srl ncd action plan 2016 2020
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES
2016-2020
MINISTRY OF HEALTH, NUTRITION AND INDIGENOUS MEDICINE
SRI LANKA
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
NATIONAL MULTISECTORAL ACTION PLAN FOR
THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
MINISTRY OF HEALTH, NUTRITION AND INDIGENOUS MEDICINE
SRI LANKA
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Contents
Message from the Prime Minister 7
Message from the Minister of Health, Nutrition and Indigenous Medicine 8
Message from the Director General of Health Services
Message from the Country Representative for Sri Lanka, World Health Organization
10 List of abbreviations and acronyms 11 Introduction 13 5
Strategic Priority Action Areas of the National Multisectoral Action Plan for the
Prevention and Control of Noncommunicable Diseases 2016-2020 21
Prioritized National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2017 69 Summary of targets and monitoring framework of the Prioritized National Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases
Costs for the implementation of the Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020 117
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Message from the Prime Minister
I am pleased to provide a message of felicitations for the National Multi Sectorial Action Plan for The Prevention and Control of Noncommunicable Diseases 2016 - 2020. In today’s technology driven environment, many changes have taken place in society. People are adopting a more sedentary lifestyle with less exercise outdoors. They are also more prone to stress. At the same time, food consumption patterns have changed, with more emphasis on processed food instead of fresh fruits and vegetables; accordingly, the intake of sugar and salt has increased. These variable risk factors have resulted in causing chronic Noncommunicable Diseases (NCDs-) such as high blood pressure, high blood lipid levels, high blood sugar and obesity.
The NCDs have been identified as a major cause of mortality in Sri Lanka. The efforts undertaken by the Ministry of Health to minimize the risks of NCDs are commendable and worthy of recognition. These measures, taken in con- junction with other Ministries, groups and civil organizations towards the upliftment of health for all, will undoubtedly decrease the cost of secondary care provided for NCDs, palliative care and rehabilitation. On the threshold of being classified as a middle income country, Sri Lanka will certainly benefit tremendously from this action plan which propos- es specific direction mechanisms for the healthy sector.
I take this opportunity to wish the Ministry of Health and the Noncommunicable Disease Unit all the very best in their quest to achieve proposed targets.
Ranil Wickremesinghe Prime Minister
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Message from the Minister of Health, Nutrition and Indigenous Medicine
Since independence, Sri Lanka has achieved much in the control of communicable diseases, virtually eliminating vac- cine preventable diseases and became exemplary amongSouth East Asian nations in its achievements in the arena of maternal and child health. Currently,non-communicable diseases are the dominant health problem and are presently the leading cause of mortality, morbidity and disability in the country.
Noncommunicable diseases are not just the most pressing health concerns in the country but also is a significant challenge for development. They are driven by underlying social, economic, political, environmental and cultural fac- tors, broadly known as ‘social determinants’. Sri Lanka needs to address the social determinants of non-communica-
8 ble diseasesthrough health promoting partnerships and coordinated actions of many sectors beyondthe healthsector, partnering with non-governmental sectors and civil society organizations where necessary.
This National, Multisectoral Action Plan for the Prevention and Control of Noncommunicable Diseases 2016-2020 developed with theleadership of theMinistry of Health, Nutrition IndigenousMedicine, in consultation with all other partners,is the guiding tool for such coordinated actions,and will ensure that the country will successfully address the burden of NCDs in the years to come.
Dr. Rajitha Senarathne Minister of Health, Nutrition and Indigenous Medicine
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Message from the Director General of Health Services
Major noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes, cancer and chronic respiratory diseases account for more than 36 million deaths at the global level. Smoking, alcohol, unhealthy diet and insufficient physical activity have identified as four main modifiable behavioural risk factors for NCDs.
Nearly 65 of the hospital deaths in Sri Lanka are due to NCDs. Cardiovascular diseases are the number one lead- ing cause of death in Sri Lanka. Sri Lanka is experiencing an increase in trend of morbidity and mortality due to NCDsoverthe past few decades due to the changes in the life styles of the people. Considering the need of contri- butions by sectors outside the health in addressing the burden of NCD, the NCD Unit of the Ministry of Health, Nutri-
tion and Indigenous Medicine developed this National Multi-sectoralAction Plan for Prevention and Control of NCD. Development of this plan was through a consultative process which ensured contributions of the academia, profes- sional colleges and officials of the Ministry of Health and other relevant Ministries.
I hope that this action plan will generate collaboration between different ministries, authorities and departments to combat the burden incurred by NCDs in Sri Lanka.
Dr. P G Mahipala
Director General of Health Services Ministry of Health, Nutrition and Indigenous Medicine
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Message from the Country Representative for Sri Lanka, World Health Organization
The global burden and threat of noncommunicable diseases constitute a major public health challenge that undermines social and economic development of the countries throughout the world. Realizing the requirement of urgent and concerted action at the global and national levels to overcome the challenge of NCDs, at the 66th World Health Assembly in September 2011, the Heads of State of Governments committed themselves in the United Nations Political Declaration on the Prevention and Control of NCDs. The declaration pledges to establish and strengthen the multisectoral national policies and plans for the prevention and control of NCDs. The National Multisectoral Action Plan for the Prevention and Control of NCDs 2106-2020 is the result of this national commitment. It presents a road map for and calls for the support of whole of government, whole of United Nations and
10 whole of society to achieve its stipulated national voluntary targets on NCDs. Recognizing the role of international cooperation to support this important national effort, the World Health Organization has se-
lected Sri Lanka as a fast-track country for NCDs. The selected fast-track countries are eligible to receive ‘One-WHO’ integrated technical support for implementation of the plan from the global, regional and national levels of WHO in a coordinated manner.
We are looking forward to working with the stakeholders to ensure that the country achieves its targets ensuring that the human and financial burden of NCDs does not undermine the development gains.
Dr Jacob Kumaresan World Health Organization Representative to Sri Lanka
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
List of abbreviations and acronyms
BOI Board of Investment
MoJ Ministry of Justice
CEA Central Environment Authority
MoNPEF Ministry of National Policy and Economic Affairs
DDG Deputy Director General
MoS Ministry of Sports
DGH District General Hospital
MoSRT Ministry of Technology and Research
DoP Department of Police
MRI Medical Research Institute
E OH Environment and Occupational Health
MS I Medical Services I
ET R Education, Training and Research
MSD Medical Supplies Division
FAO World Agriculture Organization
NATA National Authority on Tobacco and Alcohol
HEB Health Education Bureau
NCCP National Cancer Control Programme
HITA Health Intervention and Technology Assessments
NCD Noncommunicable diseases
ITI Industrial Technology Institute
NPTCCD National Programme on Tuberculosis Control and
MH Mental Health
Chest Diseases
MoA Ministry of Agriculture
PDHS Provincial Director Health Services
MoC Ministry of Cultural Affairs
PGIM Postgraduate Institute of Medicine
MoE Ministry of Education
PHC Primary Health Care
MoH Ministry of Health, Nutrition and Indigenous Medicine
PHI Public Health Inspector
MoI Ministry of Industry and Commerce
PHM Public Health Midwife
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
List of abbreviations and acronyms (Cont.)
PHNS
Public Health Nursing Sister
PMCU
Primary Medical Care Unit
RDHS
Regional Director Health Services
UNDP
United Nations Development Programme
UNICEF United Nations Children’s Funds WB World Bank
12 WHA World Health Assembly WHO World Health Organization
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Introduction
Sri Lanka is often cited as an example in the world for
Communicable meter-
Injuries
achieving high health indices with low health expenditure
nal, perinatal and nutri-
tonal condition 11
and is moving towards an upper middle income country.
A good political commitment in Sri Lanka throughout the period after independence from British ruling to maintain
Other NCDs
the free health services has contributed much towards
improvements in health condition and the country is proud of its free health system which is accessible to all of its Diabetes
population.
Changes in life style in its population associated with
Chronic
improved economic conditions in an open economy respiratory
diseases
have contributed towards epidemiological transition on
demographic transition. Similar to global situation, the Cardiovascular
Cancers
10 diseases 40
present burden due to non-communicable diseases (NCD) in Sri Lanka outweighs the burden due to communicable diseases and maternal and child health conditions. While
Total deaths: 138,000
contributing to a huge disease burden, chronic NCDs also
NCDs are estimated to account for 75 of total deaths.
have serious socio- economic consequences. NCDs incur a
Source WHO - NCD Country Profiles, 2014.
huge cost to individuals, families and the societies due to the need of a lifelong treatment, escalating health care cost
Figure 1: Cause specific mortality Sri Lanka 2012
and loss of productivity.
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
In keeping with the global pattern, cardio-vascular diseases, cancer, chronic pulmonary diseases and diabetes are known to be the major contributors to the NCD burden in the country. Of the annual total deaths of 138,000 in the country in 2012 75 of deaths were due to NCDs and 40 of deaths were due to cardiovascular diseases (Figure 1).
Top ten causes of deaths indicate that Ischemic heart disease was the leading cause of death, killing 32.6 thousand people in 2012 (Figure 2). The data on burden of diseases of Sri Lanka indicate that the burden due to cardiovascular diseases and diabetes is the highest (Figure 3).
Use of tobacco, consumption of alcohol, unhealthy dietary practices and physical inactivity are the leading behavioural risk factors for NCDs. Air pollution contributes to a great extent in causing chronic pulmonary diseases.
According to the STEPS survey (2008), to assess the NCD behavioural risk factors, 8.4 of males and 10.5 of females had systolic blood pressure more than 160 mmHg and diastolic blood pressure more than 100 mmHg or were on medication at the time of survey. Approximately one fourth of the populations were overweight or obese with the corre- sponding figures among males being 19.5 and among females being
Source WHO country Health profile Sri Lanka 2015
30.5. A great majority (82.4) of the population consume less than
Figure 2: Top ten leading causes of deaths in Sri Lanka 2012
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
It is proven that primordial and primary prevention plays a major role in reduction in the prevalence of behavioural risk factors and NCDs. Second- ary prevention measures to improve the secondary and tertiary care to NCD patients, play a major role in reducing premature mortality of the NCD patients. A programme on prevention and control of NCDs in any country needs a comprehensive approach and contributions of multiple sectors is essential to make it a success.
The National Multisectoral Action Plan for the Prevention and Control of NCDs
The National Multisectoral Action Plan for the Prevention and Control of
Other noncommunicable deseases (NCDs) including non-malignant neoplasms; endocrine, blood and immune disorders; sense organs,
Non-communicable diseases 2016- 20120 is a result of untiring efforts of
digestive, genitourinary and skin desease; oral conditions; and congenital
the NCD unit of the Ministry of Health, Nutrition and indigenous Medicine
anomalies. Infectious diseases other than accute repiratory diseases, HIV, TB and
which led the process of consultations with relevent units in the health
malaria
sector and professional colleges along with the support of the World Health Organization and other stakeholders. This has been developed in order to achieve the ten voluntary targets adopted by Sri Lanka based on the nine
Source WHO country Health profile Sri Lanka 2015
Figure 3: Burden of diseases in Sri Lanka 2012
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020 NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
This plan is composed of four strategic areas, namely; Advo- cacy, partnership and leadership; health promotion and risk reduction; strengthen health system for early detection and management of NCDs and their risk factors and surveillance, monitoring, evaluation and research. The strategic area health promotion and risk reduction specifies the plans on reduc- tion of tobacco use, reduction of use of alcohol, promotion of healthy diet high in fruit and vegetables and low in saturated fat trans-fat free sugar and salt, , promotion of physical ac- tivity and promote healthy behaviors and reduce household air
16 pollution. The plan provides a comprehensive description of the out-
comes to be achieved, specific activities to be implemented, the multi-stakeholder partnership including civil society and the time frame by which the targets are to be achieved. Sim- ilar to the contribution in the process of preparation of the plan the maximum corporation of relevant departments of the Ministry of Health, Nutrition and Indigenous Medicine, other ministries, departments, professional colleges, civil societies and other relevant parties is vital in achieving the specified targets of NCD prevention and control in the plan.
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Vision
A country free of the avoidable burden of noncommunicable diseases
Goal • Human rights approach
• Equity-based approach • National action and international cooperation and solidarity
To reduce the preventable and avoidable burden of morbidity, mortality and disability due to noncommunicable diseases by
• Multisectoral action
means of multisectoral collaboration and cooperation at na- tional level, so that populations reach the highest attainable
Objectives
standards of health and productivity at every age and those diseases are no longer a barrier to well-being or socioeco- 17 1. To raise the priority accorded to the prevent ion and
nomic development.
control of noncommunicable diseases in national agenda through strengthened mutltisectoral cooperation and advo-
Overarching Principles
cacy
2. To strengthen national capacity, leadership governance,
• Life-course approach
multisectoral action and partnerships to accelerate country
• Empowerment of people and communities
response for the prevent ion and control of noncommuni-
• Evidence-based strategies
cable diseases
• Universal health coverage • Management of real, perceived or potential conflicts of
3. To reduce modifiable risk factors for noncommunicable
interest
diseases and under lying social determinant s through cre- ation of health-promoting environments
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
4. To strengthen and orient health systems to address the prevent ion and control o f noncommunicable diseases and the under lying social determinants through people- cent red primary health care and universal health coverage
5. To promote and support national capacity for high-qual- ity research and development for the prevent ion and con- trol of noncommunicable diseases
18 6. To monitor the trends and determinants of noncommu- nicable diseases and evaluate progress in their prevention and control
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Sri Lanka aims to achieve the following targets by 2025
1. A 25 relative reduction in premature mortality from cardiovascular disease, cancer, diabetes, or chronic respiratory diseases
2. A 10 relative reduction in the use of alcohol
3. A 10 relative reduction in prevalence of insufficient physical activity
4. A 30 relative reduction in mean population intake of saltsodium
5. A 30 relative reduction in prevalence of current tobacco use in persons aged over 15 years
6. A 25 relative reduction in prevalence of raised blood pressure and or contain the prevalence of raised blood pressure
7. Halt the rise in obesity and diabetes
8. A 50 of eligible people receive drug therapy and counseling (including glycaemic control) to prevent heart attacks and
strokes
9. An 80 availability of affordable basic technologies and essential medicines including generics, required to treat major noncommunicable diseases in both public and private facilities
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Strategic Priority Action Areas of the National Multisectoral Action Plan for
the Prevention and Control of NCD
2016-2020
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Strategic action area 1: Advocacy, partnership and leadership
1.1 Advocacy
Time
Desired outcome
Indicator
Proposed actions
Responsibility
frame
1.1.1 NCD recognized as a
1.1.1.a Establish A National NCD council and
Availability of a National
national priority in national
convene regular meetings bi annually
NCD council chaired by Hon.
NCD unit
agenda in the country
President Prime Minister
1.1.1.b Develop advocacy packages on
Availability of advocacy
prevention and control of NCDs for politicians,
each levels in the health sector and non- health package for various HEB
sectors at national, provincial and district levels NCD unit
stakeholders
1.1.2 NCD recognized as
1.1.2.a Advocacy meetings for the upper level
a priority in ministries,
managers of the relevant ministries, authorities
authorities and departments No. of ministries
and departments at the national, provincial and
outside the Ministry of
authorities
district levels
NCD Unit
Health
departments in which NCD
• twice a year at the national level
PDHS
included as a priority area in • twice a year at the provincial level
RDHS
the policy
• twice a year at the district level
1.1.3 NCD prioritized in
1.1.3.a Advocacy meeting for the political
national health action plan NCD Unit No. of NCD related decisions authorities
actions taken by the political
• Once a year at the national level PDHS
authorities
• -Once a year at the district level RDHS
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
1.2 Partnership
Desired outcome
Indicator
Proposed actions
Responsibility
Time frame
1.2.1 National and subnational
No. of workshops held at
1.2.1.a Conduct workshops at National,
mechanisms for multisectoral
national, provincial and
rovincial and district levels to map stake
NCD Unit
actions established and
district levels to map
holders and to design health promotion
stakeholders and to design
activities
RDHS health promotion activities
No. of Ministries authorities
1.2.1.b Establish provincial and district
departments implementing
level multi sectoral committees and
NCD prevention actions
monitor implementation of existing
NCD Unit
indicated in their policies
at national and subnational
RDHS
levels
1.2.2 Place NCDs on broader
1.2.2.a Integrate the prevention and
health and development agenda
control of NCDs in to national planning
Department of National
NCD related targets
processes and broader development
Planning
2016-2020
incorporated into the
agendas
DDG (NCD)
monitoring framework of the Sustainable Development
1.2.2.b Share process indicators and
Department of National
Goals
global NCD targets with the national team
Planning
2016-2017
working on Sustainable Development DDG (NCD) Goals
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
1.3 Leadership
Desired outcome
Indicator
Proposed actions
Responsibility Time frame
Availability of a
1.3.1.a Ensure activities relevant to different units
coordinated mechanism
of the MoH are coordinated to strengthen the
DDG (NCD)
within the Ministry of
linkages between different units of Ministry of
NCD Unit
Health for NCD prevention Health for NCD prevention and control and control
1.3.1.b Initiate action to obtain the required human resources for NCD related work
1.3.1 Health Ministry
• identify a healthcare worker at the grass root
DDG (NCD)
effectively leading and
level to perform NCD activities
Organizatonal and
coordinating the national
•
Development Unit
NCD prevention and control
Availability of adequate
Salary and Cadre Commission
programme
human resources at
• proposal for cardre approval to be submitted
DDG (NCD)
national, district and grass
Organizatonal and
root levels to perform NCD
2016 Development Unit
related activities
Salary and Cadre Commission DDG (NCD)
• provide facilities and staff for the NCD unit to NCD unit facilitate the monitoring mechanism of the NCD
Organizatonal and 2016
action plan
Development Unit Salary and Cadre Commission
Adequate funds allocated
1.3.1.c Conduct advocacy meetings with the
NCD Unit
for NCD activities from
officers in the Ministry of Finance and UN agencies
Finance Ministry 2016
GOSL funds and funds
from UN agencies
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome
Indicator
Proposed actions
Responsibility
Time frame
1.3.1 Health Ministry
No. of trained health staff
1.3.1.d Capacity building of relevant staff on NCD
DDG (NCD)
effectively leading and
at national and district
Prevention and Control
NCD unit
coordinating the national
NCD prevention and control
• capacity building of the national programme
managers capacity building of the MO(NCD)
Continued.
• capacity building of the MO(NCD)
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Strategic action area 2: Health promotion and risk reduction
2.1 Reduce tobacco use
Desired outcome
Indicator
Proposed actions
Responsibility Time frame
Age standardized prevalence of
2.1.1.a Accelerate full implementation of FCTC
DDG (MS I)
2016-2020
current tobacco use among 18yrs
• implement pictorial warning (80)
DDG (NCD)
and above
• prohibit elicit trade of tobacco products
NATA
• ban all forms of advertising
NCD Unit
Prevalence of tobacco use among
• ban point of sale display
PDHS
adolescents
• ban sponsoring community activities
RDHS
• conduct trade seminars No. of provisions of FCTC implemented
2.1.1.b Bring about amendments to NATA Act
DDG (MS I)
2016-2018
• ban all forms of advertising
DDG (NCD)
• ban point of sale display
NATA
2.1.1 Prevalence of
• prohibiting smoking in outdoor public places
NCD Unit
tobacco use reduced
(100 tobacco free outdoor environment)
Availability of an amended NATA • bring legislation on retail sales of cigarettes Act • bring policies on smokeless tobacco use
• bring legislation on sales of smokeless tobacco products • surveillance to prevent importation of e-cigarettes
2.1.1.c Advocate to raise tobacco tax
DDG (MS I)
2016-2018
• advocate to raise taxes and inflation adjusted
DDG (NCD)
of tax increase in comparison to
prices on tobacco
NATA
increase in GDP
Ministry of Finance NCD Unit
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome
Indicator
Proposed actions
Responsibility
Time frame
2.1.1.d Setup tobacco cessation services
DDG (MS) 1
• review evidence and develop a national
DDG (NCD)
programme on tobacco cessation service
NCD Unit
development in Sri Lanka
NATA
• establish tobacco cessation clinics
Professional Colleges
• develop training module on smoking cessation No. of functioning community • develop tobacco cessation guidelines based tobacco cessation services • conduct International workshop on tobacco available cessation
• capacity building of the health staff on tobacco
2.1.1 Prevalence of
cessation
tobacco use reduced
• training the health staff on counseling
continued.
• initiation of community based tobacco cessation
services
2.1.1.e Strengthen the services available for tobacco
DDG (MS) 1
2016-2020
cessation
NCD Unit
Proportion of smokers successfully • set up community based tobacco cessation
NATA
quitting smoking
services
Professional Colleges
• strengthen the tobacco cessation hotline No. of 24 hour hotlines for tobacco • display the tobacco cessation hot line number in cessation available
cigarette packets • display tobacco cessation hot line number to display at point of sale
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome
Indicator
Proposed actions
Responsibility Time frame
2.1.1.f Improve community awareness on tobacco use DDG (MS I)
2016-2020
including the use of smokeless tobacco
NCD Unit
• conduct mass media and social media campaigns NATA
Ministry of Mass
Propotion of smokers successfully
Media
quitting smoking
• conduct community awareness programmes for
Ministry of
2016-2020
o teachers
No. of 24 hour hotlines for tobacco
Education
o
school children
cessation available
National Youth
o youth
Services Council
o
for different community groups
NATA NCD unit
28 2.1.1 Prevalence of
NCCP
tobacco use reduced
2.1.1.g Conduct trade seminars in view of
NCD Unit
2016-2020
continued.
No. of trade seminars conducted in
establishing tobacco free zones
NATA
view of establishing tobacco free
Ministry of Trade
zones
and Commerce
2.1.1.h Conduct awareness programmes for media
Ministry of
No. of media workshops conducted • conduct media workshop
and Digital Infrastructure NCD unit
Availability of data on prevalance
2.1.1.i Conduct tobacco research
NCD Unit
of use of tobacco and other details • conduct tobacco use related surveys
NATA
related to use
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome
Indicator
Proposed actions
Responsibility
Time frame
2.1.1.j Strengthen NATA
MOH
• ensure continuous funds to NATA Increase the capacity of NATA
•
2016-2020
• conduct once month meetings (multi stake
RDHS
2016-2020
holder)by district NATA cell
Availability of a mechanism for
•
NATA to monitor ban on advertising • strengthen the activities to detect and eliminate DDG (MS)1
2017-2020
including community activities,
illegal tobacco products in airports and ports
DDG (NCD)
illegal tobacco products available
•
2.1.1 Prevalence of
Customs
in the country and point of sale
tobacco use reduced
Department
continued 29 NCD unit
display
NATA NATA
2017-2020
• setup a mechanism at NATA to monitor ban on advertising including community activities , illegal tobacco products available in the country and point of sale display
No. of health staff trained on
2.1.1.k Train the health staff on tobacco (including
NCD Unit
2016-2018
tobacco prevention and control
smokeless) prevention and control • conduct training programme for health care
workers
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
2.2 Reduce alcohol use
Desired
Indicator
Proposed actions
2.2.1.a Implement the National Alcohol
Tele Communication 2017
Policy
Regulatory Commission
• develop a mechanism to monitor
NATA
social media for on alcohol promotion • establish a mechanism to report
Availability of a national action plan to
violations of laws in alcohol marketing Ministry of Finance 2016-2020
implement the policy on reduce alcohol use
promotion
Ministry of External Affairs
• enact regulations to eliminate all
Import Export Control
2.2.1 Prevalence
forms of tax concessions for alcohol
Commission
of alcohol use
Total alcohol per capita (aged 15+ years old)
production, import, retail and
and its harmful
consumption within a calendar year
effects reduced
Ministry of Foreign Affairs
• initiate a system where the NATA Act is taken into consideration by
Age standardized prevalence of heavy episodic
the Ministry of Foreign Affairs when
drinking among adolescents and adults
International Treaties are scrutinized
Department of Excise 2017 Ministry of Finance
• establish a mechanism to monitor
Department of Police
production, pricing and sale and
NATA
income
Department of Customs 2018
BOI
• restrict selling of duty free alcohol
Ministry of Trade
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired
Indicator
Proposed actions
• review and revise the licensing system Department of Excise
to control the availability of alcohol
Tourist Board
products • advocate political leadership and
Mental Health Unit
2017-2020
other relevant stakeholders to get
c ontinued.
their support for law enforcement
• • strengthen life skills of school children Mental Health Unit
2017-2020
2.2.1 Prevalence
to resist the influence on alcohol
Ministry of Education
of alcohol use
promotion
NYSC
and its harmful
Ministry of Child
effects reduced
Development
continued.
2.2.1.b Reduce production and sale of
Department of Excise
illicit alcohol
Department of Police
• establish a mechanism receive
Public Administration
information on availability of illicit
Ministry
Production and sale of illicit alcohol
alcohol products
Mental Health Unit Social Service Ministry
• educate the community on harmful
Ministry of Women’s
effects of these products and
Affairs
empower to act against illicit alcohol District Secretariat
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired
Indicator
Proposed actions
2.2.1.c Reduce alcohol related violence
NATA
and injuries
Ministry of Justice • strengthen legal action for alcohol use Min. of Social service
and violence and accidents
Department of Police 2017
• strengthen the service availability
Mental Health Unit
of detecting Blood Alcohol
Proportion of alcohol related violence and
NATA
2017-2020
Concentration (BAC) including
injuries
Mental Health Unit
following accidents
Department of Police
• increase public awareness on harm
Ministry of Education
due to alcohol, control direct and
Ministry of Social Services
indirect promotion of alcohol use, and
2.2.1 Prevalence
related laws
Department of Police 2017-2020
32 of alcohol use
• empower the community to act
MOH
and its harmful
Ministry of Education
effects reduced
2.2.1.d Monitor prevalence of alcohol
Mental Health Unit
2016-2020
among adults and harmful effects of
Department of Police
alcohol in the country and share the findings • conduct alcohol prevalence surveys
Prevalence of alcohol among adults and
every 3 yrs
harmful effects of alcohol
• establish a surveillance mechanism
to report alcohol related violence, accidents and injuries
• promote alcohol related research • establish a mechanism to disseminate
the evidence
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired
Indicator
Proposed actions
2.2.1.e Establish treatment and
Mental Health Unit
rehabilitation services related to alcohol
NATA
• build the capacity of PHC workers Mental Health Unit other grass root level field officers in
non health sector to screen and refer alcohol dependents follow-up
Mental Health Unit
Availability of treatment and rehabilitation
• establish a mechanism to report
services related to alcohol
alcohol related services available in the government, NGOs and private sector for treatment and rehabilitation
• establish alcohol rehabilitation units and Alcohol treatment clinics in all districts at institutional and community settings
2.2.1 Prevalence 33
2.2.1.f Establish a mechanism to
of alcohol use
implement, monitor and evaluate alcohol
and its harmful
policy at national and district levels
MOHDMH
effects reduced
• establish a sub-committee within
RDHS
National Mental Health Committee to District Psychiatrist review the implementation of alcohol MOMH (Focal Point) policy
Mental Health Unit • develop a strategic plan and
Availability of a mechanism to implement and
guidelines for implementation
NATA
2017-2020
monitor the alcohol policy
• empower NATA to implement alcohol Mental Health Unit
policy as this is its legitimate role
NATA
2017-2020
• ensure availability of adequate Mental Health Unit funding for implementing activities at
national and district levels
Mental Health Unit
• preparation of documentation for the NATA periodically reporting of the progress to the Presidential Task Force on Prevention of Substance Use
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
2.3 Promote healthy diet high in fruit and vegetables and low in saturated fattrans fat, free sugar and salt
Desired outcome Indicator
Proposed actions
Responsibility
Time frame
2.3.1.a Accelerate the implementation of the diet
EOH
2017-2020
component of the Global Strategy on Diet, Physical
Ministry of Trade
Activity and Health
Ministry of Consumer
Availability of policies
• create a mechanism for monitoring of food and
affairs
and mechanisms to
beverages advertisements and complains
Ministry of
increase intake of
• develop national policies on marketing of food and
Agriculture
healthy foods
non alcoholic beverages to children
Nutrition Division
2.3.1 Increased
• develop policies to promote availability of healthy
NCD unit
intake of healthy
Prevalence of persons
food
foods
(aged +18 years )
• develop policies to increase the affordability of
consuming less than five
healthy food
34 total servings (400 g) of • set up a committee to review food advertisement fruit and vegetables per
before airing
day
• conduct programme to increase the acceptability of
healthy food • establish policies on taxes and subsidies to promote consumption of fruits and vegetables
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome Indicator
Proposed actions
Responsibility
Time frame
2.3.1.b Increase availability of fruits and vegetables
Nutrition
2017-2020
• home gardening promotion programme
Coordination division
Availability of fruits and
• provide plants and seeds free low cost
vegetables
• conduct home gardening competitions
Ministry of
• establish a mechanism to provide seasonal fruits and Agriculture vegetables for low cost
Availability of policies
2.3.1.c Make available data and initiate policies to
Nutrition Division
2017-2020
and mechanisms to
increase intake of healthy foods
MRI
increase intake of
• nutrition profiling to define unhealthy food and
NCD unit
healthy foods
drinks
Nutrition Division
• develop food composition tables
2.3.2 Reduced
Availability of food
• draft a policies to increase intake of healthy foods
consumption of
composition tables and
saturated fats trans
nutrition profiling
fats, sugar and salt
2.3.1.d Develop and implement a national salt reduction strategy • advocate recommended salt consumption and define
E OH
2016-2017
Age-standardized mean
key components of the policy
NCD Unit
population intake of salt • determine the main sources of sodium chloride in Sri MRI
2016-2017
(sodium chloride) per
Lanka ( survey)
day in grams in persons
• conduct urinary salt surveys once in every 3 years
Nutrition division
2016-2017
aged 18+ years
• Develop and implement a national salt reduction
NCD Unit
2016-2017
strategy • evaluate locally tailored interventions adopted to
MRI
2016-2017
reduce the salt consumption
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome
Indicator
Proposed actions
Responsibility Time frame
• strengthen the laboratory facilities at MRI and to
MOH
2018-2019
check salt, fat content in the diet and urinary sodium concentration
• develop the lab at MRI and in a selected hospital
MOH
2018-2019
• strengthen of MLT schools at MRI
MOH
2018-2019
2.3.2.e.Increase the availability of healthy foods low in
E OH
2016-2019
salt, sugar and fats
Nutrition Division
• advocacy meeting with food producers, processors,
NCD Unit
2.3.2 Reduced
retailers to lobby to change the composition of food Ministry of Trade and
consumption of
• lobby food industry to manufacture healthy food
Consumer Affairs
saturated fats trans
options
Food manufacturers
36 fats, sugar and salt
• motivate food industry to reformulate processed
Chamber of
continued.
Availability of food low
food
Commerce
in food low in salt, sugar • conduct award programme for companies who and fats
prepare healthy food • establish a mechanism to ensure voluntary reduction of salt, sugar and fat • establish a mechanism to ensure mandatory
EOH
2017-2019
reduction of salt, sugar and fat
MRI
• evaluate the effects of major interventions for
EOH
2017-2019
reducing salt MRI
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome Indicator
Proposed actions
Responsibility
Time frame
2.3.2f Take measures to reduce trans fat in processed foods • conduct a survey to identify sources of trans fat and MRI
base line levels
ITI
Availability of processed • develop a national strategy to address trans fat
NCD Unit
foods with no trans fats • develop a policy to limit use of trans fat and use of
EOH, Nutrition
PHVO (partially hydrogenated vegetable oil) in all Division
processed food and restaurants NCD unit
Food manufacturers
2.3.2.g Introduce food labeling to indicate unhealthy
2.3.2 Reduced
Availability of food
foods
consumption of
labeling with nutrition
• introduce traffic light system for salt, sugar and
EOH, NCD
2017-2020
saturated fats trans composition and traffic
saturated fat, trans fat, energy content
Nutrition Division
fats, sugar and salt
light system
Food manufacturers
continued.
• indicate the nutrition composition of the food in the EOH
2018-2020
No. of food items
labels
NCD unit
certified by given the MoH certification on the Food manufacturers
contents of the food
• strengthen laboratory network in the country to
certify the contents in the food labels (one per
NCD unit
2.3.2.h Increase tax for unhealthy food
EOH
2018-2020
• establish policies on taxes to discourage
Ministry of Finance
Availability of policies on consumption of unhealthy food high in fat, sugar and Food manufacturers taxing unhealthy diet
salt
Nutrition Division
• impose taxes on un healthy food and beverages
NCD Unit
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome Indicator
Proposed actions
Responsibility Time frame
Availability of a
2.3.2.i Establish a mechanism to monitor compliance of
mechanism to monitor
the private sector with reduction of salt, sugar and fat in
consumption of
compliance of the
processed food
saturated fats trans private sector with fats, sugar and salt
reduction of salt, sugar
continued.
and fat in processed food
2.3.3.a Improve awareness of the public on cardio
HEB
2017- 2019
metabolic risk of consuming unhealthy foods through a
Ministry of Mass
mass media campaign
communication
Knowledge of the public
• develop IEC materials on salt, sugar, fat
NCD unit
on
38 2.3.3 Reduced cardio
• telecast commercials on sugar , salt, fat reduction
Professional Colleges
daily requirement of
metabolic risk of
• develop IEC materials on BMI, obesity, overweight
salt, sugar, fats and
consuming unhealthy
prevention
cardio metabolic risk of
foods
• telecast commercials on fruits and vegetables
consuming unhealthy consumption foods • publish newspaper advertisement on healthy foods
and unhealthy food habits • conduct healthy dish competitions
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome Indicator
Proposed actions
Responsibility
Time frame
of infants receive
2.3.3.b Promote maternal and child nutrition
FHB
2016- 2020
complementary feeding • promote exclusive breast feeding after 6 months
• implement breast feeding code • promote complementary feeding
of mothers who
• ensure good maternal nutrition
exclusively breast
• improve nutrition in malnourished girl children
feed for 6 months and appropriate complementary feeding
2.3.3.c Improve availability of healthy foods
Ministry of Education 2016- 2020
• implement healthy canteen policy in schools
FHB
2.3.3 Reduced cardio
PDHS
No. of schools practicing
metabolic risk of
RDHS
healthy canteen policy
consuming unhealthy foods continued.
• establish healthy canteens in work places according
No. of workplaces
All Ministries
2016- 2020
to the guidelines
practicing healthy
NCD Unit
canteen policy
Nutrition division EOH PDHS RDHS
2.3.3.d Increase availability of food based dietary
Ministry of Education 2018
guidelines
FHB
Availability of locally
• revise the Sri Lankan food based dietary guidelines
PDHS
relevant food based RDHS
dietary guidelines
• disseminate the food based dietary guidelines
Nutrition division
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome Indicator
Proposed actions
Responsibility Time frame
2.3.3.e Conduct awareness programmes on healthy
Nutrition division 2016 - 2020
foods and food based dietary guidelines
NCD Unit
Knowledge of the public • conduct programmes for pre school teachers,
PDHS
on healthy foods
school children, teachers, parents, youth, university
RDHS
students, community groups on food based dietary guidelines
2.3.3 Reduced cardio
2.3.3.f capacity building of health workers on food based Nutrition division 2016
metabolic risk of
No. of staff trained
dietary guidelines
NCD Unit
consuming unhealthy
on food based dietary
• training programmes on healthy diet for healthcare
foods continued.
guidelines
workers based on food based dietary guidelines
Availability of obesity
2.3.3.g Improve obesity management
NCD Unit
2017-2018
management guidelines • develop a teaching module on obesity management Professional Colleges and obesity management
guidelines
clinics
• establish obesity management clinics
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
2.4 Promote physical activity
Desired outcome
Indicator
Proposed actions
Responsibility
Time frame
2.4.1. a Develop physical activity guidelines for NCD unit
public
Ministry of Sports
Availability of a physical activity
2.4.1.b Conduct advocacy meetings for town
Ministry of Sports
2016-2018
guidelines for public
planners, politicians to improve environmental
Ministry of Local
Availability of environment
changes to promote physical activity
Government
conducive to promote physical activity
2.4.1.c Establish Strengthen the PA
2017-2020
programmes in work places
Ministry of Sports
• develop policies on supportive environment
EOH
for physical activity in workplaces
NCD unit
Prevalence of physical inactivity • develop an action plan to promote physical
Ministry of Sports
2016-2017 41
in people 18 yrs and over
activity through sports clubs , other
EOH
2.4.1 Physical inactivity
community settings and schools
reduced
• develop guidelines for physical activity at
Ministry of Sports
work places NCD Unit
Availability of policy on doing
• introduce regulation to establish a place to do
physical activity during working
exercise in new office buildings
Ministry of Sports
• introduce a mechanism to provide
Ministry of Sports
membership at sport complexes for a
EOH
subsidize prize for government workers
Age standardized prevalence of • bring up policy decision on permitting
NCD unit
overweight and obesity among
exercise during working hours
Sports ministry
the curative health staff
Ministry of Labour
• establish a place to do physical activity in
hospitals (as a pilot)
EOH
2017 - 1018
NCD unit
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome
Indicator
Proposed actions
Responsibility
Time frame
Prevalence of overweight and
2.4.1.d Strengthen the PA programmes in the
Ministry of Education 2016-2020
obesity in adolescents
schools
Ministry of Sports
HB
• revise guidelines on physical activity in
schools
NCD unit
• develop policies on supportive environment Ministry of Local
for physical activity in schools
Government
• ensure mandatory exercise time in the school • establish a mechanism that all children engaged in one type of PA • increase the availability of sports equipment
2.4.1 Physical inactivity
in the schools
reduced
• increase the availability of spaces to do
physical activity in schools • recruit adequate number of teachers for
physical education • revise the school curriculum • make health science a compulsory subject
Venues available to do PA
2.4.1.e Improve facilities for physical activity for Ministry of Local
the community
Government
of towns with a standard play • increase venues for (people to do PA
Ministry of Sports
area
(swimming fools, sport fields complexes, gym facilities)
NATIONAL MULTISECTORAL ACTION PLAN FOR THE PREVENTION AND CONTROL OF NONCOMMUNICABLE DISEASES 2016-2020
Desired outcome
Indicator
Proposed actions
Responsibility
Time frame
continued.
• introduce legislation to ensure safe walking Ministry of Local
paths cycling paths facility to do PA in
Government
new town and housing development • introduce legislation to ensure each town
has at least one play area
Ministry of Local
Government Ministry of Sports
• establish a play area in each town1-3 per
50,000 population)
Ministry of Local
Government Ministry of Sports