Transcript Achievements of Mauritius - African Health Observatory

Seychelles Declaration - 2006
Cap Verde Declaration - 2009


National Disaster and Preparedness
Committee – High level Chaired ( PMO/ Sec to
Cab)
Health Disaster & Preparedness Committee
at level of MOHQL – Chaired by DGHS
Various Heads of Section
Terms of Reference :
1.To validate the P&R plan
2.To activate & implement the plan.
3.Establish intersectoral collaboration
•
4. Promulgation and Enactment of any
Legislation concerned with disaster
management
5. Ensure availability of resources
6. Set up a communication unit
7. Training of staff
•
-
-
-
Emergency Response Team in each of the 5
Health Regions
An Emergency Response Plan for each Regional
Hospital
Capacity Building in collaboration with WHO/
Technical Assistance
Regular meetings
Regular mock exercise
Mechanism set up to call meetings of both of
Health Disaster Committee and Response Team
to meet at short notice and implement
emergency plan.




Cyclone
Mass Casualty
Emerging Communicable Diseases ( AH7N9,
Chikungunya, Dengue...)
Other Natural Disasters ( Flood, Tsunami...)
Tobacco
- Mauritius signed FCTC on 17 June, 2003
- Mauritius ratified the FCTC on 17 May 2004
- Developed and implemented a National
Action Plan on Tobacco Control 2008-2012.
Plan 2013 – 2016 currently being finalized
- Pass the Public Health (Restrictions on
Tobacco Products) Regulations 2008.

GOALS
•
to reduce tobacco use;
•
to reduce exposure to tobacco smoke ;
to promote smoking cessation among
smokers.
Implementation nearly 100%
•
•
•
•
•
•
•
Ban advertisement, promotion and
sponsorship
Protect from tobacco smoke
Reduce access to tobacco products
(particularly to minors)
Control illicit trade
Control packaging and labeling
Penalties



Mauritius: first African country to implement
pictorial health warnings
Among country to have largest total surface
covered by health warnings (65%)
International request for Mauritius health
warnings (Togo, Iran, Russia)
•
Reduction in tobacco consumption from 1.3 billion
sticks in 2009 to around 1 billion sticks in 2012.
•
Information and education of the public
•
More anti-tobacco programmes in schools
•
Regular increase in price of tobacco products
•
Setting up of smoking cessation clinics ( 7 clinics
are operational)
•
Monitoring and research


PUBLIC HEALTH (PROHIBITION ON
ADVERTISEMENT, SPONSORSHIP AND
RESTRICTION ON SALE AND CONSUMPTION IN
PUBLIC PLACES, OF ALCOHOLIC DRINKS)
REGULATIONS 2008
National Action Plan on Harmful Use of
Alcohol – based on WHO Global Strategy on
Harmful Use of Alcohol
OBJECTIVES OF LEGISLATION
• Restriction of alcoholic consumption
in public places
• Ban on advertisement and
sponsorship related to alcohol drink
• Ban on sale of alcohol to minors
• Inclusion of “health warning” on labels
of alcoholic drink
• Separation of alcoholic drink on
shelves at point of sales
• New Penalties



To improve health and social outcomes for
individuals, families and communities,
To reduce morbidity and mortality due to
harmful use of alcohol and their ensuing
social consequences.
To develop a mass communication strategy
to vulgarize ill effects of alcohol/need to
comply with legislation

Yearly per capita consumption of alcohol has
come down from 40.9 litres in 2009 to 38.0
litres in 2012 ( notwithstanding the fact that
number of tourists visiting Mauritius has
increased)

-
Body Corporate set up under Act of
Parliament ( National Agency for Treatment
and Rehabilitation of Substance Abusers Act);
Prevention of drug and substance abuse
Provide support in treatment of drug and
substance abusers
Support NGOs in running of Rehabilitation
Centres
•
•
•
•
•
Need to reinforce action to reduce supply
Need for multisectoral approach
Need to integrate drug addicts in the
mainstream.
Strengthening Methadone Substitution
Therapy as an exit
Development of a National Drug Control
Master Plan ( to address both supply and
demand) - CSR
•Adoption
of the 2008-2013 Action Plan for the Global Strategy for
the Prevention and Control of Noncommunicable Diseases as generic
plan for Mauritius
•Development of National Service Framework for Diabetes ( NSFD )
(2007)
•National Nutrition Action Plan ( 2007-2010) (2013-2017 in
preparation)
•Action Plan for Tobacco Control ( 2008 – 2012) 2013 – 2017 being
finalized
•Action Plan for Cancer Control and Prevention ( 2011 – 2015)
•National Action Plan for Physical Activity ( 2007 – 2011) ( 2012 – 2016)
•National Strategy for Mental Health
Action Plan for Cardiovascular Diseases ( in pipeline)
Action Plan for Prevention of Harmful use of alcohol (Draft ready)
Action Plan for Respiratory Diseases ( in pipeline)
Strategy for Salt Intake ( in preparation)
•
•
•
•
•
•
•
NCD Surveys ( 1987, 1992, 1998, 2004 and
2009)
National Nutrition Survey in 2004 and 2012
Salt Intake Study in 2012
Trans fatty Acid in fast food and snacks in
2010
Study on re-used oil in 2010
Mauritius Type 2 DM Prevention Study ( 2012
to 2015)
DM Surveillance (1987 to 2004)
Ten Year Aims
 To reduce new cases of blindness
due to diabetes by one third or
more

To reduce end-stage diabetic renal
failure by at least one third

To reduce limb amputations for
diabetic gangrene by one half

To reduce morbidity and mortality
from coronary heart disease
Cases sent abroad for advanced Eye Surgery usually due to
diabetes
Tobacco Graphic Warnings - 2008
A general decreasing trend has been observed in
regards to first attendances at Primary Health Care
Centres between 2006 and 2011 due to both diabetes
(from 25,156 to 15,868) and hypertension (from
29,464 to 17,775) respectively.
Males
Prevalent Sites
Females
% change
Prevalent
Sites
%
change
Colon-rectum
Prostate
Lungs
Stomach
Urinary Bladder
Oral cancers
Lymphomas
+59%
+25%
+11%
+5%
-4%
-19%
-34%
Breast
Ovary
Colon-rectum
Uterine Cervix
Stomach
Oral cancers
Leukaemias
+45%
+26%
+21%
-15%
-18%
-33%
-38%
TOTAL
-17%
TOTAL
+4%
The Objectives of the Mauritius Cancer
Programme are:
 1. To prevent cancer through public
education
 2. To reduce the morbidity and mortality due
to cancer
 3. To promote early detection of cancer
 4. To provide adequate therapy
 5. To develop an effective palliative care
service







Sensitization campaigns
National Cervical Cancer Screening
Programme
Breast Examination and Breast Self Palpation
New Digital Colposcopy machines for treatment of
cervical cancer.
New Cobalt machine for Radiotherapy
New Brachytherapy machine for cancer of the
cervix.
Endoscopy equipment for detection of intestinal
cancer.




A New Children Cancer Unit with all facilities
for chemotherapy was set up in 2008.
Decentralization of chemotherapy services
Molecular testing for Human Papilloma virus
prior to considering vaccination for cervical
cancer.
Two new digital mammography machines
have been installed for screening and
diagnosis
•
•
•
•
•
Ageing population – increase prevalence of
NCDs
Multi ethnicity – complex human, social and
economic issues.
Globalization – more exposed to unhealthy
lifestyle
Strong lobbies like the food industry – fast
food chains, resistance to reformulation of
food items
Capacity building




Identify and implement the ‘Best Buys’
Set reasonable targets (bear in mind the
limited resources in this region)
Develop an efficient NCD Surveillance System
for each country
Encourage more regional collaboration. Learn
from experiences of other countries.
Exchange of expertise
1987 - 2012
5508 Mauritians
4375 M + 1333 F
Sex Ratio M : F 3.9 : 1
623 death cases


Estimated prevalence of HIV in the population
aged 15 -49 years : 0.97 % (2012). From 1.8%
in 2008.
Estimated number of People Living with the
Disease is between 8000 – 10,000
MODES DE TRANSMISSION OF
NEW CASES IN 2000
0%
MODES OF TRANSMISSION OF
NEW CASES IN 2002
2%
0% 5%
2%
3%
9% 14%
19%
IDVI
HTS
IDVI/HTS
TME
HSH
INDETERMINES
MODES OF TRANSMISSION OF
NEW CASES IN 2004
3%
0%
0%
35%
37%
74%
IDVI
HTS
IDVI/HTS
TME
HSH
INDETERMINES
MODES OF TRANSMISSION OF
NEW CASES EN 2005
6%2%
1%
9%
92%
87%
IDVI
HTS
IDVI/HTS
TME
HSH
INDETERMINES
IDVI
HTS
IDVI/HTS
TME
HSH
INDETERMINES
•
•
NATIONAL MULTISECTORAL HIV AND AIDS
STRATEGIC FRAMEWORKS (2007 – 2012 & 20132017)
Harm Reduction Strategy
- METHADONE SUBSTITUTION THERAPY
- NEEDLE EXCHANGE PROGRAMME
•
•
•
PUBLIC AWARENESS CAMPAIGNS
DECENTRALISATION OF HIV TESTING SERVICES
AND FACILITIIES
DECENTRALISATION OF CARE & TREATMENT

Following the introduction of Harm Reduction
measures in 2006, transmission among the
PWID steadily decreased to reach 68.1% of all
detected cases in 2011.
Trends of the modes of transmission of the epidemic from 2000 to
Dec 2012
100
92.4
86.7
90
84.7
81.5
80
73.6
73.7
74
70
70
68.1
66.7
64.8
60
47.2
46.6
50
36.7
34.7
40
30
20
26.2
18
20.4
19.1
14.3
12
7.4
10
21.7
2
20.3
17.6
14.5
9.3
9.2
2.7
5.9
1.6
2.6
1.5
'2004
'2005
'2006
'2007
3.5
4.2
5.2
'2008
'2009
2010
3.5
2.5
2011
2012
0
'2000
'2001
'2002
'2003
IDU
Hetero
IDU/Hetero
Number of yearly detected cases among Mauritians
1000
921
900
800
700
nombre de cas
600
555
525
546
538
548
568
500
401
400
320
300
225
200
98
100
28
0
50
55
Average monthly of new cases dropped from 45 to about 27 cases as from
2011
"1999
"2000
"2001
"2002
"2003
"2004
"2005
"2006
"2007
'2008
"2009
"2010
"2011
"2012
•
•
•
Reduction of new
HIV cases
Increased
knowledge of
PWIDS on safe
injection drug
practices
Prevalence of HIV
infection among
PWIDS – stable
between 2009 to
2012
Good Monitoring
and evaluation
system
1000
921
900
800
700
nombre de cas
•
600
525
555 546 538 548 568
500
401
400
320
300
225
200
98
100
0
28
50 55




50% of cases need to be detected
10, 000 estimated cases – 5508cases
reported
Follow up at National Day Care Centre
treatment : 3811 but only 75 % compliance
rate
estimated no of cases needing ARV
treatment 2000-2500
50% on ARVs are diagnosed at AIDS Stage


Last case of indigenous case of malaria in
1996
An average of 40 imported cases of malaria
yearly
•
•
•
•
•
•
•
•
Surveillance
Intra-domiciliary spraying over a period of three
years in all active foci.
Fogging operations in specific regions.
Larviciding.
Environmental management.
Strengthening of laboratory and entomology
services.
Health Education.
Provision of logistic support.
Identify weaknesses in terms of collaboration among
SIDS member states to support each other in the
implementation of declarations. For example :
- Institutionalize SIDS Expert Technical Working Group
with defined TOR.
• Set up a mechanism for virtual networking among
National experts (teleconference/intranet ...)
• Formalize the cooperation with other
organizations/network ( proposal of IOC to join WHO
Afro SIDS Network)
•