PRESENTATION OUTLINES

NCD z NCD burden

Prevention & Control Program

z Cancer & Tobacco Control Program
z Violence Prevention Program
z Injury Prevention Program
z Diabetes Prevention & Control Program
z CVD Prevention & Control Program
z Blindness Prevention & Control Program
z NCD Surveillance

Global CVD-Death 16.6 million (2001)

Is NCD (CVD, DM) an important health problem ?

Disease Burdens :
c
Global & Local

How serious is the problem ?

3 4

Death, by broad cause group in year 2000 The Global Death due to
Chronic Diseases (NCD)
Total deaths: 55,694,000

z ~60% of the 56.5 million total reported deaths in the

world (2001)
z CVD -16.6 millions : 7 million CHD, 4.5 millions Stroke
Non-communicable z DM with complication- 4 millions
Injuries (9.1%)
conditions (59.0%) z COPD -2.7 millions
z Expected to increase to ~70% by 2020
z Developing countries:
z 71% - IHD
z 75% - stroke
z 70% - diabetes
Communicable diseases, maternal and
perinatal conditions and nutritional
deficiencies (31.9%)

5
Source: WHO, World Health Report 2001 6
The world health report 2002: reducing risk, promoting healthy life.
Geneva, World Health Organization,2002
 Leading Causes of Death in Rural Areas, China, 1998 High Burden in Developing Countries
Lost healthy years (000’s) from Cardiovascular disease in 2000

5,000 10,000 15,000 20,000 25,000 30,000

SEAR D
WPR B (CHN,VTN, MAL)
EUR C
EUR A
EUR B
EMR D
AMR A Ischaemic heart disease
AMR B
Stroke
SEAR B
AFR E
Other cardiovascular dis
Communicable diseases (2.6%) AFR D
EMR B
Injuries (11.2%) Undiagnosed (3.3%) WPR A (JPN)
Source: World Health Report, 2002
Non-communicable conditions (82.9%)
Noncommunicable conditions AMR D
7 8

Source: Ministry of Health, China, 2000

Changes in age-adjusted mortality rate, Japan

400 400
1965 Stroke The proportion of lifestyle-related diseases to all death in Japan.
350 350 Heart disease

Tuberculosis
300 About 60%
age adjusted mortality ( /100,000)

300

250 Males 250

1965 Females

200 200
others cancer
150 150 38.2 31.0%
%
100 100

50 50
Cardiovascular disease
stroke 15.3%
0 0 13.6%
hypertension
47

50

55

60

65

70

75

80

85

90

95

47

50

55

60

65

70

75

80

85

90

95
19

19

19

19

19

19

19

19

19

19

19

0.6%
19

19

19

19

19

19

19

19

19

19

19

year year

9 diabetes 10
1.3%
（2001）

The World Health is in Transition

Epidemiological: NCD overriding CD, & double
burden of diseases in many “The Tip of the iceberg”
developing countries
Demographic: Population ageing 32 million heart attacks per year

Lifestyles: Diets are rapidly changing

Physical activity reducing
Tobacco use increasing
Urbanization: Growing cities
Globalisation: Increasing global influences

12
 The Global Burden of
World Health Report 2002 Chronic Diseases (NCD)

z 10 of the top risks explain a high z ~46% of the global burden of disease (2001)
proportion of the premature z DM – 177 millions
deaths and disease burden z Expected to increase to 57% by 2020
z 7 are related to diet and physical z Diabetes > 2.5 fold increased
z 84 million (1995) to 228 million (2025)
activity
z One third of the disease burden
is due to 5 risk factors
z Concentrating on a few key major
RF will have a big impact

13 14
The world health report 2002: reducing risk, promoting healthy life.
Geneva, World Health Organization,2002

NCD NCD

THE LOCAL SITUATION THE LOCAL SITUATION

10 ++ millions-
at least 1 NCD Risk Factors

15 16

MALAYSIA
Epidemiological Transition
ƒ NCD is leading in the 10 leading causes of
morbidity and mortality for the last few
z Moving from a developing to a develop
years.
status
ƒ Double burdens in term of disease pattern:
Preexisting infectious diseases and z Lifestyle related diseases increase
emerging of NCD problem. z “Double burden” of the disease

17 18
 Common Risk Factors of Lifestyle Diseases

Share Predisposing Conditions:

z Hypertension
z Obesity (especially central obesity)
z Diabetes Mellitus
z Cancer

And Common Risk Factors:

z Tobacco
z Physical Inactivity

z Irrational Diet (especially high fat intake)

z Alcohol over-consumption

19 20

Smoking Physical Inactivity

z 30.6% ever smokers z NHMS2 – 11.6% exercised adequately, 31.7%

z 24.8% current smokers ever exercised
z Higher in Kelantan (31.7%), Pahang (29.8%) z Nearly 70% of Malaysians do not exercise
and Sabah (29.3%). Lowest in Penang (20.7%)
z Higher amongst Malay, rural, males (females
only 3.5%)

21 22

Alcohol (amongst non-Muslims) HYPERTENSION

z 29.2% ever drank
z 23% current drinkers
z Higher prevalence in Sabah, rural location,
males. Increase of cases due to;
•aging
•Smoking habit
•?life stressors
•? Excessive dietary salt
23
intake 24
 10 Leading Causes of Death in Government Hospital, 2000
Sebab Bilangan kematian %

Heart Disease and Disease of Pulmonary Circulation 4779 15.76

Septicemia 4167 13.74

Malignant Neoplasm 2832 9.34
Cerebrovascular Diseases 2811 9.27
Injury (Accident) 2404 7.93
Certain conditions originating in the perinatal period 1811 5.97

Disease of Digestive System 1425 4.70

Pneumonia 1422 4.69
Nephritis, Nephrotic Syndrome, Nephrosis 1125 3.71
(glomerular diseases)
Ill-defined conditions 785 2.59
Sumber : IDS-Kementerian Kesihatan Malaysia 2002
25 26

TOTAL NUMBER OF ADMISSION (CVA/STROKE) TO GOVERNMENT

TOTAL NUMBER OF ADMISSION (CVD) TOTAL NUMBER OF DEATHS (CVD) HOSPITALS 1991 - 2000
TO GOVERNMENT HOSPITALS IN GOVERNMENT HOSPITALS
1985 - 1998 1965 -2000

Year Hospital Admission Death

9000 1991 8,037 2,183

120000
103512 108087 8000
16000
104751 7812
7496 7559 1992 9,033 2,416
100000 7000
7249 7307
14000
6000 1993 9,420 2,338
80000 5181
5459 5383
5487
5859
58961 5000
4953
5294 5383 5201
5502 12000 1994 10,132 2,490
60000 4000
10000
3323
3428 1995 11,422 2,635
3000 2707 2730 2728
40000 2139
2510 2488 2523
1986 2592 2702 2516 2251
1836
2000 1619
2154
2301
8000 1996 12,365 2,610
20000 1791 1794
1000 1557
1997 12,985 2,790
0 0 6000
85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 '00 1998 14,047 2,822
4000
1999 12,416 2,674
Admission
2000
2000 13,868 2,801

0
91 92 93 94 95 96 97 98 99 2000
Sumber: Unit Sistem Dokumentasi dan informasi-KKM 2002

27 28

Leading Causes of Diseases Burden, Malaysia 2000

TOTAL DALY Status & Rank Order One DALY = one lost year of ‘healthy’ life
DIABETES MELLITUS
Rank No DALY Total % Total

1 Ischaemic Heart Diseases 278,733 9.8%

2 All mental illness 206,898 7.3%

3 Cerebro-vascular Disease/stroke 180,431 6.4%

4 Road Traffic Injuries 162,736 5.7%

•Increasing prevalence
5 All cancers 137,675 4.9% 1986 6.3%,
6 Septicemia 127,714 4.5% 1995 7.7%,
7 Diabetes Mellitus 103,449 3.7%

8 Acute Lower Respiratory tract infections 87,539 3.1%

1996 8.3%
9 Hearing loss 83,560 3.0% due to sedentary lifestyle, obesity and
10 Other respiratory disease 82,032 2.9% high fat diet.
11 Asthma 61,005 2.2%

12 Chronic obstructive pulmonary disease 60,728 2.1%

13 Cirrhosis 54,687 1.9%

14 Other cardiovascular diseases 51,315 1.8%

29 30
 Number of Diabetes Cases in Projection of Risk Factor Burden-1
Klinik Kesihatan (2000 – 2002)

Disease Prev 1996 2002 2006 2010 2020

657958 Burden Rate NHMS2

525858 HPT 29.9% 2,190,504 2,631,500 2,850,000 2,987,900 3,557,400

446847

DM 8.3% 608,000 730,490 790,400 829,400 987,500

Stroke* 12,365

IHD* 33,070

Year 2000 Year 2001 Year 2002 Note: Based on NHMS2 1996. Prevalance rate remain constant.
Disease Burden= Pi x [p0 + (pi x Td)]

31 32

Projection of Risk Factor Burden -2 Projection of Risk Factor Burden-1

Disease 1996 2002 2006 2010 2020 Burden of Risk Prev 1996 2002 2006 2010 2020
Burden NHMS2 Factor
Smoking 24.8% 1,816,900 2,182,700 2,368,400 2,478,300 2,950,600
HPT 2,190,504 3,476,435 4,383,450 5,226,300 8,126,100
(29.9%) (39.5%) (45.9%) (52.3%) (68.3%) Obesity 4.6% 322,348 387,248 420,200 459,700 547,300

Overweight 16.6% 1,216,326 1,460,982 1,585,300 1,658,800 1,957,000

DM 608,000 836,200 983,650 1,109,200 1,558,600
(8.3%) (9.5%) (10.3%) (11.1%) (13.1%) Physical 88.4% 6,476,300 7,780,200 8,442,200 8,853,700 10,597,000
Inactivity

IGT 4.3% 315,022 378,447 410,650 429,700 511,600

Note: Based on NHMS2 1996. Prevalence rate increase proportionately. Alcohol 23%

Note: Based on NHMS2 1996. Prevalence rate remain constant.

Disease Burden= Pi x [p0 + (pi x Td)]

33 34

Figure 2 : Risk Factors of Chronic Disease

Projection of Risk Factor Burden -2
12
10
Cases Millions

Diseases Current/Latest 2005 2010 2020

8 2002
Cancers (All forms) 26,089 cases 27,840 30,883 38,021
6 (NCR 2002)
4
2 Assumptions:
1. Population growth at 2.1% yearly is constant with similar growth in number of males and females
2. Incidence rate of cancer remain constant in both sexes
0
1996 2002 2006 2010 2020
Year
Smoking Obesity Overweight
Physical Inactivity IGT Alcohol
Note: Based on NHMS2 1996. Prevalance rate remain constant.
Disease Burden= Pi x [p0 + (pi x Td)]
35 36
 % of Most Common Cancers in Penang
by Gender, 1994-1998
The Malaysia Health is in Transition
Epidemiological: NCD overriding CD, &
MALE FEMALE double burden of diseases
z Lung (20.2%) z Breast (24.4%)
Demographic: Population ageing :
z Colorectal (10.6%) z Cervix (12.2%) Increasing life expectancy
z Nasopharynx ( 8.5%) z Colorectal ( 8.7%)
Lifestyles: Diets are rapidly changing
z Stomach ( 8.0%) z Lung ( 5.8%) - High fat, low fiber, high salt
z Liver ( 5.0%) z Ovary ( 4.9%) Physical activity reducing
Tobacco use increasing
z Prostate ( 4.6%) z Stomach ( 4.5%) Alcoholic

Urbanization: Growing cities : pollution

Globalisation: Increasing global influences
Source: Penang Cancer Registry report 1994-1998
increased trade- foodstuffs, tobacco
37

LIFESTYLES CHANGES (Individuals)

NCD Prevention & Control Program:

Intensify Prevention and Promotion Activities
Malaysia Experience
z Adopt healthy lifestyle, be active
z Regular Exercise
z Eat Right – Low Sugar, Low Salt, Low Fat,
High Fibre.
z No Smoking, No Alcohol

40

Determinants of CVD (NCD) RISK FACTORS

Non-modifiable risk factors:

BEHAVIORAL
BEHAVIORAL age,sex,ethnic, genes
¾ Tobacco
¾ Tobacco Intermediate risk
¾ Diet
¾ Diet factors: END POINTS
¾ Physical
¾ Physical Activity
Activity Behavioural risk factors:
hypertension CHD
¾ Alcohol
¾ Alcohol smoking
blood lipids
alcohol Stroke
ENVIRONMENTAL
ENVIRONMENTAL obesity
PVD
INTERMEDIATE
INTERMEDIATE END-POINTS diet
overweight
¾ Socio-cultural
¾ Socio-cultural RISK
RISK FACTORS
FACTORS END-POINTS physical activity Cancers
¾Ischemic Heart Dis. diabetes
¾ Policy
¾ Policy ¾Ischemic Heart stress COPD
¾Hypertension
¾Hypertension ¾Stroke
depression
¾ Economic
¾ Economic Dis. Emphysema
¾Blood lipids
¾Diabetes
¾ Physical
¾ Physical ¾Obesity ¾Stroke Vasc. Dis.
¾Peripheral Mental condition
¾Diabetes ¾Cancer
NON-MODIFIABLE
NON-MODIFIABLE ¾Blood lipids ¾Peripheral Vasc.
¾Obesity ¾Chronic Lung Dis. Socio-economic risk factor:
¾ Age,
¾ Age, Sex,
Sex, Genes
Genes Dis.
Cultural & environment

41 42
 NCD Should We Attempt To Prevent
Prevention & Control Program A Chronic Disease (NCD) ?

Programs: z An Important health problem

z Natural history is established
• Diabetes Prevention and Control Program
• CVD Prevention and Control Program z Early detection test available
• Blindness Prevention and Control Program z Effective intervention
• Injury Prevention and Control Program
• Violence Intervention Program
z Cost effective program
• Substance Abuse Program
• Non-Communicable Disease Surveillance

44

NCD Prevention & Control Program NCD Prevention & Control Program

General OBJECTIVES

z To reduce morbidity and premature mortality of z Promotion

NCD
z Assessment
z To reduce NCD modifiable risk factors such as
hypertension, smoking, hypercholesterolemia, z Intervention
diabetes mellitus, obesity and physical inactivity in
the community.

z To improve the quality of life of people with NCD

45 46

NCD Prevention & Control Program

LEVELS OF PREVENTION
ACTIVITIES
z Health Promotion & z To prevent risk factors
Healthy individual Risk factors & Established Complication Health Education z To prevent diseases
Early Disease Disease
Health Specific Disability Rehab
z Screening /assessment z To identify Risk factors
Promotion Protection Screening Early Detections
z To diagnose diseases
& App Rx
z Intervention: z To control diseases :
z appropriate treatment - treat at the earliest possible stage
z Behavioral modification - slow disease progression
z Pharmacotherapy
z Surgical , etc
z To prevent complications

z rehabilitation z To limit disability at the earliest possible

stage
Primary Prevention Secondary Prevention Tertiary Prevention z To restore an affected individual to a
useful, satisfying & when possible, self
sufficient role in society

Evaluation / audit / surveillance

Capacity building
Inter & intra sectoral coordination and collaboration : smart partnership
47 48
 CVD (NCD) Prevention & Control Program Natural History disease and Hierarchy of Action
Policy and Decision Maker
Program Managers
Health
Promotion & Education
Under the scope of Hospital care and
Clinical specialist Severe Apparent
follow up form diseases
Primary care Mild form
Mild
Under the scope of
Evaluation: Health public health Physician form
Audit & Research Assessment
Customized
Secondary
personalised Remove causes prevention Unapparent
and risk diseases
Eradicate Primary
Eliminate prevention Pathogenesis started
INTERVENTION:
Behavior Modification Reduce burden Exposure
Pathogenesis Occur
Pharmacotherapy Control
Customized, personalised, self-empowerment, Early detection Availability of disease determinants
family & community involvement

49 50

Framework for the prevention and control of CVD (NCD) NCD Prevention & Control Program

STRATEGY
Comprehensive NCD strategy
Integrated national NCD plans; STEPS surveys z Two strategies are used :
i) The population strategy
Direction & ii) The individual or high risk strategy.
Infrastructure

z They are complementary and reduction of

Changing Changing Reorienting Cardiovascular diseases are likely to be most
Environments Lifestyles Health Services
successful where both are pursued simultaneously.
Model community-based prevention programs Evidence-based guidelines;
Demonstration NCD prevention & control projects Capacity-building

51 52

NCD Prevention & Control Program NCD Prevention & Control Program
Studies show that appropriate intervention can reduce
Studies show that appropriate intervention can reduce
the morbidity and mortality due NCD the morbidity and mortality due NCD
High Risk & Population approaches High Risk & Population approaches

POPULATION Approach
Target: General population
+
Aim to correct/modify underlying
causes or risk factors of CVD in
the community.

To lower the mean of risk factors

and to shift the whole distribution
of exposure in favourable
direction
Reduce a small amount of risk in a Truncate high risk end of Reduce a small amount of risk in a
large number of people (e.g. reduce exposure distribution (e.g. large number of people (e.g. reduce
salt intake - promoting healthy organise an obesity clinic or a salt intake).
lifestyle). quit smoking clinic).
Lifestyle change plus environmental
Lifestyle change plus environmental Clinical approach to disease approach.
approach. prevention.
53 54
 NCD Prevention & Control Program
POPULATION APPROACH/STRATEGY
HIGH RISK STRATEGY
z Aim to correct/modify underlying causes or risk
factors of NCD in the community.
Target: High risk population
z To lower the mean of risk factors and to shift the Activities :
whole distribution of exposure in favourable z Identifying high risk individual:
direction z CVD screening programme
z Health Status Surveillance (My HeSS)

z Appropriate management of the risk factors

55 56

NCD Prevention & Control Program NCD Entry point

ACTIVITIES
z Health Promotion & z To prevent risk factors DIABETES HYPERTENSION PIKAM Program
Health Education z To prevent diseases

z Screening /assessment z To identify Risk factors PROMOTION &

World Diabetes Day Awareness week World Heart Day
z To diagnose diseases EDUCATION

z Intervention: z To control diseases :

z appropriate treatment - treat at the earliest possible stage
z Behavioral modification - slow disease progression SCREENING Diabetes Clinic Hpt Clinic CVD screening
z Pharmacotherapy
z Surgical , etc
z To prevent complications

z rehabilitation z To limit disability at the earliest possible

stage Behavior Behavior
INTERVENTION PIKAM Packages
z To restore an affected individual to a Diabetes CPG Hpt CPG
useful, satisfying & when possible, self
sufficient role in society
Audit Audit Surveillance
Evaluation / audit / surveillance EVALUATION
Research: SDM Research Research
Capacity building
Inter & intra sectoral coordination and collaboration : smart partnership
57 58

Components of the CVD (NCD) Program

PROMOTION & SCREENING/ INTERVENTION SURVEILLANCE/

EDUCATION ASSESSMENT Behavior & Phm EVALUATION
Health Promotion
Healthy Lifestyle My HeSS Guidelines
My HeSS &
Campaign Health provider Developed
Health Education
Demonstration Individual/ PHC staff is being
(10 Prevention)
National Survey
Project Family trained

IEC plus Env.

community Quality is Audited Audit/HSR
Interventions

POLICY MAKER INTERSECTORAL SMART

COLLABORATION
PROG. MANAGER COMMITTEE PARTNERSHIP

59
 HEALTH PROMOTION HEALTH PROMOTION
z Incorporate into Healthy Lifestyle campaigns
- adopt healthy lifestyle z Phase 1 – 1991 to 1996
z Disease oriented campaign-yearly themes
- good nutrition
- weight reduction z Phase 2- 1997 to 2002
z Behavioral oriented- yearly themes
- increase physical activity
z Phase 3- 2003 to 2008
z Behavioral oriented -2 yearly
z Focus to special target groups : school children,
work place
z 4 elements: Physical activity, diet, smoking, stress

61 62

PHASE 2 HLSC - Behavioural Oriented

PHASE 1 HLSC- Disease Oriented
1997-2002
1991-1996

z LOVE YOUR HEART 1991

HEALTHY EATING
z CLEAN FOOD, HEALTHY RECIPE FOR GOOD HEALTH
FAMILY 1993 1997 EXERCISE 1998 PREVENT INJURY 1999
AIDS KILL 1992

HEALTHY CHILDREN. STAY AHEAD PREVENT DIABETES ADOPT A HEALTHY LIFESTYLE

THE NATIONS FUTURE OF CANCER 1996 PRACTISE GOOD MENTAL HEALTH TOWARDS A HARMONIOUS
1994 1995 2000 AND HEALTHY FAMILY 2001
63 64

¾ World Heart Day Theme:

z 2000: "Exercise”
z 2001
z 2002 Nutrition, obesity and physical activity
z 2003: women, heart diseases and stroke
z 2004: children, adolescent and heart disease

¾ Partners:

65 66
 PARTNERS IN CVD:
NGO, INDUSTRY

• 1. Working closely with agencies, NGO: Screening

-Heart Foundation, Hypertension Soc., MASSO etc. Health Assessment
• 2. Organize with MOH in the following area:
z NCD Resource centre (CVD/DM)
z Health Promotion and education
z Training

67

My HeSS (2004)
My Health Status Surveillance
CARDIOVASCULAR DISEASES ACTIVITIES
z An Initiative
z CVD Risk Factors Screening (1999)
z An assessment tools/ enabler:
- plan to be incorporated into Well-Adult Clinic & Life-
z Socio-demography
Time Health Record ( LHR )
z Health Assessment :
- Initially one center per district
z medical & life style history :
- Screening of : Body Mass Index (BMI) for Obesity smoking, diet, alcohol, DM, Hpt
: Blood Pressure z Clinical : weight, BMI, BP, body
: Blood Glucose for Diabetes composition
z Biochemical : glucose & lipid
: Blood Cholesterol profiles
: Smoking Status z Physical fitness Assessment
: Family History of Heart Disease (ACSM)
z Diet Assessment & Management
z Stress Assessment

69 70

CVD (NCD) Prevention & Control Program

What MyHeSS offers ? Policy and Decision Maker
Program Managers
Health
TOOLS DETECTION Promotion & Education
Questionnaire Risk Factors: INTERVENTION
Physical - Smoking
Biochemical
- Hypertension Behavioral Mod.
Evaluation: Health
- Obesity Audit & Research Assessment
- Dyslipidemia Pharmacotherapy My Health Status Surveillance System
Customized
- IGT/Diabetes personalised
To prevent:
Fitness
CVD
Diet Fitness level
Hypertension
Stress Dietary pattern Diabetes
INTERVENTION:
Stress level & coping Behavior Modification
Stroke (CVA) Pharmacotherapy
Cancer Customized, personalised, self-empowerment,
family & community involvement

71 72
 My Health Surveillance System (MyHeSS)

Socio- Health Physical Stress Diet

demography Assessment Fitness Assessment Management
Profile Module Module Module Module

INTERVENTION
NCD Behavioral Modification
Surveillance
Database Pharmacotherapy
Surgical, etc.

Analysis Report Intervention

CVD (NCD) Prevention & Control Program

Intervention Policy and Decision Maker
Program Managers
Health
z Physical activity Promotion & Education

z Quit smoking
z Healthy diet
Evaluation: Health
z Avoid alcohol Audit & Research
My Health Status Surveillance System
Assessment
Customized
z Handle stress personalised

z Weight reduction INTERVENTION:

Behavior Modification
Pharmacotherapy
Customized, personalised, self-empowerment,
family & community involvement

75 76

Intervention INTERVENTION
Level of pre
ven tion
Health Clinic: n & z PIKAM
tio on t
t&

ec cti
rot n
z Malaysia Cardiovascular
en

Prevention :10 20 30 te me
&P De eat
tio atm

n
otio rly t tr Intervention Project (2000/2001)
lita e
n
bi Tr

om Ea om
z Hypertension clinic Pr
ha lar

r
Stress Mng

P
Re egu

Avoid alcohol
R

z Diabetes clinic z Malaysia Cardiovascular

Quit smoking

Intervention Program
z NCD clinic (2004) HOSPIT
ServIces

AL
Physical activity

z Behavioral Modification modules

Diet

for :
z Physical activity
n
Io

Hospital HEALTH z Diet

t
en

z Smoking
Prevention: 20 30
rv
te

z Hypertension
In

z Obesity
z IGT / DM
z Dyslipdemia
z Stress

77 78
 CLINICAL PRACTISE GUIDELINES Appropriate facilities and equipments

z CPG on The Management of Hypertension 2002 z NCD Resource Center

z CPG for Treatment of Tobacco Smoking and Dependence 2003 z At district/clinics
z CPG on Management of Obesity 2003 z Manpower, machine,
materials & management
z CPG on Dyslipidaemia 2003
z Consensus Statement on The Management of Ischemic Stroke
2000
z CPG on Myocardial Infarction 2001
z CPG on Heart Failure 2000

79 80

EVALUATION :
TRAINING for Diabetes Program
Audit & Research
• Short term
z MyHeSS
• 3 days diabetes management courses for paramedic from
PHCs. z NCD Risk Factor Study
• 3 months courses for diabetes nurses and MA of diabetes z Physical Activity Study
team z Physical Fitness Study
• Refresher courses for doctors. z Diet Study
• 6 months courses for diabetes management. z Stress Study
• Special courses in Diabetic foot, diabetes retinopathy and z NCD Surveillance in the Community
nephropathy. z Work Place related Disease
Long term z Audit for Hypertension & Diabetes Mx
• Diabetologist.
z NCD Research
• Dietitian.
• Podiatrist. z Hypertension Registry (Hi-Trax)
z Diabetes Registry

81 82

Thank You