National strategic action plan (nsap) for prevention & control of non-communicable diseases in ethiopia

Objectives

The 2014–2016 National Strategic Action Plan for Prevention and Control of Non-Communicable Diseases provides Ethiopia’s national and sub-national framework for reducing preventable morbidity, disability and premature mortality from non-communicable diseases (NCDs).[1][2]Its vision is healthy and productive Ethiopians free from avoidable NCDs, and its mission is to prevent and reduce morbidity and premature mortality through health promotion, healthy lifestyles, and treatment of NCDs and their risk factors.[3]The plan prioritises cardiovascular diseases, cancers, chronic respiratory diseases and diabetes, alongside tobacco use, physical inactivity, unhealthy diets, harmful alcohol use and khat consumption.[4][3]

• Strengthen national policy, governance and leadership, including multisectoral ownership, legislative and regulatory action, political commitment, partnerships and sustainable resources.[3][5]
• Reduce exposure to behavioural risk factors by creating health-promoting environments and applying population-wide measures on tobacco, diet, physical activity, alcohol and khat.[6][7]
• Promote health and prevent disease throughout the life course, combining action from pregnancy and early childhood to adulthood and older age with individual interventions for people at high risk or living with NCDs.[8][9]
• Provide comprehensive, people-centred prevention, early detection, treatment, rehabilitation, long-term care and palliative care through primary health care and universal health coverage.[3][10]
• Strengthen monitoring, evaluation, surveillance and research on disease prevalence, risk factors, service capacity and behavioural trends, using national targets and locally relevant measures, including khat consumption.[3][11]

The strategic direction combines promotive, preventive, curative and rehabilitative services with attention to social determinants, poverty and equitable access.[12][13]It seeks to protect national progress in poverty reduction, education, gender equality and economic development by addressing the health and economic consequences of NCDs.[14]

Implementation

Implementation combines a whole-of-government and whole-of-society response with integrated health-system delivery.[14]NCD prevention, diagnosis, treatment and care are to be incorporated throughout Ethiopia’s three-tier health system, from health posts and the Health Extension Programme to health centres, primary hospitals and tertiary referral facilities.[2][4]Primary health care is the central delivery platform, supported by functional referral networks, essential technologies, affordable generic medicines, multidisciplinary teams, task shifting, clinical mentorship and supportive supervision.[4][15]

• Coordinate implementation through a multisectoral National Steering Committee, supported by a National Multisectoral Technical Advisory Group that provides scientific and technical advice, policy recommendations and support for national action planning.[11][16]
• Lead health-sector coordination through the Federal Ministry of Health, which serves as secretary to the National Steering Committee, supports other sectors, coordinates implementation and prepares biannual and annual performance reports for the committee and head of government.[17]
• Engage sectoral ministries, specialised agencies, regional health bureaux, development partners, professional and patient associations, civil-society organisations, private-sector bodies and communities across national, regional, zonal, woreda and kebele levels.[16][17]
• Enable regions to plan, implement, coordinate, monitor and evaluate NCD programmes through Regional Health Bureaus and NCD case teams, including context-specific regional plans and, where established, regional steering committees.[17]
• Use schools, workplaces, media, communities, health extension workers and the health development army to deliver health promotion, public education and risk-factor prevention.[9][18]
• Develop clinical protocols, training materials, provider-support tools, client-education materials, recording tools and standardised reporting systems for screening, diagnosis, treatment, follow-up and referral.[10][19]

The plan assigns cross-sectoral responsibilities for policies affecting agriculture, education, finance, trade, transport, urban planning, communications, labour, sport, energy and the environment.[12][9]It envisages regulatory and fiscal measures including tobacco, alcohol, unhealthy-food and possible khat taxation, alongside smoke-free settings, marketing controls, health warnings, food standards and physical-activity-supportive environments.[18][10][20]

Operational accountability is supported by nationally agreed targets and indicators aligned with the global monitoring framework, selected integration of NCD indicators into the Health Management Information System, facility reporting, administrative compilation at woreda, zonal and regional levels, and submission to the Federal Ministry of Health.[21]Participating stakeholders are expected to collect specified indicators and report them to the National Steering Committee.[5]Surveillance and evaluation include periodic health examination and risk-factor surveys, cancer registries, verbal autopsy, cause-of-death certification, civil registration, facility assessments and annual health-sector reviews.[22][23]

Resource mobilisation is expected through domestic, bilateral, regional and multilateral channels, with federal and regional governments expected to allocate regular NCD budgets to health facilities.[8][24]The supplied material does not provide a consolidated programme budget, detailed financing allocation, quantified funding gap or overall costed implementation plan.[24]

Monitoring & Evaluation

Monitoring, evaluation, surveillance and research form a dedicated priority area, intended to generate evidence on non-communicable disease patterns, trends and determinants and to assess progress towards strategic objectives.[3][22]The framework combines routine reporting, population surveys, disease registries, vital-event data, facility assessments, supportive supervision and periodic performance review.[23][17]

• Integrate selected non-communicable disease indicators into the national Health Management Information System, using revised registers, follow-up charts, standardised reporting tools and administrative reporting from health facilities through woreda, zonal and regional levels to the Federal Ministry of Health.[5][10][21]
• Monitor disease-specific morbidity and mortality, behavioural and metabolic risk factors, service capacity, health-system inputs, outputs and coverage, including diagnostics, essential medicines, case detection, treatment access and treatment coverage.[22][23]
• Strengthen civil registration, cause-of-death certification and coding using the International Classification of Diseases, while applying verbal autopsy and sample registration where routine death registration is weak.[22][23]
• Establish and maintain cancer and cardiovascular disease registries where feasible, using hospital-based and population-based registry data alongside routine health information systems to monitor morbidity and cancer incidence.[22][11]
• Conduct representative national health examination surveys at least every five years, combining interviews with physical, biological and biochemical measurements; the World Health Organization Stepwise approach to Surveillance is identified as a model.[23]
• Undertake periodic surveillance of tobacco use, harmful alcohol use, diet, physical inactivity, khat use, overweight and obesity, raised blood pressure, raised blood glucose and hyperlipidaemia, as well as infections associated with subsequent cancer development.[11]
• Adopt a minimum national set of targets and indicators aligned with the global monitoring framework, supplemented by locally relevant indicators such as khat consumption.[23][11]Nationally agreed indicators and targets are to be adapted to local evidence and capacity, with reference to the global framework’s 25 indicators and nine voluntary targets.[21]
• Require participating stakeholders to collect specified indicators and report them to the National Steering Committee, while the Ministry of Health compiles biannual and annual performance reports for the committee and head of government.[5][17]
• Use the National Steering Committee for overall coordination of multisectoral monitoring and evaluation, with the National Multisectoral Technical Advisory Group providing technical oversight and tracking implementation.[11][16]
• Conduct supportive supervision, intersectoral consultative and evaluative workshops, biannual performance reviews and annual dissemination through a non-communicable disease bulletin.[21][25][26]
• Review policies regularly and independently to establish whether they have been adopted, implemented and enforced, while using findings to address data gaps and improve risk-factor monitoring.[23]

Key evidence-system weaknesses include poor health-management-information and vital-registration systems, limited research capacity and a lack of representative national data at the start of implementation.[27]The supplied text does not provide named indicator values, a comprehensive reporting timetable or detailed evaluation methodologies beyond the stated surveys, reviews, reports and verification sources.[23][7]

Costing & Financing

Financing provisions emphasise sustained resource mobilisation, government budget allocation and efficient use of resources, but the supplied extracts do not provide a consolidated programme budget, detailed costed implementation plan, quantified funding gap or Ethiopian financing target.[8][24]

• Mobilise adequate, predictable and sustained resources through domestic, bilateral, regional and multilateral channels, including traditional and voluntary innovative financing mechanisms.[8]
• Allocate regular non-communicable disease budgets from federal and regional governments to health facilities, and provide working budgets for non-communicable disease offices and case teams.[28][24]
• Strengthen partnerships and pursue resource mobilisation through national symposia and fundraising events.[28]
• Use taxation of cigarettes, alcohol, unhealthy diets, health-hazardous foods and khat as policy instruments that may generate resources for prevention and control, although no projected revenue or earmarked allocation is specified.[9][18][10]
• Prioritise resources for primary health care integration, health workers and training, infrastructure, diagnostics, essential medicines, palliative care, therapeutic technologies and affordable generic medicines.[13][4]
• Recognise insufficient resources, limited funding sources and limited donor and partner support as implementation threats.[29]

The plan recognises that non-communicable diseases create treatment and long-term-care costs, catastrophic household expenditure, impoverishment, productivity losses and slower economic growth.[30][14]It also identifies health insurance coverage that includes prevention and treatment services as an existing strength.[27]

Illustrative campaign costs are provided for public-walk T-shirts and 30-minute radio and television programmes, while financial support from the World Health Organization country office in Ethiopia is identified for printing the plan.[31][32]No source text quantifies the overall cost of surveillance, service delivery, medicines, workforce development or implementation of the strategic action plan.[22][15]