Multi-level interventions for prevention of lifestyle related non communicable diseases

(NCD) in Romania

RO 19.04 project

National Institute of Public Health – Bucharest, Romania

Dr. Livia Cioran, project manager

General data Programm : Public Health Initiatives

Project RO 19.04 : Multi-level interventions for prevention of lifestyle related non communicable diseases (NCD) in Romania developed through the Norwegian Financial Mechanism 2009-2014

Programm Operator: Ministry of Health

Project Promoter: National Institute of Public Health

Project Partners:

• National Foundation Center for Family Medicine Studies

• Alliance to Fight Against Alcoholism and Drug Addiction

• Romania Health Psychology Association

• University of Medicine and Pharmacy Targu-Mureș

Implementation period: 01 iunie 2014 – 30 aprilie 2017

Why this project?

• An incontestable burden of non-communicable diseases;

• The major chronic diseases in Romania – cardiovascular , diabetes, cancer, have comune risk factors;

• Currently, interventions for those risk factors in are segmented and partial;

• European health policies demonstrate the

effectiveness of such interventions and recommends

State health indicators: WHO 2013

INCIDENCE Structure/general morbidity by disease group- România 2010

Catedra de Sanatate Publica si

Management, UMF "Carol Davila"

Bucureşti

5

43.10%

10.16%

8.42%

8.06%

6.64%

5.68%

5.08%

3.63%

3.16% 1.98%

Boli ale aparatului respirator

Boli ale aparatului digestiv

Boli ale sistemului osteo-muscular

Boli ale sistemului nervos şi organelor desimţ Boli ale organelor genito-urinare

Boli ale aparatului circulator

Boli de piele şi ţesut subcutanat

Boli infecţioase şi parazitare

Boli endocrine, de nutriţie şi metabolism

Traumatisme, otrăviri

Tulburări mentale

Sursa: INSP–CNSISP:Anuar statistic 2011

Solution? An integrated approach of bad behavior ►component A – primary health care component ► component B – community health care component

Project relevance • Romania faces a high burden of non-communicable diseases, being a

European country with relative low life expectancy due primarily to high levels of diabetes, coronary heart diseases, and cancers that can be explained by the high risk associated with unhealthy behaviors such as smoking (both men and women), unhealthy nutrition and physical inactivity and by inefficient use of the available health services. This project, in addition to risk assessment, provide appropriate interventions based on clinical evidence addressing risks related to lifestyle, and thus ultimately contributing to reduced burden of lifestyle-related NCDs among all population.

• The project logic aims at addressing NCDs in about 100 communities where family doctors would be approached via component A (primary health care component) and schools and kindergartens shall be approached via component B (community health component).

GENERAL OBJECTIV

• Increase access to high quality NCD prevention services by multi-level evidence-based interventions and an integrated community-based approach.

Project Beneficiaries

• Direct beneficiaries:

– 250 health care professionals from 100 PHC units in 6 counties – trained to apply developed instruments;

– Min 890 health education professionals across the country;

– Participants of the meetings, conferences and work-shops;

– Relevant interested involved in development of new policies and legislatives proposals and responsible authorities ;

• Indirect beneficiaries/finals:

– 25.000 persons from registered family doctors lists benefit of risk evaluation associated with an unhealthy life style;

– 20.000 children from schools and kindergartens educated to adopt a healthy nutrition and physical activity

– All country population will benefits of this after new legislative proposals are made and formalizing them by the concerned institutions (MoH, government and / or Parliament)

Specific objectives • SO1. Improve capacity in order to effectively implement

preventive interventions addressed to major lifestyle risk factors (unhealthy nutrition, type of physical activity, alcohol and tobacco consumption) at primary health care (PHC).

• SO2. Institutional capacity building for support of behaviour change by healthy nutrition and physical activity lifestyle messages communication to children and adolescents

• SO3. Develop/ advocate for improved policy, strategy, legal and/or regulatory framework needed for sustainable action

• SO4. Ensure appropriate project management, including project / donor visibility

Activities regarding SO1 • A.1. Develop and upgrade the clinical prevention guideline and

operational tools with the latest evidence in the field of prevention, in such way as to enable the identification of the individual’s patients risks for related NCD by the family doctors;

• A.2. The development of tools to enable the family doctors to control the identified risks for diseases in their patients (risks for diabetes, coronary heart diseases, mental health diseases, alcohol consumption, cancer diseases);

• A.3.Training of primary health care staff for motivational interviews;

• A.4.Training of Family Physicians/ community nurses in the use of instruments mentioned above

Activities regarding SO 2

A.5. Review and printing the existing the manual, training educators and teachers + study H.B.S.C (Health Behaviour in School Aged Children):

• Develop a community guideline promoting healthy nutrition and physical activity in kindergartens and schools;

• 2 TOT sessions based on developed guideline information;

• Training sessions in all 42 counties;

• 16,800 printed copies of the guide distributed in 42 counties;

• Minimum 890 health education professionals across the country trained to use developed tools of the guide;

• Minimum 84 schools and kindergartens nationwide where the manual is distributed;

• Minimum 20,000 children from schools and kindergartens across the country will benefit from developed and promoted tools;

• Realizing the H.B.S.C study for Romania / 2015;

• Develop national report H.B.S.C / Romania 2014/2015.

Activities regarding SO3

A.6. Advocacy to establish the necessary legislative framework of sustainable activities:

• Realizing 2 legislative consensus session;

• Drafting a proposal for legislative change.

Activities regarding SO4

A.7. Ensuring project visibility: • 1 Kick off Conference;

• Realizing 2 consensus sessions on developed guidelines implementations

• Newsletters (Romanian and English) available on the website at http://insp.gov.ro/sites/1/newsletter/ Insp;

• 1 conference for project completion

A.8. Project management and auditing: • Project management implemented consistently throughout the project;

• External audit periodically.

Project outcome

Develop an integrated framework for interventions in order to prevent the life-style-related NCD and build institutional capacity to support behaviour change related to healthy nutrition and physical activity lifestyle.

Achieved results • 1 Clinical Prevention Guideline developed that has attached instruments used in

preventive current doctors practice and risk-assessment tools that support risk communication and provision of counselling services

• One IT solution developed (Prevent module) and 26836 preventive assessments made using developed tools:

• An e-learning platform developed and functional at https://edu-cnsmf.ro/

4 course modules loaded on the e-learning:

Course 1 – Screening and Preventive interventions for alcohol use problem approach;

Course 2 – Nutrition, growth and development in children 0 -2 years 3 modules: Module 1 – Exclusive breastfeeding, Module 2 – Complementary Nutrition Module 3 – Supervision of growth and development in infants and small children,

Course 3 – Integrated Preventive interventions addressed to cardiovascular and metabolic risk in adults;

Course 4 – Essential Interventions addressed the cancer risk in primary health care;

• 100 family doctors practices from six counties participating in the pilot –

Prevent Network

• 25 training sessions for clinical prevention guideline and IT solution implementation in the 100 AMP units enrolled in the project;

• 250 employed people from primary health care units trained to use developed guideline instruments and IT solution;

• 100 tool-kits distributed in 100 pilot family practices

• Were developed training materials for integrated development and implementation of clinical guidelines;

• Training courses and interactive activities were carried out and 246 people across the country were trained in motivational interviewing.

• 45 primary health professionals trained regarding NCD risk factors in adults.

1 Community guideline promoting healthy nutrition and physical activity in kindergartens and schools developed and 16,800 copies of the guide printed and distributed in all 42 counties

• 153 training sessions conducted in 42 counties

• 2327 health education professional throughout the country trained to use developed tools of the guide;

Teachers,educators School nurses Community nurses

Roma comm. mediators School doctors

786 615 545 334 47

• 3649 schools and kindergartens nationwide where the guide was distributed;

• 411 464 school age and pre-schools and kindergartens children across the country can benefit from developed and promoted instruments;

• The HBSC study – Romania 2014/ 2015 realized;

• The HBSC report – Romania 2014/2015 achieved.

• 1 legislative consensus session for establishing sustainable activities achieved the necessary legislative framework realized and a legislative proposed amendment submitted

• Kick-off conferences (press release in Romanian and English) was conducted

• 4 issues of the newsletter and made available on the INSP website at http://insp.gov.ro/sites/1/newsletter/;

• Project management was consistently implemented throughout all project and 6 external audit reports were carried out.

THANK YOU !