1. Ministry of Health Oman Integration of Chronic Disease Care in PHC Dr. Ali Jaffer Mohammed Advisor & Director General of Health Affairs

2. Ministry of Health Oman Rational High Prevalence of NCDs in Oman (Ages 20+ years): Diabetes 12% Hypertension35% Dyslipidaemia 40% Overweight & obesity 48% Tobacco use23%

3. Ministry of Health Oman Deaths attributable to diseases and injuries, all ages, Oman, 2002. Al-Lawati JA. et al., Prev Chronic Dis 2008; 5 (3):A99.

4. Ministry of Health Oman Disability-adjusted life years lost attributable to diseases and injuries, all ages, Oman, 2002. Al-Lawati JA. et al., Prev Chronic Dis 2008; 5 (3):A99.

5. Ministry of Health Oman Rational WHO objective # 3 of the Action Plan for Prevention and Control of NCD

6. Ministry of Health Oman NCDs Integrated in PHC Management of: –Diabetes Mellitus –Hypertension Screening common NCD conditions: (only for 40+ years) –Diabetes (FBS) –Hypertension (BP measurement) –Chronic Renal disease (GFR) –Dyslipidaemia (TC, HDL, LDL, TG) –Obesity (BMI, WC)

7. Ministry of Health Oman Approaches in Oman Political commitment Accessible PHC to all Managers are family physicians Availability of structures and logistics needed for integration (health centres, staff, medication)

8. Ministry of Health Oman Steps of integrating NCD Management into PHC in Oman Formulation of the clinical guidelines for each condition.e.g. Diabetes, Hypertension, … etc Advocacy Training for PHC workers. Availability of necessary medications and equipments in PHC institutions. Arrangements at PHC institution (allocation of specific days for the clinic, appointments) Presence of specialists to support PHC ( in Polyclinics and secondary hospitals)

9. Ministry of Health Oman NCD Screening Results (2008) BothFemalesMales No. Screened 17,67910,894 (62%)6,785 (38%) 31%36%23%BMI>30 68%76%54%Abnormal WC 14% 15%Pre-HTN 19% 21%HTN 35% 36%Pre-DM 7%6%8%DM 46%47%43%High Choles. 28%26%32%eGFR < 90

10. Ministry of Health Oman Challenges (1) PHC structure needs further changes Untrained staff to deal with complex NCD conditions Unavailability of medications (ACEI, Statins limited lab services for tests in PHC Even if test done in 2y services, results not communicated in time to PHC

11. Ministry of Health Oman Need for electronic record system for defaulters follow-up, monitoring & evaluation Shortage of health educators Challenges (2)

12. Ministry of Health Oman Thank You