Table 2. Summary of Stated Policies on NCDs in Barbados at the Time of the Study, Their Source Document (See Box 2 for Key), and Comments on Their Implementation From Key Informant Interview Data .

Summary of Stated Policies	Source	Comments on Implementation
Overarching Structures, Processes and Finance
1.1 Establish national multi-sectoral NCD Commission	B	1.1 Barbados NCD Commission established March 2007 (predated Port of Spain Declaration, document D). Multi-sectoral membership, 10 meeting/year. Dedicated staff and budget.
1.2 Establish post of SMO of Health for NCDs		1.2 SMO NCDs established. Not all support staff in place.
1.3 Establish Health Promotion Unit		1.3 Health Promotion Unit established with Senior HP Officer and 1 HP Officer (not 2 as planned).
1.4 Establish Committee of Focal Points from other Ministries		1.4 No functional Committee of Focal Points from other Ministries.
2.1 Use revenue from tobacco, alcohol and other products to support the work of the NCD Commission	D	2.1 Ministry of Finance has declined to ear-mark tobacco or alcohol taxes to support the Commission, instead giving annual subventions for its operations, through the MoH.
Risk Factor Reduction
Tobacco
3.1 Pursue immediately a legislative agenda for passage of the legal provisions related to the FCTC	D	3.1 FCTC ratified in 2005.
3.2 Legislation to limit or eliminate smoking in public places		3.2 Legislation prohibiting smoking in all indoor spaces enacted and fully implemented in 2010.
3.3 Ban the sale, advertising and promotion of tobacco products to children		3.3 No sale, advertising, or promotion to children. Partial ban in place through “gentlemen’s agreement” but not legislated.
3.4 Effective warning labels		3.4 Implementation of warning labels failed as regional initiative, but a regional standard has been established for each country to implement. Progress is sporadic, and not implemented in Barbados.
3.5 Introduce such fiscal measures as will reduce accessibility of tobacco		3.5 In 2011, taxes comprised 48% of tobacco sale price (PAHO Barbados Tobacco Control Report 2011).
Alcohol
3.1 Behavioural intervention programmes…to address...alcohol abuse prevention	B,C	Limited, general, mention of alcohol. Reluctance nationally and regionally to address alcohol-related harm, because of economic and perceived cultural importance. No evidence further development or implementation.
3.2 Promotion of moderate alcohol consumption
Diet
4.1 Creation of a ‘National Food Authority’	B, E	All are statements that were made without specific actions for their further development or implementation, and there was no evidence from the interviews that significant progress had been made in these areas.
4.2 Ensuring that only healthy foods and snacks available in schools and healthy options are available at work places
4.3 Develop incentive/recognition programme for vendors/restaurants to offer healthy options
4.4 Promote ‘backyard gardens’
4.5 Reduction in high fat, sugar and salt intake, and increase fresh fruit and vegetables
5.1 Education sectors to promote programmes for healthy school meals	D	5.1 Dietary guidance produced for school meals, however, this is against a backdrop of aggressive marketing of unhealthy foods to school children, including branding of classroom items with local fast food logos.
5.2 Support elimination of transfats		5.2-4 Seen as requiring regional action. CFNI was to be the regional focal point. However, CFNI now merged into Caribbean Public Health Agency with diminished capacity. Requires regional negotiating machinery to pursue fair trade policies, and no evidence of progress at the time of the study.
5.3 Support for mandating the labelling of foods
5.4 Promote greater use of indigenous agricultural products and foods
Physical Activity
6.1 Ensure physical activity is part of curriculum for every child	B, D, E	6.1-2 No evidence of implementation.
6.2 Re-introduction of physical education in our schools where necessary
6.3 Provide opportunities and facilities for physical activity at work		6.3 Reported that some uptake by the private sector of Workplace Wellness programmes.
6.4 Promote policies and actions aimed at increasing physical activity in the entire population eg, through worksites, through sports, especially mass activities		6.4 Some mass media awareness raising from the MoH, such as around Caribbean Wellness day (see next section).
6.5 Commit to increasing adequate public facilities such as parks and other recreational spaces		6.5 Urban planning department has commitment to providing public space for recreation in new housing developments.
Health Promotion and Education
7.1 Develop education programmes and campaigns providing information about NCDs, and in support of wellness, healthy life style, and improve self-management of NCDs	B, D, E	7.1 Regular mass media activities by the Health Promotion Unit, such as campaign on salt reduction.
7.2 Create a reward-based system to encourage participation in the Healthy Schools Initiative		7.2 No evidence of implementation.
7.3 Embrace the role of the media as a responsible partner in all our efforts to prevent and control NCDs		7.3 Sub-optimal media engagement and public education, due in part to lack of funding. Compared to funding for media for HIV/AIDS, NCDs have had no funding and relatively little media.
7.4 Celebrate second Saturday in September as ‘Caribbean Wellness Day’		7.4 Caribbean Wellness Day celebrated annually since 2008. Has not been used to sufficiently to promote activities across sectors. However, impression is that frequency of organised physical activity events has increased.
7.5 Increase work wellness programmes		7.5 Reported that some uptake by private sector.
7.6 Support faith-based health promotion		7.6 Little evidence of implementation.
Integrated Disease Management
8.1 Establish by mid-2008 comprehensive plans for the screening and management of chronic diseases and risk factors so that by 2012, 80% of people with NCDs would receive quality care and have access to preventive education based on regional guidelines	C, D, E	8.1-2 Regional treatment guidelines disseminated but uptake and impact unknown; lack of systematic monitoring on coverage and disease control.
8.2 Comprehensive plans for screening and management of NCDs
8.3 Establish NCD clinics within government primary healthcare system		8.3 Clinics for diabetes and hypertension within government primary healthcare; drugs for diabetes and hypertension available free of cost.
8.4 Annual training to primary healthcare professionals on use of protocols		8.4 Some training workshops in the use of the regional guidelines have occurred, not annual training. However, since Jan 2013 medical practitioners need to show evidence annually of continuing medical education to remain on the medical register.
Surveillance, Evaluation and Research
9.1 Develop comprehensive health information strategy	C, E	9.1 Work still in progress on developing health information system. Lack routine data on disease treatment and control.
9.2 Establish cardiac and stroke event registry		9.2 Barbados National Register of Strokes and Myocardial Infarctions established, including data from private sector, but relative lack of resources to produce timely reports and investigate findings.
9.3 Commission research to develop appropriate baseline measures for health improvement and service framework		9.3 Partially met through 9.2, and through supporting MoH personnel to undertake research as part of studying for a master in public health.
9.4 Repeat the Behavioural Risk Factor Survey in 2010		9.4 Repeat of risk factor survey being completed at the time of the study.
9.5 Private sector data fed into national NCD data		9.5 Inadequate routine private sector data.

Abbreviations: SMO, Senior Medical Officer; FCTC, framework convention of tobacco control; CFNI, Caribbean Food and Nutrition Institute; NCD, non-communicable disease; MoH, Ministry of Health; PAHO, Pan American Health Organizatio