National Strategic and Action Plan for the Prevention and Control Non-Communicable Diseases in Jamaica 2013-2018

Objectives

Jamaica’s National Strategic and Action Plan for the Prevention and Control of Non-Communicable Diseases, covering 2013–2018, provides a national framework and roadmap to reduce the burden of non-communicable diseases (NCDs), injuries and shared risk factors in the country’s socioeconomic and cultural context.[1][2]Its vision is for healthy Jamaicans living in healthy communities, including people affected by NCDs and injuries achieving optimal quality of life; its mission is to enable healthier lives through integrated whole-of-society action, supportive social and environmental policy, and health-system improvement.[3][2]

The overarching goal is to reduce preventable morbidity and disability and avoidable premature mortality from NCDs and injuries by 25% by 2025.[3][4]The plan focuses on cardiovascular diseases, diabetes, cancers and chronic respiratory diseases, while also addressing sickle cell disease, mental health disorders, violence and injuries, and healthy ageing.[5][2][6]

• Reduce exposure to tobacco, harmful alcohol use, unhealthy diets, excess salt, trans-fats, insufficient physical activity, obesity, hypertension, diabetes and raised cholesterol, while increasing fruit and vegetable consumption and public awareness of priority conditions and risks.[7][8][9]
• Strengthen people-centred primary health care, universal health coverage, early detection, treatment, rehabilitation, palliative care, self-management and quality of care for NCDs and injuries.[10][4][11]
• Establish comprehensive screening and disease-management arrangements, including targets for at least 80% age-appropriate screening for priority conditions and risk factors by 2018.[12][11]
• Build surveillance, research, monitoring and evaluation capacity, including national registries for cancer, cardiovascular disease, diabetes, asthma and other priority conditions.[12][13][14]
• Advance Health in All Policies, public advocacy, international cooperation, leadership, governance, multisectoral action and partnerships.[10][15][16]

The plan is organised around five priority areas: risk-factor reduction and health promotion; comprehensive and integrated disease management; surveillance, research, monitoring and evaluation; public policy and advocacy; and leadership, governance and capacity building.[17][4]It aligns priority interventions with World Health Organization cost-effective “best buys”, including tobacco and alcohol control, salt reduction, replacement of trans-fats, healthy diets, physical activity, cardiovascular risk management, hepatitis B immunisation and cervical cancer prevention.[3]

Key 2018 outcome targets include relative reductions in tobacco use of 10%, harmful alcohol use of 3%, and insufficient physical activity, obesity, hypertension, diabetes and raised total cholesterol of 5%; a 10% reduction in mean salt or sodium intake; and a doubling of the proportion of adults consuming at least five servings or 400 grams of fruit and vegetables daily.[7][8]The plan also seeks a 25% increase in awareness of hypertension, diabetes, depression, dyslipidaemia and cervical-cancer status, alongside a 25% increase in control of hypertension, diabetes and dyslipidaemia.[7]

Implementation

Implementation is phased over five years, with short-term actions over one to two years, medium-term actions over three years and long-term actions over five years; phasing may be adjusted according to resources and evidence.[10][18]The Ministry of Health leads and oversees implementation through annual sector-wide operational plans, supported by separate detailed action plans for priority diseases and risk factors.[3][4][18]Delivery is intended as a whole-of-government and whole-of-society response because many determinants and interventions sit beyond the health sector.[6][2]

• Coordinate implementation through the Ministry of Health, Regional Health Authorities, public and private health services, other government sectors, academia, civil society, faith-based organisations, communities, professional associations and international partners.[12][19][13]
• Strengthen primary-care delivery through national clinical and screening guidelines, workforce training, chronic-disease care plans and passports, self-monitoring support, patient education, essential medicines, laboratory capacity, diagnostic services and pharmacy services.[20][21][22]
• Implement risk-reduction measures through tobacco taxation, promotion restrictions, smoke-free settings, cessation support and tobacco-control legislation; alcohol awareness, screening and brief interventions; healthier food standards, labelling and fiscal measures; and physical-activity action in schools, workplaces, transport planning and communities.[23][9][24]
• Develop cross-sector policies with agriculture, education, sport, transport, labour, local government, national security, finance, food-industry and private-sector actors.[6][9][15][25]
• Establish or upgrade a high-level National NCD Commission or multisectoral taskforce, supported by a secretariat and National NCD Unit, to coordinate action, review progress and provide recommendations to the Minister of Health.[16][26]

Governance arrangements include upgrading the National NCD Committee into a high-level multisectoral commission or taskforce involving government, civil society, the private sector, academia and faith-based organisations.[16]The body is expected to meet at least six times annually, assess progress towards targets and submit annual reports and recommendations to the Minister of Health.[16][26]A policy review committee under the National NCD Committee is intended to review relevant government policies, meet quarterly and produce annual reports to support Health in All Policies.[25]

The monitoring approach includes integration of NCD surveillance with the National Health Information System, standardised indicators, compulsory reporting of selected conditions, registry development, improved data linkage through unique identifiers, routine analysis of survey and clinical data, and dissemination through annual reports, policy briefings, press releases and community education.[14][27]Targets include more than 80% reporting by facilities and practitioners, more than 80% island registry coverage, at least half of primary-care facilities using the chronic disease clinical information system, and use of unique identifiers in more than 95% of facilities and records.[14][27]

Financing is to draw on government subvention, national funding agencies, international donors, grants and project proposals, with potential domestic support from the National Health Fund, the Culture Health Arts Sports and Education Fund and corporate foundations.[8][16]If resources are inadequate, the NCD Committee and Ministry of Health NCD Unit are expected to prioritise core programmes and projects.[8]The supplied material does not provide a detailed costed budget, programme allocations or quantified funding gap.[12][16]

Monitoring & Evaluation

The plan places surveillance, research, monitoring and evaluation among its five core programme areas, with the Ministry of Health responsible for oversight and annual sector-wide operational planning.[4]A companion monitoring and evaluation plan is intended to guide annual planning by sectors and lead agencies, although the supplied material does not set out a full reporting cycle, data-quality protocol or independent evaluation design.[18]

• Strengthen the national non-communicable disease surveillance system, integrate it with the National Health Information System and Caribbean information systems, and use a unique identifier to link surveys with hospital, civil-registration and National Health Fund data.[13][27]
• Establish national registries for cancer, cardiovascular disease, diabetes, asthma and chronic kidney disease, supported by compulsory reporting of selected cases across public and private providers.[14][27]
• Monitor progress against 2018 risk-factor targets, including relative reductions of 10% in tobacco use and salt intake, 3% in harmful alcohol use, and 5% in insufficient physical activity, obesity, hypertension, diabetes and raised total cholesterol.[7]
• Track service-coverage and outcome measures, including at least 80% age-appropriate screening for priority conditions and risk factors, 25% increases in awareness of specified disease status and in control of hypertension, diabetes and dyslipidaemia, and access to essential medicines and basic technologies.[12][21]
• Measure registry and reporting performance through targets of more than 80% reporting by facilities and practitioners, more than 80% island registry coverage, use of the clinical information system in at least half of primary-care facilities, and unique identifiers in more than 95% of facilities and records.[14][27]
• Conduct targeted data collection and surveys, including salt-intake and fruit-and-vegetable measures in national health surveys, a physical-activity Knowledge, Attitude, Practice and Behaviour survey, and monitoring of vaccination, environmental-risk and occupational-health actions.[9][24]
• Publish annual surveillance and research reports, policy briefings, press releases and community education materials, and monitor research outputs, funding applications and evidence-based programme development.[27]
• Hold annual national reviews and conferences, while the proposed National Non-Communicable Disease Commission or taskforce is expected to meet at least six times yearly and submit annual reports and recommendations to the Minister of Health.[15][16][26]

Available evidence identifies important baseline gaps, notably limited national incidence data for heart attacks and strokes, lack of population-based peripheral arterial disease data, and incomplete national cancer incidence and outcome data.[28][29]Earlier programme experience also highlighted the need for specific, measurable and sustainable objectives: a formal evaluation found that the Healthy Lifestyle Project was overly broad and did not achieve the intended improvement in health behaviours.[30]

Costing & Financing

No comprehensive costed implementation plan, programme budget, allocation by priority area, quantified funding gap or economic assumptions are provided in the supplied material.[2][4][7]Financing is nevertheless framed as a requirement for implementation, workforce development, diagnostics, laboratory services, pharmacy capacity, registries, surveillance and research.[12][14][16]

• Mobilise funding through government subvention, national funding agencies, international donors, programme grants and project proposals, with the Ministry of Health coordinating with the Ministry of Finance and the Planning Institute of Jamaica.[8][16]
• Draw on named domestic and external sources, including the National Health Fund, Culture Health Arts Sports and Education Fund, corporate foundations, Pan American Health Organization, World Health Organization, Inter-American Development Bank and World Bank.[8]
• Allocate 20% of tobacco-tax revenue to the National Health Fund, an arrangement in place since 2008.[31]
• Prioritise core programmes and projects through the Non-Communicable Disease Committee and Ministry of Health Non-Communicable Disease Unit if adequate resources are not secured.[8]
• Seek public-sector investment equivalent to 3% of gross domestic product for non-communicable disease prevention and control, although the source does not clarify whether this is a committed allocation or a lead target.[18]

The material describes a substantial economic burden. In Jamaica, direct and indirect diabetes and hypertension costs were estimated at US dollars 460,442,870 in 2001, while diabetes treatment alone was estimated at US dollars 221 million.[32][28]Violence-related injuries were estimated to incur Jamaican dollars 2.1 billion in direct medical costs in 2006 and Jamaican dollars 27.5 billion in productivity losses.[33]Sickle-cell-related diagnoses also accounted for approximately 2% of admissions and 2,783 person-days of hospitalisation at the University Hospital of the West Indies in 2010.[34]