NCD Situation in Botswana Ministry of Health Department of Public Health Disease Control Division Non-communicable Diseases Program By Bame Punah Shatera

Presentation Layout Introduction Situation of NCDs Strategies/Response to NCDs Successes and difficulties Next steps

Switzerland Botswana

Introduction cont. Demography Relatively small population estimated in 2008 at 2million Population density of 3 persons per sq km 34% of the population is under the age of 15years 6% are over the age of 65 years. 27% of the total population are women of child-bearing age 12% children under five years Annual population growth rate 2.4 % and the total fertility rate is 3.17.

Introduction Health System Ministry of Health runs the health care system in the country It runs the hospitals and provides primary care through network of clinics, health posts, mobile stops as well as community based preventive and promotive services Ministry of Health currently has 5 Departments Prevention of HIV/AIDS; Corporate Services; Policy Planning and Monitoring and Evaluation; Clinical Services and Care and Public health, where NCD Programme falls.

The role of NCD Programme: Introduction cont. The role of NCD Programme: Develop and maintain an effective disease surveillance system Carry out preventive and promotive activities Coordinate and monitor NCD activities

Introduction cont. At the moment NCD focuses on selected diseases Cancer Diabetes Hypertension Cardiovascular diseases

Situation of NCDs Number of cases and deaths due to NCDs (CSO-HEALTH STATISTICS REPORT 2001-2005) 2002 2003 2004 2005 Cases Deaths DM 1.042 73 1.189 74 1.417 81 4.523 88 5.388 107 CVD 13.325 - 10.758 55 12.676 105 3.495 305 528 316 Hypertension 1.082 135 6.729 13 42.172 150 47.949 279 Neoplasm 2.143 442 1.198 415 3.109 437 8.939 410 2.879 486

Situation of NCDs cont. The WHO STEPS survey, Botswana, 2007 revealed that risk factors identified were: Tobacco use currently smoking 32%males,7.8% females Alcohol consumption 54.l% males 51.8% males(binge drinking) Inadequate fruits and vegetable intake 96% of all respondents ate less than 5 servings of fruits and or vegetables on average per day Physical inactivity 27% males, 42% females Raised Blood Pressure 29% in males, 37% females. Obesity/overweight 22% males, 53% females

Situation of NCDs cont. Global Youth Tobacco Survey (2008)

Strategies/Responses The NCD program in the Ministry of Health The National Health Policy revised in 2009 to include Non-Communicable Diseases A multisectoral and multidisciplinary team set to draft national policy and strategic plan on NCD(end 2009) BNCR(population based) Identified risk factors are addressed in the following ways: Tobacco use Control of Smoking Amendment Act Cap 2004 Protection from second hand smoking Prohibition of marketing, promotion and advertising of tobacco products Health education campaigns on harmful use of tobacco Age restriction

Strategies/Response 2.Harmful use of alcohol Alcohol policy now finalized and ready Introduction of Levy Fund Educational campaigns financed from the levy fund to target youths and the community. Reduction of selling hours Age restriction Home brews

Strategies/Response 3.Nutrition 4. School Health Program Breast feeding 1st 6months(SRH) School Feeding programs National action plan on nutrition 4. School Health Program The National School Health Policy and Procedure Manual revised in 2010 to provide: Physical examination for primary school pupils from STD 1-7 which includes: BMI-To isolate obesity Oral health Eye examination Mental Health

Strategies/Response to NCDs 5. Physical Activity Inclusion of safe walk and bicycle lanes in major cities and towns School Health Policy (revised 2010) which has a provision of safe and sanitary school environment such as: Playgrounds and large rooms for indoor activities in every school Adequate sports facilities and equipment in schools A variety of other recreational activities in schools Private Sector and NGO Other Ministries CAB DAB Private hospitals

Strategies/Response to NCDs Wellness programmes Wellness programmes in all government sectors and most of the private sectors

Screening and mgnt programs Screening for High BP routine Screening program for cancer of the cervix is run by Sexual Reproductive Health division Management of High BP and diabetes is integrated in the health care system

Successes Completion of draft Strategic Plan and on NCD. BNCR Inclusion of NCDs in the NHP Completion of draft Strategic Plan and on NCD. BNCR Continued advocacy on NCD Data on risk factors

Challenges Inadequate trained personnel Lack of standard management guidelines Inadequate advocacy Poor surveillance system

Next steps Develop communication strategy Strengthen partnership Widen scope of public education Pilot the WHO package for integrating Essential NCD interventions into Primary Care(WHO-PEN)