Study On The Current Status And Mechanism Of Multi-sectoral Collaboration On Noncommunicable Disease Demonstration Areas

BackgroundMulti-sectoral collaboration has become a hotspot in management of public health as well as noncommunicable disease (NCD) control and prevention. The National Health and Family Planning Commission of China has been actively promoting the NCD demonstration areas since 2010. The primary purpose of the creation of NCD demonstration areas is to minify the adverse impact of NCD among the individual level, group level and the social level, to reduce the harms of the NCD, to improve the quality of life and the health level of the residents, and to promote the harmonious development of the public health and the environment and society through strategies such as multi-sectors collaboration, government-leading and general public involvement.By the end of the year 2015, two hundred and fifty-six NCD demonstration areas had been set up in China. We need urgently to understand the current conditions of multi-sectoral collaboration on NCD control and prevention, to study the effectiveness of the mechanisms, the problems during their operation and the successful experience we can learn from since the project has been implemented for more than five years. China CDC conducted field investigation of multi-sectoral cooperation on NCD control and prevention which based on China-WHO Biennial Collaborative Project at two NCD demonstration areas of different economic level. In the investigation process, we aim to explore and discern strengths and shortcomings in the current state of NCD control and prevention in each district and to elucidate mechanisms for multi-sectoral collaboration. It has important significance to further push the progress of the integrated prevention and control of NCDs over the country.Objective1. To understand the current status (including operational mechanism) of multi-sectoral collaboration in NCD demonstration areas and analyze the existing problems.2. To establish evaluation index system of multi-sectoral collaboration on NCD control and prevention.MethodsThis study applied qualitative research method, and used semi-structured interviews, semi-structured questionnaire survey and focus group discussions to collect relevant information. We chose Putuo District of Shanghai which represents eastern economy developed region of China and Litong District of Ningxia which represents western less developed area as study sites.In-depth interviews were used to collect data from leaders of leading groups of NCD demonstration areas and residential committee directors. Focus group interviews were used to collect data from department heads (including Education Bureau, Sports Bureau, National Development and Reform Commission, Finance Bureau, Environmental Protection Agency, etc.) and residents. All interviews were audio-taped and transcribed verbatim. We performed framework method to analyze the data and qualitative analysis software(NVivo10) was used to facilitate the analysis.Quantitative data were collected through questionnaire which finished by directors of relevant departments. Descriptive analysis was used to analyze the data through SAS9.3.Evaluation index system of multi-sectoral collaboration on NCD control and prevention were established through focus group discussion.Results1. General conditionsThe two districts which we investigated were both named national NCD demonstration areas in 2012. Two leaders of leading groups of NCD demonstration areas, Twenty-six department heads, four residential committee directors and seventy-seven residents were interviewed. Thirty-six questionnaires were issued and all were valid.2. Current situation of multi-sectoral collaboration on noncommunicable disease demonstration areas2.1 Government level2.1.1 Leadership and organization settingsBoth sites set up leading group of integrated demonstration area of chronic diseases and work leading group office. A system of joint conference on NCD control and prevention, which is based on government-leading and multi-sectors collaboration, has been established.2.1.2 Coordination and guarantee mechanismThe interviews and file records showed that the government had issued Non-communicable Chronic Diseases Prevention and Treatment Plan, made implementation programs and had joint meetings regularly.2.1.3 Consensus on multi-sectors collaboration of NCD controlThrough the investigation, it can be known that the leaders of government and most departments (21/26) were aware of the dangers of NCD and the importance of the prevention and control of chronic diseases in multi-sectoral cooperation.32 departments (88.8%) in the study had already in cooperation with health sector and they were looking forward to more cooperation. Two departments (5.6%) didn't cooperate with other departments but they would like to have cooperation in the future. The other two departments didn't want to participate in cooperation.2.1.4 The performance of relevant functional departments on multi-sectors collaboration of NCD controlAll interviewees from departments (26/26) indicated that tasks on NCD control and prevention have been done according to the established work plan and obtained certain achievements.2.1.5Information sharingRelevant leaders and department heads realized the importance of communication and information resources sharing. The most common way through which staff from different departments acquired information was from policy documents issued through the chain of command (94.4%), working conference (88.9%), training (58.3%) and so on. Few departments (3/26) had established the corresponding communication and coordination mechanism. Some interviewees (10/26) suggested that their database can be available as a shared resource.2.1.6 The establishment of supervision, incentive and accountability mechanismBoth sites were carried out by certain supervisory work with certain evaluation mechanism to each sector. Many interviewees from departments (15/26) indicated that a clear responsibility management is very important. Encourage measures will help to improve the motivation of staff.2.2 Community level2.2.1 Knowledge on noncommunicable chronic diseaseManagers of the two districts (4/4) and most of the community residents (70/77) who were interviewed have basic knowledge on NCDs and related risk factors, including variety of NCDs, behavior risk factors and their harm.2.2.2 Activities on NCDs control and preventionInterviews showed that physical activities were widely carried out by communities under the direction and cooperation of health department and other related sectors, such as Sports Bureau, the Women's Federation, companies, etc. Although some of these activities were supported by different departments, residential committees, volunteers and community health service centers were major organizers.2.2.3Requirements of NCD control and preventionMore attention need to be paid to medical insurance system and a healthy living environment. Departments such as Municipal Labor and Social Security Bureau, Sports Bureau, Food and Drug Administration should participate in to reduce the medical care burdens of chronic patients, maintain fitness facilities and strengthen the food safety management.2.3 Successful experienceThe health department of Litong District in Wuzhong, Ningxia, with full support from local Bureau of religion, propagandized knowledge on NCD control and prevention to Muslim in the mosque through akhond (the leader of Muslin). Putuo District of Shanghai has cooperated with Women's Federation to carry out the "Healthy building campaign", making full use of its widespread impact to spread health knowledge in communities.2.4 Deficiencies found in the survey2.4.1The department taking the lead lack of leadershipThe leading group office was set up in hygiene department which lead to limitation of their work. The enthusiasm and initiative of non-health sectors have not been aroused.2.4.2 Lack of funding and light handedMost interviewees from departments (20/26) indicated that Special funds for NCD control and prevention and light handed were problems which impeded their work running smoothly.2.4.3 Absence of clearly defined duties and responsibilitiesHalf of the interviewees from departments (13/26) considered that their responsibilities were not clear, especially in Litong district.2.4.4 The cooperation is single in form and intermittentAccording to the questionnaire survey, the approach to cooperation of NCD control and prevention was relatively single in most departments (83.3%), which cooperated in form of meetings or trainings.19/26 of the departments took part in the NCD control and prevention through the government liaison meetings. It is necessary to build effective supervision mechanism, incentive mechanism and accountability mechanism to promote the sustainability of multi-sectoral collaboration.2.4.5Information sharing between each department was insufficient.According to interviews, we can see that the data resources failed to share or to take full advantage among different departments (15/26). The problem of information asymmetry existed between health sectors and non-health sectors since the lack of professional and authoritative information release (10/26).3. Explore the establishment of an evaluation index system of multi-sectoralcollaborationWe have initially established an evaluation index system of multi-sectoral through focus group discussion based on literature reviews, evaluation system of NCD demonstration areas and field survey. The final draft is composed of two first class indicators, seven second class indicators and twenty-seven third class indicators.ConclusionThe collaboration framework of government-leading, multi-sectors collaboration has been laid out, upon which more in-depth collaboration on NCD control and prevention may be developed. Strategies and recommendations:1. leading group office of NCD demonstration areas should be set up in local government and multi-sectoral collaboration should be dominated by government to improve working efficiency.2. Health Bureau or an office for coordination work should be set up in Litong district to guarantee a good connection between city-level and district level.3. Set up information sharing platform and encourage innovation to expand channels of cooperation. Putuo district should make full use of the available data resources, and Litong district should strengthen the information construction to gradually achieve information sharing.4. Supervision program should be improved and timely feedback should be provided. Improve the evaluation index system and make multi-sectoral collaboration on NCD control and prevention sustainable.5. Social organizations and private enterprises should be encouraged to join in the NCD control and prevention to create social supportive environment. Meeting people's demand of NCDs prevention and healthcare service and creating a healthy social environment should be attached more importance by relevant government departments at all levels.