1. International Conference on Healthy Lifestyles and Non
Communicable Diseases (NCD)
In the Arab World and the Middle-East
(Riyadh, KSA, 9-12 September 2012)
NCD Prevention and
Control
Experience in North Africa
Pr Habiba Ben Romdhane
Cardiovascular Epidemiology &
Prevention Resarch Laboratory
Tunisia

2.  This presentation examines the
preparedness of three of the Northern
Africa countries (Algeria, Morocco and
Tunisia) to manage the challenge posed
by the increase of NCDs.
 The choice of these countries is motivated
by their similarity in culture and
lifestyle , and health sector organization ,
heritage of the French colonisation .
 Their total population is almost 25% of
the Arab population .

3. Burden of NCDs
 NCD are the causes of deaths: 56%
in Morocco, 58% in Algeria and
62% in Tunisia
 Tunisia has the highest prevalence
of tobacco and obesity
 There is a gender specificity on
risk factors prevalence : highest
prevalence of tobacco smoking on
men and obesity on women

4. NCDs Management
 MoH is the key strategic and delivery
institution, overseeing the planning and
provision of the bulk of health services.
 Within the MoH, NCDs responsibility lies
with the Department of Primary Health Care
where are established NCDs Unit
/Department
 Steering committees are established in the
MoH
 A growing private sector exists in the main
urban centres, offering diagnostic services

5. NCDs Management
 Early in the 1990’s , national programs on
hypertension and diabetes were
implemented;
 In Tunisia CVDs strategy document was
elaborted since 1999.
 During the 2000’s were elaborated :
 Plans on Cancer,on Mental Health and
on Tobacco
 Ariana Healthy Urbanization Project
(Tunisia). This project was based on
multisectorial approach .

6. 2008-2013 Action Plan: what
has it achieved ?

7. 
Plans of action for the period
(2008-2013) are elaborated.
However, in the three countries,
the plans are not really
implemented . They are not
endorsed by the different
departments and stakeholders.

8. NCDs Surveillance
Death Registry Risk
certification factors
Quality survey
Important Cancer CHD
issue
Algeria Yes 3 - Yes
Morocco Yes - - Yes
Tunisia Yes 3 1 Yes

9.  Health information systems
are fragmented and ill-
suited to the task of
monitoring patient
treatment, at either an
individual or a population
level, or resources .

10. Health care
 Integration in PHC (Hypertension
and diabetes)
 Absence of coherent – indeed any –
referral pathways between primary
and secondary health services
 inadequate access to essential
health technologies and medicines
 Inequalities

11. Reduction of risk factors
Gaps in implementing “best
buys” :
FCTC and tobacco control
measures
salt reduction
programmes marketing of
foods
physical activities
programmes

12. Multisectorial Actions
 A lack of coordination within the
health sector is perceived to be
worsening with the growth of a
private sector .
 The need to be tackling such a
major public health concern
through collaboration outside the
health sector is subordinated to the
more pressing issue of collaboration
within the health sector itself.

13. Financing
 The economic implications of rising
NCD levels is an adding urgency to the
search for alternative financial models
of health care
 The private sector is seen as almost a
parallel health economy, NCDs are “an
abyss of money”
 Out-of-pocket and catastrophic
expenditure due to NCDs are source of
inequality

14.  Epidemiological Transition And
Health Impact In North Africa
(TAHINA)
 MEDiterranean studies of
Cardiovascular disease and
Hyperglycaemia: Analytical
Modelling of Population Socio-
economic transitions
(MedCHAMPS)
 NCDs & their social determinants
in Mediterranean : building
sustainable RESearch CAPacity
for effective policy intervention
(RESCAP-MED)

15. Key Outcomes
 Determinants , trend and impact of the
Epidemiological transition in North
Africa
 Epidemiological modelling (IMPACT
CHD mortality model)
 Diabetes projection and policy
modelling tool
 Stroke modelling

16. Key Outcomes
 Health system analysis : how is it
organised to manage the care of those
with CVD or diabetes and what are key
concerns about the institutional
capability to address these challenges.
 A ‘policy effectiveness-feasibility loop’
designed to foster collaboration
between researchers and policy makers.

17. Key Outcomes
 Cost effectiveness analysis of salt
reduction policies to reduce coronary
heart disease
 Policy options beyond salt reduction
 Building research capacity in several
disciplines which must work together to
improve health care policies for NCDs .

18. CHD Mortality Trends in Tunisia 1997-2009: additional deaths
attributable to risk factor changes & deaths prevented or
postponed by treatments*
* MedCHAMPS Project

19. Forecasting Tunisian Type 2 Diabetes
Prevalence to 2027

20. Forecasting Tunisian Type 2 Diabetes Prevalence to 2027
and Scenario Projections
*Reduce the smoking prevalence by 20% in 10 years starting in 2009
*Reduce the prevalence of obesity by 20% in 10 years will start in 2013
A 3.3% reduction in diabetes prevalence would be reach in 2027 (1.6%
in men and 4.1% in women) (Figure 5), this corresponds to 61321 of
postponed case of diabetes.

21. What is the way forward in NA
 Northern Africa countries are facing
many challenges to achieve the
objectives of Global Action Plan for
the Prevention and Control of
NCDs
 Regional partnership for capacity
building is one of the strategic
areas to bridge the gap

22. Thank you for your
attention