National Policy And Strategic Plan Of Action On Prevention .

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National PolicyandStrategic Plan of ActiononPrevention and Control ofNon-Communicable Diseases(NCDs)Non-Communicable Disease Control ProgrammeFederal Ministry of HealthAbuja, Nigeria.May 2013

ForewordI am indeed delighted to write the foreword to this maiden edition of the National Policy andstrategic plan of action on Non-Communicable Diseases (NCDs). As we are all aware, Nigeria iscurrently undergoing both epidemiological and demographic transition from CommunicableDiseases to Non-Communicable Diseases (NCDs) and as a result, NCDs are increasinglybecoming an important contributor to the national disease burden and therefore a major publichealth problem. Major NCDs in Nigeria include hypertension, diabetes mellitus, coronary heartdisease, stroke, sickle cell disease, cancers, asthma, oral health diseases, mental health, alcohol,and substance use disorders, and road traffic injuries and violence. The modifiable risk factorsfor NCDs are unhealthy diet, physical inactivity, use of tobacco and harmful use of alcohol.Other risk factors include climate change, occupational exposure, advancing age and unhealthyreproductive or sexual behaviour. In 2005, NCDs accounted for about 35 million (60%) deathsworldwide of which 80% occurred in developing countries including Nigeria. Death toll fromNCDs is projected to increase by a further 17% over the next decade unless something positive isdone urgently. NCDs are virtually without a cure, extremely expensive to treat and notorious forcausing debilitation, discomfort, morbidity, disability and premature deaths.As part of our commitment to the fight against NCDs, Nigeria was signatory to the politicaldeclaration at the UN General Assembly High Level Meeting on NCDs in September 2011.Thus, the purpose of this document is to develop and ensure the implementation of policies andprogrammes that will engender and guarantee a healthy lifestyle and quality health for allNigerians. The core sections include background, scope of the policy, policy goal, strategicthrusts for implementation, programme management and coordination, roles of stakeholders andpartnership coordination. It is expected that with the adoption of this policy, the control andprevention of NCDs and their associated risk factors will be well integrated at all levels ofgovernment and health care delivery system in Nigeria. This policy document is therefore astepping stone towards the development of guidelines for the prevention and management ofNCDs.In conclusion, I would like to express my profound appreciation to experts and stakeholders onNCDs for their commitment throughout the development stages of this policy. Their effort iswarmly and heartily acknowledged. I am assuring you that this policy document would becirculated at all levels of government including private organizations for immediateimplementation.National Policy & Strategic Plan of Action on NCDsPage 2 of 135

Professor C.O. Onyebuchi ChukwuHonourable Minister of HealthMay 2013AcknowledgementThe Non-Communicable Diseases Prevention and Control Programme, Department of PublicHealth, Federal Ministry of Health appreciates all stakeholders and experts on NCDs for theirtremendous efforts in ensuring a successful National Policy and strategic plan of action onNCDs.The Ministry acknowledges with thanks the contributions, assistance and support of thefollowing in the development of this policy.S/NNAME1Prof. C.O. Onyebuchi ChukwuDESIGNATIONHonourable MinisterORGANIZATIONFederal Ministry of Health2Dr. Muhammad Ali PateHonourable Minister of StateFederal Ministry of Health3Mrs. Fatima BamidelePermanent SecretaryFederal Ministry of Health4Dr. Mansur KabirFormer Director Public HealthFederal Ministry of Health5Dr. Bridget OkoegualeDirector Public HealthFederal Ministry of Health11Members of National Experts Committee on NCDsProf. Ima-Obong A. EkanemConsultant PathologistUniversity of Calabar Teaching(Chairman)Hospital, CalabarProf. Ambrose O. IsahConsultant ClinicalUniversity of Benin TeachingPharmacologistHospital, BeninMrs. Sherifat A. AbariFormer National CoordinatorLagosNCDDr. Jacintha E. GeorgeFormer National CoordinatorLagosNCDDr. David OkelloFormer WHO CountryWHO Country Office NigeriaRepresentativeDr. Rui Gama VazWHO Country RepresentativeWHO Country Office Nigeria12Dr. Emmanuel MusaMO/DPCWHO Country Office Nigeria13Prof. Owoidoho Udofia14Prof. Oye GurejeConsultant Neuropsychiatristand PresidentConsultant Neuropsychiatrist15Dr. Victor MakanjuolaConsultant NeuropsychiatristUniversity of Calabar TeachingHospital, CalabarUniversity College Hospital,IbadanUniversity College Hospital,678910National Policy & Strategic Plan of Action on NCDsPage 3 of 135

Ibadan16Dr. J.O. LawsonConsultant PaediatricianZankli Medical Centre, Abuja17Dr. Ogugua Osi-OgbuConsultant GeriatricianNational Hospital Abuja18Dr. Biodun OgunboConsultant NeurosurgeonNational Hospital Abuja19Dr. Obiageli E. NnoduConsultant Haematologist20Dr. Mustapha JamdaPublic Health Physician21Dr. Emmanuel C. OtohConsultant Dental Surgeon22Dr. Bashiru O. IsmailaConsultant General Surgeon23Dr. Peter U. Bassi24Mrs. Mnena S. LanConsultant ClinicalPharmacologistPharmacist/Programme OfficerUniversity of Abuja TeachingHospitalUniversity of Abuja TeachingHospitalRegional Centre for Oral HealthResearch and TrainingInitiatives (RCORTI) for AfricaJosJos University TeachingHospitalUniversity of MaiduguriTeaching HospitalNigerian Academy of Science25Dr. Sunny Chinenye26Dr. Mijinyawa BashirConsultant Physician andPresident DANConsultant EndocrinologistDiabetes Association of Nigeria(DAN)Diabetes Association of Nigeria27Dr. Bawa A. AbimikuNigeria Cancer Society28Dr. Kingsley K. AkinroyeConsultant Pathologist/President NCSExecutive Director29Mrs. Adanma OdefaChief Executive Officer30Dr. Olanrewaju O. OnigbogiConsultant Public HealthPhysician31Mrs. Lola Kola32Dr. Luka M. IbrahimNational Consultant MentalHealthNFELTP ResidentDiabetes and HypertensionHelp SocietyCollege of Medicine Universityof Lagos/ Global Actions,LagosWHO Country Office, Nigeria33Miss Faith O. Ezinwa .Industrial Trainee in FMOH35Enugu State University ofScience and TechnologyStaff Non-Communicable Diseases Control ProgrammeDr. Anthony UsoroDivisional HeadFederal Ministry of HealthNCD/NTD/OHMrs. Jummai J.C. BalamiCNO/NCDFederal Ministry of Health36Mr. Joseph O. NwokochaCEHO/NCDFederal Ministry of Health37Dr. Mangai T. MalauSMO/NCDFederal Ministry of Health38Dr. Jibrin B. SuleimanMO/NCDFederal Ministry of Health34National Policy & Strategic Plan of Action on NCDsNigerian Heart FoundationFederal Ministry of HealthPage 4 of 135

39Dr. Alayo SopekanSMO/NCDFederal Ministry of Health40Dr. Benard A. BeneMO/NCDFederal Ministry of Health41Mrs. Veronica S. AugustineMLT /NCDFederal Ministry of Health42Mrs. Bosede KehindeSOFederal Ministry of Health43Mrs. Nneka EttaACSO/NCDFederal Ministry of Health44Mrs. Fortune UdottMLSFederal Ministry of Health45Miss Funmi AreolaCCO/NCDFederal Ministry of HealthAssociations and other Stakeholders46Nigerian Cardiac Society47Nigerian Association of Nephrology48Diabetes Association of Nigeria49Nigeria Cancer Society50Nigerian Heart Foundation51Nigerian Hypertension Society52Christian Association of Nigeria53Supreme Council of Islamic Affairs54National Council for Women Society55Federal Road Safety Commission56Sickle Cell Disease Network of Nigeria57States Ministry of Health58Federal and States Ministry of Education59Federal and States Ministry of Information60National Primary Health Care Development Agency61National Health Insurance Scheme62Health Management Organizations63Regional Centre for Oral Health Research and Training Initiatives for Africa64Directors of PHCs in all local government areas65Community and Religious LeadersNational Policy & Strategic Plan of Action on NCDsPage 5 of 135

66Regulatory and Professional Bodies of Primary Health Care and Allied Health Workers67Conglomerates Involved in Manufacturing of Oral Health Products68National Assembly69Regulatory Agencies – MDCN, Dental Therapists Registration Board70Schools of Health Technology71Federal Ministry of Finance72Federal Ministry of Agriculture73Federal ministry of Internal Affairs74Nigerian Customs Services75Standard Organization of Nigeria76Anti-tobacco Coalition Group77Export Promotion Council78Media (Nigerian Television Authority, dailies, newspaper houses etc.)79National Orientation Agency80Broadcasting Organization of NigeriaDr Bridget OkoegualeDirector, Public HealthMay 2013Abbreviations and AcronymsMeaningAbbreviations/acronymsAIDSAcquired Immuno-deficiency SyndromeACEHOAssistant Chief Environmental Health OfficerACSOAssistant Chief Scientific OfficerCCOChief Clerical OfficerCNOChief Nursing OfficerCEOChief Executive OfficerNational Policy & Strategic Plan of Action on NCDsPage 6 of 135

CSOCivil Society OrganizationCBNCentral Bank of NigeriaCHDCoronary Heart DiseaseCBOCommunity Based OrganizationDALYsDisability Adjusted Life YearsDHSDemographic Health SurveyDMDiabetes mellitusDANDiabetes Association of NigeriaDPCDisease Prevention and ControlEBVEpstein Barr VirusFBOsFaith Based OrganizationsFCTFederal Capital TerritoryFMOHFederal Ministry of HealthFRSCFederal Road Safety CommissionFCTCFramework Convention on Tobacco ControlGDPGross Domestic ProductGNPGross National ProductGYTSGlobal Youth Tobacco SurveyHgHaemoglobinHHV-8Human Herpes Virus 8HIVHuman Immune deficiency VirusHBVHepatitis-B VirusHCVHepatitis-C VirusHPVHuman Papilloma VirusIDSRIntegrated Disease Surveillance and ResponseISHInternational Society of HypertensionLGALocal Government AreaLGHDLocal Government Health DepartmentMOMedical OfficerMLTMedical Laboratory TechnologistMSGMonosodium GlutamateMDGsMillennium Development GoalsMICSMultiple Indicator Cluster SurveyNBSNational Bureau of StatisticsNFELTPNigerian Field Epidemiology and Laboratory TrainingNational Policy & Strategic Plan of Action on NCDsPage 7 of 135

ProgrammeNCSNigeria Cancer SocietyNHSNigerian Hypertension SocietyNHFNigerian Heart FoundationNGOsNon-Governmental OrganizationsNPHCDANational Primary Health Care Development AgencyNPCNational Population CensusNCDsNon-Communicable DiseasesNENorth EastNCWSNational Council of Women SocietyNDHSNational Demographic Health SurveyNCNorth CentralNWNorth WestNHISNational Health Insurance SchemeNHMISNational Health Management Information SystemNEEDSNational Economic Empowerment Development StrategyNAPEPNational Poverty Eradication ProgrammeNTDsNeglected Tropical DiseasesOHOccupational HealthPHCPrimary Health CarePLCCPrimary Liver Cell CarcinomaPSAProstate Specific AntigenRCORTIRegional Centre for Oral Health Research and TrainingInitiatives for AfricaSMOHState Ministry of HealthSCDSickle Cell Disease/DisorderSHCSecondary Health CareSESouth EastSWSouth WestSSSouth SouthSURE-PSubsidy Re-investment and Empowerment ProgrammeTHCTertiary Health CareUNUnited NationsUNDPUnited Nations Development ProgrammeUCTHUniversity of Calabar Teaching HospitalNational Policy & Strategic Plan of Action on NCDsPage 8 of 135

UCHUniversity College HospitalUBTHUniversity of Benin Teaching HospitalVIAVisual Inspection of Cervix Stained with Acetic AcidWHAWorld Health AssemblyWHOWorld Health OrganizationTable of ContentsForeword . 2Acknowledgement . 3Abbreviation and Acronyms . 6SECTION A: POLICY . 111.0.Background . 111.1.Introduction . 111.2.Health Services . 121.3.Situation Analysis/Justification for Non-Communicable Disease Control Policy . 131.3.1.Factors Driving Non-Communicable Diseases . 131.3.2.Risk Factors . 141.4.Priority Non-Communicable Diseases (Non-Communicable Diseases) . 141.4.1.Cardiovascular Diseases . 141.4.2.Diabetes Mellitus (DM) . 151.4.3.Cancers . 161.4.4.Chronic Respiratory Diseases (CRDs) . 171.4.5.Mental Health Disorders . 171.4.6.Sickle Cell Disease (SCD) . 191.4.7.Violence and Injuries . 191.4.8.Oral Health Diseases . 211.5.Notable risk factors limiting the burden of Non-Communicable Diseases . 231.5.1.Tobacco use . 231.5.2.Harmful alcohol use . 231.5.3.Physical inactivity . 241.5.4.Unhealthy diet . 241.5.5.Other modifiable risk factors . 252.0.Scope of Policy . 262.1.Vision. 262.2.Mission . 262.2.1.Specific Objectives . 272.3.The Guiding Principles . 273.0.Legal Framework . 273.1.Legislation/Legal Considerations . 283.2.Policy Declaration . 294.0.Policy actions . 305.0.Strategic Thrust for Implementation . 315.1.Advocacy and Sensitization. 31National Policy & Strategic Plan of Action on NCDsPage 9 of 135

5.2.Health promotion (Information, Education and Communication) . 325.3.Capacity building and development .Error! Bookmark not defined.5.4.Reduction of risk factors. 335.4.1.Tobacco Use . 335.4.2.Unhealthy diets . 345.4.3.Physical inactivity . 345.4.4.Harmful use of alcohol . 355.4.5.Other risk factor in Nigeria: Sickle Cell Trait . 355.5.Prevention of Complications due to NCDs . 365.6.Palliative and Rehabilitative Care . 365.7.National Survey of NCDs and Risk Factors . 365.8.Research. 365.9.Monitoring and Evaluation . 375.10.Supervision . 376.0.Programme Management and Coordination. 387.0.Roles of Stakeholders in the National Policy . 387.1.Stakeholders. 387.1.1.Role of the Federal Ministry of Health . 387.1.2.Role of State Governments . 397.1.3.Role of Local Government Areas. 407.1.4.National Primary Health Care Development Agency . 407.1.5.Multisectoral Technical Advisory Committee . 407.1.6.Role of Development partners. 417.1.7.Role of Private Sector . 417.1.8.Role of Pharmaceutical and other health related industries . 417.1.9.Non-Governmental Organizations and Civil Society Organization. 417.1.10.Professional Bodies . 417.1.11.Traditional, Religious and Opinion Leaders . 427.1.12.Media Organizations . 428.0.Partnership Coordination . 42References .Error! Bookmark not defined.SECTION B: STRATEGIC PLAN OF ACTION. 421.0.Preamble .Error! Bookmark not defined.2.0.Stakeholders for NCDs.Error! Bookmark not defined.3.0.Advocacy, sensitization and awareness creation.Error! Bookmark not defined.4.0.Human resource development .Error! Bookmark not defined.5.0.Referral system .Error! Bookmark not defined.6.0.Modifiable risk factors .

National Policy & Strategic Plan of Action on NCDs Page 5 of 135 39 Dr. Alayo Sopekan SMO/NCD Federal Ministry of Health 40 Dr. Benard A. Bene MO/NCD Federal Ministry of Health 41 Mrs. Veronica S. Augustine MLT /NCD Federal Ministry of Health 42 Mrs. Bosede Kehinde SO Federal Ministry of Health .

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