1. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT The University of the West Indies Regional Non Communicable Diseases Surveillance System Project An IDB Regional Public Goods (RPG) project

2. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Outline Context Project Components Governance Challenges Opportunities

3. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Project Partners IDB funding: US$650,000 Executing Agency: The University of the West Indies Collaborator: CAREC/PAHO Duration: 36 months Project countries: – The Bahamas – Barbados – Belize – Guyana – Jamaica – Trinidad and Tobago

4. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Overall Objective To develop a Regional Non Communicable Diseases Surveillance System for the Caribbean to better plan, deliver and monitor programmes and protocols targeting chronic disease prevention, control and health promotion.

5. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Caribbean Cooperation in Health The following priority areas have been targeted: Strengthening Health Systems Human Resource Development Family Health Food and Nutrition Non-Communicable Diseases Communicable Diseases Mental Health Environmental Health http://altatorre.com/cpc/index2.php?option=com_content&do_pdf=1&id=27 The UWI’s Regional Spread

6. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT The UWI’s Mission To propel the economic, social, political and cultural development of West Indian society through teaching, research, innovation, advisory and community services and intellectual leadership

7. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT The UWI’s Core Values Commitment to the pursuit of excellence A keen sense of individual and social responsibility Respect for cultural diversity and the rule of law Multidisciplinary and interdisciplinary collaboration Ethical values, attitudes and approaches Community service, involvement and dedication to regional development

8. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT CARICOM SUMMIT ON NCDs: DECLARATION OF PORT-OF-SPAIN: UNITING TO STOP THE EPIDEMIC OF CHRONIC NCDs (September 2007) That we will establish, as a matter of urgency, the programmes 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 Organisation (CAREC/PAHO). http://www.caricom.org/jsp/communications/meetings_statements/declaration_port_of_spain_chronic_ncds.jsp

9. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT DATA IT PLATFORMPOLICY & PROTOCOLS Regional Public Good

10. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT MILESTONES 2007: Convergence of ideas- UWI; MOH’s; IDB; Sir George Alleyne AUG 2007: Videoconference- agreement among Chief Medical Officers of Health that focus should be on surveillance, in particular on the need for data generation and use APRIL 2008: Inaugural Steering Committee meeting MAY 2008: UWI and IDB sign project agreement

11. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT MILESTONES FEB 2009: The 6 participating countries and CAREC/PAHO signed agreements with the UWI APRIL 2009: 2 nd Steering Committee meeting, St Lucia JUNE 2009: Commencement of Gap analysis FEB 2010: Commencement of IT platform APRIL 2010: 3 rd. Steering Committee meeting, St. Augustine APRIL 2009: 2 nd Steering Committee meeting, St Lucia

12. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT DATA STANDARDISED MINIMUM DATA SET (CAREC/PAHO) –MORTALITY DATA (Ischaemic heart disease, cerebro vascular disease, cancer (malignant neoplasms, cervical, lung, female breast cancer, digestive system), mortality with diabetes, chronic lower respiratory diseases, external causes, land transport accidents, assault (homicide) –MORBIDITY DATA (diabetes, hypertension, overweight/obese) –RISK FACTORS (tobacco use, alcohol use, fruit and vegetable intake, physical activity, blood pressure readings, blood glucose readings) –HEALTH SYSTEM PERFORMANCE (use of preventive care – mammograms, pap smears, blood pressure testing, cholesterol testing, monitoring of care by diabetics, hospital discharges) –SOCIO-ECONOMIC AND CONTEXT INDICATORS (population ratio, income, rural/urban, population below poverty line, production/import/export of fruit and vegetables/alcohol/tobacco)

13. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT DATA Six-country Gap Analysis: – To assess data collection and processing capability of countries in relation to the Minimum Dataset – To assess the use of data for decision-making, policy and programme development – To make recommendations for the harmonisation of NCD Registries in the region

14. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Gap Analysis Findings Lack of data – reliability and validity Paper-based (manual) data collection, processing and reporting Lack of standard instruments for NCD data collection and reporting Data management system not integrated

15. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Recommendations Mortality Issue electronic provisional Death Certificate by registered practitioner Electronic submission to local Registrar’s Office Report electronically to MoH vital statistics, international agencies Create a unique national death database Compile minimal database and share with other countries Death notification 1. Code primary and secondary causes of death 2. Issue an electronic definite Death Certificate. Copies may be used for legal purposes by relatives, funeral homes, etc.

16. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Recommendations Registries Make reporting of cancer cases (public and private) compulsory Start planning cardiovascular disease (heart attack, heart failure and stroke) registry National: Implement a population-based cancer registry Regional: Implement a harmonized cancer registry

17. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Recommendations Ambulatory Services Estimate costs of public ambulatory clinic visits, medications and procedures Create a unique national personal identifier Implement computer-based public health information system

18. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Surveillance System (recommendation from Gap Analysis) Internet -based = interactive Reliable Timely Accessible User-friendly Flexible

19. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT IT PLATFORM  Mortality  Morbidity  Risk Factors Central, secure data repository Web-Internet access from virtually anywhere Database Server Web / Application Server Efficient data submission Firewall On demand data retrieval Reports Statistics

20. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Declaration of Port Of Spain That our Ministries of Health, in collaboration with other sectors, will establish by mid-2008 comprehensive plans for the screening and management of chronic diseases and risk factors so that by 2012, 80% of people with NCDs would receive quality care and have access to preventive education based on regional guidelines http://www.caricom.org/jsp/communications/meetings_statements/declaration_port_of_spain_chronic_ncds.jsp POLICY & PROTOCOLS

21. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT POLICY & PROTOCOLS September 2010: Regional Consultation hosted by the UWI St. Augustine Campus Objectives: – produce the first draft of a Chronic Care Model of care for the region – produce the first draft of an updated CARICOM Primary Health Care policy – identify mechanisms for implementation of POS Declaration Item#5 (improving quality of care for persons already living with NCDs)

22. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Challenges Lack of continuity of project Focal Points Delays in feedback from CMOs & Focal Points Human resource constraints in-country Competing priorities for Health Ministry, e.g. swine flu, dengue fever Lack of continuity of project Focal Points Delays in feedback from CMOs & Focal Points Human resource constraints in-country Competing priorities for Health Ministry, e.g. swine flu, dengue fever “Suspicion” of University as a partner in NCD surveillance

23. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Governance of Project “Ownership” by Chief Medical Officers of Health Focal Points nominated by each CMO Project Coordination Unit at the UWI – UWI as facilitator of the demands and wishes of the participating countries Support from IDB Communication: – Consultation and feedback mechanisms – Decision-making by consensus

24. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Recognition and Publicity Case study on project presented at Bogota as a good example of best practice of South- South Cooperation Featured in Trinidad Guardian newspaper

25. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT Opportunities Opportunity to build de novo a regional data system Opportunity to involve all CARICOM countries Opportunity for streamlined and standardised data collection mechanisms and processes for regional NCD data collection, collation and reporting Opportunity for on-demand access to national and regional data for more informed decision-making Opportunity for increased responsiveness by regional governments on NCD issues through use of IT tool

26. CARIBBEAN REGIONAL NON-COMMUNICABLE DISEASES SURVEILLANCE SYSTEM PROJECT OPPORTUNITY TO DEMONSTRATE WILLINGNESS TO COOPERATE NOT AN END.. BUT A BEGINNING!