Geneva Health Forum Archive

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NCD Japan Platform: Raising Awareness in the Second Largest Donor of the UN

Author(s): Ryoji Noritake1, Miki Kunimura1, Haruko Sugiyama1
Affiliation(s): 1Health and Global Policy Institute, Tokio, Japan
Name your project or intiative: NCD Japan Platform: Raising awareness in the second largest donor of UN
1st country of focus: Japan
Relevant to the conference theme: Non-communicable chronic diseases
Summary: We intend to found the “NCD Japan Platform”, with the following 3 activities forming the central undertakings of the organization. (1) “NCD Japan Platform "Building of a new web platform for NCD in Japanese/English (2) “NCD Japan Forum 2011 "Provision of opportunities for multi-stakeholders to discuss NCD countermeasures (3) “Advocacy Link for NCD Japan” Networking across patient leaders and key opinion leaders in Japan.
What challenges does your project address and why is it of importance?: Although Japan has a strong health management infrastructure for the implementation of such actions, there continue to be challenges. Firstly, public awareness in Japan of NCDs in general is weak in comparison to more specific issues such as cancer. There continues to be little availability of comprehensive Japanese-language information regarding NCDs on the internet, and poor coverage of such issues within other types of media in Japan. Secondly, there is a widening gap between prefectures within Japan in terms of their ability to implement plans and achieve goals relating to the control of NCDs. In addition to the importance of developing effective disease policies relating to the NCD situation in Japan, doing so may also contribute to assisting the NCD situation for the world at large through the sharing of strategies with other countries. Low and middle-income countries (LMIC) in particular might benefit from receiving information regarding Japan’s experiences and countermeasures, and this may thus enable them to develop better foundational policies. Japan itself may also learn from the strategies of other countries, something which would help to formulate a more advanced NCD policy.
How have you addressed these challenges? Do you see a solution?: In order to achieve such things however, various steps need to be taken. Raising public awareness through the medium of an informative webpage containing patient guidelines for NCDs, and also guidelines for best practices by community advocates and the municipality will be crucial steps in the movement towards a reduction in unnecessary deaths. In addition, the opportunity to involve foreign and domestic multi-stakeholders in discussions would also have the potential to have a great impact on NCD policy promotion. Furthermore, the creation of opportunities for cooperation between Japan’s chronic disease patient groups should also help to lay the groundwork for consolidated patient advocacy.
How do you know whether you have made a difference?: Although this initiative just started and the kick off forum, NCD Japan Forum 2011, is to take place on November 29, 2011, we have already received positive commitments from multi-stakeholders. The forum will be joined by officers from Ministry of Health, Labour and Welfare, NCD Alliance, Lance Armstrong Foundation, International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), University of Tokyo, and Japan Center for International Exchange (JCIE).
Have you or the project mobilized others and if so, who, why and how?: This project, which aims to share information regarding best practices between multi-stakeholders, will directly contribute to the whole population of Japan through the elimination of existing health disparities between municipalities and reductions in the numbers of unnecessary deaths. The project aims to be capable of reaching all 128 million of the Japanese population across all 47 of Japan’s prefectures, regardless of gender, geographical location or financial means.  Since the project also intends to drive international collaboration, the benefit will be shared not only by the Japanese public but also by diverse regions and ethnic groups in the international community. Information on NCDs and good practice will be shared widely with the public via the NCD Japan Platform, with the Platform providing comprehensive and collective information on NCDs. The website will be used as a platform for the introduction of information regarding effective interventions and good practice within Japan, and also information on the advanced efforts being made across the globe to tackle issues such as tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The website aims to attract more than 5000 visits every month.  Through these approaches, it is envisioned that in addition to steadily increasing public awareness about NCD issues it will also facilitate the international sharing of information regarding Japan’s experiences and strategies that will act as a large aid towards helping LMIC’s in particular to develop better foundational policies in this area.
When your donor funding runs out how will your idea continue to live?: Through holding a kick-off meeting targeted at Japan’s key patient groups and carrying out campaigns which are sponsored by patient groups, networking between patient groups should be promoted spontaneously.

Towards a healthy Global Society – “Youth Tobacco Prevention” is the first Stepping Stone.


Last: Venkatachalam Pillai
Name your project or intiative: To create a Global HEalthy Society - "Youth Tobacco Prevention"  is the first Stepping Stone.
1st country of focus: India
Additional countries of focus: All Countries across the Globe
Relevant to the conference theme: Non-communicable chronic diseases
Summary: The Project envisages to create an awareness of the harmful effects of tobacco  smoking among the  Youth and School-children of all countries across the Globe, with a view to creating a TOBACCO-FREE  GLOBAL SOCIETY - in order to establish a HEALTHY GLOBAL SOCIETY.
What challenges does your project address and why is it of importance?: Tobacco is the single most important preventable risk to human health in developed countries and an important cause of premature death worldwide.   Tobacco use leads to many cardiovascular & respiratory diseases  by affecting the heart and lungs and causing heart attacks, strokes, chronic obstructive pulmonary disease (COPD) (including emphysema and chronic bronchitis).  Tobacco is a major cancer-causing agent particularly lung cancer, cancers of the larynx, mouth, throat, mouth, esophagus, pancreas, bladder, kidney, stomach, breast, head & neck, etc.   Tobacco is a gate-way Drug - an addictive Drug. For young people an tobacco is an "implicit-change-agent" which indicates an "explicit-tilt/tendency" towards Alcohol, Drugs and thereofre HIV/AIDS.  Tobacco Control is a Public Health priority.  To-day's students / youth  are tomorrow's pillars of global society.  Hence, it is our duty to create a TOBACCO-FREE STUDENT COMMUNITY  to create a HEALTHY WORLD. However, present-day Students and Global Youth  are very easily attracted towards Tobacco Smoking / Chewing.   To sum-up, for molding the character of a youth/student, tobacco-prevention plays an very important role.
How have you addressed these challenges? Do you see a solution?: To create an awareness of the harmful effects of Tobacco,  I have launched a "GLOBAL YOUTH TOBACCO AWARENESS CAMPAIGN"  for the youth - of the youth - by the youth, and it involves school students and youth of all countries across the globe. The aims arethe following:  a)  to  initially sensitize a minimum of 10 million school students/youth of all countries,  about the harmful-effects of  Tobacco/Smoking and then collect  their  signatures against tobacco/smoking  on eco-friendly cloth banners, in their native languages (mother tongue), as a token of their moral commitment to lead a tobacco-free-life. b)  to display signature-banners-against-tobaccosSmoking  of a length of 25 Kms  or more  and this will be the world's longest signature wall against tobacco. This a mosaic of millions of voices, in all languages from all countries,  invites the attention of all governments and the print & electronic media of all  countries, to highlight the importance of creating a smoke-free/tobacco-free global society.  c)  finally these Signature Banners will be handed to the U.N. Secretary General and the WHO  Director General, urging them to save the global youth from tobacco/smoking.         The Project is named as "G-BAT 10x10" - standing for "GLOBAL BATTLE AGAINST TOBACCO"   with "10 MILLION SIGNATURES" and "10 THOUSAND BANNERS". So far,  I have collected around 1200 Banners (each measuring 2 Mtrs. in length and 1 Mtr. In width) from Taiwan, India, Thailand, Canada, USA, Tunisia, Serbia, Kazakhstan, Singapore, Jordan, Italy, Japan, Turkey, Channel-Islands, Azerbaijan, Australia, Bulgaria, etc.   In many other countries this Global Campaign is scheduled to be organised in the coming months.
How do you know whether you have made a difference?: Surely,  this is an unique and novel project - which is self starting and self-sustaining.  The project does not differentiate between color, region, religion, age-group, ethnicity, etc. etc.   This Project is open to all citizens of all countries across the Globe.  The Project concentrates on the prevention of initiation of the tobacco habit.  The early years of life are vital forlife long learning.
Have you or the project mobilized others and if so, who, why and how?:  The initiative mobilised the support of many school-children and youth groups from almost all countries around the World.  Organising Committees of the following Tobacco-Control and Cancer-Control International Conferences offered me various Scholarships / Bursaries / Travel-grants to attend these Conferences and supported my theme / efforts for establishing a Tobacco-free Global Society.  1.   7th Asia Pacific Conference on Tobacco or Health-2004 - South Korea (7th APACT)  2.   8th Asia Pacific Conference on Tobacco or Health-2007 - Taiwan      (8th APACT)  3.   9th Asia Pacific Conference on Tobacco or Health-2010 - Australia   (9th APACT)  4.   13th World Conference on Tobacco or Health -  2009 - India. (13th WCTOH)  5.   "Global Youth Meet" on Tobacco Control - Mumbai -- March 2009.  6.   6th Global Conference on Health Promotion-2005 - Thailand *6GCHP)  7.   1st Asian Regional SRNT Conference-2008 - Thailand    8.   "Towards Smoke-Free Society....." International Conference-2007 - Edinburgh/Scotland  9.   First  National Tobacco Control Conference-2006 - India (1NCTOH) 10.   Second National Tobacco Control Conference-2010 - India (2NCTOH)  11.   Pre-Conference Workshop of Smoke-Free Workplaces (NATOCON) - India-2006 12.   “National Workshop on STRATEGIES FOR EFFECTIVE IMPLEMENTATION OF TOBACCO CONTROL LAW”, New Delhi - 2006 13.   "3rd International Cancer Control Congress" - COMO / ITALY -- Nov. 2009 14.   "5th APOCP (Asia Pacific Organisation for Cancer Prevention) Conference" Istanbul/Turkey - April 2010.  15.   "21st IAVE WORLD VOLUNTEER CONFERENCE-2011" - Singapore - Jan.2011 16.   "First Asia-Pacific Quit-Line Workshop" - Taipei/Taiwan-2007. At these International Conferences, I was able to meet hundreds of Delegates (both youth and elders) and sow the seed for creating a Tobacco-free Global Society – in order to create a Healthy Tomorrow.
When your donor funding runs out how will your idea continue to live?: To date the  Global Campaign has not sought any financial support from any source – but had sought only moral and logistical supports from global youth.  Since the project is of  a self-starting and self-sustainable nature so even without funding support – the idea shall continue to live.

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Community Action for Health: Kyrgyzstan

Author(s): Tobias Schueth1, Gulmira Aitmurzaeva2, Tolkun Jamangulova2, Monika Christofori-Khadka3
Affiliation(s): 1Swiss Red Cross, Bishkek, Kyrgyzstan, 2Republican Centre for Health Promotion under the Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgystan, 3Swiss Red Cross, Bern, Switzerland
1st country of focus: Kyrgyzstan
Relevant to the conference theme: Equity and empowerment
Summary: CAH (Community Action for Health Project) is a country-wide partnership between Village Health Committees (VHCs) and the governmental health system of the country (Kyrgystan). Its goals are to enable rural communities to act on their own for improvement of health in their villages and to enable the governmental health system to work in partnership with VHCs for improving health. There are currently over 1500 VHCs covering about 80% of the villages. CAH is part of the health reform programme of Kyrgyzstan.
What challenges does your project address and why is it of importance?: The challenge was to develop a health promotion programme in rural areas that involved communities and could become part of the health reform programme of the country. There was no dedicated health promotion structure in the health system. The CAH programme was developed by a project financed by the Swiss Agency for Development and Cooperation (SDC). The project has been implemented by the Swiss Red Cross under various project names; its present name is Communty Action for Health Project.
How have you addressed these challenges? Do you see a solution?: Starting in 2001 the project trained governmental Primary Health Care (PHC) providers in a pilot rayon (district) of 15 villages to facilitate the identification of people’s health priorities (with instruments of Participatory Reflection and Action, PRA) and the subsequent election of VHC members. Project staff then trained these VHCs in implementing campaigns (so called health actions) on issues that people had prioritised in the analysis. Simultaneously they offered seminars in organisational development of these VHCs. The first health actions were very successful; VHCs displayed enthusiasm for this voluntary work and showed potential to become independent civil society organisations and a valuable partner of PHC staff for health promotion in the villages. With this proof of concept the Ministry of Health (MoH) agreed to establish Health Promotion Units (HPU) in two pilot oblasts (regions) with the task of establishing and working with VHCs. This HPU staff, under guidance from project trainers, extended CAH into the 200 villages of these two oblasts (2003-04), which proved that the programme could be scaled up. This led the MoH to include CAH into the health sector strategy 2006-10, asking donors to support its extension throughout the country. SDC, Sida, USAID, and LED supported the extension, while the MoH established HPUs and put the Republican Health Promotion Centre (RCHP) in charge of coordinating the extension. The RCHP received intensive capacity development from the SDC-funded project.  During the extension a number of health actions were developed on diseases that had been prioritised by the people and were major public health issues, including hypertension, iron deficiency anemia, iodine deficiency, alcohol consumption, nutrition in pregnancy and early childhood, brucellosis, sexual-reproductive health, hygiene/sanitation, dental health, acute respiratory infections. VHCs implement these health actions voluntarily, without payment. They consist mostly of distribution of information orally and with the help of educational material, but also involved actions like testing of salt for iodine content in households and shops or screening for hypertension with automatic cuffs.  Simultaneously organisational development of VHCs was supported with a series of seminars, the formation of 36 federations on rayon level (Rayon Health Committees, RHCs, registered as NGOs), and the formation of a national Association of VHCs. HPU staff visit each VHC on average once per month. An important element of their training is a focus on respectful, non-dominant behaviour with community members; this is also constantly supervised and reflected upon.
How do you know whether you have made a difference?: Health actions: VHCs collect baseline and monitoring data on a few indicators for each health action. The data are compiled on village, rayon, oblast and national level and give an indication of the overall effect of the health actions. Examples: For hypertension VHCs screened 128,683 people in 4 oblasts in 2009, or 24% of the adult population; 79% of those found with high blood pressure did later go to a PHC provider for diagnosis and treatment. VHCs tested the iodine content of salt in households before and after giving test kits to all shops selling salt and asking them to use them at whole sale markets. Coverage with iodated salt rose in all oblasts to over 90% within 1 year (from baselines between 71% to 85%), contributing to a decrease in goitre prevalence in school students from around 50% in the mid 90's to 10% in 2008. Reported exclusive breastfeeding in the first 6 months increased in a pilot oblast from 64% to 92% within 18 months. Reported cleaning of teeth 2 times per day increased in school students from 45% to 58% within one year in 5 oblasts. The proportion of mothers not knowing the danger signs for pneumonia decreased from 54% to 34% within one year in 5 oblasts.  Organisational capacity is measured with 17 indicators that are assessed yearly by HPU staff for each VHC, by a self-evaluation exercise of VHCs once a year, and by the number of own initiatives VHCs undertake independently from health actions. The HPU assessment of 17 indicators from end of 2010 show that 75% of VHCs received more than two-thirds of the maximum score. The self-evaluation data from 2011 show that VHCs have mobilised in average 200 USD in own resources, that 70% of villagers regard the VHC as an important organisation in their village, and that on a scale of 1-10 VHC members rate the level of joy from their work at 8 and that of burden at 5. The number of own initiatives increased from 0.5 per VHC in 2007 to 1.1 per VHC in 2010. A gender analysis of the programme in 2010 concluded that the VHCs give the women involved a platform to venture out of the confines of their homes into broader roles of village society. In about 10% of villages VHC members have been elected into the village parliament.
Have you or the project mobilized others and if so, who, why and how?: CAH was endorsed by the MoH who allocated resources to it by creating HPUs. Several donors have been collaborating with VHCs, including UNICEF, World Bank, Global Fund, GIZ, GAVI, and others. Presently, the extension of CAH to the last remaining uncovered rayons is financed by DFID and World Bank.
When your donor funding runs out how will your idea continue to live?: CAH was designed as a partnership between VHCs and the governmental health system. The MoH shows commitment to this programme by allocating resources to it, first by establishing HPUs and from 2012 on by financing a quarterly visit of HPU staff to all VHCs. With this, the link between VHCs and health system and a baseline support of VHCs will be sustained. Most project trainers have become HPU staff, preserving know-how. The investment in organisational capacity building of VHCs has enabled many of them to function on their own. The rayon federations registered as NGOs can link to other resources. The national Association of VHCs is learning to represent the VHCs vis-à-vis MoH and projects; it is a member of the supervisory council of the MoH. The interest that a number of donors/projects have shown to collaborate with the VHCs gives rise to the hope that such collaborations will also take place in the future, offering a frequent, if not constant, source of support and inputs for VHCs. All collaborating projects are requested to contribute in one way or other to the sustainability of VHCs, e.g. by paying into the funds of VHCs, or by financing rayon committee meetings or administrative costs of the national Association of VHCs. The Republican Centre for Health Promotion has gained sufficient skills to steer this partnership together with the national Association of VHCs.

Mental Health and Young People: International Perspectives on Growing Challenges

Author(s): Anne Meynard1, Dagmar Haller1, Daliborka Pejic2, Suzanne Ehrensberger3, Patana Mulisanze3, Saskia von Overbeck4
Affiliation(s): 1Hôpitaux universitaires Genève, Departement de l’enfant et de l’adolescent et Dpt de médecine communautaire, de premier recours et des urgences, 2Fondacija fami, Doboj, Bosnia & Herzegovina, 3Association Santé Mentale: Suisse Rwanda, 4Service de psychiatrie de l’enfant et de l’adolescentDepartement de l’enfant et de l’adolescent Hôpitaux Universitaires de Genève
1st country of focus: Bosnia and Herzegovina, Switzerland, Australia
Relevant to the conference theme: Vulnerable groups
Summary (max 100 words): There is urgent need of innovative and multisectoral interventions to address mental health issues in young people. Lack of trained professionals or adapted services, impact of socioeconomic factors on mental health are some of the challenges faced by many countries around the world. Interprofessional collaboration, community programs, International partnerships and web-based interventions can maximize the use and exchange of expertise among professionals, young people and their families.
What challenges does your project address and why is it of importance?: The presentation will present short aspects of two collaboration projects (Rwanda and Bosnia and Herzegovina) and experience in Geneva with vulnerable youth, questioning innovative ways of addressing mental health issues with young people and international collaboration. About Bosnia &Herzegovina: Great societal changes and turmoil, such as postwar trauma, unemployment and poverty, have undoubtedly negative effects on the occurrence of risk behavior and health of youth in BiH. About 50% of the young people have lost some family member or a close relative, and around 16% of people suffer from PTSD. UNPFA data show that around 50% of young people in Sarajevo and around 60% in Banja Luka do not use condom during sexual intercourses. Around 30% of young people are regular smokers, 21% frequently consume alcohol; 5.8% of boys and 6,8 of girls have experienced drugs. UNFPA data show that around 50% of young people in Sarajevo, i.e. around 60% in Banja Luka, do not use condom during sexual intercourses. In spite of significant achievements (psychiatric services and community mental health), existing mental health services are still unable to respond to the multiple and growing needs of the population, and in particular young people. Social stigma, segregation and isolation of people with mental health problems, are main barriers to treatment and reintegration of the people with mental health problems. About Rwanda: In the aftermath of the genocide, a significant number of the Rwandan population is traumatised and needs help. The country has very few psychiatrists to take care of the patients and the task is not easy for them because they have to face a huge demand. Moreover, physicians in general have practically no training in mental health. In view of the current state of affairs that is high demand of patients to take care of alongside scarce human and logistical resources, group therapy is deemed to be a very good way to treat people. This form of care can be used in different age ranges from children to adults. Since there is a shortage of skilled and trained people in psychiatry, it is of paramount importance to train the available health workers in this kind of care. This year we start to teach our colleagues with the Child Psychiatry, again this was very useful.
How have you addressed these challenges? Do you see a solution?: About Bosnia &Herzegovina: An established network of family medicine teams is serving as the base to support the development of new activities in various fields, including mental health. According to the BiH Strategic Health Care Reform plan, Family Medicine has been assigned as the primary health care provider also for adolescents. The projects focus has been, therefore, on strengthening family medicine activities in the field of working with youth. Training provided FM teams with the basic knowledge on developmental issues, epidemiological data, communication skills with young people and their families, use of screening tools (HEADSSS), confidentiality and youth-friendly principles. Improvement of multidisciplinary and multi-sectoral collaboration started by including the participants from other departments/institutions/organizations in the training, thus initiating the creation of a network of health and non-health service providers in the municipality (CBR professionals, youth-friendly center staff, social workers, school pedagogues, young people, NGOs, VCCT center. etc.). The network is to be strengthened through implementation of practical tasks, development of procedure/protocols and actions plans, network meeting, etc. Promotional activities, such as round table public discussion and distribution of network leaflets, aim to better inform the community and young people, about the available help. Development of practical tools, such as translation of the WHO Adolescent Job Aids, will be of valuable assistance in everyday work with youth.

About Rwanda: One way to address these challenges is to train the Rwandan colleagues in these methods of treatment. We have been working with them since 1996 and they are currently becoming little by little familiar with the basic notions of psychiatry. After years of collaboration, we can now start to introduce them to different aspects of this specialization. A few weeks ago the Minister of Health talked about launching the training phase of colleagues assisted with partners. We hope to participate to this coming form of collaboration. As long as we do not foresee in the near future any university training in psychiatry, I do not think we there will be any tangible solution to these challenges.
How do you know whether you have made a difference?: About Bosnia &Herzegovina: The training itself showed how important it was for the participants to have the opportunity to “hear each other”, learn more about already available services in the community and together start improving work with and for youth and develop specific services for young people adapted to the local context of each municipality.

About Rwanda:We examined the first sessions we conducted with health workers and noticed that they have started to integrate or internalize some theoretical aspects. In addition, these health workers are more receptive to new concepts. We also observed that our colleagues are becoming more skilled and comfortable in their work. They also are more interested in the training, we have new demands.
Have you or the project mobilized others and if so, who, why and how?: About Rwanda: Since the HUG has stopped their funding, we only have the membership fee from our joint mental health Association (Association Santé Mentale: Suisse Rwanda). The Association “Saturnales 2010” gave us some funds to run and conduct a training in group therapy. As a result, there is a positive feedback from Rwanda and we have begun the process of sensitizing the importance of this project and calling for partners in different kinds of forum such as this congress
When your donor funding runs out how will your idea continue to live?: About Bosnia &Herzegovina: By relying on existing standards and strategies, formalizing mutual collaboration and work with youth with protocols and procedures, improving knowledge and skills with training and practical assistance in their implementation, building a pool of local youth health experts, and creating a network of youth service providers, there are reasonable chances that the changes made will continue to live and grow.

About Rwanda: Since we are training doctors, nurses in the country, our goal is that the latter will take over the work we have started and train others when we complete our training activities.