Ministry of Health

Oman

Integration of Chronic Disease Care in PHC

Dr. Ali Jaffer MohammedAdvisor & Director General of Health Affairs

Ministry of Health

Oman

Rational• High Prevalence of NCDs in Oman (Ages

20+ years):

• Diabetes 12%• Hypertension 35%• Dyslipidaemia 40%• Overweight & obesity 48%• Tobacco use 23%

Ministry of Health

Oman

Deaths attributable to diseases and injuries, all ages, Oman, 2002.

Al-Lawati JA. et al., Prev Chronic Dis 2008; 5 (3):A99.

Ministry of Health

Oman

Disability-adjusted life years lost attributable to diseases and injuries, all ages, Oman, 2002.

Al-Lawati JA. et al., Prev Chronic Dis 2008; 5 (3):A99.

Ministry of Health

Oman

Rational• WHO objective # 3 of the Action Plan for

Prevention and Control of NCD

Ministry of Health

Oman

NCDs Integrated in PHC• Management of:

– Diabetes Mellitus– Hypertension

• Screening common NCD conditions: (only for 40+ years)

– Diabetes (FBS)– Hypertension (BP measurement)– Chronic Renal disease (GFR)– Dyslipidaemia (TC, HDL, LDL, TG)– Obesity (BMI, WC)

Ministry of Health

Oman

Approaches in Oman• Political commitment

• Accessible PHC to all

• Managers are family physicians

• Availability of structures and logistics needed for integration (health centres, staff, medication)

Ministry of Health

Oman

Steps of integrating NCD Management into PHC in Oman

• Formulation of the clinical guidelines for each condition .e.g. Diabetes, Hypertension, … etc

• Advocacy• Training for PHC workers.• Availability of necessary medications and equipments in

PHC institutions.• Arrangements at PHC institution (allocation of specific

days for the clinic, appointments)• Presence of specialists to support PHC ( in Polyclinics

and secondary hospitals)

Ministry of Health

Oman

NCD Screening Results (2008)

No. ScreenedMales Females Both

6,785 (38%) 10,894 (62%) 17,679

BMI>30 23% 36% 31%

Abnormal WC 54% 76% 68%

Pre-HTN 15% 14% 14%

HTN 21% 19% 19%

Pre-DM 36% 35% 35%

DM 8% 6% 7%

High Choles. 43% 47% 46%

eGFR < 90 32% 26% 28%

Ministry of Health

Oman

Challenges (1)• PHC structure needs further changes

• Untrained staff to deal with complex NCD conditions

• Unavailability of medications (ACEI, Statins

• limited lab services for tests in PHC

• Even if test done in 2y services, results not communicated in time to PHC

Ministry of Health

Oman

• Need for electronic record system for defaulters follow-up, monitoring & evaluation

• Shortage of health educators

Challenges (2)

Ministry of Health

Oman

Thank You