National Action Plan for control and prevention of Non-communicable diseases (2019-2030)

1.1 Integrate non-communicable diseases into national policies Non-communicable diseases prevention plan is included in all and development plans. national health and economical plans

1.2 Increase budgetary allocations for non- communicable 1. The government has imposed a 50% tax increase on diseases prevention and control including through innovative carbonated high- calorie drinks and 100% on energy drinks. financing mechanisms such as taxation of tobacco, alcohol and 1. 2. The government has imposed 100% selective tax on retail other unhealthy products. price on all tobacco products. Implementation strategies:

1.1 Coordinate with concerned sectors and partners through National NCD committee

1.1 KPI: Multi-sectoral coordination is in place with clear role for each sector Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Identify a representative from each  National NCD  Action Plan is Done partner within the committee. committee available with each  NCD unit team partner in the committee 2. Agreed on specific role to each  Role of partners Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing member. are specified and agreed on. 9 3. Meet with the partners to share  The approved Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing the approved action plan. action plan is shared with the partners 4. Monitor the implementation of the  Regular feedback is Twice Twice Twice Twice Twice Twice Twice assigned role. received. yearly yearly yearly yearly yearly yearly yearly 1.2Develop and approve a multi-sectoral NCD action plan for prevention and control of NCDs and associated risk factors

1.2 KPI: Approved multi-sectoral NCD action plan for prevention and control of NCDs and associated risk factors that is aligned with economic and national strategic plans including matching KPIs is in place Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 Update the national NCD action plan  National NCD The national NCD Done Planned with matching KPIs. committee action plan is and  NCD unit team updated and ongoing approved. every 4 years

1.3 Incorporate NCD multi-sectoral action plan in concerned sectors plans

1.3 KPI: NCD multi-sectoral action plan is incorporated in concerned sectors plans Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Ensure NCD multi-sectoral action  NCD unit team / Feedback reports are Annually Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing plan is incorporated within the Public Health received from the concerned sectors plans team representatives Directorate To Follow-Up With NCD Committee Members. 10

1.4 Propose a costing breakdown for the NCD plan

1.4 KPI: Costing breakdown is proposed and integrated in the NCD action plan Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. List the NCD ongoing programs  NCD national List of priority Review Review Review Review and projects according to the committee proposed projects and and and and budgeting priority needed.  NCD Unit team are available. update update update update  Ministry Of every 2 every 2 every 2 every 2 Finance years years years years

1.5 Develop an NCD investment case

1.5 KPI: NCD investment case is developed Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Participate and lead the process  National NCD NCD investment case Planned - - - - - - of development and committee is developed implementation of NCD  NCD Unit team investment case.  In collaboration with WHO

1.6 Ensure NCD prevention and control and universal health coverage are embedded into the health service reform

1.6 KPI: NCD prevention and control and universal health coverage are embedded into the health service reform Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Monitor and ensure that the  Supreme Council Universal health Annually Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing UHC is embedded in the NCD of Health coverage is prevention and control  National NCD considered in all NCD programs in the health service committee prevention programs. reform.  NCD unit team (Refer to UHC indicators from SDG) 11 2. Strategic Objective To strengthen national capacity, leadership, governance, multi-sectoral action and partnerships to accelerate country response for the prevention and control of NCDs. Goals Indicators

2.1 Establish a multisector strategy/ plan and 1. A multisectoral1 NCD action plan is developed and operational with which sets out a set of national targets and indicators for 2025 number of time-bound objectives based on the UN Declaration and in line with the based on national situation and WHO sustainable developmental agenda and targets. guidance and incorporate SDGs targets in the 2. The formation of the National NCD multisector committee. plan

2.2 Periodically assess national capacity for The work of the assessment of national capacities is conducted according to schedule prevention and control of non-communicable timetable. diseases using the WHO tools.

2.3 Accelerate implementation of WHO 1. The WHO Framework Convention on Tobacco Control (WHO FCTC) has been ratified. Framework Convention on Tobacco Control 2.The following MPOWER measures are being implemented including MPOWER package. M: Monitor tobacco use and prevention policies P: Protect people from tobacco smoke O: Offer help to quit tobacco use W: Warn about the dangers of tobacco E: Enforce ban on tobacco advertisement, promotion and sponsorship. R: Raise taxes on tobacco

2.4 Implement the WHO recommendations on The WHO recommendations on marketing of foods and non-alcoholic beverages to children marketing of foods and non-alcoholic are implemented. beverages to children.

2.5 Raise tax/levy on alcohol and impose a NA total ban on advertising (for countries where alcohol is marketed).

2.6 Implement interventions to reduce salt 1. An operational policy, strategy or action plan to reduce salt intake is being implemented. intake and media campaigns on diet and 2. A population-based national initiative or project on salt reduction is being implemented. physical activity. 3. A plan to develop/generate baseline data measurements on salt intake is in place. 4. Policies to reduce the impact on children of marketing of foods and nonalcoholic 12 beverages high in saturated fats, trans fatty acids, free sugars or salt are being implemented. 5. An operational policy, strategy or action plan to promote physical activity is in place 6.Mass health promotion campaigns on physical activity are being implemented

2.7 Replace trans-fat with polyunsaturated National policies that limit saturated fatty acids and industrially produced trans fats in the fat. food supply are being implemented.

2.8 Promote breast feeding and implement Breast feeding is promoted and the international code of Marketing of Breast Mild the international code of Marketing of Breast Substitutes is implemented. Mild Substitutes.

2.9 Promote access to vaccination to prevent Vaccination to prevent cancer is promoted cancers based on national priorities. Key definitions: Operational” refers to a policy, strategy or action plan which is in place and being implemented in the country, and has resources and funding available to support it. 1 An NCD unit/branch/department is defined as having at least one full-time staff and funding for the following major NCD activities: primary prevention and health promotion; early detection/screening; health care and treatment; and surveillance, monitoring and evaluation. 1 A multisector NCD action plan refers to a national action plan that addresses the 4 main NCDs (cardiovascular disease, diabetes, cancer, and chronic respiratory disease) and their main risk factors (tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol) through the engagement of one or more government sectors outside of health. Implementation strategies

2.1 Integrating NCDs prevention and control into health developmental plans (Special focus to social determinants of health, gender equity and the health needs of vulnerable populations who are economically or psychosocially disadvantaged)

2.1 KPI: The NCD prevention plans is integrated in health developmental plans and focused on social determinants of health Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. To identify social determinants of  National NCD Social determinants of Planned health (such as gender equity) and the committee health, gender equity health needs of vulnerable  NCD unit and the health needs of populations who are economically or team vulnerable populations psychosocially disadvantaged. who are economically or psychosocially 13 disadvantaged are identified. 2. To do situational analysis for social Situational analysis is determinants of health, and the done. health needs of vulnerable populations who are economically or  psychosocially disadvantaged. 3. To focus on social determinants of Social determinants of Included health, gender equity and the health health, gender equity and needs of vulnerable populations who the health needs of are economically or psychosocially vulnerable populations disadvantaged in the action plan for who are economically or prevention and control in the health psychosocially developmental plans. disadvantaged are included in the action plan for prevention and control of NCD.

2.2 Encourage and activate feasible resources for NCDs prevention and control and for universal health coverage (UHC)

2.2 KPI: Resources are provided for UHC Action/ process Assigned KPI 2019 2020 2021 2022 2023 2024 2025 section 1. To identify feasible resources that can  National NCD The UHC resources for Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing support the UHC for NCD prevention committee NCD prevention are and control.  NCD unit identified. team 2. To activate feasible resources of NCD The UHC resources for Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing prevention and control. NCD prevention are activated.

2.3 Attract an expertise and resources to strengthen national NCD prevention and control and associated risk factors programs 14

2.3 KPI: Experts and human resources are available and involved in NCD prevention and control and associated risk factors programs Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. To identify national and  National NCD Expertise’s are identified. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing international expertise in the committee prevention and control of NCD.  NCD unit team 2. To communicate with national and international expertise Expertise’s are Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing approached. 3. To involve the expertise from different countries in the field Expertise’s are involved. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing of NCD programs.

2.4 Provide adequate training and appropriately deploy health, social services and community workforces toward NCD prevention and control

2.4 KPI: Adequate training programs are available Action/ process Assigned KPI 2019 2020 2021 2022 2023 2024 2025 section 1. To identify available training  NCD Unit • No of available training Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing programs in the field of NCD team programs prevention and control. • No of newly planned programs 2. To facilitate the conduction of Training programs are Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing training programs in the facilitated. prevention and control of NCD.

2.5 Empower communities by social commitment, engaging and involving people specially women

2.5 KPI: NCD prevention programs in collaboration with the Supreme Council of Woman (SCW) and community 15 Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Identify the stakeholders  National NCD  No. of programs done in Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing involved in NCD prevention committee collaboration with SCW. with the SCW.  NCD Unit team  No. of newly planned 2. Enhance cooperation with SCW  SCW programs in Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing in the field of NCD prevention  Community leaders collaboration with SCW. programs.  NGOs  No. of programs done in collaboration with 3. Enhance cooperation with community leaders and Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing community leaders & NGOs in NGOs. the field of NCD prevention programs.

2.6 Develop technical tools and information products that help implementation of cost-effective interventions needed for monitoring multi-sectoral action for the prevention and control of NCDs.

2.6 KPI: The technical tools and information for implementation of cost-effective interventions are developed or adopted Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Identify available technical  National NCD  Best buys are adopted. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing tools and information for committee  The available technical implementation of cost-  NCD unit team tools are identified. effective interventions. 2. Initiate new technical tools and  No of newly initiated Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing information that can help in technical tools. implementation of cost- effective interventions. 16 3. Strategic Objective To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting environments. Goals Indicators

3.1 Accelerate implementation of WHO 1. The WHO Framework Convention on Tobacco Control (WHO FCTC) has been ratified. Framework Convention on Tobacco 2.The following MPOWER measures are being implemented Control including MPOWER package. M: Monitor tobacco use and prevention policies P: Protect people from tobacco smoke O: Offer help to quit tobacco use W: Warn about the dangers of tobacco E: Enforce ban on tobacco advertisement, promotion and sponsorship. R: Raise taxes on tobacco

3.2 Implement the WHO 1. reduction of the percentage of marketing for un healthy food in all areas attended by kids ( cinema , festivals, recommendations on marketing of foods playing area ) . 2. reduction of un healthy food consumption. and non-alcoholic beverages to children. 3.Increase awareness of consumption healthy food.

3.3 Raise tax/levy on alcohol and impose NA a total ban on advertising (for countries where alcohol is marketed).

3.4 Implement interventions to reduce 1. Release of multi-legislation controlling the consumption of the salt. salt intake and media campaigns on diet 2. Released of ministerial decree ( reduction salt content in all bread product in local and and physical activity. automatic bakeries. 3. Reduction in salt content in local and automatic bread bakeries. 4. Implementing of in front labeling traffic system for all imported and local food items. 5. Implementing nutrition fact menu labelling in all restaurants. 6. Implementation of policies to reduce the effect of marketing of non-alcoholic surgery drinks, and food rich in saturated and hydrogenated fats , sugar and salt for children. 7. Media Campaign: % of healthy message through differentness media channel. 8. An operational policy, strategy or action plan to promote physical activity is in place 9.Mass health promotion campaigns on physical activity are being implemented

3.5 Replace trans-fat with National policies that limit saturated fatty acids and industrially produced trans fats in the food polyunsaturated fat. supply are being implemented.

3.6 Promote breast feeding and Breast feeding is promoted and the international code of Marketing of Breast Mild Substitutes is 17 implement the international code of implemented. Marketing of Breast Mild Substitutes.

3.7 Promote access to vaccination to Vaccination to prevent cancer is promoted prevent cancers based on national priorities. Implementation strategies

3.1 Fully implement WHO FCTC MPOWER package.

3.1 KPI: WHO Framework Convention on Tobacco Control including MPOWER package is fully implemented. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Accelerate implementation of  National NCD  % of places that implemented Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing WHO Framework Convention on committee Smoke-free policies. Tobacco Control including  Tobacco control  % of taxes applied on tobacco MPOWER package. committee products. 2. Advocate the raise of taxation on  Antismoking  % of places violating the law of Implemented Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing tobacco products. group Smoke Free policies. in 2018  Pictorial Health warnings 3. Fully ban tobacco products covering at least 50% of front Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing advertising, promotion and side. sponsorship.  % of violation for tobacco advertising bans. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing 4. Convey tobacco consumption surveys and repeating them every  Availability of fully equipped 3-5 years. quit smoking clinics in the primary care. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing 5. Completely ban smoking in  Availability of tobacco indoor public places consumption surveillance. 6. Offer help for quit tobacco within Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing  % of surveys repeated every 3-5 the primary care services years.  Quit rate among those above 18 7. Warn people about the dangers years old attending quit Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing of tobacco smoking clinics.  Quit rate among those below 18 years old attending quit 18 smoking clinics.

3.2 Consider appropriate responses to emerging challenges of nicotine and non-nicotine delivery systems (e.g. e-cigarettes)

3.2 KPI: Appropriate actions are taken to emerging challenges in tobacco control Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Update current laws  National NCD  No of legislations To include and regulations to committee in the field emerging include emerging and  Tobacco control emerging products in laws novel products. committee challenges. and regulations of  Antismoking tobacco products 2. Monitor group  % of violation to Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing implementation of Laws laws and and Regulations in the regulations field of the emerging challenges. 3. Initiate and update  No. of health Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing health education education programs in the field of campaigns in the the emerging field of the challenges. emerging challenges.

3.3 Consider ratifying the WHO FCTC Protocol on Illicit Trade of Tobacco.

3.3 KPI: The WHO FCTC protocol on Illicit Trade of tobacco is ratified and implemented Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. To advocate for ratifying the WHO  National NCD committee  Status of Ongoing Planned FCTC protocol on Illicit Trade of  Tobacco control committee ratification of Tobacco.  Antismoking group protocols. 19

3.4 Scaling up graphic health warnings and to consider plain packaging

3.4 KPI: The graphic health warnings about tobacco is scaled up and plain packaging is implemented Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Advocate for the  Tobacco control  Size of graphic health warning ongoing Planned implementation of plain committee covering at least 50% of the packaging.  National NCD front side of the package. committee 2. Implement graphic  Availability of graphic health ongoing Planned health warnings on all  Antismoking warnings on all tobacco tobacco products. group products.

3.5 Scale up school and adolescent interventions for smoking prevention

3.5 KPI: School and adolescent quit smoking and smoking prevention campaigns are available. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Develop  National NCD  No. of school based preventive programs / ongoing ongoing ongoing ongoing ongoing ongoing ongoing smoking committee campaigns for tobacco cessation prevention plans  Tobacco control  Availability of tobacco-use prevention education in schools. committee in schools and universities curricula.  School health  % of tobacco consumption among adolescents 2.Implement section 13-15 years old* ongoing ongoing ongoing ongoing ongoing ongoing ongoing tobacco control  Antismoking plans in schools group *To be repeated every 3-5 years. 20

3.6 Develop Bahrain nutrition strategy

3.6 KPI: Bahrain nutrition strategy is developed and implemented Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Review and update  National NCD  Percentage of goal Done Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing the implementation committee achievement in each section ongoing and monitoring of  NCD unit team of the national nutritional the evidence based  Nutrition section strategy. national nutritional  All KPIs as mentioned in the strategy and below sections : nutritional guidelines. *Salt *trans-fat *sugary sweetened beverages. *TV and Radio advertisements.  25% reduction of obesity in Bahraini adults and adolescents: 30% Adults Adults : 24% 2018 40 % Adolescent Adolescents : 24% 2018 32%

3.7 Develop gradual salt reduction in food products

3.7 KPI: A plan for gradual salt reduction in food products is in place and implemented Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 21 1. Implement the action  NCD national  Percentage of salt reduction in Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing plan of salt reduction. committee traditional and automatic  NCD unit team bakeries local and imported.  Nutrition section  Percentage of compliance of the traditional and automatic bakeries to the ministerial decree. 2. Conduct workshops  Numbers of workshops per year Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing to support the to the professions and bakeries implementation. worker.  Percentage in reduction of salt 3. Develop and monitor imported. the implementation indicators.

3.8 Apply taxes on sugary sweetened beverages

3.8 KPI: Taxes on sugary sweetened beverages are imposed Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Monitor the  Nutrition section  Implementing of taxation Ongoing Ongoing Ongoing Ongoing Ongoing Ongoin Ongoing Implementation of  NCD national committee on the energy drink and g the action plan of  NCD unit team carbonated beverages. sugary sweetened  Implementing legislation beverages to cover sugary reduction. sweetened beverages.  Percentage of Bahrain restaurants implementing (foods labeling menu).  Percentage of implementing beverages and food items (in front food label). 22

3.9 Implement national strategy on trans-fat reduction/elimination in food industry

3.9 KPI: The national strategy on trans-fat reduction/elimination in food industry is implemented. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Monitor the  Nutrition  Published the national guidance for Implemented ongoing ongoing ongoing ongoing ongoing ongoing Implementation of section reducing trans-fat content in in 2017 and the action plan of  NCD national restaurants, processed food). ongoing trans-fat reduction. committee  Released of legislation about control  NCD unit team the using of trans and saturated fat.  % of restaurants implements the guideline of fat reduction.  % of food industries implements the guideline of fat reduction.  % in reduction of trans-fat imported calculated from information and e- government authority.

3.10 Ensure legislative actions on all media sectors that advertise for unhealthy food and drink products

3.10 KPI: Legislations are in place on TV and Radio advertisement of unhealthy food and drink products Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Develop action  Nutrition section  Evidence based action plan on marketing is plan to control  NCD national developed. marketing. committee  % of inappropriate unhealthy food marketing  NCD unit team through common media channel.  % of healthy food marketing in media.  % of consumption of healthy and unhealthy food.

3.11 Integration of physical activities and sport in schools, work places, social centers, etc. 23

3.11 KPI: physical activities and sport in schools, work places, social centers, etc. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Advocate for physical activities and  NCD national  Number of available Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing sport in schools, work places, social committee Programs on physical centers, etc.  NCD unit team activity in schools, 2. Develop and implement a plan for  School health work places, social Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing physical activities and sport in schools,  Health centers, etc. work places, social centers, etc. promotion 3. Conduct workshops to support the  No. of conducted Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing implementation workshops 4. Develop and monitor the indicators to  Available indicators Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing assess the implementation for implementation of programs.

3.12 Expand and multiply healthy settings projects (healthy cities, healthy malls, etc.);

3.12 KPI: healthy settings projects are available Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Advocate healthy settings  NCD national  Healthy cities initiatives are adopted. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing projects committee  No of Healthy malls 2. Develop and implement a  NCD unit  Availability of healthy settings projects (e.g. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing plan for healthy settings team Protect your Heart Campaign, healthy projects  School health Workplace project) 3. Conduct workshops to  Health  No of schools which adopted the healthy Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing support the promotion promoting schools program. implementation  Availability of indicators for 4. Develop and monitor the implementation of healthy settings Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing indicators to assess the projects. implementation  No. of conducted workshops in this topic.

3.13 Accelerate physical activity and sports promotion through media. 24

3.13 KPI: Physical activity and sports promotion is accelerated through media. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Collaborate to conduct  NCD national committee  Plan is developed for Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing physical activity and sports  NCD unit team promoting physical promotion programs in the  School health activity and sports in media with assigned  Health promotion media sectors 2. Develop and implement a plan of Physical activity and sports promotion in the media.

3.14 Integrate healthy environment into planning

3.14 KPI: Healthy environment is integrated in planning Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Identify the environmental  National NCD committee  Assessment studies about risk factors related to NCD  NCD unit team environmental health impact in Bahrain  Environmental health for some developmental projects are conducted.  Availability of implemented 2. To develop and Implement initiatives of environmental environmental health health programs such as: programs in the planning. EMW, Recycling, Plastic, Waste management, Air pollution control programs and Water pollution prevention program (implementing the national water strategy plan). 25

3.15 Influencing the consumers' consumption habits towards more sustainable options by involving the community, civil societies, media and other stakeholders

3.15 KPI: Involving the community, civil societies, media and other stakeholders in influencing the consumers' consumption habits towards more sustainable options Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. To involve the community,  NCD national committee  No. of targeted campaigns and civil societies, media and  NCD unit team programs to change habits other stakeholders in  School health and lifestyle toward influencing the consumers'  Health promotion sustainable options. consumption habits towards more sustainable options. 26 4. Strategic Objective To strengthen and orient health systems to address the prevention and control of NCDs and the underlying social determinants through people-centered primary health care and universal health coverage. Goals Indicators

4.1 Integrate NCD interventions into the essential PHC package 1. Guidelines/protocols for management of common NCDs in primary health care are available3 and updated every four years. 2. NCD management guidelines have been incorporated into health professional education and/or continuing medical education.

4.2 Prioritize cost-effective interventions for early detection and Cost effective intervention for early detection and treatment treatment; based on WHO recommendations. are selected within priority.

4.3 Improve access to safe, affordable and quality essential medicines and NCD medicines are included in the national essential technologies for common NCDs. medicine list, based on WHO’s essential medicine list

4.4 Improve access to essential palliative care services. 1. NCD medicines are provided regularly in primary health care 2. Guidelines for use of opiate-based analgesics for palliative care are available

4.5 Explore viable health financing mechanisms, and innovative financing Fees on tobacco and alcohol are imposed to provide the approaches like tobacco and alcohol taxation to generate resources to necessary resources to expand health coverage. expand health coverage. Key definitions: 3 Guidelines/protocols for the management of common NCDs: presence of government approved evidence-based national guidelines/ protocols/standards for the management of the 4 main NCDs. 27 Implementation strategies

4.1 Support national efforts on cancer prevention and control and empower early detection/diagnosis of cancer

4.1 KPI: National cancer prevention and control plan is developed Assigned Action/ process KPI 2019 2020 2021 2022 2023 2024 2025 section 1. To update a  National NCD  A comprehensive national cancer  guideline is guideline is comprehensive committee prevention and control plan is developed, developed updated national cancer  National updated and approved. 2016 every 4 prevention and cancer  A comprehensive national cancer registry  Cancer years. control plan. prevention has been developed. registry is and control established 2. To monitor the committee  A national cancer guideline has been Ongoing ongoing ongoing ongoing ongoing ongoing ongoing implementation of  NCD unit updated and approved. cancer early team  The cancer early detection guidelines are detection  King Hamad implemented and outcome indicators are guidelines within University measured primary and Hospital secondary health care. 3. To assign focal  Focal point is assigned for early detection Ongoing ongoing ongoing ongoing ongoing ongoing ongoing point in primary and cancer in primary and secondary and secondary health care. health care for early detection and cancer program. 4. Collaborate with  Collaboration is established with Ongoing ongoing ongoing ongoing ongoing ongoing ongoing concerned concerned partners for prevention and partners for early detection of most common cancers . prevention and early detection of most common 28 cancers

4.2 The Breast Screening program is in line with WHO recommendations

4.2 KPI: Early breast cancer detection and diagnosis is established and in line with WHO recommendation in terms of screening test and population age range. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Update Breast cancer early detection  National NCD  A national guideline is guideline is updated guideline committee. comprehensive developed 2016 every 4 years 2. Monitor the implementation of Breast  National cancer Breast screening cancer early detection program in prevention program is in Primary and Secondary Health care  and control place 3. Monitor breast cancer early committee  Detection rate of detection, diagnosis and management  NCD unit team breast cancer is indicators in Health care.  King’s Hamad calculated. University Hospital

4.3 Early CVD diagnosis approaches

4.3 KPI: Early CVD diagnosis programs are developed and implemented Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Identify CVD risk factors  NCD unit team  Number of Community Health campaigns Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing in the community from  Primary health  Number of Workplace health campaign the health campaigns care  Screening 10% of governmental employee (work place) and  Secondary every 4 years healthcare systems. health care  Percentage of participants who completed the 29  Health sessions in the campaign promotion  Detection rate among the participants in the  National campaign health surveys  Percentage of participants who completed the  Cardiac Center sessions in the campaign and been referred for further follow up 2. Track CVD risk factors and  Management indicators of NCDs in the health Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing management indicators services. from the health systems and surveys.

4.4 Scaling up cardiovascular risk stratification and management

4.4 KPI: CVD morbidity and mortality rates are reduced Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Ensure CVD preventive  National NCD  CVD preventive services are in place. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing services are in place in committee. primary, secondary and  NCD unit team. tertiary levels of health  Primary health care. services.  Secondary health care. 2. Ensure the CVD risk  Health promotion.  CVD risk is estimated and assessed. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing estimation.  National health surveys.  CVD prevention outcome indicators  Cardiac Center are measured 3. Monitor CVD morbidity  CVD morbidity and mortality rates Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing and mortality. are calculated.

4.5 Develop interventions and referral for pre-diabetic patients

4.5 KPI: Comprehensive referral system for pre-diabetic is in place Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 30 1. Monitor a specific  National NCD committee.  percentage of pre- diabetic Ongoing OngoingOngoing Ongoing Ongoing Ongoing Ongoing management protocol for  NCD unit team. patients referred for follow patients with pre-diabetes.  Primary health care. up and managed as per  Secondary health care. guidelines.  Health promotion.

4.6 Incorporating mental health for NCD patients

4.6 KPI: Availability of mental health services for NCD patients in PHC and Secondary health care Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Update/develop mental health  National NCD  Mental health guideline is in Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing guideline in PHC for patients with NCD committee place and recently updated 2. Integrate the mental health services in  Primary Health for primary healthcare. Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing NCD clinics in PHC  Mental health services are Care 3. Develop mental health management integrated within PHC for all Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing  NCD unit team patients in general. indicators for patients with NCDs 4. Monitor mental health service  Psychiatrists  NCD clinics mental health Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing indicators in primary and secondary within primary mini questionnaire is health care healthcare incorporate in mental health.  Mental health management indicators for primary healthcare patients in general are in place.  Monitoring for primary health care patients through ISEHA and patient questionnaire (HADS scale) is applied.

4.7 Incorporating smoking cessation services in primary care

4.7 KPI: Number of primary healthcare regions covered by smoking cessation services Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 31 1. Ensure that Smoking  The national  Availability of one smoking  Smoking cessation Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing cessation guidelines are Antismoking cessation clinic in each statistics ae in place and committee governorate. established and implemented in PHC.  Antismoking Group  Percentage of Smoking ongoing cessation guidelines in place and implemented 2. Developing training  Availability of Free nicotine  To establish Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing program on brief replacement therapy training for PHC interventions of  Percentage of trained doctors in Doctors (training smoking cessation for primary health care doctors on already PHC doctors brief interventions of smoking established and cessation ongoing) 32 33 5. Strategic Objective To promote and support national capacity for high-quality research and development for the prevention and control of NCDs. Goals Indicators

5.1 Scale up NCD related research by academia through provision of grant funding and international recognition of academic achievements.

5.2 Make more effective use of academic institutions and multidisciplinary agencies to promote research, retain research workforce, incentivize innovation and encourage the establishment of national reference centers.

5.3 Develop, implement and monitor national research policy and plans in collaboration The availability of research policy with academic and research institutions. with an implementation plan and indicators

5.4 Increase investment in research, innovation and development and its governance as The availability of NCD research an integral part of the national response to NCDs; allocate budgets to promote relevant budget plan research to fill gaps around the interventions.

5.5 Strengthen national institutional capacity for research, and the competence of The availability of NCD research researchers to conduct quality research. training plan

5.6 Strengthen the evidence-based decision making through NCD-related research.

5.7 Track the domestic and international resource flows for research and national research output for the prevention and control of NCDs. 34 Implementation strategies

5.1 Increase investment in NCDs and risk factors research, innovation and development.

5.1 KPI: A proper budgeting system is proposed in order to cover research expenses and help implement useful projects and research. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Prepare a list of the available  National NCD committee  A list of the available In process stakeholders and funding companies  MOH Research committee stakeholders and that are willing to support research  NCD unit team funding companies is projects financially. prepared. 2. Facilitate proper usage of the  Proper usage of the budget assigned for research budget assigned for expenses and help implement useful research expenses. projects and research.  useful projects and research are implemented.

5.2 Develop, implement and monitor national NCD research policy and plans

5.2 KPI: NCD related topics that lack research or need further exploration and update are identified. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Develop national NCD  MOH research committee  Approved NCD research Ongoing research policy and plan.  National NCD committee policy plan.  NCD unit team  National NCD researches are in progress. 35

5.3 Strengthen national institutional capacity and competence for research (Make more effective use of academic institutions and multidisciplinary agencies to promote research, retain research workforce, incentivize innovation and encourage the establishment of national reference centers).

5.3 KPI: NCD data, trained personnel and training are in place Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Encourage establishing a  National NCD  NCD-related research areas are Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing national reference center. committee identified.  MOH Research  List of all NCD related research is committee conducted previously is developed. 2. Utilize the available evidence  NCD unit team  Availability of access to evidence-based Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing based access for researches. data. 3. Identify the available  Availability of training program to help Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing resources and utilize them conducting a quality research. for research.

5.4 Track the national and international resource flows for research and national research output for prevention and control of NCDs

5.4 KPI: Contact domestic and international health care institutes, universities and research institutions to explore their progress in research. Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Identify national and international  National NCD  Percentage of domestic and planned health care institutes, universities committee international health care and research institutions.  MOH Research institutes identified. 2. Collaborate with domestic and  committee  Percentage of domestic and international health care  NCD unit team international healthcare institutes, universities and institutes that have been research institutions to explore contacted. research flow and output in  Percentage of response from the controlling and preventing NCDs. previously contacted institutes. 36 6. Strategic Objective To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control. Goals Indicators

6.1 Implement/strengthen the WHO NCD surveillance 1. A system for generating mortality by cause of death is in place and framework that monitors exposures (risk factors), outcomes being used on a regular basis. (morbidity and mortality), and health system capacity and 2. Cause-specific NCD mortality among the age group of 30–70 years is reported 4. response (interventions). 3. A functioning population-based cancer registry is in place, with a published report within the past 5 years

6.2 Develop national targets and indicators based on WHO A set of national targets and indicators abased on WHO guidance are guidance. place

6.3 Integrate surveillance and monitoring schemes for NCD The below surveys have been conducted within the past 5 years: into national health information systems. 1. STEPS survey for NCDs and risk factors 2. Global Youth Tobacco Survey

6.4 Develop clear indicators to measure the engagement of A set of national indicators to measure the engagements of non-health non-health sectors. sectors are in place. Key definitions: 4 Cause-specific NCD mortality among age group 30–70: Country reporting mortality of the 4 main NCDs by age group. 37 Implementation strategies

6.1 Align national NCD–related targets and indicators with the emerging global and regional commitments in the area of sustainable development

6.1 KPI: National NCD–related targets and indicators are in place and are aligned with the SDGs Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Develop a set of national indicators  National NCD committee  National NCD – Started OngoingOngoing Ongoing Ongoing Ongoing Ongoing for prevention and control of  NCD Unit team related targets and 2013 and individual NCDs and associated risk indicators are in ongoing  World health Organization factors. place update as  Planning and Information  National NCD – per the Directorate related targets and SDGs 2. Align the indicators with the  Salmaniya Medical Complex indicators are Ongoing OngoingOngoing Ongoing Ongoing Ongoing Ongoing regional, global and SDG set of  Primary Health Care calculated indicators.  Nutrition section  Calculated national 3. Ensure that the numerators and NCD –related targets Ongoing OngoingOngoing Ongoing Ongoing Ongoing Ongoing  School health denominators for the set of and indicators are indicators are being included in the  Health Promotion reported electronic file and surveys and are Directorate measured on regular basis at least  Antismoking and Tobacco annually. Group or Tobacco control 4. Ensure that the annual indicators group Ongoing OngoingOngoing Ongoing Ongoing Ongoing Ongoing undergo proper calculation,  Cancer registry team improvement and are reported. 38

6.2 Expand achievements of the integrated healthcare system I-SEHA,

6.2 KPI: The electronic health file is fully implemented Action/ process Assigned section KPI 2019 2020 2021 2022 2023 2024 2025 1. Develop an electronic health  National NCD committee  Fully implemented electronic Started Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing file.  NCD Unit team health file. 2013 and  World health ongoing Organization annually 2. Ensure that the numerators  Planning and Information  The numerators and Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing and denominators for the set denominators for the set of NCD Directorate of NCD prevention and prevention and control national control national indicators  Salmaniya Medical indicators are being included in are being included in the Complex the electronic file and are electronic file and are  Primary Health Care measurable on regular basis. measurable on regular basis  Nutrition section at least annually.  School health 3. Work with the partners to  Health Promotion  The national electronic file BI is Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing improve the national improved. Directorate electronic file.  Antismoking and 4. Develop a more  A comprehensive national NCD Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing comprehensive national NCD Tobacco Group or registry is developed. registry (electronic file).  Tobacco control group  Cancer registry team 39