283 520 km2 Cultural diversity Great biodiversity 15’000.000 hab

Life expectancy: 77 years (INEC, 2011)

GENERAL MORTALITY

GENDER ANALYSIS MEN MORTALITY WOMEN MORTALITY

Diabetes estimated prevalence: 4 Diabetes estimated prevalence: 4.8 – 6% (>18ª) AHT: estimated prevalence: 27% (>35ª) Over weight scholars 29% (ENSANUT Survey 2013 Incorporar diferencias por género

VICEMINISTTRY OF GOBERNANZE NCD NATIONAL STRATEGY 2013 NACIONAL SECRETARIAT OF PUBLICA HEALTH SURVEILLANCE NCD NATIONAL STRATEGY 2013 6

NCD NATIONAL STRATEGY: 2013-2017 Strategyc information: epidemiological suveillance, research and M&E. Governance and multisectorial coordination Health promotion and prevention Diagnosis, Treatment, care (Universal Access) Social Participation 2012 Change the structure of the MOH from vertical programs to horizontal strategies. Incorporar la meta de estrategia. Acceso universal a atención,Cuidados paliativos

Visión En el año 2017 la población del Ecuador ha adoptado una cultura alimentaria, física, de consumo y autocuidado más saludable, que posibilita la disminución de los factores de riesgo para las enfermedades no transmisibles, la prevención de complicaciones de las ENT y el disfrute de una vida sana y activa, gracias a una respuesta nacional, multisectorial, coordinada y con políticas públicas en ejecución, que garantizan, con enfoque de género y derechos humanos, el acceso universal a la promoción, prevención y atención integral de salud.   Misión Responder de manera integral a las necesidades de las personas expuestas y a las que viven con enfermedades crónicas no transmisibles en el Ecuador para garantizar su derecho a la salud y el buen vivir, mediante una gestión multisectorial coordinada para la promoción de la salud, prevención de la enfermedad, manejo integral de servicios de calidad y la información estratégica para la orientación de intervenciones.

STRATEGY AND NATIONAL DEVELOPMENT PLAN TARGETS DIABETES: Avoid the expected increase in specific mortality rate 30-70 years 8.36% diabetes (Baseline: 34.3 per 100,000 with an average annual increase of 0.78 years from 2006 to 2011, low total the rate at 3.13 in 4 years) ISQUEMIC HEART DISEASES: Keep downward trend of the specific death rate of 30-70 years ischemic heart disease in 13% (Baseline: 12.6 per 100,000 with an average annual decrease of 0.41 based on 25 % decrease of average 2006-2011, low total rate at 1.64 in 4 years) Incorporar la meta de estrategia. Acceso universal a atención,Cuidados paliativos

HEALTH PROMOTION Tobacco law Schools: Regulation of school food, Increasing since 60 to 90 minutes/week of physical activity at school. Local government initiatives: promote cycling and safe spaces to increase the physical activity Regulation and control of advertising, promotion and processed food labeling National survey about risk factors (similar STEPs). Incorporar la meta de estrategia. Acceso universal a atención,Cuidados paliativos

Law for the Regulation and Control of Tobacco: taxes, marketing, selling restrictions, forbidden under 18 years, and restricted spaces. Approved 2011 Regulation and control of advertising, promotion and processed food labeling / …2013 Regulation of Alcohol Consumption 2010: (Violence and injury), not under 18 y, not Sunday, 2h00, taxes, marketing. Ministry Coordinator of the Production, Industry , Trade Ministry Coordinator of Social Development National Communications Secretariat ARCSA: Regulation and Control Agency Health Tax National Secretariat

Barriers and limitations Favorable Conditions Special political moment in Ecuador since 2006: New Constitution with a Human Rights Focusing, more resources for public health, free access to all health services and treatments. President and legislators of the National Assembly are from the same political party: possible approve laws. High level of acceptance of the government High capacity of negotiation with the productive sector International context Mutisectorial high level committee Media campaigns goes along the regulations Barriers and limitations Industry: increase costs, decrease work places, lost of money of packages that are still ready. No monitoring the law enforcement. Cultural changue, change of habits, change of stereotypes: need expensive communicational strategies Don't have measurements of the impact of the initiatives

DIABETIC FOOT DISABILITY 65% of diabetic foot amputation  GOAL 30% II & III LEVEL (HOSPITALS): Creation of Diabetic Foot Units with multidisciplinary teams: diabetologist, vascular surgeon, plastic surgeon, orthopedic surgeon, nurse, nutritionist. Treatment with human epidermal growth factor recombinant (Alliance wit Cuba) I LEVEL: Primary Atention Services: Improve capacities to indetify on risk patients and cases in the comunity with health teams and health promotors