Dr. Ali Jaffar
Integration of Chronic
Disease Care in PHC
Dr. Ali Jaffer Mohammed
Advisor & Director General of Health Affairs
Ministry of Health
Oman
Rational
• High Prevalence of NCDs in Oman (Ages
20+ years):
• Diabetes
• Hypertension
• Dyslipidaemia
• Overweight & obesity
• Tobacco use
12%
35%
40%
48%
23%
Ministry of Health
Oman
Deaths attributable to diseases and injuries, all ages,
Oman, 2002.
Al-Lawati JA. et al., Prev Chronic Dis 2008; 5 (3):A99.
Ministry of Health
Oman
Disability-adjusted life years lost attributable to diseases and injuries, all ages, Oman, 2002.
Al-Lawati JA. et al., Prev Chronic Dis 2008; 5 (3):A99.
Ministry of Health
Oman
Rational
• WHO objective # 3 of the Action Plan for
Prevention and Control of NCD
Ministry of Health
Oman
NCDs Integrated in PHC
• Management of:
– Diabetes Mellitus
– Hypertension
• Screening common NCD conditions:
(only for 40+ years)
– Diabetes (FBS)
– Hypertension (BP measurement)
– Chronic Renal disease (GFR)
– Dyslipidaemia (TC, HDL, LDL, TG)
– Obesity (BMI, WC)
Ministry of Health
Oman
Approaches in Oman
• Political commitment
• Accessible PHC to all
• Managers are family physicians
• Availability of structures and logistics needed for integration (health centres, staff, medication)
Ministry of Health
Oman
Steps of integrating NCD Management into
PHC in Oman
• Formulation of the clinical guidelines for each condition
.e.g. Diabetes, Hypertension, … etc
• Advocacy
• Training for PHC workers.
• Availability of necessary medications and equipments in
PHC institutions.
• Arrangements at PHC institution (allocation of specific days for the clinic, appointments)
• Presence of specialists to support PHC ( in Polyclinics and secondary hospitals)
Ministry of Health
Oman
NCD Screening Results (2008)
No. Screened
BMI>30
Abnormal WC
Pre-HTN
HTN
Pre-DM
DM
High Choles.
eGFR < 90
Males
6,785 (38%)
23%
54%
15%
21%
36%
8%
43%
32%
Females
10,894 (62%)
36%
76%
14%
19%
35%
6%
47%
26%
Both
17,679
31%
68%
14%
19%
35%
7%
46%
28%
Ministry of Health
Oman
Challenges (1)
• PHC structure needs further changes
• Untrained staff to deal with complex NCD conditions
• Unavailability of medications (ACEI,
Statins
• limited lab services for tests in PHC
• Even if test done in 2y services, results not communicated in time to PHC
Ministry of Health
Oman
Challenges (2)
• Need for electronic record system for defaulters follow-up, monitoring & evaluation
• Shortage of health educators
Ministry of Health
Oman
Thank You
Ministry of Health
Oman
