Transcript Definition - Western Cape

Western Cape Province Burden of
Disease Reduction Project:
The approach taken
Prof Jonny Myers
Symposium 25 – 26 June 2007
1
History of Project
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•
•
•
•
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Approach from Prof Househam 9/2005
Nature of the Mandate/conceptual model
Project Reference Group established 9/2005
6 Proposals identified
Formation of a Project Management Team
2 Workteams and 5 Expert Groups
2
The Project Mandate: looking upstream for
risk and intervention
Sex
Age
STIs
Viral load
Gender
Older partners
Violent crime
Social systems
Structural
Biological
Method of sex
No of partners
Substance abuse
Behavioural
Societal
Indicators of poverty
Migration / Urbanisation
Education
Institutions
3
Infrastructures
It must be said
• Very atypical request
• Amounting to a PH Professionals dream in
its far-sightedness
• Not the usual Health Sx or systems Mx
request or even clinical request
• But directed at the primary end of the
prevention hierarchy, and
• Intrinsically inter-sectoral in approach
4
History of Project
•
•
•
•
•
•
Approach from Prof Househam 9/2005
Nature of the Mandate/conceptual model
Project Reference Group estab 9/2005
6 Proposals identified
Formation of a Project Management Team
2 Workteams and 5 Expert Groups
5
History of Project
•
•
•
•
•
•
Approach from Prof Househam 9/2005
Nature of the Mandate
Project Reference Group established 9/2005
6 Proposals identified
Formation of a Project Management Team
2 Workteams and 5 Expert Groups
6
The six original proposals
PROPOSAL 1:To produce estimates of the Provincial burden of disease for the Western
Cape , utilizing both morbidity and mortality data, both at a provincial level and at the level
of the 6 districts, for the year 2005.
PROPOSAL 2: To optimally design a rapid mortality surveillance system for districts with
expert public health support from the MRC and UCT Public Health, and assist with its
institutionalization and rollout.
PROPOSAL 3: To ascertain the available information on the incidence and prevalence of
mental health morbidity both nationally and in the Western Cape, in order to derive
estimates of the BoD in DALYs due to mental illness in the Province and explore the scope
for conducting morbidity surveillance.
PROPOSAL 4: To ascertain the availability of current facility-based morbidity data within
Western Cape health information systems, and its potential utility for input to provincial
Burden of Disease estimation.
PROPOSAL 5: To produce an inventory of public (and private/NGO) sector interventive
responses aimed at reducing BoD risk factors
PROPOSAL 6: To compare the inventory of interventive responses with a master list of
interventions, to identify gaps and to evaluate existing interventions within the context of
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a surveillance system.
History of Project
•
•
•
•
•
Approach from Prof Househam 9/2005
Nature of the Mandate
Project Reference Group established 9/2005
6 Proposals identified
Formation of a Project Management
Team
• 2 Workteams and 5 Expert Groups
8
Project Structure
PRG
PMT
WT 1
Surveillance (P1-4)
WT 2
Prevention (P5 -6)
9
PMT
• Project Leader
• DOH Representative
• WT 1 Champion
• WT2 Champions (5)
Function: Project Management to deliver
high quality product within budget and
timelines
10
The 2 Work Teams
• Work Team 1:
Proposal 1 -4 Surveillance
• Work Team 2: Proposal 5 -6
– Preventive interventions
– Evidenced based upstream recommendations
11
Ranked BoD components provided
focus for Work Team 2
Rank
Cause of Death
% YLL
1
HIV/AIDS
14.1
2
Homicide/Violence
12.9
3
TB
7.9
4
Road Traffic Accidents
6.9
5
Ischaemic Heart Disease
5.9
6
Stroke
4.6
Total
52.3%
12
Principal components of the BOD
Cause of Death
% YLL
MID: HIV/AIDS/ TB
22.0
19.8
INJURY: Violence & Road Traffic
related
CVD: Ischaemic Heart
Disease/Stroke
10.5
Childhood Diseases
6.0 minimum
58.3%
Total
PLUS
hidden burden of Mental Health Disorders not captured by mortality
13
5 Expert Groups
Outcome (disease group)
Major risk factor(s) for this outcome
1. Major Infectious diseases
Unsafe sex
2. Injury
Alcohol abuse
3. Mental disorders
Early Childhood Development
3. Cardiovascular disease
Obesity and Exercise
4. Childhood diseases
Environmental factors
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5 Expert Groups
• Structure and function
– each group with specific champion
– Authors identified
– Multi stakeholder expert group assembled–including
many members of PRG
– examined evidence for intervention effectiveness
(where this existed or was possible) or promise (where
more complex causally).
– Peer review (incl. international review) where possible
given time constraints
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The Report: March 2007 and as
edited June 2007
Volume 1 - You have been given hardcopy of the June 2007 version
Foreword by Prof C Househam, Head of Health
Overview chapter by Jonny Myers and Tracey Naledi and executive
summaries from Volumes 2 to 7 from other authors
There is a CD Rom in your pack containing electronic copy of
everything from Volume 1 through Volume 7 June 2007 version
Volume 2: Mortality surveillance
Executive summary with appendices
• Paper 1: Cape Town Mortality by authors
• Paper 2: Boland/Overberg Mortality by authors
• Paper 3: Western Cape overall Mortality by authors
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The Report (2)
Volumes 3,4,5,6
• Order of appearance follows the degree of contribution to the overall
burden of disease
• Each has an executive summary.
• Authored by Champions plus authors’ groups
• Incorporating where appropriate Reviewers’ comment
Volume 3:
Volume 4:
Volume 5:
Volume 6:
Major Infectious Diseases (HIV/AIDS and TB)
Mental Health
Injury – intentional/violence and unintentional/RTI
Cardivascular Diseases - IHD and stroke
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The Report (3)
Volume 7
Overview of Childhood Diseases with 5 appendices:
HIV/AIDS in children
Diarrhoea
Low birth weight
Acute Respiratory Infections
Malnutrition
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The 7 Volumes
Constitute a rich source of outputs with useful
information about interventions against the
major risk factors for the top 5 BoD
components for which there is either
– Evidence
– Or which are agreed to be promising
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Fidelity to mandate
• Maintained faithfulness of mandate to look
upstream in terms of
– The conceptual model focussing on societal and
structural risk factors and levels of intervention
– and beyond the health department to other sectors
and relevant government departments
• While retaining focus on “downstream” health
sector based interventions with recursive
preventive effects at the primary level eg ARVs,
Mental Health Services
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The Project Mandate: looking upstream for
risk and intervention
Sex
Age
STIs
Viral load
Gender
Older partners
Violent crime
Social systems
Structural
Biological
Method of sex
No of partners
Substance abuse
Behavioural
Societal
Indicators of poverty
Migration / Urbanisation
Education
Institutions
21
Infrastructures
Main Points:
1. Surveillance is crucial
• Whatever we do with interventions into the future
we need to know where we are at any one time,
and what the impact measurable at the
population level could be.
• So we need improved and institutionalised
mortality surveillance systems sensitive to rapid
change at the most disaggregated level
22
2. Upstream risks and upstream interventions
for all risks
are critical for reduction of BoD
• Have highlighted the role of behavioural factors
(alcohol, road use, sexual and health-seeking) in
contributing to the BoD
• And how these link to even more upstream
infrastructural risks of material and social
deprivation
• And how upstream interventions have multiple
direct and indirect impacts on all risks
23
Used global and local evidence
• To provide highlights of upstream
interventions that have been:
– shown to be effective
– or are considered by consensus to be promising
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Value of the output
• Study has not broken entirely new ground
• Overlap with WCPPoA 07/08 – provincial
strategic objectives
• Our recommended interventions can provide
detail and more concrete proposals for the
achievement of these strategic policy objectives
• Provides a menu of interventions for policy
makers – and a guide to feasibility and
practicability
25
Value of the output (2)
• Our recommendations can help assessment
of current, consideration of new, and
dropping of existing interventions that have
been shown not to work.
• The devil is in the detail
– some interventions are nominally present but
not implementable any time soon and
– others are inadequately targeted to high risk
groups who could benefit most
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Tasks ahead for 2007/8
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Principal tasks as seen by
the project team
1. Institutionalisation of mortality surveillance
should continue
2. Intersectoral engagement with other nonhealth government departments on upstream
interventions to mitigate risk, involving:
a.
Identification of optimal intersectoral structures
and vehicles for reducing the BoD
b. Making specific Public Health contributions to this
work including assistance with design of intervention
implementation and monitoring systems and data
analysis and interpretation for evaluating these
interventions over time
28
Structure of Symposium
• Presentations in some detail
• Lots of time for input from the floor
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