PASIFIKA NCD - WPRO | WHO Western Pacific Region · for the South Pacific, Director of ... A coordinated United Nations response to the NCD crisis through the Pacific Interagency

Programme areas include: • Tobacco Free Pacific 2025 • Promotion of healthy diet with emphasis on salt reduction• Strengthening NCD management in primary care through the WHO Package of Essential NCD interventions• Mental health including Pacific Islands Mental Health Network (PIMHnet)• NCD Surveillance including STEPS surveys• Blindness prevention • Disability and rehabilitation • Violence and injury prevention This vast scope of work requires a partnership approach. With countries leading the process, WHO, other United Nations (UN) agencies and partners are working together to tackle the NCD crisis in the Pacific.

Pacific island countries face an NCD emergency with some of the world’s highest NCD rates and high prevalence of NCD risk factors. The World Health

Organization (WHO) works with Pacific island countries and areas to plan, implement and monitor the impact of NCD programmes. Guided by the Western Pacific Regional Action Plan for the Prevention and Control of Noncommunicable Diseases (2014–2020) countries have prioritized effective actions and interventions. These priorities are reflected in country-specific NCD crisis response plans and roadmaps.

Preface

Dr. Liu Yunguo, WHO Representative for the South Pacific, Director of Pacific

Technical Support

In July 2014, WHO Division of Pacific Technical Support (DPS) established a UN Pacific Interagency Task Force on NCD prevention and control (PIATF).

PIATF was established in line with the global UN Interagency Task Force on the Prevention and Control of NCDs. PIATF coordinates NCD-related activities and provides systematic and technical support to Pacific island countries and areas to prevent, control and mitigate the impact of NCDs.

The Task force has four focus areas: 1) leadership, governance, multisectoral action and partnerships, and accountability; 2) trade, marketing and price incentives; 3) double burden of malnutrition; and 4) health systems strengthening.

A coordinated United Nations response to the NCD crisis through the Pacific Interagency Task Force on NCD prevention and control (PIATF)

Ongoing activities of different agencies have been mapped against the four focus areas. Some gaps were identified and joint-activities are being initiated as a result.

PASIFIKA NCD UPDATES

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Newsletter December, 2014 Issue: 1

Protecting people from second-hand smoke in the Federated States of MicronesiaThe Federated States of Micronesia National Government is taking action to protect the public from second-hand smoke. In June 2014, President Manny Mori signed into law, legislation that prohibits smoking within 150 feet of all facilities owned by the National Government.

This law aims to protect people, especially children, from the dangers of second-hand smoke in public places.

The National Government is putting the health of the public at the forefront of policy-making. The National Tobacco Control Advisory Council has designed signs to be displayed in all government facilities.

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T o b a c c o F r e e P a c i f i c 2 0 2 5

Honourable Minister for Health presents a tobacco free settings award to a village leader

Multisectoral collaboration for tobacco control in Solomon Islands In September 2014, a shipment of cigarettes intended for duty-free sales in Solomon Islands was destroyed because the ship-ment did not meet the requirements of the Solomon Islands Tobacco Control Act and Regulations.

The seizure and destruction was a collaborative effort between Solomon Islands Ministry of Finance and Treasury Customs Department, the Ministry of Health and Medical Services, and the National Tobacco Control Taskforce.

Tobacco Free Pacific 2025A Tobacco Free Pacific 2025 Network (TFP2025 Network) was launched in July 2014. Through the TFP 2025 Network, coun-tries will have direct access to technical support, and discussion forums to generate ideas and share experiences.

Pacific tobacco control focal points, and tobacco control advocates and experts are invited to join the TFP2025 Network. The TFP2025 Network will be hosted by Pacific island countries on a 2-year rotational basis. In 2015–2016, Solomon Islands will host the Network.

Watch the call “we want it done” from some future leaders of the Pacific here: https://www.youtube.com/watch?v=QGw5fVqj_0&feature=youtube

Tobacco free maneaba - Building community ownership for controlling tobacco

WHO Regional Director for the Western Pacific Region, Dr. Shin Young-soo at the launch of Tobacco Free Pacific in Honiara, Solomon Islands

As the centre of village life in Kiribati, maneaba, or meeting houses, are leading by example. Village elders have become champions for tobacco control by declaring their maneaba tobacco free areas to protect community health from the dangers of tobacco smoke. Gifting tobacco when visiting maneaba is no longer the norm. Instead, visitors give health–with gifts such as sports equipment. Kiribati has one of the highest male tobacco use prevalence rates in the Pacific. To curb these rates, the support of traditional leaders, as influential and inspirational members of i-Kiribati villages, has been crucial. The effort began in 2012 when WHO worked with the Ministry of Health and Medical Services to reach beyond the health sector to establish tobacco free settings in Kiribati. Since then, 217 out of 610 maneaba have been declared tobacco free. Communities are noticing the change. Mr Taeua Tooma a Catechist at Bonriki maneaba shared, “I supported the idea of making our maneaba tobacco free because I wanted to protect people who do not smoke; especially our children. Next, we will need to make tobacco less affordable and help young people learn how to deal with the peer pressure they face to use tobacco.”

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Monitoring and evaluating PENThe Package of Essential NCD (PEN) interventions in Solomon Islands is now in its monitoring and evaluation (M&E) phase. The M&E team visited health facilities in zone 3 of the Western Province for on-site refresher train-ing with clinic staff, and to give talks at schools and in communities. Cardiovascular disease (CVD) risk assessments were also conducted for community members aged 40 years and above.

Checking blood glucose and cholesterol

The Cook Islands PEN programme is continuing to show good results in the second half of 2014. Highlights include:• NCD Guidelines updated and printed in Rarotonga, along with CVD risk charts. • Cook Islands Family Welfare Associa tion has become a PEN partner. • In Aitutaki, staff have implemented daily lunch hour physical activities, including badminton, table tennis and volleyball. • The community-based Neke Fitness is increasing in popularity. Aitutaki World Diabetes day, Public Health Check

PEN programme intergrated in Cook Islands

Strong commitment for PEN programmeThe Ministry of health of the Marshall Islands is showing strong support for the national roll-out of PEN. Then Acting Secretary of Health Mr Russell Edwards appointed Dr Z. Zachraias as the leader of a PEN steering group. Dr Zachraias will lead a team of public health and clinical staff from the Ministry of Health, Majuro hospital, and the outer atolls.

Dr Z. Zachraias, Director of Public Health, Ministry of Health

A 3-day training workshop was successfully conducted by Shefa Provincial Health and Paunangisu Health Centre with the assistance of the national NCD, health promotion and primary health care programmes and WHO. Challenging messages were put to the participants such as ‘it is a CRISIS’ and that NCDs are present in our communities and in every home. Participants agreed it is high time we seriously address this crisis in a ‘proactive manner’.

PEN trainings successful in Vanuatu

Group activity in progress

Two villages in Samoa, Faleasiu in Upolu and Lalomaulova in Savaii, have been selected to pilot Package of Essential NCD interventions (PEN). The project was jointly organized by the Ministry of Health and WHO.

Community members including Matais, village council members, church leaders, representatives of women and youth joined the launch ceremonies in both villages on 6 and 7 November 2014.

The Minister of Health and WHO team have conducted promotion and advocacy with active community participation and support. Phase 1 of the project runs for 2 months and has three main objectives: 1. to develop a model for strengthening early detection and management of NCD with community participation

PEN Fa’a Samoa

Participants at the meeting

Hon. Dr. Leau Talalelei Tuitama, Minister of Health, Western Samoa and WHO Representative to Samoa, Dr. Yang Baoping

2. to operationalize WHO PEN at health facilities and outreach programmes in the Samoan context 3. to demonstrate early outcomes of an integrated approach (CVD risk scoring and case management)

P a c i f i c P E N p a l s

Country updatesKiribati is serious about salt reductionKiribati is committed to reduce salt. The national salt reduction strategy and the preliminary baseline for salt intake have laid good foundations. Now salt reduction activities have been integrated across sectors and programmes. The Pacific salt reduction targets have been included in the draft Food Regulations and Standards (2014). A healthy school food policy has been developed and is being implemented in all primary schools in Tarawa; and the forthcoming WHO global toolkit on salt reduction will be field tested before the end of 2014.

WHO DPS, in collaboration with the George Institute for Global Health, recently published the media and advocacy toolkit Salt matters for Pacific island countries–Mobilizing for effective action to reduce population salt intake in Pacific island countries.

The toolkit supports advocacy to key leaders and decision-makers in the Pacific. The toolkit provides people with an interest in public health, information and resources for advocacy to reduce salt intake.

The toolkit consists of a booklet; a DVD with a drama documentary on salt reduction in the Pacific; and 12 advocacy tools to support salt reduction advocacy. Download the toolkit today from the DPS website: http://http://www.wpro.who.int/southpacific/publications/salt-matters-doc/en/

For hard copies contact the NCD and Health through the Life-Course Team

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Fiji works with the food industry to reduce salt in processed foodIn recent years Fiji has worked intensively with the local food industry to reduce salt in processed foods. Following three industry consultations, industry sector groups have agreed to a set of voluntary targets for salt reduction.

Good progress is clear in the snacks sector where an increasing number of products now comply with the national targets.

Salt matters for Pacific island countries

Salt Matters for the Pacific Island Countries IslandsMobilizing for effective action to reduce population salt intake in the Pacific Islands

Vanuatu prepares to conduct a salt baseline study Vanuatu is the first country in the Pacific to conduct a stand-alone salt baseline survey based on spot and 24-hour urine collection. Planning started in October 2014 and data collection will start in early 2015.

The outcome of the survey will help inform policies andinterventions to reduce population salt intake.

Federated States of Micronesia targets schools for salt reduction awareness activities In May and June 2014, the Island Food Community with support from Pohnpei State and WHO conducted a week-long salt reduction and health advocacy school programme targeting 9-14 year-old school children. The programme included classroom sessions on healthy eating and reducing salt intake; games, quizzes and competitions; product and cooking demonstrations; and community outreach activities.

Students, teachers and parents increased their understanding of healthy diets and the importance of salt reduction.

Facilitators also showed how to integrate salt reduction into health promoting school initiatives that are ongoing in Pohnpei and other Pacific Islands.

Salt survey in Kiribati

H e a l t h y D i e t / P h y s i c a l A c t i v i t y

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H e a l t h y S e t t i n g s

About 400 head teachers across Fiji convened for the 19th Fiji Head Teachers Association Conference at Suva’s Civic Centre. The theme of the conference was Wellness.

Dr Cherian Varghese of WHO presented the concept of Wellness as key to productivity in any work place. About 200 head teachers participated in NCD screening with appropriate counselling on identified risk factors.

The following tests were carried out: • CBG • Cholesterol • B/P • Weight and Height • BMI calculation

Healthy teachers are critical to healthy schools. A healthy work-place leads to teachers who are more satisfied with their jobs and are able to perform higher, resulting in a better education for children. Healthy teachers provide continuity and stability so essential for educational success. They also contribute to workplace excellence and job satisfaction in variety of ways.

“Wellness” a Concern at Head Teachers Conference

Tobacco Free Market in ApiaIn September 2014, as Apia took to the global centre-stage hosting the Third International Conference on Small Island Developing States (SIDS), the Samoa Ministry of Health showed tobacco control leadership by declaring Fugalei Market the first smoke-free market in Samoa.

WHO supported the Ministry of Health with the launch, which was attended by chief guests, the Honourable Dr Leao Talalelei Tuitama, Minister for Health, Susuga Hon Laauli Leuatea Polataivao Fosi Schmidt, Speaker of the House and other distinguished guests.

The prevalence of tobacco smokers in Samoa has reduced from 40.3% in 2002 to 25.6% in 2013. This is due to concentrated efforts to protect the public, especially children, pregnant women and non-smokers from the dangers of tobacco use.Since the passing of the Samoa Tobacco Control Regulations in 2013, the Ministry of Health has led community-based

awareness and media programs to inform the public of the law. With continued enforcement efforts, Samoa will continue towards a tobacco free Samoa.

World Health Organization Regional Director for theWestern Pacific Region , Dr Shin Young Soo, Hon. Dr. Leau Talalelei Tuitama, Minister of Health, Western Samoa and WHO Representative to Samoa, Dr. Yang Baoping together with Senior Health Staffs after the declaration of the Smoke Free Apia Market

Savusavu town declared Smoke free Savusavu town was officially declared a tobacco smoke free zone in September 2014. Fiji’s then Minister for Health Dr Neil Sharma together with WHO Regional Director for the Western Pacific, Dr Shin Young-soo, and Savusavu Special Administrator Vijay Chand were chief guests at the launch event to prohibit tobacco use in public.

Dr Shin congratulated the Fijian government’s efforts to control tobacco use. He added that engaging with town councils to implement these measures would ultimately save lives.

Dr Sharma said new measures like the tobacco smoke free zones are designed to discourage and prevent smoking habits.

World Health Organization Regional Director for theWestern Pacific Region , Dr Shin Young Soo; Hon. Dr. Neil Sharma, former Minister of Health, Fiji ; Dr. Liu Yunguo, WHO Representative to the South Pacific Director of Pacific Technical Support, Savusavu Special Administrator, Mr. Vijay Chand with senior staffs after the declaration of the Smoke Free zone.

Health screening provided by the Ministry of Health during the Head Teachers conference

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STEPS

Standard ProtocolThe standard protocol for STEPS now includes additional questions to support reporting against target 9 of the WHO Global Monitoring Framework for NCDs: At least 50% of eligible people to receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes.

This target also relates to PEN monitoring. As this is a coverage target there is no need for a baseline in countries.

Tonga – first in the Pacific to complete a second STEPS ReportTonga has published its second STEPS

report – the first country in the Pacific to do this. Tonga undertook their first STEPS survey in 2004. The second STEPS survey was conducted in 2012. The comparison between these two surveys showed an increase in fruit and vegetable intake, and improvements in physical activity levels.

Pacific Monitoring Alliance for NCDs to ActionThe Pacific Monitoring Alliance for NCDs to Action (MANA) was discussed and accepted at the Heads of Health and Ministers of Health meetings in 2014. The coordinating team is drafting a proposed governance process, for Pacific health ministers to consider in 2015. Discussions with development partners are also underway.

Health Information and Intelligence Platform (HIIP)The Health Information and Intelligence Platform (HIIP) is a platform from the WHO Regional Office for the Western Pacific to increase access to health data. Review health indicators and compare data sets at: http://hiip.wpro.who.int/portal/default.aspxData tables can be exported and graphs can be developed online.

Tokelau STEPS survey in progress

MoH staff during STEPS survey STEPS training in Kiribati

Tokelau –leveraging data collection Tokelau has completed data collection for its second STEPS survey. Its first survey in 2005, was a census survey of the adult population. While collecting data for the second STEPS, Tokelau has collected data from adolescents for their first Global School-Based Student Health Survey (GSHS) and Global Youth Tobacco Survey (GYTS).

Cook Islands –data collection completeCook Islands has almost completed data collection in their second STEPS survey, and a report is being drafted.

Other Pacific Island CountriesIn the last six months, five countries and areas have been planning their second STEPS survey. American Samoa, Kiribati, Solomon Islands and Tuvalu will all begin data collection in the first quarter of 2015.

N C D S u r v e i l l a n c e

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The Mental Health Gap Action Programme (mhGAP) integrates mental health by training doctors and nurses to assess and manage priority conditions.

To provide mhGAP training to large number of primary health care staff, mental health specialists have been trained to deliver mhGAP training. In turn the new trainers will train primary health care staff on mhGAP. This training of trainers model emphasizes support and supervision after the initial training. Trainers are encouraged to use modern methods such as group discussion, case study and role-plays, and to provide strong student support.

The first training of trainers workshop in the Pacific was held in Suva, Fiji in August 2014, organized by the Ministry of Health, WHO and PIMHnet. Participants included 10 mental health specialists from Fiji, and doctors from Kiribati, Tonga and Vanuatu. Some participants from neighbouring Pacific Islands, in Fiji for the Postgraduate Diploma for Mental Health at Fiji National University, also completed the workshop.

The roll out will continue with 11 workshops planned up to December 2014. The trainers will run the mhGAP training for more than 200 health staff across Fiji’s four divisions.

Pacific Islands Mental Health Network (PIMHnet) scale-up projects for 2015To accelerate achievements, more than 40 Pacific mental health focal points came together at the Fourth PIMHnet Meeting on 22–25 September 2014 in Auckland, New Zealand.

Launched in 2007, Pacific Islands Mental Health Network (PIMHnet) aims to overcome challenges in mental health in the Pacific.

PIMHnet members last convened in 2011. Delegates from 14 PIMHnet countries, WHO experts and observers updated on mental health system developments since 2011 and discussed ways forward. Countries shared best mental health practices and voted on outstanding practices. The meeting was co-hosted with Counties Manukau District Health Board, New Zealand. The Board invited participants to see mental health services in Counties Manukau.

With these inputs countries developed short term action plans, including steps and milestones for two projects per country, to be completed by the end of 2015.

mhGAP – Increasing Coverage of Mental Health Care in FijiThis will substantially increase coverage and access to mental health services. The roll out will also enhance supervision, and the referral network between nurses and doctors across Fiji and the mental health specialists in divisional hospitals and Fiji’s mental health hospital, St Giles.

Participants at the 4th PIMHnet meeting in Auckland

Group discussion during the training

Participants in discussion during the training

M e n t a l H e a l t h

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World Heart DayStudents at Suva Methodist Primary School (SMPS), Suva, celebrated World Heart Day and World Teachers day in style by having an oratory contest for class 6 students. Out of the seven streams of class 6 a speaker was given a topic that relates to the World Heart Day 2014 theme: Creating Heart – Healthy Environments. About 200 parents, teachers and family members were present at SMPS to hear the children speak on ways to prevent cardiovascular diseases. World Heart Day 2014 encourages everyone to reduce our cardiovascular risk, and promotes a heart-healthy planet – so we can all make heart-healthy choices wherever we live, work and play.

World Diabetes DayOn World Diabetes Day, 14 November 2014, Fiji’s Assistant Minister for Health, Ms Veena Bhatnagar, advised the public to make healthy food and drink choices and to manage stress effectively. Also present at the celebration in Nausori, was Dr Wahid Khan, Chairperson, members of the Latter Day Saints Church, schools from Nausori area and representatives from WHO. Diabetes in Fiji and Pacific countries is now extremely common. Complications from diabetes, such as amputations and blindness, have huge personal and economic costs for individuals and for national development. Dr Cherian Varghese of WHO, called for behaviour change to reduce salt intake, increase fruits and vegetables intake and participate more in physical activity.

Suva Methodist Primary School students providing entertainment during the celebration

Dr. Andrews and a workshop participant in Suva

Schools taking part in the march during the World Diabetes day celebration in Nausori. Inset: Dr. Cherian Varghese and Assitant Minister of Health Ms Veena Bhatnagar are being garlanded.

Share your story!Are you working to combat NCDs? Share your story with us.

Your story would be welcomed and should be no longer than 150 words in length. Send your article to the contacts below.

Mr. Saula Volavola Dr Cherian VargheseTechnical Officer Health Promotion Coordinator, Pacific NCD and Health through the [email protected] [email protected]

http://www.wpro.who.int/southpacific/programmes/healthy_communities/en/

World Mental Health DayOn 10 October 2014, the theme for World Mental Health day was: Living with Schizophrenia.

People affected by schizophrenia often face neglect but with proper treatment, they can lead healthy lives. In Fiji, a person affected by schizophrenia shared her story of recovery at the launch of a campaign for mental health awareness.

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