Non-Communicable Diseases Strategic Plan 2015-2019

Objectives

Fiji’s Non-Communicable Disease Strategic Plan 2015–2019 provides a whole-of-system response to the country’s high burden of premature mortality from conditions including ischaemic heart disease, diabetes mellitus and cerebrovascular disease, addressing major risk factors such as unhealthy diet, high body-mass index and raised fasting plasma glucose.[1]Its overarching mission is to contribute to a healthier Fiji, including a 25% reduction in premature mortality from four key non-communicable diseases by 2025.[2][3]

The strategy combines prevention, early diagnosis, treatment, rehabilitation and management through a Wellness-centred approach, with attention to mental health, stress management, violence and injuries as integral components of the non-communicable disease response.[4][5]It aims to improve health for all Fijians while tailoring activities towards groups at greatest risk.[5]

• Reduce premature mortality and prevent increases in obesity and adult diabetes prevalence.[2][3]
• Reduce salt intake among adults by 20% by 2019 and 30% by 2025, and increase fruit and vegetable consumption among adolescents and adults by 10% by 2019.[2][6]
• Reduce insufficient physical activity among adolescents and adults by 5% by 2018 and 10% by 2025.[7]
• Reduce tobacco use, expand tobacco-free settings-based policies by 20% by 2019, and reduce heavy episodic drinking, per-capita alcohol consumption and harmful kava use.[2][8][9]
• Improve hypertension and diabetes control, increase access to essential non-communicable disease medicines and technologies, identify people at high cardiovascular risk, and strengthen cancer, renal, diabetes and rehabilitation services.[1][10][11]
• Reduce suicide and attempted suicide by 20% by 2019, reduce violence and injuries by 5% by 2019, and reduce alcohol-related violence and injuries by 10% by 2019.[12][13]

Priority action areas are diet, physical activity, tobacco, alcohol and kava, clinical and public health services, mental health and stress management, violence and injuries, and cross-cutting health-system measures.[14][4]The plan also seeks to align non-communicable disease resource allocation with the scale of the crisis.[3][13]

Implementation

Implementation is based on multisectoral action, integrated service delivery and progressive operationalisation through annual corporate and related action plans.[5][2]The Ministry of Health and Medical Services retains overall responsibility, coordinating with government agencies, civil society organisations, faith-based organisations, communities, private-sector partners and development partners because health services alone cannot address the social and economic drivers of unhealthy behaviour.[5][15]

• Strengthen community prevention through Wellness Fiji activities, community health workers, healthy schools, workplaces, churches and communities, and targeted communication and education.[5][15][16]
• Deliver integrated primary care through the Package of Essential Non-Communicable Disease Interventions, standardised risk assessment and management, essential medicines and technologies, early diagnosis, and referral pathways.[5][10]
• Extend services from nursing stations and health centres to primary outpatient departments, specialist outpatient departments for complication management, and rehabilitation services.[5][2]
• Strengthen food and nutrition policy through controls on marketing foods and non-alcoholic beverages to children, implementation of the Fiji Plan of Action for Nutrition, and the Salt, Sugar, Fat action plan.[6][17]
• Apply fiscal and regulatory measures including annual tobacco and alcohol tax increases of at least 10%, healthier-food taxation, price controls or subsidies, and reduced taxes on physical-activity equipment.[18][8][9][19]
• Establish and support specialised functions, including a screening unit, diabetes hubs, oncology services, mental health wards, lifeline-style support, tobacco cessation programmes and injury rehabilitation.[11][12][20][21]

Coordination is assigned to the Wellness Unit and the Planning and Policy Development Unit, working with Ministry divisions and departments; the organisation listed first for a strategy is intended to lead coordination with participating bodies.[2]The strategy proposes a cross-sectoral committee through a Cabinet paper, decree or Act for Wellness, with a mandate to incorporate non-communicable diseases and Wellness into annual corporate plans.[15][16]Specific delivery partners include the Police, National Fire Authority, Land Transport Authority, education and agriculture authorities, local government, the Fiji Women’s Crisis Centre, professional groups and faith-based organisations.[5][13]

Monitoring uses a results framework linked to global and regional targets, with the 2011/2012 STEPwise approach to non-communicable disease risk-factor surveillance survey serving as a baseline for many indicators.[2]Indicators cover mortality, diabetes, hypertension, cancer, suicide, injuries, obesity, diet, physical activity, tobacco and alcohol use, service coverage, screening, clinical practice and community health-worker capacity.[22][23]Data sources include STEPS surveys, the Global School-based Student Health Survey, medical cause-of-death certificates, cancer registries, hospital and injury information systems, clinical audits and programme records.[22][23]

The Wellness Unit leads ongoing monitoring with Ministry monitoring and evaluation support, stakeholders are expected to provide relevant information quarterly, and a mid-term review is intended to assess indicator progress, outcomes, new priorities and changing disease burden.[2]Performance indicators are to be clarified annually, with metadata recording data sources, calculation methods, reporting frequency, assumptions, risks and interpretation.[2]The plan includes indicative costing for planning and anticipates more comprehensive annual costings; the only quantified implementation requirement in the supplied material is Fiji dollar 28 million over five years for roll-out of the Package of Essential Non-Communicable Disease Interventions.[2][10]

Monitoring & Evaluation

The plan establishes a broad monitoring and evaluation system linking national non-communicable disease targets, intervention outputs, service delivery and cross-sectoral accountability. It uses the 2011/2012 STEPwise approach to non-communicable disease risk-factor surveillance survey as a baseline for many indicators and aligns monitoring with global and regional targets, including a 25% relative reduction in premature mortality from major non-communicable diseases by 2025.[2][24]

• Monitor population outcomes including premature non-communicable disease mortality, diabetes and hypertension prevalence, cancer incidence, suicide, self-harm, rheumatic fever, injuries, overweight and obesity, physical activity, diet, tobacco and alcohol use, salt and saturated-fat intake, and diabetic foot amputations.[22]
• Track service and implementation measures including detection of diabetes and hypertension, adherence to Diabetes Management Guidelines, screening and follow-up, essential medicine and technology availability, tobacco-free policies, school canteen guidelines, community health worker training and functioning Community Health Committees.[22][23]
• Use data from medical cause-of-death certificates, STEPS surveys, the Global School-based Student Health Survey, cancer registries, hospital and injury information systems, the Non-Communicable Disease Surveillance System, Population Health Information System, PATIS, clinical audits, programme records and Fiji Revenue and Customs Authority alcohol-consumption figures.[22][23][19][25]
• Apply reporting frequencies ranging from quarterly and six-monthly to annual and three-to-five-yearly intervals, depending on the indicator.[22][23][25]
• Require stakeholders to submit relevant information quarterly, with the Wellness Unit leading ongoing monitoring alongside the Ministry of Health and Medical Services monitoring and evaluation team.[2]
• Clarify indicators annually and maintain metadata covering data sources, calculation methods, reporting frequency, assumptions, risks and interpretation; update targets in response to implementation progress, outcomes and changing context.[2]
• Conduct a mid-term review of indicator progress, outcomes, new priorities and shifts in disease burden, and use the Results Framework to connect interventions with expected outcomes.[2][15]
• Repeat the STEPS survey in 2019 and conduct the Global School-based Student Health Survey every three years, with dissemination of findings to guide interventions and service delivery.[6][16]
• Monitor diet-related action through the 2015 Fiji School-based Health and Nutrition Survey, the Fiji Plan of Action for Nutrition reports, food and beverage advertising monitoring, enforcement reports and Salt, Sugar, Fat action-plan progress.[6]
• Assess clinical implementation through a 2018 evaluation of the Package of Essential Noncommunicable Disease Interventions, staff-training coverage, screening and follow-up data, rehabilitation assessments, diabetes complications and compliance with SMS-based services.[10]
• Strengthen injury surveillance by extending the Public Health Information System to incorporate police, Land Transport Authority and fire authority data.[13][26]
• Establish a dedicated non-communicable disease strategy post for monitoring and reporting to the proposed cross-sectoral committee, and use national advisory, taskforce and committee structures to support oversight.[15][27][12][13]

Some data sources remain to be developed, notably those for community health worker adequacy and functioning Community Health Committees.[23]Formal reporting, evaluation and review arrangements are not fully detailed in the Results Framework extract, although the wider plan specifies quarterly stakeholder reporting, annual indicator refinement and a mid-term review.[22][23][2]

Costing & Financing

Financing is framed around increasing allocation for non-communicable diseases in proportion to the scale of the crisis, incorporating actions into annual corporate plans, and using fiscal measures to support prevention and health promotion.[13][15]Indicative cost information is included for planning, with more comprehensive costing intended through annual plans.[2]

• Allocate Fiji dollar 28 million over five years to roll out the Package of Essential Noncommunicable Disease Interventions.[10]
• Increase tobacco and alcohol taxation by at least 10% annually as control and revenue-related measures.[8][9]
• Increase tobacco-licence fees on an ongoing basis, with revenue intended to be retained by the Ministry of Health and Medical Services.[13][26]
• Pursue a share of tobacco, alcohol and unhealthy-food tax revenue for health promotion, with a Cabinet paper to be lodged and discussed in 2015.[15]
• Plan the Ministry of Health and Medical Services non-communicable disease budget annually across divisions, subdivisions and departments, including funding for educational materials.[15][26]
• Use taxation, price controls and subsidies to improve affordability of healthier foods, and reduce taxes on sports, physical-activity, mobility and gym equipment.[18][8][28]
• Assess the need and potential scope for a study of the economic cost of non-communicable diseases, supported by finance, planning, development and academic partners.[15][27]

Implementation tables include budget fields and a five-level budget notation for the violence and injury strategic plan, but the supplied material does not provide corresponding monetary amounts.[6][13]Beyond the Package of Essential Noncommunicable Disease Interventions estimate, the material does not specify total programme budgets, funding allocations, financing gaps, funding-source commitments or economic assumptions.[10][15]