Non-Communicable Diseases

This mission included a training workshop on strengthening NCD surveillance system in Oman held from 11th to 14th March 2019 at the Millineum Hotel Muscat. The aim of the workshop was to provide the participants with an orientation on the three pillars of NCD surveillance, as well as equipping them with the essential background knowledge to guide the development of a national capacity building plan for NCD surveillance, monitoring and evaluation based on the national multi-sectorial strategy on NCDs. It provided an interactive forum to promote a two-way exchange of experiences and knowledge and support effort to further develop or strengthen the NCD Surveillance system, including the development of databases, indicators and other details to better track NCD intervention share and use data more effectively, and ultimately inform policy making Day care ophthalmic surgery is a cost-effective surgery that has rapidly years. Multiple factors have contributed to this transition, including economic forces, improved anesthetic and surgical techniques, better pre-operative planning, better patient education and an enhanced ability to deliver adequate analgesia in the outpatient setting. A quantitative cross-sectional study looking at the knowledge of NCDs and their risk factors and knowledge attitude and practice of the National screening program for and barriers to its uptake, among the

In order to effectively tackle the NCDs (which caused 72%of deaths in 2018) and their key risk factors, a detailed understanding of the current status and progress made at the country level is required. NCD surveillance is a critical piece of NCD prevention work, which captures the magnitude of NCDs and their risk factors, and availability of best possible data is the key to curb the rise in NCDs. With this in mind the NCD department in collaboration with WHO EMRO and WHO Regional office in Oman arranged a WHO expert mission visit to Muscat, Oman from 10 th to 14 th of March 2019 in order to strengthen the existing NCD surveillance system as well as to assess the cancer registry and the facility level information system on Noncommunicable Diseases.
Dr. Heba Fouad, opened the workshop by welcoming all the participants, presenting the main objectives, the expected outcomes, and the agenda of the Mission. Acknowledged the long-standing collaboration between WHO and Oman on containing the NCD epidemic in the Region, she highlighted the global and regional burden of NCDs, the need for political leadership on NCDs from the Region and the benefits of regional networking and collaboration, as well as stressing on the importance of having progress monitoring matrix and of scaling up action on mental health. She pointed out the challenges to building an effective surveillance system, such as the standardization of implementation of surveillance, monitoring and evaluation, integration of NCD surveillance into existing health information systems, carrying out STEPS survey or comprehensive health examination survey on regular bases, bridging the gap between surveillance data ascertainment and policy development, and the shortage of regional experts on NCD surveillance to support countries with national capacity building The training workshop concluded with the identification of way forward for capacity building and insights gained by participants into formulating a plan of action on strengthening national NCD surveillance in Oman. In order to adapt the workshop group work on existing gaps and challenges, two parallel visits were arranged prior to the workshop by MOH and the consultants. First visit was to the cancer registry hosted in the MOH NCD department, with participation of Cancer registry focal point; Dr. Najla Al Lawati and the cancer registry team together with Ariana Znaor from IARC. The second visit was to Al Udhaiba Primary Healthcare Center, in Muscat with participation of the NCD team ; Dr Shadha Al-Raisi, Dr Ali Gherbal, Dr. Nada Al Sumri and Fatma Al Jardani and the team from EMRO; Dr. Heba Fouad, Dr. Azza Badr and Dr Mahmoud Ismail The Sultanate hosted the WHO Global Meeting on Non-communicable Diseases from the 9 th -12 th December 2019 at Muscat. Page 4 The overarching goal of the Global meeting was accelerating the implementation of national responses to address NCDs and mental health conditions with a view to reduce the premature mortality and scale up interventions to reach SDG target 3.4 by 2030 by catalyzing action through partnerships and capacity building.
Over 600 delegates from around the world, including Ministers and other representatives from over 100 member states of the World Health Organization (WHO) across the globe and from public health and other sectors, UN agencies, civil society, private sector, philanthropies, and academia attended the meeting.
H.E. Dr. Ali Talib Al Hinai, MOH's Undersecretary for Planning Affairs welcomed the honorable ministers of health and the distinguished delegates. He highlighted the Sultanates effective multisectoral approach, to implement the evidence-based interventions for NCD prevention and control". H.E. Dr. Ahmed Al Mandhari, Regional Director, WHO-EMRO stressed the importance of strengthening health systems, to help protect individuals and promote community resilience, while Dr Akjemal Magtymova, WHO Representative in Oman, emphasized that "PHC for UHC" is the key to tackling NCDs, because prevention is as vital as cure. Dr. Svetlana Axelrod, WHO global NCD platforms director, emphasized that the meeting would ensure that the NCD and mental health directors and managers of the member states, have all the necessary tools and knowledge to implement all the high-level commitments articulated in political declarations, in order to reach SDG target 3.4 by 2030.
The NCD Alliance announced that it would launch a collaboration with WHO to support national responses by advocating for NCD interventions and policies and supporting countries to track progress towards SDG target 3.4.
The summit came up with a list of eight recommendations, which countries would need to follow if they were to reduce the deaths caused by non-communicable diseases (NCDs). Some of these were, encouraging governments to: • Provide strategic leadership by involving all relevant stakeholders.
• Empower individuals to make healthy choices, by ensuring that a conducive environment and information to make healthy choices is available. • Invest in NCD prevention and control to enhance human capital and accelerate economic growth. • Ensure provision of adequate social protection for everyone to prevent catastrophic health expenditure and resultant fall into poverty. • Increase engagement with businesses and provide technical support, so they can mount effective national responses to NCDs and mental health conditions. • Promote meaningful engagement with civil society, and advocate for the establishment of a multi-donor trust fund, to support countries in their activities reduce NCDs and promote mental health

Non-Communicable Diseases Initiatives Forum
The Ministry of Health, (MOH) represented by the non-communicable diseases department and in collaboration with the United Nations Population Fund (UNFPA) and Baxter Company organized the "Non communicable diseases initiatives forum" at Intercontinental Muscat hotel on 4 th of April 2019. Dr. Said Al-Lamki, Director General of primary health care welcomed the participants and said that the aim of summit was to refresh the skills and knowledge of the health workers in the primary healthcare institutions in the field of non-communicable diseases, as well as to discuss the latest developments in this regard.
The aim of forum was to view the new initiatives for the non-communicable diseases, which the various governorates have put in place, and which have played an important role in improving the services delivered for the patients.
The Forum reviewed the indicators of primary health care institutions, (PHCI) during the forum, and discussed the challenges related to the prevention and control of non-communicable diseases.
In addition the forum honored the best initiatives at the level of health institutions in the governorates, as well as all efforts exerted in various programs and fields such as mental health program, peritoneal dialysis, eye health, national cancer registry all non-communicable diseases departments in the Governorates along with the best non-communicable diseases clinics in the PHCI. Acceptability of day care opthalmic surgery in patients is gauged by, the number of unsolicited complaints received, the incidence of readmission after patients have returned home, and the postoperative complication rates. The positive feedback from the patients and their relations will enhance the popularity of outpatient surgery in years to come.

Day Care Ophthalmic Surgeries at Rustaq Regional Hospital in Oman
The summit focused on primary health care as the main entry point to the health system, receiving patients and guiding them to the different levels of service and healthcare. It stressed the importance of integration of the chronic non-communicable diseases in primary health care for early detection and treatment, and prevention of the long term complications due to them. Some of the topics touched upon were, treatment of adult & pediatric asthma in primary care, diabetes & coronary artery disease, patient referral, management of acute complications of diabetes in primary care, management of acute asthma and others.
Some of the topics touched upon were, treatment of adult & pediatric asthma in primary care, diabetes & coronary artery disease, patient referral, management of acute complications of At present, there is lack of any standard practice and uniform policy in Oman for day care ophthalmic surgeries. An ideal setting for day care ophthalmic surgery in Oman would be hospital based / supported with well-equipped theatres, recovery rooms, post-anesthesia care rooms and specially trained staff. In addition, there should be a strong social backup with satisfactory transport and telecommunications system, follow up and audit.
With advances in ophthalmic surgical techniques and anesthesia in Oman, the needs of the future are: • Setting up of specially designed pre-anesthesia clinics in all regional hospitals, • Specialized day care wards manned by specially trained staff in all regional hospitals, • Specialized ophthalmic team to perform the microsurgeries.
The Mental health section organized the first mental health forum at Hormuz Grand hotel on 17 th of November 2019. Dr. Said Al Lamki, director-general of primary health care, gave the inaugural speech in the presence of director generals of health services in the governorates, the director of non-communicable diseases, directors of primary healthcare, heads of NCDs sections, as well mental health focal points at the governorates. This forum aimed to set up a platform for the participants from the various governorates to exchange ideas, and work experiences as well as highlighting the achievements and challenges in the field of mental health services.
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First Mental Health Forum
The head of mental health section, discussed the status of the mental health care services in the primary healthcare institutions. She also reviewed the most prominent mental health data and statistics registered in the MOH and highlighted the importance of community awareness and the significant role played by it in the community's psychological, social and economic status, while emphasizing the World Health Organization (WHO) strategy of "No health without mental health".

Integration of mental health and physical health
This initiative reached out to the community to raise mental health awareness by destigmatizing mental illness and the taboo associated with it and encouraging people to seek help. It was conducted in North Al Batinah as one among the many mental health initiatives in the governorate, whereas in Sohar a special initiative was established called "Refeq", which focused on giving lectures on common mental disorders, outdoor counseling in public areas & doing home visits.
The forum allowed the participants to highlight the challenges faced by them in provision of mental health services, present their best practices, and suggest recommendations for enhancing the existing mental health services, improving the mental health services in primary healthcare setting, as well as for establishing a community based mental health promotion program

De-Stigmatization of mental health
The non-communicable diseases section at the DGHS, Muscat governorate, has been effectively working towards accomplishing the main goal of preventing and controlling non-communicable diseases in Muscat governorate. In 2019, several initiatives and activities were done to achieve the objectives of the section.
The NCD section in collaboration with the general authority of radio and television, represented by the Oman sports channel, participated in a television program called "Be Careful" ‫بالك(‬ ‫,)دير‬ which was broadcast during the course of the holy month of Ramadan. This TV program was concerned with public health, in particular non-communicable diseases, their causes, risk factors, and prevention and management.
This initiative was a part of the activation of the national multi-sectoral strategy to combat noncommunicable diseases, which was recently adopted by the Sultanate.
The non-communicable diseases section worked for approximately two months on preparing scientific materials and producing the TV episodes. To prepare for the program, many meetings were held for the media staff.
A total of 30 episodes, were produced and broadcast on TV, during the Holy month of Ramadhan.

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Muscat Governorate NCD initiative "Be Careful"

Introduction:
Cardiovascular diseases (CVD) are a leading cause of death in developed nations, and the incidence is expected to rise as the population ages. The single most effective intervention for reducing CVD risk is the lowering of low-density lipoprotein (LDL) cholesterol to normal levels, using either lifestyle modification, or LDL-lowering agents.
With the intention of providing a user-friendly updated concise summarized guideline for treatment of dyslipidemia in primary health care setting, the Dhahira governorate decided to develop a lipid management flow chart.

Process:
Synthesis of the evidence:

Evaluation and impact:
There has been a positive feedback from the PHC physicians, who have said that it is concise and practical. More time is needed for the evaluation. Evaluation will be done, by auditing documentation of the physician's diagnosis and treatment of dyslipidemia in patients, recorded in AL-Shifa electronic system.

National Manual for Management of Hypertension in PHC
The section of non-communicable disease control in the department of noncommunicable diseases has updated and published the third edition of the national manual on the management of hypertension in the primary health care. Hypertension is considered as a key risk factor for cardiovascular diseases and its prevalence has been increasing both globally and nationally because of the socio-economic development. Oman STEPS survey that was conducted in 2017 showed that the prevalence of raised blood pressure was 33.3%. Primary health care plays a major role in delivering care to patients with raised blood pressure, through public awareness campaigns, and screening, as well as through diagnosis and treatment of hypertension cases to achieve good control and prevent complications. This publication focuses on the diagnosis, clinical evaluation and treatment of patients with hypertension in the primary health care setting. In addition, it highlights the role of the primary care team members in the management and the indications of referral to higher levels of care. The department of non-communicable diseases worked with a number of pharmaceutical companies to conduct workshops on the management of asthma in primary health care. These aim of these workshops, was to train a large number of individuals from the different governorates. The department also coordinated with the pharmaceutical companies to broadcast these workshops, to governorates, which are far away, as well as to allow speakers to participate in workshops, in governorates outside of Muscat governorate. The department also worked with the Royal hospital to train respiratory therapists on the use of spirometry machines. These respiratory therapists could then be utilized for training the primary healthcare teams in the governorates regarding use of the spirometry machines.

Asthma
During 2019, a first comprehensive report of cancer incidence in Oman titled "Twenty Year trends of cancer incidence in Oman 1996-2015" was prepared. It summarized the overall incidence of cancer in Oman over two-decade period and described the most common types of cancer diagnosed between 1996 and 2015. Its release marked the 20th anniversary since the first publication of cancer incidence in Oman. The official launch of this document was under the patronage of HE Dr. Ahmed Al Saidi, the Minister of Health and Dr. Ahmed Al-Mandhari, WHO Regional director for the Eastern Mediterranean Region. Coinciding with this report, the Oman medical journal also published an editorial and a supplement, which gives a summary of the data.
Additionally, Oman national cancer registry released the report of cancer incidence in Oman for year 2016. Currently, the program is in process of finalizing the data collection for the 2017 cancer incidence report. The aim is to get this report ready for printing by mid-year of 2020. Moreover, to improve the skills and knowledge of cancer registrars, they were sent for two training workshops, one in the Kingdom Arabia Saudi, which was for preparation for CTR (Certified Tumor Registrar) exam and the other in Cairo, for a cancer registration workshop.

Eye Health Program
The successes of the National eye health care program are continuing. The Sultanate's success in applying the surveillance system for trachoma was presented at the American society of tropical medicine and hygiene 2019 (ASTMH) annual meeting on 20-24 November 2019 in National Harbor, Maryland. Cataract surgery in Oman: cataract is the leading cause of blindness in the world. Cataract surgery is the most cost-effective public health intervention. National eye services should provide the requisite high-quality cataract surgeries to reduce blindness and improve the quality of life. The national eye health care program monitors the progress indicators for arriving at the cataract surgery rate. The benchmark of good cataract services is; CSR of 4,500 to 6,000 per million population per year (as it is in the industrialized countries), with more than 95% of surgeries using lens implantation, and >90% of the patients with ≥6/12 vision after cataract surgeries. The table below gives a snapshot of the 6-years of cataract surgery in the ministry of health institutions at all governorates in Oman. More than 90% of them were provided with intraocular lens implants.

Disability program
After the creation of the disability section at the department of non-communicable diseases, it has worked to implement the goals assigned to it, in cooperation with other departments, other governmental and non-governmental institutions/organizations, and international organizations like the UNICEF office and the WHO office in Muscat.
Training in sign language, has been conducted for 14.2% of all PHC staff working in PHC institutions since 2017. In addition, the section is following up the implementation of the programs of the ninth -five-year plan 2016 -2020 related to disability, especially the evaluation of the achievement of the goals/indicators of the disability action plan. For this purpose, a "checklist" form to evaluate disability programs in primary health care institutions has been designed, and is currently under trial.
The formulation of the first version of the primary health care policy for disability is nearing completion.

Disability Section
There are at least 2.2 billion people around the world who have vision impairment, of whom at least 1 billion are having a vision impairment, that could have been prevented, or is yet to be addressed.
The world faces considerable challenges in terms of eye care such as, • Inequalities in the coverage • Quality of prevention, • Treatment and rehabilitation services • A shortage of trained eye care service providers • And poor integration of eye care services into primary health care systems, among others

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The World report on vision

Ear Health Program
Ear health care Manual third edition -2020: The third edition of the ear health manual has been finalized, and it will be circulated shortly to all health care institutions after it is published in early 2020. This document contains the latest information in term of ear health care and guidelines for neonatal hearing screening, primary health care guidelines, school health screening and others.
The World report on vision released in 2019, aims to address these challenges in terms of eye health care and galvanize action. It is directed at, the ministries of health, the development agencies, civil society organizations and researchers, practitioners and policy-makers, from the field of eye care.
The report has applauded and incorporated Oman's development of a well-integrated Health information system for eye care into the PHC. This is accessible through the following link below: https://www.who.int/publications-detail/world-report-on-vision . The above-mentioned report on Oman is on page 132-133 in the document.
Eye health care through school health services in Oman was once again in the limelight, when member countries of WHO-EMR discussed integration of eye care within school health. This is because Oman has already integrated of eye care in primary health centres and school health services since the last 20 years. School health activities were also instrumental in attaining the ultimate intervention goals for 'Elimination of blinding trachoma in Oman. Omani refractionists look after eye care in schools. Their commitment and hard work was vital to maintaining the high quality of eye care delivered to the students in the last 20 years.
Coverage of school screening of all four levels in 2019 is nearly 98%. All the schools of Oman are conducting vision screening. Since screening is compulsory in the primary or 1 st grade, the prevalence of eye diseases found in these students represents, the common eye diseases among 6 -7 years old Omani population. The outcome of screening in the other three grades, i.e. the 4 th , 7 th , and 10 th grade, represents the prevalence of eye diseases among 10 -11 years, 13-14 years, and 16 -17 years old school going Omani population.
Hearing screening is also carried out in schools. This is done by the trained PHC doctors and nurses in the primary or 1 st grade. The table below gives data for 5 years.
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Mental Health
Ge story headline

Mental Health Services
Mental health program witnessed remarkable growth and development in service. It   • The mental health section has also assisted in developing "The child and adolescent school mental health guideline" in collaboration with the department of school health.
This has been approved for the training of master trainers (TOT training) • In addition, mental health educational materials packages have also been produced in collaboration with mental health focal points in the governorates.

Kidney Disease
In order to facilitate and improve the management of chronic kidney diseases (CKD) in primary health care, the department of non-communicable diseases has developed a flowchart. This flowchart helps the health care providers in primary health care to manage and treat the cases with renal failure based on the stage, and to guide referral to secondary and tertiary health care levels. Early diagnosis and treatment of the underlying cause may slow the progression of the disease.

The 8 th EASD/GGSD/Lilly postgraduate course in clinical diabetes
The European and Gulf Groups for the study of diabetes, with the support of Lilly diabetes, and in coordination with the department of non-communicable diseases, organized a training course on diabetes management from 21 st to 23 rd of November 2019 at the Sheraton Muscat hotel. The aim of the course was to address the updates in the field of diabetes management. It included interactive lectures, abstract presentations and workshops, which were delivered and moderated, by a number of physicians from the European and Gulf groups for the study of diabetes. The course highlighted the economic and social burden of diabetes, the updates in the management of diabetes and its complications, as well as the updates in the management of gestational diabetes and obesity, the role of modern technology in the management and other related topics. This course targeted doctors and nurses working in diabetes clinics in the primary and specialized health care institutions. Around 200 participants from the Sultanate and the Gulf Cooperation Council countries, as well as from the Islamic Republic of Pakistan attended the course.
Training is an important aspect of a successful PD program. It includes continuous education and training of medical staff, (nurses and nephrologists) and patient education programs. One responsibility of PD focal points (doctor & nurse) is to train other health care providers and to create a well-organized patient education program. Therefore, in order to have an effective PD trainer, the department of NCD in collaboration with the center for continuous professional development (CCPD) organized a workshop that aimed to: 1. Assess patients' needs 2. Identify the problems 3. Identify learning styles and models 4. Formulate session objectives 5. Plan for an effective teaching session 6. Structuring presentation 7. Creating a positive teaching and learning environment 8. Teaching communication skills 9. Identify the updates in management of patients on peritoneal dialysis therapy.

World Diabetes Day
The world celebrates world diabetes day every year on 14 November. The theme for world diabetes day in 2019 was "The family and diabetes". Over 425 million people around the world are currently living with diabetes. Most of these cases are type 2 diabetes, which is largely preventable through regular physical activity, healthy and balanced diet, and promotion of healthy living environments. Families have a key role to play in addressing the modifiable risk factors for type 2 diabetes, and therefore they need to be provided, with the education, resources and environments to live a healthy lifestyle. A number of governorates celebrated this day through activities in the health care facilities and community. The activities were in the form of lectures, workshops, symposiums, exhibitions and campaigns for the health care professionals and the public.

International Day of People with Disability (IDPWD) -3 rd December 2019
The ministry of health in Oman also celebrated this day like the rest of the world. Various governorates along with stakeholders from different institutions concerned with disability, conducted health education regarding health care provision for the persons with disability. There was a practical demonstration, as well as distribution of education pamphlets on hand hygiene techniques by the department of infection control. An eye screening camp conducted for the general public and hospital staff, and any newly diagnosed eye disorders in these patients were referred for detailed eye checkup at health centers.

World Hearing Day 3 rd -March 2019
This is an advocacy event celebrated each year. The aim of this day is to raise awareness and improve access to services for hearing loss, and to promote ear and hearing care at national and community levels across the world. Every year, the national ear health care program guides the governorate to raise awareness in the community on, hearing related problems, ways to prevent hearing loss, the importance of hearing check-ups, and the use of hearing aids. Screening for hearing loss was conducted in all governorates, (by using audiometer) for children in schools, as well for geriatric patients in the community (in PHCs and private sector health institutions).
Another activity carried out was giving presentation on common ear diseases and ear health care to general-public, school students, and health workers, by the health educators and ENT consultants. In addition, one of the Governorate carried out activities on stage, which included games and songs.

World Mental Health Day-10 th October 2019
Mental health section in the DNCD department celebrated the "World mental health day" for year 2019 by producing public educational and awareness messages that were released in social media channels and the E-health gate of MOH. Around five awareness messages have been produced and released till date.
In addition, a poster (in Arabic) focusing on the concept of well-being entitled "How to recognize and deal with the stigma of mental illness", was developed and it will be published at the beginning of 2020.

Increasing Thyroid Cancer Incidence in Oman: A Joinpoint Trend Analysis
This study was carried out by analysing data generated by the national populationbased cancer registry covering the entire Omani population mostly through an active data collection system.
It is the first report to evaluate thyroid cancer epidemiology in Oman, its trends over 20-year using log-linear joinpoint regression models, incidence projections by gender for the next 20 years and PAF for thyroid that is accounted by exposure to obesity and non-smoking status. The study concluded that the incidence of thyroid cancer in Oman is of moderate rate compared to regional and international published figures, with evidence of increasing trend in women but not in men. Significant amount of thyroid cancer can be prevented by controlling obesity, which requires the whole risk factor approach for control, not just for thyroid cancer but also other chronic diseases that have obesity as an etiological factor.
It has been published in Oman Medical Journal and can be found at the link below: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029156/

Study on knowledge of Omanis employees in the various ministries and private sector institutions regarding, common non-communicable diseases (NCDs), their risk factors as well as their knowledge, attitudes and practice towards the National non-communicable diseases screening program in Oman.
A quantitative cross-sectional study looking at the knowledge of NCDs and their risk factors and knowledge attitude and practice of the National screening program for NCDs and barriers to its uptake, was conducted between November 2019 to January 2020 among the Omani staff of the various government ministries and the private sector institutions An electronically administered questionnaire (in Arabic), to the selected staff in the sample from four government ministries and two private sector institutions was used to collect the survey data.
The aim of the study was to assess, describe and explore the knowledge of the Omani employees regarding the NCDs, their risk factors and their knowledge attitude and practice towards the national non-communicable disease-screening program. This would give an idea regarding the awareness and uptake of the national NCD screening program, as well as the drivers and barriers to its uptake . This in turn would help ministry of health to assist in building an effective, evidence-based health policy for the program.
Status in2019: The fieldwork has been completed and data analysis and study writing is ongoing. Achieving universal health coverage, including quality essential service coverage and financial protection for all, is target 3.8 of the sustainable development goals (SDG). Service coverage within universal health coverage can be measured by an index of essential health service coverage indicators selected by the UN for measuring SDG 3.8.1.

Universal Health Coverage and the Service Coverage Index
These 16 tracer indicators include four from within each of the categories of reproductive, maternal, newborn, and child health; infectious disease; non-communicable diseases; and service capacity and access

Report Highlights
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UHC SCI Global Monitoring report 2019
Source WHO:https://www.who.int/healthinfo/universal_health_coverage/report/uhc_report_2019.pdf The UHC service coverage index (SCI), has increased from a global average of 45 (of 100) in 2000 to 66 in 2017. All regions and all income groups recorded gains. Progress has been greatest in lower income countries, starting from a lower base and mainly driven by interventions for infectious diseases and, to a lesser extent, for reproductive, maternal, newborn, and child health services. The poorest countries, and those affected by conflict, were generally found to lag far behind Globally and for many countries, the pace of progress especially for low-income countries (which requires considerable strengthening of health systems to provide UHC) has slowed since 2010. The UHC SCI increased the fastest in countries with lower initial values in 2000, but rates of change varied substantially. Country-level UHC SCI values in 2017 varied often substantially within WHO regions In 2017, between one-third and half the world's population (33% to 49%) were covered by essential health services. Large gaps between high-income and low-income countries persisted over time on the service capacity and access component of the UHC SC.
Of the index's four components, infectious disease coverage improved the fastest. Globally, since 2000, the infectious disease component of the UHC SCI increased fastest in low-and low middle-income countries The reproductive, maternal, neonatal, and child health subcomponent of the UHC SCI improved the fastest in low-income countries. While absolute progress on the non -communicable disease UHC SCI component was not large for any income group, high-income countries saw somewhat faster gains since 2000.
Large out-of-pocket spending in relation to household consumption or income, increased continuously between 2000 and 2015. The proportion of the population with out-of-pocket spending exceeding 10% of their household budget rose from 9.4% to 12.7%, and the proportion with out-of-pocket spending exceeding 25% rose from 1.7% to 2.9%. The percentage of the population impoverished by out-of-pocket health spending increased from 1.8% in 2000 to 2.5% in 2015 If recent trends continue to 2030, the world is likely fall well below the SDG target of universal health coverage for all. Anchored by a clear goal, the initiative seeks to ensure universal health coverage involving access to quality and affordable care for mental health conditions in 12 priority countries to 100 million more people. The WHO special initiative for mental health (working in partnership with member states, local, and international partners, as well as organizations of people with lived experience), will advance mental health policies, advocacy and human rights, and scale up quality interventions and services for individuals with mental health conditions, including substance use and neurological disorders. This WHO special initiative for mental health is summarized in Figure 1, which demonstrates how the programme will contribute towards the wider goals of the GPW13 and the sustainable development goals (SDGs) Every personin every country in the worldshould have the opportunity to live a long and healthy life. Healthy ageing is about creating the environments and opportunities that enable people to be and do what they value throughout their lives. Everybody can experience healthy ageing. Being free of disease or infirmity is not a requirement for healthy ageing, as many older adults have one or more health conditions that, when well controlled, have little influence on their wellbeing.

WHO Special Initiative for Mental Health
WHO defines healthy ageing "as the process of developing and maintaining the functional ability that enables wellbeing in older age." Functional ability is about having the capabilities that enable all people to be and do what they have reason to value. This includes a person's ability to: • meet their basic needs; • learn, grow and make decisions; • be mobile; • build and maintain relationships; and • contribute to society.
Functional ability is made up of the intrinsic capacity of the individual, relevant environmental characteristics and the interaction between them. Intrinsic capacity comprises all the mental and physical capacities that a person can draw on and includes their ability to walk, think, see, hear and remember. The level of intrinsic capacity is influenced, by a number of factors, such as the presence of diseases, injuries and age-related changes. Environments include the home, community and broader society, and all the factors within them such as the built environment, people and their relationships, attitudes and values, health and social policies, the systems that support them and the services that they implement. Being able to live in environments that support and maintain your intrinsic capacity and functional ability is key to healthy ageing. Healthy ageing, (2015-2030) emphasizes the need for action across multiple sectors and enabling older people to remain a resource to their families, communities and economies and replaces the World Health Organization's previous "Active ageing: a policy framework" developed in 2002. Populations around the world are ageing at a faster pace than in the past and this demographic transition will have an impact on almost all aspects of society. At the same time, all countries and stakeholders have pledged under the 2030 agenda for sustainable development that no one will be left behind, and are determined to ensure that every human being can fulfil their potential in dignity and equality and in a healthy environment.
Therefore, a decade of concerted global action on healthy ageing is urgently needed, since many of the elderly do not have access to even the basic resources necessary for a life of meaning and of dignity. While many others confront multiple barriers that prevent their full participation in society.
The WHO "Decade of healthy ageing (2020-2030)", thus is an opportunity to bring together governments, civil society, international agencies, professionals, academia, the media, and the private sector for ten years of concerted, catalytic and collaborative action to improve the lives of older people, their families, and the communities in which they live The WHO has listed ten priorities, which provide the path forward for a "Decade of action on healthy ageing". These are concrete actions, which are needed to achieve the objectives of the WHO Global strategy and action plan on ageing and health, for healthy ageing to become a reality.
Each priority is crucial for getting the world to the point where it can take on a decade of concerted action. Many of them are inextricably linked, and all will require collaboration with many key partners. Healthy ageing will not become a reality without focused global action. • There are 466 million people in the world with disabling hearing loss This is over 5% of the world's population; 34 million of these people are children. Unless action is taken, by 2030, there will be nearly 630 million people with disabling hearing loss. By 2050, the number could rise to over 900 million. Disabling hearing loss is defined as follows: • Adults (15 years and older): hearing loss greater than 40 decibels (dB) in the better hearing ear; • Children (0 -14 years of age): hearing loss greater than 30 dB in the better hearing ear There are significant costs associated with the impacts of unaddressed hearing loss. These include costs to the health, education and employment sectors as well as the costs associated with lost productivity. Interventions to address hearing loss including prevention, screening and provision of hearing devices are cost effective • 34 million children have disabling hearing loss It is estimated that up to five out of every 1000 babies are born with hearing loss or acquire it soon after birth. Hearing loss can have a significant impact on a child's development and educational achievements. Early identification of such hearing loss followed by prompt and suitable interventions can help to ensure that children with deafness and hearing loss enjoy equal opportunities in society • Chronic ear infections are a leading cause of hearing loss Over 30% of hearing loss in children is caused by diseases such as measles, mumps, rubella, meningitis and ear infections. It is estimated, that up to 330 million people suffer with chronic ear infections or chronic otitis media globally. When left untreated, chronic ear infections lead to hearing loss and can cause life-threatening complications and mortality. Chronic ear infections are preventable, and can be managed effectively through medical and surgical interventions • Nearly 1 out of every 3 people over 65 years are affected by disabling hearing loss Left untreated, hearing loss can lead to people being excluded from the most basic communication, thereby contributing to feelings of loneliness, frustration and social isolation. Hearing loss in the elderly is linked with early cognitive decline and dementia. Age-related hearing loss can be managed effectively through a variety of means, including hearing aids. • Noise is a major avoidable cause of hearing loss It is estimated that 1.1 billion people (aged between 12-35 years) are at risk of developing hearing loss due to noise exposure in recreational settings such as concerts and sporting events and with personal audio devices. Regular exposure to loud sounds for prolonged periods poses a serious threat of irreversible hearing loss. This is largely preventable through raising awareness of risks, legislation and following safe listening practices Page 43

Facts on deafness (Source WHO)
• Hearing loss can be caused by occupational noise and the use of ototoxic medications In many places, occupational noise, such as the loud sounds of machinery and explosions, has become the most compensated occupational hazard. Occupational noise can largely be prevented through improved awareness of the danger it poses and use of personal protective devices. Some commonly used medicines (such as aminoglycosides and certain anti-malarial medicines) can also lead to irreversible hearing loss. Ototoxicity can be prevented by raising awareness of its risks among health care providers and by the rational use of drugs.
• People with hearing loss can benefit from devices such as hearing aids and cochlear implants Current production of hearing aids meets less than 10% of the global need, and in developing countries, this figure is less than 3%. It is estimated that there are 72 million people who could potentially benefit from the use of a hearing device • Sign language and captioning services facilitate communication with deaf and hard of hearing people Deaf people often use sign language as a means of communication. Family members, medical professionals, teachers and employers should be encouraged to learn signs/sign language in order to facilitate communication with deaf people. The use of loop systems in classrooms and public places, as well as the provision of captions on audio-visual media, are important for improving the accessibility of communication for people with hearing loss.
• 60% of childhood hearing loss is preventable through public health actions Strategies for the prevention of hearing loss include: