National Strategy for Prevention and Control of Non-Communicable Diseases 2015-2020

1.2.1. Achievements .................................................................................................................. 5

1.2.2. Challenges ....................................................................................................................... 5

1.2.3. Governance reform .......................................................................................................... 6 2. Developing the Strategy for Prevention and Control of NCDs 2015-2020 ..................................... 8

2.1. Methodology........................................................................................................................... 8

2.2. Strategy Focus Areas ............................................................................................................. 9 3. Implementing the Strategy .......................................................................................................... 11 4. National Strategy for prevention and control of NCDs (Hala Fonongaki ha Tonga Mo’ui Lelei) 2015-2020 ...................................................................................................................................... 12 2020 Outcome 1: Tongan infants (age 2 and under) have a healthier start to life............................ 13 2020 Outcome 2: Tongans are leading healthier lifestyles (with a focus on children and adolescents) ....................................................................................................................................................... 15 2020 Outcome 3: Improved early detection, treatment and sustained management of people with or at high risk of NCDs ........................................................................................................................ 23 2020 Outcome 4: Strengthened monitoring and surveillance supports evidence based action........ 24 Annex 1: Members of the National NCDs Committee..................................................................... 25 Annex 2: Terms of Reference of the National NCDs Committee .................................................... 26 Annex 3a: Members of the TongaHealth Board .............................................................................. 27 Annex 3b: Members of TongaHealth Staff ...................................................................................... 27 Annex 4: MoU between the National NCDs Committee and TongaHealth ..................................... 28 Annex 5: Terms of Reference and Members of the four Advisory Committees .............................. 36 Annex 6: Members of the Situational Analysis Group .................................................................... 40 Annex 7: Authors of NCDs technical papers .................................................................................. 41 Annex 8: Members of the Research Task Force and their Terms of Reference ............................. 42 Annex 9: Members of the M&E Task Force and their Terms of Reference ..................................... 43 Annex 10: Members of the Strategy Drafting Committee ............................................................... 44 National Strategy for Prevention and Control of NCDs 2015-2020 Acronyms ADB Asian Development Bank CEO Chief Executive Officer DFAT Department of Foreign Affairs and Trade, Australian Government FCTC Framework Convention on Tobacco Control HPU Health Promotion Unit INHPF International Network of Health Promotion Foundations MAFFF Ministry of Agriculture, Forestry & Food and Fisheries MDG United Nations Millennium Development Goals M&E Monitoring and Evaluation MET Ministry of Education and Training MIA Ministry of Internal Affairs MOH Ministry of Health MOP Ministry of Police MOU Memorandum of Understanding NCDs Non-Communicable Diseases NGO Non-Governmental Organisation NNCDC National Non-Communicable Diseases Committee SDG United Nations Sustainable Development Goals SPC Secretariat of the Pacific Community STEPS STEPwise approach TongaHealth Tonga Health Promotion Foundation TOR Terms of Reference TSDF Tonga Strategic Development Framework UN United Nations VicHealth Victoria Health Promotion Foundation WHO World Health Organization National Strategy for Prevention and Control of NCDs 2015-2020 Foreword The vision for the Tonga Strategic Development Framework is, “a more progressive Tonga supporting a higher quality of life for all”. A healthy, productive population is the cornerstone for achieving this vision, which is why Tonga remains committed to strengthening our fight against our biggest killer: Non-communicable disease (NCDs). 99% of the Tongan adult population is at medium or high risk of developing a NCD. We are one of the most at risk populations globally and NCDs such as diabetes and heart disease will continue to cripple our families, our communities and our nation unless we continue to commit to strong and decisive action. Tonga has a history of taking progressive action to tackle NCDs: • In 2004, Tonga was the first Pacific Island Country to launch a National NCDs strategy. • In 2007, Tonga was the first Pacific island Country to set up an autonomous body to address NCDs – The Tonga Health Promotion Foundation (TongaHealth). • In 2013, Tonga was awarded the WHO ‘Healthy Islands Recognition-Best practice’ award for the “Kau Mai Tonga” women’s physical activity program. • In 2014, Tonga received a ‘World No Tobacco Day Award’ for its tobacco tax measures. • In 2014 Tonga was the first Pacific Island Country to publish our second NCDs STEPS report. Despite these positive steps, much more needs to be done and NCDs must be kept at the forefront of the agenda for Government, donor partners, civil society, Churches, the community, families and individuals if we are to progress and prosper together as a nation. We cannot and must not “tinker at the edges” of this crisis. The introduction of the Tonga National Strategy to Prevent and Control NCDs 2015-2020 is an opportunity to continue Tonga’s commitment to progressive good practice. The strategy uses a mix of policy and program to address the multiple layers that influence NCDs, including the impact of a complex global economy on what we eat, drink, our consumption of tobacco and how we move. “God and Tonga are my inheritance” means we commit to building a culture and society that supports health and wellbeing and that does not compromise the ability of future generations to meet their own needs by raising them in an environment that makes lifestyles that lead to premature death and disability normal. May the launch of this strategy be a call to arms for all of us to work hard and to work together for a stronger, healthier, happier and more productive Tonga. ______________________ Hon. Dr. Saia Ma’u Piukala Minister for Health National Strategy for Prevention and Control of NCDs 2015-2020 0 1 Remarks from the Chairman, National NCDs Committee The Sustainable Development Goals call for a one-third reduction in NCDs by 2030. This is an ambitious goal for Tonga, not only because 99% of our adult population is at risk of NCDs but because the health status of our young people represents an alarming ‘pipeline of disease’. Many of our children are already overweight; levels of smoking continue to be high amongst young men and are growing alarmingly amongst young women and 63% of our young people have tried alcohol by age 14. In addition, it is now well established that NCDs in adulthood are influenced by factors such as nutrition and maternal diabetes during fetal development and early childhood, and that these factors establish the trajectory of NCDs risk throughout a person’s life1. Tonga has been tackling NCDs prevention and control for over ten years. The Tonga NCDs Strategy 2015-2020 builds on the expertise and knowledge of implementing partners whilst taking into account global guidelines to focus on good practice, feasible actions that address the whole population but place a clear emphasis on young people and a healthy start to life. Actions include: • Targeted interventions that support healthier pregnancy and first 2 years of life. • Policy action for pro-active management of the growing complexities of living in a global economy that have led to changes in the Tongan diet and lifestyle. • Introduction of an intensive mass media and community mobilisation nutrition campaign. • Strengthened implementation of the Framework Convention on Tobacco Control, including launching our first mass media campaign and cessation service. • Expansion of community based physical activity initiatives. Because all strategies rely on effective implementation, for the first time Tonga’s NCDs Strategy will be supported through a secretariat function, the Tonga Health Promotion Foundation (TongaHealth) whose role is to support implementation effectiveness. Consistent with the Tonga Strategic Development Framework Organisational Outcome 2.6 which calls for “a stronger and more integrated approach by all parts of society to address non-communicable disease”, the secretariat’s role will include harmonising funding streams for NCDs prevention, strengthening communication and collaboration among implementing partners and strengthening the monitoring, evaluation and reporting of progress. Introduction of the secretariat is an innovative first for the Pacific. Turning the tide on non-communicable disease is in our hands. Whether you are a Minister of Cabinet, CEO, teacher, farmer, employed or unemployed you can make a change. In particular, we must make a change for our young so that they grow up in a society, community and family that values and cherishes the life and body that God gave us. Malo ‘aupito, . Dr. Siale ‘Akau’ola Chairman NNCDC 1 https://www.niehs.nih.gov/news/newsletter/2012/6/science-origins/file72241_508.pdf National Strategy for Prevention and Control of NCDs 2015-2020 0 2 Acknowledgement The ongoing leadership and support of the Minister of Health, Hon. Saia Ma’u Piukala, to the prevention and control of NCDs and the design and implementation of this NCDs Strategy 2015- 2020 is highly commendable. The contribution of TongaHealth Board members, TongaHealth CEO and staff in undertaking the design of this Strategy is greatly appreciated. Special thanks are extended to Sara Gloede, NCDs Adviser at the Ministry of Health for her guidance and assistance to TongaHealth during the design of this Strategy, and preparation of this Strategy report. Members of the National NCDs Committee under the leadership of the Chairman, Dr Siale ‘Akau’ola, and the four NCDs Advisory Committees and Task Force Groups have contributed enormously to the design of this NCDs Strategy report. The leadership and support of Lord Tangi o Vaonukonuka, Chief Surgeon Specialist, the Medical Superintendent, Dr. Lisiate ‘Ulufonua, Dr. Lei Saafi, Dr. Ma’ake Tupou, Dr. ‘Amanaki Fakakovikaetau, Dr. Veisinia Matoto, Dr. Taniela Palu, Dr. Toakase Fakakovikaetau, and Senior officials of the Ministry of Health is greatly appreciated. The support of Dr. Reynold ‘Ofanoa, Chief Medical Officer Public Health, and Dr. ‘Ofa Tukia, Head of the Health Promotion Unit (HPU) of the Ministry of Health and HPU staff is greatly appreciated. Sincere appreciation is extended to our international partners for their ongoing support in undertaking this work. The Australian Government provided funding for the design of this Strategy and commits ongoing funding towards implementation. The Asian Development Bank (ADB) is supporting the delivery of Strategy 1.1. The World Health Organization (WHO) has provided invaluable technical support, peer review and financial support for printing of the Strategy. Sincere appreciation is extended to Dr. Li Dan (CLO/WHO, Nuku’alofa), Dr. Cherian Varghese (WHO, Geneva), Dr. Wendy Snowdon (WHO, Suva) and Dr. Ada Moadsiri (WHO, Suva). Sincere appreciation is also extended to Dr. Philayrath Phongsavan of the University of Sydney, a long-time supporter of Tonga, for her efforts in peer reviewing the Strategy document. The support of Dr. Paula Vivili and the SPC Public Health Team is also greatly appreciated. Sincere appreciation is also extended to experts at VicHealth for commenting on the Strategy, as well as Professor Prakit Vathesatogkit, Advisor to the International Network of Health Promotion Foundations (INHPF), and Executive Secretary for Action on Smoking, Health Foundation, Thailand, for taking time to go through the Tobacco Strategy, and offering useful comments. Sincere thanks are extended to authors of various NCDs documents that were produced to help with the design of the Strategy. This NCDs Strategy report is a result of many consultations and workshops with multi-sectoral stakeholders. The contributions of CEOs and senior officials of these multi-sectoral stakeholders including representatives of the Commercial Business Sector and the Community to this third National NCDs Strategy Report are greatly appreciated. National Strategy for Prevention and Control of NCDs 2015-2020 0 3 1. Background

1.1. The International and Regional Agenda for NCDs Prevention and Control In May 2011, the UN convened a high-level meeting on the Prevention and Control of NCDs. This meeting reported that NCDs are now responsible for more deaths than all other causes combined. In addition, strong evidence links poverty, lack of education and other social determinants to such diseases and their risk factors, and increasingly low and middle-income countries are hardest hit by NCDs2. In September 2011, the Pacific Island Forum Leaders meeting declared that the Pacific is currently experiencing a NCDs crisis. Leaders expressed alarm that, “75 percent of all adult deaths in the Pacific are due to NCDs, the majority of whom are in the economically active age bracket and that many more times this number suffer severe side effects that undermine their capacity to contribute further to economic development”3. In 2013, at the direction of the Forum Economic Ministers, the SPC, WB, WHO, Australia and New Zealand jointly prepared the ‘NCD Roadmap’ to guide Pacific Island Countries in the most effective use of resources to prevent and control NCDs. In 2014, at the inaugural Joint Forum Economic and Pacific Health Ministers Meeting, the ministers commit to five key strategies4: • Strengthening tobacco control, including raising the excise duty to 70% of the retail price of cigarettes; • Considering an increase in taxation of alcohol products as a way of reducing harmful alcohol consumption; • Reducing consumption of food and drinks directly linked to obesity, heart disease and diabetes such as sugar-sweetened drinks, salty and fatty food (including through taxation measures); • Improving the efficiency and impact of the health sector for prevention and early treatment; • Strengthening the evidence base for better investment planning and programme effectiveness. In 2013, the WHO launched the ‘Global Action Plan for the Prevention and Control of Non- Communicable Diseases 2013-2020’. The global framework is supported by an aligned regional framework, the ‘Western Pacific Global Action Plan 2014-2020’. These documents provide guidelines for action that draw together key documents and initiatives; for example, the Economic Forum/WHO “From Burden to Best Buys” report, and the FCTC. In September 2015, the UN launched the SDGs. SDG Goal 3 ‘Good health and wellbeing’ targets include; a one third reduction in premature mortality from NCDs by 2030, along with a commitment to strengthened implementation of the FCTC, and achieving universal coverage of health care services. 2 United Nations (2011) http://www.un.org/en/ga/search/view_doc.asp?symbol=A/66/83&Lang=E 3 Secretariat of the Pacific Community (2011) http://www.spc.int/hpl/index.php?option=com_content&task=view&id=124 4 http://forumsec.org/resources/uploads/attachments/documents/2014_Joint_FEMM_PHMM_%20Meeting_Out comes_Statement_July14_approvedbyMinisters1.pdf National Strategy for Prevention and Control of NCDs 2015-2020 0 4

1.2. NCDs Prevention and Control in the Kingdom of Tonga 2004-2015 In 2004, Tonga became the first Pacific Country to launch a National Strategy for the Prevention and Control of NCDs. Since that time, Tonga has remained committed to multi-sectoral action for the prevention and control of NCDs, implementing both the 2004-09 and 2010-15strategies through a multi-sectoral governance mechanism, the NNCDC (Refer Annex 1). The NNCDC has been advised and supported by four advisory committees for Healthy Eating, Physical Activity, Alcohol and Tobacco. The membership of these committees is made up of representatives from government, the private sector, NGOs, and civil society to engender a whole of society and people-centred approach to NCDs prevention and control (Refer Annex 5).

1.2.1. Achievements There have been notable achievements, including: • The strategic prioritisation of NCDs by the Government of Tonga through both the TSDF 2011-2014 and the TSDF 2015-2025. • Strengthened implementation of the FCTC. • Reductions in the prevalence of low levels of physical activity (STEPS 2014). • Prioritisation of NCDs within the MDG Goal 6. • Development of the MDG Acceleration Framework titled Reducing the Incidence of NCDs in Tonga, which identified key bottlenecks to effective implementation and recommendations for action. • Establishment of TongaHealth to strengthen the definition and distribution of NCDs funding sources5. • Achieving WHO recognition for work done in relation to tobacco taxation and interventions to increase women and girls physical activity. • Strengthening of alcohol related legislation, including in relation to opening hours. • Introduction of drink driving campaigns by the MOP.

1.2.2. Challenges However, despite these efforts, NCDs remain a critical challenge, with the ‘Kingdom of Tonga Health System Review’ noting that: • 99.9% of Tongan adults aged 25-64 are at moderate to high risk of developing a NCD. • In 2012, Tonga was ranked the third most overweight country in the world. • Obesity and overweight is commonly occurring at younger ages. • The percentage of the population with impaired fasting glycaemia rose by around 7% between 2004 and 2012. • Raised cholesterol affects almost half the adult population. • Almost one in two men are smoking, and smoking appears to be increasing amongst young women. • The number of cases of lung and tracheal cancer has rapidly increased over the last 30 years and admissions for chronic obstructive pulmonary disease are growing. 5 Asia Pacific Observatory on Health Systems and Policies (2015) The Kingdom of Tonga Health System Review http://www.wpro.who.int/asia_pacific_observatory/hits/series/tonga_health_systems_review.pdf National Strategy for Prevention and Control of NCDs 2015-2020 0 5

1.2.3. Governance reform It is well established that multi-sectoral action and co-operation underpins effective NCDs prevention. In 2004, the Tongan Cabinet committed to this principle by placing oversight of the NCDs prevention and control with the NNCDC. Reviews of the Tonga National NCDs Strategy 2010-2015 identified strong support for the NNCDC and for a multi-sectoral strategy, but also found that critical governance and infrastructure gaps were impeding the implementation of NCDs prevention and control in Tonga. This finding was reinforced by the MDG Acceleration Framework titled Reducing the Incidence of NCDs in Tonga report, which found that ‘inadequate co-ordination and cross-sectoral collaboration’ was a key bottleneck in the successful implementation of NCDs prevention and control. As a result, in August 2014, His Majesty’s Cabinet approved the membership and revised TOR for the NNCDC (Refer Annex 2) as well as a recommendation to establish TongaHealth in the role of secretariat to the NNCDC, with the intention to establish: • A national over-sighting entity outside of any Ministry that is accountable to Cabinet and which has multi-sectoral engagement and inclusive representation. • Operational capacity to coordinate the planning and distribution of funds for the implementation of activities. • Simplified reporting structures with clear roles and responsibilities. Establishing a dedicated secretariat is a strong and innovative move that is intended to support improvements in the way Tongan partners design, implement and report efforts to combat NCDs. In January 2015, the NNCDC signed a MOU with TongaHealth, detailing roles, delegations, decision- making, and reporting processes (Refer Annex 4). TongaHealth is governed by the TongaHealth Board according to the Health Promotion Foundation Act 2007, the Governance Manual, the MOU with the NNCDC, and existing TongaHealth Policies. Members of the TongaHealth Board (Refer Annex 3a) are appointed by the Minister of Health, and include two representatives from health and illness prevention, one with expertise in business, management or law, one representing the interests of churches or community groups, and one member of the Legislative Assembly. The TongaHealth Board appoints a CEO to manage operations, as well as staff (Refer Annex 3b) to implement core functions of TongaHealth, as well as its new role of secretariat to the NNCDC. TongaHealth in the reformed governance model for NCDs is tasked with establishing time-limited taskforce groups, to assist with specialised tasks related to the implementation of the NCDs Strategy. Two taskforce groups were established namely the Research Taskforce and a Monitoring & Evaluation Taskforce, to help identify research needs as well as prioritise monitoring and evaluation tools. (Refer Annex 8 and Annex 9). Figure 1 outlines the roles of the secretariat and the alignment of the National NCDs Strategy 2015- 2020 with national, regional and international priorities. National Strategy for Prevention and Control of NCDs 2015-2020 0 6 FIGURE 1: TONGA NATIONAL NCDS STRATEGY 2015-2020 ARCHITECTURE TONGA NATIONAL NCDs STRATEGY-ARCHITECTURE INTERNATIONAL PRIORITIES TONGA NATIONAL DEVELOPMENT PRIORITIES DEVELOPMENT Sustainable Development Goals (SDGs) EFFECTIVENESS SDG 1: End poverty in all its forms. Tonga St rategic Development Framework Tonga Strategic Development Framework 2015- The Paris Decla ration/ Accra Agenda SDG 2: Achieve food security and 2015-2025 Health Specific Outcomes 2025 Cross-Cutting Outcomes • Ownership. improved nutrition. Outcome 2.5: Improved, country-wide, health Outcome 2.1: Improved colla boration with, and • Alignment. SDG 3: Ensure healthy lives and promote ~ care systems. support to, social and civil society organisations. +-- • Harmonisation. well-being: Outcome 2.6: A stronger and more integrated Outcome 2.2: Closer collaboration between • Managing for results. approach by all parts of society to address non- government, churches and other stakeholders for • Mutual accountability. • Reduce premature mortality from non-communicable diseases. communicable disease. community development. • Strengthen prevention and Outcome 3.6: Improved collaboration with The Busan Partnership treatment of harmful use of alcohol. development partners ensuring programs better Use results frameworks designed with aligned to government prioritie s. • Strengthen implementation of the the partner country, and use country-led WHO FCTC. SDG 5: Achieve gender equality. t t coordination arrangements. SDG 10: Reduce inequalities. EFFFECTIVE AND EFFICENT IMPLEMENTATION United Nations (UN ) • Tongan Government Ministries. • Private Sector. • UN Convention on the Rights of the • Civil Society Organisations. • Communities. MULTI-SECTOR GOVERNANCE Child (1990), Article 24. • Churches. The National NCOs Committee: World Health Organization (WHO) • Global Action Plan for the Prevention t STRENGTHENED COORDINATION, • • CEO Ministry of Health. CEO Ministry of Education and and Control of Non-Communicable NATIONAL NCDs STRATEGY Training. Diseases 2013-2020. Outcome 1: Tongan infants (age 2 and under) INTEGRATION, MONITORING, • CEO Ministry of Internal Affairs. • Framework Convention on Tobacco have a healthier start to life. AND REPORTING • CEO of Ministry of Agriculture and TongaHealth appointed as secretariat to the Control (FCTC). __..,. Outcome 2: Tongans are leading healthier Food, Forestry and Fisheries. NNCDCto: Tobacco Free Pacific 2025 lifestyles (with a focus on children and • CEO for Ministry of Finance and World Bank NCDs Roadmap Report adolescents). • Coordinate planning and implementation ~ National Planning. Outcome 3: Improved early detection, of National NCDs Strategy. • Police Commissioner. treatment and sustained management of • Facilitate multi-sectoral engagemen t to • Representative of the National DONORS AND OTHER KEY people with or at high risk of NCDs. harmonise and coordinate activities per Forum of Church leaders. STAKEHOLDERS ~ Outcome 4 : St rengthened monitoring and the National NCOs Strategy. • Asian Development Bank. • Representative of the Commercial surveillance supports evidence based action. • Make decisions on activities to be funded Business Sector. • Australian Government. • Representative of Civil Society. • Secretariat of the Pacific Community. • Chairman TongaHealth Board. • World Health Organization. • CEO TongaHealth. • Prospective Donors and Key EVIDENCE-BASED ACTION STRENGTHENED SURVEILLANCE • Supported by the four Advisory Stakeholders. AND TECHINCAL SUPPORT Committees, and Task Forces. • INHPF and VicHealth National Strategy for Prevention and Control of NCDs 2015-2020 0 7 2. Developing the Strategy for Prevention and Control of NCDs 2015-2020

2.1. Methodology The National NCDs Strategy 2015-2020 sought to build on the successes of previous strategies whilst being mindful of areas that needed improvement, as identified through the NCDs Strategy 2010-2015 mid-term and end of term reviews, and the MDG Acceleration Framework bottleneck analysis. As a result, the design process was a highly collaborative and iterative process that sought to develop a well prioritised, evidence-based and feasible strategy by: a. Aligning closely to international and regional evidence-based frameworks. b. Understanding and incorporating local evidence and expert perspectives. c. Understanding and aligning to implementing partners' existing strategic priorities. d. Establishing a robust and feasible monitoring and evaluation framework. The NCDs Strategy 2015-2020 covers financial years 2015-2016 to 2019-2020, a period of five years, with implementation commencing in the second half of 2015-2016. The NCDs Strategy 2015-2020 design was done through a multi-step and iterative process that is broadly outlined below: a. Healthy Eating and Physical Activity technical review papers were produced with strong leadership from the MOH (Refer Annex 7). These papers reviewed regional and local frameworks, local evidence, analysis and perspectives to identify priority areas for action, which included a Paper on Obesity, healthy eating and physical activity health trends in Tonga and the implications for the prevention and control of NCDs; A Public Health evidence paper related to obesity in Tonga- Literature review; and a Healthy Eating Discussion Paper (Refer Annex 7). These papers, along with an overarching summary of the key findings, are available at: http://www.tongahealth.org/#!ncd-publications/c1uef b. Ongoing one-on-one consultations and policy review were undertaken with implementing partners to refine goals and targets and to develop activities based on partners' strategic priorities and perspectives on feasibility and effectiveness. c. This process resulted in draft goals, actions and activities for healthy eating and physical activity that were reviewed by the advisory committees. d. With support from Dr. Ada Moadsiri from the WHO Pacific Technical Support group, workshops were held with the Tobacco and Alcohol Advisory Committees to establish goals, targets and activities for Tobacco Control and management of harmful use of Alcohol. e. An overview of the proposed goals, targets and activities across the four risk factors were peer reviewed by the WHO Division of Pacific Technical Support, the University of Sydney, VicHealth and an Adviser to the International Network of Health Promotion Foundations, before being presented to a Situational Analysis Group for review. The final draft of the NCDs Strategy 2015-2020was then presented to the NNCDC for comment and endorsement. Figure 2 gives an illustration of the input to the Situational Analysis Process, and membership in this Group is provided at Annex 6. A drafting committee (Refer Annex 10) was then tasked to prepare the Strategy Report, review and finalise the report for approval by the NNCDC and printing. f. A comprehensive M&E framework was then developed through close collaboration with implementing partners to ensure the framework aligned to existing data collection and reporting processes. Where the process highlighted gaps in data and reporting, investment National Strategy for Prevention and Control of NCDs 2015-2020 0 8 was made by TongaHealth to bridge surveillance gaps and to support partners to strengthen their ability to collate and report data. Figure 2: The Situational Analysis Process One on One Advisory group stakeholder meetings meetings 4. Physical activity and 5. Healthy Eating health eating Discussion Paper trends in Tonga review 2. Hala Fononga Alcohol and 2010-2015 mid Tobacco and end of term Workshop reviews 1. Comphrensive review of public health literature Situational FCTC needs assessment re: obesity in Analysis Tonga

2.2. Strategy Focus Areas Whilst the NCDs Strategy 2015-2020 will continue to focus on tobacco use, unhealthy eating, harmful use of alcohol and physical inactivity across the population, investment and effort will be focused on areas and groups where it is anticipated the best long-term impact on reducing NCDs morbidity and mortality can be achieved. a) Supporting Tongans to have a healthier start to life One in four pregnant women and one in five women of reproductive age in the Western Pacific region are anaemic, which increases the risk of maternal mortality, fetal growth retardation, and prenatal mortality. There is growing evidence about the impact of under nutrition in the first 1000 days during pregnancy, infancy and young childhood on an individual’s NCDs risk in later life6. Ensuring Tongan children have a healthy start to life is crucial to improving long-term NCDs outcomes. b) Policy action to address environmental determinants Given that 99% of the Tongan population is at moderate to high risk of NCDs, strong evidence- based action needs to be taken to address environmental determinants of disease. Interventions that seek to educate the population will have very limited effectiveness without taxation, policy, regulatory and infrastructure action that makes healthy options affordable and accessible 6 WHO (2014) http://www.wpro.who.int/mediacentre/factsheets/nutrition/en/ National Strategy for Prevention and Control of NCDs 2015-2020 0 9 comparative to unhealthy options. Actions that alter the environment are also important in their ability to create sustainable change across age, social and economic demographics. c) Tobacco and Unhealthy eating Whilst physical activity and alcohol continue to be important, the strategy will weight investment towards addressing unhealthy eating as a critical and underserved contributor to the extremely high levels overweight, obesity and diabetes in Tonga. Ongoing strengthening of implementation of the FCTC will also be a key focus area. d) Universal Coverage of essential services Effective control of NCDs is critical to reducing NCDs morbidity and mortality. The NCDs Strategy 2015-2020 reflects the work being done by the MOH to strengthen NCDs control through universal coverage of essential services. National Strategy for Prevention and Control of NCDs 2015-2020 0 10 3. Implementing the Strategy TongaHealth will support partners overcome identified challenges such as a lack of co-ordination and confusion over roles and responsibilities. TongaHealth will also provide funding to strengthen the project management processes required for effective and efficient delivery of the NCDs Strategy 2015-2020. This will include: a. Working with partners to develop annual work-plans and budgets. b. Simplifying and strengthening monitoring and evaluation processes. c. Introducing a participatory annual review process to drive performance-based funding. d. Providing ongoing training and support as required in key areas such as monitoring and evaluation, financial management, and child protection. e. Making key project management information publically available for increased transparency and accountability. f. Providing funding to bridge identified evidence gaps. g. Strengthening consideration of gender, equity and social inclusion through the work planning process. h. Facilitating consistent communication between stakeholders. i. Ensuring principles of sustainability are imbedded into the planning process. j. Adopting an ‘action-research’ approach so that programs remain flexible and responsive to monitoring and evaluation data and that evidence about effectiveness for NCDs prevention and control will build over the life of the NCDs Strategy 2015-2020. For further information, please visit: http://www.tongahealth.org/#!ncd-publications/c1uef National Strategy for Prevention and Control of NCDs 2015-2020 0 11 4. National Strategy for prevention and control of NCDs (Hala Fononga ki ha Tonga Mo’ui Lelei) 2015-2020 Vision Goal Indicator/s Data source Positive trends in Tonga's 1. NCDs policy environment index developed 2. Trends in TongaHealth performance against a relevant Tonga's performance against its policy environment index NCDs environment policy index that measures key influences like funding Stronger integrated and resources, health-in-all-policy, approaches to address leadership and governance non-communicable diseases result in 1. Positive trends in implementing partners satisfaction Annual survey, NNCDC reduced premature with NCDs partnership governance Annual Report death, illness and Positive trends in the effectiveness 2. Positive trends in the on-time and on-budget delivery of disability of NCDs related multi-sectoral NCDs Workplan partnership in delivering against 3. Positive trends in performance against impact and NCDs strategy goals outcome indicators 4. Number of National NCDs governance and Advisory Committee meetings Long term outcome (5+ years) % of STEPS survey respondents with 1-2 (medium risk) STEPS 2014 or 3-5 (high risk) risk factors Prevalence of raised blood glucose/ diabetes among STEPS 2014 A reduction in the unconditional persons aged 18+ years The incidence and probability of dying between age 30 Prevalence of raised blood pressure amongst persons 18+ STEPS 2014 prevalence of NCDs is and 70 from cardiovascular reduced diseases, cancer, diabetes or Prevalence of raised cholesterol among persons aged 18+ STEPS 2014 chronic respiratory diseases Cancer incidence, by type of cancer, per 100 000 Ministry of Health population Cancer registry Incidence of Chronic obstructive pulmonary disease Ministry of Health (COPD) per 100 000 population National Strategy for Prevention and Control of NCDs 2015-2020 0 12 2020 Outcome 1: Tongan infants (age 2 and under) have a healthier start to life Indicator/s Source 1. Trends in infant consumption of healthy and unhealthy Reproductive nursing foods (to be defined) data 2. Rates of exclusive breastfeeding until 6 months 3. Rates of breastfeeding along with complementary feeding up to age 2 Trends in the prevalence of gestational mothers with GDM GDM Taskforce or Type 2 diabetes screening (October 2015-March 2016 baseline, 2020 evaluation). Strategy 1.1 Halt the number of babies exposed to the risks associated with being born to a mother with diabetes (GDM or Type 2) Goal Activity Indicator/s Source Halt the % of gestational % of pregnant women with GDM or Type 2 diabetes GDM Taskforce data mothers with GDM or disaggregated by age (October 2015-March Type 2 diabetes 2016 baseline, October 2019-March 2020 evaluation). Reduce diabetes related Trends in diabetes related maternal and infant mortality Obstetric and Special maternal and infant and morbidity (e.g. macrosomic, hypoglaecemia, Care nursery data mortality and morbidity congenital malformation) Proportion of GDM mothers who develop Type 2 diabetes Diabetes clinic data within 5 years of delivery Implement the 'First 1000' days 1. % change in women and community knowledge and 1. 'First 1000' days program to improve maternal and attitudes program pre/post survey community KAB in relation to healthy 2. Reduction of the rate and degree of excessive weight 2. Ante-natal clinic data pregnancy and the first 2 years of life gain during pregnancy 3-4.Reproductuve 3. Positive trends in level of overweight or obesity amongst nursing data mothers of children aged 2 or younger 4. % reduction in births that are hi-risk due to inadequate spacing (less than 2 years) or multiple births (5th birth or National Strategy for Prevention and Control of NCDs 2015-2020 0 13 more) or a maternal age of 35 or older Deliver effective clinical management 1. Guidelines in place, # of GDM clinics 1. Ministry of Health of pregnant women with, or at risk, of 2. % of gestational mothers with, or at risk of, diabetes Annual Report diabetes maintaining blood sugar levels within recommended 2. GDMT Taskforce parameters data Lifestyle interventions support Prevalence overweight/obesity women 18-44 1. STEPS Gap 2016 women to maintain a healthier weight 2. STEPS 2014 during their childbearing years Strategy 1.2 Improve infant and toddler nutrition Goal Activity Indicator/s Source 10% increase in the % increase in the number of babies exclusively breastfed Reproductive nursing number of babies until 6 months survey exclusively breastfed until 6 months Improve awareness and % change in maternal and community KAB in relation to 1. 'First 1000' days attitudes about breastfeeding along with complementary feeding until age program pre/post survey breastfeeding along with 2 2. Reproductive nursing complementary feeding data until age 2 Policy action strengthen and Increases in the # of breast feeding friendly policies Policy audit tool increases 'breast-feeding friendly' actively implemented (e.g. baby friendly hospital) environments Through the Food Act Standards, 1. Legislation/standards enacted Ministry of Agriculture, implement the International Code of 2. % of retailers/vendors compliant with the legislation Food, Forestry and Marketing of Breast milk Substitutes Fisheries Implement the 'First 1000' days 1. % change in women and community knowledge and 1. 'First 1000' days program to improve maternal and attitudes about a healthy 'First 1000' days program pre/post survey community KAB in relation to healthy 2. Trends in % of children breast fed (along with 2. Reproductive health pregnancy and the first 2 years of life complementary feeding) until age 2 data 3. Trends in appropriate, timely and adequate feeding 3. 'First 1000' days practices of breastfed and non-breastfed infants up to age pre/post survey 24 months (appropriate, timely and adequate as defined by WHO guidelines) Breast counsellors’ assists mothers 1. # of mothers provided with breast feeding support Reproductive nursing to maintain breastfeeding 2. % of mothers who are counselled and maintain breast data (adjusted) feeding until 6 months National Strategy for Prevention and Control of NCDs 2015-2020 0 14 2020 Outcome 2: Tongans are leading healthier lifestyles (with a focus on children and adolescents) Indicator/s Source Prevalence of overweight and obesity in adolescents Global School Health Survey 2016 Age-standardised prevalence of overweight and obesity in 1. STEPS Gap 2016 persons aged 18+ years 2. STEPS 2014 Age standardised prevalence of heavy episodic drinking 1. STEPS Gap 2016 among adolescents and adults 2. STEPS 2014 Age standardised prevalence of current tobacco use 1. STEPS Gap 2016 among persons aged 15+ 2. STEPS 2014 Trends in the consumption of unhealthy foods and 1. STEPS Gap healthier foods 2. Global School Health Survey 2016 Strategy 2.1: More Tongans are meeting the WHO Global Physical Activity Guidelines Goal Activity Indicator/s Source Age-standardised prevalence of insufficiently 1. STEPS Gap 2016 physically active persons aged 18+ 2. STEPS 2014 Prevalence of insufficiently active adolescents (less Global School Health Survey than 60 minutes of moderate to vigorous daily activity) 2016 Increase the accessibility 1.% of districts where regular physical activity is being 1.Ministry of Internal and affordability of delivered Affairs/Physical activity providers physical activity 2. Trends in the price of a 'basket of sport goods' (to 2. Statistics Department be defined) and the component that is tax Economic measures make sports Trends in the price of a 'basket of sports goods' and Statistics Department equipment more affordable the component that is tax Volunteer led community programs 1. # active volunteers, # communities regularly Ministry of Internal Affairs co- increase the availability of local, low running or participating in physical activities ordinate 'Community Hub' cost physical activity 2. Trends in participation over time program monitoring data, disaggregated by gender and age Fiefia workplace program National Strategy for Prevention and Control of NCDs 2015-2020 0 15 3. Perceived affordability and availability of monitoring data, Pacific Sports physical activity Partnership monitoring data Targeted initiatives assist hi-risk or 1. # and type of physical activity programs being priority groups (children, adolescents, delivered for priority groups through partnership women) to re-engage in physical activity arrangements 2. Trends in participants level of physical activity over time Improved provision of physical activity Increase in # schools delivering physical activity, 1. MET monitoring data in schools trends in the # of children participating in school 2. MIA Sports Division based physical activity by age group and gender Maximise the Nuku'alofa Strategic 1. Nuku'alofa Strategic Development Plan Health sector inputs into Development Plan as a mechanism to adopted as a planning framework NSPAO process promote increased green spaces, active 2. # of planning initiatives within the document to transport and other urban planning improve physical activity. mechanisms to promote physical 3. Positive environmental changes to support activity. increased physical activity Increase demand for physical activity Media campaigns build demand for, and % change in physical activity KAB 1. STEPS Gap acceptance of, all Tongans being 2. STEPS 2014 physically active 3. Global School Health Survey 2016 Curriculum builds young people's 1. Trends in the number of schools delivering the MET school and student physical activity confidence and movement and fitness curriculum and the surveys competence frequency with which it is delivered 2. changes in student knowledge and attitudes towards physical activity Expansion of the Fiefia program drives Positive trends in levels of physical activity Ministry of Health workplace increased levels of physical activity amongst Nuku'alofa based workers screening data 2015/2020 amongst Nuku'alofa based workers (NBW), as an hi-risk group National Strategy for Prevention and Control of NCDs 2015-2020 0 16 Strategy 2.2 Tongans are eating a healthier diet Indicator/s Source Age-standardised mean population intake of salt 1. STEPS Gap 2016 (sodium chloride) per day in grams in persons 2. STEPS 2014 aged 18+ Age-standardised prevalence of persons 1. STEPS Gap 2016 consuming less than five total servings of fruit 2. STEPS 2014 and vegetables per day 3. Global School Health Survey 2016 Trends in import levels of less healthy food 1.Ministry of Revenue goods and healthier food goods (goods to be and Customs defined) Goal Activity Indicator/s Source Increase the availability, Trends in the price differential between ‘healthy’ Statistics Department affordability and and ‘less healthy’ meals and diets (to be defined) consumption of healthy and the tax component of the prices food and reduce the availability, affordability and consumption of unhealthy food Strengthened management of Tongan 1. # of new special management area (SMA) 1. Fisheries Department fisheries increases the sustainability, fisheries 2. STEPS Gap 2016 and accessibility and affordability of fresh 2. Changes in perceived affordability, availability Global School Health Survey fish for the Tongan community and consumption of fish in SMA communities 2016 3. Changes in the price index of fresh fish 3. Statistics Department 4. Changes in the consumption of fresh fish Economic measures increase the cost 1. # of economic measures introduced Policy audit tool of less healthy foods and reduce the 2. Trends in the price differential between cost of locally produced healthier foods ‘healthy’ and ‘less healthy’ meals and diets (and the tax component of the prices) National Strategy for Prevention and Control of NCDs 2015-2020 0 17 Increased supply, diversity and 1. Number of village resilient agriculture plans Tonga Agricultural Sector Plan nutritional value of agricultural products (VRAPs) prepared and implemented Co-ordination Unit 2. Number of farmers trained in resilient farming practices - NRM and diversity, crop and livestock production 3. Number of farmers trained in crop production and value added processing Licensing measures encourage retailers 1. # of measures introduced Ministry of Commerce and to sell a healthier mix of food products 2. # of retailers compliant with measures Labour, Consumer Affairs Unit Partnership with local food producers 1. # of consultations/meetings with private sector Ministry of Health/Ministry of encourages the adoption of voluntary partners, # of voluntary measures adopted Agriculture, Food, Forestry measures to modify basic food goods to and Fisheries monitoring data make them healthier Through the Food Act Standards, 1. Number of Food Act standards introduced in 1. Ministry of Agriculture, consider fortification of a common food relation to the fortification of food Food, Forestry and Fisheries group to reduce anaemia 2. Trends in levels of anaemia amongst pregnant 2. Ante-natal data women Increase demand for healthier food/diets and reduce demand for unhealthy foods School and child care centres are # schools with gardens, # schools using produce MET school survey health and nutrition promoting in school canteens, # schools linking gardens to environments curriculum Improve children and adolescents 1. % change in children and adolescents health Pacific Science Health Literacy health related knowledge, attitude and related KAB Project Data behaviours through curriculum 2. % of classes that are exposed to PSHLP interventions learning modules in each school, at each target year level Strengthened nutrition information 1. Nutrition information labelling introduced 1. Policy Audit Tool labelling helps consumers to choose 2. # Product numbers rejected/recalled due to 2. Enforcement data healthier foods non-compliance with the standards 3. Pre/post survey 3. Changes in consumer perceived ability to choose healthy foods Nutritional counselling and education is # of counselling sessions conducted Monitoring data provided to priority groups National Strategy for Prevention and Control of NCDs 2015-2020 0 18 Economic measures increase the cost Trends in the price differential between ‘healthy’ Statistics Department of less healthy foods and reduce cost of and ‘less healthy’ meals and diets (and the tax locally produced healthy foods component of the prices) Mass media and community Changes in healthy eating related knowledge, 1. Campaign pre/post surveys mobilisation increase knowledge and attitudes and behaviours 2. STEPS Gap attitudes towards healthy eating 3. Global School Health Survey 2016 Strategy 2.3 Reduce alcohol related harm Indicator/s Source Alcohol related morbidity and mortality among Ministry of Health HIS adolescents and adults Trends in alcohol related crime and Ministry of Police misdemeanours Age standardised prevalence of heavy episodic 1. STEPS Gap drinking among adolescents and adults 2. Global School Health Survey 2016 3. Census 2016 Volume of alcohol imported per annum and 1. Ministry of Revenue and volume of alcohol manufactured per annum Customs 2. Statistics Department Goal Activity Indicator/s Source Reduce the supply of alcohol Community mobilisation supports # of community notifications to police of violations Ministry of Police alcohol free environments and limits the of alcohol management laws or alcohol related sale of liquor to minors harm Develop and implement a liquor 1. Policy developed Liquor Licensing Authority licensing policy to limit the number of 2. % reduction in # of outlets selling alcohol outlets selling alcohol and their opening 3. % outlets with reduced opening hours hours Support and strengthen the responsible 1.Number of alcohol service staff provided with Ministry of Police service of alcohol training/guidance 2. Guidelines in place Reduce demand for alcohol National Strategy for Prevention and Control of NCDs 2015-2020 0 19 Establish a reliable Economic measures increase the price Changes in retail cost of alcohol and proportion 1. Ministry of Revenue and evidence base on of alcohol, in particular alcohol products of retail cost that is tax (excluding inflation related Customs alcohol consumption most associated with alcohol related changes) patterns harm Limit alcohol advertising and # Legislative measures introduced to limit or ban Alcohol advisory audit tool sponsorship advertising or sponsorship Raise public awareness about alcohol Changes in knowledge, attitudes and behaviours Pre/post survey related harm Ban or restrict discounting # Legislative measures introduced to limit or ban Alcohol advisory audit tool discounting Strengthen cessation services 1. Number of health staff trained to deliver 1. Ministry of Health alcohol brief interventions 2. Counselling service 2. Number of clients attending counselling providers monitoring data services 3. Number of clients attending cessation services who report drinking at a safe level for 12 months or more Relevant legislation is Strengthen community collaboration 1. Trends in alcohol related crime and Ministry of Police effectively enforced with police to improve reporting of misdemeanours violations 2. Number of citations paid Strategy 2.4 Reduce tobacco related harm Indicator/s Source Age standardised prevalence of current tobacco 1. STEPS Gap 2016 use among persons aged 15+ 2. STEPS 2014 3.Census 2016 % of daily adult tobacco use 1. STEPS Gap 2016 2. STEPS 2016 3. Census 2016 % of daily adolescent tobacco use 1. STEPS Gap 2016 2. STEPS 2014 3.Census 2016 Goal Activity Indicator/s Source Reduce demand for tobacco products and exposure to second hand smoke National Strategy for Prevention and Control of NCDs 2015-2020 0 20 Economic measures continue to 1. % of the final retail price of a 20 pack of the 1. Global Tobacco Control increase the price of tobacco most popular cigarettes that is excise tax Report 2. Number of smokers where affordability is a 2. Quit line data factor in making a quit attempt Mass media campaigns increase 1. Proportion of people surveyed who report Campaign pre-post intention to quit, reduce uptake and having seen or heard the campaign longitudinal survey educate on the dangers of second hand 2. Positive trends in smokers knowledge, attitude smoke and behavioural intentions as a result of mass media campaigns Cessation services support smokers to 1. Number of people contacting quit services who 1. Quit line data 2. Tobacco quit attempt quitting Control Unit 2. Number of people who quit for at least 6 months 3. Number of health professionals trained in tobacco control/brief interventions Expanded smoke free settings 1. Proportion of public places required by law to 1. Attorney General’s Office display smoke free signage 2. Tobacco Control Unit 2. Number of smoke-free cities, towns, islands 3. Global Tobacco Control and other local jurisdictions in the country Report 3. Number of mega events (e.g. sports tournaments) declared smoke free Strengthened regulation of tobacco All forms of tobacco advertising, promotion and 1. Attorney General’s Office advertising sponsorship are banned 2. Global Tobacco Control Report Ongoing strengthening of tobacco Proportion of planned amendments to the Attorney General’s Office product regulation Tobacco Control Act/Regulations that are passed into law Reduce the supply of tobacco products Accede to the protocol to Eliminate Illicit Tonga government accession to the Protocol to Attorney General’s Office Trade of Tobacco Eliminate Illicit Trade of Tobacco Products Minimise substitution with Tapaka 1. Number of acres planted with Tapaka Tonga 1. Agricultural census Tonga 2. Proportion of tobacco users surveyed who 2. Campaign pre/post survey report substituting with Tapaka Tonga in lieu of 3. TongaHealth audit quitting 4. Ministry of Revenue & 3. Price of Tapaka Tonga by 100g Customs 4. Enforcement of collection of tax on Tapaka 5. Census 2016 Tonga National Strategy for Prevention and Control of NCDs 2015-2020 0 21 5. Prevalence of Tapaka Tonga smoking daily Develop government code to minimise 1. # of Legislative, executive, administrative or 1. Attorney General’s Office tobacco industry interference in other measures consistent with the FCTC Article 2. Policy Audit Tool legislative and policy processes 5.3 and its guidelines 2. Number of government and NGO entities implementing policies to prevent tobacco industry interference Strengthen Tobacco Control 1. Proportions of tobacco control citations paid 1. Police Enforcement 2. Number of trained officers routinely carrying 2. Enforcement monitoring out enforcement activities data Strategy 2.5 Build evidence about the health impact of kava use in Tonga Goal Activity Indicator/s Source There is improved Assess the viability of including 1. # of relevant surveillance survey reports that 1. Surveillance survey reports evidence about the questions on kava use in future document evidence about the prevalence of 2. Census 2016 prevalence of Kava use surveillance surveys, and Population Kava use in Tonga in Tonga Census 2016 2. Prevalence of kava drinking in Tonga National Strategy for Prevention and Control of NCDs 2015-2020 0 22 2020 Outcome 3: Improved early detection, treatment and sustained management of people with or at high risk of NCDs Strategy 3.1: Improve early detection, treatment and sustained management of people with or at high risk of NCDs Goal Activity Indicator/s Source People with, or at high Trends in the # of NCDs patients maintaining Ministry of Health Annual risk of, NCDs are their blood sugar, blood lipids and/or blood Report / NCDs Register staying healthier for pressure within recommended levels longer Performance against Ministry of Health targets Ministry of Health annual and indicators for early identification and Report management of diabetes, cancer, COPD and CVD (to be defined in the 'Essential package') Develop a policy outlining the Ministry 1. Essential package policy completed Ministry of Health Annual of Health's 'essential package' of Report realistic, prioritised, promotive, preventative, curative, rehabilitative and palliative basic health services Ensure sufficient skilled workforce, 1.% of the population with access to basic 1. Facilities survey infrastructure and health financing services mechanisms are in place to deliver the 2. % of Health facilities maintaining staffing, basic health service infrastructure and drugs as per the minimum requirements of the 'essential package' policy National Strategy for Prevention and Control of NCDs 2015-2020 0 23 2020 Outcome 4: Strengthened monitoring and surveillance supports evidence based action Goal Activity Indicator/s Source Strengthen the collection, collation and timely reporting of NCDs data for improved policy and program decision making Prioritise budget allocations for % of overall health budget allocated to Ministry of Health Annual surveillance and monitoring systems for surveillance and monitoring Report the prevention and control of NCDs Improve the collection, collation and # of priority indicators (as established through the Ministry of Health Annual regular reporting of NCDs related essential package process) regularly reported Report clinical data Maintain regular reporting from existing # registries established, # of annual registry Ministry of Health Annual disease registries (e.g. Cancer, reports Report Diabetes, NCDs) Develop a 10 year plan to specify the 1. # of survey reports reported on time as per the 1. Surveillance reports timing of the major NCDs related plan 2. Survey contracts surveillance survey and to build the in- 2. Aspects of the survey process (instrument 3. Survey budgets country capacity for managing the design, enumeration, reporting) managed in- survey and reporting process country per survey 3. Trends in the cost of delivering major surveys Ensure regular reporting against the # of NCDs strategy quarterly and annual reports TongaHealth Report NCDs Strategy M&E framework delivered on time, % of framework indicators reported against Evaluate and measure # of NCD program/project intervention evaluated Program/project evaluation effectiveness/impact of NCD and reported reports intervention National Strategy for Prevention and Control of NCDs 2015-2020 0 24

Annex 1: Members of the National NCDs Committee (Ref. Cabinet Decision No.637 dated 29 August 2014) Name Delegation 1. Dr. Siale ‘Akau’ola CEO for Ministry of Health (Chairman) 2. Dr. Raelyn ‘Esau A/CEO for Ministry of Education and Training 3. Mrs. Ana B. Fonua CEO for Ministry of Internal Affairs 4. Mrs. Losaline Ma’asi CEO for Ministry of Agriculture & Food, Forests and Fisheries 5. Mr. Tatafu Moeaki CEO for Ministry of Finance and National Planning 6. Mr. Stephen Caldwell Police Commissioner 7. Rev. Fili Lilo Representative of the National Forum of Church Leaders 8. Mrs. Maliana Tohi Representative of the Commercial Business Sector 9. Mr. Drew Havea Representative of Civil Society 10. Rev. Dr Ma’afu’otu’itonga Palu Chairman of Tonga Health Promotion Foundation 11. Mrs. Seini Filiai CEO for Tonga Health Promotion Foundation (as Executive Officer) National Strategy for Prevention and Control of NCDs 2015-2020 0 25

Annex 2: Terms of Reference of the National NCDs Committee (Ref. Cabinet Decision No.637 dated 29 August 2014) 1. To advise government on issues pertaining to the prevention of Non-Communicable Diseases in the Kingdom of Tonga. 2. To inform and make recommendations on policy pertaining to the Kingdom’s Non- Communicable Diseases health promotion and prevention strategies, including legislation and regulations as may be required. 3. To oversee the implementation of activities related to the prevention and control of Non- Communicable Diseases in accordance with a National Strategy and Annual Plans. 4. To monitor and review progress against Annual Plans on a quarterly basis and update plans and programs as required. 5. To delegate the responsibility for coordinating policy development processes including decision-making to TongaHealth, who will administer and support the NNCDC, relevant Advisory Committees and time limited task groups. 6. To review annually the processes and outcomes of the delegation of authority to TongaHealth against desired outcomes detailed in longer term Strategic Plans and Annual Plans. National Strategy for Prevention and Control of NCDs 2015-2020 0 26 Annex 3a: Members of the TongaHealth Board Name Representation 1. Rev. Dr. Ma’afu’otu’itonga Palu The interests of churches or community groups (Chairman) 2. Hon. Fe’aomoeata Vakatā Member of the Legislative Assembly and Minister for Internal Affairs 3. Dr. ‘Amelia Tu’ipulotu Expertise in health and illness prevention 4. Dr. Reynold ‘Ofanoa Expertise in health and illness prevention 5. Mrs. Leta Kami Expertise in business, management or law

Annex 3b: Members of TongaHealth Staff Name Designation 1. Seini Filiai Chief Executive Officer 2. Monica Tu’ipulotu Project Coordinator 3. Sione Fifita Monitoring &Evaluation Manager 4. Losaline Fonua Finance Manager 5. Matthew Oxenham Administration & Finance Adviser (AVID) 6. Viliami Tongamana Senior Health Promotion Project Officer 7. Temaleti Moala Monitoring &Evaluation Officer 8. Shubhra Shandilya Corporate Communications Officer 9. Sevaki Fe’ao Project Officer 10. Graham Tukuafu Administration Assistant Finance 11. Seini Telefoni Administration Assistant National Strategy for Prevention and Control of NCDs 2015-2020 0 27

Annex 4: MoU between the National NCDs Committee and TongaHealth Memorandum of Understanding National Strategy for Prevention and Control of NCDs 2015-2020 0 28 1. Parties to this Agreement This is an agreement between “Party A”, hereinafter called the National Non-Communicable Diseases Committee (NNCDC) and “Party B” hereinafter called the Tonga Health Promotion Foundation or TongaHealth. The National Non-Communicable Diseases Committee (Party A), was established by Cabinet decision No.1449 dated 8/11/2004. Tonga Health Promotion Foundation (TongaHealth) (Party B) is a body corporate established by the Tonga Health Promotion Foundation Act 2007. 2. Purpose of this Agreement 2.1 The purpose of this agreement is to set out the programs and administrative roles and responsibilities including delegations of authority by which the National Non-Communicable Diseases Committee (NNCDC) and Tonga Health Promotion Foundation (TongaHealth) agree to on the governance of Non-Communicable Diseases (NCDs) prevention and control in Tonga. 2.2 This agreement is a compliance with Cabinet Decision No. 637 dated 29 August 2014, which directs that the National NCDs Committee enters a Memorandum of Understanding with Tonga Health Promotion Foundation detailing agreed program and administrative roles and responsibilities including a table of delegations of authority that is reviewed annually. 2.3 This agreement acknowledges that the Ministry of Health is responsible for the delivery of preventative and curative health services in Tonga. It also supports the Ministry of Health mission to support and improve the health of the nation by providing quality, evidence base best practice, effective and sustainable health services, and being accountable for health outcomes. It also supports the Ministry of Health vision to be the healthiest nation by 2025 compared with Pacific neighbours, as judged by international determinants. 2.4 This agreement also acknowledges the Ministry of Health commitment to improve the provision of health services across Tonga, with continued emphasis on preventative health care that focuses on NCDs, rather than on curative medicine alone. Also the commitment by the Ministry of Health preventive healthcare programmes to be improved to encourage healthy life styles, with greater emphasis on reducing the main NCDs risk factors such as tobacco smoking, alcohol abuse, physical inactivity and unhealthy eating, in order to reduce the incidence of NCDs. 2.5. This agreement acknowledges that the responsibility for the successful delivery of the National NCDs strategy 2015-2025 belongs to the whole of government as reflected in cabinet’s appointment of the CEOs of key Ministries to the NNCDC. 2.6 This agreement also recognises the authority of the Tonga Health Promotion Foundation Act 2007, and TongaHealth’s mission to prevent and reduce harm from NCDs in Tonga, and vision of a healthy Tonga where everyone is responsible for promoting health and everyone shares in the benefits of a healthy population. National Strategy for Prevention and Control of NCDs 2015-2020 0 29 3. Effective Date This Agreement takes effect on the date that it is executed by both parties. 4. Terms of Reference for the NNCDC 2014 i. To advise government on issues pertaining to the prevention of NCDs in the Kingdom of Tonga. ii. To inform and make recommendations on policy pertaining to the Kingdom’s NCDs health promotion and prevention strategies, including legislation and regulations as may be required. iii. To oversee the implementation of activities related to the prevention and control of NCDs in accordance with a National Strategy and Annual Plans. iv. To monitor and review progress against annual plans on a quarterly basis and update plans and programs as required. v. To delegate the responsibility for coordinating policy development and implementation processes, including decision-making, to Tonga Health who will administer and support the NNCDC, relevant Advisory Committees and time limited task groups. vi. To review annually the processes and outcomes of the delegations of authority to TongaHealth against the desired outcomes detailed in longer term Strategic Plan and Annual Plans. 5. NNCDC Membership Membership of the National Non-Communicable Diseases Committee are: CEO for Ministry of Health (Chair) CEO for Ministry of Education and Training CEO for Ministry of Internal Affairs CEO for Ministry of Agriculture & Food, Forests and Fisheries CEO for Ministry of Finance and National Planning Police Commissioner Representative of the National Forum of Church Leaders Representative of the Commercial Business Sector Representative of Civil Society CEO for Tonga Health Promotion Foundation (as Executive Officer) Chairman of Tonga Health Promotion Foundation Board Secretary (Minute Taker) 6. The National NCDs Committee may co-opt members as required (such as the Ministry of Infrastructure and Tonga Family Health Association). 7. The National NCDs Committee reports annually on progress against the national Strategy for preventing Non- Communicable Diseases. 8. Chair of Committee The CEO for Ministry of Health will chair the NNCDC and a Deputy Chair will be appointed annually and on rotation between CEOs of other government ministries. The NNCDC will select and appoint members from the National Forum of Church Leaders, Commercial Business Sector and Civil Society with the endorsement of the NNCDC Chair National Strategy for Prevention and Control of NCDs 2015-2020 0 30 9. TongaHealth Responsibilities under this MOU TongaHealth shall undertake the following activities related to the management and implementation of the National Strategy for preventing NCDs: 9.1 Policy development i. TongaHealth in conjunction with stakeholders and technical experts will coordinate the formulation of evidence-informed NCDs prevention and health promotion policy frameworks to guide strategic planning and implementation of the National NCDs strategy, Halafononga 2015-2020. ii. TongaHealth in conjunction with stakeholders and technical experts will coordinate briefing papers for the NNCDC as requested. 9.2 Decision making powers i. TongaHealth, and where appropriate in consultation with multi-sectoral Advisory Committees, will make decisions on the activities to be funded to support health promotion and NCDs prevention in Tonga as per Halafononga 2015-2020, Strategic Plan, Annual Plan and Budget, taking into account the knowledge of existing programs and ensuring complementarity. ii. TongaHealth will fund activities in accordance with detailed annual work plans and budgets that are developed in collaboration with key stakeholders and which are designed to deliver on the National NCDs Strategy 2015-2020. The advisory committees, TongaHealth board and NNCDC will approve these annual work plans and budgets in accordance with the delegation chart. iii. TongaHealth will seek endorsement by NNCDC on single large program grants that are greater than or equal to TOP 100,000. 9.3 Sector engagement i. TongaHealth is responsible for establishing formal mechanisms for engaging stakeholders and accessing subject area technical expertise in planning and decision-making processes (such as Advisory Committees and task groups). ii. TongaHealth will consult with the Chair of the NNCDC on the number and membership of Advisory Committees supporting the implementation of the National NCDs Strategy. 9.4 Fund raising i. Where appropriate, TongaHealth will enter into discussions with donors with respect to major projects that the National NCDs Committee endorses. ii. TongaHealth will strengthen the harmonisation of donor funds by ensuring NCDs health promotion funding is coordinated against delivery of the National NCDs Strategy 2015-2020 9.5 Monitoring and Evaluation i. TongaHealth will ensure that all contracts have a sound monitoring and evaluation framework and grantees regularly report on progress against this framework ii. TongaHealth will prepare the National Strategy Annual Report for endorsement by the NNCDC prior to publication each year iii. TongaHealth will ensure that lessons learnt from program evaluation are shared with stakeholders and taken into account with program development. National Strategy for Prevention and Control of NCDs 2015-2020 0 31 9.6 Management, Contracting, Fund Disbursement and Financial Accountability Accountabilities and Responsibilities will be in accordance with Tonga Health Governance and Administration policies, and donor requirements. 9.7 Meetings NNCDC meeting will be held every 6 months and as required and agreed by both parties. Regular meetings are advised between the chair of NNCDC and CEO of TongaHealth. 9.8 Management of Conflict Should any conflict arise between the two parties in the deployment of this MOU the Minister of Health and Crown Law Solicitor General are to be invited to act as arbitrators if the two parties are unable to resolve the conflict in the first instance. 10. Variation This Agreement, including the Annex constitutes the entirety of the agreement between the National Non-Communicable Diseases Committee and Tonga Health Promotion Foundation. Both parties in accordance with their delegation levels and legal authority may vary this Agreement at any time in writing. 11. Termination This memorandum may be terminated by either party giving the other party four months’ notice in writing. 12. Contact Details Dr Siale Akau’ola Chairman, NNCDC and Chief Executive Officer Ministry of Health Taufa’ahau Road, Tofoa, Tonga Tel 28-233 Mrs Seini Mafi Filiai Chief Executive Officer TongaHealth Private Mail Bag 26, Post Office Nuku’alofa, Tonga Tel 25-721 National Strategy for Prevention and Control of NCDs 2015-2020 0 32 13. Execution Executed as a Deed by: Signature: Signature: -.0aui ~~ Dr Siale 'Akau'ola 'itonga Palu NNCDC Chairman & CEO Ministry of Chairman, TongaHealth Governance Health Board Date: Date: ~~ / 01 ( lot f Witness Signature: rSJv~V:V Witness Signature: S'J-11~tf-LAA~, Witness Name: ()f\1J\\J i~ r~~u~,o Witness Name: S6If\/ I m. {IL,/ National Strategy for Prevention and Control of NCDs 2015-2020 0 33 Annex to the MOU NNCDC Delegations of Authority Policy 1. Policy The National NCDs Committee (NNCDC) sets the following policy guidelines for delegation of authority to TongaHealth to coordinate policy development and implementation of the National Strategy for Preventing and Controlling NCDs: i The rationale for delegating responsibility to TongaHealth is to streamline approval processes, maximise efficiency and minimise the NNCDC involvement in detailed processing required for the implementation of the National Strategy for Preventing and Controlling NCDs in Tonga. ii All delegations must be approved by the NNCDC within the framework set by the Cabinet Terms of Reference. iii A review of delegations will be held annually in accordance with reporting on outcomes. Any revoking of delegations requires a three-month advance notification by the NNCDC to TongaHealth Board and an agreed change process. iv The TongaHealth Board may recommend, for ratification by the NNCDC, changes to delegation levels. v The TongaHealth Board in accordance with the Tonga Health Promotion Act 2007, other applicable legislation, and TongaHealth’s Governance Manual will also apply its own Delegations of Authority policy, which will be consistent with this policy. vi The process for updating the register of delegations involves a review of the Chart every year and a continuous process of adjustment according to revisions of policy and changes in responsibility. The TongaHealth CEO is responsible for ensuring revisions are documented and the updated Chart circulated to the NNCDC, TongaHealth Board, Advisory Committees and staff. National Strategy for Prevention and Control of NCDs 2015-2020 0 34 2. Delegations chart – operations RESPONSIBILITIES ADVISORY TONGAHEALTH NNCDC COMMITTEE BOARD GOVERNANCE Strategic Planning - 5 Year Recommend Review and Approve National NCDs Strategy 2015- Recommend 2020 Annual report Recommend Approve (prepared by TH Board) Annual Accounts Approve Note (TH Board reports to Minister of Health) TongaHealth Delegation of Approve Authority Policy (Board and CEO) Annual Planning Recommend Approve and Approve (with CEO TH) Recommend FINANCE Annual Budget Recommend Approve and Approve Global Allocation to Priority (with CEO TH) Recommend Areas Grants approval more than or Recommend Approve and Approve equal to TOP100,000 Recommend Grants approval less than Recommend Approve in TOP100,000 with CEO; accordance with Taskforce THB Governance Committee manual & Advisory Committee policies The following functions are the responsibility of TongaHealth and should be in accordance with the most current version of the TongaHealth Delegations of Authority Policy and Administration Policies: i. Organisational development ii. Human resources iii. Financial management iv. Community Relations v. Information Technology vi. Purchasing National Strategy for Prevention and Control of NCDs 2015-2020 0 35

Annex 5: Terms of Reference and Members of the four Advisory Committees 1. Physical Activity Advisory Committee Members (15) Name of Member Name of Ministry/Organisation Designation 1. ‘Ana Bing Fonua Ministry of Internal Affairs CEO (Chairperson) 2. Dr. Toakase Ministry of Health Project Coordinator Fakakovikaetau THSSP 3. ‘Eva Mafi Ministry of Health HPU 4. Seilini Soakai Ministry of Health NCDs Nurse 5. ‘Onetoto ‘Anisi Ministry of Internal Affairs Deputy Director, Sports Division 6. Netina Latu Ministry of Internal Affairs Principal Sports Officer 7. Taniela Kula Ministry of Lands, Environment, Deputy Secretary, Natural Climate Change & Natural Resources Resources 8. Soane Selui Ministry of Education & Training D/CEO, Secondary Schools 9. ‘Ana Tukia Ministry of Infrastructure Senior Assistant Secretary, Policy & Planning Division 10. Suliasi ‘Aholelei Ministry of Revenue& Customs Senior Revenue Officer 11. ‘Emeline Tuita TASANOC Member of TASANOC Executive Committee 12. Rev. Fili Lilo Health Promotion Church Secretary Church Leaders Partnership Desk 13. Tiola Fotukava Business sector Representative OE Sports 14. Tavake Fangupo Teufaiva Fitness Centre Manager, Teufaiva Fitness Centre 15. Monica Tu’ipulotu TongaHealth Project Coordinator (Secretary) 1.1. Terms of Reference The Physical Activity Advisory Committee exists to support the design and implementation of the National NCDs Strategy and will: • Advise the TongaHealth Board and, through the TongaHealth Board, the National NCDs Committee on evidence and statistics on policy and planning issues relating to physical activity. • Support the assessments by TongaHealth CEO and staff (subject to delegation levels) on the efficacy of physical activity programs/projects seeking partnership grants and making recommendations to the TongaHealth Board for approval. • Lead communication and advocacy within their organisation and sector about the importance and implications of the Physical Activity Strategy and its implementation and evaluation. • Support the co-ordination of technical feedback and input from their organisation and sector on physical activities as appropriate. • Liaise within their organisation and sector as appropriate to strengthen the effective implementation of the physical activity Strategy and its associated work plan. • Support advocacy strategies in relation to promoting the physical activity goals of the National NCDs Strategy. National Strategy for Prevention and Control of NCDs 2015-2020 0 36 2. Healthy Eating Advisory Committee Members (15) Name of Member Name of Ministry/ Organisation Designation 1. Losaline Ma’asi Ministry of Agriculture & Food, Forestry CEO (Chairperson) & Fisheries 2. Vilimo Fakalolo Fisheries Department CEO 3. Dr Veisinia Matoto Ministry of Health CMO, Diabetes Clinic 4. ‘Elisiva Na’ati Ministry of Health Senior Nutritionist 5. Dr ‘Ofa Tukia Ministry of Health HPU 6. Dr Ma’ake Tupou Ministry of Health Reproductive Health 7. Dr Fusi Fifita Ministry of Health Dental Pathologist 8. Natalia Latu Ministry of Finance & NP Deputy Secretary 9. Lepaola Vaea Ministry of Revenue & Customs Deputy CEO 10. Soane Selui Ministry of Education& Training D/CEO, Secondary Schools 11. ‘Ata’ata Finau Statistics Department Government Statistician 12. Sandra Fifita Ministry of Labour and Commerce Director, Consumer Affairs Division 13. Minoru Nishi Nishi Trading Mai e 5 Representative 14. Mele Afu Commercial business sector Importer of fruits and Representative vegetables 15. ‘Ana Ika LDS Welfare Manager, LDS Welfare Services 16. Monica Tu’ipulotu TongaHealth Project Coordinator (Secretary) 2.1. Terms of Reference The Healthy Eating Advisory Committee exists to support the design and implementation of the National NCDs Strategy and will: • Advise the TongaHealth Board and, through the TongaHealth Board, the National NCDs Committee on evidence and statistics on policy and planning issues relating to healthy eating. • Support the assessments by TongaHealth CEO and staff (subject to delegation levels) on the efficacy of healthy eating programs/projects seeking partnership grants and making recommendations to the TongaHealth Board for approval. • Lead communication and advocacy within their organisation and sector about the importance and implications of the Healthy Eating Strategy and its implementation and evaluation. • Support the co-ordination of technical feedback and input from their organisation and sector on healthy eating as appropriate. • Liaise within their organisation and sector as appropriate to strengthen the effective implementation of the healthy eating Strategy and its associated work plan. • Support advocacy strategies in relation to promoting the healthy eating goals of the National NCDs Strategy. National Strategy for Prevention and Control of NCDs 2015-2020 0 37 3. Tobacco Control Advisory Committee Members (15) Name of Member Name of Ministry/ Organisation Designation 1. Sione Taumoefolau Tonga Red Cross Society Secretary General (Chairman) 2. Dr. ‘Ofa Tukia Ministry of Health HPU 3. ‘Eva Mafi Ministry of Health HPU 4. Tupou Tu’ilautala Ministry of Health HPU 5. Le’omolotu Havea Ministry of Health HPU 6. Natalia Latu Ministry of Finance & NP Deputy Secretary 7. Salote Tonga Ministry of Police Deputy Commissioner 8. Michael Cokanasiga Ministry of Revenue & Customs Technical & Legal Officer 9. Mele Lavemaau Ports Authority HR Manager 10. Sione Sisifa Crown Law Department Solicitor General 11. ‘Ata’ata Finau Statistics Department Government Statistician 12. Rev. Laki Pifeleti HPCP Deputy Secretary 13. Sila Siufanga Salvation Army Regional Commander 14. Vanesa Lolohea Tonga National Youth Congress Director 15. Viliami Tongamana TongaHealth Senior Project Officer (Secretary) 3.1. Terms of Reference The Tobacco Control Advisory Committee exists to support the design and implementation of the National NCDs Strategy and will: • Advise the TongaHealth Board and, through the TongaHealth Board, the National NCDs Committee on evidence and statistics on policy and planning issues relating to tobacco control. • Support the assessments by TongaHealth CEO and staff (subject to delegation levels) on the efficacy of tobacco control programs/projects seeking partnership grants and making recommendations to the TongaHealth Board for approval. • Lead communication and advocacy within their organisation and sector about the importance and implications of the Tobacco Control Strategy and its implementation and evaluation, as well as legislative changes as appropriate. • Support the co-ordination of technical feedback and input from their organisation and sector on tobacco control as appropriate. • Liaise within their organisation and sector as appropriate to strengthen the effective implementation of the Tobacco Control Strategy and its associated work plan. • Support advocacy strategies in relation to promoting the Tobacco Control goals of the National NCDs Strategy, and social marketing campaign focusing on smoking cessation and prevention. National Strategy for Prevention and Control of NCDs 2015-2020 0 38 4. Alcohol Harm Reduction Advisory Committee Members (15) Name of Member Name of Ministry/ Organisation Designation 1. Drew Havea Civil Society Chairman 2. Dr. Veisinia Matoto Ministry of Health CMO Diabetes Clinic 3. Dr. ‘Ofa Tukia Ministry of Health, HPU 4. Soane Selui Ministry of Education& Training D/CEO, Secondary Schools 5. Michael Cokanasiga Ministry of Revenue & Customs Technical & Legal Officer 6. Sione Sisifa Crown Law Department Solicitor General 7. Salote Tonga Ministry of Police Deputy Commissioner 8. Natalia Latu Ministry of Finance & NP Deputy Secretary 9. ‘Ofa Likiliki Women’s Crisis Centre CEO 10. Vanesa Lolohea Tonga National Youth Congress Director 11. Sila Siufanga Salvation Army Regional Commander 12. ‘Amelia Hoponoa Tonga Family Health Association CEO 13. Maliana Tohi Business sector Representative Manager, Molisi Tonga 14. Faiva Tu’ifua Community Representative District Officer, Kolofo’ou 15. Viliami Tongamana TongaHealth Senior Project Officer (Secretary) 4.1. Terms of Reference The Alcohol Harm Reduction Advisory Committee exists to support the design and implementation of the National NCDs Strategy and will: • Advise the TongaHealth Board and, through the TongaHealth Board, the National NCDs Committee on evidence and statistics on policy and planning issues relating to alcohol harm reduction and related issues. • Support the assessments by TongaHealth CEO and staff (subject to delegation levels) on the efficacy of alcohol harm reduction programs/projects seeking partnership grants and making recommendations to the TongaHealth Board for approval. • Lead communication and advocacy within their organisation and sector about the importance and implications of the Alcohol Harm Reduction Strategy and its implementation and evaluation. • Support the co-ordination of technical feedback and input from their organisation and sector on alcohol harm reduction as appropriate. • Liaise within their organisation and sector as appropriate to strengthen the effective implementation of the Alcohol Harm reduction Strategy and its associated work plan. • Support advocacy strategies in relation to promoting alcohol harm reduction strategies, and advocate for improved public policies and legislation. National Strategy for Prevention and Control of NCDs 2015-2020 0 39

Annex 6: Members of the Situational Analysis Group Name Designation 1. Dr. Lisiate ‘Ulufonua* Chairman of the National NCDs Committee and A/CEO for Ministry of Health 2. Dr. Raelyn ‘Esau* A/CEO for Ministry of Education and Training 3. Mrs. ‘Ana Fonua* CEO for Ministry of Internal Affairs 4. Mrs. Losaline Ma’asi* CEO for Ministry of Agriculture & Food, Forestry and Fisheries 5. Mr. Vilimo Fakalolo CEO for Fisheries Department 6. Mr. Tatafu Moeaki* CEO for Ministry of Finance and National Planning 7. Mr. ‘Anisi K Bloomfield CEO for Ministry of Revenue and Customs 8. Mr. Stephen Caldwell* Police Commissioner 9. Rev. Fili Lilo* Representative of the National Forum of Church Leaders 10. Mrs Maliana Tohi* Representative of the Commercial Business Sector 11. Mr. Drew Havea* Representative of Civil Society 12. Rev. Dr. Ma’afu’otu’itonga Chairman of Tonga Health Promotion Foundation Palu*&** Board 13. Hon. Fe’aomoeata Vakatā** Minister for Internal Affairs 14. Dr. Li Dan WHO Country Liaison Officer/Head of WHO Office 15. Sione Taumoefolau Chairman, Tobacco Advisory Committee 16. Lord Tangi o Vaonukonuka Chief Surgeon Specialist, MoH 17. Dr. ‘Amelia Tu’ipulotu** Chief Nursing Officer 18. Dr. Reynold ‘Ofanoa** CMO, Public Health 19. Dr Veisinia Matoto CMO, Diabetes Clinic 20. Dr ‘Ofa Tukia HPU, MoH 21. Sione Hufanga Information Officer, MoH 22. Leta Kami** TongaHealth Board member 23. Kathleen Bombell DFAT 24. Elizabeth Palu DFAT 25. Julie Bowen HSS Adviser, MoH 26. Sara Gloede NCDs Adviser, MoH 27. Seini Filiai CEO for TongaHealth Note: * Members of the National NCDs Committee ** Members of the TongaHealth Board National Strategy for Prevention and Control of NCDs 2015-2020 0 40

Annex 7: Authors of NCDs technical papers 1. Obesity, healthy eating and physical activity health trends in Tonga and the implications for the prevention and control of NCDs Dr. Toakase Fakakovikaetau Saia Faletau Seini Filiai Sara Gloede Sione Hufanga Dr. Veisinia Matoto ‘Elisiva Na’ati Dr. Reynold 'Ofanoa Dr. Taniela Palu Dr. 'Ofa Tukia 2. Public health evidence related to obesity in Tonga – a Literature review Michelle Kermode Gregory Armstrong Sara Gloede Seini Filiai Dr. Reynold ‘Ofanoa Sione Hufanga Dr. ‘Ofa Tukia 3. Healthy Eating Discussion Paper Jenna Pauli ‘Elisiva Na’ati Lesieli Taoi National Strategy for Prevention and Control of NCDs 2015-2020 0 41

Annex 8: Members of the Research Task Force and their Terms of Reference Name Organisation 1. Dr. Reynold ‘Ofanoa MoH (Chairman) 2. Dr. ‘Ofa Tukia MoH 3. Sione Hufanga MoH 4. Sara Gloede MoH 5. Julie Bowen MoH 6. Masiva Masila Statistics Department 7. Seini Filiai TongaHealth 8. Sione Fifita TongaHealth 9. Temaleti Moala TongaHealth (Secretary) Terms of Reference: • To assess the need for research during the implementation of the NCDs Strategy. • To identify research partners for partnership with TongaHealth in conducting research. • To review TORs of research partners and make recommendations to the TongaHealth Board on research partners to employ. National Strategy for Prevention and Control of NCDs 2015-2020 0 42

Annex 9: Members of the M&E Task Force and their Terms of Reference Name Organisation 1. Losaline Ma’asi MAFFF (Chairperson) 2. ‘Ana Bing Fonua MIA 3. Masiva Masila Statistics Department 4. Dr. Veisinia Matoto MoH 5. Dr. ‘Ofa Tukia MoH 6. Sione Hufanga MoH 7. Sara Gloede MoH 8. Julie Bowen MoH 9. Vilimaka Foliaki MET 10. Sione Fifita TongaHealth (Secretary) Terms of Reference: • To identify emerging research questions and needs related to the implementation of M&E initiatives and communicates these to appropriate partners. • To advise on, and advocate for, improved M&E of the TongaHealth Initiative. • Supporting coordination/harmonisation of M&E activities (data collection, analysis, dissemination) among the partners. • Identifying and recommending strategies for addressing the needs for capacity building in M&E at all levels. • Developing and maintaining consensus around M&E strategies across partners and institutions. • Providing technical guidance on appropriate data collection methods, analytic strategies, and dissemination of recommendations. • Advising the TongaHealth Board on appropriate monitoring frameworks for TongaHealth initiatives. Keeping TongaHealth partners informed of developments within their institutions and other initiatives that are relevant for M&E work. • Informally advocating for increased attention to and resources for monitoring and evaluation activities. National Strategy for Prevention and Control of NCDs 2015-2020 0 43

Annex 10: Members of the Strategy Drafting Committee Name Organisation 1. Dr. Reynold ‘Ofanoa CMO Public Health, MoH 2. Sara Gloede NCDs Adviser MoH 3. Dr. Cherian Varghese WHO, Geneva 4. Seini Filiai CEO for TongaHealth 5. Matthew Oxenham Administration& Finance Adviser (AVID) TongaHealth National Strategy for Prevention and Control of NCDs 2015-2020 0 44 Copyright (c) 2016 Tonga Health Promotion Foundation (TongaHealth). All Rights Reserved.