National Multisectoral Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2015-2020

Objectives

Papua New Guinea’s National Multisectoral Strategic Plan for the Prevention and Control of Non-Communicable Diseases 2015–2020 seeks to reduce the burden, premature deaths and disability associated with non-communicable diseases through practical, sustainable prevention and treatment across society. Its mission combines risk-factor reduction through enabling environments with cost-effective, evidence-based disease management, using whole-of-government and whole-of-society action.[1][2]

• Reduce major non-communicable diseases, particularly cardiovascular disease, cancer, diabetes and chronic respiratory disease, while recognising the country’s concurrent communicable-disease burden and epidemiological transition.[1][3][4]
• Reduce exposure to tobacco, betel nut, harmful alcohol use, unhealthy diets, physical inactivity, substance use, overweight, hypertension and raised blood glucose.[3][5]
• Promote healthy lifestyles and address social determinants of health through a Health in All Policies approach that is equitable, culturally sensitive and feasible in a resource-constrained setting.[1][6]
• Prevent cancer through immunisation against cancer-causing infections, including timely hepatitis B vaccination and nationwide human papillomavirus vaccination, alongside cervical screening, early detection, treatment and management.[6][7]
• Improve screening, early detection, treatment, palliative care, rehabilitation and clinical management for heart disease, stroke, diabetes, cancer and other non-communicable diseases.[2][8]
• Prevent injuries, trauma and violence through policy, legislation, prevention guidance, advocacy, disability management and rehabilitation.[6][9]
• Apply World Health Organization best-buy interventions, prioritised according to national disease burden, local risk factors including betel-nut chewing, and available resources.[1][3]
• Work towards proposed 2020 targets for reductions in tobacco use, harmful alcohol use, betel-nut chewing, salt intake, insufficient physical activity and raised blood pressure; prevent increases in diabetes and obesity; increase fruit and vegetable consumption; reduce premature mortality; and improve access to essential medicines and technologies.[10][11]

Implementation

Implementation uses a phased multisectoral model that combines population-wide regulation and health promotion with primary-care and community-based screening, treatment, rehabilitation and palliative care. The National Department of Health leads technical coordination, supported by national and provincial working groups, while ministries, providers, civil society, communities and private-sector actors share responsibility for policy implementation and service delivery.[12][13]

• Coordinate action through the Ministerial Task Force on Non-Communicable Diseases and multisectoral working groups involving health, agriculture, education, trade, Treasury, Lands, Roads, police, Customs, the National Statistical Office, provincial and local-level governments, development partners and other public bodies.[1][4][12]
• Engage churches, civil-society organisations, non-governmental organisations, foundations, academia, media, communities, families and the private sector in advocacy, awareness, screening and healthy-lifestyle action.[1][4][12]
• Strengthen regulatory and fiscal measures through tobacco and alcohol taxation, smoke-free environments, advertising restrictions, licensing and enforcement, and consideration of earmarked revenues for non-communicable disease and tobacco-control funds.[12][14][15][16]
• Develop healthy environments through safe spaces for walking and exercise, school-based education and healthy-school programmes, workplace health promotion, nutrition policy, salt-reduction measures, food-supply regulation and action on trans fats and unhealthy foods.[4][5][16]
• Adapt the World Health Organization Package of Essential Noncommunicable Disease Interventions, train health workers, revise the essential medicines list, improve medicine availability and progressively extend cost-effective screening and clinical services from primary care to community and national levels.[12][8]
• Develop specialised workforce capacity through pre-service and in-service training, clinical guidelines, academic curricula, cessation and rehabilitation services, and community networks for palliative care, disability support and rehabilitation.[12][17][15][8]
• Monitor implementation through non-communicable disease STEPS surveys, the Global School-based Student Health Survey, tobacco surveys, salt-consumption assessment, hospital and population-based cancer registration, civil registration and vital statistics, death certification and International Classification of Diseases 10th Revision coding.[18][10][11]
• Use baseline status, national targets and means of verification for behavioural and medical risk factors, with STEPS surveys supporting measurement of tobacco, alcohol, betel-nut use, diet, physical activity, diabetes and hypertension, and the National Health Information System tracking medicine and technology availability.[10][11]
• Allocate an implementation budget totalling 33,450,000 Kina across risk-factor reduction, cancer, injury prevention, monitoring and evaluation, and administration, while anticipating additional implementation costs in other government departments and non-government organisations.[13]

Monitoring & Evaluation

The strategy establishes monitoring, evaluation and surveillance as a core objective for non-communicable disease prevention and control, linking measurement to risk-factor reduction, service delivery, cancer control, injury prevention and progress towards proposed 2020 targets.[3][6][18][10][11]

• Use the 2007–08 Non-Communicable Disease STEPS survey as a baseline source for assessing the national non-communicable disease burden and risk profile. Reported findings included 99.6% of the population at moderate or high risk and 77.7% at high risk.[1][4]
• Track behavioural and medical risk factors, including tobacco and betel-nut use, harmful alcohol use, fruit and vegetable consumption, salt intake, physical inactivity, overweight and obesity, hypertension, raised blood glucose and diabetes.[5][10][11]
• Measure progress against proposed national targets, including relative reductions in tobacco use, harmful alcohol use, betel-nut chewing, salt intake, insufficient physical activity and raised blood pressure; prevention of rises in diabetes and obesity; reduced premature mortality; and improved access to essential medicines.[4][10][11]
• Use STEPS surveys as the means of verification for tobacco, alcohol, betel-nut, diet, physical activity, diabetes and hypertension indicators, and use the National Health Information System to verify medicine and technology availability.[10][11]
• Monitor the target that 80% of health facilities have no stock-outs of medicines required for major non-communicable diseases.[11]
• Conduct a second STEPS survey with a salt-consumption module and the Global School-based Student Health Survey by 2017, and continue regular STEPS surveys thereafter.[18]
• Establish hospital-based cancer registries at Angau Memorial Hospital and Port Moresby General Hospital by 2015, expand registration to other provincial sites, and develop a national population-based cancer registry.[18]
• Strengthen mortality surveillance through civil registration and vital statistics, International Classification of Diseases 10th Revision coding and death certification.[18]
• Evaluate media campaigns, school cafeteria interventions and human papillomavirus pilot and roll-out projects; undertake the Global Youth Tobacco Survey; assess tobacco-industry interference; and conduct betel-nut research to inform cessation services.[18]
• Monitor tobacco-control enforcement, alcohol-reduction implementation, substance-abuse data, salt and iodine intake, and injury, trauma and violence trends.[14][17][16][9]

Accountability is primarily associated with enforcement teams and officers, policy review, legislative enforcement, multisectoral implementation and participation in national working groups.[12][14][17][15]The supplied material does not specify a consolidated reporting timetable, publication arrangements, formal evaluation design, named accountability body or comprehensive indicator definitions for all objectives.[3][6][10][11]

Costing & Financing

The plan includes an implementation budget of 33,450,000 Kina across major programme areas, monitoring and evaluation, and administration and management.[13]It also promotes resource mobilisation through government budgeting, taxes and potential earmarked funds, although the supplied material does not identify confirmed funding sources, financing gaps, fiscal years, expenditure ceilings or a detailed costing methodology.[12][15][16][13]

• Allocate 10,100,000 Kina for tobacco-use reduction, 9,000,000 Kina for cancer-incidence reduction, and 6,100,000 Kina for healthy diet and physical activity promotion, which are the largest stated programme allocations.[13]
• Allocate 2,100,000 Kina each for alcohol-use reduction, monitoring and evaluation, and administration and management; 1,350,000 Kina for betel-nut and substance-use reduction; and 600,000 Kina for injury, trauma and violence reduction, including road-traffic accidents.[13]
• Provide adequate resourcing for non-communicable disease activities through the budgeting processes of government ministries and other stakeholders.[12]
• Establish a proposed non-communicable disease control fund supported by earmarked taxes on cigarettes, alcohol, unhealthy food and drinks.[12]
• Increase tobacco excise tax to at least 70% of retail value and consider dedicated funding for a tobacco-control fund.[14]
• Consider increased alcohol and unhealthy-food taxation, with possible earmarking of alcohol taxes, food-related taxes and licensing fees for alcohol control or non-communicable disease control.[15][16]
• Recognise that intervention selection depends partly on available resources and that chronic non-communicable diseases can require expensive lifelong treatment.[1][3][19]
• Include costs expected to be incurred by other government departments and non-government organisations because implementation is multisectoral.[13]

An estimate places the cost of managing road-traffic-injury cases at Port Moresby General Hospital at approximately 4 to 20 million Kina; no date or costing assumptions are provided.[5]The material does not specify recurrent versus capital costs, revenue projections, funding gaps, allocation years or economic assumptions for the overall implementation budget.[13]