Draft Sri Lanka National Health Promotion Policy

Draft Sri Lanka National Health Promotion Policy

Table of contents Executive summary...1 Forewords...2 Preamble...3 The Concept for Health Promotion development...4 Guiding Principles...4 Current Sri Lanka Health Challenges...5 New challenges...5 Responding to the challenges...6 Current health promotion implementation...6 Health Promotion Policy...7 Policy statement...7 Vision...7 Mission...7 Goal...7 Policy objectives...8 Strategies...8 National Health Promotion Policy monitoring and evaluation...13

Executive summary Health promotion in Sri Lanka has been very successful during recent decades as shown by the health indicators. Despite the numerous successes over the years, the integrity of the Health System has been subjected to many challenges. Sri Lanka is already facing emerging challenges due to demographic, epidemiological, technological and socio-economic transitions. The disease burden has started to shift rapidly towards life style and environmental related non-communicable diseases. These are chronic and high cost and will cause more and perhaps unaffordable burden to the country s health care expenditure, under the free of charge health services policy. The previous success of health development increased the life expectancy of Sri Lankan people to 72 for male and 76 for women but the estimated healthy life expectancy at birth of all Sri Lanka population is only 61.6 Health is affected by biological, psychological, chemical, physical, social, cultural and economic factors in people s normal living environments and people s lifestyles. With the current rapid changing demographic, social and economic context and the epidemiological pattern of diseases, the previous health promotion interventions which found to be effective in the past may not be effective enough now and the future to address all the important determinants that affect health. Promoting people s health must be the joint responsibility of all the social actors. These challenges require significant changes in the national health system toward new effective health promotion which has been accepted worldwide as the most cost effective measure to reduce the disease burden of the people and the burden of the nation on the increasing cost for treatment of diseases. The development of this National Health Promotion Policy is based on (a) the evidences from Sri Lanka health promotion situation analysis, (b) the international accepted concept, the WHO guiding principle for health promotion and the World Health Assembly resolutions and WHO South East Asia Regional Committee Resolution, and (c) the State Policy and Strategy for Health and the Health Master Plan 2007-2016. The key strategies for health promotion are: advocacy and mediate between different interests in society for the pursuit of health; empower and enable individual and communities to take control over their own health and all determinants of health; improve the health promotion management, health promotion interventions, programmes, plans and implementation; and partnership, networking, alliance building and integration of health promotion activities across sectors. In Sri Lanka, other non health government sectors and NGOs are currently active implementing their community development projects with the community empowerment concept that resemble the healthy setting approach for health promotion. These projects are the high potential entry points and good opportunity for the formal commencement of the new effective setting approach health promotion and the holistic life course health promotion. It is also an opportunity for partnerships and alliance building for concerted action to promote health of the nation. 1

This policy is formulated to promote health and well-being of the people by enabling all people to be responsible for their own health and address the broad determinants of health through the concerted actions of health and all other sectors to make Sri Lanka a Health Promoting Nation where all the citizens actively participate in health promotion activities continuously for a healthy life expectancy. The policy objectives are as follow : 1. To strengthen leaderships for health promotion at all levels and all sectors through advocacy. 2. To mobilize the society and create nationwide health promotion actions. 3. To develop and implement effective comprehensive holistic and multisectoral approach health promotion interventions. 4. To establish an effective system and mechanism for health promotion management and coordination at all levels. 5. To build capacity for health promotion at all levels and across sectors. 6. To improve financing and resources allocation and utilization for health promotion. 7. To establish an evidence-base for health promotion effectiveness. Various strategies have been developed for the attainment of each objective focus on the multi-sectoral comprehensive approach and participation of all stakeholders and the people themselves. This National Health Promotion Policy will be monitored and evaluated at all levels. Participatory monitoring and evaluation will be encouraged at implementation level. The National Health Promotion Consortium and the National Health Council will be responsible for the regular monitoring and evaluation of the implementation of this National Health Promotion Policy. Implementation of this policy will also be monitored regularly as part of the overall process of monitoring the activities of the Government and Ministries and covering various sectors and levels of government. Forewords The health system in Sri Lanka has realized the importance of health promotion to achieve its goals. This National Health Promotion Policy document is the outcome of a series of extensive policy development process which has been initiated and planned as a project in the National Health Master Plan. The development of this National Health Promotion Policy is based on (a) the evidences from Sri Lanka health promotion situation analysis (b) the international accepted concept, the WHO guiding principle for health promotion, the World Health Assembly resolutions and WHO South East Asia Regional Committee Resolution, and (c) the State Policy and Strategy for Health and the Health Master Plan 2007-2016. The situation analysis was done by reviewing numerous existing literatures, reports and documents related to health promotions in Sri Lanka. Additional information have been collected by interviewing several relevant persons including politicians, health and health promotion related administrators and practitioners at all levels across 2

sectors, health volunteers and community members. Field visits were also made to several levels of health care settings and community development programmes. The policy development process involved several consultations with all level of administrators of all relevant bureaus and technical units in the Ministry of Health care and Nutrition, Ministry of Education, Ministry of Nation Building and Ministry of Labour. Health mangers and service providers at all levels, Specialists from Universities and the Institute of National Health Science, NGOs, International development partners and a number of influential people with key roles in health promotion in Sri Lanka. This policy document provides the policy objectives and strategic framework for the development of an innovative multisectoral health promotion approach, health promotion infrastructure and direction for health promotion approach and effective intervention development. Implementing the policy must be an integral part of the health and social development management of all relevant sectors and not be seen as an additional piece of bureaucracy. It will facilitate, support and complement to the attainment of objectives and development goals of all sectors and the Nation. Health promotion is a living process and needs continuous development. All health and social development partners have a common role for the implementation, monitoring, evaluation and further development of this policy and to contribute to the achievement of National health goal toward a healthier nation. Preamble A healthy population is an important precondition for economic growth and competitiveness of the country. Health is affected by biological, psychological, chemical, physical, social, cultural and economic factors in people s normal living environments and people s lifestyles, Addressing these broad determinants of health that lie outside the hands of the health sector is the joint responsibility of all the social actors. Health care alone is not enough to advance people's good health. Promoting people s health as a component of social development is an integral part of the national health system and an integral element in overall sustainable development. Health factors have to be taken into account in all decision making affecting society and in all policies. With the current complex and dynamic changes of the context for health promotion and changes of the epidemiological diseases pattern in the country, couple with rapid increase of life style and socio economic and environment factors related illness, the health promotion interventions should be designed to address all determinants that affect health of the people. The health promotion system should be developed to support the multisectoral participatory health promotion. This policy is a part of the National Health Master Plan, builds upon the evidences from Sri Lanka health promotion situation analysis and based on the concept of health promotion in the Ottawa Charter, the Recommendations of the subsequent global health promotion conferences and the Bangkok Charter for health promotion and the WHO guiding principle for health promotion and WHO South-East Asia Region s 3

Regional framework for health promotion, and builds in accordance with and support the implementation of the State Policy and Strategy for Health and the Health Master Plan 2007-2016. It also builds in responding to the World Health Assembly Resolutions WHA42.44, WHA51.12, WHA57.16, WHA59, EB117.R9, EB120/12 and WHO Regional Committee Resolution SEA/RC59.R4 which called Member States and WHO to give priority to strengthening health promotion. The Concept for Health Promotion development According to the Ottawa charter, Health Promotion is defined as a comprehensive social and political process of enabling people to increase control over and improve their health. It embraces not only action to strengthen individual skills and capabilities, but also actions to change social, environmental, and economic conditions to alleviate their impact on public and individual health, which mean not only the absence of infirmity or disease but also a state of physical fitness, efficient functioning, the capacity to perform at more productive and satisfying level, and the opportunity to live out their life span with vigor and stamina, longevity with quality of life, mental and social well-being. According to the Ottawa charter, the key strategies for health promotion are advocacy for health, enable people to take control of all determinants of health and mediate between different interests in society for the pursuit of health. The 5 key action areas for health promotion are : building healthy public policies; creating supportive environments for health; strengthen community actions; developing personal skills; and reorient health services. To accelerate these key actions into practice, during the 6 th Global Conference on Health Promotion in August 2004 in Bangkok, the Bangkok Charter was adopted. The strategies for health promotion in the Bangkok Charter are: 1. Advocacy for health based on human rights and solidarity ; 2. Invest in sustainable policies, actions and infrastructures to address the determinants of health 3. Build Capacity for policy development, leadership, health promotion practice, knowledge transfer and research, and health literacy ; 4. Regulate and legislate to ensure a high level of protection from harm and enable equal opportunity for health and well being for all people ; 5. Partner and build alliances with public, private, NGOs and international organizations and civil society to create sustainable actions. The concepts settings of everyday life and course of life health promotion have been proven most effective and play a key role in current health promotion programmes worldwide and will be the key approaches for health promotion in Sri Lanka as well. Guiding Principles This health promotion policy development is guided by the following principles: Health as a fundamental Human Right and sound social investment; 4

Equity and Social justice in health promotion; The individual, public and private sectors has a social responsibility to build up their own health and the health of the society; Empowerment of the individual and communities and their participation are pre-requisite; Partnership, networking and alliance building for health; Development of healthy public policy; Integration of health promotion activities across sectors; Development of infrastructure for health promotion; Professional ethics and standards These guiding principles will be incorporated and operationalized through the strategies given in the policy. Current Sri Lanka Health Challenges New challenges Health promotion in Sri Lanka has been very successful during recent decades as shown by the health indicators. Despite the numerous successes over the years, the integrity of the Health System has been subjected to many challenges. Sri Lanka is already facing emerging challenges due to demographic, epidemiological, technological and socio-economic transitions. Issues such as morbidity due to certain communicable diseases and problems of malnutrition are still widely prevalent. The disease burden has started to shift rapidly towards non-communicable diseases, morbidity and mortality due to certain noncommunicable diseases and life style related illness. Cardiovascular diseases, diabetes, mental health, high levels of tobacco and alcohol abuse, cancers, accidents and injuries have increased in a proportionate manner and causing a double burden of disease. With the rapid increasing of the ageing population, which will make increasing demands on the health service, and the rapid increasing of non communicable diseases, which are chronic and high cost, while the number of working age group is starting to decrease in the near future, the dependency rate is going to increase and will cause more and perhaps unaffordable burden to the country s health care expenditure under the free of charge services policy. According to the data from the WHO global comparison of the estimated healthy life expectancy among countries in 2002, while the life expectancy of Sri Lankan people is 72 for male and 76 for women, the estimated healthy life expectancy at birth of all Sri Lanka population is only 61.6 The male healthy life expectancy at birth is 59.2, while the female healthy life expectancy at birth is 64.0. This clearly shows that while the life expectancy is increasing but the added life is the unhealthy life with more suffering from un-prevented preventable chronic illness and low quality of life. These challenges require significant changes in the national health system toward new effective health promotion, improve the health promotion management and significant changes in health promotion interventions, programmes, plans and implementation. 5

Responding to the challenges Health promotion, which has been accepted worldwide as the most cost effective measure to reduce the prevalence of non communicable diseases and disabilities has already been recognized and stated in the National Development Policy and Plan and the National Health Master Plan as the key direction of the health system reform and development. Development of National Health Promotion Policy is one important project that has been indicated in the National Health Master Plan. Current health promotion implementation Sri Lanka has adequate and strong infrastructure and successful health promotion experience. But with the current rapid changing demographic, social and economic context and the epidemiological pattern of diseases, the previous effective interventions for health promotion which are mainly based on the provision of services by public health midwifes and public health inspectors under various vertical programmes are not effective enough and do not directly address all the important determinants that affect health. Collaboration and coordination among sectors are insufficient. The new multisectoral comprehensive health promotion approach, the life course holistic approach and the setting approach health promotion still have not been formally started. Some initiatives have been created and implementing in some areas by local health personnel with limited support from central technical units. Other non health government sectors and NGOs are also implementing their community development projects with the community empowerment concept that resemble the healthy setting approach. These projects are focusing mainly on some specific health issues or issues which are the socio-economic determinants of health. Some projects are strongly supporting by the government. These projects are the high potential entry points and good opportunity for the formal commencement of the setting approach health promotion and the holistic life course health promotion. It is also an opportunity for partnerships, alliance building and budgets sharing with the other existing projects and to start some community self funding projects by the multisectoral community empowerment process. The policy support from the central government and high level administration is in placed but the leadership is still insufficient at all levels. Policy advocacy and technical support for Provincial Governments and decentralization of authority for health promotion decision are essential but still insufficient. Laws and legislations that support health promotion still have not been effectively enforced or implemented. Reform of the health system, re-orientation of health services and re-organization of the Ministry of Health are in the National Health Master Plan and should be developed toward health promotion and facilitate the integration of all relevant technical issues and the multisectoral participation. An effective coordinating and managerial mechanism for health promotion is urgently needed to be developed at all levels. A high capacity National central unit for health promotion collaboration and coordination is needed to be established to facilitate and support health promotion development in the country. Capacity building for health personnel and all other partners and a health promotion knowledge management system are needed for the development of effective intervention and implementation. 6

Establishment of a sustainable health promotion financial system is essential to ensure adequate and sustainable health promotion in the country. Health Promotion Policy Policy statement The Government of Sri Lanka recognizes the important of health promotion as it is the most cost effective strategy to foster a healthy nation and will - make the promotion of health a core responsibility for all of the government sectors and put health promotion central to the national development agenda. - promote health of the people throughout their life course by the setting approach health promotion action through every settings of their everyday life, and incorporate health to all socio-economic development programmes. - advocate, mobilize and support the whole Sri Lanka society to continuously active participate in health promotion activities across settings. - make the health consequences of policies and legislation explicated by all levels of government. - partner and build alliances with public, private, nongovernmental and international organizations and civil society to create and support sustainable health promotion actions. - develop an effective mechanism for collaboration and coordination for health promotion, establish a National Health Promotion Collaborating Center and a Consortium for National Health Promotion to strengthen National health promotion development and to consider establishing a Health Promotion Foundation to facilitate and support broader multisectoral implementation of health promotion policy. - build organizational and individual capacity for health promotion and - develop sustainable financial system such as funded from the Acts using dedicated tax on tobacco and alcohol for health promotion to ensure adequate and sustainable health promotion in the country. Vision Sri Lanka, a Health Promoting Nation where all the citizens actively participate in health promotion activities continuously for a healthy life expectancy. Mission To build a health promoting society by advocating, mobilizing, empowering and supporting every sectors and every people to continuously active participate in health promotion activities in every setting of their everyday life in order to develop sustainable health, well being and quality of life of all people in the country. Goal Promoting health and well-being by enabling all people to be responsible for their own health and address the broad determinants of health through the concerted actions of health and all other sectors. 7

Policy objectives 1. To strengthen leaderships for health promotion at all levels through advocacy. 2. To create nationwide health promotion actions by mobilize and empower communities toward active participation in comprehensive health promotion continuously throughout the life course. 3. To develop and implement effective comprehensive holistic and multisectoral approach health promotion interventions 4. To establish an effective system and mechanism for health promotion management and coordination at all levels. 5. To build capacity for health promotion at all levels and across sectors. 6. To improve financing and resources allocation and its utilization system for effective and sustainable health promotion. 7. To establish an evidence-base for health promotion effectiveness. Strategies In order to achieve the policy objectives, the strategies for each objective are as follow: Objective 1. To strengthen leaderships for health promotion at all levels through advocacy. Strategies : 1.1 Revitalize the National health council and make it an agenda item. 1.2 Establish a consortium for national health promotion comprises of members from multi-sectors to develop, facilitate, monitor and evaluate the implementation of National health promotion programme. Chairman will be selected by the consortium members. Similar consortiums will be established at provincial and district levels. The consortium will consider to develop a Health Promotion Foundation to support the broader implementation of the National Health Promotion Policy. Technical support would be provided by WHO SEARO and practical experience could be gained from several countries that have successfully established a Health Promotion Foundation. 1.3 Establish A Health Promotion Bureau Health education bureau of the Ministry of Healthcare and Nutrition will be renamed and reorganized with appropriate adjusted functions, authorities and work system. It will function as a national health promotion focal unit and National Health Promotion Collaborating Center taking the leading proactive role in national health promotion collaboration including advocacy, mediation and coordination. 1.4 Advocate all level politicians, administrators and stakeholders from all relevant sectors, mediate between differing interests with mutual benefit aims at policy and support and their leaderships for the pursuit of National health goal. Integrate health promotion thinking and strategies at all levels of planning and implementation. Encourage Provincial, District, Municipality and Local administration to execute their autonomy and increase their responsibility under the Local Government Act 8

and increase financial and resources allocation for health promotion. Empower decision makers and administrators and health promotion managers at all levels for need based management. 1.5 Make health promotion a core responsibility for all of the government Develop a National health promotion programme in collaboration with all sectors to make health promotion an agenda of the National Health Council and a National Agenda leads by the government, supervise and monitor by the National Health Promotion Council. Objective 2. To create nationwide health promotion actions by mobilize and empower communities toward active participation in comprehensive health promotion continuously throughout the life course. Strategies: 2.1 Mobilize individuals, families, communities, civil society groups, public and private sectors and development partners in order to promote, support and protect health. Empower people to take care of their own health by create and continuously participate in comprehensive health promotion activities throughout their life course and thereby develop health promotion social norm and value. 2.2 Strengthen health volunteer system and all kinds of groups and networks in the society to take the leading role in promoting health in their settings. Provide financial support for health volunteer activities. 2.3 Periodically organize national campaigns to motivate and maintain countrywide continuity of health promotion awareness. Objective3. To develop and implement effective comprehensive holistic and multisectoral approach health promotion interventions. Strategies : 3.1 Life course health promotion Develop effective integrated comprehensive health promotion interventions packages appropriate for each and cover all different population age groups, the vulnerable poor and marginalized groups and appropriate for the provision through the related setting approach programmes. Consider the utilization of both western and indigenous health promotion wisdom. 3.2 The Settings Approach: The Major Settings for the development of healthy setting in Sri Lanka are : Families, Villages, Communities, Estates, Cities, Islands, Workplaces, Marketplaces, Schools and Hospitals. 1.) Incorporate health promotion into the existing social development programmes which are created and implementing by health and other sectors to cover all major settings. Develop and implement under the leadership of the organizations actually responsible for and are supporting the development in that particular setting. 2.) Ensure that health promotion is strengthened in curative care services. 9

Develop a comprehensive health care system, Redesign the function and work system of the health service units at all levels. Incorporate health promotion into the curative services and link the services with health promotion activities of the networks in communities and various settings. Increase involvement of private and estate health care sectors in health promotion. 3.) Develop national standard criteria for healthy settings and quality development supporting mechanism to facilitate health promoting setting development attached with the existing quality improvement programme and quality assurance system. Develop awarding system and further develop to be healthy setting accreditation system. 3.3 Health issues-based approach Sri Lanka is facing double burden of diseases. Both the remaining unfinished health problems and the new emerging problems are considered to be in priority issues requiring new effective and sustained multisectoral approach interventions. The current priority issues that must be actively participating by all relevant sectors are: smoking reduction, nonsmoking measures and implementing the Tobacco Act reducing the use and harmful effects of alcohol and drugs Road safety, accident, violence and injury prevention mental health promotion promotion of sexual and reproductive health and HIV/AIDS prevention prevention of cancers nutrition interventions to address protein calorie malnutrition and micronutrient deficiencies, obesity prevention and control and healthy diets promotion food safety and food security promotion of physical activities for health work safety and occupational health effective communication systems for disasters and emergencies initiatives to create healthy environments development and utilization of indigenous and alternative health promotion Objective 4. To establish an effective system and mechanism for health promotion management and coordination at all levels. Strategies: 4.1 Develop an effective system and mechanism for health promotion management and coordination at all levels Strengthen system for coordination, health promotion planning, improved financial and resources management for health promotion, efficient management information system and develop results-based performance appraisal mechanism and strengthening monitoring and evaluation. 4.2 To increase Provincial District and Local administration authority in health promotion management in order to facilitate multisectoral participation and to encourage local initiatives. Develop more flexible management system to break the bureaucratic barrier to facilitate multisectoral coordination and collaboration. 4.3 To partner and build alliances with government ministries, local administrations, private sector, non-governmental development partners., professional associations, media, and international organizations and civil society to engage non health sector partners in health service system with mutual benefit and for purposes of resource 10

mobilization and resource management, capacity building, knowledge and experience sharing. Recognize NGOs, CBOs, all existing community groups as full partners with equal right and privileges in health promotion. 4.4 Develop National Health Promotion Association, Health Promotion Society and National Network for Health Promotion to strengthen multisectoral participation, coordination and exchange of experiences, knowledge sharing and support among network members. Health promotion association would include professionals practicing health promotion. Health promotion society comprises of concerned citizens who taking main role for fund raising for health promotion. Health promotion network comprises of representation of partner organizations and civil society. 4.5 Policies, Legislations, regulations, and laws enforcement Policy, legislation and regulation deemed detrimental to health shall be rescinded. Review the health impact and strengthen the implementation and enforcement of the existing health and other policies, legislations, regulations, and laws. Develop additional policies, legislations regulations and laws to support health promotion management, prevent health risks, promote health and create supportive environment for health. Objective 5. To build capacity for health promotion at all levels and across sectors Capacity will be built and support for health promotion advocacy, social mobilization and empowerment, leaderships, coordination, policy and strategies development, planning, implementation, monitoring and evaluation, research and knowledge transfer and skills on health promotion technical issues. Strategies : 5.1 Human resource development 1.) Improve the management of human resources Develop health promotion human resources development plan to rationalize the development and management of human resources for health promotion in all of the health sectors and relevant non health partners. Fully utilize the existing personnel for health promotion. Redefine the role, responsibility and function of all categories of health personnel in the healthcare system to strengthen health promotion practice. Support health promotion profession development and develop appropriate and fair career and training opportunity for personnel working on health promotion. 2.) Paradigm shift, health promotion skills and leadership building for personnel in health and non health sectors to increase capacity to take on new roles and responsibilities in moving beyond the conventional health promotion to multisectoral comprehensive health promotion, addressing broad determinants of health. 3.) Energize personnel working on health promotion in all sectors by empowerment, generate inspiration, increase recognition, motivate and encourage creativity and support new initiatives, provide forums for presentation and sharing of experience, commendation and rewarding system etc. 4.) Improve Health promotion education and training system and quality. Strengthen the role of academic and training institutions. Review and alignment of curriculum contents and techniques of all levels of health promotion related education and training, including medical and nursing education, focus on skill based health promotion. Develop health promotion diploma, degree and post graduated health 11

promotion courses, fellowships, awarding system for institutions and accreditation system. 5.2 Organizational capacity building 1.) Develop infrastructure facilities of the Health promotion bureau to cater to needs of health sector as well as other sectors 2.) Develop infrastructure facilities of Health institutions and MOH offices / clinics for health promotion activities and services. 3.) Develop capacities of other sectors for coordination and management of health promotion related activities. 4.) Encourage partner organizations to develop system to facilitate and support health promotion programme development and management. Objective 6. To improve financing and resources allocation and system utilization for effective and sustainable health promotion. With the changing diseases burden towards chronic non communicable diseases especially due to lifestyle related diseases including alcohol and tobacco use, health promotion programmes need to be strengthened. Financial constraints faced by the health sector hinder the strengthening of the programmes. To ensure the sustainability of health promotion development, a sustainable health promotion financing system will be developed. Strategies : 6.1 Dedicated tax The government will review the case for additional taxation on products that harm health, such as alcohol and tobacco and also on vehicle insurance, earmarking for health promotion and designate an appropriate health promotion supporting organization to manage the fund with system to ensure the highest efficient and transparent allocation and utilization of the fund and with a mechanism to ensure that the fund will not be allocated for the other purpose. 6.2 Additional sustainable health promotion financing system from local revenue will also be considered to develop. 6.3 Fund raising from private sectors or funding agencies and self funding health promotion will be encouraged for provincial, district and division health promotion managers with authority to manage the fund with effective control mechanism to ensure transparent and efficient management. 6.4 Increase government budget and resources allocation to support health promotion at all levels. Objective 7 To establish an evidence-base for health promotion effectiveness. Strategies : 7.1 Establish a Health Promotion Knowledge Management System. 1.) Establish a Health promotion knowledge management unit to collaborate and provide funding and managerial support for multisectoral participation health promotion knowledge management. 12

2.) Develop a programme for health promotion knowledge management with participation of all levels of health promotion network to generate, collect, demonstrate, document, disseminate and utilize of evidences regarding the effectiveness of health promotion. Promote health promotion action research on the effectiveness of health promotion policies, strategies, interventions, health promotion management and including study on determinants of health. Documentation of evidence and disseminate widely including among communities. 7.2 Promote evidence-based health promotion management and practice to close the gap between current practice and evidences. Provide evidences regarding the health promotion effectiveness to all levels of decision makers and practitioners and promote the utilization of the evidence in the development of policy, strategies, planning and resources allocation, intervention design, implementation, programme deletions or replication and scaling up or down and programme monitoring and evaluation. 7.3 Develop health promotion information system to support the health promotion knowledge management and evidence based health promotion management and practice in all sectors. Develop a National health promotion capacity profile with system for updating information. Establish system for health promotion network communication and information sharing e.g. Health promotion website etc. 7.4 Develop health promotion monitoring and evaluation system, a monitor and evaluation mechanism for health promotion policy, strategies, programmes, infrastructure and investments related to health promotion, multisectoral health promotion management, and performance assessment. Develop appropriate indicators and expected outcome based on health promotion objectives. Encourage participatory monitoring and evaluation at implementation level with the purpose to support continuous health promotion development and evidence based management at all level and across sectors. National Health Promotion Policy monitoring and evaluation - The National Health Promotion Consortium and the National Health Council will responsible for the regular monitor and evaluation of the implementation of this National Health Promotion Policy. - Implementation of this policy will also be monitored regularly as part of the overall process of monitoring the activities of the Government and ministries and covering various sectors and levels of government. - Attainment of the objectives in this policy will be evaluated and reported annually. - External evaluation of the National Health Promotion Policy, Assessment of health promotion structures, resources, activities and performance will be carried out every 5 years. 13