For public health students in the university to increase their knowledge on disesaese invistigation

1. Strengthening NCD and RF surveillance in
the Americas
Branka Legetic.
PAHO-WHO Regional adviser,
Workshop on STEPS Stoke ,Curacao, Nov 2010

2. Strategic Plan 2008-2012
Surveillance & policy of NCDs & RF
• SO 3: To prevent and reduce disease,
disability and premature death of chronic
non communicable diseases, violence and
injuries
• SO6: To promote health and development and
prevent and reduce RF such as use of tobacco,
alcohol, drugs and other psychoactive substances,
unhealthy diets, physical inactivity and unsafe sex
• SO 6; SO9;SO11;SO15

3. PAHO Regional Strategy and Plan
of Action on an Integrated
Approach to the Prevention and
Control of Chronic Diseases
WHO 2008-2013 Action Plan for
the Global Strategy for the
Prevention and Control of Non
communicable Diseases
http://www.paho.org/cncd_surveillance
Development and strengthening of
Country capacity for surveillance of
chronic diseases, their consequences,
RF, and impact of PH interventions
Monitoring NCDs and their
determinants and evaluate progress
at the national, regional and global
levels

4. Surveillance line of
Action
To encourage and
support the
development and
strengthening of
countries’ capacity for
better surveillance of
chronic diseases, their
consequences, their
risk factors, and the
impact of public health
interventions.
Development & strengthening
of chronic disease and risk
factor surveillance systems

5. Focus on the following in the countries, sub
regions and the Region:
• Capacity assessment, use for monitoring & evaluation
• Ongoing collection of reliable, comparable, and quality
data;
• timely and advanced analysis;
• dissemination and use of analysis results for national
policy and program planning & evaluation,
• technical competency of the surveillance
workforce
• novel thinking and innovation

6. Available documents and tools
http://www.paho.org/cncd_surveillance

7. TOOL: Country Profile of Capacity and
Response to NCDs
http://www.paho.org/cncd_surveillance/countrycapacityandresponse

8. TOOL: Minimum dataset for
NCDs
http://paho.org/cncd_surveillance/minimumdataset
Purpose:
• to combine multiple data
sources in one functional annual
reporting system as a foundation
for CNCD surveillance.
• to remedy the fragmentation of
traditional country surveillance
systems
• to facilitate further analysis on
a national, sub Regional, and
Regional level and
the generation of more complex
indicators for NCDs.

9. In 2010
Assessment of capacity:
• Country capacity to respond to NCDs : instrument in Excel
available on www.paho,org/cncd_surveillance
• PROGRES REPORT for Directing Council
Ongoing collection of reliable, comparable
and timely data
• Implementation of Minimum data set in implementation in
20 countries
• Support RF studies
• Pan Am STEPS & introducing new methods

10. TOOLS: Methodology for Risk Factor
Surveillance
Disease, risk and protective factors in adults:
Pan Am STEPS-
New fact sheet on Determinants & RF
E STEPS
Additional modules
MULTIMOD: Methodology for use of land and cell
phones

11. Pan American STEPS
-UPDATE
January 2008 Presently in the Field:
Paraguay
Published and
promoted for policy
purposes: Aruba,
Bahamas, St Kitts
Attended II Level training &
completed data processing :
Aruba, Bahamas, Uruguay, St
Kits, Barbados, BVI, Dominica
Trained level 1 and in
preparatory phase:
Dominican Republic,
Cuba, T&T, Curacao,
Turks & Cayucos
Planning I Level training in
2008: St Lucia, St Vincent,
Panama, C Rica, Grenada
Chile, Argentina, Brazil, Mexico, Colombia, Jamaica are in process of mapping and harmonization of
data with Pan Am STEPS

12. Advances in 2010
Dissemination and use of analysis results for national policy
and program planning & evaluation
• Workshops for STEPS advanced analysis CAREC Feb 2010
• Policy and program implementation based on data analysis
• Caribbean Portal as part of PAHO health observatory CAREC 2010
Technical competency of the surveillance workforce
• FETP including NCDs, in collaboration with Brazil, Colombia &
CDC
• Training for cancer registry: in collaboration with IARC,
• Guayaquil 2010; Port of Spain 2010,

13. 2010 cont
Novel thinking and innovation
• Training & pilot of Multi Mod surveillance
Miami Sept 2010
• Mini STEPS as part of census, labor or other
studies for annual updates on behavioral RF,
Caribbean
• Use of Sentinel sites for PHC and hospital
performance monitoring C Rica pilot

14. Cancer incidence/ cancer registers –
geographic coverage in LAC based on CI5 IX

15. Improving information on incidence,
prevalence and survival of CVD
WHOs STEPwise Aapproach to Stroke Surveillance, STEPS Stroke
(based on WHO MONICA Project)
TOOLS: STEPS
Stroke methodology
http://www.paho.org/cncd_surveillance/stepsstroke

16. Stroke as one of the 3 main causes of death in the
Americas
1st % 2nd % 3rd %
Anguilla 14.7 Argentina 8.2 Antigua and Barbuda 8.3
Brazil 10.7 Belize 6.7 Canada 7
French Guyana 8.7 Barbados 8.8 Colombia 7.4
Guadeloupe 11.9 Bermuda 7.4 Haiti 8.6
Guyana 10.9 Cayman Islands 6.4 Montserrat 8.8
Martinique 12.2 Chile 9.6 Nicaragua 7.7
Panama 11.2 Costa Rica 6.3 Puerto Rico 5.8
Paraguay 10.6 Cuba 10.4 Trinidad and Tobago 10.7
Suriname 12.9 Dominican Republic 10
St. Kitts and Nevis 10.1 Ecuador 6.2
Uruguay 12.4 Peru 4.8
St. Lucia 12.1
United States 6.9
Venezuela 7.2
Virgin Islands (US) 7.6

17. STEPS Stroke in LAC – State and Perspectives
Countries that have implemented STEPS stroke, 1,2, 3 step : Chile, Mexico,
Brazil (Sao Paulo + 5 regions), Barbados,
Countries interested in implementing STEPS Stroke: Colombia, Uruguay,
Argentina, Honduras, Curacao
STEPS Stroke Instrument available on PAHO WEB: in English, Spanish and soon in Portuguese
STEPS Stroke supported by: World Stroke organization, World Federation of Neurology, PAHO-WHO
EMMA: Estudo de Mortalidade
e Morbilidade do Acidente
Vascular Cerebral
STROQUE: Stroke
Register of Queretaro.
Municipio Queretaro
TAURUSs: Talca Urban
& Rural Stroke Study
Barbados, MI &
Stroke register

18. STEPS STROKE initiatives in Latin
America and Caribbean
Acronym Name City,
Country
Population STEPS P.I Funding
Agency
EMMA Estudo de
Mortalidade e
Morbidade do
Acidente
Vascular
Cerebral
Sao Paulo,
Brazil
10 Million 1-2-3 Dr. P.A
Lotufo
CNP
STROQUE Stroke Register
of Queretaro,
Municipio
Queretaro
Municipio
Queretaro,
Mexico
725,000 1-2-3 Dr. F.
Barrinagarre
menteria
CONCYTEQ
CONACYT
TAURUSs Talca Urban &
Rural Stroke
Study
Provincia
Talca, Chile
390,000 1-2-3 Dr. P.M
Lavados
CONICYT
National
population
Register of
Barbados
Barbados 300,000 1-2-3 Dr. Anselm
Hennins
MOH
Barbados

19. STEPS Stroke...what it offers
• Study Protocol and
Instrument
• Data Entry Tool
• International Comparisons

20. Advances in 2010
• Cancer Registry: Brasilia Declaration on improving
information on cancer signed by 19 countries
• Training for cancer registry: in collaboration with
IARC: Guayaquil 2010; Port of Spain 2010
• Stroke registry: Manual STEP STROKE in en, Sp &
Portuguese on the WEB
• Temporary advisers to support countries
• Training for Step Stroke: Curacao 2010

21. SUBREGIONAL Support
• MERCOSUR:
Common Market
of the South
- VENT working group
• 2008, 2009,2010
• Andean
- VENT working group
• 2009, 2010
Chile

22. English Speaking Caribbean
• Declaration of Port of Spain
(2007)
• To be established, as a matter of
urgency, the programs necessary
for research and surveillance of
the risk factors for NCDs with
the support of our Universities
and the Caribbean Epidemiology
Centre/Pan American Health
Organization (CAREC/PAHO);”
• EPI meetings :
• 2006,
• 2007,
• 2008,
• 2010

23. PHIP Architecture

24. Use of results for national policy
Policy Observatory
Project

25. Policy
Developm
ent
Policy
Developm
ent
Policy
M
onitoring
Policy
M
onitoring
Capacity B
uilding
Capacity B
uilding
Policy Research
Policy Research
Advocacy
Advocacy
NCD POLICY
NCD POLICY
OBSERVATORY
OBSERVATORY
Policy Dialogue
Policy Dialogue
Operationally the Observatory will support and
promote a number of functions, at regional, sub-
regional and country levels:

26. Advances in use of results for
national policy
Case study methodology:
• Brazil
• C Rica
• Canada
National NCD policies
• Chile
• Uruguay
• Aruba,
• Dominica
• Bahamas,
• St Kits & Nevis
Policy dialogues
Support Sub regional or Regional policy
planning process
Caribbean –Summit &
follow up

27. Advances in 2010
• Policy Observatory project meeting
Port of Spain, November 17,18 2010
Purpose: Discus and prepare governments for UN
Special Session on NCD September 2011

28. Conclusions
 NCD and RF surveillance are of importance for political
and technical agenda
 Secures commitment for strengthening capacity at national
and sub regional level
 Jointly developed & implemented standardized
instruments:
1. Shorten the process of obtaining reliable timely information
2. Secure inter-country comparability and comparability over
time
3. Secures sustainability of collection and analysis
4. Strengthen partnerships

29. Please visit:
www.paho.org/cncd_surveillance
Thank You