Outcome of the Thirteenth Pacific Health Ministers Meeting Tahiti, French Polynesia 6–8 August 2019 Thirteenth Pacific Health Ministers Meeting MINISTERE DE LA SANTE ET DE LA PREVENTION, en charge de la protectio sociale généralisée
Thirteenth Pacific Health Ministers Meeting Outcome of the Thirteenth Pacific Health Ministers Meeting Tahiti, French Polynesia 6–8 August 2019 MINISTERE DE LA SANTE ET DE LA PREVENTION, en charge de la protectio sociale généralisée WPR/2019/DPS/001 © World Health Organization 2019 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. 1Introduction We are pleased to present the outcome document of the Thirteenth Pacific Health Ministers Meeting held in Tahiti, French Polynesia in August 2019. This document highlights the outcomes, actions and commitments for the health of the population in the region. Healthy Islands was adopted by the Pacific Health Ministers at its first meeting in 1995 as the unifying theme for health promotion and protection in the Pacific. The ministries of health of the Pacific have worked hard to realize the Healthy Islands vision and make progress towards universal health coverage and the attainment of the health-related Sustainable Development Goals by 2030. The Government of French Polynesia cordially hosted the Thirteenth Pacific Health Ministers Meeting with support from the Pacific Community (SPC) and the World Health Organization (WHO). This was the first Pacific Health Ministers Meeting with participation from the Australian and New Zealand health ministers. The main issues discussed were: primary health care and its role in universal health coverage; the climate crisis and its impact on health; the burden of noncommunicable diseases, childhood obesity and cancer contol; mechanisms to strengthen the health workforce in the Pacific; health security and achievements in meeting the International Health Regulations (2005) core capacities; immunization coverage towards global and regional targets; and the need for a Pacific-specific approach to water, sanitation and hygiene (WASH). The Pacific Health Ministers welcomed these discussions and committed to continued action at the country and Pacific regional levels to address these issues. We look forward to continuing our work to keep the Pacific and its population healthy. Dr Takeshi Kasai, WHO Regional Director for the Western Pacific Honourable Dr Jacques Raynal, Minister of Health, French Polynesia Dr Colin Tukuitonga, Director-General of the Pacific Community
3 4Outcomes of the Thirteenth Pacific Health Ministers Meeting We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, reaffirmed our commitment to the Healthy Islands vision and the attainment of the Sustainable Development Goals (SDGs). We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, endorsed: • the recommendations of the 2018 and 2019 Pacific Heads of Health meetings. Universal health coverage and primary health care We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, endorsed: • the second progress report of the Healthy Islands Monitoring Framework and the proposed changes to the Healthy Islands Monitoring Framework. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, acknowledged: • that strengthening primary health care should prioritize effective mechanisms for addressing noncommunicable diseases (NCDs) and health security, and building climate-resilient health systems, communities and infrastructure. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, committed to: • strengthening primary health care as the key delivery strategy for universal health coverage in the Pacific; • continued efforts to define and implement the right service model for universal health coverage at the national level; • advocating for strengthened leadership by ensuring that we work beyond the health sector to strengthen primary health care; • raising awareness of and increasing the health literacy of institutional and political partners, as well as individuals and communities; • active reporting against the Healthy Islands Monitoring Framework every two years; • championing a Pacific-specific approach to advancing the safe and affordable surgery agenda as a critical part of our efforts to achieve universal health coverage and the Healthy Islands vision, including the development and implementation of national surgical, obstetric and anaesthesia plans with the support of technical and development partners; 5• strengthening regional and country level coordination mechanisms to achieve better outcomes and cost–effectiveness for overseas medical referral schemes (OMRS) and visiting specialist medical teams (VSMT); • establishing a subregional platform for Pacific pharmaceutical governance that supports countries to develop comprehensive medicines regulations with appropriate legislative frameworks. Climate change and health We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, endorsed: • the Roadmap to Implement the Pacific Islands Action Plan on Climate Change and Health with the vision that by 2030 all health systems and infrastructure in our island countries will be resilient to climate variability and change. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, acknowledged: • that the Pacific is on the front line of the world’s climate crisis, and that right now, in our countries, seas are rising, oceans are warming, frequent and intense cyclones, typhoons, flooding, drought and king tides are inflicting damage and destruction, and the health of our people is at risk; • that the climate crisis undermines good health and well-being – a central pillar for Pacific Island countries’ sustainable development, that Pacific Health Ministers need to work beyond the health sector to tackle the impacts of climate change and that this needs to remain an essential part of the agenda of future Pacific Health Ministers Meetings; • that a WHO regional platform on climate change and the environment will be established for the sharing of information and actions and to ensure a collective response to the crisis, and that the WHO Division of Pacific Technical Support based in Suva will serve as the Secretariat of this platform; • that the Pacific Community (SPC) and the Secretariat of the Pacific Regional Environment Programme (SPREP) are accredited entities of the Green Climate Fund. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, are committed to: • ensuring that health is a central component of each country’s National Climate Adaptation Plans and improving communication on climate change both within and outside the health sector; • continuing to advocate for climate-friendly policies throughout the health and other sectors; • investigating how the Green Climate Fund and other relevant mechanisms can be leveraged to support health-related climate change activities in the Pacific; • supporting WHO in becoming an accredited entity of the Green Climate Fund. 6Noncommunicable diseases (NCDs) We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, endorsed: • the Pacific Monitoring Alliance for NCD Action (MANA) regional report, Status of Non-communicable Diseases Policy and Legislation in Pacific Island Countries and Territories; • the development of the Pacific legislative framework for NCDs using the proposed structure and approach. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, acknowledged: • the high burden of obesity and the ongoing NCD crisis in the Pacific; • innovative actions, particularly those led by the community and targeting schoolchildren, which are helping to combat NCDs and childhood obesity; • country reports of increases in taxation leading to reductions in unhealthy behaviours; • that support is available for countries to strengthen NCD-related policy and legislation. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, committed to: • ensuring that each country has an up-to-date, multisectoral national strategic plan for NCDs, with clearly defined priorities, indicators and timelines, which incorporates actions on childhood obesity and cancer control; • ensuring that our country has a national multisectoral NCD task force that supports the implementation of the plan; • utilizing the Pacific NCD Dashboard to prioritize our key national NCD actions for the next 12 months, with particular consideration for those actions with current regional-level gaps (for example, setting controls on marketing of unhealthy foods and sugar-sweetened beverages to children, restricting trans-fats in the food supply, prohibiting tobacco industry interference, and further raising taxes on unhealthy products); • supporting the identified regional priorities of physical activity, fiscal measures and restriction of marketing of foods and sugar-sweetened beverages to children as per the Pacific Ending Childhood Obesity (ECHO) Network action plan; • utilizing tax impact assessment studies to support further the effective use of taxation, pursuing the exclusion of tobacco and alcohol from future trade agreements and taking actions to prevent the undermining of the impacts of taxation approaches; 7• advocating for appropriate collaborative approaches for cancer control at the regional, subregional and country levels and striving to improve cancer surveillance, screening, diagnostic, treatment and palliative care capacity; • leading by example as a role model of good health by advocating for tobacco- free islands, adopting healthy practices and insisting that future Pacific Health Minister Meetings are tobacco, alcohol and sugar free. Health workforce We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, acknowledged: • the work undertaken to map the human resources for health in the Pacific and the increase in the number of local clinical and public health doctors practising in the Pacific; • that the number of doctors is only one component of health workforce development and that challenges persist for all cadres of health-care workers. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, committed to: • expanding the medical workforce survey already undertaken by the Secretariat to include the whole health workforce in all Pacific island countries and areas; • developing training programmes targeted at isolated medical practitioners and implementing effective health workforce retention strategies; • identifying the health workforce indicators needed for decision-making for the issues of development, shortages, retention and regulations of the health workforce across primary health care and specialized services in the Pacific; • exploring the creation of a Pacific human resources for health entity to manage the medical workforce survey, coordinate training programmes targeted at isolated medical practitioners and implement effective health workforce retention strategies; • supporting linkages with the education sector to increase the number of students both entering and completing health professional education; • working with medical training institutions in the region to review the entry requirements of their undergraduate programmes and ensure they take into consideration the variation in education systems and assessment processes in Pacific island countries and areas. 8Health information We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, committed to: • strengthening national health information systems, e-health strategies and civil registration and vital statistics (CRVS) in line with our national health priorities; • supporting regional mechanisms for improving the availability of quality and timely data, for example, the Pacific Health Information Network (PHIN) and the Pacific Public Health Surveillance Network (PPHSN). Health security We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, endorsed: • the appropriate resourcing of National IHR Focal Points, engagement with sectors beyond health to support IHR implementation, and promotion of IHR Monitoring and Evaluation Framework (MEF) activities to assess and test capacities and capabilities for IHR (2005) implementation; • the development and funding of national health security action plans and the use of pandemic planning efforts as a foundation for this preparedness work; • the recommendations of the 2018 Pacific Meeting on Health Emergency Risk Management to strengthen all-hazards health emergency preparedness, readiness and response. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, acknowledged: • the progress made in health security and the implementation of the IHR (2005); • the need to actively engage with sectors beyond health to support IHR (2005) implementation and to consider inviting these key sectors to be part of the National IHR Focal Point team to strengthen awareness, intersectoral collaboration and accountability; • the use of Wolbachia as a vector control measure being piloted in four Pacific island countries through the World Mosquito Programme and that the Vector Control Advisory Group is awaiting additional evidence before endorsing the Wolbachia method for further use and future expansion into other countries; • the function of the PPHSN in its role in alert and communication through reporting of outbreaks and information sharing; • the importance of risk communications and community engagement and the need for capacity development in these areas; 9• the concerning issue of the emerging burden of antimicrobial resistance, its adverse impact on people in the Pacific and the need to strengthen antimicrobial resistance surveillance, governance and stewardship in the region; • the importance of chemical safety as an IHR core capacity and the need for strengthened capacity for mapping and managing hazardous chemicals. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, committed to: • working further on the adaption of the Joint External Evaluation (JEE) and State Party Self-Assessment Annual Reporting (SPAR) processes to be fit for purpose for small island states and using collective approaches to provide access to capacities, where appropriate; • moving towards a more country-led and multisectoral approach to the self- assessment of core capacities and capabilities; • contributing to the PPHSN review and advocating for their work in strengthening the regional laboratory network and epidemiology capacity- building programmes. Immunization We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, acknowledged: • that harmonizing childhood immunization schedules across the Pacific is a valuable tool in increasing vaccine coverage, but that further consultation, collaboration and support is required before this can be endorsed. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, committed to: • prioritizing efforts to increase vaccination coverage towards achieving the regional coverage target of 95% for all vaccines in national immunization schedules and to fully implement the other Global Vaccine Action Plan (GVAP) immunization programme components, over efforts to harmonize childhood immunization schedules across the Pacific; • implementing human papillomavirus (HPV) vaccination programmes as a priority; • improving the monitoring of and data collection on vaccine hesitancy and implementing evidence-based interventions to overcome the uncertainty causing this hesitancy. 10 Water, sanitation and hygiene (WASH) We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, acknowledged: • the dire situation and multiple challenges of water, sanitation and hygiene (WASH) in the Pacific and the impact on health and well-being and reiterated the Healthy Islands vision to “take action to ensure universal access to safe water and sanitation”. We, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, committed to: • supporting the development of a Pacific Strategy on WASH for Health to be presented at the next Pacific Health Ministers Meeting. Support from partners In conclusion, we, the Pacific Health Ministers at this Thirteenth Pacific Health Ministers Meeting, invite our partners to continue to support the implementation of activities and the development of relevant policies and strategies at the regional and country levels, ensure that this support is coordinated and aligned to national action plans, and assist in accessing resources and providing technical support. Pacific Health Ministers Meetings We recommend a review of the Pacific Health Ministers Meeting mechanism and task the Secretariat with developing terms of reference for a review in 2020. We acknowledge the offer of Tuvalu to host the Fourteenth Pacific Health Ministers Meeting in 2021 and the offer of Tonga to host the Fifteenth Pacific Health Ministers Meeting in 2023. 11 MINISTERE DE LA SANTE ET DE LA PREVENTION, en charge de la protectio sociale généralisée