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WHO report on Global Forum on NCD Prevention and Control, Rotating International Visitors' Programme 2003
 
WHO report
Global Forum on NCD Prevention and Control Rotating International Visitors Program 2003
5-9 October 2003 Isfahan, Islamic Republic of Iran
Contents
1. Background
2. Rotating International Visitors Program
3. Contents of the Program
3.1 Theoretical Components
3.2 Field Visit Component.
4. Comments
5. Recommendations
6. Acknowledgements
7. Appendices
A The program of the Rotating International Visitors Program 2003
B List of participants
C The introduction of IHHP
Promotion and Dr. Oussama Khatib, Regional Advisor NCD/WHO/EMRO addressed the meeting on the purpose of the Global Forum and the WHO/Regional Network and on worldwide and national NCD trends and on the importance of RIVP. Professor N. Sarraf - Zadegan, Director ICRC, -outlined the history and activities oflCRC and introduced the program

3.1 Theoretical Component

The first two days provided an opportunity to discuss experiences worldwide, regionally and locally.

The international speakers addressed pertinent topics which included: the development of the Global Forum and Regional Networks; the Intervention experience of NCD/CVD Prevention and Health Promotion; Building up local and national frameworks for NCD control and methods of monitoring, surveillance and evaluation. prevention in the health services.

The specific experience of North Karelia project was discussed as well as specific topics such as control ofhypertension, tobacco and diet related problems and those activities as well as integration of NCD.

The national speakers outlined the size of the problem, policies and legislations both in action or planned with a view to enhance prevention and control of NCD in Iran.


The local speakers from ICRC, described the llIHP and the specific ongoing intervention activities in the three targeted areas of smoking, diet and physical inactivity. They also discussed the specific intervention programs targeting special groups' children, worksite employees and women.


The participants from Oman, Bahrain, Jordan, Bangladesh, Fiji, China and Saudi Arabia gave an
overview of the size of the problem and the status of NCD control and prevention programs in their countries. They addressed the barriers facing them and their future plans towards NCD prevention and control.
A panel discussion was held on the first day where the international speakers responded to questions from the participants. The theme of the discussion was community-based interventions, their rationale, structure, feasibility and importance as the most effective strategy for NCD prevention and control taking into consideration the specific needs and prevailing conditions in each country.



3.2 Field Visit Components: {Tues.-wed 7th-8th)

The 13 international participants from 10 countries: Bahrain, Bangladesh, Belgium, China, Fiji, Finland, Jordan, Kuwait, Oman, Saudi Arabia, as well as WHO temporary advisors, Dr. Mustafa Khogali, K.Srinath Reddy, and Erkki Vartiadnen and WHO secretariat R. Shao; were taken on well structured field visits covering the intervention projects. The visit were comprised of the following:

3.2.1 Worksite Intervention Project:
Participants visited Isfahan Electricity Company. The intervention was developed on the already existing occupational health service and had an impact on periodical medical examination; improvement of environment; education of employees and introduction of healthy food menu in the company canteen. Also a big factory (Pishro Yadak) for producing mini-bus body was visited and the ways of intervention like daily exercise sessions, serving healthy food, removing salt shakers from tables and strict tobacco control rules were introduced.

3.2.2 Heart Health Promotion from Childhood The visit covered a primary school and private kindergarten. In the kindergarten children are educated about healthy habits through drawings and puzzles, exhibitions etc. In both schools, children presented songs, which effectively communicated health messages. The Healthy Heart Buffets with healthy snacks were introduced also. Schoolchildren IHHP role models took care for the visit. Both governmental and private schools and kindergartens are included in the initiative.



3.2.3 Healthy food for Healthy Community
Two bakeries were visited, Khageh Bakery (traditional bread) and Daneshjou Bakery (for Fantasy bread). They produce different types of healthy bread and other bakery products at reasonable cost. Also participants visited a 4star hotel (Kosar Hotel) which embraced the healthy food Program. The healthy breaks, which were produced by cooperating healthy food industries & shops, lunches and dinner offered during the programme, were also part of this activity.



3.2.4 Isfahan Exercise Project
The visit to Exhibition Street was illuminating. One day a month the street is closed for 4-6 hours for traffic Different kiosks and stands offer free BP cheek, weight measurement and different healthy snacks health messages (in posters, pamphlets etc) are communicated by NGO volunteers and people participate in group exercise activities.

3.2.5 Women's Healthy Heart Project
At health Centers No. 1 and 2 where different activities of the Women Healthy Heart Project are carried, were visited on the second day. The activities include NCD risk factors and its prevention, premarital counseling and family planning.
3.2.6 Healthy Lifestyle for Cardiac Patients
Participants visited two sites: the park where cardiac patients and their families organize on the last Friday of every month exercise followed by healthy breakfast and social gathering. The second site was the cardiac centre where a secondary and tertiary prevention program is ongoing. All patients start rehabilitation the day they are admitted. On discharge, they and their spouses are given face to face education, and provided with a folder containing instructions to follow at home. Already Insurance companies have started covering the cost of preventive services and education offered by physicians in these hospitals.


3.2.7 NGO and volunteers participation
Women volunteers after training provide NCD preventive and health promotive education to the community in different settings including homes, social gatherings, Mosques etc. The participants met with a number of the volunteers.

3.2.8 Second site of the intervention
A visit was paid to Najaf-Abad -the second site of the intervention 37 kilometres away from Isfahan. A rural health centre and health house where the health professional project introduced their activities was visited.

3.2.9 Young Healthy Heart Yacht
The intervention activities targeting the young group 19-25 years in the community was introduced in the Red Crescent Society with the presence of the project authorities.
1. Background
Non-communicable diseases (NCD) are the leading cause of mortality and disability worldwide. In 2002 NCDs accounted for about 60% of all deaths and 43% of the global burden of disease. Low and middle- income countries suffered 79% of the deaths due to NCDS and 85% of the burden of disease. One of the main objectives of the Global Forum on NCD Prevention and Control (GFNCDPC) is to: "Contribute to training and capacity building and develop guidance packages for NCD prevention and control particularly in low and middle-income countries.

2. Rotating International Visitors Program (RIVP)
To fulfil the above- mentioned objective the RIVP , was initiated. Its aim is to present theory and practice of integrated NCD prevention programs for participants who are or will be involved in the planning, implementation, and/or evaluation of local or national projects in the field ofNCD prevention and control, and in health promotion.
The RIVP should be conducted in settings that have established ongoing model projects of comprehensive, integrated, community-based NCD prevention activities. Participants are exposed to principles, practical implementation of different intervention and evaluation process.

This first RIVP was hosted by Isfahan Healthy Heart Program (IHHP), which was launched in late 1999.Isfahan city and Najaf-Abad, covering rural and urban areas, were defmed as intervention areas with a population of 1,900,000. Arak province was identified as the reference area with a population of 420,000 of similar age and sex distribution as the intervention area. The population sample surveyed in the 1 st phase was 12600 aged 319 years, of whom 6300 are in the intervention areas and 6300 in the reference area. Also 2000 schoolchildren aged 6-18 years, 2000 health professionals and 2000 high risk and patients were studied in both intervention and reference areas.

During the period since its inception the IHHP has attained a well-structured status with different activities suitable for training. It is now in the second (intervention) phase which will last for 4-5 years and is conducted on the whole population in Isfahan and Najaf-Abad. While Activities comprise 9 intervention projects:
(1) Worksite Intervention Project
(2) Heart Health Promotion from Childhood (3) Healthy Food for Healthy Community (4) Isfahan Exercise Project
(5) Health Professional Project
(6) Women Healthy Heart Project (7) Young Healthy Heart Yacht
(8) Healthy Lifestyle for Cardiac Patients
(9) NGOs and Volunteers Participation in IHHP
The APPX C shows the whole design and , methodology, the objectives and intervention strategies
of the 9 intervention projects. In the last phase the whole studies of the Ist phase will be repeated on an independent random samples in intervention and reference areas.

3. Contents of The Program

The program had two main components, theoretical based on presentations and discussions (Sunday 5th - Monday 6th) and field visits (Tuesday -Thursday 6- 9th)
The Director Bureau of Scientific & International Affairs (ruMS), Dr. A.Z. Zadeh welcomed the meeting in Isfahan Cardiovascular Research Centre (ICRC) Isfahan University of Medical Sciences (IUMS). Professor M. Pour Moghaddas was elected chairman of the meeting and Professor Mustafa Khogali, Deputy Chairman and Rapporteur.
During the opening session Prof. A. Rezaie, President ruMS, Dr. H. Gezairy, Regional Director WHO/EMRO and Dr. M. Pezeshkian, Minister of Health and Medical Education, welcomed participants and emphasized the importance of RIVP to WHO strategies and they commended the GF NCD -PC for its activities. Dr. Pekka Puska Director NCD Prevention and Health

4. Comments
The participants and the temporary advisors were highly impressed with the commitment and dedication of the managers of the different 9 intervention programs. They have intimate and objective relationship with the community, leaders and members of the teams of the different programs. They have to be strongly commended for their work and respect of the responsibilities they are undertaking.

5. Recommendations
The training program was well organized and addressed many issues. For future programs it is advisable.

5.1 To limit the number of papers and presentations and to combine the visits with the seminars and presentations i.e. each morning there should be a visit to two intervention programs followed by the presentations and discussions in the afternoon so to allow enough time for interaction between participants and managers.

5.2 To limit the theoretical session to major four areas addressing concepts and comparative experiences.

5.3 To give up a greater role for the temporary advisors to moderate and lead the discussions towards identifying the barriers and the different approaches to overcome them.

5.4 International participants should be identified at least six months before the training program so that they can prepare their presentations on the bases of a structured framework-which will guarantee a more effective and interactive training sessions.

5.5 At the end of the visits, participants should work together in groups of two to try and apply the interventions they have seen, to their situation, identify barriers and difficulties and suggest methods of overcoming the barriers. These exercises will then be presented to the group for discussion.

5.6 Although we are advocating teamwork, nearly all the participants were physicians- it is strongly recommended that other members of the team should attend the training program.

Acknowledgments
Our great thanks to the organizing committee for such a great effort and for its hospitality and especially for Prof. Nizal-SarrafZadegan. Great appreciation to the managers of the different intervention projects, they have been super in their dedication and knowledge of the project. They were greatly accommodating and made every effort to answer all questions.
Our thanks to professor A. Rezaie the President IUMS, Dr. A. Zargar Zadeh Director of Scientific and International Affairs IUMS, and to the Governor General Isfahan Mr. M. Hussieni for his hospitality and support.
Also our thanks to the executive and research managers and all other members of ICRC, the unknown soldiers, whose efforts made this training program successful and special appreciation to Dr. Roya Kelishadi and her colleagues, who quietly and efficiently orchestrated the different efforts prior and during the training, workshop and field visiting.
Our thanks to the Directorate ofNCD prevention and Health promotion from WHO/HQ and WHO/EMRO.
7. Appendices
A The programme of the Rotating International Visitors Programme 2003
B List of participants
C The introduction of IHHP
Global Forum on NCD Prevention and Control Rotating International Visitors' Programme 2003
Programme Outline

Venue: Isfahan Cardiovascular Research Centre Isfahan University of Medical Sciences Isfahan, Islamic Republic of Iran

Sunday, 5th October 2003

Opening Ceremony:

08:15.09:30 Welcome and Introduction :
08:15-08:25 Holy Quran Recitation National Anthem
08:25-08:30 Welcome and Introduction
(Dr. A. Zargar Zadeh), Director Bureau of Scientific &
International Affairs, Isfahan University of Medical Sciences 08:30-08:45 Introduction of the Programme
(Prof N. Sarraf-Zadegan), Director of Isfahan Cardiovascular Research Center 08:45-08:55 Welcome Speech
(Prof A.Rezaie),President, Isfahan University of Medical Sciences 08:55-09:15 Addressing the forum
(Dr. H. Gezayeri), Regional Director, WHO/EMRO 09:15-09:30 Inaugurating the forum(Dr.M.Pezeshkian),
The Minister of Health, Treatment and Medical Education, Islamic Republic of Iran . 09:30-10:00 WHO Global Strategy on NCD Prevention
(Dr. P. Puska), Director Non-Communicable
Disease Prevention and Health Promotion, WHO/HQ 10:00-1 0:30 WHO Regional Networks on NCD Prevention
(Dr. 0. Khatib), Regional Adviser Non-Communicable Diseases, WHO/EMRO

10:30.11 :00 Break

11 :00-11 :30 Global forum and regional networks for integrated NCD Prevention and control
(Dr. R. Shao), MedicalOfficer, National and Community Programmes, Non-communicable Disease Prevention and Health Promotion, WHO/HQ
11 :30-12:00 International experiences in CVD/NCD Prevention and Health Promotion
(Prof S. Reddy), Professor of Cardiology, Coordinator, Initiative for Cardiovascular Health in the Developing Countries
12:00-12:30 General Evaluation and Monitoring Principles and NCD Prevention (Dr. P. Puska),Director, Non- Communicable Disease Prevention and Health Promotion, WHO/HQ
12:30-13:00 Risk Factors; Surveillance, Trends, Predictions
(Prof E. Vartiainen), Director, Department of Epidemiology and Health Promotion, National Public Health Institute, Finland

13:00-14:00 Lunch

14:00-14:30 Elements of practical demonstration programme in NCD Prevention and Health Promotion (~ Reddy), Professor of Cardiology, Coordinator, Initiative for Cardiovascular Health in the Developing COUntries
14:30-15:00 General description of Isfahan Healthy Heart Programme(IHHP)
(Prof N. Sarraf-Zadegan), Professor of Cardiology and Internal Medicine, Director of Isfahan Cardiovascular Research Center

15:00-15:30 Break

15:30-17:00 Short presentations by the visitors
17:00 Closure of 1 St day

Monday, 6th October 2003
8: 15-8:30 Policies and legislations (Prof M. E. Akbari) Deputy of Health, Ministry of Health in Iran
8:30-9:00 Tobacco Control activities in NCD Prevention (Dr. P. Puska), WHO/HQ
9:00-9:30 Diet-related activities in NCD prevention (Prof S. Reddy), Professor of Cardiology, Coordinator, Initiative for Cardiovascular Health in the Developing Countries
9:30-9:45 The role of NGOs in interventions for disease prevention and health promotion
(Dr. M. Gooya), Chairman, Center of Disease Control, Ministry of Health in Iran ,
(Dr. A. Delavari), Manager, Non-Communicable Diseases, Ministry of Health in Iran 9:45-1 0:00 Stress management in practice (Dr. H. Rooh Afza), Assistant Prof of
Psychiatry, Head of Mental Health Unit, Isfahan Cardiovascular Research Center, Manager of Young Healthy Heart Yatch (YHHY) Project, IHHP

10:00.10:30 Break

10:30-11 :00 Community control of hypertension (Prof S. Reddy), Professor of Cardiology, Coordinator, Initiative for Cardiovascular Health in the Developing Countries
11 :00-11 :30 Diabetes related activities and results (Dr. S. Yarahmady), Expert of Cardiovascular Diseases Center of Disease Control- Ministry of Health in Iran
11 :30-11 :45 Health Promotion in childhood(Dr.R. Kelishadi), Assistant Professor of Pediatrics, Head of Preventive Pediatric Cardiology Department, Isfahan Cardiovascular Research Center, Manager of Heart Health Promotion from Childhood (HHPC) Project, IHHP
11 :45-12:00 How to integrate NCD prevention in health services(Prof A. Nissinen), Department of Epidemiology and Health Promotion, National Public Health Institute, Finland
12:00-12: 15 Youth interventions for NCD prevention (Prof E. Vartiainen), Director, Department of Epidemiology and Health Promotion, National Public Health Institute, Finland
12: 15-12:30 Healthy lifestyle for patients (Prof M. PourMoghaddas), Professor of Cardiology, Director of Chamran Hospital, Isfahan University of Medical Sciences

12:30.13:30 Lunch

13.30-14:00 Feasibility of disease prevention and health promotion in countries with economic constraints (Dr 0. Khatib), WHO/EMRO
14:00-14:30 Building up a local/national framework for NCD control (Prof M. Khogali), American University of Beirut
14:30-15:00 Evaluation &Monitoring of Isfahan Healthy Heart Pogramme (Dr. A. Baghaei) , Head of Evaluation Committee, IHHP

15:00.15:30 Break

15:30-17:00 Experiences with various interventional methods:
15:30-15:45 Promotion of exercise and physical activity (Dr. A. Khosravi), Assistant Professor of Cardiology, Executive Manager Isfahan Cardiovascular Research Center
15:45-16:00 The role of volunteers, role models and intersectoral cooperation (Dr. Gh. Sadri), Vice Chancellor of Health and Head of Provincial Health Office, Isfahan University of Medical Sciences
16:00-16:10 Use of mass media (Dr.K.Rabiei), Head of Rehabilitation Department, Isfahan Cardiovascular Research Center, Manager of Isfahan Exercise Project(IEP), IHHP
16: 10-16:25 Food industry collaboration (Mrs. N. Mohammadi-Fard), Head of Nutrition Unit, Isfahan Cardiovascular Research Center
16:25-16:35 Quit and Win competitions (Dr. R. Moilabashi), Head of Tobacco Control Unit, Isfahan Cardiovascular Research Center
16:35-16:45 Women's Healthy Heart Project-lsfahan experience (Dr. M. Sadeghi), Assistant Professor of Cardiology, Head of CVD in Women Unit, Isfahan Cardiovascular Research Center, Manager of Women Healthy Heart Project (WHHP), IHHP
16:45-17:00 Worksite intervention programme-lsfahan experience (Mrs. M. Boshtam),
Manager of Worksite Intervention Project (WIP), Isfahan Healthy Heart Programme

17:00 Closure of 2nd day

19:00 The General Governor Esfahan Province Message. The 3'rd & 4'th Day
Field Visit: 08:00-17:00 Tuesday-Wednesday, 7th-8th October 2003

Field visits to Isfahan Healthy Heart Programme activities:

Schools, Kindergartens and Universities .Factories & Companies
.Urban/Rural health centers .Rehabilitation centers
.Restaurants, pizza shops, bakeries etc .Supermarkets
.Food Industries
.Healthy Heart Exhibition
.Healthy Heart related NGOs

The 5th Day

Thursday, 9th October 2003

08:00-11 :00 Visit to Isfahan Cardiovascular Research Center
11 :00-13:00 Closure of the Programme
GLOBAL FORUM ON NCD PREVENTION AND CONTROL
ROTATING INTERNATIONAL VISITORS' PROGRAMME 2003 ISFAHAN, I. R. IRAN, 5-9 October, 2003
List of Participants

International Participants

Dr Jamal AI Sayyad
Chief of the Chronic Diseases Control Programme And Coordinator of the Cancer Registry Public Health Directorate Ministry of Health P.O.Box: 12
Tel: 00973-279224, 9690770 Fax: 00973-279292,422047
e-mail: sayyadjj@batelco.com.bh Manama Bahrain

Dr. Meerjady Sabrina Flora
Associate Professor of Epidemiology
National Institute of Preventive and Social Medicine (NIPSOM)
Tel: 0088028829337 Fax: 8821326
e-mail: flora@eitechco.net Mohakhali, Dhaka 1212 Bangladesh

Prof. Hugo Kesteloot
Department of Epidemiology School of Public Health
University zeikenhuizen Saint-Rafael Kapucijnenvoer 33 B-3000 Leuven Belgium

Dr. Liping Zhu Director
NCD prevention and control CDC of Jiangxi Province
Tel: (+86791) 8319809(0), 8507173(H) Fax: (+86791) 8319858 Nanchang, China
e-mail: ZLP210@yahoo.com.cn, jxmbk@163.com

Dr. Salanieta Saketa National Epidemiologist Ministry of Health Fiji
e-mail: ssaketa@health.gov.fj

Prof. Aulikki Nissinen, M.D., Ph.D. Research Professor
Department of Epidemiology and Health Promotion National Public Health Institute Mannerheimintie 166
Tel: 0358947448336 Fax: +358947448338
e-mail: aulikki,nisinen@ktl.fi FIN-00300 Helsinki Finland

Dr. Meyasser Zindah
Manager of National Non Communicable Diseases Programme
Head of NCD Division
Control Disease Directorate/MOH Ministry of Health
e-mail: meyasserz@yahoo.com Mobile: 00962-79-5646658 Amman, Jordan

Dr. Yousef AI Nesef
Assistant Undersecretary for Medical Supportive Services
Ministry of Health
Tel: 00965-4863722 Fax: 00965-4862535
e-mail: drnesef@hotmail.com Kuwait

Mr. Saleh AI-Hadabi
Director General of Health Services/ WHO Muscat, Oman

Mrs. Raha AI-Salmi
Project Nurse Covered by the Nizwa Project Oman

Miss. Rabha AI-Sulaimani Nutritionist, NCD Section,
Ministry of Health, Sultanate of Oman, Tel: 00968-696187
e-mail: raI2000@hotmail.com

Dr Nabil Hazza'a AI Kahtani
Director General for Non-Communicable Diseases Ministry of Health Tel: 014057494 Fax: 014028941
e-mail: nhkahtani@moh.gov.sa Riyadh
Saudi Arabia

Dr. Abeer AI-Saweer
Focal Person for CVD in Kingdom of Bahrain Tel: 973-9633188 Fax: 973-793579
e-mail: salman24@batelco.com.bh

WHO Temporary Advisers

Prof. K. Srinath Reddy Professor of Cardiology Coordinator
Initiative for Cardiovascular Health in the Developing Countries T -7 , Green Park Extn .
Tel: 91-11-26167459,26101980 Fax: 91-11-26167397
e-mail: ksreddy@ccdcindia.org New Delhi India

Prof. Erkki Vartiainen Director
Department of Epidemiology and Health Promotion National Public Health Institute Tel: +358-9-47448622 Fax: + 358-9-47448338
e-mail: erkki.vartiainen@ktl.fi Mannerheimintie 166 00300 Helsinki Finland

Prof. Mustafa Khogali
American University of Beirut Beirut, Lebanon
Dept. Family medicine Faculty of Medicine P.O.Box: 113-6044
America University of Beirut Tel: 961-1-374-374 X5450/1 Fax: 961-1-744464
e-mail: khogali@aub.edu.lb

National Participants

Prof. M. Pezeshkian
Minister of Health, Treatment and Medical Education I.R. Iran

Prof. M. E. Akbari
Deputy minister for Health MOH & ME I.R.lran

Prof. A. Rezaie Chancellor
Isfahan University of Medical Sciences Isfahan, Iran

Dr. M M. Gouya
Director General, Center of Disease Control MOH & ME
Tel: (+9821) 8827265 Fax: (+9821) 8300444
e-mail: mgoya57@yahoo.com South Iranshahr Ave. No: 68
Center for disease control, TEH-lRAN I.R. Iran

Dr. A. Delavari
Deputy Director General for NCDs
MOH & ME
Tel: (+9821) 8827265 Fax: (+9821) 8300444
e-mail: delavariar@yahoo.com I.R.lran

Prof. M. Pour Moghaddas Professor of Cardiology
Chief, Cardiology Division Dep. of Internal Medicine
Isfahan University of Medical Sciences Mobile: 0911-318-758
Tel: (+98311)-2225134 Isfahan, Iran

Prof. N. Sarraf-Zadegan
Prof of Cardiology and Internal Medicine Director of Isfahan Cardiovascular Research Center
Office Phone: ( +98 311) 4460787, 3359696, 3359797 and 3359090
Office Fax: ( +98 311) 4459023 P.O. Box: 81465-1148
Office e-mail: crc@mui.ac.ir
e-mail: sarafzadegan@med.mui.ac.ir Isfahan, Iran

Dr. Gh. Sadri
Vice Chancellor of Health, Director of Provincial Health Office
Isfahan University of Medical Sciences Tel: (+98311) 2644399 Fax: (+98311) 2643402 Isfahan, Iran

Dr. A. Salehi
Chancellor, Hamedan University of Medical Sciences
Tel: 09118114010
e-mail: chancellor@umsha.ac.ir Hamedan, Iran
Dr. A. Khosravi
Assistant Professor of Cardiology
Executive Manager, Isfahan Cardiovascular Research Center
Office Phone: ( +98 311) 4460787, 3359696 Office Fax: (+98311) 4459023 P.O. Box: 81465-1148
Office e-mail: crc@mui.ac.ir Mobile: 9133143710
Personal e-mail: dr_alireza108@yahoo.com Isfahan, Iran

Dr. R. Kelishadi
Assistant Professor of Pediatrics
Head of Prevention Pediatric Cardiology Department
Isfahan Cardiovascular Research Center
Local Secretary, Global Forum on NCD Prevention & Control
Isfahan, Iran
Office Phone: (+98311) 3377881 e-mail: kelishadi@med.mui.ac.ir

Dr. A Fayaz-Bakhsh
Head of Section for International Affairs
National Research Center of Medical Sciences Mobile: 09132277218
Fax: (+9821) 8730830
e-mail: aafayaz@yahoo.com Tehran, Iran

Dr. H. Talebi
Vice Chancellor of Medical Treatment, Arak University of Medical Sciences Tel: 3134817
e-mail: hoshang_talebi@yahoo.com Arak, Iran

Dr. S. Yarahmady
Expert of Diabetes and Endocrine Diseases, Center for Disease Control, NCD Dept. MOH & ME
Tel: (+9821) 8250883, 8273185 Mobile: 09132083983
e-mail: yarahmad@hotmail.com Tehran, Iran

Dr. H. R. Tolouie
Deputy, Isfahan Provincial Health Office Tel: (+98311) 2644399 Fax: (+98311) 2643402
e-mail: h_tolouei@mui.ac.ir Isfahan, Iran

Dr. A. Mahdavi
Expert, Center of Disease Control, NCD Dept. MOH & ME
Mobile: 09112452231 Tel: 8822334 (0) : 8002426 (H)
e-mail: armahdavi@yahoo.com Tel fax: (+9821) 8002426 Fax: (+9821) 8300444 (0) Tehran, Iran

Mr. A. Norouzi Nezhad
Expert, Center of Disease Control, NCD Dept. MOH & ME
Tel: (+9821) 8822334 (0) Fax: (+9821) 8300444 (0)
e-mail: sabzvar@hotmail.com Tehran, Iran -

Mrs. E. Hojatzadeh
Expert, Center of Disease Control, NCD Dept. MOH & ME
Tel: (+9821) 8822334 (0), (+9821) 7206162 (H) Fax: ( +98 21 ) 8300444
e-mail: alieghh@yahoo.com Tehran, Iran

Dr. A. Bahonar
Deputy, Isfahan Provincial Health Office Tel: (+98311) 2644399 Fax: (+98311) 2643402
e-mail: ab_bahonar@mui.ac.ir Isfahan, Iran

Dr. A. M. Baghaei Research Manager
Isfahan Cardiovascular Research Center Isfahan University of Medical Sciences e-mail: baghaei@mui.ac.ir Tel: 0098-913-311-1176 Isfahan, Iran

Dr. Roohafza
Assistant Professor of Psychiatry Head of Mental Health Unit
Isfahan Cardiovascular Research Center Isfahan University of Medical Sciences Tel: (+98311) 6615872
e-mail: dr_roohafza@yahoo.com Isfahan, Iran

Dr. Siamak Alikhani
Senior Heart Health Professional Center for Disease Management MOH & ME
Tel: 8822334 Fax: 8300444
e-mail: sialik@yahoo.com

WHO Secretariat:

Dr. Hussein A. Gezairy Regional Director
Regional Office for the Eastern Mediterranean Office
World Health Organization

Dr. Oussama Khatib Regional Adviser
Non-Communicable Diseases
Regional Office for the Eastern Mediterranean Office
World Health Organization
e-mail: khatibo@emro.who.int I ncd@emro.who.int website: www.emro.who.int/ncd/ Tel: 002022765364 Fax: 00202 2765415

Dr. Antonio Filipe Jr. Regional Adviser
Non-Communicable Disease Prevention and Control African Regional Office
World Health Organization Tel: +4724139344 Fax: +4724139514
e-mail: filipea@afro.who.int Brazaville, Congo

Dr. Pekka Puska
Director, Non-Communicable Disease Prevention and Health Promotion
World Health Organization, 20, Avenue Appia
CH-1211 Geneva 27 Switzerland

Dr. Ruitai Shao Medical Officer
National and Community Programmes Noncommunicable Disease Prevention and Health Promotion
World Health Organization 20 Avenue Appia
CH-1211 Geneva 27 Switzerland Tel: + 41227913329 Fax: +41227914186 Email: shaort@who.int

Dr. EL-Fatih EL Samani WHO Representative
World Health Organization Tehran, Iran

Dr. Ali R Mafi Medical Officer WHO
Tel: (+9821) 6700361
Fax: (+9821) 6708969
e-mail: mafia@ira.emro.who.int Tehran I Iran

Dr. Atarod Mojtabaie STP/NCD/EMRO
13928 ESWORN/RN TEL: 301 5279090
Annex C:

Example of the project plan
Introduction to Isfahan Healthy Heart Programme

The Isfahan Healthy Heart Programme (IHHP) is a comprehensive integrated community-based intervention programme for the prevention and control of noncommunicable diseases. The programme began in late 1999 and will last until 2006. The intervention communities are Isfahan and Najafabad (rural and urban areas) in the central part of Iran (1,900,000 population). Arak has been selected as the reference community (about 700,000 population).

1 Goal and Objectives

1.1 Goal
To improve NCDs prevention and control and promote healthy lifestyles in the Intervention Community .

1.2 Objectives
(1) Assessment and comparison of the prevalence of NCD risk factors in the first and final phases of the programme (intervention versus reference communities).
(2) Assessment and comparison of the prevalence of some NCDs (coronary artery diseases, stroke, diabetes mellitus, and hypertension) in the first and final phases of the programme (intervention versus reference communities).
(3) Assessment and comparison of the annual incidence of coronary arterial diseases and stroke in the first and final phases of the programme (intervention versus reference communities).
(4) Assessment and comparison of cardiovascular causes of mortality rate in the first and final phases of the programme (intervention versus reference communities).
(5) Assessment and comparison of morbidity from coronary arterial diseases and stroke in the first and final phases of the programme (intervention versus reference communities).
(6) Assessment and comparison of trends of the general population's BASK2 about NCDs and their risk factors between intervention and reference communities.
(7) Assessment and comparison of trends of health professionals' BASK about NCDs and their risk factors between intervention and reference communities.
(8) Assessment and comparison of trends of CVD patients' and high-risk population' BASK about NCDs and their risk factors between intervention and reference communities.
(9) Drawing up the CVD risk chart for Iranian society and related risk assessment. 2

3 IHHP Phases

The Isfahan Healthy Heart Programme is designed in three phases:

2.1 Phase I- Situation analysis: Identification of the intervention and reference populations

This first phase of the programme, which includes mainly community diagnosis, evaluates the characteristics of the population (3) and the distribution of variables selected as programme indicators in random samples of the two intervention populations (Isfahan and Najafabad) and the control population (Arak).
1 Dyslipidaemia, hypertension, smoking, diabetes mellitus, obesity, physical inactivity. 2 BASK: Behavior, Attitude, Skill, Knowledge
3 General adult population, health professionals, CVD patients, high-risk group, young population and children.
Annex C: Example of the project plan

Introduction to Isfahan Healthy Heart Programme

The Isfahan Healthy Heart Programme (IHHP) is a comprehensive integrated community-based intervention programme for the prevention and control of noncommunicable diseases. The programme began in late 1999 and will last until 2006. The intervention communities are Isfahan and Najafabad (rural and urban areas) in the central part of Iran (1,900,000 population). Arak has been selected as the reference community (about 700,000 population).

1 Goal and Objectives

1.1 Goal
To improve NCDs prevention and control and promote healthy lifestyles in the Intervention Community .

1.2 Objectives
(1) Assessment and comparison of the prevalence of NCD risk factors in the first and final phases of the programme (intervention versus reference communities).
(2) Assessment and comparison of the prevalence of some NCDs (coronary artery diseases, stroke, diabetes mellitus, and hypertension) in the first and final phases of the programme (intervention versus reference communities).
(3) Assessment and comparison of the annual incidence of coronary arterial diseases and stroke in the first and final phases of the programme (intervention versus reference communities).
(4) Assessment and comparison of cardiovascular causes of mortality rate in the first and final phases of the programme (intervention versus reference communities).
(5) Assessment and comparison of morbidity from coronary arterial diseases and stroke in the first and final phases of the programme (intervention versus reference communities).
(6) Assessment and comparison of trends of the general population's BASK2 about NCDs and their risk factors between intervention and reference communities.
(7) Assessment and comparison of trends of health professionals' BASK about NCDs and their risk factors between intervention and reference communities.
(8) Assessment and comparison of trends of CVD patients' and high-risk populations' BASK about NCDs and their risk factors between intervention and reference communities.
(9) Drawing up the CVD risk chart for Iranian society and related risk assessment. 2

3 IHHP Phases

The Isfahan Healthy Heart Programme is designed in three phases:

2.1 Phase I- Situation analysis: Identification of the intervention and reference populations
This first phase of the programme, which includes mainly community diagnosis, evaluates the characteristics of the population3 and the distribution of variables selected as programme indicators in random samples of the two intervention populations (Isfahan and Najafabad) and the control population (Arak).
1 Dyslipidaemia, hypertension, smoking, diabetes mellitus, obesity, physical inactivity. 2 BASK: Behaviour, Attitude, Skill, Knowledge
3 General adult population, health professionals, CVD patients, high-risk group, young population and children.

2.2 Phase 11- Implementing population interventions and periodical evaluations
In this phase, the population strategies for interventions are designed and performed within the framework of nine projects in the entire intervention communities (Isfahan and Najaf-Abad). Evaluation at the formative and process levels is performed simultaneously with continuous implementation of interventions and within defined timeframes in intervention areas. Impact evaluation is conducted annually in both intervention and reference communities.
2.3 Phase III -Final programme evaluation In this phase, based on the above-mentioned objectives of the programme and as in Phase I, data and indicators corresponding to the objectives are collected from independent random samples from both intervention and reference communities. Data is analysed and compared between the two societies. The overall efficiency and effectiveness of the programme are shown in this phase. The risk chart of the population is also drawn up. This phase of the programme is scheduled for the first half of2006.
Programme evaluation is done at four levels (formative, process, impact and outcome). While outcome evaluation is done at the beginning and in the last phase of IHHP on independent random samples in both communities, impact evaluation on BASK about diseases and their risk factors is conducted annually on independent samples from the two communities.

4 Main Strategies and Domains for Interventions

3.1 The four main areas of intervention are as follows: ( 1) Healthy nutrition
(2) Increased physical activity (3) Tobacco control activities
(4) Dealing with stress and tensions.

3.2 The intervention criteria are as follows:
( 1) Simplicity, feasibility and cost-effectiveness (2) Applicability to large populations
(3) Exploiting available resources and facilities
(4) Possibility of integration into the health care system, and implementation as part of the responsibilities of health professionals
(5) Sustainability of activities
(6) Possibility of being readily carried out at the national level (7) Possibility of being evaluated.

3.3 Main Strategies
(I) Focusing on main NCD risk factors
(2) Focusing on all prevention levels (primordial, primary, secondary and tertiary) for NCD prevention and control (3) Carrying out comprehensive integrated interventions using population and high-risk approaches
(4) Introducing suitable models applicable to other parts of the country, and to developing nations in general, for correcting unhealthy lifestyles.

5 IHHP Projects

4.1 Heart Health Promotion from Childhood

4.1.1 Target Population
Children and adolescents younger than 18 years, parents, school and kindergarten administrators.

4.1.2 Objectives:

(1) Improving BASK about prevention and control ofNCD risk factors from an early age
(2) Providing integrated facilities in the existing system in schools and kindergartens to correct lifestyles (3) Contributing to development of healthy lifestyles from an early age.

4.1.3 Activities:
(I) Conveying health messages on healthy lifestyles to parents via the children (2) Correcting unhealthy eating habits to prevent nutritional disorders
(3) Increasing scientific potential and encouraging avoidance of NCD-predisposing factors from childhood and adolescence, and creating the ability to withstand the influence of negative advertising later in life.
4.2 Youth Healthy Heart Project

4.2.1 Target Population
Youth aged between 19 and 25 years.

4.2.2. Objectives:
(I) Improving BASK about NCDs and risk factors among youth
(2) Modifying lifestyles (i.e. smoking cessation, increasing physical activity, coping with stress, and healthy nutrition) (3) Reducing NCD risk factors in youth.

4.2.3 Interventions
(I) Education: Group education, face-to-face education, the use of learning aids such as pamphlets, brochures, posters, educational leaflets, using mass media, including radio and television, to communicate educational guidance
(2) Introducing healthy patterns of behaviour, promoting the culture of cycling at university, and organizing recreational and scientific camps
(3) Legislating and ensuring strict observance of anti-smoking regulations in universities, discouraging the use of automobiles and creating bicycle tracks on university campuses
(4) Using cultural and artistic activities (theatre and cinema) to raise awareness in regard to NCD prevention and control.

4.3 Healthy Life for Cardiovascular Patients Project

4.3.1 Target Population
Patients with definite diagnosis of ischaemic heart disease (IHD) or stroke and the high-risk group (population with at least one major risk factor like diabetes mellitus, hypertension, dyslipidaemia, smoking, positive family history for IHD or stroke).

4.3.2 Objectives:
(1) Improve BASK of the target population about CVD risk factors (2) Reduce mortality in CVD patients (IHD or stroke) (3) Reduce morbidity in CVD patients (IHD or stroke) (4) Improve CVD patients' quality of life.

4.3.3 Activities:
(1) In-hospital education for CVD patients about their disease, its complications, medication and healthy lifestyle changes
(2) Educating the patients' relatives and families before discharge from CCUs and cardiology wards in hospitals, and offering them information on means of secondary or tertiary prevention
(3) Holding cardiac rehabilitation sessions (in and out of hospitals) and providing all necessary education (4) Public education via mass media.

4.4 Women's Healthy Heart Project

4.4.1 Target population
Women in the intervention community.

4.4.2 Objectives:
(I) Identification of NCD risk factors and behaviors regarding NCD in women, prior to and after interventions (2) Improving BASK of women in dealing with risk factors and healthy lifestyles for their families (3) Reducing NCD risks in high-risk individuals
(4) Improving BASK of women in dealing with IHD patients.

4.4.3 Activities:
(1) Activating field professionals from the health service system in areas such as education, arranging educational contests, face-to-face education of women referred to health houses and other health and treatment centres, organizing group activities, establishing educational kitchens
(2) Educating marrying couples upon their referral to the health centres regarding healthy lifestyles
(3) Motivating the cooperation of company illiteracy instructors to implement educational programmes in their literacy courses with regard to NCD risk factor prevention and healthy lifestyles
(4) Motivating the cooperation of administrators of Municipal Culture Houses and health and treatment centres in holding practical courses on healthy cooking, cardiopulmonary resuscitation, and indoor exercise for women during seasonal educational terms
(5) Motivating the support of mosque clerics (religious leaders) in educating people attending mosque services
(6) Holding theoretical and field courses on healthy cooking, physical exercise and risks of passive smoking in women's theology schools, and conveying educational messages on these topics
(7) Encouraging the family counselors of the Imam Khomeini Relief Committee (a charity institute) to exploit supportive educational opportunities in their sessions with families.
4.5 Health Professional Education Project

4.5.1 Target Population.
(1) Physicians (cardiologists, internists, neurologists and general physicians) (2) Health workers and experts (3) Nurses
(4) Medical students
(5) Health volunteers and carers.

4.5.2 Objectives
Improving BASK of health professionals about NCDs and their risk factors, and ways to bring about healthy lifestyle change.

4.5.3 Activities
(1) Arranging educational seminars for the target population (2) Holding educational workshops for the target population
(3) Establishing educational task groups comprising physicians, nurses, health instructors, etc.
(4) Self-education of physicians (remote education using books and leaflets) which is approved by CME in Iran
(5) Preparing educational books and leaflets (e.g. leaflets for distribution in seminars, the Healthy Heart book for nurses, educational booklets for health assistants).

4.6 Worksite Intervention Project

4.6.1 Target Population
Worksite employees (governmental and private offices, companies, factories, syndicates, etc.)

4.6.2 Objectives
(1) Improving BASK of factory workers, office employees, workers in other trades in relation to risk factor prevention and control and healthy lifestyles
(2) Improving BASK of workplace managers and directors in regard to NCDs and their risk factors.

4.6.3 Activities
(1) Improving healthy cooking in the restaurants ofworksites
(2) Providing education on ways of coping with stress in the workplace
(3) Physical activity and exercise-related interventions in factories and organizations by designating certain times for physical exercise and enforcing workplace exercise regulations; practical education
(4) Advocating and enforcing non-smoking regulations in the workplace
(5) Opportunistic screening of employees for hypertension and overweight obesity in offices, factories, etc. (6) Using data regarding biological indicators and NCD risk factors, if the project is ongoing in worksites.

4.7 Healthy Food for Healthy Communities

4.7.1 Target Population
General population, food industries, food providers, etc.

4.7.2 Objectives:
(1) Carrying out and following up necessary interventions in organizations responsible for the supply of foodstuffs in the society, food-producing centres, food industries, and food outlets
(2) Improving public BASK about healthy nutrition
(3) Improving the status of nutrition in the society at large.

4.7.3. Activities:
(1) Setting up healthy food stations ( e.g. restaurants, sandwich shops, pizzerias, confectioners, bakeries, supermarkets, etc.)
(2) Providing education on cooking healthy food in organizations, etc. which cater for their personnel
(3) Modifying and improving cooking procedures in food industries; encouraging the production ofhigher-quality non- industrial food and low-salt bread, substituting yeast for sodium bicarbonate in bakeries, producing low-fat and low- sugar confections, producing low-fat dairy products
(4) Enforcing existing regulations in the community on the sale of healthy foods to:
-Encourage food industries to produce healthier products
-Encourage the production and supply of liquid oil, reducing the production of hydrogenated oil and lowering consumption oftrans-fatty acids
-Passing the necessary regulations related to supply ofhealthy food products in stores
-Passing regulations on labelling of food products
(5) Educating and encouraging the public to buy and consume healthy food products, and to heed food labels
(6) Publication and circulation of healthy food cookbooks
(7) Arranging competitions with themes on choosing and making healthy food for healthy hearts (8) Producing and broadcasting educational television and radio programmes on healthy cooking.

4.8 Isfahan Exercise Project

4.8.1 Target Population
General population, sport clubs, exercise and training centres

4.8.2 Objectives:
(1) Improving the population's BASK in regard to regular daily exercise (2) Decreasing air pollution
(3) Providing suitable physical exercise environments for different age and sex groups for regular daily exercise.

4.8.3 Activities:
(1) Arranging healthy heart exhibitions and holding sports events in some streets while closing the street and prohibiting private transport
(2) Educating the society via radio and television programmes about the benefits of doing regular daily exercise
(3) Providing education on equivalent physical exercises that can be carried out by housewives at home and by employees in the workplace
(4) Altering the prevailing models and habits toward a more physically active society (5) Enforcing regulations about exercise in schools and the workplace
(6) Promoting the culture ofbiking and walking; making bicycle tracks and encouraging people to ride rather than drive (7) Holding sports competitions that encourage participation by women, men, children and adolescents.

4.9 NGOs and Volunteers in IHHP

4.9.1 Target Population
Non-governmental organizations, volunteers (health workers, Red Crescent etc).

4.9.2 Objectives:
(I) Improving BASK ofNGOs, health workers and other volunteers in relation to NCDs risk factors and healthy lifestyles
(2) Organizing NGO activities in regard to risk factor prevention and healthy lifestyles.

4.9.3 Activities:
(1) Arranging educational sessions for NGOs' members and officials and health volunteers concerning risk factor prevention and healthy lifestyle changes
(2) Studying the existing activities conducted by those NGOs or volunteers whose objectives include healthy lifestyles (3) Implementing joint educational activities (materials, face-to-face, mass media, etc.) or services regarding risk factor
prevention and control
Establishing and empowering the NGOs with main objectives ofprimary and secondary CVD prevention and healthy lifestyle change (e.g. Iranian Chapter of Heart Friends around the World, the food industry, healthy community groups, Iranian Heart Foundation, etc).

 

Last update:  Sunday  1  March  2004
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