Country Capacity and Accomplishments and Application of the Policy Options Framework(cont...)

Pakistan

Key Policy Options and Strategic Actions

Assess

* Create a national NCD surveillance system. Needed to inform strategic planning and policy, this will allow implementation of the national NCD policy to have more immediate impact. Initial

efforts can be built on. In 2003, a pilot was implemented in one district (population 1 million) for

developing a model for population based surveillance of NCDs.22 Results of the initial round of

surveillance have been published.23 A World Bank/CDC/WHO joint study in 2004 recommended that it be replicated and taken to nationwide scale.24 The system should include mortality, morbidity, utilization of services, and risk behaviors. In addition, there should be early focus on tobacco, road traffic injuries, mental health, youth, and high-risk ethnic groups. Special studies in representative subsamples will also help understand the burden. The core public and private institutions with experience and capacity should be tapped for capacity development and

technical assistance.

Plan

* Develop and adopt and national NCD policy. The National Action Plan for the Prevention and

Control of Non-communicable Diseases and Health Promotion has been in existence for the last

7 years.25 Its recommendations can be updated with the outputs of the more recent rounds of

planning which were conducted in anticipation that an NCD commission will be created.

Implementation of the recommendations needs to be tasked to a unit with the capacity and

resources adequate for implementation.

Develop and Implement

* Strengthen tobacco control policies. While some early efforts have been made, implementation

and enforcement lag.

* Strengthen injury control policies with a focus on road traffic injuries. The ongoing surveillance

can help target efforts. Policy should be oriented initially toward prevention (seat belt and

helmet use).

* Retool the heath workforce for NCD prevention and control. NCD management is not

institutionalized into training on NCDs for either physicians or non-physicians. For the current

workforce, in-services and skills training is needed. A primary care NCD training track

implementing evidence-base interventions is a priority. In addition, assuring availability and

access to NCD services and drugs for the poor with NCDs and financing to achieve this is key.

Evaluate

* Develop monitoring and evaluation capacity A health management information system is in

place and will be a major asset, although it needs to be retooled for NCDs. In addition, as the

national NCD plan is implemented, an evaluation plan will be needed to fine tune and redirect

efforts and resources. Indicators and monitoring mechanism of the Integrated Framework for

Action of the National Action Plan can guide this process.