Chronic diseases and health promotion

Part Four - Taking action: essential steps for success

Chapter One: Providing a unifying framework - the role of government

Planning step 2. Spotlight: Indonesia

STEP 2: Formulate and adopt policy

The second planning step, after estimating population need and advocating for action, is to formulate and adopt policy. A policy sets out the vision for prevention and control of the major chronic diseases and provides the basis for action in the next 5- 10 years. It is accompanied by plans and programmes that provide the means for implementing the policy. The main goals of a public health policy for chronic disease prevention and control are similar to those of any health policy:

  • improve the health of the population, especially the most disadvantaged;
  • respond to needs and expectations of people who have chronic diseases;
  • provide financial protection against the costs of ill-health.

In all countries, a national policy and planning framework is essential to give chronic diseases appropriate priority and to organize resources efficiently. At the sub-national level, complementary policies, plans and programmes can be developed at the state, province, district, and/or municipal levels to respond to local circumstances.

Guiding principles
Chronic disease policy should be based on the following guiding principles:

  • comprehensive and integrated public health action;
  • intersectoral action;
  • a life course perspective;
  • stepwise implementation based on local considerations and needs.

SPOTLIGHT: Indonesia's national policy development

For many years the scale of the chronic disease problem in Indonesia had been concealed by a lack of reliable information. Prevention and control activities were scattered, fragmented and lacked coordination. Periodic household surveys later revealed that the proportion of deaths from chronic diseases doubled between 1980 and 2001 (from 25% to 49%). The economic implications and the pressing need to establish an integrated prevention platform at national, district and community levels became clear. In 2001, inspired by the WHO Global Strategy on the Prevention and Control of Noncommunicable Diseases, Indonesia’s Ministry of Health initiated a broad consultative process that resulted in a national consensus on chronic disease policy and strategy. A collaborative network for chronic disease surveillance, prevention and control was established, involving health programmes, professional organizations, nongovernmental organizations, educational institutions and other partners from both the public and private sectors (including those not directly concerned with health). The WHO STEPS manual was translated into Indonesian and implemented as part of the overall surveillance approach.

A national policy and strategy document was published by the Ministry of Health in 2004. The document recommends targeting major diseases that share common risk factors through surveillance, health promotion, prevention and reform of health services. The need for integrated, efficient and sustainable surveillance, prevention and control efforts has been recognized as a vital component of the national health development agenda.