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
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.
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