Dr. Yasmin Williams‐RobinsonMinistry of Health
SignificanceSignificanceGlobal momentum to scale‐up response to chronic disease burdenNeed for accurate, timely & comparable data
Develop or expand programmesStrengthen health care systemStrengthen ‘whole government’ approach to partnerships and decision‐making
SignificanceSignificanceNeed for analysis and construction of indicators to follow trends over time; build on existing PAHO/WHO initiatives e.g. STEPSFinal indicators to be those that can lead to prevention activitiesMinimum core set of data + expanded and optional indicators
Current SituationCurrent SituationRegional strategy for addressing NCDs exists; includes surveillanceFew epidemiologists in CaribbeanKnowledge on reporting of data exists but little training on effective dissemination of the data for actionPAHO program for improvement of vital and health statistics is ongoing
The ProcessThe ProcessCollaborative effort of PAHO/WHO/CARECPAHO Inter‐programmatic CNCD surveillance working group convened in March 2007Work based on principles of WHO chronic disease and risk factor surveillance principles & PAHO Core Health Data initiative
The ProcessThe ProcessList of NCD indicators from CAREC (2004)Review of other materials
CDC, Canada, Brasil and MexicoSuggestions submitted by epidemiologists from the LAC regionAim to harmonize Caribbean & MERCOSUR
The ProcessThe ProcessData set to be congruent with basic data set of PAHO Data selected based on:
international resolutionspublic health importanceavailability of national data
First attempt at uniform definition, collection and reporting of NCD data on annual basis
Data SetData SetCore, expanded and optional indicatorsCombines multiple data sources into one functional reportFoundation of NCD surveillanceAttempt at reducing fragmentation of traditional in‐country surveillanceAllow for further analysis of data collection practices
Data SetData SetIndicators divided into:
I MortalityII Prevalence & IncidenceIII Risk FactorsIV Health System Performance IndicatorsV Socioeconomic and Context Indicators
Data SetData SetDiseases covered:
CardiovascularCancerDiabetesAsthma & COPDOverweight & Obesity
Additional topic areas:Violence & InjuryTobaccoAlcoholFruit & Vegetable consumptionPhysical inactivityPreventive servicesPovertyInsuranceImports & Exports
The PilotThe PilotInitial meeting with CAREC/PAHO and six (6) countries in August 2008
BahamasBarbadosBelizeBermudaCayman IslandsDominica
ObjectivesObjectivesStrengthen knowledge of indicators for NCDsStrengthen ability to reportReview draft data setAgreement on reporting formatAgreement on timeline for reportingFeedback to countries for action
The PlanThe Plan
Draft minimum data set & instruction manualPilot in six countries (October to December 2008)Revision of data set based on feedback (February 2009)
Selected ConditionsSelected Conditions
Ischaemic Heart DiseaseCerebrovascular DiseaseMalignant Neoplasms (all)
Cervix, Lung, Female Breast, Digestive SystemDiabetesChronic Lower Respiratory DiseasesExternal causes (all)
Land TransportHomicide
Mortality DataMortality DataAlready reported to CARECData set reflects deaths <70yrsDeath rates will be calculated using age‐standardized rates by age, sex and total for under 70s.PYLL to be calculated for all mortality data (for the country‐specific average life expectancy).
Process for Mortality DataProcess for Mortality Data
Source is registered deaths, DOSProvided to HIRU on annual basisICD‐10 usedData already available in HIRUMost recent data 2006No challenges encountered
Prevalence / Incidence DataPrevalence / Incidence Data
•Diabetes, Hypertension, Overweight and Obesity
•Data to come from surveys/studies/registries
•Reported as per ten‐year age groups between 25 and 64
Risk Factor DataRisk Factor DataDaily and current smokersExposure to second‐hand smokeBinge drinking / Alcohol consumptionFruit & vegetable intakeLevel of activityBlood pressureBlood glucose levelsBMI and WC
Risk Factor DataRisk Factor DataAdult and youth categoriesData exists but not by same definitionFuture studies to address gapsStudies lacking in 13‐15 age group
GSHS
Highlights the need for information systems in public healthPopulation screening occurring but challenge in data analysis
System Performance DataSystem Performance Data
Health insurance coveragePap smear & Mammogram uptakeBlood chemistry checksEye & foot exam among diabeticsHospital dischargesALOSAmputations related to DiabetesRenal dialysis in diabeticsAccessibility of PHC
Process for Morbidity DataProcess for Morbidity Data
Private SectorInvolved at stakeholders meetingIntegrated Health Information System
Health Information & Resource Unit, MOHData from Public Hospitals AuthorityClose relationship with PHALatest data 2004, already available
LimitationsLimitations
Readmission data not availablePrivate sector still using ICD‐9
Socioecomonic DataSocioecomonic Data
Population dataGross national incomePopulation below poverty lineFruit & vegetable productionTobacco / Alcohol import & export
The Way ForwardThe Way ForwardRefine in‐country data collectionFuture surveys/studies to ensure questions reflect reporting requirementsPublic Health surveillance needs strengtheningOvercoming the main challenge of timeliness of reporting
The Way ForwardThe Way Forward
Training of remaining countries (Oct 09)Data collected by all countriesNational reports producedSubregional report producedINFOBase
Thank You