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The Global Alliance against Chronic Respiratory Diseases. Dr Nikolai Khaltaev "Global lung health in 2000's" Antalya, Turkey, 25 – 26 April 2007. The global burden of chronic respiratory diseases Chronic obstructive pulmonary disease (COPD) Asthma - PowerPoint PPT Presentation
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Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
The Global Alliance against Chronic Respiratory Diseases
Dr Nikolai Khaltaev"Global lung health in 2000's"
Antalya, Turkey, 25 – 26 April 2007
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Overview
• The global burden of chronic respiratory diseases– Chronic obstructive pulmonary disease (COPD)
– Asthma
• WHO global approach to control chronic respiratory diseases
• The Global Alliance against Chronic Respiratory Diseases (GARD): a new way to prevent and control chronic respiratory diseases
• GARD country activities
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
The global burden of chronic respiratory diseases
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Did you know??
4 000 000 PEOPLE
DIED FROM CHRONIC
RESPIRATORY DISEASES
IN 2005
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Some widespread misunderstandings about chronic respiratory diseases - and the reality
87% OF CHRONIC RESPIRATORY DISEASES DEATHS OCCUR IN LOW & MIDDLE INCOME COUNTRIES
REALITY
MISUNDERSTANDING
CHRONIC RESPIRATORY DISEASES MAINLY AFFECT HIGH INCOME COUNTRIES
Upper middle income
countries 5%
Lower middle income countries
48%
Low income countries
34%
High income countries
13%
Projected global distribution of chronic respiratory disease deaths By World Bank income group, all ages, 2005
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
CHRONIC RESPIRATORY DISEASES AFFECT WOMEN AND MEN ALMOST EQUALLY
REALITY
MISUNDERSTANDING
CHRONIC RESPIRATORY DISEASES MAINLY AFFECT MEN
Projected global distribution of chronic respiratory disease deaths all ages, 2005
men52%
women48%
Some widespread misunderstandings about chronic respiratory diseases - and the reality
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Chronic respiratory diseases worldwide
Cardiovascular diseases mainly heart disease and stroke
Cancer Chronic respiratory diseases Diabetes
Main chronic diseases include:
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Chronic respiratory diseases worldwide
• including 300 million people with asthma, • 80 million people with moderate to severe chronic obstructive pulmonary disease (COPD)• and millions of others with mild COPD, allergic rhinitis, and other chronic respiratory diseases, which are often undiagnosed.
Hundreds of millions of people have chronic respiratory diseases,
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Chronic respiratory diseases in Turkey
In Turkey, chronic respiratory diseases accounted for 6% of all deaths or 26 220 deaths in 2002.
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
What are the causes of chronic respiratory diseases?
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Burden of Major Respiratory Conditions
Source: World Health Report 2003
DALYs*
%
Bronchus /Trachea Cancer
Condition Deaths
%Lower Respiratory Infections 6.6 5.8
COPD 4.8 1.9
Tuberculosis 2.8 2.4
Lung/ 2.2 0.8
Asthma 0.4 1.0
Total 16.8 11.9
*DALYs = Disability-Adjusted Life-Years
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
What are DALYs?
age (years)
DisabilityAdjustedLifeYears
One DALY: one lost year of “healthy” life
DALY = YLD + YLL
55 65 75
COPDonset death
expecteddeath
YLLYears of Life LostYears of Life
with Disability
YLD50
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Increasing Burden of Diseases and Injuries:Change in Rank Order of DALYs*
*DALYs: Disability Adjusted Life Years
*DALYs = Disability-Adjusted Life-Years Source: WHO Evidence, Information and Policy, 2005
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
"When I was 16 years old, my primary doctor told me that smoking would help me lose weight, so every time I started a diet, I also started to smoke.
Now I am an invisible picture of COPD disability. I am not yet using oxygen, but I know that day will come. I am unable to do many of the things I love. I cannot dance. I cannot do my own food shopping. I cannot take long walks along the river at sunset with my husband."
Elaine L. Ackley, 58 years, New York, United States of America
Chronic obstructive pulmonary disease (COPD)
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Burden of COPD
• COPD is a major cause of morbidity, death and disability
• The main cause for developing COPD is tobacco smoking
• COPD is not just simply a "smoker's cough", but a disease that kills per year 3 million people worldwide
• Despite its ease of diagnosis, COPD remains an under-diagnosed disease, chiefly in its milder and more treatable form
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
World map COPD - Deaths / 1000 year 2000
<6.2 .6.2-9.7
9.7-15.7
18.1-19.919.9-22.1
35.5-38.122.1-35.5
15.7-18.1
>38.1no data
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
<0.100.10-0.790.80-2.192.20-2.592.60-3.493.50-3.893.90-4.399
>6.704.40-6.69
no data*DALYs: disability-adjusted life year
World map COPD – DALYs* / 1000 year 2000
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Prevalence of COPD in Europe
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Risk factors
Passive smoking
"Keep it funny, Keep it smoke free"
Anti smoke campaign, The Netherlands
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
The relative importance of Tobacco Smokeand other risk factors relevant for COPD
Opposite patterns in different geographic areas
EUROPE versus AFRICASource: World Health Report 2002
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
0 5000 10000 15000 20000
Indoor smoke from solid fuels Unsafe water, sanitation, and hygiene
Underweight Childhood sexual abuse
Urban air pollution Occupational risk factors for injury
Iron deficiency Unsafe sex
Lead exposure Illicit drugs
Physical inactivity Fruit and vegetable intake
High Body Mass IndexCholesterol
Alcohol Tobacco
Blood pressure
Number of Disability-Adjusted Life Years (000s)
Tobacco
Urban airpollution
EUROPEDisease burden (DALYs) in 2000 attributable to selected risk factors
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
AFRICADisease burden (DALYs) in 2000 attributable to selected risk factors
Lead exposure
0 10000 20000 30000 40000 50000 60000 70000
Fruit and vegetable intake Occupational risk factors for injury
Global climate change Unsafe health care injections
Cholesterol Tobacco
Lack of contraception Blood pressure
Alcohol Iron deficiency
Indoor smoke from solid fuels Zinc deficiency
Vitamin A deficiency Unsafe water, sanitation, and hygiene
Underweight Unsafe sex
Number of Disability-Adjusted Life Years (000s)
Tobacco
Indoor air pollution
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Risks are increasing: burden of disease attributable to tobacco (% DALYs in each subregion)
Source: World Health Report, 2002
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Source: World Health Report, 2002
Risks are increasing: burden of disease attributable to indoor smoke from solid fuels (% DALYs in each subregion)
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Source: World Health Report, 2002
Risks are increasing: burden of disease attributable to urban air pollution (% DALYs in each subregion)
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Burden of asthma• Asthma is not just a public health
problem for high income countries: it occurs in all countries regardless of level of development. Over 80% of asthma deaths occurs in low and lower-middle income countries.
• Asthma deaths will increase by almost 20% in the next 10 years if urgent action is not taken.
• According to WHO estimates, 300 million people suffer from asthma and 255 000 people died of asthma in 2005.
• Asthma is the most common chronic disease among children.
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Global Burden of Asthma 2004
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Global Burden of Asthma 2004
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Global Burden of Asthma 2004
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
WHO global approach to control Chronic Respiratory Diseases
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
As for 17 December 2004: 47 countries haveratified the treaty. On 27 February 2005:
the FCTC has entered into force and has become an International law.
Today the FCTC has 146 parties(16 April 2007)
Framework Convention on Tobacco Control (FCTC)
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
• Taxes – tax and price measures are an important way of reducing tobacco consumption, particularly in young people, and requires signatories to consider public health objectives when implementing tax and price policies on tobacco products.
• Labelling – The text requires that at least 30 per cent of the display area on tobacco product packaging is taken up by clear health warnings in the form of text, pictures or a combination of the two. Packaging and labelling requirements also prohibit misleading language such as “light”, “mild” or “low tar”.
• Advertising –The final text requires parties to move towards a comprehensive ban within five years of the convention entering into force.
Framework Convention on Tobacco Control (FCTC)
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
• Liability – Parties to the convention are encouraged to pursue legislative action to hold the tobacco industry liable for costs related to tobacco use.
• Financing – Parties are required to provide financial support to their national tobacco control programmes. A number of countries and development agencies, have already pledged their commitment to include tobacco control as a development priority.
• Other issues - The text also requires countries to promote treatment programmes to help people stop smoking and education to prevent people from starting, to prohibit sales of tobacco products to minors, and to limit public exposure to second-hand smoke.
Framework Convention on Tobacco Control (FCTC)
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
WHO/NHLBI
One of the first examples of worldwide used disease-specific guidelinesand the 1st one on Asthma
Project coordinatorsNikolai Khaltaev (WHO)Claude Lenfant (NHLBI)
1995
WHO/ARIA
Including adaptation to developing countries:
EBMlow drug cost affordable for most patients
WHO essential list of drugs
2001
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
WHO/NHLBI
The first worldwide used guidelines
on COPD
2001
NHLBI/WHO Workshop Report: Global Strategy for the Diagnosis,
Management, and Prevention of COPD. Scientific information and
recommendations for COPD programs.
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Practical Approach to Lung health
A primary health care strategy for a coordinated and standardized approach for an integrated management of the patient with respiratory symptoms in countries with epidemiological transition.
TargetsImprove diagnostic strategies, reduce inappropriate care, foster cost reduction strategies, savings in antibiotic usage andincrease appropriate CS usageTested in 15 different countries
2003
Source : WHO/STB
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
STEP
SuRF
FCTC
Prevention ofAllergy andAllergic AsthmaBased on the WHO/WAO Meeting on thePrevention of Allergy and Allergic AsthmaGeneva,8-9 January 2002
WHO/MNC/CRA/03.2
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
A new way to prevent and control chronic respiratory diseases
Global Alliance against Chronic Respiratory Diseases
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
The enormous human suffering caused by chronic respiratory diseases (CRD) has been recognized by the
53rd World Health Assembly (May 2000) which requested the Director General to:
• To continue giving priority to prevention and control of noncommunicable diseases, including CRD, with special emphasis on developing countries and other deprived populations;
• To coordinate, in collaboration with the international community, global partnerships and alliances for resource mobilization, advocacy, capacity building and collaborative research
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
What is the value added of this new way?
The value added of developing an alliance with specialized national and international NGOs is to:
• To share responsibilities and building on each partner's expertise
• To combine the partners' strengths and knowledge, thereby achieving results that no one partner could attain alone.
• To improve coordination between existing governmental and nongovernmental programmes, which avoids duplication of efforts and wasting of resources.
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Before GARD = lack of coordination, competition
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
WHO calls for a global and coordinated effortto fight Chronic Respiratory Diseases
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
GARD Global Launch, 28 March 2006, Beijing, People's Republic of China
"GARD will provide an effective form in which health care workers, institutions and governments from all countries may jointly work to mobilize the entire population in efforts to prevent and control chronic respiratory diseases".
Dr Longde Wang Vice Minister of Health, People's
Republic of China
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
GARD“I am happy to hear that the Global Alliance against Chronic Respiratory Diseases is now in place as a global team. As a team, each member will contribute his or her unique strengths, just like in football. Together, the Alliance's teamwork will provide help to the hundreds of millions of people who suffer from chronic respiratory diseases, including those in my country who do not have access to essential treatments.”
Pele, soccer legend
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
GARD
"Reaching a major goal like conquering chronic respiratory diseases is similar to a marathon run: it's a big effort but with energy, knowledge, support and the will to win, it can be done. I am convinced that the Global Alliance for Respiratory Diseases will win the battle against chronic respiratory disease, which kills four million people a year"
Rosa Mota, former Portuguese marathon runner and Olympic champion
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
GARD VisionA world where all people breathe freely
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
GoalTo reduce the global burden of chronic respiratory diseases
ObjectiveTo initiate a comprehensive approach to fight chronic respiratory diseases through:
• developing a standard way of obtaining relevant data on chronic respiratory disease risk factors;
• encouraging countries to implement health promotion and chronic disease prevention policies; and
• making recommendations of simple strategies for management of chronic respiratory diseases.
GARD Goal and Objective
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
June 2004
WHOACAAIALATARIAATS EAACIEFAERSFILHAFIRSGA2LENGINAGOLD NHLBIWAOWHO-CC DU
15
Jan 2005
WHOAAAAIAAAFACAAIARIAATSEAACIEFAERSFILHAFIRSGA2LENGINAGOLDICCINTERASMAKAFNHLBIWAOWHO-CC DUWHO-CC UCMWONCA
21
March 2007WHOAAA (D. Vervloet, France)AAAAI (E. Simon, CAN)AAAF (R. Pawankar, JAP)ACAAI (M. Blaiss, USA)AIMAR (C. Donner, ITA)ALAT (C. Luna, ARG)ALLERG.O.S (P. Demoly, FRA)APAACI (T. Fukuda, JAP)APRS (Y. Fukuchi, JAP)ARIA (J. Bousquet, FRA)ATS (P. Wagner, USA)CCM (D. Greco, ITA)CNR-INMM (G. Rasi, ITA)DLHA (DK)EAACI (U. Wahn, GER)ECARF (T. Zuberbier, GER)EFA (S. Palkonen, FIN)ERS (R. Dahl, DK)FEMTEC (U. Solimene, ITA)FILHA R. Kauppinen, FIN)FIRS (A. Turnbull, SWI)GA2LEN (P. Van Cauwenberge, BEL)
45
GINA (P. O’Byrne, CAN)GOLD (L. Fabbri, ITA)ICC (L. Grouse, USA)INTERASMA (I. Ansotegui, SPA)IPCRG (A. Ostrem, UK)IPRAIS (J. Warner, UK)IUATLD (N. Billo, FRA)KAF (Y. Kim, KOR)KTL (P. Puska, FIN)NHLBI (B. Alving, USA)PSA (M. Kowalski, POL)RSP (A. Chuchalin, RUS)SIMER (G. D'Amato, ITA)SFAIC (G.Pauli, FRA)SPAIC (M. Morais de Almeida)SPLF (B. Housset, FRA)TTS (A. Kocabas, TUR)TNSACI (O. Kalayci, TUR)WAO (C. Baena-Cagnani, ARG)WHO-CC DU (S. Makino, JAP)WHO-CC GU (G. Joos, BEL)WONCA (A. Loh, SIN)
Oct 2002
WHOEFA
2
Jan 2003
WHOEFAARIA
3
Participants
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
GARD is part of WHO's work to prevent and control chronic diseases
Comprehensive and integrated action is the means to prevent and control chronic diseases
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
• GARD focuses on the needs of countries
• and fosters country-specific initiatives tailored to local conditions.
A global alliance working at country level
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Desired outcome at country level: initiated or upgraded
programme on surveillance, prevention and control of chronic respiratory diseases
HOW?
Approach:Alliances against Chronic Respiratory Diseases
are established at country level (GARD Country), in order for the activities of the Alliance to meet the specific needs of countries.
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
What does GARD Country do?
1. Coordinating already existing activities and exchanging relevant information
2. Analysing the situation of chronic respiratory diseases in the country
3. Raising greater awareness on chronic respiratory diseases and their risk factors
4. Running intervention projects on chronic respiratory diseases prevention and control
5. Generating political commitment
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Who guides the process to explore and build GARD Country?
• GARD Country Initiator is a person or an organization that develops the initial idea and takes the first step in formulating the apporach of building an alliance at country level
• The Core Group of interested parties is a group of interested parties which gathers with GARD Country Initiator
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
1. The situation of chronic respiratory disease surveillance, prevention and control programme in the country is analysed.
2. The Ministry of Health is informed about GARD Country and invited to be involved in its development.
3. WHO Regional Office and WHO Representative are informed about GARD Country and invited to be involved in its development.
Prerequisites
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Situation analysis…
GARD runs pilot projects on surveillance of chronic respiratory diseases at primary health care level
– Georgia– Russian Federation– Cape Verde– Philippines
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Secondly, patients are screened by doing a spirometry test that
measures the lung capacity
Firstly, patients fill in a WHO questionnaire on symptoms of chronic respiratory diseases, environmental exposure and
smoking habits
… in Georgia
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
A patient is screened by doing a spirometry test
…. in Ryazan, Russian Federation
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
…in Cape Verde and the PhilippinesCape Verde (Praia and Sao Vincente): data on the prevalence of CRD have been collected and are being processed
Philippines (Guimaras): data on the prevalence of CRD have been collected and are being processed
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Involvement of the Ministry of Health
• Poland:GARD Symposium for Eastern European countries under auspices of Professor Zbigniew Religa, Minister of Health, Republic of Poland, Zakopane, Poland, 23-24 March 2007
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Involvement of the Ministry of Health
• Algeria: Meeting between GARD Chairman and Minister of Health, Dr Amar Tou, Alger, 23 July 2006
• Turkey: participation of GARD initiator in a meeting on chronic diseases organized by the Ministry of Health, Istanbul, 16 January 2007
GARD Focal Point appointed within the Ministry of Health
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
• Brazil:Meeting with Dr Luis Fernando Sampaio, Director of Primary Care, Ministry of HealthApril 2006
Involvement of the Ministry of Health
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
• China: Dr Longde Wang, Vice Minister of Health, opening GARD Global Launch, 28 March 2006, Beijing
"GARD will provide an effective form in which health care workers, institutions and governments from all countries may jointly work to mobilize the entire population in efforts to prevent and control chronic respiratory diseases".
Involvement of the Ministry of Health
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Steps to develop a GARD Country
1. Agreeing on a definition of Alliance2. Nominating a GARD Country Coordinator3. Identifying other partners4. Running an exploratory workshop5. Defining the Terms of Reference6. Defining the structure7. Identifying outcomes
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
1. Agreeing on a definition of Alliance
GARD Country shall act as a coordination and creation of a momentum
A strategic alliance
between organizations drawn from different sectors of societies(government, business, NGOs)
who commit to work collaboratively towards a common goal.
that invites new inputs from various interested parties
in order to strengthen the national capacity to face the increasing impact of CRD.
PROPOSED DEFINITION GARD COUNTRY
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
2. Nominating a GARD Country Coordinator
• International recognition of his/her capabilities in surveillance, prevention and control of CRD
• Entrusted by Ministry of Health, GARD Country initiator and other interested parties
• Committed to the public health system of the country• Good communication and diplomatic skills
GARD Country Coordinator
WHO on behalf of GARD Executive Committee
NOMINATES
Ministry of Health
GARD Country initiator
Core group of interested parties
ENDORSE
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Faces of GARD Country Coordinators
Prof Paulo Camargos GARD coordinator Brazil
Prof Tamaz MaglakelidzeGARD coordinator Georgia
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
3. Identifying other potential partners
Within Ministry of Health:• Between specific programmes on chronic respiratory diseases• Between supporting programmes, services, departments at national and regional
level: – Human Resources Development Department – Health Statistics Department– Health Finance Department– Drug Control Department– Health Education Programme– Health Care Reforms– Environmental Health Unit
GARD Country Coordinator shall make an inventory of the various interested parties:
Related Ministries
CRD and public health
experts
Professional Associations
Patient Groups
NGOs
Educational Sector
Multilateral Bilateral Agencies
Communities, churches, religious leaders
Private sector, media
Identifying partners
outside Ministry of Health
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
4. Running an exploratory workshop
• a vision for the alliance is agreed upon• the purpose and shared objectives of the alliance are agreed• the interest and expected benefit of each single partners are identified• the resources and competencies that each partner could bring to the alliance are
mapped• roles and responsibilities of each partner are decided• project ideas are that could be carried out collaboratively are outlined• options for management mechanisms are explored
The country coordinator and the Ministry of Health focal point call a workshop with the core group of interested parties and the short listed potential partners.
During this workshop:
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Exploratory workshop in Brazil, April 2006
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Exploratory workshop for Eastern European Countries, Poland, 23-24 March 2007
4
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
A sub-committee is appointed by GARD Country Coordinator to draft the Terms of Reference of GARD Country
5. Defining the Terms of Reference
a. General Purpose: to reduce the burden of CRD at national levelb. Technical Objectives: different according to the products of GARD
action plan that best suit the countryc. In general:
Coordinating existing activities related to CRD Exchanging relevant information Raising greater awareness on CRD and their risk factors as well as on
prevention and treatment Running intervention projects on CRD surveillance, prevention and control Generating political commitment at country level Raising additional resources
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
The Launch Meeting of China COPD Alliance in Guangzhou,
4 November 2006
Raising greater awareness on chronic respiratory diseases in China
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
The Launch Meeting of Asthma Alliance in Zhengzhou, Henan
4 June 2005
Raising greater awareness on chronic respiratory diseases in China
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Running intervention projects
GARD has started to run intervention projects on chronic respiratory diseases prevention and control:– Brazil– Tunisia
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
… in Brazil
Brazil (Bahia): Pilot project on control of severe asthma
Brazil (Belo Horizonte): Programme Criança que Chia (Wheezing Child)
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
… in Tunisia
TUNISIATUNISIA
WHOWHO
GA
RD
GA
RD
PALPAL
Tunisia (since 2002): Pilot project on control of CRD:• Practical Approach to Lung Health (PAL) implemented• Increased diagnosis• Reduction of prescription of antibiotics• Reduction of medication costs per patient
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
6. Defining the structure
GAR
D C
ount
ry
Cou
ncil
GAR
D Co
untry
Pl
anni
ng G
roup
GAR
D Co
untry
se
cret
aria
t
Plenary body of all GARD Country partners
Chaired by GARD Country Coordinator
It supports GARD Country and assists the partners
Managed by GARD Country Coordinator
Driving force of the Alliance
Composed of partners elected by the Council
A proposal:
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
GARD Brazil Council
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
7. Identifying outcomes• Are you doing things right?• What have you learnt from building the alliance?• Has the alliance been effective to achieve its aims?• Have the partners all benefited from their involvement?• How much has GARD Country achieved in the country (process and
output)?• Has GARD Country brought any change in CRD surveillance,
prevention and control in he country (outcome)?
If not, EXIT STRATEGY
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Overview
• A global alliance working at country level• Who guides the process?• Prerequisites to develop an alliance at country
level• Steps to develop an alliance at country level• Current activities countries
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
Overview of GARD in countries
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard
• Pilot projects in:– Algeria– Brazil– Cape Verde– China– Georgia– Republic of Korea– Philippines– Russian Federation– Tunisia– Turkey
• Other interested countries:– Argentina– Bulgaria– France– Greece– Italy– Kazakhstan– Norway– Paraguay– Poland – Portugal– South Africa– Vietnam
Overview of GARD in countries
Global Alliance against Chronic Respiratory Diseaseswww.who.int/gard