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Samoa Pathway - outcome document
[Samoa Pathway]
SIDS Action Platform
The SIDS Action Platform has been developed to support the follow up to the Third International Conference on Small Island Developing States (SIDS Conference), including through a partnerships platform, a partnerships framework, and a UN Implementation Matrix. [Click to view]
Pacific NCD Partnership for a Multi-sector Approach to Prevent and Control NCDs (Pacific NCD Partnership)
Ref# 2759
Pacific Island Forum Leaders, Pacific Ministers of Health, Pacific Islands Permanent Missions at the UN, PICTs, SPC, PIFS, WHO, UNDP, World Bank, Australia DFAT, NZAP, US Department of State, NCD Alliance, PIHOA (other partners are welcome to join as desired also).
The Partnership's objective is to strengthen and coordinate the necessary capacity and expertise to support Pacific SIDS to significantly progress the prevention and control of NCDs in order to meet the globally agreed NCD targets, in particular through:
1.Advocating for the necessary political will, adequate institutional support and resources to underpin country level development outcomes that have effectively integrated NCD prevention and control considerations;
2.Using the Pacific NCD Roadmap as a key document guiding the NCD support provided by existing partners.
3.Strengthening their strategic multi-sector response to prevention and control of NCDs by mobilising and co-ordinating the support and expertise embedded in partners now working in the Region.
4.Promoting and supporting the mainstreaming of targets, activities and funding related to NCD prevention and control into national plans and budgets, including through advocating for partner support is on-plan and on-budget.
5.Building and strengthening a network/partnership/alliance of multi-sector stakeholders to focus their collective capacity, skills and resources, on supporting structured and sustainable approaches to addressing the prevention and control of NCDs;
6.Supporting where practical and cost effective, the provision of Pacific regional public goods related to the prevention and control of NCDs in the Pacific region;
7.Sharing information and to maintain an inventory of ongoing NCD Roadmap relevant actions in countries and the region by partners, countries and civil society.
8.Supporting the reporting back to Ministers of Economics and Health in the region as the key regional arrangements for accountability and direction on addressing the NCD crisis in the region; and
9.Mobilising and maximising the use of existing and new and additional resources to support all of the above.
The Partnership intends to build on, and strengthen existing relevant coordination mechanisms across the development and health spheres specific to the region and Pacific SIDS and in line with the Pacific Leaders Forum Compact for strengthening development coordination. The Partnership expects to draw its guidance for this support from existing agreed priorities and commitments relevant to Pacific SIDS as outlined in relevant national, regional and international policies (some of these are elaborated in later parts of this document).

The Partnership's goal is for a better networked alliance of the necessary stakeholders and does not seek to create a new organisation or new, regionally-driven programmes of support or technical assistance. Communication and consultation will be through virtual means except for opportunities for face to face side meetings at regional and international meetings. Participation is voluntary. It intends to facilitate coordination, cooperation and collaboration through cost effective and virtual means of regular communications and consultation and report to other partners and countries. It recognizes that the NCD response must be country led, embedded in broader health sector and multi-sectoral development plans and will guard against the creation of vertical, partner-driven approaches to NCD support.

The Partnership aims to help fulfil recent commitments by Pacific leaders and Ministers in recognition of the NCD crisis and the need for a more robust and coordinated effort;

1.Pacific Islands Forum Leaders Meeting (31 July 2014)
Leaders committed to support, the Pacific Non-Communicable Diseases (NCDs) Partnership to be launched at the (SIDS) Conference.

2.Joint Forum Economic and Pacific Health Ministers Meeting (11 July 2014)
Establish a high-level multi-sectoral mechanism to oversee and drive the NCD work in our countries;

3.Pacific Health Ministers Meeting (10 July 2014)
Supported the establishment of a virtual regional partnership focused on coordination and accountability, including traditional and non-traditional partners, which will adopt a multi-sectoral approach to addressing NCDs.

4.Resolution of the 20th Micronesian Chief Executives Summit (6 June 2014)
relevant stakeholders, work together to develop a representative and working Pacific NCD Partnership to strengthen and foster collaboration and improved efficiency to make regional coordination of NCD efforts between the North and the South more effective and impactful,

5.Forum Trade Ministers Meeting (19 July 2013)
considered linkages between trade and health, including NCDs, trade in alcohol and tobacco and other health issues.
Ministers acknowledged the decisions of the 2013 Forum Economic Ministers and Pacific Health Ministers regarding actions to address NCDs in the region, and noted the importance of a balanced approach to public health issues, and the need for trade and health officials to work closely.

[Pacific Island Forum] Leaders expressed their deep concern that non-communicable diseases (NCDs) has reached epidemic proportions in Pacific island countries and territories (PICTs) and has become a human, social and economic crisis requiring an urgent and comprehensive response Leaders called on SPC, WHO and other CROP Agencies to work with all PICTs through their respective whole of government, whole of society machineries to strengthen their capacities to address NCDs as a matter of urgency [Forum Leaders Communiqué 2011, Annex 2 Forum Leaders Statement on Non-Communicable Diseases].
PICTs have been fortunate to have had strong political support and goodwill to addressing NCDs. In the past 11 years, PICTs have endorsed a number of Commitments related to NCDs including the Tonga Commitment (2003), Framework Convention on Tobacco Control (2003), Samoa Commitment (2005), WHO Action Plan on Global Strategy for the Prevention and Control of NCDs (2008), Western Pacific Regional Action Plan for NCDs (2009), PIHOA Resolution 48-1 (2010), Honiara Communique (2011), Forum Leaders Communique (2011) and the UN High Level Meeting on NCDs (2011). In addition, all PICTs have some form of a National NCD Action Plan.

Despite the Commitments and efforts thus far, much still needs to be done. Within the context of sustainable development now and into the future the NCDs crisis plays an enormous factor in SIDS with already limited human capacity and resources.
Some alarming statistics on NCDs in the Pacific from recently released NCD Roadmap includes:
-Around 75 per cent of all adult deaths in the Pacific are due to NCDs; the majority of such adults would be in the economically active age bracket and for many others their capacity to contribute further to economic development is significantly reduced.
-Most countries in the Pacific now have much higher rates of premature (below age 60) deaths than the comparable global average.
-The top 10 countries with the highest overweight and obesity rates in the world are PICTs.
-Huge economic costs of NCDs in the Pacific in particular the rapidly rising expenditure on NCDs comprising well over 50 percent of the total health budget of many island countries.
-Growing NCD burdens, combined with modest economic growth, will inevitably further squeeze Ministry of Health and national development budgets unless urgent action is taken now.
-Drug costs alone for treating one diabetic patient in one PICT equals drug budget for 76 others
-In the same PICT only 1.3% of the total population can be treated with insulin before the country's total drug budget allocation is used up.
-Dialysis in another PICT costed USD $ 38,686 per patient per year in 2010/11, more than 12 times GNI per capita. Around two out of three of the patients had then died within two years of starting dialysis.
-Several NCD related programs are already financially unaffordable / unsustainable: Overseas Treatment ~ 15% total MOH budget for 0.1% total population in one PICT.
-NCDs are already causing a health crisis in the Pacific, with most of the trends and risk factors pointing to a substantial worsening of the situation unless action is taken now.
Fortunately, many NCDs are often preventable, or their health and financial burdens can at least be postponed with relatively simple and cost-effective interventions which in some cases are cost-saving.
Despite high and rising burden of NCDs in the region and the many commitments (at different levels) to addressing NCDs, the level of investment and coordination in NCD prevention and control is relatively low.

Country-level activities are paramount in addressing NCDs. For Pacific SIDS however, due to their special circumstances , the provision of ‘Regional Public Goods and Services’ (public health services that are most effectively and efficiently provided through cooperation and collective action, realising economies of scale and/or better results) that enhance local level activities and outcomes, are a matter of necessity. Further, Pacific SIDS face enormous challenges in coordinating the number of development partners operating at country, regional and international level that impact across their development agendas. These development partners often operate with different timeframes, criteria for soliciting support and funding, and have different agendas and reporting requirements. This fragmented ensemble of good intentioned support can often become more burdensome than helpful if collaboration amongst key stakeholders is not strong and focused on common objectives and in respect of each others comparative advantages. This is all the more complex in areas of intervention requiring multi-sector/stakeholder interventions such as NCD prevention and control.
The Partnership endeavours to create the necessary platform for strengthened collaboration and harmonisation of efforts at regional level, recognizing that many countries have established national forums for co-ordinating country-level responses. The Partnership will achieve this goal by networking the necessary local, regional and international partners and stakeholders, that collectively have the comparative advantages, capacity, and resources to support whole of government, whole of society machineries to strengthen PICTs capacity to address NCDs as a matter of urgency over the short, medium and long term.
Given the current and projected burden and implications NCDs have on the economic, social and development capacities of PICTs, if not addressed, this issue has the potential to undermine any MDG (or post 2015 SDG) achievement or sustainable development ability of SIDS across the entire development spectrum. On the other hand, with a more comprehensive and structured intervention now national resources may become freed up, human capacity may become more productive and last longer and many other benefits of food and nutrition security may contribute to the overall sustainable development goals of PICTs.
The partnership intends to encourage national stakeholders to target big early wins, best buys, outlined in the NCD Roadmap, including:

1.tobacco control (including Tobacco Free Pacific 2025);
2.reducing unhealthy food and drink;
3.improve efficiency of existing health dollar (including scale up PEN);
4.strengthen evidence base to ensure resources are used well

The Partnership will also investigate where regional collaboration can progress these objectives, e.g., through the development of food standards for the region.

The Pacific Roadmap also proposes over 30 additional possible structured interventions that can be included for implementation depending on PICTs specific circumstances and once the priority programmes are in place. These are to be rolled out through a number of agents in-country with particular emphasis on Ministries of Finance and development planning, Agriculture and Trade, Health and Education, civil society organisations and the private sector.

The multi-sectoral nature of NCDs requires a truly collaborative and multi-disciplinary group of stakeholders focused on deploying effective preventative programmes/approaches and control in a sustainable way. A combination of partners with expertise in development, trade, consumption and production, health, investment, education and other sectors is expected to help to bring to the table the necessary breadth of skills to deal with NCDs from all necessary angles. Strength of the Partnership is the involvement of partners not normally associated with Health but play an important role in the areas above.
2014 marks an important year for the Pacific region with the development of the NCD Roadmap initiated by the Forum Economic Ministers. The Joint Ministers of Economics and Health in the region have committed to developing a National NCD Roadmap for each PICT.

Underpinning these roadmaps are region wide activities and policies, covering: Healthy Islands Vision; a Tobacco Free Pacific 2025; regional Food Security Policy; etc.
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