Non-Communicable Diseases Strategic Plan 2015-2019

Objectives

Fiji’s Non-Communicable Disease Strategic Plan 2015-2019 provides a five-year, Wellness-centred framework to reduce the national burden of non-communicable diseases, improve mental health, and address violence and injuries through prevention, early diagnosis, treatment, rehabilitation and cross-sectoral action. It responds to high premature mortality from ischaemic heart disease, diabetes mellitus and cerebrovascular disease, alongside major risks including high body-mass index, unhealthy diets and raised blood glucose.[1][2][3]

• Achieve a 25% reduction in premature mortality from the four principal non-communicable diseases by 2025, aligned with the World Health Organization global action plan and associated targets.[4][5]
• Reduce modifiable risks by lowering salt intake, increasing fruit and vegetable consumption and physical activity, preventing further rises in obesity and diabetes, and reducing tobacco use, harmful alcohol use and kava-related harm.[1][6][7]
• Improve food environments through the Salt, Sugar, Fat action plan, nutrition policies, food-marketing controls, healthier school and workplace settings, food-labelling education, local-food production and public communication.[8][9][10]
• Strengthen tobacco control through taxation, smoke-free settings, enforcement, cessation support and restrictions on sales, promotion, advertising and sponsorship.[11][12][13]
• Reduce heavy episodic drinking among adolescents and adults by 5% by 2018 and 10% by 2025, and reduce annual per-capita alcohol intake among people aged 15 years and over by 5% by 2019.[7][14]
• Improve clinical outcomes by expanding early detection, standardised risk assessment, affordable essential medicines and technologies, diabetes management, screening, oncology, renal services, rehabilitation, palliative care and continuity of care.[15][16][17][18]
• Reduce suicide and attempted suicide by 20% by 2019 through mental-health promotion, stress management, decentralised services, community support and suicide-prevention action.[19][20]
• Reduce violence and injuries by 5% by 2019 and alcohol-related violence and injuries by 10% by 2019, while strengthening surveillance, prevention and rehabilitation.[21][22]
• Increase resource allocation for non-communicable diseases in line with the scale of the national crisis and embed Wellness and non-communicable disease priorities across sectors.[6][23][24]

Implementation

The strategy adopts a multisectoral, whole-of-system delivery model that combines population prevention, healthier settings, regulation and fiscal measures with integrated primary care, specialist services and rehabilitation. Overall governance rests with the Ministry of Health and Medical Services, supported by the Wellness Unit and Planning and Policy Development Unit, while annual corporate plans are intended to translate the strategy into action across government and partner organisations.[3][5][25]

• Deliver care through five linked levels: community health workers; nursing stations and health centres; primary outpatient services using the non-communicable disease toolkit and the Package of Essential Non-Communicable Disease Interventions; specialist outpatient management of complications; and rehabilitation services.[3][5]
• Use the Package of Essential Non-Communicable Disease Interventions to standardise risk identification and management in primary care, supported by specified medicines, technologies, frontline training and integrated people-oriented services.[3][15]
• Establish a screening unit to coordinate screening, referral, treatment continuity, data management, case follow-up and collaboration with civil-society organisations for conditions including cancer, diabetes and rheumatic heart disease.[16][18]
• Strengthen diabetes hubs, oncology services at divisional hospitals, renal clinical-service planning, rehabilitation partnerships, counselling, respite care and appointment reminders to improve access and continuity.[16][18][20]
• Implement mental-health and suicide-prevention measures through the mental health decree and national strategy, mental-health champions, stress-management wards, training, awareness activities and lifeline-style counselling and alcohol-support services.[19][21][20]
• Coordinate regulatory and environmental interventions with the Ministry of Education, agriculture and food bodies, industry and trade, finance and taxation agencies, local government, transport authorities, employers, private-sector actors, professional groups, civil society and faith-based organisations.[8][26][10][27]
• Use fiscal and regulatory levers including annual tobacco and alcohol tax increases, food-marketing regulation, healthier catering and school-canteen policies, alcohol licensing controls, and lower taxes on physical-activity and mobility equipment.[8][11][12][14]
• Establish cross-sectoral leadership through a national non-communicable disease taskforce, Wellness committee, champions and a dedicated strategy post, supported by communication plans, stakeholder briefings and healthy-settings recognition programmes.[23][25][28][29]
• Monitor implementation through the Results Framework, quarterly stakeholder information, routine service data, clinical audits, enforcement reports and periodic population surveys, including the STEPwise survey in 2019 and the Global School-based Student Health Survey every three years. A mid-term review is anticipated to respond to progress, new priorities and changing disease patterns.[5][30][31][32][29]
• Support planning through indicative costing and annual budget planning; the plan identifies a projected Fiji Dollar 28 million cost over five years for rollout of the Package of Essential Non-Communicable Disease Interventions, although the supplied material does not provide a comprehensive financing breakdown.[5][15][23]

Monitoring & Evaluation

The plan establishes a structured monitoring and evaluation approach that combines a results framework, routine administrative reporting, clinical audit, population surveys, service indicators and periodic review. It uses the 2011/2012 STEPwise approach to non-communicable disease risk-factor surveillance survey as a baseline for many measures and aligns progress reporting with global and regional non-communicable disease targets.[5]

• Monitor population outcomes including premature non-communicable disease mortality, diabetes and hypertension prevalence, cancer incidence, suicide and self-harm, injuries, obesity, dietary intake, physical activity, tobacco use, alcohol consumption and diabetic-foot amputation.[31]
• Track service and response indicators including detection of diabetes and hypertension, compliance with Diabetes Management Guidelines, availability of diabetes clinics, screening and follow-up coverage, human papilloma virus vaccination, school canteen guideline implementation, trained community health workers and functioning community health committees.[31][32]
• Use quarterly monitoring for many mortality, morbidity, service-delivery, school, community and screening measures, while conducting population surveys generally every three to five years.[31][32]Tobacco-free policy endorsement is monitored annually, and alcohol consumption among people aged 15 years and over is also monitored annually.[31][32]
• Collect data through medical cause-of-death certificates, cancer registry records, hospital discharge records, the National Non-Communicable Disease Surveillance System, the Population Health Information System, Wellness Unit records, clinical audits, dieticians’ reports and community health-worker training databases.[31][32]
• Conduct the STEPwise survey in 2019 and the Global School-based Student Health Survey every three years to assess risk factors and population outcomes.[5][25]
• Measure diet interventions through the 2019 STEPwise survey, the three-yearly Global School-based Student Health Survey, the 2015 Food Systems Innovation and Action survey, and food-advertising enforcement reports.[33]
• Track tobacco and alcohol control using survey findings, Fiji Revenue and Customs Authority data on alcohol consumption, annual reports to the Framework Convention on Tobacco Control and the Global Information System on Alcohol and Health, and enforcement and campaign reports.[7]
• Monitor mental health, suicide, violence and injuries through the mental health information system, the Pacific Anti-Tobacco Information System, the Pacific Health Information System, accident and emergency data, and an extended surveillance system incorporating police, transport and fire-authority information.[19][21][24]
• Require annual elaboration of performance indicators, including data sources, calculations, frequency, assumptions, risks, interpretation, application and revised targets where appropriate.[5]
• Obtain relevant stakeholder information quarterly through the Wellness Unit and Ministry monitoring and evaluation team, and conduct a mid-term review informed by implementation progress, outcomes, new priorities and changing disease patterns.[5]
• Support accountability through six-monthly clinical audits of Diabetes Management Guidelines, routine online and monthly reporting, designated dietician reports, taskforce and committee minutes, annual corporate-plan documentation, communication-plan evaluations and a dedicated non-communicable disease strategy post reporting to a cross-sectoral committee.[31][32][23][25][29]
• Develop data sources for indicators where arrangements remain incomplete, notably adequate community health-worker coverage and functioning community health committees.[32]
• Support targeted research and data analysis throughout implementation to inform planning, intervention delivery, service design and assessment of impacts.[5][25][29]

Costing & Financing

Financing is framed principally as increased resource allocation for non-communicable diseases, annual budget planning and use of fiscal measures to support prevention. The plan provides limited quantified costing: the rollout of the Package of Essential Non-communicable Disease Interventions is projected to cost 28 million Fijian dollars over five years.[15]

• Increase non-communicable disease resource allocation in proportion to the scale of the crisis, undertake annual budget planning across Ministry of Health and Medical Services divisions and departments, and provide sufficient funding for educational materials.[23]
• Use indicative cost information for planning and develop more comprehensive costing through annual plans.[5]
• Finance prevention partly through annual tobacco and alcohol tax increases of at least 10%, while also considering increased tobacco-licence fees retained within the Ministry of Health and Medical Services.[12][14][23]
• Pursue a share of revenue from tobacco, alcohol and unhealthy-food taxes for health promotion.[23]
• Consider targeted taxation, price-control changes or subsidies to improve healthier-food affordability, and reduce taxes on sports, physical-activity, gym and mobility equipment and sports shoes.[8][11]
• Identify resource requirements for essential medicines and technologies, non-communicable disease toolkits, diabetes hubs, screening systems, rehabilitation, oncology, renal services, mental health wards, specialised staff, training and counselling support, although detailed financing for these inputs is not specified.[16][21][17][18][20]
• Undertake or assess the scope for a cost-of-non-communicable-diseases study; a costing study is also identified as an indicator for whether healthier food has become more affordable.[23][8]
• Note that most implementation tables include budget fields or qualitative budget indications, but the supplied material does not provide a consolidated budget, funding envelope, source-by-source allocations, funding gap analysis or broader economic assumptions.[33][21][34][9][35]