History
The WHO Countrywide Integrated Noncommunicable Diseases (CINDI) programme began in the early 1980s with preparatory meetings, and gradually countries signed an agreement with the WHO Regional Office for Europe to take part. The protocol and guidelines for the programme were prepared and published in 1987. (Leparski, E. & Nüssel, E., ed. CINDI Countrywide Integrated noncommunicable Diseases Intervention Programme. Protocol and guidelines for monitoring and evaluation procedures. Berlin, Springer-Verlag, 1987)
Since then, the CINDI programme has grown to be a major European collaborative effort for the prevention of noncommunicable diseases and the promotion of health in the WHO European Region. It is also one of the main vehicles for implementing the regional policy for health for all.
CINDI programme focuses its action on the reduction of levels of major noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes through coordinated comprehensive health promotion and disease prevention measures. (Countrywide Integrated. Noncommunicable Disease Intervention (CINDI) Programme: protocol and guideline. Copenhagen; 1995)
CINDI programme was a major international collaborative effort to reduce major noncommunicable disease (NCD). It was established by the World Health Organization within the framework of the Health for All global health movement. It was one of the most active WHO programmes in influencing health professionals to adopt a comprehensive disease prevention and health promotion strategy and in translating theoretical evidence into practical action (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016)
The concept of the integrated approach towards the prevention and control of noncommunicable diseases was a very innovative idea at that time in 80’s and no experience was available on how to apply the existing knowledge among large population groups. The approach implies recognition that a number of risk factors are common to major noncommunicable diseases (NCD) and are related to lifestyle. The measures are aimed to favourably influence health related lifestyles in communities and to prevent and control common risk factors (such as hypertension, hyperlipidemia, obesity, smoking, alcohol abuse, sedentary lifestyle). In addirion CINDI has been one of the most active WHO programmes in influencing health professionals to adopt Health For All principles and in mobilizing them for action. (Countrywide Integrated. Noncommunicable Disease Intervention (CINDI) Programme: protocol and guideline. Copenhagen; 1995)
The main objective of CINDI programme was based on the population strategy for simultaneously reducing prevalence of the common risk factors of major NCD, such as smoking, unbalanced nutrition, alcohol abuse, physical inactivity and psychosocial stress. CINDI's main objective focused on the common risk factors and related lifestyle changes in the population, thus emphasizing primary prevention and healthy promotion. (World Health Organization. Regional Office for Europe, Kaunas University of Medicine & Health Promotion Agency for Northern Ireland. (2004). A strategy to prevent chronic disease in Europe: a focus on public health action : the CINDI vision. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107570)
The CINDI programme has covered six main practical objectives.
• To achieve a coordinated approach to the prevention or reduction of NCDs. This requires the establishment of a suitable organizational structure for implementing the programme and the drawing up of national guidelines for its further development.
• To determine the relative importance of common risk factors and their influence on NCD in the nationa setting as a basis for the inclusion of preventive programmes among the different sectors of the national health system and hence the identification of possible means of intervention.
• To develop a comprehensive approach to public education, a service structure and other strategies for the prevention and control of NCDs. The major target groups, intervention channels and strategies should be identified, and guidelines for reaching them set.
• To develop information support for the implementation and monitoring of the programme. This requires the development and use of appropriate indicators of outcome and process in relation to the various risk factors, and the identification of types of NCD.
• To evaluate the results of the programme. This requires the measurement and follow – up of appropriate indicators in the CINDI population in order to assess the process and efectiveness of the programme and to give feedback for its further stregthening.
• To promote research in the prevention and control of NCD, and to establish methods, facilities and activities for this purpose. (World Health Organization. Regional Office for Europe, Kaunas University of Medicine & Health Promotion Agency for Northern Ireland. (2004). A strategy to prevent chronic disease in Europe: a focus on public health action : the CINDI vision. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107570)
The aim in each CINDI participating country was to carry out a nationwide programme that integrates and coordinates various strategies and activities. The national programmes were well grounded in the health system of the member countries and had extensive partnerships. This constituted real resources to organize and implement the integrated approach to preventative interventions at country, regional and local levels. (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016)
The main features and strategies of the CINDI programme included (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016):
• evidence based preventative measures that were tested at the community level;
• a policy framework for prevention;
• scientific databases for planning and evaluation;
• organizational structures grounded in the health system;
• trained personnel and guidelines to support preventive practices through primary care;
• linkage with countrywide health promotion and prevention programmes;
• and wide international network of countries, agencies and experts committed to prevention of NCD.
Member countries planned and carried out national CINDI programmes that employ the objectives and strategies outlined above, in cooperation with the international CINDI programme at the WHO Regional Office for Europe. (World Health Organization. Regional Office for Europe, Kaunas University of Medicine & Health Promotion Agency for Northern Ireland. (2004). A strategy to prevent chronic disease in Europe: a focus on public health action : the CINDI vision. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107570)
Basic guidance for countries on the strategy for the implementation of the integrated approach was provided by an international CINDI protocol (Countrywide Integrated. Noncommunicable Disease Intervention (CINDI) Programme: protocol and guideline. Copenhagen; 1995;Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016)
Demonstration areas. The degree of the adaptation of the protocol varied from country to country according to the culture, socioeconomic characteristics. Most countries used a demonstration area for testing and training in support of the national programme. With this regard demonstration areas were a basic component of national CINDI programmes. A demonstration area was a geographically defined area where intervention approaches were tested on a limited scale and their feasibility was evaluated. 105 demonstration areas across the CINDI network were established.
The main intervention target was the community. The settings for intervention ranged from the national level to regional and local level and included communities, workplaces, kindergartens, schools, health centres and other settings.
Demonstration areas served to create models that could be used by other communities across the country, collect information for programme monitoring and evaluation, generate new intervention knowledge and provide opportunities to build skills. (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016)
Multisectorial approach. CINDI Programme strategies aimed to integrate activities relating to different parts of the health sector (health promotion, disease prevention, treatment, and rehabilitation) and some of those undertaken by other sectors. These activities were focused on: Health services, Public education, Community organization, Regulation. (World Health Organization. Regional Office for Europe, Kaunas University of Medicine & Health Promotion Agency for Northern Ireland. (2004). A strategy to prevent chronic disease in Europe: a focus on public health action : the CINDI vision. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107570)
The main strategies for implementatio of CINDI Programme were as following: (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016):
• policy development,
• legislation and coordination,
• marketing and organizational development,
• public education and use of mass media,
• practice guidelines,
• professional education and involvement,
• monitoring,
• evaluation,
• research
The WHO Countrywide Integrated Noncommunicable Diseases (CINDI) programme began in the early 1980s with preparatory meetings, and gradually countries signed an agreement with the WHO Regional Office for Europe to take part. The protocol and guidelines for the programme were prepared and published in 1987. (Leparski, E. & Nüssel, E., ed. CINDI Countrywide Integrated noncommunicable Diseases Intervention Programme. Protocol and guidelines for monitoring and evaluation procedures. Berlin, Springer-Verlag, 1987)
Since then, the CINDI programme has grown to be a major European collaborative effort for the prevention of noncommunicable diseases and the promotion of health in the WHO European Region. It is also one of the main vehicles for implementing the regional policy for health for all.
CINDI programme focuses its action on the reduction of levels of major noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes through coordinated comprehensive health promotion and disease prevention measures. (Countrywide Integrated. Noncommunicable Disease Intervention (CINDI) Programme: protocol and guideline. Copenhagen; 1995)
CINDI programme was a major international collaborative effort to reduce major noncommunicable disease (NCD). It was established by the World Health Organization within the framework of the Health for All global health movement. It was one of the most active WHO programmes in influencing health professionals to adopt a comprehensive disease prevention and health promotion strategy and in translating theoretical evidence into practical action (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016)
The concept of the integrated approach towards the prevention and control of noncommunicable diseases was a very innovative idea at that time in 80’s and no experience was available on how to apply the existing knowledge among large population groups. The approach implies recognition that a number of risk factors are common to major noncommunicable diseases (NCD) and are related to lifestyle. The measures are aimed to favourably influence health related lifestyles in communities and to prevent and control common risk factors (such as hypertension, hyperlipidemia, obesity, smoking, alcohol abuse, sedentary lifestyle). In addirion CINDI has been one of the most active WHO programmes in influencing health professionals to adopt Health For All principles and in mobilizing them for action. (Countrywide Integrated. Noncommunicable Disease Intervention (CINDI) Programme: protocol and guideline. Copenhagen; 1995)
The main objective of CINDI programme was based on the population strategy for simultaneously reducing prevalence of the common risk factors of major NCD, such as smoking, unbalanced nutrition, alcohol abuse, physical inactivity and psychosocial stress. CINDI's main objective focused on the common risk factors and related lifestyle changes in the population, thus emphasizing primary prevention and healthy promotion. (World Health Organization. Regional Office for Europe, Kaunas University of Medicine & Health Promotion Agency for Northern Ireland. (2004). A strategy to prevent chronic disease in Europe: a focus on public health action : the CINDI vision. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107570)
The CINDI programme has covered six main practical objectives.
• To achieve a coordinated approach to the prevention or reduction of NCDs. This requires the establishment of a suitable organizational structure for implementing the programme and the drawing up of national guidelines for its further development.
• To determine the relative importance of common risk factors and their influence on NCD in the nationa setting as a basis for the inclusion of preventive programmes among the different sectors of the national health system and hence the identification of possible means of intervention.
• To develop a comprehensive approach to public education, a service structure and other strategies for the prevention and control of NCDs. The major target groups, intervention channels and strategies should be identified, and guidelines for reaching them set.
• To develop information support for the implementation and monitoring of the programme. This requires the development and use of appropriate indicators of outcome and process in relation to the various risk factors, and the identification of types of NCD.
• To evaluate the results of the programme. This requires the measurement and follow – up of appropriate indicators in the CINDI population in order to assess the process and efectiveness of the programme and to give feedback for its further stregthening.
• To promote research in the prevention and control of NCD, and to establish methods, facilities and activities for this purpose. (World Health Organization. Regional Office for Europe, Kaunas University of Medicine & Health Promotion Agency for Northern Ireland. (2004). A strategy to prevent chronic disease in Europe: a focus on public health action : the CINDI vision. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107570)
The aim in each CINDI participating country was to carry out a nationwide programme that integrates and coordinates various strategies and activities. The national programmes were well grounded in the health system of the member countries and had extensive partnerships. This constituted real resources to organize and implement the integrated approach to preventative interventions at country, regional and local levels. (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016)
The main features and strategies of the CINDI programme included (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016):
• evidence based preventative measures that were tested at the community level;
• a policy framework for prevention;
• scientific databases for planning and evaluation;
• organizational structures grounded in the health system;
• trained personnel and guidelines to support preventive practices through primary care;
• linkage with countrywide health promotion and prevention programmes;
• and wide international network of countries, agencies and experts committed to prevention of NCD.
Member countries planned and carried out national CINDI programmes that employ the objectives and strategies outlined above, in cooperation with the international CINDI programme at the WHO Regional Office for Europe. (World Health Organization. Regional Office for Europe, Kaunas University of Medicine & Health Promotion Agency for Northern Ireland. (2004). A strategy to prevent chronic disease in Europe: a focus on public health action : the CINDI vision. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107570)
Basic guidance for countries on the strategy for the implementation of the integrated approach was provided by an international CINDI protocol (Countrywide Integrated. Noncommunicable Disease Intervention (CINDI) Programme: protocol and guideline. Copenhagen; 1995;Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016)
Demonstration areas. The degree of the adaptation of the protocol varied from country to country according to the culture, socioeconomic characteristics. Most countries used a demonstration area for testing and training in support of the national programme. With this regard demonstration areas were a basic component of national CINDI programmes. A demonstration area was a geographically defined area where intervention approaches were tested on a limited scale and their feasibility was evaluated. 105 demonstration areas across the CINDI network were established.
The main intervention target was the community. The settings for intervention ranged from the national level to regional and local level and included communities, workplaces, kindergartens, schools, health centres and other settings.
Demonstration areas served to create models that could be used by other communities across the country, collect information for programme monitoring and evaluation, generate new intervention knowledge and provide opportunities to build skills. (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016)
Multisectorial approach. CINDI Programme strategies aimed to integrate activities relating to different parts of the health sector (health promotion, disease prevention, treatment, and rehabilitation) and some of those undertaken by other sectors. These activities were focused on: Health services, Public education, Community organization, Regulation. (World Health Organization. Regional Office for Europe, Kaunas University of Medicine & Health Promotion Agency for Northern Ireland. (2004). A strategy to prevent chronic disease in Europe: a focus on public health action : the CINDI vision. Copenhagen: WHO Regional Office for Europe. https://apps.who.int/iris/handle/10665/107570)
The main strategies for implementatio of CINDI Programme were as following: (Cindi-life Countrywide Integrated Noncommunicable Diseases Intervention. Âncora Editora; 2016):
• policy development,
• legislation and coordination,
• marketing and organizational development,
• public education and use of mass media,
• practice guidelines,
• professional education and involvement,
• monitoring,
• evaluation,
• research