1 1 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 Scaling up prevention and control of chronic noncommunicable diseases in the South-East Asia Region Agenda item 5.5 2 2 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 NCDs health and socio-economic impact regional framework and RC resolution progress in implementing the framework and RC resolution challenges way forward Outline 3 3 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 COMMON MODIFIABLE RISK FACTORS INTERMEDIATE RISK FACTORS MAIN CHRONIC DISEASES Unhealthy diet Raised blood pressure Heart disease Physical inactivity Raised blood glucose Stroke Globalization Tobacco use Abnormal blood lipids Cancer Urbanization NON- MODIFIABLE RISK FACTORS Overweight/obesity Chronic respiratory diseases Population ageing Age Diabetes Heredity UNDERLYING SOCIOECONOMIC, CULTURAL, POLITICAL AND ENVIRONMENTAL DETERMINANATS 4 4 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 54% deaths (largely premature mortality) 46% of disease burden 21% increase in NCD deaths over 10-years (up to 2015) NCD epidemics fueled by demographic change unhealthy behaviours health system failure majority of premature NCD deaths preventable with available interventions Health impact of NCDs in SEA Region 5 5 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 2005 2006-2015 (cumulative) Geographical regions (WHO classification) Total deaths (millions) NCD deaths (millions) NCD deaths (millions) Trend: Death from infectious disease Trend: Death from NCD Africa 10.8 2.5 28 +6% +27% Americas 6.2 4.8 53 -8% +17% Eastern Mediterranean 4.3 2.2 25 -10% +25% Europe 9.8 8.5 88 +7% +4% South-East Asia 14.7 8.0 89 -16% +21% Western Pacific 12.4 9.7 105 +1 +20% Total 58.2 35.7 388 -3% +17% Projected Mortality Dynamics – SEAR and Global Picture 6 6 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 one of the most serious risks to development 4 -10% of GDP foregone in India (WB estimate) microeconomic dimension (impoverishment, catastrophic expenses) growing inequities (risk factors; disease outcomes) no NCDs in MDG NCDs recognized as global development and health issue by UN GA in 2010 Socio-economic impact 7 7 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 Oil spikes Retrenching from globalization Asset price collapse Food price volatility Financial crisis NCDs Infectious diseases "A problem neither the developed world nor the developing world can afford" "Declining development assistance has already led to a significant reduction of public spending on health in many countries. When funds are limited, governments tend to focus on basic health services, in line with the MDGs, at the expense of the prevention and treatment of non-communicable diseases." (WEF Global Risk 2010 Report) "A problem neither the developed world nor the developing world can afford" "Declining development assistance has already led to a significant reduction of public spending on health in many countries. When funds are limited, governments tend to focus on basic health services, in line with the MDGs, at the expense of the prevention and treatment of non-communicable diseases." (WEF Global Risk 2010 Report) Global Risks Landscape, 2010: likelihood with severity by economic loss (source: World Economic Forum 2010) 8 8 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 guides NCD work in the Region major strategy targets main modifiable NCD risk factors focus on surveillance, health promotion and primary prevention developed in 2006 endorsed by RC in 2007 RC Resolution on scaling up prevention and control of NCDs UN GA resolution 2010 Regional Framework for Prevention and Control of NCDs 9 9 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 Regional Framework Awareness Generation and High-level Advocacy Development of Policy and Strategic Plan Capacity Strengthening, Resource Mobilization and Infrastructure Development Multisectoral and Multilevel Action to modify determinants (physical, social and economic) Health Sector Interventions Decrease in NCD RF Level and Reduced Adverse Health Events Reduced Health and Economic Burden of NCDs Epidemiological Assessment 10 10 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 Endorsed the Regional Framework for Prevention and Control of NCDs Urged Member States: � to initiate appropriate steps to formulate, update and strengthen national policies, strategies and programmes for integrated prevention and control of NCDs � to establish suitable infrastructure and appropriate funding mechanisms for this purpose � to set up mechanisms to promote multilateral, multisectoral, multidisciplinary and multilevel collaboration for integrated prevention and control of NCDs and to facilitate establishment of national and regional networks for NCD prevention and control 11 11 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 REQUESTS the Regional Director: to provide technical assistance to Member States, and to mobilize necessary resources for developing the capacity to implement national policies, strategies and programmes for integrated prevention and control of NCDs, and to facilitate and coordinate international support of development partners 12 12 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 assessing situation capacity strengthening for NCD policy makers and programme managers assisting in formulation & implementation of NCD policies, programmes measuring progress other areas Progress in implementing NCD framework (2007-2010) 13 13 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 standardized NCD risk factor surveys (STEPS approach) surveys Bangladesh, Bhutan, DPR Korea, India, Maldives, Myanmar and Nepal and Sri Lanka first-ever nationally representative datasets on major NCD risk factors in Bangladesh, Myanmar, Nepal and Sri Lanka NCD Info-Base regional paper “Challenges and Opportunities for NCD Surveillance in the SEA Region of WHO” set of core NCD indicators regional NCD profile (Bhutan, India, Myanmar, Sri Lanka - core info not easily accessible at national level) Gathering core evidence 14 14 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 NCD risk factors in STEPS surveys in SEA Region (2004-2009) (25-64 years, both sexes) Risk factor Prevalence (%) Current daily smokers 5 - 48 Current consumers of alcohol 5 – 37 Eating < 5 servings of fruits & vegetables/day 49 - 99 Physically inactive 4 - 92 Overweight or obese (BMI ≥ 25) 4 – 54 Raised blood pressure (≥ 140/90 mm Hg) 12 – 31 Raised fasting blood sugar (≥ 7 mmol/l) 4 – 11 Raised blood cholesterol (≥ 5.2 mmol/l) 19 - 54 15 15 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 SEA regional package of NCD capacity strengthening materials developed & systematic update and expansion of the package national capacity strengthening workshops in Bangladesh, Bhutan, DPR Korea, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand set of materials to train managers and facilitators of national and sub- national NCD capacity strengthening programmes developed training of NCD programme workforce from nine Member States on planning and conducting NCD capacity strengthening activities Capacity strengthening for policy makers and programme managers 16 16 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 review of national NCD policies, strategies, plans, legislation progress in Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar Nepal, and Sri Lanka other countries are in various stages of formulating national policies and strategies for prevention and control of NCDs Bangladesh, Bhutan, Indonesia, Maldives and Sri Lanka - important structural adjustments, strengthening NCD units/departments , national DPAS action plans formulated in Indonesia, Myanmar, Nepal, and Sri Lanka Formulating, implementing & evaluating NCD policies, plans and programmes 17 17 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 regional publication on progress in capacity 2001 - 2006 national NCD capacity surveys conducted in 2009-2010 findings: increase in capacity demonstrated presence of NCD units in MoH funding of NCD programmes through regular government budget universal NCD policies/plans progress in developing different components of NCD prevention and control limited progress in establishing regular surveillance system limited availability of guidelines for management of NCDs and their risk factors legislation largely restricted to tobacco Measuring progress 18 18 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 Progress in prevention and control of NCDs SEA Region (2001-2010) No. of countriesArea Indicator 2001 2006 2010 Infrastructure Presence of an NCD unit or department in MoH 4 7 11 Financial allocation Allocation for NCDPC in regular budget of MoH 6 7 11 National health policy addresses NCDs 3 3 6 National integrated NCD programme/plan 2 3 9 Target setting Quantifiable targets set for the country for NCDPC 4510 Inclusion of NCDs in national HIS 9 9 11 STEPwise approach implemented in the country 0 9 10 Routine or regular surveillance for NCDs/RFs 1 2 2 National guidelines Availability of national guidelines for all major NCDs & RF 124 Surveillance Policy/programs 19 19 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 community-based interventions (Bangladesh, India, Indonesia, Sri Lanka and Thailand); guidelines for monitoring strengthening prevention & management of NCDs at PHC (implementing WHO PEN package in Bhutan and Sri Lanka; introduction in Maldives) building partnerships with stakeholders SEANET NCD national networks (Bangladesh, Indonesia, Maldives, Sri Lanka, Thailand. WHO CC (3 new) collaboration with WB and WDF regional NCD research agenda Other areas of work 20 20 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 growing health and developmental challenge progressive socioeconomic divide persisting gap in allocation of human and financial resources insufficient technical and managerial capacity application of integrated approaches (involvement of non-health sectors, private sector and civil society) health-system adjustment Challenges 21 21 High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee, New Delhi, 28 June – 1 July 2010 major shift in policy attention need to invest institutional and individual capacity building application of feasible, low-cost, efficient solutions strengthening partnerships with non-health stakeholders establishing coordinating mechanisms empowering partners establishing channels to share information and resources Way forward
High-Level Preparatory (HLP) Meeting for the 63 rd Session of WHO/SEA Regional Committee WHO/SEARO, New Delhi, 28 June – 1 July 2010 Agenda item 5.5 SEA/HLP-Meet/5.5 15 June 2010 Follow-up action on pending issues and selected Regional Committee resolutions/decisions for the last three years: Scaling up prevention and control of chronic noncommunicable diseases in the South-East Asia Region (SEA/RC60/R4) WHO action in the area of prevention and control of noncommunicable diseases (NCDs) in the South-East Asia (SEA) Region is guided by the Regional Framework for Prevention and Control of NCDs. The Framework was formulated in close collaboration with Member States and endorsed by the health secretaries of Member States of the Region at their 11th Meeting in 2006. The WHO Regional Committee for South-East Asia, vide its resolution on Scaling up Prevention and Control of Chronic Noncommunicable Disease (NCDs) in the South-East Asia Region (SEA/RC60/R4) further deliberated on and endorsed the Regional Framework and requested the Regional Director to report to the Sixty-third session of the Regional Committee in 2010 on the progress achieved in its implementation. The Regional Framework aims at facilitating the process of developing, updating and implementing national policies, plans and programmes for integrated prevention and control of major NCDs including cardiovascular diseases, cancer, chronic pulmonary diseases and diabetes. It is based on public health principles and on national, regional and global consensus on policy and technical actions for prevention and control of NCDs and their primary risk factors. The attached working paper reflects on the health and socio-economic impact of NCDs in the Region. It reports on actions taken by Member States and by the WHO Secretariat, since the adoption of the Framework, to scale up prevention and control of NCDs. The attached working paper (Doc. SEA/RC63/20) is submitted to the High-Level Preparatory (HLP) Meeting for its review and recommendations. The recommendations made by the HLP Meeting will be submitted to the Sixty-third Session of the Regional Committee for its consideration.
SEA/RC63/20 REGIONAL COMMITTEE Provisional Agenda item 16.5 Sixty-third Session SEA/RC63/20 Bangkok, Thailand 7–10 September 2010 15 June 2010 Follow-up action on pending issues and selected Regional Committee resolutions/decisions for the last three years: Scaling up prevention and control of chronic noncommunicable diseases in the South-East Asia Region (SEA/RC60/R4)
SEA/RC63/20 Introduction 1. Noncommunicable diseases (NCDs) of chronic character including cardiovascular disease, diabetes, cancers and chronic lung diseases account for an estimated 54% of the 14.7 million annual deaths and more than half of the total disease burden occurring in the South-East Asia (SEA) Region of WHO. 2. The burden of NCDs in the Region continues to grow in an accelerated pace in both urban and rural settings. According to WHO projections there will be a 21% increase in the number of deaths caused by these conditions over the 10-year period up to 2015. The increasing burden of NCDs is the outcome of three main processes: (i) ongoing demographic change, (ii) acquisition of unhealthy behaviours by growing segments of socio-economically disadvantaged urban and rural dwellers, and (iii) the failure of health systems to protect the health of the people and deliver basic health services in an equitable way. 3. In addition to its vast impact on the health status of individuals and on national health systems, the growing burden of NCDs has also serious macro- and micro-economic implications. The World Economic Forum has estimated that, at the global level, the pandemic of NCDs is one of the most serious ‘global risks’ to development in terms of likelihood and severity (comparable to global financial crisis). The World Bank estimates that 4 to 10% of the potential Gross Domestic Product is foregone in India every year due to NCDs. The non-inclusion of NCD control in the MDGs plays a part in the continuing exclusion of this important public health priority from the global framework and goals for investment in international development. 4. NCDs impose a large economic burden on individuals and families. They often are the major cause of poverty at individual and household level, drawing them into a downward spiral of worsening health and poverty. 5. NCDs can no longer be considered as diseases of affluence. Contrary to long-held beliefs, the poor are now extensively and disproportionately exposed to the health-harming impacts of man-made socioeconomic, psychosocial, cultural, political and physical environments. The poor have less freedom and power to make right, health-enhancing behavioural choices. Major health-damaging behaviours such as tobacco use, harmful use of alcohol, inadequate consumption of fruits and vegetables and preferential use of less expensive (thus more affordable) foods rich in saturated and partially hydrogenated fats and salt have become increasingly common among the disadvantaged, vulnerable and marginalized groups of people in the SEA Region. 6. If not appropriately addressed, the currently observed reversal in socio-economic gradient in NCD risk factors (i.e. preferential growth in prevalence and intensity of major NCD risk factors among poorer and less educated segments of population) will be translated soon to further increase health inequalities in terms of NCD-related mortality, morbidity and disability. 7. A large share of the burden of NCDs occurs in populations of productive age. It is estimated that the majority (up to 80%) of premature deaths from NCDs (deaths occurring below the age of 70 years) could be prevented by tackling major risk factors i.e. poor diet, tobacco use SEA/RC63/20 Page 2 and lack of physical activity and their socioeconomic determinants at population, community and individual levels. 8. There is strong evidence that a significant reduction in NCDs can be achieved. Effective, efficient, workable, low-cost public health solutions to the NCD problem in developing countries are known but largely are underutilized. Member States of the SEA Region are in the process of strengthening their public health response to ongoing epidemics of NCDs. Regional Framework 9. The work in the NCD area in the SEA Region of WHO is guided by the Regional NCD Framework. The Framework is based on national and regional consensus on policy and technical actions for prevention and control of NCDs and their primary risk factors. It proposes the policy development framework and provides technical inputs for consideration in the process of developing national policies, plans and programmes. The Framework builds on the Global Strategy for the Prevention and Control of NCDs (2000) and contributes to the implementation of the 2008-2013 Action Plan for the Global Strategy. 10. The Framework provides a step-wise construction that offers a flexible and practical approach taking into consideration available resources and local needs. Three planning steps proposed by the Framework include: (1) estimating population needs and advocating for action; (2) formulating and adopting policy, and (3) identifying the policy implementation process. The Framework also reaffirms WHO’s commitment to provide technical support and facilitate national capacity building, resource mobilization and the development of tools, norms and standards. 11. The main strategy targets major modifiable NCD risk factors. This strategy is pursued through risk factor surveillance and integrated population-based interventions. The strategic direction of WHO programme development is to move towards a well-defined package of interventions, which is based on primary prevention through health promotion and disease prevention. These interventions must be integrated operationally into the general health systems. 12. The health secretaries of Member States of the Region, at their 11th Meeting held in 2006, reviewed the Regional Framework and reiterated the need to strengthen the regional epidemiological surveillance and population-based public health interventions that make optimum use of existing health-care systems and target the common risk factors and determinants of major NCDs. 13. The WHO Regional Committee for South-East Asia, vide its resolution on Scaling up Prevention and Control of Chronic Noncommunicable Disease (NCDs) in the South-East Asia Region (SEA/RC60/R4) further endorsed the Regional Framework. The Regional Action Plan for implementation of the Framework was formulated in 2007. SEA/RC63/20 Page 3 14. In May 2010, the UN General Assembly adopted a resolution recognizing NCDs as a global development and health issue. It decided to convene a meeting on NCDs, with the participation of heads of state and government, in September 2011. It was also decided to hold consultations on the scope, modalities, format and organization of the high-level meeting. The resolution requested the Secretary-General to submit a repot to the General Assembly at its Fifty-sixth session on the global status of NCDs, with a particular focus on the developmental challenges faced by developing countries. Progress in implementing the NCD framework 15. In the spirit of the recommendations of the Regional Committee resolution on Scaling up Prevention and Control of Chronic NCDs and in line with the Regional Framework for Prevention and Control of NCDs the major focus of the regional NCD programme has been to provide technical assistance to Member States. This has been mainly in developing the capacity and capability to assess the current risk profile and to formulate, implement and evaluate NCD policies, plans and programmes. 16. Technical support in gathering of core evidence essential for planning and evaluation of NCD programmes that has contributed to the successful adaptation of WHO NCD surveillance tools (STEPS and InfoBase) has been an important priority of the regional NCD programme. 17. Member States were supported in conducting NCD surveillance activities thus helping to strengthen the national capacity to collect, manage and use relevant data. The regional evidence on NCDs has been improved in this process. NCD risk factor surveys that applied WHO STEPwise approach in Bangladesh, Bhutan, DPR Korea, India, Maldives, Myanmar and Nepal and Sri Lanka have received support at various stages including planning, implementation, data analysis and results dissemination. First-ever nationally representative and standardized datasets on major NCD risk factors emerged in Bangladesh, Myanmar, Nepal and Sri Lanka. Technical support was also provided for establishing national NCD data bases. 18. To stimulate a debate on future directions and priorities a working paper on “Challenges and Opportunities for NCD Surveillance in the SEA Region of WHO” was prepared and discussed at the regional meeting. The debate has contributed towards strengthening of regional and national NCD surveillance systems. As a follow up, the Regional Office developed a set of indicators for reporting core NCD mortality, morbidity and risk factors data and conducted a regional data collection exercise that resulted in updating a regional NCD profile. The exercise indicates persisting large gaps in availability/ accessibility of population based data on NCDs and nearly total absence of information on temporal trends in NCD mortality, morbidity and risk factors. 19. Capacity of Member States to scale up public health response to the accelerated epidemiological transition observed in the Region was improved through NCD capacity strengthening activities that targeted policy makers and NCD programme managers. The SEA regional package of NCD capacity strengthening materials has been developed, systematically SEA/RC63/20 Page 4 updated, expanded and extensively used at national workshops conducted with WHO assistance in Bangladesh, Bhutan, DPR Korea, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand. 20. To further support national efforts in formulating and implementing comprehensive NCD policies, plans and programmes the Regional Office has developed a comprehensive set of materials to train managers and facilitators of national and sub-national NCD capacity strengthening programmes. Subsequently, WHO conducted a training for the NCD programme workforce from nine Member States on planning and conducting NCD capacity strengthening activities. 21. With WHO technical assistence and guidance significant progress in formulating, implementing and evaluating national NCD policies, action plans and programmes was noted in Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar Nepal, and Sri Lanka. Other countries are in various stages of formulating national policies and strategies for prevention and control of NCDs. In this process collaboration with multiple public sector groups outside health and civil society groups has been strengthened. The ministries of health of Bangladesh, Bhutan, Indonesia, Maldives and Sri Lanka made important structural adjustments, strengthening technical units or departments at national level to coordinate NCD programmes. 22. The regional framework and guidance for implementation of the WHO global strategy on diet, physical activity and health (DPAS) was reviewed and finalized at an intercountry consultation held in Myanmar in October 2006. Subsequently, national DPAS action plans were formulated in Indonesia, Myanmar, Nepal, and Sri Lanka. In 2009 the Regional Office facilitated a regional debate on the recommendations on marketing of food and non-alcoholic beverages to children that provided important inputs towards global recommendations in this regard. 23. The growing commitment and capacity of Member States of the SEA Region towards scaling-up the integrated prevention and control of NCDs has been documented in standardized national NCD capacity surveys undertaken by the Regional Office on three occasions: in 2001, 2006 and again in 2010. The comparative analysis of the surveys’ results track the progress achieved in the Region between 2001 and 2010. By and large, the repeat surveys revealed an increase in capacity and demonstrated that all countries have made some progress in developing different components of NCD prevention and control. The presence of NCD units within the ministries of health and funding of NCD programmes through regular government budget has become universal. More countries have developed NCD policies, plans and programmes. Progress was also evident in the area of tobacco control. However, there has been limited progress in establishing a regular surveillance system for NCDs and their risk factors as well as in development of guidelines for management of all NCDs and their risk factors. The use of legislation as a strategy has been largely restricted to tobacco and to some extent alcohol. It is yet to be explored in the Region in the areas of healthy diet and physical activity. 24. Community-based intervention projects have been implemented with WHO support in Bangladesh, India, Indonesia, Sri Lanka and Thailand. These projects furnished evidence on the feasibility and appropriateness of applying population-based approaches for integrated SEA/RC63/20 Page 5 prevention and control of NCDs in developing countries. The Regional Office has developed guidelines for monitoring and evaluation of such projects. 25. In response to the demand for technical and policy guidance on strengthening prevention and management of NCDs at the primary health care level, WHO has developed a package of essential NCD interventions (PEN) consisting of sets of protocols designed for non-physicians and for medical doctors and a packet of tools facilitating their application. Bhutan, Maldives and Sri Lanka have been supported in implementing the package. For this purpose the package was introduced at national training workshops. Subsequently the feasibility of a broad application of the package has been pilot-tested in select districts of Bhutan and Sri Lanka. 26. Efforts have been made to strengthen partnerships with the stakeholders within and outside the health sector and to mobilize resources through regional (SEANET-NCD) and national NCD networks. The Regional Office continued to provide secretariat support to SEANET-NCD. Biennial meetings of the network organized by the Regional Office in 2007 in Phuket, Thailand and in 2009 in Chandigarh, India provided an opportunity to strengthen advocacy for applying multisectoral approaches for prevention and control of NCDs and contributed to development of the regional NCD action plan. Progress in the implementation of the Regional Committee resolution on scaling up prevention and control of NCDs adopted in 2007 was reviewed, national experiences shared and inputs towards establishing monitoring mechanisms have been provided. 27. Activities of national networks for NCD prevention and control have been maintained in Bangladesh, Indonesia, Maldives, and Thailand. New NCD networks have been established in India and Sri Lanka. Three institutions involved in NCD control (two in India and one in Thailand) joined the network of regional WHO collaborating centres and the process of designation of three futher centres has been advanced. 28. Collaboration has been intensified with partners including the World Bank (WB) and World Diabetes Foundation (WDF). The Diabetes Summit for SEA Region organized in collaboration with the WDF, WB, the SEA Regional Office and the International Diabetes Federation in November 2008 addressed the urgent need for prevention and control of diabetes and related NCDs and resulted in the widely publicized Chennai Call for Action. 29. Researchers from Member States of the Region furnished important evidence for NCD prevention and control through participating in a number of large-scale international collaborative projects such as a cervical cancer screening and prevention projects, poly-pill project, and assessment of cause of death project. In July 2009 the SEA Advisory Committee on Health Research deliberated on the research priorities in NCDs. The thrust was to strengthen advocacy for and build awareness on the need to generate and use scientific evidence for prevention and control of NCDs. A consensus on the regional NCD research agenda was also developed. SEA/RC63/20 Page 6 Future challenges and opportunities 30. NCDs present a growing health and developmental challenge to the Region. Also, there is mounting evidence on the progressive socioeconomic divide in terms of exposure to NCD- causing factors and in access to basic health services by people at risk and those with established NCDs. The rise of NCDs in the Region presents an ominous warning and an important challenge to public health that merits a major shift in policy attention. 31. In this situation intensified efforts should be made by Member States, WHO, developmental partners and donors to build on and implement workable, low-cost solutions to the NCD problem and to recognize the urgent need to invest in the prevention and control of NCDs. The persisting gap in allocation of human and financial resources needs to be bridged. These are in fact excellent investments that should be recognized as an imperative for further economic and health development of the Region. 32. There is a growing commitment by Member States to apply efficient public health approaches for prevention and control of NCDs. Intensified efforts are needed to enhance the capacity of the health workforce and partners outside the health sector to implement public health-oriented NCD prevention and control programmes. As socio-economic, cultural, political and other determinants of NCDs reside largely outside the domain of health systems the action to prevent these diseases requires application of integrated approaches that involve other than health sectors as well as stakeholders from the private sector and civil society. It is postulated that the health sector takes a lead in establishing coordinating mechanisms, setting coordinating bodies and institutions, empowering the partners and establishing channels for sharing and using information. 33. While the concept of multisectoral collaboration for integrated prevention and control of NCDs is broadly accepted in the Region, establishment of sustainable collaborative platforms, legal and structural frames and partners’ capability enhancing mechanisms in addressing NCD- related health objectives remain an important challenge.