Background: Non-Communicable Diseases (NCD) are the leading cause of death in the Pacific Island Countries and Territories (PICTs) accounting for approximately 70% of mortalities. Pacific leaders committed to take action on the Pacific NCD Roadmap, which specifies NCD policy and legislation. To monitor progress against the NCD Roadmap, the Pacific Monitoring Alliance for NCD Action (MANA) was formed and the MANA dashboard was developed. This paper reports on the first status assessment for all 21 PICTs. Methods: The MANA Dashboard comprises 31 indicators across the domains of leadership and governance, preventive policies, health system response and monitoring processes, and uses a 'traffic light' rating scheme to track progress. The dashboard indicators draw on WHO's best-buy interventions and track highly cost-effective interventions for addressing NCDs. The MANA coordination team in collaboration with national NCD focal points completed Dashboards for all 21 PICTs between 2017 and 2018 in an agreed process. The data were analysed and presented within each area of the MANA dashboard. Results: This assessment found that PICTs are at varying stages of developing and implementing NCD policy and legislation. Some policy and legislation are in place in most PICTs e.g. smoke free environment (18 PICTs), alcohol licensing (19 PICTs), physical education in schools (14 PICTs), reduction of population salt consumption (14 PICTs) etc. However, no PICTs has policy or legislation on tobacco industry interference, controlling marketing of foods and drinks to children, and reducing trans-fats in the food supply, and only 7 PICTs have policies restricting alcohol advertising. Eighteen PICTs implement tobacco taxation measures, however only five were defined as having strong measures in place. Nineteen PICTs have alcohol taxation mechanisms and 13 PICTs have fiscal policies on foods to promote healthier diets. Conclusion: This baseline assessment fills a knowledge gap on current strengths and areas where more action is needed to scale up NCD action in a sustained 'whole of government and whole of society approach' in PICTs. The findings of this assessment can be used to identify priority actions, and as a mutual accountability mechanism to track progress on implementation of NCD policy and legislation at both national and Pacific level.
After decades of pressure from vulnerable developing countries, the Warsaw International Mechanism on Loss and Damage (the WIM) was established at the nineteenth Conference of the Parties (COP 19) in 2013 to address costly damages from climate change. However, little progress has been made towards establishing a mechanism to fund loss and damage. The WIM's Executive Committee issued its first two-year workplan the following year at COP 20 which offered, among other things, a range of approaches to financing loss and damage programmes, which we review here. We provide brief overviews of each mechanism proposed by the WIM ExCom, describe their current applications, their statuses under the UNFCCC, some of their advantages and disadvantages, and their current or potential application to loss and damage. We find that several of these mechanisms may be useful in supporting loss and damage programmes, but identify three major gaps. First, most of the mechanisms identified by the WIM ExCom are insurance schemes subsidized with voluntary contributions, which may not be adequate or reliable over time. Second, none were devised to apply to slow-onset events, or to non-economic losses and damages. That is, if harms are to parts of a society or its ecosystems that have no price, or if they occur gradually, they would probably not be covered by these mechanisms. Finally, the lack of a dedicated and adequate flow of finance to address the real loss and damage being experienced by vulnerable nations will require the use of innovative financial tools beyond those mentioned in the WIM ExCom workplan. Key policy insights• Despite a full article of the 2015 Paris Agreement devoted to loss and damage, there is little international agreement on the scope of loss and damage programmes, and especially how they would be funded and by whom. • Most of the loss and damage funding mechanisms identified by the WIM ExCom are insurance schemes subsidized with voluntary contributions, which may burden the most vulnerable countries and may not be reliable over time. • None of the mechanisms were devised to apply to slow-onset events, or to non-economic losses and damages.Policy Relevance Statement: After years of arguments by developing countries for recognition of loss and damage (beyond their ability to adapt to climate impacts), a full article of the 2015 Paris Agreement was devoted to the issue. International mechanisms to address loss and damage are receiving increased attention, particularly given the intensification of climate impacts occurring and projected to occur in the coming years, and the inability of mitigation and adaptation projects to adequately address those impacts. However, there is little international agreement on the scope of loss and damage programs, and especially how they would be funded and by whom. As such, it is crucial to identify potential funding sources and assess their efficacy, reliability, and equity, so that loss and damage response programs can be institutionalized, implemented, evaluated and improved.
BackgroundNon-communicable diseases (NCD) are the leading cause of premature death and disability in the Pacific. In 2011, Pacific Forum Leaders declared “a human, social and economic crisis” due to the significant and growing burden of NCDs in the region. In 2013, Pacific Health Ministers’ commitment to ‘whole of government’ strategy prompted calls for the development of a robust, sustainable, collaborative NCD monitoring and accountability system to track, review and propose remedial action to ensure progress towards the NCD goals and targets. The purpose of this paper is to describe a regional, collaborative framework for coordination, innovation and application of NCD monitoring activities at scale, and to show how they can strengthen accountability for action on NCDs in the Pacific. A key component is the Dashboard for NCD Action which aims to strengthen mutual accountability by demonstrating national and regional progress towards agreed NCD policies and actions.DiscussionThe framework for the Pacific Monitoring Alliance for NCD Action (MANA) draws together core country-level components of NCD monitoring data (mortality, morbidity, risk factors, health system responses, environments, and policies) and identifies key cross-cutting issues for strengthening national and regional monitoring systems. These include: capacity building; a regional knowledge exchange hub; innovations (monitoring childhood obesity and food environments); and a robust regional accountability system.The MANA framework is governed by the Heads of Health and operationalised by a multi-agency technical Coordination Team. Alliance membership is voluntary and non-conditional, and aims to support the 22 Pacific Island countries and territories to improve the quality of NCD monitoring data across the region. In establishing a common vision for NCD monitoring, the framework combines data collected under the WHO Global Framework for NCDs with a set of action-orientated indicators captured in a NCD Dashboard for Action.SummaryViewing NCD monitoring as a multi-component system and providing a robust, transparent mutual accountability mechanism helps align agendas, roles and responsibilities of countries and support organisations. The dashboard provides a succinct communication tool for reporting progress on implementation of agreed policies and actions and its flexible methodology can be easily expanded, or adapted for other regions.
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