Kiri

For the 20 21 survey: Ms Sille Pihlak , Chief Specialist, Public Health Department, Ministry of Social Affairs of Estonia ( e-mail: [email protected] ) - was nominated as a focal point . WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ WELTGESUNDHEITSORGANISATION Date: 12 May 2023 ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ REGIONAL OFFICE FOR EUROPE Ms Elen Ohov BUREAU RÉGIONAL DE L’EUROPE REGIONALBÜRO FÜR EUROPA Adviser ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО European Union Affairs and International Co- Head office: operation Department UN City, Marmorvej 51, Ministry of Social Affairs DK-2100 Copenhagen Ø, Denmark Suur-Ameerika 1 Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Email: [email protected] 10122 Tallinn Website: https://www.who.int/europe Estonia Our reference: WHO/GDO Your reference: Notre référence: -30-2023 Votre référence: Unser Zeichen: Ihr Zeichen: См. наш номер: На Ваш номер: Dear Ms Ohov, Nomination of data provider for the 2023 Global Survey on Assessment of National Capacity for the Prevention and Control of Noncommunicable Diseases The Global Survey on Assessment of National Capacity for the Prevention and Control of Noncommunicable Diseases (NCDs) has been organized every two years by the Department for Prevention of NCDs at WHO headquarters in collaboration with WHO regional offices. The aim of the survey is to collect information from countries on their current capacities with regard to NCD infrastructure and governance, policy action, surveillance and health system response, as well as to identify areas that require further prioritization and strengthening. The data collected through the survey are used to report on progress made towards meeting commitments made by heads of states and governments in the 2011 Political Declaration of the United Nations High-level Meeting of the General Assembly on the Prevention and Control of NCDs and in subsequent high-level meetings held in 2014 and 2018, as well as those commitments made with the adoption of the Global NCD Action Plan 2013–2030, the European Action Plan for the Prevention and Control of NCDs 2016–2025, and the general and European programmes of work. In the last three rounds of data collection, all Member States of the WHO European Region provided data for this important survey. Data are usually provided by designated national data providers, whose names and affiliations for the 2021 round of data collection are given in Annex 1. As in previous rounds, data collection for the survey, which will be launched in June 2023, will be conducted via an online platform. WHO is currently finalizing the questionnaire 2023, previous version of questionnaire 2021 is given in Annex 2. The 2023 data collection in the WHO European Region will be coordinated by the Special Initiative on NCDs and Innovation. The contact person is Dr Ivo Rakovac, Regional Adviser NCD Surveillance ([email protected]). With this letter, we kindly request that you nominate a data provider for the 2023 round of the Global Survey on Assessment of National Capacity for the Prevention and Control of NCDs. Please send contact details of the designated data provider by email to [email protected] with a copy to [email protected] and [email protected] by 2 June 2023. UN City, Marmorvej 51 Tel.: +45 45 33 70 00 Email: [email protected] DK-2100 Copenhagen Ø Fax: +45 45 33 70 01 Website: https://www.who.int/europe Denmark We will then contact the nominated data provider with detailed instructions. If we do not receive your nomination in time, we will assume that you will be acting as data provider. I express my gratitude for your support and collaboration in this important activity. Sincerely yours, Dr Gauden Galea Strategic Advisor Special Initiative on NCDs and Innovation Encls: Annex 1. Nominated data providers for the 2021 Global Survey on Assessment of National Capacity for the Prevention and Control of NCDs Annex 2. Questionnaire for the 2021 survey Copy for information to: Ms Triin Uusberg, Head, European Union Affairs and International Co-operation Department, Ministry of Social Affairs, Suur-Ameerika 1, 10129 Tallinn, Estonia H.E. Ms Katrin Saarsalu-Layachi, Ambassador Extraordinary and Plenipotentiary, Permanent Representative, Permanent Mission of the Republic of Estonia to the United Nations Office and other international organizations in Geneva, Chemin du Petit-Saconnex 28A, CH-1209 Genève, Switzerland H.E. Mr William Mart Laanemäe, Ambassador Extraordinary and Plenipotentiary, Embassy of the Republic of Estonia, Frederiksgade 19, 4th floor, 1265 Copenhagen K, Denmark Ms Kristina Köhler, Liaison Officer, WHO Country Office, Estonia, Paldiski Road 81, 10617 Tallinn, Estonia –2– 2021 Country Profile of Capacity and Response to Nonc ommunicable Diseases ( NCD s ) MODULES: I PUBLIC HEAL T H INFRAS T RUC T URE , PARTNERSHIPS AND MULTISECTORAL COLLABORATION FOR NCD s AND THEIR RISK FACTORS II S T A T US OF NCD - RELEVAN T POLICIES, S T RA T EGIES AND AC T ION PLANS III HEAL T H INFORMA T ION SYS T EMS, MONITORING, SURVEILLANCE AND SURVEYS FOR NCD s AND THEIR RISK FACTORS I V CAPACITY FOR NCD EARLY DETECTION, TREATMENT AND CARE WITHIN THE HEALTH SYSTEM V NCD-RELATED DISRUPTIONS DURING THE COVID-19 PANDEMIC Purpose The purpose of this survey is to gauge your country ’s capacity for responding to noncommunicable diseases (NCDs) . It will guide Member States, WHO Regional Offices and WHO HQ in planning future actions and technical assistance required to address NCDs and their risk factors . This is also the basis for ongoing assessment of changes in country capacity and response. Responses to the survey enable reporting against NCD Global Action Plan process indicators and UN High Level Meeting national commitment progress indicators. The information collected through this survey will also be used to produce some of the indicators that Member States have agreed to monitor and will be held accountable to the United Nations General Assembly (UNGA) and World Health Assembly (WHA); Use of standardized questions allows comparisons of country capacities and responses. We have divided this survey into four modules, assessing key aspects of NCD prevention and control. The four main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. The survey also captures information on policies related to other NCDs of importance to countries such as oral health , diseases of eyes or ears and sensory impairments including hearing or vision impairment . The main risk factors for NCDs are harmful use of alcohol, tobacco use, unhealthy diet, and physical inactivity. Capacity assessment related to some specific risk factors is also captured in other topic-specific assessments such as tobacco, alcohol, and nutrition, which may be used to cross-validate some survey items. Process T he survey is intended to assess national level capacity and response to NCDs. If responsibility for health is decentralized to sub-national levels, it can also be applied at sub-national levels. A focal point or survey coordinator will need to be identified to coordinate and ensure survey completion. However, in order to provide a complete response , a group of respondents with expertise in the topics covered in the modules will be needed. Please use the table provided to indicate the names and titles of all of those who have completed the survey and which sections they have completed. Please also add any additional information on other sources you may have consulted in developing your response. Please note that while there is space to indicate “Don’t Know” for most questions, there should be very few of these. If someone is filling in numerous “Don’t Knows”, another person who is more aware of this information should be found to complete this section. In order to validate responses, documentation will be requested for affirmative responses throughout the questionnaire. Please make every effort to provide electronic copies of the requested documentation. If documentation has been provided previously and is available in the NCD Document Repository ( https://extranet.who.int/ncdccs/documents ), please indicate this. If you are unable to provide electronic copies through the provided links, please ask your regional focal point for an alternative means to submit documentation. Information on those who completed the survey Who is the focal point for completion of this survey? Name: _____________________________ ___ Position : ________________________________ Contact Information: _______________________________________________________________________ Sections completed: _______________________________________________________________________ Name and contact information of others completing survey Sections completed -20375 258390 A dditional information sources consult ed: I: PUBLIC HEALTH INFRASTRUCTURE, PARTNERSHIPS AND MULTISECTORAL COLLABORATION FOR NCD s AND THEIR RISK FACTORS This module includes questions related to the presence of a unit or division in the ministry of health dedicated to NCDs and risk factors , staff and funding. It also includes an assessment of the existence of fiscal interve n tions as incentives to influence health behaviour and/or to raise funds for health-related activities. Finally , it assesses the existence of a formal multisectoral mechanism to coordinate NCD -related activities in sectors outside of health. Is there a unit/branch/department in the ministry of health or equivalent with responsibility for NCD s and their risk factors ? Yes No Don’t Know IF NO: Go to Question 2 Please indicate the number of full-time -equivalent technical/professional staff in the unit/branch/department. □ 0 □ 1 □ 2- 5 □ 6 - 10 □ 11 or more □ Don’t know 1b) Are there technical/professional staff in the unit/branch/ department dedicating a significant proportion of their time to: Harmful use of alcohol Yes No Don’t Know Unhealthy diet Yes No Don’t Know Physical inactivity Yes No Don’t Know Tobacco use Yes No Don’t Know v) Cancer Yes No Don’t Know vi) Cardiovascular diseases Yes No Don’t Know vii) Chronic respiratory diseases Yes No Don’t Know viii) Diabetes Yes No Don’t Know ix) Oral diseases Yes No Don’t Know x) Ear diseases/hearing impairment Yes No Don’t Know xi) Eye diseases/vision impairment Yes No Don’t Know 1c) Are there unit s /branch es /department s with responsibility for NCDs and their risk factors at the subnational/state/regional level? Yes No Don ’ t Know 2 ) Is there dedicated funding allocated in the government budget for the following NCD and risk factor activities/functions? i ) Primary prevention Yes No Don’t Know ii) Health promotion Yes No Don’t Know iii) Early detection/screening Yes No Don’t Know iv) Health care and treatment Yes No Don’t Know v) Surveillance, monitoring and evaluation Yes No Don’t Know v i ) Capacity building Yes No Don’t Know vi i ) Palliative care Yes No Don’t Know viii) Research Yes No Don’t Know ix) Rehabilitation Yes No Don’t Know I f at least one Yes to above questions: 2 a ) What percentage of regular funding for NCD s and their risk factors come from each of the following sources ? ____ General government revenues ____ Health insurance ____ International Donors ____ National Donors ____ Earmarked taxes on alcohol, tobacco, etc . ____ Other (specify) _____________________ Don’t Know 3 ) Is your country implementing any of the following fiscal interventions? (for taxes, please respond “Yes” only if excise taxes and/or special VAT/ s ales tax rates are applied) taxation on alcohol ic beverages Yes No Don’t Know taxation on tobacco (excise and non-excise taxes ) Yes No Don’t Know taxation on sugar sweetened beverages Yes No Don’t Know taxation on foods high in fat, sugar s or salt Yes No Don’t Know price subsidies for healthy foods Yes No Don’t Know taxation incentives to promote physical activity Yes No Don’t Know o thers (specify) Yes No Don’t Know If Yes to at least one of the above , other than price subsidies : 3a ) Are any of these funds earmarked for health promotion or health service provision ? Yes No Don’t Know 4 ) Is there a national multisectoral commission, agency or mechanism to oversee NCD engagement, policy coherence and accountability of sectors beyond health? Yes No Don’t Know IF NO: Go to MODULE II 4 a ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational or under development : 4 b ) Please provide name: _____________________________________________ 4 c ) Please provide year of establishment : _____________________ 4 d ) Who leads or chairs the commission/agency/mechanisms (provide name ) : _____________________________________________ 4 e ) Which of the following are members ? (Check all that apply) □ Other Government Ministries (non-health , e.g. minist ries of sport, education , transport, urban planning ) □ United Nations Agenci e s □ Other international institutions □ Academia (including research centres) □ Nongovernmental organizations/community-based organizations/civil society □ Private Sector □ Other (specify) _____________________ □ Don’t know IF “Private Sector” is one of the members: 4f ) Is the participation of industry (i.e. tobacco, food, beverage) to the consultations and decision-making process excluded from the national multisectoral commission? Yes No Don’t Know If Yes, please indicate which industries: Tobacco  Yes  No  Don ’ t Know Food  Yes  No  Don ’ t Know S ugar-sweetened beverages  Yes  No  Don ’ t Know Alcohol  Yes  No  Don ’ t Know Other (specify)  Yes  No  Don ’ t Know II : STATUS OF NCD- RELEVANT POLICIES, STRATEGIES, AND ACTION PLANS This module includes questions relating to the presence of policies, strategies, or action plans - the questions differentiate between integrated policies/strat egies/action plans that address several risk factors or diseases, and policies/strate gies/action plans that address a specific disease or risk factor. Additional questions address the existence of specific policies related to the cost-effective interventions for NCDs. 1 a ) Are NCDs included in the outcomes or outputs of your current national health plan? Yes No Don’t Know 1b) Are NCDs included in the outcomes or outputs of your current national development agenda? Yes No Don’t Know 1 c ) Are NCD services included in your n ational e ssential package of h ealth s ervice s or universal health coverage -priority b enefit s p ackage? Yes No Don’t Know 1 c i) If Yes, please specify the scale of i mplementation:                                                                                                     2) Is there a set of time-bound national targets for NCDs based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs ? Yes No Don’t Know If Yes: 2a ) Is there a set of national indicators for these targets based on the indicators from the WHO Global Monitoring Framework for NCDs ? Yes No Don’t Know II A: IN T EGRA T ED POLICIES, S T RA T EGIES, AND AC T ION PLANS 3 ) Does your country have a national NCD policy , strategy or a ction plan which integrates several NCDs and their risk factors ? Please note that this may be a stand-alone NCD policy, strategy or action plan, or a national health policy, strategy or action plan where NCDs comprise a significant proportion of the document . Also note that disease- and risk factor-specific policies, strategies, and action plans will be reported in other questions later in this module. Yes No Don’t Know IF NO: Go to Question 4 If yes: Is it multisectoral? Yes No Don’t Know Is it multi-stakeholder? Yes No Don’t Know Please provide the following information about the policy , strategy or action plan : 3 a) T itle: _____________________________________________________ 3 b ) D oes it address one or more of the following major risk factors? Harmful use of a lcohol Yes No Don’t Know U nhealthy d iet Yes No Don’t Know Physical inactivity Yes No Don’t Know T obacco Yes No Don’t Know 3 c ) D oes it include early detection, treatment and care for: Cancer Yes No Don’t Know Cardiovascular disease s Yes No Don’t Know Chronic respiratory diseases Yes No Don’t Know D iabetes Yes No Don’t Know 3 d ) Does it include palliative care for patients with NCDs ? Yes No Don’t Know 3 e ) Does it include rehabilitative care for patients with NCDs? Yes No Don’t Know 3 f ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know I f Operational: 3 f -i) What was the first year of implementation? ___________ 3 f -ii) W hat year will it expire? ___________ II b: Policies, strategies, action plans for SPECIFIC KEY NCD s The questions in this sub-section only refer to policies, strategies and action plans that are specific to key NCD s . If your integrated policy, strategy or action plan addresses the NCD, you do not need to re-enter that information. 4 ) Is there a policy, strategy, or action plan for cardiovascular diseases in your country? Yes No Don’t Know IF NO: Go to Question 5 If yes: 4 a ) Write the title _ ____________________ __________________________ 4 b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 4 b -i) What was the first year of implementation? ___________ 4 b -ii) What year will it expire? ___________ 5 ) Is there a policy, strategy, or action plan for cancer or some particular cancer types in your country? Yes for all cancers or cancer in general Yes but only for specific cancers (specify : ___________________________ ) No Don’t Know IF NO: Go to Question 6 If yes , provide the following for the general cancer policy/strategy/action plan or , if there i sn’t one , for the most important specific cancer policy/strategy/action plan : 5 a ) Write the title _______________________________________________ 5b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 5b -i) What was the first year of implementation? ___________ 5b-ii) What year will it expire? ___________ 6 ) Is there a policy, strategy, or action plan for diabetes in your country? Yes No Don’t Know IF NO: Go to Question 7 If yes: 6 a ) Write the title _______________________________________________ 6b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 6b -i) What was the first year of implementation? ___________ 6b-ii) What year will it expire? ___________ 7 ) Is there a po licy, strategy, or action plan for chronic respiratory diseases in your country? Yes No Don’t Know IF NO: Go to Question 8 If yes: 7 a ) Write the title _______________________________________________ 7b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 7b -i) What was the first year of implementation? ___________ 7b-ii) What year will it expire? ___________ 8 ) Is there a policy, strategy, or action plan for oral health in your country? Yes No Don’t Know IF NO: Go to Question 9 If yes: 8 a) Write the title _______________________________________________ 8 b) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 8 b-i) What was the first year of implementation? ___________ 8 b-ii) What year will it expire? ___________ 9 ) Is there a policy, strategy, or action plan for eye health in your country? □ Yes □ No □ Don’t Know IF NO: Go to Question 10 If yes: a) Write the title _______________________________________________ b) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: b- i ) What was the first year of implementation? ___________ b-ii) What year will it expire? ___________ 10 ) Is there a policy, strategy, or action plan for hearing health in your country? □ Yes □ No □ Don’t Know IF NO: Go to Question 11 If yes: a) Write the title _______________________________________________ b) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: b- i ) What was the first year of implementation? ___________ b-ii) What year will it expire? ___________ 11 ) Is there a policy, strategy, or action plan for another non-communicable disease of importance in your country? Yes No Don’t Know IF NO: Go to Question 12 If yes: Please provide the following information about the policy / strategy / action plan. If there is more than one, please provide the information for the most recent one. Please specify which NCD: ______________________________________________ 11 a ) Write the title _______________________________________________ 11 b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 11 b -i) What was the first year of implementation? ___________ 11 b -ii) What year will it expire? ___________ I I c: Policies, action plans, strategies for NCD risk factors The questions in this sub-section only refer to policies, strategies and action plans that are specific to an NCD risk factor. If your integrated policy, strategy or action plan addresses the risk factor, you do not need to re-enter that information. 12 ) Is there a po licy, strategy, or action plan for reducing the harmful use of alcohol i n your country? Yes No Don’t Know IF NO: Go to Question 1 3 If yes: 12 a ) Write the title _______________________________________________ 12 b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 12 b -i) What was the first year of implementation? ___________ 12 b -ii) What year will it expire? ___________ 1 3 ) Is there a po licy, strategy, or action plan for reducing overweight / obesity i n your country? Yes No Don’t Know IF NO: Go to Question 1 4 If yes: 1 3 a ) Write the title _______________________________________________ 1 3 b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 1 3 b -i) What was the first year of implementation? ___________ 1 3 b -ii) What year will it expire? ___________ 1 4 ) Is there a policy, strategy, or action plan for reducing physical inactivity and/or promoting physical activity i n your country? Yes No Don’t Know IF NO: Go to Question 1 5 If yes: 1 4 a ) Write the title _______________________________________________ 1 4 b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 1 4 b -i) What was the first year of implementation? ___________ 1 4 b -ii) What year will it expire? ___________ 15 ) Are there national guidelines which provide recommended levels of physical activity for the population or a specific segment of the population ? Yes No Don’t Know IF NO: Go to Question 16 If yes: 15a ) Are there guidelines specifically addressing any of the following age groups: Children under 5 Yes No Don’t Know Children and adolescents ( ages 5 – 19) Yes No Don’t Know Adults Yes No Don’t Know Older adults Yes No Don’t Know 16 ) Is there a policy, strategy, or action plan for reducing unhealthy diet related to NCD and/or promoting a healthy diet i n your country? Yes No Don’t Know IF NO: Go to Question 1 7 If yes: 1 6 a ) Write the title _______________________________________________ 1 6 b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 1 6 b -i) What was the first year of implementation? ___________ 1 6 b -ii) What year will it expire? ___________ 17 ) Are there national food-based dietary guidelines for the population or a specific segment of the population? Yes No Don’t Know 18 ) Is there a policy, strategy, or action plan to decrease tobacco use i n your country? Yes No Don’t Know IF NO: Go to Question 19 If yes: 18 a ) Write the title _______________________________________________ 18 b ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know If Operational: 1 8 b -i) What was the first year of implementation? ___________ 1 8 b -ii) What year will it expire? ___________ II D: SELECTED COST-EFFECTIVE Policies for NCD s AND RELATED RISK FACTORS N B: Only selected policies are captured here as information on some policy measures, e.g. for tobacco and alcohol, are included in other assessment tools . 19 ) Is there a policy and/or plan on NCD-related research including community-based research and evaluation of the impact of interventions and policies? Yes No Don’t Know IF NO: Go to Question 20 If Yes: 19 a ) Indicate its stage: □ Operational □ Under development □ Not in effect □ Don’t know 20 ) Is there a national network for NCD-related research including community-based research and evaluation of the impact of interventions and policies? Yes No Don’t Know 21 ) Is your country implementing any policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fat ty acids , trans -fatty acids, free sugars, or salt? Yes No Don’t Know IF NO: Go to Question 2 2 If yes: 21 a ) A re the policies : □ V oluntary □ Mandatory Don’t know 21 b ) Who is responsible for overseeing enforcement and complaints? ☐ Government ☐ Food Industry ☐ Independent regulator ☐ Other, please specify: _______________ 21 c ) Do they include steps taken to address the effects of cross-border marketing of food and non-alcoholic beverages on children? Yes No Don’t Know 21 c -i ) If yes, please provide details: ____________________________________ 2 2 ) Is your country imp lementing any policies on nutrition labelling to identify foods high in saturated fatty acids, trans -fatty acids, free sugars, or salt? Yes No Don’t Know IF NO: Go to Question 2 3 If yes , please indicate which types of nutrition labelling are being implemented : 2 2 a) List of ingredients Yes No Don’t Know 2 2 b) Nutrient declaration (i.e. back-of-pack labelling) Yes No Don’t Know 2 2 c) F ront-of-pack labelling Yes No Don’t Know 23 ) Is your country implementing any national policies to reduce population saturated fatty acid intake ? Yes No Don’t Know IF NO: Go to Question 24 23 a ) If yes, are the policies: Voluntary Mandatory Don’t know 24 ) Is your country implementing any national policies to eliminate industrially produced trans -fat ty acids in the food supply? Yes No Don’t Know IF NO: Go to Question 25 24 a ) If yes, indicate which policies are being implemented: Select all that apply Mandatory national ban on the production or use of partially hydrogenated oils (PHO) as an ingredient in all foods Mandatory national limit of 2g of industrially produced trans-fatty acids per 100g of total fat in all foods Don’t know 25 ) Is your country implementing any policies to reduce population salt /sodium consumption ? Yes No Don’t Know IF NO: Go to Question 26 If yes: 2 5 a ) Are these targeted at: Product reformulation by industry a cross the food supply Yes , Voluntary Yes, Mandatory No Don’t Know Regulation of salt content of food served in specific settings such as hospitals, schools, workplaces Yes , Voluntary Yes, Mandatory No Don’t Know Public awareness programme Yes No Don’t Know Front - of - pack n utrition labeling Yes , Voluntary Yes, Mandatory No Don’t Know 2 6 ) H as your country implemented any national public education and awareness campaign on diet within the past 2 years ? Yes No Don’t Know IF NO: Go to Question 2 7 2 6 a ) If yes, please provide details of the public education and awareness campaign (s): _________________________________ 27 ) Is your country implementing any national policies in the following areas to promote population physical activity? This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events. Walking and cycling Yes No Don’t Know Workplace physical activity initiatives Yes No Don’t Know Active aging Yes No Don’t Know Community-based physical activity and sports initiatives Yes No Don’t Know Public open spaces (including parks) Yes No Don’t Know Childcare settings Yes No Don’t Know 2 8 ) Has your country implemented any national public education and awareness campaign on physical activity within the past 2 years? Examples of national public education and awareness campaign s include large scale campaigns targeted at large segments of the population or the whole population , using mass media , and last ing for a longer period of time or repeated throughout the year. Conducting “one day events” (such as a car free day, sport days, physical activity day) on their own is not included in the definition of “public education campaign” and should be considered and reported in the following question on mass participation events. Yes No Don’t Know IF NO: Go to Question 2 9 If yes : 2 8 a ) Does the national public education campaign integrate with community-based programmes or initiatives supporting promotion of physical activity ? Yes No Don’t Know 2 8 b) Is the national public education campaign supported by any environmental changes that aim to improve access to facilities that enable physical activity (such as infrastructure for walking or cycling, design or improvements to public open space or other facilities) ? Yes No Don’t Know 2 8 c) Do the national public education campaign “messages” address any of the social, environmental and economic benefits of physical activity, in addition to the mental and physical health benefits? Yes No Don’t Know 2 8 d) P lease provide brief details of the national public education campaign (s) , including where possible the primary focus and name of campaign, target audience(s), type of mass media used, duration of campaign, and links to any reports, campaign resources and evaluations : ____________________________________ _________________________________ 2 9 ) Has your country implemented any national or subnational mass participation events to encourage participation by the general public in free opportunities for physical activity within the past 2 years? Examples of free mass participation events include holding national walk to school or work days; car-free days; national PA or sports days, or days celebrating other physical activities providing free participation , such as cycling, yoga, tai chi, dance , or sports . Note this does NOT include hosting of major competitive sporting events , nor events such as marathons, which require paid participation , unless there is opportunity for free participation in shorter distances (e.g. 1km, 5km) . Yes No Don’t Know IF NO: Go to Question 30 2 9 a) P lease provide details of the event(s) : _________________________________ _________________________________ 30 ) Has your country implemented any national , NCD-related mHealth initiatives , such as tobacco cessation, hypertension management, cervical cancer screening awareness, promotion of physical activity , within the past 2 years? Yes No Don’t Know IF NO: Go to MODULE III 30 a) P lease provide details of the mHealth initiative (s): _________________________________ III : HEALTH INFORMATION SYSTEMS, MONITORING, SURVEILLANCE AND SURVEYS FOR NCD s AND THEIR RISK FACTORS The questions in this module assess surveillance relating to the NCD morbidity and risk factor reporting systems of each country and whether data were included in their national health reporting systems. 1) In your country, who has responsibility for surveillance of NCDs and their risk factors? An office/department/administrative division within the MOH exclusively dedicated to NCD surveillance An office/department/ administrative division within the MOH not exclusively dedicated to NCD surveillance Responsibility is shared across several offices/departments/administrative divisions within the MOH Coordination is by an external agency, such as an NGO or statistical organization No one has this responsibility Don’t know III a : Da t a included in t he na t ional heal t h INFORMATION sys t em ( National health information system refers to the annual or regular report ing system of the National Statistical Office or Ministry of Health ) 2) Does your country have a disease registry for: (Please fill in all columns) 2a) Cancers 2b) Diabetes 2c) Myocardial Infarction/ coronary events 2d) Cerebro -vascular accident /Stroke 2e) Other NCD of importance to your country Yes No D on’t know IF NO: Skip to next column. IF YES, is it: i ) National (covers the whole population of the country) Sub-national ( covers only the population of a defined region, not the whole country ) Don’t know ii ) Population –based hospital based other If other, specify: _______ Don’t know iii) What is the latest year for which data are available ? _________ Yes No D on’t know IF NO: Skip to next column. IF YES, is it: i ) National (covers the whole population of the country) Sub-national ( covers only the population of a defined region, not the whole country ) Don’t know ii ) Population –based hospital based other If other, specify: _______ Don’t know iii) Does the registry include data on any chronic complications which are updated as the patient’s complications status changes? Yes No D on’t know iv) W hat is the latest year for which data are available ? _________ Yes No D on’t know IF NO: Skip to next column. IF YES, is it: i ) National (covers the whole population of the country) Sub-national ( covers only the population of a defined region, not the whole country ) Don’t know ii ) Population –based hospital based other If other, specify: _______ Don’t know iii) W hat is the latest year for which data are available ? _________ Yes No D on’t know IF NO: Skip to next column. IF YES, is it: i ) National (covers the whole population of the country) Sub-national ( covers only the population of a defined region, not the whole country ) Don’t know ii ) Population –based hospital based other If other, specify: _______ Don’t know iii) W hat is the latest year for which data are available ? _________ Yes No D on’t know Specify which NCD(s): _____ IF NO: Skip to next question . IF YES, is it: i ) National (covers the whole population of the country) Sub-national ( covers only the population of a defined region, not the whole country ) Don’t know ii ) Population –based hospital based other If other, specify: _______ Don’t know iii) W hat is the latest year for which data are available? _________ 2f) Are there any other registries that can provide information on NCDs? Yes No Don’t know If yes, please list: ____________________________________________________________ 3 ) Please indicate the existence of a standardized system for recording patient level data that includes NCD status and risk factors in the following PUBLIC facilities: P rimary Health Care Centres Hospitals i ) Does a standardized system for recording patient level data that includes NCD status and risk factors exist ? Yes No Don't Know IF NO: Go to next column. Yes No Don't Know IF NO: Go to next question . ii) What is the scope of the system? National (covers the whole population of the country) Subnational (covers only the population of a defined region or regions or only certain segments of the population) Do n’t know National (covers the whole population of the country) Subnational (covers only the population of a defined region or regions or only certain segments of the population) Do n’t know iii) What type of system is it? Paper-based Electronic Mixed (please describe______) Don’t know Paper-based Electronic Mixed (please describe______) Don’t know iv) What is the coverage of the system? &lt;25% of facilities 25% to 50% of facilities more than 50% of facilities to 75% of facilities More than 75% of facilities Don’t know &lt;25% of facilities 25% to 50% of facilities more than 50% of facilities to 75% of facilities More than 75% of facilities Don’t know v) Can private facilities access or share data with this system? Yes No Don't Know Yes No Don't Know vi ) Which NCDs and related risk factors are covered? If Yes to having a patient information system including NCD status and risk factors in both P rimary Health Care Centres &amp; Hospitals: 3 b) Are the patient information systems in primary health care centres &amp; hospitals interoperable? (does one system cover both types of facilities or can information be passed between the two systems?) Yes No Don’t Know III B : Risk Factor Surveillance 4 a ) Harmful alcohol use 4 b ) Unhealthy diet 4 c ) Physical inactivity 4 d ) Tobacco use 4 ) Have population-based surveys of risk factors (may be a single RF or multiple) been conducted in your country for any of the following: (Please fill in all columns, start in the first row, going left to right, and then continue left to right across the second row.) For the questions on surveys on adolescents or children , please include here only surveys specifically targeting adolescents or children (i.e. do not repeat adult surveys that may have covered part of the adolescent or child age range). Yes No Don’t know IF NO: Go to next column. IF YES: i ) Was there a survey on adolescents? Yes No Don’t know IF YES: i-1) Was it: National Subnational Don’t know i-2) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know i-3) When was the last survey conducted? (give year) _____ ii) Was there a survey on adults? Yes No Don't know IF YES: ii-1) Was it: National Subnational Don’t know ii-2) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know ii-3) When was the last survey conducted? (give year) _____ Yes No Don’t know IF NO: Go to next column. IF YES: i ) Was there a survey on adolescents? Yes No Don’t know IF YES: i-1) Was it: 24 - hour recall F ood frequency O ther Don’t know i- 2 ) Was it: National Subnational Don’t know i- 3 ) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know i- 4 ) When was the last survey conducted? (give year) _____ ii) Was there a survey on adults? Yes No Don't know IF YES: i i-1) Was it: 24 hour recall Food frequency Other Don’t know ii- 2 ) Was it: National Subnational Don’t know ii- 3 ) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know ii- 4 ) When was the last survey conducted? (give year) _____ Yes No Don’t know IF NO: Go to next column. IF YES: i ) Was there a survey on children ? Yes No Don’t know IF YES: i-1) Was it: Measured Self-reported Don ’ t know i-2) Was it: National Subnational Don ’ t know i-3) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don ’ t know i -4) When was the last survey conducted? (give year) _____ i i) Was there a survey on adolescents? Yes No Don’t know IF YES: i i-1) Was it: Measured Self-reported Don’t know i i- 2 ) Was it: National Subnational Don’t know i i -3 ) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know i i - 4 ) When was the last survey conducted? (give year) _____ i ii) Was there a survey on adults? Yes No Don't know IF YES: i i i-1) Was it: Measured Self-reported Don’t know ii i -2) Did it assess physical activity for work/in the household, for transport and during leisure time? Yes No Don't know ii i -3) Was it: National Subnational Don’t know ii i - 4 ) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know i i i-5) When was the last survey conducted? (give year) _____ Yes No Don’t know IF NO: Go to next column. IF YES: i ) Was there a survey on adolescents? Yes No Don’t know IF YES: i-1) Was it: National Subnational Don’t know i-2) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know i-3) When was the last survey conducted? (give year) _____ ii) Was there a survey on adults? Yes No Don't know IF YES: ii-1) Was it: National Subnational Don’t know ii-2) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know ii-3) When was the last survey conducted? (give year) _____ 4 ) cont. 4e ) Raised blood glucose/ diabetes 4 f ) Raised total cholesterol 4 g ) Raised blood pressure/ Hypertension 4 h ) Overweight and obesity 4 i ) Salt / Sodium intake Yes No Don't know IF NO: Go to next column. IF YES: i ) Was it: Measured Self-reported Don’t know ii) Was it: National Subnational Don’t know iii) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know iv) When was the last survey conducted? (give year) _____ Yes No Don't know IF NO: Go to next column. IF YES: i ) Was it: Measured Self-reported Don’t know ii) Was it: National Subnational Don’t know iii) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know iv) When was the last survey conducted? (give year) _____ Yes No Don't know IF NO: Go to next column. IF YES: i ) Was it: Measured Self-reported Don’t know ii) Was it: National Subnational Don’t know iii) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know iv) When was the last survey conducted? (give year) _____ Yes No Don't know IF NO: Go to next column. IF YES: i ) Was there a survey on children ? Yes No Don’t know IF YES: i-1) Was it: Measured Self-reported Don’t know i-2) Was it: National Subnational Don’t know i-3) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know i-4) When was the last survey conducted? (give year) _____ i i) Was there a survey on adolescents? Yes No Don't know IF YES: i i -1) Was it: Measured Self-reported Don’t know i i-2) Was it: National Subnational Don’t know i i-3) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know i i-4) When was the last survey conducted? (give year) _____ i i i) Was there a survey on adults? Yes No Don't know IF YES: i ii-1) Was it: Measured Self-reported Don’t know i ii-2) Was it: National Subnational Don’t know i ii-3) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know i ii-4) When was the last survey conducted? (give year) _____ Yes No Don't know IF NO: Go to MODULE IV . IF YES: i ) Was it: Measured by 24-hr urine collection Measured by 12-hr urine collection Measured by spot urine collection Measured by combination of urine collection methods Self-reported salt intake Don’t know ii) Was it: National Subnational Don’t know iii) How often is the survey conducted? Ad hoc Every 1 to 2 years Every 3 to 5 years Other Don’t know iv) When was the last survey conducted? (give year) _____ IV : capacity for NCD EARLY DETECTION, treatment and care WITHIN THE HEALTH SYST EM The questions i n this module assess the health care systems capacity related to NCD early detection, treatment and care within the health care sector. Specific questions focus on availability of guidelines or protocols to treat major NCDs, and the tests, procedures and equipment related to NCDs within the health-care system. It also assesses the availability of palliative care services for NCDs. 1 a ) Please indicate whether evidence-based national guidelines/protocols/standards are available for the management (diagnosis and treatment) of each of the major NCDs through a primary care approach recognized/approved by government or competent authorities. Where guidelines/protocols/standards are available, please indicate their implementation status , when they were last updated and whether they contain standard criteria for the referral of patients from primary care to a higher level of care (secondary/tertiary) . Cardiovascular Disease Diabetes Cancer Chronic Respiratory Disease i ) Are they available? Yes (specify topics covered) No Don't Know Yes No Don't Know Yes (specify cancer types) No Don't Know Yes (specify topics covered) No Don't Know ii ) Do they include drug- and dose-specific protocols? Yes No Don't Know If Yes: If there are multiple guidelines, specify for which conditions: __________ Yes No Don't Know Yes No Don't Know If Yes: If there are multiple guidelines, specify for which cancers: __________ Yes No Don't Know If Yes: If there are multiple guidelines, specify for which conditions: __________ iii ) Are they being utilized in at least 50% of health care facilities Yes No Don't Know Yes, No Don't Know Yes, No Don't Know Yes No Don't Know iv ) When were they last updated? v ) Do they include referral criteria? Yes No Don't Know Yes No Don't Know Yes No Don't Know Yes No Don't Know 1b ) Please indicate whether evidence-based national guidelines/protocols/standards are available for the management of each of the following NCD risk factors through a primary care approach recognized/approved by government or competent authorities. Alcohol use disorders Tobacco d ependence Overweight/ obesity Physical inactivity i ) Are they available? Yes No Don't Know Yes No Don't Know Yes No Don't Know Yes No Don't Know ii ) Are they being utilized in at least 50% of health care facilities Yes No Don't Know Yes, No Don't Know Yes, No Don't Know Yes No Don't Know iii ) When were they last updated? iv ) Do they include referral criteria? Yes No Don't Know Yes No Don't Know Yes No Don't Know Yes No Don't Know 2 ) Indicate the availability of the following basic technologies for early detection, diagnosis / monitoring of NCD s in the primary care facilities of the public and private health sector where : Generally available=1 ; Generally not available = 2, Don't know = 3. * Generally available: in 50% or more health care facilities Generally not available: in less than 50% health care facilities Availability in the primary care facilities of the public health sector (1, 2, or 3) Availability in the primary care facilities of the private health sector (1, 2, or 3) Overweight and obesity 2 a) Measuring of weight 2 b) Measuring of height _____ _____ _____ _____ Diabetes mellitus 2 c) Blood glucose measurement 2 d) Oral glucose tolerance test 2 e) HbA1c test 2 f ) Dilated fundus examination 2 g ) Foot vibration perception by tuning fork 2 h ) Urine strips for glucose and ketone measurement _____ _____ _____ _____ _____ _____ _____ _____ Cardiovascular disease 2 i ) Blood pressure measurement 2 j ) T otal cholesterol measurement 2 k ) Urine strips for albumin assay _____ _____ _____ _____ _____ _____ Asthma and chronic obstructive pulmonary disease 2l) Peak flow measurement 2 m ) spirometry _____ _____ 3) Please indicate if there is a national screening program targeting the general population for the following cancers and, if yes, provide details. Cancers Initial s creening method (indicate only one, the most widely used) Population targeted by the program Type of program Screening coverage Breast ☐ Yes ☐ No ☐ Don’t know If NO: Go to next row ☐ Clinical breast exam ☐ Mammography screening ☐ Don’t know Women aged …….. to ……. Other, specify: ☐ Don’t know ☐ Organised population-based screening ☐ Opportunistic screening ☐ Don’t know ☐ Less than 10% ☐ 10% to 50% ☐ more than 50% but less than 70% ☐ 70% or more ☐ Don’t know Cervix ☐ Yes ☐ No ☐ Don’t know If NO: Go to next row ☐ Visual inspection ☐ PAP smear ☐ HPV test ☐ Don’t know Women aged …….. to ……. Other, specify: ☐ Don’t know ☐ Organised population-based screening ☐ Opportunistic screening Don't Know ☐ Less than 10% ☐ 10% to 50% ☐ more than 50% but less than 70% ☐ 70% or more ☐ Don’t know Colon ☐ Yes ☐ No ☐ Don’t know If NO: Go to next row ☐ Faecal test ☐ Colonoscopy / sigmoidoscopy ☐ Don’t know People aged …….. to ……. Other, specify: ☐ Don’t know ☐ Organised population-based screening ☐ Opportunistic screening ☐ Don’t know ☐ Less than 10% ☐ 10% to 50% ☐ more than 50% but less than 70% ☐ 70% or more ☐ Don’t know Other cancer type(s) Specify: _______ ☐ Yes ☐ No ☐ Don’t know 4 ) Please indicate if early detection of the following cancers by means of rapid identification of the first symptoms is integrated into primary health care services and if there is a clearly defined referral system from primary care to secondary / tertiary care for suspect cases (in low - and middle- income countries this set of measures may be designated as an "early diagnosis" programme): Breast Cervix Colon Cancers in Children Other cancer types (specify: ______) Program/guidelines to strengthen early diagnosis of first symptoms at primary health care level ☐ Yes ☐ No ☐ Don’t know ☐ Yes ☐ No ☐ Don’t know ☐ Yes ☐ No ☐ Don’t know ☐ Yes (please specify types of cancer) ☐ No ☐ Don’t know ☐ Yes ☐ No ☐ Don’t know Clearly defined referral system from primary care to secondary and tertiary care ☐ Yes ☐ No ☐ Don’t know ☐ Yes ☐ No ☐ Don’t know ☐ Yes ☐ No ☐ Don’t know ☐ Yes ☐ No ☐ Don’t know ☐ Yes ☐ No ☐ Don’t know 5 ) Is HPV vaccination included in the national immuniz at ion schedule ? Yes No Don’t know If NO: Go to Question 6 . 5a ) What was the HPV vaccine coverage (last dose) in the last calendar year? ☐ Less than 10% ☐ 10% to 50% ☐ more than 50% but less than 8 0 % ☐ 8 0 % or more ☐ Don’t know 6 ) Describe the availability * of the medicines below in the primary care facilities of the public health sector , where: Generally available=1; Generally not available = 2, Don't know = 3. * Generally available: in 50% or more pharmacies Generally not available: in less than 50% of pharmacies Generic drug name Availability 6 a) Insulin 6 b) Aspirin ( 75/ 100 mg) 6 c) Metformin 6 d) T hiazide Diuretics 6 e) ACE Inhibitors 6f ) Angiotensin II receptor blockers (A RBs ) 6 g ) C alcium channel Blockers 6 h ) Fixed dose combination ( lisinopril + amlodipine ) 6 i ) Fixed dose combination ( lisinopril + hydrochlorothiazide ) 6 j ) Fixed dose combination ( telmisartan + amlodipine ) 6 k ) Fixed dose combination ( telmisartan + hydrochlorothiazide ) 6 l ) Beta Blockers 6 m ) Statins 6 n ) Oral morphine 6 o ) Steroid inhaler 6 p ) Combination budesonide-formoterol inhaler 6 q ) Bronchodilator inhaler 6 r ) Sulphonylurea (s) 6 s ) Benzathine penicillin injection 6 t ) Nicotine Replacement Therapy 7 ) Indicate the availability * of the following procedures for managing and treating NCDs in the publicly funded health system, where : 1=Generally available; 2=Generally not available; 3=Don't know. * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need Procedure name Availability 7 a ) Diabetic retinopathy screening 7 b ) Retinal photocoagulation 7 c ) Renal replacement therapy by d ialysis 7 d ) Renal replacement by transplantation 7 e ) Coronary bypass 7 f ) Coronary s tenting 7 g ) T hrombolytic therapy (streptokinase) for acute myocardial infarction 7 h ) Alteplase for acute stroke management 7 i ) Bone marrow transpla nta tion 8 ) Indicate the availability* of the following procedures for detecting, managing and treating oral diseases in the primar y care facilities in the public health sector * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need Procedure name Availability Oral health screening for early detection of oral diseases ☐ Generally available ☐ Generally not available ☐ Don’t know U rgent treatment for providing emergency oral care and oral pain relief ☐ Generally available ☐ Generally not available ☐ Don’t know Basic restorative dental procedures to treat existing dental decay ☐ Generally available ☐ Generally not available ☐ Don’t know 9 ) Detail the availability * of cancer diagnosis and treatment services in the public sector: * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need Service Availability Cancer centres or cancer departments at tertiary level ☐ Generally available ☐ Generally not available ☐ Don’t know Pathology services (laboratories) ☐ Generally available ☐ Generally not available ☐ Don’t know Cancer surgery ☐ Generally available ☐ Generally not available ☐ Don’t know C hemotherapy ☐ Generally available ☐ Generally not available ☐ Don’t know R adiotherapy ☐ Generally available ☐ Generally not available ☐ Don’t know 10 ) How many dedicated cancer centres are there in the country? Cancer centres provide coordinated, multi-disciplinary care inclusive of all services generally available in the country. This may include, for example, pathology, radiotherapy, surgery and systemic therapy. A facility can count as a “cancer centre” even if other non-oncology services are provided in that facility. If you don’t know the exact number, please give an estimated range. Number of public cancer centres: _____________ _ ☐ Don’t know Number of private cancer centres: ______________ ☐ Don’t know 11 ) Detail the availability * of rehabilitative care in the public sector for patients with the following NCDs : * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need Inpatient care availability Outpatient care availability Cancer ☐ Generally available ☐ Generally not available ☐ Don’t know ☐ Generally available ☐ Generally not available ☐ Don’t know Stroke ☐ Generally available ☐ Generally not available ☐ Don’t know ☐ Generally available ☐ Generally not available ☐ Don’t know Acute Myocardial Infarction ☐ Generally available ☐ Generally not available ☐ Don’t know ☐ Generally available ☐ Generally not available ☐ Don’t know Chronic Respiratory Diseases ☐ Generally available ☐ Generally not available ☐ Don’t know ☐ Generally available ☐ Generally not available ☐ Don’t know Musculoskeletal Conditions ☐ Generally available ☐ Generally not available ☐ Don’t know ☐ Generally available ☐ Generally not available ☐ Don’t know 1 2 ) Indicate the availability* of palliative care for patients with NCD in the public health system: * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need 1 2 a ) In p rimary health care facilities : Generally available Generally not available Don't know 1 2 b ) In community or home-based care : Generally available Generally not available Don't know 1 3 ) What proportion of primary health care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke? none less than 25% 25% to 50% more than 50% Don’t know 1 4 ) Indicate the availability* of provision of care for acute stroke in the public health system: * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need Generally available Generally not available Don't know 1 5 ) Is there a register of patients who have had rheumatic fever and rheumatic heart disease? Yes No Don’t know IF YES: 15a ) Are there systems for follow-up/recall to deliver long-term penicillin prophylaxis ? Yes No Don’t know V : NCD-RELATED DISRUPTIONS DURING THE COVID - 19 PANDEMIC T he questions in this module assess how NCD essential services and programmes are being impacted in your country by the current COVID-19 pandemic. INFRASTRUCTURE 1) During the previous 3 months, have the Ministry of Health (or equivalent institutes) staff with responsibility for NCDs and their risk factors been reassigned/deployed to help with overall COVID-19 response? YES – All staff supporting COVID-19 efforts full time YES – All staff partially supporting COVID-19 efforts along with routine NCD activities YES – Some staff supporting COVID-19 efforts full time YES – Some staff partially supporting COVID-19 efforts along with routine NCD activities NO Don’t know 2) During the previous 3 months, how much of the government (or Ministry of Health) funds initially allocated for NCDs have been reassigned to non-NCD services due to COVID-19 response efforts? None or not yet 1 - 25% 26 -50% 51-75% 76 -100% Don’t know POLICIES AND PLANS 3) Has your country defined a national essential health services package prior to the COVID-19 pandemic? Yes No Don’t know 4) Has your country identified a core set of essential health services to be maintained during the COVID-19 pandemic? Yes No Don’t know If NO: Go to Question 7 5) Is ensuring continuity of NCD services included in the list of essential health services in your country’s COVID-19 response plan? Yes No Don’t know If NO: Go to Question 7 6) Which NCD services are included in the list of essential health services of your country’s COVID-19 response plan? Cardiovascular disease services Yes No Don’t Know Cancer services Yes No Don’t Know Diabetes services Yes No Don’t Know Chronic respiratory disease services Yes No Don’t Know v) Chronic kidney disease and dialysis services Yes No Don’t Know vi) Dental services Yes No Don’t Know vii) Rehabilitation services Yes No Don’t Know viii) Tobacco cessation services Yes No Don’t Know ix) Others (specify :________________ ) Yes No Don’t Know 7) During the previous 3 months, has additional funding been allocated for NCDs in the government budget for the COVID-19 response? Yes No Don’t know 8) During the previous 3 months, which of the following Ministry of Health NCD activities planned for this year been postponed because of COVID-19? None Yes No Don’t Know Implementation of NCD Surveys Yes No Don’t Know Public screening programmes for NCDs Yes No Don’t Know WHO Package for Essential NCDs (PEN) training and implementation in Primary Health Care Yes No Don’t Know WHO HEARTS technical package Yes No Don’t Know v i ) Mass communication campaigns Yes No Don’t Know vi i ) Others (specif y: _____________ ) Yes No Don’t Know NCD-RELATED HEALTH SERVICES 9) During the previous 3 months, how have government policies and directives affected the level of access to the following service delivery platforms? Outpatient NCD services Functioning as normal Limited Access Suspended Don’t Know Not applicable In patient NCD services Functioning as normal Limited Access Suspended Don’t Know Not applicable Community-based NCD care (e.g. outreach campaigns, home-based care, care in long-term facilities) Functioning as normal Limited Access Suspended Don’t Know Not applicable Mobile NCD clinics Functioning as normal Limited Access Suspended Don’t Know Not applicable 10) During the previous 3 months, which of the following services have been disrupted due to COVID-19? Definitions: More than 50% of users not served as usual; 26-50% of users not served as usual 5-25% of users not served as usual; Less than 5% of users not served as usual; Don’t know: Information is not /not yet available; Not applicable: Service/intervention is not usually delivered in country Service Level of disruption i ) Hypertension management More than 50% 26-50% 5-25% Less than 5% Not disrupted Don’t Know Not applicable ii) Cardiovascular emergencies (including MI, Stroke and cardiac Arrhythmias) More than 50% 26-50% 5-25% Less than 5% Not disrupted Don’t Know Not applicable iii) Cancer screening More than 50% 26-50% 5-25% Less than 5% Not disrupted Don’t Know Not applicable iv) Cancer treatment More than 50% 26-50% 5-25% Less than 5% Not disrupted Don’t Know Not applicable v) Diabetes and diabetic complications management More than 50% 26-50% 5-25% Less than 5% Not disrupted Don’t Know Not applicable vi) Asthma services More than 50% 26-50% 5-25% Less than 5% Not disrupted Don’t Know Not applicable vii) Urgent dental care More than 50% 26-50% 5-25% Less than 5% Not disrupted Don’t Know Not applicable IF response to all subquestions is “Not disrupted” or “Don’t know” or “Not applicable”: Go to Question 1 4 11) During the previous 3 months, what have been the main reasons for service disruption(s) and/or change(s) in service utilization? (check all that apply) Supply-side factors □ Closure of outpatient services as per government directive □ Closure of outpatient disease specific consultation clinics □ Closure of population level screening programmes □ Decrease in inpatient volume due to cancellation of elective care □ Inpatient services/hospital beds not available □ Insufficient staff to provide services □ Related clinical staff deployed to provide COVID-19 relief □ Insufficient Personal Protective Equipment (PPE) available for health care providers to provide services □ Unavailability/Stock out of essential medicines, medical diagnostics or other health products at health facilities □ Changes in treatment policies for care seeking behaviour (e.g. stay at home policies) □ Others (please specify what are the other causes of this disruption and/or changes in service utilization): ___________________________________________________ □ Do n’ t know Demand-side factors □ Decrease in outpatient volume due to patients not presenting □ Community fear/mistrust in seeking health care □ Travel restrictions hindering access to the health facilities □ Financial difficulties during outbreak/lock down □ Others (please specify what are the other causes of this disruption and/or changes in service utilization): ______________________________________________ □ Do n’t know 12) During the previous 3 months, what approaches have been used to overcome service disruptions to essential health services in public sector health facilities and long-term care facilities? (check all that apply) □ Triaging to identify priorities □ Redirection of patients to alternate care sites /reorientation of referral pathways □ Telemedicine deployment to replace in-person consults □ Integration of several services into single visit □ Self-care interventions where appropriate □ Provision of home-based care where appropriate □ Catch-up campaigns for missed appointments □ Task shifting / role delegation □ Recruitment of additional staff □ Expanding facility hours □ Novel supply chain management and logistics approaches □ Novel dispensing approaches for medicines □ Novel prescribing approaches (e.g. tele-prescription, extended drug prescriptions) □ Community communications (e.g. informing on changes to service delivery, addressing misinformation and community fears of infection) □ Government removal of user fees □ Others (please describe what other approaches are being used): _____________________ □ Do not know 13) What are your country’s plans to re-initiate any suspended NCD services? ______________________________________________________________________ ______________________________________________________________________ 14) Is the country collecting or collating data on NCD-related comorbidities in COVID-19 patients? Yes No Don’t know Not applicable 15) Are there any technical guidance or tools that you would suggest WHO to develop related to NCDs during COVID-19 pandemic ? ______________________________________________________________________ ______________________________________________________________________ G LOSSARY Academia: Refers to educational institutions, especially those for higher education. Broadcast media: Media which is broadcast to the public through radio and television. Cancer: A generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. Cancer registry: A systematic collection of data about cancer cases in a certain region or a certain hospital. The first aim is to count cancer cases to get an idea of the magnitude of the problem. WHO advises national coverage by population-based registry in small countries only. Capacity building: The development of knowledge, skills, commitment, structures, systems and leadership to enable effective action. Cardiovascular disease s : A group of disorders of the heart and blood vessels that includes coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism. Cardiovascular risk stratification : Use of risk prediction charts to indicate the risk of a fatal or non-fatal major cardiovascular event in the next 5 to 10 years. Based on the assessment people can be stratified into different levels of risk , which will help in management and follow up. Chronic respiratory diseases : Diseases of the airways and other structures of the lung. Some of the most common are: asthma, chronic obstructive pulmonary disease, occupational lung diseases and pulmonary hypertension. Collaboration: A recognized relationship between different groups with a defined purpose . Community: A specific group of people, often living in a defined geographical area, who share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them . Cross-border marketing: Marketing originat ing in one country that crosses national borders through broadcast media and internet, print media, sponsorship of events and programmes or any other media or communication channel. It includes both in-flowing and out-flowing cross-border marketing. Diabetes: A disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Early detection/screening: Measures p er formed in order to identify individuals who have early stages of a disease (with apparent symptoms in the case o f early detection and without in the case of screening). Earmarked taxes: Taxes which are collected and used for a specific purpose. Electronic health record: An electronic health record is an in-house electronic version of the traditional paper charts that collect, store and display patient information. Fiscal interventions: Measures taken by the government such as taxes and subsidies. Free sugars: Monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups , fruit juices and fruit juice concentrates . Front-of- pack labelling (FOPL) : Nutrition labelling systems that are presented on the front of food packages (in the principle field of vision) and can be applied across the packaged retail food supply. FOPL comprise an underpinning nutrient profile model that considers the overall nutrition quality of the product and/or the nutrients of concern for NCD; and presents simple, often graphic information on the nutrient content and/or nutritional quality of products to complement the more detailed nutrient declarations usually provided on the back of food packages. There are two major categories of FOPL, including interpretive and non-interpretive systems. Non-interpretive nutrient-based systems provide a summary of nutrient information, but no advice on the overall nutritional value of the food to assist with purchasing decisions. Interpretive systems may provide no nutrient information but only at-a-glance guidance on the rel ative healthiness of a product. General government revenue: The money received from taxation, and other sources, such as privati z ation of government assets, to help finance expenditures. Health: A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. A resource for everyday life which permits people to lead an individually, socially and economically productive life. A positive concept emphasizing social and personal resources as well as physical capabilities. Health behaviour: Any activity undertaken by an individual, regardless of actual or perceived health status , f or the purpose of promoting, protecting or maintaining health , whether or not such behaviour is objectively effective towards that end . Health care and treatment: The diagnosis and treatment of diseases. Health care facility: Facilities which provide h ealth services. They may include mobile clinics, pharmacies, laboratories, primary health care clinics, specialty clinics, and private and faith-based establishments. Health promotion: T he process of enabling people to increase control over, and to improve their health . Healthy diet: A healthy diet throughout the life-course helps prevent malnutrition in all its forms as well as a range of noncommunicable diseases (NCDs) and conditions. The exact make-up of a healthy, balanced diet will vary depending on the individual needs (e.g. age, gender, lifestyle, degree of physical activity). For adults , a healthy diet contains fruits, vegetables, legumes, nuts and whole grains and should be limited in free sugars, salt, total fat, saturated fats and free of industrial trans-fats. International donors: Organizations which extend across national boundaries and which give funds for projects of a development nature. Intervention: Any measure whose purpose is to improve health or alter the course of disease. Legislation: A law or laws which have been enacted by the governing bodies in a country. Long-term care facility: Long-term care facilities may vary by country. Nursing homes, skilled nursing facilities, assisted living facilities, residential facilities and residential long-term care facilities are collectively known as long-term care facilities that provide a variety of services, including medical and assistive care, to people who are unable to live independently in the community. Marketing: Any form of commercial communication or message that is designed to, or has the effect of, increasing the recognition, appeal and/or consumption of particular products and services. It comprises anything that acts to advertise or otherwise promote a product or service . mHealth: The use of mobile and wireless technologies to support the achievement of health objectives. Multisectoral : Involving different sectors, such as health, agriculture, education, finance, infrastructure, transport, trade, etc. Multisectoral collaboration: A recognized relationship between part or parts of differe nt sectors of society (such as ministries ( e.g. health, education), agencies, non-government al agencies, private for-profit sector and community representation) which has been formed to take action to achieve health outcomes in a way that is more effective, efficient or sustainable than might be achieved by the health sector acting alone. Multi-stakeholder : Involving stakeholders from across the public sector, civil society, NGOs and the private sector. Musculoskeletal conditions: Musculoskeletal conditions comprise more than 150 conditions that affect the locomotor system of individuals. They range from conditions that arise suddenly and are short-lived, such as fractures, sprains and strains, to conditions associated with long-term functional limitations and disability, such as low back pain and osteoarthritis. Musculoskeletal conditions are typically characterized by pain (often persistent) and limitations in mobility, dexterity and overall level of functioning, reducing people’s ability to engage in their regular activities. Na tional Cancer Screening Program me : A government- endorsed program me where screening is offered. NGO- led program me s or national recommendations to go for screening at one’s own cost, do not qualify as national screening program mes . National focal point, unit or department: National focal point : the person responsible for the prevention and control of chronic diseases in a ministry of health or national institute. Unit or department : a unit or department with responsibility for NCD disease prevention and control in a ministry of health or national institute. National health reporting system, survey and surveillance: National health reporting system : T he process by which a ministry of health produces annual health reports that summarize data on , for example, national health human resources, population demographics, health expenditures, and health indicators such as mortality and morbidity. Includes the process of collecting data from various health information sources , e.g. disease registries, hospital admission or discharge data. National survey : A f ixed or unfixed time interval survey on the main chronic diseases, or major risk factors common to chronic diseases. Surveillance : T he systematic collection of data (through survey or registration) on r isk factors, chronic diseases and their determinants for continuous analysis, interpretation and feed-back. National integrated action plan : A concerted approach to addressing a multiplicity of issues within a chronic disease prevention and health promotion framework, targeting the major risk factors common to the main chronic diseases, including the integration of primary, secondary and tertiary prevention, health promotion and diseases prevention programme s across sectors and disciplines. National policy, strategy, action plan: Policy : A specific official decision or set of decisions designed to carry out a course of action endorsed by a political body, including a set of goals, priorities and main directions for attaining these goals. T he policy document may include a strategy to give effect to the policy. Strategy : a long - term plan designed to achieve a particular goal . Action plan : A scheme of course of action, which may correspond to a policy or strategy, with defined activities indicating who does what (type of activities and people responsible for implementation), when (time frame), how and with what resources to accomplish an objective. National protocols/guidelines/standards for chronic diseases and conditions: A recommended evidence-based course of action to prevent a chronic disease or condition or to treat or manage a chronic disease or condition aiming to prevent complications, improve outcomes and quality of life of patients. NGO: Non - governmental organization. Noncommunicable diseases (NCDs): The four main types of noncommunicable diseases are cardiovascular diseases ( such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. Noncommunicable diseases prevention and control: All activities related to surveillance, prevention and management of the chronic noncommunicable diseases. Not in effect : Any policy, strategy or plan of action which has been previously developed and is no longer under development, but for various reasons is not being implemented. Nutrient declaration: A standardized statement or listing of the nutrient content of a food . Nutrition labelling: A description intended to inform consumers of the nutritional properties of food. Nutrition labelling consists of two components: (a) nutrient declaration; (b) supplementary nutrition information (e.g. front-of-pack labelling) . Operational: A policy, strategy or plan of action which is being used and implemented in the country, and has resources and funding available to implement it. Also applies to a multisectoral commission/mechanism which is functional and meets on a regular basis. Palliative care: Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual. Partnership for health: A n agreement between two or more partners to work cooperatively towards a set of shared health outcomes . Peak flow measurement: A peak flow meter is a simple, hand-held device which measures how well a person can expel air from their lungs. The patient blows quickly and forcefully through a mouthpiece at one end, and a measurement is read from a built-in numbered scale on the device. Peak flow measurement can be done by a patient at home or in a health facility. Price subsidies: Economic benefit provided by the government (such as a tax allowance or duty rebate) to keep the price of healthy foods low. Primary health care: R efers to core functions of a nation’s health system. Encompassing front-line health service delivery (primary care) as well as health system structure; governance and financing; the intersectoral policy environment; and social determinants of health, primary health care provides essential health interventions according to a community’s needs and expectations. Primary prevention: Measures directed towards preventing the initial occurrence of a disease or disorder. Print media: Communicating with the public through printed materials such as magazines, newspapers and billboards. Product reformulation by industry : Refers to the process of changing the composition of processed foods to be healthier and reduce the salt content. Public awareness programme: A comprehensive effort that includes multiple components (messaging, grassroots outreach, media relations, government affairs, budget, etc.) to help increase public understanding about the importance of an issue. Public health sector: Publicly funded health care sector. Rehabilitation: A set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments. Risk facto rs associated with nonc ommunicable diseases The four main risk factors for NCDs are tobacco use, harmful use of alcohol, unhealthy diet and low levels of physical activity. Saturated fats: Fats found in animal products, including meat and whole milk dairy products, as well as certain plant oils like palm, palm kernel and coconut oils. Screening: Measures preformed across an apparently healthy population in order to identify individuals who are at high risk or in the early stages of disease, but do not yet have symptoms. Screening coverage: T he proportion of people in the population targeted by the program me who actually received screening in the time frame defined by the program me . (F or example , if a country recommends mammography screening every 2 years for women aged 50 to 60. The screening coverage is the number of women aged 50 to 60 who benefitted from mammography thanks to the program me in the past 2 years, divided by the total number of women aged 50 to 60 in the country . ) Self-regulation: In this context refers to when a group or private sector entity governs or polices itself without outside assistance or influence. Spirometry: A spirometer is a complex piece of equipment which provides a number of different lung function measurements. The patient makes a prolonged, but forceful exhalation into a mouthpiece, connected to a machine which typically produces a graphical output. Spirometry requires a trained technician to oversee the testing and to interpret the results. Sugar-sweetened beverages: Sugar-sweetened beverages (SSB) are defined as all types of beverages containing free sugars and these include carbonated or non-carbonated soft drinks, fruit/vegetable juices and drinks, liquid and powder concentrates, flavoured water, energy and sports drinks, ready-to-drink tea, ready-to-drink coffee, and flavoured milk drinks. Free sugars include monosaccharide and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates . Target: A specific aim to be achieved, should be time bound, and define a ‘desired’, ‘promised’, ‘minimum’ or ‘aspirational’ level of achievement. Taxation incentives to promote physical activity : Involve removing the tax (or a portion of the tax) in order to promote increased use of goods or services to encourage physical activity. Trans - fatty acids (trans fats): U nsaturated fatty acids with at least one double carbon–carbon bond in the trans configuration. Trans -fatty acids can be produced industrially by the partial hydrogenation of vegetable and fish oils, but also occur naturally in meat and dairy products from ruminant animals (e.g. cattle, sheep, goats, camels). Industrially-produced trans -fatty acids can be found in baked and fried foods, pre-packaged snacks and food, and partially hydrogenated cooking oils and fats which are often used at home, in restaurants, or in the informal food sector (such as street vendors), and are the predominant source of trans -fatty acid intake in many populations. Under development: S omething which is still being developed or finalized and is not yet being implemented in the country. U niversal H ealth C overage- P riority B enefits P ackage ; A universal health coverage-priority benefits package (UHC-PBP) is a set of evidence-informed prioritized health interventions, services and programmes, including intersectoral actions and fiscal policies, defined through a deliberative process that accounts for economic realities and social preferences. A UHC-PBP should be available for all, in good quality, at the appropriate service delivery platform(s) using an integrated people-centred approach and covered by relevant financial protection arrangement(s). VAT/Sales Tax: “ Value-added tax” (VAT) is a “multi-stage” tax on all consumer goods and services applied proportionally to the price the consumer pays for a product. Although manufacturers and wholesalers also partici pate in the administration and payment of the tax all along the manufacturing/distribution chain, they are all reimbursed through a tax credit system, so that the only entity who pays in the end is the final consumer. Most countries that impose a VAT do so on a base that includes any excise tax and customs duty. Example: VAT representing 10% of the retail price. Some countries, however, impose sales taxes instead. Unlike VAT, sales taxes are levied at the point of retail on the total value of goods and services purchased. Saatja: EURO NCD Surveillance <[email protected]> Saadetud: 17.05.2023 17:13 Adressaat: <"Elen Ohov"> Koopia: RAKOVAC, Ivo <[email protected]>; FEDKINA, Natalia <[email protected]>; <"Triin Uusberg">; <"SM Info">; Ms K. Saarsalu- Layachi <[email protected]>; <[email protected]>; Kaisa.Mitt-Alvarez <[email protected]>; <[email protected]>; KÖHLER, Kristina <[email protected]>; <[email protected]> Teema: Nomination of a national data provider for the 2023 round of the Global Survey on Assessment of National Capacity for the Prevention and Control of NCDs (CCS). Dear Ms Ohov, On behalf of Dr Gauden Galea, Strategic Advisor, Special Initiative on NCDs and Innovation at WHO Regional Office for Europe, we are pleased to share with you the letter, requesting for nomination of a national data provider for the 2023 round of the Global Survey on Assessment of National Capacity for the Prevention and Control of NCDs (CCS). We would very much appreciate receiving your official nomination as soon as possible and no later than 2 June 2023. We would like to receive the name, functional title, and email address of the nominated expert so that we can liaise with him/her directly, sending the questionnaire and links, and communicate about any follow-up queries regarding the questionnaire, to the following addresses: ; ; Thank you, Best regards, WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office)