Non-Communicable Diseases Strategic Plan 2015-2019

Objectives

Fiji’s Non-Communicable Diseases Strategic Plan 2015–2019 sets a comprehensive Wellness-centred framework to improve the health of all Fijians, with particular attention to communities at greatest risk.[1][2]Its overarching ambition is to contribute to a healthier Fiji through a 25% reduction in premature mortality from the four principal non-communicable diseases by 2025.[3]The strategy combines prevention, early diagnosis, treatment, complication management, rehabilitation, mental health, stress management, violence and injury prevention within a five-year national response.[4][5]

• Reduce premature mortality and the major modifiable risk factors of tobacco use, harmful alcohol and kava use, unhealthy diets, excess salt intake, raised blood pressure, obesity and insufficient physical activity.[6][3]
• Improve hypertension and diabetes control, prevent increases in adult diabetes and obesity prevalence, and increase fruit and vegetable consumption.[6][3][7]
• Reduce population salt intake among people aged 18 years and over by 20% by 2019 and 30% by 2025, while increasing average fruit and vegetable intake among adolescents and adults by 10% by 2019.[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]
• Reduce heavy episodic drinking among adolescents and adults 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.[12][13]
• Increase the availability of affordable essential medicines and basic technologies for non-communicable disease treatment to 50% of public and private facilities by 2019 and 80% by 2025, while treating 30% of people at high risk of stroke or heart attack by 2019 and 50% by 2025.[14][15]
• 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.[16][17]
• Prioritise action on diet, physical activity, tobacco, alcohol and kava, clinical and public health services, mental health, violence and injuries, health financing, research, surveillance, workforce capacity, communication and governance.[18][19][20]

Implementation

Implementation combines multisectoral prevention policy with an integrated, stepped service-delivery model across community, primary, specialist and rehabilitation settings.[2][5]The Ministry of Health and Medical Services provides overall governance, supported operationally by the Wellness Unit and Planning and Policy Development Unit, while organisations listed first against individual strategies are expected to coordinate delivery.[5]The approach seeks whole-of-government and whole-of-society action because non-communicable disease drivers extend beyond the health sector and are shaped by socioeconomic conditions.[4][2]

• Deliver Wellness Fiji activities through community health workers; add the non-communicable disease toolkit at nursing stations and health centres; provide the Package of Essential Non-Communicable Disease interventions at standard outpatient departments; manage complications through specialist outpatient departments; and provide rehabilitation services.[2]
• Strengthen primary health care through evidence-based, cost-effective interventions, standardised protocols, essential medicines and technologies, early diagnosis, high-risk case identification and trained frontline staff.[2][15]
• Implement healthier food environments through food marketing controls, the Food and Nutrition Policy and Action Plan, the Salt, Sugar, Fat action plan, school and early-childhood nutrition measures, catering guidance, food-labelling education, gardening and support for local food production.[21][22][23][24]
• Apply regulatory, fiscal and community measures for tobacco and alcohol control, including annual tax increases of at least 10%, smoke-free enforcement, advertising and sponsorship restrictions, cessation support, licensing controls and alcohol or kava restrictions led by communities and faith-based organisations.[12][14][11][13]
• Expand specialised services by establishing a screening unit, strengthening oncology services, developing renal services, resourcing diabetes hubs, coordinating allied health providers and introducing appointment reminders with mobile operators.[25][26]
• Decentralise mental health support through stress-management wards, specialised sub-divisional staff, referral systems, community awareness, counselling and alcohol-support services, alongside implementation and review of mental health legislation and strategic planning.[16][27]
• Establish cross-sectoral mechanisms including a National Violence and Injuries Committee, a national non-communicable disease taskforce, and a proposed cross-sectoral committee established through a Cabinet paper, decree or Act.[17][20][28]
• Engage government ministries, local authorities, police, fire and transport bodies, education and academic institutions, professional bodies, private-sector organisations, civil society, faith-based organisations, development partners and the World Health Organization.[6][2][29]
• Translate strategic actions into annual corporate and sectoral plans, prioritise activities scheduled to begin earlier, and support other organisations to incorporate non-communicable disease actions into their planning.[2][5][19]
• Monitor delivery through a results framework, quarterly stakeholder information, annual indicator clarification and metadata, a mid-term review, repeated STEPS surveys, the Global School-based Student Health Survey every three years, routine health information systems, registries, audits and enforcement reports.[5][30][31][32]
• Mobilise resources through annual Ministry planning, proposed health-promotion revenue from tobacco, alcohol and unhealthy-food taxes, tobacco-licence fee increases and assessment of the need for a cost-of-non-communicable-diseases study.[19][33][34]The plan specifies Fiji Dollars 28 million over five years for rolling out the essential medicines and technologies package; wider allocations and funding gaps are not specified in the supplied material.[15]

Monitoring & Evaluation

The plan establishes a monitoring and evaluation system linking a results framework, baseline surveys, routine service information and stakeholder reporting to national and global non-communicable disease targets. The 2011/2012 STEPwise Approach to Surveillance (STEPS) report is the baseline for many indicators, and the framework is intended to report progress against global and regional targets.[5]

• Monitor outcomes covering premature mortality, disease prevalence and incidence, injuries, suicide and self-harm, obesity, diet, physical activity, tobacco and alcohol use, salt and saturated-fat intake, diabetes complications, case detection, clinical-guideline adherence and tobacco-free policies.[30]
• Track implementation through indicators for school canteens, community health-worker capacity, functioning Community Health Committees, human papilloma virus vaccination, screening for diabetes, hypertension, rheumatic heart disease and cervical cancer, diabetes-clinic functionality, clinician training, and the timeliness, completeness and accuracy of reporting.[31][32]
• Use data from cause-of-death certificates, surveys, registries, hospital and health-information systems, programme audits, training databases and Wellness Unit records; measurement frequencies range from six-monthly and quarterly to annual and three-to-five-year intervals.[30][31][32]
• Repeat the adult STEPS survey in 2019 and conduct the Global School-based Student Health Survey every three years, with findings reported and disseminated.[21][20][35]
• Measure diet-related outcomes through the 2019 STEPS survey, the three-yearly student health survey and the 2015 Fiji Schools Infant and Adolescent survey; use advertising-monitoring and enforcement reports for food marketing and relevant policy reports for the Food and Nutrition Policy and Action Plan.[21]

Annual implementation monitoring is to use quarterly information supplied by stakeholders, while a mid-term review is to be informed by monitoring led by the Wellness Unit with support from the Ministry monitoring and evaluation team.[5]Indicators are to be clarified annually, with metadata covering data sources, calculations, reporting frequency, assumptions, risks and interpretation; targets may be updated in response to implementation progress, outcomes and contextual change.[5]

• Evaluate the Package of Essential Non-Communicable Disease interventions in 2018 and track staff training, medicine and technology availability, screening, follow-up, rehabilitation assessments, diabetes complications and appointment adherence.[15]
• Monitor tobacco control through annual reporting to the Framework Convention on Tobacco Control, enforcement reports, participation figures for cessation services, media evaluation and evidence of tobacco-free policies.[12]
• Monitor alcohol outcomes using STEPS, the student health survey and Fiji Revenue and Customs Authority data on alcohol units consumed; report alcohol measures annually to the Global Information System on Alcohol and Health.[12][14]
• Use the mental health information system and Police Accident and Traffic Information System, alongside hospital, police, transport, fire and accident-and-emergency data, to monitor suicide, violence and injuries.[16][17][33]
• Maintain accountability through taskforce and committee minutes, enforcement and evaluation reports, service assessments, documented policy changes, and a dedicated NCD strategy post reporting to the proposed cross-sectoral committee.[17][20][35]

The Ministry of Health and Medical Services has overall governance responsibility, while the Wellness Unit and Planning and Policy Development Unit coordinate implementation with divisions, departments and external organisations.[5]The document proposes implementation of a monitoring and evaluation framework, monitoring and evaluation reports and a mid-term review, but some extracts do not specify consolidated reporting schedules or formal accountability procedures for every intervention.[19][36][26][27]

Costing & Financing

Financing provisions combine indicative planning costs, annual budgeting, tax-based resource mobilisation and commitments to increase investment in non-communicable disease services. The only stated currency-denominated programme cost is Fiji Dollar 28 million over five years for rolling out the Package of Essential Non-Communicable Disease interventions, including essential medicines and technologies.[15]

• Plan annual non-communicable disease budgets with Ministry of Health and Medical Services divisions, sub-divisions and departments, including adequate allocations for educational materials.[19][34]
• Increase resource allocation for non-communicable diseases in line with the scale of the crisis, although no allocation amount is specified.[3][17]
• Seek a share of tobacco, alcohol and unhealthy-food tax revenue for health promotion, including consideration of a Cabinet paper on this mechanism in 2015.[19]
• Pursue annual increases of at least 10% in tobacco taxation and alcohol taxation as fiscal measures supporting risk-factor reduction.[10][12][11][13]
• Increase tobacco-licence fees and retain the resulting revenue within the Ministry of Health and Medical Services.[34]
• Consider taxation, price controls or subsidies to improve the affordability of healthier foods, supported by a costing study, and reduce taxes on sports, physical-activity and gym equipment.[22][10][37]

The strategy provides indicative cost information for planning, with more comprehensive costing expected through annual plans.[5]An assessment of the need and possible scope for a cost-of-NCDs study was scheduled for 2015.[19]The implementation-plan and intervention-table formats contain budget columns, but many supplied extracts leave these fields blank or provide no monetary values.[21][38][7][23]

No wider budget envelope, funding gap, external financing source, expenditure total or economic assumption is specified for most actions, including screening, oncology, renal, mental health, rehabilitation, violence and injury interventions.[25][16][17][36][26][27]A violence and injuries strategic-plan activity has a qualitative five-dollar-sign budget notation, but no currency or numerical amount is provided.[17]