National Executive Plan for NCDs (2014 – 2025)

1. Primary Prevention of NCDS

2. Secondary prevention of NCDS

3. Improvement of the quality of the health services with their three levels provided to patients suffering from NCDs and its complications

4. To strengthen the monitoring, follow-up and assessment of NCDs

5. Perform and enhance the research tools and studies relevant to NCDs

6. Empowerment of patients with NCDs and their families in the contribution and participation in the provided services and monitoring their quality.

7. The social partnership in NCDs control. Objective 1: Primary preventing of NCDs Target: Reduce the rate of the risk factors leading to NCDs in the Saudi community within the following ten years through: - Improving health awareness about NCDs and prevention by 50 % (with a rate of 5 % per annum) - Increasing people who consume at least 3 services of fruits and vegetables bye 20 % (with a rate of 2% per annum) - Reducing of consumption of food rich with monosaccharide and saturated fat bye 10 % (with a rate of 1% per annum) - Increasing the physical activity practitioners by 20% as a minimum (i.e. with a rate of 2% per annum). - Reduction of overweight and obesity by 10% as a minimum (i.e. with a rate of 1% per annum). - Reduction of tobacco consumption rates (current and occasional smokers) among adults by 5% (i.e. with a rate of 0.5% per annum). - Reduction of the rate of those exposed to negative smoking by 80% as a minimum (i.e. with a rate of 8% per annum). - Reduction of hyperlipidemia by 5 % (i.e. with a rate of 0.5% per annum) - Reduction of hypertension bye 5 % (i.e. with a rate of 0.5% per annum) The Target Index: - KSP study to identify awareness about NCDs (its risk factors, prevention) - The prevalence rate of overweight (BMI 25-29.9 Kg\m²) and obesity (BMI < 30 Kg\m²) - The percentage of the community members (Adults and school children) who practice the physical activity as per the WHO definition of the Stepwise Surveillance System for chronic diseases. - The rate of people consume 3-5 services of fruits and vegetables - The rates of tobacco consumption - The rate of hyperlipidemia - The rate of hypertension Executive plan Objective 1 : Primary Prevention of NCDS Strategies Application Mechanism Application Mechanism Indices

1. Raising the health 1. Implementation of field and 1. The percentage of the community awareness about risk informational awareness programs & members who are aware of the risk factors for NCDs campaigns about the risk factors of factors of the total study subjects and NCDs and prevention. their percentages after introducing the

2. Inclusion of NCDs within the educational program. scientific subjects in the school 2. Number of programs and campaigns curricula. implemented in different sectors.

3. Inclusion of NCDs within the educational scientific subjects.

2. Promoting healthy foods 1. To establish and implement the 1. The presence of the national strategy and including physical national strategy about the diet, about diet, physical activity and activity among the physical activity and health (in the light health. various categories of the of the WHO strategy). 2. The extent of the implementation of community. 2. Inclusion and identification of physical such national strategy about diet, activity as a basic compulsory subject physical activity and health. at schools. 3. Number of physical activity classes at

3. Carrying out campaigns for promoting schools. the practice of walking sports in the 4. Number of awareness campaigns community. about physical activity.

4. Promoting the establishment of 5. Number of walkways per 10.000 walkways and parks within a people of the population reasonable distance from the local 6. Number of public gardens per 10.000 inhabitants. people

5. Improve Schools restaurant's food 7. Number of schools provide healthy quality food

8. Number of schools addressing health promotion

3. Tobacco control Educational campaign about the Number of health educational campaign controlling tobacco consumption

4. Decree the legislations Decree the essential legislations 1. Number of laws fighting the risk promoting the reduction factors. of risk factors such as 2. The extent of implementation of the (foods & drinks labeling legislation. laws and advertising about fast foods, anti- smoking laws, . . . ) Objective 2: Secondary prevention of NCDs Target: Early detection of NCDs and their risk factors. Target Index: - Number of screening programs for NCDs and their risk factors - Percentage of discovered cases in target population for the screening programs Strategies Application Mechanism Application Mechanism Indices

1. Early detection of NCDs 1. Provision of resources 1. Availability of resources and its risk factors in 2. Implementation of local or national 2. Implementation of the project / or high risk group. screening program to detect NCDs not

3. Implementation of training programs for 3. Number of training course, and health care professionals about screening trainees from target program 4. Number of health promotion

4. Establishing health promotion clinics clinics in PHCs

5. Establishing guidelines for early 5. Availability of guidelines detection for NCDs and its risk factors 6. Availability of referral system

6. Referral system 7. Objective 3 Improvement of the health services quality with its three levels provided to NCDs patients and their complications Targets

1. Improvement of NCDs patients care within the PHC.

2. Complete medical care in the presence of optimal medical staff.

3. Coordination and integration between different medical care levels

4. Provide the necessary resources to control non-communicable diseases.

5. Improving health care services and control of non-communicable diseases and reduce the incidence of acute and chronic complications Targets indicator 1- The proportion of primary health care centers where there is a clinic for chronic diseases 2- The proportion of qualified health workers to care for chronic diseases patients. 3- The proportion of health centers that meet the requirements of the care required for patients with chronic diseases. 4- The proportion of specialized units in the level of secondary and tertiary care that follow the correct methods of care for patients with chronic diseases. 5- The proportion of patients who are cared for according to the adopted national guidelines. 6- The incidence of complications of chronic diseases (stroke, heart attack, stroke, blindness, kidney failure, amputation). 7- The existence of an elaborate system of shared care and referrals between the three levels of care Strategies Enforcement mechanisms Indicators of Enforcement mechanisms

1. Development of 1- The establishment of clinics for chronic • Proportion of primary health care centers where infrastructure for diseases in primary health care. there is a clinic for chronic diseases. primary health care 2- Establishment of clinics to help quit smoking. • The existence of clinics to help quit smoking. centers to make them 3- The provision of diagnostic and laboratory • Proportion of availability of diagnostic and more suitable for the services to primary health care centers. laboratory services in primary health care centers. treatment of chronic 4- Provision of essential drugs for the treatment • The availability of medicines in primary centers. diseases. of chronic diseases in all primary health care centers. 2- Providing qualified 1- Completion of the health team to treat chronic • Coverage rate of primary and secondary health medical staff in the field diseases in primary and secondary care units. care with a qualified health team. of combating NCDs. 3- Raise the efficiency 1- Development of training programs for the • Percentage rate of trainees per year from a total of health workers in care and control of chronic diseases for all target of all health categories. primary health care in health workers the fight against NCDs. 4- The development of 1- Creation of diabetes units in referral • The existence of diabetes units in the referral secondary and hospitals hospitals specialized care 2- Establishment of specialized centers in the • The existence of specialized centers for the services in the treatment of cardiovascular disease and its treatment of cardiovascular diseases. treatment of chronic complications and to rehabilitate patients. • The existence of a national specialized centers for diseases. 3- Creation of specialized centers (third level) the treatment of diabetes for the treatment of diabetes and its • The existence of cancer treatment centers. complications, and to rehabilitate patients • The existence of palliative services for cancer 4- Establishing centers for cancer treatment patients in referral hospitals 5- Existence of services or centers to provide palliative treatment for cancer. 6- 5-The presence of a 1- Create and update guidance manuals for • The presence of updated guidelines for clinical joint and fixed criteria health workers in the fight against chronic practice for chronic diseases based on evidence based on scientific diseases on a regular basis. and proof. evidence and proof and to be kept up-to- date. 7- 6- Create an effective 1- Issue a clear policy for the referral system • Evidence to show details of the referral system at referral system from primary care to secondary and specialized each level. between the three care. levels of care Objective 4: Perform and strengthen the NCDs related research and studies tools Target:

1. Perform health researches based on scientific proofs that assist in health planning and assessment.

2. Create information that contributes in making NCDs priorities for the decision markers 3. Target Index:

1. The availability of the fore mentioned health researches. Strategies Application Mechanism Application Mechanism Indices

1. Study of the burden of NCDs 1. Capacity building for national team 1. Number of trained personnel and its risk factors on in statistics and health economics 2. Establishment of research team periodical basis 2. Constitute a research team 3. Allocation of budget

2. Economic impact of NCDs specialized in the disease, 4. Finalizing the study in 2 years.

3. Economic impact of tobacco economics and burden use 3. Assign the budget necessary for implementing study.

4. Start the study in 2012. Objective (5): To enable patients and their families to participate in controlling NCDs and their complications Target: 1- Improve the life style and health behaviors. 2- Improve the quality of life for people with chronic diseases. 3- The patient is the major hub for the services provided. 4- Raising the awareness of the patient and his family with the disease, how to cure and control it. Targets Indicators: 1- The impact of programs on patients and their families to control the disease and risk factors associated. 2- How the patient involved in bearing the responsibility of his own treatment, in order to improve his quality of life. 3- Patient’s satisfaction of the quality of services provided to them. 4- Awareness level of the patient and his family about the disease and how to cure and control it. Strategies Enforcement mechanisms Indicators of Enforcement mechanisms 1- Involvement of patients 1- Implement educational programs • Number of educational programs with NCDs and their individually and collectively for patients implemented (awareness programs - Home families to bear the and their families within the primary care Care - Training of patients) responsibilities of the services • Number of patients registered among treatment and prevention 2- Contribute to the requirements of participants. of complications. diagnostic, therapeutic and rehabilitation • Number of patients who are committed to 2- Provide support and care needs. implementing programs for NCDs patients and 3- Provision of Self-monitoring booklet for • The presence of diagnostic, therapeutic and their families. every NCDs patient. rehabilitation devices and tools, 4- Training patients to self-care. • Availability of the self-monitoring booklet 5- Provision of social and mental • The number of patients who have been counseling services for patients and trained to self-care their families. • The number of patients who underwent the 6- The involvement of patients or their social and psychological counseling. representatives in the audits to ensure • The number of the active electronic programs quality services. and their users. 7- Creation of interactive electronic software design for education, communication and follow-up with the patients and their families. Objective 6: Activate the societal partnership for NCDs control Target:

1. Participation of both the government and private institutions in bearing the national responsibility about NCDs Target Index:

1. Degree of expected community participation from concerned sectors

2. Numbers of programs and activities of NCDs implemented with partners

3. Implementation of joint programs among the related-institutions.

4. The extent of assignment of the government, private and social institutions of their resources in the field of controlling NCDs Strategies Application Mechanism Application Mechanism Indices

1. Create a higher national board for 1. Decree a decision from the high 1. The availability of a political NCDs control. rank authorities to establish the decision to establish the board.

2. Coordination and cooperation board. 2. The availability of the board. between governmental and 2. Set up joint programs & 3. Number of the programs and private sectors activities among the related activities implemented within the

3. Involvement of private sector and institutions. context of partnership with other civil community in NCDs control institutions. Objective (7): Strengthening the means of monitoring, follow-up and evaluation of NCDs. Target: 1- Create a database of chronic diseases 2- The establishment of a national surveillance programs for chronic diseases. 3- Continuous development and improvement of national registries. 4- Application of quality standards, monitoring and performance indicators. Target Indicator: 1- The existence of a comprehensive database able to provide the necessary data for evaluation. 2- The existence and application of quality standards and performance indicators. Strategies Enforcement mechanisms Indicators of Enforcement mechanisms 1- Establishment of a 1- Create and implement an information * Proportion of health institutions that apply comprehensive database to system to collect data statistics institution the national information system. enable evaluation of the in each health unit, for the indicators that * Proportion of risk factors that can be programs. contribute to evaluating the obtained from the data collected in health implementation of this plan institutions routinely on patients. 2- Develop a mechanism for checking to * Proportion of registration completion. ensure the quality of information (Completeness) * The proportion of correct data (Accuracy). * Proportion of recorded data in a timely manner (Timeliness) 2-Establishment of a national and 1- Computerize Standardization to review • Proportion of primary health institutions; a unified information system for patients with chronic diseases in all activate the unified computerized NCDs chronic diseases, linking all health care institutions. reference to program. health institutions in different 2- Creation of a system to facilitate the • Proportion of early detection of risk levels. extraction of information about the follow- factors. up of patients will allows the follow up of • Proportion of early detection of retarded patients. complications of NCDs. 3- The development of a unified system for early detection of risk factors. 4- A sensor system to detect early complications of chronic diseases 3- Commitment to uniform 1- Development of criteria and indicators of • Percentage of commitment to these standards and performance quality performance in all health standards and indicators indicators reflect the quality of institutions at various levels service 4-Annual evaluation of 1- Develop a mechanism for annual • Coverage of performance indicators in commitment to the standards and evaluation and shall be conducted on a the elements for control of chronic indicators to prevent chronic regular basis. diseases. diseases. 2- Include the results of the evaluation • The existence of indicators in the annual through indicators of quality performance statistics. in the Statistical Yearbook. • Proportion of referrals returned in all health institutions at various levels. 5- The development of the 1- Improve the quality of data and private • Proportion of follow-up cases. National Cancer Registry information, especially about the stages of • The number and type of studies. disease progression. 2- Use the information of the national registry for clinical and epidemiological studies