Tackling risk factors for NCDs in Jordan: Lessons from the COVID-19 pandemic

Jordan addressed tobacco use and mental health as two public health priorities both before and during the pandemic. Through extensive multisectoral collaboration, bringing together multiple government departments, nongovernmental organizations and international agencies, Jordan has taken effective steps to address tobacco use and mental health. It has also used this collaborative approach to tackle noncommunicable disease (NCD) risk factors as the country moves towards its 2030 goals.

Jordan has successively raised tobacco taxes between 2010 and 2019, including on e-cigarettes and heated tobacco products in its campaign to reduce tobacco use.

During the pandemic, Jordan set up remote tobacco cessation services, which were assisted by the donation of thousands of nicotine patches from Johnson & Johnson.

The Ministry of Health used a web-based assessment tool to assess the impact of COVID-19 on access to medication for NCD and other chronic disease patients.

Jordan has carried out wide-ranging reforms on its mental health system since 2008 with a focus on community mental health services.

Jordan met the increasing demand for mental health services caused by the pandemic by including mental health and psychosocial support interventions in essential health services.

SHINE – Jordan is one of four countries collaborating on this project researching the challenges of scaling up school-based mental health services. See Pakistan for details.

Combating obesity

A multisectoral technical committee on nutrition is working to reduce levels of obesity in Jordan. The committee includes members from a range of government departments and medical services, as well as academics. Its work has led to:

• The elimination of trans fats and non-dairy fats from dairy products
• The reduction of salt in flat bread from 1.5% to 1%
• Prohibiting the use of trans fats, margarine and saturated fats in food supplied by public institutions including hospitals
• The publication of food composition tables for traditional Jordanian foods, dietary guidelines for managing NCDs, and food-based national dietary guidelines.

Assessing access to NCD medication

The Ministry of Health collaborated with WHO and the Center for Strategic Studies at the University of Jordan to assess the impact of COVID-19 on access to medication for NCD and other chronic disease patients. The web-based assessment tool also identified those who had not received medication, which the Ministry of Health then delivered to their homes. The assessment guided proposals to establish helplines to give patients better access to the health care system and set up home delivery of medications and remote health care services.

Curbing the tobacco epidemic

Smoking is one of the main risk factors for NCDs in Jordan. Therefore, in an effort to curb tobacco use, the Ministry of Health worked with the Income and Sales Tax Department of the Ministry of Finance to raise taxes on tobacco products – more than doubling the retail prices of tobacco between 2010 and 2018. Jordan also introduced a tax on heated tobacco products and e-cigarettes in 2019.

Alongside taxation, tobacco cessation services are a vital tool in reducing tobacco use. The Ministry of Health collaborated with the National Call Centre and the Ministry of Digital Economy and Entrepreneurship to provide remote tobacco cessation services during the pandemic, including free consultations and medications.

This policy was bolstered by a donation of nicotine patches worth US$ 1 million by Johnson & Johnson Consumer Health, through the Access Initiative for Quitting Tobacco.

Jordan was the first country in the world to benefit from this initiative. Jordan also introduced the population to WHO’s first-ever virtual health worker, Florence, who uses AI to dispel myths around COVID-19 and smoking, while helping people develop a personalized plan to quit tobacco.

Provision of mental health and psychosocial support services

The Ministry of Health, with support from WHO, led the reform of the mental health system from 2008, focusing on the development of community mental health services. Since 2011, as part of Jordan’s first Mental Health Policy and Plan, the Ministry of Health has set up:

• A Mental Health Unit within the Ministry to lead the governance of mental health services
• Community mental health centres in existing Ministry facilities to provide comprehensive psychosocial support services
• Mental health care for children and adolescents with collaboration from the University of Jordan and WHO
• The integration of mental health in primary health care
• Mental health training for general medical and non-medical staff

The policy also implemented the Our Step Association project to advocate for the rights of mental health service users and include them in mental health strategic planning in Jordan. The result is that people with lived experience are now part of the national mental health technical committee and the mental health and psychosocial support coordination group.

These reforms helped Jordan to respond effectively to the increasing demand for mental health and psychosocial support services during the pandemic. The Directorate for Disability and Mental Health remained open during lockdowns, answering calls, making referrals and providing care and support. It also collaborated with the Syrian American Medical Association to train health care staff in psychological first aid.

Meanwhile, the National Center for Mental Health acted to:

• Deliver free treatment to patients in their homes through the “Watan” initiative in collaboration with the Jordanian Medical Association
• Give psychological support to health care staff
• Increase awareness of mental health issues during the pandemic by collaborating with media outlets

Jordan sees multisectoral collaboration as central to improving and scaling up mental health and psychosocial support and NCD services in the future.

This country story is part of a series on sharing successful strategies from the Eastern Mediterranean Region mitigating noncommunicable diseases and mental health disorders during the COVID-19 pandemic and beyond. Discover additional stories and insights in the full report published by the World Health Organization Regional Office for the Eastern Mediterranean.