Western Pacific Region
Table of Contents 1. Introduction and Rationale. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2. Target Audience. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 3. Purpose. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 4. Process of Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 5. Vision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 6. Goals and Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 6.1 Goals for 2008-2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 6.2 Targets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 7. Role of the Health and Other Sectors in Injury and Violence Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 8. Recommended Actions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 9. Mechanism for Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 1. Cross-Cutting Action Areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table 2. Specific Injury Prevention Action Areas. . . . . . . . . . . . . . . . . . . . . . . . . 20 Annex: Country Profile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
1. Introduction and Rationale
T
he Global Burden of Disease 2002 mortality data estimate that 5.2 million people die annually as a result of injury. This number is small compared to the number of survivors of injuries, many of whom suffer lifelong health and psychological consequences. Given current trends, the global burden of injury and violence is expected to rise considerably during the coming decades, particularly in low- and middle-income countries. The cost to society of these injuries and other health consequences is highly significant, particularly since it is the young who are disproportionately killed, injured and otherwise affected, with profound effects on families, poverty and productivity. In response to the magnitude of the injury and violence problem globally, the World Health Organization (WHO) has recently placed injury and violence prevention higher on the global public health agenda. WHO has published world reports and guidelines to assist countries in defining and preventing avoidable deaths and disability from these causes. The World report on violence and health and the World report on road traffic injury prevention were launched by WHO in 2002 and 2004, respectively, with the objective of bringing these issues to the attention of world leaders and providing recommendations for action. These reports were endorsed by the World Health Assembly (WHA) in resolutions WHA 56.24 (Implementing the recommendations of the World report on violence and health) and WHA 57.10 (Road safety and health), respectively. The World report on road traffic injury prevention provided a basis for several sessions in the United Nations General Assembly (UNGA) on global road safety crisis and produced the UNGA resolutions on improving global road safety in 2004 and 2005 (A/RES/58/289 in 2004, and A/60/L.8 in 2005). Currently, WHO, in collaboration with the United Nations Children’s Fund (UNICEF), has initiated the preparation of a World report on child and adolescent injury prevention expected to be launched in late 2008. These reports and resolutions call on ministries of health to take action.
These global developments and resolutions have provided the foundation for regional responses. In the Western Pacific Region, injury deaths exceed an estimated 1.2 million per year, equivalent to 24% of the total number of injury deaths recorded worldwide. More than 93% of injuries in the Region occurred in low- and middle-income countries, affecting the five to forty four year age group in particular. In 2002, the major causes of injury deaths in the Region were road traffic injuries (304 000 deaths), drowning (132 000 deaths), falls (116 000 deaths), poisoning (76 000 deaths), interpersonal violence (67 000 deaths), and burns (20 000 deaths). With rapid strides in development and motorization, injury deaths can be expected to increase in the Region. The scientific literature confirms that, at least in high-income countries, most severe injuries are preventable or can have their consequences mitigated. Nevertheless, numerous gaps still exist between this knowledge and its implementation. Disparities are marked between regional high-income country injury mortality rates, such as Australia, where rates are low, compared with high rates for China and other countries in the Region. In many cases, high-income countries had historically high fatality rates similar to current low- and middle-income country rates, 50-100 years ago. This was followed by dramatic and sustained downward trends. Examples include drowning and road traffic injuries. For some countries in the region, the fatality rates of these injuries have achieved substantial, world-leading reductions, whereas for other countries they continue to be high. There is an imperative to solve injury and violence problems in the developing world and a need for a systematic regional approach to promote effective and efficient injury and violence prevention practices across geographical boundaries and jurisdictions. At a country level, defining a shared vision and common values should help to unite all those who are involved in injury and violence prevention, such as the government sector, nongovernmental organizations (NGOs) and community stakeholders, and in turn ensure that efforts are channeled in the same direction. Further, it has been observed that the very act of developing a policy document can bring about significant changes in attitudes and perceptions that can go a long way towards tackling injury and violence problems. It is for this reason that a Regional Framework for Action is developed.
Regional Framework for Action on Injury and Violence Prevention 2008-2013
2. Target Audience
T T
he primary target audience for this Framework for Action is decision makers in all sectors of governments, particularly Ministries of Health. It is also relevant for United Nations agencies, nongovernmental organizations, donors, and other actors in the public health sector.
3. Purpose his Regional Framework for Action aims to provide guidance on specific actions by key stakeholders for injury and violence prevention, in the form of objectives, priorities, timetables and mechanisms for evaluation. It also addresses resources needed to improve injury and violence prevention, and provides evidencebased information on how to implement, monitor and evaluate these activities. This Framework serves a number of purposes: l To raise awareness and create mutual understanding about injury and violence prevention l To articulate ethical and other principles to justify and guide action l To build on the concept of the preventability of injury and violence by a systematic scientific approach and multi-sectoral action l To build on the experiences of countries that have begun implementing national plans of action for injury and violence prevention l To generate a consensus vision on the actions to be undertaken l To define institutional responsibilities and mechanisms of coordination; and to engage a variety of partners l To provide a framework for countries to set their own national quantitative and qualitative targets, as well as capacity building targets l To encourage countries to collaborate at local, national and regional levels to maximize resources and to benefit from each other’s experiences l To give coherence and visibility to the issue at the political level
Regional Framework for Action on Injury and Violence Prevention 2008-2013
4. Process of Development
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he Regional Framework for Action was developed through discussions at two regional meetings involving technical government officials of countries and areas in the Region. One was held for Asian countries and areas of the Region in Manila, Philippines in May 2006. The other was held for Pacific island countries and areas in Nadi, Fiji in April 2007. Prior to the Manila meeting, a draft was prepared, based on a review of literature and available information on injury and violence prevention in the Region. This framework has also been developed along with country profiles on injury and violence prevention. These profiles were compiled by respective Members based on a common format, which is given in the Annex. These country profiles provide a reasonably comprehensive picture of the status of regional injury and violence prevention and baseline data for the implementation and monitoring.
5. Vision The Framework for Action on Injury and Violence Prevention in the Western Pacific Region envisions a region where fatal, severe and disabling injury and violence rates are reduced to current world best practice rates or below.
6. Goals and Targets 6.1 Goals for 2008-2013 The goals are to: l Establish and sustain the necessary infrastructure and capacity to support effective policy development and implementation for injury and violence prevention and care in countries and areas of the Western Pacific Region.
Regional Framework for Action on Injury and Violence Prevention 2008-2013
l
Achieve accelerated progress in halting rising trends and reducing fatal, severe and disabling injury and violence rates in all regional countries.
6.2 Targets Targets in violence and injury prevention may relate to outcomes in terms of infrastructure developments and violence and injury reductions, impacts in terms of risk factors, or intermediate outcomes and process measures. All of these measures have been employed in this broad-based framework. There are many arguments for and against setting targets in an action plan. Clearly setting achievable targets with regard to injury and violence rates is problematic in the absence of reliable data. Furthermore, improvements to injury and violence data may result in apparent increases in rates in some countries, and real increases in the presence of rising trends in some violence and injury rates. Importantly, if targets are set, it may be seen as a failure if they are not achieved. Each country will need to make its own determinations of its strategic development process and whether or not it will set targets, whether these are quantitative or qualitative. The major regional targets set at the regional meetings are, by 2013, to achieve: l An overall reduction in fatal child and adult injuries by 20% l An increased number of countries with a documented strong commitment to injury and violence prevention at the highest level of government l National action plans developed and implemented by an increased number of regional countries and areas and supported by reliable and timely fatality data l An increase in the allocations of the government and donor budgets for injury and violence prevention regionally
Regional Framework for Action on Injury and Violence Prevention 2008-2013
7. Role of the Health and other Sectors in Injury and Violence Prevention
I
njury and violence prevention requires multi-sectoral action that includes the sectors that have jurisdiction over and can solve the problems. The health sector has particular responsibilities and issues under its influence. The health sector is expected to play major roles in the following areas: Areas Activities
Policies and planning Data collection Services
• Develop a plan of action for the health sector. • Support and facilitate the development of multisectoral plans of action. • Support the development of legislation. • Collect data on injury deaths, non-fatal injuries, their causes, and prevention, trauma care and rehabilitation activities. • Organize injury information systems with injury surveillance programmes and community/household surveys. • Conduct specific research. • Compile and disseminate data. • Organize and provide pre-hospital trauma care systems. • Provide hospital trauma care. • Organize rehabilitation and integrated services for victims and ensure these are coordinated with services of other sectors. • Coordinate, facilitate, or support the development and implementation of multi-sectoral interventions. • Monitor the effectiveness of interventions with indicators. • Build human resource capacity strengthening across all relevant sectors through training. • Maintain effective networks for exchanges and skills development. • Advocate to guide the public with correct information. • Advocate to support the work of other sectors.
Prevention Capacity building Advocacy
10 Regional Framework for Action on Injury and Violence Prevention 2008-2013
8. Recommended Actions
R
ecommended actions are presented in two sections. These are cross-cutting areas and specific injury prevention areas, which are presented in Tables 1 and 2, respectively. The specific injury prevention areas chosen are: road traffic injury, child and adolescent injury, and violence. For each of these cross-cutting and specific injury prevention areas, a set of objectives, actions, key players and targets has been developed in order to focus attention. Targets are indicative only. They are intended as regional targets which can only be achieved by the participation of countries and areas in the Region. Most targets are qualitative rather than quantitative. The objectives and actions are also indicative and may serve best for countries as a menu from which to choose their own activities for national purposes, but also to contribute to strategic regional action. While actions undertaken by Ministries of Health will clearly have a health sector orientation, a strong emphasis will also be needed on a multisectoral approach. The Ministries of Health, however, may take any of the following roles: leadership, catalytic, supporting or coordinating multisectoral action on all or only some of the issues. The designation of responsibilities will change in each country but the Ministry of Health should play a proactive role in ensuring that such multi-sectoral approaches are developed, informed by health impact data, and draw on evidencebased preventive strategies.
Regional Framework for Action on Injury and Violence Prevention 2008-2013 11
9. Mechanism for Evaluation A mechanism for evaluation is an essential component of any framework for action. The country reports prepared in 2006 and 2007 provide the baseline data for the evaluation, in the form of a needs assessment, and baseline information and injury data for each country, against which to monitor the effectiveness of interventions. Improved regional injury outcomes will reflect the sum of gains made by each country, although it must be recognized that improved data may give the initial appearance of rising rates in some countries. While optional targets, both qualitative and quantitative, have been included in this Framework for Action as recommendations, they are indicative only and if adopted, timeframes will be determined by each country. A formal regional review of progress against the Framework for Action should be undertaken in 2013 with a mid-term review in 2010. Consideration should also be given to the appointment of a regional advisory committee for both implementation and evaluation. Country profiles should be updated every 2-3 years by means of country reports using the established format (Annex).
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Table 1. Cross-cutting Action Areas (1 of 7) Themes and Specific Objectives Action Key Players Targets
Infrastructure for injury prevention Priority types of injury and violence identified by countries Highest level of government support for national injury and violence prevention action plan agreed upon Coordination of action mechanisms for injury and violence prevention within health and between sectors, including NGOs and donor National goals and targets set for injury and violence prevention Provincial (sub-level) goals, targets and action plans set for injury and violence prevention, where applicable Prepare country reports, including detailed injury and violence data in all settings. Documentation on size and nature of problems and clear directions for inter-sectoral interventions provided to government. Appoint a high-level inter-sectoral committee. Ministry of Health, other ministries Ministry of Health, other ministries, United Nations’ agencies, NGOs Priority injuries identified by all regional countries by 2013. An increased number of countries with documented strong commitment to injury and violence prevention at the highest levels of government with an inter-sectoral committee actively implementing a national strategy.
Regional Framework for Action on Injury and Violence Prevention 2008-2013 13
Prepare an inter-sectoral national report and action plan on injury and violence prevention. Prepare an inter-sectoral province report and action plan on injury and violence prevention.
Ministry of Health, other ministries, United Nations’ agencies, NGOs Ministry of Health, other ministries, NGOs
National action plans, developed and implemented by an increased number of regional countries by 2013. Development and implementation of provincial or state-level action plans where applicable.
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Table 1. Cross-cutting Action Areas (2 of 7) Themes and Specific Objectives National laws for injury and violence prevention implemented, where gaps exist Increased allocation of funds for injury prevention in budgets of Ministry of Health and other agencies Action Introduce and publicize legislation. Implement enforcement. Prepare report for government on the cost of injury and potential benefits of investment in prevention. Key Players Police, regulators, standards’ authorities Ministries of Health, National Government, United Nations’ agencies, regional aid agencies Ministries of Health, other ministries Targets Evidence of effective new laws and enforcement. Increase in Ministry of Health and donor budget allocations for injury prevention regionally by 2013.
Implementation of policies for Advocate for policies to ensure safe design of environments safe design of environments and products and consumer products.
Policies implemented and enforced.
D ata Reliable national (and provincial) injury death statistics available, (including those on homicide, suicide, unintentional and intentional injury, and undetermined causes) Review and improve the reporting of injury death statistics. Ministry of Health, other ministries An increased number of countries providing reliable, timely injury death statistics reported nationally and to WHO by ICD 9 or 10 detailed external cause codes. Injury death data widely available and disseminated within countries and at the regional level.
Table 1. Cross-cutting Action Areas (3 of 7) Themes and Specific Objectives Reliable national (and provincial) hospital admission injury statistics available Action Ensure that International Classification of Diseases (ICD) codes are applied for diagnoses and external causes, including intent, place and activity for all hospital admitted injuries. Undertake a country survey (or province level surveys) to verify death and injury statistics, exposure, and risk and protective factors; to provide information on violence-related health risk behaviours and current health status; and to provide information on exposure to hazards and protective factors. Key Players Ministry of Health, hospitals, schools of public health Targets Reliable, timely injury hospital admission statistics reported to WHO by an ICD 9 or 10 diagnosis and external cause codes. Hospital admissions data generally available and widely disseminated within countries. Results available locally and internationally for an increased number of countries. Results reported in the scientific literature, by countries undertaking surveys.
Regional Framework for Action on Injury and Violence Prevention 2008-2013 15
Country-level household survey for injury and violence
Ministry of Health, United Nations agencies, WHO Collaborating Centres, NGOs, academic institutions
16 Regional Framework for Action on Injury and Violence Prevention 2008-2013
Table 1. Cross-cutting Action Areas (4 of 7) Themes and Specific Objectives Action Key Players C A PA C I T Y Build capacity for injury and violence prevention and evaluation, including intervention, leadership, coordination, administration and research. Increase the number of fulltime staff devoted to injury and violence prevention in health and other relevant ministries. Implement training programmes for injury prevention professionals. Integrate TEACH-VIP curriculum into medical school and MPH courses. WHO, WHO Collaborating Centres, academic institutions Ministry of Health, other ministries, academic institutions At least one full-time focal person designated for violence and injury prevention in the Ministry of Health at national and province levels in a greater proportion of regional countries. An increase in the number of designated injury and violence prevention personnel with 20 hours or more of relevant training. An increase in the proportion of medical schools teaching violence and injury prevention in their undergraduate curricula. An increase in the percentage of public health schools teaching injury and violence prevention. An increase in the number of PhD students with violence and injury prevention topics. Targets
Implement formal mentoring programme within the region (e.g. MENTOR-VIP).
WHO, academic institutions, Ministry of Health
Table 1. Cross-cutting Action Areas (5 of 7) Themes and Specific Objectives Action Key Players Targets A functional and effective formal regional violence and injury prevention mentoring programme established. Research Conduct research on causes, risk factors, consequences and prevention of injury and violence, monitoring and evaluation. Identify research gaps, set a research agenda and allocate research funding. Implement research programme. Establish data management systems to monitor injury and violence trends. Identify specific indicators for different injury mechanisms (e.g. motorcyclist head injuries). Evaluate interventions in terms of implementation and outcomes. Ministry of Health, other ministries, academic institutions Research agenda set for regional issues and an increase in the number of countries with an injury and violence research agenda. Sources of research funds identified. Trends established for national deaths and hospital admissions due to injury and violence in a greater percentage of countries.
Regional Framework for Action on Injury and Violence Prevention 2008-2013 17
An increase in the regional dissemination of results of research and interventions.
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Table 1. Cross-cutting Action Areas (6 of 7) Themes and Specific Objectives Action Key Players Targets
P r e - Hos p ita l a n d Hos p ita l C a r e Widespread community knowledge of first aid, including emergency resuscitation Mass casualty management Implement first-aid training into tertiary courses, police and emergency services. Build capacity and a triage system. Reduce time to care and ensure efficient transportation system for response to emergencies. Conduct training for all levels of staff. Defined and optimized training of doctors and nurses in trauma care Provide trauma care training in basic education and during postgraduate training. Ministry of Health, academic institutions, hospitals Proportion of staff trained in trauma care increased to 75%. Ministries of Health and Education, academic institutions Ministry of Health, police and emergency responders, hospitals Increased percentage of the population trained in first aid. Emergency triage piloted and implemented.
Table 1. Cross-cutting Action Areas (7 of 7) Themes and Specific Objectives Performance improvement Action Evaluate the performance of both individual providers and the system in which they work. Key Players Ministry of Health, hospitals Targets All trauma hospitals to implement: • Morbidity and mortality conferences • Preventable death studies • Quality of care audits • Complications tracked Rehabilitation services integrated with primary care.
Regional Framework for Action on Injury and Violence Prevention 2008-2013 19
Rehabilitation services integrated with primary care
Provide rehabilitation services at all trauma treatment facilities.
Ministry of Health, hospitals
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Table 2-1
Table 2. Specific Injury Prevention Action Areas (1 of 10) Themes and Objectives Action Categories
Key Players
Targets (optional)
Roa d T r a f f ic I n j u r y Motorcyclist injury prevention Advocate for and support implementation of: • Implementation of helmet legislation. • Enforcement of helmet wearing laws. • Enforcement of helmet standard. • Enforcement of general road traffic laws. Ministry of Health and UN agencies to set policy for staff helmet wearing. Advocate for and support implementation of: • Construction of footpaths and bicycle paths. • Construction of pedestrian barriers in unsafe locations. • Provision of median strips, overpasses, subways, traffic lights for safe pedestrian crossing points.
Government, police, NGOs, role models
Reduce head injuries to motorcyclists by 75%.
Ministry of Health, United Nations agencies Government, road designers/engineers Reduce pedestrian deaths by 25%. Reduce bicyclist deaths by 30%.
Safer routes for pedestrians and bicyclists
Table 2. Specific Injury Prevention Action Areas (2 of 10) Themes and Objectives Action Categories • Separation of bicycles from other traffic. • School policies on safe transport to school. Vehicle occupant protection Advocate for and support implementation of: • Implementation of mandatory seat-belt wearing laws for all vehicle occupants. • Enforcement and publicizing of seat belt laws. • Enforcement of child restraint laws. • Implementation of seat belt reminder systems. • Implementation of new vehicle safety rating system. Ministry of Health to establish child restraint loan programmes and set policy for seat belt wearing by staff. Government, police, automobile associations, automobile industry, media Turn around rising trends in occupant deaths and injuries by 2010. Seat belt wearing and child restraint use by at least 80% of vehicle occupants. Awareness of safety rating scheme by new vehicle purchasers. Key Players Targets (optional)
Regional Framework for Action on Injury and Violence Prevention 2008-2013 21
Ministry of Health
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Table 2-3
Table 2. Specific Injury Prevention Action Areas (3 of 10) Themes and Objectives Make safety a key consideration in design of all roads and vehicles Action Categories Advocate for: • Making safe road and vehicle design strategies widely available to all key players. • Common road signage for all countries. Advocate for improved enforcement of alcohol and driving laws. Advocate for the provision of public transport to lessen exposures of vulnerable road users, such as pedestrians, bicyclists and motorcyclists.
Key Players
Targets (optional)
Government, road designers, traffic engineers, donors
Safety considerations included and funds allocated in new road works.
Reduce harmful use of alcohol Adequate public transport
Transport sector, police, media Governments
Reduction in alcohol involved deaths and injuries. Reductions in vulnerable road user deaths and injuries.
Table 2-4
Table 2. Specific Injury Prevention Action Areas (4 of 10) Themes and Objectives Action Categories
Key Players
Targets (optional)
C h i l d a n d A d o l e sc e n t I n j u r y Drowning prevention Advocate for and support implementation of: • Drainage of unnecessary accumulations of water (e.g. baths, ponds, ditches). • Promotion of “learn to swim” and water safety programmes for primaryschool children. • Training of lifeguards for regular deployment in supervised swimming locations. • Fencing around other bodies of water, around houses and in the community. • Encouraging fencing around rural homes in proximity to water (e.g. farmhouses). • Encouraging the use of grills over water wells. Ministry of Health, other ministries, WHO / UNICEF, TASC, life saving organizations, swimming associations, other NGOs (including Red Cross), WHO Collaborating Centres, academic institutions
Reduce child drowning deaths by 40%.
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Table 2-5
Table 2. Specific Injury Prevention Action Areas (5 of 10) Themes and Objectives Action Categories • Increase in awareness of the need to supervise children both in and outside the home. • Development of caretaker plans for flash floods. • Increase education of the need for personal floatation devices when boating and near water. • Provision of CPR training to community. Falls prevention Advocate for and support implementation of: • Implementation and enforcement of playground safety standards. • Implementation and enforcement of standards for children’s furniture and products to same standards applied in high income countries.
Key Players
Targets (optional)
Government (including product safety, labour, education, health), international agencies, NGOs, standards organizations, manufacturers, regulators, media
Reduce deaths and serious injuries due to falls by 40%.
Table 2-6
Table 2. Specific Injury Prevention Action Areas (6 of 10) Themes and Objectives Action Categories • Implementation and enforcement of occupational health and safety regulations. • Planting of low-growing tree varieties (coconut, grapefruit, mango) to prevent injury from falls from trees; teaching of traditional safe methods of tree climbing. • Supporting communitybased strategies including safe workplaces and safe schools and playgrounds. Burns and scalds prevention Advocate for and support implementation of: • Use of smoke alarms and fire sprinklers. • Provision of fire-escape systems in residential dwellings. • Use of safer stoves to protect and prevent access by children.
Key Players
Targets (optional)
Regional Framework for Action on Injury and Violence Prevention 2008-2013 25
Government, international agencies, NGOs, standards organizations, manufacturers, regulators, media
Reduce deaths and serious burn injuries by 50%.
26 Regional Framework for Action on Injury and Violence Prevention 2008-2013
Table 2-7
Table 2. Specific Injury Prevention Action Areas (7 of 10) Themes and Objectives Action Categories • Implementation of safety regulations to housing designs and materials. • Lowering the temperature of domestic hot water delivered at taps. Ministry of Health to promote less hazardous fuels. Animal related injury prevention Snake bite prevention Snake bite emergency care Promote the wearing of protective clothing. Promote public awareness of first aid for snake bite. Store specific anti-venoms locally for specific species. Prevention of dog bite and serious consequences Provide public education on responsible pet ownership including rabies vaccination for dogs. Register pets.
Key Players
Targets (optional)
Ministries of Health, Education, Agriculture, NGOs
Reduce snake bite fatalities by 40%.
Local storage of relevant anti-venoms 80%. Rabies eradication programme implemented.
Registration and vaccination of pet dogs implemented.
Table 2-8
Table 2. Specific Injury Prevention Action Areas (8 of 10) Themes and Objectives Action Categories Destroy feral dogs. Provide public education on dog bite treatment.
Key Players
Targets (optional)
Regional Framework for Action on Injury and Violence Prevention 2008-2013 27
Vio l e n c e C o n s e q u e n c e s Prevent violence by identifying precipitating factors. Prevent violence among mentally ill patients. Implement programmes to address precipitating factors. Create social support network programmes. Promote training of life skills. Strengthen responses for victims of violence. Promote recognition of signs of violent incidents and referral to appropriate agencies. Ensure accessible services. Government, NGOs Ministry of Health, NGOs
Measured reduction in violence. Reduced violence among the mentally ill.
Ministry of Health, hospitals, primary health care workers, NGOs
Measured increase in diagnoses and referrals.
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Table 2-9
Table 2. Specific Injury Prevention Action Areas (9 of 10) Themes and Objectives Promote gender and social equality. Action Categories Integrate violence prevention into social and educational policies. Add gender and social equality to school curriculum. Intensify collaboration and exchange of information on violence prevention. Promote protection of human rights. Seek practical, internationally agreed responses to the global drugs trade and the global arms trade. Sharing of knowledge, agreement on prevention goals and coordination of action. Promote adherence to international treaties, laws and other relevant mechanisms. Support international implementation of constraints on drugs and arms trades.
Key Players Governments
Targets (optional)
Increased percentage of relevant policies include gender and equality.
International agencies, governments, researchers, networks and NGOs Governments, advocates Government, advocates
Action plans prepared and implemented.
Proportion of relevant government documents promoting human rights increased by 50%. Support of containment resolutions at international assemblies.
Table 2-10
Table 2. Specific Injury Prevention Action Areas (10 of 10) Themes and Objectives Reduce drug and alcohol related violence among youth. Action Categories Implement programmes providing information about drug abuse. Legislate to control sales and access to alcohol. Form partnerships with alcohol outlets (e.g. nightclubs) to promote responsible serving of alcohol. Enforce laws that prevent access to minors. Suicide prevention by: (1) Reducing access to the means of suicide. (2) Promoting a supportive social environment. Reduce accessibility of highly toxic pesticides by limited sales, volumes and safe packaging. Promote the provision of social support, network and coping skills.
Key Players
Targets (optional)
Ministries of Health and Justice, NGOs, WHO Collaborating Centres, entertainment industry
Reduce drug and alcohol related violence among youth by 20%.
Regional Framework for Action on Injury and Violence Prevention 2008-2013 29
Ministry of Health, other ministries, manufacturers, international agencies
Reduce suicide rate by pesticide ingestion by 40%.
Reduce overall suicide rate.
Annex — Country Profile 1. Demographics. Provide a brief description of the country’s demographics, including total population, socio-economic indicators (such as per capita income and gross domestic product), major causes of injury and injury-related deaths, and injury statistics. 2. Public policy and legislation. Describe the following: l Is there commitment to injury and violence prevention at the highest levels of government in your country? Please describe. l Are there national laws relating to injury and violence prevention? Please outline. l Are these laws well enforced? 3. National programme development and implementation. Indicate your country’s current and planned developments against the following: (a) Priority types of injury and violence identified in the country (indicate these and attach a summary) (b) National report on injury and/or violence (c) National strategy/action plan/implementation plan for injury and/ or violence prevention; priority areas for action (how priorities are determined) (d) National targets/goals set for injury prevention (e) Provincial (sub-national) level strategies and plans, if any (f) Current or recently completed major injury and violence prevention intervention programmes (g) Evaluation of interventions in terms of implementation and outcomes (h) Dissemination of results of programmes
30 Regional Framework for Action on Injury and Violence Prevention 2008-2013
4. Coordination, leadership, administration and capacity. Provide information about each of the following: l National government agencies and institutes involved in different aspects of injury and violence prevention in the country, and the lead agencies that coordinate multi-sectoral actions l NGOs, if any, active in injury and/or violence prevention in the country l How is injury prevention coordinated within health, between sectors, between NGOs, and with funders/donors? l Human resources, including the number of full-time staff devoted to injury and/or violence prevention in the health and other relevant ministries l Do they, particularly those working full-time for injury and/or violence prevention, have the necessary knowledge and skills for administration and coordination? l Are funds allocated for injury prevention in the budget of the Ministry of Health and other government agencies? l Capacity building activities for injury and violence prevention: - Training programmes - University education and research programmes - Other: please specify 5. Data collection systems. For the data listed below, indicate who holds the data; how they are collected; if they are centralized; how they are stored; how they are disseminated (see also 3(a) above). Please describe any plans for improving coverage or access to data. (a) Death statistics (b) Hospital admission data: ICD coded for diagnoses and external causes (c) Injury surveillance data - Hospital based - Other primary care settings (d) Country level household survey for injury. Date of last survey or planned survey. Are the results available internationally?
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6. Pre-hospital and hospital care. Describe the current services available for emergency pre-hospital and hospital care for injured persons in the country. Are standards of care specified? Are rehabilitation services integrated with primary care? 7. Issues and challenges. List the critical issues and challenges that the country faces in successfully ensuring effective injury and violence prevention programmes.