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

Objectives

Fiji’s Non-Communicable Diseases Prevention and Control Strategic Plan 2010-2014 seeks to reduce premature illness, disability and death from non-communicable diseases through a whole-Ministry, evidence-based reform of prevention, detection, treatment and rehabilitation services. Its goal is a population with healthy lifestyles, and its aim is to improve the national non-communicable disease status by 5% by 2014.[1][2][3][4]

• Reduce common risk factors, intermediate risk factors and major non-communicable diseases by 5% by 2014, using a life-course approach from conception to older age.[5][4]
• Address smoking, unhealthy diets and nutrition, alcohol-related harm, physical inactivity, overweight and obesity through risk-factor interventions.[6][7][4]
• Strengthen medical interventions for diabetes mellitus, cardiovascular diseases, cancers, accidents and injuries, while recognising oral diseases, blindness, deafness and mental disorders within a holistic non-communicable disease agenda.[6][5][4]
• Improve early detection and 3M management, meaning mouth, muscle and medicine, in 80% of primary health-care facilities and improve 3M management of non-communicable disease admissions in 80% of subdivisional and divisional hospitals.[1][4]
• Reduce major population risk and disease burdens through targets including lower smoking, overweight, obesity, diabetes and hypertension prevalence, alongside improved breastfeeding, diet, physical activity, detection and control of diabetes and hypertension.[8]

Implementation

The plan adopts a comprehensive, outcome-focused, multisectoral and multidisciplinary approach described through the acronym COMMUNITY: universally accessible, life-course-based, innovative, technical and evidence-based, while acknowledging a spiritual dimension. It combines environmental, lifestyle, clinical, advocacy, and surveillance, monitoring and evaluation interventions across each priority area.[4]

• Integrate prevention and management into primary health care, Clinical Service Networks and a role-delineated referral pathway from nursing stations and health centres to subdivisional, divisional and specialist hospitals.[5][9]
• Deliver age-appropriate services through antenatal care, maternal and child health, school and adolescent health, general outpatient services, elderly care and specialist clinical disciplines.[5][9]
• Strengthen legislation, policy, affordable technology, clinical infrastructure, procurement, workforce capacity and public-private partnerships, including one-stop services, Hospital in the Home, green prescriptions, diabetes and renal hubs, foot care, radiology and other specialist services.[1][10][11]
• Mobilise communities, schools, workplaces and faith-based organisations through toolkit and Mini STEPS programmes addressing tobacco, nutrition, alcohol, physical activity and chronic disease management.[12][13][14][15]
• Assign implementation roles across Ministry of Health public-health, health-promotion, clinical-service, non-communicable disease and environmental-health bodies, supported by national advisers, disease-specific committees and advocacy organisations.[16][17][18][19]
• Use consultations involving government, non-governmental and faith-based stakeholders, clinicians, technical civil servants, divisional representatives and international partners, including technical assistance from the World Health Organization and support from the Fiji Health Sector Improvement Programme.[2][20]
• Align activities with relevant national policies, clinical guidelines and Pacific frameworks, including the Pacific Framework for the Prevention and Control of Non-communicable Diseases.[5][21][19]
• Monitor progress through STEPS and Mini STEPS surveys, disease surveillance systems, facility-coverage targets and outcome measures for risk factors, disease prevalence, complications, detection and clinical control.[8][22][15][23]

Monitoring & Evaluation

The plan embeds surveillance, monitoring and evaluation as one of five intervention strategies across risk-factor and medical components, using an outcome-focused approach to track health gains and guide resources.[4]It sets a national aim to improve non-communicable disease status by 5% by 2014, supported by targets for risk factors, disease prevalence, service coverage, detection and clinical control.[4][8]

• Use the 2002 Fiji Non-Communicable Disease Stepwise Survey, the 2004 National Nutrition Survey, the Obesity Prevention in Communities Project, Health Information Unit data and the National Youth Tobacco Survey as evidence inputs for decision-making.[5]
• Track baseline population risks including tobacco use at 36.6%, overweight at 29.9%, obesity at 18%, diabetes at 16% among people aged 25 to 64, and hypertension at 19.1%.[7][3]
• Monitor national targets to reduce smoking prevalence from 36.6% to 30%, daily smoking from 42% to 35%, overweight from 29.9% to 25%, obesity from 18% to 12%, diabetes from 16% to 10%, and hypertension from 19.1% to 15% by 2014.[8]
• Measure early detection and 3M management, with objectives for 80% of primary health-care facilities to provide improved early detection and management, and for 80% of subdivisional and divisional hospitals to improve management of non-communicable disease admissions.[4]
• Assess detection and control gaps, including previously undiagnosed diabetes, which represented 53.2% of diabetes cases, and previously unrecognised hypertension, which represented 63.3% of hypertension cases.[3]
• Monitor tobacco control through adult and youth tobacco-use prevalence, smoke-free setting coverage, toolkit-based cessation advice, quit-smoking clinic establishment, Mini STEPS assessments, a National Youth Tobacco Survey planned for 2009, and a National Non-Communicable Disease STEPS Survey planned for 2010.[24][25][26][12]
• Track nutrition through exclusive breastfeeding at six months, fruit and vegetable consumption, nutrition advice coverage, Mini STEPS, the Fiji Food Balance Sheet, the National Nutritional Survey, the National Iron Fortification Survey 2010 and the 2010 national STEPS survey.[13][22]
• Measure alcohol-related harm through prevalence of binge drinking and responsible drinking, supported by Mini STEPS in primary medical care settings and national STEPS surveillance.[27][28]
• Assess physical-activity action through school activity among children, adult achievement of 600 metabolic equivalent task minutes, the proportion of settings with physical-activity plans, toolkit advice coverage and establishment of weight-watch clinics.[29][14][30]
• Strengthen disease-specific surveillance for diabetes, cancer, cardiovascular disease, and accidents and injuries, including Mini STEPS delivery in community, workplace and faith-based settings and the 2010 national STEPS survey.[15][31][32][23]
• Monitor diabetes, cancer and cardiovascular services through targets for prescription compliance, annual status assessment among at-risk populations, controlled blood glucose or blood pressure, disease prevalence, complications and clinical-management coverage.[33][34][35][19][36]
• Assign implementation responsibility for selected programme areas to bodies including the Tobacco Control Unit, National Centre for Health Promotion, Division of Public Health Services, National Food and Nutrition Centre, National Diabetes Centre and relevant national advisers.[16][17][18]

Detailed reporting schedules, data-collection protocols, evaluation designs, performance-review processes and formal accountability mechanisms are generally not specified in the supplied extracts, beyond named institutions, surveillance activities, implementation timeframes and stated indicators.[4][8][18][37][23]

Costing & Financing

Financial information is limited and largely consists of annual intervention budgets for 2010 to 2014. The source does not identify the currency for most dollar-denominated amounts, nor does it set out aggregate programme costs, funding sources, disbursement arrangements, funding gaps, resource-mobilisation plans or economic assumptions.[16][17][19]

• Provide an annual tobacco-control programme budget of 40,000 dollars for 2010 to 2014.[16][38]
• Allocate 80,000 dollars annually to nutrition and non-communicable disease strategic activity, with a further annual 80,000-dollar allocation listed for the nutrition environment-intervention programme.[17][39]
• Allocate 20,000 dollars annually to alcohol-related-harm interventions.[40]
• Allocate 200,000 dollars annually to the physical-activity intervention framework.[41]
• Allocate 50,000 dollars annually to diabetes-related programme activities.[18]
• Allocate 40,000 dollars annually to improving cancer services, technology, access and Oncology Unit development.[34]
• Allocate 30,000 dollars annually to the listed accidents-and-injuries strategic activity and intervention.[37][42]
• Allocate 40,000 dollars annually to cardiovascular disease strategic activities and a listed cardiovascular intervention.[19][43]
• Recognise financial support from the Fiji Health Sector Improvement Programme for development of the strategic plan; the amount and terms are not specified.[2]

The plan also refers to affordable technologies, clinical infrastructure, service hubs, procurement, workforce capacity and public-private partnerships, but supplies no related cost estimates or financing mechanisms.[1][10][11]