4. In which ways is the initiative creative and innovative?
|
Focus on raising the availability resources in preventive services , monitoring and follow up of detected cases with risk factors and the most vulnerable for NCDS ,through implementation of this project in primary health care level where by using available resources, Re-engineering the roles of medical team such as doctors, nursing ,health educators specialist, social workers specialist, in primary health care level with collaboration between all these services with concerned sectors such as emergency sector in the hospital ,health Promotion Department, public health Department ,involvement of community partnership, regional multidisciplinary council, the ministry of Education, the ministry of youth and sports affairs, ministry of Social development and volunteers, through health promotion, encouragement physical activity, reduction on exposure to tobacco smoke , emphasized the effect of harmful use of alcohol ,highlight on healthy diets ,enhance awareness sessions about impact of obesity ,asymptomatic high cholesterol ,high blood pressure and high blood sugar to Strengthening the role of community in their health , to achieves our goals in improving of quality of their life, and to be a sector of the national economy added value (healthy citizen contributes to the development) and reduction of the incidence and mortality rates of non-communicable diseases.
|
|
5. Who implemented the initiative and what is the size of the population affected by this initiative?
|
The program was implemented by primary health care leadership in the ministry of health level/ Kingdom of Bahrain (government), collaboration with concerned sectors (private and government sectors) to provide the services to all citizens. Till 2015, 30% of the attendees to the health center whom examined in the early detection clinics had 99-100% of risk factor, most of them had 1-2 risk factor and chance of developing a cardiovascular disease within the following 10 years, showed 63% of them had < 10%, with levels of blood pressure and lipid improvements. In the non-communicable disease clinics in the primary health centers, the trend of the attendants for follow up was sustained with no high outbreak cases during 2012-2015. The national anti-tobacco committee launched with primary health care early detection clinics and quit smoking clinics, the result (during 2014-july 2015) showed 13% quit in males, and 50%in the females, NCDS campaign which implemented in a work place, where the employees screened and launched with primary health care centers, 83.3% were Bahraini citizens and 16.2% were non-Bahraini, 86.6% of the were referred to their local health centers. 40% of the screened were overweight and 33.5% obese, they were referred to follow up in the nutritional clinics in primary health care centers.
|
6. How was the strategy implemented and what resources were mobilized?
|
Primary health care leadership formed on January 2012 to implement the project whom were put the strategic plan, polices and the main activities for self-assessment ,training the staff ,update the guideline for follow up and monitoring , arranged several meetings with stakeholders to study the obstacles and challenges to overcome them, field visits were done to all health centers to evaluate the available resources , of the clinics and staff, equipped the clinics with all the requirements for early detection of risk factors of non-communicable diseases ,standardized all forms to record the detection cases that have been screened ,fixed all visual signs and educational leaflet and posters for all people in health centers ,design feedback form for clients and update the guideline and the statements for calculation for estimation of cardiac diseases for the health care doctors , the nurse for follow up and referral to the concerned clinics and departments for early detection of risk factors (person is not regular in the treatment to be transferred to a clinic of non-communicable diseases, and those with high risk factors to the health promotion specialist , to the nutrition clinic to deal with the obese and overweight clients, quit smoking clinic or the social worker and mental clinics. And enhanced the collaboration between the medical and nursing sectors in primary health care with emergency sector of the hospital( refer the emergency cases with uncontrolled non-communicable diseases whom attended to accident emergency as pull system to health centers) , public health department for collecting the statistics for evaluation ,arranging the NCDS campaign where the multidisciplinary team screened the employees in their work place ,to detect the risk factors and encouraged for an healthy lifestyle and provided health promotion programs in workplace .The project collaborated with quit smoking committee which is responsible to arrange for awareness campaigns and educational activities on harmful effects of tobacco and opened Tobacco cessation clinic in one health center at each region. With health promotion department to provide health promotion and awareness sessions for referred clients in their health centers whom are most vulnerable to get non-communicable diseases, and for public in different media. With regional multidisciplinary council, The Ministry of Education to provide free of charge of halls for exercise and the Ministry of youth and sports affairs to provide coach volunteers to training and follow up the client, Ministry of Social development to provide the social centers for healthy cooking classes and calorie counting.
The strategy of the project implemented without addition resources, it started in one health center( Hamad Kanoo health center) on May 2012 ,with four doctors (out of 10 doctors), each doctor to choose 5- 10 people from his or her the daily list for detection the high risk factors ( hit rat ) and then referred them to the nurse in the early detection clinic where the registration done and take the full history of the individual, measure the vital signs and estimate the chance of developing a cardiovascular disease within the following 10 years, and request the laboratory investigations required, and follow up the high risk factors and as needed , if it that a person is one of the non-communicable diseases, not on regular treatment refer to a clinic of non-communicable diseases., or if one of vulnerable refer either to health promotion specialist , nutrition clinic, quit smoking clinic, mental clinic or social worker, on the same day, where all of them are available in the health center.
The implementation of strategic plan for the availability of the early detection of risk factors clinics in all health centers in Bahrain had completed in December 2016.
|
|
7. Who were the stakeholders involved in the design of the initiative and in its implementation?
|
The project was implemented through the optimal use of resources,
• The primary health care leadership with their staff in different level of responsibility supported from high executive leadership in the ministry of health and government with involvement of concerned sectors governorate were contributed in the design and /or in implementation of the project.
• Re-engineering the roll of the physicians, nursing staff, health promotion specialist, social worker who were available in same primary health center without recruit new staff or build new place.
• Creating the concept of collaboration with community, civil society, private sector and regional governorate as partnership to take the responsibility and became actively involved in awareness of patients or clients to taking care of their health.
• involvement of the governmental organizations (the ministry of youth and sports through volunteers, such as sports trainers, Sports (Khalifa) City and the Ministry of Social Development where trained healthy cooking and how counting the calories, and the ministry of education.
• Creating resource groups (nurse, health educator, educated patient, doctor). To support the patients and their family.
• Developed the concept of work between staff work in specialized clinics (non-communicable diseases, mental health, nutritional, quit smoking) to create an educated patient’s dependent on themselves know the right time to ask for help.
|
|
8. What were the most successful outputs and why was the initiative effective?
|
The most successful outputs of our project goals for male and female(age18-65), to ensure healthy lives, through sustainable approach of all health system for early detection and prevention of risk factors for NCDS:
1. 30% of the attendees (male and female) to primary the health centers examined in the early detection clinics, had 99-100% of risk factor, the composite risk factors show most of them had 1-2 risk factor The calculation of chance of developing a cardiovascular disease within the following 10 years, showed that 63% had < 10%, with levels of blood pressure and lipid improvements, but through NCDS campaign, in 2014 the composite risk factors showed in screen employees 52.0% had 3-5risk factors and 45.8%had 1-2 risk factors.
2. In 2014, total number of 5149 employees) were screened by NCDS campaign launched with primary health care centres (early detection clinics),. Out of 5149 employees ,83.3% were Bahraini citizens and 16.2% were non-Bahraini, 43.8% male and 56.2% female, wait circumference by sex 57.2% in male and 84.6% in female, 86.6% of the were referred to their local health centres. 40% of the screened were overweight and 33.5% obese, and mainly highlight in most vulnerable women to a healthy lifestyle, were referred for follow up in the nutritional clinic, encouragement physical activity, healthy diets, enhance awareness sessions in impact of obesity in their equity of their life
3. The national anti-tobacco committee launched with primary health care quit smoking clinics, the result (during 2014-july 2015) showed in males there was 13% quit, and in the females, it was 50%. Anti-tobacco Committee Collaborate with the competent authorities inside and outside the Ministry of Health to facilitate the implementation of Antismoking Law.
4. Creation of an educated groups, were implemented further programs for most vulnerable people, the results showed that 85% of diabetic patients now know how to measure and control their sugar, 100% can rely on themselves in taking insulin doses, and 21% now know how to measure blood pressure.
5. Following up the outcomes of mortality rates from NCDS and their risk factors had from 2008-2014 showed a reduction in the rate of death due to hypertensive, pulmonary diseases but increase in incidence of diabetes disease and its complications, which is major challenges, need refocus in a comprehensive set of health, more detection of diabetes disease, update their treatment and rehabilitation more NCDS campaign, health promotion activates and follow up.
|
|
9. What were the main obstacles encountered and how were they overcome?
|
If the health workers in government and private organizations and community were not collaborated together to provide competent care, patients were at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care. The following points were the main obstacles encountered during the implementation of the project and overcome:
• Inadequate Staff and staff resistance to change their roles, which overcame by empower them through training more nursing staff, workshops, field visits to their work place and involved them during the project implementation, participated in decision and solutions to the obstacles during the application.
• Lack of follow up in the health system for detecting early risk factors, which overcame by review and updated the polices and a clinical guideline for the staff.
• Loss of the visual signs, educational leaflet and posters for tracks the placed in the health center for the availability of the early detection clinic, which re-arrange them back through continuous field visits by the team of project to the health centers.
• The most vulnerable people were loss their follow up, the team of the project created a clear mechanism to attracted them, follow-up with more awareness, education sessions in impacts of risk factors of NCDS and the important of the early detection.
• Reform the indicators for early detected risk factors cases, with adequate information and accountability done by the team of the project which were not available and integrated with public health department, besides the non-communicable diseases clinics indicators, , the outcomes of the NCDS campaign and national health promotion activities which done by health centers collaborated with concerned departments.
|