Non-Communicable Diseases Strategic Plan 2015–2019

Objectives

Fiji’s 2015-2019 Non-Communicable Disease Strategic Plan seeks to improve the health of all Fijians through a Wellness-centred, whole-system response to prevention, early diagnosis, treatment, complication management, rehabilitation, mental health, violence and injuries. It contributes to a longer-term goal of reducing premature mortality from the four principal non-communicable diseases by 25% by 2025.[1][2]

• Reduce major behavioural and metabolic risks, including tobacco use, harmful alcohol consumption, poor diet, excessive salt intake, physical inactivity, obesity, raised blood pressure and diabetes.[3][2]
• Improve diet by reducing mean salt intake among adults by 20% by 2019, increasing fruit and vegetable consumption among adolescents and adults by 10%, and preventing increases in obesity and adult diabetes prevalence.[2][4]
• Reduce insufficient physical activity among adolescents and adults, with interim and longer-term milestones of 5% by 2018 and 10% by 2025.[5]
• Reduce tobacco use among adolescents and adults, expand tobacco-free policies, and reduce heavy episodic drinking and annual per-capita alcohol consumption.[2][6][7]
• Expand access to affordable essential non-communicable disease medicines and basic technologies to 50% of public and private facilities by 2019 and 80% by 2025, while identifying and treating people at high risk of stroke and heart attack.[8][9]
• Reduce suicide and attempted suicide by 20% by 2019, and reduce violence and injuries by 5%, including alcohol-related violence and injuries by 10%.[10][11]

Priority action areas encompass nutrition, tobacco, alcohol and kava, physical activity, clinical and public-health services, mental health, suicide prevention, violence and injury prevention, health communication, healthy settings, workforce capacity, research and surveillance. The plan recognises that non-communicable diseases are influenced by socioeconomic and environmental factors and cannot be addressed by the health sector alone.[12][1][13]

Implementation

Implementation combines multisectoral governance, integrated primary health care, community-based Wellness activities, regulatory and fiscal measures, stronger clinical services, and a structured monitoring framework. The Ministry of Health and Medical Services leads overall governance, operationalisation and coordination, supported by the Wellness Unit, Planning and Policy Development functions, divisions, departments and partner organisations.[14][15][13]

• Translate the strategy into annual Ministry corporate plans and corresponding action plans in other sectors, with the first-named organisation for each strategy coordinating delivery with named partners.[14]
• Deliver services through five levels: community health workers providing Wellness Fiji; nursing stations and health centres using Wellness Fiji and a non-communicable disease toolkit; primary outpatient departments additionally delivering the Package of Essential Noncommunicable Disease Interventions; specialist outpatient departments managing complications; and rehabilitation services.[14][16]
• Strengthen integrated primary care through the Package of Essential Noncommunicable Disease Interventions, standardised protocols, key medicines and technologies, frontline training, high-risk identification, diabetes hubs and community health worker involvement.[1][9]
• Establish or strengthen screening, oncology, renal, rehabilitation, palliative-care, counselling and mental health services, including a screening unit responsible for follow-up, data management and continuity from screening to treatment.[17][18][19]
• Implement population-level prevention through food-marketing controls, food and nutrition policies, school and workplace standards, gardens and local foods, accessible spaces for physical activity, tobacco and alcohol controls, taxation, licensing measures, awareness campaigns and community or faith-based action.[16][20][5][7][8]
• Establish national coordination mechanisms, including a non-communicable disease taskforce, cross-sectoral committee and National Violence and Injuries Committee, alongside a proposed Cabinet paper, decree or Act for Wellness.[15][21][22]

Delivery depends on participation from government ministries, health services, education, agriculture, finance, transport, police, fire and licensing authorities, academic institutions, private-sector bodies, civil-society organisations, faith-based organisations, community health workers, development partners and the World Health Organization. Consultation informed the strategy through meetings across government and civil society, including a national workshop in Suva in February 2014.[12][23][24]

Monitoring is intended to support reporting against global and regional targets. The Wellness Unit leads ongoing monitoring with the Ministry monitoring and evaluation team; stakeholders are expected to provide relevant information quarterly, and a mid-term review is to consider implementation progress, indicators, outcomes, new priorities and changing disease patterns.[14]Indicators draw on routine information systems, surveys, registries, clinical audits, training databases and community data. Risk-factor surveillance includes the STEPwise survey in 2019 and the Global School-based Student Health Survey every three years, while the Results Framework identifies quarterly monitoring for several service and outcome measures.[13][25][26]

Financing is not comprehensively specified. The plan calls for increased resource allocation proportionate to the non-communicable disease crisis, annual budget planning with operational units, retention of increased tobacco-licence revenue by the Ministry, and pursuit of a share of tobacco, alcohol and unhealthy-food tax revenue for health promotion.[15][27]The Package of Essential Noncommunicable Disease Interventions roll-out is costed at Fiji Dollars 28 million over five years; most other budget tables and resource requirements do not provide monetary allocations.[9][28]

Monitoring & Evaluation

The strategy establishes a monitoring and evaluation framework to support reporting against global and regional non-communicable disease targets, using the 2011/2012 STEPwise approach to Surveillance (STEPS) report as a baseline for many measures.[14]The Wellness Unit is to lead ongoing monitoring with support from the Ministry of Health and Medical Services monitoring and evaluation team, while a dedicated non-communicable disease strategy post is intended to facilitate monitoring and reporting to a cross-sectoral committee.[14][13][22]

• Clarify and update performance indicators annually, supported by metadata on data sources, calculations, reporting frequency, assumptions, risks, interpretation, application and targets.[14]
• Link intervention areas, expected outcomes and illustrative performance indicators through the Annex Two Results Framework.[14][29][30]
• Require stakeholders to provide relevant implementation information quarterly and conduct a mid-term review based on delivery progress, indicators, outcomes, emerging priorities and disease patterns.[14]
• Use routine systems, surveys, registries, clinical audits, school and dietitian reports, training databases and community-level records to monitor implementation.[25][26]
• Monitor premature mortality, cancer incidence, suicide and self-harm, rheumatic fever, non-fatal injuries, childhood overweight and obesity, diabetic foot amputations, diabetes and hypertension detection, diabetes-centre guideline adherence, school canteens, community health capacity, human papilloma virus vaccination, and screening and SNAP coverage quarterly.[25][26]
• Measure population risk factors, including diabetes, raised blood pressure, overweight and obesity, diet, physical activity, tobacco, alcohol, salt and saturated-fat intake, generally every three to five years; monitor annual per-capita alcohol consumption and tobacco-free policies annually.[25]
• Conduct the Global School-based Student Health Survey every three years and repeat the STEPS survey in 2019, with findings reported and disseminated.[13][22]
• Use planned diet data sources including the 2019 STEPS survey, the triennial Global School-based Student Health Survey and the 2015 Fiji Salt Intake Assessment survey.[16]
• Track nutrition delivery through store and industry surveys, Food Safety and Information Authority data, campaign evaluations, compliance monitoring, costing studies, enforcement cases, and records of gardens and local products.[20][5]
• Assess physical-activity actions through infrastructure-access assessments, health-promoting school reports, campaign evaluations, evidence of partner action, tax changes and workplace-policy adoption.[5][6]
• Monitor tobacco and alcohol controls through enforcement reports, media evaluations, programme participation, annual reporting to the Global Information System on Alcohol and Health, community-policy counts, and Fiji Revenue and Customs Authority alcohol-consumption figures.[7][8]
• Evaluate the Package of Essential Noncommunicable Disease Interventions (PEN), availability of medicines and technologies, screening and follow-up volumes, rehabilitation coverage, diabetes complications and missed clinic appointments.[9]
• Use the Patient Information System and mental health information system to monitor suicide and attempted suicide, including annual review of the mental health decree and reporting on training.[10][11]
• Track violence and injuries through the Public Health Information System, Patient Information System, accident and emergency data, and an expanded surveillance system incorporating police, Land Transport Authority and fire-authority data.[11][21]
• Include monitoring and evaluation in strategic health communication plans, issue evaluation reports, disseminate research across sectors and provide regular stakeholder newsletters and briefings.[13][27]

Some detailed reporting lines, baseline values, indicator definitions, targets and formal accountability procedures are not specified in the supplied Results Framework extracts beyond the listed data systems, frequencies, audits, reports and responsible bodies.[25][26]

Costing & Financing

The plan calls for increased resource allocation for non-communicable diseases in proportion to the scale of Fiji’s crisis, but much of the detailed costing is intended to be undertaken through annual plans.[2][14]Indicative costs are included for planning purposes and implementation tables contain budget columns, although most supplied extracts do not provide specific allocations, financing sources, funding gaps or economic assumptions.[14][16][28]

• Fund the PEN roll-out at an identified cost of Fiji Dollars 28 million over five years.[9]
• Increase tobacco and alcohol taxation by at least 10% annually as fiscal-control measures; the extracts do not quantify resulting revenue or its allocation.[6][7]
• Use targeted taxation, price controls or subsidies to improve affordability of healthier food, and reduce taxes on sports, physical-activity and mobility equipment.[20][6]
• Increase tobacco-licence fees progressively, retain this revenue within the Ministry of Health and Medical Services, and seek a share of tobacco, alcohol and unhealthy-food tax revenue for health promotion.[15][27]
• Develop annual non-communicable disease budget plans with divisions, sub-divisions and departments, including resources for educational materials.[15][27]
• Assess whether a study of the cost of non-communicable diseases is required and determine its possible scope.[15][27]
• Resource essential medicines and technologies, diabetes hubs, oncology, rehabilitation, mental health staffing, screening systems and workforce training, without quantified allocations in the supplied sections.[17][18][19]

A non-numeric budget notation is shown for the violence and injury action plan, but no monetary value or currency is provided.[11]No quantified funding gap, overall programme budget, financing total or detailed economic assumption is specified in the available material.[2][15][21]