For the 2023 survey:
• Ms Brigitta Õunmaa, Adviser, Public Health Department, Ministry of Social Affairs
(e-mail: [email protected]; tel: +372 6269 122) - was nominated as a focal point.

For the 2023 survey:
• Ms Brigitta Õunmaa, Adviser, Public Health Department, Ministry of Social Affairs
(e-mail: [email protected]; tel: +372 6269 122) - was nominated as a focal point.

2023
Country Profile of Capacity and Response to
Noncommunicable Diseases (NCDs)


MODULES:

I PUBLIC HEALTH INFRASTRUCTURE, PARTNERSHIPS AND MULTISECTORAL COLLABORATION FOR NCDs AND THEIR RISK FACTORS

II STATUS OF NCD-RELEVANT POLICIES, STRATEGIES AND ACTION PLANS

III HEALTH INFORMATION SYSTEMS, MONITORING, SURVEILLANCE AND SURVEYS FOR NCDs AND THEIR RISK FACTORS

IV CAPACITY FOR NCD EARLY DETECTION, TREATMENT AND CARE WITHIN THE HEALTH SYSTEM





































Purpose
• The purpose of this survey is to gauge your country’s capacity for responding to noncommunicable diseases (NCDs). It will guide Member States, WHO Regional Offices and WHO HQ in planning future actions and technical assistance required to address NCDs and their risk factors. This is also the basis for ongoing assessment of changes in country capacity and response. Responses to the survey enable reporting against NCD Global Action Plan process indicators and UN High Level Meeting national commitment progress indicators.
• The information collected through this survey will also be used to produce some of the indicators that Member States have agreed to monitor and will be held accountable to the United Nations General Assembly (UNGA) and World Health Assembly (WHA);
• Use of standardized questions allows comparisons of country capacities and responses. We have divided this survey into four modules, assessing key aspects of NCD prevention and control.
• The four main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. The survey also captures information on policies related to other NCDs of importance to countries such as oral health, diseases of eyes or ears and sensory impairments including hearing or vision impairment.
• The main risk factors for NCDs are harmful use of alcohol, tobacco use, unhealthy diet, and physical inactivity. Capacity assessment related to some specific risk factors is also captured in other topic-specific assessments such as tobacco, alcohol, and nutrition, which may be used to cross-validate some survey items.

Process
• The survey is intended to assess national level capacity and response to NCDs. If responsibility for health is decentralized to sub-national levels, it can also be applied at sub-national levels.
• A focal point or survey coordinator will need to be identified to coordinate and ensure survey completion. However, in order to provide a complete response, a group of respondents with expertise in the topics covered in the modules will be needed. Please use the table provided to indicate the names and titles of all of those who have completed the survey and which sections they have completed. Please also add any additional information on other sources you may have consulted in developing your response.
• Please note that while there is space to indicate “Don’t Know” for most questions, there should be very few of these. If someone is filling in numerous “Don’t Knows”, another person who is more aware of this information should be found to complete this section.
• In order to validate responses, documentation will be requested for affirmative responses throughout the questionnaire. Please make every effort to provide electronic copies of the requested documentation. If documentation has been provided previously and is available in the NCD Document Repository (https://extranet.who.int/ncdccs/documents), please indicate this. If you are unable to provide electronic copies through the provided links, please ask your regional focal point for an alternative means to submit documentation.

Information on those who completed the survey


Who is the focal point for completion of this survey?
Name: ________________________________
Position: ________________________________
Contact Information: _______________________________________________________________________
Sections completed: _______________________________________________________________________


Name and contact information of others completing survey
Sections completed





















Additional information sources consulted:
I: PUBLIC HEALTH INFRASTRUCTURE, PARTNERSHIPS AND MULTISECTORAL COLLABORATION FOR NCDs AND THEIR RISK FACTORS

This module includes questions related to the presence of a unit or division in the ministry of health dedicated to NCDs and risk factors, staff and funding. It also includes an assessment of the existence of fiscal interventions as incentives to influence health behaviour and/or to raise funds for health-related activities. Finally, it assesses the existence of a formal multisectoral mechanism to coordinate NCD-related activities in sectors outside of health.

1) Is there a unit/branch/department in the ministry of health or equivalent with responsibility for NCDs and their risk factors?
 Yes  No  Don’t Know
IF NO: Go to Question 2

1a) Please indicate the number of full-time-equivalent technical/professional staff in the unit/branch/department.
□ 0
□ 1
□ 2-5
□ 6 - 10
□ 11 or more
□ Don’t know

1b) Are there technical/professional staff in the unit/branch/ department dedicating a significant proportion of their time to:
i) Harmful use of alcohol  Yes  No  Don’t Know
ii) Unhealthy diet  Yes  No  Don’t Know
iii) Physical inactivity  Yes  No  Don’t Know
iv) Tobacco use  Yes  No  Don’t Know
v) Cancer  Yes  No  Don’t Know
vi) Cardiovascular diseases  Yes  No  Don’t Know
vii) Chronic respiratory diseases  Yes  No  Don’t Know
viii) Diabetes  Yes  No  Don’t Know
ix) Oral diseases  Yes  No  Don’t Know
x) Ear diseases/hearing impairment  Yes  No  Don’t Know
xi) Eye diseases/vision impairment  Yes  No  Don’t Know
xii) Rehabilitation  Yes  No  Don’t Know
xiii) Disability  Yes  No  Don’t Know

1c) Are there units/branches/departments with responsibility for NCDs and their risk factors at the subnational/state/regional level?  Yes  No  Don’t Know

2) Is there dedicated funding allocated in the government budget for the following NCD and risk factor activities/functions?
i) Primary prevention and health promotion  Yes  No  Don’t Know
ii)Early detection/screening  Yes  No  Don’t Know
iii)Health care and treatment  Yes  No  Don’t Know
iv) Population-based surveys  Yes  No  Don’t Know
v) Facility-based data collection  Yes  No  Don’t Know
vi) Programme monitoring and evaluation  Yes  No  Don’t Know
vii) Palliative care  Yes  No  Don’t Know
viii) Research  Yes  No  Don’t Know
ix) Rehabilitation  Yes  No  Don’t Know
x) Health equity/gender equality/accessibility/disability
 Yes  No  Don’t Know
If at least one Yes to above questions:

2a) What are the major sources of regular funding for NCDs and their risk factors?
More than one can apply, rank order them where:
1=Largest source; 2=Next largest; 3=Others
____ General government revenues
____ Health insurance
____ International Donors
____ National Donors
____ Earmarked taxes on alcohol, tobacco, etc.
____ Other (specify) _____________________
 Don’t Know

2b) What impact has the COVID-19 pandemic had on funding for NCDs?
□ The COVID-19 pandemic had no impact on funding for NCDs
□ The COVID-19 pandemic temporarily impacted funding for NCDs but funding has returned to pre-pandemic levels
□ Funding for NCDs has decreased since the COVID-19 pandemic
□ Funding for NCDs has increased since the COVID-19 pandemic
□ Other (please explain) ____________________________
□ Don’t know


3) Is your country implementing any of the following fiscal interventions? (for taxes, please respond “Yes” only if excise taxes and/or special VAT/sales tax rates are applied)
taxation on alcoholic beverages  Yes  No  Don’t Know
taxation on tobacco  Yes  No  Don’t Know
taxation on sugar sweetened beverages  Yes  No  Don’t Know
taxation on foods high in fat, sugars or salt  Yes  No  Don’t Know
price subsidies for healthy foods  Yes  No  Don’t Know
taxation incentives to promote physical activity  Yes  No  Don’t Know
others (specify)  Yes  No  Don’t Know

If Yes to at least one of the above, other than price subsidies:
3a) Are any of these funds earmarked for health promotion or health service provision?  Yes  No  Don’t Know


4) Is there a national multisectoral commission, agency or mechanism to oversee NCD engagement, policy coherence and accountability of government sectors beyond health?
 Yes  No  Don’t Know
IF NO: Go to MODULE II
4a) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know

If Operational or under development:
4b) Please provide name: _____________________________________________

4c) Please provide year of establishment: ____________________________________

4d) Which government agency leads or chairs the commission/agency/mechanisms:

□ Office of the President/Prime Minister or equivalent
□ Government ministries (e.g. Ministry of Health), please specify: ______________
□ Other (specify): ____________________

4e) Which of the following government agencies are members?
(Check all that apply)
□ Office of central government (e.g. President/Prime Minister and Cabinet or equivalent)
□ Agriculture
□ Communication/Information
□ Health
□ Economy and/or Finance
□ Education
□ Home affairs
□ Recreation, sport
□ Social affairs
□ Trade and industry
□ Urban planning
□ Women, children, youth affairs
□ Other (please specify: ___________________________)

4f) Which of the following stakeholders does the commission/agency/mechanism engage with? (Check all that apply)
□ United Nations Agencies
□ Other international institutions
□ Academia (including research centres)
□ Nongovernmental organizations/community-based organizations/civil society/patient organizations
□ Private Sector
□ Other (specify) _____________________
□ Don’t know

IF “Private Sector” is one of the stakeholders:
4g) Are the following industries excluded from participating in policy development and decision-making processes of the commission/agency/mechanism?

Tobacco  Yes  No  Don’t Know
Food and non-alcoholic
beverage production and trade  Yes  No  Don’t Know

Alcohol production and trade  Yes  No  Don’t Know
Other (specify) ___________  Yes  No  Don’t Know


II: STATUS OF NCD-RELEVANT POLICIES, STRATEGIES, AND ACTION PLANS

This module includes questions relating to the presence of policies, strategies, or action plans - the questions differentiate between integrated policies/strategies/action plans that address several risk factors or diseases, and policies/strategies/action plans that address a specific disease or risk factor. Additional questions address the existence of specific policies related to the cost-effective interventions for NCDs.

1a) Are NCDs included in the outcomes or outputs of your current national health plan?
 Yes  No  Don’t Know

1b) Are NCDs included in the outcomes or outputs of your current national development agenda?
 Yes  No  Don’t Know

1c) Are NCD services included in your national essential package of health services or universal health coverage-priority benefits package?
 Yes  No  Don’t Know


1d) Is ensuring continuity of NCD services included in the list of essential health services in your country's preparedness and response plan?
 Yes  No  Don’t Know


2a) Is there a set of time-bound national targets for NCDs based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs?
 Yes  No  Don’t Know

If Yes:
2ai) Is there a set of national indicators for these targets based on the indicators from the WHO Global Monitoring Framework for NCDs?
 Yes  No  Don’t Know

2b) Has your country set any other time-bound national targets for NCD-related areas, beyond any based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs, such as for diabetes coverage, cervical cancer or oral health?
 Yes  No  Don’t Know


II A: INTEGRATED POLICIES, STRATEGIES, AND ACTION PLANS

3) Does your country have a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors?
Please note that this may be a stand-alone NCD policy, strategy or action plan, or a national health policy, strategy or action plan where NCDs comprise a significant proportion of the document. Also note that disease- and risk factor-specific policies, strategies, and action plans will be reported in other questions later in this module.

 Yes  No  Don’t Know
IF NO: Go to Question 4
If yes:
Was it developed through multisectoral collaboration?
 Yes  No  Don’t Know
Was it developed through multi-stakeholder engagement?
 Yes  No  Don’t Know

Please provide the following information about the policy, strategy or action plan:

3a) Title: ­­­­­­­­­­­­­_____________________________________________________

3b) Does it address one or more of the following major risk factors?
Harmful use of alcohol  Yes  No  Don’t Know
Unhealthy diet  Yes  No  Don’t Know
Physical inactivity  Yes  No  Don’t Know
Tobacco  Yes  No  Don’t Know

3c) Does it include early detection, treatment and care for:
Cancer  Yes  No  Don’t Know
Cardiovascular diseases  Yes  No  Don’t Know
Chronic respiratory diseases  Yes  No  Don’t Know
Diabetes  Yes  No  Don’t Know

3d) Does it include palliative care for patients with NCDs?
 Yes  No  Don’t Know

3e) Does it include rehabilitative care for patients with NCDs?
 Yes  No  Don’t Know

3f) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know

If Operational:

3f-i) What was the first year of implementation? ___________
3f-ii) What year will it expire? ___________

II b: Policies, strategies, action plans for SPECIFIC KEY NCDs
The questions in this sub-section only refer to policies, strategies and action plans that are specific to key NCDs. If your integrated policy, strategy or action plan addresses the NCD, you do not need to re-enter that information.

4) Is there a policy, strategy, or action plan for cardiovascular diseases in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 5
If yes:


4a) Write the title _______________________________________________

4b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know

If Operational:
4b-i) What was the first year of implementation? ___________
4b-ii) What year will it expire? ___________


5) Is there a policy, strategy, or action plan for cancer or some particular cancer types in your country?
 Yes for all cancers or cancer in general
 Yes but only for specific cancers (specify: ___________________________)
 No
 Don’t Know
IF NO: Go to Question 6

If yes, provide the following for the general cancer policy/strategy/action plan or, if there isn’t one, for the most important specific cancer policy/strategy/action plan:


5a) Write the title _______________________________________________


5b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
5b-i) What was the first year of implementation? ___________
5b-ii) What year will it expire? ___________


6) Is there a policy, strategy, or action plan for diabetes in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 7
If yes:

6a) Write the title _______________________________________________

6b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
6b-i) What was the first year of implementation? ___________
6b-ii) What year will it expire? ___________

7) Is there a policy, strategy, or action plan for chronic respiratory diseases in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 8

If yes:


7a) Write the title _______________________________________________

7b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
7b-i) What was the first year of implementation? ___________
7b-ii) What year will it expire? ___________

8) Is there a policy, strategy, or action plan for oral health in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 9

If yes:


8a) Write the title _______________________________________________

8b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
8b-i) What was the first year of implementation? ___________
8b-ii) What year will it expire? ___________

8c) Is there a monitoring framework with a set of time-bound national targets for oral health based on the national oral health policy, strategy or action plan?
 Yes  No  Don’t Know

9) Is there a national oral health research agenda in your country that focuses on public health programmes and population-based interventions (e.g. a list of oral health research priorities in the country, guidance on research focus, a specific research component in the national oral health policy or in the national research agenda)?
 Yes  No  Don’t Know

10) Does your country have national guidance on optimal fluoride delivery for oral health of the population that addresses the universal availability of systemic or topical fluorides?
 Yes  No  Don’t Know

11) Is there a policy, strategy, or action plan for eye health in your country? 
□ Yes   □ No      □ Don’t Know
IF NO:  Go to Question 12
If yes:
11a) Write the title _______________________________________________ 
11b) Indicate its stage:  
□ Operational
□ Under development
□ Not in effect
□ Don’t know 
             If Operational:
                        11b-i) What was the first year of implementation? ___________
11b-ii) What year will it expire? ___________

12) Is there a policy, strategy, or action plan for hearing health in your country? □ Yes   □ No      □ Don’t Know
IF NO:  Go to Question 13
If yes:
12a) Write the title _______________________________________________ 
12b) Indicate its stage:  
□ Operational
□ Under development
□ Not in effect
□ Don’t know 
             If Operational:
                        12b-i) What was the first year of implementation? ___________
12b-ii) What year will it expire? ___________




13) Is there a policy, strategy, or action plan for another non-communicable disease of importance in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 14

If yes:
Please provide the following information about the policy / strategy / action plan. If there is more than one, please provide the information for the most recent one.

Please specify which NCD: ______________________________________________

13a) Write the title _______________________________________________

13b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
13b-i) What was the first year of implementation? ___________
13b-ii) What year will it expire? ___________


II c: Policies, action plans, strategies for NCD risk factors
The questions in this sub-section only refer to policies, strategies and action plans that are specific to an NCD risk factor.  If your integrated policy, strategy or action plan addresses the risk factor, you do not need to re-enter that information.  

14) Is there a policy, strategy, or action plan for reducing the harmful use of alcohol in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 15
If yes:


14a) Write the title _______________________________________________

14b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
14b-i) What was the first year of implementation? ___________
14b-ii) What year will it expire? ___________

15) Is there a policy, strategy, or action plan for reducing overweight / obesity in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 16
If yes:


15a) Write the title _______________________________________________

15b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
15b-i) What was the first year of implementation? ___________
15b-ii) What year will it expire? ___________


16) Is there a policy, strategy, or action plan for reducing physical inactivity and/or promoting physical activity in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 17
If yes:

16a) Write the title _______________________________________________

16b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
16b-i) What was the first year of implementation? ___________
16b-ii) What year will it expire? ___________

17) Are there national guidelines which provide recommended levels of physical activity for the population or a specific segment of the population?
 Yes  No  Don’t Know
IF NO: Go to Question 18
If yes:
17a) Are there guidelines specifically addressing any of the following groups:
Children under 5  Yes  No  Don’t Know
Children and adolescents (ages 5 – 19)  Yes  No  Don’t Know
Adults  Yes  No  Don’t Know
Older adults  Yes  No  Don’t Know
Persons with NCDs/chronic conditions  Yes  No  Don’t Know
Persons with disabilities  Yes  No  Don’t Know


18) Is there a policy, strategy, or action plan for reducing unhealthy diet related to NCD and/or promoting a healthy diet in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 19
If yes:

18a) Write the title _______________________________________________

18b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
18b-i) What was the first year of implementation? ___________
18b-ii) What year will it expire? ___________

19) Are there national food-based dietary guidelines for the population or a specific segment of the population?
 Yes  No  Don’t Know

20) Is there a policy, strategy, or action plan to decrease tobacco use in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 21
If yes:

20a) Write the title _______________________________________________

20b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
20b-i) What was the first year of implementation? ___________
20b-ii) What year will it expire? ___________



II D: SELECTED COST-EFFECTIVE Policies for NCDs AND RELATED RISK FACTORS
NB: Only selected policies are captured here as information on some policy measures, e.g. for tobacco and alcohol, are included in other assessment tools.


21) Is there a policy and/or plan on NCD-related research including community-based research and evaluation of the impact of interventions and policies?

 Yes  No  Don’t Know
IF NO: Go to Question 22
If Yes:
21a) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know

22) Is there a national network for NCD-related research including community-based research and evaluation of the impact of interventions and policies?

 Yes  No  Don’t Know


23) Is your country implementing any policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fatty acids, trans-fatty acids, free sugars, or salt?  Yes  No  Don’t Know
IF NO: Go to Question 24

If yes:
23a) Are the policies: □ Voluntary
□ Mandatory
 Don’t know
23b) Who is responsible for overseeing enforcement and complaints?
☐ Government
☐ Food Industry
☐ Independent regulator
☐ Other, please specify: _______________

23c) Do they include steps taken to address the effects of cross-border marketing of food and non-alcoholic beverages on children?
 Yes  No  Don’t Know

23c-i) If yes, please provide details: ____________________________________

24) Is your country implementing any policies on nutrition labelling to identify foods high in saturated fatty acids, trans-fatty acids, free sugars, or salt?

 Yes  No  Don’t Know
IF NO: Go to Question 25


If yes, please indicate which types of nutrition labelling are being implemented:
24a) List of ingredients  Yes  No  Don’t Know
24b) Nutrient declaration (i.e. back-of-pack labelling)  Yes  No  Don’t Know
24c) Front-of-pack labelling  Yes  No  Don’t Know
24d) Other interpretive labelling (e.g. menu or vending
machine labelling, back of pack warning messages)  Yes  No  Don’t Know


25) Is your country implementing any national policies to reduce population saturated fatty acid intake?
 Yes  No  Don’t Know
IF NO: Go to Question 26

25a) If yes, are the policies:  Voluntary
 Mandatory
 Don’t know


26) Is your country implementing any national policies to eliminate industrially produced trans-fatty acids in the food supply?
 Yes  No  Don’t Know
IF NO: Go to Question 27

26a) If yes, indicate which policies are being implemented:
Select all that apply
 Mandatory national ban on the production or use of partially hydrogenated oils
(PHO) as an ingredient in all foods
 Mandatory national limit of 2g of industrially produced trans-fatty acids per 100g of total fat in all foods
 Don’t know

27) Is your country implementing any policies to reduce population salt/sodium consumption?  Yes  No  Don’t Know

28) Are measures to reformulate foods and beverages (e.g. specific reformulation targets or legal limits) which are high in saturated fatty acids, trans-fatty acids, sugars or salt/sodium being implemented?
 Yes  No  Don’t Know

29) Are public food procurement and service policies for various settings (e.g. schools, government offices, public events) to reduce the content of saturated fatty acids, trans-fatty acids, sugars or salt/sodium in food served or sold being implemented?
 Yes  No  Don’t Know

30) Has your country implemented any national public education and awareness campaign on diet within the past 2 years?  Yes  No  Don’t Know
IF NO: Go to Question 31

30a) If yes, please provide details of the public education and awareness campaign(s):
_________________________________


31) Is your country implementing any national policies in the following areas to promote population physical activity?
This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events.

Walking and cycling  Yes  No  Don’t Know
Workplace physical activity initiatives  Yes  No  Don’t Know
Active aging  Yes  No  Don’t Know
Community-based physical activity and sports initiatives  Yes  No  Don’t Know
Public open spaces (including parks)  Yes  No  Don’t Know
Childcare settings  Yes  No  Don’t Know


32) Has your country implemented any national public education and awareness campaign on physical activity within the past 2 years?
Examples of national public education and awareness campaigns include large scale campaigns targeted at large segments of the population or the whole population, using mass media, and lasting for a longer period of time or repeated throughout the year. Conducting “one day events” (such as a car free day, sport days, physical activity day) on their own is not included in the definition of “public education campaign” and should be considered and reported in the following question on mass participation events.
 Yes  No  Don’t Know
IF NO: Go to Question 33

If yes:
32a) Does the national public education campaign integrate with community-based programmes or initiatives supporting promotion of physical activity?
 Yes  No  Don’t Know

32b) Is the national public education campaign supported by any environmental changes that aim to improve access to facilities that enable physical activity (such as infrastructure for walking or cycling, design or improvements to public open space or other facilities)?
 Yes  No  Don’t Know

32c) Do the national public education campaign “messages” address any of the social, environmental and economic benefits of physical activity, in addition to the mental and physical health benefits?
 Yes  No  Don’t Know

32d) Please provide brief details of the national public education campaign(s), including where possible the primary focus and name of campaign, target audience(s), type of mass media used, duration of campaign, and links to any reports, campaign resources and evaluations: ____________________________________
_________________________________

33) Has your country implemented any national or subnational mass participation events to encourage participation by the general public in free opportunities for physical activity within the past 2 years? Examples of free mass participation events include holding national walk to school or work days; car-free days; national PA or sports days, or days celebrating other physical activities providing free participation, such as cycling, yoga, tai chi, dance, or sports. Note this does NOT include hosting of major competitive sporting events, nor events such as marathons, which require paid participation, unless there is opportunity for free participation in shorter distances (e.g. 1km, 5km).
 Yes  No  Don’t Know

IF NO: Go to Question 34

33a) Please provide details of the event(s): _________________________________
_________________________________

34) Has your country implemented any national, NCD-related mHealth initiatives, such as tobacco cessation, hypertension management, cervical cancer screening awareness, promotion of physical activity or oral health, within the past 2 years?  Yes  No  Don’t Know

IF NO: Go to MODULE III

34a) Please provide details of the mHealth initiative(s):
_________________________________


III: HEALTH INFORMATION SYSTEMS, MONITORING, SURVEILLANCE AND SURVEYS FOR NCDs AND THEIR RISK FACTORS

The questions in this module assess surveillance relating to the NCD morbidity and risk factor reporting systems of each country and whether data were included in their national health reporting systems.

1) In your country, who has responsibility for surveillance of NCDs and their risk factors?
 An office/department/administrative division within the MOH exclusively dedicated to NCD surveillance
 An office/department/ administrative division within the MOH not exclusively dedicated to NCD surveillance
 Responsibility is shared across several offices/departments/administrative divisions within the MOH
 Coordination is by an external agency, such as an NGO or statistical organization
 No one has this responsibility
 Don’t know


III a: Data included in the national health INFORMATION system (National health information system refers to the annual or regular reporting system of the National Statistical Office or Ministry of Health)

2) Does your country have a disease registry for:
(Please fill in all columns)


2a) Cancers
2b) Diabetes
2c) Myocardial Infarction/
coronary events
2d) Cerebro-vascular accident/Stroke
2e) Other NCD of importance to your country
 Yes  No  Don’t know

IF NO: Skip to next column.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) What is the latest year for which data are available? _________
 Yes  No  Don’t know

IF NO: Skip to next column.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) Does the registry include data on any chronic complications which are updated as the patient’s complications status changes?
 Yes  No  Don’t know

iv) What is the latest year for which data are available? _________
 Yes  No  Don’t know

IF NO: Skip to next column.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) What is the latest year for which data are available? _________
 Yes  No  Don’t know

IF NO: Skip to next column.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) What is the latest year for which data are available? _________
 Yes  No  Don’t know

Specify which NCD(s): _____

IF NO: Skip to next question.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) What is the latest year for which data are available? _________

2f) Are there any other registries that can provide information on NCDs?
 Yes  No  Don’t know
If yes, please list: ____________________________________________________________



3) Please indicate the existence of a standardized system for recording patient level data that includes NCD status and risk factors in the following PUBLIC facilities:
A standardized system for recording patient-level data has a specified set of data elements that are well-defined and collected consistently.


Primary Care Centres
Secondary and tertiary care facilities / Hospitals
i) Does a standardized system for recording patient level data that includes NCD status and risk factors exist?
 Yes
 No
 Don't Know

IF NO: Go to next column.
 Yes
 No
 Don't Know

IF NO: Go to next question.

ii) Which topics are covered? (check all that apply)
 Cancers
 Cardiovascular diseases
 Chronic respiratory diseases
 Diabetes
 Eye health
 Hearing health
 Oral health
 Rehabilitation
 NCD risk factors, specify_____
 Other NCDs, specify ________
 Cancers
 Cardiovascular diseases
 Chronic respiratory diseases
 Diabetes
 Eye health
 Hearing health
 Oral health
 Rehabilitation
 NCD risk factors, specify_____
 Other NCDs, specify________
iii) What type of system is it?
 Paper-based
 Electronic
 Mixed (please describe, giving an indication to what degree a paper-based system versus an electronic system are used ______)
 Don’t know
 Paper-based
 Electronic
 Mixed (please describe, giving an indication to what degree a paper-based system versus an electronic system are used ______)
 Don’t know
iv)What is the coverage of the system?
 <25% of facilities
 25% to 50% of facilities
 more than 50% of facilities to 75% of facilities
 More than 75% of facilities
 Don’t know
 <25% of facilities
 25% to 50% of facilities
 more than 50% of facilities to 75% of facilities
 More than 75% of facilities
 Don’t know
v) Can private facilities access or share patient-level data with this system?
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
vi) Has an assessment ever been done to review the quality of the data collected by this system?
 Yes
 No
 Don't Know

If yes, please describe: ______

 Yes
 No
 Don't Know

If yes, please describe: ______


If Yes to having a patient information system including NCD status and risk factors in both primary care centres & hospitals:

3b) Are the patient information systems in primary care centres & hospitals interoperable? (does one system cover both types of facilities or can information be passed between the two systems?)
 Yes  No  Don’t Know

4) Does your country have a system for evaluating the experience of patients receiving NCD-related health services?
 Yes  No  Don’t know

5) Does your country have an electronic system to facilitate reporting of facility-level or aggregated patient data on NCD indicators from health facilities to district/subnational and national levels?
 Yes  No  Don’t know

III B: Risk Factor Surveillance

6a) Harmful alcohol use
6b) Unhealthy diet
6c) Physical inactivity
6d) Tobacco use
6) Have population-based surveys of risk factors (may be a single RF or multiple) been conducted in your country for any of the following:

(Please fill in all columns, start in the first row, going left to right, and then continue left to right across the second row.)

For the questions on surveys on adolescents or children, please include here only surveys specifically targeting adolescents or children (i.e. do not repeat adult surveys that may have covered part of the adolescent or child age range).

 Yes  No  Don’t know

IF NO: Go to next column.
IF YES:

i) Was there a survey on adolescents?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 National
 Subnational
 Don’t know

i-2) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-3) When was the last
survey conducted?
(give year) _____



ii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
ii-1) Was it:
 National
 Subnational
 Don’t know

ii-2) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

ii-3) When was the last
survey conducted?
(give year) _____
 Yes  No  Don’t know

IF NO: Go to next column.
IF YES:


i) Was there a survey on adolescents?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 24-hour recall
 Food frequency
 Other
 Don’t know


i-2) Was it:
 National
 Subnational
 Don’t know

i-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-4) When was the last
survey conducted?
(give year) _____



ii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
ii-1) Was it:
 24 hour recall
 Food frequency
 Other
 Don’t know

ii-2) Was it:
 National
 Subnational
 Don’t know

ii-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

ii-4) When was the last
survey conducted?
(give year) _____
 Yes  No  Don’t know

IF NO: Go to next column.
IF YES:

i) Was there a survey on children?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 Measured
 Self-reported
 Don’t know

i-2) Was it:
National
 Subnational
 Don’t know

i-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-4) When was the last
survey conducted?
(give year) _____

ii) Was there a survey on adolescents?
 Yes  No  Don’t know

IF YES:
ii-1) Was it:
 Measured
 Self-reported
 Don’t know

ii-2) Was it:
 National
 Subnational
 Don’t know

ii-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

ii-4) When was the last
survey conducted?
(give year) _____


iii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
iii-1) Was it:
 Measured
 Self-reported
 Don’t know

iii-2) Did it assess physical activity for work/in the household, for transport and during leisure time?
 Yes  No  Don't know

iii-3) Was it:
 National
 Subnational
 Don’t know

iii-4) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iii-5) When was the last
survey conducted?
(give year) _____
 Yes  No  Don’t know

IF NO: Go to next column.
IF YES:

i) Was there a survey on adolescents?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 National
 Subnational
 Don’t know

i-2) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-3) When was the last
survey conducted?
(give year) _____



ii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
ii-1) Was it:
 National
 Subnational
 Don’t know

ii-2) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

ii-3) When was the last
survey conducted?
(give year) _____

6) cont.
6e) Raised blood glucose/
diabetes
6f) Raised total cholesterol
6g) Raised blood pressure/
Hypertension
6h) Overweight and obesity
6i) Salt / Sodium intake

 Yes  No  Don't know

IF NO: Go to next column.

IF YES:

i) Was it:
 Measured
 Self-reported
 Don’t know

ii) Was it:
 National
 Subnational
 Don’t know

iii) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iv) When was the last
survey conducted?
(give year) _____



 Yes  No  Don't know

IF NO: Go to next column.

IF YES:

i) Was it:
 Measured
 Self-reported
 Don’t know

ii) Was it:
 National
 Subnational
 Don’t know

iii) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iv) When was the last
survey conducted?
(give year) _____



 Yes  No  Don't know

IF NO: Go to next column.

IF YES:

i) Was it:
 Measured
 Self-reported
 Don’t know

ii) Was it:
 National
 Subnational
 Don’t know

iii) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iv) When was the last
survey conducted?
(give year) _____



 Yes  No  Don't know

IF NO: Go to next column.

IF YES:
i) Was there a survey on children?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 Measured
 Self-reported
 Don’t know

i-2) Was it:
 National
 Subnational
 Don’t know

i-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-4) When was the last
survey conducted?
(give year) _____

ii) Was there a survey on adolescents?
 Yes  No  Don't know

IF YES:
ii-1) Was it:
 Measured
 Self-reported
 Don’t know

ii-2) Was it:
 National
 Subnational
 Don’t know

ii-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i i-4) When was the last survey conducted?
(give year) _____

iii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
iii-1) Was it:
 Measured
 Self-reported
 Don’t know

iii-2) Was it:
 National
 Subnational
 Don’t know

iii-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iii-4) When was the last survey conducted?
(give year) _____
 Yes  No  Don't know

IF NO: Go to MODULE IV.

IF YES:

i) Was it:
 Measured by 24-hr urine collection
 Measured by 12-hr urine collection
 Measured by spot urine collection
 Measured by combination of urine collection methods
 Self-reported salt intake
 Don’t know

ii) Was it:
 National
 Subnational
 Don’t know

iii) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iv) When was the last
survey conducted?
(give year) _____



IV: capacity for NCD EARLY DETECTION, treatment and care WITHIN THE HEALTH SYSTEM

The questions in this module assess the health care systems capacity related to NCD early detection, treatment and care within the health care sector. Specific questions focus on availability of guidelines or protocols to treat major NCDs, and the tests, procedures and equipment related to NCDs within the health-care system. It also assesses the availability of palliative care services for NCDs.

1a) Please indicate whether evidence-based national guidelines/protocols/standards are available for the management (diagnosis and treatment) of each of the major NCDs through a primary health care approach recognized/approved by government or competent authorities. Where guidelines/protocols/standards are available, please indicate their implementation status and when they were last updated.

Hypertension
Other Cardiovascular Diseases
Diabetes
Cancer
Chronic Respiratory Disease
i) Are they available?
 Yes
 No
 Don't Know
 Yes (specify topics covered)
 No
 Don't Know
 Yes
 No
 Don't Know
 Yes (specify cancer types)
 No
 Don't Know
 Yes (specify topics covered)
 No
 Don't Know
ii) Do they include drug- and dose-specific protocols?
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know

If Yes: If there are multiple guidelines, specify for which conditions:
__________
 Yes
 No
 Don't Know

 Yes
 No
 Don't Know

If Yes: If there are multiple guidelines, specify for which cancers:
__________
 Yes
 No
 Don't Know

If Yes: If there are multiple guidelines, specify for which conditions:
__________
iii) Are they being utilized in at least 50% of health care facilities
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
 Yes,
 No
 Don't Know
 Yes,
 No
 Don't Know
 Yes
 No
 Don't Know
iv) When were they last updated?







1b) Please indicate whether evidence-based national guidelines/protocols/standards are available for the management of each of the following NCD risk factors through a primary care approach recognized/approved by government or competent authorities.


Alcohol use disorders
Tobacco dependence
Overweight/
obesity
Physical inactivity
i) Are they available?
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
ii) Are they being utilized in at least 50% of health care facilities
 Yes
 No
 Don't Know
 Yes,
 No
 Don't Know
 Yes,
 No
 Don't Know
 Yes
 No
 Don't Know
iii) When were they last updated?





2) Indicate the availability of the following basic technologies for early detection, diagnosis / monitoring of NCDs in the primary care facilities of the public and private health sector where: Generally available=1; Generally not available = 2, Don't know = 3.

* Generally available: in 50% or more health care facilities
Generally not available: in less than 50% health care facilities

Availability in the primary care facilities of the public health sector
(1, 2, or 3)
Availability in the primary care facilities of the private health sector
(1, 2, or 3)
Overweight and obesity
2a) Measuring of weight
2b) Measuring of height

_____
_____

_____
_____
Diabetes mellitus
2c) Blood glucose measurement
2d) Oral glucose tolerance test
2e) HbA1c test
2f) Dilated fundus examination
2g) Foot vibration perception by tuning fork
2h) Urine strips for glucose and ketone measurement
_____
_____
_____
_____
_____
_____
_____
_____
Cardiovascular disease
2i) Blood pressure measurement
2j) Total cholesterol measurement
2k) Urine strips for albumin assay

_______________
_____
_____

_____
_____
_____
Asthma and chronic obstructive pulmonary disease
2l) Peak flow measurement
2m) Spirometry
_____
_____



3) Please indicate if there is a national screening program targeting the general population for the following cancers and, if yes, provide details.

Cancers
Initial screening method (indicate only one, the most widely used)
Population targeted by the program
Type of program
Screening coverage
Breast
☐Yes
☐No
☐Don’t know

If NO: Go to next row
☐Clinical breast exam
☐Mammography screening
☐Both
☐Don’t know

Women aged …….. to …….
Other, specify:

☐Don’t know
☐ Organised population-based screening
☐ Opportunistic screening
☐Don’t know
☐ Less than 10%
☐10% to 50%
☐ more than 50% but less than 70%
☐70% or more
☐Don’t know
Cervix
☐Yes
☐No
☐Don’t know

If NO: Go to next row
☐Visual inspection
☐PAP smear
☐ HPV test with no triage
☐ HPV test with triage ☐Don’t know
☐ General population
☐ Women living with HIV
☐ Both of the above
☐ Don’t know

Please also indicate targeted age range:
Women aged …….. to …….
Other, specify:

☐Don’t know
☐ Organised population-based screening
☐ Opportunistic screening
 Don't Know
☐ Less than 10%
☐10% to 50%
☐ more than 50% but less than 70%
☐70% or more
☐Don’t know
Colon
☐Yes
☐No
☐Don’t know

If NO: Go to next row
☐Faecal test
☐ Colonoscopy/ sigmoidoscopy
☐Don’t know
People aged …….. to …….
Other, specify:

☐Don’t know
☐ Organised population-based screening
☐ Opportunistic screening
☐Don’t know
☐ Less than 10%
☐10% to 50%
☐ more than 50% but less than 70%
☐70% or more
☐Don’t know
Other cancer type(s)

Specify: _______

☐Yes
☐No
☐Don’t know






4) Please indicate if early detection of the following cancers by means of rapid identification of the first symptoms is integrated into primary health care services and if there is a clearly defined referral system from primary care to secondary / tertiary care for suspect cases (in low- and middle-income countries this set of measures may be designated as an "early diagnosis" programme):


Breast
Cervix
Colon
Cancers in Children
Other cancer types (specify: ______)
Program/guidelines to strengthen early diagnosis of first symptoms at primary health care level
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes (please specify types of cancer)
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
Clearly defined referral system from primary care to secondary and tertiary care
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know

5) Does your country have a programme specifically targeting those living with HIV that offers early detection and comprehensive treatment of cancer?
 Yes
 No
 Don’t know


6) Is there a national essential medicines list or equivalent in your country?
 Yes
 No
 Don’t know

7) Describe the availability* of the medicines below in the primary care facilities of the public health sector, where: Generally available=1; Generally not available = 2, Don't know = 3.
* Generally available: in 50% or more pharmacies
Generally not available: in less than 50% of pharmacies

Generic drug name
Availability
7a) Insulin

7b) Aspirin (75/100 mg)

7c) Metformin

7d) Thiazide Diuretics

7e) ACE Inhibitors

7f) Angiotensin II receptor blockers (ARBs)

7g) Calcium channel Blockers

7h) Fixed dose combination (lisinopril + amlodipine)

7i) Fixed dose combination (lisinopril + hydrochlorothiazide)

7j) Fixed dose combination (telmisartan + amlodipine)

7k) Fixed dose combination (telmisartan + hydrochlorothiazide)

7l) Beta Blockers

7m) Statins

7n) Oral morphine

7o) Steroid inhaler

7p) Combination budesonide-formoterol inhaler

7q) Bronchodilator inhaler

7r) Sulphonylurea(s)

7s) Benzathine penicillin injection

7t) Nicotine Replacement Therapy

7u) Non-nicotine cessation medication (e.g. Bupropion, Varenicline)



8) Indicate the availability* of the following procedures and services for managing and treating NCDs in the publicly funded health system, where: 1=Generally available; 2=Generally not available; 3=Don't know.
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need

Procedure/Service name
Availability
8a) Diabetic retinopathy
screening

8b) Retinal photocoagulation

8c) Renal replacement therapy by dialysis

8d) Renal replacement by transplantation

8e) Therapeutic patient education for diabetes

8f) Coronary bypass

8g) Coronary stenting

8h) Thrombolytic therapy (streptokinase) for acute myocardial infarction

8i) Alteplase for acute stroke management

8j) Bone marrow transplantation



9) Indicate the availability* of the following procedures for detecting, managing and treating oral diseases in the primary care facilities in the public health sector and through other service providers (e.g. private sector, non-for profit).
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need

Procedure name
Availability in the primary care facilities of the public sector
Availability through other service providers
Oral health screening for early detection of oral diseases
☐ Generally available
☐ Generally not available
☐ Don’t know
☐ Generally available
☐ Generally not available
☐ Don’t know
Urgent treatment for providing emergency oral care and oral pain relief
☐ Generally available
☐ Generally not available
☐ Don’t know
☐ Generally available
☐ Generally not available
☐ Don’t know
Basic restorative dental procedures to treat existing dental decay
☐ Generally available
☐ Generally not available
☐ Don’t know
☐ Generally available
☐ Generally not available
☐ Don’t know


10) Detail the availability* of cancer diagnosis and treatment services in the public sector:
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need

Service
Availability
Cancer centres or cancer departments at tertiary level
☐ Generally available
☐ Generally not available
☐ Don’t know
Cancer centres or cancer departments dedicated to children at tertiary level
☐ Generally available
☐ Generally not available
☐ Don’t know
Pathology services (laboratories)
☐ Generally available
☐ Generally not available
☐ Don’t know
Cancer surgery
☐ Generally available
☐ Generally not available
☐ Don’t know
Chemotherapy
☐ Generally available
☐ Generally not available
☐ Don’t know
Radiotherapy
☐ Generally available
☐ Generally not available
☐ Don’t know

11) How many dedicated cancer centres are there in the country?
Cancer centres provide coordinated, multi-disciplinary care inclusive of all services generally available in the country. This may include, for example, pathology, radiotherapy, surgery and systemic therapy. A facility can count as a “cancer centre” even if other non-oncology services are provided in that facility. If you don’t know the exact number, please give an estimated range.

Number of public cancer centres: ______________ ☐Don’t know
Number of private cancer centres: ______________☐Don’t know


12) Detail the availability* of rehabilitative care in the public sector for patients with the following NCDs:
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need


Availability in primary care
Availability in secondary care
Availability in tertiary care
Cancer
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
Stroke
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
Acute Myocardial Infarction
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
Chronic Respiratory Diseases
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
Musculoskeletal Conditions
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know


13) Indicate the availability* of the following procedures for detecting and managing hearing loss in the public health sector
* Generally available:  reaches 50% or more patients in need 
Generally not available:  reaches less than 50% of patients in need  

Procedure name 
Availability 
Newborn hearing screening for early detection of hearing loss in infants 
☐ Generally available  
☐ Generally not available  
☐ Don’t know 
School ear and hearing screening for early detection of ear diseases and hearing loss 
☐ Generally available  
☐ Generally not available  
☐ Don’t know 
Hearing screening for older adults 
☐ Generally available  
☐ Generally not available  
☐ Don’t know 
Hearing aid fitting 
☐ Generally available  
☐ Generally not available  
☐ Don’t know 

14) Indicate the availability* of the following programmes or services for detecting, managing and treating eye conditions in the public health sector
*Generally available: reaches 50% or more patients in need 
Generally not available: reaches less than 50% of patients in need 

Name of programme or service
Availability 
Pre-school (aged 3–5 years) eye care programme for early detection of eye conditions, including refraction. 
☐ Generally available   
☐ Generally not available
☐ Not existent     
☐ Don’t know
School eye care programme for early detection of eye conditions, including refraction. 
☐ Generally available   
☐ Generally not available 
☐ Not existent      
☐ Don’t know
Provision of spectacles
☐ Generally available   
☐ Generally not available
☐ Not existent       
☐ Don’t know
Cataract surgery
☐ Generally available   
☐ Generally not available   
☐ Not existent     
☐ Don’t know


15) Indicate the availability* of palliative care for people living with NCD in the public health system:
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need

15a) In primary care facilities:
 Generally available for adults only
 Generally available for adults and children
 Generally not available
 Don't know

15b) In community or home-based care:
 Generally available for adults only
 Generally available for adults and children
 Generally not available
 Don't know

16) What proportion of primary care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke?
 none
 less than 25%
 25% to 50%
 more than 50%
 Don’t know

17) Indicate the availability* of provision of care for acute stroke in the public health system:
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need
 Generally available
 Generally not available
 Don't know

18) Is there a register of patients who have had rheumatic fever and rheumatic heart disease?
 Yes
 No
 Don’t know

IF YES:
18a) Are there systems for follow-up/recall to deliver long-term penicillin prophylaxis?
 Yes
 No
 Don’t know


GLOSSARY

Academia: Refers to educational institutions, especially those for higher education.
Broadcast media: Media which is broadcast to the public through radio and television.
Cancer: A generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs.
Cancer registry: A systematic collection of data about cancer cases in a certain region or a certain hospital. The first aim is to count cancer cases to get an idea of the magnitude of the problem. WHO advises national coverage by population-based registry in small countries only.

Capacity building: The development of knowledge, skills, commitment, structures, systems and leadership to enable effective action.
Cardiovascular diseases: A group of disorders of the heart and blood vessels that includes coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease,
congenital heart disease, deep vein thrombosis and pulmonary embolism.

Cardiovascular risk stratification: Use of risk prediction charts to indicate the risk of a fatal or non-fatal major cardiovascular event in the next 5 to 10 years. Based on the assessment people can be stratified into different levels of risk, which will help in management and follow up.

Chronic respiratory diseases: Diseases of the airways and other structures of the lung. Some of the most common are: asthma, chronic obstructive pulmonary disease, occupational lung diseases and pulmonary hypertension.


Collaboration: A recognized relationship between different groups with a defined purpose.

Community: A specific group of people, often living in a defined geographical area, who share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them.

Cross-border marketing: Marketing originating in one country that crosses national borders through broadcast media and internet, print media, sponsorship of events and programmes or any other media or communication channel. It includes both in-flowing and out-flowing cross-border marketing.

Diabetes: A disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

Early detection/screening: Measures performed in order to identify individuals who have early stages of a disease (with apparent symptoms in the case of early detection and without in the case of screening).

Earmarked taxes: Taxes which are collected and used for a specific purpose.

Electronic health record: An electronic health record is an in-house electronic version of the traditional paper charts that collect, store and display patient information.

Fiscal interventions: Measures taken by the government such as taxes and subsidies.

Free sugars: Monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Front-of-pack labelling (FOPL): Nutrition labelling systems that are presented on the front of food packages (in the principle field of vision) and can be applied across the packaged retail food supply. FOPL comprise an underpinning nutrient profile model that considers the overall nutrition quality of the product and/or the nutrients of concern for NCD; and presents simple, often graphic information on the nutrient content and/or nutritional quality of products to complement the more detailed nutrient declarations usually provided on the back of food packages. There are two major categories of FOPL, including interpretive and non-interpretive systems. Non-interpretive nutrient-based systems provide a summary of nutrient information, but no advice on the overall nutritional value of the food to assist with purchasing decisions. Interpretive systems may provide no nutrient information but only at-a-glance guidance on the relative healthiness of a product.

General government revenue: The money received from taxation, and other sources, such as privatization of government assets, to help finance expenditures.

Health: A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. A resource for everyday life which permits people to lead an individually, socially and economically productive life. A positive concept emphasizing social and personal resources as well as physical capabilities.

Health behaviour: Any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting or maintaining health, whether or not such behaviour is objectively effective towards that end.

Health care and treatment: The diagnosis and treatment of diseases.

Health care facility: Facilities which provide health services. They may include mobile clinics, pharmacies, laboratories, primary care clinics, specialty clinics, and private and faith-based establishments.

Health promotion: The process of enabling people to increase control over, and to improve their health.

Healthy diet: A healthy diet throughout the life-course helps prevent malnutrition in all its forms as well as a range of noncommunicable diseases (NCDs) and conditions. The exact make-up of a healthy, balanced diet will vary depending on the individual needs (e.g. age, gender, lifestyle, degree of physical activity). For adults, a healthy diet contains fruits, vegetables, legumes, nuts and whole grains and should be limited in free sugars, salt, total fat, saturated fats and free of industrial trans-fats.

International donors: Organizations which extend across national boundaries and which give funds for projects of a development nature.

Intervention: Any measure whose purpose is to improve health or alter the course of disease.

Legislation: A law or laws which have been enacted by the governing bodies in a country.

Long-term care facility: Long-term care facilities may vary by country. Nursing homes, skilled nursing facilities, assisted living facilities, residential facilities and residential long-term care facilities are collectively known as long-term care facilities that provide a variety of services, including medical and assistive care, to people who are unable to live independently in the community.

Marketing: Any form of commercial communication or message that is designed to, or has the effect of, increasing the recognition, appeal and/or consumption of particular products and services. It comprises anything that acts to advertise or otherwise promote a product or service.

mHealth: The use of mobile and wireless technologies to support the achievement of health objectives.

Multisectoral: Engaging different government sectors, such as health, agriculture, education, finance, infrastructure, transport, trade, etc.

Multisectoral collaboration: Collaboration/action within and between government sectors (e.g., ministry of health, ministry of education). Intersectoral or cross-sectoral actions or Health in All Policies (HiAP) are types of multisectoral collaboration.

Multi-stakeholder: Engaging non-State actors, such as NGOs, academia, the private sector and philanthropic foundations.

Musculoskeletal conditions: Musculoskeletal conditions comprise more than 150 conditions that affect the locomotor system of individuals. They range from conditions that arise suddenly and are short-lived, such as fractures, sprains and strains, to conditions associated with long-term functional limitations and disability, such as low back pain and osteoarthritis. Musculoskeletal conditions are typically characterized by pain (often persistent) and limitations in mobility, dexterity and overall level of functioning, reducing people’s ability to engage in their regular activities.

National Cancer Screening Programme: A government-endorsed programme where screening is offered. NGO-led programmes or national recommendations to go for screening at one’s own cost, do not qualify as national screening programmes.

National focal point, unit or department:
i. National focal point: the person responsible for the prevention and control of chronic diseases in a ministry of health or national institute.
ii. Unit or department: a unit or department with responsibility for NCD disease prevention and control in a ministry of health or national institute.

National health reporting system, survey and surveillance:
i National health reporting system: The process by which a ministry of health produces annual health reports that summarize data on, for example, national health human resources, population demographics, health expenditures, and health indicators such as mortality and morbidity. Includes the process of collecting data from various health information sources, e.g. disease registries, hospital admission or discharge data.
ii National survey: A fixed or unfixed time interval survey on the main chronic diseases, or major risk factors common to chronic diseases.
iii Surveillance: The systematic collection of data (through survey or registration) on risk factors, chronic diseases and their determinants for continuous analysis, interpretation and feed-back.
National integrated action plan: A concerted approach to addressing a multiplicity of issues within a chronic disease prevention and health promotion framework, targeting the major risk factors common to the main chronic diseases, including the integration of primary, secondary and tertiary prevention, health promotion and diseases prevention programmes across sectors and disciplines.

National policy, strategy, action plan:
i. Policy: A specific official decision or set of decisions designed to carry out a course of action endorsed by a political body, including a set of goals, priorities and main directions for attaining these goals. The policy document may include a strategy to give effect to the policy.
ii. Strategy: a long-term plan designed to achieve a particular goal.
iii. Action plan: A scheme of course of action, which may correspond to a policy or strategy, with defined activities indicating who does what (type of activities and people responsible for implementation), when (time frame), how and with what resources to accomplish an objective.

National protocols/guidelines/standards for chronic diseases and conditions:
A recommended evidence-based course of action to prevent a chronic disease or condition or to treat or manage a chronic disease or condition aiming to prevent complications, improve outcomes and quality of life of patients.

NGO: Non-governmental organization.

Noncommunicable diseases (NCDs): The four main types of noncommunicable diseases are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes.

Noncommunicable diseases prevention and control: All activities related to surveillance, prevention and management of the chronic noncommunicable diseases.

Not in effect: Any policy, strategy or plan of action which has been previously developed and is no longer under development, but for various reasons is not being implemented.

Nutrient declaration: A standardized statement or listing of the nutrient content of a food.

Nutrition labelling: A description intended to inform consumers of the nutritional properties of food. Nutrition labelling consists of two components: (a) nutrient declaration; (b) supplementary nutrition information (e.g. front-of-pack labelling).

Operational: A policy, strategy or plan of action which is being used and implemented in the country, and has resources and funding available to implement it. Also applies to a multisectoral commission/mechanism which is functional and meets on a regular basis.

Palliative care: Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

Partnership for health: An agreement between two or more partners to work cooperatively towards a set of shared health outcomes.

Peak flow measurement: A peak flow meter is a simple, hand-held device which measures how well a person can expel air from their lungs. The patient blows quickly and forcefully through a mouthpiece at one end, and a measurement is read from a built-in numbered scale on the device. Peak flow measurement can be done by a patient at home or in a health facility.

Price subsidies: Economic benefit provided by the government (such as a tax allowance or duty rebate) to keep the price of healthy foods low.

Primary health care: Refers to core functions of a nation’s health system. Encompassing front-line health service delivery (primary care) as well as health system structure; governance and financing; the intersectoral policy environment; and social determinants of health, primary health care provides essential health interventions according to a community’s needs and expectations.

Primary prevention: Measures directed towards preventing the initial occurrence of a disease or disorder.

Print media: Communicating with the public through printed materials such as magazines, newspapers and billboards.

Product reformulation by industry: Refers to the process of changing the composition of processed foods to be healthier and reduce the salt content.

Public awareness programme: A comprehensive effort that includes multiple components (messaging, grassroots outreach, media relations, government affairs, budget, etc.) to help increase public understanding about the importance of an issue.

Public health sector: Publicly funded health care sector.

Rehabilitation: Rehabilitation addresses the impact of a health condition on a person’s everyday life by optimizing their functioning and reducing their experience of disability. Rehabilitation expands the focus of health beyond preventative and curative care to ensure people with a health condition can remain as independent as possible and participate in education, work and meaningful life roles.

Risk factors associated with noncommunicable diseases
The four main risk factors for NCDs are tobacco use, harmful use of alcohol, unhealthy diet and low levels of physical activity.

Saturated fats: Fats found in animal products, including meat and whole milk dairy products, as well as certain plant oils like palm, palm kernel and coconut oils.

Screening: Measures preformed across an apparently healthy population in order to identify individuals who are at high risk or in the early stages of disease, but do not yet have symptoms.

Screening coverage: The proportion of people in the population targeted by the programme who actually received screening in the time frame defined by the programme. (For example, if a country recommends mammography screening every 2 years for women aged 50 to 60. The screening coverage is the number of women aged 50 to 60 who benefitted from mammography thanks to the programme in the past 2 years, divided by the total number of women aged 50 to 60 in the country.)

Self-regulation: In this context refers to when a group or private sector entity governs or polices itself without outside assistance or influence.

Spirometry: A spirometer is a complex piece of equipment which provides a number of different lung function measurements. The patient makes a prolonged, but forceful exhalation into a mouthpiece, connected to a machine which typically produces a graphical output. Spirometry requires a trained technician to oversee the testing and to interpret the results.

Sugar-sweetened beverages: Sugar-sweetened beverages (SSB) are defined as all types of beverages containing free sugars and these include carbonated or non-carbonated soft drinks, fruit/vegetable juices and drinks, liquid and powder concentrates, flavoured water, energy and sports drinks, ready-to-drink tea, ready-to-drink coffee, and flavoured milk drinks. Free sugars include monosaccharide and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Target: A specific aim to be achieved, should be time bound, and define a ‘desired’, ‘promised’, ‘minimum’ or ‘aspirational’ level of achievement.

Taxation incentives to promote physical activity: Involve removing the tax (or a portion of the tax) in order to promote increased use of goods or services to encourage physical activity.

Trans-fatty acids (trans fats): Unsaturated fatty acids with at least one double carbon–carbon bond in the trans configuration. Trans-fatty acids can be produced industrially by the partial hydrogenation of vegetable and fish oils, but also occur naturally in meat and dairy products from ruminant animals (e.g. cattle, sheep, goats, camels). Industrially-produced trans-fatty acids can be found in baked and fried foods, pre-packaged snacks and food, and partially hydrogenated cooking oils and fats which are often used at home, in restaurants, or in the informal food sector (such as street vendors), and are the predominant source of trans-fatty acid intake in many populations.

Under development: Something which is still being developed or finalized and is not yet being implemented in the country.

Universal Health Coverage-Priority Benefits Package; A universal health coverage-priority benefits package (UHC-PBP) is a set of evidence-informed prioritized health interventions, services and programmes, including intersectoral actions and fiscal policies, defined through a deliberative process that accounts for economic realities and social preferences. A UHC-PBP should be available for all, in good quality, at the appropriate service delivery platform(s) using an integrated people-centred approach and covered by relevant financial protection arrangement(s).

VAT/Sales Tax: “Value-added tax” (VAT) is a “multi-stage” tax on all consumer goods and services applied proportionally to the price the consumer pays for a product. Although manufacturers and wholesalers also participate in the administration and payment of the tax all along the manufacturing/distribution chain, they are all reimbursed through a tax credit system, so that the only entity who pays in the end is the final consumer. Most countries that impose a VAT do so on a base that includes any excise tax and customs duty. Example: VAT representing 10% of the retail price. Some countries, however, impose sales taxes instead. Unlike VAT, sales taxes are levied at the point of retail on the total value of goods and services purchased.

2023
Country Profile of Capacity and Response to
Noncommunicable Diseases (NCDs)


MODULES:

I PUBLIC HEALTH INFRASTRUCTURE, PARTNERSHIPS AND MULTISECTORAL COLLABORATION FOR NCDs AND THEIR RISK FACTORS

II STATUS OF NCD-RELEVANT POLICIES, STRATEGIES AND ACTION PLANS

III HEALTH INFORMATION SYSTEMS, MONITORING, SURVEILLANCE AND SURVEYS FOR NCDs AND THEIR RISK FACTORS

IV CAPACITY FOR NCD EARLY DETECTION, TREATMENT AND CARE WITHIN THE HEALTH SYSTEM





































Purpose
• The purpose of this survey is to gauge your country’s capacity for responding to noncommunicable diseases (NCDs). It will guide Member States, WHO Regional Offices and WHO HQ in planning future actions and technical assistance required to address NCDs and their risk factors. This is also the basis for ongoing assessment of changes in country capacity and response. Responses to the survey enable reporting against NCD Global Action Plan process indicators and UN High Level Meeting national commitment progress indicators.
• The information collected through this survey will also be used to produce some of the indicators that Member States have agreed to monitor and will be held accountable to the United Nations General Assembly (UNGA) and World Health Assembly (WHA);
• Use of standardized questions allows comparisons of country capacities and responses. We have divided this survey into four modules, assessing key aspects of NCD prevention and control.
• The four main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. The survey also captures information on policies related to other NCDs of importance to countries such as oral health, diseases of eyes or ears and sensory impairments including hearing or vision impairment.
• The main risk factors for NCDs are harmful use of alcohol, tobacco use, unhealthy diet, and physical inactivity. Capacity assessment related to some specific risk factors is also captured in other topic-specific assessments such as tobacco, alcohol, and nutrition, which may be used to cross-validate some survey items.

Process
• The survey is intended to assess national level capacity and response to NCDs. If responsibility for health is decentralized to sub-national levels, it can also be applied at sub-national levels.
• A focal point or survey coordinator will need to be identified to coordinate and ensure survey completion. However, in order to provide a complete response, a group of respondents with expertise in the topics covered in the modules will be needed. Please use the table provided to indicate the names and titles of all of those who have completed the survey and which sections they have completed. Please also add any additional information on other sources you may have consulted in developing your response.
• Please note that while there is space to indicate “Don’t Know” for most questions, there should be very few of these. If someone is filling in numerous “Don’t Knows”, another person who is more aware of this information should be found to complete this section.
• In order to validate responses, documentation will be requested for affirmative responses throughout the questionnaire. Please make every effort to provide electronic copies of the requested documentation. If documentation has been provided previously and is available in the NCD Document Repository (https://extranet.who.int/ncdccs/documents), please indicate this. If you are unable to provide electronic copies through the provided links, please ask your regional focal point for an alternative means to submit documentation.

Information on those who completed the survey


Who is the focal point for completion of this survey?
Name: ________________________________
Position: ________________________________
Contact Information: _______________________________________________________________________
Sections completed: _______________________________________________________________________


Name and contact information of others completing survey
Sections completed





















Additional information sources consulted:
I: PUBLIC HEALTH INFRASTRUCTURE, PARTNERSHIPS AND MULTISECTORAL COLLABORATION FOR NCDs AND THEIR RISK FACTORS

This module includes questions related to the presence of a unit or division in the ministry of health dedicated to NCDs and risk factors, staff and funding. It also includes an assessment of the existence of fiscal interventions as incentives to influence health behaviour and/or to raise funds for health-related activities. Finally, it assesses the existence of a formal multisectoral mechanism to coordinate NCD-related activities in sectors outside of health.

1) Is there a unit/branch/department in the ministry of health or equivalent with responsibility for NCDs and their risk factors?
 Yes  No  Don’t Know
IF NO: Go to Question 2

1a) Please indicate the number of full-time-equivalent technical/professional staff in the unit/branch/department.
□ 0
□ 1
□ 2-5
□ 6 - 10
□ 11 or more
□ Don’t know

1b) Are there technical/professional staff in the unit/branch/ department dedicating a significant proportion of their time to:
i) Harmful use of alcohol  Yes  No  Don’t Know
ii) Unhealthy diet  Yes  No  Don’t Know
iii) Physical inactivity  Yes  No  Don’t Know
iv) Tobacco use  Yes  No  Don’t Know
v) Cancer  Yes  No  Don’t Know
vi) Cardiovascular diseases  Yes  No  Don’t Know
vii) Chronic respiratory diseases  Yes  No  Don’t Know
viii) Diabetes  Yes  No  Don’t Know
ix) Oral diseases  Yes  No  Don’t Know
x) Ear diseases/hearing impairment  Yes  No  Don’t Know
xi) Eye diseases/vision impairment  Yes  No  Don’t Know
xii) Rehabilitation  Yes  No  Don’t Know
xiii) Disability  Yes  No  Don’t Know

1c) Are there units/branches/departments with responsibility for NCDs and their risk factors at the subnational/state/regional level?  Yes  No  Don’t Know

2) Is there dedicated funding allocated in the government budget for the following NCD and risk factor activities/functions?
i) Primary prevention and health promotion  Yes  No  Don’t Know
ii)Early detection/screening  Yes  No  Don’t Know
iii)Health care and treatment  Yes  No  Don’t Know
iv) Population-based surveys  Yes  No  Don’t Know
v) Facility-based data collection  Yes  No  Don’t Know
vi) Programme monitoring and evaluation  Yes  No  Don’t Know
vii) Palliative care  Yes  No  Don’t Know
viii) Research  Yes  No  Don’t Know
ix) Rehabilitation  Yes  No  Don’t Know
x) Health equity/gender equality/accessibility/disability
 Yes  No  Don’t Know
If at least one Yes to above questions:

2a) What are the major sources of regular funding for NCDs and their risk factors?
More than one can apply, rank order them where:
1=Largest source; 2=Next largest; 3=Others
____ General government revenues
____ Health insurance
____ International Donors
____ National Donors
____ Earmarked taxes on alcohol, tobacco, etc.
____ Other (specify) _____________________
 Don’t Know

2b) What impact has the COVID-19 pandemic had on funding for NCDs?
□ The COVID-19 pandemic had no impact on funding for NCDs
□ The COVID-19 pandemic temporarily impacted funding for NCDs but funding has returned to pre-pandemic levels
□ Funding for NCDs has decreased since the COVID-19 pandemic
□ Funding for NCDs has increased since the COVID-19 pandemic
□ Other (please explain) ____________________________
□ Don’t know


3) Is your country implementing any of the following fiscal interventions? (for taxes, please respond “Yes” only if excise taxes and/or special VAT/sales tax rates are applied)
taxation on alcoholic beverages  Yes  No  Don’t Know
taxation on tobacco  Yes  No  Don’t Know
taxation on sugar sweetened beverages  Yes  No  Don’t Know
taxation on foods high in fat, sugars or salt  Yes  No  Don’t Know
price subsidies for healthy foods  Yes  No  Don’t Know
taxation incentives to promote physical activity  Yes  No  Don’t Know
others (specify)  Yes  No  Don’t Know

If Yes to at least one of the above, other than price subsidies:
3a) Are any of these funds earmarked for health promotion or health service provision?  Yes  No  Don’t Know


4) Is there a national multisectoral commission, agency or mechanism to oversee NCD engagement, policy coherence and accountability of government sectors beyond health?
 Yes  No  Don’t Know
IF NO: Go to MODULE II
4a) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know

If Operational or under development:
4b) Please provide name: _____________________________________________

4c) Please provide year of establishment: ____________________________________

4d) Which government agency leads or chairs the commission/agency/mechanisms:

□ Office of the President/Prime Minister or equivalent
□ Government ministries (e.g. Ministry of Health), please specify: ______________
□ Other (specify): ____________________

4e) Which of the following government agencies are members?
(Check all that apply)
□ Office of central government (e.g. President/Prime Minister and Cabinet or equivalent)
□ Agriculture
□ Communication/Information
□ Health
□ Economy and/or Finance
□ Education
□ Home affairs
□ Recreation, sport
□ Social affairs
□ Trade and industry
□ Urban planning
□ Women, children, youth affairs
□ Other (please specify: ___________________________)

4f) Which of the following stakeholders does the commission/agency/mechanism engage with? (Check all that apply)
□ United Nations Agencies
□ Other international institutions
□ Academia (including research centres)
□ Nongovernmental organizations/community-based organizations/civil society/patient organizations
□ Private Sector
□ Other (specify) _____________________
□ Don’t know

IF “Private Sector” is one of the stakeholders:
4g) Are the following industries excluded from participating in policy development and decision-making processes of the commission/agency/mechanism?

Tobacco  Yes  No  Don’t Know
Food and non-alcoholic
beverage production and trade  Yes  No  Don’t Know

Alcohol production and trade  Yes  No  Don’t Know
Other (specify) ___________  Yes  No  Don’t Know


II: STATUS OF NCD-RELEVANT POLICIES, STRATEGIES, AND ACTION PLANS

This module includes questions relating to the presence of policies, strategies, or action plans - the questions differentiate between integrated policies/strategies/action plans that address several risk factors or diseases, and policies/strategies/action plans that address a specific disease or risk factor. Additional questions address the existence of specific policies related to the cost-effective interventions for NCDs.

1a) Are NCDs included in the outcomes or outputs of your current national health plan?
 Yes  No  Don’t Know

1b) Are NCDs included in the outcomes or outputs of your current national development agenda?
 Yes  No  Don’t Know

1c) Are NCD services included in your national essential package of health services or universal health coverage-priority benefits package?
 Yes  No  Don’t Know


1d) Is ensuring continuity of NCD services included in the list of essential health services in your country's preparedness and response plan?
 Yes  No  Don’t Know


2a) Is there a set of time-bound national targets for NCDs based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs?
 Yes  No  Don’t Know

If Yes:
2ai) Is there a set of national indicators for these targets based on the indicators from the WHO Global Monitoring Framework for NCDs?
 Yes  No  Don’t Know

2b) Has your country set any other time-bound national targets for NCD-related areas, beyond any based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs, such as for diabetes coverage, cervical cancer or oral health?
 Yes  No  Don’t Know


II A: INTEGRATED POLICIES, STRATEGIES, AND ACTION PLANS

3) Does your country have a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors?
Please note that this may be a stand-alone NCD policy, strategy or action plan, or a national health policy, strategy or action plan where NCDs comprise a significant proportion of the document. Also note that disease- and risk factor-specific policies, strategies, and action plans will be reported in other questions later in this module.

 Yes  No  Don’t Know
IF NO: Go to Question 4
If yes:
Was it developed through multisectoral collaboration?
 Yes  No  Don’t Know
Was it developed through multi-stakeholder engagement?
 Yes  No  Don’t Know

Please provide the following information about the policy, strategy or action plan:

3a) Title: ­­­­­­­­­­­­­_____________________________________________________

3b) Does it address one or more of the following major risk factors?
Harmful use of alcohol  Yes  No  Don’t Know
Unhealthy diet  Yes  No  Don’t Know
Physical inactivity  Yes  No  Don’t Know
Tobacco  Yes  No  Don’t Know

3c) Does it include early detection, treatment and care for:
Cancer  Yes  No  Don’t Know
Cardiovascular diseases  Yes  No  Don’t Know
Chronic respiratory diseases  Yes  No  Don’t Know
Diabetes  Yes  No  Don’t Know

3d) Does it include palliative care for patients with NCDs?
 Yes  No  Don’t Know

3e) Does it include rehabilitative care for patients with NCDs?
 Yes  No  Don’t Know

3f) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know

If Operational:

3f-i) What was the first year of implementation? ___________
3f-ii) What year will it expire? ___________

II b: Policies, strategies, action plans for SPECIFIC KEY NCDs
The questions in this sub-section only refer to policies, strategies and action plans that are specific to key NCDs. If your integrated policy, strategy or action plan addresses the NCD, you do not need to re-enter that information.

4) Is there a policy, strategy, or action plan for cardiovascular diseases in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 5
If yes:


4a) Write the title _______________________________________________

4b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know

If Operational:
4b-i) What was the first year of implementation? ___________
4b-ii) What year will it expire? ___________


5) Is there a policy, strategy, or action plan for cancer or some particular cancer types in your country?
 Yes for all cancers or cancer in general
 Yes but only for specific cancers (specify: ___________________________)
 No
 Don’t Know
IF NO: Go to Question 6

If yes, provide the following for the general cancer policy/strategy/action plan or, if there isn’t one, for the most important specific cancer policy/strategy/action plan:


5a) Write the title _______________________________________________


5b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
5b-i) What was the first year of implementation? ___________
5b-ii) What year will it expire? ___________


6) Is there a policy, strategy, or action plan for diabetes in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 7
If yes:

6a) Write the title _______________________________________________

6b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
6b-i) What was the first year of implementation? ___________
6b-ii) What year will it expire? ___________

7) Is there a policy, strategy, or action plan for chronic respiratory diseases in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 8

If yes:


7a) Write the title _______________________________________________

7b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
7b-i) What was the first year of implementation? ___________
7b-ii) What year will it expire? ___________

8) Is there a policy, strategy, or action plan for oral health in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 9

If yes:


8a) Write the title _______________________________________________

8b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
8b-i) What was the first year of implementation? ___________
8b-ii) What year will it expire? ___________

8c) Is there a monitoring framework with a set of time-bound national targets for oral health based on the national oral health policy, strategy or action plan?
 Yes  No  Don’t Know

9) Is there a national oral health research agenda in your country that focuses on public health programmes and population-based interventions (e.g. a list of oral health research priorities in the country, guidance on research focus, a specific research component in the national oral health policy or in the national research agenda)?
 Yes  No  Don’t Know

10) Does your country have national guidance on optimal fluoride delivery for oral health of the population that addresses the universal availability of systemic or topical fluorides?
 Yes  No  Don’t Know

11) Is there a policy, strategy, or action plan for eye health in your country? 
□ Yes   □ No      □ Don’t Know
IF NO:  Go to Question 12
If yes:
11a) Write the title _______________________________________________ 
11b) Indicate its stage:  
□ Operational
□ Under development
□ Not in effect
□ Don’t know 
             If Operational:
                        11b-i) What was the first year of implementation? ___________
11b-ii) What year will it expire? ___________

12) Is there a policy, strategy, or action plan for hearing health in your country? □ Yes   □ No      □ Don’t Know
IF NO:  Go to Question 13
If yes:
12a) Write the title _______________________________________________ 
12b) Indicate its stage:  
□ Operational
□ Under development
□ Not in effect
□ Don’t know 
             If Operational:
                        12b-i) What was the first year of implementation? ___________
12b-ii) What year will it expire? ___________




13) Is there a policy, strategy, or action plan for another non-communicable disease of importance in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 14

If yes:
Please provide the following information about the policy / strategy / action plan. If there is more than one, please provide the information for the most recent one.

Please specify which NCD: ______________________________________________

13a) Write the title _______________________________________________

13b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
13b-i) What was the first year of implementation? ___________
13b-ii) What year will it expire? ___________


II c: Policies, action plans, strategies for NCD risk factors
The questions in this sub-section only refer to policies, strategies and action plans that are specific to an NCD risk factor.  If your integrated policy, strategy or action plan addresses the risk factor, you do not need to re-enter that information.  

14) Is there a policy, strategy, or action plan for reducing the harmful use of alcohol in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 15
If yes:


14a) Write the title _______________________________________________

14b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
14b-i) What was the first year of implementation? ___________
14b-ii) What year will it expire? ___________

15) Is there a policy, strategy, or action plan for reducing overweight / obesity in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 16
If yes:


15a) Write the title _______________________________________________

15b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
15b-i) What was the first year of implementation? ___________
15b-ii) What year will it expire? ___________


16) Is there a policy, strategy, or action plan for reducing physical inactivity and/or promoting physical activity in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 17
If yes:

16a) Write the title _______________________________________________

16b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
16b-i) What was the first year of implementation? ___________
16b-ii) What year will it expire? ___________

17) Are there national guidelines which provide recommended levels of physical activity for the population or a specific segment of the population?
 Yes  No  Don’t Know
IF NO: Go to Question 18
If yes:
17a) Are there guidelines specifically addressing any of the following groups:
Children under 5  Yes  No  Don’t Know
Children and adolescents (ages 5 – 19)  Yes  No  Don’t Know
Adults  Yes  No  Don’t Know
Older adults  Yes  No  Don’t Know
Persons with NCDs/chronic conditions  Yes  No  Don’t Know
Persons with disabilities  Yes  No  Don’t Know


18) Is there a policy, strategy, or action plan for reducing unhealthy diet related to NCD and/or promoting a healthy diet in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 19
If yes:

18a) Write the title _______________________________________________

18b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
18b-i) What was the first year of implementation? ___________
18b-ii) What year will it expire? ___________

19) Are there national food-based dietary guidelines for the population or a specific segment of the population?
 Yes  No  Don’t Know

20) Is there a policy, strategy, or action plan to decrease tobacco use in your country?
 Yes  No  Don’t Know
IF NO: Go to Question 21
If yes:

20a) Write the title _______________________________________________

20b) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know
If Operational:
20b-i) What was the first year of implementation? ___________
20b-ii) What year will it expire? ___________



II D: SELECTED COST-EFFECTIVE Policies for NCDs AND RELATED RISK FACTORS
NB: Only selected policies are captured here as information on some policy measures, e.g. for tobacco and alcohol, are included in other assessment tools.


21) Is there a policy and/or plan on NCD-related research including community-based research and evaluation of the impact of interventions and policies?

 Yes  No  Don’t Know
IF NO: Go to Question 22
If Yes:
21a) Indicate its stage:
□ Operational
□ Under development
□ Not in effect
□ Don’t know

22) Is there a national network for NCD-related research including community-based research and evaluation of the impact of interventions and policies?

 Yes  No  Don’t Know


23) Is your country implementing any policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fatty acids, trans-fatty acids, free sugars, or salt?  Yes  No  Don’t Know
IF NO: Go to Question 24

If yes:
23a) Are the policies: □ Voluntary
□ Mandatory
 Don’t know
23b) Who is responsible for overseeing enforcement and complaints?
☐ Government
☐ Food Industry
☐ Independent regulator
☐ Other, please specify: _______________

23c) Do they include steps taken to address the effects of cross-border marketing of food and non-alcoholic beverages on children?
 Yes  No  Don’t Know

23c-i) If yes, please provide details: ____________________________________

24) Is your country implementing any policies on nutrition labelling to identify foods high in saturated fatty acids, trans-fatty acids, free sugars, or salt?

 Yes  No  Don’t Know
IF NO: Go to Question 25


If yes, please indicate which types of nutrition labelling are being implemented:
24a) List of ingredients  Yes  No  Don’t Know
24b) Nutrient declaration (i.e. back-of-pack labelling)  Yes  No  Don’t Know
24c) Front-of-pack labelling  Yes  No  Don’t Know
24d) Other interpretive labelling (e.g. menu or vending
machine labelling, back of pack warning messages)  Yes  No  Don’t Know


25) Is your country implementing any national policies to reduce population saturated fatty acid intake?
 Yes  No  Don’t Know
IF NO: Go to Question 26

25a) If yes, are the policies:  Voluntary
 Mandatory
 Don’t know


26) Is your country implementing any national policies to eliminate industrially produced trans-fatty acids in the food supply?
 Yes  No  Don’t Know
IF NO: Go to Question 27

26a) If yes, indicate which policies are being implemented:
Select all that apply
 Mandatory national ban on the production or use of partially hydrogenated oils
(PHO) as an ingredient in all foods
 Mandatory national limit of 2g of industrially produced trans-fatty acids per 100g of total fat in all foods
 Don’t know

27) Is your country implementing any policies to reduce population salt/sodium consumption?  Yes  No  Don’t Know

28) Are measures to reformulate foods and beverages (e.g. specific reformulation targets or legal limits) which are high in saturated fatty acids, trans-fatty acids, sugars or salt/sodium being implemented?
 Yes  No  Don’t Know

29) Are public food procurement and service policies for various settings (e.g. schools, government offices, public events) to reduce the content of saturated fatty acids, trans-fatty acids, sugars or salt/sodium in food served or sold being implemented?
 Yes  No  Don’t Know

30) Has your country implemented any national public education and awareness campaign on diet within the past 2 years?  Yes  No  Don’t Know
IF NO: Go to Question 31

30a) If yes, please provide details of the public education and awareness campaign(s):
_________________________________


31) Is your country implementing any national policies in the following areas to promote population physical activity?
This question refers to national policy actions by Ministry of Health or Ministry of Transport or Ministry of Education or Ministry of Sport, Recreation, Leisure, or Ministry of Labour or Ministry of Social Welfare or Ministry of Planning or other related ministries, or municipalities or local authorities. The policy actions taken should be formal and sustained national initiatives or programmes but do NOT include ad hoc events.

Walking and cycling  Yes  No  Don’t Know
Workplace physical activity initiatives  Yes  No  Don’t Know
Active aging  Yes  No  Don’t Know
Community-based physical activity and sports initiatives  Yes  No  Don’t Know
Public open spaces (including parks)  Yes  No  Don’t Know
Childcare settings  Yes  No  Don’t Know


32) Has your country implemented any national public education and awareness campaign on physical activity within the past 2 years?
Examples of national public education and awareness campaigns include large scale campaigns targeted at large segments of the population or the whole population, using mass media, and lasting for a longer period of time or repeated throughout the year. Conducting “one day events” (such as a car free day, sport days, physical activity day) on their own is not included in the definition of “public education campaign” and should be considered and reported in the following question on mass participation events.
 Yes  No  Don’t Know
IF NO: Go to Question 33

If yes:
32a) Does the national public education campaign integrate with community-based programmes or initiatives supporting promotion of physical activity?
 Yes  No  Don’t Know

32b) Is the national public education campaign supported by any environmental changes that aim to improve access to facilities that enable physical activity (such as infrastructure for walking or cycling, design or improvements to public open space or other facilities)?
 Yes  No  Don’t Know

32c) Do the national public education campaign “messages” address any of the social, environmental and economic benefits of physical activity, in addition to the mental and physical health benefits?
 Yes  No  Don’t Know

32d) Please provide brief details of the national public education campaign(s), including where possible the primary focus and name of campaign, target audience(s), type of mass media used, duration of campaign, and links to any reports, campaign resources and evaluations: ____________________________________
_________________________________

33) Has your country implemented any national or subnational mass participation events to encourage participation by the general public in free opportunities for physical activity within the past 2 years? Examples of free mass participation events include holding national walk to school or work days; car-free days; national PA or sports days, or days celebrating other physical activities providing free participation, such as cycling, yoga, tai chi, dance, or sports. Note this does NOT include hosting of major competitive sporting events, nor events such as marathons, which require paid participation, unless there is opportunity for free participation in shorter distances (e.g. 1km, 5km).
 Yes  No  Don’t Know

IF NO: Go to Question 34

33a) Please provide details of the event(s): _________________________________
_________________________________

34) Has your country implemented any national, NCD-related mHealth initiatives, such as tobacco cessation, hypertension management, cervical cancer screening awareness, promotion of physical activity or oral health, within the past 2 years?  Yes  No  Don’t Know

IF NO: Go to MODULE III

34a) Please provide details of the mHealth initiative(s):
_________________________________


III: HEALTH INFORMATION SYSTEMS, MONITORING, SURVEILLANCE AND SURVEYS FOR NCDs AND THEIR RISK FACTORS

The questions in this module assess surveillance relating to the NCD morbidity and risk factor reporting systems of each country and whether data were included in their national health reporting systems.

1) In your country, who has responsibility for surveillance of NCDs and their risk factors?
 An office/department/administrative division within the MOH exclusively dedicated to NCD surveillance
 An office/department/ administrative division within the MOH not exclusively dedicated to NCD surveillance
 Responsibility is shared across several offices/departments/administrative divisions within the MOH
 Coordination is by an external agency, such as an NGO or statistical organization
 No one has this responsibility
 Don’t know


III a: Data included in the national health INFORMATION system (National health information system refers to the annual or regular reporting system of the National Statistical Office or Ministry of Health)

2) Does your country have a disease registry for:
(Please fill in all columns)


2a) Cancers
2b) Diabetes
2c) Myocardial Infarction/
coronary events
2d) Cerebro-vascular accident/Stroke
2e) Other NCD of importance to your country
 Yes  No  Don’t know

IF NO: Skip to next column.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) What is the latest year for which data are available? _________
 Yes  No  Don’t know

IF NO: Skip to next column.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) Does the registry include data on any chronic complications which are updated as the patient’s complications status changes?
 Yes  No  Don’t know

iv) What is the latest year for which data are available? _________
 Yes  No  Don’t know

IF NO: Skip to next column.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) What is the latest year for which data are available? _________
 Yes  No  Don’t know

IF NO: Skip to next column.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) What is the latest year for which data are available? _________
 Yes  No  Don’t know

Specify which NCD(s): _____

IF NO: Skip to next question.
IF YES, is it:

i)  National (covers the whole population of the country)
 Sub-national (covers only the population of a defined region, not the whole country)
 Don’t know

ii)  Population –based
 hospital based
 other
If other, specify: _______
 Don’t know

iii) What is the latest year for which data are available? _________

2f) Are there any other registries that can provide information on NCDs?
 Yes  No  Don’t know
If yes, please list: ____________________________________________________________



3) Please indicate the existence of a standardized system for recording patient level data that includes NCD status and risk factors in the following PUBLIC facilities:
A standardized system for recording patient-level data has a specified set of data elements that are well-defined and collected consistently.


Primary Care Centres
Secondary and tertiary care facilities / Hospitals
i) Does a standardized system for recording patient level data that includes NCD status and risk factors exist?
 Yes
 No
 Don't Know

IF NO: Go to next column.
 Yes
 No
 Don't Know

IF NO: Go to next question.

ii) Which topics are covered? (check all that apply)
 Cancers
 Cardiovascular diseases
 Chronic respiratory diseases
 Diabetes
 Eye health
 Hearing health
 Oral health
 Rehabilitation
 NCD risk factors, specify_____
 Other NCDs, specify ________
 Cancers
 Cardiovascular diseases
 Chronic respiratory diseases
 Diabetes
 Eye health
 Hearing health
 Oral health
 Rehabilitation
 NCD risk factors, specify_____
 Other NCDs, specify________
iii) What type of system is it?
 Paper-based
 Electronic
 Mixed (please describe, giving an indication to what degree a paper-based system versus an electronic system are used ______)
 Don’t know
 Paper-based
 Electronic
 Mixed (please describe, giving an indication to what degree a paper-based system versus an electronic system are used ______)
 Don’t know
iv)What is the coverage of the system?
 <25% of facilities
 25% to 50% of facilities
 more than 50% of facilities to 75% of facilities
 More than 75% of facilities
 Don’t know
 <25% of facilities
 25% to 50% of facilities
 more than 50% of facilities to 75% of facilities
 More than 75% of facilities
 Don’t know
v) Can private facilities access or share patient-level data with this system?
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
vi) Has an assessment ever been done to review the quality of the data collected by this system?
 Yes
 No
 Don't Know

If yes, please describe: ______

 Yes
 No
 Don't Know

If yes, please describe: ______


If Yes to having a patient information system including NCD status and risk factors in both primary care centres & hospitals:

3b) Are the patient information systems in primary care centres & hospitals interoperable? (does one system cover both types of facilities or can information be passed between the two systems?)
 Yes  No  Don’t Know

4) Does your country have a system for evaluating the experience of patients receiving NCD-related health services?
 Yes  No  Don’t know

5) Does your country have an electronic system to facilitate reporting of facility-level or aggregated patient data on NCD indicators from health facilities to district/subnational and national levels?
 Yes  No  Don’t know

III B: Risk Factor Surveillance

6a) Harmful alcohol use
6b) Unhealthy diet
6c) Physical inactivity
6d) Tobacco use
6) Have population-based surveys of risk factors (may be a single RF or multiple) been conducted in your country for any of the following:

(Please fill in all columns, start in the first row, going left to right, and then continue left to right across the second row.)

For the questions on surveys on adolescents or children, please include here only surveys specifically targeting adolescents or children (i.e. do not repeat adult surveys that may have covered part of the adolescent or child age range).

 Yes  No  Don’t know

IF NO: Go to next column.
IF YES:

i) Was there a survey on adolescents?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 National
 Subnational
 Don’t know

i-2) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-3) When was the last
survey conducted?
(give year) _____



ii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
ii-1) Was it:
 National
 Subnational
 Don’t know

ii-2) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

ii-3) When was the last
survey conducted?
(give year) _____
 Yes  No  Don’t know

IF NO: Go to next column.
IF YES:


i) Was there a survey on adolescents?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 24-hour recall
 Food frequency
 Other
 Don’t know


i-2) Was it:
 National
 Subnational
 Don’t know

i-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-4) When was the last
survey conducted?
(give year) _____



ii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
ii-1) Was it:
 24 hour recall
 Food frequency
 Other
 Don’t know

ii-2) Was it:
 National
 Subnational
 Don’t know

ii-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

ii-4) When was the last
survey conducted?
(give year) _____
 Yes  No  Don’t know

IF NO: Go to next column.
IF YES:

i) Was there a survey on children?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 Measured
 Self-reported
 Don’t know

i-2) Was it:
National
 Subnational
 Don’t know

i-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-4) When was the last
survey conducted?
(give year) _____

ii) Was there a survey on adolescents?
 Yes  No  Don’t know

IF YES:
ii-1) Was it:
 Measured
 Self-reported
 Don’t know

ii-2) Was it:
 National
 Subnational
 Don’t know

ii-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

ii-4) When was the last
survey conducted?
(give year) _____


iii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
iii-1) Was it:
 Measured
 Self-reported
 Don’t know

iii-2) Did it assess physical activity for work/in the household, for transport and during leisure time?
 Yes  No  Don't know

iii-3) Was it:
 National
 Subnational
 Don’t know

iii-4) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iii-5) When was the last
survey conducted?
(give year) _____
 Yes  No  Don’t know

IF NO: Go to next column.
IF YES:

i) Was there a survey on adolescents?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 National
 Subnational
 Don’t know

i-2) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-3) When was the last
survey conducted?
(give year) _____



ii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
ii-1) Was it:
 National
 Subnational
 Don’t know

ii-2) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

ii-3) When was the last
survey conducted?
(give year) _____

6) cont.
6e) Raised blood glucose/
diabetes
6f) Raised total cholesterol
6g) Raised blood pressure/
Hypertension
6h) Overweight and obesity
6i) Salt / Sodium intake

 Yes  No  Don't know

IF NO: Go to next column.

IF YES:

i) Was it:
 Measured
 Self-reported
 Don’t know

ii) Was it:
 National
 Subnational
 Don’t know

iii) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iv) When was the last
survey conducted?
(give year) _____



 Yes  No  Don't know

IF NO: Go to next column.

IF YES:

i) Was it:
 Measured
 Self-reported
 Don’t know

ii) Was it:
 National
 Subnational
 Don’t know

iii) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iv) When was the last
survey conducted?
(give year) _____



 Yes  No  Don't know

IF NO: Go to next column.

IF YES:

i) Was it:
 Measured
 Self-reported
 Don’t know

ii) Was it:
 National
 Subnational
 Don’t know

iii) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iv) When was the last
survey conducted?
(give year) _____



 Yes  No  Don't know

IF NO: Go to next column.

IF YES:
i) Was there a survey on children?
 Yes  No  Don’t know

IF YES:
i-1) Was it:
 Measured
 Self-reported
 Don’t know

i-2) Was it:
 National
 Subnational
 Don’t know

i-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i-4) When was the last
survey conducted?
(give year) _____

ii) Was there a survey on adolescents?
 Yes  No  Don't know

IF YES:
ii-1) Was it:
 Measured
 Self-reported
 Don’t know

ii-2) Was it:
 National
 Subnational
 Don’t know

ii-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

i i-4) When was the last survey conducted?
(give year) _____

iii) Was there a survey on adults?
 Yes  No  Don't know

IF YES:
iii-1) Was it:
 Measured
 Self-reported
 Don’t know

iii-2) Was it:
 National
 Subnational
 Don’t know

iii-3) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iii-4) When was the last survey conducted?
(give year) _____
 Yes  No  Don't know

IF NO: Go to MODULE IV.

IF YES:

i) Was it:
 Measured by 24-hr urine collection
 Measured by 12-hr urine collection
 Measured by spot urine collection
 Measured by combination of urine collection methods
 Self-reported salt intake
 Don’t know

ii) Was it:
 National
 Subnational
 Don’t know

iii) How often is the survey conducted?
 Ad hoc
 Every 1 to 2 years
 Every 3 to 5 years
 Other
 Don’t know

iv) When was the last
survey conducted?
(give year) _____



IV: capacity for NCD EARLY DETECTION, treatment and care WITHIN THE HEALTH SYSTEM

The questions in this module assess the health care systems capacity related to NCD early detection, treatment and care within the health care sector. Specific questions focus on availability of guidelines or protocols to treat major NCDs, and the tests, procedures and equipment related to NCDs within the health-care system. It also assesses the availability of palliative care services for NCDs.

1a) Please indicate whether evidence-based national guidelines/protocols/standards are available for the management (diagnosis and treatment) of each of the major NCDs through a primary health care approach recognized/approved by government or competent authorities. Where guidelines/protocols/standards are available, please indicate their implementation status and when they were last updated.

Hypertension
Other Cardiovascular Diseases
Diabetes
Cancer
Chronic Respiratory Disease
i) Are they available?
 Yes
 No
 Don't Know
 Yes (specify topics covered)
 No
 Don't Know
 Yes
 No
 Don't Know
 Yes (specify cancer types)
 No
 Don't Know
 Yes (specify topics covered)
 No
 Don't Know
ii) Do they include drug- and dose-specific protocols?
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know

If Yes: If there are multiple guidelines, specify for which conditions:
__________
 Yes
 No
 Don't Know

 Yes
 No
 Don't Know

If Yes: If there are multiple guidelines, specify for which cancers:
__________
 Yes
 No
 Don't Know

If Yes: If there are multiple guidelines, specify for which conditions:
__________
iii) Are they being utilized in at least 50% of health care facilities
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
 Yes,
 No
 Don't Know
 Yes,
 No
 Don't Know
 Yes
 No
 Don't Know
iv) When were they last updated?







1b) Please indicate whether evidence-based national guidelines/protocols/standards are available for the management of each of the following NCD risk factors through a primary care approach recognized/approved by government or competent authorities.


Alcohol use disorders
Tobacco dependence
Overweight/
obesity
Physical inactivity
i) Are they available?
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
 Yes
 No
 Don't Know
ii) Are they being utilized in at least 50% of health care facilities
 Yes
 No
 Don't Know
 Yes,
 No
 Don't Know
 Yes,
 No
 Don't Know
 Yes
 No
 Don't Know
iii) When were they last updated?





2) Indicate the availability of the following basic technologies for early detection, diagnosis / monitoring of NCDs in the primary care facilities of the public and private health sector where: Generally available=1; Generally not available = 2, Don't know = 3.

* Generally available: in 50% or more health care facilities
Generally not available: in less than 50% health care facilities

Availability in the primary care facilities of the public health sector
(1, 2, or 3)
Availability in the primary care facilities of the private health sector
(1, 2, or 3)
Overweight and obesity
2a) Measuring of weight
2b) Measuring of height

_____
_____

_____
_____
Diabetes mellitus
2c) Blood glucose measurement
2d) Oral glucose tolerance test
2e) HbA1c test
2f) Dilated fundus examination
2g) Foot vibration perception by tuning fork
2h) Urine strips for glucose and ketone measurement
_____
_____
_____
_____
_____
_____
_____
_____
Cardiovascular disease
2i) Blood pressure measurement
2j) Total cholesterol measurement
2k) Urine strips for albumin assay

_______________
_____
_____

_____
_____
_____
Asthma and chronic obstructive pulmonary disease
2l) Peak flow measurement
2m) Spirometry
_____
_____



3) Please indicate if there is a national screening program targeting the general population for the following cancers and, if yes, provide details.

Cancers
Initial screening method (indicate only one, the most widely used)
Population targeted by the program
Type of program
Screening coverage
Breast
☐Yes
☐No
☐Don’t know

If NO: Go to next row
☐Clinical breast exam
☐Mammography screening
☐Both
☐Don’t know

Women aged …….. to …….
Other, specify:

☐Don’t know
☐ Organised population-based screening
☐ Opportunistic screening
☐Don’t know
☐ Less than 10%
☐10% to 50%
☐ more than 50% but less than 70%
☐70% or more
☐Don’t know
Cervix
☐Yes
☐No
☐Don’t know

If NO: Go to next row
☐Visual inspection
☐PAP smear
☐ HPV test with no triage
☐ HPV test with triage ☐Don’t know
☐ General population
☐ Women living with HIV
☐ Both of the above
☐ Don’t know

Please also indicate targeted age range:
Women aged …….. to …….
Other, specify:

☐Don’t know
☐ Organised population-based screening
☐ Opportunistic screening
 Don't Know
☐ Less than 10%
☐10% to 50%
☐ more than 50% but less than 70%
☐70% or more
☐Don’t know
Colon
☐Yes
☐No
☐Don’t know

If NO: Go to next row
☐Faecal test
☐ Colonoscopy/ sigmoidoscopy
☐Don’t know
People aged …….. to …….
Other, specify:

☐Don’t know
☐ Organised population-based screening
☐ Opportunistic screening
☐Don’t know
☐ Less than 10%
☐10% to 50%
☐ more than 50% but less than 70%
☐70% or more
☐Don’t know
Other cancer type(s)

Specify: _______

☐Yes
☐No
☐Don’t know






4) Please indicate if early detection of the following cancers by means of rapid identification of the first symptoms is integrated into primary health care services and if there is a clearly defined referral system from primary care to secondary / tertiary care for suspect cases (in low- and middle-income countries this set of measures may be designated as an "early diagnosis" programme):


Breast
Cervix
Colon
Cancers in Children
Other cancer types (specify: ______)
Program/guidelines to strengthen early diagnosis of first symptoms at primary health care level
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes (please specify types of cancer)
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
Clearly defined referral system from primary care to secondary and tertiary care
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know
☐Yes
☐No
☐Don’t know

5) Does your country have a programme specifically targeting those living with HIV that offers early detection and comprehensive treatment of cancer?
 Yes
 No
 Don’t know


6) Is there a national essential medicines list or equivalent in your country?
 Yes
 No
 Don’t know

7) Describe the availability* of the medicines below in the primary care facilities of the public health sector, where: Generally available=1; Generally not available = 2, Don't know = 3.
* Generally available: in 50% or more pharmacies
Generally not available: in less than 50% of pharmacies

Generic drug name
Availability
7a) Insulin

7b) Aspirin (75/100 mg)

7c) Metformin

7d) Thiazide Diuretics

7e) ACE Inhibitors

7f) Angiotensin II receptor blockers (ARBs)

7g) Calcium channel Blockers

7h) Fixed dose combination (lisinopril + amlodipine)

7i) Fixed dose combination (lisinopril + hydrochlorothiazide)

7j) Fixed dose combination (telmisartan + amlodipine)

7k) Fixed dose combination (telmisartan + hydrochlorothiazide)

7l) Beta Blockers

7m) Statins

7n) Oral morphine

7o) Steroid inhaler

7p) Combination budesonide-formoterol inhaler

7q) Bronchodilator inhaler

7r) Sulphonylurea(s)

7s) Benzathine penicillin injection

7t) Nicotine Replacement Therapy

7u) Non-nicotine cessation medication (e.g. Bupropion, Varenicline)



8) Indicate the availability* of the following procedures and services for managing and treating NCDs in the publicly funded health system, where: 1=Generally available; 2=Generally not available; 3=Don't know.
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need

Procedure/Service name
Availability
8a) Diabetic retinopathy
screening

8b) Retinal photocoagulation

8c) Renal replacement therapy by dialysis

8d) Renal replacement by transplantation

8e) Therapeutic patient education for diabetes

8f) Coronary bypass

8g) Coronary stenting

8h) Thrombolytic therapy (streptokinase) for acute myocardial infarction

8i) Alteplase for acute stroke management

8j) Bone marrow transplantation



9) Indicate the availability* of the following procedures for detecting, managing and treating oral diseases in the primary care facilities in the public health sector and through other service providers (e.g. private sector, non-for profit).
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need

Procedure name
Availability in the primary care facilities of the public sector
Availability through other service providers
Oral health screening for early detection of oral diseases
☐ Generally available
☐ Generally not available
☐ Don’t know
☐ Generally available
☐ Generally not available
☐ Don’t know
Urgent treatment for providing emergency oral care and oral pain relief
☐ Generally available
☐ Generally not available
☐ Don’t know
☐ Generally available
☐ Generally not available
☐ Don’t know
Basic restorative dental procedures to treat existing dental decay
☐ Generally available
☐ Generally not available
☐ Don’t know
☐ Generally available
☐ Generally not available
☐ Don’t know


10) Detail the availability* of cancer diagnosis and treatment services in the public sector:
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need

Service
Availability
Cancer centres or cancer departments at tertiary level
☐ Generally available
☐ Generally not available
☐ Don’t know
Cancer centres or cancer departments dedicated to children at tertiary level
☐ Generally available
☐ Generally not available
☐ Don’t know
Pathology services (laboratories)
☐ Generally available
☐ Generally not available
☐ Don’t know
Cancer surgery
☐ Generally available
☐ Generally not available
☐ Don’t know
Chemotherapy
☐ Generally available
☐ Generally not available
☐ Don’t know
Radiotherapy
☐ Generally available
☐ Generally not available
☐ Don’t know

11) How many dedicated cancer centres are there in the country?
Cancer centres provide coordinated, multi-disciplinary care inclusive of all services generally available in the country. This may include, for example, pathology, radiotherapy, surgery and systemic therapy. A facility can count as a “cancer centre” even if other non-oncology services are provided in that facility. If you don’t know the exact number, please give an estimated range.

Number of public cancer centres: ______________ ☐Don’t know
Number of private cancer centres: ______________☐Don’t know


12) Detail the availability* of rehabilitative care in the public sector for patients with the following NCDs:
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need


Availability in primary care
Availability in secondary care
Availability in tertiary care
Cancer
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
Stroke
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
Acute Myocardial Infarction
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
Chronic Respiratory Diseases
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
Musculoskeletal Conditions
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know
☐ Generally available
☐ Generally not available
☐Don’t know


13) Indicate the availability* of the following procedures for detecting and managing hearing loss in the public health sector
* Generally available:  reaches 50% or more patients in need 
Generally not available:  reaches less than 50% of patients in need  

Procedure name 
Availability 
Newborn hearing screening for early detection of hearing loss in infants 
☐ Generally available  
☐ Generally not available  
☐ Don’t know 
School ear and hearing screening for early detection of ear diseases and hearing loss 
☐ Generally available  
☐ Generally not available  
☐ Don’t know 
Hearing screening for older adults 
☐ Generally available  
☐ Generally not available  
☐ Don’t know 
Hearing aid fitting 
☐ Generally available  
☐ Generally not available  
☐ Don’t know 

14) Indicate the availability* of the following programmes or services for detecting, managing and treating eye conditions in the public health sector
*Generally available: reaches 50% or more patients in need 
Generally not available: reaches less than 50% of patients in need 

Name of programme or service
Availability 
Pre-school (aged 3–5 years) eye care programme for early detection of eye conditions, including refraction. 
☐ Generally available   
☐ Generally not available
☐ Not existent     
☐ Don’t know
School eye care programme for early detection of eye conditions, including refraction. 
☐ Generally available   
☐ Generally not available 
☐ Not existent      
☐ Don’t know
Provision of spectacles
☐ Generally available   
☐ Generally not available
☐ Not existent       
☐ Don’t know
Cataract surgery
☐ Generally available   
☐ Generally not available   
☐ Not existent     
☐ Don’t know


15) Indicate the availability* of palliative care for people living with NCD in the public health system:
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need

15a) In primary care facilities:
 Generally available for adults only
 Generally available for adults and children
 Generally not available
 Don't know

15b) In community or home-based care:
 Generally available for adults only
 Generally available for adults and children
 Generally not available
 Don't know

16) What proportion of primary care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke?
 none
 less than 25%
 25% to 50%
 more than 50%
 Don’t know

17) Indicate the availability* of provision of care for acute stroke in the public health system:
* Generally available: reaches 50% or more patients in need
Generally not available: reaches less than 50% of patients in need
 Generally available
 Generally not available
 Don't know

18) Is there a register of patients who have had rheumatic fever and rheumatic heart disease?
 Yes
 No
 Don’t know

IF YES:
18a) Are there systems for follow-up/recall to deliver long-term penicillin prophylaxis?
 Yes
 No
 Don’t know


GLOSSARY

Academia: Refers to educational institutions, especially those for higher education.
Broadcast media: Media which is broadcast to the public through radio and television.
Cancer: A generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs.
Cancer registry: A systematic collection of data about cancer cases in a certain region or a certain hospital. The first aim is to count cancer cases to get an idea of the magnitude of the problem. WHO advises national coverage by population-based registry in small countries only.

Capacity building: The development of knowledge, skills, commitment, structures, systems and leadership to enable effective action.
Cardiovascular diseases: A group of disorders of the heart and blood vessels that includes coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease,
congenital heart disease, deep vein thrombosis and pulmonary embolism.

Cardiovascular risk stratification: Use of risk prediction charts to indicate the risk of a fatal or non-fatal major cardiovascular event in the next 5 to 10 years. Based on the assessment people can be stratified into different levels of risk, which will help in management and follow up.

Chronic respiratory diseases: Diseases of the airways and other structures of the lung. Some of the most common are: asthma, chronic obstructive pulmonary disease, occupational lung diseases and pulmonary hypertension.


Collaboration: A recognized relationship between different groups with a defined purpose.

Community: A specific group of people, often living in a defined geographical area, who share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them.

Cross-border marketing: Marketing originating in one country that crosses national borders through broadcast media and internet, print media, sponsorship of events and programmes or any other media or communication channel. It includes both in-flowing and out-flowing cross-border marketing.

Diabetes: A disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

Early detection/screening: Measures performed in order to identify individuals who have early stages of a disease (with apparent symptoms in the case of early detection and without in the case of screening).

Earmarked taxes: Taxes which are collected and used for a specific purpose.

Electronic health record: An electronic health record is an in-house electronic version of the traditional paper charts that collect, store and display patient information.

Fiscal interventions: Measures taken by the government such as taxes and subsidies.

Free sugars: Monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Front-of-pack labelling (FOPL): Nutrition labelling systems that are presented on the front of food packages (in the principle field of vision) and can be applied across the packaged retail food supply. FOPL comprise an underpinning nutrient profile model that considers the overall nutrition quality of the product and/or the nutrients of concern for NCD; and presents simple, often graphic information on the nutrient content and/or nutritional quality of products to complement the more detailed nutrient declarations usually provided on the back of food packages. There are two major categories of FOPL, including interpretive and non-interpretive systems. Non-interpretive nutrient-based systems provide a summary of nutrient information, but no advice on the overall nutritional value of the food to assist with purchasing decisions. Interpretive systems may provide no nutrient information but only at-a-glance guidance on the relative healthiness of a product.

General government revenue: The money received from taxation, and other sources, such as privatization of government assets, to help finance expenditures.

Health: A state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity. A resource for everyday life which permits people to lead an individually, socially and economically productive life. A positive concept emphasizing social and personal resources as well as physical capabilities.

Health behaviour: Any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting or maintaining health, whether or not such behaviour is objectively effective towards that end.

Health care and treatment: The diagnosis and treatment of diseases.

Health care facility: Facilities which provide health services. They may include mobile clinics, pharmacies, laboratories, primary care clinics, specialty clinics, and private and faith-based establishments.

Health promotion: The process of enabling people to increase control over, and to improve their health.

Healthy diet: A healthy diet throughout the life-course helps prevent malnutrition in all its forms as well as a range of noncommunicable diseases (NCDs) and conditions. The exact make-up of a healthy, balanced diet will vary depending on the individual needs (e.g. age, gender, lifestyle, degree of physical activity). For adults, a healthy diet contains fruits, vegetables, legumes, nuts and whole grains and should be limited in free sugars, salt, total fat, saturated fats and free of industrial trans-fats.

International donors: Organizations which extend across national boundaries and which give funds for projects of a development nature.

Intervention: Any measure whose purpose is to improve health or alter the course of disease.

Legislation: A law or laws which have been enacted by the governing bodies in a country.

Long-term care facility: Long-term care facilities may vary by country. Nursing homes, skilled nursing facilities, assisted living facilities, residential facilities and residential long-term care facilities are collectively known as long-term care facilities that provide a variety of services, including medical and assistive care, to people who are unable to live independently in the community.

Marketing: Any form of commercial communication or message that is designed to, or has the effect of, increasing the recognition, appeal and/or consumption of particular products and services. It comprises anything that acts to advertise or otherwise promote a product or service.

mHealth: The use of mobile and wireless technologies to support the achievement of health objectives.

Multisectoral: Engaging different government sectors, such as health, agriculture, education, finance, infrastructure, transport, trade, etc.

Multisectoral collaboration: Collaboration/action within and between government sectors (e.g., ministry of health, ministry of education). Intersectoral or cross-sectoral actions or Health in All Policies (HiAP) are types of multisectoral collaboration.

Multi-stakeholder: Engaging non-State actors, such as NGOs, academia, the private sector and philanthropic foundations.

Musculoskeletal conditions: Musculoskeletal conditions comprise more than 150 conditions that affect the locomotor system of individuals. They range from conditions that arise suddenly and are short-lived, such as fractures, sprains and strains, to conditions associated with long-term functional limitations and disability, such as low back pain and osteoarthritis. Musculoskeletal conditions are typically characterized by pain (often persistent) and limitations in mobility, dexterity and overall level of functioning, reducing people’s ability to engage in their regular activities.

National Cancer Screening Programme: A government-endorsed programme where screening is offered. NGO-led programmes or national recommendations to go for screening at one’s own cost, do not qualify as national screening programmes.

National focal point, unit or department:
i. National focal point: the person responsible for the prevention and control of chronic diseases in a ministry of health or national institute.
ii. Unit or department: a unit or department with responsibility for NCD disease prevention and control in a ministry of health or national institute.

National health reporting system, survey and surveillance:
i National health reporting system: The process by which a ministry of health produces annual health reports that summarize data on, for example, national health human resources, population demographics, health expenditures, and health indicators such as mortality and morbidity. Includes the process of collecting data from various health information sources, e.g. disease registries, hospital admission or discharge data.
ii National survey: A fixed or unfixed time interval survey on the main chronic diseases, or major risk factors common to chronic diseases.
iii Surveillance: The systematic collection of data (through survey or registration) on risk factors, chronic diseases and their determinants for continuous analysis, interpretation and feed-back.
National integrated action plan: A concerted approach to addressing a multiplicity of issues within a chronic disease prevention and health promotion framework, targeting the major risk factors common to the main chronic diseases, including the integration of primary, secondary and tertiary prevention, health promotion and diseases prevention programmes across sectors and disciplines.

National policy, strategy, action plan:
i. Policy: A specific official decision or set of decisions designed to carry out a course of action endorsed by a political body, including a set of goals, priorities and main directions for attaining these goals. The policy document may include a strategy to give effect to the policy.
ii. Strategy: a long-term plan designed to achieve a particular goal.
iii. Action plan: A scheme of course of action, which may correspond to a policy or strategy, with defined activities indicating who does what (type of activities and people responsible for implementation), when (time frame), how and with what resources to accomplish an objective.

National protocols/guidelines/standards for chronic diseases and conditions:
A recommended evidence-based course of action to prevent a chronic disease or condition or to treat or manage a chronic disease or condition aiming to prevent complications, improve outcomes and quality of life of patients.

NGO: Non-governmental organization.

Noncommunicable diseases (NCDs): The four main types of noncommunicable diseases are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes.

Noncommunicable diseases prevention and control: All activities related to surveillance, prevention and management of the chronic noncommunicable diseases.

Not in effect: Any policy, strategy or plan of action which has been previously developed and is no longer under development, but for various reasons is not being implemented.

Nutrient declaration: A standardized statement or listing of the nutrient content of a food.

Nutrition labelling: A description intended to inform consumers of the nutritional properties of food. Nutrition labelling consists of two components: (a) nutrient declaration; (b) supplementary nutrition information (e.g. front-of-pack labelling).

Operational: A policy, strategy or plan of action which is being used and implemented in the country, and has resources and funding available to implement it. Also applies to a multisectoral commission/mechanism which is functional and meets on a regular basis.

Palliative care: Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

Partnership for health: An agreement between two or more partners to work cooperatively towards a set of shared health outcomes.

Peak flow measurement: A peak flow meter is a simple, hand-held device which measures how well a person can expel air from their lungs. The patient blows quickly and forcefully through a mouthpiece at one end, and a measurement is read from a built-in numbered scale on the device. Peak flow measurement can be done by a patient at home or in a health facility.

Price subsidies: Economic benefit provided by the government (such as a tax allowance or duty rebate) to keep the price of healthy foods low.

Primary health care: Refers to core functions of a nation’s health system. Encompassing front-line health service delivery (primary care) as well as health system structure; governance and financing; the intersectoral policy environment; and social determinants of health, primary health care provides essential health interventions according to a community’s needs and expectations.

Primary prevention: Measures directed towards preventing the initial occurrence of a disease or disorder.

Print media: Communicating with the public through printed materials such as magazines, newspapers and billboards.

Product reformulation by industry: Refers to the process of changing the composition of processed foods to be healthier and reduce the salt content.

Public awareness programme: A comprehensive effort that includes multiple components (messaging, grassroots outreach, media relations, government affairs, budget, etc.) to help increase public understanding about the importance of an issue.

Public health sector: Publicly funded health care sector.

Rehabilitation: Rehabilitation addresses the impact of a health condition on a person’s everyday life by optimizing their functioning and reducing their experience of disability. Rehabilitation expands the focus of health beyond preventative and curative care to ensure people with a health condition can remain as independent as possible and participate in education, work and meaningful life roles.

Risk factors associated with noncommunicable diseases
The four main risk factors for NCDs are tobacco use, harmful use of alcohol, unhealthy diet and low levels of physical activity.

Saturated fats: Fats found in animal products, including meat and whole milk dairy products, as well as certain plant oils like palm, palm kernel and coconut oils.

Screening: Measures preformed across an apparently healthy population in order to identify individuals who are at high risk or in the early stages of disease, but do not yet have symptoms.

Screening coverage: The proportion of people in the population targeted by the programme who actually received screening in the time frame defined by the programme. (For example, if a country recommends mammography screening every 2 years for women aged 50 to 60. The screening coverage is the number of women aged 50 to 60 who benefitted from mammography thanks to the programme in the past 2 years, divided by the total number of women aged 50 to 60 in the country.)

Self-regulation: In this context refers to when a group or private sector entity governs or polices itself without outside assistance or influence.

Spirometry: A spirometer is a complex piece of equipment which provides a number of different lung function measurements. The patient makes a prolonged, but forceful exhalation into a mouthpiece, connected to a machine which typically produces a graphical output. Spirometry requires a trained technician to oversee the testing and to interpret the results.

Sugar-sweetened beverages: Sugar-sweetened beverages (SSB) are defined as all types of beverages containing free sugars and these include carbonated or non-carbonated soft drinks, fruit/vegetable juices and drinks, liquid and powder concentrates, flavoured water, energy and sports drinks, ready-to-drink tea, ready-to-drink coffee, and flavoured milk drinks. Free sugars include monosaccharide and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Target: A specific aim to be achieved, should be time bound, and define a ‘desired’, ‘promised’, ‘minimum’ or ‘aspirational’ level of achievement.

Taxation incentives to promote physical activity: Involve removing the tax (or a portion of the tax) in order to promote increased use of goods or services to encourage physical activity.

Trans-fatty acids (trans fats): Unsaturated fatty acids with at least one double carbon–carbon bond in the trans configuration. Trans-fatty acids can be produced industrially by the partial hydrogenation of vegetable and fish oils, but also occur naturally in meat and dairy products from ruminant animals (e.g. cattle, sheep, goats, camels). Industrially-produced trans-fatty acids can be found in baked and fried foods, pre-packaged snacks and food, and partially hydrogenated cooking oils and fats which are often used at home, in restaurants, or in the informal food sector (such as street vendors), and are the predominant source of trans-fatty acid intake in many populations.

Under development: Something which is still being developed or finalized and is not yet being implemented in the country.

Universal Health Coverage-Priority Benefits Package; A universal health coverage-priority benefits package (UHC-PBP) is a set of evidence-informed prioritized health interventions, services and programmes, including intersectoral actions and fiscal policies, defined through a deliberative process that accounts for economic realities and social preferences. A UHC-PBP should be available for all, in good quality, at the appropriate service delivery platform(s) using an integrated people-centred approach and covered by relevant financial protection arrangement(s).

VAT/Sales Tax: “Value-added tax” (VAT) is a “multi-stage” tax on all consumer goods and services applied proportionally to the price the consumer pays for a product. Although manufacturers and wholesalers also participate in the administration and payment of the tax all along the manufacturing/distribution chain, they are all reimbursed through a tax credit system, so that the only entity who pays in the end is the final consumer. Most countries that impose a VAT do so on a base that includes any excise tax and customs duty. Example: VAT representing 10% of the retail price. Some countries, however, impose sales taxes instead. Unlike VAT, sales taxes are levied at the point of retail on the total value of goods and services purchased.