Joint mission of the United Nations Interagency Task Force on the prevention and control of noncommunicable diseases: Democratic Republic of the Congo, 13-17 July 2015

– Joint Mission of the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases Democratic Republic of the Congo 13–17 July 2015 WHO/NMH/NMA/17.89 © World Health Organization 2017 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). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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This publication contains the collective views of the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases and does not necessarily represent the decisions or the policies of WHO. iii Contents Page Executive Summary 3 Introduction 4 Background 4 Context 4 Findings of the Mission 6 Recommendations for Action 8 Annexes 1. Participants in the joint mission 12 2. Joint Mission Terms of Reference 13 3. Joint Mission Programme 16 4. Evidence-based cost-effective interventions for the prevention and control of NCDs 17 5. National commitments as set out in the Outcome Document of the High-Level Meeting of the General Assembly on the Review of the Progress Achieved in the Prevention and Control of NCDs 18 6. Luanda commitment on NCDs in Africa: policies and strategies to address risk factors 21 7. Roadmap following the Joint UN NCD Task Force mission to the Democratic Republic of Congo 22 iv Executive Summary A Joint Mission of the United Nations Inter Agency Task Force on the Prevention and Control of Noncommunicable Diseases (NCDs) to the Democratic Republic of the Congo (DRC) was held from 13 to 17 July 2015 at the request of the government of DRC. NCDs are a growing public health challenge in DRC and are estimated to cause 24% of premature deaths in the country1 and globally nearly three quarters of all NCDs deaths are premature (i.e. under the age of 70 years). Most NCD deaths are caused by stroke, cardiovascular diseases and diabetes. The leading cause of death from NCDs in DRC is cardiovascular diseases, followed by cancers, chronic respiratory diseases and diabetes. The main risk factors for NCDs are exposure to tobacco, harmful use of alcohol, physical inactivity and unhealthy diet, in large part because of globalisation, rapid urbanization and population ageing. Addressing NCDs and their risk factors therefore requires a “whole of government” and “whole of society approach”. The Joint Mission consisted of UNAIDS, UNDP, UNFPA, UNICEF, UN WOMEN and WHO. The main objective was to provide technical support to the government and the United Nations Country Team to support national efforts in the prevention and control of NCDs. Key findings of the mission were that: (i) a draft multisectoral NCD action is currently being developed; (ii) NCDs are not yet prioritised in development plans; 2 (iii) coordination needs considerable strengthening within the health sector and across sectors for effective action on NCDs; (iv) there is lack of robust data on NCDs; and (v) the tobacco control law which has been in preparation since 2006, is still to be adopted. Key recommendations included: (i) finalizing the multisectoral NCD Action Plan; (ii) reinforcing NCD multi-sectoral mechanisms to support implementation of the Action Plan; (iii) improving data collection; (iv) including NCDs into the UNDAF and PRSP and (v) accelerating the process of adoption of the tobacco control law in the DRC. The mission also recommended a short follow up Joint Mission in January 2016 to review progress. 1WHO NCD country profile for the Democratic Republic of the Congo, 2015.http://www.who.int/nmh/countries/cod_en.pdf?ua=1 2 The National Health Development Plan, the Poverty Reduction Strategy Paper (PRSP) or United Nationals Development Assistance Framework (UNDAF). 1 Introduction 1. A Joint Mission of the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases (UNIATF) to the Democratic Republic of the Congo was held from 13 to 17 July 2015. In alphabetical order, the following agencies participated in the mission: UNAIDS, UNDP, UNFPA, UNICEF, UN WOMEN and WHO (Annex 1). Terms of Reference are included as Annex 2 and the programme is Annex 3. The Mission is grateful to the Ministry of Public Health and other government ministries, civil society organizations, the private sector and the United Nations Country Team for their contributions. Background 2. The UNIATF was formed by the United Nations Economic and Social Council (ECOSOC) in 2013. In 2014, the ECOSOC approved the UNIATF’s Terms of Reference. 3 As part of this, a division of tasks and responsibilities was adopted by the UN agencies, funds and programmes to support the implementation of the Global NCD Action Plan 2013-2020. Activities identified in the UNIATF’s 2014- 15 workplan4 include a series of joint missions to selected countries to support governments and UN Country Teams (UNCTs) scale up their response to Noncommunicable Diseases (NCDs). The Joint Mission to DRC was the second one to be undertaken in Africa. Context At the global level there are clear frameworks to guide national action… 3. The 2011 Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of NCDs called upon UN agencies and key international organizations to work together in a coordinated manner to support national efforts to prevent and control NCDs and mitigate their impacts.5 The WHO Global Action Plan for the Prevention and Control of NCDs, 2013- 2020 also highlights the role of the UN system in supporting Member States and highlights interventions for the prevention and control of NCDs (Annex 4) in four key areas: (i) tobacco control; (ii) harmful use of alcohol; (iii) unhealthy diet; and (iv) physical inactivity.6 These interventions save lives. They also save individuals, communities and governments money in both the short and long term. They are all evidence-based, high impact, cost effective, affordable and feasible to implement. Acting alone, ministries of health are limited to remedial action, treating the sick; a whole-of- government approach is required for the societal causes of NCDs to be addressed… 4. Although these interventions are simple to execute, a number require political commitment and coordinated action across government. Acting alone, ministries of health are limited to remedial action, treating the sick. A whole-of-government approach is required for the societal causes of NCDs to be addressed. In parallel, a whole-of-UN approach must support a comprehensive national response. In addition, strategic engagement with civil society, academia, professional bodies and selected private entities are also important when it comes to tackling NCDs. 3E/2014/55, Appendix. http://www.who.int/nmh/events/2014/ecosoc-20140401.pdf?ua=1 (pages 11-18) 4 http://www.who.int/nmh/UN_Task_Force_on_NCDs_Workplan_2014_2015.pdf 5 Paragraph 51 of the Political Declaration “calls upon WHO, as the lead UN specialized agency for health, and all other relevant UN system agencies, funds and programmes, the international financial institutions, development banks and other key international organizations to work together in a coordinated manner to support national efforts to prevent and control NCDs and mitigate their impacts”. http://www.who.int/nmh/events/un_ncd_summit2011/political_declaration_en.pdf?ua=1 6 http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf?ua=1 2 5. In July 2014 in New York at the UN General Assembly, UN Member States undertook a comprehensive review and assessment on the prevention and control of NCDs and progress since the 2011 Political Declaration on NCDs.7 Key national commitments agreed at that meeting include: (i) setting national targets for NCDs for 2025; (ii) developing national multisectoral policies and plans to achieve the targets; (iii) considering establishing a national multisectoral mechanism for engaging policy coherence and mutual accountability of different spheres of policy-making that have a bearing on NCDs; (iv) reducing NCD risk factors by implementing interventions identified in the WHO NCD Global Action Plan, 2013-2020. The full set of national commitments is set out in Annex 5. At the Regional level there is also significant commitment... 6. In 2011, the 47 member states of the WHO African Region adopted the Brazzaville Declaration which called for the development and implementation of strategies, policies, guidelines, legislation and regulatory framework for the prevention and control of NCDs.8 Member States committed themselves to strengthen their health systems including health financing, training and retention of health workers. Member States also committed themselves to allocate resources commensurate with the burden of NCDs. In 2012, Resolution AFR/RC62/R79 endorsed the Brazzaville Declaration and further urged member states to strengthen monitoring and surveillance systems for NCDs to generate reliable data and use evidence to raise awareness of NCDs and strengthen political commitment for effective national actions. 7. In 2014, African Health Ministers attended a meeting jointly convened by the African Union Commission and WHO in Luanda and adopted the Luanda commitment on NCDs in Africa: policies and strategies to address risk factors. The commitments and undertakings made by minsters is included in Annex 6 At the country level NCDs is now becoming a major concern … 8. In 2012, NCDs were estimated to account for 23% of total deaths in DRC, representing just over 210,000 deaths per year. Of these 23% of deaths related to NCDs, 9% were from cardiovascular diseases, 3% cancers, 2% CRD, 1% diabetes and 8% attributed to other NCD deaths. 9. The estimated probability of dying between the ages 30 and 70 years from the four main NCDs is 24%.10 The estimated mortality due to the 4 major NCDs has increased by 60% in men (50,000 deaths in 2000 to nearly 80,000 deaths in 2012) and 56% in women (48,000 deaths to 75,000).11 10. In 2014, it was estimated that 32.1% of men and 31.5% of women had raised blood pressure.12 4.3% of adults had raised blood glucose/diabetes; 12.0% of men and 24.3% of women aged 18 years and older were overweight; 21.8% men and 28.1% of women were insufficiently physically active. 7 http://www.un.org/en/ga/68/resolutions.shtml 8 http://www.who.int/nmh/events/2011/ncds_brazzaville_declaration.pdf 9 http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=7971&Itemid=2593 10 WHO NCD country profile for the Democratic Republic of the Congo, 2015 (http://www.who.int/nmh/countries/cod_en.pdf?ua=1) 11 Ibid. 12 WHO Global Status Report on NCDs (add full ref….) 2015.. 3 11. Results from recent survey between 2010 and 2012 in Ndjili and Roi Baudouin described cause of death as follows: stroke (27.1%), diabetes (11.3%) and heart disease (9.3%).13 12. A now rather outdated STEPS survey conducted in 2005-6 in Kinshasa revealed that among adults aged 15 to 64 years, 6.4% were current smokers (14.1% among men and 1.4% among women) and that 5.6% had consumed alcohol on 4 or more days in the week prior to interview (7.3% among men and 3.6% among women).14 13. Similarly, older data from the Global Youth Tobacco Survey on tobacco conducted in 2008 in Kinshasa among youth aged 13-15 years, showed the proportion of smokers in this younger age group was much higher with 23.8% of current tobacco users (26.1% among boys and 21.9% among girls).15 14. In addition to the four principle NCDs, other noncommunicable conditions are important in DRC. For example, it is estimated that up to 12 % of children hospitalized in pediatric ward, had sickle cell anemia and the annual cost of the treatment is over US $1 000 per patient. 16 This impacts negatively on the education, employment and mental health of the individual affected and contributes to as well as stigma and discrimination. Findings of the Mission Government-level 14. There is commitment at the highest level in the Ministry of Public Health to address NCDs and that NCDs are a growing public health challenge that will have a devastating impact in future if not addressed. NCDs are included in the National Health Development Plan 2011-2015 but action has yet to be prioritized by Government. There is limited funding for NCD-related activities and total health expenditure per capita remains very low. Only 5% of health expenditure is funded through the government and for NCDs this is as low as 0.02% with a zero level of implementation. The Ministry of Public Health is keen to make NCDs a priority in the new National Health Development Plan 2015-2020. 15. There are a number of NCD programmes within the Ministry of Public Health that are led by energetic and dedicated staff. Unfortunately, these programmes are not well coordinated and are not operational at provincial or district level. Capacity in the provinces is almost non-existent: there are no provincial NCD focal points nor budget for NCDs. 16. There are 16 National Programmes relevant to NCDs within the Ministry of Public Health that bring together senior officials from health and other sectors, such as Road safety in the Ministry of Transportation, and Disabilities in the ministry of Social Affairs. Other multi-sectoral coordination mechanisms in health include the National Multisectoral Programme for the Fight against AIDS17 which reports to the President and the newly created National Nutrition Council that reports to the Prime Minister. 17. The Joint Mission reviewed the draft NCD Action Plan 2015-2020. The Action plan outlines strategies to manage cardiovascular diseases, diabetes, cancer and chronic respiratory diseases but 13 Programme National de Lutte contre les Toxicomanies et les Substances Toxiques (PNLCT) etc. 14 WHO Steps Factsheet for DRC. 2005. http://www.who.int/chp/steps/2005_DRC_FactSheet_EN.pdf?ua=1 15 Global Youth Tobacco Survey, DRC. 2008. http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=5491 16 WHO Regional Committee report, DRÉPANOCYTOSE : UNE STRATÉGIE POUR LA RÉGION AFRICAINE DE L’OMS AFR/RC60/8, 22 juin 2010 17 Programme national multisectoriel pour la lutte contre le SIDA (PNMLS) 4 does not adequately describe strategies to reduce NCD risk factors or their determinants at the population level. The Plan does not yet include national targets. In addition, other government ministries have not yet participated in the process of drafting the NCD Action Plan - involvement of all government sectors in finalizing the action plan is critical if DRC is to have a “whole of government” response to NCDs and to clarify roles, responsibilities and accountability of individual ministries. 18. Although the mission did not see evidence of other ministries being engaged in preventing NCDs, during discussions, some ministries such as Planning, Finance and Social Affairs expressed a keen interest to support NCD prevention and control. The Ministry of Social Affairs described willingness to support the Ministry of Public Health’s efforts tackle NCDs through the Social Health Promotion Fund and highlighted the opportunities for innovative financing, for example through using taxes on tobacco products for NCD prevention and control. 19. A draft tobacco control bill has been under development since 2006 and the draft law has been in Parliament since February 2014. As a Party to the WHO Framework Convention on Tobacco Control since 2005, DRC has committed to implement a set of tobacco control measures within the framework of a comprehensive law such as the one to be adopted. The Speaker of the House expressed his commitment and determination to the Joint Mission that the legislation would be passed as soon as possible. 20 The last STEPS survey was done in 2005-2006 and covered Kinshasa alone. Accurate data are critical for policy makers and planners in determining an effective response and allocating appropriate levels of resources for NCDs. The Ministry of Planning for example pledged to the Joint Mission that they would support integration of NCDs into development planning if there is adequate and reliable data. 21. The mission heard of the massive shortage of resources for the prevention and management of NCDs. These include human resources (especially health care professionals) as well as basic drugs and equipment. Where policy and guidelines on cancer, diabetes and cardiovascular diseases exist, they are rarely implemented because there is inadequate financial and human resources. The Ministry of Public Health expressed the urgent need to improve such capacity. The United Nations response 22. NCDs are not currently included in the 2013-17 UNDAF nor the 2011-15 Poverty Reduction Strategy Papers (PRSP). There is no UN Thematic Group on NCDs nor coordinating mechanism for NCDs. The UNDAF and PRSP are being reviewed with new ones will come into effect in 2017 for UNDAF and 2016 for the PRSP. There is therefore an opportunity for integrating NCDs into the next UNDAF and PRSP. The United Nations Country Team recognised in their discussions with the Joint Mission that NCDs are a growing public health issue and support advocating for NCDs to be higher on the political agenda. The inclusion of NCDs in Social Development Goal 3 was seen as important in this regard. 23. While there is weak coordination of NCD activities among UN agencies in the DRC, there are examples of effective coordination in other areas such as the UN H4+ (a joint partnership of UN agencies to improve maternal and child health). Some members of the UNCT suggested expanding the H4+ partnership to include NCDs. 5 24. The Joint Mission noted that the NCD focal point in the WHO Country Office covers both immunization and NCDs. This, in the Joint Mission’s view, does not provide sufficient resource to spearhead the NCD agenda across the UNCT. Multi stakeholder response 25. The Joint Mission heard of examples where universities and NGOs provide screening and treatment for some cancers notably breast and cervical cancer and for raising awareness and advocating for action against NCDs. These initiatives would benefit from considerably more effective coordination with one another and with government. 26. National Multisectoral Programme for the Fight against AIDS (Programme National Multisectoriel de lutte contre le SIDA - PNMLS) is one multisectorial structure that includes multiple partners and stakeholders, working with the community structures, and under the supervision of the President of the Democratic Republic of Congo. It was suggested by many that expanding the PNMLS would be an appropriate way to provide national coordination of NCDs within the resource constrained environment of the DRC. Recommendations for Action 27. The Ministry of Public Health recognizes the increasing prevalence of NCD risk factors and mortality and disability from NCDs and the huge socioeconomic impact this will have on the country in the coming years. There is therefore a commitment from the Ministry of Public Health to make NCD prevention and control a priority across Government. The Ministry of Public Health will need the support of the United Nations Country Team, civil society organizations, academia and the private sector to advocate for a “whole of government” and “whole of society effort” in scaling up NCD prevention and control. 28. The Joint mission proposes the following actions to be implemented in the next 12 months. The key areas are: (i) finalization of the national multi-sectoral NCD action plan, including national targets; (ii) strengthening NCD coordination and governance; (iii) improving data on NCDs to enable evidence-based decision making on resource requirements; (iv) advocating for an increased budget for NCDs and; (v) taking action on tobacco control. A road map for the next 12 months is included as Annex 8. a) National Multisectoral NCD Action Plan 29. The mission recommends that the National Multisectoral NCD Action Plan is finalised as soon as possible and that it includes national targets that take into account the NCD Global Action Plan 2013-2020. The Joint Mission recommends that the NCD Action Plan be integrated into the National Health Development Plan. The Joint Mission also recommends that key government ministries participate in finalising the NCD Action Plan so that there is full ownership and support across government and that non-government stakeholders also be invited to participate to ensure that the NCD Action Plan is truly whole-of-society. 30. The Joint Mission recommends that a consultant be recruited by WHO within the next 2-3 months to support the UNCT provide assistance to the Ministry of Public Health with: 6 • technical assistance in revising the draft NCD Action plan with the full participation of key experts from government and the United Nations Country Team; • consultation between different government ministries, the UN Country Team, civil Society, academia and the private sector; • costing the NCD Action Plan; • undertaking a national workshop to review and endorse the final NCD Action Plan; • preparing submission of the final draft for submission to Cabinet/Parliament for approval. b) Improve Coordination and Governance for NCDs 31. The Joint Mission recommends that immediate action be taken to reinforce multi-sectoral mechanisms to address NCDs and their risk factors, within the context of universal health coverage under the leadership of the President or Prime Minister with technical leadership provided by the Minister of Health. The mission recommends expanding the mandate of existing multisectorial structures (e.g. the Programme National Multisectoriel pour la Lutte contre le SIDA or the National Nutrition Council) under the Prime Minister’s office to include coordination of NCDs). 32. The mission recommends that during the next 2-3 months the UNCT, either directly or through a consultant, undertakes the following: • an assessment of existing structures to determine the most appropriate mechanisms for coordinating and governing the Government’s response to NCDs; • drafts terms of reference for the recommended governance and coordination structures. 33. The Mission recommends strengthening joint and coordinated work within the UN agencies to support national NCD prevention and control efforts by strengthening existing structures and expanding one of them to coordinate technical support on NCDs to Government. The mission recommends that the UN Country Team identifies a clear mechanism driving forward coherent support for the Government on NCDs over the next 2-3 months and that the mechanism is established in time before or at the time of the launch of the National NCD Action Plan. The coordinating mechanism could either be a new thematic group or the expansion of an existing group. In addition the Joint Mission recommends that funds be identified for a National Professional Officer to coordinate a coherent UN response in the area of NCDs for DRC. c) Strengthen the NCD Programme within the Ministry of Public Health 34. The Joint Mission recommends that the NCD programme within the Ministry of Public Health be strengthened to ensure there is sufficient capacity for leadership and coordination for both the prevention and management of NCDs across the entire country. There should be focal points for the four main risk factors (tobacco, harmful use of alcohol, physical inactivity and unhealthy diet). In addition, each province should have at least one focal point for NCD prevention and control and there should be clear linkages between the national and provincial level. The UN Country Team should support capacity building of the NCD Programme at both national and provincial levels. d) Strengthen surveillance and Monitoring of NCDs and their risk factors and improving data quality and coverage nationwide 35. The Joint Mission recommends that efforts be made to strengthen the quality and coverage of NCD and risk factor surveillance nationwide. In this regard, the Joint Mission recommends that resources are identified to enable a STEPS survey to be is carried out in 2016 or early 2017. In 7 addition, the Joint Mission endorses plans for the multi risk factor Global School-based Student Health Survey (GSHS) that WHO has resources to undertake in early 2016. 36. In the meantime, the Joint Mission recommends that WHO and the Ministry of Public Health lead the development of an NCD factsheet to collate existing data that can be shared with Government and development partners. This should be done as soon as possible. e) Financing the NCD response 37. The mission recommends that the Ministries of Finance and Planning and the Ministry of Public Health collaborate to set out the economic and business/investment case for investing in NCDs in DRC. This should highlight the impact of NCDs on the economy and the benefits of taking timely and decisive action to reduce premature mortality and disability from NCDs by tackling their risk factors. The investment case should also highlight the public health and economic benefits of increasing tobacco and alcohol taxation and the opportunity to hypothecate some of these funds for NCD prevention and control. 38. The mission recommends that the UN County Team supports the Government in drafting the above business case for addressing NCDs. f) Tobacco control 39. The mission recommends the Ministry of Public Health and non-government agencies advocate with parliamentarians and ministries such as finance, budget, planning, agriculture and trade for the adoption of the tobacco control bill as soon as possible. As part of this the Joint Mission recommends that there is agreement that some of the revenue from tobacco taxation is used to finance action to combat NCDs. 40. The UNCT should support the above efforts and the Joint Mission recommends that the UNCT develops material that summarizes the benefits of adopting the tobacco control bill and supports the Ministry of Public Health arrange hearings with parliamentarians and other stakeholders to encourage speedy adoption of the bill. g) Strengthen human resources capacity for NCD prevention and control 41. The Joint Mission recommends the Government develops a national human resource strategy for NCDs with a focus on community and primary care and identifies the necessary resources for the rapid scale up of human resource training and capacity building to deliver care at this level. Because of the shortage of doctors and medical specialists, the Joint Mission recommends that government scales up the capacity for nurses and community health workers to manage NCDs in primary care. Follow up 42. The Joint Mission recommends a short follow up joint mission in January 2016 to review progress. = = = 8 Annex 1. Participants in the joint mission (in alphabetical order) UNAIDS Osseni Yessifou, Alladji, DRC Country Office UNDP Ofosu Koranteng, Benjamin, Regional Office, Addis Ababa Biock, George, DRC Country Office Ngoie, Erick , DRC Country Office UNFPA Bilanda Ndele, Abetty, DRC Country Office Nkongnyuy, Eugene, DRC Country Office UNICEF Bansimba, Theophile, DRC Country Office UN WOMEN Mulimbi, Jules, DRC Country Office WHO Perucic, Anne-Marie, HQ Bruni, Andrea, AFRO Musavuli, Patrick, AFRO Shongwe, Steven, AFRO Sookram, Chandralall, AFRO Tcha Kondor, Noureiny, AFRO Lokonga, Jean Pierre, DRC Country Office Manzengo, Casimir, DRC Country Office Mopyi Mutombo, Etienne, DRC Country Office Nkongolo, Adolphe, DRC Country Office Sambou, Bacari, DRC Country Office 9 Annex 2. Joint Mission Terms of Reference Mission conjointe de la Task Force Inter-Agence des Nations Unies de Prévention et de Maitrise des Maladies Non Transmissibles République Démocratique du Congo 13-17 Juillet 2015 Termes de Référence – version provisoire Rappel et justification Les maladies non transmissibles (MNT) sont les principales causes de décès dans le monde. En 2012, 38 millions de décès ont été causés par les quatre principales MNT, à savoir les maladies cardio- vasculaires, le cancer, les maladies respiratoires chroniques et le diabète. La majorité (85%) de ces décès sont survenus dans les pays à revenu faible et intermédiaire et étaient en grande partie évitables. 48% des décès liés aux MNT sont survenus chez des personnes âgées de moins de 70 ans. Les quatre principales MNT sont liées à quatre principaux facteurs de risques : usage du tabac, consommation abusive d'alcool, alimentation non saine et manque d'activité physique. Dans la région de l'Afrique et au-delà des 4 principales MNT, il est important de noter la forte prévalence d’autres affections chroniques non transmissibles telles que les troubles mentaux, les violences et traumatismes, la drépanocytose, les affections orales et les maladies oculaires et auditives. Toutes ces conditions contribuent à une mauvaise santé et à une détérioration de la qualité de vie des populations. Les MNT ont des conséquences humaines, sociales et économiques néfastes dans tous les pays, et en particulier dans ceux à revenu faible et intermédiaire. Les MNT apparaissent comme un obstacle à la réduction de la pauvreté et au développement durable. La Déclaration politique des Nations Unies sur les MNT approuvée par les chefs d'État et de gouvernement en Septembre 2011 reconnait que les MNT constituent un des défis du 21ème siècle en matière de développement et appelle à un « effort d’ensemble des gouvernements et de la société en générale ». Le plan d'action mondial de l'OMS pour la prévention et la maîtrise des MNT 2013-2020 approuvé par la 66e Assemblée Mondiale de la Santé en mai 2013 propose une feuille de route et des options stratégiques / interventions pour les Etats membres et les partenaires au développement, qui une fois mis en œuvre collectivement entre 2013 et 2020, doit contribuer à une réduction de 25% de la mortalité prématurée d’ici à 2025. En Juillet 2014, une réunion de haut niveau de l'Assemblée Générale des Nations Unies sur les MNT a permis un examen et une évaluation des progrès accomplis dans le domaine de la lutte contre les MNT depuis la signature de la déclaration politique de 2011. Les conclusions de cette rencontre signalent que les progrès réalisés dans les pays en développement sont lents et inégaux. Le défi majeur est la faiblesse des pays en matière de capacité à répondre aux MNT. Au cours de la réunion de haut niveau, les Etats membres ont convenu 1) de fixer des objectifs nationaux pour 2025, 2) d’élaborer des politiques et des plans d’action multisectoriels de lutte contre les MNT pour atteindre les objectifs, et intégrer les MNT dans les plans nationaux sanitaires et de développement 3) de 10 mettre en œuvre des interventions coûts-efficaces «best buys» pour réduire l'exposition aux facteurs de risque liés aux MNT et 4) de renforcer la réponse des systèmes de santé. Le Groupe de travail de l’inter-agence des Nations Unies (UNIATF) sur les MNT a été créé par le Secrétaire Général en 2013 pour coordonner la contribution des agences des Nations Unies pour la prévention et la maîtrise des MNT. À ce jour, le Groupe de travail a effectué des missions en Biélorussie (Europe de l'Est), au Kenya (Afrique de l'Est), en Inde (Asie) et à La Barbade (Caraïbes). But et objectif général La mission de l’UNIATF en République Démocratique du Congo (RDC) a pour but d’apporter un soutien technique à la fois au Gouvernement de RDC et à l’équipe pays des Nations Unies afin d’appuyer les efforts nationaux dans le domaine de la lutte contre les MNT. L’objectif général étant d’initier un travail en vue de l’élaboration d’un Plan d'action national multisectoriel de lutte contre les MNT en fixant des objectifs nationaux et les interventions prioritaires à mener entre 2015 et 2025 afin de contribuer à la réduction de la mortalité prématurée associée aux MNT d’ici à 2025. La mission sera conduite par une équipe d’agents de l'OMS, du PNUD, de l'UNICEF, de la Banque Mondiale, du Programme Alimentaire Mondial, et de l’Office des Nations Unies contre la drogue et le crime (ONUDC). Objectifs spécifiques …en soutien à l’équipe pays des Nations Unies 1. Comprendre la pertinence de la relation entre les MNT et les efforts menés dans le domaine du développement humain dans le pays ; 2. Évaluer les progrès accomplis à ce jour dans le soutien à une réponse nationale multisectorielle de lutte contre les MNT ; 3. Intégrer les MNT et leurs déterminants dans leurs plans bilatéraux des agences des Nations Unies avec le gouvernement de la RDC afin d’examiner conjointement les progrès dans leur mise en œuvre ; 4. Etablir un mécanisme de coordination dans le cadre du soutien du Groupe thématique MNT UNDAF/UNCT aux efforts du gouvernement dans la lutte contre les MNT ; 5. Elaborer le cadre de développement d’une stratégie multisectorielle de prévention et de maîtrise des MNT en RDC. …en soutien au Gouvernement de RDC 6. Mettre en cohérence les processus bilatéraux et multilatéraux en cours pour soutenir le Gouvernement dans ses efforts pour lutter contre les MNT dans le cadre de l'UNDAF et des stratégies de coopération avec les différentes agences des Nations Unies ; 7. Organiser une réunion des parties prenantes incluant notamment le gouvernement, les agences des Nations Unies, les ONG, la société civile, les universités et les instituts de recherche afin de s’entendre sur les éléments clés d'un plan d'action multisectoriel national de lutte contre les MNT, y compris des objectifs nationaux alignés avec le Plan d'action mondial de lutte contre les MNT 2013-2020 ; 8. Appuyer les partenaires nationaux pour élaborer le cadre d’une stratégie nationale multisectorielle de lutte contre les MNT qui inclue des cibles nationales, des objectifs et des options stratégiques pour la prévention et le contrôle des MNT ; 9. Proposer un mécanisme de coordination de la réponse nationale contre les MNT en RDC 11 10. Faire un plaidoyer, pour intégrer les MNT parmi les maladies prioritaires à prendre en compte dans les efforts de couverture sanitaires universelle en cours dans le pays ; 11. Faire un plaidoyer une réponse multisectorielle efficace et pour une augmentation des investissements multisectoriels pour les MNT en RDC ; 12. Elaborer une feuille de route sur les prochains 12 mois qui devra se traduire par des progrès significatifs en lien avec les efforts nationaux en cours et qui contribuera à une réponse multisectorielle aux MNT. La mission sera effectuée en conformité avec les termes de référence du Groupe de travail inter- agences des Nations Unies. Un élément clé de la mission sera d'évaluer la réponse actuelle nationale et le soutien apportés par l'équipe pays des Nations Unies au Gouvernement de la RDC en matière de prévention et de maîtrise des MNT. Cela inclus une revue et une évaluation des structures existantes de coordination de la réponse aux MNT, à la lutte contre le tabagisme, à la consommation abusive de l'alcool et aux autres facteurs de risque, de promotion de la santé, de sécurité routière et de prise en charge en général des MNT. Dates proposées Les dates de mission proposées sont du 13 au 17 juillet 2015. Annex 3. Joint Mission Programme AGENDA MISSION CONJOINTE DE LA TASK FORCE INTER-AGENCE DES NATIONS UNIES SUR LA PREVENTION ET LE CONTROLE DES MALADIES NON TRANSMISSIBLES EN RDC JOURS ET DATES HEURES ACTIVITES RESPONSABLES LIEUX Lundi 13/07/2015 8h30-9h00 9h00-11h00 11h00-12h00 12h00-17h00 • Civilités et briefing UN : 1) Visite de briefing au WR OMS 2) Séance de travail et briefing au groupe de travail UN pour les MNT • Visite de travail au MSP • Visite de travail aux différentes agences UN (UNDP, UNFPA) Groupe de travail UN MSP Groupe de travail UN Bureau OMS Salle des conférences OMS SG de la Santé Publique Bureaux Agences (PNUD, UNFPA) Mardi 14/07/2015 8h30-16h00 16H00-17H00 • Journée de travail avec tous les experts des parties prenantes sur la lutte contre les MNT, y compris ceux de la primature : DLM, Programmes Spécialisés, Commission de prévention routière, Comité National de lutte antidrogue, Fonds National de Promotion et de Sécurité Sociale. • Atelier sur la taxation du tabac • Conférence de presse MSP MSP Service de communication OMS-PNUD-Presse Salle des conférences OMS Hôtel du Fleuve Salle des conférences OMS Mercredi 15/07/2015 8h30-10h00 10h00-11h00 • Séance de travail de l’équipe de la mission et évaluation de l’agenda Groupe de travail UN Salle des conférences de l’OMS 14 13h00-14h00 14h00-16h00 16h00-17h00 • Séance de travail avec le Représentant adjoint de ONUFEMME • Séance de travail avec le Chargé de bureau de ONUSIDA • Séance de travail avec le Secrétaire Général du PNMLS • Réunion d’évaluation de la journée de l’équipe de la mission Groupe de travail UN Groupe de travail UN Bureau des réunions de ONUFEMMES Salle des réunions des ONUSIDA Bureau du SG de PNMLS Salle des conferences OMS Jeudi 16/07/2015 9h00-9h30 10h00-11h00 11h30-12h00 13h00-14h00 14h00-16h00 18h00-19h00 • Séance de Travail avec le Représentant adjoint de l’Unicef par intérim • Séance de travail avec UNCT • Séance de travail avec le Ministre du Plan et Révolution de la Modernité • Séance de travail avec le Ministre du Genre, famille et Enfants et Ministre intérimaire des Affaires Sociales et Action Humanitaires • Séance de travail avec les OSC impliquées dans la lutte contre les MNT par leur groupe thématique : lutte contre la toxicomanie, l’alcool et les drogues, lutte contre le cancer, lutte contre la drépanocytose, lutte contre les maladies cardiovasculaires, lutte contre le diabète, lutte contre la malnutrition, santé mentale, handicap, lutte contre les accidents de trafic routier, … • Séance de travail avec le Vice- Ministre des finances. Groupe de travail UN – MSP Groupe de travail UN - MSP Bureau de l’UNICEF Salle des réunions PNUD Cabinet du Ministre du Plan Cabinet du Ministre du Genre, Famille et Enfant Salle des conférences OMS Cabinet du Ministre des Finances Vendredi 8h30-10h00 • Séance de préparation de la Groupe de travail Salle des conférences OMS 15 17/07/2015 10h00-12h00 14h00-16h00 16h00-16h30 restitution par l’équipe de la mission • Visite de travail auprès du Président du Parlement • Séance de restitution au Groupe de travail des parties prenantes de la lutte contre les MNT/RDC • Conférence de presse UN Groupe de travail UN Groupe de travail UN – MSP Service de communication OMS-PNUD Bureau du Président du Parlement Salle des conférences OMS Salle des conférences OMS Key persons that participated in meetings with the Joint Mission in DRC. N° Noms Structures Fonctions 1 Honorable Aubin Minaku Assemblée Nationale Président 2 Excellence Olivier Kamitatu Gouvernement Central Ministre du Plan et Révolution de la Modernité 3 Excellence Bijoux Mushitu Kat Gouvernement Central Ministre du Genre, de la Famille et de l'Enfant et Ministre Intérimaire des Affaires sociales et Action Humanitaire 4 Excellence Albert M'PETI BIYOMBO Gouvernement Central Vice-Ministre des Finances 5 Dr Mukengeshayi Kupa Secrétariat Général à la Santé Secrétaire Général 16 6 Mme Alice Mirimo Kabetsi Fond National de Promotion et des Services Sociaux (FNPSS) Directrice Générale 7 Pr Liévin Kapend'A Kalala Programme National Multisectoriel de lutte contre le Sida (PNMLS) Secrétaire Exécutif National 8 Dr Bakary Sambou WHO OIC 9 Mme Priya Gajraj UNDP Directeur Pays 10 Mr Niyi Ojuolape UNFPA OIC 11 Mr Adama Moussa UNWOMEN Représentant Adjoint 12 Mr Juvenal Nshimiyimana UNAIDS OIC 13 Mr Guy Clarysse UNICEF Chef de Section Survie 14 Salomon Tudiese ONEUN Chargé des missions 15 Dr Edumbadumba Pierre César Assemblée Nationale Député et 2ème Vice-Président Commission Socio-Culturelle Other persons who participated in meetings with the Joint Mission in DRC N ° NOM ET POSTNOMS STRUCTURES 1. GENTIL DEPAUL TSHITE MINISANTE 2. NTANGU MPIALU NELLY MINISANTE 3. EBOMA FATOUMA MINISANTE 4. Dr BAUMA M. NGOY CESVI 5. MOULANGA MARIE-CLAIRE CNPR 6. Prof Dr GERTRUDE LUYEYE UNIVERSITE DE KINSHASA 7. CELESTIN KATSHUNGA M. ASSICAS 8. RITIN NZOMAKODI SOCIETE CIVILE 9. LISETH NUMBI ASSICAS 10. MBUYU RIGOBERT PNLCT 11. CATHY MUZAIRUNGU K. CNPR 12. NGOMBO DIANKANGA J. MINISANTE 13. Ir MARC IYONGEN ACCT 14. Dr LIMBOLE BAKILO PNLMCV 15. Dr TSHITENGE VALENTIN FNPSS 16. Dr AYUMUNA MALASI MINISANTE 17. Dr NZAMBIMPUNGU LEOPOLD PNLCD 18. Dr JEANNETTE NONGE PNSR 19. AG. MINSAMI GEORGES DLM 20. Dr EPUMBA EPONDO DEP 21. LIEVIN KAPEND PNMLS 22. EDMOND MAGAZANI PNMLS 23. Dr LEBUKI EMILE PNMLS 24. Dr VIANNEY SELEMANI MINISANTE 18 25. Dr WATSENGA LAYA SERVICE DES URGENCES DE LA POLICE 26. MABIALA LANDU MINISTERE DE TRAVAIL 27. MILAMBO KAPIA PNLCT 28. Dr PATRICK SHAMBA ACCT 29. NSARAZA FERDINAND MINISTERE AFFAIRES SOCIALES 30. USSENI ACCT 31. Pr Dr MUKENDI UNIVERSITE DE KINSHASA 32. YAMO TOUSSAINT SOCIETE CIVILE 33. Dr ILUNGA MULEYA JOSETTE PNSOV 34. Dr WOMBA LUCETTE MINISANTE 35. Dr SOPHONIE KYAKIMWA MINISANTE 36. LEONTINE KAZAMWALI SOCIETE CIVILE 37. Dr EBEYA EFINI DLM 38. ALBERT KALONJI MINISANTE 39. MAYENGO LIVIO MINISANTE 40. Dr UMBA KAZADI PNSBCD 41. Dr JUSTUS NSIO DLM 42. Dr VINCENT LUKUNKU PNCS 43. Dr FOTTO EBUTI PNLCD 44. Dr BEN BOLA PNMLS 45. Dr JEANINE KIMBOKO CCMS 46. Dr DIADIA NGUBIDI SERGE SOCIETE CIVILE 47. DANIEL NDIBU MULEMBWE FNPSS 48. BANGALA TABUKU SOCIETE CIVILE 49. YAMO TOUSSAINT SOCIETE CIVILE 50. SHAKILA YUNUS SOCIETE CIVILE 19 51. Dr SULU LINAC 20 Annex 4. Evidence-based cost-effective interventions for the prevention and control of NCDs 18 Tobacco use 19 • Reduce affordability of tobacco products by increasing tobacco excise taxes • Create by law completely smoke-free environments in all indoor workplaces, public places and public transport • Warn people of the dangers of tobacco and tobacco smoke through effective health warnings and mass media campaigns • Ban all forms of tobacco advertising, promotion and sponsorship Harmful use of alcohol • Regulating commercial and public availability of alcohol • Restricting or banning alcohol advertising and promotions • Using pricing policies such as excise tax increases on alcoholic beverages Unhealthy diet • Reduce salt intake (and adjust the iodine content of iodized salt, when relevant) • Replace trans fats with unsaturated fats • Implement public awareness programmes on diet and physical activity 18 Taken from the WHO NCD Global Action plan 2013-2020 (http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf?ua=1, pages 66 and 67).The measures listed are recognized as very cost-effective i.e. generate an extra year of healthy life for a cost that falls below the average annual income or gross domestic product per person. In addressing each risk factor, governments should not rely on one single intervention, but should have a comprehensive approach to achieve desired results. 19 These measures reflect one or more provisions of the WHO Framework Convention on Tobacco Control (WHO FCTC). The measures included are not intended to suggest a prioritization of obligations under the WHO FCTC. Rather, these measures have been proven to be feasible, affordable and cost-effective and are intended to fulfil the criteria for assisting countries to meet the agreed targets as quickly as possible. The WHO FCTC includes a number of other important provisions, including supply-reduction measures and those to support multisectoral actions, which are part of any comprehensive tobacco control programme. 21 Annex 5. National commitments as set out in the Outcome Document of the High-Level Meeting of the General Assembly on the Review of the Progress Achieved in the Prevention and Control of NCDs (a) Enhance governance: (i) By 2015, consider setting national targets for 2025 and process indicators based on national situations, taking into account the nine voluntary global targets for non- communicable diseases, building on guidance provided by the World Health Organization, to focus on efforts to address the impacts of non-communicable diseases and to assess the progress made in the prevention and control of non-communicable diseases and their risk factors and determinants; (ii) By 2015, consider developing or strengthening national multisectoral policies and plans to achieve these national targets by 2025, taking into account the WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020; (iii) Continue to develop, strengthen and implement, as appropriate, multisectoral public policies and action plans to promote health education and health literacy, with a particular focus on populations with low health awareness and/or literacy; (iv) Raise awareness about the national public health burden caused by non-communicable diseases and the relationship between non-communicable diseases, poverty, and social and economic development; (v) Integrate non-communicable diseases into health planning and national development plans and policies, including the United Nations Development Assistance Framework design processes and implementation; (vi) Consider establishing, as appropriate to the respective national context, a national multisectoral mechanism, such as a high-level commission, agency or task force for engagement, policy coherence and mutual accountability of different spheres of policy making that have a bearing on non-communicable diseases, in order to implement health-in- all-policies and whole-of-government and whole-of-society approaches, and to monitor and act on the determinants of non-communicable diseases, including social and environmental determinants; (vii) Enhance the capacity, mechanisms and mandates, as appropriate, of relevant authorities in facilitating and ensuring action across government sectors; (viii) Strengthen the capacity of Ministries of Health to exercise a strategic leadership and coordination role in policy development that engages all stakeholders across government, non-governmental organizations, civil society and the private sector, ensuring that non- communicable disease issues receive an appropriate, coordinated, comprehensive and integrated response; (ix) Align international cooperation on non-communicable diseases with national non- communicable diseases plans, in order to strengthen aid effectiveness and the development impact of external resources in support of non-communicable diseases; 22 (x) Develop and implement national policies and plans, as relevant, with financial and human resources allocated particularly to addressing non-communicable diseases, in which social determinants are included. (b) By 2016, as appropriate, reduce risk factors for non-communicable diseases and underlying social determinants through implementation of interventions and policy options to create health- promoting environments, building on guidance provided by Appendix 3 of the WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020. (c) By 2016, as appropriate, strengthen and orient health systems to address the prevention and control of non-communicable diseases and the underlying social determinants through people- centered primary health care and universal health coverage throughout the lifecycle, building on guidance provided by Appendix 3 of the WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020. (d) Consider the possible linkages between non-communicable diseases and some communicable diseases, such as HIV/AIDS, call for the integration, as appropriate, of responses to HIV/AIDS and non-communicable diseases, and in this regard call for attention to be given to people living with HIV/AIDS, especially in countries with a high prevalence of HIV/AIDS, in accordance with national priorities. (e) Continue to promote the inclusion of non-communicable disease prevention and control within programs for sexual and reproductive health and maternal and child health, especially at the primary health-care level, as well as communicable disease programs, such as TB, as appropriate. (f) Consider the synergies between major non-communicable diseases and other conditions as described in Appendix 1 of the WHO Global Action Plan for the Prevention and Control of Non- Communicable Diseases 2013-2020 in order to develop a comprehensive response for the prevention and control of non-communicable diseases that also recognizes the conditions in which people live and work. (g) Monitor the trends and determinants of non-communicable diseases and evaluate progress in their prevention and control: (i) Assess progress towards attaining the voluntary global targets and report on the results using the established indicators in the Global Monitoring Framework, according to the agreed timelines, and use results from surveillance of the twenty five indicators and nine voluntary targets and other data sources to inform and guide policy and programming, aiming to maximize the impact of interventions and investments on non-communicable disease outcomes; (ii) Contribute information on trends in non-communicable diseases to the World Health Organization, according to the agreed timelines on progress made in the implementation of national action plans and on the effectiveness of national policies and strategies, coordinating country reporting with global analyses; (iii) Develop or strengthen, as appropriate, surveillance systems to track social disparities in non-communicable diseases and their risk factors as a first step to addressing inequalities, and pursue and promote gender-based approaches for the prevention and control of non- communicable diseases founded on data disaggregated by sex and age and disabilities, in an effort to address the critical differences in the risks of morbidity and mortality from non- communicable diseases for women and men. 23 (h) Continue to strengthen international cooperation in support of national, regional and global plans for the prevention and control of non-communicable diseases, inter alia, through the exchange of best practices in the areas of health promotion, legislation, regulation and health systems strengthening, training of health personnel, development of appropriate health-care infrastructure and diagnostics, and by promoting the development and dissemination of appropriate, affordable and sustainable transfer of technology on mutually agreed terms for the production of affordable, safe, effective and quality medicines and vaccines, while recognizing the leading role of the World Health Organization as the primary specialized agency for health in that regard. 31. Continue to strengthen international cooperation through North-South, South-South and triangular cooperation, in the prevention and control of non-communicable diseases to promote at the national, regional and international levels an enabling environment to facilitate healthy lifestyles and choices, bearing in mind that South-South cooperation is not a substitute for, but rather a complement to, North-South cooperation. 32. Continue to explore the provision of adequate, predictable and sustained resources, through domestic, bilateral, regional and multilateral channels, including traditional and voluntary innovative financing mechanisms. 24 Annex 6: Luanda commitment on NCDs in Africa: policies and strategies to address risk factors 25 Annex 7: Roadmap following the Joint UN NCD Task Force mission to the Democratic Republic of Congo Next step (activity) Link to recommendati on Link to findings Output/delivera bles from the next step Timeframe for delivering on the next steps HR inputs required (availability and gap) Financial resources required Lead agency Partner agencies Lead individua l Government – domestic funding Financial gap to be provided by donors (start- up/catalytic money) 1. Support technical assistance to assess the existing multisectorial structures to advise de UNTIAF in witch structure can well play the role of coordinating multisectorial NCD activities Reinforce NCD multisectorial structure to address NCDs and their risk factors, universal health coverage, financing under the stewardship and political leadership of the President or Prime Minister and the technical leadership of the Minister of Health (or expand the mandate of existing structures like the PNMLS – The country does not have a multisectoral action plan on the prevention and control of NCDs. A draft is being developed but it has yet to be finalized and adopted by the Government Technical report of the assessment of health multisectorial existing in the country with clear recommendatio ns 30 October 2015 Need of TA 15 000 UNDP WHO Benjamin 26 Programme National Multisectoriel pour la Lutte contre le SIDA) 2. Support a technical assistance to help the country to finalize the multisectoral NCD Strategic plan Support the development and finalization of a National Multisectoral NCD Strategic Plan that is aligned to the NCD Global Action Plan 2013- 2020 with defined targets in priority areas. This Plan should be integrated into the National Health Development Plan Additionally, NCDs are not prominent in the national health development plan highlighting the lack of prioritization of the NCD issue NCD Multisectoral Strategic Plan finalized and shared with all partners 30 November 2015 Need of TA 15 000 WHO UNDP, UNICEF, UNFPA, UNWOME N, WFP, UNAIDS Steven 3. Support advocacy and activities within the Reorganize and strengthen the NCD There is weak coordination within the health sector Publishing of the final document on National 30 June 2016 No need of TA 10 000 WHO Adolphe 27 MoH for finalizing the process of National Program reform that include the creation of a National Program for the Control of NCD programme within the Ministry of Health to coordinate prevention and control of NCDs throughout the country and across sectors for activities related to the prevention and control of NCDs Program reform that include the creation of the NCD Control National Program 4. Support a StepWise survey in the country and Global School-based Student Health Survey Strengthen surveillance and monitoring of NCDs and their risk factors and improve data collection quality and coverage nationwide Data collection is sparse and of insufficiently good quality, especially in relation to NCDs. For example, the last STEPS survey was done in 2005 and covered only Kinshasa DRC 2016 STEPS survey, final report available 31 December 2016 Need of TA 300 000 WHO UNDP, UNICEF, UNFPA, UNWOME N, WFP, UNAIDS Steven/N ick 5. Conduct advocacy within UNCT to include the issue of NCD in H4+ Strengthen joint and coordinated work within the UN agencies to support national NCD prevention and control efforts There is weak coordination within the health sector and across sectors for activities related to the prevention and control of NCDs NCD officially included in discussions in the H4° meetings 31 December 2015 No need of TA WHO UNDP, UNICEF, UNFPA, UNWOME N, WFP, UNAIDS Deo 28 (possibility expand the mandate of existing groups such as the UN H4+ group on maternal health) 6. Support NCD assessment activities within UN agency to sustain the advocacy for including NCD issues in UNDAF Include prevention and control of NCDs in the UNDAF agenda and PRSP along with the other health conditions NCDs prevention and control are not mentioned in the current UNDAF or the PRSP NCDs assessment activities conducted within the current UNDAF after the current review 31 December 2015 No need of TA 50 000 UNDP/WH O UNDP, UNICEF, UNFPA, UNWOME N, WFP, UNAIDS George/ Adolphe 7. Conduct advocacy activities between the two Ministers including civil society and parliament to institute Tobacco tax collaboration to provide some revenue for NCD control Stronger collaboration between Ministry of Finance and Ministry of Health on fiscal measures related to tobacco and alcohol and regularly reviews and increase taxes on those The tobacco control law has been in the making since 2006 and has faced strong resistance partly because of interference from the tobacco industry. It is sitting now at the Parliamentary level for Existence of collaboration between the MoH and the Minister of finance on tobacco taxation to enhance NCD 30 June 2016 Need of TA 15 000 WHO UNDP, UNICEF, UNFPA, UNWOME N, WFP, UNAIDS Fwelo 29 products. Some of the additional revenues generated from the tax increases could be used to support NCD prevention and control adoption 8. Conduct advocacy activities to obtain adoption of the tobacco law Support timely adoption of the draft tobacco control bill currently with Parliament The tobacco control law has been in the making since 2006 and has faced strong resistance partly because of interference from the tobacco industry. It is sitting now at the Parliamentary level for adoption 31 December 2015 No need of TA 10 000 WHO UNDP, UNICEF, UNFPA, UNWOME N, WFP, UNAIDS Fwelo