Chronic Disease Policy in Barbados:
analysis and evaluation of policy
initiatives
Promoting Healthy Living in the Americas: Multisectoral Interventions to reduce health risks factors
Washington, DC, November 18th, 2013
Trevor Hassell, MBBS, FRCP, FACC.
Chairman National NCD Commission, Barbados
NCD policies - Barbados
• Barbados National Strategic Plan for Health, 20022012
• Strategy for the Prevention and Control of Chronic
NCDs, 2004
• Strategic Plan for the National Chronic Non
Communicable Disease Commission, 2009 – 2012
• Regional and international commitments, plans and
declarations
Outline
• Challenges and opportunities in the design
and implementation of multi-sectoral NCD
policies
• Strategies used to involve stakeholders in the
implementation of these policies /activities
• Next steps in the future implementation of
multi-sectoral policies
• Concluding remarks
Challenges and opportunities in the
design and implementation of multisectoral NCD policies
• An analysis of The National NCD Commission
Barbados
TA Hassell, Chairman of the NCD Commission
• Chronic Disease Policy in Barbados: Analysis and
Evaluation of Policy Initiatives.
C Guell, TA Samuels, TA Hassell and N Unwin
• Personal observations
Challenges to NCD policy
implementation - Government
• Apparent low priority by Non health sectors of Government
• NCDs not fully incorporated in National Development agenda
• Linkage between NCDs and climate change, saving of foreign
exchange, greening of Barbados and energy conservation not
recognised
• NCD policy and stakeholder action not significantly informed
by National NCD Surveillance data
• Perceived communication gap between Ministry of Health and
health NGOs
• Nonexistence of a National NCD communication plan
• Absence of an NCD health economist
Challenges to NCD policy
implementation – Civil society
• NGOs often lack the capacity to contribute effectively
• Absence of a strong tradition of health advocacy
• NGOs consider themselves to be on the periphery of
policymaking
• Insufficient information about evidenced based best
practice by NGOs
• Limited monitoring and reporting by health NGOs
• Absence of tradition of collaboration between often
competing disease specific NGOs
• NCD effort not prioritised by non-health sectors of civil
society – a few exceptions
Challenges to NCD policy
implementation - Private Sector
• Not appreciative of their role in addressing the
NCD challenge
• Not aware of the financial cost of NCDs to their
companies
• Priority given to financial issues at the expense
of NCD engagement
Opportunities - 1
• Very high level of awareness of policy makers and the
public on the health burden imposed by NCDs
• Genuine political commitment and formulation of
strategic policy frameworks by Ministry of Health to
address NCDs
• Since 2002 the need for multi-sector response has been
recognised by Government
• Longstanding commitment to surveillance by Ministry of
Health
• Chronic Disease Research Centre, plays a major role in
raising awareness
• Regional civil society alliance formed to contribute to
the response to NCDs
Opportunities - 2
• Inclusion of the issue of NCDs in Protocol VI of the Social
Partnership - a permanent arrangement of government,
labour and private sector in the Barbados governance
structure
• NCD medication provided free of cost at point of use National Drug Service
• Barbados has been signatory to, and actively participated at
the regional and international level in the multi-stakeholder
approach
• A mechanism established 5 years ago to effect a multistakeholder approach to NCDs – the National NCD
Commission
National NCD Commission
• Established in 2007
• Appointed by the Minister of Health and Cabinet of
Barbados
• Multi-sectoral: government, civil society and private sector
representation (education, agriculture, academia, retired
persons, health NGOs, business community, labour union,
physical activity, media, medical and nursing professions,
private health insurance sector and Faith based)
• Technical support provided by the staff of the Ministry of
Health
• Funding provided out of the budget of the Health
Promotion Unit, Ministry of Health
• Terms of Reference
The Commission’s Terms of
Reference
• Advise the Minister of Health on NCD policies and legislation
• Broker and promote effective involvement in programme
implementation
• Assist in the mobilization of resources.
• Recommend relevant research and education programmes
• Promote collaboration and partnerships
• Review the National Strategic Plan for Health
• Monitor regional and international trends
• Assist the Ministry of Health in commissioning studies
• Recommend to the Minister of Health a legal, policy and service
framework that encourages and promotes behaviour change and
the prevention of NCDs.
Strategies
• Multi-sectoral collaboration
• Policy recommendation
• Stimulation of behavioural change to effect
risk factor reduction
• Public education and outreach
• Advocacy and facilitating the national dialogue
• Over-arching focal point for all matters related
to NCDs at the National level
Promoting healthy living: multistakeholder interventions
• Legislation to ban sale of tobacco to minors
• Legislation to prohibit smoking in public places
• Provision of tax concessions for healthy lifestyle
interventions
• Public education: “The Get Healthy Barbados”
television series and Public service advertisements
• Consultations with school canteen operators,
itinerant vendors and the manufacturing sector
• Inclusion of the issue of NCDs in Protocol VI of the
Social Partnership
Promoting healthy living: multistakeholder interventions
• National consultation on NCDs
• Presentations to staff of Ministry of Foreign Affairs and
to various Sub-Committees of Cabinet of Barbados
• Oversight of the Barbados National Registry
 Advocacy
 Quality control
 Promotion
• Active engagement in Caribbean Wellness Day
• National Nutrition Improvement and Population Salt
Reduction Programme
Promoting Healthy Living: multi-stakeholder intervention
•
•
•
NCD
Commission
and
Government
Civil
society
Improve
Labelling
•
•
Salt the
Difficult
Choice
Raise
Awareness
NNI &
Population
Salt
reduction
Private
sector
Seminars
PSAs
Meetings with food
producers
Advertisements on
buses
Nutrition booklet for
schools
Health of the Nation Study
Academia
Reduce
Salt in
Food
•
Publication and funding
of No Salt booklet for
opinion Leaders
Drink & food
reformulation
•
•
Educational Outreach
Next steps
• Finalisation by the NCD Commission of National NCD Strategic Plan
2013- 2016
• Review of NCD Commissions at a Regional NCD Multi-stakeholder
meeting, 22nd November 2013
• Review of the role of a regional NCD civil society alliance (HCC) to
determine how best that organisation may contribute to facilitating
the involvement of stakeholders at the country level in NCD Policy
• In-depth assessment of effectiveness of NCD policies and
programmes
• Appointment of NCD Health economist
• Secure funds to develop and promote a comprehensive long-term
national multi-sector approach to NCDs
• Host a National NCD consultation to determine and obtain
commitments of stakeholders to further NCD policy action
Concluding Remarks
• Much has been achieved: much needs to be done
• For the most part stakeholders are aware of the adverse
health and to a lesser extent development impact of
NCDs
• Challenge to translate knowledge into action leading to
full incorporation of the NCD response into the National
development agenda by:
 Greater political leadership, including appropriate policies and
enactment and enforcement of legislation
 More effective initiatives by strengthened, better informed, and
empowered civil society
 Increased commitment by private sector to create healthy
workplaces
 Greater technical and financial support of international organisations
and donor agencies to all sectors in the response to NCDs