National Targets for Reducing Premature Mortality from Noncommunicable Diseases

Objectives

Costa Rica’s National Strategy for the Integrated Approach to Non-Communicable Diseases and Obesity, covering 2014–2021, seeks to reduce morbidity, premature mortality and disability from non-communicable diseases and obesity, while improving quality of life through action on protective factors, risk factors and health-service provision.[1]It responds to international commitments, the national burden of disease and Sustainable Development Goal 3 on reducing premature mortality from non-communicable diseases.[1][2]

• Reduce premature mortality from priority diseases, initially through a 2021 target of a 17% reduction and subsequently through revised 2030 disease-specific mortality targets.[3][2]
• Address harmful alcohol use, physical inactivity, excessive salt or sodium consumption, tobacco use, hypertension, diabetes, obesity and cardiovascular-risk treatment.[3]
• Target ischaemic heart disease, chronic respiratory disease, diabetes mellitus and cerebrovascular disease using the 2014–2016 average premature mortality rate among people aged 30–69 as the baseline.[2][4]
• Reduce mortality by 2030 by 5 deaths per 100,000 inhabitants for ischaemic heart disease, 1 for chronic respiratory disease, 2 for diabetes mellitus and 5 for cerebrovascular disease.[4]
• Reduce the overall average mortality rate from 76.15 to 65.00 per 100,000 inhabitants by 2030.[5]
• Maintain and strengthen cancer objectives, including human papillomavirus vaccination, premature-mortality targets for cervical, breast, stomach and colon cancer, earlier detection and diagnosis of gastric and colorectal cancer, and improved oncology-care quality.[5][6]
• Consider chronic kidney disease as a separate target because non-traditional chronic kidney disease is significant in Central America; cancer targets were subject to final review and validation.[2]

Implementation

The strategy adopts an intersectoral, multi-factorial approach, recognising that non-communicable diseases have multiple causes and require political commitment and participation across sectors.[1]The National Agreement for the Integrated Approach to Chronic Non-Communicable Diseases and Obesity 2014–2021 supported an intersectoral action plan to achieve national targets.[1]The Ministry of Health provides stewardship, while interventions are to be adapted to institutional conditions, cost-effectiveness, national circumstances and available resources.[2]

• Analyse epidemiological trends for 2006–2016 to establish mortality baselines and agree revised targets.[2][4]
• Convene health-sector institutions through workshops held on 6 December 2017 and 1 February 2018 to examine priority diseases and determine baselines and targets.[2]
• Phase mortality reduction across 2019–2022, 2023–2026 and 2027–2030, then allocate the required reduction annually for each disease and for the overall rate.[4][7]
• Deliver prevention and treatment measures for priority diseases, including human papillomavirus vaccination, earlier cancer detection and diagnosis, and improvements in oncology care.[5][6]
• Align implementation with Costa Rica’s National Development and Public Investment Plan, World Health Organization voluntary targets and the Sustainable Development Goals.[5][6]
• Use mortality information from the Ministry of Health’s Directorate of Health Surveillance, drawing on National Institute of Statistics and Census data.[4]
• Review the action plan in 2019 to identify outputs achieved, challenges, limitations and institutional changes affecting delivery, alongside a design and process evaluation under the Ministry of National Planning and Economic Policy’s National Evaluation Agenda.[2]

Progress is to be assessed at the end of 2022, 2026 and 2030, allowing for a one-year delay in final mortality data.[7]Annual monitoring uses three-year rates comprising the assessment year and the preceding two years, reducing variability and enabling comparison with milestone targets.[4][7]An earlier review by the Office of the Comptroller General of the Republic found that 2007–2017 actions were insufficient to meet the original targets, prompting adjustment of premature-mortality targets.[3]The source does not specify a complete institutional division of delivery responsibilities, detailed accountability procedures, reporting arrangements or a budget, funding source or resource allocation.[1][6]

Monitoring & Evaluation

Monitoring centres on revised premature-mortality targets for non-communicable diseases (NCDs), using three-year average mortality rates and milestone assessments through 2030. The framework also provides for action-plan review, a design and process evaluation, and subsequent adjustment of risk-condition targets.[1][2][4]

• Use the 2014-2016 average premature mortality rate among people aged 30-69 as the baseline for ischaemic heart disease, chronic respiratory disease, diabetes mellitus and cerebrovascular disease.[4]
• Use mortality data compiled by the Ministry of Health’s Directorate of Health Surveillance from National Institute of Statistics and Census data.[4]
• Calculate three-year average rates, comprising the assessment year and two preceding years, to reduce variability in mortality events and assess annual change.[4][7]
• Monitor disease-specific and overall mortality rates per 100,000 inhabitants against milestone values for 2022, 2026 and 2030.[7][5]
• Assess progress at the end of 2022, 2026 and 2030, while accounting for a one-year delay in availability of final mortality data.[7]
• Review annual and period-based reductions against the 2022 and 2030 targets; the overall rate was expected to decline by 4 deaths per 100,000 inhabitants by 2022.[4]
• Conduct a general 2019 review of the Strategy action plan to identify outputs achieved, challenges, limitations and changes in the institutional context affecting implementation.[2]
• Undertake a 2019 design and process evaluation through the National Evaluation Agenda of the Ministry of National Planning and Economic Policy, pursuant to official letter DM-1270-18 of 6 November 2018.[2]
• Adjust impact targets for risk conditions after revising targets for premature mortality.[2]
• Track mortality-reduction targets for ischaemic heart disease, chronic respiratory disease, diabetes mellitus and cerebrovascular disease, while subjecting cancer targets to final review and validation and considering chronic kidney disease as a separate target.[2]
• Monitor the 2030 reduction trajectory from an average mortality rate of 76.15 to 65.00 per 100,000 inhabitants for prioritised NCDs.[5]
• Track associated cancer-related targets, including human papillomavirus vaccination, early detection and diagnosis of gastric and colorectal cancer, and quality of oncology care.[5][6]
• Recognise that a Comptroller General of the Republic analysis covering 2007-2017 found actions insufficient to achieve the original targets, prompting adjustment of premature-mortality targets for chronic diseases.[3]
• Note that the available text does not specify a complete indicator framework, routine reporting timetable, detailed surveillance protocol, designated evaluation body or formal accountability procedure beyond the review, data-use and target-adjustment arrangements described.[3][7][5][6]

Costing & Financing

No explicit budget, costing, funding allocation, financing source, resource-mobilisation measure, funding gap or quantified economic assumption is provided.[1][6]

• Adjust interventions and actions to national circumstances, available resources and cost-effectiveness considerations.[2]
• Recognise finance only through an indirect linkage to Sustainable Development Goal 17; no financing mechanism or monetary commitment is quantified.[6]
• Note that the available text does not define a resource envelope, programme-level expenditure, donor contribution, domestic funding source or estimated funding shortfall.[1][2][6]