|ORIGINAL ARTICLE- ROUNDTABLE
|Year : 2017 | Volume
| Issue : 4 | Page : 134-137
Extent of multisectoral participation for noncommunicable diseases: Outcomes of roundtable discussions during world noncommunicable diseases congress
Rahul Gogia1, Gursimer Jeet1, JS Thakur1, Anil Garg2
1 Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh Administration, India
2 NHM, Chandigarh Administration, India
|Date of Web Publication||22-Feb-2018|
School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
India was first in delineating Global Action Plan in 2013 with the monitoring framework having specific targets and indicators to overcome noncommunicable diseases (NCDs) burden, which entails the requirement of vital phase that is multisectoral participation of different sectors for its implementation. Therefore, for involving different sectors, there is a requirement of the multisectoral action plan which can be helpful in providing the environment of buttress footprint, i.e., all stakeholders can draw on their collective core accomplishment to create a more comprehensive deck of potential in achieving a common goal. Initial case study was done through interviewing total 28 stakeholders to analyze the situation, perspective, and the extent of the participation of the different stakeholders from various sectors, toward the multisectoral participation in Chandigarh using World Health Organization (WHO) NCD map tool. Following the case study analysis, roundtable meeting was done; total 21 stakeholders participated in meeting, which was moderated by the WHO Coordinator NCD, SEARO region. Results of the case study assessing the multisectoral participation in Chandigarh and outcomes of the roundtable are presented in this manuscript. Case study emanates that majority of the stakeholders answering lack of coordination mainly affecting the success of any program and outcomes of the roundtable meeting underlined the requirement of proper coordination mechanism, strengthening of surveillance, implementation, monitoring and evaluation of NCD programs, political will by advocacy, and its prioritization.
Keywords: Multisectoral coordination, National Multisectoral Action Plan, noncommunicable diseases, stakeholders
|How to cite this article:|
Gogia R, Jeet G, Thakur J S, Garg A. Extent of multisectoral participation for noncommunicable diseases: Outcomes of roundtable discussions during world noncommunicable diseases congress. Int J Non-Commun Dis 2017;2:134-7
|How to cite this URL:|
Gogia R, Jeet G, Thakur J S, Garg A. Extent of multisectoral participation for noncommunicable diseases: Outcomes of roundtable discussions during world noncommunicable diseases congress. Int J Non-Commun Dis [serial online] 2017 [cited 2020 Aug 8];2:134-7. Available from: http://www.ijncd.org/text.asp?2017/2/4/134/225983
| Introduction|| |
Noncommunicable diseases (NCDs) rising situation is alarming as they are having direct and indirect effects on health of the public, economy, and resources of nation. India was first in delineating National Monitoring Framework for NCDs with 10 targets and 25 indicators to overcome the burden of NCDs that requires multisectoral participation. An example of UK Department of Health and Food Standards Agency which including the other stakeholders sensed the burden of increasing of NCDs majorly due to salt content. This made them do something to bring down the salt content for unlacing the preventable burden. Therefore to decrease the salt usage among population in UK, Department of Health and Food agency coordinated with other key stakeholders like impression maker, drivers of salt consumption, also the industry and consumers. Following the multisectoral approach, food stock was reformulated from all sectors/departments. Concomitantly, 8-year mass awareness campaign was allied to make people recognize health risk associated with high salt consumption along with the multisectoral approach. This resulted in 90 past formal commitments by food sectors, the projecting reduction in a salt consumption by 1/3rd, and further, 43% of the population in 2009 got practicality of the salt intake recommendation.
Similarly in 2004, Union Territory, Chandigarh took the step toward comprehensive public health by establishing Chandigarh Healthy Heart Action Project, which was an integrated program launched for the containment of NCD aiming to raise the awareness in regard of major risk factors for cardiovascular disease and other NCDs. There are many more past experiences from developed and developing countries in achieving upright results through multisectoral partnerships in different fields and situations. So there is a need of working together to overcome the NCDs burden following multisectoral approach. Keeping this in mind, initial case study was done in Chandigarh by interviewing with the stakeholders from different departments to analyze the situation, perspective, and extent of multisectoral coordination for the prevention and control of NCDs. Following the analysis of in-depth interviews, Roundtable meeting was organized with the key aim for the development of multisectoral action plan with involvement of central ministries and other key stakeholders working for NCDs.
| Methods and Participants|| |
Extent of multisectoral participation was assessed in Chandigarh by interviewing and analyzing 66% (n = 28) stakeholders out of the total 100% (n = 42) approached using World Health Organization (WHO) NCD map tool. For roundtable meeting, 39 central ministries in India were approached, 30 out of them were visited for invitation. Similarly, 28 stakeholders from Chandigarh approached and invited. A total of 21 stakeholders participated in the roundtable meeting, which was moderated by Dr. Palitha Mahipala Coordinator NCD, WHO, SEARO region [Figure 1].
|Figure 1: Roundtable meeting during world noncommunicable diseases congress in Chandigarh on multisectoral participation of central ministries and key stakeholders for the prevention and control of noncommunicable diseases|
Click here to view
Results of the case study; highlighting extent of multisectoral participation
It was found that out of 28 stakeholders from various sectors of Chandigarh, 21% (n = 6) of the participants were aware of the existence of NPCDCS Program, belonging to different sectors, 35% (n = 10) of the stakeholders were found to be contributing directly toward NCDs with moderate to high level of coordination. Out of the total, 82% (n = 23) of the participants agreed about the need of multisectoral action. Similarly, 82% (n = 23) of the participants showed willingness to participate in multisectoral action for NCDs, provided order comes from higher authorities. It was accepted by 75% (n = 21) of all the stakeholders that lack of coordination affect the success of efforts under any programme.
Proceedings of the meetings
Background work undertaken by the researcher in Chandigarh was presented during the meeting. It was clear that efforts need to be made to strengthen the multisectoral participation. Following to the in depth interview analysis, theme and sub themes were extracted. Further, in order to understand the national situation on action plan and way forward for the government agencies, the roundtable was held. The outcomes of roundtable started with the overview of current situation on NCDs and approaches adopted for NCD prevention and control were discussed. Implementation, gaps, barriers, and opportunities available from different sectors were explored. Following that, question was raised that what do we do differently for Multisectoral Coordination? Responses to the question came as involvement of all ministries, press, civil societies, and health sector through evidence-based interventions. Question was raised as to how do we convene all other ministries for participation? Constitution of steering committees, inclusion of the higher authorities to convene such meetings when officials under the program take lead, political leadership, and need of champions from different fields to participate in coordination were the key suggestions. Learning from other success stories in other fields within health was encouraged by the moderator as he added,
“HIV/AIDS presents experience of multisectoral coordination mechanisms. But we have not been able to do it so far for NCDs.”
Deputy Assistant Director General, MoHFW, Government of India (GoI), New Delhi, presented the highlights of National Multisectoral Action Plan (NMSAP) draft for NCDs in India. In the presentation, program strategy and mechanisms under National Multisectoral Action Plan of India were highlighted. Director NCD, MOHFW, India further informed how multiple stakeholders and government agencies helped in successful drafting of the NMSAP. He said multisectoral action in NCDs is crucial due to the involvement of multiple risk factors and multicomponent nature of interventions for NCDs. He also outlined the need for detailed policy analysis when sectors meet, as otherwise the policy changes are done on the margin without identifying the social gains from it. There is also a need to build legal capacity to defend these policies. Following the discussion, National Program Officer, NCD from WHO, India highlighted the concept of health in all policies, especially in relation to NCDs. She emphasized on the need to identify stakeholders and supportive structures and processes for multisectoral action. She added further that the multisectoral action will also facilitate the health impact assessments to evaluate the population impact of interventions and its need to do before implementation.
Information and Broadcasting Ministry, GoI, representative highlighted the key points to create communication strategy for involving different sectors. Another stakeholder, Country Project Manager, from INGO (Building Healthy Cities, John Snow India), said that India was the first to develop the NCD monitoring framework and the national plan; however, still, there is need to take the work forward. Thematic working groups need to be created to work out details of implementation. UNDP, representative advised there is a need to develop partnership process that country should follow. State Nodal Officer, NCD Chandigarh highlighted the constraints such as limited budget for NCDs, less human resource, low priority in health department meetings, and lack of coordination between public and private sectors.
Example underlined of NAPCOM, for which awareness done by celebrities, showing the involvement of the peoples from the creative sphere of the society as suggested by Director Principal of Medical College, Chandigarh. One of the stakeholders said that coordination mechanism for involving NGOs in the implementation of the multisectoral plan and strengthening of NCD surveillance in the nation is required. With the flow of the discussion, Nodal officer, tobacco control WHO India, talked about successful initiatives wherein bidi workers were rehabilitated through coordination between Ministry of Labour, Ministry of Information and Broadcast, and Ministry of Finance in India.
Representatives from different ministries, organizations, and key stakeholders discussed and put forward their views and work done for the prevention and control of NCDs. The highpoints of the roundtable are mainly the requirement of political commitment, public–private partnership and advocacy for policy formulation on multisectoral coordination, strong integrated health-care delivery system, and health promotion activities pertaining to NCDs especially about the risk factors of NCDs must be increased at every level such as camps, campaigns, workshops, and comprehensive strategy-based programs for the prevention and control of NCDs. The other outcomes and recommendations were made on the roundtable meeting as follows:
- Clear-cut coordination mechanism is critical to ensure multisectoral participation at higher level is required
- Strengthening of surveillance, implementation, monitoring, and evaluation of NCD programs
- Political advocacy for ensuring prioritization of NCDs prevention and control
- Evidence-based quality research on multisectoral coordination mechanism
- Health in all Policies (HiAP) approach.
| Conclusions|| |
Participation and involvement of ministries and key stakeholders for NCD prevention and control is critical. Reciprocal learning, collaboration, and coordination between the stakeholders for the implementation of multisectoral action are must. Initiation of advocacy for “Health in all policies” should be promoted with “whole of government” and societal approach. Hence in order to overcome this huge burden of NCDs, holistic approach along with the quality based interventions are required. This is possible through implementation of multisectoral action plan.
Resource persons/ Contributors
Palitha Mahipala NCD Coordinator, WHO, SEARO region; Arvind Mathur, WHO representative, Maldives; Kirk Smith, Professor of Global Environmental Health University of California, Berkley; Rajeev Kumar, Director NCD, Ministry of Health and Family Welfare, GoI, New Delhi; Sanjeev Kumar, Ministry of Health and Family Welfare, Government of India, New Delhi; Chinmoyee Das, Deputy Assistant Director General, Ministry of Health and Family Welfare, Government of India; Sadhana Bhagwat, National Program Officer, WHO, New Delhi; Damodar Bachani, Ex-Deputy Commissioner NCD, MoHFW, New Delhi; Subash Varma, Ex-Dean PGIMER, Chandigarh; Jagdish Kaur, Regional Adviser, Tobacco Free Initiative, WHO; Sanjay Kumar Bhadada, Additional Professor, Department of Endocrinology at PGIMER; Manjeet Singh, NHM; Manoranjan Kumar, New Delhi; Komal Khanna, Healthrise Program Director Medtronic foundation; Anil Garg, DFWO cum PO, NPCDCS, NHM UT, Chandigarh; Nalini, Arogya Samiti; Dhirendra Sinha, Regional Advisor, Surveillance (Tobacco Control), WHO; Dr. Dalip Kumar, Education Department, Chandigarh; Vineet Gill, NPO, WHO; A. K. Janmeja, Principal GMCH-32 Chandigarh J S Thakur, Prof. Department of Community Medicine, School of Public Health, PGIMER, Chandigarh; Apart from the 21 participants, 10 representatives from several departments' representatives (I and B, education, agriculture ministries) and other key stakeholders also attended the roundtable meeting.
Financial support and sponsorship
The meeting was hosted by the World NCD Congress in collaboration with MoHFW, AYUSH, and WHO.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Arora M, Chauhan K, John S, Mukhopadhyay A. Multi-sectoral action for addressing social determinants of noncommunicable diseases and mainstreaming health promotion in national health programmes in India. Indian J Community Med 2011;36:S43-9.
Ministry of Health and Family Welfare. National NCD Monitoring Framework 2013. New Delhi: Ministry of Health and Family Welfare; 2013.
Wyness LA, Butriss JL, Stanner SA. Reducing the population's sodium intake: The UK Food Standards Agency's salt reduction programme. Public Health Nutr 2012;15:254-61.
Thakur JS, Sharma YP, Jain S, Kumar R. CHHAP Project Report; 2006-07.
Tools for Developing, Implementing and Monitoring the National Multisectoral Action Plan (MAP) for NCD Prevention and Control. World Health Organization. Available from: http://www.who.int/nmh/action-plan-tools/en/
. [Last accessed on 2016 Dec 27].