Non-Communicable Diseases Prevention and Control Strategic Plan 2010-2014

Objectives

Fiji’s Ministry of Health Non-Communicable Disease Strategic Plan 2010–2014 provides a comprehensive health-sector framework to reduce the national burden of non-communicable diseases, which account for 82% of deaths, and to address premature mortality as a principal challenge.[1][2]Its goal is a Fiji population with healthy lifestyles, with an aim to improve national non-communicable disease status by 5% by 2014.[3]The framework, represented by “COMMUNITY”, promotes comprehensive, outcome-focused, multisectoral and multidisciplinary action; universal access; a life-course perspective; innovation; and technical, evidence-based initiatives.[3]

• Reduce common risk factors, intermediate risk factors and major non-communicable diseases by 5% by 2014.[3][4]
• Apply the holistic 3M approach across mouth, muscle and medicine, combining risk-factor prevention, early detection, clinical management, medication and behaviour change.[5][2]
• Organise interventions around environment, lifestyle, clinical services, advocacy, and surveillance, monitoring and evaluation.[2][6]
• Address smoking, nutrition, alcohol use and physical inactivity, alongside diabetes, cardiovascular diseases, cancers, accidents and injuries.[3]
• Integrate management of blindness, deafness, oral diseases, accidents, injuries and mental disorders into person-centred non-communicable disease care.[6]
• Strengthen leadership, policy, legislation, affordable technologies, clinical infrastructure, staff capacity and public-private partnerships.[5][2]

The plan sets service-coverage ambitions to improve early detection and 3M management in 80% of primary health-care facilities and 3M management of non-communicable disease admissions in 80% of subdivisional and divisional hospitals by 2014.[3][4]It adopts a life-course approach spanning conception, maternal and child health, school and adolescent health, adulthood and older age.[2][3]

Priority risk-factor objectives include reducing tobacco use among adults and young people by 5% from the latest baseline by 2014; improving nutritional status; reducing binge drinking by 5%; increasing responsible drinking by 5%; and expanding health-related physical activity among children and adults.[7][8][9][10]Tobacco targets include reducing smoking prevalence from 36.6% to 30%, daily smoking from 42% to 35%, and increasing the mean age of initiation from 18 to 21 years.[4]Nutrition targets include increasing exclusive breastfeeding from 39.8% to 80%, reducing consumption of fewer than one daily fruit and vegetable serving from 65% to 50%, and increasing consumption of more than five servings from 1.2% to 5%.[4]

Disease-specific objectives seek to reduce diabetes, cardiovascular disease, cancers, and accidents and injuries by 5% by 2014.[11][12][13][14]Further aims include reducing overweight from 29.9% to 25%, obesity from 18% to 12%, diabetes from 16% to 10%, and hypertension from 19.1% to 15%.[4]

Implementation

Implementation combines prevention, health promotion, clinical care, referral, rehabilitation, advocacy and surveillance through existing primary health care, Clinical Service Networks and role-delineated services from nursing stations and health centres to subdivisional, divisional and specialist hospitals.[6][15]The plan aligns with the Pacific Framework for the Prevention and Control of Non-Communicable Diseases and the 2-1-22 Pacific Non-Communicable Disease Programme Implementation Plan 2008–2011.[6]

• Deliver toolkit-based risk assessment, advice, early detection and referral for at-risk populations through nursing stations and health centres.[16][17][18][19]
• Develop one-stop services, including three Diabetes/Renal Hubs, cancer outpatient services, cardiovascular outpatient services, and accident and emergency services at subdivisional and divisional levels.[18][20][21][22]
• Strengthen Hospital in the Home and home-based care for diabetes, terminal cancer, stroke, accident and injury rehabilitation.[23][20][19][22]
• Build workforce capacity in 3M management, smoking cessation, nutrition, alcohol-related harm, physical activity and clinical disease management across facility and specialist levels.[24][25][26][27][28]
• Improve clinical infrastructure, technologies and specialist services, including cardiac catheterisation laboratories, eye-unit support, radiology, mammography, computed tomography, prostheses, diabetes software, oncology, rehabilitation, laboratory, pharmaceutical and biomedical services.[5][28][29]
• Implement enabling policies, legislation and standards, including tobacco-control measures, food-safety standards, school canteen guidance, breastfeeding and food-marketing legislation, a salt-reduction strategy, alcohol policy, and physical-activity guidelines.[30][31][32][33]

The Ministry of Health is the central implementing institution, with responsibilities distributed across public health, strategic health services, environmental health, health promotion, national non-communicable disease authorities and clinical services.[34][35][36]Plan development involved government, non-governmental and faith-based stakeholders, clinicians, Ministry personnel and divisional participants, with technical assistance from the World Health Organization, the Secretariat of the Pacific Community and the Fiji Health Sector Improvement Programme.[37]Communities, schools, workplaces and faith-based organisations are intended delivery settings for toolkit interventions, smoke-free action, nutrition, alcohol and physical-activity initiatives.[16][17][32][38]

Coordination mechanisms include national and divisional non-communicable disease project officer posts, specialist units and advisory bodies, plus proposed or supported committees for tobacco control, alcohol-related harm, physical activity, accidents and injuries, cancer advocacy and cardiovascular advocacy.[7][39][26][40][41][29][42]The National Diabetes Centre is to be re-established as a national research and education centre, while the National Heart Foundation is supported in cardiovascular advocacy.[43][42]

Surveillance, monitoring and evaluation form a strategic action area intended to guide resource investment and maximise health gains.[2][3]Implementation draws on the Fiji Non-Communicable Disease STEPS survey, National Nutrition Survey, Health Information Unit, National Youth Tobacco Survey and Mini STEPS activities in community settings.[6][39][44]The provided text does not specify a single consolidated reporting schedule, evaluation methodology or formal accountability framework.[2][4][15]

Monitoring & Evaluation

Surveillance, monitoring and evaluation form one of the plan’s five strategic action areas and are intended to track health outcomes, guide resource investment and maximise health gains.[2][6][3]The plan draws on the 2002 Fiji Non-Communicable Disease STEPS survey, the 2004 National Nutrition Survey, the Obesity Prevention in Communities Project, the Health Information Unit and the National Youth Tobacco Survey as evidence sources.[6]

• Monitor national risk-factor and disease outcomes, including smoking, nutrition, alcohol use, physical activity, overweight, obesity, diabetes, hypertension and non-communicable disease prevalence.[4]
• Target a 5% improvement in Fiji’s national non-communicable disease status by 2014, including a 5% reduction in common risk factors, intermediate risk factors and major non-communicable diseases.[3][4]
• Track tobacco targets of reducing overall tobacco use from 36.6% to 30%, daily smoking from 42% to 35%, and increasing mean initiation age from 18 to 21 years.[4]
• Track nutrition targets of increasing exclusive breastfeeding from 39.8% to 80%, reducing consumption of fewer than one daily fruit and vegetable serving from 65% to 50%, and increasing consumption of more than five servings from 1.2% to 5%.[4]
• Track reductions in overweight from 29.9% to 25%, obesity from 18% to 12%, diabetes from 16% to 10%, and hypertension from 19.1% to 15%.[4]
• Measure tobacco-control progress through a 5% reduction in adult and youth tobacco-use prevalence by 2014, smoke-free settings, cessation advice, quit-smoking outcomes and the establishment of quit-smoking clinics.[7][16][24]
• Conduct a National Youth Tobacco Survey by 2009 and a National Non-Communicable Disease STEPS Survey in 2010.[39]
• Measure nutrition progress through a 5% increase in consumption of three to five daily servings of vegetables and/or fruit, and use Mini STEPS, the Fiji Food Balance Sheet, the National Nutritional Survey and the 2010 National Iron Fortification Survey.[45][44]
• Monitor alcohol-related harm through prevalence of binge drinking and responsible drinking, supported by Mini STEPS in primary medical care settings and National Non-Communicable Disease STEPS surveillance.[9][46]
• Monitor physical activity through children undertaking 30 minutes of health-related activity at school, adults undertaking 600 metabolic equivalent minutes on most days, settings with physical-activity action plans, and weight-watch clinic establishment.[10][38][27]
• Track diabetes prevalence and complication prevalence, annual diabetes-status assessment, prescription compliance and blood-sugar control among people receiving mouth, muscle and medicine management.[34][47]
• Improve national surveillance systems for diabetes, cancer, accidents and injuries, and cardiovascular disease, with Mini STEPS activities and a National Non-Communicable Disease STEPS Survey in 2010 supporting several disease areas.[48][49][41][50]
• Measure disease-specific outcomes including a 5% reduction in cardiovascular disease, accidents and injuries, and cancer prevalence by 2014, alongside service indicators for annual status ascertainment, prescription compliance and controlled disease or functional independence among people receiving 3M management.[12][13][51][14][52]

Responsibilities are assigned in several programme areas to Ministry of Health divisions, the National Centre for Health Promotion and relevant national non-communicable disease, public-health, environmental-health and clinical service bodies.[53][10][35][36]However, the supplied text does not specify a common reporting schedule, indicator definitions, evaluation methodology, data-quality process, formal accountability framework or consequences for non-performance.[2][4][35]

Costing & Financing

The plan includes several annual programme budgets for 2010–2014, but does not identify the currency, financing source, disbursement mechanism, expenditure profile or economic assumptions for most allocations.[54][53][32][10][34][35][55][36]Financial support from the Fiji Health Sector Improvement Programme contributed to development of the strategic plan, while the World Health Organisation provided technical assistance.[37]

• Allocate 40,000 annually to tobacco control.[54][30]
• Allocate 80,000 annually to nutrition-related strategic activities and 80,000 annually to environmental interventions.[53][31]
• Allocate 20,000 annually to alcohol-related harm activities and 200,000 annually to physical-activity interventions.[32][10]
• Allocate 50,000 annually to diabetes-related strategic actions, 40,000 annually to cancer-service activities, 30,000 annually to accidents and injuries, and 40,000 annually to cardiovascular disease interventions.[34][35][55][36]
• Prioritise investment options that prevent, delay or reverse non-communicable diseases and their complications, and use outcome monitoring to support optimal allocation of resources.[2][6]

The supplied text does not specify a consolidated plan budget, total programme cost, domestic or external funding shares, resource-mobilisation strategy, affordability analysis, funding gap, or arrangements to sustain investments after 2014.[37][2][3]