Belize National Plan of Action for the Prevention and Control of Non-Communicable Diseases 2013-2023

Objectives

Belize’s National Plan of Action for the Prevention and Control of Non-communicable Diseases (NCDs) 2013–2023 provides a cross-sector blueprint to improve Belizeans’ wellness, reduce the NCD burden and improve life expectancy and well-being. Its overarching target is a 25% reduction by 2023 in premature mortality from cardiovascular diseases, cancer, diabetes mellitus and chronic respiratory diseases.[1][2]

• Address the four priority diseases, cardiovascular disease, diabetes, chronic respiratory disease and cancer, and their shared risk factors: tobacco use, harmful alcohol use, unhealthy diet and insufficient physical activity.[2][3]
• Apply four lines of action: risk-factor reduction, health promotion and communications; integrated disease management and patient self-management; surveillance, monitoring and evaluation; and programme management, policy and advocacy.[4][3]
• Promote prevention, health promotion, primary health care and policy implementation through both population-wide and individual-based measures, with attention to health inequities, gender and multisectoral action.[2]
• Reduce tobacco smoking by 30%, alcohol consumption per capita by 10%, and heavy episodic drinking by 10% by 2023, subject to stated baselines and national context.[5][6]
• Reduce insufficient physical activity and sedentary behaviour, contain raised blood pressure, and halt increases in adult overweight, obesity and type 2 diabetes.[7][8]
• Improve food environments through an operational food and nutrition security policy, school healthy-eating and physical-education policies, healthier food labelling, voluntary reformulation of locally produced foods, and controls on children’s exposure to marketing of foods and non-alcoholic beverages high in saturated fat, trans fat, free sugars or salt.[9][6]
• Achieve equitable access to prevention, diagnosis, treatment, rehabilitation and palliative care, including affordable, safe and effective essential medicines and technologies.[5][10]

The plan aligns Belize’s response with the World Health Organization (WHO) Global Monitoring Framework and Global Action Plan, the Pan American Health Organization (PAHO) regional NCD plan, Caribbean Community directions and Belize’s Horizon 2030 framework.[11][12]It was developed from a situational analysis incorporating epidemiological evidence, stakeholder feedback and review of relevant policies, programmes and procedures.[13]

Implementation

Implementation combines policy and advocacy, risk-factor prevention, health promotion, integrated patient-centred care, self-management support, strengthened surveillance and multisectoral coordination.[1][14]The Ministry of Health is the central health-sector institution, supported by government, civil society, private-sector and international partners.[11][2]

• Coordinate multisectoral action involving sectors responsible for health, education, agriculture, economic development, finance, trade, labour, social development and local government, alongside schools, universities, media, professional bodies, insurers, trade unions, food producers and vendors.[7][5]
• Use the multisectoral NCD Commission, chaired by the Director of Health Services, for advocacy, monitoring and oversight, while strengthening its mandate, membership, coordination mechanisms and engagement with Cabinet.[15]
• Establish a dedicated NCD programme and secretariat within the Ministry of Health, with defined leadership, mandate, accountability and a corresponding budget, although the supplied material does not quantify that budget.[5][10]
• Implement tobacco and alcohol measures through policy finalisation, legislation and enforcement, including action on taxation, advertising, smoke-free environments, warning labels and point-of-sale restrictions.[3][9]
• Deliver nutrition action through the Food-Based Dietary Guidelines, revision of food and nutrition security policy, school-meal improvements, school gardens, vendor education and voluntary reductions in salt, fat and sugar.[16][17]
• Develop national physical-activity guidance and support practical low-cost activity in schools, workplaces, communities and public spaces for walking, cycling, jogging and games.[17][18]
• Lead health promotion through the Health Education and Community Participation Bureau, using school and community education, media messaging, training, health fairs and technical support, while addressing its identified human and financial resource constraints.[19]
• Strengthen integrated NCD service delivery across community, primary, secondary and tertiary care through minimum service packages, evidence-based guidelines, clinical information systems, laboratory support, referral and counter-referral arrangements, community support and patient self-management.[14][7]
• Procure essential medicines and technologies through the PAHO Strategic Fund, Revolving Fund and other cost-saving mechanisms, with a target of 80% availability of affordable, safe and effective essential NCD medicines and basic technologies by 2018.[7][20]

The delivery model builds on existing Ministry of Health programmes and the public health network, including National Health Insurance arrangements.[15][14]Patient self-management is to use culturally relevant and language-appropriate education, routine reinforcement during clinical visits, psychosocial support and collaboration with organisations including the Belize Diabetes Association.[14][21]

Monitoring uses 33 indicators, incorporating seven WHO voluntary global targets, 18 WHO global indicators, eight additional PAHO regional indicators and seven country-specific indicators.[12]The Belize Health Information System, cause-specific mortality and hospital morbidity reporting, disease registries, periodic risk-factor surveys and Caribbean Minimum Dataset reporting are intended to support evidence-based planning and surveillance.[18][22][20]

Planned accountability measures include annual reviews of operational plans, risk-factor surveys by the ends of 2018 and 2023, functional population-based cancer and diabetes registries by 2015, and mid-term and final evaluations in 2018 and 2023.[20][10]National Health Insurance contracts also use performance indicators and financial rewards for primary care providers meeting standards, while annual audits are proposed for all primary care facilities.[14][21]

The supplied material does not provide an overall costed implementation plan, itemised budget allocations, quantified financing gap or identified financing sources.[7][10]It identifies the need for adequate resources for surveillance, health information systems and health promotion, and recognises the high economic and household costs associated with NCD care.[13][23][19]

Monitoring & Evaluation

The plan establishes a monitoring and evaluation framework for reducing premature mortality and the burden of non-communicable diseases (NCDs), combining World Health Organization (WHO), Pan American Health Organization (PAHO), regional and country-specific measures. It uses 33 indicators, including seven of nine WHO voluntary global targets, 18 of 25 WHO global indicators, eight of 10 additional PAHO regional indicators and seven country-specific indicators.[12][3]

• Monitor mortality, morbidity, behavioural and biological risk factors, and national health-system responses, including premature mortality among people aged 30 to 70 years, cancer incidence, alcohol consumption, physical inactivity, tobacco use, blood pressure, diabetes, overweight, obesity, diet and cholesterol.[8][24]
• Track outcome targets including a 25% relative reduction in premature mortality by 2023, a 30% reduction in tobacco use by 2023, reductions in alcohol consumption and heavy episodic drinking, a 25% reduction in raised blood pressure, and no increase in diabetes or obesity.[5][6][8]
• Monitor process targets such as Cabinet endorsement, establishment of a functional NCD secretariat, operational food and nutrition security policy, school healthy-eating and physical-education policies, and population-based cancer and diabetes registries.[5][6]
• Conduct annual operational-plan reviews, nationally representative adult and youth risk-factor surveys by the ends of 2018 and 2023, and mid-term and final plan evaluations in 2018 and 2023.[20][10][25]
• Use the Belize Health Information System, cause-specific mortality data, hospital morbidity data and the Caribbean Minimum Dataset to strengthen surveillance, reporting and disease registries.[18][22]
• Improve dissemination and use of surveillance findings through quarterly and annual reporting, Ministry of Health web publication, stronger analytical capacity and more complete data from public and private providers.[18][26]
• Apply accountability mechanisms through National Health Insurance performance indicators, monthly and annual clinic reporting, performance-linked financial rewards and phased annual primary-care audits.[14][21]

Implementation capacity remains uneven: Belize had reported 31 of 44 core Caribbean Minimum Dataset indicators, none of 19 expanded indicators and all 12 optional indicators.[22][26]The plan identifies data gaps concerning disaggregation by ethnicity, region, age, gender and vulnerable groups, as well as gaps in information on alcohol-related harms, NCD economic costs and intervention impacts.[26]Detailed reporting lines, data-quality procedures and accountability arrangements are not consistently specified beyond the monitoring, review, audit and oversight mechanisms described.[12][2]

Costing & Financing

The supplied material does not provide an overall costed implementation plan, total budget, itemised allocations, financing gap or quantified resource-mobilisation target for Belize’s NCD strategy.[7][20]It nevertheless identifies financing needs, economic consequences of NCDs and procurement mechanisms intended to improve affordability of essential medicines and technologies.[13][27]

• Establish a corresponding budget for a dedicated Ministry of Health NCD programme, although no amount, source or allocation is specified.[5][25]
• Use the PAHO Strategic Fund, Revolving Fund and other cost-saving procurement mechanisms to obtain essential medicines and health technologies for prevention, treatment and palliation.[7][27]
• Improve affordability and availability of quality-assured essential NCD medicines, generic medicines and basic technologies, with an 80% availability target by 2018.[20][10]
• Increase human and financial resources for the Health Education and Community Participation Bureau, which is identified as substantially under-resourced for health-promotion responsibilities.[19]
• Strengthen funding for NCD and risk-factor surveillance, health-information systems, registries and data analysis, which are described as insufficiently resourced.[23][22]
• Assess cost-benefit and analytical questions relating to vaccines, technologies and National Health Insurance interventions through the NCD research agenda.[20][10]

NCDs are framed as a development and household-financial-risk issue because of rising healthcare expenditure, productivity losses from premature death and potential catastrophic spending.[13]A cited analysis associates a 10% rise in NCD cases with a projected 0.5% decrease in annual economic growth, while treatment of diabetes and hypertension in selected Latin American and Caribbean countries was reported at 5% to 8% of gross domestic product.[13][28]In Belize, dialysis represented 1.6% of health expenditure in 2010 despite serving less than 0.015% of the population.[29]Fiscal measures noted include a 12.5% general sales tax and a 2% environmental tax on gym and exercise equipment; the material does not quantify revenues, health effects or the costs of proposed policy changes.[4][16]