Strengthening NCD and RF surveillance in the Americas Branka Legetic. PAHO-WHO Regional adviser, Workshop on STEPS Stoke,Curacao, Nov 2010

Strategic Plan Surveillance & policy of NCDs & RF SO 3: To prevent and reduce disease, disability and premature death of chronic non communicable diseases, violence and injuries SO6: To promote health and development and prevent and reduce RF such as use of tobacco, alcohol, drugs and other psychoactive substances, unhealthy diets, physical inactivity and unsafe sex SO 6; SO9;SO11;SO15

PAHO Regional Strategy and Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases WHO Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases Development and strengthening of Country capacity for surveillance of chronic diseases, their consequences, RF, and impact of PH interventions Monitoring NCDs and their determinants and evaluate progress at the national, regional and global levels

Surveillance line of Action To encourage and support the development and strengthening of countries’ capacity for better surveillance of chronic diseases, their consequences, their risk factors, and the impact of public health interventions. Development & strengthening of chronic disease and risk factor surveillance systems

Focus on the following in the countries, sub regions and the Region: Capacity assessment, use for monitoring & evaluation Ongoing collection of reliable, comparable, and quality data; timely and advanced analysis; dissemination and use of analysis results for national policy and program planning & evaluation, technical competency of the surveillance workforce novel thinking and innovation

Available documents and tools

TOOL: Country Profile of Capacity and Response to NCDs

TOOL: Minimum dataset for NCDs Purpose: to combine multiple data sources in one functional annual reporting system as a foundation for CNCD surveillance. to remedy the fragmentation of traditional country surveillance systems to facilitate further analysis on a national, sub Regional, and Regional level and the generation of more complex indicators for NCDs.

In 2010 Assessment of capacity : Country capacity to respond to NCDs : instrument in Excel available on PROGRES REPORT for Directing Council Ongoing collection of reliable, comparable and timely data Implementation of Minimum data set in implementation in 20 countries Support RF studies Pan Am STEPS & introducing new methods

TOOLS: Methodology for Risk Factor Surveillance Disease, risk and protective factors in adults: Pan Am STEPS- New fact sheet on Determinants & RF E STEPS Additional modules MULTIMOD: Methodology for use of land and cell phones

Pan American STEPS -UPDATE January 2008 Presently in the Field: Paraguay Published and promoted for policy purposes: Aruba, Bahamas, St Kitts Attended II Level training & completed data processing : Aruba, Bahamas, Uruguay, St Kits, Barbados, BVI, Dominica Trained level 1 and in preparatory phase: Dominican Republic, Cuba, T&T, Curacao, Turks & Cayucos Planning I Level training in 2008: St Lucia, St Vincent, Panama, C Rica, Grenada Chile, Argentina, Brazil, Mexico, Colombia, Jamaica are in process of mapping and harmonization of data with Pan Am STEPS

TOOLS: Methodology for youth RF surveillance Pan Am GSHS & GYTS: 11 countries in the Region

Advances in 2010 Dissemination and use of analysis results for national policy and program planning & evaluation Workshops for STEPS advanced analysis CAREC Feb 2010 Policy and program implementation based on data analysis Caribbean Portal as part of PAHO health observatory CAREC 2010 Technical competency of the surveillance workforce FETP including NCDs, in collaboration with Brazil, Colombia & CDC Training for cancer registry: in collaboration with IARC, Guayaquil 2010; Port of Spain 2010,

2010 cont Novel thinking and innovation Training & pilot of Multi Mod surveillance Miami Sept 2010 Mini STEPS as part of census, labor or other studies for annual updates on behavioral RF, Caribbean Use of Sentinel sites for PHC and hospital performance monitoring C Rica pilot

Cancer incidence/ cancer registers – geographic coverage in LAC based on CI5 IX

Improving information on incidence, prevalence and survival of CVD WHOs STEPwise Aapproach to Stroke Surveillance, STEPS Stroke (based on WHO MONICA Project) TOOLS: STEPS Stroke methodology

Stroke as one of the 3 main causes of death in the Americas 1st%2nd%3rd % Anguilla14.7Argentina8.2Antigua and Barbuda8.3 Brazil10.7Belize6.7Canada7 French Guyana8.7Barbados8.8Colombia7.4 Guadeloupe11.9Bermuda7.4Haiti8.6 Guyana10.9Cayman Islands6.4Montserrat8.8 Martinique12.2Chile9.6Nicaragua7.7 Panama11.2Costa Rica6.3Puerto Rico5.8 Paraguay10.6Cuba10.4Trinidad and Tobago10.7 Suriname12.9Dominican Republic10 St. Kitts and Nevis10.1Ecuador6.2 Uruguay12.4Peru4.8 St. Lucia12.1 United States6.9 Venezuela7.2 Virgin Islands (US)7.6

STEPS Stroke in LAC – State and Perspectives Countries that have implemented STEPS stroke, 1,2, 3 step : Chile, Mexico, Brazil (Sao Paulo + 5 regions), Barbados, Countries interested in implementing STEPS Stroke: Colombia, Uruguay, Argentina, Honduras, Curacao STEPS Stroke Instrument available on PAHO WEB: in English, Spanish and soon in Portuguese STEPS Stroke supported by: World Stroke organization, World Federation of Neurology, PAHO-WHO EMMA: Estudo de Mortalidade e Morbilidade do Acidente Vascular Cerebral STROQUE: Stroke Register of Queretaro. Municipio Queretaro TAURUSs: Talca Urban & Rural Stroke Study Barbados, MI & Stroke register

STEPS STROKE initiatives in Latin America and Caribbean AcronymNameCity, Country PopulationSTEPSP.IFunding Agency EMMAEstudo de Mortalidade e Morbidade do Acidente Vascular Cerebral Sao Paulo, Brazil 10 Million Dr. P.A Lotufo CNP STROQUEStroke Register of Queretaro, Municipio Queretaro Municipio Queretaro, Mexico 725, Dr. F. Barrinagarre menteria CONCYTEQ CONACYT TAURUSsTalca Urban & Rural Stroke Study Provincia Talca, Chile 390, Dr. P.M Lavados CONICYT National population Register of Barbados Barbados300, Dr. Anselm Hennins MOH Barbados

STEPS Stroke...what it offers Study Protocol and Instrument Data Entry Tool International Comparisons

Advances in 2010 Cancer Registry: Brasilia Declaration on improving information on cancer signed by 19 countries Training for cancer registry: in collaboration with IARC: Guayaquil 2010; Port of Spain 2010 Stroke registry: Manual STEP STROKE in en, Sp & Portuguese on the WEB Temporary advisers to support countries Training for Step Stroke: Curacao 2010

SUBREGIONAL Support MERCOSUR: Common Market of the South - VENT working group 2008, 2009,2010 Andean - VENT working group 2009, 2010 Chile

English Speaking Caribbean Declaration of Port of Spain (2007) To be established, as a matter of urgency, the programs necessary for research and surveillance of the risk factors for NCDs with the support of our Universities and the Caribbean Epidemiology Centre/Pan American Health Organization (CAREC/PAHO);” EPI meetings : 2006, 2007, 2008, 2010

PHIP Architecture

Use of results for national policy Policy Observatory Project

Advances in use of results for national policy Case study methodology : Brazil C Rica Canada National NCD policies Chile Uruguay Aruba, Dominica Bahamas, St Kits & Nevis Policy dialogues Support Sub regional or Regional policy planning process Caribbean –Summit & follow up

Advances in 2010 Policy Observatory project meeting Port of Spain, November 17, Purpose: Discus and prepare governments for UN Special Session on NCD September 2011

Conclusions  NCD and RF surveillance are of importance for political and technical agenda  Secures commitment for strengthening capacity at national and sub regional level  Jointly developed & implemented standardized instruments: 1.Shorten the process of obtaining reliable timely information 2.Secure inter-country comparability and comparability over time 3.Secures sustainability of collection and analysis 4.Strengthen partnerships

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