Table 1 The six monitoring components and current status

Mortality

Age, sex and causes of death are critical for defining the extent of the impact of NCDs on a population and monitoring reductions in probability of dying from NCDs.

• Forms part of the country’s broader, multi-sectoral CRVS.

• Since 2011 under the 10 yr Pacific Vital Statistics Action Plan, significant progress has been achieved in strengthening PICTs’ CRVS systems and health information systems [16]. Substantial gains in coverage, quality, data use and accessibility have been made; most importantly is growing country commitment and engagement. Ensuring countries can at least report accurate, all-cause mortality by age group is a priority (the 15-59 age group being a close proxy for premature NCD mortality), alongside continuing improvements in cause of death data.

• The Pacific SHIP Program is working alongside the Brisbane Accord Group initiative to strengthen in-country capacity for monitoring of mortality.

Morbidity

Self-reported diseases, mainly diabetes and cardio-vascular disease.

• Data collection is generally problematic as central disease registries are not common.

• Self-reported conditions captured by the WHO STEPS survey or CDC Behavioral Risk Factor Surveillance System (BRFSS).

• The Pacific SHIP Program is working to strengthen in-country capacity for monitoring of NCD morbidity.

Risk Factors

NCD risk factors include tobacco use, harmful use of alcohol, diet, physical inactivity, obesity and hypertension

• STEPS and BRFSS surveys provide the prevalence data.

• The WHO Global School-based student Health Survey and CDC Youth Risk Factor Behaviour Survey provide data for adolescents.

• By 2015, 19 PICTs have completed at least one adult and one adolescent NCD risk factor survey [39].

• North Pacific – South Pacific variation and survey changes over time makes some regional or cross-country comparisons difficult. Some initial research is underway to assess where changes could be made.

• The Pacific SHIP Program is working to strengthen in-country capacity for monitoring of NCD risk factor prevalence.

Environments

The physical, economic, policy and socio- cultural environments that influence diet, tobacco use, alcohol uptake and physical activity.

• The food environment has been identified as a target for the Pacific.

• Some environment indicators are included in existing monitoring frameworks (e.g. policies to limit saturated fats and virtually eliminate trans-fats in the WHO GMF; tobacco indicators in the WHO MPOWER measures [40]).

• The INFORMAS ⁶ group has developed a series of monitoring tools to measure food environment indicators [25]. These are being adapted for the Pacific by researchers at C-POND at Fiji National University.

Policies

Policy indicators are ‘solution’ indicators – they indicate what governments are doing to tackle the NCD crisis.

• The Pacific NCD Roadmap initiative encourages governments to undertake a range of multi-sectoral cost-effective, ‘best buy’ policy directives that will impact legislation [13]. Some key policy data are collected by WHO through Country Capacity Surveys.

• Some food policy monitoring is included in food environment work being carried out by C-POND.

• The US Affiliated Pacific Islands NCD Policy Commitment Package is a Pacific-customized, expanded set of set of legislative, regulatory, and institutional policies endorsed by the health Secretaries, Directors and Ministers in the US-affiliated Pacific, which can be incorporated into the MANA dashboard on request [23].

• Boosted by the INFORMAS⁶ approach and drawing on other existing tools, the development of the Pacific MANA Dashboard for Action will provide a multi-layer monitoring tool and an accountability mechanism for governments to demonstrate leadership through targeted policies and legislation aimed at reducing unhealthy lifestyle choices.

Health System Responses

This covers monitoring of the use and accessibility to essential medicines, cardio-vascular disease risk assessment, drug therapy and counselling.

• For member countries, some data are captured on the WHO Country Capacity Surveys.

• For countries participating in the regional rollout of the WHO Package of Essential NCD interventions for primary health care, establishing an integrated monitoring system within the NCD plan will be beneficial [41].