FROM HONIARA TO APIA: REPORT ON PROGRESS AND CHALLENGES

Transcription

1 TENTH PACIFIC HEALTH MINISTERS MEETING PIC10/4 26 June 2013 Apia, Samoa 2 4 July 2013 ORIGINAL: ENGLISH Agenda item 4 FROM HONIARA TO APIA: REPORT ON PROGRESS AND CHALLENGES This report is a compilation of reports received from 13 Pacific island countries and areas (PICs), the Secretariat of the Pacific Community (SPC) and World Health Organization (WHO). It highlights country implementation efforts in addressing the five scheduled topics and 10 priority topics discussed during the Ninth Meeting of Ministers of Health for the Pacific Island Countries held 28 June to 1 July 2011 in Honiara, Solomon Islands. Fifteen topics were discussed during the Honiara meeting. Thirty-nine overarching recommendations were made under those 15 topics. A summary table of those recommendations can be found in Annex 1. Across the Pacific, there has been progress in implementing the recommendations from the Honiara meeting, although the progress has not been uniform across all PICs. For example, a majority of PICs are making progress or have plans to strengthen health leadership and multisectoral action to address noncommunicable diseases (NCDs); continue to address emerging and neglected infectious diseases in endemic countries; prepare for disaster risk management; plan for the development of national health plans, strategies and policies in line with best practices, aid effectiveness principles and which incorporate the Healthy Islands agenda into national development plans; and strengthen health information systems, evidence, epidemiology and statistics. Some PICs have utilized the recommended tools for assisting with health-care financing and resource planning to support national health plans and strategies and have identified plans to develop standard treatment protocols developed for primary, secondary and tertiary levels of health care. However, very few PICs have progressed or are planning to act on the social determinants of health through public policy and national strategies. Challenges in implementing some recommendations remain and require re-examination and the scale up of action. Such challenges include the triple burden of communicable diseases, NCDs and the health impacts of climate change, as well as strengthening fundamental country capacity and strengthening aid effectiveness.

2 page 2 1. BACKGROUND The Ninth Meeting of Ministers of Health for the Pacific Island Countries, jointly organized by SPC and WHO in Honiara, Solomon Islands, 28 June to 1 July 2011, addressed a wide range of health issues from NCDs to strengthening health systems. Five of the topics were specific agenda items that were agreed in advance. The five scheduled agenda topics included: 1) strengthening health leadership and multisectoral action to address NCDs; 2) the Framework of Action for Revitalization of Healthy Islands in the Pacific; 3) improving performance: strengthening national health planning and monitoring and evaluation; 4) strengthening food security in the Pacific: Pacific Food Summit and beyond; and 5) achieving Millennium Development Goals (MDGs) 4 and 5: Pacific strategy for scaling-up action on women s and children s health. An additional 10 priorities were identified in an open forum format, through which Health Ministers selected priority issues for deliberation and discussion. The 10 additional open forum-selected priorities included: mental health social determinants of health health information systems, evidence, epidemiology and statistics human resources for health (HRH) clinical care/clinical governance; emerging and neglected tropical diseases; laboratories; disaster risk management; health-care financing; and new technologies

3 page 3 2. ACHIEVEMENTS AND PROGRESS Five Agenda Topics Strengthening health leadership and multisectoral action to address noncommunicable diseases At the Honiara meeting, Pacific Health Ministers issued the Honiara Communiqué on the Pacific NCD Crisis. Shortly thereafter, the Pacific Islands Forum leaders declared NCDs a crisis. PICs have strengthened their response through multisectoral actions. For example, through the joint SPC/WHO Pacific NCD Programme, supported by the Australian Agency for International Development (AusAID) and the New Zealand Aid Programme (NZAID), PICs developed national NCD strategies. As a means of enhancing implementation of the NCD strategies, a few countries (including Palau, Samoa and Tonga) have formed multisectoral committees to address NCDs. Furthermore, as a result of the 2012 NCD Forum, PICs developed crisis response packages (CRPs) that are action plans aligned with national NCD strategies and guided by local data and WHO s best-buy interventions. Multisectoral action to address the NCD crisis was further enhanced through joint programming with the sports and trade sectors. Surveillance has improved through strengthening of civil registration and vital statistics (CRVS) systems. In addition, surveys for NCD surveillance using the STEPwise Approach to Surveillance of Risk Factors for NCDs continue to be applied in several countries to enable future monitoring of trends. Thus far, 10 countries have implemented the Package of Essential NCD Interventions, known as PEN, which incorporates both clinical and community interventions and both primary and secondary prevention to strengthen health system capacity for NCD service delivery. Detailed data on NCD-related deaths by age, and adult mortality levels where cause of death is not available, are critical in monitoring the impact of NCDs. Countries have made significant progress in improving their routine reporting systems for deaths and causes of death under the Pacific Vital Statistics Action Plan supported by the Brisbane Accord Group (BAG) of partner agencies and coordinated by SPC and University of Queensland Health Information Systems Hub. Countries have been encouraged to form multisectoral national committees to assess and prioritize improvements to the CRVS systems, resulting in a nationally agreed improvement plan that also allows for more coordinated support from development partners.

4 page 4 Framework of Action for Revitalization of Healthy Islands in the Pacific In March 1995, the Pacific began a journey towards the attainment of Healthy Islands through a ministerial conference on health in Yanuca Island, Fiji. Healthy Islands has continued to be reinforced in subsequent biennial meetings of ministers of health and remained the unifying vision for better health in the Pacific. In 2011, the Ministers of Health for the Pacific Island Countries and Pacific Islands Forum Leaders declared a health and development crisis in the Pacific due to the high burden of NCDs, which are major barriers to achieving the Healthy Islands vision. Subsequent to the Eighth Meeting of Ministers of Health for the Pacific Island Countries in 2009, consultations were carried out with health leaders in PICs and a steering group was established to finalize the endorsed draft Framework of Action for Revitalization of Healthy Islands in the Pacific. Operationalizing the framework across the PICs has occurred in various ways. Most commonly, PICs have implemented Healthy Islands programmes through settings platforms with an emphasis on multisectoral involvement and community engagement. These settings have included schools, workplaces, churches, markets and villages. Monitoring and evaluation of progress to build upon existing indicators and measurement tools are currently being discussed and developed, but require further attention and action. Through the Healthy Islands Recognition Programme and the annual NCD Forum, PICs draw from each other s experiences through networking with support from regional partners and stakeholders. Improving performance: strengthening national health planning and monitoring and evaluation Support for developing National Health Strategies, Policies and Plans (NHSPPs) has been undertaken through various means. At the subregional level, a database on development of NHSPPs has been developed and maintained. Technical support has been provided to review NHSPPs and service plans, such as those for laboratories, sexually transmitted infections (STIs) and HIV among others. To date, PICs were supported to develop and endorse new NHSPPs and monitoring and evaluation frameworks for HIV and other STIs. Given the movement towards a more integrated reproductive and sexual health approach in the region, the new NHSPPs were developed to enable PICs to readily align their respective HIV and other STI NHSPPs to a more integrated approach. Additionally, technical support aimed to ensure that NHSSPs are aligned with national development objectives, global

5 page 5 standards of best practices and the Paris Declaration on Aid Effectiveness. Activities carried out under health information and health-care financing have been part of national planning and monitoring, as each of these focus areas are part of support to strengthen national health planning, monitoring and evaluation. Specific country support for drafting the NHSPPs was carried out in Tokelau, and a review of the Public Health Act and the Pharmacy and Poisons Act was conducted in Tuvalu. NHSSPs in Kiribati and Solomon Islands were reviewed, and ongoing support is being provided to Vanuatu. The national minimum development indicators (NMDIs) also provide an important tool for improving data accessibility for monitoring and evaluation, and for accountability, at a regional level across a range of development sectors. The NMDIs were developed under the Ten-Year Pacific Statistics Strategy in response to country requests and include 53 healthrelated indicators across a range of topics, such as vital statistics, NCDs, health services, and maternal and child health. There is a database coordinated by SPC ( Strengthening food security in the Pacific: Pacific Food Summit and beyond At the regional level, WHO has joined SPC as co-chair of the multi-agency Food Secure Pacific Working Group (FSPWG), which also consists of the Food and Agriculture Organization of the United Nations (FAO), the United Nations Children s Fund (UNICEF) and the Pacific Islands Forum Secretariat. The FSPWG has prepared a joint proposal on Improving food security in the Pacific islands and increasing resilience to climate change by building leadership, cooperation, information and awareness. The proposal has been informally discussed with development partners, but funding has yet to be committed. Implementation of the Framework of Action on Food Security in the Pacific is ongoing. Members of the FSPWG have integrated strategies and actions outlined in the framework into their ongoing programmes and activities. Some initial work on developing a food security information system for the Pacific using Fiji and Tuvalu as case studies was conducted in partnership with Massey University and the FSPWG. Additionally, the Statistics for Development Division at SPC has conducted consultations with national statistics offices and other international agencies on incorporating food security indicators into the NMDI. A few countries have established high-level food security coordination mechanisms, while other countries have made use of existing multisectoral coordination mechanisms to

6 page 6 include food security-related issues, such as Fiji, the Marshall Islands, Palau, Papua New Guinea, Solomon Islands, Tonga and Vanuatu. Nine countries 1 have received support in drafting up-to-date food laws and regulations based on Codex Alimentarius and a common Pacific approach. Salt reduction strategies have been drafted in 13 countries 2, and initiatives to reduce salt, sugar and fat in the diet of Pacific islanders are ongoing through implementation of regulatory and voluntary measures. Country-specific examples include Fiji, which has developed a five-year implementation Plan for Salt, Sugar and Fat Reduction ( ). The plan outlines a series of time-bound activities and performance indicators, as well as agencies and ministries responsible for implementation of the plan. Initiatives to reduce salt intake are well under way through strategic health communications and food industry consultation. With support from WHO, Vanuatu has developed a National Plan of Action on Food and Nutrition Security ( ) and established a multisectoral Codex Alimentarius and Food Security and Nutrition Council responsible for coordination of Codex-related work in Vanuatu and for monitoring the implementation of the Plan of Action. The plan has been developed through consultation with all relevant food security stakeholders in Vanuatu. Achieving MDGs 4 and 5: Pacific Strategy for Scaling Up action on Women s and Children s Health Based on 2012 Pacific Regional MDGs Tracking Report, only Cook Islands, Niue and Tonga are on track for achieving MDGs 4 (improving maternal health), 5 (reducing child mortality) and 6 (combat HIV/AIDS, malaria and other diseases), while Papua New Guinea is not on track for all three goals. Other countries have experienced mixed progress. Programmatically, in many countries headway has been made to make services more accessible in maternal, newborn and child health (MNCH), including training, facility support, medicines and health systems strengthening. Overall, increased STI/HIV surveillance work and strengthening national responses also have been achieved. WHO, UNICEF and the United Nations Population Fund (UNFPA) are attempting to build joint approaches to implement the concept of a continuum of care for MNCH services in the context of primary health care, focusing on strengthening services in rural and remote areas. 1 Commonwealth of the Northern Mariana Islands, Cook Islands, Fiji, Kiribati, Palau, Samoa, Solomon Islands, Tuvalu and Vanuatu 2 Cook Islands, the Federated States of Micronesia, Fiji, Guam, Kiribati, the Marshall Islands, Nauru, Palau, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu

7 page 7 Specifically, in Vanuatu, an MNCH working group has been established to provide technical guidance on advancing the MNCH national agenda. Monthly reviews of perinatal and maternal deaths serve as a tool for learning and improving services. Significant progress has been made in Solomon Islands as well. For example, a family health coordination group was established but has experienced difficulties maintaining momentum due to competing commitments. An Expanded Programme on Immunization review was undertaken, and there has been assistance for implementation of recommendations. An integrated National Child Health Strategy was developed and is being implemented. Coverage of the Baby-friendly Hospitals initiative has increased and the National Referral Hospital was awarded Baby-friendly Status. Ten Priorities Mental health Health ministers agreed that mental health issues, if not addressed appropriately and immediately, will continue to grow, with a significant adverse impact on health and socioeconomic development. With the dedicated focus on mental health as a priority, progress has been achieved in a variety of areas, including awareness, needs assessment, policies and laws, services, capacity-building and networking for mental health. Through the Pacific Island Mental Health Network (PIMHNet) with support by the New Zealand Aid Programme, most PICs have begun drafting a national mental health policy or plan. Various training initiatives are addressing human resource constraints, including a one-year postgraduate diploma in Mental Health (PGDMH) established at Fiji National University, fellowship programmes on community mental health and depression provided by WHO collaborating centres in Australia and the Republic of Korea, technical support visits by mental health professionals and national workshops. Health and legal professionals from various PICs have received support for study. The integration of mental health services into general and primary health care has progressed in some PICs. Social determinants of health Globally, important strides have been made with regards to bringing attention to the need for understanding and addressing the social determinants of health. Since the 2005 establishment of the Commission on Social Determinants of Health, governments have gone on to adopt the Rio Political Declaration on Social Determinants of Health in 2011 and have participated in the Global Conference on Health Promotion in 2013, which advocates a Health in All Policies (HiAP) approach to policy development.

8 page 8 These global movements have translated into action at the country level in numerous ways, including actions to address inequities such as access to social welfare in Fiji and Guam, access to education and technology in Fiji and Papua New Guinea, and access to fair wages in Fiji and Papua New Guinea. Many countries have advocated an end to violence against women and children through support for nongovernmental organizations, such as national women and children s crisis centres. Kiribati, the Marshall Islands and Tuvalu have taken action to address climate change, while Fiji, Guam, Tonga and Solomon Islands are exploring ways that renewable energy can contribute to a sustainable environment. The work led by the Pacific Islands Forum has fostered many specific achievements in the Pacific, such as natural summits in the United States Affiliated Pacific Islands, action planning in Nauru and development of legislation in Tonga. Health information systems, evidence, epidemiology and statistics All PICs have been involved in capacity-building activities, including supporting staff to attend workshops and trainings on health information systems (HIS) and CRVS principles and practices. Progress has been varied. American Samoa, Fiji, Nauru and Tonga have organized HIS committees, undertaken comprehensive assessments of their HIS and developed national frameworks to guide investments, including HIS strategic plans with priorities and costing. They also have begun to implement activities from within their strategic plans with increased national budgets and more rational and targeted support by partners. The Commonwealth of the Northern Mariana Islands, Cook Islands, the Federated States of Micronesia, Kiribati, the Marshall Islands (partial assessment), Samoa, Solomon Islands, Tokelau and Vanuatu have established committees working towards the development of national frameworks and policies to guide HIS developments. They have also invested in improving basic data collection processes, such as improving medical records, data collection forms and routine HIS processes. Regional networks such as the Pacific Health Information Network and Pacific Public Health Surveillance Network (PPHSN) are playing an important role in sharing approaches and tools across countries. PICs are working to improve their statistics on births, deaths and cause-of-death under the Pacific Vital Statistics Action Plan with the support of the BAG partner agencies. 3 3 Secretariat of the Pacific Community (SPC), United Nations Population Fund (UNFPA), United Nations Children s Fund (UNICEF), University of Queensland Health Information Systems Knowledge Hub (UQ HIS Hub), Queensland University of Technology (QUT), Australian Bureau of Statistics (ABS), Fiji National University (FNU),World Health Organization (WHO)

9 page 9 Country systems assessments and planning in CRVS have commenced in American Samoa, the Commonwealth of the Northern Mariana Islands, Cook Islands, the Federated States of Micronesia, Fiji, Guam, Kiribati, the Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu, with many having completed draft plans and begun implementation of improvement activities. In each PIC, planning work has involved staff from the ministry of health, the national statistics office and the civil registry, along with other key partners. Human resources for health (HRH) Several PICs, with support from external partners, are undertaking a detailed programme of analytical work to update national human resources for health (HRH) profiles, review evidence-based policy options and develop or update national HRH plans. The Pacific Human Resources for Health Alliance provided a platform for countries to identify needs and develop strategies for the integration of foreign-trained medical school graduates. The formation of multisectoral task forces to address the integration of new foreign-trained graduates, for example in Kiribati, Tuvalu and Solomon Islands, is having a catalytic effect on broader HRH planning and decision-making. There has been increased participation in Pacific Open Learning Health Net (POLHN) courses, which underlines the importance of distance learning and flexible learning in initial training, continuing professional development (CPD) and career advancement. Clinical care/clinical governance PICs have improved access to specialized clinical training and addressed the lack of qualified biomedical technicians and engineers in the Pacific by working with training institutions to establish a Pacific Biomedical Training Programme through the Strengthening Specialised Clinical Services in the Pacific (SSCSiP) programme. The People at the Centre of Care Initiative and the People-centred Health Care: A Policy Framework are aimed at providing guidance to countries regarding quality of care, patient safety, appropriate health care use by empowered patients, patient and provider satisfaction, and cost-effective and sustainable health systems. Specific progress has occurred to various extents in PICs at four levels of the system: (1) informed and empowered individuals, families and communities; (2) competent and responsive health practitioners; (3) efficient and just health-care organizations; and (4) supportive and humanitarian health systems.

10 page 10 Countries have trained infection control focal points in hospitals. Drug and therapeutic committees that oversee the rational use of medicines have been established or strengthened in at least 10 countries, namely Cook Islands, Fiji, Kiribati, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu. National campaigns to empower individuals to have a say in their treatment and to complete their medications have been undertaken, as have efforts to promote patient safety and blood safety. Regulations have been strengthened to ensure that health professionals remain competent through continuous professional development and renewal of licences to practise, and medical laboratory quality and standards have been improved. Emerging and neglected tropical diseases (NTDs) Priority NTDs include lymphatic filariasis, soil-transmitted helminthiasis (STH) and leprosy. Other NTDs, such as blinding trachoma and yaws, are also endemic in parts of the Pacific. Since the inception of the Pacific Programme to Eliminate Lymphatic Filariasis (PacELF) in 1999, PICs have made remarkable progress in the elimination of lymphatic filariasis and are expected to eliminate the disease as a public health problem within 10 years. The experience gained over decades in tackling lymphatic filariasis has created a solid platform for other NTD programmes. National health systems have made significant strides in fighting lymphatic filariasis. Sixteen countries were endemic for lymphatic filariasis in Now 12 countries are endemic. Niue, Palau and Vanuatu have completed all rounds of mass drug administration (MDA) and the necessary requirements of post-mda surveillance for verification of lymphatic filariasis elimination. All but three PICs have achieved leprosy elimination (the Federated States of Micronesia, Kiribati and the Marshall Islands). In order to determine the extent of endemicity of blinding trachoma, partners have begun assisting countries in determining the extent of the disease burden. Yaws remains endemic in three PICs. Vanuatu has made significant progress toward elimination by conducting a national prevalence survey and developing a national action plan for yaws elimination. Laboratories Since the Ninth Meeting of Ministers of Health for the Pacific Island Countries, laboratory progress has focused on implementation of the Asia Pacific Strategy for Strengthening Health Laboratory Services ( ). Significant progress has been made in establishing coherent national frameworks for laboratory services. As a result, all PICs

11 page 11 currently have national laboratory policies and strategic plans (at least in draft form). Four PICs have laboratory policies and plans officially endorsed by governments. Several other countries have introduced or are introducing laboratory quality standards, complete with monitoring and evaluation mechanisms, including development of assessment tools and conducting external quality audits. Human capacity for implementation of the laboratory quality management systems (LQMS) was built through training. Laboratory personnel have received LQMS training in Fiji, Solomon Islands and Tonga. Sustainability mechanisms have been built through training-of-trainers (TOT) courses and continuous mentoring. As a result, countries are gradually taking over activities previously performed by development partners. Safety of laboratory operations was strengthened through safety audits and training, including new safety manuals. Safety training took place in Palau and Fiji. Safety manuals were introduced in Fiji, Palau and Solomon Islands. Dialogue has begun with clinicians regarding rational and evidence-based use of laboratory services. Fiji has a complete national framework for laboratory services in place, including a national laboratory policy, strategic plan and quality standards. The country is drafting legislation to regulate domestic accreditation and licensing. All laboratories undergo regular quality audits. A national external quality assessment scheme is being developed and will be managed by three senior laboratory staff trained in New Zealand. Disaster risk management According to the United Nations Framework on Climate Change, preventing and reducing the health consequences of climate change require both mitigation and adaptation strategies. While mitigation strategies can slow the process of climate change, adaptation plans are necessary to reduce the impacts of climate change. Recognizing the impact of climate change, Kiribati, Palau and Tonga have piloted health adaptation to climate change plans that identify country-specific initiatives to reduce the real and potential effects on populations and their environments. Natural disasters may cause increases in risk factors for communicable diseases. For example, a climatological hazard such as drought may affect the sanitation capacity in a community. In order to improve disaster risk management, development partners have recently assisted countries, including the Marshall Islands and Solomon Islands, with

12 page 12 epidemiological surveillance of outbreaks following natural disasters. Of the top 15 countries at highest risk for environmental degradation and disasters, five are PICs: Fiji, Papua New Guinea, Solomon Islands, Tonga and Vanuatu. This demonstrates the vulnerability of PICs and the need for concentrated efforts to mitigate disaster-related risks. Health-care financing PICs have three different levels of National Health Account (NHA) development. Level 1 includes countries that have not yet commenced any NHA reports (Kiribati, Solomon Islands and Tuvalu). Level 2 includes countries that have done one or two reports, but NHA work has ceased or is struggling (the Federated States of Micronesia, Papua New Guinea and Vanuatu). Level 3 includes countries that have institutionalized NHAs (Fiji, Samoa and Tonga). The Centre for Health Information, Policy and Systems Research of the Fiji National University was engaged to carry out in-country training and development, strengthen incountry analysis and policy use, and facilitate information exchange. Furthermore, three country representatives from Fiji, Samoa and Tonga were given the opportunity to connect with the Asia Pacific National Health Accounts Network (APNHAN) to support NHA institutionalization and sustainability. Country support was provided to Fiji to cost health services and examine the feasibility of health-care financing, including social health insurance. New technologies Medicines supply management, such as access to essential medicines and medical devices, has been improved significantly in PICs through the introduction of computerized inventory management systems and capacity-building of staff on the use of the system. A number of countries have received technical and financial support for this activity. Effective computer systems can help countries save money, promote efficiency and improve service quality just as poorly implemented computer systems waste money and decrease efficiency. Computers, however, have limitations. They cannot: assume responsibility (ordering and receiving of stock has to be handled by personnel); make decisions (when to order medicines); define problems (which medicines are out-of-stock and when and how much to order); or improve the basic data available (all necessary data should be available regardless of the compute system).

13 Support has been provided to the Marshall Islands and Vanuatu to introduce a PIC10/4 page 13 computerized inventory system to manage supply and distribution of medicines at national and provincial levels. This system has led to reduced stock-outs and improved inventory management. Fiji, the Federated States of Micronesia, Palau, Tonga and Tuvalu have been supported to upgrade their systems and build inventory management capacity of pharmacy staff. Niue is upgrading its patient referral and medical records databases to enable future telemedicine. 3. CHALLENGES AND ISSUES Challenges remain in the implementation of initiatives in priority areas identified by Pacific health ministers. These challenges and issues include: the triple burden of communicable diseases; NCDs and the health impacts of climate change; strengthening fundamental country capacity; and strengthening aid effectiveness. Triple burden of communicable diseases, NCDs and the health impacts of climate change Emerging and neglected tropical diseases o Sustaining progress made towards control and elimination of neglected tropical diseases in the Pacific requires PICs and development partners to renew commitments to support proven effective interventions. NCD crisis o Dedicated resources needed to increase country capacities to address the growing NCD crisis. o Connection of primary and secondary prevention 4 involving clinical and community NCD intervention approaches to reduce the disease burden. Climate change o Natural disasters often require immediate attention that diverts resources from other health needs. The challenge is addressing emergency needs without negatively impacting existing needed health services. 4 Primary prevention aims to prevent disease development; interventions may include addressing behavioural risk factors such as tobacco use, the harmful use of alcohol, unhealthy diet and physical inactivity. Secondary prevention aims to screen and provide early treatment for diseases that are not yet symptomatic.

14 page 14 Strengthening fundamental country capacity Leadership and political commitment o For some PICs, the constantly changing political environment results in instability and uncertainty. Health system and human resource capacity o Need for strengthening planning and implementation capacity for primary health care and clinical services. o Need to strengthen utilization of health information for evidence-based policy formulation. In-country multisectoral collaboration o Need for strengthened multisectoral communication and collaboration to address issues of inequity through social determinants of health and to address the NCD crisis in the Pacific. Strengthening aid effectiveness Country ownership o Need for countries to drive development and implementation of national health strategies, policies and plans, and subsequently for countries to drive health sector coordination. Harmonization o Development partners need to improve joint planning and communication to avoid duplication of work at the country and regional levels. Sustainability of regional support platforms o Ensuring greater sustainability of funding to support effective regional partnerships and platforms, such as the work under the Pacific Vital Statistics Action Plan by BAG and the work by PHIN that supports countries in improving their HIS and CRVS systems.

15 page 15 ANNEX 1 Summary of reporting by countries on recommendations from the Ninth Meeting of the Health Ministers for Pacific Island Countries in Honiara, Solomon Islands, 2011 Key Recommendations from Honiara Strengthening health leadership and multisectoral action to address noncommunicable diseases Healthy Islands: Framework of action for revitalization of healthy islands in the Pacific Improving performance: strengthening national health planning and monitoring and evaluation Strengthening food security in the Pacific: Pacific Food Summit and beyond Achieving MDGs 4 and 5: Pacific strategy for scaling-up action on women s and children s health Number of Pacific island countries and areas reporting on actions carried out on the recommendations No plans Completed Progressing Planning to initiate Mental health Social determinants of health Health information systems, evidence, epidemiology and statistics Human resources for health (HRH) Clinical care/clinical governance Emerging and neglected tropical diseases Laboratories Disaster risk management Health care financing New technologies Total Percentage* 9% 61% 23% 7% Note: Country reporting is averaged against the number of recommendations under each theme

16 page 16 ANNEX 2 Detail of reporting by countries on recommendations from the Ninth Meeting of Ministers of Health for the Pacific Island Countries in Honiara, Solomon Islands in 2011 Key recommendations from Honiara Strengthening health leadership and multisectoral action to address noncommunicable diseases (NCDS) 1. NCDs incorporated into national health and development plans with costing 2. Acceleration of the implementation of the WHO Framework Convention on Tobacco Control 3. Plans to reduce salt intake implemented 4. Selected NCD prevention and control indicators integrated into national health information systems Framework of Action for Revitalization of Healthy Islands in the Pacific 5. Healthy Islands agenda incorporated into national development plans 6. Coordinating Committee on Healthy Islands established 7. Development partnership plans are in line with aid effectiveness principles Improving performance: strengthening national health planning and monitoring and evaluation 8. NHPSP are in line with best practices, as outlined in the Framework on National Health Policies, Strategies and Plans (NHPSP) 9. Working arrangements, led by government and inclusive of key stakeholder representation, are in place and effective Number of countries reporting on actions carried out on the recommendations Completed Progressing Planned No plans to initiate Not appropriate or available

17 page 17 Annex 2 Strengthening food security in the Pacific: Pacific Food Summit and beyond 10. Cabinet subcommittees on food security to strengthen high-level national coordination established 11. National food security implementation plans developed and/or strengthened 12. Multisectoral approaches implemented and strengthened National champions identified Monitoring and evaluation mechanisms in place 15. Ministers and regional partners support resource mobilization to implement the Framework Achieving MDGs 4 and 5: Pacific strategy for scaling-up action on women and children s health 16. National maternal and child health plans (with costing) using the Continuum of Care Model enhanced or developed 17. Plans to improve access to care for most-affected populations developed Mental health 18. Human rights-based mental health plans (with costing) included in national health and development plans 19. Mental health policies and legislation updated 20. Human resources for mental health augmented 21. Data collection regarding the burden of mental illness improved 22. Multisectoral action and networking for mental health harnessed 23. Mental health integrated into existing frameworks and plans of work (for example, Pacific Human Resources for Health Alliance (PHRHA))

18 page 18 Annex Regional academic institutions and professional bodies support capacity-strengthening for mental health. Social determinants of health (SDH) 25. All public policy and national strategies to act on all SDH explicitly seek to achieve equity Health information systems, evidence, epidemiology and statistics 26. Personnel trained in core competencies in data techs, epi techs and epidemiologists 27. In-country and regional surveillance and response strengthened, possibly through mechanisms such as PPHSN, Pacific Health Information Network (PHIN), Pacific Island Health Officers Association (PIHOA) and full adoption of regional initiatives, such as the Pacific Syndromic Surveillance System Human resources for health (HRH) 28. Strategic health workforce plans including training (with costing) that can be implemented, monitored and evaluated developed Clinical Care / Clinical Governance 29. The regional initiative, People at the Centre of Care Initiative is promoted and utilized 30. Standard treatment protocols developed for the three levels of health care 31. Best practices, experiences and tools shared across the region to facilitate overall health systems strengthening

19 page 19 Annex 2 Emerging and Neglected Infectious Diseases 32. Emerging disease plans, based on Asia Pacific Strategy for Emerging Diseases (APSED 2010) being implemented 33. Strategies to address neglected tropical diseases, such as leprosy and lymphatic filariasis, in place for relevant countries Disaster Risk Management 34. Countries and areas have a plan to prepare for and respond to disasters, including national linkages between the sectors targeted by each of the agencies through multisectoral training Laboratories 35. Laboratory regulatory framework in place 36. Numbers and expertise of technical staff are adequate 37. Quality assurance and management practices are adequate Health-Care Financing 38. The Health Financing Strategy for the Asia Pacific Region ( ), and tools (such as National Health Accounts, the United Nations One Health costing tools) are being used to assist with the issue of health-care financing and resource planning in support of national health policy, strategy and plans New Technologies 39. New technologies incorporated in the health sector Note: Not all countries reported progress for all recommendations