Baseline status of policy and legislation actions to address non communicable diseases crisis in the Pacific

Abstract

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.

Non-communicable diseases’ risk factors in Iran; a review of the present status and action plans

“…Another survey in India revealed four levels of implementation gap including community level, healthcare facility level, public health system and management level, and policy and research level that need to be handled to combat the NCDs [ 79 ]. A good example is the Pacific Monitoring Alliance for NCD Action (MANA) that Pacific countries leaders have developed to monitor the Pacific NCD Roadmap, the NCD policy and legislation program in mentioned countries [ 80 ]. Countries in the African region also adopted multi-sectoral action plans to prevent and control NCDs in this region since the prevalence and burden of NCDs are significantly rising in these countries [ 81 , 82 ].…”

Noncommunicable Diseases Prevention Policies and Their Implementation in Africa: A Systematic Review

“…Researchers corroborate the author’s findings on the NCD policies implementation gaps in that the implementation levels varied widely from one policy and country to another because of inadequate funding, limited institutional capacity, inadequate action across different sectors within and outside the health system, and a lack of standardized monitoring and evaluation mechanisms to inform policies [ 50 ]. Inadequate administration also hinders policy formulation and multi-sectoral action, and in most countries, governments were slow in acting and often lacked the political will to formulate policies to address NCD risk factors [ 51 , 52 ]. Malawi exemplifies this by failing to ratify the WHO FCTC [ 41 ], whereas, in Cameroon, the government granted massive subsidies to tobacco farmers in the country [ 32 ].…”

“…In South Africa, the Department of Trade and Industry's priorities and those of Treasury clashed with the Department of Health and Social Development. As a result, passing a bill to ban alcohol advertising became complicated and fraught and was eventually withdrawn -The current high taxation rate on alcohol products in Ethiopia to reduce the use of alcohol Implementation of NCD policies [11, 34-36, 39, 41, 43] -Execution of the ratified WHO Framework Convention on Tobacco Control (FCTC) addressed tobacco and alcohol control policies also hinders policy formulation and multi-sectoral action, and in most countries, governments were slow in acting and often lacked the political will to formulate policies to address NCD risk factors [51,52]. Malawi exemplifies this by failing to ratify the WHO FCTC [41], whereas, in Cameroon, the government granted massive subsidies to tobacco farmers in the country [32].…”

Assessing the progress on the implementation of policy and legislation actions to address the Non-Communicable Diseases crisis in the Pacific

“…The MANA dashboard indicators and indicator ratings using a ‘traffic light’ scheme ( Table 1 ) was used to assess the progress on the implementation of policies and legislation. The MANA Dashboard includes 31 indicators across four different domains such as leadership and governance; preventative policies and legislations; health system response programmes; and NCD monitoring [ 9 , 10 ].…”