Plan d’activités des Maladies Chroniques Non Transmissibles 2017

Objectives

The National Integrated Programme for the Fight against Non-Communicable Diseases is mandated to develop national strategies and coordinate countrywide action on diabetes, hypertension, cancer, respiratory diseases and mental-health problems. Its strategic purpose is to strengthen quality preventive, curative, promotive and rehabilitation services at all levels of the health system, while improving access to medicines, governance, health information, planning, monitoring, evaluation and research.[1][2][3][4]

• Develop national policies and strategies for prevention, risk-factor control, screening, early diagnosis, clinical management and management of complications from non-communicable diseases.[1][5]
• Ensure access to quality care for children and young people with diabetes, including insulin and self-monitoring products.[2][6][7]
• Promote healthier practices and nutrition, including fruit and vegetable consumption, and raise awareness of tobacco, alcohol, cancer, sickle-cell disease, mental health, epilepsy, trauma, violence and asbestos-related risks.[6][8][9][10]
• Improve the availability, geographical accessibility and rational use of quality medicines and other health products, including psychotropic medicines and treatments for sickle-cell disease.[3][11]
• Strengthen human resources through continuing education, specialist training, cancer-screening capacity building and training for community health workers.[6][3][8][11]
• Reinforce sector leadership, coordination, institutional capacity and rational, transparent management at all levels.[3][12][13][4]
• Establish an integrated monitoring and evaluation system that includes routine health information system indicators for non-communicable diseases, a functional cancer registry and a non-communicable disease database.[12][14][4]

Implementation

The programme is located within the Ministry of Public Health and AIDS Control and is managed by a Director, supported by a Deputy Director, advisers, unit heads and a secretariat. Its structure includes prevention, screening and care; monitoring and evaluation; and administration and resource-management units. Mental-health promotion was integrated in 2013, while physical medicine and medical rehabilitation were incorporated through a partnership with APEFE, which provides technical assistance to the Ministry.[15][5]

• Coordinate national interventions through the programme, health-care providers, diabetes-control associations, community actors, technical and financial partners, and relevant sectoral authorities. Identified partners include the World Health Organization, APEFE, Life For A Child, the National Centre for Transfusion and PAISS/CTB.[16][3][12][14][9]
• Deliver diabetes services by procuring and supplying insulin, self-monitoring equipment and other inputs to health facilities and diabetes associations, and by supervising management of Life For A Child inputs.[17][6][3][7]
• Conduct formative and joint supervision for diabetes, hypertension, rehabilitation standards, medicines management and integration of non-communicable disease indicators into the routine health information system.[2][3][14][7]
• Organise community workshops, awareness events, global health days, communication campaigns and educational materials to address risk factors, screening and prevention.[6][8][9][10]
• Build workforce capacity through laboratory training for cancer screening, training of community health workers in diabetes, hypertension and chronic obstructive pulmonary disease, and professional-development activities for clinical personnel.[6][3][8][11]
• Maintain governance through weekly programme meetings, monthly management committee meetings, quarterly stakeholder coordination meetings, dissemination of the strategic plan, office supplies and maintenance of information-technology equipment.[2][12][13][4]
• Monitor performance through activity-level indicators, baselines, target values, verification sources, responsible personnel, supervision arrangements and quarterly or scheduled self-evaluation periods. Verification sources include activity, training, supervision, requisition and management reports.[14][7][8][11]
• Address implementation constraints related to limited partner engagement, insufficient provider refresher training and specialist staff, inadequate community involvement and awareness materials, weak coordination, high medicine costs and insufficient operating-budget resources.[16][17]

Monitoring & Evaluation

Monitoring and evaluation are embedded in the National Integrated Programme for the Fight against Non-Communicable Diseases through a dedicated monitoring and evaluation unit, responsibility for nationwide follow-up of interventions, and activity-level performance tracking.[1][5]The extracts describe an evolving framework that links indicators, baseline and target values, verification sources, responsible staff, supervision and self-evaluation periods.[14][7]

• Track implementation through indicators covering insulin and other product supplies, supervisory visits, training placements, awareness workshops, global health days, coordination meetings, strategic-plan dissemination, equipment maintenance and availability of office inputs.[6][3][12]
• Integrate non-communicable disease indicators into the routine health information system, establish a non-communicable disease database and operationalise a cancer registry.[12][14][4]
• Monitor rehabilitation-service standards in ten centres and services supported by the Association pour la Promotion de l’Éducation et de la Formation à l’Étranger programme, with four reporting periods identified.[14][4]
• Use requisition forms to verify insulin and health-product availability, and use activity, training and management reports to verify supervision, awareness and capacity-building activities.[7][8][11]
• Review activities through weekly programme meetings during 2017, monthly management committee meetings, quarterly sector-partner coordination meetings and scheduled self-evaluation periods.[2][3][12][7]
• Measure selected diabetes-care activities against explicit targets: distribution of insulin to children aged 0–23 years reached the reported 100% target, while continuing training for rehabilitation-centre staff reached 75% against a 100% target.[18][19]
• Address underperformance identified in the 2016 review, including a provincial medical-directors workshop on harmful alcohol use that recorded 0% achievement against a 100% target because of unavailable budget, and a physical medicine and rehabilitation strategic plan that remained unvalidated at 75% achievement.[18][19]
• Recognise system weaknesses, including the absence of baseline data on non-communicable diseases and limited research on diseases and their risk factors.[16]

The supplied material does not set out a consolidated surveillance architecture, common reporting timetable, independent evaluation method, formal sanctions or other detailed accountability arrangements beyond management structures, supervision, committee meetings and indicator tables.[1][16][2][8][11]

Costing & Financing

Financing combines State budget lines, programme operating resources, technical and financial partners, and activity-specific contributions.[20][18][17]The extracts identify budget forecasts and financial-monitoring arrangements, but do not provide a complete, internally unambiguous plan-wide costing, currency, quantified funding gap or economic assumptions.[15][1][18]

• Record a 2016 State budget credit of 28,998,156 for the National Integrated Programme for the Fight against Non-Communicable Diseases and 2,400,000 for Mental Health; reported execution rates were 75% and 60% respectively.[20]
• Show 2017 financing figures of 569,400,000 for the State non-communicable disease programme and 2,400,000 for Mental Health, although the extracted table layout makes some financing-category alignment uncertain.[20][18]
• Identify the World Health Organization, the Association pour la Promotion de l’Éducation et de la Formation à l’Étranger, CELUCODIA, ABTEL and APREPRIDIA as technical or financial partners in the 2016–2017 financing table.[18]
• Allocate funds at activity level for diabetes supplies, supervision, community awareness, training, cancer-screening capacity, medicine management, information systems, rehabilitation monitoring and the cancer registry.[6][3][12][14][9][10]
• Identify inadequate operating-budget resources, weak partner engagement, high medicine costs and a financial crisis as constraints on implementation and planned activities.[16][17]
• Include equipment-acquisition costs and administrative expenditure requirements for information-technology maintenance, vehicle maintenance, fuel, lubricants, communications and office supplies; no rehabilitation or construction cost is recorded in the infrastructure table.[21][22][20]

Several activity tables name the National Integrated Programme for the Fight against Non-Communicable Diseases, partners, Life For A Child, the National Centre for Transfusion, PAISS/CTB and the World Health Organization as funding sources.[2][3][12][9]The extracts do not specify the currency for these amounts, the methodology used to produce costs, or a resource-mobilisation target.[21][3][14]