Plan Multisectoriel de Lutte et de Contrôle des Maladies Non Transmissibles 2017-2021

Objectives

Chad’s 2017-2021 Multisectoral Plan for Non-Communicable Diseases aims for a country free from the burden of non-communicable diseases and their complications. Its mission is to establish coordinated multisectoral action that delivers a collective national response to prevention and control.[1]The overall objective is to reduce non-communicable disease morbidity, mortality, disability and associated risk factors among the Chadian population by the end of 2021.[2]

• Apply a human-rights, equity, partnership, universal health coverage and evidence-based framework for action.[1][3]
• Strengthen leadership, governance, coordination and multisectoral collaboration across national, regional, district and community levels.[2][4]
• Prevent disease by addressing modifiable behavioural risk factors and underlying social determinants, including tobacco, harmful alcohol use, other drugs, unhealthy diets, excess salt, physical inactivity, overweight and obesity.[2][5][6]
• Improve prevention, diagnosis, treatment, referral and access to essential medicines and basic technologies through primary health care and the wider health system.[2][4][7]
• Prioritise cardiovascular disease, diabetes, cancer, chronic respiratory disease, oral disease, eye disorders, sickle-cell disease, violence and injuries, suicide, epilepsy and mental-health conditions.[6][8][9][10][11]
• Promote research and strengthen surveillance, monitoring and evaluation of diseases, risk factors and social determinants.[2][11][12]
• Meet national 2025 targets, including a 25% reduction in premature non-communicable disease mortality, 30% reductions in current tobacco use and mean salt intake, a 10% reduction in insufficient physical activity, and 80% availability and affordability of essential medicines and basic technologies in public and private facilities.[3]

Implementation

Implementation uses a decentralised, multisectoral delivery model that combines policy and legislative action, health promotion, primary-care integration, specialist-service development, community engagement, research and routine surveillance.[2][4][13]The Ministry of Public Health leads coordination through the Non-Communicable Diseases Service, supported by a national multisectoral committee and actors from relevant ministries, development partners, civil society and non-governmental organisations.[2]

• Coordinate national action through a multisectoral committee for relevant ministries, technical and financial partners, civil-society organisations and non-governmental organisations, with the Ministry of Public Health Secretary-General providing the secretariat.[2]
• Assign Regional Health Delegations to integrate activities into annual regional action plans, convene quarterly reviews and undertake awareness campaigns, while District Medical Officers perform corresponding functions in district operational plans.[4]
• Deliver services through national, regional and district hospitals, health centres and community networks: national hospitals manage referred cases and analyse data; regional and district hospitals provide preventive and curative care; and health centres provide the minimum package of activities and routine reporting.[4][13]
• Engage community health workers in awareness, support to affected people and families, and tracing of patients lost to follow-up.[13]
• Develop and apply legislation, regulation and fiscal measures concerning tobacco, alcohol, healthy diets, road safety and other risk factors, alongside advocacy for health-insurance coverage and social-protection arrangements for non-communicable diseases.[2][5][14]
• Strengthen prevention and care through communication campaigns, screening, clinical protocols, workforce training, essential-medicine-list revision, provision of technologies and equipment, and functional referral and counter-referral mechanisms.[6][15][7]
• Expand specialist capacity and infrastructure, including cardiology, neurology, cancer, pathology, oncology, mental-health and emergency-care services, while supplying district and regional facilities with diagnostic and treatment materials.[8][9][16][11]
• Finance the plan through the State, local authorities, households, non-governmental organisations and associations, and development partners; the plan calls for a substantial non-communicable disease allocation within the health budget, but the supplied material does not specify a consolidated total budget or funding gap.[13]
• Establish continuous surveillance through systematic collection, analysis, interpretation and dissemination of health and service data; harmonise classifications; integrate a minimum indicator set into the health database; and use population surveys to establish baselines.[13]
• Track implementation through supervision, periodic dashboards, semi-annual and annual financial reports, investment-monitoring sheets and an intervention dashboard; conduct a mid-term assessment of process and outcome indicators and a final qualitative and quantitative impact evaluation.[17]
• Conduct a second STEPwise approach to Surveillance survey by the end of 2017, publish a semi-annual non-communicable disease bulletin, support 25 studies on diseases and risk factors, establish a cancer registry and create a national observatory for social determinants, behaviours and risk factors.[11][12][4]

Monitoring & Evaluation

The plan establishes surveillance, monitoring and evaluation of non-communicable diseases (NCDs) and their risk factors at every level as a strategic objective. It combines routine health-information reporting, population surveys, disease registries, periodic review, research and formal verification of activity delivery.[2][4][13][17]

• Establish continuous surveillance through systematic collection, analysis, interpretation and dissemination of health and service data, while strengthening the capacity to collect, transmit and use quality information.[13]
• Integrate a minimum NCD indicator set into the health-system database, harmonise concepts and classifications, and use population surveys to establish baseline indicators.[13]
• Conduct a second WHO STEPwise Approach to Surveillance survey by the end of 2017 and use its data for risk-factor surveillance.[11][12]
• Publish a semi-annual NCD bulletin and monitor the number of bulletins issued.[12]
• Establish a cancer registry, train personnel in case-notification forms, publish cancer data in the health statistical yearbook, and improve death and cause-of-death notification.[12][18][19][20]
• Create a national observatory to monitor social determinants, behaviours and NCD risk factors, and integrate monitoring and evaluation into hospital, regional, departmental and sub-prefectural bodies.[4][13]
• Hold quarterly regional and district review meetings, conduct supervision and periodic reporting, and use dashboards to show trends in diseases, risk factors and determinants.[4][17]
• Conduct a mid-term evaluation using process and outcome indicators, investment-monitoring sheets, semi-annual and annual financial reports, and an intervention dashboard.[17]
• Conduct a final evaluation using qualitative and quantitative impact surveys and epidemiological data to assess implementation and impact.[17]

The framework uses mainly process, activity, coverage and service-readiness indicators. These include revitalised NCD programmes, appointed focal points, partnership agreements, legal instruments, awareness sessions, trained personnel, equipped facilities, screening campaigns, communication tools, referral systems and availability of essential medicines and technologies.[5][21][6][15][8][9]

Selected outcome targets use the 2008 STEPS survey as baseline evidence. They include reducing low physical activity from 34.90% to 33.90% in 2019 and 32.90% in 2021, current tobacco use from 11.2% to 10.2% and 9.7%, raised blood pressure from 27.6% to 25.15% and 24.15%, and age-standardised hyperglycaemia or diabetes from 6.1% to 4.05% and 3.05%.[12]National 2025 targets include a 25% reduction in premature NCD mortality, a 30% reduction in current tobacco use and salt intake, a 10% reduction in harmful alcohol use and insufficient physical activity, and 80% availability and affordability of essential NCD medicines and basic technologies.[3]

Accountability is linked to the Ministry of Public Health, the Non-Communicable Diseases Service, a national multisectoral committee, Regional Health Delegations, District Medical Officers, health facilities and participating partners. The national mechanism is expected to prepare implementation-progress reports for decision-makers and development partners, while verification sources include activity, training, supervision, survey, financial, meeting, legal and receipt records.[2][4][14][22][23][24]

Earlier assessments identified major weaknesses: NCD surveillance was not fully integrated into the national surveillance system, routine data were incompletely published, risk factors were not systematically recorded, documentation was weak and existing monitoring and evaluation systems were only weakly functional.[25][26][27][1]

Costing & Financing

The plan identifies insufficient, delayed and inconsistent financing as a principal constraint on NCD prevention, service delivery, coordination, research and monitoring. Its detailed implementation budget is denominated in CFA francs and covers 2017 to 2021, although the available extracts provide only selected activity costs rather than a consolidated total plan budget.[27][1][28]

• Mobilise financing from the State, local authorities, households, non-governmental organisations and associations, development partners, and national and international organisations.[13][14]
• Increase the NCD allocation within the health budget and encourage national social-protection and solidarity systems, including health-insurance schemes, to cover NCDs.[13][14][22]
• Advocate fiscal measures, including taxation of harmful products such as tobacco and alcohol and subsidies or tax relief for products supporting prevention, including fruit and vegetable production.[5][29]
• Strengthen financial-management capacity among programme managers, as five of seven managers interviewed reported limited understanding of financial management.[25]
• Support research financing and submission of research protocols to funding institutions, although no research-financing amounts are specified.[11][24]

Selected costed governance activities include 1.6 billion CFA francs to revitalise the NCD service and programmes in 2017/2018, 3 million CFA francs to mobilise national and international organisations for NCD financing in 2017, 10 million CFA francs for awareness-raising during 2017-2021, 20 million CFA francs for two joint annual reviews, and 17.5 million CFA francs for legal and regulatory instruments.[28]Several listed activities, including establishing the high-level multisectoral committee, designating sectoral focal points, fiscal advocacy and insurance-coverage advocacy, have recorded zero costs in the budget table.[28]

Health financing draws on the State, households and partners. State health spending represented between 5.29% and 9.14% of the general State budget during 2012-2016, below the Abuja commitment of at least 15%; external aid was declining and was not always aligned with national mechanisms.[30]

The economic burden of NCDs includes catastrophic household expenditure, lost employment, reduced quality of life and weakened family and social cohesion. A 14-day diabetes admission at the National General Reference Hospital was estimated to cost 75,050 CFA francs, equivalent to 150.10 US dollars, in 2014.[31]The extracts do not specify a total NCD-plan budget, full activity-level costing, quantified funding gap, detailed allocation by intervention, or economic assumptions.[13][28]