National Chronic Non-Communicable Disease Policy and Multisectoral Action Plan for Grenada

Objectives

Grenada’s 2013–2017 National Chronic Non-Communicable Disease Policy and Multisectoral Action Plan seeks to reduce preventable illness, premature mortality and the social and economic burden of chronic non-communicable diseases through coordinated action at individual, community, health-system, political, legislative and environmental levels. It prioritises cancers, cardiovascular disease, hypertension, diabetes, chronic respiratory disease and mental health conditions, while addressing complications and comorbidities including obesity, renal and oral disease.[1][2][3]

The policy is aligned with regional and Pan American Health Organization frameworks and adopts a life-course, primary-health-care-oriented and all-of-society approach. Its overarching vision is improved quality of life and sustainable wellbeing, especially for vulnerable groups, through equitable prevention, early detection, treatment, rehabilitation, palliative care and protection from the social determinants of ill health.[4][5]

• Strengthen surveillance, monitoring, evaluation, operational research and information sharing so that policy and programme decisions are evidence-based.[6][7]
• Develop multisectoral leadership, partnerships and legislation that integrate non-communicable disease prevention and control into national development and economic agendas.[8][9]
• Reduce tobacco use, exposure to second-hand smoke, harmful alcohol use, unhealthy diets, physical inactivity, sedentary behaviour, overweight and obesity, while strengthening protective factors and healthy social norms.[1][10][11]
• Improve equitable access to high-quality, integrated chronic care, including screening, diagnosis, treatment, medicines, technologies, rehabilitation, palliative care, self-management support and continuity of care.[12][13]
• Advance progress towards global targets for reduced premature mortality, obesity, raised blood pressure, diabetes risk, physical inactivity and dietary salt intake, alongside expanded preventive treatment and cancer-screening coverage.[5][11][14]
• Promote targeted prevention and service responses for cervical, breast and prostate cancer; hypertension and cardiovascular disease; diabetes and kidney disease; chronic respiratory disease; and mental health.[15][16][17][14]

Implementation

Implementation uses a multisectoral action-plan model led principally by the Ministry of Health, combining public policy, regulation, health promotion, primary health-care reform, community participation and integrated service delivery. Partners span government ministries, public and private providers, civil society, schools, workplaces, professional associations, faith organisations, media, businesses, academic institutions, regional bodies and international agencies.[8][13][18]

• Coordinate implementation through the Ministry of Health, the multisectoral Chronic Non-Communicable Disease Commission and partnerships with ministries responsible for education, agriculture, finance, legal affairs, trade, social development, youth and sports, labour and other relevant sectors.[9][13][18]
• Require stakeholders to prepare annual work plans and related budgets, with implementation supported by political leadership, advocacy, coordination and redirected or additional financial, human and material resources.[19][20]
• Formalise collaboration through memoranda of understanding, a systematic partnership application and verification process, partner reporting, joint outreach, information dissemination, events and fundraising, including potential contributions from the Grenadian diaspora.[9][18]
• Implement and enforce measures on tobacco and alcohol sales, marketing, promotion, public consumption, age verification, smoke-free public places, drink-driving, taxation and informal-market sales; strengthen food standards, labelling, school food and physical-activity policies, occupational health and environmental safeguards.[9][21]
• Deliver health promotion through schools, workplaces, communities, sporting settings, health facilities and media, including tobacco and alcohol prevention and cessation, responsible alcohol-service training, nutrition counselling, salt reduction, kitchen gardens, school feeding links, active-living programmes and health literacy.[10][22]
• Reorient services towards comprehensive primary health care, initially piloted in three rural districts and two large facilities in St George’s, using multidisciplinary teams, improved district gatekeeping and stronger coordination with hospitals and private providers.[23]
• Expand screening and follow-up for priority conditions, report health-fair cases to the Ministry of Health, use targeted screening schedules, strengthen referrals and continuity of care, and support clients through mechanisms such as a Chronic Care Passport and unique identifiers.[12]
• Strengthen workforce capacity through continuing medical education, pre-service and in-service training, health-promotion competency assessment, retention incentives and training on clinical practice, ethics, communication, health literacy and population health.[10][12]
• Secure medicines, vaccines and diagnostic technologies through regional procurement, public-private partnerships and regional collaboration; support rational prescribing, adherence, treatment review and access to rehabilitation and palliative care.[13]
• Finance implementation through annual work-plan budgets, better balancing of primary and secondary-care expenditure, potential earmarking of tobacco and alcohol taxes, public-private partnerships and exploration of fee-for-service arrangements through national health insurance. No quantified total policy budget or funding gap is specified.[24]
• Operate national monitoring and evaluation through integrated administrative data, surveys and surveillance, with the Epidemiology and Information Department routinising reporting from health centres, hospitals and private providers. An intersectoral National Health Status Steering Committee is to set indicators and reporting schedules, review progress quarterly and prepare an annual Grenada Health Status Report.[25]
• Strengthen information systems through standardised cross-sector indicators, disaggregated patient data, strengthened registries including a National Chronic Disease Registry, repeat adult and adolescent risk-factor surveys, research priorities, privacy protections and dissemination of findings through reports, media and an annual national Health Minister’s Conference.[7][25]

Monitoring & Evaluation

The policy establishes surveillance, monitoring, evaluation, research and information sharing as a core strategic area, intended to strengthen evidence-based planning, implementation and accountability for chronic non-communicable disease prevention and control.[6][8]It seeks to use monitoring and evaluation to assess whether implementation is on course, whether objectives are achieved and where early corrective action is required.[24]

• Strengthen national surveillance and research capacity for chronic non-communicable diseases, risk factors and social determinants, and use findings to guide policy, programmes and service development.[8][24]
• Develop a national chronic non-communicable disease information-system plan, collect data using international criteria, standardise indicators across sectors, and disaggregate information by age, sex, location, risk factors and occupation.[7]
• Consolidate disease registries into a functional National Chronic Disease Registry, strengthen health-information systems and ensure protection of patient privacy.[7]
• Routinise data collection and reporting by the Ministry of Health Epidemiology and Information Department from district health centres, hospitals, private providers and relevant non-health sectors.[25]
• Repeat nationally representative adult and adolescent risk-factor surveys at scheduled intervals, including the World Health Organization STEPwise approach to non-communicable disease risk-factor surveillance and the Global School-based Student Health Survey.[7][26]

The monitoring system is intended to combine administrative records, surveys, vital statistics, death registration, screening data, hospital discharge records and information from psychiatric and private facilities.[25][27]Mortality data quality, cancer incidence by type, risk-factor prevalence, health-service access and quality, medicine availability, palliative care, chronic kidney disease treatment, obesity, diabetes and multisectoral policy implementation are among the proposed areas for measurement.[26][11]

Data-quality weaknesses are recognised. Mortality figures vary across data sources and classification systems, and clearer variable definitions and standardised indicators are needed to improve comparability.[28]Mental-health reporting from Mt. Gay Psychiatric Hospital and community facilities was not integrated with the Ministry of Health Epidemiology and Information Department, creating a surveillance gap.[3]The plan also calls for investigation of unexplained trends in diabetes, hypertension and obesity data.[28][29]

• Establish an intersectoral National Health Status Steering Committee, convened by the Minister of Health or designee and chaired by the Chief of the Epidemiology Unit, to oversee monitoring and evaluation.[25]
• Set indicators, allocate surveillance responsibilities, determine reporting schedules, interpret data and prepare the annual Grenada Health Status Report in collaboration with the CNCD Commission.[25]
• Hold quarterly Steering Committee meetings to review progress, corrective actions and changing priorities.[25]
• Require quarterly partner reports through the Ministry of Health partnership process and disseminate annual findings through multiple media formats and a national Health Minister’s Conference.[18][25]
• Expand the Chief Medical Officer’s Report to include chronic non-communicable disease outcomes, risk factors and demographic, socioeconomic and environmental determinants.[9]

Specific targets include progress by 2017 towards global 2025 targets on adult obesity, adolescent overweight and obesity, raised blood pressure, preventive drug therapy and counselling, and cancer-screening coverage.[14]The plan also envisages biennial analytical reporting, repeated representative surveys, programme audits, client feedback mechanisms and mandatory routine reporting by public and private providers.[23][5][26]

Costing & Financing

Financing information is largely strategic rather than costed. The policy and multisectoral action plan was funded by the Pan American Health Organization, but the supplied material does not provide a total implementation budget, programme cost estimates, quantified funding gap or expenditure forecast.[1][4]

• Allocate adequate financial and human resources for national surveillance, monitoring, evaluation, staffing, information technology and research infrastructure.[7][24]
• Develop an annual work-plan budget and financial sustainability plan aligned with disease burden, policy priorities, essential services and workforce needs.[20][24]
• Rebalance existing health-sector resources towards primary health care and prevention, as current allocation patterns are described as inconsistent with the stated primary-health-care priority.[23][20]
• Mobilise resources through Pan American Health Organization and United Nations support, public-private partnerships, national health insurance arrangements and integration of chronic disease prevention within existing programmes.[20][24]
• Direct revenue from tobacco, alcohol and unhealthy-food taxation towards health-sector priorities, including primary health care, prevention, treatment, public health advertising and related chronic non-communicable disease services.[9][21][24]

In 2010, Community Health Services received 20% of health financing and the General Hospital received 49%.[23]In 2013, the General Hospital allocation increased by 2% to 51%, while Community Health Services increased by almost 1%.[23]These figures are percentages rather than monetary amounts and do not establish a costed financing plan.

Affordability is identified as a barrier to healthier diets: the average cost of a nutritionally balanced 2,400-kilocalorie meal rose from 7.14 Eastern Caribbean dollars in 2008 to 8.85 Eastern Caribbean dollars in 2012, with equivalent reported US dollar costs of 2.64 and 3.28.[30]Resource constraints also prevented biochemical testing in the national risk-factor survey.[31]

At the global level, chronic non-communicable diseases were projected to cost more than 30 trillion US dollars over the subsequent 20 years, equivalent to 48% of global gross domestic product.[32]The material argues that prevention investment could reduce deaths and economic losses, but does not quantify Grenada-specific savings, costs or returns on investment.[32]