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Health Policy Abstract The paper explores development and implementation of non-communicable disease (NCD) prevention polices in the developing countries by the example of Pakistan and its National Action Plan for Non-Communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD). The NAP-NCD health policy that addresses clinical prevention is analyzed and the advocacy activities that brought the policy into being are described in details. Health Policy Introduction The development and implementation of non-communicable disease (NCD) prevention polices in the developing countries can be considered the issue of the day. The necessity of designing strategic approaches using a concerted and integrated approach to non-communicable disease prevention policy is of a primary importance.
Non-communicable diseases impose a threat on developing countries. Pakistan, with its population of 150 million, reports that non-communicable diseases make up about 25 per cent of the overall mortality rate in the country, thus imposing a heavy economic burden on individuals, societies and health systems (World Health Report 2000). The necessity to decrease the quantity of deaths caused by non-communicable diseases forced the world society to develop an appropriate health policy addressing the issues of risk factor control, disease prevention and health promotion. There was a necessity to lobby for appropriate investments and policies to facilitate their inclusion in the development and health agenda (Yach D, 2004) and to design resource-sensitive, culturally appropriate and scientifically valid models that could embrace and integrate the variety of actions relevant for the disease prevention. The National Action Plan for Non-Communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) The participants of the project were Heartfile (NGO registered according to the Societies Registration Act of 1860 in Pakistan), the Ministry of Health, and the WHO Pakistan office. In result of their efforts the National Action Plan for Non-Communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) was developed and promulgated.
The health policy was the first national plan of actions for prevention of non-communicable diseases with the Governments' commitment to NCD prevention as a priority (Nishtar 2004) that implied a wide range of policies and advocate activities. NAP-NCD activities were as follows: to combine prevention and health promotion, harnessing the potential within partnerships (Nishtar 2004), integrate the activities with public health systems that were currently in force, to incorporate contemporary evidence-based concepts, to mention a few. First of all, the NAP-NCD policy delivered an Integrated Framework for Action (IFA) to affect a number of aspects. It was designed in compliance with the concept highlighted in Figure 1 and implied two sets of strategies. The first set of strategies involved common approaches across the entire range of Ncd's (Nishtar 2004) and included behavioral change communication strategy, reorientation of health services strategy (e. g.
making changes in basic infrastructure, etc) and surveillance (Nishtar 2004), while the second set of strategies included the activities that were specific to each NCD domain (Nishtar 2004) and pertained to legislative and regulatory matters (Nishtar 2004). The system level integration approach combined non-communicable diseases prevention with existing public health and social welfare infrastructure (Nishtar 2004). It allowed enhancing the public health configuration and redirected health services to a more preventive orientation (Nishtar 2004). The population approach involved a social marketing-guided communication strategy and behavioral research. It required active participation of educational institutions and local opinion leaders. The IFA successfully designed a common population surveillance mechanism for all NCD's (with the exception of cancer) (Nishtar 2004), with the inclusion of population surveillance of common risk factors (Nishtar 2004) and combining a module on population surveillance of injuries and mental health (Nishtar 2004).
The Ministry of Health adopted the NAP-NCD plan, as far as there were no specially designed policies for NCD prevention until the adopting the agreement within the terms of the NAP-NCD (Memorandum of Understanding 2007). The Ministry of Health approved budgetary allocations from its existing resources for the first phase of implementation (National Action Plan 2003). Additionally, a behavioral change communication campaign was supported in the media, and the training program was included in the work-plan of Lady Health Workers. As far as advocacy activities primarily place an emphasis on large-scale changes in programs, policies and environments, as well as mobilization of resources, they included education, counseling (developing approaches to culturally appropriate changes, such as counseling skill training, etc), and awareness-raising, to mention a few. During the second stage of the policy implementation World Health Organization supported the initiative by its Joint Government/WHO Program Review Mission (JPRM) program. Pakistan government allocated a budget of $ 20 million for 2001 - 2003.
Heartfile was responsible for a wide range of public activities aimed to increase public awareness through implementation of community-based projects and national media campaigns. Conclusion The implementation of health policy for non-communicable disease prevention, control and health promotion in Pakistan resulted in a positive change in population health. NAP-NCD allowed the country to accomplish necessary changes in order to meet the desired goals. References Memorandum of Understanding: National Action Plan for non-communicable diseases prevention, control and health promotion. (n. d. ). Retrieved May 29, 2007, from web National Action Plan for the Prevention, control and health promotion of Ncd's in Pakistan. (n.
d. ). Planning Commission (Health) Ministry of Health, Government of Pakistan F. NO. 25 - 21 / 2003 - (Planning). Nishtar, S. (2004). Prevention of non-communicable diseases in Pakistan: an integrated partnership-based model. Health Research Policy and Systems, 2 (7).
World Health Report 2000 Health Systems: Improving Performance. World Health Organization. Yach D, Gould CL, Hawkes C, Hofman K. (2004). The Global Burden of Chronic Diseases: dispelling Myths and Identifying Levers for Change. Figure 1 (Nishtar Health Research Policy and Systems 2004 2: 7 doi: 10. 1186 / 1478 - 4505 - 2 - 7)
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