united nations general assembly review on non communicable

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United Nations General Assembly

Review on Non Communicable

Diseases 2014

Summary Report of the Region of

the Americas

Washington D.C. June 2014

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TABLE OF CONTENTS

ACRONYMS .................................................................................................................................................. iii

1. INTRODUCTION ..................................................................................................................................... 1

2. OBJECTIVE ............................................................................................................................................. 1

3. PROCESS ................................................................................................................................................ 1

4. GENERAL RECOMMENDATIONS TO BE CONSIDERED FOR THE OUTCOME DOCUMENT: AMRO

REGION .......................................................................................................................................................... 2

ANNEX 1: “UNGA NCD Review 2014” questionnaire .................................................................................... 6

ONLINE QUESTIONNAIRE: RESULTS .............................................................................................................. 9

SECTION 1: WHERE DO WE STAND? ......................................................................................................... 9

SECTION 2: ACTION PLAN INDICATORS .................................................................................................. 11

SECTION 3: FROM BOTTLENECKS TO SOLUTIONS ................................................................................... 13

SECTION 4: ACCELERATING PROGRESS ................................................................................................... 14

SECTION 5: UNGA NCD REVIEW 2014 AND BEYOND .............................................................................. 16

ANNEX 2: UNGA Subregional Consultation Summary ................................................................................ 18

ANNEX 3: UNGA Local Consultation Summary ........................................................................................... 37

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ACRONYMS

ANI Antigua and Barbuda

ARG Argentina

BAH Commonwealth of The Bahamas

BAR Barbados

BLZ Belize

BOL Bolivia

BRA Brazil

BVI British Virgin Islands

CAN Canada

COL Colombia

COR Costa Rica

CUB Cuba

CCS NCD Country Capacity Survey

DOR Dominican Republic

ECU Ecuador

ELS El Salvador

GUT Guatemala

GUY Guyana

HAI Haiti

HON Honduras

JAM Jamaica

MEX Mexico

NCDs Noncommunicable diseases

PAN Panama

RF Risk factors

SKN St Kitts and Nevis

SUR Suriname

SVG St Vincent and the Grenadines

TRT Trinidad and Tobago

UNHLM UN High Level Meeting on NCDs

UNGA United Nations General Assembly

UNDAF United Nations Development Assistance Framework

URU Uruguay

USA United States of America

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1. INTRODUCTION

Noncommunicable diseases (NCDs), and their risk factors (RFs), are the leading causes of morbidity,

disability and premature death in the Americas, representing an enormous threat to social and

economic development. In response to this growing public health challenge, Member States in the

Region are making significant advances in both preventing and controlling NCDs and their RFs,

developing and implementing policies and programs with comprehensive and integrated approaches.

Additionally a growing number of global and regional political declarations and resolutions have

increasingly raised the profile of NCDs and their RFs on the health, social protection and economic

development agendas, including the landmark 2011 Political Declaration of the UN High Level Meeting

on NCDs (UNHLM)1,2.

As a follow up to the 2011 UNHLM and responding to the commitment made in paragraph 65 of the

UNHLM Political Declaration, the UN General Assembly (UNGA) is convening a Comprehensive Review

and Assessment of the Progress Achieved in the Prevention and Control of NCDs (UNGA NCD Review

2014) to take place in New York City, USA, on 10-11 July 2014.

2. OBJECTIVE

To support preparations by Member States for the Comprehensive Review and Assessment of the

Progress Achieved in the Prevention and Control of NCDs (UNGA NCD Review 2014), and to provide

feedback to WHO on possible elements that can be included in an outcome document.

3. PROCESS

To support Member States in their preparations for the UNGA NCD Review 2014, and following the

World Health Organization (WHO) recommendations, the Pan American Health Organization (PAHO) is

undertaking several steps including:

a webinar to present results of the 2013 Country Capacity Survey on NCDs (11 April),

an online “2014 UNGA NCD Review” questionnaire,

virtual consultations with Member States organized by subregions (28-30 May), and

a local consultation in Washington D.C. with stakeholders including academia, governmental

public health agencies and NGOs (13 June).

This report summarizes the main results from all the consultation processes, and it aims to serve as

input to national and regional preparatory efforts towards the 2014 UNGA NCD review. The report

consists of the recommendations summarized from all the consultations, organized according to the

main topics identified as possible elements for an outcome document3. Annexes 1 and 2 include the

source data that support those recommendations: Annex 1 summarizes the responses to the “2014

1 Regional Plan of action for the prevention and control of NCDs (CD52/7, Rev. 1 PAHO, Sept 2013), available from:

http://bit.ly/1lLjJQT 2 Political Declaration of the High Level Meeting of the General Assembly on the Prevention and Control of NCDs (A/Res/66/2,

UN September 2011), available from http://bit.ly/OrRFmw . 3 Power Point presentation shared by WHO.

http://bit.ly/1lLjJQT

http://bit.ly/OrRFmw

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UNGA NCD Review” questionnaire and Annex 2 summarizes the Subregional Online Consultations.

Annex 3 summarizes the Local Consultation discussions.

4. GENERAL RECOMMENDATIONS TO BE CONSIDERED FOR THE OUTCOME DOCUMENT:

AMRO REGION

The following statements constitute a summary of the findings resulting from the online consultations

with the countries on advances, gaps and lessons learnt after the 2011 Political Declaration of the UN

High Level Meeting on NCDs (UNHLM). The first six topics have been identified by WHO as possible

elements for an outcome document. Two additional topics were considered with regards

recommendations for collaboration with the UN and international collaboration, and they principally

address how PAHO/WHO technical cooperation on NCDs can be strengthened.

It should be noted that this document does not constitute an official report from Member States, but

rather a summary of the discussions and perspectives that were considered during the consultations.

The deadlines suggested by WHO were not emphasized discussed during the consultations, but there

seemed to be a general consensus in support of these timelines.

Table 1. AMRO General Recommendations for the Outcome Document (June 6, 2014)

WHO Topic and Detail AMRO’s General Recommendations

1. Set national targets

Member States to commit to consider, by 2014, the development of national targets for 2025 based on national situations, taking into account the 9 voluntary global targets adopted by the 66th World Health Assembly (May 2013)

Review or adopt national targets and indicators, in line with the WHO and PAHO Global and Regional Monitoring Frameworks on NCDs. This would allow achievement of the respective global and regional targets, ease reporting demands and facilitate resource mobilization

2. Develop a national plan

Member States to commit to develop, by 2014, a multisectoral national policy and plan for the prevention and control of NCDs to attain national targets, and strengthen capacity in implementing the national strategy and plan in three major components: (i) surveillance; (ii) reduction of exposure to risk factors and (iii) improved health care, with allocation of adequate budget and resources

Develop and implement plans and policies on NCDs at the national level with committed human and financial resources that consider social determinants of health and health inequities. Take into account the community level when developing, implementing and resourcing policies and plans.

3. Establish a national multisectoral mechanism

Member States to commit to establish, by 2014, a high-level national multisectoral commission, agency or task force for engagement, policy coherence and

Establish multisectoral technical committees on NCDs and their risk factors, with clear roles that facilitate work among different sectors, including the public and private sectors, civil society and NGOs

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accountability of sectors beyond health that have a bearing on NCDs, and to monitor the implementation of the national policy and plan

Apply a health promotion approach to promote or strengthen multisectoral action against NCDs and their RFs through collaboration with key stakeholders at the local, municipal and community level. Stakeholders include different players such as the private sector, NGOs, academia, finance, sports, and the agricultural sectors to build healthy environments and promote health. Rules of engagement and accountability must be very well defined for all actors involved.

Strengthen countries’ capacity to negotiate with other sectors, strengthen Ministries of Health and gain support and trust of NGOs with regards NCDs

Consider incorporating NCDs and their RFs in broader national policies such as the National Health Plans, and the Coordination Mechanisms at the Subregional Level (CARICOM, MERCOSUR, etc).

4. Reduce exposure to risk factors

Member States to implement, by 2015, as part of a national multisectoral policy and plan, a set of very cost-effective and affordable interventions for all Member States ("best buys") to reduce the exposure to risk factors for NCDs

Strengthen regulatory frameworks and their implementation to tackle NCD Risk Factors including, among others, marketing to children, legislation against the use of tobacco, harmful use of alcohol, and promotion of processed food with high sugar, salt and fat content.

strengthen integration of approaches to risk factors (tobacco, alcohol, and unhealthy diets) within/between health systems

Improve communication on risk factors, including the use of social media, especially as they relate to equity. Engage journalists as communicators for public health, and include experiences from patients to personalize the messages to be delivered.

Disseminate guidelines on best practices to address risk factors.

5. Enable health systems to respond

Member States to implement, by 2015, as part of a national multisectoral policy and plan, a set of very cost-effective and affordable interventions for all Member States ("best buys") to enable health systems to respond to the NCD challenge of epidemic proportions

Reorganization and strengthening of health services for the integrated management of NCDs and RFs, with emphasis on PHC, the strengthening of health care personnel capacities, and the development of guidance and guidelines

Strengthen the provision of universal health care to promote increased access to prevention and treatment services for NCDs and RFs

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Evaluate funding mechanisms for health care to increase funds and improve coverage of health systems

6. Measure results

Member States to implement, by 2015, the WHO Framework for NCD Surveillance covering: (i) monitoring of risk factors and determinants; (ii) outcomes (mortality and morbidity) and (iii) health system response, as well as to integrate NCDs into the national health information systems, and develop national indicators taking into account the global ones.

Strengthen capacity to measure national performance and disease burden to improve monitoring, evaluation, and surveillance, such as through PAHO/WHO surveys (STEPS, GYTS). Include measures that address social determinants and can be translated into action, as well as evaluation of policies, among others. When possible, consider multi disease reporting to improve efficiency.

Engage academic and research institutions to strengthen monitoring capacity, and to generate evidence.

UN country collaboration

Highlight the implementation of the UN Inter Agency Task Force for NCDs at the country level, to promote and improve integration of UN agencies in terms of NCDs, and as a means to foster economic development

Include work on NCDs and their RFs in UNDAFs in those countries that have such framework, with a focus on social determinants and life course. Include participation of civil society where and when applicable.

International collaboration

WHO/PAHO to strengthen country capacity to meet the commitments of the High Level political declaration on NCDS including, but not limited to surveillance; legislation on NCD risk factors; resource mobilization; strengthening capacities of human resources, and research to generate evidence.

WHO/PAHO to strengthen advocacy to position NCD and RF topics and to mobilize the necessary political support. This includes promoting the inclusion of NCDs in the agendas of other relevant Political Regional and Subregional Mechanisms such as MERCOSUR, CARICOM, UNASUR, etc, and on technical mechanisms such as CARPHA.

WHO/PAHO to create a virtual hub of resources of national NCD plans and policies to provide real-time updates, and to provide guidance on the process.

WHO/PAHO to promote the sharing of experiences between countries, and collaboration among different stakeholders through networks such as CARMEN and the Pan American Forum for NCDs. Promote and facilitate work between government and civil society.

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WHO/PAHO to increase its technical/financial presence in countries with higher burdens of disease/risk factors

PAHO/WHO to take the lead in mobilizing UN agencies to address NCDs and their RFs

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ANNEX 1: “UNGA NCD Review 2014” questionnaire

The “2014 UNGA NCD Review” questionnaire was designed to facilitate Member States’ preparations for

both the virtual consultations and the NCD Review at the UNGA in July 2014, encompassing the main

agenda topics of the UNGA 2014 NCD review discussion. It was based on the original questions

proposed by WHO in the Terms of Reference for Regional Consultations on the NCD Review 2014 at the

UN General Assembly4.

This report summarizes the main results from the “2014 UNGA NCD Review” questionnaire, and it aims

to serve as input to national and regional preparatory efforts for the 2014 UNGA NCD review.

Overview

An online questionnaire was sent to the National Health authorities through the PAHO/WHO NCD focal

points in all Member States of the Americas Region (35 countries), and completed via the online website

Surveymonkey.com in May 2014 by the designated country team. In order to improve quality and

completeness of the responses, Member States were encouraged to convene country teams including

partners and stakeholders identified by the WHO as follows: Ministries of Health, Ministries of Foreign

Affairs, Development and/or Planning and UN country teams. No validation process was undertaken

prior to analysis, thus this report is entirely based on the responses submitted by the countries.

Questionnaire

The questionnaire consisted of five sections including 23 questions, following the main topics that will

be discussed during the UNGA NCD Review 2014 (Table 2). The questions comprised a combination of

open questions and multiple choice questions.

Table 2. Sections of the questionnaire

Section Description

Section 1: Where do we stand?

The purpose of this section is to establish the level of progress achieved at country level since September 2011 in implementing the UN Political Declaration on NCDs, the WHO Global NCD Action Plan 2013-2020 (including the 9 global targets for NCDs and risk factors to be attained by 2025), and the PAHO regional action plan on NCDs.

Section 2: NCD Action Plan Indicators

This section included a set of questions related to the 9 NCD Action plan indicators agreed on by Member States to inform reporting on progress made in the process of implementing the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020.

Section 3: From bottlenecks to solutions

This section is intended to determine the major gaps that have been identified at country level in the implementation of the global and regional commitments on NCDs, and to establish possible actions to advance these processes.

Section 4: Accelerating progress

This section is intended to assess lessons learnt and possible synergies with other sectors and/or agencies in the implementation of national multisectoral NCD plans.

4 Annex 1 of WHO Internal Document: Briefing for GPG (version dates 28 February 2014).

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Section 5: UNGA NCD Review 2014 and beyond

This section is relevant to the outcome document, on partnerships that need to be established at the country level for the successful implementation of the agreed commitments

To facilitate the completion of Section 2 of the questionnaire “NCD Action Plan Indicators”, countries

were encouraged to review their 2013 NCD Country Capacity Survey responses, which were provided as

a separate annex, together with other relevant information available at the country level.

Response rate

In total, 28 countries completed the online survey, representing an overall response rate of 80% (28/35

countries). Table 3 presents a complete list of responding countries classified by subregion.

Analysis

Data were automatically downloaded from the Surveymonkey server into an excel file. A qualitative

content analysis of open questions was performed, identifying common categories to summarize

results. For Section 2 on “Action Plan Indicators”, the nine progress indicators were calculated following

WHO definitions5 and based on the information reported by 36 countries that completed the 2013 NCD

Country Capacity Survey (CCS). Responses from the 28 countries that completed the 2014 UNGA NCD

review survey were used to complete the indicators where possible. Nevertheless, the 2014 UNGA NCD

Review questionnaire didn’t provide sufficient information to verify that the indicator criteria were met

for all cases. Finally, Indicator 5 on a national NCD research agenda was entirely based on the 2014

UNGA NCD review survey responses, as the 2013 CCS didn't include questions related to this topic.

5 Development of a limited set of action plan indicators to inform reporting on progress made in the implementation of the

WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020, available from: http://bit.ly/T6VKzE.

http://bit.ly/T6VKzE

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Table 3. List of countries that have completed the survey

English speaking Caribbean (11 countries) 1 Antigua and Barbuda

2 Commonwealth of The Bahamas

3 Barbados

4 Belize

5 British Virgin Islands

6 Guyana

7 Jamaica

8 St Kitts and Nevis

9 St Vincent and the Grenadines

10 Suriname

11 Trinidad and Tobago

Central America, Hispanic Caribbean and Haiti (8 countries) 12 Costa Rica

13 Cuba

14 Dominican Republic

15 El Salvador

16 Guatemala

17 Haiti

18 Honduras

19 Panama

South America (6 countries) 20 Argentina

21 Bolivia

22 Brazil

23 Colombia

24 Ecuador

25 Uruguay

North America (3 countries) 26 Canada

27 Mexico

28 United States of America

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ONLINE QUESTIONNAIRE: RESULTS

SECTION 1: WHERE DO WE STAND?

Question 1.1. Response rate: 28/28 (100%) What progress has been made at country level since September 2011 in implementing strategies and actions for the prevention and control of NCDs and their risk factors? Please provide a brief description on the specific progress that has been achieved so far. Please consider in your responses the commitments made by countries in a) the UN Political Declaration on NCDs, b) the WHO Global NCD Action Plan 2013-2020 (including the 9 global targets for NCDs to be attained by 2025), and c) PAHO Regional Action Plan on NCDs?

1. Progress in NCD policy development and implementation:

* 4 countries (BEL, JAM, SVG, COL) have included NCDs in broader national plans

* 14 countries have drafted (ANI) or developed and/or implemented (BAR, BEL, GUY, JAM, SKN, SUR, DOR, BOL, COR, ELS, PAN, BRA, ECU) integrated NCD National plans, policies or strategies

* 6 countries have drafted, developed and/or implemented national plans, policies or strategies for specific NCDs, including cancer (COR, JAM, PAN, BOL, COL), cardiovascular diseases (COR), mental health (COR), obesity (COR, MEX) and diabetes (MEX)

2. Progress in multisectoral action for NCDs and their RF:

* 11 countries have reported progress in establishing multisectorial approaches to NCDs and their RF, mostly through multisectoral plans (ANI, ECU), councils and commissions (BAH, BVI, JAM, SVG, GUA, HON, COL), and in two countries through a Multisectoral Partners Forum for NCDs (GUA, TRT)

3. Progress in available infrastructure for NCDs and their RF:

* 7 countries have strengthened their infrastructure for NCDs and RF, creating a unit, branch or department for NCDs within the

Ministry of Health (SVG, COL), appointing an NCD focal point (ANI, SVG, PAN), and/or establishing an NCD committee, council or

some other form of coordinating mechanism (ANI, BEL, SKN, PAN, USA)

4. Progress in addressing major risk factors and protective factors:

* Most countries have reported progress in addressing major risk factors and protective factors, including:

** 18 countries have reported progress in advancing tobacco control efforts in align with the Framework Convention for Tobacco Control (ANI, BAR, BAH, BEL, GUY, JAM, SKN, SVG, SUR, TRT, COR, ELS, GUA, ARG, COL, ECU, URU, USA), including smoke-free public spaces, increased taxation, restriction on marketing, expansion of tobacco cessation coverage and tobacco prevention campaigns.

** 8 countries have developed policies, legislation and actions to address harmful use of alcohol (BEL (draft), SVG, TRT, SUR, DOR (draft), COR, COL, ECU), and 4 countries in substance abuse policies and programs (TRT, DOR, COR, ELS)

** 16 countries (ANI, BAH, BAR, BEL, GUY, JAM, TRT, COR, DOR, ELS, GUA, ARG, COL, ECU, URU, USA) have undertaken actions to promote healthy eating, including the development of nutrition policies and guidelines, strategies to promote healthy eating at schools and in the community, regulation of food labelling and discussions with food and beverages manufacturers to discuss reductions in sugar and salt.

** 9 countries (GUY, BAH, COR, DOR, ELS, GUA, BRA, COL, USA), have reported progress in tackling physical inactivity, including the development of national plans and policies, as well as advocacy efforts to raise public awareness.

** 5 countries (BAH, GUY, DOR, USA, CAN) have reported specific actions to address childhood obesity

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5. Progress in strengthening health systems response:

** 6 countries (BVI, CUB, BOL, BRA, ECY, USA) have reported progress in the implementation of an integrated model of care for NCDs and their risk factors, and 4 countries (ANI, BAH, JAM, COR) have undertaken actions to assess and improve quality of care

** 8 countries (BAH, BEL, SKN, JAM, TRT, GUA, COL, URU) have carried out capacity building activities to improve core competencies of their workforce for the management of NCDs and their RF.

** 9 countries (JAM, COR, ELS, GUA, HON, BOL, COL, ECU, URU) have developed or updated guidelines and standards for the management of NCDs and their RF

** 3 countries (CUB, COL, ECU) have reported improved access to essential NCD medicines and technologies.

** 9 countries (BAH, GUY, COR, CUB, DOR, BRA, COL, URU, USA) have strengthened their health systems response capacity for the management of specific NCDs, with a special focus on specific cancer types, cardiovascular diseases and chronic kidney disease

6. Progress in health education, public awareness and community based programs:

** 4 countries (TRT, COR, HON, USA) have carried out activities to raise public education and awareness about NCDs, including community engagement programs

7. Progress in NCD and RF surveillance:

** 4 countries (BAR, CUB, ARG, COL) have strengthened NCD and RF surveillance, and 2 countries (JAM, COL) have reported the development of targets and indicators as part of their national plans

** 6 countries (BAR, TRT, SUR, COR, COL, URU) have finalized or are conducting risk factors surveys

** 5 countries (JAM, COR, GUA, PAN, COL) are establishing and/or strengthening disease specific registries, mainly cancer registries

** 3 countries (TRT, COR, COL) have performed data analysis for NCDs and RF publications and one country (COL) has developed policy briefs based on surveillance data

** 1 country (COL) is conducting virtual trainings on basic epidemiology for NCDs

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SECTION 2: ACTION PLAN INDICATORS

The Action Plan indicators have been calculated according to the WHO definitions (available from http://bit.ly/T6VKzE) and based on the information reported by 36 countries that completed the 2013 CCS. Responses from the 28 countries that completed the 2014 UNGA review survey have been added where possible. Indicator 5 on a national NCD research agenda is entirely based on the 2014 UNGA review survey responses, as the CCS didn't include questions related to this topic.

Number of countries

Indicator definition

20 1. Number of countries with at least one operational multisectoral national policy, strategy or action plan that integrates several noncommunicable diseases and shared risk factors in conformity with the global/regional noncommunicable disease action plans 2013-2020

17 2013 CCS: ARG, BAR, BOL, BVI, CAN, CHI, COL, DOR, ECU, GUA, MEX, MON, PUR, SUR, TRT, USA, VEN

3 UNGA 2014 survey: BEL, BRA and CUB reported an operational multisectoral plan; JAM, ELS, PAN, GUY reported an NCD policy, strategy or action plan but didn't specify if it is operational and/or multisectoral.

21 2. Number of countries that have operational NCD unit(s), branch(es) or department(s) within the Ministry of Health, or equivalent.

21 2013 CCS: ANG, ARG, BAR, BRA, BVI, CAN, CHI, COL, CUB, DOR, GUA, MEX, MON, NIC, PAN, PER, PUR, SUR, URU, USA, VEN

UNGA 2014 survey: BAH, JAM, COR, ECU, HON, ANI, GUYM SKN, SVG, TRT, reported that they have a unit, branch or department for NCDs, but the questionnaire didn't request enough information to verify if all the indicator criteria were met.

22 3a. Number of countries with an operational policy, strategy or action plan to reduce the harmful use of alcohol, as appropriate, within the national context.

21 2013 CCS: ARG, BAR, BOL, BVI, CAN, CHI, COL, CUB, DOR, ECU, ELS, GUA, MEX, MON, PAN, PAR, PER, PUR, SUR, TRT, USA

1 UNGA 2014 survey: BRA; JAM reported that alcohol is part of the NCD strategic plan, but didn't specify if the plan is operational

26 3b. Number of countries with an operational policy, strategy or action plan to reduce physical inactivity.

24 2013 CCS: ANG, ARG, BAR, BOL, BRA, BVI, CAN, CHI, COL, COR, CUB, DOR, ECU, GUA, MEX, MON, PAN, PAR, PUR, SUR, TRT, URU, USA, VEN

2 UNGA 2014 survey: ANI and BEL; ELS and GUY reported a specific policy, strategy or action plan, and JAM indicated it is part of the NCD Strategic Plan, but it was not specified if they are operational.

26 3c. Number of countries with an operational policy, strategy or action plan, in line with the WHO Framework Convention on Tobacco Control, to reduce the burden of tobacco use.

26 2013 CSS: ARG, BAR, BOL, BRA, BVI, CAN, CHI, COL, COR, CUB, DOR, ECU, ELS, GUA, HON, MEX, MON, NIC, PAN, PAR, PUR, SUR, TRT, URU, USA, VEN

UNGA 2014 survey: ANI, SVG and GUY responded that they have specific policies, strategies or action plans (ANI, SVG) for tobacco, and GUY and JAM indicated that tobacco is part of the NCD policy, strategy or action plan, but it was not specified if they are operational.

http://bit.ly/T6VKzE

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Number of countries

Indicator definition

23 3d. Number of countries with an operational policy, strategy or action plan to reduce unhealthy diet related to NCDs.

22 2013 CCS: ARG, BAR, BOL, BRA, BVI, CAN, CHI, COL, COR, DOR, ECU, GUA, MEX, MON, PAN, PAR, PUR, SUR, TRT, URU, USA, VEN

1 UNGA 2014 survey: BEL; JAM, HAI, CUB, ANI and GUY indicated that there is a National nutrition policy, or that nutrition is part of the NCD policy, strategy or action plan (JAM), but it was not specified if they are operational

13 4. Number of countries that have government approved evidence-based national guidelines/protocols/standards for the management of major noncommunicable diseases through a primary care approach, recognized/approved by government or competent authorities.

13 2013 CCS: BRA, CAN, CHI, CUB, JAM, NIC, PAN, PUR, SKN, SUR, TRT, USA, VEN

UNGA 2014 survey: COR, PAN, MEX and BAR indicated they have guidelines for NCDs but the questionnaire didn't request enough information to verify if all the indicator criteria were met.

7 5. Number of countries that have an operational national policy and plan on noncommunicable disease-related research, including community-based research and evaluation of the impact of interventions and policies.

The 2013 CCS didn't include questions related to this indicator

7 UNGA 2014 survey: BAR, ARG, BRA, CAN, CUB, TRT, USA indicated that they have developed and implemented an operational prioritized research agenda with financial and human resources.

11 6. Number of countries with noncommunicable disease surveillance and monitoring systems in place to enable reporting against the nine voluntary global noncommunicable disease targets

11 2013 CCS: ARG, BAH, BAR, BRA, CHI, ECU, MEX, PAR, SAL, TRT, USA

UNGA 2014 survey: The UNGA survey included a general question on periodic data collection on risk factors, without mention to specific risk factors. Therefore, the answers could not be used to calculate this indicator.

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SECTION 3: FROM BOTTLENECKS TO SOLUTIONS

Question 3.1. Response rate: 27/28 (96%) Can you identify the major gaps that your country is facing in the effective implementation of its action plan?

1. Financial resources constrains (12 countries: ANI, GUY, JAM, SKN, SVG, TRT, DOR, ELS, HAI, PAN, BOL, ECU)

2. Human resources constrains (12 countries: ANI, BAR, GUY, JAM, SUR, SKN, SVG, TRT, DOR, BOL, BRA, ECU), in terms of quantity, technical capacity and high turnover of technical staff

3. Difficulties to establish effective multisectoral action for NCDs and their RF (12 countries: ANI, BAR, BEL, JAM, SVG, ELS, HAI, HON, ARG, BRA, COL, CAN)

4. Insufficient legal frameworks, regulatory measures and fiscal measures for risk factors (8 countries: ANI, BVI, JAM, SUR, COR, CUB, BRA, COL)

5. Insufficient commitment at the highest political levels and insufficient visibility in the national political/development agenda (7 countries: BAR, SUR, JAM, HON, GUA, PAN, ECU)

6. Inadequate organization of health systems and health services to respond to NCDs and their RF (6 countries: SKN, BAH, JAM, PAN, BRA, MEX)

7. Lack of adequate information systems for surveillance, monitoring and evaluation (5 countries: BAH,TRT, COR, GUA, URU)

8. Limited public awareness, knowledge and perception of risk (3 countries: TRT, CUB, COL)

9. Inadequate access to essential NCD medicines and technologies (3 countries: BAH, SKN, ECU)

10. Insufficient research on NCDs and RF at the country level (2 countries: CUB, GUA)

11. Absence of a national NCD policy, strategy or action plan (2 countries: BAH, HAI)

12. Fragmented interventions to address NCDs and their RFs and insufficient managerial capacities to operationalize interventions at the local level (1 country: DOR)

Question 3.2. Response rate: 27/28 (96%) Can you identify the actions and/or interventions that you believe should be prioritized to fill those gaps? Please describe the criteria used to define these priority actions.

1. Increase human resources for NCDs and RF, and strengthen capacity building activities both for program coordination and clinical management (12 countries: BAH, GUY, SUR, SKN, SVG, COR, DOR, GUA, HON, PAN, BRA, ECU)

2. Increase resource mobilization and financial allotments to NCDs and their RF, including costing of NCDs and RF plans (11 countries: ANI, GUY, JAM, SKN, SVG, HAI, COR, DOR, ELS, PAN, URU)

3. Strengthen multisectoral action for NCDs and RFs (9 countries: BAH, BEL, SUR, SVG, ELS, GUA, COL, URU, CAN)

4. Advocate for greater political leadership and political commitment to NCDs and their RF ,including other ministries and government agencies outside the health sector (9 countries: ANI, BAR, SVG, TRT, GUA, HAI, HON, PAN, ARG)

5. Strengthen legal frameworks, regulatory measures and fiscal measures for risk factors (7 countries: ANI, GUY, CUB, BOL, BRA, COL, ECU). Specific proposed actions include developing Global Frameworks similar to the Tobacco FTCT was proposed as a strategy to accelerate this process for other RF (COL), and empowering civil society to accelerate change (BRA)

6. Strengthen health systems response to NCDs and their RF (6 countries: BAH, JAM, COR, GUA, ECU, MEX). Specific

proposed actions include promoting universal health coverage (MEX), and expanding the list of NCD medicines included in the

PAHO Strategic Fund (ECU, GUA)

7. Improve information systems to facilitate adequate surveillance of NCDs and RF (5 countries: BAH, SKN, COR, GUA, PAN)

8. Promote research, including costing, cost-effectiveness and impact studies of NCD and RF programs and interventions (4 countries: SKN, CUB, BRA, ECU)

9. Improve NCD and RF program coordination, monitoring and evaluation (3 countries: SKN, TRT, COR)

10. Increase technical cooperation for the prevention and control of NCDs and their RF (1 country: DOR)

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SECTION 4: ACCELERATING PROGRESS

Question 4.1. Response rate: 26/28 (93%) How can WHO and other UN organizations better support national efforts to set targets for NCDs and RF and develop national multisectoral NCD plans?

1. Providing technical cooperation for the development and implementation of NCD and RF policies, plans and programs (9 countries: BAH, GUY, SVG, TRT, DOR, ARG, BRA, URU, CAN)

2. Supporting NCD and RF surveillance, monitoring and evaluation, including establishing baselines and producing NCD country profiles (8 countries: ANI, BAH, BVI, TRT, CUB, GUA, HON, PAN)

3. Facilitating south-to-south cooperation and sharing of best practices (8 countries: BAH, BAR, TRT, CUB, ARG, BOL, BRA, ECU)

4. Assisting advocacy efforts for NCDs and RF prevention and control (6 countries: BVI, GUY, JAM, TRT, GUA, HON)

5. Improving coordination and communication mechanisms among international agencies to advance NCDs and RF efforts at the country level (6 countries: COR, DOR, PAN, BRA, COL, CAN), and including NCDs and RF as a cross-cutting theme (GUA)

6. Assisting countries in developing and/or strengthening multisectorial action, legislative capacity and regulatory strategies for NCDs and RF (6 countries: SKN, SVG, SUR, TRT, ARG, ECU)

7. Assisting countries with resource mobilization efforts (5 countries: BAH, BAR, HAI, JAM, SUR)

8. Supporting countries to conduct research on NCDs and RF (4 countries: ANI, BEL, GUA, BRA), including costing studies (BAR).

9. Strengthening health systems response (3 countries) supporting the reorientation of primary health care (MEX), and increasing access to essential NCD medicines through the Strategic Fund (PAN, SUR)

10. Strengthening sustainable communication strategies and social marketing (2 countries: BVI, COL)

11. Supporting countries to analyze local data for decision making and policy development (1 country: BEL)

Question 4.2. Response rate: 22/28 (79%) How can very cost-effective and affordable interventions for NCDs and RFs be integrated into the national development planning processes, including UNDAF roll-outs?

1. Including cost-effective and affordable interventions for NCDs and RF in the United Nations Development Assistance Framework (UNDAF) (6 countries: HAI, JAM, TRT, COL, GUA, MEX)

2. Presenting the evidence base supporting cost-effective interventions, including impact assessments, economic studies showing the cost of inaction, and successful experiences from countries that have implemented such interventions (5 countries: COR, CUB, HON, PAN, BRA)

3. Strengthening advocacy efforts at the highest political level to promote health in all policies (4 countries: COR, CUB, SUR, ARG)

4. Establishing effective multisectorial actions for NCDs and RF (2 countries: BOL, ECU)

5. Integrating NCD prevention and control into primary health care, including community and social development interventions (2 countries: SKN, MEX)

6. Including NCDs into the post-2015 development agenda (2 countries: JAM, COL)

7. Implementing guidelines for NCDs and their RF and monitoring their use, as well as increasing access to generic medicines (1 countries: BAR)

8. Promoting an inter-agency approach to multisectorial action, resource mobilization and monitoring and evaluation of interventions (1 countries: DOR)

15

Question 4.3. Response rate: 25/28 (89%) Will integrating NCDs and their risk factors in the post-2015 development agenda raise the priority accorded to NCDs at country level and help the world to attain the 9 global targets for NCDs in 2025?

All the countries that responded to this question indicated that they agreed on the importance of including NCDs and their RF in the post-2015 development agenda. This would raise the priority accorded to NCDs and RFs, shifting financial resources, promoting a more integrated approach, facilitating the integration of NCDs and RF into the national development plans, and creating a mechanism for systematic monitoring and evaluation of the established targets

16

SECTION 5: UNGA NCD REVIEW 2014 AND BEYOND

Question 5.1. Response rate: 24/28 (86%)

What are the main elements for an outcome document (or call to action) to be implemented at country level before a third meeting of the UNGA on NCDs takes place?

1. Call for the adoption of targets and indicators, in line with the GMF, as well as a monitoring and evaluation mechanism to assess progress (9 countries: BAH, GUY, SVG, SUR, DOR, GUA, PAN, COL, MEX)

2. Emphasize the importance of multisectoral action to address NCDs and RFs, including mechanisms for private-public partnerships (9 countries: BEL, GUY, JAM, SUR, TRT, COR, HON, BRA)

3. Define priority RF policies and regulatory strategies for their implementation (8 countries: BAH, BAR, CUB, DOR, GUA, BRA, COL, ECU), including the proposal for International Frameworks, similar to the Tobacco FCTC, for other risk factors (COL, ECU)

4. Call for the allocation of adequate financial and human resources to address NCDs and their RFs (6 countries: ANI, GUY, JAM, TRT, PAN, BOL)

5. Emphasize the need for increased coverage of NCD and RF health care services, with a focus on primary health care, including improved access to essential medicines and technologies (5 countries: BAR, COR, GUA, BOL, BRA)

6. Establish the need to include NCDs and RFs as part of the national development agendas and raise their priority (4 countries: HAI, TRT, COR, GUA)

7. Establish the importance of developing and implementing NCD national action plans and policies (3 countries: ANI, SUR, HON)

8. Call for improved coordination and alignment of international cooperation agencies (2 countries: HAI, JAM)

9. Establish the terms of reference for WHO’s action on NCDs, including a consultative committee (1 country: ARG)

Question 5.2. Response rate: 21/28 (75%)

When should a third meeting take place?

* Annual with follow up meetings every 6 months: 1 country (HON)

* 2014: 2 countries (ARG, BOL)

* 2015: 5 countries (BAH, BEL, GUY, PAN, COL)

* 2016: 6 countries (ANI, BAR, JAM, CUB, DOR, GUA)

* 2017: 5 countries (ANI, SVG, TRT, MEX, BRA)

* 2018: 1 country (ECU)

* 2019: 1 country (BVI)

* 2021: 1 country (CAN)

17

Question 5.3. Response rate: 22/28 (79%) What is the role of Ministries of Health, Foreign Affairs, Development and Planning in supporting the preparations for the NCD Review in 2014?

1. Role of the Ministry of Health:

1. 1. Prepare a situation analysis and progress report (5 countries: ANI, HAI, SUR, COR, MEX, CAN) and brief the high level delegation (BVI, BEL)

1.2. Governance, coordination, monitoring and evaluation (3 countries: COL, GUA, ECU)

1.3. Lead advocacy efforts to improve NCD and RF prevention and control (COR)

2. Role of the Ministry of Foreign Affairs:

2.1. Facilitate the participation of the national authorities (3 countries: HAI, BEL, COR)

2.2. Review global and regional commitments (2 countries: GUA, COL)

2.3. International relations and diplomatic role (2 countries: ECU, MEX)

2.4. Facilitate arrangements derived from the decisions made at the meeting (MEX)

2.5. Participate of the review process (CAN)

2.6. Advocate at UN and other agencies to ensure NCDs are on the global and regional agenda (BVI)

2.7. Prepare the national delegation for the meeting (TRT)

3. Role of the Ministry of Development and Planning:

3.1. Provide support on the monitoring of national indicators for NCDs and RF (3 countries: TRT, GUA, ECU)

3.2. Convene and coordinate other relevant sectors for the prevention and control of NCDs and their RF (2 countries: COR, COL)

3.3. Planning of feasible public health interventions for the prevention and control of NCDs and RF (MEX)

4. General roles of the Ministries (individual Ministries not specified in the response):

4.1. Prepare a situation analysis and progress report to inform the country position for the UNGA NCD review meeting (4 countries: ANI, BAH, CUB, PAN)

4.2. Conduct advocacy efforts to ensure political commitment (HON) and ensure participation from the highest political level (ARG)

4.3. Organize a multidisciplinary team to represent the country, designating official delegates (PAN)

4.4. The role of the Ministries includes providing technical, scientific and political support, while the Ministry of External Affairs has a leading role (BRA)

4.5. The actions of these Ministries will be key to advancing the process, specially using the Country Missions and the UN and in Geneva (BAR)

4.6. Provide technical support and facilitate country participation (DOR)

18

ANNEX 2: UNGA Subregional Consultation Summary

Objectives

The three objectives of the PAHO Subregional virtual consultations on the UNGA NCD Review 2014 were

as follows:

To support Member States in their preparations for the United Nations General Assembly Non-communicable diseases Review 2014 (UNGA NCD Review 2014) meeting.

To obtain regional feedback on the elements and commitments that should be present in the outcome document of UNGA NCD Review 2014.

To gather regional information on current status, as well as on barriers that countries have faced since the adoption of the Political Declaration of the High-level Meeting of the UNGA on NCDs in 2011.

Methodology

The agenda for the consultations consisted of three activities. The first two sessions were drafted to be

in line with the main topics of the two roundtables that will be discussed during the UNGA NCD Review

2014 meeting in July. Each session was moderated by a senior member of the NMH Department. The

third session consisted of an open discussion moderated by PAHO, on the possible recommendations for

the outcome document.

In the first two sessions, PAHO included a series of questions in the agenda to promote discussion

(attached below) and asked each participating country to provide its views about each topic. A group of

rapporteurs at the Regional Office summarized the main findings, and organized them into the draft list

of possible elements for an outcome document provided by WHO. The third session, moderated by the

NMH Director, presented the summary to each subregion and reached a general consensus on the

accuracy of the reported statements. The overall conclusion of the meeting was a call to action for

Member States to liaise with their delegations who were going to participate in the July meeting, and to

fully prepare them using the tools prepared for the PAHO consultations.

Summary Results

PAHO will share the recommendations included in this document with its country offices to facilitate

discussion and preparation of delegations that will participate in the UNGA NCD Review 2014. It should

be noted that the high level of engagement by the PAHO country offices led to the success of these

consultations.

19

Table 4. List of countries that participated in the Consultations

English speaking Caribbean (9 countries) 1 Antigua and Barbuda

2 Commonwealth of The Bahamas6

3 Barbados

4 Guyana

5 Jamaica

6 St Kitts and Nevis

7 St Vincent and the Grenadines

8 Suriname

9 Trinidad and Tobago

Central America, Hispanic Caribbean and Haiti (6 countries) 10 Belize7

11 Costa Rica

12 Cuba

13 Guatemala

14 Honduras

15 Panama

South America (7 countries) 16 Argentina

17 Brazil

18 Chile

19 Colombia

20 Ecuador

21 Paraguay

22 Peru

North America (3 countries) 23 Canada

24 Mexico

25 United States of America

6 Participated as an observer on the 30

th May consultation. A written report will be provided.

7 Participated as an observer on the 30

th May consultation.

20

Table 5. Template of the Subregional Consultations (Agenda for the Caribbean consultation)

Time Activity

9:00 a.m. – 9:05 a.m. (5 minutes)

Opening Remarks

Dr. Anselm Hennis

9:05 a.m. - 9:15 a.m. (10 minutes)

Update on the UNGA Process

Dr. Joy St John

9:15 a.m. – 10:00 a.m. (45 minutes)

Strengthening national and regional capacities, including health systems, effective multi-sectoral and whole-of-government responses for the prevention and control, including monitoring, of NCDs. Member States will reflect on the following aspects:

What are the main capacities that need to be strengthened at country level, for the prevention, control and monitoring of NCDs and their risk factors?

How is your country integrating the management of NCDs and their risk factors at the health system level, including health promotion and regulatory capacity? How can it be improved?

Share your best experiences and lessons learnt on the most effective multisectoral and/or whole of government approaches for the prevention, control and monitoring on NCDs and their risk factors at national and/or local level.

Does your country have any experiences that did not work in addressing NCDs and their risk factors at national or local level? Please refer to the context in which they did not work.

How are the public health programs for the prevention, control and monitoring of NCDs addressing equity in your country?

What should be the role of the regional level to strengthen national and health system capacities, as well as multisectoral and whole-of-government approaches to address NCDs and their risk factors?

Moderator: Dr. Branka Legetic Member States will be given equal time to share their comments. Rapporteurs: ND and RF

10:00 a.m. – 10:45 a.m. (45 minutes)

Fostering and strengthening national, regional and international partnerships and cooperation in support of efforts to address NCDs. Member States will reflect on the following aspects: Local Stakeholders

What is the Member States’ experience in terms of partnerships at national and local level to address NCDs and their risk factors?

Moderator: Dr. Carlos Santos Burgoa Member States will be given equal time to share their comments. Rapporteurs: ND and RF

21

Time Activity

Mention some of the roadblocks that have prevented better coordination with stakeholders at the national and local levels, and lessons that can be drawn from that experience.


Has your country integrated NCDs in your United Nations Development Assistance Frameworks (UNDAF)?

What is the experience of the coordination that exists between UN agencies and your government to address NCDs and their risk factors?

What has been the impact of the level and quality of coordination among UN Agencies in the overall intersectoral coordination to address NCDs and their risk factors in your country?


How can PAHO/WHO strengthen and foster partnerships and cooperation to address NCDs and their risk factors?

How can PAHO/WHO foster and support collaboration among countries to address NCDs and their risk factors?

Can your country share experiences on country to country collaboration in addressing NCDs and their risk factors?

Are there any elements or experiences that you consider your country can share with other countries in addressing NCDs?

How are the public health programs for NCDs and their risk factors being influenced by the international context?

10:45 a.m – 12:25 p.m. (1 hour, 40 minutes)

Subregional recommendations for the outcome document

Draft elements that come from the previous discussions will be summarized for consideration of Member States.

Moderators: Dr. Anselm Hennis and Dr. Joy St John

12:25 a.m.- 12:30 p.m. (5 minutes)

Conclusion

Dr. Anselm Hennis

22

Table 6. Possible elements for an outcome document: UN General Assembly NCD Review 2014: Summary from consultations

WHO Topic General

Summary Online Survey

responses UNGA Caribbean

Consultation

UNGA Central America

Consultation

UNGA South America

Consultation

UNGA North America

Consultation

Prepared by

PAHO based on consultations

Deadline of Survey 16 May

2014

Caribbean 28 May

Central America 29 May

South America 30 May

North America 30 May

1. Set national targets

Member States to commit to consider, by 2014, the development of national targets for 2025 based on national situations, taking into account the 9 voluntary global targets adopted by the 66th World Health Assembly (May 2013)

Review or adopt national targets and indicators, in line with the WHO and PAHO Global and Regional Monitoring Frameworks on NCDs. This would allow achievement of the respective global and regional targets, ease reporting demands and facilitate resource mobilization

1. Call for the adoption of targets and indicators, in line with the Global Monitoring Framework (GMF), as well as a monitoring and evaluation mechanism to assess progress (6 countries: GUY, SVG, GUT, PAN, COL, MEX)

Verify and support countries to include national targets in national plans that contribute to the achievement of regional and global targets

Establish national surveillance systems to better respond to global and regional indicators and goals

No comments from the countries

Consider the adoption/update of national targets

Ensure adequate alignment of national and regional targets with global targets to facilitate resource mobilization

Present the need to adjust the indicators based on the goals established by WHO

23

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation

2. Develop a national plan

Member States to commit to develop, by 2014, a multisectoral national policy and plan for the prevention and control of NCDs to attain national targets, and strengthen capacity in implementing the national strategy and plan in three major components: (i) surveillance; (ii) reduction of exposure to risk factors and (iii) improved health care, with allocation of adequate budget and resources

Develop and implement plans and policies on NCDs at the national level with committed human and financial resources that consider social determinants of health and health inequities.

7. Establish the importance of developing and implementing NCD national action plans and policies (2 countries: ANI, HON)

Mobilize political commitment, for example, by establishing an NCD coordinator in each country and creating a dedicated national budget for NCDs

Establish the importance of developing and implementing plans and policies at the national level on NCDs

Incorporate NCDs in broader national policies (national health plans), including infrastructure and programs, as well as coordination mechanisms at the subregional level

Develop and implement prevention strategies and action plans that include social determinants of health and consider health inequities

Support costing of national plans [commitment for PAHO/WHO]

Strengthen leadership and level of priority of NCDs and RF at national agendas and UN Agencies

Establish/strengthen the Committee on inequality and NCDs, including regional coordinators

support policies that consider the social determinants of health through joint action among various sectors, including committees based on the Rio Declaration and focused on school health

Development and implementation of policies, plans and strategies to address NCDs as well as for specific NCDs

country-specific indicators for social determinants of

24

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation health

include family health content in school curriculum

3. Establish a national multisectoral mechanism

Member States to commit to establish, by 2014, a high-level national multisectoral commission, agency or task force for engagement, policy coherence and accountability of sectors beyond health that have a bearing on NCDs, and to monitor the implementation of the national policy and plan

Establish multisectoral technical committees on NCDs and their risk factors with clear roles that facilitate work among different sectors, including the public and private sectors, civil society and NGOs

2. Emphasize the importance of multisectoral action to address NCDs and RFs, including mechanisms for private-public partnerships (6 countries: GUY, TRT, COR, HON, BRA, CAN)

strengthen NCD multisectoral action to engage stakeholders in public/private sectors/NGOs/civil society (opportunity to find various sources of funding) and ensure health in all policies, such as through multisectoral NCD commissions

Role of committees or technical groups to address NCDs and their RFs, facilitating multidisciplinary work

Establish intersectoral work that is essential to tackle NCDs, including work, for example, on physical activity, and bike lanes (Sunday Streets)

Mainstream all-government approaches to national health plans

Apply a health promotion approach to promote or strengthen multisectoral action against NCDs and their RFs through collaboration with key stakeholders at the local, municipal and community level. Stakeholders include different

agreement with 2014 timeline

Strengthen multisectoral action through technical commissions, as well as partnerships with key stakeholders at the local, municipal and community level

Establish/improve partnerships with the private sector, universities and schools and better coordination with Ministries of Health

Apply a health promotion approach and engage different players such as the private sector, education, finance, sports, and agricultural sectors to build healthy environments and promote health; create declarations to ensure they take action

25

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation players such as the private sector, academia, finance, sports, and the agricultural sectors to build healthy environments and promote health. Rules of engagement and accountability must be very well defined.

Strengthen countries' capacity to negotiate with other sectors; strengthen Ministries of Health and gain support of NGOs for NCDs

intersectoral committee on health education to include NDCs in the curricula at elementary and secondary school levels

Improve impact of intersectoral work through various levels of cooperation: individual, collective, population-wide, and municipal, including data collection

Consider incorporating NCDs and their RFs in broader national policies such as National Health Plans, and Coordination Mechanisms at the Subregional Level (CARICOM, MERCOSUR, etc).

review and implement the Port of Spain Declaration to align with UNGA

Strengthen local alliances, including municipalities, NGOS and other stakeholders to address NCDs and RFs, even though lack of human and financial resources has been identified as an obstacle

Establish/strengthen partnerships with other sectors beyond health (education, agriculture, transport public works, etc..), municipalities, scientific societies and universities, for instance, to reduce salt. Identification of weaknesses in partnerships with education and commercial/private

Foster public-private collaboration to address obesity and other health problems through increased engagement with sectors beyond health such as communities, schools, local leaders and social media initiatives

26

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation sectors

strengthen ability of countries to negotiate with other sectors to strengthen Ministries of Health and gain support of NGOs for NCDs

Address the difficulty of implementing intersectoral work with partners and counterparts with broader mandates

Innovation key for advancing multi-stakeholder collaboration as well as the need for research and integrating science into the community action

Integration of activities in MERCOSUR and UNASUR agendas

4. Reduce exposure to risk factors

Member States to implement, by 2015, as part of a national multisectoral policy and plan, a set of very cost-effective and affordable interventions for all Member States ("best buys") to reduce the exposure to risk factors for NCDs

Strengthen regulatory frameworks and their implementation to tackle NCD Risk Factors including, among others, marketing to children, legislation against the use of tobacco, harmful use

4. Define priority RF policies and regulatory strategies for their implementation (5 countries: CUB, GUT, BRA, COL, ECU), including the proposal for International Frameworks,

strengthen integration of risk factors (tobacco, alcohol, and unhealthy diet) within/between health systems

Strengthen the regulatory framework and its implementation, for example on tobacco

Improve bicycle use and healthy eating and support initiatives with legislation to promote them, including cutting fats and salt in food, dry laws, smoke free environments, etc..

Promote strengthening / inclusion of major risk factors into national action plans by regulating products such as tobacco

27

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation of alcohol, and promotion of processed food with high sugar, salt and fat content.

similar to the Tobacco FCTC, for other risk factors (COL, ECU)

strengthen integration of approaches to risk factors (tobacco, alcohol, and unhealthy nutrition) within/between health systems

develop guidelines on tobacco, alcohol, and unhealthy diet

Support to counter the actions of the tobacco industries

Improve communication on risk factors as they relate to equity

Promote the use of social media to address tobacco

Improve communication on risk factors, including the use of social media, especially as they relate to equity.

reduce illicit trade

Establish fiscal policies in general; improve access to foods that constitute a basic healthy diet; regulate publicity on processed food with high content of sugar, salt, fat, especially those directed to children

Include guidelines about best practices

Strengthen multisectoral frameworks to combat obesity, such as through physical activity strategies

28

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation

Disseminate guidelines on best practices to address risk factors.

adopt and enforce a FCTC-like framework for processed foods (trans fats, salt, and sugar) supported by multisectoral commissions *with consideration that small island states cannot individually regulate the contents of imported foods

Guidance for actions to improve the social determinants as they relate to NCDs and RFs

agreement with 2015 timeline [not realistic for the FCTC framework model –this proposal may be better linked to a 2020 timeline]

Focus on activities of healthy eating, physical inactivity, and sodium/salt consumption

Guidance for actions to control marketing to children of risk factors

5. Enable health systems to respond

29

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation

Member States to implement, by 2015, as part of a national multisectoral policy and plan, a set of very cost-effective and affordable interventions for all Member States ("best buys") to enable health systems to respond to the NCD challenge of epidemic proportions


5. Emphasize the need for increased coverage of NCD and RFs, health care services, with a focus on primary health care, including improved access to essential medicines and technologies (4 countries: COR, GUT, BOL, BRA)

strengthen human resources and health system capacity for training and care (including palliative), including guideline development (capture lessons learned regarding implementation)


Promote/increase universal health coverage and financial insurance against catastrophic spending including improving access to essential medicines and services and treatment and prevention service

Strengthen the provision of universal health care to promote increased access to prevention and treatment services for NCDs and RFs

Strengthen the provision of universal health care to promote increased access to prevention and treatment services for NCDs and RF

reorient primary health care services to integrate care for NCDs and improve access to services and screening

Strengthen access to essential NCD medicines, maximizing the use of the Strategic Fund

Restructure health services and strengthen the inclusion of NCDs in PHC

Strengthen PHC for NCDs by increasing human resource capacity to deliver more effective and high-quality clinical and preventive services


strengthen universal health coverage

Support for a 2015 deadline

Develop practical guidelines for scientific community and educators


2015 timeline- proposed change to 2016

Capacity building for human resources in NCD care

6. Measure results

30

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation

Member States to implement, by 2015, the WHO Framework for NCD Surveillance covering: (i) monitoring of risk factors and determinants; (ii) outcomes (mortality and morbidity) and (iii) health system response, as well as to integrate NCDs into the national health information systems, and develop national indicators taking into account the global ones.

Strengthen capacity to measure national performance and disease burden to improve monitoring, evaluation, and surveillance, such as through PAHO/WHO surveys (STEPS, GYTS). Include measures that address social determinants and can be translated into action, as well as evaluation of policies, among others.

1. Call for the adoption of targets and indicators, in line with the GMF, as well as a monitoring and evaluation mechanism to assess progress (6 countries: GUY, SVG, GUT, PAN, COL, MEX)

strengthening capacity to measure national performance and disease burden to improve monitoring, evaluation, and surveillance, such as through PAHO/WHO surveys (STEPS, GYTS)

Consistent surveillance of risk factors covering various aspects such as social determinants, policies, and others

Improve integration between screening and health care, including capacity building to improve electronic medical registries, as well as to develop surveys and studies to measure inequality

Establish measures for social determinants of health that are translated into action

Engage academic and research institutions to strengthen monitoring capacity, and to generate evidence.

role of academic institutions to strengthen capacity

Establish a periodic evaluation framework for situation analysis with support from different agencies

Establish different strategies for data collection to measure changes in prevalence of RFs, including information system improvement

Foster research projects in health promotion

timeline of 2015 agreed

Surveillance system exists but baselines need to be improved, as well as more coverage of risk factors, especially among adults and children

31

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation

Coordination of the production of information on NCDs/RF from different sources

timeline of 2015 agreed


Highlight the implementation of the UN Inter Agency Task Force for NCDs at the country level, to promote and improve integration of UN agencies in terms of NCDs, and as a means to foster economic development

Implementation of the UN task force to promote and improve integration of UN agencies in terms of NCDs

Working experience of countries including topics such as social inclusion, equity, the environment, violence, and malnutrition in UNDAFs. This has served as a starting point to include NCDs to these working frameworks with the UN system

Lack of collaboration with UN on the global risk associated with NCDs

Spur collaboration through IATF task force in areas such as nutrition

Include work on NCDs and their RFs in UNDAFs in those countries that have such framework, with a focus on social determinants and life course.

UN working group on NCDs

The UN system can provide support in analyzing information available to each country for advocacy

Develop mechanisms that complement actions of political cooperation (MERCOSUR, UNASUR, OIM, ORAS) that support regional agreements

Clarify and promote the role of UN agencies to address NCDs at the country level and foster economic development

32

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation

improve communication and participation of country health sectors in UNDAF processes

In our region most countries have a structure for UNDAF

Integration in UNDAF on NCD results with a focus on social determinants and life course

integrate NCDs into UNDAF

Coordination with UNICEF, PAHO, and National authorities on regulation for children and adolescents in coordination with the ministry of development

Importance of intergovernmental partnerships


33

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation

WHO/PAHO to strengthen country capacity to meet the commitments of the High Level political declaration on NCDS including but not limited to surveillance; legislation on NCD risk factors; resource mobilization; strengthening capacities of human resources, and research to generate evidence.

PAHO to take a coordination role in implementing an international trade instrument

PAHO/WHO is taking a leadership role in Cuba, to facilitate the coordination between UN agencies. There are very important initiatives in that sense, such as a technical roundtable on joint interagency work that will be established in Cuba

Experience sharing between countries in networks such as CARMEN or through integrated systems (MERCOSUR)

Promote the development and use of systematic reviews, tools, and guidelines produced by PAHO

PAHO/WHO to strengthen advocacy to position NCD and RF topics and to mobilize the necessary political support. This includes promoting the inclusion of NCDs in the agendas of other relevant Political Regional Subregional Mechanisms such as MERCOSUR, CARICOM, UNASUR, etc, and on technical

PAHO Support for surveillance

Technical support from PAHO for the development of national policies and plans on NCDs and RFs

UNICEF and PAHO are addressing NCDs throughout the life course

Utilize the Pan American Forum as a mechanism to promote collaboration among different stakeholders

34

WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation mechanisms such as CARPHA.

WHO/PAHO create a virtual hub of resources of national NCD plans and policies to provide real-time updates

CARPHA to support countries in nutrition and risk factors

Support for the identification of financial resources that can support the work on NCDs and RFs

Need for PAHO to create a mechanism to help countries share lessons learned, such as on tobacco, nutrition, physical activity, cancer registries, etc..

PAHO can provide more support by improving access to medicines and technologies through the strategic fund, promoting involvement of other UN agencies at the country level , and developing workshops with all UN agencies to address NCDs

WHO/PAHO to promote the sharing of experiences between countries, and collaboration among different stakeholders through networks such as CARMEN and the Pan American Forum for NCDs

PAHO has a leading role in strengthening country capacity to meet the UN political declaration commitments

Need to harmonize cooperation to avoid duplication. Frequently, several agencies, governments and even political integration systems, work (independently) on the same topics

PAHO support to strengthen services and chronic care models and human resources

Improve collaboration to share best practices

WHO/PAHO to increase technical/financial presence in countries with higher burdens of disease/risk factors

There is a need to increase commitment from PAHO both technically and financially through BWP

Technical support from PAHO to countries in relation to advocacy that allows to position NCD and RF topics and mobilize the necessary political

PAHO can support the development of legal frameworks such as the tobacco convention

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WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation support

PAHO/WHO takes the lead in mobilizing UN agencies to address NCDs and their Risk Factors

Virtual hub of resources of national NCD plans and policies to provide real-time updates through PAHO technical cooperation

Highlight and raise the importance of country - country cooperation that should cover other topics

Use existing mechanisms to exchange experiences between countries, such as the CARMEN network or political integration systems (UNASUR, MERCOSUR)

PAHO to provide technical support for regional trade matters

PAHO to ensure that Member States engage in ECOSOC through the PAHO NCD focal point

Increase the PAHO presence in countries with higher burdens of disease/risk factors; identify which countries need special support

PAHO/WHO takes the lead in mobilizing UN agencies to collaborate

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WHO Topic General



Consultation


Consultation

UNGA South America

Consultation

UNGA North America

Consultation

Suggestion for an annual meeting of PAHO NCD focal points and program managers, CMOs, and technical advisors

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ANNEX 3: UNGA Local Consultation Summary

The Political Declaration of the UN High-level Meeting of the General Assembly on the Prevention and

Control of Non-communicable Diseases (UN HLM), recognized, in paragraphs 33 to 42, that, in order to

respond to this challenge, we need to exercise a whole-of-government and a whole-of-society approach.

Relevant stakeholders include individuals, families and communities, intergovernmental organizations

and religious institutions, civil society, academia, the media, voluntary associations and where and as

appropriate, the private sector and industry.

For UNGA NCD Review 2014, the United Nations General Assembly opened the consultation process to

representatives of nongovernmental organizations in consultative status with the United Nations

Economic and Social Council, civil society organizations, the private sector and academia, an informal

interactive hearing with nongovernmental organizations, civil society organizations, the private sector

and academia to provide an input to the comprehensive review and assessment (participant list

attached in Table 8.). Is in this context that PAHO held a consultation with the participation of civil

society organizations and academia mostly from around the region.

Objectives

The PAHO local virtual consultations on UNGA NCD Review 2014 had the three following objectives:

To assess, from a stakeholder perspective, advances, as well as barriers and gaps that need to be overcome for the implementation of the Political Declaration of the High-level Meeting of the UNGA on NCDs in 2011.

To obtain stakeholder feedback on the elements and commitments that might be considered for the outcome document of UNGA NCD Review 2014.

To promote and strengthen stakeholder collaboration with PAHO/WHO in addressing NCDs and their risk factors in the Region.

Methodology

The agenda for the consultations consisted of three activities (attached in Table 7). The first session

included a panel of speakers who talked about the following elements:

Advances of the UNGA NCD Review process.

Where do we stand? Main achievements and lessons learnt since the adoption of the High Level Political Declaration of the United Nations General Assembly on NCDs.

From bottlenecks to solutions: effective multi-sectoral and whole-of-government responses for the prevention and control, including monitoring, of NCDs and their risk factors.

Accelerating progress: Fostering and strengthening national, regional and international partnerships and cooperation in support of efforts to address NCDs.

These presentations set the stage for the second part of the consultation. The next activity consisted in

two working groups where participants discussed on the main topics of the two roundtables that will be

discussed during the UNGA NCD Review 2014 meeting in July. The third session consisted of an open

discussion moderated by PAHO, on the possible recommendations for the outcome document, from the

civil society and academic perspective.

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Summary Results

The specific summary recommendations resulting from the roundtables are included below.

From bottlenecks to solutions: Strengthening national and regional capacities, including health

systems, effective multisectoral and whole-of-government responses for the prevention and control,

including monitoring, of NCDs. What needs to be done?

Government should take a leading role in the strengthening national and regional capacities, and

engage civil society to fully collaborate in the process.

Strengthen roles of advocacy to improve political will and increase training, as well as the message

they are delivering, guaranteeing that equity is addressed. Utilize civil society as messengers,

highlighting outstanding examples of effective advocates, such as the Healthy Caribbean Coalition.

Improve surveillance systems to include diseases as well as social determinants and the economic

impact of the implementation of policies on plans. Consider multi NCD registries, and the collection

of comprehensive data –using unique identifiers.

Improve the amount of information being collected, considering what information is needed to

guide policy. Assess the cost effectiveness of traditional surveillance vs surveys or personal

reporting.

Address knowledge gaps, and interventions that should be tailored for different populations.

Improve access to affordable treatment.

Raise the voice of those that are affected (patients)

Fostering and strengthening national, regional and international collaboration and cooperation in

support of efforts to address NCDs.

Fostering National Collaboration

Strengthen public-private partnerships, with an eye on conflict of interest. But, at the same time,

establish a clear delineation between civil society and private sector engagement.

Improve engagement between civil society and government, so as to build trust between these

entities and an exchange of information to promote an understanding of government processes and

a sharing of the focus. Avoid silos in the approach to disease that prevent cooperation (including

within government agencies). Instead, look for integrated approaches and highlight successful

examples of civil society engagement, for instance the Susan G. Komen organization.

Empower civil society when and where relevant.

Consider the establishment of a global fund for NCDs to channel resources towards NGOs that work

on NCDs. Well-resourced organizations are far more likely to deliver.

Facilitate dialogue with other sectors for example, those that address poverty, women, climate

change. Build broad coalitions for this purpose.

Engage journalists as communicators for public health. They can play a critical role in communicating

with civil society.

Consider the community level when developing and implementing policies and plans.

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Pair rural communities with academic institutions.

PAHO’s role in fostering collaboration among partners

Ensure that civil society and WHO are engaged in UNDAF frameworks.

Convene non-traditional players and encourage Member states to do so.

Help build a better definition of the role between civil society and Member States.

Consider advocating for a Framework Convention on Diet (similar to the Framework Convention on

Tobacco Control). Establish discussion forums in that respect.

Open a space for the inclusion of the civil society’s input in the Plan of Action on Childhood Obesity.

In coordination with the Ministries of Health, take a leading role in mobilizing work at national level.

Given the numerous processes that are currently undergoing for NCDs –e.g. Inter-Agency Task

Force, Global Coordinating Mechanism, and others, assist Member States and stakeholders in

understanding which mechanism to use for collaboration.

Recommendations for outcome document

Establish clear roles for the civil society and the government.

Establish an accountability framework that documents the work of civil society from the perspective

of its different areas of expertise.

Develop strong models on working with the private sector that include firewalls to prevent and

manage risk.

Establish discussion forums to share lessons learnt among participants, and adapt best experiences

to the national and local contexts.

Take into account already existing frameworks from the civil society –such as the Global Action Plan

from the NCD Alliance- as a mechanism to translate policy into actions.

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Table 7. Agenda of Local Consultation on UNGA NCD Review 2014

Date Activity

9:00 a.m. – 9:05 a.m.

Opening Remarks Dr Jon Kim Andrus, Deputy Director PAHO/WHO

9:05 a.m. - 9:20 a.m. Update on the UNGA Process Dr. Joy St. John, WHO Senior Advisor to the UN

9:20 a.m. – 10:10 a.m.

Presentations: Dr. Francisco Becerra, Assistant Director PAHO/WHO, Moderator

Where do we stand? Main achievements and lessons learnt since the adoption of the High Level Political Declaration of the United Nations General Assembly on NCDs. Dr. Rodney Ghali, PHAC (10 min) Dr. Ted Trimble, NCI (10 min) Dr. Jeffrey Levy, Trust for America´s Health (10 min)

From bottlenecks to solutions: effective multi-sectoral and whole-of-government responses for the prevention and control, including monitoring, of NCDs and their risk factors. Ms. Ariella Rojhani NCD Alliance (10 minutes)

Accelerating progress: Fostering and strengthening national, regional and international partnerships and cooperation in support of efforts to address NCDs. Dr. Douglas Webb, UNDP (10 minutes)

10:10 a.m. - 10:30 a.m. Discussion Dr. Francisco Becerra, Moderator

10:30 a.m. – 10:40 a.m. Break

10:40 a.m. – 12:00 p.m.

Working sessions in groups: Groups will reflect on the following topics, choose a rapporteur and prepare a summary of their results.

From bottlenecks to solutions: Strengthening national and regional capacities, including health systems, effective multi-sectoral and whole-of-government responses for the prevention and control, including monitoring, of NCDs. o From the perspective of your organization, which are the main elements

that need to be strengthened at country level, for the prevention, control and monitoring of NCDs and their risk factors? Where are the gaps, and how they can be overcome?

o From your successful experiences, what lessons can be learnt on the most effective multisectoral and/or whole of government approaches for the prevention, control and monitoring on NCDs and their risk

41

Date Activity

factors at national and/or local level? o From the perspective of your organization, what have been the main

roadblocks to further advance the agenda on NCDs at country and local levels?

o For those interventions that are promoted by your organization, how do you address equity issues in the prevention, control and monitoring of NCDs in your country?

Accelerating progress: Fostering and strengthening national, regional and international partnerships and cooperation in support of efforts to address NCDs. o How has civil society influenced the development of policies for the

prevention, control and monitoring of NCDs in your country? o What is your organization’s experience in terms of partnerships at

national and local level to address NCDs and their risk factors? o Mention, from your organization’s perspective some of the roadblocks

that have prevented better coordination with stakeholders at the national and local levels, and lessons that can be drawn from that experience.

o How can PAHO/WHO improve or facilitate the involvement of Non State Actors for the technical cooperation to address NCDs and their risk factors?

12:00 p.m. – 12:30 p.m.

Plenary to present the results: groups will be given equal amount of time to present.

Dr. Anselm Hennis, Moderator

12:30 p.m. – 12:55 p.m.

UNGA NCD Review 2014 and beyond: the stakeholder perspective. Dr. Joy St. John, Moderator

o Open discussion to summarize recommendations for the outcome

document.

12:55 p.m. – 13:00 p.m. Closing Remarks. Dr. Anselm Hennis

13:00 p.m. – 14:00 p.m. Light lunch

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Table 8. List of participants in Local Consultation UNGA NCD

# Name Title Organization Email

1. Aaron Emmel Manager of Global Health Advocacy Initiatives

American Academy of Pediatrics [email protected]

2. Anders Dejgaard Managing Director World Diabetes Foundation ade@worlddiabetesfoundation

3. Anna Cabanes, Ph. D., MPH Director, International Programs Susan G. Komen [email protected]

4. Aracelli Delgado (online) CEO Inter American Society of Cardiology

[email protected]

5. Ariella Rojhani Senior Advocacy Manager NCD Alliance [email protected]; [email protected]

6. Bent Lautrup-Nielsen Senior Programme Coordinator, MA

World Diabetes Foundation [email protected]

7. Bob Chapman Director US Government and Multilateral Global Health Advocacy

American Cancer Society Cancer Action Network, Inc.

[email protected]

8. Cassandra Greisen Center Program Coordinator Johns Hopkins Bloomberg School of Public Health

[email protected]

9. Claudia R Baquet M.D., M.P.H. Associate Dean for Policy and Planning; Director, Center for Health Disparities

University of Maryland [email protected]

10. Daniel J. Piñeiro (online) Immediate Past President Inter American Society of Cardiology

[email protected]

11. Diana Pinto Especialista líder en salud, de la División de Protección Social y Salud del BID

IADB [email protected]

12. Diana Vaca McGhie Global Advocacy Manager American Heart Association [email protected]

13. Douglas Webb

Cluster Leader Mainstreaming, Gender and MDGs, HIV, Health and Development Group

UNDP [email protected]

14. Edgar Gil Rico Senior Director for Innovation and Program Development

National Alliance for Hispanic Health

[email protected]

15. Henry Falk, MD, MPH

Carter Consulting, Inc. Consultant to Office of Noncommunicable Disease, Injury and Environmental Health (ONDIEH)/CDC.

CDC [email protected] ; [email protected]

16. Jack Rayburn Senior Government Relations Manager

Trust for America's Health [email protected]

17. Jeff Levi Executive Director Trust for America’s Health [email protected]

18. Jeff Meer Special Advisor for Global Health Public Health Institute [email protected]

19. Joelle Walker Senior Manager, Public and International Affairs

Canadian Cancer Society, National Office

[email protected]

20. Kelley Curry Associate, International Affairs American College of Cardiology [email protected]

21. Laurent Huber Framework Convention Alliance for Tobacco Control

[email protected]

22. Lois K. Cohen, Ph.D. Consultant & Paul G. Rogers Ambassador for Global Health Research

National Institute of Dental and Craniofacial Research National Institutes of Health

[email protected]

23. Mary Collins (online) Director, BC Healthy Living Alliance Secretariat

[email protected]

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# Name Title Organization Email

24. Michael J. Klag, MD, MPH Johns Hopkins Bloomberg School of Public Health

Johns Hopkins University [email protected]

25. Michael Splaine Policy Adviser Alzheimer’s Disease International

[email protected]

26. Neal Kovach Director, International Affairs American College of Cardiology [email protected]

27. Nicole Burda Deputy Director, Government Relations

American Public Health Association

28. Rachel Rodin

Scientific Director, WHO Collaborating Centre on Noncommunicable Disease Policy Senior Medical Advisor, Centre for Chronic Disease Prevention

Public Health Agency of Canada Government of Canada

[email protected]

29. Rebecca L Ramirez Executive Director National Liquor Law Enforcement Association

[email protected]

30. Regina Davis Moss Associate Executive Director American Public Health Association

[email protected]

31. Rodney Ghali Director General, Centre for Chronic Disease Prevention

Public Health Agency of Canada [email protected]

32. Shaun Slade Vice President for Advocacy IUHPE/NARO [email protected]

33. Ted Trimble Director, NCI Center for Global Health

NIH/NCI [email protected]

34. Vanessa Eaton Manager of International Education International Affairs

American Society of Clinical Oncology

[email protected]

35. Vanessa Sarchet American Society for Clinical Oncology

[email protected]

36. Victoria Fan Center for Global Development [email protected]

37. Vina Hulamm Global Health Manager American Public Health Association

[email protected]













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