Non-Communicable Diseases Strategic Plan 2015-2019

Objectives

Fiji’s Non-Communicable Disease Strategic Plan 2015–2019 provides a comprehensive, wellness-centred framework to prevent, treat and manage non-communicable diseases, mental health conditions, violence and injuries. It seeks to improve the health of all Fijians, particularly populations at greatest risk, through coordinated action on behavioural, social and health-system determinants.[1]The plan contributes to a healthier Fiji and is aligned with international and regional commitments, including the goal of a 25% relative reduction in premature mortality from four major non-communicable diseases by 2025.[2][3][4]

• Reduce premature mortality and major risk factors, including tobacco use, harmful alcohol and kava use, excess salt intake, raised blood pressure, insufficient physical activity, poor diet, obesity and diabetes.[5][4]
• Reduce mean population salt intake by 20% by 2019 and 30% by 2025, increase average fruit and vegetable consumption by 10% by 2019, and prevent increases in adult and adolescent obesity.[6][7]
• Reduce insufficient physical activity among adolescents and adults by 5% by 2018 and 10% by 2025.[8][9]
• Reduce tobacco use among adolescents by 10% by 2019 and 30% by 2025, reduce adult tobacco use by 10% by 2019, and increase settings-based tobacco-free policies by 20% by 2019.[10][11][12]
• Reduce heavy episodic drinking by 5% by 2018 and 10% by 2025, and reduce annual per-capita alcohol consumption among people aged 15 years and over by 5% by 2019.[13][14]
• Improve clinical prevention and treatment by making affordable essential non-communicable disease medicines and basic technologies available in 50% of public and private facilities by 2019 and 80% by 2025, and by treating people at high risk of stroke and heart attack.[15][16]
• 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.[17][18][19]
• Address diet, physical activity, tobacco, alcohol and kava, clinical and public health services, mental health and stress management, violence and injuries, rehabilitation, and cross-cutting system actions.[20][2]

Implementation

The plan uses a whole-of-system, multisectoral delivery model in which prevention, early detection, treatment, complication management and rehabilitation are complementary.[2][3]The Ministry of Health and Medical Services leads overall governance, working with government agencies, health services, local authorities, civil society, faith-based organisations, communities, academic institutions, development partners and private-sector bodies.[3][21][22]Actions are intended to be incorporated into the Ministry’s annual corporate plans and relevant plans in other sectors.[3][23]

• Deliver a staged continuum of care through Wellness Fiji at community health worker level; Wellness Fiji and a non-communicable disease toolkit at nursing stations and health centres; the toolkit and the Package of Essential Non-Communicable Disease Interventions at standard outpatient departments; specialist complication management; and rehabilitation services.[3][6]
• Implement the Package of Essential Non-Communicable Disease Interventions through primary health care, with standardised identification and management of high-risk people, essential medicines and technologies, workforce training, and cost-effectiveness-based priorities.[1]
• Strengthen screening, referral, follow-up and continuity of care through a screening unit, community health worker screening, diabetes services, cancer and oncology services, gestational diabetes work, renal-service planning, palliative care and rehabilitation.[24][25][26]
• Adopt population measures for healthier diets, including controls on marketing foods and non-alcoholic beverages to children, implementation of nutrition and salt, sugar and fat action plans, school food and catering standards, gardening, food-labelling education, healthier food production, and fiscal measures such as taxes, price controls and subsidies.[6][27][9]
• Improve opportunities for physical activity through accessible walkways, parks, active play, physical education, workplace policies, targeted interventions and mass-media promotion.[8][28][11]
• Strengthen tobacco, alcohol and kava controls through taxation, licensing, smoke-free and tobacco-free policies, advertising and sponsorship restrictions, enforcement, cessation support, public education, community action and support for people with alcohol dependence.[13][15][14]
• Implement mental health, suicide-prevention, violence and injury actions through a national mental health and suicide prevention plan, stress-management services, counselling and referral arrangements, a National Violence and Injuries Committee, injury-prevention campaigns, rehabilitation and extended surveillance.[17][18][29]
• Coordinate implementation through the Wellness Unit and Planning and Policy Development Unit, with the organisation listed first for each strategy expected to coordinate other named partners.[3]
• Monitor progress through a results framework, annual clarification of performance indicators and metadata, quarterly stakeholder information, ongoing Wellness Unit monitoring, a mid-term review, targeted research and use of baseline data from the 2011/2012 STEPwise survey.[3]
• Use the 2019 STEPwise survey, the Global School-based Student Health Survey every three years, routine health information, hospital and registry data, enforcement reports and partner reporting to assess outcomes and implementation.[6][8][30][23]
• Mobilise resources through indicative annual planning and proposed health-promotion revenue from tobacco, alcohol and unhealthy-food taxes, tobacco-licensing fees and increased allocations proportionate to the scale of the crisis.[3][21][29]The plan identifies an estimated Fiji dollars 28 million over five years for Package of Essential Non-Communicable Disease Interventions roll-out, while broader costing is incomplete and intended to be refined through annual plans.[24][3]

Monitoring & Evaluation

The monitoring and evaluation framework links the 2015-2019 plan to global and regional non-communicable disease targets, using the 2011/2012 STEPwise approach to non-communicable disease risk-factor surveillance survey as the baseline for many measures.[3]It combines population surveys, routine health information, administrative data, service audits, research and implementation reports to track risk factors, disease outcomes, service coverage and cross-sector delivery.[3][30][31]

• Monitor core outcomes including premature mortality, hypertension and diabetes prevalence, cancer incidence, rheumatic fever, suicide and self-harm, injuries, overweight and obesity, tobacco and alcohol use, dietary intake, and diabetic foot amputations.[30]
• Measure behavioural and dietary targets through the STEPS survey in 2019 and the Global School-based Student Health Survey every three years, including salt intake, fruit and vegetable consumption, obesity, physical activity, tobacco use and alcohol-related outcomes.[6][8][10][13][7][9]
• Use Fiji Revenue and Customs Authority data on alcohol units consumed, annual reporting to the Framework Convention on Tobacco Control, and reporting to the Global Information System on Alcohol and Health to support tobacco and alcohol monitoring.[13][15]
• Track service and implementation measures including screening and follow-up for diabetes, hypertension, rheumatic heart disease and cervical cancer; adherence to diabetes-management guidance; trained clinicians and Community Health Workers; essential medicine and technology availability; school food-policy compliance; tobacco-free settings; and the quality and timeliness of health information reports.[30][31][32]
• Monitor mental health through PATIS and the mental health information system, including annual review of the mental health decree and training reports.[17]Monitor violence and injuries through the Public Health Information System, PATIS, accident and emergency records, police data and an extended surveillance system incorporating land-transport and fire-authority information.[17][18][29]
• Require stakeholders to provide relevant information quarterly, with the Wellness Unit leading ongoing monitoring and receiving support from the Ministry of Health and Medical Services monitoring and evaluation team.[3]
• Clarify and elaborate performance indicators annually, including data sources, calculation methods, reporting frequency, assumptions, risks, interpretation, application and updated targets.[3]
• Use the Annex Two Results Framework to connect intervention areas with intended outcomes and illustrative performance indicators, while Annex Three provides the implementation-plan structure.[20][3]
• Undertake a mid-term review to assess progress against indicators and outcomes, emerging priorities and changes in disease burden.[3]
• Evaluate specific interventions through PEN implementation evaluation by 2018, campaign evaluations, enforcement reports, screening-unit review, study reports, committee and taskforce records, service-availability evidence and health-promotion reports.[27][24][25][18]
• Support planning through research on intervention impacts, home-brew and kava abuse, gestational diabetes burden and screening coverage, and targeted research and data analysis for programme design.[3][16][26][23]

Accountability is principally operational: the Ministry of Health and Medical Services has overall governance responsibility, the first-listed organisation for each strategy coordinates participating bodies, and implementation is intended to be incorporated into annual corporate and sectoral action plans.[3]A proposed cross-sectoral committee and dedicated non-communicable disease strategy post would support monitoring and reporting.[22][23]The extracts do not provide a complete national evaluation methodology, all indicator definitions and baselines, or a comprehensive formal accountability and reporting schedule.[30][31][32]

Costing & Financing

Financing provisions combine limited identified costs with proposed fiscal and planning mechanisms. The plan calls for resource allocation for non-communicable diseases proportionate to the scale of the crisis, but most supplied sections do not provide a complete budget, financing framework, funding-gap analysis, expenditure breakdown or economic assumptions.[4][18][21]

• Cost the roll-out of the Package of Essential Non-communicable Disease Interventions at an estimated 28 million Fijian dollars over five years.[24]
• Use indicative, incomplete cost information for planning and develop more comprehensive costing through annual plans.[3]
• Include annual non-communicable disease allocations in Ministry of Health and Medical Services planning, including sufficient provision for educational materials.[21]
• Pursue health-promotion revenue from tobacco, alcohol and unhealthy-food taxes, including a proposed share of these revenues for health promotion.[21][29]
• Pursue annual tobacco and alcohol taxation increases of at least 10%, while also considering taxation, price controls, subsidies and reduced taxes on physical-activity equipment as policy instruments.[10][13][15][11][12]
• Increase tobacco-licence fees progressively, with one proposal that licence-fee revenue be retained by the Ministry of Health and Medical Services.[18][29]
• Assess the need and scope for a study of the costs of non-communicable diseases.[21][23]

A violence and injury action-plan budget is represented only as “$$$$$”, without a currency or numerical amount.[18]Strategy and implementation-plan tables contain budget headings, but the supplied extracts generally do not show monetary values, funding sources, allocations, resource-mobilisation commitments or quantified funding gaps.[6][33][34]