic package for NCD screening revised revised NCD management guidelines to be used in PHCs available 60% eligible people receive drug thera py and counselling (including glycae mic control) to prevent heart attacks and strokes Plan for integration of NCD manage ment into the PHC system available Activities Lead agency Milestones 2018 3.1 Access to health service NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 76 Prioritized actions Improve management of NCDs Improve the quality of care and outcome of NCD man agement Improve palliative and termi nal care for NCD Improve access to safe, af fordable and quality essential medicines and technologies for major noncommunicable diseases 3.1.g Review and update guidelines for managing major NCDs 3.1.h Establish a referral and back referral system at PMCU for NCDs 3.1.i Establish a quality assurance system for PMCU to improve the quality of care with focus on clinical services quality standards, management systems and risk management 3.1.j Develop terminal and palliative care protocols for cancers, CVDs, COPDs, diabetes, and conduct trainings of multidisciplinary health care providers 3.1.k Establish a mechanism to ensure availability of essential NCD drugs according the essential drug list at all levels, including provi sion of facilities for timely supply of drugs and equipment 3.1.l Revise the essential technologies and equipment list • NCD Unit • PHC Unit • PHC Unit • NCCP • MSD • NCD Unit Guidelines for managing the major NCDs Finalized guideline on referral system at PMCU for NCDs Establishment of a quality assurance system for PMCU Terminal and palliative care protocols for cancers, CVDs, COPDs, diabetes available Essential medicines and equipments are available according to the list at all facilities Revised list on essential technologies and equipments for NCD care Activities Lead agency Milestones 2018 3.1 Access to health service NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 77 Prioritized actions Improve access to safe, affordable and quality essential medicines and technologies for major noncommunicable diseases Improve Information system for NCD management Improve health workforce knowledge and skills on NCDs including addressing risk factors 3.1.m Improve facilities to do Fasting Lipid profile at DGH and above facilities and develop criteria to do HBA1c in medical clinics 3.1.n Ensure colposcopy is available at all DGHs 3.1.o Software to monitor availability of drugs and equipment 3.1.p Develop an IT system to capture the OPD data as a pilot project 3.1.q Introduce a personal health records system 3.2.a Identify required health workforce and project the required cadre 3.2.b Revise the available NCD modules in basic training programme of health care workers • NCD Unit • NCCP • MSD • NCD Unit • NCD Unit • Organizational and Develop ment Unit • ET &R Facilities for NCD investigations are available at relevant facilities Functioning IT system linking all the government institutions Personal health record books available A document with a list of cadre required at each level and their duties Availability of NCD training modules for basic training programme of health care workers Activities Lead agency Milestones 2018 3.1 Access to health service 3.2 Health Workforce NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 78 Strategic area 4: Surveillance, monitoring, evaluation and research 2016-2017 Prioritized actions Implement/strengthen the NCD surveillance framework 4.1.a Establish national surveillance and monitoring framework for NCD prevention and control 4.1.b improve the quality of IMMR data (diagnosis and COD) 4.1.c Conduct the STEPS survey to provide follow up data 4.1.e Establish the online system to monitor the availability of essential NCD drugs and essential technologies at healthcare facilities 4.1.f Review the current cancer registry and establish cancer registries in two regional referral hospitals 4.1.d Conduct National School Health survey • NCD Unit • Medical Statistics Unit • NCD Unit • MSD • NCCP • NCD Unit Establishment of the national surveillance and monitoring framework for NCD prevention and control Available quality data on NCD and risk factors, including national statistical model available to project NCD mortality and estimate the prevalence data for target risk factors Report of STEPS survey available A function system which provides weekly reports on essential drugs and technologies Report of reviewing the current can cer registry available Activities Lead agency Milestones 2018 4.1 Strengthen surveillance NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 79 Prioritized actions Improve systems to monitor activities in the multisectoral action plan Research agenda 4.2.a Develop a monitoring framework to assess progress towards the goal 4.3.a Identify research questions to support the implementation, monitoring and evaluation of the NCD action plan 4.2.b Conduct baseline survey in health facilities and patients seek ing care for NCD 4.2 c Clinical audits to assess adherence to guidelines • NCD Unit • NCD Unit • NCD Unit • Planning Unit Monitoring system in place with trained staff members at national, provincial and district level A list of useful research questions available for researchers Activities Lead agency Milestones 2018 4.2 Improving monitoring and evaluation 4.3 Strengthen research NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 80 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 81 Summary of targets and monitoring framework of the Prioritized National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 82 Summary of targets and monitoring framework of the Prioritized National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases Baseline Target 2020 Target 2025 Indicator Measurement Technique Premature mortality from NCD Physical inactivity Salt/sodium intake Tobacco use (among males) Use of alcohol (among males) Raised blood Pressure Diabetes and obesity 17.6% (1) 25% (2) 8.4 gram/day 29.8% (3) 26% (4) 16.1% (5) 4.7% (6) 10% relative reduction 5% relative re duction 10% relative reduction 15% relative reduction 5% relative re duction 12.5% relative reduction Halt the rise 25 % relative reduction 10% relative reduction 30% relative reduction 30% relative reduction 10% relative reduction in the use of alcohol 25% relative reduction Halt the raise in diabetes & obesity Mortality of NCD (Unconditional probability of dying) prevalence of insufficiently physically active among adults mean population intake of salt in persons aged 18+ years Prevalence of current t obacco use among adults Prevalence of current alcohol use among adults Prevalence of raised blood pres sure among adults Prevalence of raised blood glu cose/diabetes among adults Death registry STEPS survey Appropriate method should be developed STEPS survey STEPS survey STEPS survey STEPS survey NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 83 Baseline Target 2020 Target 2025 Indicator Measurement Technique Drug therapy to prevent CVD Essential NCDs medicines and basic technologies to treat major NCDs households using solid fuels as the primary source of cooking (1) Estimates 2012 WHO (2) Low level of total physical activity, STEPS Survey, 2008 (3) Daily and non-daily smokers among males STEPS Survey, 2008 (4) Current drinkers (past 30 days) among males STEPS Survey, 2008 (5) Raised blood pressure excluding those on medication, STEPS Survey, 2008 (6) Obesity (those with BMI>30), STEPS Survey, 2008 (7) Primary Health Care Institutions having one month’s buffer stock for 16 essential NCD, 2014, World Bank SHSDP data Not avail able 43.4% (7) not available At least 25% of eligible people to receive 80% available in 50% of the insti tutions 25% relative reduction At least 50% of eligible people to receive 80% availability in all the relevant institutions A 50% relative reduction in the propor tion of households Proportion of eligible persons receiving NCD care Availability of essential NCDs medicines, proportion of households using solid fuels as the primary source of cooking Appropriate method should be developed Appropriate method should be developed Appropriate method should be developed NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 84 Aligning the National Multisectoral Action Plan for the Prevention and Control of NCDs 2016-2020 with the Global Process Indicators and Monitoring Framework Strategic area 1: Advocacy, partnership and leadership Prioritized actions NCD recognized as a priority in the national agenda Advocacy to recognize NCD as a priority and to take up prevention and control of NCDs and its risk factors 1.1.a Establish national NCD Council and convene regular meetings to coordinate and supervise, including twice a year meet ings to review progress and to facilitate the implementation of the national NCD MSAP 1.1.b. Develop advocacy packages on pre vention and control of NCDs for politicians and for the health sector and non- health sectors at national, provincial and district levels. Establishment of a National NCD Council Availability of advocacy pack ages for various stakeholders, covering major NCDs and NCD risk factors Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 1.1 Advocacy NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 85 Prioritized actions Strengthen national coor dination for multisectoral actions on the prevention and Control of NCDs Place NCDs on broader health and development agenda 1.2.a Establish provincial and district level a multi-sectoral committees to implement and monitor the policies and interventions. 1.2.b Integrate the prevention and control of NCDs into national and provincial health planning processes and broader develop ment agendas. 1.2.c Share global NCD targets and process indicators with the national and provincial team working on SDGs Committees established in all Districts • National NCD targets and indicators • National NCD policy/ strategy/action plan Integration of NCDs as one of the criteria to as sess new national and provincial level projects National and pro vincial committee accepted the indicators identified by the NCD MSAP Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 1.2 Partnership NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 86 Prioritized actions Enhance the human resourc es at national, regional and grass root levels to perform NCD related activities 1.3.a Identify the cadre and fill the identi fied cadres of staff members at NCD Unit 1.3.b Capacity building of the relevant staff 1.3.c Provide infra structure facilities 1.3.d Provide facilities and staff for the NCD unit to support and monitor the implemen tation of the NCD MSAP Fully staffed NCD unit A mechanism to monitor and co ordinate the NCD MSAP established Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 1.3 Leadership NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 87 Strategic area 2: Health promotion and risk reduction Prioritized actions Raise taxes and inflation adjusted prices on tobacco Strengthen the governance and legal frame work for tobacco control 2.1.a Establish a taxation mechanism for tobacco 2.1.b Ban of tobacco smoking in outdoor/public places 2.1.b Bring legislation on retail sales ciga rettes 2.1.c Bring policies on smokeless tobacco use 2.1.d Surveillance to prevent importation e-cigarettes 2.1.e Set up a mechanism at NATA to moni tor ban on advertising including community activities, illegal tobacco products available in the country and point of sale display Establishment of a taxation mecha nism for tobacco Draft legislation available • Prevalence of current tobacco use among adolescents. • Age-standardized prevalence of current tobacco use among persons aged 18+ years. 5.a. Tobacco taxation imple mented 5b. Tobacco smoke-free policies 5.c. Tobacco health warnings 5.d. Tobacco advertising bans) Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 2.1 Reduce tobacco use NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 88 Prioritized actions Strengthen the services available for tobacco cessa tion 2.1 g Review evidence and prepare a tech nical report on tobacco cessation service development in SL 2.1.h Strengthen and build the capacity of the tobacco cessation hotline Technical report on tobacco cessation service develop ment Availability of an effective tobacco cessation hotline Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 2.1 Reduce tobacco use NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 89 Prioritized actions Update guidelines on drink driving and ensure enforce ment Taxation mechanism for alcohol Implement national policy to reduce alcohol use 2.2.a Conduct workshop with relevant stakeholders to update the guidelines 2.2.c Develop a national plan to implement the policy to reduce alcohol use Guidelines on drink driving available Relevant taxation strategy available National imple mentation plan of policy on alcohol control available • 6a. Alcohol availability regulations, • 6.b. Alcohol advertis ing and promotion bans, • 6.c. Alcohol pricing policies, • Total (recorded and unrecorded) alcohol per capita (15+ years old) consumption within a calendar year in litres of pure alco hol, as appropriate, within the national context • Age-standardized prevalence of heavy episodic drinking among adolescents and adults, as appro priate within the na tional context. • Alcohol-related mor bidity and mortality among adolescents and adults, as appro priate, within the na tional context. Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 2.2 Reduce the use of alcohol 2.2.b Develop strategy with stakehold ers for developing taxation mecha nisms NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 90 Prioritized actions Policy to promote healthy di ets and to reduce exposure to unhealthy foods through mass media and all forms of advertising 2.3.a Develop policies and guidelines to reduce marketing of unhealthy foods to children 2.3.b Conduct nutrition profiling workshop to create a nutrition profile 2.3.c Develop food composition tables 2.3.d Set up a committee to review food advertisement 2.3.e Create a mechanism for monitoring of unhealthy food and drink advertisements and complaints Guideline to reduce marketing of unhealthy food and drinks for children Food composition tables available Having a func tional process in place to handle complaints • 7.c. Marketing to chil dren restrictions • 7d. Marketing of breast-milk substitutes restrictions Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 2.3 Promote healthy diet high in fruit and vegetables and low in saturated fat/trans-fat, free sugar and salt NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 91 Prioritized actions Develop and implement a national salt reduction strategy Nutrition labeling and infor mation Taxation mechanism to re duce unhealthy foods Subsidies for fruits and vegetables 2.3.f Conduct a national survey to identify common sources of salt in SL diet and salt intake levels 2.3.h introduce traffic light system for salt, sugar and saturated fat, trans fat, energy content 2.3.i Conduct a workshop for national multi-sectoral team with WHO to develop a taxation mechanism for unhealthy foo estab lish policies on taxes to discourage consump tion of unhealthy food high in fat, sugar and salt 2.3.j Measures to increase production, access and availability of fruits and vegetables 2.3.g Develop national salt reduction strategy and advocate recommended salt consumption Mean pop salt intake level available Nutrition labeling using traffic light system available Availability of the Sri Lankan taxation policy to discourage unhealthy foods Economic subsidies are available to in crease the availability and access to fruits and vegetables Draft national salt reduction strategy available • Age-standardized mean population in take of salt (sodium chloride) per day in grams in persons aged 18+ years. Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 2.3 Promote healthy diet high in fruit and vegetables and low in saturated fat/trans-fat, free sugar and salt • 7.a. Salt/sodium policies NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 92 Prioritized actions Develop a strategy to ad dress trans-fats Policies with local govern ments to include space for physical activity Facilities at schools, work places and communities for physical activity 2.3.i kConduct a survey to identify sources of trans-fat and baseline levels 2.4.a Develop policies , guidelines and pro vide facilities to do PA in workplaces 2.3.l Develop a national strategy to address trans-fats Report on sources of trans-fat and base line levels Policies available National strategy on trans fats available • Prevalence of insuffi ciently physically ac tive adolescents defined as less than 60 minutes of moderate to vigorous intensity activity daily. • Age-standardized prevalence of insuffi ciently physically active persons aged 18+ years (defined as less than 150 minutes of moderate-intensi ty activity per week, or equivalent). • 8. Public awareness on diet and/or physical activity Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 2.3 Promote healthy diet high in fruit and vegetables and low in saturated fat/trans-fat, free sugar and salt 2.4 Promote physical activity NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 93 Prioritized actions Policies with local govern ments to include space for physical activity Facilities at schools, work places and communities for physical activity Promote healthy lifestyle to control obesity among school children Mapping community based multisectoral interventions to promote healthy lifestyles Community based multi sectoral interventions to promote healthy lifestyles 2.4.b Improve availability of sports equip ment in schools and availability of facilities to do PA in schools 2.4.d develop a teaching module on obesity management guidelines and establish obe sity management clinics 2.5.a Workshops at MOH level with other officials to map stakeholders and to design health promotion activities 2.5.b Integrate risk factor approach through community level health education and health promotion programmes 2.4.c Improve awareness and availability of facilities to do PA in the community Facilities available in schools and work places Health-promoting School initiative addressing obesi ty among school children Workshop report available Guide on community based health promo tion at village level. Availability of facilities to do PA in the community Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 2.4 Promote physical activity 2.5 Health promotion and healthy settings • 8. Public awareness on diet and/or physical activity • Prevalence of insuffi ciently physically ac tive adolescents defined as less than 60 minutes of moderate to vigorous intensity activity daily. • Age-standardized prevalence of insuffi ciently physically active persons aged 18+ years (defined as less than 150 minutes of moderate-intensi ty activity per week, or equivalent). NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 94 Prioritized actions Mass media campaign for NCD risk factors Strategy to increase the uptake of improved cook stoves Subsidize the clean fuel for cooking 2.5.c Revise the NCD communication strategy 2.6.a Develop a strategy to increase the uptake of improved cook stoves 2.6.b Advocacy with stakeholders to pro mote clean fuel for cooking 2.5.d Conduct mass media campaign through electronic, print and online media Finalized NCD com munication strategy A programme to promote improved cooked stoves Subsidies for clean fuel for cooking Evaluation report of the mass media campaign for first 2 years Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 2.5 Health promotion and healthy settings 2.6 Reduce household air pollution NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 95 Prioritized actions Improve early detection of NCDs and risk factors, and provide counseling Improve management of NCDs 3.1.a Review the Healthy Lifestyle centre guidelines 3.1.d Revise NCD management guidelines to be used in PHCs 3.1.e Provide drug therapy and counselling (including glycaemic control) for eligible people receive to prevent heart attacks and strokes 3.1.b Revise the basic package for NCD screening o HLCs o Workplaces o mobile clinics 3.1.c Expand screening programme for cer vical cancer, breast cancer, and oral cancer hepatitis B specific population groups Revised guidelines for NCD screening available revised NCD manage ment guidelines to be used in PHCs available 60% eligible people receive drug thera py and counselling (including glycaemic control) to prevent heart attacks and strokes The basic package for NCD screening revised Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 3.1 Access to health service • Guidelines for the management of major NCDs • Drug therapy/ counselling for high-risk persons • Unconditional probability of dying between ages of 30 and 70 from cardiovas cular diseases, cancer, diabetes or chronic respiratory disease • Proportion of eligible persons (defined as aged 40 years and over with a 10-year car diovascular risk ≥30%, including those with existing cardiovascular disease) receiving drug therapy and counsel ling (including glycae mic control) to prev ent heart attacks and strokes Strategic area 3: Health system strengthening for early detection and management of NCDs and their risk factors NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 96 Prioritized actions Improve management of NCDs Improve the quality of care and outcome of NCD man agement Improve palliative and termi nal care for NCD 3.1.f Integrate the NCD management into the PHC system 3.1.g Review and update guidelines for managing major NCDs 3.1.i Establish a quality assurance system for PMCU to improve the quality of care with focus on clinical services quality standards, management systems and risk management 3.1.j Develop terminal and palliative care protocols for cancers, CVDs, COPDs, dia betes, and conduct trainings of multidisci plinary health care providers 3.1.h Establish a referral and back referral system at PMCU for NCDs Plan for integration of NCD management into the PHC system available Guidelines for man aging the major NCDs available Finalized guideline on referral system at PMCU for NCDs Establishment of a quality assurance system for PMCU Terminal and pallia tive care protocols for cancers, CVDs, COPDs, diabetes available Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 3.1 Access to health service • vailability and affordability of quality, safe and efficacious essential noncommunicable disease medicines, including generics, and basic technologies in both public and private facilities • Guidelines for the management of major NCDs • Drug therapy/ counselling for high-risk persons NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 97 Prioritized actions Improve access to safe, af fordable and quality essential medicines and technologies for major noncommunicable diseases 3.1.k Establish a mechanism to ensure availability of essential NCD drugs ac cording the essential drug list at all levels, including provision of facilities for timely supply of drugs and equipment 3.1.l Revise the essential technologies and equipment list 3.1.m Improve facilities to do Fasting Lipid profile at DGH and above facilities and develop criteria to do HBA1c in medical clinics 3.1.n Ensure colposcopy is available at all DGHs Essential medicines and equipment are available according to the list at all facilities Revised list on essen tial technologies and equipment for NCD care Facilities for NCD investigations are available at relevant facilities Activities Milestones 2018 Global Process Indicators(18) Global Monitoring Indica tors (25) 3.1 Access to health service NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 98 Prioritized actions Improve Information system for NCD management Improve health workforce knowledge and skills on NCDs including addressing risk factors 3.1.o Software to monitor availability of drugs and equipments 3.1.p develop an IT system to capture the OPD data as a pilot project 3.1.q Introduce a personal health records system 3.2.a Identify required health workforce and project the required cadre 3.2.b Revise the available NCD modules in basic training programme of health care workers Functioning IT system linking all the govern ment institutions Personal health record books available A document with a list of carder required at each level and their duties Availability of NCD traning modules for basic training pro gramme of health care workers Activities Milestones 2018 Global Process Indicators (18) Global Monitoring Indica tors (25) 3.1 Access to health service 3.2 Health Workforce NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 99 Prioritized actions Implement/strengthen the WHO surveillance framework 4.1.a Establish national surveillance and monitoring framework for NCD prevention and control 4.1.b Improve the quality of IMMR data (diagnosis and COD) 4.1.c Conduct the STEPS survey to provide follow up data 4.1.d Conduct National School Health survey Establishment of the national surveil lance and monitor ing framework for NCD prevention and control available quality data on NCD and risk factors, including national statistical model available to project NCD mortality and estimate the preva lence data for target risk factors Report of STEPS sur vey available Activities (10) Milestones 2018 Global Process indicators Global Monitoring Indicators 4.1 Strengthen surveillance • Mortality data • Risk factor surveys • Unconditional probability of dying between ages 30 and 70 from cardiovascu lar diseases, cancer, diabetes, or chronic respiratory diseases. Strategic area 4: Surveillance, monitoring, evaluation and research NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 100 Prioritized actions 4.1.e Establish the online system to mon itor the availability of essential NCD drugs and essential technologies at healthcare facilities 4.1.f Review the current cancer registry and establish cancer registries in two regional referral hospitals 4.2.a Develop a monitoring framework to assess progress towards the goal 4.2.b Conduct baseline survey in health facilities and patients seeking care for NCD 4.2.c Clinical audits to assess adherence to guidelines A function system which provides week ly reports on essential drugs and technolo gies Report of reviewing the current cancer registry available Monitoring system in place with trained staff members at na tional, provincial and district level Activities (10) Milestones 2018 Global Process indicators Global Monitoring Indicators 4.1 Strengthen surveillance 4.2 Improving monitoring and evaluation Improve systems to monitor activities in the multisectoral action plan NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 101 Prioritized actions 4.3.a Identify research questions to support the implementation, monitoring and evalu ation of the NCD action plan A list of useful research questions available for researchers Activities (10) Milestones 2018 Global Process indicators Global Monitoring Indicators 4.3 Strengthen research Research agenda NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 102 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 103 A framework for Monitoring the progress in implementing National Multisectoral Action Plan for prevenation and Control of NCD 2016-2020 Firgure 1: National Monitoring Framework of development and implementation of NCD MAP 2016-2020, Sri Lanka A Framework for Monitoring the progress in implementing National Multisectoral Action Plan for Prevention and Control of NCD 2016 - 2020 Figure 1: National Montioring Framework of developement and implementation of NCD MAP 2016 - 2020, Sri Lanka NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 104 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 105 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 106 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 107 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 108 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 109 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 110 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 111 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 112 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 113 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 114 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 115 Costs for the implementation of the Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 116 Costs for the implementation of the Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020 The cost for the implementation of the Multisectoral Action Plan for the Prevention and Control of Noncommunicable Dis eases 2016-2020 has been estimated in consideration to the targets set and activities defined in the plan. Implementation costs are estimated for those activities which fall under the responsibility of Ministry of Health, Nutrition and Indigenous Medicine, although many other line ministries will also have their roles for the implementation of the Action Plan. Existing network and capacity of public health facilities including hu man resources profile are considered for the delivery of health services, current drugs consumption and fund allocation for routine services are not included in this document but taken as a reference while defining the new interventions and treat ment inputs needed. The approach used was built on estimating costs of imple menting the priority actions using country specific data from reliable sources, and data from global database. Proposed in terventions and program activities were clustered by the con cerned Directorates/Units of the Ministry of Health, Nutrition and Indigenous Medicine and implementation costs were esti mated through a consultative process in a series of workshops. Thus estimated costs were further refined following in-depth discussions with key Directorates/Units. Different cost scenar ios have been estimated for the years 2016-2020 considering the costs requirements for the nationwide implementation of the plan. The results of the cost estimation of the implementation of the Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020 over the period of five years and the costs based on the four strategic action areas are presented below. Further analyses of costs based on the area of intervention as individual interventions and health services, population based interventions, monitoring and eval uation, program management and supportive activities and the analyses by level of implementation as national, provincial and district for each of the five years are presented in the detailed report of cost estimation. NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 117 Total cost of the implementation of the NCD Action Plan in Sri Lanka estimated to LKR 15.2 billion and presented below in Figure 1. The estimates show that cost of implementation increas es from LKR 1.1 billion in 2016 to LKR 5.8 billion in 2019 and down to LKR 2 billion in 2020. The proposed sources of funds for the action plan are GOSL funds which includes the loan provided by the World Bank for health system improvement from 2013 -2018 and the proposed loan from Figure 1: Composition and trend of cost over the years 1,123.42 2,014.241,880.54 4,417.64 5,855.76 JICA for improvement of tertiary healthcare facilities and hu man resource development. Table 1 below depicts the composition of the cost by different strategic action areas and provides the government and its de velopment partners with financial information for the 5 years plan. Out of the total estimated cost of implementation for the next five years, over 72% is needed for the Strategic action area 3 on health system strengthening for early detection and management of NCDs and their risk factors and 26% for Strate gic action area 2 on health promotion and risk reduction. Cost of implementation (in Million LKR) NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 118 Table 1: Estimates of cost by strategic action areas Summary NCD costing strategy (In million LKR) Strategic action area 1: Advocacy, partnership and leadership Strategic action area 2: Health promotion and risk reduction Strategic action area 3: Health system strengthening for early detection and management of NCDs and their risk factors Strategic action area 4: Surveillance, monitoring, evalua tion and research TOTAL Total 5 years Cost 66.7 3,994.6 1,1061.5 169.1 2016 13.4 374.5 727.2 8.3 1,123.4 1,880.9 4,417.6 5,855.7 2,014.2 15,291.9 2017 13.7 519.3 1,312.8 35.1 2018 12.7 1,388.0 2,979.9 37.0 2019 12.7 1,368.2 4,415.1 59.7 2020 14.2 344.6 1,626.5 28.9 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 119 Contributors for the preparation of National Multisectoral Action Plan for the Preven tion and Control of Noncommunicable Diseases 2016-2020 Dr. Lakshmi S Somatunga Dr. S.C. Wickramasinghe Dr. V.T.S.K.Siriwardana Dr. D. S. Virginie Mallawaarachchi Dr. A. M. A. B. Mahamithawa Dr. Bhanuja S Wijayatilaka Dr. H. D. B. Herath Dr. Inoka Suraweera Dr. Ishani Fernando Dr. Suraj N. Perera Dr. Nayana De Alwis Dr. Nirupa Pallewatta Dr. Priyadarshani Samarasinghe Dr. Chithramalee de Silva Dr. Rasanjalee Hettiarachchi Dr. R.I.W. Nilaweera Dr. P. Y. S. Jayasinghe Dr. Palitha Abeykoon Dr. Turline Abeyanayaka Dr. Thalatha Liyanage Dr. Samitha Siritunge Dr. Prasad Katulanda Dr. Uditha Bulugahapitiya Prof. Chandrika Wijeratne Dr. Jayanthimala Jayawardena Dr. Padma Gunaratne Dr. Pyara Ratnayaka Dr. Pujitha Wickramasinghe Dr. Mahesh Rajasooriya Dr. N.M.C.K. Arambepola Dr. Amitha Fernando Dr. Nilmini Wijemanna Dr. Ravi Rananeliya NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 120 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 121