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 (NCDs) provides Trinidad and Tobago with a coordinated framework to reduce preventable illness, disability and premature mortality from cardiovascular disease, diabetes, cancer, stroke and associated risk factors. It envisages healthier, fitter and more productive people living longer, using prevention, equity, inclusion, people-centred care, evidence-based practice and results-driven action.[1][2]The plan is aligned with national development priorities and international and regional NCD frameworks, and applies primary health care, universal health coverage, integrated management, Health in All Policies, whole-of-government and whole-of-society approaches.[1][2]

• Reduce premature mortality before age 70 from priority NCDs by 25% by 2025.[2]
• Reduce high blood pressure, high cholesterol and high blood sugar by 20%; adult overweight and obesity by 10%; overweight and obesity among adolescents aged 13 to 15 by 12%; and child overweight and obesity by 15% over five years.[2][3]
• Reduce behavioural risks by targeting tobacco use, harmful alcohol use, unhealthy diets and physical inactivity, while addressing biological risks including obesity, hypertension, elevated cholesterol and raised blood glucose.[4][5]
• Promote healthier food environments, increased fruit and vegetable consumption, reduced salt, sodium and trans-fat intake, physical activity, breastfeeding and healthy development across the life course.[5][6][7]
• Strengthen comprehensive, integrated prevention, early detection, treatment, follow-up, self-management and rehabilitation for NCDs and their risk factors, with particular attention to primary care.[3][8]
• Improve prevention and early detection of cervical, breast, prostate, colon and lung cancers, including national cervical-screening scale-up and review of the human papillomavirus vaccination strategy.[9][10]
• Address social determinants of health, including poverty, gender, food environments and socioeconomic, cultural, environmental and political influences on health.[4][11]
• Organise action through four priority areas: risk-factor reduction and health promotion; comprehensive and integrated NCD care and management; surveillance, monitoring, evaluation and research; and governance, policy and advocacy.[5]

Implementation

Implementation combines policy and legislative action, health promotion, community participation, primary-care strengthening, clinical standards, surveillance and multisectoral governance. The Ministry of Health leads national policy-setting, regulation, quality assurance, monitoring and population public-health services, while five Regional Health Authorities deliver primary, secondary and tertiary services through community health centres and hospitals in accordance with Ministry policy and standards.[12][13]Delivery is intended to involve government, civil society, non-governmental and faith-based organisations, the private sector, academia, media, communities, international partners and the Tobago House of Assembly.[14][3]

• Coordinate national action through a strengthened NCD Unit within the Ministry of Health, a national coordinating mechanism, Cabinet-level or Cabinet-appointed structures, intergovernmental mechanisms and a transitional NCD Working Committee.[15][16][17]
• Implement phased delivery: strengthen Ministry capacity, establish multisectoral arrangements, develop the first annual action plan and monitoring framework, and mobilise an Inter-American Development Bank loan in the first year; intensify annual implementation over the following three years; and evaluate progress in Year 5 before preparing a subsequent plan.[18]
• Use annual action plans, budgets and reporting to connect implementation with the national budgeting process and enable public reporting through a Partners Forum.[18][19]
• Reorient services towards patient-centred, coordinated care across the life course, including implementation of a chronic care model or NCD treatment protocol in at least 70% of primary health-care facilities and self-management education for 80% of people with NCDs.[3][5]
• Maintain access to essential NCD medicines through the Chronic Disease Assistance Programme, which provides approximately 51 prescription medicines free of charge, including blood-glucose testing strips for people with diabetes.[20]
• Strengthen tobacco cessation by training health professionals and primary-care supervisors, establishing additional cessation clinics, enforcing tobacco-control legislation and operating the Tobacco Control Unit.[21][22]
• Deliver school, workplace and community health-promotion activities, including nutrition standards for foods offered to children, healthy-lifestyle education, physical-activity initiatives, obesity programmes and NCD risk-factor screening.[23][9][24]
• Establish screening programmes in each Regional Health Authority reaching at least 5,000 people annually, with annual reporting on behavioural and biological risks and referrals for follow-up care.[25]
• Develop a National Chronic Disease Surveillance System and Unit, strengthen NCD data quality, pilot core datasets and data-capture tools, and use repeated population and school-based surveys to track risk factors and programme outcomes.[9][10][15]
• Develop a monitoring and evaluation plan covering all NCD components, continuously track core targets and outcomes, and strengthen research capacity, agendas and databases across sectors.[9][18]
• Secure sustainable, predictable funding, develop a dedicated NCD budget, report public-sector NCD expenditure, explore earmarking tobacco and alcohol revenues, and develop resource mobilisation arrangements beyond the finite Inter-American Development Bank loan.[15][18][19]

Monitoring & Evaluation

The plan combines results-based monitoring with strengthened surveillance, research, routine data use and multisectoral accountability. It recognises significant data limitations, including dated and inconsistent information, incomplete collation and analysis of Regional Health Authority data, and the absence of a national non-communicable disease surveillance system.[12]

• Develop and implement 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.[9]
• Develop a detailed monitoring and evaluation framework during the first year, aligned with national targets and global, regional Latin American and Caribbean, and Caribbean Community reporting commitments.[18]
• Use results-based monitoring to track target achievement and evaluation to assess intervention effectiveness and affordability.[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.[9]
• Use population-based surveys to establish risk-factor baselines, follow trends and monitor progress, including measures for diabetes, hypertension and raised cholesterol.[2]
• Use the 2011 STEPS Non-Communicable Disease Risk Factor Survey as a baseline evidence source, alongside the Global School-based Student Health Survey, Global Youth Tobacco Survey, body-mass-index surveys and school-meal evaluations.[19][2]
• Design and pilot a core non-communicable disease dataset and data-capture forms at two pilot sites in at least two Regional Health Authorities, and redesign community-health reporting to capture health-system indicators.[10]
• Require annual reporting from community screening on behavioural and biological risk-factor distribution and referrals for follow-up care.[25]
• Track service and policy outputs, including trained tobacco-cessation providers, new cessation clinics, policy briefs, legislative amendments, nutrition studies, revised school-health policies, educational materials and school programmes.[22][6][24]
• Use Annual Service Agreements between the Ministry of Health and Regional Health Authorities as a monitoring and evaluation mechanism.[13]
• Assign the Tobacco Control Unit responsibility for enforcing and monitoring implementation of the Tobacco Control Act and Tobacco Control Regulations.[21]
• Strengthen research capacity, establish a research agenda and database involving public, academic, civil-society and private-sector partners, and support research on issues including maternal diabetes screening and early detection and management.[9]
• Report implementation progress to citizens through a Partners Forum during the three-year second phase, and evaluate achievements in Year 5 before preparing the subsequent five-year plan for 2020 to 2025.[18]
• Require the Non-Communicable Disease Unit to report total non-communicable disease budgets and expenditure, particularly in the public sector, while strengthening ongoing monitoring and evaluation at national and Regional Health Authority levels.[19]

The plan identifies measurable targets across mortality, risk factors, treatment coverage and medicine availability, while the global monitoring framework includes mortality between ages 30 and 70, cancer incidence, alcohol use, physical activity, salt intake, tobacco use, blood pressure, diabetes, obesity, cholesterol, diet, access to therapy, medicine availability, palliative care, cervical screening and hepatitis B vaccination.[26][27]However, several supplied sections do not specify a consolidated reporting timetable, data-management arrangements, evaluation methodology or formal accountability process beyond the surveillance, monitoring, quality-assurance, governance and reporting functions described.[22][6][24][28]

Costing & Financing

Financing is framed as a multisectoral responsibility requiring sustainable, predictable and adequately staffed non-communicable disease programmes, but the supplied material does not provide a total strategy budget, quantified allocations, funding gap, costing methodology or economic assumptions.[9][3][5]

• Allocate Ministry of Health resources to Regional Health Authorities through Annual Service Agreements for service implementation.[13]
• Develop a dedicated budget for non-communicable diseases within the governance and implementation framework.[15]
• Prepare budgets for each annual action plan through the national budgeting process.[18]
• Increase and prioritise government budget allocations for prevention and control, subject to economic and fiscal conditions, including resources for the national coordinating mechanism and the Ministry of Health Non-Communicable Disease Unit.[18]
• Mobilise budgetary contributions from government ministries and agencies, civil society and the private sector to support the multisectoral response.[18]
• Explore dedicating revenue from tobacco, alcohol and similar products to prevention and control activities and the operations of proposed commissions.[18][29]
• Use the Inter-American Development Bank loan to accelerate implementation, while developing a resource-mobilisation strategy to sustain critical interventions after the finite and repayable loan period.[19]
• Address financing constraints arising from resource allocation favouring secondary and tertiary care and the absence of a dedicated budget for non-communicable disease promotion, prevention and research.[19][30]
• Maintain publicly funded access to approximately 51 prescription medicines through the Chronic Disease Assistance Programme, including free blood-glucose testing strips for people with diabetes since 2008.[20]
• Support community-level prevention by funding non-governmental organisations, although funding amounts and wider resource-mobilisation arrangements are not specified.[14]

The estimated annual economic burden of diabetes, hypertension and cancer is approximately 8.7 billion Trinidad and Tobago dollars, equivalent to about 5% of current gross domestic product.[11]Diabetes is estimated to cost 3.5 billion Trinidad and Tobago dollars, hypertension 3.3 billion Trinidad and Tobago dollars and cancer 2 billion Trinidad and Tobago dollars.[11]Indirect costs comprise an estimated 58% of hypertension costs, 65% of diabetes costs and 90% of cancer costs.[11]A 50% reduction in diabetes and hypertension is projected to save almost 2 billion Trinidad and Tobago dollars in labour productivity, while a 20% reduction in cancer mortality could reduce productivity losses by approximately 360 million Trinidad and Tobago dollars.[11]