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 and injuries provides a national framework and road map for 2013 to 2018, addressing cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, sickle cell disease, mental health and injuries within the country’s social, cultural and development context.[1][2]Its vision is healthy Jamaicans living in healthy communities, with optimal quality of life for people living with or affected by non-communicable diseases and injuries.[1]Its mission is to enable healthy living through integrated whole-of-society action, supportive social and environmental policies, and system improvements that support health in all settings.[1]

The overarching goal is to reduce preventable morbidity and disability and avoidable premature mortality from non-communicable diseases and injuries by 25% by 2025.[2]The framework is organised around five programme 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.[2]

• Reduce exposure to tobacco, harmful alcohol use, unhealthy diets, high salt intake, physical inactivity, obesity, hypertension, diabetes and raised cholesterol, while increasing fruit and vegetable consumption and public awareness of priority diseases and risk factors.[3][4]
• Promote healthy environments and health throughout the life course through Health in All Policies, equitable universal access, gender equality, community empowerment and a life-course approach.[1][2]
• Strengthen people-centred primary health care and universal health coverage through prevention, screening, early detection, treatment, rehabilitation, palliative care and quality integrated services.[1][5]
• Develop comprehensive screening for priority non-communicable diseases and risk factors, aiming for at least 80% age-appropriate coverage by 2018.[5][6]
• Improve awareness, diagnosis and control of hypertension, diabetes, dyslipidaemia, depression and cervical cancer, including targeted 25% increases in disease-status awareness and in control of hypertension, diabetes and dyslipidaemia by 2018.[5][7]
• Prevent violence and injuries, build self-management skills for chronic diseases and injuries, and strengthen sickle cell disease management across all levels of care.[4][5]
• Build national surveillance, registry and research capacity so that evidence informs policy, programme design and evaluation.[8][9]
• Advance public policies on tobacco control, harmful alcohol use, healthy diets, physical activity, food systems, environmental and occupational risks, and health-promoting settings.[10][11][12]

Measurable 2018 objectives include relative reductions of 10% in tobacco use and mean population salt or sodium intake, 3% in harmful alcohol use, and 5% in insufficient physical activity and adult and adolescent obesity.[3]The plan also seeks a 5% reduction in adult hypertension, diabetes and raised total cholesterol, a doubling of adult consumption of at least five servings or 400 grams of fruit and vegetables daily, and awareness of priority conditions and risk factors among at least 80% of the population from baseline.[3]

Implementation

Implementation uses a phased five-year model: Phase I actions over one to two years, Phase II actions over three years and Phase III actions over five years, with periodic adjustment according to resources and evidence.[6]The Ministry of Health leads oversight and supports implementation through annual sector-wide operational plans, building on existing programmes, policies, national commitments and World Health Organization evidence-based best buys.[13][2]

The delivery model is multisectoral and whole-of-society because many determinants of non-communicable disease lie outside the health sector.[14]It combines health promotion, regulation, fiscal measures, primary-care reorientation, integrated clinical management, community action and evidence-informed policy.[2][11]

• Coordinate action through the Ministry of Health, Regional Health Authorities, public and private health services, other government ministries, local government, academia, professional associations, civil society, faith-based organisations, community groups and private-sector bodies.[6][7]
• Establish a high-level multisectoral National Non-Communicable Disease Commission or taskforce, supported by a funded secretariat, to coordinate the response, meet at least six times yearly and submit annual reports and recommendations to the Minister of Health.[15][16]
• Develop disease- and risk-factor-specific action plans, including cancer prevention and control plans, alongside detailed annual operational planning.[6]
• Implement tobacco-control measures through taxation and pricing, smoke-free settings, promotion restrictions, health warnings, cessation counselling, smoking-status recording, referral systems and protection from tobacco-industry influence.[3][10]
• Deliver alcohol prevention and treatment through public awareness, primary-care screening and brief interventions, strengthened services and implementation of World Health Organization recommendations.[10]
• Use public education, social marketing, healthier food policies, food labelling, fiscal measures, school and workplace initiatives, parks and walking trails, and exercise prescription in primary care to improve diet and physical activity.[11][12]
• Develop and disseminate national guidelines for priority conditions and risk factors, train health-care workers annually, introduce treatment protocols across primary, secondary and tertiary facilities, and establish a palliative-care policy.[17]
• Expand self-management support through chronic disease passports, patient and family education, home glucose and blood-pressure monitoring, personal treatment targets and trained lay health promoters.[7]
• Scale up neonatal screening, genetic counselling, treatment guidance and workforce training for sickle cell disease.[8]

Surveillance and accountability rely on strengthening the Ministry of Health Non-Communicable Disease Surveillance System, integrating it into the National Health Information System and Caribbean surveillance, updating the minimum dataset, and establishing registries for cancer, cardiovascular disease, diabetes, chronic kidney disease and asthma.[8][9]Priority data actions include making cancer, chronic kidney disease, heart attack and stroke reportable, improving reporting from public and private providers, using unique identifiers, and deploying a Chronic Disease Clinical Information System in primary-care curative clinics.[9][18]

A comprehensive monitoring and evaluation plan is intended to guide annual planning and assess progress, gaps and strengths.[19]Monitoring covers risk factors, screening, treatment, disease control, service availability, workforce capacity, registry coverage, reporting quality, research outputs and dissemination.[7][9][18]Annual reports, press releases, policy briefings, community information and an annual Non-Communicable Disease Conference are intended to support transparency, advocacy and cross-sector review.[18][20]

Resource mobilisation seeks government subvention, national funding agencies, grant applications and international donors, coordinated with the Ministry of Finance and the Planning Institute of Jamaica.[15]If resources are insufficient, the National Non-Communicable Disease Commission and Ministry of Health Non-Communicable Disease Unit are to prioritise a limited set of core programmes and projects.[4]The source does not specify a quantified overall budget or detailed financing allocation.[15][16]

Monitoring & Evaluation

The plan establishes surveillance, research, monitoring and evaluation as one of five priority programme areas and places the Ministry of Health in the lead oversight role, supported by annual sector-wide operational plans.[2]It seeks to strengthen the national non-communicable disease surveillance system, integrate it with health information systems and Caribbean surveillance, establish national disease registries, and use evidence to guide policy, planning and programme evaluation.[6][8]

• Develop a comprehensive monitoring and evaluation plan to guide annual operational planning and assess progress, gaps and strengths.[19]
• Establish registries for cancer, cardiovascular disease, diabetes, asthma and chronic kidney disease, with reporting of confirmed or suspected cancer, chronic kidney disease, heart attack and stroke cases from public and private providers.[6][9]
• Integrate surveillance into the National Health Information System, update the minimum non-communicable disease and injuries dataset, use geographic information systems, standardise survey indicators, introduce unique identifiers and implement a Chronic Disease Clinical Information System in primary-care curative clinics.[9][18]
• Monitor report quality, registry coverage, facility and practitioner reporting, primary-care use of clinical information systems, workforce training, infrastructure, research outputs and dissemination of annual reports, press releases and policy briefings.[9][18]
• Produce annual reports, publish them on the Ministry of Health website, contribute to national, regional and global reporting, and use surveillance, research and evaluation findings to inform policy and planning.[20]

Measurable population targets for 2018 include reductions in tobacco use, harmful alcohol use, salt or sodium intake, insufficient physical activity, obesity, hypertension, diabetes and raised cholesterol; increased fruit and vegetable consumption and awareness of priority conditions; improved screening, disease-status awareness and clinical control.[3]Screening coverage is intended to reach at least 80% of relevant age groups, while awareness and control indicators for selected chronic conditions are each intended to increase by 25%.[5][7]

• Achieve implementation of integrated surveillance and registries by 2018, with more than 80% reporting by health facilities and practitioners, more than 80% registry coverage, at least 50% of primary-care facilities using the clinical information system, at least 80% of surveillance staff trained, and unique identifiers used in more than 95% of health facilities and records.[9][18]
• Track clinical guideline publication, workforce training, screening-policy implementation, palliative-care policy development, treatment-protocol availability and the proportion of chronically ill patients meeting treatment targets.[17]
• Monitor tobacco regulation, smoke-free settings, cessation access, smoking-status documentation, tobacco sales and prevalence, with a 10% relative reduction in tobacco use and 100% smoking-status documentation targeted by 2018.[10]
• Assess alcohol-policy implementation, service access and alcohol use, with at least 80% implementation of relevant World Health Organization recommendations and a 2% relative reduction in alcohol use by 2018.[10]
• Review policies through a committee reporting quarterly to the National Non-Communicable Disease Committee, convene an annual national conference, and require the proposed multisectoral Commission or taskforce to meet at least six times yearly and submit annual reports and recommendations to the Minister of Health.[21][15][16]

Existing evidence mechanisms include national risk-factor surveys, the Jamaica Health and Lifestyle Survey, hospital discharge summaries, mortality statistics from the Statistical Institute of Jamaica, and disease-specific studies.[22][23][24]Important information gaps include national cancer incidence and outcome data, population-based data on peripheral arterial disease and chronic obstructive pulmonary disease, and national epilepsy data.[23][25][26]Detailed indicator definitions, baseline values and evaluation methods are not consistently specified.[2]

Costing & Financing

The strategy seeks adequate financing for non-communicable disease prevention and control through government subvention, national funding agencies, international donors and grants for specific programme components.[6][15]Government commitment is expected to include resources for core staff positions, priority programmes and projects, with contingency arrangements to prioritise a limited core package if sufficient resources are not secured.[4]

• Mobilise resources with the Ministry of Finance, the Planning Institute of Jamaica, national funding agencies and international donors, and pursue Cabinet approval for the government-funded component of the programme budget.[15]
• Provide a specific budgetary allocation for the proposed multisectoral National Non-Communicable Disease Commission or taskforce, including a funded secretariat, and fund posts through government resources or grants.[15][16]
• Seek funding by 2014 through government subvention, national funding agencies and international donors.[6]
• Use the National Health Fund, the Culture Health Arts Sports and Education Fund, corporate foundations, the Pan American Health Organization, the World Health Organization, the Inter-American Development Bank and the World Bank as potential funding sources.[4]
• Increase official development funding for non-communicable diseases by 20% by 2018 and monitor public-sector investment, with an indicative investment target equivalent to 3% of gross domestic product.[20][19]

No consolidated budget, costed implementation plan, expenditure breakdown, quantified funding gap, unit-cost schedule or economic assumptions are provided.[6][15]The plan nevertheless identifies substantial economic burdens associated with diabetes, hypertension, and violence-related injuries, and describes taxation, subsidies and other fiscal measures as policy tools to influence consumption and support health promotion.[27][14][11]Tobacco tax revenue has included a 20% allocation to the National Health Fund since 2008.[28]