National Joint Secretariat for Multisectoral Response for NCDs
6.1 National Joint Secretariat for Multisectoral Response for NCDs
Effective prevention and control of NCDs is a multisectoral response involving multiple agencies. Coordination of stakeholders require a strategic mechanism that can optimize meaningful participation at the national and sub-national levels. Various overarching committees will coordinate the multisectoral coordination and engagement under the presidential decree.
At the national level, a Joint Secretariat will coordinate the multisectoral NCD response among various sectors. The Joint Secretariat will be constituted and managed by the Coordinating Ministry for Human and Cultural Development. The committee will be chaired by the Vice President or the Minister of Health. Members of the Joint Secretariat will be comprised of high- level bureaucrats from the various sectors and representation from the academia and civil society organization. The broad terms of reference for the Secretariat are to:
• Provide political leadership and guidance to relevant sectors for the prevention and
control of NCDs • Enhance the integration of NCD prevention and control in the policies and programmes
of relevant Ministries and agencies of the Government • Provide a dynamic platform for dialogue, stock taking and agenda-setting and
development of public policies for NCD prevention and control • Facilitate resourcing of the RAN PP- PTM • Coordinate technical assistance for mainstreaming NCDs in relevant sectors at national,
provincial and district levels • Monitor implementation of the action plan and review progress at national and sub
national levels • Meet six monthly to review the progress of the implementation status of the RAN PP-
PTM 2015-2019 • Submit a minimum of one yearly implementation status report of the RAN PP-PTM 2015-
• Identify implementation gaps and propose measures to implement newer strategies and
programmes • Support stakeholder in accessing resource needs for implementing their commitments • Facilitate bilateral multi-lateral meetings to advance work on thematic issues and
agreed NCD goals, and • Prepare consolidated reports on the implementation of the NCD response
6.1.2 Provincial and district Level NCD Committees
The NCD committees will be constituted at the provincial and district levels under the chair of the governor and mayors respctively. The core functions of these committees are to: • Provide cross sectoral coordination to mainstream NCD prevention and control at
provincial and district levels; • Identify and access local Government resources for the implementation of the RAN PP-
PTM; • Conduct a quarterly meeting to monitor the implementation of the RAN PP-PTM);
6.1.3 Multisectoral collaboration accountability indicators
The progress of work of the coordination mechanism will be monitored in an accountability framework consisting of both process indicators and outcome indicators. The multisectoral coordination mechanism will be monitored using the following accountability process indicators:
Number of full time and part time staff for multisectoral coordination Number of coordinating body meetings convened in a year at national and provincial
levels Number of agencies attending the coordinating body meetings
Sector-wise process indicators for the plan Resource allocation and utilization for NCDs by relevant sectors Policy decisions taken by the Coordinating body and other sublevel committees Number and nature of assistance requests received and processed by the Secretariat
6.1.4 Annual Consolidated Progress Report on NCD response to the President
6.2.1 A logic model for monitoring a National Multisectoral Action Plan for NCDs
6.1 Figure 1 provides a logic model for monitoring a national multisectoral action plan for NCD prevention and control from inputs, process to outcomes. (Figure 6.1 ). The comprehensive global framework for monitoring prevention and control of NCDs will guide this process (Annex 1)
6.2.2 A framework for monitoring and evaluating progress in implementing national NCD
MAP
Table 6.1 provides a national framework for monitoring and evaluating progress in implementing national NCD MAP, including key elements such as strategic action, output, leading agency, relevant agency, timeframe, process indicators and outcomes (targets).
6.2.3 Data sources and main methods for monitoring and evaluation
Mortality and morditiry data from the SRS
There are many data sources from health sector and relevant sectors that can be used to estaimate the health status of the population and monitor the trends of noncommunicable diseases, for instance, mortality and morbidity due to NCDs can be gained from the annual report of national health information generating from sample registry system. In addition, data of cancer can be get from national cancer registry areas in country in order to estimate the cancer morbidity.
Risk factors and health care data from WHO STEPs and GSHS
WHOSTEPs and GSHS surveys can provide information on prevalence of main risk factors and coverages of risk factors and national response to NCDs every five years
National survey on progress in implementation of NCD MAP
Figure 1 A National Monitoring Framework
Goal: To improve healthy life and reduce the preventable and avoidable burden of morbidity, mortality and disability due to NCDs through multisectoral action at the national, local and community levels.
Strategic areas
2 Infrastructure for
3 Implementation Examples:
ons
indicator
relative reduction in
risk of premature
(including National
• Advocacy and
services and
Establishment
mortality from NCDs
coordination
Governance
events that are
of
function and joint-
• Health
intended to lead
coordination
Risk reduction
secretary for
promotion
to the outcomes)
mechanism
Increase of eligible
coordination,
and risk
For example:
Availability of
people receive drug
national, local
reduction
Policy, plan
technical
therapy and
implementing
• Increase
agencies and agency
coverage for
programme
Availability of
Increase of
focal points)
people with
developed
funding for
availability of
NCDs and at
and approved
NCD
essential medicines
Existing and further
high risk
budget
Percentage of
and technologies
development of
• Surveillance,
allocation
villageskelurah
infrastructure based on
monitoring,
Implementati
an
Capacity improved
additional funding and
evaluation
on mechanism established
implementing
Partnership
other resources
and research
Media
the NCD
network
Data sources: National NCD Risk Factor Survey (STEPS), Global School-based Health Survey (GSHS), Global Youth Tobacco Survey (GYTS), Civil Registration, Cancer and Other NCD Registries and NCD Hospital-based Mortality Registry, and national adapted SARA for essential medicines, and natioanl capcity survey for implementing NCD MAP.
Table 6.2 National monitoring and evaluation of implementing NCD MAP
Strategic area
Strategic Action
Output
Lead agency
Relevant Timeline
Indicators of Progress
Outcomes
sector
Strategic area 1: Advocacy, partnership and leadership
1.1 Advocacy,
• Strengthen advocacy
• Advocacy packages on
• Ministry of
KESJAOR
2016-2020
• Establishment of time-
• All NCD
partnership and
for NCD prevention
prevention and control
human
and health
bound national targets
targets
leadership
and control
of NCDs available.
developmen promotion
and indicators based on
produced and advocate
t and culture
UNIT
WHO guidance (1)
activities conducted
• Ministry of
• An operational
health (NCD
multisectoral national
unit)
strategyaction plan that
• Strengthen national
• Establishment of
• Human
• All
2016-2020
integrates the major
coordination for
national joint-
developmen
other
NCDs and their shared
multisectoral action
secretariat for
t and culture
relevan
risk factors (4)
on the prevention and
coordinating and
• Ministry of
t
• NCD related targets
incorporated into the
implementation of NCD
• Ministry of
monitoring framework of
MAP
home affairs
the Sustainable
• Enhance international
• Participation in
• Ministry of
• All
2016-2020
Development Goals
cooperation
international dialogue
Health
relevan
Establishment of joint-
on NCDs
t
secretary for improving
sectors
coordination
• Finance NCD
• Adequate fund for
• Human
• Relevan 2016-2020
• No of relevant sectors
prevention and
NCDs provided
developmen
t
prioritized and
control
t and culture
sectors
implemented NCD
• Ministry of
interventions
finance
• Adequate fund allocated
• Ministry of
for implementing
health
National NCD MAP • Availability of adequate human resources at national, district and
Strategic area
Strategic Action
Output
Lead agency
Relevant
Timeline
Indicators of Progress
Outcomes
sector
Strategic area 2: Reduce risk factors and promoting health
2.1 Reduce
• Raise taxes on tobacco
• A taxation mechanism
• Ministry of
• Ministr
• Reduce affordability of
3 A 30 relative
tobacco use
product (R)
for tobacco established
Finance
y of
tobacco products by
reduction in
Health
increasing tobacco
prevalence of
• Expand and enforce
• Report of executive
excise taxes (5.a)
current
Smoke-Free Laws (P)
review to amend
• Create by law
tobacco use in
smoke free article in
completely smoke-free
persons aged
the prevailing
environments in all
over 15 years
Government
indoor workplaces,
Regulation
public places and
No.1092012
public transport(5.b) .
• Minimum 50
• Warn the dangers of
• Process to amend the
• Warn people of the
of districts that
tobacco (W)
Government
dangers of tobacco and
has
Regulation
tobacco smoke through
implemented
No.1092012 initiated
effective health
smoking free
warnings and mass
zone law in
media campaigns (5.c)
schools
• Introduce
• Broadcasting Law and
• Ban all forms of
comprehensive ban on
Press Law to prohibit
tobacco advertising,
tobacco advertising,
tobacco
promotion and
promotion and
advertisements on
sponsorship(5.d)
sponsorship (E)
mass media amended
•
Percentage of districts
• Ban sale of tobacco
• Policiesregulation on
that has small free zone
products to minors
ENDS products
law in school
developed
• Capacity building for
• National quitline
tobacco cessation (O)
established
• Accession to FCTC
• Report of technical
analysis and policy discussions on national impact of FCTC accession prepared
2.2 to reduce
• Increase taxes on
• Taxes on all types of
• Regulations over
• A 10 relative
alcohol use
alcoholic beverages
alcoholic beverages
commercial and public
reduction in
Increased, accounting
availability of alcohol
the use of
for various percentage
(6.a)
alcohol
of alcohol volume
• Comprehensive
• Strengthen
• Report of assessment
restrictions or bans on
enforcement of
on advertisement and
alcohol advertising and
existing policies on
promotion of alcoholic
promotions (6.b)
ban of advertisement
drinks conducted and
• Pricing policies such as
and promotion of
submitted
excise tax increases on
alcoholic beverages
alcoholic beverages (6.
• Review and update
• Report of alcohol
C)
alcohol legislations and
legislations and policies
policies
developed and published
• Restrict production and • Rules on illegal sale of
sale of cheap local
cheap illegal alcohol
alcohol
products enforced
• Promote programs to
• National Ban use of
reduce alcohol related
alcohol among
violence and injuries
motorists (drivers) implemented
• Advocate community
• Social mobilization
based and political
campaigns against
support for
alcohol abuse and
enforcement of alcohol
illegally produced
laws and policies
alcoholic drinks conducted
2.3 Promote
• Implement the Global
• New work plan for
• Adopted national
• A 30
healthy diet high
Strategy on Diet,
implementing DPAS
policies to reduce
relative
in fruit and
Physical and
developed and
population saltsodium
reduction in
vegetables and
Health(DPAS)
implemented
consumption (7. a)
mean
low in saturated
• Advocate for healthy
• Advocacy material
•
Adopted national policies
population
fattrans-fat, free
diet
developed and
that limit saturated fatty
intake of
sugar and salt
activities conduced
acids and virtually
saltsodium
• Develop and update
• National food based
produced trans fatty acids • A 25
eliminate industrially
national food based
dietary guidelines
reduction in
in the food supply (7. b).
dietary guidelines
updated
•
prevalence of
WHO set of
recommendations on
raised blood
• Strengthen food and
National
marketing of foods and
pressure and
nutrition labelling
communication and
non-alcoholic beverages
or contain
to children (7. c). implementation
the
strategy to advocate Legislation regulations
•
prevalence
fully implementing the
the food based
of raised
International Code of
Indonesian dietary
blood
Marketing of Breast-milk
guidelines developed
pressure
Substitutes (7. d).
and approved
• Halt the
•
Proportion of population
aged ≥ 10 years with low
rise in
• Develop fiscal policies
• Fiscal policies to
fruit and vegetable
obesity
to subsidize
subsidize consumption
consumption ()
and
consumption of
of vegetables and fruits
•
Number and duration of
diabetes
vegetables and fruits
developed and
unhealthy food and drink
• A 5
implemented
advertisements during
reduction in
children programmes on
population • Increase availability major TV channels. • National guidelines on aged ≥ 10
food products low in
sugar, salt and fat
• Number of companies
years with
fat, salt and sugar
developed and adapted
following the nutrition
labelling guidelines low fruit and vegetable
consumption
2.4 Promote
• Promote physical
• National or sub-
• Public awareness on
• A 10 relative
physical activity
activity (PA) awareness
national PA guideline
diet andor physical
reduction in
across all age groups
and recommendation
activity(8)
prevalence of
insufficient
different age groups
• Create conducive
• PA integrated in urban
urban environment for
development plan
active life-styles • Promote public and
• Collaborative
private partnerships to
mechanisms between
develop physical
public and private
activity promoting
sectors to promote
venues including
healthy workplaces,
sports
healthy communities, and support events for physical activities established
• Support PA promoting
• Facilities for physical
events
activities including sports and exercise at school, at workplace and in public areas improved by local government
2.5 Promote
• Establish healthy
• Guideline for healthy
• No of health village in
• All NCD targets
healthy
villages
village developed
selected areas
behaviours and reduce
• Establish health
• WHO guideline for
NCDs in key
promotion schools
health promotion
settings
schools adapted
• Establish healthy work • Guidelines for healthy
places
work places available
2.6 Reduce
• Strengthen capacity
• Report on on indoor air
• Availability of advocacy
• Reduction of
household
for documentation of
pollution assessment in
materials on reducing
premature
air pollution
indoor air quality and
selected sites
household air
mortality due
household pollution
submitted
to NCDs
• Support cleaner
• Government subsidies
• Reduction of
technologies for
for improved cook
Cancer
cooking
stoves and cleaner technologies for low income groups available
• Advocate on reducing
• Advocacy materials
household air
available
Strategic area
Strategic Action
Output
Lead agency
Relevant
Timeline
Indicators of Progress
Outcomes
sector
Strategic area 3: Strengthen management of NCDs and health system
3.1 Improve NCD • Improve access and
• Guidelines for NCD
• Evidence-based national
• At least 50
management
availability to essential
treatment reviewed
guidelinesprotocolssta
of eligible
through
NCD medicines and
andor implemented
ndards for the
management of major
receive drug
g health
• Strengthen capacity
• Training materials
NCDs through a primary
therapy and
system
building for health
developed and pilot
care approach,
counselling
workforce on NCD
training conducted
recognizedapproved by
(including
management
government or
glycaemic
• Increase financing for
• 100 of population
competent
control) to
NCDs through
covered by UHC,
authorities(9)
prevent heart
innovative funding
including NCD package
• Provision of drug
attacks and
mechanism and other
service
therapy, including
strokes
government allocation
glycaemic control, and
• An 80
3.2 Strengthen
• Improve access to
• 50 of PUSKESMAS
MOH
counseling for eligible
availability of
NCD
basic NCD screening
implementing CVD risk
persons at high risk to
the
management
and management
charts
prevent heart attacks
affordable
services at primary
and strokes, with
basic
health care system
emphasis on the primary
technologies
• Strengthen diabetes
• 100 of PUSKESMAS
MOH
care level (10)
and essential
services
providing HbA1C
• Proportion of PUSKSMAS medicines
testing
with providing PANDU
• 50 by 2019
• Strengthen cancer
• 2400 centers
MOH
PTM
• 50 by 2019
services
conducting CBE and
• Proportion of villages that
cervical cancer
has pos Bindu
screening
• Proportion of PUSKAMAS • 20 of
• Strengthening chronic
• Report of the reviewed
providing CBE and VIA or BUSKSMAS
respiratory diseases
guidelines on
pas smear text
by 2019
services
management of CRDs
• Percentage of patients
for PUSKESMAS and
with 30 absolute CVD
POSBINDU
risk or greater receiving
• 50 of
antihypertensive and
• Build community
• A network with
• Percentage of women
years
networks for NCD
community
aged 30-50 years
screened
screening and health
organizations and
screened d with cervical
education
religious bodies for
(IVA) breast cancer
NCD established
(Sadanis) ()
3.3 Strengthen
• Expansion palliative
• Palliative care
MOH
palliative
care services at
guidelines developed
care
primary health care
and Oral morphines
level
available at PHC
3.4 Community
• Build community
• A network with
• Participation of
based
networks for NCD
community
community organizations
approaches
screening and health
organizations and
and religious bodies
education
religious bodies for NCD established
Strategic area
Strategic Action
Output
Lead agency
Relevant
Timeline
Indicators of Progress
Outcomes
sectors
Strategic area 4: Surveillance, monitoring and evaluation, research
4.1 Strengthen
• Integration of NCD
• NCD profiles at district,
Annual
• Inclusion of NCDs and
All NCD targets
surveillance of
related information
provincial and national
their risk factors in
main NCDs and
into national
level established
national health profiles
their risk factors
health information
• A functioning system for
generating reliable cause-specific mortality data on a routine
• Improve mortality
• Mortality data related
Regular
basis(2)
and morbidity data
to NCDs improved in
• A STEPS survey or a
in the SRS
the selected areas
comprehensive health examination survey
every 5 years (3)
• Mechanism of monitoring
progress in place for
• Strengthen
• Report of STPES
implementation of the
surveillance on
national NCD MAP
NCD risk factors
• A set of research topics
and health service
are provided for MOH to
for NCD
take action for support
management
the implementation of the National NCD MAP
4.2 Improve
• Strengthen
• Monitoring system in
• A country survey with a
monitoring and
capacity and
place with trained staff
set of core indication for
evaluation of
promote network
members
monitoring progress
implementing
for monitoring and
• Report of evaluation of
NCD
evaluation
PEN including follow up
programmes
care of patient for NCD services
4.3 Strengthen
• Increase research
• National NCD research
Research
to generate local
network established
evidence related to burden of diseases, health services, health economics
: Global progress monitor indicators
Appendix 1. Ten Causes of Death by Age and Sex, 2012 () Appendix 2. Proportion and Estimation of Population by Affliction of NONCOMMUNICABLE DISEASES by Province, 2013
Appendix 3: Cross Sector Roles in the Prevention and Control of NCDs ) Appendix 4. Voluntary global targets for the prevention and control of noncommunicable diseases