Non-Communicable Diseases Strategic Plan 2015-2019

1.1 Adopt and implement draft Wellness Unit (MIT, Ministry of Adoption by Monitoring of - regulations to control the Info & Communications),NFNC, 2015. advertisements. marketing of foods and non- FT-TAG, MoHMS Implementation Enforcement reports. alcoholic beverages to children ongoing

1.2 Support FPAN implementation NFNC, Wellness Unit, (MIT, Ongoing FPAN reports Private sector, C-POND), FT- TAG, FPAN steering committee

1.3 Implement the Salt, Sugar, Fat NFNC, Wellness Unit, (all Ongoing Monitoring of actions action plan (2014-2017), and progress by Page 14 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program including adoption of the salt sectors), FT-TAG, MIT industry: store targets. survey, reports from industry. FSIA baseline and follow-up data.

1.4 Incorporation of gardening (MoE, MPI) 2015 Gardening taught in into primary school curriculum all primary schools

1.5 Increased nutrition capacity (MoE), FT-TAG 2015 Officers in place within Ministry of Education including nutritionist at CDU and each division

1.6 Introduce restrictions on Wellness Unit, (MoE, City 2015-2016 Introduction of ha ke licence in a ea councils) regulation to restrict around schools (and develop licences around approach for other informal schools. sources of foods and drinks)

1.7 Introduce catering policy for Wellness Unit, NFNC, NA- 2015 (MoHMS) Policies adopted - all Government workshops and Dietetics, (all sectors), FT-TAG meetings (beginning with MoHMS), and support adoption by private sector Page 15 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

1.8 Development of early (MoE), Wellness Unit, NFNC, 2015-2016 New guidelines - childhood education healthy FT-TAG adopted food guidelines

1.9 Enforce School canteen and (MoE), MoHMS Ongoing Monitoring of boarding school guidelines canteen guideline (and provide training for compliance and operators) boarding school guidelines

1.10 Continue efforts to support Wellness Unit (MIT, MFNP, Ongoing Healthier food is - healthier eating through FRCA, CC, MoW), FT-TAG more affordable targeted taxation, price control (costing study) changes or subsidies

1.11 Enforce existing regulations Food Unit, (Consumers Council, Ongoing Number of cases - regarding misleading food and Commerce Commission) drink advertising

1.12 Media and other educational NFNC, Wellness Unit, (MoW, Ongoing Evaluation reports campaigns to support healthier MYS, Ministry of iTaukei from all campaigns eating, including provision of Affairs) and educational recipes using local foods and programmes promotion of gardening (including baseline measurements) Page 16 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

1.13 Educational programmes on NFNC, Wellness Unit, FT-TAG Ongoing Evaluation report on reading nutrition labels on campaigns processed foods to assist consumers with making healthier choices

1.14 S ppo fo back a d ga den (MPI, MoE in schools), NFNC, Ongoing Establishment of new in settings (including FT-TAG , (MPI), MoHMS, (FBO, gardens information on cost-saving, City Councils, MoW, MYS, nutrition and health) and Ministry of iTaukei Affairs) homes

1.15 Support for developing (MPI, SPC), MoHMS, (USP, FNU) Ongoing New products methods of processing local available foods which allow value- adding, but are also health, convenient and affordable

1.16 Encourage religious leaders to (FBO), Wellness Unit, NFNC, Ongoing Evaluation report on support low salt, low sugar campaigns diet for all religious members during holy week celebrations Page 17 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program PHYSICAL ACTIVITY Overall targets (Long-term outcomes): Prevalence of insufficiently physically active adolescents (defined as less than 60 minutes of moderate to vigorous intensity activity daily) reduced by 5% by 2018 (and by 10% by 2025). Age-standardized prevalence of insufficiently physically active persons aged 18+ years (defined as less than150 minutes of moderate-intensity activity per week, or equivalent) reduced by 5% by 2018 (and by 10% by 2025). Tools (Data Sources): STEPS survey in 2019. GSHS survey every 3 years.

2.1 Ensure all existing and new Wellness unit, (Local govt, Ongoing Assessment of new developments include Ministry of Lands, LTA, Roads developments and infrastructure, walkways and authority, Housing authority, accessibility of new communal parks (which are MFNP, MYS), MoHMS physical activity accessible for persons living infrastructure with disability).

2.2 Assess existing Council spaces Wellness Unit, (Private sector, Ongoing Evidence of and parks and ensure that they MYS, Ministry of iTaukei appropriate use of are being used as public parks Affairs) parks on PA

2.3 Guide all schools and (MoE including HPS, MYS), Ongoing Reports from HPS educational establishments in Wellness Unit the provision of safe places and opportunities for active play Page 18 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program for children and youth.

2.4 Review and strict (MoE) 2015 Report on Physical implementation of Physical Education Education curriculum. curriculum review

2.5 Ongoing, targeted mass-media Wellness Unit, (MYS, private Ongoing Include evaluation in campaigns to promote physical sector, CSOs), Physios, MoHMS all campaigns. activity, particularly among the less active (including use of sports icons)

2.6 Targeted interventions with (Private sector, CSOs, FBOs), Ongoing Evidence of private population sub-groups to MoHMS and civil society encourage physical activity, actions on PA including support for leaders to become champions

2.7 Decrease all forms of taxes on Wellness Unit, (MIT, MFNP, 2015 Taxes reduced all sports, physical activity and MYS, FRCA) gym equipment including mobility devices and sports shoes

2.8 Support workplaces policies Wellness Unit, (Private sector, Ongoing Policies adopted in for physical activity (e.g. time MYS, Public Service private sector breaks for exercise, provision Commission), Physios of fitness facilities, Page 19 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program shower/change facilities) TOBACCO Overall targets (Long-term outcomes): Reduced prevalence of current tobacco use among adolescents by 10% by 2019 (and by 30% by 2025). Reduced age standardized prevalence of current tobacco use among persons aged 18 yrs+ by 10% by 2019. Increase in number of settings-based tobacco-free policies by 20% by 2019. Tools (Data Sources): STEPS survey in 2019. GSHS survey every 3 years

3.1 Pursue annual increase of at (MFNP)/Wellness Unit, (FRCA) Annually Budget statements least 10% in tobacco taxation demonstrating tax increases

3.2 Strengthen efforts to enforce Tobacco control enforcement Ongoing Reports on existing tobacco control unit, Wellness Unit, (Police, enforcement policies (smoke-free places, Customs office, Ministry of activities restrictions on sales to minors, iTaukei Affairs, Ministry of advertising) Labor, Ministry of Education)

3.3 Increase staffing in Tobacco Tobacco enforcement unit, End 2015 New positions Enforcement Unit, in line with MoHMS created needs Page 20 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

3.4 Continue enforcement of Tobacco enforcement Unit, Ongoing Reports to FCTC regulations for promotion, (NSAAC). annually. advertising and sponsorship Reports on bans enforcement activities

3.5 Review and revision as needed Tobacco Enforcement Unit 2015 Amendment of of existing tobacco legislation, tobacco control including smoke-free decree requirements

3.6 Establish tobacco cessation Wellness Unit, NA-MH, National 2015 and Establishment of support programmes in all Advisory Council on Mental ongoing support sub-divisions. Including Health and all Sub-divisional programmes. training for relevant health staff, (CSOs, FBO). Participation figures staff/individuals

3.7 Continue developing effective Wellness Unit, (local media, Ongoing Evaluation reports of media activities on the dangers NSAAC) media activities of smoking

3.8 Encourage settings-based Wellness Unit and all sub- Ongoing Number of settings tobacco-free policies (eg divisional health staff, (CSOs, with tobacco-free church, community) as part of FBO) policies tobacco-free Pacific Page 21 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

3.9 Support compliance with no (FBO), Wellness Unit Ongoing Reports on campaign smoking, no alcohol, no kava implementation consumption in holy weeks in the religious calendars

3.10 Restrict sales of small packs of Tobacco enforcement unit 2015 Amendment of cigarettes (10s) tobacco control decree

3.11 Conduct awareness raising (NSAAC) Ongoing Report on awareness programmes on dangers of conducted tobacco, in schools and communities ALCOHOL & KAVA Overall targets (Long-term outcomes): Age-standardized prevalence of heavy episodic drinking among adolescents and adults reduced by 5% by 2018 (and by 10% by 2025). Reduced annual per capita intake of alcohol per person aged 15years+ by 5% by 2019 Tools (Data Sources): STEPS survey in 2019. GSHS survey every 3 years. FRCA figures on units alcohol consumed annually.

4.1 Pursue annual increase in Wellness Unit, Annually Reports to GISAH alcohol taxation of at least 10% annually (Global (MFNP, FRCA) Information System Page 22 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

4.2 Pursue restrictions on alcohol Wellness Unit, (NSAAC), (SPC, 2015 on Alcohol and advertising and sponsorship WHO, Police) Health) (including restricting licenses Reports on for outlets to sell alcohol and enforcement increasing license fees) activities 4.3 Continue efforts to enforce (Liquor Control Board, Police, Ongoing existing alcohol control LTA) policies (age limits, sales limits, licensing limitations)

4.4 Encourage communities to Wellness Unit and all public Ongoing Number of adopt own alcohol restrictions health staff, (FBO) communities with and kava restrictions alcohol/kava policies

4.5 Strengthen programmes in all (Alcoholics Anonymous, FBOs By end 2016 Establishment of sub-divisions and religious and CSOs),Wellness Unit and all support communities for alcoholics public health staff, NA-MH, programmes. (refer Mental Health and stress (National Advisory Council on Participation figures management section) Mental Health, NSAAC)

4.6 Engage with breweries to (NSAAC, private sector, MIT) 2016 Paper prepared reduce alcohol content of documenting locally produced beverages comparison of and/or to produce lower alcohol content of alcohol alternatives locally produced and international Page 23 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program beverages Alcohol content reduced

4.7 Increase effective media Wellness Unit (MoE, NSAAC, Ongoing Evaluation of media activities on the dangers of Government Communication and promotional alcohol abuse (including home Officers, Ministry of campaigns re alcohol brew) Information, media dangers organisations, Media Council)

4.8 Assess extent of problems with (NSAAC) 2015-2016 Report on extent of use of home brew home brew consumption

4.9 Assess extent of kava abuse (NSAAC) 2015-2016 Report on kava abuse problem, and association with alcohol and tobacco use and risk for NCDs

4.10 Selected health officers to be Wellness Unit, MoHMS 2016 New designations designated as alcohol enforcement officers

4.11 To investigate scope for other Wellness Unit, (all Ministries) 2016 Report on potential government officers to be new enforcement designated as alcohol designations Page 24 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program enforcement officers CLINICAL& PUBLIC HEALTH SERVICES Overall targets (Long-term outcomes): By 2019, 50% availability of affordable basic technologies and essential medicines required to treat NCDs in public and private facilities(and 80% by 2025) Identify high risk population for stroke and heart attack and treat 30% of them by 2019 (and 50% of them by 2025)

5.1 Evaluation of PEN Wellness Unit, DMOs, SDMOs, 2018 PEN evaluation implementation (WHO) report

5.2 Ensure incorporation of risk- (FNU, UniFiji, WHO) By 2018 Changes made in reduction strategies into training curricula to medical and nursing training meet accreditation standards

5.3 All relevant front-line MoHMS (FHSSP), MoHMS By 2018 All MoHMS staff staff to receive PEN/NCD risk providing NCD reduction training service trained

5.4 Ensure essential medicine and Pharmaceutical team, Ongoing Evaluation report on PEN roll-out to technologies (as detailed in procurement unit (Commerce level of availability cost PEN) are accessible (including Commission, Consumers FJD28million over 5 years availability of NCD tool kits) Council, MFNP) Page 25 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

5.5 Continue scale-up of early (FHSSP), MoHMS, communities Ongoing Numbers of new detection services including people screened and the utilization of trained identified at risk and community health workers followed up by a medical officer

5.6 Provision of adequate Rehab service (CSOs, FBOs, By 2019 Assessment of rehabilitation services for private sector, Fiji council rehabilitation NCD-related disability and disabled persons, Social services in all injuries (based on needs Services, MoW) divisions assessment currently underway and other data)

5.7 Strengthen co-ordination MoHMS, (CSOs) 2015 MoUs in place between allied health service providers through active consultation and MoUs eg rehabilitation, cancer care, counseling, palliative care

5.8 Diabetes hubs to be sufficiently Wellness Unit, (Diabetes Fiji) Ongoing Number of diabetes- resourced to provide a suite of related services for diabetes related complications complications

5.9 Work with mobile operators to Clinical Services, Health 2015 onwards Increase in develop SMS-based services Information, (Private sector) compliance Page 26 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program for clinic appointment (reduction of reminders defaulting rates)

5.10 Work with CSOs to establish (FNCDP) Onwards MoUs in places respite care for individuals living with disability

5.11 Develop a screening unit to Wellness Unit, CSOs, CWMH, 2015 Evaluation report of oversee all screening activities Clinical Services Network, the unit for NCDs (eg cancer, diabetes, Health Information Unit rheumatic heart disease). This unit will ensure continuum of care from screening to treatment, data system, manage and follow-up cases and will co-ordinate role of CSOs.

5.12 Undertake a study of CWMH Maternity Unit, HIRA, 2015 Study report gestational diabetes (GDM) Clinical Services Network, available burden, including analysis (academic institutions) according to different definitions of GDM, and coverage of screening services currently.

5.13 Establish targets for screening FHSSP, Maternity Units, HIRA 2016 Targets established Page 27 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program coverage for GDM, in new deliveries.

5.14 Strengthen oncology unit at all Wellness Unit, Clinical Services 2018 Functioning oncology the divisional hospitals. This Network, HIRA units at the divisional should include cancer hospitals screening and management Coverage of HepB and palliative care services. and HPV vaccinations

5.15 Development of a Clinical Services Network, 2015 Plan established comprehensive clinical PPDU services plan for renal disease. Page 28 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program Budget MENTAL HEALTH AND STRESS MANAGEMENT Overall targets (Long-term outcomes): To reduce number of suicide cases and attempted suicide cases by 20% by 2019 Tools (Data Source): PATIS, mental health information system

6.1 Implementation, monitoring and review of the mental National Advisory Ongoing Annually health decree Council on Mental Health, NA-MH

6.2 Implementation of a National Mental Health and National Advisory By early Strategic plan Suicide Prevention Strategic Plan Council on Mental 2015 finalised Health, NA-MH, (CSOs)

6.3 Review and revision of friendly mental health MoHMS Epidemiologist, 2015 Modifications information system within existing structures NA-MH, (Police, MoW) developed

6.4 Identify mental health champions National Advisory 2016 Champions recruited Council on Mental Health

6.5 Support relevant stakeholders to raise mental health National Advisory 2016 Training delivered to awareness in communities Council on Mental relevant stakeholders Health Page 29 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

6.6 Strengthening and monitoring of decentralisation of NA-MH Ongoing Wards operational in services through the establishment of stress all hospitals. management wards at all hospitals and increased Admission records specialized staff at sub-divisional levels

6.7 Establishment of lifeline-style service for mental NA-MH, (CSOs), (mobile 2016 Service established health issues, counseling and alcohol support operators) and operational programmes. (Include specialized training for those involved, referral systems and accreditation scheme)

6.8 Development and roll out of capacity building NA-MH Ongoing Reports on training programme for relevant sub-divisional staff in activities annually MoHMS thereafter

6.9 Development and roll out of capacity building NA-MH Ongoing Reports on training programme for relevant community leaders and CSOs activities annually thereafter

6.10 Incorporation of stress management and awareness (MoE) 2016 Stress management into school curriculum taught in schools Page 30 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program VIOLENCE AND INJURIES Overall targets (Long-term outcomes): To reduce the prevalence of violence and injuries by 5% by 2019 To reduce cases of violence and injuries related to alcohol by 10% by 2019 Tools (Data Sources): PHIS, PATIS, Accident and emergency data & extended surveillance system

7.1 Development of a detailed strategic Wellness Unit, (Police, NFA, LTA, CSOs, By Action plan developed $$$$$ plan based on evidence of risk WHO MoW Women C i i Cen e 2016 (multi-sectoral, national factors, to target key causes of Physios and sub-divisional) injuries and violence

7.2 Establish National Violence and Wellness Unit, (Police, NFA, LTA, CSOs, 2015 Committee established. Injuries Committee WHO MoW Women C i i Cen e Minutes of meetings Physios, FBO, Elimination of Violence against Women Taskforce

7.3 Develop extended surveillance MoHMS Epidemiologist 2019 Surveillance system system based on PHIS to established incorporate police, LTA and Fire authority data

7.4 Introduce mass media campaign on Physios, Wellness Unit, (MYS) 2016 Mass media campaign preventing injury in sports evaluation report Page 31 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

7.5 Strengthen rehabilitative services for Physios, MoHMS, (CSOs, FBO) 2017 Increased availability of those affected by injuries or violence rehabilitation services CROSS-CUTTING ISSUES Overall targets (Long-term outcomes): Increased resource allocation for NCDs that is in line with the scale of the crisis

8.1 Establish a National taskforce for NCDs that is Wellness Unit, (All 2015 Taskforce minutes focused on innovative avenues to address the Ministries, CSOs) crisis

8.2 Continue efforts to inform key stakeholders and Wellness Unit, all Ongoing High-level support for NCDs leaders of the scale of the NCD/mental staff of Ministry of across government, health/injuries and violence crisis: including Health and Medical evidenced by statements by regular briefings for key stakeholders Services leaders

8.3 Identify champions for NCDs Wellness Unit, 2015 Champions confirmed P ime Mini e Office P e iden office)

8.4 Pursue ongoing increases in the fees charged Wellness Unit, Ongoing Increase in fees for tobacco for tobacco licenses (and ensure revenue Ministry of Health Page 32 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program retained by MoHMS) and Medical Services licenses

8.5 Pursue share of taxes from revenue on Wellness Unit 2015 Cabinet paper lodged and tobacco/alcohol/ unhealthy food for health (MFNP, FRCA, MIT, discussed promotion WHO, SPC)

8.6 Ensure NCD budget within Ministry of Health Wellness Unit, Annually Annual budget plan for NCDs and Medical Services is planned in conjunction MoHMS, (all with Divisions, Sub-Divisions and Departments Ministries) annually. (To include allocations for sufficient educational materials)

8.7 Assess need for a cost of NCDs study (including Wellness Unit 2015 Need assessment report possible scope) (MFNP, WHO, SPC, UNDP, academic institutions)

8.7 Improving human resource capacity for NCDs in HRH, HR 2016 Capacity building activities. MoHMS in response to training needs assessment

8.9 All government and relevant CSOs should All MoHMS areas, Ongoing NCDs documented within incorporate relevant areas of this strategic plan (MFNP, other Page 33 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program in their annual corporate plans (Wellness Unit relevant government ACP to meet annually with all key government sectors, FBO) sectors to discuss their next ACP)

8.10 Strategic health communication plans to be Wellness Unit Ongoing SHC plans produced and developed and followed prior to any media or adhered to. Evaluation community educational activities, and to reports for all health include monitoring and evaluation component communication activities.

8.11 Healthy settings including workplaces, Wellness Unit, (all Ongoing. Adoption of healthy settings communities, schools, churches, islands, cities sectors) Award to be utilized. (Award programmes to be programme developed to recognize achievements) commences in 2015

8.12 Implementation of monitoring and evaluation PPDU, HIRA& all 2015 Monitoring and evaluation framework sub-divisions report. Mid-term review.

8.13 Planned and proactive engagement with Wellness Unit, PPDU, Ongoing Inclusion of engagement appropriate private sector and civil society Forum of Healthy plans within ACP organisations including faith-based Policy Technical organisations Support Group

8.14 Capacity-building available for key community Wellness Unit, Ongoing Capacity building activities members, faith-based organization leaders and (communities, FBOs, held annually community health workers to support and CHWs, empower a greater role in NCD activities. Turanganikoro) Page 34 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

8.15 Encourage targeted research (including by HIRA, Wellness Unit, Ongoing Relevant data available to students) and data analysis to allow for (research guide planning and service targeting of interventions and programmes, organisations and delivery including strong dissemination across sectors academic institutions, FBO)

8.16 GSHS survey in schools to be conducted every 3 MoE, (WHO) Every 3 Reports produced years and effectively disseminated years

8.17 STEPS survey to be repeated in 2019 and MoHMS, (WHO) 2019 Reports produced effectively disseminated

8.18 Cabinet paper/decree/act for Wellness to be Wellness Unit, 2015 Cabinet paper/decree developed and approved (to include the Minister of Health adopted establishment of a cross-sectoral committee and Medical Services and mandate to include NCDs and Wellness in all ACPs).

8.22 Establishment of a dedicated NCD strategy post MoHMS 2015 Post established and filled to facilitate monitoring and reporting related to NCD strategy (and report to cross-sectoral committee)

8.23 Development of communication plan including Wellness Unit 2015 Communication plan in place regular newsletter, to update stakeholders regarding NCD strategy and activities Page 35 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

8.24 Relevant curricula for health professionals, (MoE, academic 2015-2016 Curricula reviewed and teachers and FBO leaders should be reviewed institutions) Pacific revised and revised if needed to ensure relevance to Theological College NCD strategy (including behavior change/motivational interviewing) Page 36 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program References: 1 Carter, K. et al. Mortality trends in Fiji. Aust. N. Z. J. Public Health35, 412-420, doi:10.1111/j.1753-6405.2011.00740.x (2011). 2 Lozano, R. et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet380, 2095-2128, doi:http://dx.doi.org/10.1016/S0140-6736(12)61728-0 (2012). 3 Roberts, G. et al. The Fiji Islands Health System Review. Health Systems in Transition1 (2011). 4 Wainiqolo, I. et al. A profile of Injury in Fiji: findings from a population-based injury surveillance system (TRIP-10). BMC Public Health12, 1074 (2012). Page 37 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program Annex One: Consultations for NCD Strategic Plan 2015-2019 Date Consultations Number of Participants 22nd November 2013 MoHMS Suva Diabetic Hub 4 27th November 2013 Ministry of Education, CDU Conference Room, Waisomo 7 House, Suva 28th November 2013 MoHMS - St. Giles Hospital 5 28th November 2013 Fiji Police Force, Police HQ Conference room, Vinod Patel 10 Building, Centre point 2nd December 2013 MoHMS Lautoka Western Health Services 12 3rd December 2013 MoHMS - Lautoka Diabetic Hub 3 3rd December 2013 MoHMS - ViseiseiSai Health Centre 9 4th December 2013 MoHMS Sigatoka Subdivisional Hospital 2 5th December 2013 MoHMS- Bureta Health Centre 4 5th December 2013 MoHMS- Levuka Subdivisional Hospital 4 6th December 2013 Public Service Commission and Ministry of Industry and 4 Trade 6th December 2013 Nuffield Medical Clinic 4 9th December 2013 MoHMS - Labasa Diabetic Hub 3 9th December 2013 MoHMS Wainikoro Health Centre 5 10th December 2013 MoHMS SeaqaqaHealth Centre 8 11th December 2013 Academic Fiji National University, College of Medicine 7 Nursing and Health Sciences 11th December 2013 Ministry of Women 2 12th December 2013 Ministry of iTaukei , Ministry of Youths and the 5 SoqosoqoVakamarama 13th December 2013 Ministry of Rural and Maritime Development and National 4 Disaster Management and the Fiji Alliance for Mental Health 16thJanuary 2014 Faith Based Organisation - SDA 1 28th January 2014 NFNC 2 Page 38 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program 29th January 2014 CSNs 3 6th February 2014 Methodist Church 2 10th February 2014 Ministry of Primary Industries 6 13th February 2014 National Consultation Workshop 64 NCD STRATEGIC ACTION PLAN ONE-DAY CONSULTATION WORKSHOP THURSDAY 13TH FEBRUARY AT STUDIO 6, SUVA INVITEES LIST ATTENDEES NO NAMES DESIGNATION/ORGANIZATION 1 Dr Eloni Tora PSH YES 2 Dr M Tuicakau DSHS 3 Dr E Rafai DSPH YES 4 Dr S Nakalevu DMO Western YES 5 Dr T Qoriniasi DMO Northern YES 6 Dr Bale Kurabui Fiji Police Force YES 7 Mr. T. Lewesi HPS Coordinator, MOE YES 8 Mr. A. Sailo MOE YES 9 Mr K. Pratap Ministry of Industry & Trade YES 10 Ms. V. Tamanu Ministry of Industry & Trade YES 11 Mr Vijay Kumar Ministry of Social Welfare YES 12 Mr Paula Tuione Ministry of Agriculture YES 13 Mr Atama Masioliva Ministry of Foreign Affairs YES 14 Ms Vasitia Duikoro Ministry of Foreign Affairs YES 15 Ms Aliti Radevo Ministry of Foreign Affairs YES 16 Mr Josua Naisele MoE (NSAAC) Snr Advisor YES Health 17 Ms Artika Nand Ministry of Justice Page 39 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program 18 Ms Sanjana Lal Ministry of Fisheries & Forests - Deputy Conservator of Forests 19 Mr Joela Cama Ministry of Fisheries & Forests YES 20 Ms Teari Kaure Ministry of Fisheries & Forests - YES Fisheries Department 21 Ms Roshni Gounder Ministry of Works, Transport & YES Public Utilities 22 Ms Elenoa Neimila Ministry of Lands 23 Mr Josateki T Ministry of Lands YES 24 Mr Sainitiki Ravuso Ministry of Defense - SAO YES 25 Dr G. Rao Consultant Physician, CWMH YES 26 Dr S. Dasi SDMO Nadroga/Navosa YES 27 Dr P. Biukoto MS St Giles Hosp 28 Mrs J. Tikoitoga Acting NA N&D, MOH YES 29 Mrs. A. Kama Manager, NFNC 30 Dr T. Tamani Acting DMOE YES 31 Mr A. Vosanibola Chief Pharmacist 32 Ms M. Gounder Principal Pharmacist, FPBS, MOH YES 33 Ms S. Waqa DNS, MOH 34 Dr J. Fong Consultant O&G, CWMH 35 Dr J. Kado Consultant Paediatrician, CWMH 36 Mr. M. Luveniyali DSAF, MOH YES 37 Dr P. Singh MS Rehab. Hosp YES 38 Mrs A. Deo Senior Nutritionist, NFNC YES 39 Mr R Singh DPPD, MOH YES 40 Mr S. Naidu DHIRA, MOH YES 41 Dr L. Cikamatana MS Ltka Hosp YES Page 40 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program 42 Mr A. Momoka Food Unit, MOH YES 43 Mrs Una Bera CHI, MOH YES 44 Mr A. Tavui TCU, MOH YES 45 Dr Joan Lal NA OH, MOH YES 46 Dr I. Tukana NA NCD/Wellness, MOH YES 47 Dr J. Andrews MA MH, MOH YES 48 Ms. E. Younger PO PA, Wellness Unit YES 49 Mr. A. Matanitobua PO PEN Model, Wellness Unit YES 50 Ms J. Pullar Dietitian, Wellness Unit YES 51 Ms P. Druavesi DHS CHS MOH YES 52 Mr K. Kumar PO NCD, Wellness Unit YES 53 Ms E. M. Naiceru PO RHD, Wellness Unit YES 54 Dr Ilisapeci K- Samisoni FNU - C-POND YES 55 Dr Wendy Snowdon FNU C-POND YES 56 Ms Gade Waqa FNU C-POND YES 57 Ms Jillian Wate FNU C-POND YES 58 Ms A. Prasad FNU-C-POND YES 59 Dr Odille Chang FNU Mental Health 60 Mrs Railala Tavui FNU Dept. of Public Health YES 61 Dr R. Gyaneshwar Viseisei Sai H/C YES 62 Mr Mosese Baseisei Viseisei Sai H/C YES 63 Mrs Salanieta Matiavi Fiji Nursing Association YES 64 Mr Peter Hoejskovp WHO Technical Officer Food YES Safety 65 Ms Sashi Kiran FRIENDS Fiji YES 66 Mr Kishan Kumar Diabetes Fiji YES 67 Mr Rosan Lal ACATA YES Page 41 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program 68 Ms Sarah Burgess ACATA YES 69 Ms Archana Mani In-Country Manager for AVID 70 Adi Finau Soqosoqo Vakamarama YES 71 Tabakaucoro 72 Mr. R. Yee DFAT, AHC YES 73 Mr. T. Waqaiyavana Suva City Council YES 74 Dr Rosa S. Banuve PD FHSSP YES 75 Dr M. Cornelius TF Diabetes, FHSSP YES Total Attended: 64 Total Invites : 75 Page 42 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program Annex Two: Non-Communicable Disease Results Framework with Indicators Page 43 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program # Illustrative Indicators* Frequency Data Source 1 Premature mortality due to non-communicable diseases Quarterly Medical Cause of Death Certificates 2 Population prevalence rate of diabetes Every 3-5 years NCD STEPS Survey, GSHS Survey, FSIA Survey 3 Population prevalence rate of raised blood pressure/hypertension Every 3-5 years NCD STEPS Survey, GSHS Survey, FSIA Survey 4 Incidence of cancer, total and disaggregated by type and sex Quarterly Cancer registry 5 Suicide rate (per 100,000 population) Quarterly Medical Cause of Death Certificates 6 Teenage suicide rate (per 100,000 teenagers) Quarterly Medical Cause of Death Certificates 7 Rate of intentional self-harm, not including suicide (per 100,000 population) Quarterly PATIS; Hospital discharge records 8 Incidence of rheumatic fever (RF) Quarterly NNDSS 9 Incidence of nonfatal injuries Quarterly PHIS; PATIS 10 Population prevalence of overweight and obesity among adults Every 3-5 years NCD STEPS Survey, GSHS Survey, FSIA Survey 11 Prevalence of overweight and obesity among primary school children Quarterly Consolidated Monthly Return, PHIS 12 % of people who engaged in leisurely physical activity x/month Every 3-5 years NCD STEPS Survey 13 of people consuming servings of fruit and vegetables a day Every 3-5 years National Nutrition Survey 14 Prevalence of tobacco consumption, disaggregated by adolescents/adults Every 3-5 years NCD STEPS Survey 15 % of people with moderate to no alcohol consumption Every 3-5 years NCD STEPS Survey 16 Annual per capita consumption of alcohol per person aged 15 years+ Annually NCD STEPS Survey 17 Prevalence of heavy episodic drinking among adolescents and adults Every 3-5 years NCD STEPS Survey 18 Average population daily intake of salt (18+) Every 3-5 years National Nutrition Survey 19 Average % of total energy intake from saturated fatty acids (18+) Every 3-5 years National Nutrition Survey 20 Amputation rate for diabetic foot sepsis Quarterly PATIS; hospital discharge records 21 # of new cases of diabetes detected (medical area and below) Quarterly PHIS online (monthly reports) 22 # of new cases of hypertension detected (medical area and below) Quarterly PHIS online (monthly reports) 23 Percentage (%) of Diabetes Hubs/Centres adhering to Diabetes Management Guidelines Quarterly DMG six-monthly clinical audit 24 Number of settings-based tobacco-free policies endorsed Annual Wellness Unit records 25 # and % of primary schools implementing canteen guidelines Quarterly Dieticians report 26 # and % of secondary schools implementing canteen guidelines Quarterly Dieticians report 27 % of communities with adequate number of trained Community Health Workers Quarterly Data source to be developed 28 % of communities with functioning Community Health Committee Quarterly Data source to be developed 29 # of Community Health Workers trained (disaggregated by training topic/competency) Quarterly CHW training database 30 % coverage of vaccination against the human papilloma virus (HPV) among Class 8 girls Quarterly PHIS online 31 % of population 30+ screened for diabetes and hypertension (medical area level) Quarterly PHIS online (monthly reports) 32 % of population screened for diabetes and hypertension who receive SNAP Quarterly PHIS online (monthly reports) Page 44 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program # Illustrative Indicators* Frequency Data Source 33 % coverage of screening of rheumatic heart disease (RHD) among primary school children Quarterly PHIS online 34 % coverage of cervical cancer screening (e.g., pap smear, visual inspection w/acetic acid) Quarterly PHIS, PATIS, obstetric monthly returns 35 % of targeted facilities with established, functioning diabetes clinic Quarterly Diabetes SOPD six-monthly audit 36 # of clinicians trained in Diabetes Management Guidelines, disaggregated by facility Six-monthly Training database 37 % of PHIS reports in past quarter that were timely, complete and accurate Quarterly PHIS Data Verification Audit 38 Number of settings-based tobacco-free policies developed Annual Wellness Unit records *Indicators listed in the table above are illustrative and will be further developed and defined, including all relevant metadata (data sources, calculation, frequency of reporting, critical assumptions and risks, interpretation and application, etc.) and performance targets through annual work plans to operationalize the NCD Strategic Plan. Wherever applicable, indicators will be calculated and disseminated by the Health Information Unit of the Fiji Ministry of Health and Medical Services and metadata will be compiled and stored in the National Health Data Dictionary. Page 45 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program Annex Three: Non Communicable Disease Strategic Plan 2015-2019 Implementation Plan Strategy Strategy Targeted Timeframe Responsibility Budget Code 2015 2016 2017 2018 2019 DIET Overall Target: Age Standardized mean population intake of salt, per day in grams per person aged 18+ yrs reduced by 20% by 2019 (and by 30% by 2025). Increased daily average serves of fruit and vegetables among adolescence and adults by 10% by 2019. No increase in obesity prevalence in adults or adolescents. Data Sources: STEPS Survey in 2019. GSHS survey every 3 years. FSIA Survey 2015.

1.1 Adopt and implement draft Wellness Unit (MIT, Ministry of Info & regulations to control the Communications),NFNC, FT-TAG, marketing of foods and non- MoHMS alcoholic beverages to children

1.2 Support FPAN implementation NFNC, Wellness Unit, (MIT, Private sector, C-POND), FT-TAG, FPAN steering committee

1.3 Implement the Salt, Sugar, Fat NFNC, Wellness Unit, (all sectors), FT- action plan (2014-2017), TAG, MIT including adoption of the salt targets. Page 46 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

1.4 Incorporation of gardening into (MoE, MPI) primary school curriculum

1.5 Increased nutrition capacity (MoE), FT-TAG within Ministry of Education including nutritionist at CDU and each division

1.6 Introduce restrictions on Wellness Unit, (MoE, City councils) ha ke licence in a ea around schools (and develop approach for other informal sources of foods and drinks)

1.7 Introduce catering policy for all Wellness Unit, NFNC, NA-Dietetics, (all Government workshops and sectors), FT-TAG meetings (beginning with MoH), and support adoption by private sector

1.8 Development of early childhood (MoE), Wellness Unit, NFNC, FT-TAG education healthy food guidelines

1.9 Enforce School canteen and (MoE), MoHMS boarding school guidelines (and provide training for operators) Page 47 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

1.10 Continue efforts to support Wellness Unit (MIT, MFNP, FRCA, CC, healthier eating through MoW), FT-TAG targeted taxation, price control changes or subsidies

1.11 Enforce existing regulations Food Unit, (Consumers Council, regarding misleading food and Commerce Commission) drink advertising

1.12 Media and other educational NFNC, Wellness Unit, (MoW, MYS, campaigns to support healthier Ministry of iTaukei Affairs) eating, including provision of recipes using local foods and promotion of gardening

1.13 Educational programmes on NFNC, Wellness Unit, FT-TAG reading nutrition labels on processed foods to assist consumers with making healthier choices

1.14 S ppo fo back a d ga den (MPI,MoE in schools), NFNC,FT-TAG, in settings (including (MPI), MOHMS , (FBO, City Councils, information on cost-saving, MoW , MYS, Ministry of iTaukei nutrition and health) and homes Affairs)

1.15 Support for developing methods (MPI, SPC), MOHMS, (USP,FNU) of processing local foods which Page 48 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program allow value-adding, but are also health, convenient and affordable

1.16 Encourage religious leaders to (FBO), Wellness Unit, NFNC support low salt, low sugar diet for all religious members during holy week celebrations PHYSICAL ACTIVITY Overall targets (Long-term outcomes): Prevalence of insufficiently physically active adolescents (defined as less than 60 minutes of moderate to vigorous intensity activity daily) reduced by 5% by 2018 (and by 10% by 2025). Age-standardized prevalence of insufficiently physically active persons aged 18+ years (defined as less than150 minutes of moderate-intensity activity per week, or equivalent) reduced by 5% by 2018 (and by 10% by 2025). Tools (Data Sources): STEPS survey in 2019. GSHS survey every 3 years. Page 49 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

2.1 Ensure all existing and new Wellness unit, (Local govt, Ministry of developments include Lands, LTA, Roads authority, Housing infrastructure, walkways and authority, MFNP, MYS), MoH communal parks (which are accessible for persons living with disability).

2.2 Assess existing Council spaces Wellness Unit, (Private sector, MYS, and parks and ensure that they Ministry of iTaukei Affairs) are being used as public parks

2.3 Guide all schools and (MoE including HPS, MYS), Wellness educational establishments in Unit the provision of safe places and opportunities for active play for children and youth.

2.4 Review and strict (MoE) implementation of Physical Education curriculum.

2.5 Ongoing, targeted mass-media Wellness Unit, (MYS, private sector, campaigns to promote physical CSOs), Physios, MoHMS activity, particularly among the less active (including use of sports icons) Page 50 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

2.6 Targeted interventions with (Private sector, CSOs, FBOs), MoHMS population sub-groups to encourage physical activity, including support for leaders to become champions

2.7 Decrease all forms of taxes on Wellness Unit, (MIT, MFNP, MYS, all sports, physical activity and FRCA) gym equipment including mobility devices and sports shoes

2.8 Support workplaces policies for Wellness Unit, (Private Sector physical activity (e.g. time ,MYS,Public Service Commission), breaks for exercise, provision of Physios fitness facilities, shower/change facilities) TOBACCO Overall targets (Long-term outcomes): Reduced prevalence of current tobacco use among adolescents by 10% by 2019 (and by 30% by 2025). Reduced age standardized prevalence of current tobacco use among persons aged 18 yrs+ by 10% by 2019. Page 51 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program Increase in number of settings-based tobacco-free policies by 20% by 2019. Tools (Data Sources): STEPS survey in 2019. GSHS survey every 3 years

3.1 Pursue annual increase of at (MFNP)/Wellness Unit, (FRCA) least 10% in tobacco taxation

3.2 Strengthen efforts to enforce Tobacco control enforcement unit, existing tobacco control policies Wellness Unit, (Police, Customs office, (smoke-free places, restrictions Ministry of iTaukei Affairs, Ministry of on sales to minors, advertising) Labor, Ministry of Education)

3.3 Increase staffing in Tobacco Tobacco enforcement unit, MoHMS Enforcement Unit, in line with needs

3.4 Continue enforcement of Tobacco enforcement Unit, (NSAAC). regulations for promotion, advertising and sponsorship bans

3.5 Review and revision as needed Tobacco Enforcement Unit of existing tobacco legislation, including smoke-free requirements Page 52 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

3.6 Establish tobacco cessation Wellness Unit, NA-MH, National support programmes in all sub- Advisory Council on Mental Health and divisions. Including training for all Sub-divisional health staff, (CSOs, relevant staff/individuals FBO).

3.7 Continue developing effective Wellness Unit, (local media, NSAAC) media activities on the dangers of smoking

3.8 Encourage settings-based Wellness Unit and all sub-divisional tobacco-free policies (eg church, health staff, (CSOs, FBO) community) as part of tobacco- free Pacific

3.9 Support compliance with no (FBO), Wellness Unit smoking, no alcohol, no kava consumption in holy weeks in the religious calendars

3.10 Restrict sales of small packs of Tobacco enforcement unit cigarettes (10s)

3.11 Conduct awareness raising (NSAAC) programmes on dangers of tobacco, in schools and communities Page 53 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program ALCOHOL & KAVA Overall targets (Long-term outcomes): Age-standardized prevalence of heavy episodic drinking among adolescents and adults reduced by 5% by 2018 (and by 10% by 2025). Reduced annual per capita intake of alcohol per person aged 15years+ by 5% by 2019 Tools (Data Sources): STEPS survey in 2019. GSHS survey every 3 years. FRCA figures on units alcohol consumed annually.

4.1 Pursue annual increase in Wellness Unit, (MFNP ,FRCA) alcohol taxation of at least 10%

4.2 Pursue restrictions on alcohol Wellness Unit, (NSAAC), (SPC, WHO, advertising and sponsorship Police) (including restricting licenses for outlets to sell alcohol and increasing license fees)

4.3 Continue efforts to enforce (Liquor Control Board, Police, LTA) existing alcohol control policies (age limits, sales limits, licensing limitations)

4.4 Encourage communities to Wellness Unit and all public health adopt own alcohol restrictions staff, (FBO) and kava restrictions Page 54 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

4.5 Strengthen programmes in all (Alcoholics Anonymous, FBOs and sub-divisions and religious CSOs),Wellness Unit and all public communities for alcoholics health staff, NA-MH, (National (refer Mental Health and stress Advisory Council on Mental Health, management section) NSAAC)

4.6 Engage with breweries to (NSAAC, private sector, MIT) reduce alcohol content of locally produced beverages and/or to produce lower alcohol alternatives

4.7 Increase effective media Wellness Unit (MoE, NSAAC, activities on the dangers of Government Communication Officers, alcohol abuse (including home Ministry of Information, media brew) organisations, Media Council)

4.8 Assess extent of problems with (NSAAC) use of home brew

4.9 Assess extent of kava abuse (NSAAC) problem, and association with alcohol and tobacco use and risk for NCDs

4.1 Selected health officers to be Wellness Unit, MoHMS designated as alcohol Page 55 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program enforcement officers

4.11 To investigate scope for other Wellness Unit, (all Ministries) government officers to be designated as alcohol enforcement officers CLINICAL& PUBLIC HEALTH SERVICES Overall targets (Long-term outcomes): By 2019, 50% availability of affordable basic technologies and essential medicines required to treat NCDs in public and private facilities(and 80% by 2025) Identify high risk population for stroke and heart attack and treat 30% of them by 2019 (and 50% of them by 2025)

5.1 Evaluation of PEN Wellness Unit, DMOs, SDMOs, (WHO) implementation

5.2 Ensure incorporation of risk- (FNU, UniFiji, WHO) reduction strategies into medical and nursing training

5.3 All relevant front-line MoH staff (FHSSP), MoHMS to receive PEN/NCD risk reduction training

5.4 Ensure essential medicine and Pharmaceutical team, procurement technologies (as detailed in unit (Commerce Commission, Page 56 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program PEN) are accessible (including Consumers Council, MFNP) availability of NCD tool kits)

5.5 Continue scale-up of early (FHSSP), MoHMS, communities detection services including the utilization of trained community health workers

5.6 Provision of adequate Rehab service (CSOs, FBOs, private rehabilitation services for NCD- sector, Fiji council disabled persons, related disability and injuries Social Services, MoW) (based on needs assessment currently underway and other data)

5.7 Strengthen co-ordination MoHMS, (CSOs) between allied health service providers through active consultation and MoUs eg rehabilitation, cancer care, counseling, palliative care

5.8 Diabetes hubs to be sufficiently Wellness Unit, (Diabetes Fiji) resourced to provide a suite of services for diabetes related complications Page 57 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

5.9 Work with mobile operators to Clinical Services, Health Information, develop SMS-based services for (Private sector) clinic appointment reminders

5.1 Work with CSOs to establish (FNCDP) respite care for individuals living with disability

5.11 Develop a screening unit to Wellness Unit, CSOs, CWMH, Clinical oversee all screening activities Services Network, Health Information for NCDs (eg cancer, diabetes, Unit rheumatic heart disease). This unit will ensure continuum of care from screening to treatment, data system, manage and follow-up cases and will co- ordinate role of CSOs.

5.12 Undertake a study of gestational CWMH Maternity Unit, HIRA, Clinical diabetes (GDM) burden, Services Network, (academic including analysis according to institutions) different definitions of GDM, and coverage of screening services currently.

5.13 Establish targets for screening FHSSP, Maternity Units, HIRA coverage for GDM, in new Page 58 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program deliveries.

5.14 Strengthen oncology unit at all Wellness Unit,Clinical Services the divisional hospitals. This Network,HIRA should include cancer screening and management and palliative care services.

5.15 Development of a Clinical Services Network,PPDU comprehensive clinical services plan for renal disease. MENTAL HEALTH AND STRESS MANAGEMENT Overall targets (Long-term outcomes): To reduce number of suicide cases and attempted suicide cases by 20% by 2019 Tools (Data Source): PATIS, mental health information system

6.1 Implementation, monitoring National Advisory Council on Mental and review of the mental health Health, NA-MH decree

6.2 Implementation of a National National Advisory Council on Mental Mental Health and Suicide Health, NA-MH, (CSOs) Prevention Strategic Plan Page 59 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

6.3 Review and revision of friendly MoHMS Epidemiologist, NA-MH, mental health information (Police, MoW) system within existing structures

6.4 Identify mental health National Advisory Council on Mental champions Health

6.5 Support relevant stakeholders National Advisory Council on Mental to raise mental health Health awareness in communities

6.6 Strengthening and monitoring NA-MH of decentralisation of services through the establishment of stress management wards at all hospitals and increased specialized staff at sub- divisional levels

6.7 Establishment of lifeline-style NA-MH, (CSOs), (mobile operators) service for mental health issues, counseling and alcohol support programmes. (Include specialized training for those involved, referral systems and accreditation scheme) Page 60 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

6.8 Development and roll out of NA-MH capacity building programme for relevant sub-divisional staff in MoHMS

6.9 Development and roll out of NA-MH capacity building programme for relevant community leaders and CSOs

6.10 Incorporation of stress (MoE) management and awareness into school curriculum VIOLENCE AND INJURIES Overall targets (Long-term outcomes): To reduce the prevalence of violence and injuries by 5% by 2019 To reduce cases of violence and injuries related to alcohol by 10% by 2019 Tools (Data Sources): PHIS, PATIS, Accident and emergency data & extended surveillance system

7.1 Development of a detailed Wellness Unit, (Police, NFA, LTA, CSOs, strategic plan based on evidence WHO MoW Women Crisis Centre) of risk factors, to target key Physios causes of injuries and violence Page 61 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

7.2 Establish National Violence and Wellness Unit, (Police, NFA, LTA, CSOs, Injuries Committee WHO MoW Women C i i Cen e Physios, FBO, Elimination of Violence against Women Taskforce

7.3 Develop extended surveillance MoHMS Epidemiologist system based on PHIS to incorporate police, LTA and Fire authority data

7.4 Introduce mass media campaign Physios, Wellness Unit, (MYS) on preventing injury in sports

7.5 Strengthen rehabilitative Physios, MoHMS, (CSOs, FBO) services for those affected by injuries or violence CROSS-CUTTING ISSUES Overall targets (Long-term outcomes): Increased resource allocation for NCDs that is in line with the scale of the crisis

8.1 Establish a National taskforce Wellness Unit, (All Ministries, CSOs) for NCDs that is focused on innovative avenues to address the crisis Page 62 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

8.2 Continue efforts to inform key Wellness Unit, all staff of Ministry of stakeholders and leaders of the Health and Medical Services scale of the NCD/mental health/injuries and violence crisis: including regular briefings for key stakeholders

8.3 Identify champions for NCDs Wellne Uni P ime Mini e Office P e iden office

8.4 Pursue ongoing increases in the Wellness Unit, Ministry of Health and fees charged for tobacco Medical Services licenses (and ensure revenue retained by MoHMS)

8.5 Pursue share of taxes from Wellness Unit (MFNP, FRCA, MIT, revenue on WHO, SPC) obacco alcohol nheal h food for health promotion

8.6 Ensure NCD budget within Wellness Unit, MoHMS, (all Ministries) Ministry of Health AND Medical Services is planned in conjunction with Divisions, Sub- Divisions and Departments annually. (To include allocations for sufficient educational Page 63 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program materials)

8.7 Assess need for a cost of NCDs Wellness Unit (MFNP, WHO, SPC, study (including possible scope) UNDP, academic institutions)

8.8 Improving human resource HRH, HR capacity for NCDs in MoHMS in response to training needs assessment

8.9 All government and relevant All MoHMS areas, (MFNP, other CSOs should incorporate relevant government sectors, FBO) relevant areas of this strategic plan in their annual corporate plans (Wellness Unit to meet annually with all key govt sectors to discuss their next ACP)

8.1 Strategic health communication Wellness Unit plans to be developed and followed prior to any media or community educational activities, and to include monitoring and evaluation component Page 64 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program

8.11 Healthy settings including Wellness Unit, (all sectors) workplaces, communities, schools, churches, islands, cities to be utilized. (Award programmes to be developed to recognize achievements)

8.12 Implementation of monitoring PPDU, HIRA& all sub-divisions and evaluation framework

8.13 Planned and proactive Wellness Unit, PPDU, Forum of Healthy engagement with appropriate Policy Technical Support Group private sector and civil society organisations including faith- based organisations

8.14 Capacity-building available for Wellness Unit, (communities, FBOs, key community members, faith- CHWs, Turanganikoro) based organization leaders and community health workers to support and empower a greater role in NCD activities.

8.15 Encourage targeted research HIRA, Wellness Unit, (research (including by students) and data organisations and academic analysis to allow for targeting of institutions, FBO) interventions and programmes, Page 65 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program including strong dissemination across sectors

8.16 GSHS survey in schools to be MoE, (WHO) conducted every 3 years and effectively disseminated

8.17 STEPS survey to be repeated in MoHMS, (WHO) 2019 and effectively disseminated

8.18 Cabinet paper/decree/act for Wellness Unit, Minister of Health and Wellness to be developed and Medical Services approved (to include the establishment of a cross- sectoral committee and mandate to include NCDs and Wellness in all ACPs).

8.22 Establishment of a dedicated MoHMS NCD strategy post to facilitate monitoring and reporting related to NCD strategy (and report to cross-sectoral committee)

8.23 Development of communication Wellness Unit plan including regular Page 66 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program newsletter, to update stakeholders regarding NCD strategy and activities

8.24 Relevant curricula for health (MoE, academic institutions) Pacific professionals, teachers and FBO Theological College leaders should be reviewed and revised if needed to ensure relevance to NCD strategy (including behavior change/motivational interviewing) Page 67 FHSSP is implemented by Abt JTA on behalf of the Australian Aid Program