1. Dominica CNCDs - Current Situation Dr. David Johnson Ministry of Health and Environment CARMEN OBSERVATORY MEETING May 12, 2008

2. Ministry of Health & Environment Demographic data Total population = 68,635 (2001 census) Males = 50.3% population <25 years = 45.4% population >60 years = 13.4%

3. Ministry of Health & Environment 790 square kilometers 7 health districts 52 health centre/clinics 2 district hospitals Main hospital in Roseau (secondary care)

4. Ministry of Health & Environment Trend in Crude Birth Rate and Infant Mortality Rate, 2001-2006

5. Ministry of Health & Environment Trend in Life Expectancy, 1995-2010

6. Ministry of Health & Environment Chronic Non-communicable Diseases

7. Ministry of Health & Environment Chronic Non-communicable Diseases

8. Ministry of Health & Environment Leading Causes of Death Ranking 2002-2006 20022003200420052006 Ran k DiseaseRankDiseaseRankDiseaseRankDiseaseRankDisease 1Heart d1 1Htn1Heart d1 2Htn2 2Heart d2Stroke2 3DM3Ca pros3DM3 3 4Ca pros4DM4Ca pros4ARI4Ca pros 5Stroke5 5 5Ca pros5ARI 6Ca stomach 6 6ARI6Septicemi a 6Htn 7ARI6 7Ca Dig7Ca dig7CLRD 8Ca lung8Perinat7Ca stomach 7CLRD8Nerv S 9Homicide9Ca breast 9Urinary9Htn9Ca breast 10Urinary10Nerv S10Perinat10Nerv S10Ca dig

9. Ministry of Health & Environment Leading Causes of death by both sexes 1991 -1995 vs 2001-2005

10. Ministry of Health & Environment Percentage Obesity Among 0-5 Year Old Children, 2001-2005

11. Ministry of Health & Environment Relationship between NSPH & Other Policies/Plans National Strategic Plan for Health CNCD Strategic Plan/Corporate Plan CNCD Program Dept/Prgm Plans National Development Plans (Growth & Social Protection Strategy) National Development Plans (Growth & Social Protection Strategy) Regional plans Int’l Agreements Work Plans

12. Ministry of Health & Environment Research Field Work of PAN American Version of WHO STEPS CNCD Risk Factor Surveillance completed May 10, 2007 Data Processing is ongoing Data Analysis- June 2008 Dominica will be among 4 countries, with CAREC, PAHO Washington and WHO- Geneva in Videoconference- May 15, 2008.

13. Ministry of Health & Environment NCD Risk Factor Surveillance This surveillance will include the incidence and prevalence rates of NCDs as well as their risk factors which will be used to:  Develop and National NCD Strategic Plan  Complete National Policy on NCD  inform NCDs programmes.

14. Ministry of Health & Environment Policy and Advocacy. The response to NCDs is guided by policy documents which include: The National Strategic Plan for Health The National Policy for Chronic Non-communicable Diseases (draft) National Dietary Guidelines, 2007 Food and Nutrition Policy( to be finalized in Before end of 2008

15. Ministry of Health & Environment Policy/Advocacy Dialogues On the initiative of the Hon. Prime Minister, a National Summit on CNCDs held – December 14, 2007. The theme of Summit: “ Investing in health, Combating CNCDs”

16. Ministry of Health & Environment National Summit- Purpose To sensitize the Cabinet and other key stakeholders on the situation of CNCDs and the need for: collective policies and comprehensive program for management of and prevention of their risk factors

17. Ministry of Health & Environment National Summit- Objectives Present Dominica’s health profile, its position and response to CARICOM Heads of Government Summit on management & control of NCDs Strengthen political support and obligation for the management and prevention of NCDs and their risk factors. Foster inter-institutional and inter-sectoral actions for management and prevention of NCDs and their risk factors.

18. Ministry of Health & Environment National Summit- Objectives Advocate for strengthening social network for prevention and management of NCDs and their risk factors. Discuss and agree on the need for collective policies for prevention of risks for NCDS.

19. Ministry of Health & Environment National Summit- Outcome Clear statements on Dominica’s commitment to NCDs A deeper sense of joint collaborative commitment among stakeholders for the need to implement the necessary actions to manage and control NCDs Commitment to establishment of Dominica National Commission on NCDs

20. Ministry of Health & Environment Dominica National Commission NCD To monitor conformity of Dominica’s policies, laws and programmes with regards to its obligations arising from CARICOM Heads of Government “Declaration NCDs”. To advise Cabinet on the State’s policies, laws and programmes with regards the its obligations arising from the Declaration. To foster a multi-sectoral approach for addressing of epidemic of the CNCDs

21. Ministry of Health & Environment Community based- initiatives The Antihypertensive/Diabetes Project Woodford Hill, The Calibishie Healthy Lifestyle Group Weight Watchers Project Laplaine The school health and family life education diet and exercise healthy communities initiatives, screening prostate cancer among farmers

22. Ministry of Health & Environment Thank you

23. Ministry of Health & Environment Capacity Building- Workshop on Asthma Clinical Guidelines for Caribbean Sickle Cell Anaemia Capacity Building Workshop CARMEN Biennial Meeting in Bahamas- November 2007 PAHO/WHO Policy Analysis and Decision Making Workshop Emphasis on NCD- Barbados Oct. 2007 Meeting of Expertise

24. Ministry of Health & Environment Capacity Building- Strengthening the cervical cancer Prevention/Screening and Management Programme Development of Men’s Health Program- emphasis on Prostate cancer.