Fitness, gardening and dispensaries: tackling noncommunicable diseases in the Pacific
WHO’s Package of Essential NCD interventions (PEN) is affordable, feasible and cost-effective for tackling the crisis of premature death and morbidity from noncommunicable diseases in the Pacific region.
What do a fitness club in the Cook Islands, backyard gardens in Kiribati and a dispensary in the Federated States of Micronesia have in common? They are all actively engaged in fighting the noncommunicable disease (NCD) crisis in the Pacific by implementing WHO’s Package of Essential NCD interventions, or PEN.
In the Pacific region, 75% of deaths are due to noncommunicable diseases. WHO’s Package of Essential NCD interventions is affordable, feasible and cost-effective: a "best-buy" for tackling the crisis.
PEN is a set of evidence-based interventions to reduce premature death and morbidity from heart disease, stroke, hypertension, diabetes, cancer, asthma, chronic obstructive pulmonary disease and rheumatic heart disease.
Interventions include counselling on healthy diets, physical activity, stopping tobacco use and reducing harmful use of alcohol. It also contains specific recommendations on the most effective medicines and actions to prevent, diagnose and treat noncommunicable diseases and their complications.
That's just the core – PEN is much more. Implementing PEN means strengthening primary health care by training healthworkers, ensuring medicine supplies, procuring equipment, and maintaining robust record-keeping systems and referral processes.
Cook Islands – health clinics and beyond
In the Cook Islands, PEN has started in five settings. On Aitutaki Island, for example, the Neke Fitness Club provides daily exercise activities; and island community leaders are being consulted on future initiatives.
Kiribati – gardens galore
PEN is being implemented in five clinics in Tarawa, capital of Kiribati. This year will see further roll-out of PEN in Tarawa and the outer islands, as Kiribati commits to PEN in their national health plan.
As part of the PEN implementation in Kiribati, medical assistants and nurses are working with communities to grow vegetable gardens and organise sports activities and weight loss competitions.
Federated States of Micronesia – transformed dispensaries
Across the Federated States of Micronesia, PEN is organizing clinics, building teams, and motivating patients and staff alike. In Pohnpei, for example, the Kolonia dispensary is turning its top floor into an aerobic exercise centre. And while patients and staff move to the music on the top floor, patients in another room swap stories and share their concerns about managing their medication.
Fiji – easy-to-understand risk assessment
The benefits of PEN are rapidly being felt in Fiji. Using the WHO risk assessment charts, more than half of all regular outpatients are now classified as having low risk of cardiovascular disease (see box).
The noncommunicable disease risk chart
WHO risk prediction charts use easily-measurable variables to quantify people’s 10-year cardiovascular risk. Variables include age, gender, blood pressure, smoking status, diabetes mellitus and total cholesterol. A person’s risk can then be classified as red, yellow or green corresponding to the level of risk.
This means that the workload at outpatient clinics has dramatically decreased and that physicians are able to spend more time with people at high risk. At the same time, people with low risk are participating in group sessions that address diet, medicines and physical activity.
Towards global noncommunicable disease targets
PEN is being rolled out across the Pacific Island countries and territories as one of several approaches to reduce noncommunicable diseases and their risk factors by 25% by 2025. Other interventions include salt reduction programmes and tobacco taxation.