Tackle NCDs in Thailand

Dr. Supattra SrivanichakornDDC, Ministry of Public Health, Thailand

Present for GCM/NCD WG3.2

23 June 2016

Thailand

Causes of Deaths:1. CVDs : 1.5 m.DALYs

2. Cancer :

3. Diabetes

Mortality rate from NCDs (30-70

yrs.) increase 24.5%

Prev. DM 6.9%, HT 21.4% (2009)

NCDs BurdenNCDs caused 349,090 deaths, 78.2 % of total deaths (2013)

75.4 % DALYS from NCDs

(8.0 millions DALYs from

total 10.6 mills. DALYs)

(Yrs. 2009 - 2013)

Pop. 65.4 millions (2016)

Total mortality rate 670.6 /100,000 pop (2014)

Income / year

Thai Burden of disease 2009

3

Diseases

Risks

Male Female

1 Alcohol dependence Diabetes

2 Road traffic injuries Stroke

3 Stroke Depression

4 HIV/AIDS Myocardial Infarction

5 Myocardial Infarction Osteoarthritis

THAILAND • SMOKING stable 23 – 24 % (since

2007) increase in the youth

• Alcohol drinking 1/3

• Over-weighted 1/5

• Inadequate exercise 1/3

• Physical inactivity increase

• 12.3 % Breast feeding (6 months)

• Sodium intake more than 2 gms/day

RISK FACTORs

Innovations to tackle NCD risk factors in Thailand

“Triangle that moves the

mountain” “Tipping point”

Knowledge generation & management

Socialmovement

Political/Policy

linkages

Stickiness of the issue

Three groups of people

Conductive Environment

Wasi P. Gladwell M.

Linkage between the Triangle that moves the mountain and the Tipping points to reverse the NCD risk factors

Triangle that moves the mountain

• Legalized National Multi-sectoral Mechanisms, chaired by the PM, to tackle risk factors – Tobacco and Alcohol Control acts, National food committee act, Sin tax health promotion foundation, National Health Commission – Policy and political angle

• Social mobilizations – strong civil society and community networks on all risk factors with committed champions with high social and intellectual capital – Social angle

• Evidence Generation and Management – Tobacco Research center, Alcohol Research Center, HP/HS research networks, Food and Nutrition policy research program – intellectual angles

Sin tax based Thai Health Promotion Foundation

• Thai Health Promotion Foundation Act 2001

• 2% additional levy on excise tax of tobacco and alcohol –millions 150 $US per year

• Independent multi-sectoral board chaired by the PM, half multi-sectoral ex officio, half independent social champions

• Focus on risk factors of NCDs and SDH as well as Health Systems based Health Promotion and Disease Prevention

• Work with policy makers, civil society, academia and communities

Tackle NCD risk factors under the UHC

• 100% population coverage since 2002

• 20% UHC budget for Health Promotion and Disease Prevention – especially NCD risk factors

• Special funds for secondary prevention of metabolic diseases – DM and HT

• Establishment of almost 7,000 community health funds jointly funded by the local government to work on community health including NCD risk factors

Alcoh

ol

STOP

DRIN

K

AH

C Alcoh

ol

watch

DDD

OAC

Media

for

youthWM

P

ACC

I-

MAP

CAS

HPR

Physic

al

activity

DoPA

H

MoT

S

Arch,

UD-

CA,

MSU

VH

CM-

cycling

club

Thai

Joggin

g club

NFBT/

Rai

Poong

PARC

Toba

cco

Btc/

ddc

ส ำนก

ควบคม

กำร

บรโภค

ยำสบ EN&O

CC

PMNI

DAT

TRCASH

Thailan

d

TNSS

THPA

AT

TNQ

SEAT

CA

GL

Food

BNFDA

TIN,M

U

IFPD,

KU

TBC

SENNA

T

PNI

CTDA

HC

PP

FC

FHP

NF

BT

Lows

alt

thaila

nd

• กรมสนบสนนบรกำรสขภำพ (DHSS)

• ส ำนกโรคไมตดตอ กรมควบคมโรค (BNCD)

• สขภำพดวถชวตไทย กระทรวงสำธำรณสข (THL)

• ส ำนกงำนคณะกรรมกำรกจกำรกระจำยเสยง

กจกำรโทรทศน และกจกำรโทรคมนำคมแหงชำต

(NBTC)

• กรงเทพมหำนคร (BMD)

• กรมสงเสรมกำรปกครองสวนทองถน (DLA)

• ส ำนกงำนคณะกรรมกำรคมครองผบรโภค

(CPB)

• กระทรวงมหำดไทย (MOI)

• กระทรวงเกษตรและสหกรณ (MAC)

• กระทรวงศกษำธกำร (MOE)

• ส ำนกงำนเศรษฐกจกำรคลง (FPO)

• มลนธหมอชำวบำน (FDF)

• กรมสรรพสำมต (The Excise

Department)

• กรมประชำสมพนธ (PRD)

World recognition

NCDs

DDC

Thai

Healthy

Lifestyle

Office

IHPPAcademi

a

NCD

Alliance

Who is Who…? in NCDs

Cross cutting for

NCDs

Inter/National agencies :

WHOIOGT

International THAI

HEALTHMUGH NHCO

NCD Network

NHSO HSRI TRF NRCT

องคกรภำครฐ

องคกรภำคประชำสงคม

องคกรภำควชำกำร

• องคกำรอนำมยโลก (WHO)

• ส ำนกงำนกองทนสนบสนนกำรสรำงเสรมสขภำพ (THF)

• ส ำนกงำนคณะกรรมกำรสขภำพแหงชำต (NHCO)

• แผนงำนเครอขำยควบคมโรคไมตดตอ (NCD Network)

• ศนยวจยปญหำสรำ (CAS)

• แผนงำนกำรพฒนำระบบกำรดแลผมปญหำกำรดมสรำ

(I-MAP)

• ศนยวจยและจดกำรควำมรเพอกำรควบคมยำสบ (TRC )

• ส ำนกงำนหลกประกนสขภำพแหงชำต (NHSO)

• สถำบนวจยระบบสำธำรณสข (HSRI)

• ส ำนกงำนกองทนสนบสนนกำรวจย (TRF)

• ส ำนกงำนคณะกรรมกำรวจยแหงชำต (NRCT)

• แผนงำนวจยนโยบำยอำหำรและโภชนำกำรเพอกำรสรำง

เสรมสขภำพ (FHP)

ส ำนกงำนเครอขำยองคกรงดเหลำ (STOP DRINK)

ศนยปรกษำปญหำสรำทำงโทรศพท (AHC)

เครอขำยรณรงคปองกนภยแอลกอฮอล (Alcohol

watch)

มลนธเมำไมขบ (DDD)

ส ำนกงำนเครอขำยลดอบตเหต (OAC)

มลนธสอเพอเยำวชน (Media for youth)

มลนธหญงชำยกำวไกล (WMP)

ส ำนกงำนคณะกรรมกำรควบคมเครองดม

แอลกอฮอล (ACC)

Health Promotion Policy Research Center

(HPR)

กองออกก ำลงกำย กรมอนำมย (DoPAH)

มลนธรณรงคเพอกำรไมสบบหร (ASH Thailand)

เครอขำยครนกรณรงคเพอกำรไมสบบหร (TNSS)

เครอขำยวชำชพสขภำพเพอสงคมไทยปลอดบหร

(THPAAT)

ศนยบรกำรเลกบหรทำงโทรศพทแหงชำต (TNQ)

เครอขำยนกรณรงคเพอกำรควบคมกำรบรโภคยำสบแหง

เอเชยอำคเนย (SEATCA)

มลนธใบไมเขยว (GL)

ส ำนกโภชนำกำร กรมอนำมย (BN)

ส ำนกงำนคณะกรรมกำรอำหำรและยำ (FDAT)

สถำบนโภชนำกำร ม.มหดล IN,MU

Mahidol University Global Health (MUGH)

กระทรวงกำรทองเทยวและกฬำ (MoTS)

คณะสถำปตยกรรมศำสตร ผงเมองและนฤมตศลป

มหำวทยำลยมหำสำรคำม (Arch, UD-CA, MSU)

มลนธหวใจอำสำ (VH)

ชมรมเรำรกจกรยำนสำรภเชยงใหม (CM-cycling club)

สมำพนธชมรมวงเพอสขภำพไทย (Thai Jogging club)

เครอขำยคนไทยไรพง (NFBT/Rai Poong)

ศนยวจยกจกรรมทำงกำยเพอสขภำพ (PARC)

คณะกรรมกำรควบคมยำสบแหงชำต (Btc/ddc)

ส ำนกโรคจำกกำรประกอบอำชพและสงแวดลอม

(EN&OCC)

สถำบนคนควำและพฒนำผลตภณฑอำหำร ม.เกษตร

(IFPD,KU)

ศนยนมแมแหงประเทศไทย (TBC)

เครอขำยเดกไทยไมกนหวำน (SEN)

สมำคมโภชนำกำรแหงประเทศไทย (NAT)

โครงกำรพฒนำระบบและกลไกเพอเดกไทยมโภชนำกำร

สมวย (PNIC)

สมำคมนกก ำหนดอำหำร (TDA)

แผนงำนพฒนำวชำกำรและกลไกคมครองผบรโภคดำน

สขภำพ (HCPP)

มลนธเพอผบรโภค (FC)

ศนยพฒนำนโยบำยและยทธศำสตรแผนงำนควบคมโรคไม

ตดตอ (DDC)

องคกรทท ำงำน

ดำนปจจยเสยง 4

ดำน

International co-operation and Thai National Plan

• The National Development Plan and the National Health plan have been formulated every 5 years and every years, based on the analytic situation of Thailand. The plan have to be endorsed through to the cabinet. Then the plan will be used for budget allocation.

• The goal , principles or any agreements from international agencies that effect to the public implementation are considered during the development of the plans.

• The evidences / data used in developing the plan are the burden of diseases, risk factors and factors affecting to the goal so the NCDs situation have been address in the National Health Plan.

• Since the NCDs are complex so the plan dealing with the NCDs still more focus on treatment than prevention and control.

Alignment of International co-operation

Example from HIV-TB-Malaria program that got large amount of budget from international agencies, Thai gov. by the MOPH has set up the specific mechanism dealing with budget from the Global Fund to be aligned with the other HIV-TB-Malaria programs and Thai National Health Plan.

PR-DDC

CCM NAMC

CASC

PCMAIDS

Board PR _DDC

TC_AIDS

RCC

อธบำยควำมเชอมโยง

CCM Structure

CCMGFATMMOPH(AIDS,TB, MalariaNational Program)

National AIDS

Committee

Secretariat Office

TC_AIDS

PR_DOC

National HealthSecurity Office

R1_RCCอธบำย structure/functionของแตละกอนดวย

Global Fund

TC - AIDS

CCM

CCM

Secretari

at Office

The secretariat office for the committee, co-ordinate inside and outside the country

ใชขอมลจำกหมอเพชรศร

Technical office : Analysis and formulate the proposal with engagement of stakeholders

The Country Coordinating committee: body for Implementing the total projects support by GF in Thailand including coordinate with the central office of GF and others

TC-AIDSTC-TB

TC-Malaria

SR

PR3 PR-DDC

Board-PR

CASC

สวน.

National AIDS

NAMc(M&E)

Structure of Global Fund Mechanism In Thailand and linkage with the main structure of MoPH

PR2

CCM

AIDS/TB/Malaria

SRSR

PR1

Care …7 SRPrevention …7 SR

PCM (SSR)43 provs

BATs

สคร.

DDC-MoPH

Thai Government

National Targets on NCDs

Adopt resolution on 9 global targets on NCDs prevention n control by The 6 th Thai National Health Assembly 2014

Adopt resolution on salt reduction strategy in the 8 th Thai National Health Assembly 2015

The Health Assembly compose of civic groups, professional groups and representatives from Ministry of Public Health

The mechanism of collecting data for monitoring through collaboration among MOPH, health professional bodies and academia

Multi-sectoral NCD action plans

Thailand Healthy lifestyle strategic plan (The multi-sectoral strategic plan) , The cabinet adopt this in 2010 intended to fight against NCD through broader population interventions but the strategy has not been fully implemented. ( few actions mainly still in MoPH )

Mechanism: National Health assembly. Set up the committee for drafting the integrated multi-

sectoral NCD action plan in Feb 2015 Thai health promotion foundation(semi governmental agency

funded by sin tax) support finance and implementation of various bodies on health promotion (NGOs, civic gr, GO in and outside MOPH)

NCD Network, Thailand. (CCS program) budget support by various bodies and co-ordinate the actions of various groups but still in health sectors

Thai NCD alliances- network among professional groups

National NCD Prevention and Control

• 11th national Health Development Plan 2012-2016 : reduction of health risk in a holistic manner

• National Health Assembly’s resolutions Prevention & control of Overweight and Obesity

Tobacco and alcohol control

9 National NCD and risk factor targets

Thailand Healthy Lifestyle Strategic Plan 2011-2020

National Tobacco Control Strategic Plan 2010-2014

National Alcohol Consumption Control Policy 2010

Overweight and Obesity Management Strategic Plan

2010-2019

Thailand Healthy Lifestyle Strategic Plan ,2011-2020

• March 2011 ,the Cabinet approved the establishment of a National Steering Committee, chaired by the Prime Minister, and comprises of multi-disciplinary partners

• 5 Strategies

– Healthy Public Policy

– Social Mobilization & Public Communication

– Community Building

– Surveillance & Care System

• 5 Major diseases :– DM ,HT, IHD ,Stroke , Cancer

• 5 Aspects : Incidence, complication , Disability , Mortality , Expenditure

• 3 Areas of Sufficiency Lifestyle :

• Appropriate consumption (Balanced diet, no smoke, limit alcohol intake),

• Adequate physical exercise,

• Suitable emotional management

Implementation and Management of NCDs

• Best Buy interventions for control smoking and alcohol drinking

• Provide the services for secondary and tertiary prevention through the existing health care system

• With a strong primary care system and main health care system under the MoPH and finance by the universal health coverage scheme , social security scheme, and the MoPH budget; 60-80 % of DM, HT patients have been screened and treated properly. However ,only one third of treated patients could control their BS well.

Community and Civic group involvement / engagement

The example of good practice to reduce risk factors of NCDs as : Tobacco and alcohol control (SEATCA , ASH stop drink network, Sweet enough network, Thailand fatless belly network, Low salt network, Tobacco Research centre, Alcohol Research centre, PA Research centre, Food Health Policy.

Community involvement at the village and sub-district level to innovate the programs for reducing risk factors such as ban alcohol consumption in the religious ceremonies, various type of physical activities for the elderly, healthy food, and disease screening

Barriers / Obstacles/challenges

• Vertical implementation of each reach risk factor prevention program not well integration

• Mass Business advertisement and urbanization effecting to the norm and behaviors of Thai people

• no stable and integrated accountability mechanism to monitor and response for the overall NCDs prevention and control at the national and sub-national and not well function of national structure that could be collaborated across departments, ministries and others related sectors.

• The coverage of service screening and care for the working aged men and the mobility pop.

• Effective behavioral change programs for the risk groups• Improving the quality of care model to promote the self-

management of patients/people