Problem: High levels of chronic disease in an ageing population; health system oriented towards acute, reactive care rather than proactive, chronic care.
Solution highlights: The government developed the National Health 2020 Action Plan 2014–2020 to guide action on noncommunicable disease; international attention on key issues helped generate national momentum and political will for health reform; a strong understanding of key challenges, supported with baseline population health data, facilitated the development of the Plan and allowed tailoring of activities to population needs; intersectoral partnerships across government ministries helped to keep the Plan on the political agenda and safeguarded health reforms against being undermined by other sectors’ policies; aligning with the existing primary care infrastructure facilitated the adoption of the Plan; a strong public communication strategy and provision of patient education helped to improve population health literacy and garner support for the initiative.
Description of practice
Noncommunicable disease was the leading cause of morbidity and mortality in Turkmenistan, accounting for 81% of all-cause mortality in 2011. Cardiovascular disease alone accounted for nearly 30% of all-cause mortality in 2010. Yet the health system was oriented around the delivery of acute, reactive services and was thus ill-equipped to meet growing chronic needs. With the elderly population expected to double by 2030 to 7.9% and then quadruple by 2050 to 13.6%, an urgent need was felt to adapt the health system to meet further expected rises in the burden of noncommunicable disease.
In 2013, the WHO European Ministerial Conference on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020 was convened in Turkmenistan’s capital. As an outcome of this Conference, the Ashgabat Declaration on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020 was adopted by Member States. The Conference was a key motivator for Turkmenistan “to ramp up our response to noncommunicable disease and assume a position of regional and global leadership”. Consequently, an intersectoral steering committee spanning 38 government ministries and departments was established to design the National Health 2020 Action Plan 2014–2020 for Turkmenistan to guide the implementation of the Ashgabat Declaration, with support from WHO. A baseline assessment of noncommunicable disease risk factors, conducted using the WHO STEPwise approach to surveillance (STEPS), helped inform the Plan’s design. Building on the existing primary care network, as well as several recent national initiatives to improve population health, the Plan put forward aims to improve health promotion and disease prevention; increase population health literacy and individual engagement with health; modernize existing care facilities; introduce electronic communication technology; and conduct research on noncommunicable diseases. In 2014, the Plan was officially adopted by presidential decree and it is now in the early stages of implementation. Ongoing data collection and surveillance by the Ministry of Health will allow ongoing evaluation of the Plan’s impact. Implementation is set to continue until 2020, at which point future steps will be determined.
Implementation of practice
What stage is the practice currently in?
Who was/is responsible for the implementation of the practice?
The Ministry of Health led the national commitment to addressing noncommunicable disease challenges in Turkmenistan, working in close partnership across government ministries. Intersectoral collaboration was described as a key factor in promoting inclusive participation across government sectors and achieving broad political support for activities. An intersectoral government committee was established to collectively develop the National Health 2020 Action Plan 2014–2020. WHO and several other international organizations and foreign governments provided assistance and support to the committee in developing the Plan; for example, through training support and sharing of best practices. While implementation of the Plan falls under the remit of the Ministry of Health, intersectoral working continues to be important for realizing implementation goals.
Over the next decade, leaders of the initiative hope to achieve additional gains in life expectancy as a result of the actions taken under the Plan to reduce noncommunicable disease in the population. However, implementation of the Plan is still in the early stages and any outcomes remain to be seen. It is also recognized that attributing any population health improvements directly to the initiative will be challenging, in part due to the complex array of actions employed and the numerous other influences on health outcomes.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Muhammet Ergeshov
- Ministry of Health and Medical Industry