About the CARMEN Network

CARMEN is a network of Ministries of Health of the America working together for the implementation of the Regional Strategy and Plan of Action for NCDs.

:: Vision

CARMEN is an initiative of the Pan American Health Organization and aims to improve the health status of the populations in the Americas by reducing risk factors associated with Non Communicable Diseases (NCDs).

This is attained through the development, implementation, and evaluation of policies, social mobilization and community-based interventions, epidemiological surveillance of NCD risk conditions, and preventive health-care services.

:: Mission

To provide a forum for sharing, learning, and collaborating among the countries of the Americas to reduce the burden of chronic diseases, their risk factors, and underlying determinants.

:: General objectives

The CARMEN Initiative aims to promote and establish comprehensive, integrated NCD prevention and control policies and programs at the national and sub-regional levels in the Americas, in support of the achievement of the Regional Strategy on Chronic Disease Prevention and Control.

The CARMEN Initiative utilizes the guiding principles, strategic approaches and four lines of actions contained in the Regional Strategy:

• Health policy and advocacy
• Health promotion and disease prevention
• Surveillance
• Integrated management of chronic diseases and risk factors.

It also includes: capacity building and training; research; information dissemination; resource mobilization and partnerships; and communications and social marketing.

About CARMEN

CARMEN is a network of countries, organizations and institutions that share the common goal of reducing the burden of noncommunicable diseases and their risk factors through a multidimensional approach focusing on prevention and integrated management of non-communicable diseases (NCDs).

CARMEN stands for “Collaborative Actions for Risk Factor Prevention and Effective Management of Noncommunicable Diseases.” To find out more about the CARMEN network click here:

At the regional and subregional levels, the CARMEN initiative aims to:

• Support the implementation of the Regional Strategy and Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases;
• Serve as the principal agent to collect, analyze and disseminate information and share knowledge about the chronic disease problem and successful strategies for the formulation, execution, and evaluation of NCD policies and programs;
• Promote best practices in health promotion and integrated prevention and control of chronic non communicable diseases;
• Promote and support community participation in chronic disease prevention and control;
• Stimulate and facilitate collaboration and networking among PAHO Member States, organizations, and institutions;
• Coordinate actions with related WHO and PAHO initiatives and networks such as Healthy Municipalities, Healthy Schools, WHO Global Forum and similar initiatives in other regions (e.g. IMAN, MOANA, CINDI, SEANET);
• Integrate the initiative with related resolutions from the PAHO Directing Council and the WHO World Health Assembly.

At the country level, the CARMEN Initiative aims to:

• Raise political support and demonstrate commitment for the prevention of NCDs, their risk factors and determinants as a national public health priority;
• Foster inter-institutional and intersectoral actions and create multidisciplinary teams to carry out the strategies for health promotion and integrated prevention and control of chronic non communicable diseases;
• Conduct a situation analysis of NCDs and their risk factors and periodic monitoring, according to the abilities of each country;
• Establish demonstration sites for interventions for the prevention and control of chronic diseases;
• Implement the recommendations for Member States contained in the Regional Strategy and Plan of Action on an Integrated Approach to the Prevention and Control of Chronic Diseases;
• Support the establishment of various networks (such as nutrition, physical activity, diabetes, etc) for sharing experiences and collaboration within countries.

Who is involved in the CARMEN network?

The CARMEN Network is a vital and inclusive network composed of: PAHO Member States with representation from the Ministry of Health programs on chronic diseases; partner organizations, institutions, and networks both within and outside of the health sector; and PAHO/WHO as the secretariat.

The Biennial Meeting of the CARMEN Network has been held since 1999, where members unite to examine progress, share experiences and stimulate adoption of new strategies to address NCDs.

Why a network for chronic diseases?

• Networking achieves what individual countries may not be able to do alone, and:
• Country initiatives can gain peer recognition and international credibility.
• Countries can pursue common goals as a unified group.
• Innovative designs, implementation, and evaluation tools are more accessible for communities and countries.
• The networking facilitates exchange of experiences and information on technical and management issues, plans cooperative ventures, and launches new activities.
• The CARMEN Network is an arena where continuous improvements in integrated NCD prevention can be achieved.

What are the CARMEN strategies?

The interventions developed within the framework of CARMEN imply the definition of a population space (site, be it provincial or national) and the implementation of actions aimed at preventing risk factors for non-communicable diseases. This involves implementing strategies such as integrated prevention, promotion of health equity, and demonstrative effect.

• Integrated Prevention
• CARMEN advocates for integrated prevention as a central strategic component that simultaneously reduces multiple NCD risk factors at different levels. For practical purposes, an integrated intervention is one that includes the following:
• Simultaneous prevention and reduction of a set of risk factors common to major NCDs;
• Simultaneous use of community resources and health services.
• Combined and balanced efforts for preventive health care and general health promotion, to enable communities to become active participants in decisions concerning their health.
• Strategic consensus-building among different stakeholders-such as governmental, non-governmental, and private sector organizations-in an effort to increase cooperation and responsiveness to population needs.
• Promotion of Health Equity
• Traditionally, chronic diseases have been related to high socioeconomic levels; but currently, there exists sufficient evidence to indicate that this relation has been inverted. Evidence clearly shows that the risk for some NCDs, such as cardiovascular diseases and certain forms of cancers, are higher at low socioeconomic levels, with an apparent increase of this trend in recent years.
• Prevention strategies should consider such underlying influences on health inequalities as education, income distribution, public safety, housing, work environment, employment, social networks, and transportation, among others. It is important that strategies be aimed at reducing overall population risk while simultaneously reducing the gap among different population groups. In many instances, this requires redesigning and evaluating interventions of well-documented efficacy. It also entails identifying and paying special attention to key population groups, such as indigenous peoples, new urban migrants, and women.
• Demonstrative Effect
• Interventions are first introduced in a demonstration area, so that acceptability and effectiveness can be measured in a given context. It is feasible to conduct evaluations by monitoring the impact of NCD risk factors, morbidity, and mortality.
• In this context, the demonstrative effect measures whether the risk factors and mortality from corresponding non-communicable diseases have been modified, and whether the observed changes have occurred within a logical time sequence with regard to the interventions. For practical purposes, it is necessary to:
• Have a basal measurement that allows for later comparisons;
• Have a surveillance system of mortality and risk factors; and
• Make systematic collections of information related to the intervention, in order to evaluate its development.
• Partnerships with academic centers are highly encouraged in order to strengthen evaluation and participation in international research training activities.
• Additional CARMEN documents:

The CARMEN Initiative

National NCD commitments

The 2011 UN Political Declaration on NCDs, adopted in September 2011 by Heads of State and Government during the first UN High-level Meeting on NCDs established a road map of commitments on what governments will do to take domestic action to reduce premature mortality from NCDs. 

In July 2014, Ministers met at the United Nations General Assembly in July 2014 during the second UN High-level Meeting on NCDs and agreed that progress in countries had been largely insufficient and highly uneven. Collectively, they committed to prioritize four immediate domestic actions in 2015 and 2016, in preparation for a third UN High-level Meeting on NCDs in 2018 where will review progress made.

The 2014 UN Outcome Document on NCDs includes four time-bound commitments on when governments will take national action: 1) By 2015, consider setting national NCD targets for 2025 2) By 2015, consider developing national multisectoral policies and plans to achieve the national targets by 2025 3) By 2016, reduce risk factors for NCDs, building on guidance set out in the WHO Global NCD Action Plan 4) By 2016, strengthen health systems to address NCDs through people-centred primary health care and universal health coverage, building on guidance set out in WHO Global NCD Action Plan.

1) By 2015, consider setting national NCD targets for 2025.

2) By 2015, consider developing national multisectoral policies and plans to achieve the national targets by 2025.

3) By 2016, reduce risk factors for NCDs, building on guidance set out in the WHO Global NCD Action Plan.

4) By 2016, strengthen health systems to address NCDs through people-centred primary health care and universal health coverage, building on guidance set out in WHO Global NCD Action Plan.

In January 2015 WHO published the 10 progress indicators which WHO will use to report in 2017 to the United Nations General Assembly. These 10 progress indicators provide further guidance for Member States which actions to prioritize.

Find below relevant documents on how countries can fulfill the 4 time-bound national commitments  in 2015 and 2016. 

How to fulfill national NCD commitments in 2015 and 2016

Global Repository of NCD documents

Tool for Developing, Implementing and Monitoring National Multi-sectoral NCD Action Plans

Tools

PAHO/WHO tools for the achievements of the Time Bound Commitments on NCDs

NCD program planning and policies to reduce risk factors

• Policy briefs for sectors (trade, communications, education, finances…)
• Cancer control. Knowledge into Action. WHO guide for effective programs
• Tools for Developing, Implementing and Monitoring the National Multisectoral Action Plan for NCD Prevention and Control
• Manual for Developing Tobacco Control Legislation in the Region of the Americas
• A Guide for Population-Based Approaches to Increasing Levels of Physical Activity
• PAHO Nutrient Profile Model
• Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children

Surveillance

• STEPs
• GATS
• GYTS
• GSHS
• Manual for Cancer Registry Personnel

Health systems’ response

• PAHO strategic fund and Revolving fund
• Innovative Care for Chronic Conditions: Organizing and Delivering High Quality Care for Chronic NCDs in the Americas
• Prevention of Cardiovascular Disease: Guideline for Assessment and Management of Cardiovascular Risk
• Chronic Care Passport for Professionals
• Building Blocks in Diabetes Education and Control: A Framework for Comprehensive Diabetes Care
• Comprehensive Cervical Cancer Control. A Guide to Essential practice
• Mammography services quality assurance: baseline standards for Latin America and the Caribbean

Capacity Building

Virtual courses on NCDs and Risk Factors prevention and control

• Tobacco and Public Health: From Theory to Practice (EN and ES)
• Virtual Course on Public Health Policy for  Alcohol and Other Substance Use (EN and ES)
• Curso Virtual de Apoyo al automanejo en Diabetes (ES)
• Manejo de la Hipertensión Arterial para Equipos de Atención Primaria (ES)
• Curso de Prevención y Manejo de la Enfermedad Renal Crónica para Equipos del Primer Nivel de Atención (ES and POR)

WEBINARS

PAHO has organized a series of webinars within the CARMEN network to support exchange of information between countries, and to promote the adoption of best practices in NCD and risk factors policies, plans and programs. The series started in July 2017 and will run through December 2017.

The webinars are addressed mainly to CARMEN Network members (NCDs managers and coordinators in the ministries of health and NCD PAHO focal points), but also their colleagues in charge of areas related to NCDs risk factors, as well as other colleagues in the Ministry of Health or other ministries can be invited to participate, accordingly with their interest on the topic of the webinar.

PROGRAM

14 July 2017 – Scientific evidence on the influence of labeling on the perception and choice of foods and beverages (in Spanish).

Speaker: Gastón Ares. Núcleo Interdisciplinario “Alimentación y Bienestar”. Universidad de la República, Uruguay

• Presentation (in Spanish): 

• Summary: 

20 July 2017 – Alcohol marketing regulation 

Speaker: Dr. Maristela Monteiro. Senior Advisor on Alcohol, PAHO/WHO

• Presentation: 

21 November 2017 – Results of the NCD Progress Monitor 2017 and WHO Global Conference on NCDs in Montevideo

Speakers: 

• Dr. Anselm Hennis, Director of the Department of Noncommunicable Diseases and Mental Health, PAHO
• Ms. Silvana Luciani. Noncommunicable Diseases  Unit Chief, PAHO
• Dr. Adriana Blanco. Risk Factors and Nutrition Unit Chief, PAHO

Presentation: 

Note: the program will be updated as the sessions are confirmed.