National Strategic Plan for the Prevention and Control of Non-Communicable Diseases: Trinidad and Tobago 2017-2021

Objectives

The 2017–2021 National Strategic Plan for the Prevention and Control of Non-Communicable Diseases provides Trinidad and Tobago with a coordinated, prevention-focused framework to reduce the burden of heart disease, diabetes, cancer and stroke and their risk factors. It envisions happier, healthier and fitter people living longer, more productive lives through whole-of-government and whole-of-society action.[1][2]The framework is grounded in equity, inclusiveness, people-centred care, evidence-based practice, results-driven management, primary health care, universal health coverage, health promotion and action on social determinants of health.[3][4][5]

• Reduce preventable mortality before age 70 from heart disease, diabetes, cancer and stroke by 25% by 2025.[2]
• Reduce high blood pressure, high cholesterol and high blood sugar by 20% within five years.[2][4]
• Reduce adult overweight and obesity by 10%, overweight and obesity among adolescents aged 13 to 15 years by 12%, and child overweight and obesity by 15%.[2][4]
• Reduce tobacco use to 13% among people aged 15 years and over, reduce adolescent tobacco use by 10%, and reduce harmful alcohol use among adults and young people.[6]
• Prioritise four areas of action: risk-factor reduction and health promotion; comprehensive, integrated care and management; surveillance, monitoring, evaluation and research; and governance, policy and advocacy.[7]
• Improve healthy-food availability and consumption, physical activity, tobacco and alcohol control, risk-factor screening, health education, school and workplace health, and community empowerment.[8][9][10][11]
• Strengthen early detection, treatment and management of metabolic risks and major NCDs, including cervical, breast, prostate, colorectal and lung cancers.[3][12]
• Expand people-centred chronic care, including an integrated chronic care model in at least 70% of primary health care facilities and self-management education for 80% of people with NCDs.[7]

Implementation

Implementation combines multisectoral policy action with strengthened primary care, integrated clinical management, population health programmes and community participation.[13][3][5]The Ministry of Health leads national policy, quality assurance, regulation, public health services and monitoring, while five Regional Health Authorities deliver primary, secondary and tertiary care through 105 community health centres and eight hospitals.[14]County Medical Officers of Health lead community-level primary health responses and essential public health functions.[14][15]

• Establish a dedicated NCD Unit within the Ministry of Health, develop a human-resources plan, and implement the strategy in three phases: one year to strengthen capacity, three years of intensified delivery through annual action plans, and a fifth-year evaluation to inform the following plan.[16][17]
• Establish cabinet-level and multisectoral governance, including a national coordinating mechanism, transitional NCD Working Committee, Health in All Policies arrangements and collaboration across government, civil society, academia, private-sector organisations, non-governmental organisations and communities.[18][19][5]
• Coordinate ministry action on food and nutrition, education, agriculture, finance, labour, planning, sport, trade, transport, social development and other determinants of health.[20][21]
• Implement tobacco control through legislation, packaging and labelling regulations, the Tobacco Control Unit, primary-care cessation training and cessation clinics.[8][6]
• Establish an Alcohol Policy Committee and implement alcohol policy, marketing and education measures, particularly for children and young people.[6]
• Revise and implement policies and standards for childhood obesity, school nutrition, school health, young-child feeding, workplace health, food marketing, sodium and trans-fat reduction, and Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems.[6][10]
• Deliver health-promotion initiatives through schools, workplaces, health centres, farmers’ markets, faith-based organisations, community settings and public-sector agencies, including programmes in 10 primary schools in each county.[9][11]
• Standardise clinical care by auditing diabetes and hypertension guidance, harmonising Regional Health Authority treatment protocols, adapting the Chronic Care Model, training primary-care professionals and evaluating point-of-care testing.[22][23]
• Provide medicines through the Chronic Disease Assistance Programme, which supplies approximately 51 prescription medicines free of charge through public facilities and most private pharmacies and has included free blood-glucose testing strips for people with diabetes since 2008.[24]
• Establish community screening programmes in every Regional Health Authority to screen at least 5,000 people annually and report risk-factor distributions and referrals.[23]
• Strengthen cancer prevention through reviews of human papillomavirus vaccination and screening, standardised protocols, a national cancer symposium and implementation of National Cancer Plan actions.[12]
• Develop a National Chronic Disease Surveillance System and Unit within two years, improve NCD-data quality by at least 90% against international criteria, pilot a core dataset and data-capture forms, and strengthen cancer registries and other NCD registries.[18][12][19]
• Use the 2011 STEPS survey as baseline evidence, repeat school body-mass-index surveys and youth health and tobacco surveys, and monitor trends, programme delivery and outcomes through a comprehensive monitoring and evaluation plan.[2][19]
• Use Annual Service Agreements between the Ministry of Health and Regional Health Authorities for service delivery, financial allocations, monitoring and evaluation.[14]
• Fund annual action plans through national budgeting, prioritise resources for the NCD Unit and national coordination mechanism, seek multisectoral contributions, and explore earmarking tobacco-, alcohol- and similar-product revenues for NCD prevention and control.[17]The strategy identifies an Inter-American Development Bank loan as an implementation accelerator and calls for resource mobilisation beyond the loan period, but does not specify total budgets, loan values, allocations or funding gaps.[25]

Monitoring & Evaluation

The plan combines population surveillance, service monitoring, research and phased evaluation to track progress towards non-communicable disease targets, but several source sections do not specify complete reporting schedules, data custodians or formal accountability procedures.[4][18][17]

• Establish a National Chronic Disease Surveillance System and Unit within the first two years, improve the quantity and quality of non-communicable disease data by at least 90% against international criteria, and institutionalise analysis of international, regional and local trends.[18]
• Develop a monitoring and evaluation plan covering all non-communicable disease components and programmes, with continuous tracking of core targets, strategic priorities and outcomes.[18]
• Use the 2011 Pan American Health Organization and World Health Organization STEPwise approach to Surveillance survey as baseline evidence for risk factors and trend monitoring, alongside population-based surveillance of diabetes, hypertension and raised cholesterol.[2]
• Monitor risk factors through screening for blood pressure, blood sugar, body mass index and cholesterol, with more than 25,000 people screened through programmes conducted from 2011 to 2014.[9]
• Require each Regional Health Authority to establish community-based screening and submit annual data on risk-factor distribution and referrals for follow-up care.[23]
• Develop and pilot a core non-communicable disease dataset and data-capture forms in two sites across at least two Regional Health Authorities, and redesign community-health reporting to capture health-system indicators.[12]
• Conduct school body-mass-index surveys, repeat the Global School-based Student Health Survey and Global Youth Tobacco Survey, and review growth-monitoring data for children under five years to estimate obesity.[19]
• Track implementation outputs, including completed policies and legislative reviews, trained cessation providers, additional clinics, revised nutrition standards, school programmes, public campaigns and advocacy seminars.[6][10][11]
• Use Annual Service Agreements between the Ministry of Health and Regional Health Authorities to monitor and evaluate service implementation.[14]
• Establish a monitoring and evaluation framework in Year 1, aligned with global, regional Latin America and Caribbean, and Caribbean Community reporting commitments; use targets in Table 5 for national and global monitoring.[17]
• Report implementation through annual action plans and communicate progress to citizens through the Partners Forum during Phase II.[17]
• Evaluate achievements in Year 5, including effectiveness and affordability, and use findings to inform the following five-year plan.[17]
• Assign the Tobacco Control Unit responsibility for enforcing and monitoring the Tobacco Control Act and associated regulations.[8]
• Strengthen research capacity, maintain an evidence agenda and research database, and use patient data, cancer-registry analysis and additional disease registries to guide programme development and evaluation.[24][18][19]
• Require the Non-Communicable Disease Unit to report total public-sector non-communicable disease budgets and expenditure, while strengthening Regional Health Authority monitoring and health information systems.[25]

Costing & Financing

Financing is intended to support a multisectoral non-communicable disease response through annual programme budgeting, government allocations, external loan support and potential earmarked fiscal revenues, although the plan does not provide total budgets, annual allocations, loan terms or a quantified implementation funding gap.[17][25]

• Develop a national strategic programme budget for each annual action plan and submit it through the national budgeting process for approval.[17][25]
• Increase and prioritise Government of the Republic of Trinidad and Tobago allocations for non-communicable disease prevention and control, with resources prioritised for the national coordinating mechanism and the Non-Communicable Disease Unit in the Ministry of Health.[17]
• Mobilise budgetary inputs from government ministries and agencies, civil society and the private sector to fund the multisectoral response.[17]
• Use the Inter-American Development Bank loan to accelerate implementation while developing a resource-mobilisation strategy to sustain critical interventions after the loan period.[25]
• Explore dedicating revenues from tobacco, alcohol and similar products to prevention and control activities and the operations of national commissions.[17][26]
• Address financing weaknesses, including resource allocation favouring secondary and tertiary care and the absence of a dedicated budget for non-communicable disease promotion, prevention and research.[25]
• Allocate Ministry of Health financial resources to Regional Health Authorities through Annual Service Agreements for service implementation.[14]
• Recognise the Chronic Disease Assistance Programme as a publicly funded access mechanism that provides approximately 51 prescription medicines and blood-glucose testing strips free of charge, without a stated monetary value.[24]
• Recognise that a 2016 rapid assessment estimated the annual economic burden of diabetes, hypertension and cancer at approximately Trinidad and Tobago dollars 8.7 billion, or about 5% of current gross domestic product.[27]
• Prioritise prevention because a sustained 50% reduction in diabetes and hypertension could save almost Trinidad and Tobago dollars 2 billion in labour productivity, while a 20% reduction in cancer mortality could reduce productivity losses by about Trinidad and Tobago dollars 360 million.[27]