National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025)

1.1. Overview of NCDs 16

1.2. Country Prole 17

1.2.1. Geo-Political Prole 17

1.2.2. Population and Health Prole 17

1.2.3. Economic Prole 19

1.2.4. Social Determinants of Health 21

1.2.5. Health System Prole 21 2. Development of the Multi-Sectoral Action Plan 22

2.1. Coordination 22

2.2. Conducting a Situation Analysis 22

2.2.1. Meta-analysis to determine the burden of NCDs 22

2.2.2. Review of national level surveys 23

2.2.3. Stakeholder and policy landscape analysis 23

2.3. Setting national targets 23

2.4. Developing the Implementation Plan 24

2.4.1. Developing the Initial Draft 24

2.4.2. Prioritization and Consensus Building Workshop 24

2.4.3. Validation Process 24 3. Situation Analysis 25

3.1. Global Overview of NCDs Burden and Control 25

3.1.1. Global Burden of NCDs 25

3.2. Overview of NCDs Burden and Control in Nigeria 27

3.2.1. Burden of NCDs in Nigeria 27

3.2.2. Response to NCDs in Nigeria 32 3 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025)

3.2.3. Constraints to NCDs Prevention and Control in Nigeria 40

3.2.4. Potential Future Direction for NCD Prevention and Control 40

3.2.5. SWOT Analysis for a Multi-Sectoral Response to NCDs in Nigeria 41

3.2.5.1. Strength 41

3.2.5.2. Weakness 41

3.2.5.3. Opportunities 41

3.2.5.4. Threats 41 4. Scope ad Structure of the Plan 43

4.1. Rationale for NMSAP 43

4.2. Scope of the NMSAP 43

4.3. Linkage with Existing Global and National Plans 44

4.4. Structure of the NMSAP 45 5. National Strategic Agenda for NCDs 46

5.1. Vision 46

5.2. Mission 46

5.3. Specic National Targets 46

5.3.1. Target Statements 46

5.3.2. Annual Progression for National Targets 47

5.4. Objectives 48 6. Strategic Framework for NMSAP 49

6.1. Strategic Areas and Priority Interventions 49

6.1.1 Objective One: To Strengthen Governance and Stewardship for NCD Prevention and Control 49

6.1.2 Objective Two: To Promote Healthy Lifestyle and Implement Interventions to Reduce Modiable Risk Factors for NCDs 50

6.1.3 Objective Three: To Strengthen and Orient Health Systems to Address Prevention and Control of Non-Communicable Diseases at All Levels of Care and Contribute to the Attainment of Universal Health Coverage 56

6.1.4 Objective Four: To Monitor Trends and Determinants of Non-Communicable Diseases and Evaluate Progress in their Prevention and Control 60 4 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025)

6.1.5 Objective Five: To Promote and Support National Capacity for Quality Research and Development for the Prevention and control of Non-Communicable Diseases 62 7 Implementation Plan for NMSAP 63

7.1 Objective One: To Strengthen Governance and Stewardship for NCD Prevention and Control 64

7.2 Objective Two: To Promote Healthy Lifestyle and Implement Interventions to Reduce Modiable Risk Factors for NCDs 69

7.2.1 Reduce Tobacco Use 69

7.2.2 Reduce Harmful Use of Alcohol 72

7.2.3 Promote Healthy Diet 73

7.2.4 Promote Physical Activity 76

7.2.5 Promote Road Safety and Reduce Road Trafc Crashes 78

7.2.6 Reduce the Number of Babies Born with Sickle Cell Anaemia 79

7.2.7 Prevent Mental, Neurological and Substance Abuse Disorders 80

7.3 Objective Three: To Strengthen and Orient Health Systems to Address Prevention and Control of Non-Communicable Diseases at All Levels of Care and Contribute to the Improvement of Universal Health Coverage 82

7.4 Objective Four: To Monitor Trends and Determinants of Non-Communicable Diseases and Evaluate Progress in their Prevention and Control 88

7.5 Objective Five: To Promote and Support National Capacity for Quality Research and Development for Prevention and Control of NCDs 91 8. Accountability Framework 93

8.1. Evaluating Impact and Outcomes of NMSAP 93

8.2 Monitoring and Evaluation of the NMSAP Implementation 94

8.2.1 Objective One: To Strengthen Governance and Stewardship for NCD Prevention and Control 93

8.2.2 Objective Two: To Promote Healthy Lifestyle and Implement Interventions to Reduce Modiable Risk Factors for NCDs 99 5 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025)

8.2.3 Objective Three: To Strengthen and Orient Health Systems to Address Prevention and Control of Non-Communicable Diseases at All Levels of Care and Contribute to the Improvement of Universal Health Coverage 112

8.2.4. Objective Four: To Monitor Trends and Determinants of Non-Communicable Diseases and Evaluate Progress in their Prevention and Control 119

8.2.5 Objective Five: To Promote and Support National Capacity for Quality Research and Development for Prevention and Control of NCDs 121 9. Framework on the NCD Multi-Sectoral Coordination Mechanism 124

9.1 Membership and roles 124

9.2 Membership Structure 126

9.3 Engagement Modality 128

9.4 Health impact and economic returns of the NMSAP 129 Bibliography 131

Appendix 132 1.0 Endorsements 132 2.0 Core Technical Team of NMSAP Development 133 3.0 Technical Working Group Members 134 6 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) LIST OF TABLES Table 1: Population and Health Trend (NDHS 2003, 2008 AND 2013) 19 Table 2: Economic and Health Indicators 20 Table 3: Prevention and Response to Injuries 37 Table 4: Prevention and Response to Mental, Neurological and Substance Abuse Disorders 37 Table 5: Prevention of Physical Inactivity 38 Table 6: Reduce Consumption of Unhealthy Diets 38 Table 7: Cross-cutting Issues on Resource Mobilisation, Information Dissemination and Enacting and Enforcing Regulations 38 Table 8: National Progressions Towards Achieving Targets for Reducing the Burden of NCDs 47 Table 9: Annual Progression Towards Achieving Targets for Scaling Up NCD Prevention, Care and Treatment Interventions 48 Table 10: MSAP Strategic Areas and Priority Interventions for Governance and Stewardship for NCD Prevention and Control 50 Table 11: Priority Areas and Interventions to Promote Healthy Lifestyle 51 Table 12: Priority Areas and Interventions to Strengthen Health Systems to Address NCDs 56 Table 13: Priority Areas for Monitoring Trends and Evaluating Progress in NCD Prevention and Control 60 Table 14: Priority Areas and Interventions for Research on NCD Prevention and Control 62 Table 15: Priority Actions to Strengthen Governance and Stewardship for NCD Prevention and Control 64 Table 16: Priority Actions to Enforce the National Tobacco Control Act (2015) 69 Table 17: Priority Actions on Harmful Use of Alcohol 72 Table 18: Priority Actions to Promote Healthy Diet 73 Table 19: Priority Actions to Promote Physical Activity 76 Table 20: Priority Actions to Promote Road Safety 78 Table 21: Priority Actions to Reduce the Number of Babies Born with Sickle Cell Disease 79 7 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Table 22: Priority Actions to Prevent Mental, Neurological and Substance Abuse Disorders 80 Table 23: Priority Action to Strengthen Health Systems to Address Prevention and Control of NCDs 82 Table 24: Priority Actions to Monitor Trends and Determinants of NCDs 88 Table 25: Priority Actions for National NCD Research Agenda 91 Table 26: Evaluating Impact and Outcomes of NMSAP 93 Table 27: Priority Actions to Strengthen Governance and Stewardship for NCD Prevention and Control 94 Table 28: Priority Actions to Reduce Tobacco Use 99 Table 29: Priority Actions to Reduce Harmful Use of Alcohol 101 Table 30: priority Actions to Promote Healthy Diet 103 Table 31: Priority Actions to Promote Physical Activity 106 Table 32: Priority Actions to Promote Road Safety and Reduce Road Trafc Crashes 108 Table 33: Priority Actions to Reduce the Number of Babies Born with Sickle Cell Disease 109 Table 34: Priority Actions to Prevent Mental, Neurological and Substance Abuse Disorders 110 Table 35: Priority Actions to Strengthen Health Systems for the Prevention and Control of NCDs 112 Table 36: Priority Actions to Monitor Trends and Determinants of NCDs 119 Table 37: Priority Actions to Promote National Research on NCDs 121 Table 38: NMSAP Stakeholders and their Roles 124 Table 39: Members of National NCD Governing Council (NNGC) 126 Table 40: Endorsement 132 Table 41: Core Technical Working Group 133 Table 42: Expanded Technical Working Group 134 8 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) LIST OF FIGURES Figure 1: The Age-Sex Structure of Nigeria's Population (NDHS 2013) 18 Figure 2: Global and Regional Responses- Global status report (2014) 26 Figure 3: Premature Mortality by NCD Type 27 Figure 4: Scheme of Situation Analysis of NCDs 42 Figure 5: Structure of the MSAP 45 Figure 6: Return on investments of implementing the “Best Buys” in Nigeria 129 Figure 7: NCD prevention and control multi-sectoral coordination framework 130 9 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) ACRONYMS BMI Body Mass Index COPD Chronic Obstructive Pulmonary Disease CRDs Chronic Respiratory Diseases CSOs Civil Society Organizations CVDs Cardio-Vascular Diseases FBO Faith-Based Organization FCPCC Federal Competition and Consumer Protection Commission FMARD Federal Ministry of Agriculture and Rural Development FME Federal Ministry of Education FMEn Federal Ministry of Environment FMoIC Federal Ministry of Information and Culture FMLE Federal Ministry of Labour and Employment FMOF Federal Ministry of Finance FMOH Federal Ministry of Health FMOJ Federal Ministry of Justice FMPWH Federal Ministry of Power, Works and Housing FMWASD Federal Ministry of Women Affairs and Social Development FMYS Federal Ministry of Youths and Sports FRSC Federal Road Safety Commission GAP Global Action Plan GATS Global Adult Tobacco Survey GDP Gross Domestic Product GYTS Youth Tobacco Survey HDI Human Development Index HMH Honourable Minister of Health HPV Human Papilloma Virus IFG Impaired Fasting Glucose IGT Impaired Glucose Tolerance LGAs Local Government Areas LMICs Low- and Middle-Income Countries MBNP Ministry of Budget and National Planning MHAC Mental Health Action Committee 10 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) MDAs Ministries, Departments and Agencies MHGAP Mental Health Gap Action Programme MNSDs Mental, neurological and substance use disorders MPI Multidimensional Poverty Index MSAP Multi-sectoral Action Plan NAFDAC National Agency for Food and Drug Administration and Control NASCP National AIDS and STIs Control Programme NATOCC National Tobacco Control Committee NBC National Broadcasting Corporation NBS National Bureau of Statistics NCDs Non-Communicable Diseases NDLEA National Drug Law Enforcement Agency NEMA National Emergency Management Agency NGOs Non-governmental organisations NHIS National Health Insurance Scheme NIMR Nigerian Institute of Medical Research NIPRD National Institute for Pharmaceutical Research and Development NMSAP Multi-sectoral Action Plan NOA National Orientation Agency NPHCDA National Primary Health Care Development Agency NPoPC National Population Council NSHDP National Strategic Health Development Plan PHC Primary Health Care PLHIV People Living with HIV RMNCAH+N Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition RTC Road Trafc Crash SDGs Sustainable Development Goals SON Standards Organisation of Nigeria UDA Urban Development Authorities UHC Universal Health Coverage WAHO West African Health Organization WHO World Health Organisation WHO FTC WHO Framework on Tobacco Control 11 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) FOREWORD Non-Communicable Diseases (NCDs), which include Cardio-Vascular Diseases (CVDs), Cancers, Chronic Obstructive Pulmonary Diseases (COPD),Diabetes and Mental Ill-Health are now the leading causes of disability and death globally and fast outpacing mortality and morbidity due to communicable diseases in low and middle income countries. Fortunately, NCDs are preventable and its control can be achieved by targeting the associated risk factors including cigarette smoking/use of tobacco products, harmful alcohol intake, physical inactivity, unhealthy diet and most recently, climate change. It is therefore obvious that the control of all the risk factors does not rest with the health sector alone but requires action by other sectors as well. For this reason, the Federal Ministry of Health has taken the lead in establishing a Multi-Sectoral Action Plan on NCDs. The purpose of the multi-sectoral action is to ensure that sectoral policies have consideration for health and wellbeing of Nigerians. The development of this plan has therefore been in collaboration with other relevant government MDAs, civil societies as well as local and international non-governmental organization. This national multi-sectoral action plan for NCDs establishes a framework for reducing morbidity and mortality of NCDs by instituting cost-effective policies and social interventions that will inuence behaviours and lifestyle changes and reduce the modiable risk factors for the prioritized NCDs. Major NCDs covered in this document includes: cardiovascular diseases, diabetes mellitus, chronic respiratory diseases, cancers, sickle cell disease, mental neurological and substance use disorders, as well as road trafc injuries. I strongly believe that a conscious and judicious implementation of the Multi Stakeholder Action Plan on Non-Communicable Diseases 2019–2025 across all relevant sectors will result in improved health indices for Nigeria. Thank you. Professor Isaac F. Adewole Fas, FSPSP, FRCOG, DSc (Hons) Honourable Minister of Health 12 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) ACKNOWLEDGEMENTS The Federal Ministry of Health would like to thank all partners and stakeholders who participated in the development of this Multi-Sectoral Action Plan for the prevention and control of NCDs in Nigeria. We wish to express our gratitude to the Honourable Minister of Health for his leadership and commitment, and for prioritizing NCDs as a public health problem of national concern. We are grateful to World Health Organization and the Health Strategy and Delivery Foundation for providing technical assistance in the development of this document. Our appreciation also goes to heads of MDAs and their Multi-Sectoral Action Plan focal points for contributing towards the development of this plan. We commend and sincerely thank all our implementing partners, NGOs/CSOs as well as the Director, Department of Public Health, National Coordinator and members of staff of the NCDs Division for their invaluable contributions to the development and review of this action plan. Permanent Secretary Federal Ministry of Health 13 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) EXECUTIVE SUMMARY The National Multi-Sectoral Action Plan (NMSAP) for the prevention and control of Non- Communicable Diseases (NCDs) in Nigeria 2019 – 2025 is a strategic guide for the national response to NCDs for the next seven years in Nigeria. The development of the NMSAP is guided by the WHO Tools for National Multi-sectoral Action Plan for prevention and control of Non- Communicable Diseases (NCD MAP Tool). The document aligns with the National Health Strategic Development Plan II (NHSDP II), the Sustainable Development Goals 2015-2030 and the Economic Recovery and Growth Plan (ERGP). This document establishes a framework for reducing morbidity and mortality of NCDs within the context of the broader Nigerian health system. It aims to inform stakeholders on the strategic direction to be considered when developing programmes on prevention and control of NCDs. Development partners and stakeholders will also use this document in aligning their priorities and supporting the country in its effort to lower the burden of NCDs. The development of this document was led and coordinated by the NCD Division of the FMoH. Cognisant that the determinants for NCD interventions lie outside the Health Ministry, a wide range of relevant stakeholders from Non-Health Ministries, Departments and Agencies (MDAs and Non-Governmental Organisations/Civil Society Organisations (NGOs/CSOs) participated in the development of this document. The methodology for the development of the NMSAP followed a sequential process including a meta-analysis of primary research and review of national level surveys to determine the prevalence of major NCDs in Nigeria(cardiovascular diseases, diabetes mellitus, chronic respiratory diseases, cancers, sickle cell disease, mental neurological and substance use disorders and road trafc injuries).Findings of the meta-analysis and other available data were used as baseline to adapt global targets on NCDs and set specic national targets. The specic national targets were based on a baseline of 2017 and 2018, and targets were set up to 2025 using the WHO worksheet for NCD targets. The initial draft of the implementation plan was then developed in line with WHO “best buys” and recommendations. This was followed by a series of workshops with relevant stakeholders to review, validate and cost the implementation plan. 14 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) The plan has an overarching vision, mission, goal and target statements. The plan also has 5 specic objectives that will help in meeting these statements. The objectives include: 1. To strengthen governance and stewardship for NCD prevention and control; 2. To promote healthy lifestyle and implement interventions to reduce modiable NCDs risk factors; 3. To strengthen and orient health systems to address prevention and control of NCDs at all levels of care and contribute to the attainment of universal health coverage; 4. To monitor trends and determinants of NCDs and evaluate progress in their prevention and control; 5. To promote and support national capacity for quality research and development for prevention and control of NCDs. Each of the objectives has strategic areas that capture the specic issues/challenges to be addressed in NCD prevention and control. Each of the strategic areas has priority interventions which are evidence-informed and cost-effective interventions that responds to the issues and challenges in NCD prevention and control, outlined in the strategic area. Each priority intervention in turn has priority actions that will need to be taken to achieve universal coverage of the priority intervention. The priority actions are further broken down into activities and sub- activities in the implementation plan. The MDA or organization responsible for each activity and time frame are also clearly stated. The strategic areas for each objective and their priority intervention will make up the strategic framework. While the priority actions, activities, sub- activities, time frame and organization responsible make up the implementation plan. An accountability framework with specic output and outcome indicators has been included to ensure adequate monitoring and evaluation of progress made in the implementation of the plan in the six years A multi-sectoral coordination mechanism for NCDs is also in place to guarantee effective coordination of NCD programmes and activities across all sectors critical to the implementation of the plan. The NCD coordination mechanism has been structured in three levels, namely: The national NCD governing council (NNGC); the national NCD expert technical working group; and the expanded technical working group. The NNGC comprising of Ministers of the different NCD related sectors will function as the highest decision-making body on the prevention and control of NCDs in Nigeria. The NCD expert technical working group will include representatives of key NCD stakeholder groups while the expanded technical working group split into 4 sub- committees will include all stakeholders who wish to join the partnership. For each level of membership, a chair and secretary will be designated. 15 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1. INTRODUCTION The rapid rise in NCDs represents one of the major health challenges to global development, consequently, threatening economic and social development including the lives and health of millions of people. The rapid increase in these diseases occurs disproportionately in poor and disadvantaged populations and is contributing to widening health inequalities between and within countries. Countries are increasingly responding to the growing challenges and approaching it from a multi-sectoral perspective. With the participation of a wide range of stakeholders drawn from multiple sectors in Nigeria, this document focuses on seven major NCDs which contribute substantially to morbidity and mortality of NCDs in Nigeria. These include: cardiovascular diseases, diabetes mellitus, chronic respiratory diseases, cancers, sickle cell disease, mental neurological and substance use disorders and road trafc injuries. The National Multi-sectoral Action Plan (NMSAP) for the prevention and control of Non- Communicable Diseases (NCDs) in Nigeria 2019– 2025 is a strategic guide for the national response to NCDs for the next seven years in Nigeria. This is the rst plan that addresses NCDs in the country and has been adapted from the Global NCDs Action Plan. It aims to inform stakeholders on the strategic direction to be considered when developing programs on prevention and control of NCDs. Donors will also use this document to align their priorities and support the country in its effort to lower the burden of NCDs. This document establishes a framework for reducing morbidity and mortality from NCDs within a health in all policies approach. This National Multi-Sectoral Action Plan for NCDs focuses on cost-effective policy and social interventions that will inuence behaviours and lifestyle changes and reduce the modiable risk factors for the prioritized NCDs. 1.1. Overview of NCDs Non-Communicable Diseases are chronic diseases that are not passed from person to person. They have varying rates of progression depending on when interventions to slow their progression was started and sustained. The four main types of NCDs are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory 16 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. These major NCDs share four major behavioural risk factors namely: tobacco use and exposure, unhealthy diet, physical inactivity and harmful use of alcohol. Other NCDs of public health importance in Africa include but not limited tohaemoglobinopathies, mental neurological and substance abuse disorders, injuries from road trafc crashes, oral and eye diseases. The burden of NCDs is rapidly increasing globally. NCDs currently account for over 70% of all global deaths. In low-and middle-income countries, an estimated 48% of NCD related deaths occur among people less than 70 years. In Nigeria, there is very limited evidence on the burden of NCDs and its trends, however a recent systematic review on NCDs-related studies conducted across the country on seven NCD disease (cardiovascular diseases, diabetes mellitus, chronic respiratory diseases, cancers, sickle cell disease, mental neurological and substance use disorders and road trafc injuries indicate a rising trend in prevalence and incidence. 1.2. Country Prole 1.2.1. Geo-Political Prole Nigeria has an areaof 923,768 square kilometres and is located along the West Coast of Africa. It lies between latitudes 40o and 140o North of the equator and between longitudes 20 and 140 East of the Greenwich Meridian. There are two marked seasons: the dry season lasting from November to March and the rainy season lasting from April to October. The climate is drier further North with extremes of temperatures, sometimes reaching as high as 44°C and falling as low as 14°C. Temperatures at the coast seldom rise above 32°C but humidity is typically high. The country is a federation of 36 states and the Federal Capital Territory, Abuja, with 774 Local Governments Areas (LGAs). Nigeria has a rich cultural diversity of about 400 ethnic groups and 450 languages. English is the ofcial language while the other three main languages are Hausa, Igbo and Yoruba. 1.2.2. Population and Health Prole According to the 2006 National Population Census, Nigeria had a population of 140,431,790 with an uneven distribution of the population across the country. This placed Nigeria as the most populated country in Africa. The World Population Prospects 17 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2017 puts the current population estimate of Nigeria as 190,886,000 with a male to female population of 96,729,000 and 94,157,000 respectively. It also indicates that Nigeria’s population is the world’s fastest growing and is projected to surpass that of the Unites States of America by 2050. The most densely populated states in the country are Lagos, Kano, Anambra and Imo. Nigeria has been ranked by the World Bank in 2016 as a lower middle-income country. Figure1: The Age-Sex Structure of Nigeria's Population (NDHS 2013) Nigeria’s population pyramid is characterized by a broad base and a narrow head which indicates high fertility rates as seen in Figure 1. Children under-15 account for 46% of the population whereas 4% of the population represent 65 years and above. The ratio of males to females is 51% to 49% respectively. The life expectancy has steadily improved from 45.9 years from 1990-1995 to 54.5 years in 2016. The life expectancy is expected to rise further to 58.5 years by 2025-2030 (World Population Prospects, the 2017 Revision). 18 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Table 1: Population and Health Trend (NDHS 2003, 2008, 2013 AND 2018) Indicators 2003 2008 2013 2018 Population growth rate, percent 2.8 - 3.2 - Total fertility rate 5.7 5.7 5.5 5.3 Crude birth rate per 1000 population 41.7 40.6 39 38 Age-adjusted death rate per 1000 population - 4.6 3.5 Maternal mortality ratio per 100 000 live births 800 545 576 Infant mortality rate per 1000 live births 100 75 69 67 Under age 5 mortality rate, total, per 1000 live births 185 162 128 132 Population 65 years and over percent 2,110 10,063 10,771 Nigeria is experiencing rapid urbanization. According to the World Urbanization Prospects, the 2014 revision, 68% of the population live in the urban areas while 32% live in the rural areas. The proportion of population living in the urban areas had increased by an urbanization growth rate of 3.75% from 15% in 1960 to 46.9% in 2014 (World Urbanization Prospects 2014, United Nation Population Division). 1.2.3. Economic Prole According to the Economic Recovery Growth Plan (2017-2020), Nigeria’s real GDP in 2017 is estimated at NGN 69,447.74 Billion Naira with a growth of 2.19%. Although the economy depends highly on the oil and gas sector, it accounts for only 10% of the Gross Domestic Product (GDP) with the remaining 90% coming from the non-oil sector. The 10% contribution however, accounts for over 90% of export earnings and 62% of government revenues from 2011-2015. The United Nations Development Programme Human Development Report (UNDP HDR) 2016 report estimates Nigeria’s Human Development Index (HDI) to be 0.571 which classies the country in the low development category. About 50.9% of Nigeria’s population are multi-dimensionally poor with 18.4% living in near multidimensional poverty. The Multidimensional Poverty Index (MPI) identies multiple deprivations suffered by households in 3-dimensions - health, education and living standards. 19 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) It is estimated that greater than 60% of the Nigerian population live on US$ 1 or less a day. Human development indicators paint a bleak picture of Nigeria’s health and education systems. Nigeria’s primary school net enrolment rate is 54% and 10 million children of school age do not attend school. Unemployment is high at a rate of 14%, especially among youth (NBS Q4 2016). Table 2: Economic and Health Indicators Indicators Gross Domestic Product (GDP) per capita $2,178 (world bank 2016) Gross National income $2, 450 (world bank 2016) Ination Rate (%) 15.74 (ERGP 2017 -2020) Unemployment Rate (%) 14% (NBS, Q4 2016) Current Health Expenditure per capita (USD) 79 (GHED, 201 6) Domestic General Government Health Expenditure (% 13 (GHED, 201 6) of current health expenditure) Total Expenditure on Health (THE) % GDP 4% (NHA 2017 ) Out of pocket (OOP) as % of Total Health Expenditure 76.6% (NHA, 2017 ) External Sources of Funding for NCD s (in million 15 (GHED, 201 6) current USD) External Sources of Funding for injuries (in million 12 (GHED, 2016) current USD) Proportion of Total Health Expendit ure on NCD 7.9% (NHA 2017 ) Expenditure on Non Communicable Diseases (Naira) 342 billion (NHA 2017) Household contribution to expenditure on NCDs 84.8% (NHA 2017) *GHED, Global Health Expenditure Database *NHA, National Health Account 20 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1.2.4. Social Determinants of Health The 2013 National Demographic and Health Survey (NDHS) indicates a literacy level of 75% in males and 53% in females. The level of education is linked to health-seeking behaviour. About 97% of women with higher education received antenatal care from a skilled provider, as opposed to 36% of mothers with no education. Similarly, 95% of women in the highest wealth quintile received antenatal care from a skilled provider as opposed to the 25% in the lowest quintile. The NDHS 2013 survey illustrated a signicant link between educational attainment and the level of wealth. Approximately 67% of men in the lowest wealth quintile have no education while only 1% of men in the highest wealth quintile have no education. Similarly, 87% of women in the highest wealth quintile have attended and complete secondary education but only 4% of those in the lowest wealth quintile have attained a similar level of education. Almost half of the population in the wealthiest quintile live in the urban areas, with 5% living in the rural areas. 1.2.5. Health System Prole Nigeria’s health care delivery system is made up of three levels- tertiary, secondary and primary, which are provided by federal, state and local governments respectively. The private sector and NGOs complement health care delivery at all levels. The country is experiencing a double burden of communicable and non-communicable diseases resulting in an increased demand on health services (WHO, 2005). As at 2017, the budgetary allocation for Health at the Federal level was 4.17 %. Therefore, the country is still very far away from the target of a minimum of 15% budgetary allocation for health made in Abuja Declaration of 2001. Since the National Health Insurance Scheme (NHIS) became operational in Nigeria 2005, less than 5% of the population have been covered by the scheme. Majority of those covered are from the formal sector and this is a major impediment to the attainment of the Universal Health Coverage (UHC). As a result, the greatest percentage of health nancing is from out-of-pocket expenditure which is estimated at 72% (GHED, 2014). 21 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2. DEVELOPMENT OF THE MULTI-SECTORAL ACTION PLAN The methodology and process for the development of this document was guided by the WHO Tools for National Multi-Sectoral Action Plan for Prevention and Control of Non- Communicable Diseases (NCD MAP Tool). The methodology involved the following critical steps; 1. Coordination by NCD Division of the Federal Ministry of Health; 2. Conducting a situation analysis; 3. Adapting global targets; and, 4. Developing the strategic and implementation framework. 2.1. Coordination The NCD Division of the FMoH is responsible for the overall coordination of all NCD prevention and control activities in Nigeria. Therefore, knowing that the determinants for NCD interventions lie outside the Health Ministry, the NCD Division engaged a wide range of relevant stakeholders from both health and non-health Ministries, Departments and Agencies (MDAs and Non-Governmental Organisations/Civil Society Organisations (NGOs/CSOs) in the development of this document. The Division formed a core technical team that provided technical assistance in the development of the MSAP. The technical assistance provided involved a review of the burden and pattern of NCDs in Nigeria, outlining the methodology for developing the MSAP and facilitating the review and nalization meetings. This team which was made up of representatives from NCD Division of FMoH, World Health Organization and Health Strategy and Delivery Foundation, was also responsible for drafting and nalizing the MSAP. 2.2. Conducting a Situation Analysis 2.2.1. Meta-analysis to determine the burden of NCDs A meta-analysis was conducted to determine the: a) Prevalence of diabetes mellitus, cardiovascular diseases, sickle cell and chronic obstructive pulmonary disease in Nigeria. 22 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) b) Incidence of cancers in Nigeria. c) Prevalence of shared metabolic risk factors- obesity, hypertension and dyslipidaemia. d) Pattern of the shared behavioural risk factors- tobacco use, harmful use of alcohol, unhealthy diets and physical inactivity. 2.2.2. Review of national level surveys The database of the National Bureau of Statistics was searched to determine the number of deaths and injuries from road trafc accidents. The Global Adult Tobacco Survey and Global Youth Tobacco Survey was also reviewed to determine the burden of tobacco use. 2.2.3. Stakeholder and policy landscape analysis A stakeholder and policy landscape analysis was also conducted to identify existing policies, plans and programmes from other health and non-health MDAs that have a bearing on the development and implementation of the MSAP. 2.3. Setting national targets Findings from the meta-analysis and other available data were used as baseline to adapt global targets on NCDs and to set specic national targets. The specic national targets were based on the baseline of 2017 and 2018, and targets were projected up to 2025. The WHO worksheet for NCD targets was used to calculate the expected changes from baseline based on the agreed target for relative reduction or absolute reduction of NCDs and their risk factors outlined in the Global monitoring framework on NCDs. The calculations from these targets (nine of them) were then transferred to an Excel sheet and annual progressions from 2018 to 2025 were interpolated to determine the national targets. This MSAP also includes NCDs such as injuries, sickle cell disease and MNSD that are not covered in the global target. Thus, the targets for road trafc accidents were adapted from the SDG targets for reducing deaths and injuries from road trafc accidents. 23 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2.4. Developing the Implementation Plan 2.4.1. Developing the Initial Draft The implementation plan comprises of 5 strategic objectives. Each of these objectives has a strategic area. Each of these strategic areas has priority interventions that align closely with the WHO “best buys”. For diseases, not covered by the WHO “best buys”, recommendations from other WHO documents were reviewed and included. The enabling actions that will be needed to implement each of these priority interventions were used to develop priority actions, activities and sub-activities for the MSAP implementation plan. 2.4.2. Prioritization and Consensus Building Workshop A 3-day workshop was held to review the strategic framework and implementation plan. Participants from this workshop was drawn from various Ministries, Departments and Agencies that were identied to be critical in the implementation of the NMSAP. A formal approach was used during the workshop for consensus building and prioritization. This involved the following steps; 1. Voting to prioritize and streamline the proposed “best buys” interventions. 2. Utilizing nominal group technique to brainstorm and propose interventions for NCDs such as injuries and MNSD that are not covered by the “best buys”. 3. Scoring of the activities and sub-activities for implementing each of the priority intervention using a scoring template. The scoring was based on a Likert scale of 0 – 5 to score the feasibility of conducting the interventions in line with existing plans, policies and resources within the various ministries, departments and agencies. 2.4.3. Validation Process The draft of the NMSAP that emanated from the prioritization and consensus-building workshop was shared to the workshop participants for their feedback and consideration remotely. The same scoring template that was used during the prioritization and consensus-building workshop was used to elicit feedback on implementation considerations. These feedbacks were collated and used to further rene the NMSAP. Following this, a one-day validation workshop was convened for nal voting and consensus building to ensure that the NMSAP holistically addresses NCD prevention and aligns closely with national development priorities and plans. 24 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3. SITUATION ANALYSIS 3.1. Global Overview of NCDs Burden and Control 3.1.1.Global Burden of NCDs Non-CommunicableDiseases (NCDs) are the leading cause of death globally. They are chronic, non-contagious diseases capable of causing long term debilitation and disability if not prevented or properly controlled. NCDs affect the highly productive populations thereby posing a huge socio-economic burden and consequently undermining national development. According to WHO NCDs Global report 2014, NCDs were responsible for 38 million (68%) of the world’s 56 million deaths in 2012. More than 40% of them (16 million) were premature deaths under age 70 years. Almost three quarters of all NCD deaths (28 million), and most premature deaths (82%), occur in low- and middle-income countries. The 2011–2025 cumulative economic losses due to NCDs under a “business as usual” scenario with no intervention in low- and middle-income countries have been estimated at US$ 7 Trillion. This sum far outweighs the annual US$ 11.2 Billion cost of implementing a set of high-impact interventions to reduce the NCD burden (From Burden to “Best Buys”: Reducing the economic impact of Non-Communicable Diseases in LMICs). There is a direct link between NCDs and poverty as the presence of NCD risk factors and/or diseases, further deepens poverty. NCDs and their risk factors also increases both individual and household expenditure. NCDs disproportionately affect the poor in low- and middle-income countries thereby widening the inequality gap. Lifestyles and behaviours are responsible for the modiable risk factors that give rise to the major NCDs. These modiable risk factors include tobacco use, harmful use of alcohol, physical inactivity and unhealthy diets such as excessive consumption of red meat, salt, saturated fat, rened sugars in foods and drinks, sub-optimal consumption of bre and micronutrients. Other risk factors include hereditary conditions such as sickle cell carrier status, albinism, usage of illicit drugs, unsafe sex practices, unsafe water, poor sanitation and hygiene, outdoor and indoor smoke from solid fuels, exposure to harmful radiation 25 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) (domestic or industrial). Infectious agents such as bacteria, viruses and parasites in the environment as well as climate change contribute to an emerging increase in NCDs. The above risk factors are fuelled by increasing globalization, urbanization and industrialization in the last few years. Global Response and Commitment (Including Regional Commitments) Globally, key milestones have been reached to address NCDs. These spans from developing the Global Strategy for the Prevention and Control of NCDs, its adoption in 2000 and setting of the 9 global targets for NCDs by 2025. Figure 2: Global and Regional Responses- Global status report (2014) Heads of State from the African region adopted the Brazzaville declaration on NCDs. The declaration urged action by various stakeholders to address major NCDs and priority conditions (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, blood disorders sickle cell disease, mental health and injuries) which represent a signicant challenge to people in the Africa region: In the declaration, the ministers also committed to develop national NCD action plans and strengthening institutional capacity for NCD prevention and control among others. The WHO Regional Framework for Integrating Essential Non-Communicable Diseases in Primary Health Care Services (AFR/RC67/12) recommends the strengthening of PHCs to respond to major NCDs. At the sub-regional level, the West African Health Organization (WAHO), in collaboration with member States developed a strategic plan for the prevention and control of NCDs. 26 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3.2. Overview of NCDs Burden and Control in Nigeria Nigeria is undergoing a demographic and epidemiological transition with concomitant increase in risk factors for NCDs. According to the WHO NCD Country prole 2016 report, NCDs were estimated to cause approximately 617 300 deaths, representing 29% of total deaths in Nigeria. Out of these, injuries accounted for 8%, followed by cardiovascular diseases with 11%.Premature mortality due to NCDs, which is dened as the probability of dying between ages 30 and 70 years from the main NCDs is 22%. Figure 3: Premature Mortality by NCD Type 3.2.1. Burden of NCDs in Nigeria Major NCDs in Nigeria include: cardiovascular diseases (such as hypertension, coronary heart diseases and stroke), cancer, diabetes mellitus, sickle cell disease, chronic respiratory diseases (CRDs), mental, neurological and substance use disorders (MNSDs) and road trafc injuries, and oral health disorders (OHDs). The situation analysis assessed the current burden (prevalence and trend) of these NCDs and their metabolic and behavioural risk factors in Nigeria. 27 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3.2.1.1. Prevalence/Incidence of Major NCDs A. Cardiovascular Diseases • The prevalence of Hypertensive Heart Disease (not hypertension) was 27.6%. • The prevalence of cardiomyopathies from various causes was 11.5%. • Ischemic Heart Disease has a prevalence of 0.7%. • The prevalence of stroke survivors was 6.7%. • The incidence of stroke in Nigeria (new cases) was 25.9 per 100,000 persons per year between 2000 and 2015. B. Diabetes • The overall prevalence of Diabetes in Nigeria was 4.1%. • The highest prevalence was observed in the south-south region at 8.5%. • An increase in prevalence was observed with increasing age. C. Cancers • Among men the top ve cancer sites and their incidence were: • Prostate (12.5/100,000). • Non-melanoma skin (4.1/100,000). • Colorectal (3.0/100,000). • Connective and soft tissue (2.1/100,000). • Non-Hodgkin lymphoma (1.9/100,000). • Among women, the top two cancer sites and their incidence were: • Breast (26.0/100,000). • Cervix (11.4/100,000). • Non-melanoma skin (3.6/100,000). • Colorectal (2.6/100,000). • Non-Hodgkin lymphoma (1.3/100,000). D. Chronic Obstructive Pulmonary Disease • The estimated prevalence of Chronic Obstructive Pulmonary Disease (COPD) in Nigeria was 6.9% (5.1 - 8.7). • Prevalence of COPD signicantly increases with advancing age (a trend that agrees with observations in global and other national COPD studies). • The prevalence in men was higher at 7.9% (5.9 - 9.9) compared with women at 5.3% (3.5 - 7.0). 28 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) E. Sickle Cell Disease • The overall pooled prevalence of reported sickle cell anaemia in Nigeria was 1.5%. • The prevalence was highest in persons aged 0-5 years, at almost 2%. • A decreasing prevalence was observed as age at screening increases (less than 1% in persons older than 15 years), suggesting higher mortality rates with increasing age. • About 25% of the Nigerian adult population are carriers of the S gene. F. Injuries from Road Crashes • In 2017, about 5,121 deaths and 31,094 injuries occurred as a result of road crashes.2 G. Mental, Neurological and Substance Abuse Disorder • Local surveys show lifetime prevalence of mental disorders in Nigeria to be between 12.1% and 26.2%. The most common mental disorders were anxiety disorders with 5.7% lifetime prevalence. • The pattern of substance abuse varies by geo-political zone but the most commonly used illicit drug is cannabis and inhalants. • There is anecdotal evidence on the misuse of both prescription drugs (like opioid pain medications) and over-the-counter medications. 3.2.1.2. Metabolic Risk Factors for CVD, Diabetes, COPD and Cancers These are physiological changes in the body that give rise to four major NCDs such as CVD, Diabetes, COPD, and cancer. These physiological changes include; raised blood pressure (hypertension) increased weight gain (obesity/overweight), impaired glucose tolerance (pre-diabetes) and raised blood cholesterol (dyslipidaemia). In the absence of lifestyle changes or drug treatment, these physiological changes continue and progress and give rise to any/combination of the four major NCDs. The meta-analysis showed the prevalence and pattern of these metabolic risk factors in Nigeria. A. Raised Blood Pressure (Hypertension) • The pooled crude prevalence of hypertension was 31.2% (men 29.5%, women 31.1%). • The prevalence of pre-hypertension was 30.8%. • The mean systolic and diastolic blood pressure in Nigeria were 131mmHg and 81 mmHg, respectively. 29 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) B. Pre-Diabetes • Impaired Glucoses Tolerance (IGT) and Impaired Fasting Glucose (IFG) were estimated at 10.0% and 5.8%, respectively. C. Obesity/Overweight • The pooled prevalence of overweight, Body Mass Index(BMI 25+ kg/m2) was 25% (men 25.2%, women 25.5%). • The pooled prevalence of obesity (BMI 30+ kg/m2) was estimated at 14.3% (men 12.9%, women 19.8%). • The prevalence of obesity and overweight were highest in the middle-aged group (30-50 years). • The mean BMI was 25.6 kg/m2, and the mean waist circumference was 86.5 cm. D. High Blood Cholesterol (Dyslipidaemia) • The prevalence of hypercholesterolemia was 40% (men 41.1%, women 44.6%). • The mean concentration of total cholesterol was 4.93 mmol/l. • The mean LDL-cholesterol was 2.6 mmol/l. • The mean HDL-cholesterol was 1.6 mmol/l. • The mean triglycerides was 1.5 mmol/l. 3.2.1.3. Behavioural Risk Factors for CVD, Diabetes, COPD and Cancers Behaviours and lifestyle inuence both the onset and progression of metabolic risk factors. These behavioural risk factors are also known as modiable risk factors. They are greatly inuenced by the prevailing social, economic, environmental and policy factors (distal determinants of health). Four major behavioural risk factors were assessed in the meta-analysis and are discussed within the scope of this document. A. Tobacco Use • Tobacco use is a major preventable cause of NCDs and is responsible for 80% of the six million premature deaths annually in low-and-middle income countries including Nigeria. • It is associated with over 25 diseases including asthma, bronchitis, emphysema, diabetes mellitus and various cancers. Others are pulmonary tuberculosis, tooth decay, cataract, hearing loss, wrinkling of skin, poor wound healing, osteoporosis, congenital malformations, intrauterine growth retardation, low birth-weight, miscarriages and infertility. 30 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) • According to the most current Nigeria Global Adult Tobacco Survey (GATS)5 • About 5.6% of Nigerian adults aged 15 years and older (4.5 million adults) currently use tobacco products (4.1 million are men and 0.45 million are women). • About 17.3% of adults (2.7 million adults) who worked indoors were exposed to second-hand tobacco smoke at the workplace. • About 6.6% of adults were exposed to second-hand tobacco smoke at home. • About 29.3% of adults were exposed to second-hand tobacco smoke when visiting restaurants. • The GATS report also revealed that Nigerians generally have a good knowledge of the harmful effects of tobacco on health. • About 82.4% believed smoking causes serious illness. • About 51.4% believed smoking causes stroke. • About 76.8% believed smoking causes heart attack. • About 73.5% believed smoking causes lung cancer. • About 44.5% believed smoking causes bladder cancer. • About 75.1% believed that breathing other people’s smoke causes serious illness in non-smokers. • Among youths in Nigeria, the Global Youth Tobacco Survey (GYTS) was carried out at two sub-national levels in 2001 and 2008 among students aged 13-15 years in secondary schools. • According to the 2008 GYTS: • There was an overall relatively low proportion of students currently smoking cigarettes in Nigeria, 2.6%-6.2%. • Current use of any tobacco product was 14.6%-26.1%. • Susceptibility to initiate smoking during the next year was 3.6%-16.2%. • Exposure to second-hand smoke at home was 15.5%-31.3%. • Exposure to second-hand smoke in public places was high 35.5%- 55.5%. • Some students (1 in 7) and overall 50% favour ban of smoking in public places. • In all centres, there was considerable knowledge that smoking from others is harmful as indicated by 38.2%-67.8%e of the students. 31 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) B. Harmful Use of Alcohol • Alcohol is one of the major risk factors for NCDs contributing signicantly to premature deaths, avoidable disease burden and has a major impact on public health and socio-economic status. • Harmful use of alcohol was dened in most instances as exceeding the recommended 4 and 3 standard drinks per day for male and female, respectively. • The prevalence of harmful use of alcohol was estimated at 34.3% (28.6%-40.1%), with prevalence in men 43.9%, (31.1%-58.8%). C. Physical Inactivity • Physical inactivity is a serious behavioural risk factor for NCDs. • Physical inactivity was dened as having less than 30 minutes of moderate activity per day for at least 3 days/week. • The prevalence of physical inactivity among adults was 52 % (33.7%- 70.4%). • Prevalence in physical inactivity in men was 49.3% (24.7%-73.9%) and women 55.8% (29.4%-82.3%). D. Unhealthy Diet • Unhealthy diet is a risk factor for NCDs. • Anecdotally, it can be observed that the food consumption pattern in Nigeria is changing rapidly towards unhealthy diets with increasing consumption of processed foods high in salt, sugar and trans-fats. • Excessive salt intake is a recognized risk factor for CVDs in Nigeria. Mean sodium consumption in Nigeria ranges from 2.85 g/day to 10g/day. • The meta-analysis broadly dened unhealthy diets as having less than 3- 5 servings of fruits or vegetables per day, and/or daily intake of high fat or high sugar meals. • The meta-analysis showed the prevalence of unhealthy diets to be 74.8% (62.5%-87.1%) with similar prevalence in males and females. 3.2.2. Response to NCDs in Nigeria There are existing health sector and non-health sector responses to the growing threat of NCDs in Nigeria. 32 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3.2.2.1. Health Sector Response to NCDs A. Existing and Ongoing Efforts in NCD Prevention and Control by the Federal Ministry of Health Concerted efforts have been made by the Federal Ministry of Health since 1988 to reduce the burden of NCDs in Nigeria. The Non- Communicable Disease Control Programme, now a Division, was established in 1989 with the mandate to serve as the arrowhead for the response to NCDs in Nigeria. This was followed shortly by the establishment of an expert committee on NCDs to guide and advise the government on the implementation of policies and programmes for the prevention and control of NCDs. In addition, a national survey on NCDs was carried out in 1990-1992 to determine the prevalence of major NCDs in Nigeria, their risk factors and health determinants. Documents for health professionals on management of NCDs and health education materials were also developed. Attempts to integrate NCDs into the Primary Health Care (PHC) have also been made but with minimal success. The annual commemoration of NCDs-related Global Days with a wide range of activities such as press brieng, awareness campaign rallies, sensitization workshops/seminars for the general public, school children etc., have contributed greatly to awareness creation on NCDs and their risk factors among the general public. Following the political declaration of the high-level meeting of the 66th UN General Assembly on Prevention and Control of NCDs in September 2011, more actions have been taken to increase the momentum of the already existing efforts for the prevention and control of NCDs in Nigeria. These include: • Flagging-off of the National Stroke Prevention Programme in October 2013 by the former President of Nigeria. The programme is aimed at encouraging Nigerians to live healthy and to regularly carry out medical check-ups in order to reduce the risk of having stroke. • Development of a draft NCD desk guideline for clinicians and health educators in secondary health care facilities. This document is yet to be approved by the Honourable Minister of Health (HMH). • Intensied efforts to effectively control tobacco in Nigeria in line with the WHO Framework on Tobacco Control (WHO FCTC) by the Federal Ministry of Health and stakeholders. 33 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) • Two sub-national Global Youth Tobacco Surveys (GYTS) were successfully conducted in 2001 and 2008 and reports released in 2001 and 2008 respectively. • The Global Adult Tobacco Survey (GATS) was successfully conducted in Nigeria in 2012 and the report was released in 2013. This made Nigeria the rst country in Sub-Sahara Africa to successfully conduct GATS. • A National Tobacco Control Act was enacted in 2015. • The National Tobacco Control Committee (NATOCC) was established to provide leadership for tobacco control implementation in the country. • Development of the National Nutrition Guideline on Prevention and Control of NCDs. • Contextualization of the WHO Mental Health Gap Action Programme (MHGAP) to respond to mental, neurological and substance abuse disorders. • Finalization of the Mental Health Policy and Legislation. • Development of a National Guideline for the Control and Management of Sickle Cell Disease. • Establishment of six (6) Sickle Cell Disease centres in Federal Medical Centres in the 6 geopolitical zones in the country between 2011 and 2012. B. Existing and Ongoing Efforts in other Disease Prevention and Control by the Federal Ministry of Health The current demographic and epidemiological transition in Nigeria has created a situation where both communicable and non-communicable diseases co-exist at population and individual level. Over the past decade, health system reforms have focused mainly on communicable diseases such as HIV/STI, Malaria and Tuberculosis. Therefore, existing and ongoing efforts in communicable disease prevention and control provide unique opportunities and entry points for NCD prevention and control. Using a chronic care model, service delivery for these communicable diseases can effectively and efciently be integrated with prevention, care and treatment of NCDs. Other cross-cutting health response on Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAH+N) provide opportunities for integrating NCD prevention, care and treatment. Nutrition policies and guidelines that emphasize exclusive breastfeeding and healthy infant and young child feeding practices provide a platform for introducing life-long healthy eating behaviours in young children and reduce metabolic risk factors for insulin 34 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) resistance and dyslipidaemias. Effective RMNCAH programs provide an entry point for early diagnosis and management of diabetes, hypertension and metabolic risk factors in women and girls. National immunization programmes provide opportunities for integrating life-course vaccinations for Human Papilloma Virus (HPV) and Hepatitis B Virus (HBV) among adults. Existing and ongoing national efforts in HIV/STI, Tuberculosis, malaria, RMNCAH+N, immunization programs include; • National Guidelines for HIV Prevention, Treatment and Care developed in 2016 by the National AIDS and STDs Control Programme (NASCP) of the Federal Ministry of Health. This guideline is aimed at achieving HIV epidemic control (90-90-90 targets) and emphasizes commencing anti-retroviral treatment for all HIV positive persons regardless of CD4 count (test and treat approach). This plan also recognizes the use of the chronic care model for early diagnosis and management of NCDs among People Living with HIV (PLHIV). • National Strategic Plan of Action for Nutrition (2014-2019) developed by the Nutrition Division of the Family Health Department of the Federal Ministry of Health. This plan identies a set of priority areas such as maternal nutrition, Infant and young child feeding, management of severe acute malnutrition in children under ve and micronutrient deciency control. This plan also prioritized healthy diets to prevent non-communicable diseases. • Integrated Maternal, Newborn and Child Health strategy by the Family Health Department of Federal Ministry of Health. The ongoing update of this document will include quality improvement strategies that emphasize early identication of NCD related indirect (such as gestational diabetes) and direct causes (such as hypertension in pregnancy) causes of maternal deaths. Therefore, this strategy aims to strengthen the RMNCH continuum of care services in Nigeria and scale up coverage of NCD prevention, care and treatment for women and girls • National Tuberculosis Control guideline developed by the National Tuberculosis and Leprosy Control Program of the Federal Ministry of Health. This guideline emphasises integrated services for NCD (hypertension & diabetes) prevention, care and treatment in persons with Tuberculosis. • National Malaria Elimination Plan developed by the National Malaria Control Program of the Federal Ministry of Health. This plan focuses on community-wide strategies that will facilitate malaria elimination in Nigeria. 35 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) All these strategies if properly harnessed will contribute to raising community awareness and involvement in NCD control. C. Existing and Ongoing efforts in other Disease Prevention and Control by other Health-Related Departments and Agencies 1) National Health Insurance Scheme (NHIS) The National Health Insurance Scheme (NHIS) was established under Act 35 of the 1999 Constitution by the Federal Government of Nigeria to achieve universal health access and coverage through a combination of health nancing mechanisms. Currently the NHIS will be directly involved in administrative management, disbursement and monitoring of the Basic Health Care Provision fund. This fund provides opportunity to achieve universal coverage and access for NCD prevention and treatment services. National Primary Health Care Development Agency (NPHCDA) The Agency was established in 1992 to provide technical and programmatic support to States, LGAs, and other stakeholders in the functioning, planning, implementation, supervision and monitoring of primary health care services in Nigeria. NPHCDA is responsible for the implementation of routine immunization services, and currently nalizing plans to introduce and institutionalize a country- wide program for Human Papilloma Virus (HPV) vaccination of girls aged 9 -13 years. The Agency is also making efforts to introduce life-course vaccines for adults including Hepatitis B virus (HBV). 2) National Agency for Food and Drug Administration and Control (NAFDAC) The Agency has the statutory responsibility to regulate and control the importation, exportation, manufacture, advertisement, distribution, sales and use of foods, drugs, cosmetics, medical devices, bottled water and chemicals. NAFDAC also has the statutory duty to conduct tests and ensure compliance with specied standards for foods, drugs, cosmetics, medical devices, bottled water and chemicals. So far, the Agency has successfully enacted and implemented reformulation policies to fortify table salt with iodine, elimination of bromate in bread making and fortication of processed foods with Vitamin A. The agency will play a vital role in enacting and implementing reformulation policies to reduce salt content and eliminate trans-fats in the food chain. 36 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3) Nigerian Institute of Medical Research (NIMR) This is the apex research institute for conducting and disseminating medical research in Nigeria. The Institute is currently conducting various researches on NCD prevention and control. 4) National Institute for Pharmaceutical Research and Development (NIPRD) This institute was established under the Science and Technology Act of 1980 with the primary objective of developing drugs, biological products and pharmaceutical raw materials from indigenous resources. So far, the Institute has led the development of a drug for the prophylactic management of sickle cell called “Niprisan”. This drug has undergone randomized controlled clinical trials and has been found to be efcacious in the prophylactic management of patients with sickle cell disease. The drug is currently undergoing large-scale clinical trials and being prepared for commercial marketing. 3.2.2.2. Non-Health Sector Response to NCDs in Nigeria Other non-health MDAs in Nigeria have existing and ongoing plans and programmes that act as distal determinants of health and inuence the burden of NCDs and their behavioural risk factors. The table below provides an overview of the non-health sector responses to NCD prevention and control within the scope of this document. Table 3: Prevention and Response to Injuries Non-Health MDA Involved in the Response Existing and Ongoing Efforts by Non-Health MDA Involved in the Response Federal Road Safety Commission (FRSC) Developed and currently implementing the Nigeria Road Safety Strategy (2014-2018) to prevent road trafc crashes and respond to post-crash injuries Table 4: Prevention and Response to Mental, Neurological and Substance Abuse Disorders Non-Health MDA Involved in the Response Existing and Ongoing Efforts by Non-Health MDA Involved in the Response National Drug Law Enforcement Agency Have enacted and enforced laws that reduce (NDLEA) the supply for illicit drugs. 37 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Table 5: Prevention of Physical Inactivity Non-Health MDA Involved in the Response Existing and Ongoing Efforts by Non-Health MDA Involved in the Response Federal Ministry of Power, Works and Responsible for rural and urban planning as Housing (FMPWH) well as construction of inter-state roads around the country. Federal Ministry of Youths and Sports Responsible for designing and implementing (FMYS) National competitive sports programmes. State/LGA level Urban Development Responsible for the planning and Authorities development of “healthy cities”. Table 6: Reduce Consumption of Unhealthy Diets Non-Health MDA Involved in the Response Existing and Ongoing Efforts by Non-Health MDA Involved in the Response Federal Ministry of Agriculture and Rural Promote food safety and nutrition through Development (FMARD) agricultural production, and ensure quality control and standardization for healthy options. Standards Organization of Nigeria (SON) Establish and regulate the quality of products and commodities imported into/ or manufactured in Nigeria. National Agency for Food and Drugs Develop and enforce regulations on food Administration and Control (NAFDAC) quality, safety and standards. Table 7: Cross-cutting Issues on Resource Mobilisation, Information Dissemination and Enacting Non-Health MDAand Enforcing Involved Regulations in the Response Existing and Ongoing Efforts by Non-Health MDA Involved in the Response Federal Ministry of Budget and National Responsible for developing national Planning (FMBNP) economic plans and budgetary allocations. The ministry will facilitate budgetary allocation for NCD prevention and control activities outlined in the NMSAP. Federal Ministry of Finance(FMoF) Responsible for disbursing government funds and formulating relevant scal policies that have a bearing on the health of Nigerians. 38 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Table 7: Cross-cutting Issues on Resource Mobilisation, Information Dissemination and Enacting and Enforcing Regulations Non-Health MDA Involved in the Response Existing and Ongoing Efforts by Non-Health MDA Involved in the Response Federal Ministry of Trade and Industry Responsible for enforcing existing excise duty (FMoTI) rate on tobacco(20%) and encouraging investments in healthcare. Federal Ministry of Information and Culture Responsible for disseminating information on (FMoIC) national priorities. Works in synergy with Agencies such as National Broadcasting Commission and National Orientation Agency to disseminate information. Federal Ministry of Labour and Currently no NCD specic response but will Employment (FMLP) be responsible for creating workplace policies that promote healthy work environments and physical activity. Federal Ministry of Justice (FMOJ) Responsible for sector wide legislative reforms by drafting and gazetting laws and regulations for reforms. Federal Ministry of Environment (FMEn) Responsible for the development and enforcement of environmental standards and regulations including food safety inspection. Federal Ministry of Education (FMoE) Responsible for instituting physical education in school curriculum and enforcing standards for physical education in schools and their environments. Responsible for instituting additional NCD education (nutrition, drug abuse etc.) Federal Competition and Consumer Consumer education and assessment of Protection Commission (FCCPC) products. Federal Ministry of Youths and Sports Responsible for sports development (FMYS) programmes. 39 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3.2.3. Constraints to NCDs Prevention and Control in Nigeria The following health and non-health sector constraints impede NCD prevention and control in Nigeria: 1. The poor use of up-to-date evidence for policy and service delivery decision making for NCDs prevention and control; 2. Weak surveillance and data management system for NCDs. The National Health Management Information System does not comprehensively capture NCDs; 3. Lack of up-to-date and nationally representative data on NCDs. Currently, Nigeria relies on estimates from the 1990-1992 NCD survey, which is too out dated and practically unsuitable for planning purposes; 4. Inadequate funding for NCD control and prevention from both domestic and international sources; 5. Poor coverage of NCDs in benets package and basic healthcare provision fund of NHIS, as well as the Minimum Standards for Primary Health Care in Nigeria; 6. Poor coverage of NCD drugs and commodities in the Essential Medicines List; 7. Poor integration between NCDs and existing health services for communicable diseases at all levels of care; 8. Lack of policies/strategic plan of action for physical inactivity, unhealthy diet, and harmful alcohol intake; and, 9. Slow progress in developing regulations for enforcing some aspects of the National Tobacco Act 2015. 3.2.4. Potential Future Direction for NCD Prevention and Control in Nigeria • Establish adequate surveillance, monitoring and evaluations systems for NCD prevention and control including periodic STEPwise survey to determine the burden of NCDs in Nigeria; • Establish an effective coordination mechanism, legislation and build multi- sectoral collaboration for NCDs prevention and control; • Integrate NCDs management into primary healthcare services; • Mobilize resources for NCDs control and prevention in the country; • Establish a research agenda for NCDs prevention and control in the country. 40 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3.2.5. SWOT Analysis for a Multi-Sectoral Response to NCDs in Nigeria 3.2.5.1. Strength • Nigeria is party to the WHO FCTC and has passed the National Tobacco Act in 2015. • There is existing NCD Division in the Department of Public Health of the Federal Ministry of Health. • NCDs included in the current National Strategic Health Development Plan (2017-2022). 3.2.5.2. Weakness • Poor NCD coordination mechanism at the State and Local Government levels. • Paucity of nationally representative data on NCD risk factors and diseases. • Poor leveraging on existing resources from HIV/TB/malaria/RMNCH control programs to strengthen health system response to NCDs. • Lack of standardized national NCD reporting mechanism. • Weak regulations for the control of alcohol, foods and beverages. 3.2.5.3. Opportunities • Commitment of the management of the Federal Ministry of Health to regulate the National Tobacco Act 2015. • Increased excise taxes from tobacco control can be channelled to fund healthcare especially NCDs. • Re-inauguration of the multi-sectoralaction committee. • The overwhelming support and collaboration of WHO and Nigeria State Governments provides an opportunity for the Federal Ministry of Health to undertake the STEPS survey and pilot the WHO PEN. • Ongoing pilottesting of the WHO package on non-communicable diseases at the primary health care centres in Nigeria. • A well-established ofce for management of Sustainable Development Goals. 3.2.5.4. Threats • Other competing national priorities e.g. curbing insurgency from boko haram in the North-East,Niger Delta militancy in the South-South, control of epidemic prone diseases and other health emergencies. • Dwindling funding from donors globally. • Low level of awareness on NCDs. • Tobacco Industry interference. 41 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Cause of premature deaths and Health system determinants of premature Health system morbidities attributable to NCDS deaths and morbidities attributable to NCDs issues that Weak governance and coordination contribute to Inadequate whole-of -population preventive Poorly coordinated and integrated service delivery mortality and measures at all levels of care Late diagnosis at primary health care level Dearth of health workers with training on morbidity Inadequate care and treatment to delay disease management of NCDs progression and prevent dilapidating complications Lack of equipment, drugs and commodities for Late identification and management of prevention, diagnosis, care and treatment complications Weak health information management systems Poor rehabilitative and terminal care Weak health financing Inadequate referrals Poor community involvement and participation in NCD prevention and care Economic and Policy determinants of NCDs (including injuries and mental, neurological and substance abuse disorders) Mass marketing of unhealthy foods, tobacco, alcohol and illicit substances Underlying Urbanization compounded by proliferation of urban slums determinants Use of automated/motorized transport of the burden Poorly regulated food, alcohol and tobacco industry of NCDs Poverty Underlying causes of injuries (RTAs & Rapid population increase violence) & substance abuse The best buys Ageing RTAS are intervening Weak road safety infrastructures and policies Lack of regulations on speed limits on high at these points Poor security policies and infrastructures traffic roads, densely populated areas, and to reduce Poor conflict resolutions for inter-sectoral violence high ways exposure to the Lack of devices to implement speed limit behavioural risk regulations (speed cameras, signs and factors Social & environmental determinants fines) (intermediate Poor knowledge of what constitutes healthy diets and Poor implementation of graduated driver’s determinants) benefits of physical activity licensing Harmful traditional eating and food preparation practices Intersectoral violence: resource competition, Lack of facilities and space to support physical activity indoctrination, unregulated access to illicit Poor awareness about the harm caused by tobacco and weapons harmful alcohol use Social norms that promote unhealthy eating, physical inactivity, harmful alcohol use and tobacco intake Immediate causes of injuries (RTAs & violence) & substance abuse RTAs: Intermediate Behavioural risk factors Speed violations determinants Unhealthy diets with high sodium , sugar and Driving under influence of alcohol or other unsaturated fat intake (74.8%) substances Salt intake (g/day) =2.85g/day Driving without acquiring the required skills Physical Inactivity (52%) and licences or reaching the legal age Harmful Alcohol use (34.3%) Tobacco Smoking (10.4%) Poor use of car-occupant safety devices Violence Societal, religious or cultural beliefs that Metabolic/biological risk factors normalize violence Hypertension (31.2%) Obesity (14.3%) Hegemonic masculine behaviour/ gendered Immediate Overweight (25%) power dynamics predisposing determinants Hypercholesterolaemia (40%) Substance abuse Substance abuse Use of prescription drugs with central nervous effect for sleep or relaxation Use of substances to enhance pleasure at Burden of NCDs in Nigeria parties Cardiovascular diseases: Hypertensive heart disease Mental health problems (27.6%), Cardiomyopathies (11.5%), Ischaemic heart disease (0.7%), Stroke incidence (25. 9 per 100,000 persons) COPD (6.9%) Diabetes (4.1%) Others NCDs: Injuries & substance abuse Sickle cell disease (1.5%) Road traffic accidents (5100 deaths per Cancer incidence (57.2 per 100,000 persons): Most annum) common in men is prostate cancer. Most common in Violence (intimate partner violence, inter- women are breast and cervical cancer personal violence, inter-sectoral violence) Mental, neurological and substance abuse disorders (MNSDs) Figure 4: Scheme of Situation Analysis of NCDs 42 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 4. SCOPE AND STRUCTURE OF THE PLAN 4.1. Rationale for NMSAP Nigeria is undergoing an epidemiological transition resulting in a double burden of communicable and non-communicable diseases; however, communicable diseases far more attention than non-communicable diseases. The prevention and control of NCDs lie partly in sectors outside of health sector and so a multi-sectoral approach is required to address them. The prevention and control of NCDs do not lie within the health system alone, a whole- of-government, a whole-of-society and a multi-sectoral approach is needed to tackle NCDs. Thus, the need to involve a wide range of relevant stakeholders such as the Ministries of Power, Works & Housing, Finance, Agriculture and Rural Development, Information and Communication, Education, Women Affairs and Youth Development, Labour and Employment, Trade and Investment, Environment, Sports and Social Development, Budget and National Panning Commission, Competition and Consumer Protection Council, NAFDAC, SON, NPHCDA as well as the Civil Society Organizations cannot be overemphasized. The involvement of these stakeholders in the development of this strategic plan of action is crucial in creating a sense of ownership. This document, therefore, is intended to provide government and all relevant stakeholders a framework for designing and implementing programmes and interventions that will address NCDs beyond the health sector. It will span a period of seven years (2019 - 2025) and it is in line with the National Health Strategic Development Plan II (NHSDP II) and the Sustainable Development Goals 2015-2030 and the Economic Recovery and Growth Plan. 4.2. Scope of the NMSAP The National Multi-Sectoral Action Plan for the prevention and control of NCDs (2019 – 2025) has been developed in recognition of the huge contribution of NCDs to the burden of disease in Nigeria. Except for sickle cell disease, injuries and mental, neurological and substance abuse disorders, the major NCDs share common modiable risk factors (tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol), and therefore an integrated approach is more cost effective than individual diseases approach. These integrated approaches are comprehensively outlined in the WHO "Best Buys" and other recommended interventions for the prevention and control of NCDs. 43 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) This plan covers the prevention and control of the following NCDs; CVD, diabetes, cancers, chronic respiratory diseases, sickle cell disease, injuries from road trafc crashes and mental, neurological and substance abuse disorders. 4.3. Linkage with Existing Global and National Plans This multi-sectoral action plan for NCD prevention and control adopts an integrated approach. The plan aligns with the Global Action Plan (GAP) on Prevention and Control of NCDs 2013 – 2020 and the Sustainable Development Goals (SDGs). 4.3.1. International Resolutions and Declarations that Informed the Development of the NMSAP I. WHO Framework Convention on Tobacco Control (WHO FCTC) (Resolution WHA56.1). II. Global Strategy on Diet, Physical Activity and Health (Resolution WHA57.17). III. Global Strategy to Reduce the Harmful Use of Alcohol (Resolution WHA63.13). IV. The Brazzaville Declaration on Non-Communicable Diseases Prevention and Control in the WHO African Region 2011. V. Moscow Declaration at the First Ministerial Conference on Healthy Lifestyles and Non-Communicable Diseases Control 2011. VI. Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases: A/RES/66/2(2011) 4.3.2. National Plans that Informed the Development of the NMSAP I. Economic Recovery and Growth Plan (2017). II. National Strategic Health Development Plan (NSHDP) 2017 – 2022. III. National Health Act (NHA). IV. National Tobacco Control Act (NTCA). V. National Health Policy 2004. 44 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 4.4. Structure of the NMSAP The plan has an overarching vision, mission, goal and target statements. The plan has 5 specic objectives that will help in meeting these statements. Each of the objectives has strategic areas that capture the specic issues/challenges to be addressed in NCDs prevention and control. Each of the strategic areas has priority interventions which are evidence-informed and cost-effective interventions that responds to the issues and challenges in NCDs prevention and control outlined in the strategic area. Each priority intervention in turn has priority actions that will need to be taken to achieve universal coverage of the priority intervention. The priority actions are further broken down into activities and sub-activities in the implementation plan. The MDA or organization responsible for each activity and time frame are also clearly stated. The strategic areas for each objective and their priority intervention will make up the strategic framework, while the priority actions, activities, sub-activities, time frame and organization responsible make up the implementation plan. The schema below is a pictorial representation of the structure of the plan. Figure 5: Structure of the MSAP 45 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 5. NATIONAL STRATEGIC AGENDA FOR NCDS 5.1. Vision A healthy Nigerian population with reduced burden of non-communicable diseases and enhanced quality of life for socio-economic development. 5.2. Mission To provide a framework for strengthening multi-sectoral response to NCDs Goal To signicantly reduce the burden of non-communicable diseases in Nigeria in line with global non-communicable diseases prevention and control targets. 5.3. Specic National Targets 5.3.1. Target Statements The implementation of the MSAP aims to achieve these specic national targets as adapted from global NCD goals and SDGs are to achieve; • At least25% relative reduction in unconditional probability of dying prematurely from cardiovascular diseases, cancer, diabetes, chronic respiratory disease, sickle cell disease, injuries, mental, neurological and substance abuse disorders. • At least 10% relative reduction in the harmful use of alcohol. • At least 10% relative reduction in prevalence of insufcient physical activity. • At least 30% relative reduction in mean population intake of salt/sodium(>5gm/2gm/day). • At least 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years. • At least 25% relative reduction in the prevalence of raised blood pressure. • At least 25% relative reduction in the prevalence of diabetes. • At least 25% relative reduction in the prevalence of obesity. • At least 50% absolute reduction in the number of deaths and injuries from road trafc crashes. • At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks. • An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities. 46 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) • At least 80% uptake of vaccines for carcinogenic viruses (HBV, high risk HPV serotypes and Pneumococcal vaccination among children). • At least 80% of eligible population screened for early detection and management of NCDs. • At least 80% of persons with NCDs have access to quality treatment facilities. • At least 80% of adults are aware of their haemoglobin genotype. 5.3.2. Annual Progression for National Targets The annual progression for the national targets is shown in the tables below. The data sources were from the meta-analysis and literature review. The annual progression facilitates tracking outcomes of NMSAP on an annual basis using the data available. Table 8: National Progressions Towards Achieving Targets for Reducing the Burden of NCDs NCD or risk factor 2017/2018 2019 2020 2021 2022 2023 2024 2025 Data source for (Baseline) baseline Premature 71.00 66.56 64.34 62.13 59.91 57.69 55.47 53.25 WHO mortality from NCD (% of all NCD deaths occurring below 70 years) Harmful use of 34.30 33.44 33.01 32.59 32.16 31.73 31.30 30.87 Meta-analysis alcohol (prevalence, %) Physical 74.80 72.93 72.00 71.06 70.13 69.19 68.26 67.32 Meta-analysis inactivity (prevalence, %) Salt/sodium 10.00 9.00 8.00 7.00 6.00 5.00 4.00 3.00 Oyebode intake 2016 10 (gram/day) Tobacco use 5.60 5.18 4.97 4.76 4.55 4.34 4.13 3.92 GATS 2012 (prevalence, %) Raised blood 31.20 29.25 28.28 27.30 26.33 25.35 24.38 23.40 Meta-analysis pressure (prevalence, %) Diabetes 4.10 3.84 3.72 3.59 3.46 3.33 3.20 3.08 Meta-analysis (prevalence, %) Obesity 14.30 13.41 12.96 12.51 12.07 11.62 11.17 10.73 Meta-analysis (prevalence, %) Annual number 5121 4801 4481 4161 3841 3521 3201 2881 Meta-analysis of deaths from road trafc accidents Annual number 31094 29151 27208 25265 23322 21379 19436 17493 Meta-analysis of injuries from road trafc accidents Sickle cell 1.50 1.41 1.36 1.31 1.27 1.22 1.17 1.13 Meta-analysis disease (prevalence, %) 47 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Table 9: Annual Progression Towards Achieving Targets for Scaling Up NCD Prevention, Care and Treatment Interventions Intervention coverage (%) 2018 2019 2020 2021 2022 2023 2024 2025 (National target) Drug therapy to prevent 7.13 13.25 19.38 25.50 31.63 37.75 43.88 50.00 CVD Essential NCDs medicines 10.88 20.75 30.63 40.50 50.38 60.25 70.13 80.00 and basic technologies to treat major NCDs Uptake of vaccines for 10.88 20.75 30.63 40.50 50.38 60.25 70.13 80.00 carcinogenic viruses (HBV, high risk HPV serotypes and pneumococcal vaccination among children) Proportion of eligible 10.88 20.75 30.63 40.50 50.38 60.25 70.13 80.00 population screened for early detection and management of NCDs Access to quality treatment 10.88 20.75 30.63 40.50 50.38 60.25 70.13 80.00 facilities for persons with NCDs Proportion of Adults who 10.88 20.75 30.63 40.50 50.38 60.25 70.13 80.00 are aware of their genotype ***Baseline coverage based on assumption agreed by stakeholders 5.4. Objectives The specic objectives of this plan are: 1. To strengthen governance and stewardship for NCD prevention and control; 2. To promote healthy lifestyle and implement interventions to reduce modiable risk factors for NCDs; 3. To strengthen and orient health systems to address prevention and control of NCDs at all levels of care and contribute to the attainment of universal health coverage; 4. To monitor trends and determinants of NCDs and evaluate progress in their prevention and control; and, 5. To promote and support national capacity for quality research and development for the prevention and control of NCDs. 48 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 6. STRATEGIC FRAMEWORK FOR NMSAP 6.1. Strategic Areas and Priority Interventions Each Strategic Objective has a list of strategic areas. These strategic areas are focused on the risk factors or diseases being addressed by the NMSAP. In turn, each strategic area has a list of priority intervention. These priority interventions were adapted from WHO recommendations for tackling NCDs, injuries from road trafc crashes and mental, neurological and substance abuse disorders. Each priority intervention will require policy, population-wide or health system actions to implement them and achieve universal access and coverage. These priority actions are also considered in this strategic framework. 6.1.1 Objective One: To Strengthen Governance and Stewardship for NCD Prevention and Control Governance for preventing non-communicable diseases involves steering the entire country, states and communities towards the collective pursuit of health and well- being. It involves setting up mechanisms and platforms that are collaborative and participatory. These mechanisms must involve both health and non-health actors. They must also involve non-governmental stakeholders such as bilateral and multi- lateral agencies, donors, private sector, academia, professional bodies, civil society and non-governmental organizations. 49 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Table 10: MSAP Strategic Areas and Priority Interventions for Governance and Stewardship for NCD Prevention and Control Strategic Area Priority Interventions 1.1. To strengthen 1.1.1. Establish a national coordination mechanism governance, 1.1.2. Establish a mechanism for advocacy on NCDs coordination, prevention and control at al levels collaboration and 1.1.3. Establish a Multi-Sectoral Technical Working Group leadership. (TWG) on prevention and control of NCDs 1.1.4. Increase and prioritize budgetary allocation for prevention and control of NCDs 1.1.5. Periodic reviews of existing policies and development of policies as necessary 1.2. To strengthen multi- 1.2.1. Establish partnerships with global and regional sectoral action on NCDs stakeholders for NCD prevention and control with clearly dened roles Considerations/Priority Actions Considerations: The national coordination mechan ism will involve a high-level coordinating body that either operates above the ministerial level (under the presidency) or within the Federal Ministry of Health. This coordination mechanism will be duplicated across all tiers of government . NCD Alliance ex ists but there is poor synergy between the alliance and FMoH and other advocacy organizations working in NCDs. There is currently no budget line for NCD prevention and control activities. Priority Actions 1. Establish a national coordination mechanism for NCDs . 2. Strengthen advocacy for NCD prevention and control at all levels. 3. Strengthen FMoH capacity to provide leadership and coordination for NCDs . 4. Secure budgetary allocation for NCD prevention and control . 5. Establish a multi-sectoral technical working group on NCD prevention and control. 6. Establish partnerships with global and regional alliance for NCD prevention and control . 6.1.2 Objective Two: To Promote Healthy Lifestyle and Implement Interventions to Reduce Modiable Risk Factors for NCDs In line with the Ottawa and Bangkok Charter on Health Promotion12, this objective recognizes the need to create health promoting policies and environments that will inuence individuals to make healthier lifestyle/behavioural choices. These policy level approaches reduce modiable risks and prevent onset of new cases of NCDs and reduce the economic costs of treating and managing these NCDs. Therefore, policy and population-wide efforts will be directed at reducing the use of tobacco, reducing the harmful use of alcohol, promoting healthy diets and physical activity, reducing injuries, reducing the burden of mental, neurological and substance abuse disorders. 50 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Table 11: Priority Areas and Interventions to Promote Healthy Lifestyle Priority Area Priority Interventions 1.1 Reduce 1.1.1 Increase excise taxes and prices on tobacco products tobacco use 1.1.2 Implement plain/standardized packaging and/or large graphic health warnings on all tobacco packages 1.1.3 Enact and enforce comprehensive bans on tobacco advertising, promotion and sponsorship 1.1.4 Reduce exposure to second-hand tobacco smoke 1.1.5 Implement effective mass media campaigns that educate the public about the harms of smoking/tobacco use and second-hand smoke 1.2 To reduce the 1.2.1 Increase excise taxes on alcohol beverages harmful use of 1.2.2 Enact and enforce bans or comprehensive restrictions on alcohol exposure to alcohol advertising across multiple channels 1.2.3 Enact and enforce restrictions on the physical availability of retailed alcohol via providing sales of alcohol in only licensed premises 1.2.4 Enact and enforce drink-driving laws and blood alcohol concentration limits via sobriety checkpoints 1.3 Promote healthy 1.3.1 Reduce salt intake through the reformulation of processed diets food products to contain less salt, set target levels for processed foods and adopt standards for front-of-pack labelling 1.3.2 Reduce sugar consumption through effective taxation on sugar-sweetened products 1.3.3 Promote, protect and support exclusive breastfeeding within the rst hour of birth and for the rst 6 months of life. 1.3.4 Replace trans-fats and saturated fats with unsaturated fats through reformulation, labelling using scal policies and/or agricultural policies 1.3.5 Limiting portion and package size to reduce energy intake and the risk of overweight/obesity 1.3.6 Implement nutrition education and counselling, mass media and behaviour change campaign on healthy diets including social marketing to reduce the intake of total fat, saturated fats, sugars and salt, and promote the intake of fruits and vegetables 51 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1.4 Promote physical 1.4.1 Implement community-wide public education and activity awareness campaign for physical activity 1.4.2 Provide physical activity counselling and referral as part of routine primary health care services. 1.4.3 Ensure that macro-level urban design incorporates the core elements of residential density, connected street networks that include sidewalks, easy access to a diversity of destinations and access to public transport 1.4.4 Provide convenient and safe access to quality public open space and adequate infrastructure to support walking and cycling 1.4.5 Reinforce whole-of-school programme that includes quality physical education, availability of adequate facilities and programs to support physical activity for all children 1.4.6 Implement multi-component physical activity programmes and organize sport groups 1.5 Promote road 1.5.1 Reduce exposure and risk to road trafc crashes through safety and reduce implementation of existing speed restriction and road injuries from road safety policies trafc crashes 1.5.2 Enforce visibility for cyclers, bikers (e.g. through use of reective jackets) and vehicles (e.g. high mounted head lamps) 1.5.3 Enforce the use of crash-protective devices in vehicles (e.g. seatbelts, age appropriate car-seats for infants) 1.6 To r e d u c e t h e 1.6.1 Raise public awareness on pre-marital/pre-conception number of new screening for sickle cell disease using Point-of-Care cases of sickle cell devices. disease 1.6.2 Scale up universal screening for sickle cell disease using Point-of-care devices 1.6.3 Promote collaborative work with FBO, religious and traditional leaders 52 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1.7 To prevent Mental 1.7.1 Public awareness on the harms associated with Neurological and substance abuse (including illicit substance use and Substance use misuse of prescription medication) Disorders (MNSD) 1.7.2 Advocacy for de-criminalization of substance abuse users 1.7.3 Include psycho-education for depression and suicide prevention in education curriculum 1.7.4 Conduct a national survey on MNSD Considerations/Priority Actions • Reduce Tobacco Use Consideration: There is a National Tobacco Control Act, 2015 in place already. This Act will enable implementation of all the priority interventions. However, the regulations that will enable implementation of this Act is yet to be drafted. However, there are also some aspects of the Act that can be enforced without formal regulations. Priority Actions: 1. Prioritization of effective implementation and enforcement of the National Tobacco Control Act, 2015. 2. Monitor tobacco use and prevention policies pursuant to WHO FCTC Article 20. 3. Institute an effective tobacco tax measure and scal resources to help meet public health scal needs. • Reduce the harmful use of alcohol Consideration: There is no legislation, regulation or policy on alcohol control. However, there is a presidential approval to enforce new excise duty for alcoholic beverages. The new specic excise duty rate for alcoholic beverages cuts across beer and stout, wines and spirits for the three years, 2018 to 2020. Beer and stout will attract 0.30k per centilitre (Cl) in 2018 and 0.35k per Cl each in 2019 and 2020.Wines will attract N1.25k per Cl in 2018 and N1.50k per Cl each in 2019 and 2020, while N1.50k per Cl was approved for spirits in 2018, N1.75k per Cl in 2019 and N2 per Cl in 2020. However, it is envisaged that this approval will be sustained by subsequent administrations Priority Action: To develop a national alcohol control policy • Promote healthy diets Consideration: There is supporting legislation through the NAFDAC Act to support additional/new regulations on reformulation to reduce salt and replace trans-fats and saturated fats with unsaturated fats in industrially produced foods. 53 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Considerations/Priority Actions WHO has developed the SHAKE technical package to support development, implementation and monitoring of salt reduction strategies at population level. The package outlines evidence-informed policies and interventions which have proved to be effective in reducing population salt intake, provides evidence of the efcacy of the recommended interventions. This technical package will guide the development of reformulation regulations to reduce salt intake. WHO has also developed the REPLACE technical package to guide policy actions aimed at reducing and eliminating industrially packaged trans-fats. This technical package will also guide the development of reformulation regulations for replacing trans-fats and saturated fats with unsaturated fats. Other aspects of healthy eating that cannot be addressed through policies can be achieved through raising public awareness and health promotion in schools and communities. Priority Actions: 1. Develop a regulation on reformulation of industrially produced foods to reduce salt content and replace trans-fats and saturated fats with unsaturated fats. 2. Implement mass media campaigns to promote healthy diets. 3. Strengthen nutritional education in primary and secondary school curriculum. 4. Develop and implement a policy on marketing sweetened foods and non-alcoholic beverages to children. • Promote physical activity Consideration: There are existing policies or regulations on the design of public infrastructures, residential areas, roads, and public transport to promote physical activity under the healthy city initiative. There are also existing policies and regulations to promote physical activity in schools and workplaces. Priority Actions: 1. Implement effective mass media campaigns that educate the public on the benets of physical activity. 2. Strengthen physical activity in schools. 3. Create active environments in workplace and public spaces. • Promote road safety and reduce road trafc crashes Consideration: There are existing policies or regulations being enacted and implemented by the Federal Road Safety Commission to implement speed limits and crash-prevention strategies. There are also existing messages to promote road safety. The gap is in terms of enforcement and public awareness. Priority Actions: 1. Implement effective mass media campaigns that educate the public on road safety, speed restrictions and crash-reduction measures. 2. Enforce existing regulations on speed restriction. 54 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Considerations/Priority Actions • Reduce the number of babies born with sickle cell anaemia Consideration: There are existing messages to raise public awareness on sickle cell but the media do not have the technical knowledge to disseminate these messages correctly. There are existing policies that make it mandatory to screen for haemoglobin genotype before getting regulatory identity documents (international passport, driver’s license etc.);however, this is not adequately implemented. Faith-based organizations have also been conducting pre- marital screening for haemoglobin genotype without legislative support. Because of the unique opportunity it provides to raise awareness and promote informed decision on conception, pre-marital screening needs to be scaled up through legislative support. Priority Actions: 1. Scale-up capacity to disseminate information on sickle cell disease. 2. Scale-up universal screening for sickle cell at multiple channels using point-of-care devices. • Prevent mental, neurological and substance abuse disorders (MNSD) Consideration: There is poor awareness about the harms associated with substance abuse. There is currently no nationally representative survey on MNSD. Community level programs to prevent some mental health conditions have been piloted in Nigeria through the Mental Health GAP programme (MHGAP). Persons involved in substance abuse are currently being criminalized and this is a serious constraint to adequate care and treatment. Currently, there is no legislation to guide care and treatment of mental health problems in Nigeria. The Lunacy Act of 1958 which was enacted during the colonial era promotes prejudice, stigma and discrimination of people living with or affected by mental health problems. Therefore, there is need for legislative reforms on mental health in Nigeria. This will ensure that the dignity and fundamental human rights of people living with/affected by mental health problems are upheld. A National Mental Health Policy was developed in 2013 and there is need to review and update the policy to align with global response and priorities. Priority Action: 1. Repeal the lunacy act of 1958 and replace it with a more evidence-informed law that is grounded in human rights principles. 2. Implement effective mass media and advocacy campaigns to raise awareness on prevention, promotion and access to care for MNSD. 3. Review and update the 2013 National Mental Health Policy to align with global response and priorities. 55 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 6.1.3 Objective Three: To Strengthen and Orient Health Systems to Address Prevention and Control of Non-Communicable Diseases at All Levels of Care and Contribute to the Attainment of Universal Health Coverage A strong, resilient, effective and efcient health system is important to prevent NCDs and also to respond to the rising burden. Health systems should efciently integrate health promotion, disease prevention, chronic care management, response to acute/emergency cases and rehabilitative or long-term support/end of life care for NCD control. This objective aims at scaling up the coverage and access to evidence-informed and cost-effective interventions for NCD care and treatment. It also aims to remove all barriers (especially nancial barriers) to management of risk factors in people at high- risk as well as chronic care and treatment in persons with NCDs. This objective will emphasize improved patient pathways to care, better coordination and integration in service delivery and patient retention through patient-centred approaches. Table 12: Priority Areas and Interventions to Strengthen Health Systems to Address NCDs Priority Area Priority Interventions 1.1 To m a n a g e 1.1.1 Assessment of risk for diabetes and hypertension, using a cardiovascular risk risk assessment tool f a c t o r s 1.1.2 Provision of drug therapy (including glycaemic control for (hypertension and diabetes mellitus and control of hypertension) diabetes) 1.1.3 Assessment of risk of adverse CVD in patient with diabetes and hypertension 1.1.4 Counselling to individuals who have had a heart attack or stroke and to persons with high risk (≥ 30%) of a fatal and non-fatal cardiovascular event in the next 10 years 56 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Priority Area Priority Interventions 1.2 T o m a n a g e 1.2.1 Treatment of new cases of acute myocardial infarction cardiovascular with either: Acetylsalicylic acid (Aspirin) and/or diseases including Clopidogrel, or thrombolysis across all levels A c u t e M I , 1.2.2 Primary prevention of acute rheumatic fever and Rheumatic fevers, rheumatic heart diseases by increasing appropriate Rheumatic Heart treatment of streptococcal pharyngitis at the primary care Disease, Heart level Failure, CCF 1.2.3 Appropriate management of congestive cardiac failure ( c h r o n i c 1.2.4 Appropriate anticoagulation therapy for medium-and cardiac/heart high-risk non-valvular atrial brillation +/- mitral stenosis failure )and stroke) 1.2.5 Appropriate treatment of conrmed ischemic stroke with low-dose acetylsalicylic acid (aspirin) 1.2.6 Appropriate care of acute stroke and rehabilitation in stroke units 1.3 To manage diabetes 1.3.1 Lifestyle interventions for preventing type-2 diabetes 1.3.2 Effective glycaemic control for people with diabetes, along with standard home glucose monitoring for people treated with insulin to reduce diabetes complications 1.3.3 Screening of people with diabetes for proteinuria and treatment with angiotensin-converting-enzyme inhibitor for the prevention and delay of renal disease 1.3.4 Preconception care among women of reproductive age who have diabetes including patient education and intensive glucose management 1.3.5 Preventive foot care for people with diabetes (including educational programmes, access to appropriate footwear, multidisciplinary clinics) 1.3.6 Diabetic retinopathy screening for all diabetes patients and laser photocoagulation for prevention of blindness 1.4 To manage cancers 1.4.1 Vaccination against human papillomavirus (2 doses) of 9–13-yearsfemales 1.4.2 Prevention of cervical cancer by screening women aged 30-59 years either through: • Visual inspection with acetic acid linked with timely treatment of pre-cancerous lesions 57 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Priority Area Priority Interventions 1.4 To manage cancers • Pap smear (cervical cytology) every 3–5 years linked with timely treatment of pre-cancerous lesions; • Human papillomavirus tests every 5 years linked with timely treatment of pre-cancerous lesions 1.4.3 Screening for early detection of breast cancer (once every 2 years for women aged 40-70 years, possible use of ultra-sound, mammography) linked with timely diagnosis and treatment of breast cancer 1.4.4 Prostate Specic Antigen (PSA) for Benign Prostatic Hyperplasia (BPH) screening for prostate cancer in males 40 years and above 1.4.5 Treatment of colorectal cancer stages I and II with surgery +/- chemotherapy and radiotherapy 1.4.6 Treatment of cervical cancer stages I and II with either surgery or radiotherapy +/- chemotherapy 1.4.7 Treatment of breast cancer stages I and II with surgery +/- chemotherapy. 1.4.8 Basic long-term care and end-of-life care for cancer: hospital care with multi-disciplinary team and access to opiates and essential supportive medicine 1.4.9 Prevention of liver cancer through Hepatitis B immunization 1.4.10 Oral cancer screening in high-risk groups (for example, tobacco users, betel-nut chewers) linked with timely treatment 1.4.11 Population-based colorectal cancer screening, including through a faecal occult blood test, as appropriate, at age >50, linked with timely treatment 1.4.12 Promote use of sunscreen for prevention of skin cancers 58 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Priority Area Priority Interventions 1.5 To manage chronic 1.5.1 Symptom relief for patients with asthma with respiratory disease bronchodilators (e.g. inhaled Salbutamol) 1.5.2 Symptom relief for patients with chronic obstructive pulmonary disease with inhaled salbutamol 1.5.3 Treatment of asthma using low dose inhaled Beclometasone and short acting beta agonist 1.5.4 Access to improved stoves and cleaner fuels to reduce indoor air pollution 1.5.5 Cost-effective interventions to prevent occupational lung diseases, for example, from exposure to silica, asbestos 1.5.6 Inuenza vaccination for patients with chronic obstructive pulmonary disease 1.5.7 Control of environmental air pollution from vehicular and stationary generator emissions 1.6 To manage sickle 1.6.1 Integrate genetic counselling in routine health services cell disease 1.6.2 Ensure availability and access of routine drugs and drugs that prevent anaemia and sickle cell crisis. 1.6.3 Institutionalize universal new-born screening 1.7 To manage mental, 1.7.1 Integrate and scale-up management of common mental neurological and health disorders and suicide prevention strategies into Substance abuse services provided at PHCs disorders 1.7.2 Scale up community-based care for low cost rehabilitation for children and adults with chronic mental illness 1.7.3 Ensure availability of drugs for treatment of mental “disorders” 1.7.4 Scale up psychosocial interventions for substance use disorders Considerations/Priority Actions Considerations: There are existing policy and health nancing constraints that impede universal access and coverage of these priority interventions. Therefore, the priority actions are aimed at removing these constraints. NCD prevention, care and treatment are not currently included in the minimum service package for primary health care in Nigeria. 59 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Considerations/Priority Actions There is no technical and clinical guidance on providing integrated services for NCDs prioritized in this document. Comprehensive NCD care and treatment is not included in the Basic Minimum Package of Health Services that will be nanced through the Basic Health Care Provision Fund. NPHCDA does not currently implement life-course vaccination program. Therefore, there is no mechanism to scale-up hepatitis B virus vaccination to adults. However, there is an existing plan to roll-out HPV vaccine to girls aged 9-13 years. Priority Actions: 1. Integrate NCD prevention, care and treatment into basic primary health care with referral to all levels of care. 2. Build the capacity of health workers at all levels of care on integrated management of essential NCDs (CVD, diabetes, cancer, COPD, Sickle cell disease, MNSD and injuries). 3. Scale-up coverage of early detection and diagnosis at primary health care level. 4. Scale-up coverage of NCD prevention services at all levels of care. 5. Scale up care and treatment services for NCDs (CVD, diabetes, cancer, COPD, Sickle cell disease, MNSD and injuries) at all level of care. 6. Explore viable health nancing mechanisms. 6.1.4 Objective Four: To Monitor Trends and Determinants of Non- Communicable Diseases and Evaluate Progress in their Prevention and Control This objective recognizes and emphasizes the need for adequate health information for planning and implementing NCD control programs. Therefore, this objective aims to achieve adequate and timely data collection and analysis for monitoring and surveillance for NCDs. Table 13: Priority Areas for Monitoring Trends and Evaluating Progress in NCD Prevention and Control Priority Area Priority Interventions 1.1 To i n c o r p o r a t e 1.1.1 Develop national targets and indicators for service delivery NCD into national and multi-sectoral policy and plans based on global health information monitoring framework system 60 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) Priority Area Priority Interventions 1 . 2 To s t r e n g t h e n 1.2.1 Establish and/or strengthen a comprehensive NCD national NCD surveillance system, including reliable registration of surveillance births of children with sickle cell and deaths by cause, system including periodic and routine data collection on risk factors and monitoring national response capacity 1.2.2 Strengthen institutional capacity for surveillance and monitoring and evaluation 1.2.3 Strengthen human resources for surveillance and monitoring and evaluation 1.2.4 Integrate NCD surveillance and monitoring into national health information systems 1.3 To i m p r o v e 1.3.1 Monitor trends and determinants of NCDs and evaluate monitoring and progress in their prevention and control evaluation of NCD programs Considerations/Priority Actions Considerations: NCDs are not adequately captured in the national health management information system. The indicators are very few and focus on only new cases of diseases identied at service delivery points. The technical capacity (human resources, equipment and tools) required for surveillance is currently limited. Nationally representative Global Youth Tobacco Survey, STEPwise and MNSD surveys are yet to be conducted. Priority Actions: 1. Integrate NCDs service delivery performance monitoring indicators into the National Health Management information system. 2. Strengthen technical capacity for NCD surveillance, monitoring and evaluation. 3. Integrate NCD surveillance system into civil registration and vital statistics systems. 4. Conduct periodic surveys on NCDs. 61 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 6.1.5 Objective Five: To Promote and Support National Capacity for Quality Research and Development for the Prevention and control of Non-Communicable Diseases Research is important for evidence-informed decision-making on multi-sectoral NCD prevention and control. This will require a concerted effort to develop, implement and disseminate a national research agenda. Table 14: Priority Areas and Interventions for Research on NCD Prevention and Control Priority Area Priority Interventions 1 . 1 To s e t n a t i o n a l 1.1 1 Develop and implement a prioritized national research research agenda agenda for NCDs 1.1.2 Prioritize budgetary allocation for research on NCD prevention and control 1 . 2 To s t r e n g t h e n 1.2.1 Strengthen human resources and institutional capacity for national capacity research on NCDs for NCD research 1.2.2 Strengthen research capacity through cooperation with foreign and domestic research institutes 1.3 To s t r e n g t h e n 1.3.1 Improve collaboration among research bodies in NCDs k n o w l e d g e generation, 1.3.2 Develop a mechanism to disseminate ndings on NCDs translation and dissemination Considerations/Priority Actions Considerations: Researchers and research organizations are currently conducting research on burden of NCDs and interventions to address NCDs. However, there is poor cohesion between researchers and existing research do not align well with national priorities on NCD prevention and control. There is also paucity of funding for research. Priority Actions 1. Develop and implement a prioritized research agenda for NCD prevention and control. 2. Secure budgetary allocation for research on NCD prevention and control. 3. Strengthen technical capacity for research on NCD prevention and control. 4. Strengthen collaboration with foreign and domestic research institutes. 5. Establish knowledge translation mechanisms for NCD prevention and control. 62 #BeatNCDsNG Implementation Plan for NMSAP 63 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7 IMPLEMENTATION PLAN FOR NMSAP 7.1 Objective One: To Strengthen Governance and Stewardship for NCD Prevention and Control Table 15: Priority Actions to Strengthen Governance and Stewardship for NCD Prevention and Control 1.Priority Action: Strengthen Advocacy for NCD Prevention and Control at All Levels Activity Activities Sub-activities MDA Responsible Time Frame Code 1.1 Set up a national NCD 1.1.1 Periodic update on Lead MDA: FMoH 2019 advocacy group mapping of all Others: SMOH, NGOs/CSOs working NCD Alliance on NCDs in the country 1.1.2 Form national Lead MDA: FMoH 2018 advocacy committee Others: CSOs 1.1.3. Convene Biannual Lead MDA: FMoH 2018-2025 NCD advocacy Others: CSOs group meeting 1.2 Advocate to relevant 1.2.1. Develop advocacy Lead MDA: FMoH 2019 government non-health toolkits with key Others: CSOs sectors and private messages based on industries to deliver on the MSAP targets outlined in the MSAP 1.2.2 Conduct high level Lead MDA: FMoH 2019 advocacy visits and Others: CSOs engagements to relevant sectors and industry 64 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2. Priority Action: Establish a Multi-Sectoral Technical Working Group on NCD Prevention and Control Activity Activities Sub-activities MDA Responsible Time Frame Code 2.1 Set-up a multi-sectoral 2.1.1 Conduct a mapping Lead MDA: FMoH 2019 technical working of all the relevant group on NCD non-health MDAs, prevention and control CSOs, implementing with representatives partners and from non-health commercial sector government MDAs, CSOs, implementing 2.1.2 Bi-annual meeting Lead MDA: FMoH 2019-2025 partners and the of the TWG commercial sector 2.1.3 Mapping of already Lead MDA: FMoH 2019 existing policy documents 2.2 Build the capacity of 2.2.1 Conduct capacity Lead Sector: FMoH 2019 multi-sectoral TWG building needs Others: FMBNP Development members assessment partners 2.2.2 Conduct annual Lead Sector: FMoH 2019-2025 capacity building Others: FMBNP workshops Development / partners 65 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3. Priority Action: Strengthen the Capacity of FMoH to Provide Leadership and Co-ordination for NCDs Activity Activities Sub-activities MDA Responsible Time Frame Code 3.1 Conduct trainings for 3.1.1 Conduct a training Lead Sector: FMoH 2019 NCD Federal ofcers needs assessment Others: FMBNP on the mechanisms Development / and processes for partners reformulation and scal policies 3.1.2 Conduct annual Lead Sector: FMoH 2019 trainings on NCD Others: FMBNP control policies and Development / programming partners 3.2 Equip the NCD division 3.2.1 Conduct a needs Lead Sector: FMoH 2019 with all requisite assessment for the Others: FMBNP equipment and tools to equipment needs Development / provide oversight on partners NCD policymaking and programming 3.2.1 Conduct a needs Lead MDA: NCD 2019 assessment for the Division-FMoH equipment needs Others: DPRS of FMoH 4. Priority Action: Establish a Coordinating Mechanism on NCD Prevention and Control Activity Activities Sub-activities MDA Responsible Time Frame Code 4.1 Set up NCD National 4.1.1 Set up an inter- Lead MDA: FMoH 2019 Governing Council at ministerial the Federal level coordination mechanism 4.1.2 Convene an annual Lead MDA: FMoH 2019 high level inter- ministerial meeting on NCD prevention and control 4.2 Set up state level NCD 4.2.1 Set up NCD units Lead MDA: FMoH 2019 coordination units within the public health department of the State Ministries of Health with clear TORs and reporting lines 66 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 4.2 Set up state level NCD 4.2.2 Designate focal Lead MDA: FMoH 2019 coordination units persons to cover all the relevant diseases and issues in NCD control programming 4.2.3 Set up NCD units Lead MDA: FMoH 2019 within the disease control department of the State Primary Health Care Development Agency 4.3 Set up LGA level NCD 4.3.1 Designate NCD Lead MDA: 2019 focal point focal persons in SPHCDB LGAs 4.4 Conduct coordination 4.4.1 Convene biannual Lead MDA: FMoH 2019 meetings at all tiers of national/state level government consultative meetings on NCD prevention and treatment in the health sector with heads of NCD divisions in the SMoH and SPHCDBs 5. Priority Action: Establish Partnerships with Global and Regional Alliance for NCD Prevention and Control Activity Activities Sub-activities MDA Responsible Time Frame Code 5.1 Establish global and 5.1.1 Participate in All MDAs 2019 - regional partnerships regional and 2025 for NCD prevention and international events, control dialogues and meetings for NCD prevention and control 67 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 6. Priority Action: Prioritize and Increase Budgetary Allocation for NCD Prevention and Control Activity Activities Sub-activities MDA Responsible Time Frame Code 6.1 Advocacy for resource 6.1.1 Develop Key Lead MDA FMoH 2019 mobilization for NCDs Performance Others: FMoF, Indicators to be FMBNP used for the monitoring and evaluation of NCDs 6.1.2 Submit a request Lead MDA:FMoH 2019 letter to the DPRS of the Ministry of the Budget and planning to include NCD KPI’s on the National M&E report 6.1.3 Develop an Lead MDA: FMoF, 2019 advocacy brief that Others: FMBNP, outlines the FMoH economic burden and loss due to NCDs 6.1.4 Advocacy to the Lead MDA: FMoH 2019 Honourable Minister of Budget and Planning, (i.e. to ensure that fact sheet and other relevant documents are included) 6.1.6 Conduct a Press Lead MDA: FMoH 2019 Brieng on NCDs Others: FMoIC 68 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7.2. Objective Two: To Promote Healthy Lifestyle and Implement Interventions to Reduce Modiable Risk Factors for NCDs Implementation strategy A phased approach will also be used to implement the activities and sub-activities in this objective. Legislative and policy interventions will involve various stages of achieving legislative and policy reforms in Nigeria. Capacity building workshops and trainings will involve the following phases; development of a training curriculum and materials, training of trainers at the federal level and step-down trainings. The step-down trainings can further be cascaded. This entails a central training at geo-political zones with the participation of representatives from 5-6 states per zone. followed by state-level training with participation from various LGAs and relevant sectors. Ideally, a training session should not have more than 30 participants. Program implementation activities will entail targeted pilot programmes in selected states which will then be scaled-up to other states or nation-wide. 7.2.1 Reduce Tobacco Use Table 16: Priority Actions to Enforce the National Tobacco Control Act (2015) 1. Priority Action: Effective Implementation, Prioritization and Enforcement of the National Tobacco Control Act of 2015 Activity Activities Sub-activities MDA Responsible Time Frame Code 1.1 Secure approval for 1.1.1 Advocacy to Lead MDA: FMoH 2019 regulation in the leadership of the Others: NTCA, National Assembly NASS FOMJ, NATOCC 1.1.2 Development of Lead MDA: FMoH 2019 Tobacco Control Others: NTCA, Guidelines NATOCC 69 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1.2 Implement non- 1.2.1 Advocacy to Lead MDA: FMoH 2019 - regulatory NTCA enforcement Others: NTCA, 2020 activities agencies on CPC, NSCDC, provisions (NPF, NPF, FMIC SON, CPC, NCS, NSCDC) 1.2.2 Capacity building Lead MDA: FMoH 2019 for enforcement Others: NATOCC agencies and the development of joint enforcement operations for tobacco control i.e. a coalition of key enforcement agencies 1.2.3 Public awareness Lead MDA: FMoH 2019- on the NTCA Others: MOIC 2025 1.3 Implement all 1.3.1 Advocacy to Lead MDA: FMoH 2019 - regulations in the enforcement Others: NTCA, 2025 tobacco control act of agencies and the NATOCC, 2015 development of joint CCPC.NPF, enforcement NSCDC operations for tobacco control i.e. a coalition of key enforcement agencies 1.3.2 Development of enforcement plan for enforcement agencies 1.3.3 Convene Lead MDA: FMoH 2019 - sensitization Others: NATOCC 2025 meeting for hoteliers and managers of public places on smoke free environment 1.3.4 Convene Lead MDA: FMoH 2019 - sensitization Others: NATOCC 2025 meeting for stakeholders in lm/ entertainment industry 70 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1.3 Implement all 1.3.5 Convene national Lead MDA: FMoH 2019 - regulations in the Tobacco Control Others: NATOCC 2025 tobacco control act of Committee meeting 2015 1.3.6 Convene technical Lead MDA: FMoH 2019 - Working Group Others: NATOCC 2025 meeting on Tobacco Taxation 1.3.7 Convene technical Lead MDA: FMoH 2019 - Working Group Others: NATOCC 2025 meeting to develop strategies for the implementation of ban on Tobacco Advertising Promotion and Sponsorship (TAPS) 1.3.8 Installation of track Lead MDA: FMoF 2019 - and trace system for Others: FIRS, NCS 2021 tracking tobacco products 1.3.9 Advocacy to the Lead MDA: FMoH 2019 Honourable Minister Others: NATOCC, of Finance and Mr. NTCA President on the establishment and operationalization of the tobacco control fund pursuant to Section 8 of the NTC Act 1.4 Domestication of NTC 1.4.1 Advocacy and Lead MDA: FMoH 2019 - Act in states capacity building for Others: FMOF, 2025 SMOH and SMOF NTCA 70 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7.2.2 Reduce Harmful Use of Alcohol Table 17: Priority Actions on Harmful Use of Alcohol 2. Priority Action: Implement Effective Mass media Campaigns that Educate the Public about the Harmful Use of Alcohol Activity Activities Sub-activities MDA Responsible Time Frame Code 2.1 Develop mass media 2.1.1 Convene message Lead MDA: FMoH 2019 campaign on harmful design and materials Others: FMoIC, use of alcohol development NAFDAC, GALAXY, workshop on NOA preventing harmful use of alcohol 2.2 Disseminate messages 2.2.1 Engage with Lead MDA: FMoH 2019 on preventing alcohol National Others: FMoI, intake through multiple Broadcasting FMOE channels Corporation and media organizations to secure spots and spaces for television, radio, billboard messaging on harmful use of alcohol 2.2.2 Conduct targeted Lead MDA: FMoH 2019 message programs Others: NBC on harmful use of alcohol 3. Priority Action: Effective Population-wide Support for Harmful Alcohol Use to All Who want to Quit (Brief Advice, Toll-free lines, Social Media Support Group) Activity Activities Sub-activities MDA Responsible Time Frame Code 3.1 Develop messages to 3.1.1 Develop messages to Lead MDA: FMoH 2019 promote self- support persons with Others: NBC; management of alcohol dependence FMoIC, GALAXY, harmful alcohol use who want to quit NGOs, FMSYD 3.1.2 Development of Lead MDA: FMoH 2020 guideline on alcohol cessation services 72 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3. Priority Action: Effective Population-wide Support for Harmful Alcohol Use to 4. All Priority Who Action: want toDevelop an Advice, Quit (Brief Alcohol Toll-free Control legislation lines, Social Media Support Group) Activity Activity Activities Activities Sub-activities Sub-activities MDA MDA Responsible Responsible Time Time Frame Frame Code Code 4.1 3.1 Develop alcohol 4.1.1 Develop 3.1.1 Convene a policy to messages Lead MDA: Lead MDA: FMoH FMoH 2019 2019 Control Policy that dialogue meeting support persons withto Others: NBC; Others: FMOJ clearly stipulates develop the alcohol alcohol dependence FMoIC, GALAXY, annual increase in control who legislation want to quit NGOs, FMSYD alcohol excise tax and regulations for sales, advertising and promotions of alcoholic drinks 3.1.2 Development of Lead MDA: FMoH 2020 guideline on alcohol 4.2 Implement alcohol 4.2.1 Convene an alcohol Lead MDA: FMoH 2019 cessation services control law and industry stakeholder NAFDAC regulation engagement meeting to gain the buy-in of the alcohol manufacturing and sales industry 4.2.2 Disseminate policy Lead MDA: FMoH 2019 briefs on alcohol Others: FMOSYD legislation and regulation to all relevant stakeholders 4.3 Operationalise 4.3.1 Convene bi-annual Lead MDA: FMoH 2019 - regulation on alcohol meetings for regular Others: CCPC 2025 updates on enforcement of alcohol control 7.2.3 Promote Healthy Diet Table 18: Priority Actions to Promote Healthy Diet 5. Priority Action: Implement Effective Mass Media Campaigns to Promote Healthy Diet and Educate the Public on the Harms Associated with High Salt, Sugar and Trans-Fat Intake Activity Activities Sub-activities MDA Responsible Time Frame Code 5.1 Develop mass media 5.1.1 Develop media Lead MDA: 2019 campaign on the materials and key FMoH(Health harms associated with messaging focused Promotion) high salt, sugar on harms associated Others: NBC, (sweetened) and trans- FMoIC NAFDAC with high-salt, high- fat intake sugar and trans-fat intake 73 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 5.1 Disseminate messages 5.2.1 Engage with National Lead MDA: FMoH 2020 through multiple Broadcasting Others: NBC; channels Corporation and FMoIC media organizations to secure spots and spaces for television, radio, billboard messaging 5.2.2 Conduct targeted Lead MDA: FMoH 2020 message programs Others: NBC, NOA 6. Priority Action: Develop and Implement a Regulation on Reformulation of Industrially Processed Foods to Reduce Salt and Replace Trans-Fat Activity Activities Sub-activities MDA Responsible Time Frame Code 6.1 Develop a mandatory 6.1.1 Conduct a food Lead MDA: 2019 food reformulation analysis to identify NAFDAC regulation under the different food Others: FMoH, existing NAFDAC act sources (in-door and SON out-door) that contribute to high 6.1.2 Convene a Lead MDA: 2019 consultative forum NAFDAC (written and face-to- Others: FMoH, face) with the food SON processing industry to discuss ndings of the analysis 6.1.3 Develop Lead MDA: FMoH 2019 targets/standardsfor salt reduction and elimination of trans- fats, in the various processed food types 6.1.4 Develop sanctions for Lead MDA: (FMoH) 2019 non-compliance on Others: NAFDAC, standards/targets FMoJ 6.1 Implement a 6.2.1 Establish Lead MDA: 2019 mandatory food enforcement team NAFDAC reformulation regulation for salt and sugar Others: FMoH reduction and replacement of trans-fat 74 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 6.2.2 Coordination meeting Lead MDA: (FMoH) 2019 to strengthen existing Others: CSOs, regulatory committee NAFDAC, SON comprising of representatives from different regulators in the food industry with the oversight on the FMOH 6.2.3 Provide quarterly Lead MDA: 2019 - update on progress NAFDAC 2025 with compliance by Others: FMoH the different food industries 6.2.4 Provide an annual Lead MDA: 2019 - report on compliance NAFDAC 2025 with incentives for Others: FMoH companies that show high level of compliance 7. Priority Action: Strengthen Nutrition Education in Primary and Secondary Schools Activity Activities Sub-activities MDA Responsible Time Frame Code 7.1 Review existing policy 7.1.1 Review curriculum Lead MDA: FMoE 2019 on nutrition education and content for Others: FMoH, for schools at all levels nutrition education FMARD (home economics etc. at primary and secondary) at higher 7.1.2 Disseminate nutrition Lead MDA: FMoH 2019 - levels include in GS education materials 2025 studies at tertiary level to schools 8. Priority Action: Develop and Implement a Policy on Marketing of Foods and Non-Alcoholic Beverages to Children Activity Activities Sub-activities MDA Responsible Time Frame Code 8.1 Advocate for review of 8.1.1 Conduct a baseline Lead MDA: 2019 food policy on study on the mode, NAFDAC marketing of foods timing and scope of Others: APCON, including non-alcoholic advertising of foods FMoH drinks to children to children 75 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.1.2 Convene a Lead MDA: 2019 consultative forum NAFDAC (written and face-to- Others: FMoH face) with the food processing industry to discuss ndings of the analysis 8.1.3 Strengthen Lead MDA: 2020 regulations on NAFDAC advertising of foods Others: FMoH and drinks to children 7.2.4 Promote Physical Activity Table 19: Priority Actions to Promote Physical Activity 9. Priority Action: Implement Effective Mass Media Campaigns that Educate the Public on the Benets of Physical Activity Activity Activities Sub-activities MDA Responsible Time Frame Code 9.1 Develop messages to 9.1.1 Develop and Lead MDA: FMoH 2019 promote self- harmonize media Others: FMYS management of and messaging harmful alcohol use materials on promoting physical activity 9.2 Disseminate messages 9.2.1 Engage with National Lead MDA: FMoH 2020 through multiple Broadcasting Others: FMYS, channels Corporation, and NBC; FMoIC, media organizations APCON, GALAXY to secure slots for television, radio, billboard messaging 10. Priority Action: Strengthen Physical Education and Activity in Schools Activity Activities Sub-activities MDA Responsible Time Frame Code 10.1 Strengthen physical 10.1.1 Advocacy to Lead MDA: FMOE 2019 education and activity National Council of Other: FMoH in schools Education to Implement the legislation to ensure that all schools have 76 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 11. Priority Action: Create Active Environments in Workplace and Public Spaces Activity Activities Sub-activities MDA Responsible Time Frame Code 11.1 Create active 11.1.1 Engage with Federal Lead MDA: FMoH 2019 workplaces Ministry of Labour to Others: FMYSD strengthen existing policy on promoting physical activity in workplaces 11.1.2. Disseminate policy Lead MDA: FMoH 2019 - briefs on policies that Others: FMOLE, 2025 support physical FMSYD activity 11.1.3 Strengthen monthly Lead MDA: Ofce 2019 - physical activity to be of Head of Ofce of 2025 led by head of MDAs the Civil Service Commission of the Federation 11.2 Create and promote 11.2.1 Advocate to Federal Lead MDA: 2019 the use of active Ministry of Works and FMPWH public spaces Area Councils / LGA Others: FMoH through redesign of municipal to promote transport and cost-effective elements recreational spaces of the healthy cities initiative and include in future urban planning 11.2.2 Engage with Real Lead MDA: 2019 - Estate developers and FMWPH and UDA 2025 their regulators to promote regulations that make it mandatory for residential areas to have safe spaces for non-motorized transports 11.2.3 Create better cycling Lead MDA: 2019 - networks, encourage FMWPH 2025 bike share schemes, Others: UDA increase more walkable streets. 11.3 Create community- 11.3.1 Promote and facilitate Lead MDA: FMYS, 2019 - wide opportunities monthly or weekly Others: FMoH 2025 and programmes to community-wide promote physical sporting programs (e.g. Lagos marathons, activity cycling, dancing, swimming) 77 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7.2.5 Promote Road Safety and Reduce Road Trafc Crashes Table 20: Priority Actions to Promote Road Safety 12. Priority Action: Implement Effective Mass Media Campaigns that Educate the Public on the Road Safety and Crash Reduction Measures Activity Activities Sub-activities MDA Responsible Time Frame Code 12.1 Disseminate existing 12.1.1 Engage with National Lead: FMoH & 2020 messages through Broadcasting FRSC multiple channels Corporation and media Others: organizations to secure FMoIC/NBC spots and spaces for television, radio, print media &billboard messaging 12.1.2 Conduct targeted Lead: FMoH, 2020 message programs on FRSC Others: road safety FMoIC/NBC/NOA 13. Priority Action: Enforce Existing Regulations on Speed Restriction Activity Activities Sub-activities MDA Responsible Time Frame Code 13.1 Strengthen and 13.1.1 Advocate for speed Lead MDA: 2019 enforce existing restriction FMPWH regulations on infrastructure such as Others: FMoH speed restrictions road markings, in Nigeria (Ref signage and speed document: Nigeria limit signs Highway Code) 13.1.2 Advocate to state Lead MDA: 2019 government and LGAs FMPWH to acquire and install Others: FMoH speed cameras and radar guns 78 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7.2.6 Reduce the Number of Babies Born with Sickle Cell Anaemia Table 21: Priority Actions to Reduce the Number of Babies Born with Sickle Cell Disease 14. Priority Action: Scale-up Capacity to Disseminate Information on Sickle Cell Disease Activity Activities Sub-activities MDA Responsible Time Frame Code 14.1 Update existing key 14.1.1 Update and harmonize Lead MDA: FMoH 2019 messages on sickle print IEC materials on Others: NBC; cell disease awareness on sickle FMoIC, FMWASD cell disease; awareness on preconception and national new-born screening for SCD 14.1.2 Produce radio jingles Lead MDA: FMOH 2019 Others: NBC FMoIC 14.2 Develop and 14.2.1 Train mass media Lead MDA: 2020 disseminate practitioners on the FMOH messages through usage of the materials Others: NBC; multiple channels developed FMoIC 14.2.2 Secure spots in radio Lead MDA: 2020 stations to disseminate FMOH jingles Others: NBC 15. Priority Action: Universal Screening and Genetic Counselling for Sickle Cell at All Levels using Point-of-Care Devices Activity Activities Sub-activities MDA Responsible Time Frame Code 15.1 Collaboration with 15.1.1 Advocacy and Lead MDA: 2019 relevant collaboration to Federal FMoH stakeholders to Ministry of Interior, implement Federal Road Safety universal screening Commission and faith- for sickle cell based organizations to screen clients for sickle cell disease 15.1.2 Training of staff Lead MDA: 2019 working in Federal FMoH Ministry of Interior, Federal Road Safety Commission and faith- based organizations on screening for sickle cell 79 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7.2.7 Prevent Mental, Neurological and Substance Abuse Disorders Table 22: Priority Actions to Prevent Mental, Neurological and Substance Abuse Disorders 16. Priority Action: Repeal the Lunacy Act of 1958 and replace it with a more evidence-informed law that is grounded in human rights principles. Activity Activities Sub-activities MDA Responsible Time Frame Code 16.1 Develop and review 16.1.1 Convene a Mental Lead MDA: 2019 a new mental health Health Action FMoH, bill with key Committee meeting to Others: MHAC stakeholders develop the new bill 16.1.2 Review the draft Lead MDA: 2019 mental health bill with FMoH, key stakeholders Others: MHAC 16.1.3 Submit bill to national Lead MDA: 2019 assembly FMoH, Others: MHAC 16.1.4 Support the public Lead MDA: 2019 hearings for the mental FMoH, health bill Others: MHAC 16.1.5 Conduct advocacy Lead MDA: 2019 visits to the National FMoH, Assembly for passage Others: MHAC of the draft bill 16.1.6 Conduct advocacy to Lead MDA: 2019 - the Presidency to sign FMoH, 2020 the mental health bill Others: MHAC into law 17. Priority Action: Review and update the 2013 National Mental Health Policy to align with the current global response and priorities Activity Activities Sub-activities MDA Responsible Time Frame Code 17.1 Review the existing 17.1.1 Convene a stakeholder Lead MDA: 2019 national mental meetings to review, FMoH, health policy update and validate the Others: MHAC national mental health policy and implementation framework 80 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 18. Priority Action: Implement Effective Mass Media and Advocacy Campaigns to Raise Awareness on Prevention, Promotion and Access to Care for MNSD Activity Activities Sub-activities MDA Responsible Time Frame Code 18.1 Develop awareness 18.1.1 Number of messages Lead MDA: 2019 raising and advocacy developed on MNSD FMoH, messages on MNSD prevention, care and Others: MHAC prevention, care and treatment treatment Implementation of 18.1.2 Number of reviewed and Lead MDA: 2019 drug and substance updated modules on FMoH, abuse education substance abuse in the Others: MHAC modules in the school curriculum school curriculum 18.1.3 Number of schools using Lead MDA: 2019 the reviewed curriculum FMoH, Others: MHAC Disseminate 18.1.4 Number of mass media Lead MDA: 2019 messages through channels disseminating FMoH, multiple channels messages on MNSD Others: MHAC 81 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7.3 Objective Three: To Strengthen and Orient Health Systems to Address Prevention and Control of Non-Communicable Diseases at All Levels of Care and Contribute to the Improvement of Universal Health Coverage Implementation strategy A phased and integrated approach will also be used to implement the activities and sub- activities in this objective. Policy level actions targeted at the NPHCDA and NHIS will involve a cascade of advocacy and stakeholder engagement meetings. An integrated guideline on NCD prevention, care and treatment will be adapted from existing WHO guidelines. Measures will be taken to ensure that the recommendations in the existing guidelines can be adapted and implemented in the context of the Nigerian health system. Capacity building workshops and trainings will involve the following phases; development of a training curriculum and materials, training of trainers at the federal level and step-down trainings. The step-down trainings can further be cascaded. This entails a central training at geo-political zones with the participation of representatives from 5-6 states per zone and then followed by state-level training with participation from various LGAs and relevant sectors. Ideally, a training session should not have more than 30 participants. Pilot projects on specic disease/risk factor areas may have already been carried out or currently ongoing. Using a person-centred approach, pilot programs on integrated delivery of NCD care and treatment services will be implemented in selected states depending on availability of funding. Learnings from these programs will be used to design scaled-up country-wide implementation. Table 23: Priority Action to Strengthen Health Systems to Address Prevention and Control of NCDs 1. Priority Action: NCD Management into Basic Primary Health Care with Referral to All Levels of Care Control of NCDs Activity Activities Sub-activities MDA Responsible Time Frame Code 18.1 Review ward health 1.1.1 Advocate to NPHCDA to Lead MDA: FMoH 2019 package and the review the ward health minimum standards package and minimum for primary health standards for primary care to include health care to elaborate comprehensive NCD NCD management prevention and treatment 82 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1.1.2 Convene a policy review Lead MDA: 2019 meeting to expand the NPHCDA minimum standards for primary health care to include NCD management 1.2 Develop service 1.2.1 Conduct literature review Lead MDA: FMoH 2019 integration guidelines to identify evidence- on NCDs using best based best practices for practice and NCD service integration implementation at primary health care research learning from the Nigerian- 1.2.2 Adapt best practices Lead MDA: FMoH 2019 PEN pilot and using lessons from the MHGAP pilot Nigerian-PEN pilot and MHGAP pilot 1.2.3 Convene a 3-day meeting Lead MDA: FMoH 2019 to develop the zero-draft of the NCD service integration guideline 1.2.4 Conduct a 3-day meeting Lead MDA: FMoH 2019 to nalize the NCD service integration guideline 1.2.5 Include NCD service Lead MDA: FMoH 2019 integration into the Others: NPHCDA integrated supportive supervision checklist 2. Priority Action: Build the Capacity of Health Workers at All Levels of Care on Integrated Management of Essential NCDs (CVD, Diabetes mellitus, Cancer, COPD, Sickle Cell Disease, MNSD and Injuries) Activity Activities Sub-activities MDA Responsible Time Frame Code 2.1 Expand the task- 2.1.1 Convene a technical Lead MDA: 2019 shifting/task-sharing working group to review FMoH, policy for frontline best practices on task- Others: MHAC health workers at shifting/task-sharing for primary health care NCDs at all levels of to include essential care NCDs 2.1.2 Develop a policy case Lead MDA: 2019 - and submit to the HMH FMOH-HPRS 2025 to secure task- shifting/task-sharing policy for NCDs at all levels of care 83 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2.1.3 Support the policy reform Lead MDA: process through FMOH-HPRS advocacy to the HMH and secure task-shifting and task-sharing for NCD management at all levels of care 2.1.4 Revise the standing Lead MDA: 2019 - orders for all cadres of FMoH-HPRS 2025 health care to include Others: NPHCDA NCD management 2.2 Develop curriculum 2.2.1 Conduct a workshop to Lead MDA: FMoH 2019 - for in-service and develop in-service 2025 pre-service training curriculum for NCD on NCD management including management genetic counselling for sickle cell disease 2.2.2 Conduct stakeholder Lead MDA: FMoH 2019 - engagement meetings 2025 with regulatory bodies of health profession education and heads of medical education schools (colleges of medicine, schools of nursing and midwifery, school of health technology) to review and expand pre- service curriculum to include NCD management 2.3 Build the capacity of 2.3.1 Conduct Training of Lead MDA: FMoH 2019 - all cadres of health Trainers using the pre- 2025 workers on NCD service curriculum for management integrated NCD management 2.3.2 Conduct step-down Lead MDA: FMoH 2019 - trainings using the pre- 2025 service curriculum for integrated NCD management 2.3.3 Train a pool of lay health Lead MDA: FMoH 2019 - workers (community 2025 volunteers and expert clients) on self- management of NCDs 84 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3. Priority Action: Scale-up Coverage of Early Detection and Diagnosis at Primary Health Care Level Activity Activities Sub-activities MDA Responsible Time Frame Code 3.1 Include cost- 3.1.1 Convene a stakeholder Lead MDA: FMoH 2019 effective tools and meeting to review the Others: NPHCDA commodities for essential medicines list early detection in and minimum standards the essential for PHCs and include medicines list essential tools for NCD diagnosis and detection (glucometers, owmeters, blood pressure monitors, Acetic acid, POC test for sickle cell haemoglobin etc.) 3.1.2 Procure and disseminate Lead MDA: 2018 tools for early detection NPHCDA and diagnosis to PHCs 3.1.3 Yearly quality assurance Lead MDA: 2018 and test for equipment NPHCDA 4. Priority Action: Scale-up Coverage of NCD Prevention Services at All Levels of Care Activity Activities Sub-activities MDA Responsible Time Frame Code 4.1 Roll-out the 4.1.1 Conduct advocacy Lead MDA: FMoH 2019 proposed human (written and face-to- Others: NPHCDA papilloma virus face) to GAVI and other (HPV) for girls age relevant stakeholders to 9-13 years include HPV vaccine among support being provided for Nigeria 4.2 Institutionalization 4.2.1 Advocate for the Lead MDA: 2019 of life-course institutionalization of life- FMOH vaccine including course vaccine including Others: NPHCDA hepatitis B virus 4.3 Include lifestyle and 4.3.1 Include lifestyle and Lead MDA: 2019 - behavioural behavioural FMOH 2025 interventions for interventions for preventing CVDs, preventing CVDs, diabetes and diabetes and cancers cancers into primary into guidelines on NCD health care management 85 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 4.3.2 Training of relevant Lead MDA: FMoH 2019 - health workers on how to 2025 provide lifestyle and behavioural interventions for preventing CVDs, diabetes and cancers 4.3.3 Roll-out a package of Lead MDA: FMoH 2019 - integrated prevention 2025 services for NCDs 4.3.4 Implementation of Lead MDA: FMoH 2019 - genetic counselling and 2025 pre-marital/pre- conception screening for SCDs using POC devices 5. Priority Action: Scale-up Coverage of Treatment Services for NCDs (CVD, Diabetes, Cancer, COPD, Sickle Cell Disease, MNSD and Injuries) Activity Activities Sub-activities MDA Responsible Time Frame Code 5.1 Ensure commodity 5.1.1 Review and compile Lead MDA: FMoH 2019 security for essential cost-effective and drugs for treating efcacious medicines for diabetes, COPD, managing diabetes, hypertension and COPD, hypertension CVD, cancers, SCD and, cancers, SCD, CVD 5.1.2 Engage with the Food Lead MDA: FMoH 2019 and Drug Division of FMOH to secure inclusion of these medicines in the essential medicines list 5.1.3 Implement integrated Lead MDA: FMoH 2019 commodity logistics for NCD medicines 5.2 Develop clinical 5.2.1 Review literature to Lead MDA: FMoH 2019 guidelines for care identify evidence- and treatment of informed treatment and diabetes, care modalities for hypertension, CVD, NCDs COPD, Cancers, Sickle Cell Disease 5.2.2 Convene workshops to Lead MDA: FMoH 2019 adapt these evidence- informed treatment and care modalities for NCDS 86 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 5.3 Integrate and 5.3.1 Develop guidelines/ Lead MDA: FMoH 2019 implement services protocols on pre-hospital for managing care (to include injuries from Road ambulatory care/ trafc crashes into transfusion services ) and primary care treatment of all injuries 5.3.2 Conduct bystander Lead SMDA: FMOH 2019 education for pre-hospital management of injuries 5.4 Establish 5.4.1 Develop guidelines for Lead MDA: FMoH 2019 community-based community management services for of MNSD through managing MNSD community based lay health/volunteer workers 5.4.2 Train lay health/volunteer Lead MDA: FMoH 2019 health workers on community-based management of MNSD 5.4.3 Implement community- Lead MDA: FMoH 2019 based programmes for managing MNSD 5.5 Establish long term 5.5.1 Develop guidelines on Lead MDA: FMoH 2019 care and End-of-life long term care and End- care services of-life care services 6. Priority Action: Explore Viable Health Financing Mechanisms Activity Activities Sub-activities MDA Responsible Time Frame Code 6.1 Include NCDs in 6.1.1 Hold consultations and Lead MDA: FMoH 2019 - benets package for advocacy for inclusion of Others: NHIS 2025 NHIS at all levels of NCDs in all benets care package for NHIS at all levels of care 6.1.2 Engage with NHIS to Lead MDA: FMoH 2019 - expand the Basic Minimum Others: NHIS 2025 Package of Health Services which will be nanced by the Basic Healthcare Provision Fund to include comprehensive care and treatment of hypertension, diabetes, early detection of cancer, COPD, emergency care for stroke and heart attacks 87 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7.4 Objective Four: To Monitor Trends and Determinants of Non- Communicable Diseases and Evaluate Progress in their Prevention and Control Implementation strategy Activities aimed at revising NHMIS and civil registration tools and indicators will involve series of advocacy visits and technical engagements with the statutory bodies responsible for the revision such as HPRS department of FMoH and National Population Commission. Periodic surveys will be implemented country-wide using a phased approach. This will entail securing funding from donors and Government of Nigeria (federal and state). The surveys will involve federal level training of trainers on data collection and management with state level step-down trainings for data collectors. Field activities can occur simultaneously in all the states or sequentially (i.e. covering one geo-political zone at different times). Table 24: Priority Actions to Monitor Trends and Determinants of NCDs 1. Priority Action: Integrate NCDs into the National Health Management Information System Activity Activities Sub-activities MDA Responsible Time Frame Code 1.1 Develop national 1.1.1 Convene a technical Lead MDA: FMoH 2019 indicators for NCD meeting to develop service delivery and indicators and tools for MSAP NCD service delivery 1.1.2 Present the developed Lead MDA: FMoH 2019 indicators to the National technical working group for NHMIS for adoption 1.2 Develop tools and 1.2.1 Engage with the HPRS Lead MDA: FMoH 2019 registers to include Department of FMoH to national indicators include key service for NCD service delivery indicators into delivery into NHMIS NHMIS 1.2.2 Print registers and ensure Lead MDA: FMoH 2019 that they are included in the monthly summary forms and distribute tools for capturing NCD service delivery indicators 88 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2. Priority Action: Strengthen Technical Capacity for NCD Surveillance, Monitoring and Evaluation Activity Activities Sub-activities MDA Responsible Time Frame Code 2.1 Build the capacity of 2.1.1 Convene a 3-day Lead MDA: FMoH 2019 national and state workshop to develop a level M&E Ofcers on training curriculum for NCD surveillance and NCD surveillance and monitoring monitoring based on the 2.1.2 Conduct a training of Lead MDA: FMoH 2019 - trainers workshop to 2025 build the capacity of a critical mass of M& E ofcers in FMOH and implementing partners on NCD surveillance and monitoring 2.1.3 Conduct step-down Lead MDA: FMoH 2019 - training for state and 2025 LGA level M&E ofcers using a phased approach 2. Priority Action: Strengthen Technical Capacity for NCD Surveillance, Monitoring and Evaluation Activity Activities Sub-activities MDA Responsible Time Frame Code 2.1 Build the capacity of 2.1.1 Convene a 3-day Lead MDA: FMoH 2019 national and state workshop to develop a level M&E Ofcers on training curriculum for NCD surveillance and NCD surveillance and monitoring monitoring based on the 2.1.2 Conduct a training of Lead MDA: FMoH 2019 - trainers workshop to 2025 build the capacity of a critical mass of M& E ofcers in FMOH and implementing partners on NCD surveillance and monitoring 2.1.3 Conduct step-down Lead MDA: FMoH 2019 - training for state and 2025 LGA level M&E ofcers using a phased approach 89 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3. Priority Action: Integrate NCD Surveillance into Civil Registration and Vital Statistics Systems (Deaths by Cause) Activity Activities Sub-activities MDA Responsible Time Frame Code 3.1 Include Haemoglobin 3.1.1 Engage with the Lead MDA: FMoH 2019 genotype into birth National Population forms and birth Commission to include registers and NCD- Haemoglobin genotyping related causes into and NCD-related causes death registration into death registration tools (vital statistics) tools for vital statistics 3.1.2 Develop a Lead MDA: FMoH 2019 process/mechanism for Others: NPopC, periodic data collection NBS on NCD related deaths from vital statistics 4. Priority Action: Conduct Periodic Surveys on NCDs and Evaluate Progress in their Prevention and Control Activity Activities Sub-activities MDA Responsible Time Frame Code 4.1 Conduct periodic 4.1.1 Conduct a STEP survey Lead MDA: FMoH 2019 - survey to monitor to determine the Others: NPopC, 2025 NCD risk factors baseline burden of NBS NCDs and their risk factors every 5 years 4.1.2 Incorporate NCDs into Lead MDA: FMoH 2019 existing surveys such as Others: NPopC, MICS, NDHS NBS 4.1.3 Conduct the National Lead MDA: FMoH 2019 - MNSD survey Others: NPopC, 2025 NBS 4.1.4 Conduct the National Lead MDA: FMoH 2019 Global Youth Tobacco Others: NPopC, survey NBS 4.1.5 Conduct the National Lead MDA: FMoH 2019 Global Adult Tobacco Others: NPopC, Survey NBS 4.2 Develop a dashboard 4.2.1 Develop a dashboard for Lead MDA: FMoH 2019 on NCD summarizing and Others: NPopC, disseminating data on NBS NCDs from the NHMIS 90 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7.5 Objective Five: To Promote and Support National Capacity for Quality Research and Development for Prevention and Control of NCDs Implementation strategy Priority setting for NCD research agenda will be conducted remotely using electronic methods of data collection for a Delphi style engagement with representatives of research institutes and researchers. Capacity building and networking activities to improve research capacity will be conducted in a phased approach depending on funding availability. Table 25: Priority Actions for National NCD Research Agenda 1. Priority Action: Develop and Implement a Prioritized National Research Agenda for Non-Communicable Diseases Activity Activities Sub-activities MDA Responsible Time Frame Code 1.1 Set priorities for 1.1.1 Conduct a mapping of Lead MDA: FMoH 2019 national research research institutes and agenda researchers 1.1.2 Conduct a consultative Lead MDA: FMoH 2019 priority setting exercise (remotely or face to face) for NCD research in Nigeria 1.1.3 Publish prioritized research Lead MDA: FMoH 2019 topics and cross-cutting issues 2. Priority Action: Prioritize Budgetary Allocation for NCD Prevention and Control Research Activity Activities Sub-activities MDA Responsible Time Frame Code 2.1 Secure budgetary 2.1.1 Develop a costed Lead MDA: FMOH 2019 allocation for NCD research plan for NCDs Others: FMBP prevention and control research in NCD budget line 2.1.2 Propose the inclusion of Lead MDA: FMoH 2019 - research cost as a line item 2025 within FMOH NCD budget line 2.1.3 Advocate for budgetary Lead MDA: FMOH 2019 allocation for research Others: FMBP 91 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3. Priority Action: Strengthen Technical Capacity for Research Activity Activities Sub-activities MDA Responsible Time Frame Code 3.1 Build capacity of 3.1.1. Conduct a workshop on Lead MDA: FMOH 2019 researchers on research methodology NCDs for NCD Division-FMoH staff 3.1.2. Sponsor researchers on Lead MDA: FMoH 2019 courses related to NCD prevention and control 4. Priority Action: Strengthen Collaboration with Foreign and Domestic Research Institutes Activity Activities Sub-activities MDA Responsible Time Frame Code 4.1 Build collaboration 4.1.1 Map existing international Lead MDA: FMOH 2019 with foreign and and domestic research domestic research funding organizations institutes 4.1.2 Respond to call/request for Lead MDA: FMoH 2019 proposals 4.1.3. Attend international and Lead MDA: FMOH 2019 domestic collaborative research meetings 5. Priority Action: Strengthen Knowledge Translation in NCD Prevention and Control Activity Activities Sub-activities MDA Responsible Time Frame Code 5.1 Strengthen the 5.1.1 Identify already existing Lead MDA: FMOH 2019 dissemination and research on NCD use of research prevention and control ndings in public 5.1.2 Develop an electronic Lead MDA: FMoH 2019 health policy and database for existing programming evidence that are relevant clinical practice to NCD prevention and control 5.1.3 Identify organizations that Lead MDA: FMOH 2019 are working on knowledge translation (Nigerian branches of Cochrane, Campbell Collaborations. 5.1.4 Establish collaborative Lead MDA: FMOH 2019 research sharing networks between researchers e.g. NCD evidence summit 5.1.5 Develop targeted Lead MDA: FMOH 2019 communication and evidence summaries to policy makers 92 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8. Accountability Framework 8.1. Evaluating Impact and Outcomes of NMSAP This impact and outcome evaluation should be marched against the annual progression towards targets for NCD prevention and control Table 26: Evaluating Impact and Outcomes of NMSAP Framework Element Indicator Frequency of Reporting Data Reporting Start Year Source Premature mortality Mortality of NCD 3years 2019 NPC Vital from NCD (Unconditional probability of Registers dying) Harmful use of alcohol Total alcohol per capita 5 years 2019 STEP wise consumption in litres of pure survey alcohol Physical inactivity Prevalence of insufciently 5 years 2019 STEP wise physically active adults survey Salt/sodium intake Mean population intake of salt 5 years 2019 STEP wise in persons aged 18+ years survey Tobacco use Prevalence of current tobacco 5 years 2019 GATS survey, use among adults DHS Raised blood Pressure Prevalence of raised blood 5 years 2019 STEP wise pressure among adults survey, DHS Diabetes Prevalence of raised blood 5 years 2019 STEP wise glucose/diabetes among adults survey Obesity Prevalence of overweight/ 5 years 2019 STEP wise obesity among adults survey, DHS Sickle cell disease Prevalence of sickle cell disease 5 years 2019 NHMIS in children ≤ 59 months New cases of sickle cell Annually 2019 NHMIS Diseases Mental, neurological Prevalence of MNSD 5 years 2019 MNSD survey and substance abuse disorders Deaths from Road Death rate due to road trafc Annually 2019 Road safety Trafc accidents injuries report Drug therapy to Proportion of eligible persons Monthly 2019 NHMIS prevent CVD receiving NCD care Essential medicines Number of NCD medicines in Five years 2019 NHMIS/LMIS and basic technologies essential medicines list to treat major NCDs Coverage of NCD Medicines Annually 2019 NHMIS/LMIS and basic technology in PHCs 93 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2 Monitoring and Evaluation of the NMSAP Implementation 8.2.1 Objective One: To Strengthen Governance and Stewardship for NCD Prevention and Control Table 27: Priority Actions to Strengthen Governance and Stewardship for NCD Prevention and Control 1. Priority Action: Strengthen Advocacy for NCD Prevention and Control at All Levels Activity Activities Output Indicators Outcome Indicators Data Sources Code 1.1 Set up a national 1.1.1. Number of Increased funding Technical and NCD advocacy group NGOs/CSOs that and capacity for meeting have been identied advocacy activities reports from as potential NCD advocacy members of the group NCD advocacy group 1.1.2. Number of NGOs/CSOs that are participating members of the NCD advocacy group 1.1.3. Number of advocacy group meetings convened 1.2 Advocate to relevant 1.2.1 Number of Commitment from Technical and government non- channels that have both government and meeting health sectors and been used to private sector reports from private industries to disseminate the stakeholders to NCD advocacy deliver on targets implement group MSAP outlined in the MSAP recommendations of the MSAP 1.2.2 Number of advocacy materials (policy briefs, radio messages etc.) produced and disseminated to stakeholders 1.2.3 Number of advocacy visits conducted 94 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2. Priority Action: Establish a Multi-Sectoral Technical Working Group on NCD Prevention and Control Activity Activities Output Indicators Outcome Indicators Data Sources Code 2.1 Set-up a multi- 1.1.1 Proportion of all the Proportion of multi- Technical and sectoral technical relevant non-health sectoral activities meeting working group on MDAs, CSO, implemented by the reports of NCD prevention and implementing relevant MDAs, CSO, TWG control with partners and implementing representatives from commercial sector partners and non-health participating in commercial sector government MDAs, TWG meetings CSO, implementing partners and commercial sector 2.1.2 Number of TWG meetings convened annually 2.1.3 Number of policy documents mapped 2.2 Build the capacity of 2.2.1. Proportion of all the Strengthened Technical multi-sectoral TWG relevant Non-health capacity for reports of members MDAs, CSOs, implementing NCD TWG capacity implementing prevention and building control among all workshops partners and relevant stakeholders commercial sector that participated in capacity building workshops 2.2.2. Number of capacity building workshops convened annually 2.2.3. Change in knowledge and skills about the various multi- sectoral NCD prevention and control activities 1 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3. Priority Action: Strengthen Capacity of FMoH to Provide Leadership and Coordination for NCDs Activity Activities Output Indicators Outcome Indicators Data Sources Code 3.1 Conduct training of 3.1.1 Proportion of NCD Strengthened Technical NCD Federal ofcers federal ofcers capacity of the NCD reports on the mechanisms participating in division of FMoH to and processes for trainings on provide leadership reformulation and mechanisms and and coordination for scal policies processes for NCDs reformulation and scal polices 3.1.2 Number of annual Needs trainings on assessment mechanisms and report, processes for Equipment reformulation and inventory scal policies report conducted 3.2 Equip the NCD 3.2.1 Number of required division with all equipment and requisite equipment tools provided to and tools to provide the NCD division oversight on NCD policymaking and programming 4. Priority Action: Establish a Coordinating Mechanism on NCD Prevention and Control Activity Activities Output Indicators Outcome Indicators Data Sources Code 4.1 Set up Governing 4.1.1. Inter-ministerial High level multi- Technical Council at federal coordination sectoral coordination reports and level mechanism and commitment for communiqué established the prevention and control of NCDs 4.1.2. Number of high level inter- ministerial meetings on NCD prevention and control convened annually 1 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 4.2 Conduct training of 4.2.1. Proportion of Increased capacity of Scorecards on NCD Federal ofcers states with NCD states to respond to state capacity on the mechanisms units within the NCD prevention and to respond to and processes for public health controls NCD reformulation and department of the prevention and scal policies control State Ministries of Health with clear TORs and reporting lines 4.2.2. Number of focal persons designated to cover all the relevant diseases and issues in NCD control programming in each state NCD unit 4.3 Set up LGA NCD 4.3.1 Established and focal points functional NCD units within the disease control department of the State primary health care development agency 4.3.2 Proportion of LGAs with designated NCD focal persons 4.4 Conduct coordination 4.4.1 Number of meetings at all tiers consultative of government meetings on NCD prevention and treatment in the health sector convened at the federal, state and LGA Level 97 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 5. Priority Action: Establish Partnerships with Global and Regional Alliance for NCD Prevention and Control Activity Activities Output Indicators Outcome Indicators Data Sources Code 5.1 Establish global and 5.1.1 Number of regional Increased global and Meeting regional partnerships and international regional alliance in reports for NCD prevention events, dialogue the prevention and and control and meetings for control of NCDs in NCD prevention Nigeria and control with representation of Nigerian stakeholders 6. Priority Action: Prioritize and Increase Budgetary Allocation for NCD Prevention and Control Activity Activities Output Indicators Outcome Indicators Data Sources Code 6.1 Advocacy for 6.1.1 Inclusion of NCD Budgetary allocation National resource mobilization prevention and and release for NCD budget report for NCDs control KPIs in the prevention and and national national M&E control secured nancial report by the expenditure reports DPRS of the Ministry of the Budget and planning 6.1.2 Number of advocacy visits to relevant stakeholders conducted to secure budgetary allocation for NCDs 6.1.3 Number of press brieng on NCDs conducted 98 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.2 Objective Two: To Promote Healthy Lifestyle and Implement Interventions to Reduce Modifiable Risk Factors for NCDs 8.2.2.1 Reduce Tobacco Use Table 28: Priority Actions to Reduce Tobacco Use 1. Priority Action: Effective Implementation, Prioritization and Enforcement of the National Tobacco Control Act of 2015 Activity Activities Output Indicators Outcome Indicators Data Sources Code 1.1 Secure approval of 1.1.1 Number of Approved regulation Guideline regulation in the legislative for implementing document National Assembly advocacy the tobacco control visits to act leadership of the NASS conducted 1.1.2 Tobacco Control Guideline developed Implement non- 1.2.1 Number of Complete Capacity 1.2 building regulatory NTCA advocacy implementation of activities visits to the National workshop and enforcement Tobacco control act TWG reports; agencies of 2015 Progress report on 1.2.2 Number of implementation capacity of National building Tobacco workshops control act conducted for enforcement agencies 1.2.3 Number of key enforcement organisation participating in tobacco control enforcement coalition 99 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1.2.4 Number of public awareness programs conducted to raise awareness about the act 1.3 Implement all 1.3.1 Enforcement regulations in the plan for tobacco control act of enforcement 2015 agencies developed 1.3.2 Number of sensitization meeting for hoteliers and managers 1.3.3 Number of Tobacco Committee meetings conducted in a year 1.3.4 Number of TWG meetings on Tobacco Taxation and TAPS conducted in a year 1.3.5 Tobacco track and trace system installed 1.4 Domestication of NTC 1.4.1 Number of Number of States Progress report act in states advocacy that have on visits to domesticated the implementation SMOH AND National tobacco of National SMOF control act Tobacco control act 100 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.2.2 Reduce Harmful Use of Alcohol Table 29: Priority Actions to Reduce Harmful Use of Alcohol 2. Priority Action: Implement Effective Mass Media Campaigns that Educate the Public about the Harmful Use of Alcohol Activity Activities Output Indicators Outcome Indicators Data Sources Code 2.1 Develop mass media 2.1.1 Number of Change in level STEP survey campaignmessages on mass media of awareness, harmful use of alcohol messages knowledge and developed on practices about harmful use of harmful use of alcohol alcohol after dissemination of the messages 2.2 Disseminate messages 2.2.1 Number of on preventing alcohol mass media intake through multiple channels used channels to disseminate messages on harmful use of alcohol 3. Priority Action: Effective Population-wide Support for Harmful Alcohol Use to All Who Want to Quit (Brief Advice, Toll-Free Lines, Social Media Support Group) Activity Activities Output Indicators Outcome Indicators Data Sources Code 3.1 Develop messages to Number of public Change in number of promote self- awareness persons with management of messages developed alcoholdependence who harmful alcohol use and disseminated to have quit support persons with alcohol dependence who want to quit Lead MDA: FMoH 3.1.1 Others: NATOCC 101 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 4. Priority Action: Develop an Alcohol Control Policy Activity Activities Output Indicators Outcome Indicators Data Sources Code 4.1 Develop and secure a 2.1.1 Milestones Policy for alcohol Gazette of the policy/legislation that used to control developed FMoH clearly stipulates achieve annual increase in policy for alcohol excise tax and alcohol regulations for sale, control advertising and promotion of alcoholic drinks 4.2 Implement alcohol 4.2.1 Number of Full implementation Progress report control policy and stakeholders’ of alcohol control on regulation engagement act implementatio Enforce alcohol control meetings n of alcohol policy and regulation convened to control act gain the buy- in of the alcohol manufacturin g and sales industry 4.2.2 Number of policy briefs disseminated 4.3 Enforce alcohol control 4.3.1 Number of policy and regulation meetings with enforcement organizations (consumer protection organizations NAFDACetc.) conducted 102 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.2.3 Promote Healthy Diet Table 30: Priority Actions to Promote Healthy Diet 5.Priority Action: Implement Effective Mass Media Campaigns to Promote Healthy Diet and Educate the Public on the Harms Associated with High Salt, Sugar and Trans-Fat Intake Activity Activities Output Indicators Outcome Indicators Data Sources Code 5.1 Develop mass media 4.1.1. Number of Change in STEP survey campaign on the mass media knowledge, harms associated with messages attitude, practices high salt, sugar developed and behaviours (sweetened) and trans- on harms about harms fat intake associated associated with with high high salt, sugar and salt, sugar trans-fat intake and trans- fat intake 5.2 Disseminate messages 5.2.1 Number of through multiple channels channels used to rmful use of alcohol disseminate mass media messages on harms associated with high salt, sugar 6. Priority Action: Develop and Implement a Regulation on Reformulation of Industrially Processed Foods to Reduce Salt and Replace Trans-Fat Activity Activities Output Indicators Outcome Indicators Data Sources Code 6.1 Develop a mandatory 6.1.1 The number Enactment of Regulation food reformulation of frequently mandatory food document regulation under consumed reformulation existing NAFDAC act processed regulation foods identified to have high salt sugar and trans- fat intake 103 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 6.1 Develop a mandatory 6.1.2 Number of food reformulation consultative regulation under forums (written existing NAFDAC act and face-to-face) convened to promote mandatory food reformulation 6.1.3 Number of relevant stakeholders that participated in consultative forums 6.1.4 Number of guidelines or standard operating procedures developed to stipulate standards/targets for reformulation to reduce salt and sugar and replace trans-fat 6.2 Implement a 6.2.1 Number of Reduction of the Progress mandatory food workshops level of salt and report on reformulation convened to sugar and implementation regulation strengthen the elimination of trans- of reformulation capacity of fats from industrially regulation existing food processed foods regulatory bodies 6.2.2 Proportion of food manufacturers/pr ocessors that are complying with reformulation regulation 104 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 7. Priority Action: Strengthen Nutrition Education in Primary and Secondary Schools Activity Activities Output Indicators Outcome Indicators Data Sources Code 7.1 Integrate nutrition 7.1.1 Reviewed Number of schools Progress education into curriculum and implementing report on existing compulsory content for nutrition education implementatio subjects in schools at nutrition education programs n of nutrition all levels (home in primary and education economics etc. at secondary schools primary and secondary) 7.1.2 Nutrition education materials disseminated to schools 8. Priority Action: Develop and Implement a Policy on Marketing of Foods and Non-Alcoholic Beverages to Children Activity Activities Output Indicators Outcome Indicators Data Sources Code 8.1 Advocate for a policy 8.1.1 Baseline study on Enactment of Regulation on marketing of foods the extent and Regulation on food document and non-alcoholic pattern of food advertising to drinks to children advertising to children children conducted 8.1.2 Number of consultative forum (written and face- to-face) with the food processing industry and food regulatory bodies convened annually 105 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.2.4 Promote Physical Activity Table 31: Priority Actions to Promote Physical Activity 9. Priority Action: Implement Effective Mass Media Campaigns that Educate the Public on the Benefits of Physical Activity Activity Activities Output Indicators Outcome Indicators Data Sources Code 9.1 Develop mass media 9.1.1 Number of mass Increase in level of STEP survey campaign on benets media messages knowledge, attitude, of physical activity developed to practices on physical promote physical activity activity Disseminate 9.2.1 Number of messages through channels used to multiple channels disseminate mass media messages 10. Priority Action: Strengthen Physical Education and Activity in Schools Activity Activities Output Indicators Outcome Indicators Data Sources Code 10.1 Strengthen physical 10.1.1 Number of Increase in level of School based education and advocacy visits physical activity physical activity in schools to school among children, activity survey management adolescents and boards to young people in achieve schools enforcement of physical education and activity policies and regulation 11. Priority Action: Create active environments in workplace and public spaces Activity Activities Output Indicators Outcome Indicators Data Sources Code 11.1 Create active 11.1.1 Number of Increase in level of MDA physical workplaces advocacy visits physical activity activity survey to Federal among workers in Ministry of public sector Labour to strengthen existing policy on promoting physical activity in workplaces 106 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 11.1.2 Number of policy briefs disseminated on policies that support physical activity 11.1.3 Proportion of MDAs implementing monthly physical activity programs 11.2 Create and promote 11.2.1 Number of Proportion of cities National urban the use of active advocacy visits to that are complying planning/healt public spaces Federal Ministry of with the healthy hy city reports through redesign of Works and Area city standards in transport and Councils/LGA Nigeria recreational spaces municipal s to promote cost- effective elements of the healthy cities initiative and advocate its inclusion in future urban planning 11.2.2 Number of advocacy visits/ engagement meetings with real estate developers and their regulators to promote regulations that make it mandatory for residential areas to have safe spaces for non-motorized transports 11.2.3 Number of cycling networks created 11.3 Create community- 11.3.1 Number of cities Increase in level of STEP survey wide opportunities and communities physical activity and programmes to that are conducting among community promote physical community wide members activity physical activity programs 107 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.2.5 Promote Road Safety and Reduce Road Traffic Crashes Table 32: Priority Actions to Promote Road Safety and Reduce Road Traffic Crashes 12. Priority Action: Implement Effective Mass Media Campaigns that Educate the Public on the Road Safety and Crash Reduction Measures Activity Activities Output Indicators Outcome Indicators Data Sources Code 12.1 Disseminate existing 12.1.1 Number of Change in Road safety messages through messages knowledge, attitude KAP surveys multiple channels disseminated in and practices on mass media on road safety road safety 13. Priority Action: Enforce existing regulations on speed restriction Activity Activities Output Indicators Outcome Indicators Data Sources Code 12.1 Strengthen and 13.1.1 Number of Reduction in level of Road safety enforce existing advocacy visits to speed restriction report: Nigeria regulations on speed FMOW & H to violations and road Highway Code restrictions in Nigeria implement road crashes markings and signage and install speed limit signs 13.1.2 Number of signage and speed limit signs installed 13.1.3 Number of advocacy visits to state governments and LGAs to acquire and install speed cameras and radar guns 108 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.2.5 Reduce the Number of Babies Born with Sickle Cell Anaemia Table 33: Priority Actions to Reduce the Number of Babies Born with Sickle Cell Disease 14. Priority Action: Scale-up Capacity to Disseminate Information on Sickle Cell Disease Activity Activities Output Indicators Outcome Indicators Data Sources Code 14.1 Update existing key 14.1.1 Number of Change in NDHS messages on sickle messages knowledge, attitude cell disease developed to raise and practices about awareness about sickle cell sickle cell disease 14.2 Develop and 14.2.1 Number of mass disseminate media practitioners messages through trained on the multiple channels usage of the materials developed 14.2.2 Number of radio stations disseminating jingles on sickle cell disease 15. Priority Action: Universal Screening and Genetic Counselling for Sickle Cell at All Levels Using Point-of-Care Devices Activity Activities Output Indicators Outcome Indicators Data Sources Code 15.1 Collaboration with 15.1.1 Number of advocacy Change in NDHS relevant visits to/collaborative proportion of stakeholders to meetings with FRSC people screened implement and faith based for sickle cell universal screening organizations to raise disease for sickle cell awareness on universal screening of their clients for sickle cell disease 15.1.2 Number of children screened for SCD 15.1.3 Number of staff trained in Federal Ministry of Interior, Federal road safety commission and faith based organizations on screening for sickle cell 109 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.2.6 Prevent Mental, Neurological and Substance Abuse Disorders Table 34: Priority Actions to Prevent Mental, Neurological and Substance Abuse Disorders 16. Priority Action: Repeal the Lunacy Act of 1958 and replace it with a more evidence-informed law that is grounded in human rights principles. Activity Activities Output Indicators Outcome Indicators Data Sources Code 16.1 Develop and review a 16.1.1. A Mental Health A new Mental Health Gazette of the new mental health Action Committee Act enacted Act bill with key meeting convened stakeholders to develop the new bill 16.1.2 A draft mental health bill 16.1.3 Public hearings for the mental health bill convened by the National Assembly 16.1.4 Mental Health Bill passed by the National Assembly 16.1.5 Mental Health Bill signed into Law by the President 17. Priority Action: Review and update the 2013 National Mental Health Policy to align with the current global response and priorities Activity Activities Output Indicators Outcome Indicators Data Sources Code 17.1 Review the existing 17.1.1 Stakeholder Mental Health Policy Policy national mental meetings developed, reviewed document health policy convened to and validated review, update and validate the national mental health policy 17.1.2 Mental health policy drafted 110 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 18. Priority Action: Implement Effective Mass Media and Advocacy Campaigns to Raise Awareness on Prevention, Promotion and Access to Care for MNSD Activity Activities Output Indicators Outcome Indicators Data Sources Code 18.1 Develop awareness 18.1.1 Number of Change in MNSD survey raising and advocacy messages knowledge, attitude messages on MNSD developed on and practices on prevention, care and MNSD prevention, MNSD treatment care and treatment 18.2 Implementation of 18.2.1 Number of drug and substance reviewed and abuse education updated modules modules in the on substance school curriculum abuse in the school curriculum 18.2.2 Number of schools using the reviewed curriculum 18.3 Disseminate 18.3.1 Number of mass messages through media channels multiple channels disseminating messages on MNSD 111 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.3. Objective Three: To Strengthen and Orient Health Systems to Address Prevention and Control of Non-Communicable Diseases at All Levels of Care and Contribute to the Improvement of Universal Health Coverage Table 35: Priority Actions to Strengthen Health Systems for the Prevention and Control of NCDs 1. Priority Action: Integrate Non-communicable Disease Management into Basic Primary Health Care with Referral to All Levels of Care Activity Activities Output Indicators Outcome Indicators Data Sources Code 1.1 Review the minimum 1.1.1 Number of Inclusion of Revised standards for primary advocacy visits to comprehensive version of the health care to include NPHCDA to gain NCDs prevention minimum comprehensive NCD buy-in for the and treatment in the standards for prevention and review of the ward ward minimum primary health treatment package and care in Nigeria minimum health package and minimum standards minimum for primary health care in Nigeria standards for primary health care to elaborate NCD management 1.1.2 Number of policy review meetings convened to expand the ward minimum health package and minimum standards for primary health care to include NCD management 1.2 Develop service 1.2.1 Number of Number of Guideline/SOPs integration guidelines evidence-informed guidelines, and protocol on NCDs using best recommendations protocols, standards documents practice and identied on best of operation implementation practices for NCD developed on research learnings service integration integrated NCD from the Nigerian- at primary health prevention, care and PEN pilot and care treatment MHGAP 112 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 1.2.2 Number of best practices identied from lessons learned from Nigerian-PEN pilot and MHGAP 1.2.3 Number of meetings convened to review and nalize NCD service integration guideline 1.2.4 Inclusion of NCD service integration into the integrated supportive supervision checklist 2. Priority Action: Build the Capacity of Health Workers at All Levels of Care on Integrated Management of Essential NCDs (CVD, Diabetes, Cancer, COPD, Sickle Cell Disease, MNSD and Injuries) Activity Activities Output Indicators Outcome Indicators Data Sources Code 2.1 Expand the task- 2.1.1 The number of Task-shifting policy Task shifting shifting/task-sharing technical working for NCDs secured policy policy for frontline group meetings document health workers at convened to review primary health care best practices on to include essential task-shifting/task- NCDs sharing for NCDs at all levels of care 2.1.2 A policy case (memo) submitted to the HMH to secure task- shifting/task- sharing policy for NCDs at all levels of care 113 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2.1.3 Number of advocacy visits to the HMH and secure approval for task-shifting and task-sharing for NCD management at all levels of care 2.1.4 standing orders for all cadres of health care revised to include NCD management 2.2 Develop curriculum 2.2.1 Number of Reviewed curriculum Reviewed for in-service and workshops for in-service training curriculum pre-service training convened to on NCD document on NCD management develop in-service management curriculum for NCD management including genetic counselling for sickle cell disease 2.2.2 Number of stakeholder engagement meetings with regulatory bodies of health profession education and heads of medical education schools (colleges of medicine, schools of nursing and midwifery, school of health technology) convened to review and expand pre-service curriculum to include NCD management 114 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2.3 Build the capacity of 2.3.1 Number of Change in Training all cadres of health Training of knowledge and skills reports workers on NCD Trainers workshop of health workers on management convened using NCD management the pre-service curriculum for integrated NCD management 2.3.2 Number of step- down trainings conducted using the pre-service curriculum for integrated NCD management 2.3.3 Number of health workers trained on NCDs prevention, care and treatment 3. Priority Action: Scale-up Coverage of Early NCD Detection and Diagnosis at Primary Health Care Level Activity Activities Output Indicators Outcome Indicators Data Sources Code 3.1 Include cost-effective 3.1.1 Number of Improved capacity of Technical tools and stakeholder meetings primary health reports and commodities for early convened to review facilities to conduct health facility detection in the the essential early detection and surveys essential medicines medicines list and diagnosis of NCDs list minimum standards for PHCs and include essential tools for NCD diagnosis and detection (glucometers, owmeters, blood pressure, Acetic acid, POC test for sickle cell haemoglobin etc.) 3.1.2 Number/ types of tools and equipment procured and disseminated to PHCs for early detection and diagnosis at PHCs 115 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3.1.3 Number of quality assurance tests conducted on procured equipment annually 4. Priority Action: Scale-up Coverage of NCD Prevention Services at All Levels of Care Activity Activities Output Indicators Outcome Indicators Data Sources Code 4.1 Roll-out the proposed 4.1.1 Number of advocacy Number of girls aged Vaccination human papilloma (written and face-to- 9-13 that have been coverage virus (HPV) for girls face) visits to GAVI vaccinated against report age 9-13 years and other relevant HPV stakeholders conducted to include Number of adults HPV and HBV among vaccinated against support being HBV provided for Nigeria 4.1.2 Quantity of HPV and HBV provided by GAVI 4.2 Institutionalization of 4.2.1. Number of advocacy life-course vaccine exercise conducted including hepatitis B for the virus institutionalization of life-course vaccine including HBV 4.3 Include lifestyle and 4.3.1 Number of Integration of NCD Guideline behavioural recommendations on prevention into documents interventions for lifestyle and existing NCD care preventing CVDs, behavioural and treatment diabetes and cancers interventions included guidelines into primary health in NCD service care delivery guidelines 4.3.2 Number of health care workers trainings on developed guidelines 4.3.3 Integrated prevention services for NCDs implemented at all levels of care 4.3.4 Genetic counselling and pre-marital/pre- conception screening for SCDs using POC devices at all levels of care 116 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 5. Priority Action: Scale-up Coverage of Treatment Services for NCDs (CVD, Diabetes, Cancer, COPD, Sickle Cell Disease, MNSD and Injuries) Activity Activities Output Indicators Outcome Indicators Data Sources Code 5.1 Ensure commodity 5.1.1 Number of advocacy Change in the Updated security for essential visits conducted to number and types of version of the drugs for treating achieve inclusion of essential drugs for essential diabetes, COPD, drugs for treating treating diabetes, medicines list hypertension and diabetes, COPD, COPD, hypertension, CVD, cancers, SCD hypertension, CVD, CVD, cancers and cancers and SCD in SCD included in the the national essential essential medicines list medicines list 5.1.2 Integrated commodity logistics for NCD medicines achieved 5.2 Develop clinical 5.2.1 Number of workshops Improvement in Facility based guidelines for care to develop evidence- quality of care for data and treatment of informed treatment NCDs diabetes, and treatment and Trainings/ hypertension, CVD, care modalities for activity reports COPD, Cancers, NCDs Sickle Cell Disease Integrate and 5.2.2 Guidelines on pre- Improvement in implement services hospital care (to quality of care for for managing injuries include ambulatory NCDs from Road trafc care/transfusion crashes into services) and integrated NCD treatment of all management injuries integrated into guidelines NCD management guidelines 5.2.3 Number of bystander education conducted for pre-hospital management of injuries 5.3 Establish community- 5.3.1 Number of guidelines based services for for community MNSD managing MNSD developed 5.3.2 Number of lay health/volunteer health workers trained on community based management of MNSD 117 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 5.3.3 Number of community based programmes the management of MNSD rolled out 5.4 Establish long term 5.4.1 Number of care and End-of-life guidelines on long care services term care and end of life care services 6. Priority Action: Explore Viable Health Financing Mechanisms Activity Activities Output Indicators Outcome Indicators Data Sources Code 6.1 Include NCDs in 6.1.1 Number of Reduced out-of- Health benets package for consultations and pocket payments/ nancing NHIS at all levels of advocacy visits held expenditure for NCD surveys care to secure inclusion of prevention, care and NCDs in all benets treatment package for NHIS at all levels of care and expand the Basic Minimum Package of Health Services which will be nanced by the Basic Healthcare Provision Fund to include comprehensive care and treatment of hypertension, diabetes, early detection of cancer, COPD, emergency care for stroke and heart attacks 118 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.4. Objective Four: To Monitor Trends and Determinants of Non- Communicable Diseases and Evaluate Progress in their Prevention and Control Table 36: Priority Actions to Monitor Trends and Determinants of NCDs 1. Priority Action: Integrate NCDs into the National Health Management Information System Activity Activities Output Indicators Outcome Indicators Data Sources Code 1.1 Develop national 1.1.1 Number of Expansion in the NHMIS indicators for NCD technical meetings number of indicators service delivery and and advocacy visits and tools for NCD MSAP conducted to service delivery in develop national NHMIS indicators for NCD service delivery and MSAP 1.2 Develop tools and 1.2.1 Number of tools Higher reporting NHMIS registers. Include (Registers/Monthly rates on NCD service national indicators summary forms) delivery in NHMIS for NCD service disseminated for delivery into NHMIS capturing NCD service delivery indicators 2. Priority Action: Strengthen Technical Capacity for NCD Surveillance, Monitoring and Evaluation Activity Activities Output Indicators Outcome Indicators Data Sources Code 2.1 Build the capacity 2.1.1 Number of Change in Training and of national and workshops convened knowledge and skills monitoring state level M& E to develop a training on NCD surveillance reports ofcers on NCD curriculum for NCD and monitoring surveillance and surveillance and among national, monitoring monitoring based on state and LGA NCD the nationally set M&E ofcers targets, indicators and goal as well as the global monitoring framework 2.1.2 Number of national, state and LGA level M&E ofcers trained on NCD surveillance and monitoring 119 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3. Priority Action: Integrate NCD Surveillance into Civil Registration and Vital Statistics Systems (Births from SCD, Deaths by Cause) Activity Activities Output Indicators Outcome Indicators Data Sources Code 3.1 Include 3.1.1 Number of advocacy Inclusion of Civil Haemoglobin visits and engagement haemoglobin registration genotype into birth meetings with genotype into birth forms and forms and birth National Population forms and birth registers registers and NCD- Commission for registers and NCD- related causes into inclusion of related causes into death registration haemoglobin genotype death registration tools (vital into birth forms and tools (vital statistics) statistics) birth registers and NCD-related causes into death registration tools (vital statistics) 4. Priority Action: Conduct Periodic Surveys on NCDs and Evaluate Progress in their Prevention and Control Activity Activities Output Indicators Outcome Indicators Data Sources Code 4.1 Conduct periodic 4.1.1 Number of nation-wide Improved capacity Survey reports survey to monitor STEP surveys for NCD surveillance NCD risk factors conducted to determine the baseline burden of NCDs and their risk factors over a ve year period 4.1.1 Number of NCDs indicators included into existing surveys such as MICS, NDHS 4.1.2 Number of nation-wide national MNSD survey conducted over a Five- year period 4.1.3 Number of nation-wide National Global Youth Tobacco survey conducted over a ve year period 4.1.4 Number of nation-wide National Global Adult Tobacco survey conducted over a ve year period 4.2 Develop a 4.2.1 A dashboard for dashboard on summarizing and NCD disseminating data on NCDs from the NHMIS is developed 120 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 8.2.5 Objective Five: To Promote and Support National Capacity for Quality Research and Development for Prevention and Control of NCDs Table 37: Priority Actions to Promote National Research on NCDs 1. Priority Action: Develop and Implement a Prioritized Research Agenda for NCD Prevention and Control Activity Activities Output Indicators Outcome Indicators Data Sources Code 1.1 Set priorities for 1.1.1 Number of Priority research Research national research research institutes agenda for NCD priority setting agenda and researchers prevention and report identied control developed and published 1.1.2 Number of prioritized research topics and cross- cutting issues identied 2. Priority Action: Prioritize Budgetary Allocation for NCD Prevention and Control Research Activity Activities Output Indicators Outcome Indicators Data Sources Code 1.1 Secure budgetary 2.1.1 A costed research Increased funding for Budget report allocation for NCD plan for NCDs NCD research prevention and developed control research in NCD budget line 2.1.2 Inclusion of research cost as a line item within FMoH NCD budget line 3. Priority Action: Strengthen Technical Capacity for Research Activity Activities Output Indicators Outcome Indicators Data Sources Code 3.1 Build capacity of 3.1.1 Number of Improved capacity to Training report researchers on NCDs workshop on manage NCD-related research research methodology conducted for NCD Division-FMoH staff 121 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3.1.2. Number of NCD- FMoH staff participating in research methodology workshops 3.1.3. Number of researchers participating in NCD-related research courses 4. Priority Action: Strengthen Collaboration with Foreign and Domestic Research Institutes Activity Activities Output Indicators Outcome Indicators Data Sources Code 4.1 Build collaboration 4.1.1 Number of Improved Meeting with foreign and international and collaboration reports domestic research domestic research between foreign and institutes funding domestic research organizations institutions identied 4.1.2 Number of call/request for proposals identied and responded to 4.1.3 Number of international and domestic collaborative research meetings with representation from Nigeria 5. Priority Action: Strengthen Knowledge Translation in NCD Prevention and Control Activity Activities Output Indicators Outcome Indicators Data Sources Code 5.1 Strengthen the 5.1.1 Number of already Increase in the use Database of dissemination and existing research of domestic research NCD research use of research on NCD prevention in development of and evidence ndings in public and control guidelines and policy summaries in health policy and identied documents in NCD Nigeria programming clinical prevention and practice control 122 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 5.1.2 An electronic database for existing evidence that are relevant to NCD prevention and control is developed 5.1.3 Number of organizations that are working on knowledge translation identied 5.1.4 Number of researchers and policy makers participating in collaborative research sharing network activities 5.1.5 Number of evidence summaries on NCDs research produced and disseminated to policy makers 5.1.6 Number of policy makers reached with evidence summaries on NCDs research 123 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 9. FRAMEWORK ON THE NCD MULTI-SECTORAL COORDINATION MECHANISM This framework aims to provide guidance on how various stakeholders will be engaged to form a strategic partnership for achieving the priority actions in the NMSAP and strengthen the health system to provide high quality and seamless NCD care and treatment services. This framework will provide clarity on the roles and responsibilities of the different stakeholders as well as potential benets this partnership may bring to them. The partnership will also outline the channels that will be used for engagement and communication between various partners. 9.1 Membership and roles The partnership will include representation from the following groups of stakeholders whose roles are itemized below; Table 38: NMSAP Stakeholders and their Roles S/No Categories Role 1. Government ministries To strengthen governance and stewardship for department and agencies NCD prevention and control Both health and non-health MDAs will be responsible for formulating relevant national policies, regulations and laws for NCD prevention and control 2. Government ministries To represent the interest of people living with or department and agencies affected by NCDs and ensure that their unique experiences and perspective are considered in the formulation of policies and health system strengthening 3. Civil society organization To advocate for policy reforms and investments and hold governments and donors accountable to commitments made on NCD prevention, treatment and care 124 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 4. Private health sector To ensure affordability and availability of drugs and supplies for NCD diagnosis, treatment and care 5. Private non-health sector Tto support health promotion programs for preventing NCDs. This will include media and telecommunications companies for dissemination of information. Food and beverage companies will also participate to support implementation of reformulation programs for elimination of trans- fats, salt and sugar reduction. 6. Donors To mobilize resources for health promotion and service delivery programs for NCD prevention, treatment and care. 7. NGO/Implementing partner To support health service delivery for NCD prevention, treatment and care 8. Research Institutions To support knowledge generation and translation for evidence-informed policy making and practice 125 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 9.2 Membership Structure The partnership will have three levels of membership; I. The Governing council for NCD prevention and control: This will include relevant government ministries, department and agencies that are involved in taking multi- sectoral policy actions for NCD prevention and control. Table 39: Members of National NCD Governing Council (NNGC) S/No Stakeholder MDA 1. Secretary to the Presidency Government of the Federation (SGF) 2. Minister Ministry of Health 3. Minister Federal Ministry of Finance 4. Minister Ministry of Budget and National Planning 5. Minister Federal Ministry of Industry Trade and Investment 6. Minister Federal Ministry of Information and Culture 7. Minister Federal Ministry of Justice 8. Minister Federal Ministry of Power, Works and Housing 9. Minister Federal Ministry of Environment 10. Minister Federal Ministry of Agriculture and Rural Development 11. Minister Federal Ministry of Women Affairs and Social Development 12. Minister Federal Ministry of Youth and Sports 13. Special Assistant to the Ofce of Special Assistant to the President on SDG President on SDG 14. Minister Federal Ministry of Labour and Employment 15. Minister Federal Ministry of Education 126 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) TERMS OF REFERENCE • Set national goals and objectives for NCD prevention and control. • Approve national policies, strategies and plans for NCD prevention and control. • Ensure the full engagement of partners and broad advocacy and communication. • Oversee optimal use of existing resources and undertake resource mobilization for program implementation and research. • Evaluate progress of the partnership towards established goals (impact and coverage of cost-effective interventions). II. National NCD expert technical working group: This will include the two representatives from the next level of partnership. They will be responsible in setting the NCD agenda and in escalating all recommendations from the expanded technical working group to the NCD governing council for approval. TERMS OF REFERENCE • Develop draft National policies, Strategies and Plans on NCD prevention and control for approval by the NNGC. • Facilitate capacity building for committee members • Oversee the implementation of activities related to the prevention and control of NCDs in Nigeria. • Provide training to states on optimal implementation of the plan. • Coordinate regular monitoring, evaluation and reporting on national response to address including the implementation and updating of the national NCD MSA plan. • Report to the NNGC annually. • Lead advocacy for the implementation of the NCD MSA plan • Engage with relevant industries to achieve the national targets set in the MSAP • Develop annual research plan based on identied research priorities during implementation of the NCD MSA plan. III. The Expanded technical working group: This will include all stakeholders who wish to join the partnership. The expanded technical working group will have 4 sub- committees. These includes: 1. Regulations, policies and plans; 2. Health interventions; 3. Advocacy, communication, social and resource mobilization 4. Research and surveillance. A chair and secretary will be designated for each level of membership 127 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 9.3 Engagement Modality • The governing council will meet once a year to prioritize and review policy actions. • The NCD expert working group will meet quarterly to discuss and prioritize activities for NMSAP implementation. • The expanded group will also meet quarterly or as the need arises and will participate in the annual NCD prevention and control conference. NCD Governing Council National NCD Expert Technical Working Group Regulations, Health Advocacy, Communication, Research and policies and interventions social and resource surveillance plans mobilization 128 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 9.4 HEALTH IMPACT AND ECONOMIC RETURNS OF THE NMSAP NCDs contribute signicantly to loss of lives and disabilities. This in turn have a negative impact on national productivity and economy. Therefore, it makes economic sense to invest in NCDs prevention and control interventions. Prevention, early detection and effective treatment of NCDs will enable Nigerians to have healthier and longer lives, reduce the risk of catastrophic health expenditure and improve their productivity and earning capacity. This culminates at the national level to reduced national expenditure on health, a vibrant and productive workforce and a boost in gross domestic product. Investing in the “Best Buys” outlined in the NMSAP will save thousands of lives and generate economic outputs of approximately NGN 3502.8 Billion (USD 9.73 Billion) by 2030. Figure 6: Return on investments of implementing the “Best Buys” in Nigeria 129 #BeatNCDsNG #BeatNCDsNG 130 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) BIBLIOGRAPHY Adamson TA, Ogunlesi AO, Morakinyo O, Akinhanmi AO, Onifade PO, et al. (2015) Descriptive National Survey of Substance Use in Nigeria. J Addict Res Ther 6:234. doi:10.4172/2155-6105.1000234 Ekanem, A.I. (2008) Global Youth Tobacco Survey for Nigeria. Federal Ministry of Health (2008) Data Prole on Non-Communicable Diseases in Nigeria: A Systematic Review of the Evidence. Federal Ministry of Health (2018) Cost Estimates of the Nigeria Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases 2018-2023 FMOH Abuja. Gureje O, Lasebikan VO, Kola L, Makanjuola VA (2006) Lifetime and 12-month Prevalence of Mental Disorders in the Nigerian Survey of Mental Health and Well-Being. Br J Psychiatry 188: 465–471. Ministry of Budget and National Planning (2017) Economic Recovery & Growth Plan 2017-2020 MBNP, Abuja National Bureau of Statistics (2017). Road Transport Data. [Online] Available at: http://nigerianstat.gov.ng/elibrary?queries[search]=transport%20data (Accessed: 2 August 2018). World Health Organization.Nigeria Global Adult Tobacco Survey (2012). [Online] Available at: http://ghdx.healthdata.org/record/nigeria-global-adult-tobacco-survey- 2012 (Accessed: 2 August 2018). WHO(2017) Tackling NCDs "Best buys" and other recommended interventions for the prevention and control of Non-Communicable Diseases https://apps.who.int WHO assessed World Health Organization (2014) Global Status Report on Non-Communicable Diseases. Geneva, Switzerland: WHO; WHO (2011) Scaling up Action Against Non-Communicable Diseases: How Much will it Cost? – Prepared by the World Health Organization, Geneva. 131 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) APPENDIX 1.0 Endorsements We, hereby pledge to support Multi-Sectoral Action on Non-Communicable Diseases in Nigeria. S/No Name Designation Signature 1 Prof. Isaac F. Honourable Minister Adewole Ministry of Health 2 Mrs Zainab Honourable Minister Ahmed Ministry of Finance 3 Senator Udoma Honourable Minister Udo Udoma Ministry of Budget and National Planning 4 Suleiman Hassan Honourable Minister Federal Ministry of Environment 5 Aisha Abubakar Honourable Minister Ministry of Women Affairs and Social Development 6 Babatunde Raji Honourable Minister Fashola Ministry of Power Works and Housing 7 Chief Audu Ogbeh Honourable Minister Ministry of Agriculture 8 Dr Chris Ngige Honourable Minister Ministry of Labour and Productivity 9 Barr Solomon Honourable Minister Dalung Youth and Sport Development 10 Arc Sonny Echono Permanent Secretary Federal Ministry of Education 11 Dcns. Grace Gekpe Permanent Secretary Federal Ministry of Information and Culture 132 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 2.0 Core Technical Team of NMSAP Development Organization Name Dr Nnenna Ezeigwe Mrs Chiamaka Omoyele FMoH Dr Malau Toma Dr Alayo Sopekan Dr Ikponwosa Osaghae Mr. Emmanuel Abraham Dr Rex Mpajanze WHO Dr Mary Dewan Dr Lilian Anomnachi Dr Christine Ezenwafor Dr Ndukwe Ukoha HSDF Dr Bridget Nwagbara Priye Igali Ibrahim Khalil Ibrahim 133 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 3.0 Technical Working Group Members S/N NAME ORGANISATION GOVERNMENT Public Health Department, Federal Ministry of 1 Dr Evelyn Ngige Health Non-Communicable Diseases Division, Federal 2 Dr Nnenna Ezeigwe Ministry of Health Non - Communicable Diseases Division, Federal 3 Dr. Alayo Sopekan Ministry of Health Non-Communicable Diseases Division, Federal 4 Dr. Malau M. Ministry of Health Non-Communicable Diseases Division, Federal 5 Etta Jeanette Nneka Ministry of Health Non-Communicable Diseases Division, Federal 6 Chiamaka Omoyele Ministry of Health Non-Communicable Diseases Division, Federal 7 Fortune M. Udott Ministry of Health Non-Communicable Diseases Division, Federal 8 Emmanuel Abraham Ministry of Health Non-Communicable Diseases Division, Federal 9 Akinkoye Kehinde Olanike Ministry of Health Non - Communicable Diseases Division, Federal 10 Nwosu Ngozi U. Ministry of Health Non-Communicable Diseases Division, Federal 11 Paul Samson Ministry of Health Non-Communicable Diseases Division, Federal 12 Ologidi Ebiweni Lawrence Ministry of Health 13 ijeoma C Ike Federal Ministry of Health Non-Communicable Diseases Division, Federal 14 Onah Helen Ministry of Health Non-Communicable Diseases Division, Federal 15 Odenigbo Grace Ministry of Health Department of Health Planning Research and 16 Balogun Adeleke Statistics, Federal Ministry of Health Health Promotion Division, Federal Ministry of 17 Welle Sylvanus Health Department of Food and Drugs Services, 18 Pharm Ologun Taiye Joseph Federal Ministry of Health National Cancer Control Programme, Federal 19 Dr. Onuselogu Chinwendu Nwife Ministry of Health Nutrition Division, Family Health Department, 21 Eke Eucharia Onyinyechi Federal Ministry of Health 22 Ntia Thompson Ministry of Budget and National Planning 134 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 23 Grace Obi-Ukpabi Ministry of Budget and National Planning 24 Nwajagu Ifunanya Federal Ministry of Justice 25 Abah Anthony O. Federal Ministry of Justice 26 Odubanjo Olajumoke .A Federal Ministry of Information and culture 27 Chinyere Ifeanyichukwu Federal Ministry of Information and Culture Federal Ministry of Communication and 28 Febau Cephas Ebikeniye Technology 29 Amuchi Edwin C. Federal Ministry of Communication and Technology 30 Okereke Chinwe P. Federal Ministry of Education Federal Ministry of Women Affairs and Social 31 Ofuani Josephine Development Federal Ministry of Agriculture and Rural 32 Dr. S. A Anzaku Development 34 N. Mohammed Federal Ministry of Industry Trade and Investment 35 Beatrice U. Danladi Federal Ministry of Foreign Affairs 36 Kabiru Mohammed Federal Ministry of Youth and Sport Development 37 Janet Garba Federal Ministry of Youth and Sport Development 38 Nongo Daniel N. Federal Ministry of Power, works and Housing 39 Ogunrami.O.O Federal Ministry of Power, works and Housing 40 Vivian Idogho Federal Ministry of Finance 41 Rukayya Mohammad Federal Ministry of Environment 42 Okunbo Ruth O. Nigeria Police Force 43 Olusegun Jacob National Primary Health Care Development Agency 44 Dr. Amina Abdul-One National Primary Health Care Development Agency 45 Adeola Jegede National Institute for Pharmaceutical Research and Development 46 Enwere Francis National Health Insurance Scheme 135 #BeatNCDsNG National Multi-Sectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2019 – 2025) 47 Abioye Bolanle National Health Insurance Scheme National Agency for Food and Drugs 48 Hasatu Sirika Administration and Control 50 Cdr. B. Alti (Rtd) National Emergency Management Agency 51 Dr Barth Ugwu SON TERTIARY INSTITUTIONS 52 Dr. Taiwo Lateef Sheik Ahmadu Bello University Teaching Hospital 53 Prof. Felicia Anumah University of Abuja Teaching Hospital 54 Prof. Obiageli Nnodu University of Abuja Teaching Hospital 55 Prof. Ima- Obong A. Ekanem University of Calabar Teaching Hospital 56 Dr Osunkwo National Hospital Abuja NON-GOVERNMENTAL ORGANIZATIONS 57 Lilian Anomnachi Health Strategy Delivery Foundation 58 Ndukwe Ukoha Health Strategy Delivery Foundation 59 Bridget Nwagbara Health Strategy Delivery Foundation 60 Priye Ruth Igali Health Strategy Delivery Foundation 61 Rita Melifonwu Stroke Action Nigeria 62 Olu'seun Esan Nigerian Tobacco Control Alliance 63 Prof. Sani Malami NCD Alliance 64 Prof. Sunday A. Bwala Stroke Reference Group 65 Mrs. S. D. Alexander Policy Analysis Research and Statistics UN ORGANIZATIONS 66 Dr Wondimagegnehu Alemu World Health Organization 67 Dr Rex Mpanzanje World Health Organization 68 Dr. Mary Dewan World Health Organization 69 Sangeeta Carol Pinto World Bank 70 Alamu Mary A Food and Agriculture Organization 136 #BeatNCDsNG