establishing collaboration: the gard –cplp working...

Establishing collaboration: the GARD – CPLP working group

Cláudia Conceição, IHMT/Universidade NOVA de Lisboa, Portugal

Paulo Camargos, Universidade Federal de Minas Gerais, Brazil

Elizabete Nunes, Universidade Eduardo Mondlane, Mozambique

<date>

3rd June 2019

Disclosure

No conflict of interest to declare

GARD11

CPLP countries22

GARD – CPLP : collaboration33

Table of Content

The Global Alliance against Chronic Respiratory Diseases is a voluntary alliance

of national and international organizations, institutions and agencies

committed to the vision of a world where all people breathe freely.

Its goal is to reduce the global burden of chronic respiratory diseases.

GARD includes:

Different medical specialities;

Different levels of health care provision;

Providers and patients;

Ordinary citizens;

Policy makers

GARD - Global Alliance against Chronic Respiratory Diseases11

https://gard-breathefreely.org/

2018. Time to deliver. Third UN High-level Meeting on Non-communicable Diseases. Brochure.


Billo, N. Role of the Global Alliance against Respiratory Diseases in scaling up management of chronic respiratory diseases—summary meeting report. J Thorac Dis 2017; doi: 10.21037/jtd.2017.07.55; Global action plan for the prevention and control of noncommunicablediseases 2013-2020. WHO,2013;

GARD’ s objectives articulate with WHO NCD action plan 2013–2020 regarding CRDs

2018. Time to deliver. Third UN High-level Meeting on Non-communicable Diseases. Brochure.


GARD Alliance… Now More Than Ever

• Air pollution was recognised as a main risk factor for NCD;

• Individual choice and individual responses will not address air pollution.

Bull World Health Organ 2019;97:160–161

CPLP, Community of Portuguese Language Countries 22

https://www.cplp.org/id-2611.aspx

Angola,Brazil, Cape Verde, Guinea-Bissau, Mozambique, Portugal,São Tomé and Príncipe,East Timor

Life expectancy at birth

2017

Mean years of schooling

2017

Gross national income (GNI) per capita

(2011 PPP$) 2017

Angola ** 61.8 5.1 5.790

Brazil *** 75.7 7.8 13.755

Cape Verde** 73.0 6.1 5.983

Guinea-Bissau * 57.8 3.0 1.552

Mozambique * 58.9 3.5 1.093

Portugal **** 81.4 9.2 27.315

São Tomé and Príncipe ** 66.8 6.3 2.941

East Timor ** 69.2 4.5 6.846

CPLP countries, indicators22

WB, 2019: * Low income economy; ** lower-middle income economies; ***upper-middle income economy;

****high income economy;

Population(millions)

Under-five mortality rates

(per 1000 live births)2016

Medical doctors (per 10 000 population)

2017

Angola * 29,8 82, 5 2,1

Brazil 209,3 15, 1 21,5

Cape Verde 0,5 21, 4 7,7 (2015)

Guinea-Bissau * 1,9 88, 1 2,0 (2015)

Mozambique * 29,7 71, 3 0,7

Portugal 10,3 3, 5 33,4

São Tomé and Príncipe * 0,2 33, 8 3,2 (2015)

East Timor * 1,3 49, 7 7,2

CPLP countries, indicators22

CPLP countries, CRD22

General remarks for CPLP low and lower-middle income countries

• Non availability of epidemiological information, specially for COPD, occupational disorders and risk factors; problems in monitoring

CPLP countries22

Angola, 2014

• Asthma – 13,4%

• Rhinitis – 27%

• Eczema – 20%

• n= 3128 (13 -14 years)

ISAAC, International Study of Asthma and Allergies in Childhood

Mozambique, 2004

• Asthma 13,3%

• Rhinoconjunctivitis 23%

• Eczema 10%

• n= 2630 (13 -14 years)

• Asthma 13,3%

• Rhinoconjunctivitis 8,8%

• Eczema 8,5%

• n= 2383 (6 -7 years)

Mavale-Manuel S, et al. Asthma and allergies in schoolchildren of Maputo. Allergy 2007; 62: 265-271;Arrais M, Lulua O, Qulifica F, Rosado-Pinto J, Gama J, Taborda-Barata L. Prevalence of asthma and allergies in 13-14 year-old adolescentes from Luanda, Angola. Int J Tuberculo Lung Dis 2017; 21(6):705-712

CPLP countries22

Cape Verde, 2006

CRD prevalence

• Emphysema 0,7 %

• Tuberculosis 2 %

• Chronic Bronchitis 4,5 %

• Rhinoconjunctivitis 12,3 %

• Asthma 6,2 %

• n= 3256 (mean 30 years of age)

“GARD demonstration project”

Martins-Carreiro P, Rosado-Pinto J, Teixeira M, Neuparth N, Silva O, Papoila A, Khaltaev N, Bousquet J, Annesi-Maesano. Distribution and etiology of chornic respiratory

disease in primary healthcare departments in Cape Verde. Rev Epidemiol Sante Publique. 2015; 63(5):305-13

• Questionnaires; all health centers and emergency services on the islands of Santiago and São Vicente; 2006


• Non availability of epidemiological information, specially for COPD, occupational disorders and risk factors monitoring

• Risk factors known to be important in LIC context: indoor air pollution; TB; TB/HIV;

• Difficulty in obtaining and monitoring health care indicators (for example hospital admissions, deaths);

• Double burden for health systems: infectious diseases and increasing non communicable diseases;

• Access to medicines; WHO’ “list of essential medicines” (beclometasone; budesonide ; budesonide+formoterol; adrenaline; ipratropium bromide; salbutamol)


PEN PHC asthma

• Salbutamol prn

• Beclometasone

• Theophylline

• In some countries these medicines

are only available at district hospitals

• Frequent non availability of

medicines even on private

sector/private pharmacies

Implementation tools: package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. WHO, 2013.

CPLP countries22



• Risk factors known to be important in LIC context: indoor air pollution; TB; TB/HIV;

• Difficulty in obtaining and monitoring health care indicators (for example hospital admissions, deaths)


• Access to essential medicines WHO’ “list of essential medicines”;

• Non availability of spirometry;

• Insufficient unprepared human resources to identify and treat CRD;

• Dependence on external financing (difficulty in ownership of health agenda)

General remarks for low and middle income countries

• Non existence of a health program on chronic respiratory diseases




• Risk factors known to be important in LIC context : indoor air pollution; TB; TB/HIV;

• Difficulty in obtaining and monitoring health care indicators (for example hospital admissions, deaths)


• Access to essential medicines WHO’ “list of essential medicines”;

• Non availability of spirometry

• Insufficient unprepared human resources to identify and treat CRD

• Dependence on external financing (difficulty in ownership of health agenda)

• Non existence of a health program on chronic respiratory diseases

CRD are under-diagnosed and under-treated


General remarks for low and middle income countries

The past


From previous experiences:

• Collaboration between WHO GARD International, GARD Portugal, GARD Cape Verde and Ministries of Health of the two countries in clinical practice, training and research; 10 years of cooperation between MoH from the two countries;

• Historical bounds between the CPLP countries; other cooperation programs in different health areas; between governments but also between medical associations and other NGO


Kick off meeting April 2017, IHMT, Lisbon

• To establish the bases for an GARD Alliance in Portuguese speaking countries;

• To increase visibility and advocacy in CRD;

• October 2017, Brasilia, CPLP’ Health ministers meeting; a resolution on the creation of a “GARD CPLP” was approved; “in the respect for international GARD ToR” ;

• CPLP’ strategic plan in health cooperation was updated and integrated RCD and GARD-CPLP;

CPLP’ Health ministers meeting, October 2017


http://gard-cplp.ihmt.unl.pt


Mailing list

• To health professionals interested in CPLP collaboration;

• To increase access to scientific information in Portuguese;

• To exchange epidemiological studies, guidelines, respiratory diseases programs


11th GARD General Meeting, 2017, Brussels, Belgium

GARD in Lusophone Countries,J Rosado Pinto

12th GARD General Meeting, 2018, Helsinki, Finland

GARD - CPLP: Integration of CRD programs, Elizabete Nunes


9th April 2019 GARD-CPLP working group meeting ; Lisbon, Institute of Tropical Medicine and Hygiene

• Focal points / initiators from GARD CPLP countries;

• Invitees from CPLP;

• To discuss the current situation and the next steps

10th April 2019 Satellite symposium on GARD-CPLP

• Presentations on Chronic respiratory diseases in CPLP countries and PAL/PACK


Batman E. Integrated clinical management tools for respiratory diseases: lessons from PAL in sub-Saharan Africa. Int J Tuberc Lung Dis 2016; 20 (4): 429

Working areas

• Research: Epidemiological studies (respiratory diseases, risk factors), e.g. creation or validation of questionnaires in Portuguese;

• Training of health professionals: to identify training needs, to create and improve programs of exchange of health professionals;

• Use CPLP political influence to leverage and develop CRD health programs and advocacy;

• To propose and contribute to the introduction of PAL and PACK, clinical decision support tools in countries' health services (LIC)


Batman E. Integrated clinical management tools for respiratory diseases: lessons from PAL in sub-Saharan Africa. Int J Tuberc Lung Dis 2016; 20 (4): 429

Working areas PAL/PACK

• PAL “Practical approach to lung health: Asthma, COPD, respiratory infections and TB”, 1999; expanded to

• PACK “Practical approach to care kit”

• Portuguese version (Brazil, Florinópolis)

• Clinical tools, Training, Health systems support , Research & Audit

GARD – CPLP33GARD-CPLP country focal points:

• Margarete Arrais, Angola; • *Paulo Camargos, Brazil; • M. Céu Teixeira, Cape Verde; • Elizabete Nunes, Mozambique, • José Rosado Pinto, Portugal, • Frederico Bosco, East Timor, • *Cláudia Conceição, IHMT/NOVA

*Coordination of GARD-CPLP

[email protected] [email protected]

Thank you!

On behalf of the enthusiastic team coordinated by country focal points / initiators

establishing collaboration: the gard –cplp working...

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