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Country Situation
Sri
Lanka has made impressive progress in
control of communicable diseases, in improving maternal and child health, and
virtually eliminating vaccine preventable diseases. Currently, chronic
non-communicable diseases (NCDs) are overtaking
communicable diseases as the dominant health problem, and are now the leading
causes of mortality, morbidity, and disability. It has led to an increase in
use of health resources. Aging of the population, urbanization and lifestyle
changes are the key factors behind this epidemiological transition.
The following major chronic NCDs
have a significant disease burden in Sri Lanka; cardiovascular
diseases (including coronary heart diseases [CHD], cerebrovascular
diseases [CeVD] and hypertension), diabetes
mellitus, chronic respiratory diseases, chronic renal disease and cancers.
In 2001 chronic NCDs accounted
for 71% of all deaths in Sri
Lanka, compared with 18% due to injuries,
and 11% due to communicable diseases, and maternal and prenatal conditions.
Analysis of age- standardized data for 1991-2001 has shown that the chronic NCDs mortality is 20-30% higher in Sri Lanka
than in many developed countries (WB ageing study 2008). Moreover, trend
analysis suggests that NCD mortality rates have been rapidly increasing
during the past decade (Register General, 2008).
Strategies
The following strategic areas are identified and
prioritized for support in Non Communicable disease prevention and control:
1. Support
prevention of chronic NCDs by strengthening policy,
regulatory and service delivery measures for reducing level of risk factors
of NCDs in the population
2. Implement
a cost-effective NCD screening program at community level with special
emphasis on cardiovascular diseases
3. Facilitate
provision of optimal NCD care by strengthening the health system to provide
integrated and appropriate curative, preventive, rehabilitative and
palliative services at each service level
4. Empower
the community for promotion of healthy lifestyle for NCD prevention and
control
5. Enhance
human resource development to facilitate NCD prevention and care
6. Strengthen
national health information system including disease and risk factor
surveillance
7. Promote
research and utilisation of its findings for
prevention and control of NCDs
8. Ensure
sustainable financing mechanisms that support cost-effective health
interventions at both preventive and curative sectors
9. Raise
priority and integrate prevention and control of NCDs
into policies across all government ministries, and private sector organisations
NCD Activities
Tobacco Control and
National Authority on Tobacco and Alcohol
In 2005, Sri
Lanka was the first Asian country to adopt
and ratify the Framework Convention on Tobacco Control (FCTC). In
collaboration with the WHO and Bloomberg Global Tobacco Initiative, the focus
of efforts in Sri Lanka
have been to protect young people. Since passage of the National Authority on
Tobacco and Alcohol (NATA) Bill (2007), tobacco control policies that have
been developed include tax increases on cigarettes and tobacco products;
restrictions on sales to youth; and restrictions on public and mass media
advertising. Local control efforts include creation of district tobacco
control cells with a lead role in implementing the provisions aimed at
reducing tobacco use.
Clinical Guidelines for
Care of Selected NCDs
The hospital efficiency and quality improvement component
of the Sri Lanka Health Sector Development Program (a World Bank–financed
project in 2005–2010) developed 93 clinical guidelines for care of selected
conditions identified by teams of specialists from eight medical colleges
(internal medicine, surgery, radiology, microbiology, gynecology and
obstetrics, pediatrics, and anesthetics). These clinical guidelines should
prove to be a major asset, and currently with the pilot PEN project underway
these guidelines are being re visited to assess the applicability at the
primary care level
Pilot Initiatives for NCDs
NCD Prevention Project (NPP)
Project
This initiative is being supported by JICA and is
currently being piloted in the Kurunegala and the Polonnaruwa districts
NIROGI Lanka Project
The National Initiative to Reinforce and Organise General diabetes care In Sri Lanka (NIROGI
Lanka) is being supported by the World Diabetic Foundation. There are three
components which include training of diabetic nurse educators, strengthening
of primary care services and using of the health promotion approach to
empower communities.
Package of Essential NCD
Interventions in Primary Care in Low resource settings
The Package of Essential NCD (PEN) Interventions pilot is
supported by the WHO. The package includes six core activities as well as
plans to introduce comprehensive NCD care within the primary care settings
and includes assessing human resource availability; providing NCD care
knowledge updates for staff; assessing availability of essential equipment
needs for NCD care; making necessary
changes to the essential drugs list to include first line for NCDs; developing and applying 10-year CVD risk charts to
clinic populations; and developing and introducing protocols for follow-up
care and management of NCDs. This pilot is being conducted in the UVA
province in the Badulla RDHS area and covers a
total of 18 facilities within three MoH areas.
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