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 of non-communicable diseases, premature deaths and disability through practical, sustainable, evidence-based and cost-effective prevention and treatment measures across society.[1][2]It responds to the combined challenge of communicable diseases, undernutrition and a growing burden of obesity, hypertension, diabetes and other non-communicable diseases that threaten household wellbeing, productivity and economic development.[3][4]

• Create an enabling environment for multisectoral programme management, guided by human rights, equity, cultural sensitivity, social determinants of health, evidence and cost-effectiveness.[5]
• Reduce population exposure to tobacco, betel nut, harmful alcohol use, unhealthy diets, physical inactivity and other substance use.[4][5]
• Prevent and manage cardiovascular disease, cancer, diabetes and chronic respiratory disease through risk reduction, screening, early detection, treatment, palliative care and rehabilitation.[6][7]
• Reduce cancer incidence through hepatitis B immunisation, nationwide human papillomavirus vaccination, cervical cancer control, screening, early detection and treatment.[5][8]
• Prevent injuries, trauma and violence through policy, legislation, advocacy, rehabilitation and cross-sectoral practical measures.[9]
• Establish monitoring, evaluation and surveillance for non-communicable diseases and their risk factors.[4][10]

The plan aligns national action with the World Health Organization global strategy and the Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases 2014–2020, as well as Key Result Areas 7 and 8 of the National Health Plan 2011–2020.[1][6]Its overarching goal is to prevent disability and premature mortality from common, preventable non-communicable diseases by addressing their principal behavioural and metabolic risks.[2]

By 2020, the strategy adopts voluntary global targets to reduce premature mortality from cardiovascular disease, cancer, diabetes and chronic respiratory disease by 25%; tobacco use among people aged 15 years and over by 30%; harmful alcohol use by at least 10%; insufficient physical activity by 10%; and mean population salt or sodium intake by 30%.[6]It also aims to reduce or contain raised blood pressure by 25%, halt increases in diabetes and obesity, ensure drug therapy and counselling for at least 50% of eligible people at risk of heart attacks and strokes, and achieve 80% availability of affordable essential medicines and basic technologies for major non-communicable diseases.[6]

Priority interventions include tobacco taxation and smoke-free environments; alcohol regulation and taxation; salt reduction; healthier food and physical activity promotion; cardiovascular risk treatment; hepatitis B immunisation; cervical cancer screening; and injury prevention.[11]The plan also promotes healthy workplaces, school-based education and healthy eating and activity programmes, stronger legislation, mental health services, disability aids, physiotherapy and community-based rehabilitation.[12][2]

Implementation

Implementation uses a whole-of-government and whole-of-society model, combining population-level prevention with screening, clinical care and support for people already living with non-communicable diseases.[4][6]Interventions are to be prioritised according to the national disease burden, risk factors including betel nut chewing, available resources, and the feasibility of short-, medium- and long-term action.[1][4]

• Coordinate national action through the Ministerial Task Force on Non-Communicable Diseases, established in 2010, and strengthen a high-level multisectoral working group or task force chaired by the Minister of Health or other ministers.[1][13]
• Lead policy development, programme coordination, medicines, training and national implementation through the National Department of Health and its dedicated non-communicable disease prevention and control team.[2][7]
• Engage agriculture, education, trade, Treasury, Finance, Customs, police, the National Statistics Office, provincial and local-level governments, private providers, church-based providers, civil society, foundations, media, academia and communities.[1][6]
• Require ministries to incorporate non-communicable disease priorities into their policies, plans and budgets, and strengthen provincial networks and working groups.[13]
• Develop and enforce tobacco, alcohol, food and other supportive legislation; expand cessation, counselling, rehabilitation and public-awareness services; and create safer environments for walking, exercise and healthy choices.[6][14][15]
• Adapt and progressively implement the World Health Organization Package of Essential Noncommunicable Disease Interventions, beginning with pilots, workforce training and cost-effective screening before expansion through primary healthcare facilities.[7]

Delivery partners include the Papua New Guinea Cancer Foundation and Heart Foundation, alongside private and church-based health providers, non-governmental organisations and civil society.[2]Providers are expected to participate in multisectoral working groups, align with government programmes, train staff, deliver counselling and treatment, and support screening, rehabilitation and community awareness.[13][16]

Monitoring will use the 2008 Non-Communicable Disease STEPS survey as a baseline, regular STEPS surveys, risk-factor surveillance, the National Health Information System and targeted surveys to measure progress against 2020 targets.[1][17][11]Planned activities include a second STEPS survey with a salt-consumption module, a Global School-based Student Health Survey, hospital-based cancer registries at Angau Memorial Hospital and Port Moresby General Hospital, stronger civil registration and vital statistics, International Classification of Diseases, 10th Revision coding, death certification, and a national population-based cancer registry.[10]

The plan provides an implementation budget of 33,450,000 Kina, including 10,100,000 Kina for tobacco reduction, 9,000,000 Kina for cancer reduction, 6,100,000 Kina for healthy diet and physical activity, 2,100,000 Kina for alcohol reduction, 2,100,000 Kina for monitoring and evaluation, and 2,100,000 Kina for administration and management.[18]Financing is intended to be multisectoral, with costs incurred by government departments and non-governmental organisations; Finance and Treasury are also assigned to develop a non-communicable disease control fund using earmarked taxes on cigarettes, alcohol, unhealthy foods and drinks.[13][18]Specific funding sources, financing gaps, reporting schedules, detailed evaluation methods and formal accountability procedures are not specified.[18]

Monitoring & Evaluation

The plan establishes monitoring, evaluation and surveillance as a core strategic objective, using risk-factor surveys, health information systems, registries, campaign assessments and mortality data to measure progress towards 2020 non-communicable disease targets.[4][10][11]

• Use the 2008 Non-Communicable Disease STEPS survey, also described as the 2007–08 national risk-factor survey, as baseline evidence; the survey found 99.6% of the population at moderate to high risk and 77.7% at high risk.[1][6][12]
• Track voluntary global targets covering premature mortality, harmful alcohol use, physical inactivity, salt intake, tobacco use, raised blood pressure, diabetes, obesity, preventive drug therapy, and the availability of essential medicines and technologies.[6]
• Measure tobacco, alcohol, betel nut use, diet, physical activity, diabetes, obesity and hypertension against baseline status and 2020 targets through STEPS surveys.[17][11]
• Conduct a second STEPS survey with a salt-consumption module and a Global School-based Student Health Survey by 2017.[10]
• Establish hospital-based cancer registries at Angau Memorial Hospital and Port Moresby General Hospital by 2015, expand registration to key provincial sites, and develop a national population-based cancer registry.[10]
• Strengthen mortality surveillance through civil registration and vital statistics, International Classification of Diseases, 10th Revision coding, and death certification.[10]
• Verify essential medicine and technology availability, including the avoidance of stock-outs for major non-communicable disease treatment, through the National Health Information System.[11]
• Evaluate tobacco, betel nut, alcohol, healthy-diet and physical-activity media campaigns; assess school cafeterias; conduct tobacco-industry stakeholder analysis and the Global Youth Tobacco Survey; and report human papillomavirus vaccination pilot and roll-out findings.[10]
• Monitor salt and iodine consumption, vaccination coverage, substance-abuse data, alcohol-reduction implementation, and national trends in injuries, trauma and violence.[16][19][8][9]
• Fund monitoring and evaluation as a distinct implementation budget line.[18]

Implementation accountability is intended to operate through the National Department of Health, other ministries, providers, civil society, multisectoral working groups and provincial networks.[13]The available text does not specify a consolidated indicator framework with definitions, a reporting timetable, formal evaluation methodology, named reporting institutions, or formal accountability procedures.[4][5][14][18]

Costing & Financing

The plan presents a total implementation budget of 33,450,000 Kina and expects delivery costs to be incurred across Government departments and non-government organisations under a multisectoral approach.[18]It prioritises cost-effective and very cost-effective interventions, while recognising that implementation occurs in a resource-constrained environment.[5][11]

• Allocate 10,100,000 Kina to reduction of tobacco use, 9,000,000 Kina to reduction of cancer incidences, and 6,100,000 Kina to promotion of healthy diet and physical activity.[18]
• Allocate 2,100,000 Kina each to reduction of alcohol use, monitoring and evaluation, and administration and management; allocate 1,350,000 Kina to betel nut and substance-use reduction; and allocate 600,000 Kina to injuries, trauma and violence, including road-traffic accidents.[18]
• Develop a proposed non-communicable disease control fund financed through earmarked taxes on cigarettes, alcohol, unhealthy food and drinks.[13]
• Increase tobacco excise tax to at least 70% of retail value and consider earmarking tobacco revenue for tobacco control or enforcement.[14]
• Increase alcohol taxes and consider earmarking alcohol taxes and licensing fees for alcohol-control programmes.[15]
• Consider increased taxes on unhealthy foods and earmark food-related taxes and licensing fees for non-communicable disease control.[19]
• Recognise economic losses, reduced productivity, household poverty, premature mortality and potentially lifelong treatment costs associated with non-communicable diseases.[3][20][6]
• Record an estimated 4 million to 20 million Kina expenditure for management of road-traffic-injury cases at Port Moresby General Hospital.[12]

Specific funding sources for the implementation budget, financing allocations by institution, funding gaps, detailed programme costings beyond the budget table, and broader economic assumptions are not specified.[18]