Action plan for the prevention and control of noncommunicable diseases in South-East Asia, 2013–2020

SEA-NCD-89 Noncommunicable diseases (NCDs) are the leading cause of death globally as well as in the South-East Asia Region. The Global Action Plan (GAP) for the prevention and control of NCDs 2013–2020, including a comprehensive monitoring framework with 25 indicators and 9 voluntary global targets, was endorsed by the Sixty-sixth World Health Assembly in May 2013. The Regional Action Plan for the prevention and control of NCDs in the WHO South-East Asia Region 2013–2020, based on GAP, provides a roadmap for action at the regional and national level to develop and implement policies and programmes to reduce the burden of NCDs within the socioeconomic, cultural, political and health system contexts of Member States. The Seventy-fourth session of the Regional Committee for South-East Asia extended the Regional Action Plan to 2030. The Regional Action Plan lists priority actions for Member States and WHO in four strategic action areas, namely: (i) advocacy, partnerships and leadership; (ii) health promotion and risk reduction; (iii) health systems strengthening for early detection and management of NCDs and their risk factors; and (iv) surveillance, monitoring and evaluation, and research. While these actions will be executed until 2030, implementation of these priority actions should lead to a reduction in overall mortality from major NCDs as well as the achievement of the regional voluntary targets. In addition, the Regional Implementation Roadmap for the prevention and control of NCDs 2022–2030 will also incorporate the targets set for 2030 as part of the Sustainable Development Agenda. Action plan for the prevention and control of noncommunicable diseases in South-East Asia, 2013–2020 EXTEN DED TO 20 30

Action plan for the prevention and control of noncommunicable diseases in South-East Asia, 2013–2020 SEA-NCD-89 Distribution: General Addendum The tenure of the Regional Action Plan for the prevention and control of NCDs in the WHO South-East Asia Region 2013–2020 was extended to 2030 by the Seventy- fourth session of the WHO Regional Committee, vide Decision SEA/RC74(2). The Regional Implementation Roadmap for the prevention and control of NCDs 2022–2030 will now also incorporate the targets set for 2030 as part of the Sustainable Development Agenda. Action plan for the prevention and control of noncommunicable diseases in South-East Asia © World Health Organization 2022 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc- sa/3.0/igo). 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Action plan for the prevention and control of noncommunicable diseases in South-East Asia iii Contents Section 1. Situation analysis ......................................................................1 1.1 Regional burden of noncommunicable diseases ................1 1.2 Determinants and risk factors for NCDs ............................2 1.3 Global initiatives ...............................................................5 1.4 Regional initiatives ............................................................6 1.5 Progress and challenges in prevention and control of NCDs in the South-East Asia Region ...................8 Section 2. Action plan for the prevention and control of NCDs in South-East Asia, 2013–2020 ..................................................... 10 2.1 Purpose ..........................................................................10 2.2 Vision .............................................................................11 2.3 Goal ...............................................................................11 2.4 Targets ............................................................................11 2.5 Guiding principles ..........................................................12 2.6 Strategic Priority action areas ..........................................13 References ...............................................................................................46

Action plan for the prevention and control of noncommunicable diseases in South-East Asia 1 Section 1. Situation analysis 1.1 Regional burden of noncommunicable diseases Noncommunicable diseases (NCDs) are the leading cause of death in the WHO South-East Asia Region. Each year, an estimated 7.9 million lives are lost due to NCDs, accounting for 55% of all deaths1. Furhermore, NCDs claim lives at a younger age in the South-East Asia Region compared to the other WHO regions. In 2008, the proportion of NCD deaths occurring among people under the age of 60 was 34%, compared to 23% in the rest of the world. Cardiovascular diseases are the most frequent cause of NCD deaths, followed by chronic respiratory diseases, cancers, and diabetes (Figure 1). In addition to the four main NCDs, many other chronic conditions and diseases contribute significantly to the NCD burden in the Region, such as renal, endocrinal, mental, neurological, haematological, gastroenterological, hepatic, musculoskeletal, skin and genetic disorders, as well as oral diseases including dental caries, periodontal diseases and oral cancers. Thalassaemia is also a serious health problem in some Member States, especially in the Maldives where approximately 18% of the population carries the Beta thalassaemia trait. Besides being an enormous health burden, NCDs have serious socioeconomic implications. They disproportionately affect the poor, leading to loss of household income from unhealthy behaviours, poor physical capacity and loss of wages. Due to long-term treatment costs and high out-of-pocket costs, NCDs can result in catastrophic health expenditures and impoverishment. In India, the share of out-of-pocket expenditure due to NCDs increased from 32% in 1995 to 47% in 2004; of this NCD-related expenditure, 40% was financed by Action plan for the prevention and control of noncommunicable diseases in South-East Asia2 household borrowing and sale of assets.2 In additional to exacerbating household poverty, NCDs and their risk factors exact a huge toll on national economies. In Thailand, for example, the economic burden of the harmful use of alcohol was estimated to be equivalent to 2% of the gross domestic product in 2006.3 1.2 Determinants and risk factors for NCDs The increasing burden of NCDs is attributed to determinants such as population ageing, rapid and unplanned urbanization, negative effects of globalization (such as trade and irresponsible marketing of unhealthy products), low literacy, and poverty (Figure 2). From 2000 to 2025, it is projected that the proportion of the population aged above 65 years will increase from 3.6% to 6.6% in Bangladesh, from 4.4% to 7.7% in India and from 6.3% to 12.3% in Sri Lanka. As the prevalence of NCDs increases with age, these progressively aging populations will result in a corresponding increase in NCD cases. Urbanization in the South-East Asia Region is occurring at a rapid rate and increased from 26% in 1990 to 33% in 2009. It is projected that the percentage of populations residing in urban areas will more than double by 2050 in most Member States. Several studies in the Region show that behavioural, Figure 1: Estimated proportion of deaths by cause, South-East Asia Region, 2008 Cardiovascular diseases 25% Chronic respiratory diseases/asthma 10% Cancers 8% Diabetes 2%Other NCDs 10% Communicable diseases, maternal, perinatal and nutritional conditions 35% Injuries 11% Source: WHO Global Health Observatory 2011. Action plan for the prevention and control of noncommunicable diseases in South-East Asia 33 anthropometric and biochemical risk factors for NCDs are more prevalent in urban than rural areas. Unplanned urbanization reduces options for physical activity and increases exposure to air pollution. Globalization has brought processed foods and diets high in total energy, fats, salt and sugar into millions of homes. Nearly 30% of the Region’s population remains non-literate. Low levels of literacy affect health behaviours and lifestyle choices. Poor levels of awareness can also result in high consumption of salt, as well as saturated fats and trans fats, and thus aggravate development of NCDs. Studies in Bangladesh, India, Indonesia, Sri Lanka and Thailand have revealed that both smoking and smokeless tobacco use are more prevalent among the less educated. Globalization and underlying social determinants are driving unhealthy lifestyle behaviours. Four modifiable lifestyle-related risk behaviours, namely tobacco use, unhealthy diet, insufficient physical activity and harmful use of alcohol, are responsible for the majority of NCDs. The prevalence of these unhealthy risk behaviours is very high in the Region. Tobacco use is responsible for at least one million deaths each year. There are nearly 250 million smokers and an equal number of smokeless tobacco Figure 2: Determinants of NCDs NCDs M et ab ol ic/ ph ys io lo gi ca l ris k fa ct or s Be ha vi ou ra l ris k fa ct or s Un de rly in g dr iv er s Raised blood pressure Overweight/obesity Raised blood glucose Raised lipids Tobacco use Unhealthy diet Physical inactivity Harmful use of alcohol Social determinants of health Globalization Urbanization Population ageing Action plan for the prevention and control of noncommunicable diseases in South-East Asia4 users, who often use tobacco together with other carcinogenic substances (such as betel nut); 90% of the world’s smokeless tobacco users live in the South-East Asia Region. In some Member States, the prevalence of smoking among males is above 60%, making it the number one public health problem in the Region. Unhealthy diets are very common. Approximately 80% of the population does not consume the recommended five portions of fruits and vegetables a day. The mean intake of salt per day varies from 8 g to 13 g/day, much higher than the recommended levels of <5 g/day. There is a wide variability in the prevalence of physical inactivity ranging from 3% to 41% in males and 6.6% to 64% in females. Annually, an estimated 800 000 deaths in the Region are attributed to inadequate physical activity. Harmful use of alcohol claims an estimated 350 000 lives each year in the Region. The prevalence of alcohol consumption varies from 2% to 44% in males and 0.1% to 26% in females. The harm from alcohol use extends far beyond medical conditions to social, psychological and economic problems as well as injuries and violence. The four behavioural risk factors described above lead to four metabolic risk factors, namely overweight/obesity, high blood pressure, raised blood sugar and raised blood lipids. These four metabolic risk factors are highly prevalent in the Region. The prevalence of overweight varies from 8% to 30% among males and from 8% to 52% among females. Childhood obesity is an emerging issue of increasing relevance, particularly in urban areas. Approximately a third of the adult population has hypertension, the principal risk factor for heart attack and stroke. In 2010, the prevalence of raised blood sugar in adults aged ≥25 years ranged from 6.6% to 12.2%. The prevalence of raised cholesterol in the adult population is as high as 50% in some Member States. Clustering of more than one risk factor is found in a significant proportion of individuals. Infections and environmental factors also increase the risk of NCDs. Infections may be responsible for a fifth of cancers in developing countries. For example, human papillomavirus is responsible for the leading cause of cancer among women – cancer of the cervix – and for an increasing number of oral cancers in men and women; hepatitis B virus and hepatitis C virus cause hepatocellular carcinoma; and Helicobacter pylori causes cancer of the stomach. Household air pollution due to solid fuel combustion is an important risk factor for chronic respiratory diseases. In the South-East Asia Region, the proportion of households using solid fuel in 2010 was 61% (range 8–92%). Important environmental and occupational risk factors for NCDs include exposure to asbestos, diesel exhaust gases and ionizing and ultraviolet radiation, indiscriminate use of agrochemicals in agriculture and discharge of toxic products from unregulated chemical industries. Action plan for the prevention and control of noncommunicable diseases in South-East Asia 5 1.3 Global initiatives Global initiatives to address NCDs began in the year 2000, with the adoption of the World Health Assembly resolution WHA53.17, endorsing the global strategy for the prevention and control of NCDs, with a particular focus on developing countries. The strategy rests on three pillars: (i) surveillance; (ii) primary prevention, and; (iii) strengthened health care. Since 2000, the World Health Assembly has adopted several other resolutions in support of specific tools for the global strategy, including the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2003 (WHA56.1), the Global Strategy on Diet, Physical Activity and Health in 2004 (WHA57.17), and the Global Strategy to Reduce the Harmful Use of Alcohol in 2010 (WHA63.13). In 2008, the Health Assembly endorsed the 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases, with a particular focus on developing countries. To draw the attention of global leaders to the rising crisis of NCDs, the United Nations (UN) General Assembly convened a High-level Meeting on the Prevention and Control of Non-communicable Diseases in September 2011. It was only the second time in history that the General Assembly met with the participation of Heads of States and governments on a health issue. The main outcome of the meeting was the adoption of the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases,4 which acknowledges the rapidly growing magnitude of NCDs in developing countries and its increasingly devastating health and socioeconomic impact, and calls for concrete and comprehensive actions by Member States and the international community. As a follow-up to the Political Declaration of the High-level Meeting, WHO led a consultative process in developing a global action plan for prevention and control of NCDs 2013–2020, including a comprehensive monitoring framework with 25 indicators and 9 voluntary global targets. The Sixty-sixth World Health Assembly in May 2013 endorsed the global action plan, including indicators and voluntary targets, through resolution WHA66.10.5 The resolution urges Member States to implement the global action plan and consider the development of national NCD monitoring frameworks, with targets and indicators based on national situations, taking into account the global monitoring framework; and to establish and strengthen a national surveillance and reporting system to enable reporting against the 25 indicators and 9 voluntary global targets. Action plan for the prevention and control of noncommunicable diseases in South-East Asia6 1.4 Regional initiatives Parallel to the global NCD movement, several important activities have been undertaken at the regional level. The South-East Asia Regional Network for Prevention and Control of Noncommunicable Diseases (SEANET-NCD) was created in November 2005 to strengthen partnerships and regional cooperation among Member States for implementing policies and programmes for NCDs. Five meetings of the SEANET-NCD have taken place, with participation of multiple stakeholders from the government, academia, WHO collaborating centres, and nongovernmental organizations (NGOs). These meetings facilitated exchange of information, sensitized stakeholders about new guidelines and tools, and advocated for acceleration of global policies and strategies such as the WHO FCTC, the Global Strategy for Reducing Harmful Use of Alcohol and the Global Strategy for Diet and Physical Activity for Health. High-level advocacy has been carried out for prevention and control of NCDs through various forums including the Twenty-ninth Meeting of the Health Ministers, and the Sixtieth, Sixty-third and Sixty-fifth sessions of the Regional Committee for South-East Asia. These high-level meetings resulted in adoption of important decisions and resolutions related to NCDs, which form the basis for continued advocacy as well as a framework for future actions. To develop culturally appropriate salt reduction strategies, an expert group meeting was convened in New Delhi, India in December 2012. The meeting concluded that reducing population salt intake is a high priority, cost-effective intervention for Member States of the Region in the context of prevention and control of hypertension, cardiovascular disease and other NCDs. It was also reaffirmed that a salt reduction strategy is compatible with efforts to iodize salt and called for increased collaboration between salt reduction programmes and salt iodization programmes to increase efficiency and public health gains. In June 2013, a technical working group (TWG) meeting on the regional action plan and regional targets was organized in Bangkok, Thailand. The TWG recommended 10 regional targets and a set of priority actions for prevention and control of NCDs. To develop capacity for research, a regional workshop was conducted in Kandy, Sri Lanka in August 2012. The workshop resulted in prioritization of a regional research agenda and initiation of research protocols on key priorities. Recognizing the enormous burden of oral diseases, and considering the common risk factors responsible for NCDs and oral diseases, the integration of oral diseases into the NCD context is an important priority area. A regional oral Action plan for the prevention and control of noncommunicable diseases in South-East Asia 7 health strategy has been developed that calls attention to five priority areas: (i) integrating oral diseases and NCDs; (ii) addressing oral cancer; (iii) promoting oral health through fluorides; (iv) increasing and diversifying the oral health workforce; (v) and, oral health through school health. Effective implementation of priority actions in the regional oral health strategy should also contribute to reducing other NCDs. Technical support is being provided to Member States in three main areas of work. (i) In the area of surveillance, regional capacity was built through a training workshop on the WHO STEPwise approach to Surveillance (STEPS) in June 2012 in New Delhi, India. National implementation of STEPS surveys has been supported in several countries, particularly for developing protocols, training, data analyses and report writing. During 2007–2009, WHO supported seven Member States to conduct school-based student health surveys to collect data on NCD risk factors from adolescents. (ii) Technical assistance is being provided to Member States for developing national multisectoral policies, strategies and action plans. The national action plans should serve as a blueprint for Member States to focus on key priorities and actions related to NCD prevention and control. The national action plans should also help in assessing resource needs and mobilizing the necessary resources from domestic and international sources. (iii) Technical and financial support has been provided to several Member States to introduce the WHO Package of Essential Noncommunicable Disease Interventions (WHO PEN) into the primary health care system. Five countries are at various stages of PEN implementation, namely Bhutan, Indonesia, the Democratic People’s Republic of Korea, Myanmar and Sri Lanka. In Bhutan, WHO provided technical support for assessing the impact of the PEN pilot project in two districts. This evaluation indicates that implementation of PEN resulted in a reduction of cardiovascular risk among patients attending health clinics in the pilot project areas. The future thrust of WHO’s regional work will be: • to support Member States in developing or strengthening national multisectoral action plans; • scaling-up of cost-effective interventions for NCD prevention and control; Action plan for the prevention and control of noncommunicable diseases in South-East Asia8 • documenting best practices in the Region; • facilitating information exchange; • assisting in resource mobilization. 1.5 Progress and challenges in prevention and control of NCDs in the South-East Asia Region NCDs have been recognized as a public health priority in all Member States of the South-East Asia Region. There is high commitment for prevention and control of NCDs. The Government of Sri Lanka, for example, declared 2013 as the “Year for Prevention and Control of Noncommunicable Diseases”. Increased domestic budget allocations for NCDs have been announced in some countries. The health ministries are taking a leadership role in coordinating prevention and control activities. All 11 Member States have a designated unit for prevention and control of NCDs at the central level. In most countries, the central NCD unit is staffed by at least one full-time staff to manage the programme. Eight Member States report having a national policy or strategy for prevention and control of NCDs; however, operational multisectoral mechanisms to coordinate actions are available in less than half of these countries. Guidelines for management of NCDs or risk factors are available in all Member States. The WHO FCTC has been ratified by all except one Member State. Exemplary legislative actions in the Region towards tobacco control include pictorial warnings to cover 85% of the front and back of the cigarette packets in Thailand and Sri Lanka. Innovative financing through “excise tax” on tobacco and alcohol has yielded funds and at the same time promoted public health. Continued progress is being made towards strengthening NCD surveillance and monitoring systems. At least one national or subnational survey (WHO STEPS or equivalent) has been completed in 10 of the 11 Member States to assess prevalence of behavioural and metabolic risk factors. Global Adult Tobacco Surveys (GATS) have been conducted in 4 countries and Global Youth Tobacco Surveys (GYTS) have been conducted in 10 countries. One round of school-based multi-risk factor surveys have been conducted in seven countries. Thus, data on NCD risk factors are available in almost all Member States. NCD morbidity data are collected through the routine health information system. In addition, disease-specific registries have been established, most commonly for cancers (although not all cancer types are necessarily recorded), followed by diabetes and stroke. However, most mortality/morbidity data and disease- specific registries are hospital-based. Action plan for the prevention and control of noncommunicable diseases in South-East Asia 9 All Member States are providing one or more NCD-related services at the primary care level in public health facilities. This includes primary prevention and health promotion (11 Member States), early diagnosis of NCD risk factors (9 Member States), and risk factor and disease management (10 Member States). However, programmes for self-care and home-based care are missing in most countries. All Member States have an essential drugs list and many of the NCD-related drugs are included. Essential drugs to treat metabolic risk factors of NCDs are generally available in the public health systems, but not always at the primary health care level. Despite this significant progress, important challenges need to be overcome to further scale-up and sustain an effective response to the NCD epidemic. • Partnerships among different development sectors need to be fully operationalized and sustained. • Data on overall mortality and disease-specific mortality is generally based on estimates, due to incomplete registration of deaths and limitations in reporting of cause of death. There is a need to invest in strengthening vital statistics systems and cause of death ascertainment (including through verbal autopsy). • NCD risk factor surveillance systems should be institutionalized and better integrated into the national health information systems. • Greater resource allocation is required for primary prevention and for strengthening the capacity of primary health care systems to address NCDs. • Health workers, particularly at the primary care level, need orientation and training in addressing NCDs and their risk factors. • Overall funding levels for NCD programmes are disproportionately lower than is required to scale-up programmes to result in the necessary health impacts. Innovative financing mechanisms, such as those used in Thailand, should be explored in other Member States for generating funds for NCD prevention and control. • Reducing the NCD burden will require moving beyond pilot projects to nationwide scaling-up of cost-effective interventions, with emphasis on population-based interventions. Focus should be put on reducing exposure to risk factors and early detection and treatment of “high-risk” groups through a strengthened primary health care system. Action plan for the prevention and control of noncommunicable diseases in South-East Asia10 Section 2. Action plan for the prevention and control of NCDs in South-East Asia, 2013–2020 2.1 Purpose The regional NCDs action plan is intended to provide a roadmap for regional and national actions for developing and implementing policies and programmes to reduce the burden of NCDs within the regional socioeconomic, cultural, political and health system contexts. The regional NCD action plan is consistent with the draft global action plan 2013–20206 and consolidates follow-up actions of the Political Declaration of the High-level Meeting on NCDs. While taking specific regional issues into account, it is coherent with the major global strategies for prevention and control of NCDs. Moreover, it provides a framework to support and strengthen the implementation of existing regional resolutions, strategies and plans as well as recommendations of the various regional consultations with Member States. The regional action plan also aims to inform relevant national and regional stakeholders, as well as international development partners and donors, about regional priorities for the prevention and control of NCDs. This should facilitate the provision of technical and financial support to Member States by partner agencies through alignment along common goals and targets. Successful implementation of the regional action plan requires high-level political commitment, sustainable resources and the concerted involvement of governments, communities and other stakeholders in society. Implementation Action plan for the prevention and control of noncommunicable diseases in South-East Asia 11 of the plan will be monitored through a set of indicators which are consistent with the global monitoring framework. Reports on progress in implementing the action plan and achieving regional targets will be submitted to the Regional Committee sessions in 2016, 2018 and 2021. 2.2 Vision For all people of the South-East Asia Region to enjoy the highest attainable status of health, well-being and quality of life at every age, free of preventable NCDs, avoidable disability and premature death. 2.3 Goal To reduce preventable morbidity, avoidable disability and premature mortality due to NCDs in the South-East Asia Region. 2.4 Targets It is aimed to achieve the following 10 targets in the Region by 2025. (i) A 25% relative reduction in overall mortality from cardiovascular diseases, cancers, diabetes, or chronic respiratory diseases (ii) A 10% relative reduction in the harmful use of alcohol (iii) A 30% relative reduction in prevalence of current tobacco use in persons aged over 15 years (iv) A 10% relative reduction in prevalence of insufficient physical activity (v) A 30% relative reduction in mean population intake of salt/sodium (vi) A 25% relative reduction in prevalence of raised blood pressure (vii) A Halt the rise in obesity and diabetes (viii) A 50% relative reduction in the proportion of households using solid fuels (wood, crop residue, dried dung, coal and charcoal) as the primary source of cooking (ix) A 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes (x) An 80% availability of affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities Action plan for the prevention and control of noncommunicable diseases in South-East Asia12 2.5 Guiding principles The regional action plan relies on the following overarching principles and approaches. Focus on equity: Policies and programmes should aim to reduce inequalities in NCD burden due to social determinants such as education, gender, socioeconomic status, ethnicity and migrant status. Multisectoral actions and multistakeholder involvement: To address NCDs and their underlying social determinants and risk factors, functioning alliances are needed within the health sector and with other sectors (such as agriculture, education, finance, information, sports, urban planning, trade, transport) involving multiple stakeholders including governments, civil society, academia, the private sector and international organizations. Life-course approach: A life-course approach is key to prevention and control of NCDs, starting with maternal health, including preconception, antenatal and postnatal care, and maternal nutrition; and continuing through proper infant feeding practices, including promotion of breastfeeding and health promotion for children, adolescents and youth; followed by promotion of a healthy working life, healthy ageing and care for people with NCDs in later life. Balance between population-based and individual approaches. A comprehensive prevention and control strategy needs to balance an approach aimed at reducing risk factor levels in the population as a whole with one directed at high-risk individuals. Empowerment of people and communities: People and communities should be empowered to promote their own health and be active partners in managing disease. Health systems strengthening: Revitalization and reorientation of health care services are required for health promotion, disease prevention, early detection and integrated care, particularly at the primary care level. Universal health coverage: All people, particularly the poor and vulnerable, should have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative, rehabilitative and palliative basic health services, as well as essential, safe, affordable, effective and quality medicines and diagnostics without exposing the users to financial hardship. Action plan for the prevention and control of noncommunicable diseases in South-East Asia 13 Evidence-based strategies: Policies and programmes should be developed based on scientific evidence and/or best practice, cost-effectiveness, affordability, and public health principles. Management of real, perceived or potential conflicts of interest: Public health policies for the prevention and control of NCDs should be protected from undue influence by any form of vested interest. Real, perceived or potential conflicts of interest must be acknowledged and managed. 2.6 Strategic Priority action areas To achieve the 10 regional targets, the priority activities for WHO and Member States are structured around four strategic action areas (Figure 3). Implementation of these strategic actions will lead to a reduction in overall mortality from the four main NCDs. All actions should be implemented, as far as possible, through close collaboration with other health programmes such as infectious diseases control, maternal and child health, immunization, school health and occupational health services. Strategic action area 1: Advocacy, partnerships and leadership. Actions under this area aim to increase advocacy, promote multisectoral partnerships and strengthen capacity for effective leadership to accelerate and scale-up the national response to the NCD epidemic. Effective implementation of these actions should result in increased political commitment and availability of sustainable resources, and in setting functional mechanisms for multisectoral actions and effective coordination by ministries of health. Strategic action area 2: Health promotion and risk reduction. Actions under this area aim to promote the development of population-wide interventions to reduce exposure to key risk factors. Effective implementation of these actions should lead to reduction in tobacco use; increased intake of fruits and vegetables; reduced consumption of saturated fat, salt and sugar; reduction in harmful use of alcohol; increase in physical activity; and reduction in household air pollution. Action plan for the prevention and control of noncommunicable diseases in South-East Asia14 Strategic action area 3: Health systems strengthening for early detection and management of NCDs and their risk factors. Actions under this area aim to strengthen health systems, particularly the primary health care system. Full implementation of actions in this area should lead to improved access to health-care services, increased competence of primary health care workers to address NCDs, and empowerment of communities and individuals for self-care. Strategic action area 4: Surveillance, monitoring and evaluation, and research. This area includes key actions for strengthening surveillance, monitoring and research. The desired outcome is to improve availability and use of data for evidence-based policy and programme development Figure 3: Strategic action areas for the prevention and control of NCDs Action area 2 Health promotion and risk reduction Action area 3 Health systems strengthening for early detection and management of NCDs Action area 1 Advocacy, partnerships, and leadership Action area 4 Surveillance, monitoring and evaluation and research Action plan for the prevention and control of noncommunicable diseases in South-East Asia 15 The following tables list priority actions for Member States and WHO in each of the four strategic action areas. Partners needed for implementing these priority actions are listed. Key indicators to track progress in implementation of the action plan are also provided. Member States are encouraged to adapt this framework according to national priorities and create a detailed national action plan with specific activities and budget. The national plans can serve as blueprints for action and also facilitate resource assessment and resource mobilization. Action plan for the prevention and control of noncommunicable diseases in South-East Asia16 St ra te gi c ac tio n ar ea 1 : A dv oc ac y, p ar tn er sh ip s, a nd le ad er sh ip 1. 1 Ad vo ca cy Pa rt ne rs : pa rli am en ta ria ns , go ve rn m en t ag en ci es i nc lu di ng m in ist rie s of h ea lth , fin an ce , tra de , ed uc at io n, j us tic e, ag ric ul tu re , s po rts , y ou th a ffa irs , i nf or m at io n, a nd lo ca l g ov er nm en t; U N a ge nc ie s, d ev el op m en t p ar tn er s, c iv il so ci et y, N G O s, m ed ia , p riv at e se ct or D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es N C D s pr io rit iz ed in th e na tio na l he al th a nd de ve lo pm en t ag en da • N C D s in cl ud ed in th e na tio na l h ea lth pl an o r n at io na l de ve lo pm en t ag en da , o r b ot h • C on tin ue to s tre ng th en ad vo ca cy to H ea ds o f S ta te , pa rli am en ta ria ns a nd p ol ic y- m ak er s to g iv e a hi gh p rio rit y to N C D s • Pr ov id e te ch ni ca l s up po rt to in te gr at e N C D s in to n at io na l he al th p la nn in g pr oc es se s, de ve lo pm en t a ge nd as a nd po ve rty -a lle vi at io n st ra te gi es • Su pp or t M em be r S ta te s in re so ur ce m ob ili za tio n an d fa ci lit at e in te rc ou nt ry e xc ha ng e of in fo rm at io n on in no va tiv e fin an ci ng • In te gr at e N C D s in to h ea lth p la nn in g pr oc es se s an d de ve lo pm en t p la ns w ith sp ec ia l a tte nt io n to s oc ia l d et er m in an ts of h ea lth • G en er at e an d di ss em in at e ev id en ce on th e re la tio ns hi p be tw ee n N C D s an d ot he r de ve lo pm en t i ss ue s su ch as p ov er ty a lle vi at io n, e co no m ic de ve lo pm en t, fo od se cu rit y an d ge nd er eq ua lit y • Ra ise p ub lic a nd p ol iti ca l a w ar en es s/ un de rs ta nd in g ab ou t N C D s t hr ou gh so ci al m ar ke tin g, m as s m ed ia a nd re sp on sib le m ed ia re po rti ng • Pr ov id e ad eq ua te a nd s us ta in ed re so ur ce s fo r N C D s by in cr ea se d do m es tic b ud ge ta ry a llo ca tio ns , in no va tiv e fin an ci ng a nd o th er m ea ns Action plan for the prevention and control of noncommunicable diseases in South-East Asia 17 D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Li ai se w ith U N C ou nt ry T ea m s to in te gr at e N C D s in to th e U ni te d N at io ns D ev el op m en t As sis ta nc e Fr am ew or k (U N D AF ) pr oc es se s • Ex pl or e re so ur ce s fo r N C D p re ve nt io n an d co nt ro l f ro m e xi st in g in iti at iv es s uc h as G AV I A lli an ce , t he G lo ba l F un d to Fi gh t A ID S, T ub er cu lo sis a nd M al ar ia (G FA TM ) a nd th e Bi ll an d M el in da G at es F ou nd at io n • M ob ili ze th e U N C ou nt ry T ea m s a nd lin k N C D s i nt o th e U N D A F pr oc es se s Action plan for the prevention and control of noncommunicable diseases in South-East Asia18 1. 2 Pa rt ne rs hi ps Pa rt ne rs : pa rli am en ta ria ns , go ve rn m en t ag en ci es i nc lu di ng m in ist rie s of h ea lth , fin an ce , tra de , ed uc at io n, j us tic e, ag ric ul tu re , s po rts , y ou th a ffa irs , i nf or m at io n, a nd lo ca l g ov er nm en t; U N a ge nc ie s, d ev el op m en t p ar tn er s, c iv il so ci et y, N G O s, m ed ia , p riv at e se ct or D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es N at io na l a nd su bn at io na l m ec ha ni sm /s fo r m ul tis ec to ra l ac tio ns e st ab lis he d an d fu nc tio ni ng • M ul tis ec to ra l n at io na l N C D p ol ic y, s tra te gy or a ct io n pl an , w hi ch in te gr at es s ev er al N C D s an d sh ar ed ri sk fa ct or s, d ev el op ed a nd op er at io na l • Pr ov id e gu id an ce to M em be r St at es fo r d ev el op in g ef fe ct iv e pa rtn er sh ip s fo r m ul tis ec to ra l a ct io ns • Pr ov id e te ch ni ca l s up po rt to M em be r S ta te s fo r h ea lth im pa ct a ss es sm en t o f p ub lic po lic ie s fo r m ax im iz in g in te rs ec to ra l s yn er gi es • C oo rd in at e ac tiv iti es re la te d to N C D s of v ar io us U N a ge nc ie s, fu nd s, a nd pr og ra m m es • C ol la te a nd p ub lis h re gi on al be st p ra ct ic es fo r e ffe ct iv e pu bl ic p ol ic y de ve lo pm en t an d im pl em en ta tio n in th e Re gi on • Se t u p an e ffe ct iv e na tio na l m ul tis ec to ra l m ec ha ni sm (c om m iss io n, a ge nc y or ta sk fo rc e) re po rti ng to th e H ea d of S ta te (o r de le ga te ) t o pl an , g ui de , m on ito r an d ev al ua te th e en ac tm en t o f m ul tis ec to ra l n at io na l N C D p ol ic ie s an d pl an s an d to s ec ur e th e ne ce ss ar y bu dg et • Es ta bl ish n ew , o r s tre ng th en e xi st in g, na tio na l m ul tis ec to ra l N C D p ol ic ie s an d pl an s th ro ug h m ul tis ta ke ho ld er en ga ge m en t, an d w ith a de qu at e bu dg et , t ak in g in to a cc ou nt g lo ba l an d re gi on al a ct io n pl an s as w el l a s na tio na l p rio rit ie s • As se ss th e he al th im pa ct o f p ol ic ie s in n on -h ea lth s ec to rs e .g . a gr ic ul tu re , ed uc at io n, tr ad e, e nv iro nm en t, en er gy , l ab ou r, sp or ts , t ra ns po rt, ur ba n pl an ni ng Action plan for the prevention and control of noncommunicable diseases in South-East Asia 19 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Fa ci lit at e in te rc ou nt ry co lla bo ra tio n fo r e xc ha ng e of b es t p ra ct ic es in th e ar ea s of “ he al th in a ll po lic ie s” , “w ho le o f g ov er nm en t” an d “w ho le o f s oc ie ty ” ap pr oa ch es • M ob ili ze a s oc ia l m ov em en t en ga gi ng a nd e m po w er in g a br oa d ra ng e of a ct or s, in cl ud in g w om en as c ha ng e ag en ts , t o ca ta ly se a sy st em at ic s oc ie ty -w id e na tio na l re sp on se to a dd re ss N C D s an d th e un de rly in g so ci al , e nv iro nm en ta l a nd ec on om ic d et er m in an ts o f h ea lth Action plan for the prevention and control of noncommunicable diseases in South-East Asia20 1. 3 Le ad er sh ip Pa rt ne rs : pa rli am en ta ria ns , go ve rn m en t ag en ci es i nc lu di ng m in ist rie s of h ea lth , fin an ce , tra de , ed uc at io n, j us tic e, ag ric ul tu re , s po rts , y ou th a ffa irs , i nf or m at io n, a nd lo ca l g ov er nm en t; U N a ge nc ie s, d ev el op m en t p ar tn er s, c iv il so ci et y, N G O s, m ed ia , p riv at e se ct or D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es H ea lth m in ist ry ef fe ct iv el y le ad in g an d co or di na tin g th e na tio na l N C D p re ve nt io n an d co nt ro l pr og ra m m e • O pe ra tio na l N C D un it/ de pa rtm en t i n th e he al th m in ist ry w ith a de qu at e st af f an d fu nd s fo r m aj or N C D a ct iv iti es in cl ud in g pr im ar y pr ev en tio n an d he al th p ro m ot io n; ea rly d et ec tio n an d tre at m en t; an d, su rv ei lla nc e an d m on ito rin g of N C D s • Ex am in e th e ca pa ci ty o f M em be r S ta te s th ro ug h ca pa ci ty a ss es sm en t su rv ey s to id en tif y ne ed s an d ta ilo r t he p ro vi sio n of te ch ni ca l s up po rt • D ev el op a pp ro pr ia te tra in in g pr og ra m m es to s tre ng th en s ki lls o f na tio na l p ro gr am m e m an ag er s in d ea lin g w ith th e co m pl ex iss ue s in vo lv ed in im pl em en ta tio n of N C D pr og ra m m es • Se t u p an d/ or s tre ng th en a n at io na l u ni t f or N C D s in th e he al th m in ist ry w ith s ui ta bl e ex pe rti se a nd re so ur ce s fo r n ee ds a ss es sm en t, st ra te gi c pl an ni ng , p ol ic y de ve lo pm en t, m ul tis ec to ra l c oo rd in at io n, p ro gr am m e im pl em en ta tio n, a nd e va lu at io n • Im pl em en t n at io na l m ul tis ec to ra l p ol ic ie s an d th e ac tio n pl an th ro ug h co lla bo ra tiv e pa rtn er sh ip s w ith m ul tip le s ta ke ho ld er s, in cl ud in g go ve rn m en t a ge nc ie s, N G O s, c iv il so ci et y, a ca de m ia , a nd th e pr iv at e se ct or • St re ng th en s ki lls a nd c ap ac ity o f w or kf or ce fo r i m pl em en tin g th e na tio na l a ct io n pl an a nd to d ea l w ith th e co m pl ex ity o f i ss ue s re la tin g to N C D s in cl ud in g m ul tis ec to ra l a ct io n, ad ve rti sin g, b eh av io ur al c ha ng e, h ea lth ec on om ic s, fo od a nd a gr ic ul tu ra l s ys te m s, la w , b us in es s m an ag em en t, tra de , c om m er ci al in flu en ce a nd u rb an p la nn in g, a nd e du ca tio n, am on g ot he rs Action plan for the prevention and control of noncommunicable diseases in South-East Asia 21 St ra te gi c ac tio n ar ea 2 : H ea lth p ro m ot io n an d ri sk r ed uc tio n 2. 1 Re du ce to ba cc o us e Pa rt ne rs : pa rli am en ta ria ns , go ve rn m en t ag en ci es i nc lu di ng m in ist rie s of h ea lth , fin an ce , tra de , ed uc at io n, j us tic e, ag ric ul tu re , s po rts , y ou th a ffa irs , i nf or m at io n, a nd lo ca l g ov er nm en t; U N a ge nc ie s, d ev el op m en t p ar tn er s, c iv il so ci et y, N G O s, m ed ia , p riv at e se ct or D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es To ba cc o us e re du ce d • Ad op tio n of co m pr eh en siv e na tio na l p ol ic ie s an d le gi sla tio ns to re du ce to ba cc o us e • Ag e- st an da rd iz ed pr ev al en ce o f c ur re nt to ba cc o us e am on g pe rs on s ag ed 1 8 ye ar s an d ol de r • Pr ev al en ce o f c ur re nt to ba cc o us e am on g ad ol es ce nt s • Pr ov id e te ch ni ca l s up po rt to M em be r S ta te s in d ra fti ng to ba cc o co nt ro l l eg isl at io ns / re gu la tio ns /d ire ct iv es a nd su pp or t t he ir en fo rc em en t • D ev el op a nd d iss em in at e st an da rd g ui de lin es fo r to ba cc o ce ss at io n se rv ic es fo r us e by h ea lth p ro fe ss io na ls (e .g . p hy sic ia ns , d en tis ts , nu rs es , p ha rm ac ist s) a nd a lli ed pr of es sio ns , a nd tr ai n th em . • Pr ov id e te ch ni ca l s up po rt in tra in in g he al th p ro fe ss io na ls on to ba cc o ce ss at io n • St re ng th en n at io na l c ap ac ity in e st ab lis hi ng c om m un ity - ba se d to ba cc o ce ss at io n se rv ic es • Ac ce le ra te fu ll im pl em en ta tio n of th e W H O F C TC ; M em be rs S ta te s th at ha ve n ot y et b ec om e pa rty to th e W H O F C TC to c on sid er a ct io n to ra tif y, ac ce pt , a pp ro ve , f or m al ly c on fir m o r ac ce de to , a t t he e ar lie st o pp or tu ni ty • St re ng th en to ba cc o su rv ei lla nc e sy st em to m on ito r t ob ac co u se a nd p re ve nt io n po lic ie s • As se ss th e pr ev al en ce o f h ab itu al u se of c ar ci no ge ni c su bs ta nc es (b et el n ut ch ew in g, p an m as al a, g ut ka , e tc .) an d de ve lo p ef fe ct iv e re gu la tio ns fo r i ts pr ev en tio n an d co nt ro l • Ra ise ta xe s an d in fla tio n- ad ju st ed p ric es on to ba cc o pr od uc ts (i n lin e w ith W H O FC TC A rti cl e 6) Action plan for the prevention and control of noncommunicable diseases in South-East Asia22 D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Pr ov id e te ch ni ca l s up po rt to M em be r S ta te s to c on du ct su rv ei lla nc e to m on ito r to ba cc o us e • M ai nt ai n a da ta ba se o f pi ct or ia l w ar ni ng s to fa ci lit at e sh ar in g of b es t p ra ct ic es am on g M em be r S ta te s • Pr om ot e an d su pp or t pr io rit y re se ar ch in cl ud in g ef fe ct iv en es s of ta xa tio n po lic ie s to re du ce to ba cc o us e • Le gi sla te fo r 1 00 % to ba cc o- fre e en vi ro nm en ts in a ll in do or w or kp la ce s, pu bl ic tr an sp or t, in do or p ub lic p la ce s an d, a s ap pr op ria te , o th er p ub lic p la ce s (in li ne w ith W H O F C TC A rti cl e 8) • W ar n pe op le a bo ut th e da ng er s of to ba cc o, in cl ud in g th ro ug h ha rd -h itt in g m as s- m ed ia c am pa ig ns a nd la rg e, c le ar , vi sib le a nd le gi bl e te xt a nd p ic to ria l he al th w ar ni ng s (in li ne w ith W H O FC TC A rti cl es 1 1, 1 2) • Im pl em en t c om pr eh en siv e ba ns o n to ba cc o ad ve rti sin g, p ro m ot io n an d sp on so rs hi p (in li ne w ith W H O F C TC Ar tic le s 13 ) • O ffe r h el p to p eo pl e w ho w an t t o st op us in g to ba cc o (in li ne w ith W H O F C TC Ar tic le 1 4) • Pr ot ec t t ob ac co c on tro l p ol ic ie s fro m co m m er ci al a nd o th er v es te d in te re st s of th e to ba cc o in du st ry in a cc or da nc e w ith n at io na l l aw (i n lin e w ith W H O FC TC A rti cl e 5. 3) Action plan for the prevention and control of noncommunicable diseases in South-East Asia 23 D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Re gu la te th e co nt en ts a nd e m iss io ns of to ba cc o pr od uc ts , t ob ac co p ro du ct di sc lo su re s an d th e m et ho ds b y w hi ch th ey a re te st ed a nd m ea su re d (in li ne w ith W H O F C TC A rti cl e 9 an d 10 ) • Ta ke m ea su re s to e lim in at e th e ill ic it tra de o f t ob ac co p ro du ct s, in cl ud in g sm ug gl in g, il lic it m an uf ac tu rin g an d co un te rfe iti ng (i n lin e w ith W H O F C TC Ar tic le 1 5) • Pr oh ib it sa le o f t ob ac co p ro du ct s to , an d by , m in or s (in li ne w ith W H O F C TC Ar tic le 1 6) • C on sid er ta ki ng le gi sla tiv e ac tio n to d ea l w ith c rim in al a nd c iv il lia bi lit y, in cl ud in g co m pe ns at io n w he re a pp ro pr ia te , an d to o ffe r o ne a no th er re la te d le ga l as sis ta nc e (in li ne w ith W H O F C TC Ar tic le 1 9) Action plan for the prevention and control of noncommunicable diseases in South-East Asia24 2. 2 Re du ce h ar m fu l u se o f a lc oh ol Pa rt ne rs : pa rli am en ta ria ns , go ve rn m en t ag en ci es i nc lu di ng m in ist rie s of h ea lth , fin an ce , tra de , ed uc at io n, j us tic e, ag ric ul tu re , s po rts , y ou th a ffa irs , i nf or m at io n, a nd lo ca l g ov er nm en t; U N a ge nc ie s, d ev el op m en t p ar tn er s, c iv il so ci et y, N G O s, m ed ia , p riv at e se ct or D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es H ar m fu l u se o f al co ho l r ed uc ed • Ad op tio n of co m pr eh en siv e na tio na l po lic ie s an d le gi sla tio ns to re du ce h ar m fu l u se o f al co ho l • To ta l ( re co rd ed a nd un re co rd ed ) a lc oh ol pe r c ap ita (1 5 ye ar s an d ol de r) co ns um pt io n w ith in a c al en da r y ea r i n lit re s of p ur e al co ho l, as ap pr op ria te , w ith in th e na tio na l c on te xt • Ag e- st an da rd iz ed pr ev al en ce o f h ea vy ep iso di c dr in ki ng a m on g ad ol es ce nt s an d ad ul ts , as a pp ro pr ia te , w ith in th e na tio na l c on te xt • St re ng th en a dv oc ac y to a ll st ak eh ol de rs fo r r ed uc in g th e ha rm fu l u se o f a lc oh ol • C om m un ic at e an d pr om ot e th e co m m on u nd er st an di ng of th e te rm in ol og y “h ar m fu l us e of a lc oh ol ” ag re ed a t gl ob al le ve l, an d its p ol ic y im pl ic at io n in th e Re gi on • Pr ov id e te ch ni ca l as sis ta nc e to s up po rt th e im pl em en ta tio n of th e gl ob al st ra te gy to re du ce h ar m fu l us e of a lc oh ol • Fa ci lit at e op er at io na l re se ar ch to s ca le -u p ef fe ct iv e in te rv en tio ns fo r re du ci ng h ar m fu l u se o f al co ho l a nd d iss em in at e da ta to in fo rm p ol ic y an d pr og ra m m e de ve lo pm en t • St re ng th en le ad er sh ip a nd p ol iti ca l co m m itm en t t o re du ce h ar m fu l u se of a lc oh ol • Ac ce le ra te im pl em en ta tio n of th e G lo ba l S tra te gy to R ed uc e th e H ar m fu l U se o f A lc oh ol • Re gu la te th e co m m er ci al o r p ub lic av ai la bi lit y of a lc oh ol th ro ug h la w s, po lic ie s an d pr og ra m m es • Re st ric t o r b an a lc oh ol a dv er tis in g an d pr om ot io ns • In tro du ce a nd a dj us t p ric in g po lic ie s, s uc h as e xc ise ta xe s on al co ho lic b ev er ag es to re du ce al co ho l-r el at ed h ar m • Im pl em en t e ffe ct iv e dr in k- dr iv in g po lic ie s an d co un te rm ea su re s Action plan for the prevention and control of noncommunicable diseases in South-East Asia 25 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Pr om ot e ne tw or ki ng a nd ex ch an ge o f e xp er ie nc es an d be st p ra ct ic es a m on g M em be r S ta te s • Re du ce th e pu bl ic h ea lth im pa ct of il lic it al co ho l a nd in fo rm al ly pr od uc ed a lc oh ol th ro ug h id en tif ie d m ea su re s • Re du ce th e ne ga tiv e co ns eq ue nc es of d rin ki ng a nd a lc oh ol in to xi ca tio n an d pr ov id in g co ns um er in fo rm at io n • St re ng th en h ea lth s er vi ce s to pr ov id e pr ev en tio n an d tre at m en t in te rv en tio n to in di vi du al s an d fa m ili es a t r isk o f, or a ffe ct ed by , a lc oh ol -u se d iso rd er s an d as so ci at ed c on di tio ns • Su pp or t a nd e m po w er c om m un iti es to u se th ei r l oc al k no w le dg e an d ex pe rti se in a do pt in g ef fe ct iv e ap pr oa ch es to p re ve nt a nd re du ce ha rm fu l u se o f a lc oh ol • D ev el op a nd st re ng th en su rv ei lla nc e sy st em s to m on ito r t he m ag ni tu de an d tre nd s of a lc oh ol re la te d ha rm , t o st re ng th en a dv oc ac y, to fo rm ul at e po lic ie s an d to a ss es s im pa ct o f i nt er ve nt io ns Action plan for the prevention and control of noncommunicable diseases in South-East Asia26 2. 3 Pr om ot e he al th y di et h ig h in fr ui ts a nd v eg et ab le s an d lo w in s at ur at ed fa ts /tr an s fa ts , f re e su ga rs a nd s al t Pa rt ne rs : pa rli am en ta ria ns , go ve rn m en t ag en ci es i nc lu di ng m in ist rie s of h ea lth , fin an ce , tra de , ed uc at io n, j us tic e, ag ric ul tu re , sp or ts , yo ut h af fa irs , in fo rm at io n, a nd l oc al g ov er nm en t Pr iv at e, f oo d m an uf ac tu re rs , fo od p ro ce ss or s, re ta ile rs ; m ed ia , c iv il so ci et y, N G O s, c on su m er s D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • In cr ea se d in ta ke of fr ui ts a nd ve ge ta bl es • Re du ce d co ns um pt io n of sa tu ra te d fa ts / tra ns fa ts , s ug ar an d sa lt • Re du ce d ca rd io m et ab ol ic ris k • Ad op tio n of na tio na l p ol ic ie s to re du ce th e im pa ct on c hi ld re n of m ar ke tin g of fo od s an d no n- al co ho lic be ve ra ge s hi gh in sa tu ra te d fa ts , t ra ns - fa tty a ci ds , f re e su ga rs o r s al t • Ad op tio n of n at io na l po lic ie s th at li m it sa tu ra te d fa tty ac id s an d vi rtu al ly el im in at e pa rti al ly hy dr og en at ed ve ge ta bl e oi ls in th e fo od s up pl y • Pr ov id e te ch ni ca l su pp or t t o M em be r St at es to d ev el op a nd im pl em en t n at io na l po lic ie s an d re gu la tio ns • Pr ov id e te ch ni ca l su pp or t t o M em be r St at es fo r d ev el op m en t an d/ or u pd at in g of th e fo od c om po sit io n da ta ba se ta bl es • Pr ov id e te ch ni ca l su pp or t t o M em be r St at es to d ev el op na tio na l s od iu m re du ct io n st ra te gi es • St re ng th en c ou nt ry ca pa ci ty to c on du ct su rv ey s on p op ul at io n so di um c on su m pt io n • Ac ce le ra te im pl em en ta tio n of th e G lo ba l St ra te gy o n D ie t, Ph ys ic al A ct iv ity a nd H ea lth • Im pl em en t W H O ’s s et o f re co m m en da tio ns o n th e m ar ke tin g of fo od s an d no n- al co ho lic b ev er ag es to c hi ld re n, in cl ud in g m ec ha ni sm s fo r m on ito rin g • D ev el op p ol ic y m ea su re s an d gu id el in es in c ol la bo ra tio n w ith v ar io us s ta ke ho ld er s su ch a s fo od p ro du ce rs , p ro ce ss or s, re ta ile rs a nd c on su m er s to p ro m ot e af fo rd ab ili ty , a va ila bi lit y an d ac ce pt ab ili ty of h ea lth ie r f oo d pr od uc ts • Es ta bl ish re gu la tio ns a nd fi sc al p ol ic ie s in cl ud in g ta xe s an d su bs id ie s to p ro m ot e co ns um pt io n of fr ui ts a nd v eg et ab le s an d di sc ou ra ge c on su m pt io n of u nh ea lth y fo od op tio ns h ig h in s at ur at ed fa t, su ga r a nd s al t Action plan for the prevention and control of noncommunicable diseases in South-East Asia 27 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Pr ev al en ce o f pe rs on s ag ed 1 8 ye ar s an d ol de r co ns um in g le ss th an fiv e to ta l s er vi ng s (4 00 g ) o f f ru it an d ve ge ta bl es p er d ay • Ag e- st an da rd iz ed m ea n pr op or tio n of to ta l e ne rg y in ta ke fro m s at ur at ed fa tty ac id s in p er so ns ag ed 1 8 ye ar s an d ol de r • M ea n po pu la tio n in ta ke o f s al t (s od iu m c hl or id e) pe r p er so n pe r d ay • Pr ev al en ce o f r ai se d to ta l c ho le st er ol am on g pe rs on s ag ed 18 y ea rs a nd o ld er , an d m ea n to ta l ch ol es te ro l • D ia lo gu e w ith th e pr iv at e se ct or a nd b ui ld pr es su re to re du ce so di um c on te nt o f pr oc es se d fo od • Pr ov id e te ch ni ca l su pp or t t o M em be r St at es to d ev el op na tio na l p ol ic ie s an d re gu la tio ns to re du ce sa tu ra te d fa ts a nd el im in at e tra ns fa ts in th e fo od s up pl y ch ai n • C ar ry o ut p ub lic c am pa ig ns th ro ug h m as s m ed ia a nd s oc ia l m ed ia to in fo rm co ns um er s ab ou t a h ea lth y di et h ig h in fru its a nd v eg et ab le s an d lo w in s at ur at ed fa t, su ga r a nd s al t • Pr om ot e an d su pp or t e xc lu siv e br ea st fe ed in g fo r t he fi rs t s ix m on th s of li fe , co nt in ue d br ea st fe ed in g un til tw o ye ar s an d be yo nd a nd ti m el y co m pl em en ta ry fe ed in g • Pr om ot e nu tri tio n la be lli ng , a cc or di ng b ut no t l im ite d to , i nt er na tio na l s ta nd ar ds , i n pa rti cu la r t he C od ex A lim en ta riu s, fo r a ll pr e- pa ck ag ed fo od s in cl ud in g th os e fo r w hi ch n ut rit io n or h ea lth c la im s ar e m ad e • St re ng th en c ap ac ity o f n at io na l i nt ui tio ns fo r t es tin g an d m on ito rin g th e co nt en t o f sa tu ra te d fa t, sa lt an d su ga r i n pr oc es se d fo od • D ev el op a nd im pl em en t n at io na l s al t re du ct io n st ra te gi es in li ne w ith W H O re co m m en da tio ns Action plan for the prevention and control of noncommunicable diseases in South-East Asia28 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Ag e- st an da rd iz ed pr ev al en ce o f r ai se d bl oo d gl uc os e co nc en tra tio ns / di ab et es a m on g pe rs on s ag ed 1 8 ye ar s an d ol de r (d ef in ed a s fa st in g pl as m a gl uc os e co nc en tr at io n ≥ 7. 0 m m ol /L (1 26 m g/ dL ) or o n m ed ic at io n fo r ra ise d bl oo d gl uc os e co nc en tra tio n, re sp ec tiv el y) • Ra ise d bl oo d pr es su re a m on g pe rs on s ag ed 1 8 ye ar s an d ol de r, an d m ea n sy st ol ic b lo od pr es su re • In cr ea se c ol la bo ra tio n be tw ee n sa lt/ so di um re du ct io n pr og ra m m es a nd s al t i od iz at io n pr og ra m m es fo r i nc re as ed p ub lic h ea lth ga in s an d hi gh er p ro gr am m e ef fic ie nc y • Re gu la te p riv at e in du st ry to v ol un ta ril y re du ce s al t i n pa ck ag ed fo od a nd m on ito r co m pl ia nc e. • U nd er ta ke re pr es en ta tiv e su rv ey s to m ea su re p op ul at io n sa lt/ so di um in ta ke • Es ta bl ish p ol ic ie s an d re gu la tio ns to el im in at e pa rti al ly h yd ro ge na te d ve ge ta bl e oi ls (P H VO ) i n th e fo od s up pl y an d lim it sa tu ra te d fa tty a ci ds a nd m on ito r co m pl ia nc e of p riv at e se ct or w ith th e re gu la tio ns • Re pl ac e sa tu ra te d fa t a nd tr an s- fa t w ith un sa tu ra te d fa t Action plan for the prevention and control of noncommunicable diseases in South-East Asia 29 2. 4 Pr om ot e ph ys ic al a ct iv ity Pa rt ne rs : M in ist rie s of h ea lth , fin an ce , tra de , ed uc at io n, s po rts , yo ut h af fa irs , ju st ic e, in fo rm at io n, lo ca l g ov er nm en t, in fra st ru ct ur e/ tra ns po rt, p la nn in g an d ur ba n de ve lo pm en t; m ed ia , c iv il so ci et y, N G O s D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es Ph ys ic al in ac tiv ity re du ce d • Pr ev al en ce o f i ns uf fic ie nt ly ac tiv e pe rs on s ag ed 1 8 ye ar s an d ol de r • Pr ev al en ce o f i ns uf fic ie nt ly ac tiv e ad ol es ce nt s (d ef in ed as le ss th an 6 0 m in ut es o f m od er at e to v ig or ou s in te ns ity ac tiv ity d ai ly ) • Ag e- st an da rd iz ed p re va le nc e of o ve rw ei gh t a nd o be sit y in a do le sc en ts (d ef in ed ac co rd in g to th e W H O g ro w th re fe re nc e as : o ve rw ei gh t – on e st an da rd d ev ia tio n bo dy m as s in de x fo r a ge a nd s ex ; an d ob es e – tw o st an da rd de vi at io ns b od y m as s in de x fo r a ge a nd s ex ) • D ev el op a nd d iss em in at e m od el le gi sla tio n fo r su pp or tiv e en vi ro nm en ts fo r p hy sic al a ct iv ity • Pr ov id e su pp or t f or es ta bl ish in g co lla bo ra tio n w ith a rc hi te ct s an d to w n pl an ne rs in c ou nt rie s to ad vo ca te u rb an p la nn in g to in cr ea se p ub lic s pa ce s su pp or tiv e of p hy sic al ac tiv ity • D iss em in at e gu id el in es fo r ph ys ic al a ct iv ity • Fa ci lit at e sh ar in g of b es t pr ac tic es a nd le ss on s le ar ne d am on g co un tri es • Ad op t a nd im pl em en t n at io na l gu id el in es o n ph ys ic al a ct iv ity fo r h ea lth • D ev el op p ol ic y m ea su re s an d gu id el in es in c on ju nc tio n w ith re le va nt s ec to rs a nd s ta ke ho ld er s to p ro m ot e ph ys ic al a ct iv ity th ro ug h ac tiv iti es o f d ai ly li vi ng in cl ud in g th ro ug h “a ct iv e tra ns po rt” , r ec re at io n, le isu re an d sp or ts . • Ad vo ca te to to w n pl an ne rs fo r d es ig ni ng in cr ea se d pu bl ic sp ac es s up po rti ve o f p hy sic al ac tiv ity • Es ta bl ish le gi sla tio n to e ns ur e ne w h ou sin g de ve lo pm en ts in cl ud e sa fe s pa ce s fo r w al ki ng an d cy cl in g Action plan for the prevention and control of noncommunicable diseases in South-East Asia30 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Ag e- st an da rd iz ed p re va le nc e of o ve rw ei gh t a nd o be sit y in pe rs on s ag ed 1 8 ye ar s an d ol de r ( de fin ed a s bo dy m as s in de x gr ea te r t ha n 25 k g/ m ² fo r o ve rw ei gh t a nd 3 0 kg /m ² fo r o be sit y) . • C ar ry o ut m as s- m ed ia ca m pa ig ns a nd s oc ia l m ar ke tin g to ra ise a w ar en es s on b en ef its o f ph ys ic al a ct iv ity th ro ug ho ut th e lif e cy cl e • Ev al ua te in te rv en tio ns a im ed at in cr ea sin g ph ys ic al a ct iv ity th ro ug ho ut th e lif e- co ur se a nd us e da ta to in fo rm p ol ic y an d pr og ra m m e de ve lo pm en t Action plan for the prevention and control of noncommunicable diseases in South-East Asia 31 2. 5 Pr om ot e he al th y be ha vi ou rs a nd r ed uc e N C D s in k ey s et tin gs Pa rt ne rs : M in ist rie s of h ea lth , ed uc at io n, t ra de , sp or ts , yo ut h af fa irs , in fo rm at io n, l oc al g ov er nm en t, in fra st ru ct ur e/ tra ns po rt, p la nn in g/ ur ba n de ve lo pm en t; co rp or at e se ct or , m ed ia , c iv il so ci et y, N G O s D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es Re du ce d ris k of N C D s am on g sc ho ol c hi ld re n/ st ud en ts a t ed uc at io na l in st itu te s, a nd w or kf or ce • N at io na l g ui de lin es fo r h ea lth p ro m ot in g sc ho ol s/ st ud en ts a t ed uc at io na l i ns tit ut es de ve lo pe d an d ad op te d • N at io na l g ui de lin es fo r w or kp la ce w el ln es s pr og ra m m es de ve lo pe d an d ad op te d • Pr om ot e an d fa ci lit at e in te rs ec to ra l a ct io n th ro ug h th e de ve lo pm en t a nd di ss em in at io n of m od el he al th y sc ho ol s/ w or kp la ce po lic ie s an d pr og ra m m es • D ev el op a nd d iss em in at e m od el c om pr eh en siv e w or kp la ce w el ln es s po lic ie s an d pr og ra m m es to re du ce th e ris k of N C D s • Pr ov id e te ch ni ca l s up po rt to c ou nt rie s in d ev el op in g an d im pl em en tin g sc ho ol , w or kp la ce , p ol ic ie s an d pr og ra m m es • D ev el op c ur ric ul a m od ul es fo r p re ve nt io n an d co nt ro l o f N C D s, in cl ud in g co un se lli ng te ch ni qu es fo r in te gr at io n in te ac he r t ra in in g • En ab le a nd fa ci lit at e in te rs ec to ra l ac tio n in s ch oo ls an d w or kp la ce s th ro ug h es ta bl ish m en t o f in te rs ec to ra l w or ki ng g ro up s, ta sk te am s or fo ca l p er so ns in c ha rg e of de ve lo pi ng a nd c oo rd in at in g he al th pr om ot in g ac tiv iti es • Ap po in t a nd tr ai n fo ca l p er so ns or o th er a pp ro pr ia te c oo rd in at io n m ec ha ni sm s be tw ee n M in ist ry o f H ea lth a nd M in ist ry o f E du ca tio n to pr om ot e ef fe ct iv e in te rv en tio ns in sc ho ol s an d pr e- sc ho ol s • Es ta bl ish h ea lth p ro m ot in g sc ho ol s w ith g ui de lin es fo r i m pl em en ta tio n an d m ec ha ni sm s fo r m on ito rin g an d ev al ua tio n • C on du ct a dv oc ac y an d tra in in g w or ks ho ps to p ro m ot e he al th y be ha vi ou rs in s ch oo ls an d w or kp la ce s Action plan for the prevention and control of noncommunicable diseases in South-East Asia32 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Fa ci lit at e sh ar in g of ex pe rie nc es a nd b es t pr ac tic es a m on g M em be r St at es • Es ta bl ish e vi de nc e an d be st -p ra ct ic es fo r e ffe ct iv e in te rv en tio ns in s ch oo l a nd w or kp la ce s et tin gs • Es ta bl ish h ea lth p ro m ot in g w or kp la ce s w ith g ui de lin es fo r im pl em en ta tio n an d m ec ha ni sm s fo r m on ito rin g an d ev al ua tio n • Ba n fo od s hi gh in s at ur at ed fa t, su ga r an d sa lt fro m s ch oo l p re m ise s an d w or kp la ce c at er in g fa ci lit ie s Action plan for the prevention and control of noncommunicable diseases in South-East Asia 33 2. 6 Re du ce h ou se ho ld a ir p ol lu tio n Pa rt ne rs : M in ist rie s o f h ea lth , f in an ce , t ra de , e du ca tio n, le ga l, ag ric ul tu re , u rb an d ev el op m en t a nd h ou sin g, e nv iro nm en t, pe tro le um , e ne rg y, in du st rie s, in fo rm at io n; m ed ia , c iv il so ci et y, N G O s, c om m un ity D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es H ou se ho ld a ir po llu tio n du e to s ol id fu el u se fo r c oo ki ng a nd pa ss iv e sm ok in g re du ce d • 50 % re du ct io n in p ro po rti on o f ho us eh ol ds w ith so lid fu el u se a s pr im ar y so ur ce o f co ok in g • St re ng th en a dv oc ac y to a ll st ak eh ol de rs fo r r ed uc in g ha rm fro m h ou se ho ld a ir po llu tio n • Pr ov id e te ch ni ca l s up po rt fo r de ve lo pi ng n ew a nd re vi se d in do or a ir qu al ity g ui de lin es • Su pp or t r es ea rc h fo r e va lu at in g in te rv en tio ns a im ed a t r ed uc in g ho us eh ol d ai r p ol lu tio n • St re ng th en G lo ba l H ou se ho ld En er gy D at ab as e • Fa ci lit at e sh ar in g of e xp er ie nc es an d be st p ra ct ic es a m on g M em be r S ta te s • St re ng th en a dv oc ac y in s up po rt of tra ns iti on to c le an er te ch no lo gi es an d fu el s (L PG , b io -g as , s ol ar co ok er s, e le ct ric ity , o th er lo w -fu m e fu el s su ch a s m et ha no l, et ha no l) • D ev el op a nd m ai nt ai n na tio na l da ta ba se s on k ey v ar ia bl es to su pp or t d ec isi on -m ak in g fo r tra ns iti on to c le an s us ta in ab le ho us eh ol d en er gy • D ev el op a nd im pl em en t pr og ra m m es a im ed a t e nc ou ra gi ng th e us e of im pr ov ed c oo k- st ov es , go od c oo ki ng p ra ct ic es , r ed uc in g ex po su re to fu m es , a nd im pr ov in g ve nt ila tio n in h ou se ho ld s • C re at e aw ar en es s an d de ve lo p ap pr op ria te s tra te gi es to re du ce ex po su re to s ec on d- ha nd to ba cc o sm ok e in h ou se ho ld s Action plan for the prevention and control of noncommunicable diseases in South-East Asia34 St ra te gi c ac tio n ar ea 3 : H ea lth s ys te m s tr en gt he ni ng fo r ea rl y de te ct io n an d m an ag em en t o f N C D s an d th ei r ri sk fa ct or s 3. 1 Ac ce ss to h ea lth s er vi ce s Pa rt ne rs : M in ist rie s of h ea lth , o th er r el ev an t m in ist rie s, lo ca l g ov er nm en t a ut ho rit ie s; r eg ul at or y co un ci ls, c iv il so ci et y, m ed ic al a ss oc ia tio ns , p riv at e he al th p ro vi de rs , N G O s, p ha rm ac eu tic al a ge nc ie s, m ed ia D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es U ni ve rs al h ea lth co ve ra ge a nd eq ui ta bl e ac ce ss to p re ve nt io n, ea rly d et ec tio n an d tre at m en t of N C D s • Av ai la bi lit y an d af fo rd ab ili ty o f q ua lit y, sa fe a nd e ffi ca ci ou s es se nt ia l N C D m ed ic in es , i nc lu di ng ge ne ric s, a nd b as ic te ch no lo gi es in b ot h pu bl ic a nd p riv at e fa ci lit ie s • Ac ce ss to p al lia tiv e ca re a ss es se d by m or ph in e- eq ui va le nt co ns um pt io n of s tro ng op io id a na lg es ic s (e xc lu di ng m et ha do ne ) pe r d ea th fr om c an ce r • Pr ov id e su pp or t t o M em be r St at es in in te gr at in g co st - ef fe ct iv e in te rv en tio ns fo r N C D s an d th ei r r isk fa ct or s in to h ea lth s ys te m s, in cl ud in g es se nt ia l p rim ar y he al th c ar e pa ck ag es • D ep lo y an in te ra ge nc y em er ge nc y he al th k it fo r tre at m en t o f N C D s in hu m an ita ria n di sa st er s an d em er ge nc ie s • D ev el op a nd d iss em in at e st an da rd g ui de lin es , t oo ls an d tra in in g m at er ia ls fo r ea rly d et ec tio n, tr ea tm en t an d pa lli at iv e ca re to a dd re ss N C D s in cl ud in g or al c an ce rs at p rim ar y he al th c ar e ce nt re s • In te gr at e an d sc al e- up c os t- ef fe ct iv e N C D in te rv en tio ns , b as ed o n na tio na l po lic ie s an d pr io rit ie s, in to th e ba sic pr im ar y he al th c ar e pa ck ag e w ith re fe rr al s ys te m to a ll le ve ls of c ar e in or de r t o ad va nc e th e un iv er sa l h ea lth co ve ra ge a ge nd a • Es ta bl ish q ua lit y as su ra nc e an d qu al ity im pr ov em en t s ys te m s w ith e m ph as is on pr im ar y he al th c ar e • St re ng th en re fe rr al s ys te m s fo r m an ag em en t o f N C D s • D ev el op p ol ic ie s fo r s us ta in ab le a nd eq ui ta bl e he al th fi na nc in g (in cl ud in g in su ra nc e, ta x fu nd in g, h ea lth s av in gs ac co un t) to c ov er c os ts o f p re ve nt io n, tre at m en t, re ha bi lit at io n an d pa lli at iv e ca re Action plan for the prevention and control of noncommunicable diseases in South-East Asia 35 D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Av ai la bi lit y, a s ap pr op ria te (i f co st -e ffe ct iv e an d af fo rd ab le ), of H PV va cc in es a cc or di ng to na tio na l p ro gr am m es an d po lic ie s • Pr op or tio n of e lig ib le pe rs on s re ce iv in g dr ug th er ap y an d co un se lli ng to p re ve nt he ar t a tta ck s, s tro ke s an d ch ro ni c re sp ira to ry di se as es • Pr op or tio n of w om en ag ed 3 0– 49 y ea rs sc re en ed fo r c er vi ca l ca nc er a t l ea st o nc e, o r m or e of te n • Pr op or tio n of “ at ri sk ” po pu la tio n sc re en ed fo r o ra l c an ce r a t l ea st on ce o r a t r eg ul ar in te rv al s • Pr ov id e su pp or t t o co un tri es in in te gr at in g co st -e ffe ct iv e in te rv en tio ns fo r r ed uc in g ris k fa ct or s fo r o ra l c an ce r in to h ea lth s ys te m s, es pe ci al ly a t p rim ar y he al th ca re le ve l • N eg ot ia te w ith ph ar m ac eu tic al p ro du ce rs an d w ho le sa le rs to re du ce co st o f e ss en tia l d ru gs • Fa ci lit at e te ch no lo gy tra ns fe r f or m an uf ac tu re of m ed ic in es , v ac ci ne s, m ed ic al te ch no lo gi es , a nd in fo rm at io n te ch no lo gi es fo r pr ev en tio n an d co nt ro l o f N C D s • Fa ci lit at e de ve lo pm en t, ad ap ta tio n an d us e of ra pi d sc re en in g/ di ag no st ic te st s an d ki ts a t c om m un ity le ve l fo r e ar ly d et ec tio n of N C D s an d th ei r r isk fa ct or s. • In cl ud e es se nt ia l m ed ic in es a nd te ch no lo gi es s pe ci fic al ly fo r N C D s, in n at io na l e ss en tia l m ed ic in es a nd m ed ic al te ch no lo gi es li st s • Im pr ov e ef fic ie nc y in th e pr oc ur em en t, su pp ly m an ag em en t a nd a cc es s to e ss en tia l N C D m ed ic in es a nd te ch no lo gi es in cl ud in g th ro ug h th e fu ll us e of tr ad e- re la te d as pe ct s of in te lle ct ua l p ro pe rty ri gh ts (T RI PS ) fle xi bi lit ie s • Pr om ot e pr oc ur em en t a nd u se o f ge ne ric m ed ic in es fo r p re ve nt io n an d co nt ro l o f N C D s by q ua lit y as su ra nc e of g en er ic p ro du ct s, p re fe re nt ia l re gi st ra tio n pr oc ed ur es , g en er ic su bs tit ut io n, fi na nc ia l i nc en tiv es a nd ed uc at io n of p re sc rib er s an d co ns um er s • En su re th e av ai la bi lit y of li fe -s av in g te ch no lo gi es a nd e ss en tia l m ed ic in es fo r m an ag in g N C D s in th e in iti al p ha se o f em er ge nc y re sp on se • D ev el op a nd im pl em en t a p al lia tiv e ca re po lic y us in g co st -e ffe ct iv e tre at m en t m od al iti es , i nc lu di ng o pi oi d an al ge sic s fo r p ai n re lie f Action plan for the prevention and control of noncommunicable diseases in South-East Asia36 D es ir ed ou tc om e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • Va cc in at io n co ve ra ge ag ai ns t h ep at iti s B vi ru s m on ito re d by nu m be r o f t hi rd d os es of h ep at iti s B va cc in e (H ep B3 ) a dm in ist er ed to in fa nt s • Fa ci lit at e sh ar in g of ex pe rie nc es , b es t p ra ct ic es an d le ss on s am on g M em be r St at es • Im pr ov e co ve ra ge o f h ep at iti s B va cc in at io n • St re ng th en e du ca tio n an d aw ar en es s on e ar ly d et ec tio n of c om m on c an ce rs in cl ud in g br ea st c an ce r, ce rv ic al c an ce r an d or al c an ce r • St re ng th en b as ic fa ci lit ie s of p rim ar y he al th c ar e fa ci lit ie s fo r p re ve nt io n an d ea rly d ia gn os is of c er vi ca l c an ce r a nd or al c an ce r • Re vi ew e xi st in g pr og ra m m es , s uc h as n ut rit io n, H IV , t ub er cu lo sis a nd re pr od uc tiv e he al th , f or o pp or tu ni tie s to in te gr at e se rv ic e de liv er y fo r p re ve nt io n an d co nt ro l o f N C D s • In cr ea se c ap ac ity o f h ea lth -c ar e se rv ic es to d el iv er p re ve nt io n an d tre at m en t in te rv en tio ns fo r h az ar do us d rin ki ng a nd al co ho l u se d iso rd er s at p rim ar y ca re an d ot he r s et tin gs . • Fa ci lit at e ac ce ss to p re ve nt iv e m ea su re s, tre at m en t a nd v oc at io na l r eh ab ili ta tio n, as w el l a s fin an ci al c om pe ns at io n of oc cu pa tio na l N C D s, s uc h as c an ce r a nd ch ro ni c re sp ira to ry d ise as e, c on sis te nt w ith in te rn at io na l a nd n at io na l l aw s an d re gu la tio ns o n oc cu pa tio na l d ise as es Action plan for the prevention and control of noncommunicable diseases in South-East Asia 37 3. 2 H ea lth w or kf or ce Pa rt ne rs : M in ist rie s of h ea lth , o th er r el ev an t m in ist rie s, lo ca l g ov er nm en t a ut ho rit ie s; r eg ul at or y co un ci ls, c iv il so ci et y, m ed ic al a ss oc ia tio ns , p riv at e he al th p ro vi de rs , N G O s, p ha rm ac eu tic al a ge nc ie s, m ed ia D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es Im pr ov ed co m pe te nc e of he al th w or kf or ce fo r p re ve nt io n, ea rly d ia gn os is an d m an ag em en t of N C D s • Pe rc en ta ge o f p rim ar y he al th c ar e w or ke rs tra in ed in in te gr at ed N C D p re ve nt io n an d co nt ro l • Pr ov id e te ch ni ca l su pp or t t o de ve lo p co m pe te nc y- ba se d cu rr ic ul um fo r t ra in in g of h ea lth w or kf or ce in N C D p re ve nt io n an d co nt ro l, w ith a n em ph as is on p rim ar y ca re • Tr ai n he al th w or ke rs in us e of a va ila bl e W H O N C D to ol s, s uc h as W H O P EN • En co ur ag e in no va tiv e he al th w or kf or ce m od el s, in cl ud in g ta sk sh ift in g an d ca pa ci ty bu ild in g fo r l ow - a nd m id -le ve l p ro vi de rs in pr im ar y he al th c ar e se tti ng s • M an ag e he al th w or kf or ce to a de qu at el y ad dr es s cu rr en t N C D b ur de n as w el l as p la nn in g fo r f ut ur e ne ed s in li gh t o f po pu la tio n ag ei ng • Id en tif y co m pe te nc ie s re qu ire d an d in ve st in im pr ov in g th e kn ow le dg e, s ki lls a nd m ot iv at io n of th e cu rr en t h ea lth w or kf or ce to a dd re ss N C D s, in cl ud in g co m m on c o- m or bi di ty c on di tio ns • In co rp or at e pr ev en tio n an d co nt ro l o f N C D s in th e pr e- se rv ic e an d in -s er vi ce tr ai ni ng o f al l h ea lth w or ke rs , p ro fe ss io na l a nd n on - pr of es sio na l ( te ch ni ca l, vo ca tio na l), w ith a n em ph as is on p rim ar y ca re • Pr ov id e ad eq ua te m ec ha ni sm s (c om pe ns at io n) a nd in ce nt iv es fo r h ea lth w or ke rs , p ay in g du e at te nt io n to a ttr ac tin g an d re ta in in g th em in u nd er se rv ic ed a re as Action plan for the prevention and control of noncommunicable diseases in South-East Asia38 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es • D ev el op c ar ee r t ra ck s fo r h ea lth w or ke rs th ro ug h st re ng th en in g po st gr ad ua te tra in in g, w ith a s pe ci al fo cu s on N C D s, in va rio us p ro fe ss io na l d isc ip lin es a nd c ar ee r ad va nc em en t f or n on -p ro fe ss io na l s ta ff • Ex pl or e an d pr om ot e in no va tiv e he al th w or kf or ce m od el s, in cl ud in g ta sk s hi fti ng , an d ca pa ci ty b ui ld in g fo r l ow - a nd m id - le ve l p ro vi de rs in th e co nt ex t o f p re ve nt io n an d co nt ro l o f N C D s in p rim ar y he al th c ar e se tti ng s Action plan for the prevention and control of noncommunicable diseases in South-East Asia 39 3. 3 C om m un ity -b as ed a pp ro ac he s Pa rt ne rs : M in ist rie s of h ea lth , o th er r el ev an t m in ist rie s, lo ca l g ov er nm en t a ut ho rit ie s; r eg ul at or y co un ci ls, c iv il so ci et y, m ed ic al a ss oc ia tio ns , p riv at e he al th p ro vi de rs , N G O s, p ha rm ac eu tic al a ge nc ie s, m ed ia D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O Pr op os ed a ct io ns fo r M em be r St at es C om m un iti es / pa tie nt s em po w er ed fo r se lf- ca re • N at io na l gu id el in es o n se lf- ca re fo r pr ev en tio n an d m an ag em en t of N C D s de ve lo pe d an d ad op te d • D ev el op in no va tiv e to ol s fo r s el f- ca re , fo r e xa m pl e th ro ug h in fo rm at io n te ch no lo gy • D ev el op a nd di ss em in at e gu id el in es fo r m on ito rin g an d ev al ua tio n of co m m un ity -b as ed in iti at iv es fo r N C D pr ev en tio n an d co nt ro l • Fa ci lit at e be st p ra ct ic es on c om m un ity -b as ed ca re fo r p re ve nt io n an d co nt ro l o f N C D s • U se p ar tic ip at or y co m m un ity -b as ed a pp ro ac he s in d es ig ni ng , i m pl em en tin g, m on ito rin g an d ev al ua tin g N C D p ro gr am m es a cr os s th e lif e- co ur se a nd c on tin uu m o f c ar e • C re at e aw ar en es s to e m po w er p eo pl e to s ee k ca re a nd d et ec tio n fo r b et te r m an ag em en t o f th ei r c on di tio ns • D ev el op p at ie nt e du ca tio n/ se lf- ca re g ui de lin es fo r pr ev en tio n an d co nt ro l o f N C D s in c on su lta tio n w ith a w id e va rie ty o f s ta ke ho ld er s • En co ur ag e th e fo rm at io n of c om m un ity c oa lit io ns an d pa tie nt g ro up s, a nd b ui ld th ei r c ap ac ity • M ee t t he n ee ds fo r l on g- te rm c ar e of p eo pl e w ith N C D s, re la te d di sa bi lit ie s an d co -m or bi di tie s th ro ug h in no va tiv e an d ef fe ct iv e m od el s of c ar e (c on ne ct in g oc cu pa tio na l h ea lth s er vi ce s an d co m m un ity h ea lth re so ur ce s w ith p rim ar y ca re an d th e re st o f t he h ea lth -c ar e de liv er y sy st em • M on ito r a nd e va lu at e co m m un ity -b as ed in iti at iv es fo r p re ve nt io n an d co nt ro l o f N C D s Action plan for the prevention and control of noncommunicable diseases in South-East Asia40 St ra te gi c ac tio n ar ea 4 : S ur ve ill an ce , m on ito ri ng a nd e va lu at io n an d re se ar ch 4. 1 St re ng th en s ur ve ill an ce Pa rt ne rs : M in ist rie s of h ea lth , ot he r re le va nt m in ist rie s/ go ve rn m en t ag en ci es ; pr of es sio na l b od ie s, N G O s, a ca de m ia , N at io na l R es ea rc h C ou nc il/ ot he r r es ea rc h in st itu tio ns , U N a ge nc ie s/ bi la te ra l a nd m ul til at er al d ev el op m en t p ar tn er s D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O (R eg io na l O ff ic e an d co un tr y of fic es ) Pr op os ed a ct io ns fo r M em be r St at es Im pr ov ed av ai la bi lit y an d us e of in fo rm at io n on N C D m or ta lit y, m or bi di ty , r isk fa ct or s an d he al th sy st em re sp on se • N at io na l r isk fa ct or su rv ey s u sin g st an da rd m et ho ds c on du ct ed ev er y th re e to fi ve ye ar s • D iss em in at e st an da rd to ol s an d gu id el in es fo r N C D su rv ei lla nc e/ su rv ey s • Bu ild c ap ac ity o f M em be r St at es in s tre ng th en in g na tio na l su rv ei lla nc e an d m on ito rin g sy st em s (in cl ud in g vi ta l re gi st ra tio n, ri sk fa ct or s ur ve ys an d he al th fa ci lit y su rv ey s) a nd su pp or t i m pl em en ta tio n • Pr oc ur e a re gi on al p oo l o f d at a co lle ct io n to ol s (e .g . P D As , bl oo d pr es su re in st ru m en t) an d ot he r m at er ia ls fo r f ac ili ta tin g su rv ei lla nc e in M em be r S ta te s • Ad ap t a nd im pl em en t W H O su rv ei lla nc e fra m ew or k th at m on ito rs ex po su re (r isk fa ct or s) , o ut co m e (m or bi di ty a nd m or ta lit y) , a nd h ea lth sy st em re sp on se • Al lo ca te a de qu at e fu nd s fo r N C D su rv ei lla nc e • Ex pl or e re so ur ce s fro m e xi st in g in iti at iv es s uc h as G AV I A lli an ce , th e G FA TM fo r s tre ng th en in g N C D s ur ve ill an ce a nd m on ito rin g, in cl ud in g vi ta l r eg ist ra tio n, ri sk fa ct or su rv ei lla nc e (in cl ud in g sa lt su rv ey s) an d he al th s ys te m re sp on se . • In st itu tio na liz e N C D s ur ve ill an ce th ro ug h an a pp ro pr ia te g ov er ni ng m ec ha ni sm to e nh an ce o w ne rs hi p, su st ai na bi lit y an d co or di na tio n at co un try le ve l. Action plan for the prevention and control of noncommunicable diseases in South-East Asia 41 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O (R eg io na l O ff ic e an d co un tr y of fic es ) Pr op os ed a ct io ns fo r M em be r St at es • St re ng th en te ch ni ca l ca pa ci ty in M em be r S ta te s in c on du ct in g su rv ei lla nc e, w ith a fo cu s on b ui ld in g ca pa ci ty fo r d at a m an ag em en t, da ta a na ly sis a nd d at a us e fo r a dv oc ac y, a s w el l a s fo r pl an ni ng a nd m on ito rin g • Bu ild n at io na l c ap ac ity fo r d at a m an ag em en t, da ta a na ly sis a nd da ta u se fo r a dv oc ac y, a s w el l a s fo r pr og ra m m e pl an ni ng a nd m on ito rin g pr og re ss in p re ve nt io n an d co nt ro l of N C D s. • St re ng th en v ita l r eg ist ra tio n an d ci vi l re gi st ra tio n sy st em s an d im pr ov e m ed ic al c au se o f d ea th re po rti ng by p ro ac tiv el y en ga gi ng re le va nt st ak eh ol de rs /s ec to rs • St re ng th en n at io na l c an ce r re gi st ra tio n in cl ud in g po pu la tio n- ba se d re gi st rie s • St re ng th en n at io na l c an ce r re gi st ra tio n in cl ud in g co rr ec t di ag no sis , e nc od in g an d re co rd in g of or al c an ce r • In te gr at e su rv ei lla nc e fo r N C D s in to ot he r n at io na l h ea lth s ur ve ys • C ar ry o ut S TE PS s ur ve y (in cl ud in g St ep 3 ) o r e qu iv al en t s ur ve ys , e ve ry fiv e ye ar s. A ll M em be r S ta te s ar e en co ur ag ed to u se e ST EP S Action plan for the prevention and control of noncommunicable diseases in South-East Asia42 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O (R eg io na l O ff ic e an d co un tr y of fic es ) Pr op os ed a ct io ns fo r M em be r St at es • C ar ry o ut n at io na l s ch oo l h ea lth su rv ey s (a ge 1 3– 17 y ea rs ) u sin g th e gl ob al s ch oo l-b as ed s tu de nt h ea lth su rv ey (G SH S) e ve ry fi ve y ea rs to co lle ct d at a on m ul tip le ri sk fa ct or s (e .g . p hy sic al a ct iv ity , t ob ac co , ov er w ei gh t a nd o be sit y, a lc oh ol ) • U nd er ta ke s ec on da ry d at a an al ys es • U se s ur ve ill an ce in fo rm at io n fo r po lic y an d pr og ra m m e de ve lo pm en t • D iss em in at e re su lts o f s ur ve ill an ce w id el y to a ll st ak eh ol de rs Action plan for the prevention and control of noncommunicable diseases in South-East Asia 43 4. 2 Im pr ov e m on ito ri ng a nd e va lu at io n Pa rt ne rs : M in ist rie s of h ea lth , ot he r re le va nt m in ist rie s/ go ve rn m en t ag en ci es ; pr of es sio na l b od ie s, N G O s, a ca de m ia , N at io na l R es ea rc h C ou nc il/ ot he r r es ea rc h in st itu tio ns , U N a ge nc ie s/ bi la te ra l a nd m ul til at er al d ev el op m en t p ar tn er s D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O (R eg io na l O ff ic e an d co un tr y of fic es ) Re co m m en da tio ns fo r ac tio ns b y M em be r St at es Ti m el y re po rti ng an d us e of in fo rm at io n to im pr ov e N C D pr og ra m m e • N at io na l p ro gr es s re po rt on k ey n at io na l, re gi on al a nd g lo ba l in di ca to rs a nd ta rg et s pu bl ish ed p er io di ca lly • As se ss n at io na l c ap ac ity fo r pr ev en tio n an d co nt ro l o f N C D s at re gu la r i nt er va ls an d us e th is in fo rm at io n to p lu g ga ps in ca pa ci ty • Pr ov id e te ch ni ca l s up po rt to M em be r S ta te s to d ev el op a na tio na l N C D m on ito rin g fra m ew or k in cl ud in g in di ca to rs a nd n at io na l t ar ge ts ; m ec ha ni sm s fo r d at a co lle ct io n; fre qu en cy o f d at a co lle ct io n; an d us e of d at a • Se t u p a re gi on al m ec ha ni sm to tr ac k ac hi ev em en ts o f M em be r S ta te s ag ai ns t k ey ta rg et s an d fa ci lit at e ex ch an ge o f in fo rm at io n • D ev el op n at io na l t ar ge ts a nd in di ca to rs b as ed o n th e gl ob al an d re gi on al m on ito rin g fra m ew or k an d lin ke d to a na tio na l m ul tis ec to ra l p ol ic y an d ac tio n pl an • In te gr at e N C D m on ito rin g sy st em in to n at io na l h ea lth a nd m an ag em en t i nf or m at io n sy st em s • D es ig n an d co nd uc t e va lu at io n of N C D in te rv en tio ns p er io di ca lly • Pu bl ish p er io di c re po rts o n pr og re ss m ad e in N C D p re ve nt io n an d co nt ro l i nc lu di ng re po rti ng o n ke y na tio na l, re gi on al a nd g lo ba l in di ca to rs a nd ta rg et s Action plan for the prevention and control of noncommunicable diseases in South-East Asia44 4. 3 St re ng th en r es ea rc h Pa rt ne rs : M in ist rie s of h ea lth , ot he r re le va nt m in ist rie s/ go ve rn m en t ag en ci es ; pr of es sio na l b od ie s, N G O s, a ca de m ia , N at io na l R es ea rc h C ou nc il/ ot he r r es ea rc h in st itu tio ns , U N a ge nc ie s/ bi la te ra l a nd m ul til at er al d ev el op m en t p ar tn er s D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O (R eg io na l O ff ic e an d co un tr y of fic es ) Pr op os ed a ct io ns fo r M em be r St at es Re le va nt e vi de nc e ge ne ra te d an d us ed fo r na tio na l p ol ic y an d pr og ra m m e de ve lo pm en t • Av ai la bi lit y of a na tio na l r es ea rc h ag en da a nd a pr io rit iz ed re se ar ch pl an fo r p re ve nt io n an d co nt ro l o f N C D s • Pr ov id e te ch ni ca l s up po rt to d ev el op n at io na l N C D re se ar ch a ge nd a an d as sis t in re so ur ce m ob ili za tio n to ca rr y ou t p rio rit y re se ar ch • St re ng th en c ap ac ity o f na tio na l i ns tit ut io ns a nd s ta ff in d ev el op m en t o f r es ea rc h pr ot oc ol s, a na ly se s of d at a an d pr ep ar at io n of s ci en tif ic pe er -r ev ie w ed m an us cr ip ts • Fo st er p ar tn er sh ip s an d lin ka ge s be tw ee n ac ad em ia , re se ar ch in st itu tio ns a nd he al th s er vi ce a ge nc ie s to tra ns la te re se ar ch in to p ol ic y an d ac tio n • Al lo ca te a de qu at e fu nd s fo r N C D re se ar ch • D ev el op , i m pl em en t a nd m on ito r a pr io rit y na tio na l r es ea rc h ag en da fo r p re ve nt io n an d co nt ro l o f N C D s, b as ed o n co ns ul ta tio n w ith u ni ve rs iti es , W H O a nd o th er st ak eh ol de rs • St re ng th en n at io na l c ap ac ity fo r re se ar ch a nd d ev el op m en t, in cl ud in g re se ar ch in fra st ru ct ur e, e qu ip m en t an d su pp lie s in re se ar ch in st itu tio ns , an d th e co m pe te nc e of re se ar ch er s to co nd uc t g oo d- qu al ity re se ar ch • En ha nc e co op er at io n be tw ee n un iv er sit ie s, re se ar ch in st itu te s an d he al th s er vi ce s to e ns ur e sp ee dy ut ili za tio n of re se ar ch fi nd in gs a nd sc ie nt ifi c ba sis fo r d ec isi on -m ak in g fo r N C D p ol ic y/ pr og ra m m e de ve lo pm en t Action plan for the prevention and control of noncommunicable diseases in South-East Asia 45 D es ir ed o ut co m e In di ca to rs Ac tio ns fo r W H O (R eg io na l O ff ic e an d co un tr y of fic es ) Pr op os ed a ct io ns fo r M em be r St at es • O rg an iz e in te rc ou nt ry m ee tin gs a nd c on fe re nc es to fa ci lit at e sh ar in g of n ew re se ar ch fi nd in gs a m on g M em be r S ta te s • En co ur ag e m ul ti- co un try da ta c ol le ct io n an d an al ys is to d et er m in e di ag no st ic c ut - of f f or o ve rw ei gh t/ ob es ity a m on g So ut h- Ea st As ia n ad ul ts • Pr om ot e sh ar in g of d at a an d re se ar ch d at ab as es a m on g M em be r S ta te s • St re ng th en c ol la bo ra tio n be tw ee n na tio na l, re gi on al a nd in te rn at io na l re se ar ch c en tre s • Bu ild fo rm al li nk ag es b et w ee n re se ar ch a nd p ol ic y/ pr og ra m m e Action plan for the prevention and control of noncommunicable diseases in South-East Asia46 References (1) World Health Organization Regional Office for South-East Asia. Regional Health Observatory. http://apps.who.int/searo-rho/ - accessed 13 November 2013. (2) Mahal A, Karan A, Engelgau M. The Economic Implications of Non-communicable Diseases for India. HNP discussion paper. New York: World Bank, 2010. (3) Thavorncharoensap M, et al. The economic costs of alcohol consumption in Thailand, 2006. BMC Public Health, 2010, 10:323. (4) United Nations General Assembly resolution. Doc no. A/RES/66/2. New York. http:// www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf - accessed 13 November 2013. (5) World Health Organization. Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. Doc no. WHA66.10. Geneva: WHO 2013. http://apps.who.int/gb/ebwha/ pdf_files/WHA66/A66_R10-en.pdf - accessed 13 November 2013. (6) World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013–2020. Geneva: WHO. http://apps.who.int/gb/ebwha/ pdf_files/WHA66/A66_R10-en.pdf - accessed 13 November 2013. SEA-NCD-89 Noncommunicable diseases (NCDs) are the leading cause of death globally as well as in the South-East Asia Region. The Global Action Plan (GAP) for the prevention and control of NCDs 2013–2020, including a comprehensive monitoring framework with 25 indicators and 9 voluntary global targets, was endorsed by the Sixty-sixth World Health Assembly in May 2013. The Regional Action Plan for the prevention and control of NCDs in the WHO South-East Asia Region 2013–2020, based on GAP, provides a roadmap for action at the regional and national level to develop and implement policies and programmes to reduce the burden of NCDs within the socioeconomic, cultural, political and health system contexts of Member States. The Seventy-fourth session of the Regional Committee for South-East Asia extended the Regional Action Plan to 2030. The Regional Action Plan lists priority actions for Member States and WHO in four strategic action areas, namely: (i) advocacy, partnerships and leadership; (ii) health promotion and risk reduction; (iii) health systems strengthening for early detection and management of NCDs and their risk factors; and (iv) surveillance, monitoring and evaluation, and research. While these actions will be executed until 2030, implementation of these priority actions should lead to a reduction in overall mortality from major NCDs as well as the achievement of the regional voluntary targets. In addition, the Regional Implementation Roadmap for the prevention and control of NCDs 2022–2030 will also incorporate the targets set for 2030 as part of the Sustainable Development Agenda. Action plan for the prevention and control of noncommunicable diseases in South-East Asia, 2013–2020