Dr Abdel Rahim Mutwakel Gaffar, MBBS, DPH, FCM

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Dr Abdel Rahim Mutwakel Gaffar, MBBS, DPH, FCM

• Nizwa Healthy Lifestyle Project, Planning and
  Implementation Experience
• 1999 - 2008

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Contents

• Background information
• Milestones of NHLP
• Prevalence of NCDs and common RFs
• Strategic plan
• IHHP Role
• Interventions re-planning and implementation
• Resources available
• Challenges and issues

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Background informationSultanate of Oman

• Population 2,331,391 (1,779,318 Omani)
• Area 309,500 square kilometers
• Population settlement5051
• The Sultanate of Oman borders Saudi Arabia and
  United Arab Emirates (U.A.E.) in the West, the
  Republic of Yemen in the South, the Strait of
  Hormuz in the North and the Arabian Sea in the
  East (map)

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Background informationWillayat Nizwa (project
Area)

• Location In Ad Dakhliyah region about 175 Km
  from Muscat (the capital)
• Population 68,785
• Population settlement about 77 village including
  Nizwa center.

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Milestones of NHLP (1)

• 1996The idea to implement a community-Based
  programme for prevention of NCDs emerged.
• May 1997 Wali Nizwa (governor) express the
  willingness of the community to host the pilot
  project.
• February 1999 Minister of health decree
  appointment of a local project committee headed
  by Wali.
• April July 2001 Implementation of the Baseline
  survey.

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Milestones of NHLP (2)

• March 2002 Presentation of the preliminary
  survey results.
• November 2003 Preparation of the Five years
  intervention strategic plan completed.
• March 2004 Implementation of the intervention
  started.

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Prevalence of NCDs and common RFs
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Prevalence of Diabetes Mellitus, Hypertension and
Metabolic syndrome in Nizwa and national level
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Prevalence of IFG and Hypercholesterolemia in
Nizwa and national level
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Prevalence of Obesity, Physical Inactivity and
Tobacco use in Nizwa and national level
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Causes of unhealthy dietary habits!

• Lack of awareness
• Low availability of healthy choices at
• At food stuff stores
• At restaurants.
• At schools.

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Why people physically inactive?

• Lack of awareness regarding the of physical
  activity for health fitness and prevention of
  diseases
• Social values and traditions regarding physical
  exercise (women, restriction).
• Non-availability public places suitable for
  physical activity (walking and cycling path,
  gymnasium).
• Modernization of life that reduce physical
  activity (sedentary life, TV, Computers, tel,
  cars).

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Why people use tobacco?

• Peers pressure.
• Lack of awareness among youth.
• Media and advertisement.
• Availability of tobacco in most of the shops,
  even the small ones.
• Lack of fruitful activities/hobbies for Leisure
  time.

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Development of the strategic Plan

• The strategic intervention plan was developed
  mainly by the MOH in consultation with the other
  government sectors, CBO and WHO.
• The plan intervention areas
• Healthy nutrition promotion,
• Promotion of physical activity,
• Tobacco control and prevention,
• Road Traffic and domestic accident control.

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Development of the strategic Plan

• Activities for each intervention area were
  identified, and broad action plan was developed
  indicating the responsibilities and inputs,
  process, out puts and outcome indicators.
• The strategic plan describe the documentation
  process, evaluation mechanism, follow up
  activities ..ect.
• It was strategic plan which need operational
  planning.

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Objectives(1)

• Ultimate goal
• The main goal of the project is to improve the
  health of people in Nizwa by the implementation
  of a Community based project for primary
  prevention of non-communicable diseases and
  healthy lifestyle.

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Objectives(2)

• Main objectives
• To map the emerging epidemics of NCDs and to
  analyze the social, economic, behavioral and
  political determinants of the disease.
• To reduce the exposure of individuals and
  populations to the major determinants of NCDs and
  to prevent the emergence of preventable common
  risk factors.
• To strengthen health care for people with NCDS by
  supporting effective interventions.

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Strategies

• Promotion of development of supportive policies,
  legislation.
• Inter-sectoral collaboration.
• Community involvement.
• Health education and information.
• Development of guidelines/protocols for
  preventive interventions.
• Training of medical professionals.
• Research, monitoring and evaluation.
• International cooperation.

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Organization structure of the project
NCDC/MOH
Local project committee
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• The implementation of the project was started in
  March 2004,
• The activities in the first year was like an
  advocacy campaign.
• Thanks for the internet and IHHP

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Operational planning

• From IHHP web site we learn how to prepare the
  intervention plan. We prepare intervention plan
  for 2006 based IHHP experience and our strategic
  plan.
• BUT the questions was how to do it?
• The answer was in Isfahan 5th International
  seminar, thanks to their support to attend that
  activity.

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IHHP Lessons

• Leadership organization and personal,
• Project design clear plan, monitoring and
  evaluation indicators ,
• Partnership inter-sectoral collaboration
  create ownership
• Team work multidisciplinary, committed and
  motivated,
• Strong international co-operation open
  opportunities for exchange of experience

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NHLP Interventions

• Population approach
• School Programs (school health, Education)
• Community Empowerment (CSG, OWA, Scouts, sport
  teams,)
• Supportive Environment (municipality)
• Public Education (CSG, OWA, Scouts, sport teams,
  Education, PHC, ..ect)
• RTA prevention and control (Police, NGO)
• High-Risk Approach
• Lifestyle Clinic (NPC, nutrition department)
• Health professionals education and involvement
  (NPC)
• Obesity screening and management at PHC (NPC,
  nutrition department)

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Population approach School Programs

• 1. NHLP Friendly Schools competition
• Schools implement activities (Group education,
  Events and contests) to raise the awareness of
  children and parents regarding Healthy diet,
  physical activity, tobacco control and road
  safety.
• The activities evaluated against special criteria
  by joint NHLP and Education team.
• Winners schools were selected and appraised in
  major public event.

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Population approach School Programs

• 2. Alharaka Baraka (Move for Health)
• Programme to promote physical activity among
  children in Gulf area. For the first time to be
  implemented in Oman.

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Population approach Community Empowerment

• In collaboration with the community
  organizations
• Community Support Groups.
• Omani Women Association.
• Scouts (Jawalat Nizwa)
• Training workshops for community members to work
  as health promoters in their local community
  settings.
• Supportive Environment
• Promotion of establishment of female gymnasium in
  collaboration with OWA.
• Plan to establish walking path
• Competition between supermarket to made high
  fiber, low fat, low sugar choices available.

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Population approach Public Education

• Group and direct education schools, mosques,
  sablat, majalis and health institutions.
• Brochures and leaflets.
• Events and contests (World health, Heart, DM,
  Tobacco ect).
• Walkathons.
• Screenings campaigns (Obesity, BP, DM).
• Street Boards.

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High risk approach Lifestyle Clinic

• Provide Lifestyle Change therapy (counseling) for
  individuals with
• Obesity and overweight,
• DM,
• Hypertension,
• Dyslipidemia,
• Smoking cessation counseling.

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High risk approach Health professionals
education and involvement

• Workshops and events (WHD, tobacco day) to
  sensitize health professionals regarding risk
  factors assessment and management as a key step
  for primary prevention of non-communicable
  disease.
• Training program for 3rd year nursing student at
  Nizwa nursing institute.

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High risk approach Obesity screening and
management at PHC level

• Objectives
• To introduce a program for the detection and
  management of overweight and obesity in the
  primary health care system.
• To study the prevalence of obesity and overweight
  in adults gt20 years of age who attend the health
  centers.
• To evaluate the effectiveness of the intervention
  program.
• Finalization of the practical guidelines (first
  of its kind in Oman)

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Status of implementation(1)
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Status of implementation(2)
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Training and capacity building
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Percent of population who attend HE activity
about PA or healthy diet or tobacco control, 2001
- 2006
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Research and studies

• Abdelrahim M Belal, Raha Alsalmi, Zahir Alanqudi,
  Patterns of Physical activity and levels of
  inactivity among school children in Willayat
  Nizwa, Oman, 2006. In School Children and
  Adolescent Nutrition in Gulf. Arab Center for
  Nutrition, Bahrain 2006 1st ed. 223-242.
• Zahir Alanqoudi, Nagi Zaki, Abdelrahim M Belal,
  Diabetes Care Clinical Outcome in Ad Dakhliya
  Region, Oman (presented in Gulf Group for study
  of diabetes).
• Reports
• Evaluation of Nizwa Healthy Lifestyle Project
  activities, 2004-2006
• Nutrition Clinic Annual Report and weight
  management outcome, 2006
• Manuscripts
• Abdelrahim M Belal, Halima G Alhinai,
  Community-Based Initiatives for prevention and
  control of non-communicable diseases Nizwa
  Healthy Lifestyle Project planning experience in
  Oman.
• Abdelrahim M Belal, Raha Alsalmi, Zahra Alabri,
  Availability of nutrition choices in schools'
  food stores and their role in promotion of
  healthy eating habits.

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Resources available for the project

• Human resources
• Available full time staff in the HLP Office as
  follows
• Doctor working as regional CBI coordinator.
• Nurse project coordinator.
• Project secretary.
• Part time (4) Head of non-communicable disease
  control section (2 days/week), the community
  participation coordinator of the region, staff
  nurse from Hypertension study (one day/week) and
  the nutritionist in Nizwa Poly clinic (3
  days/week).
• Supportive staff administrative and financial
  superintendent.

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Issues..

• Number and capacity of staff (human resources).
• The delay in the starting of the interventions
  (2001 2004)!!!!
• No reference area for the project
• The design and evaluation issue!

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Thanks for your attention