COMMUNITY INTERVENTIONS AND CAPACITY BUILDING FOR NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL IN TUNISIA AND NORTH AFRICA

Pr Hassen Ghannem

Department of Epidemiology & COHRED North Africa

University Hospital Farhat Hached

Sousse, Tunisia

TUNISIA

RESEARCH & NCD RESEARCH & NCD

• HOW TO PUT NCD ON NATIONAL HOW TO PUT NCD ON NATIONAL RESEARCH AGENDA?RESEARCH AGENDA?

• HOW TO MOBILIZE LOCAL HOW TO MOBILIZE LOCAL RESOURCES?RESOURCES?

• HOW TO CREATE A TEAM?HOW TO CREATE A TEAM?

• HOW TO CREATE A COALITION?HOW TO CREATE A COALITION?

““FORWARD STEPWISE FORWARD STEPWISE APPROACH”APPROACH”

Document / Analyse the problemDocument / Analyse the problem

Sensitise politicians and health Sensitise politicians and health

professionalsprofessionals

Create partnerships (TEAM)Create partnerships (TEAM)

Start demonstration project of Start demonstration project of

global interventionglobal intervention

Proceed to generalisationProceed to generalisation

TEAM: NATIONAL PARTNERS IN TUNISIATEAM: NATIONAL PARTNERS IN TUNISIA

Department of Epidemiology, University Department of Epidemiology, University Hospital Farhat Hached, Sousse, TunisiaHospital Farhat Hached, Sousse, Tunisia

Department of Cardiology, University Hospital Department of Cardiology, University Hospital Farhat Hached, Sousse, TunisiaFarhat Hached, Sousse, Tunisia

Departments of Peadiatrics, University Departments of Peadiatrics, University Hospital F Hached & Sahloul, Sousse, TunisiaHospital F Hached & Sahloul, Sousse, Tunisia

Department of Endocrinology & Diabetology, Department of Endocrinology & Diabetology, University Hospital Farhat Hached, Sousse, University Hospital Farhat Hached, Sousse, TunisiaTunisia

Department of Occupational Health, Department of Occupational Health, University Hospital Farhat Hached, SousseUniversity Hospital Farhat Hached, Sousse

Department of Biochemistry, Faculty of Department of Biochemistry, Faculty of Medicine of SousseMedicine of Sousse

Regional Direction of Health of Sousse, Regional Direction of Health of Sousse, Primary Health Care, School Medicine UnitPrimary Health Care, School Medicine Unit

Regional Direction of Education of Sousse Regional Direction of Education of Sousse Regional Direction of Youth, Sport of SousseRegional Direction of Youth, Sport of Sousse Tunisian Heart FoundationTunisian Heart Foundation Tunisian association of life and earth sciencesTunisian association of life and earth sciences

TEAMTEAM

International PartnersInternational Partners

Department of Chronic Disease Department of Chronic Disease Prevention and Health Promotion, Prevention and Health Promotion, National Public Health Institute of National Public Health Institute of Helsinki, KTL, FinlandHelsinki, KTL, Finland

Isfahan Cardiovascular Research Isfahan Cardiovascular Research Centre, Isfahan University of Medical Centre, Isfahan University of Medical Sciences, IranSciences, Iran

Duluth Medical Research InstituteDuluth Medical Research InstituteUniversity of Minnesota Medical University of Minnesota Medical School, USASchool, USA

ADDITIONAL SUPPORTERS AND ADDITIONAL SUPPORTERS AND COLLABORATORSCOLLABORATORS

Oxford Health AllianceOxford Health Alliance MATRIX Public Health MATRIX Public Health

Solutions, Inc,Solutions, Inc, WHO Office in TunisiaWHO Office in Tunisia

THIS PROGRAM IS CURRENTLY THIS PROGRAM IS CURRENTLY FUNDED BY FUNDED BY

“ “ THE OVATIONS CHRONIC THE OVATIONS CHRONIC DISEASE INITIATIVE”DISEASE INITIATIVE”

Ovations UnitedHealth GroupOvations UnitedHealth Group

With a strong interest from With a strong interest from NHLBI (NIH)NHLBI (NIH)

The specific aims of the programme The specific aims of the programme are to:are to:

determine the effectiveness, determine the effectiveness, feasibility and necessary feasibility and necessary cultural adaptations of cultural adaptations of evidenced-based interventions evidenced-based interventions directed at tobacco use, diet, directed at tobacco use, diet, and physical inactivity in adults and physical inactivity in adults and children (known as the and children (known as the Community Intervention for Community Intervention for Health).Health).

The specific aims of the programme are The specific aims of the programme are to:to:

Develop a model for Develop a model for implementing, monitoring and implementing, monitoring and assessing sustainable assessing sustainable comprehensive community comprehensive community interventions in Tunisia, and interventions in Tunisia, and across North African countries across North African countries with similar socioeconomic and with similar socioeconomic and cultural situationscultural situations. .

The specific aims of the programme are The specific aims of the programme are to:to:

Train health officials from other Train health officials from other countries in the Eastern countries in the Eastern Mediterranean region who are Mediterranean region who are interested in planning, interested in planning, implementing or evaluating implementing or evaluating programmes for chronic disease programmes for chronic disease prevention and control.prevention and control.

CHALLENGES TO NCD CHALLENGES TO NCD PREVENTIONPREVENTION

CHALLENGES TO NCD CHALLENGES TO NCD PREVENTIONPREVENTION

The challenge facing policymakers in low and middle income countries is the "wide range of possible effective and cost-effective interventions (population based approach, high risk approach)

CHALLENGES TO NCD CHALLENGES TO NCD PREVENTIONPREVENTION

CHALLENGES TO NCD CHALLENGES TO NCD PREVENTIONPREVENTION

How to apply evidence on policy: What are the interventions that effectively reduce the risk of burden of chronic disease and alleviate the existing burden? Which of these are cost-effective in a low resource setting?

ENVIRONMENT HEALTH SYSTEM

HEALTH

LIFESTYLE BIOLOGY

HEALTH DETERMINANTSHEALTH DETERMINANTS

What is the way What is the way forward?forward?

Mobilize the publicMobilize the public

Strengthen public health capacity Strengthen public health capacity

Develop vision for national & international Develop vision for national & international

action and corresponding strategies that workaction and corresponding strategies that work

Engage the health professionals and other Engage the health professionals and other

key leaders to change coursekey leaders to change course

Monitor progressMonitor progress

Cooperate with regional and international Cooperate with regional and international

partnerspartners

PROGRAMME OVERVIEW PROGRAMME OVERVIEW FOR TUNISIAFOR TUNISIA

1.1.COMMUNITY BASED COMMUNITY BASED INTERVENTION PROGRAM INTERVENTION PROGRAM

2.2.CAPACITY BUILDINGCAPACITY BUILDING

Our design will employ rigorous Our design will employ rigorous

scientific research methodology, scientific research methodology,

including:including:

STUDY DESIGN

Quasi - experimental design (matchedintervention- control communities)

randomised sampling procedures

Power - based sample sizes

standardised operations protocols

standardised instrumentation (e.g., surveys, environmental scans)

The coordination of all the research team is under the responsibility of the principal investigator

Research Team Research Team

Research Team

Research Team Research Team

CAPACITY BUILDING

The expected plan of actions and The expected plan of actions and main achievements for the first main achievements for the first

year are:year are:

Strategic plan development for the Strategic plan development for the programme with Short Term programme with Short Term Consultants to assistConsultants to assist in planning in planning interventions interventions & a communication & a communication strategystrategy

TrainingTraining of the operational teams of the operational teams to to prepare the start of planned prepare the start of planned interventions for schools, work interventions for schools, work settings, community and health settings, community and health professionalsprofessionals

The expected plan of actions The expected plan of actions and main achievements for and main achievements for

the first year are:the first year are:

Pre assessment of the three Pre assessment of the three main risk factors and main risk factors and environmental situation in environmental situation in schools, work settings, Health schools, work settings, Health centers and the community for centers and the community for the intervention sites and the intervention sites and control group sitescontrol group sites

THANK YOUTHANK YOU