Progress on the prevention and control of noncommunicable diseases in the Western Pacific Region : country capacity survey 2017

Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region Country Capacity Survey 2017 Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region Country Capacity Survey 2017 © World Health Organization 2018 ISBN 978 92 9061 856 0 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC- SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. CONTENTS Acknowledgements vi Foreword vii Abbreviations viii Executive summary ix I. Introduction 1 II. Status of response to prevent and control NCDs in the Western Pacific Region in 2017 A. Public health infrastructure, partnerships and multisectoral collaboration for NCDs and their risk factors B. Status of NCD-relevant policies, strategies and action plans C. Health information systems, surveillance and survey for NCDs and their risk factors D. Capacity for NCD early detection, treatment and care within the health system III. Key findings and progress in country capacity for the prevention and control of NCDs A. Key findings B. Progress in country capacity for the prevention and control of NCDs IV. Ten progress monitoring indicators 25 V. Regional response and way forward 30 A. Regional response 30 33 VI. References 34 4 6 2 9 22 16 22 23 35 65 Annex 1. NCD Country Capacity Survey 2017 Questionnaire Annex 2. Indicator definitions and specifications, status of countries and areas B. Way forward Countries and areas in the Western Pacific Region that participated in the NCD CCS 2017, by World Bank income level and subregion Percentage of countries with a policy, plan or strategy addressing the major NCDs and risk factors Countries and areas with a system for collecting mortality data Countries and areas with a system for recording patient information that includes NCD status Countries and areas with cancer and diabetes registries Availability and full implementation of evidence-based clinical guidelines/ protocols / standards for the management (diagnosis and treatment) of major NCDs Percentage of countries and areas with basic technologies for early detection, diagnosis and monitoring of NCDs generally available in the primary care facilities of the public and private health sector Percentage of countries and areas with medicines generally available in the primary care facilities of the public health sector Comparison of country capacity indicators in 2004, 2010, 2013, 2015 and 2017 Achievement status of the NCD progress monitoring indicators in the Western Pacific Region, 2017 Table 1 Table 2 Table 3 Table 4 Table 5 Table 6 Table 7 Table 8 Table 9 Table 10 TABLES 3 7 9 11 13 16 17 19 24 27 Major sources of funding for NCDs and their risk factors Percentage of countries and areas with fiscal interventions to address NCD risk factors Percentage of countries and areas with members in their national multisectoral commission, agency or mechanism Number of countries and areas with a set of time-bound national targets and indicators for NCDs Percentage of countries and areas covering 0–5 risk factors in recent, national adolescent NCD risk factor surveys Percentage of countries and areas covering 0–9 risk factors in recent, national adult NCD risk factor surveys Percentage of countries and areas with procedures for treating NCDs generally available in the public health system Percentage of countries and areas with national screening programme by cancer site Progress monitoring indicators on NCDs FIGURES 4 5 6 7 15 15 18 20 26 Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017vi ACKNOWLEDGEMENTS This report was developed by the World Health Organization (WHO) Regional Office for the Western Pacific. WHO wishes to acknowledge the support and cooperation of the following national NCD focal points who provided the completed survey tool. World Health Organization: Christopher Bates, Tsogzolmaa Bayandorj, Marie Clem Carlos, Melanie Cowan, Albert Domingo, John Juliard Go, Hyobum Jang, Narwant Kaur, Sam Ath Khim, Warrick Junsuk Kim, Duc Truong Lai, Rufina Latu, Ada Moadsiri, Jamiyanjamts Naranchimeg, Leanne Riley, Hai-Rim Shin, Paulinus Sikosana, Wendy Snowdon, Chun Paul Soo, Koorio Tetabea and Douangkeo Thochongliachi. The draft version of the report was reviewed by Hai-Rim Shin, Warrick Junsuk Kim and Marie Clem Carlos. Leiema Hunt (American Samoa) Matthew Williams (Australia) Ong Sok King (Brunei Darussalam) Kol Hero (Cambodia) Liangyou Wu (China) Ching Cheuk Tuen Regina (China, Hong Kong SAR) Chan Tan Mui (China, Macao SAR) Karen Tairea (Cook Islands) Isimeli Tukana (Fiji) X-ner Luther (Federated States of Micronesia) Roselie Zabala (Guam, USA) Itsuro Yoshimi (Japan) Eretii Timeon (Kiribati) Goun Lee (Republic of Korea) Phisith Phoutsavath (Lao People’s Democratic Republic) Neiar Kabua (Marshall Islands) Baigalmaa Dangaa (Mongolia) Rebecca Robles (Commonwealth of the Northern Mariana Islands) Omar Mihat (Malaysia) Bernard Rouchon (New Caledonia) Emma Hindson (New Zealand) Grizelda Mokoia (Niue) Jojie Fesaitu (Nauru) Mario Baquilod (Philippines) Edolem Ikerdeu (Palau) Vicky Wari (Papua New Guinea) Laure Yen Kai Sun (French Polynesia) Mareta Sefo-Faalafi (Samoa) Noorul Fatha As’art (Singapore) Geoffrey Kenilorea (Solomon Islands) Petelo Tavite (Tokelau) Siale ‘Akau’ola (Tonga) Meiema Lusama (Tuvalu) Graham Tabi (Vanuatu) Tran Quoc Bao (Viet Nam) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 vii FOREWORD Noncommunicable diseases or NCDs kill 40 million people each year globally. Three out of 10 of those who die from these diseases – mainly cardiovascular diseases, cancer, diabetes and chronic respiratory diseases – come from the Western Pacific Region. Rising rates of NCDs and risk factors pose an ever-growing threat to public health, and a challenge to economic and social development in the Region. People in low- and middle- income countries are especially vulnerable to these largely preventable diseases. Leaders globally are committed to fight NCDs. The 2030 Agenda for Sustainable Development calls for a reduction by one third of premature mortality from NCDs by 2030. This target builds on the momentum from the 2011 high-level political meeting of United Nations devoted to NCDs — which is one of the few occasions in history when the General Assembly has convened exclusively to address a public health issue. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country Capacity Survey 2017 updates assessments of Member State efforts to fight NCDs. These findings form a key part of the global WHO report to the United Nations, in preparation for the third High-level Meeting on the Prevention and Control of Non-communicable Diseases in September. The meeting will include a review of progress on NCD prevention and control efforts within countries and globally. The General Assembly will also look at ways to ensure that individual countries can meet ambitious NCD targets. While we all take great pride in the Region’s progress against NCDs, we realize that much more work remains to be done. We hope this publication will help countries and areas in the Western Pacific Region to assess their accomplishments, and strengthen commitments for bolder action. As always, WHO will continue to provide strong support to Member States to reach our shared goal of reducing premature deaths from NCDs. Thank you. Shin Young-soo, MD, Ph.D. WHO Regional Director for the Western Pacific Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017viii CCS Country Capacity Survey CRD chronic respiratory disease CVD cardiovascular disease GINA Global database on the Implementation of Nutrition Action HICs high-income countries and areas HPV human papillomavirus ICD International Classification of Diseases LMICs low- and middle-income countries and areas NCD noncommunicable disease PEN Package of Essential NCD Interventions PICs Pacific island countries and areas STEPS STEPwise approach to surveillance UN United Nations WHO World Health Organization ABBREVIATIONS Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 ix EXECUTIVE SUMMARY Noncommunicable diseases (NCDs) – especially cardiovascular diseases (CVDs), cancer, diabetes and chronic respiratory diseases (CRDs) – are the leading cause of death and are responsible for 71% of deaths worldwide and 86% in the WHO Western Pacific Region. These NCDs share modifiable behavioural risk factors such as tobacco use, unhealthy diet, lack of physical activity and harmful use of alcohol, which lead to four metabolic/physiologic changes – raised blood pressure, overweight and obesity, raised blood glucose, and raised cholesterol. Global and regional commitments were made to respond to the growing NCD epidemic, including the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases in September 2011 and development of the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020, the Western Pacific Regional Action Plan for the Prevention and Control of NCDs 2014–2020 and the WHO Global Monitoring Framework for NCDs, which contains the nine voluntary global NCD targets and 25 indicators to be achieved by 2025. To monitor the progress and achievements of countries in expanding national capacities to respond to the NCD epidemic, WHO periodically conducts the NCD Country Capacity Survey (CCS). The latest round of the NCD CCS took place in 2017. The first time countries and areas of the Western Pacific Region participated in the survey was in the second round in 2005; the Region has participated in all the succeeding rounds in 2010, 2013, 2015 and 2017. Progress on the Prevention and Control of NCDs in the Western Pacific Region: Country Capacity Survey 2017 presents a snapshot of the progress on NCD prevention and control in the Region in terms of infrastructure, policies, health information systems and health systems capacity as collected in the NCD CCS 2017. Countries were grouped in the analysis based on the World Bank classification of income status – high-income countries (HICs) and low- and middle-income countries (LMICs) – while Pacific island countries and areas (PICs), including Papua New Guinea, were grouped as one subregion. The latest round of the NCD CCS in 2017 shows that some progress has been made since 2015 in the capacity of countries in overall NCD prevention and control. In terms of infrastructure, the number of dedicated staff for NCDs has increased during this time period, as well as instances of shifts from other sources to government budget allocation for NCD programmes and activities. In addition to the most prevalent fiscal interventions, which are taxation on tobacco and alcohol, other interventions have slowly been emerging in the Region, such as taxation on sugar-sweetened beverages and price subsidies for healthy foods. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017x A considerable number of countries in the Region have also been able to develop national multisectoral NCD policies, strategies and action plans that integrate the main NCDs and their risk factors. Some countries and areas have also reported positive change in developing specific policies since 2015, with most policies made addressing the NCD risk factors, especially the harmful use of alcohol. The number of countries reporting that they have a policy or plan on NCD-related research has also more than doubled from five countries in 2015 to 13 countries and areas in 2017. The majority of the countries and areas in the Region reported having a system for reporting mortality data by cause and for recording patient information that include NCD status. Disease registration has also shown some progress, with a couple of countries able to initiate work on the establishment of a cancer registry; however, these are ad hoc and neither population- nor hospital-based. Diabetes registries have been reported to exist in at least half of the countries and areas in the Region. Recent NCD risk factor surveys that collect information on the NCD risk factors for both adults and adolescents are being collected in half of the countries and areas in the Region. The least-reported NCD risk factor included in these surveys is related to the measurement of salt/sodium intake, which is similar to the findings from the NCD CCS 2015. Evidence-based national guidelines/protocols/standards for the management of diabetes and CVDs are the most commonly available guideline in the Region; however, utilization in at least 50% of the health-care facilities is only the case for 60% of the existing guidelines. Eighty per cent of existing guidelines on the management of diabetes, CVDs and cancer have referral criteria, while only 68% of the existing guidelines for CRDs include referral criteria. Basic technologies to measure blood pressure, height, weight and blood glucose are generally available in the majority of countries and areas in the Region, while tests to measure diabetes complications, asthma and chronic obstructive pulmonary disease (COPD) are the least available. National screening programmes for cancers of the cervix and breast are most prevalent in the Region, with pap smear and mammography, respectively, being the most widely used initial screening methods. However, only one fourth of the countries and areas in the Region indicated that more than half of the target population is covered by the screening programme for breast cancer. Forty per cent of the countries and areas in the Region reported that more than half of the target population is covered by screening programmes for cancers of the cervix and colon. A vaccination programme for human papillomavirus (HPV) was reported to be present in 22 countries and areas in the Region; however, only 10 countries reported that at least 50% of the target population is covered. Pathology services for cancer diagnosis are reported to be the most common cancer diagnosis and treatment service available in the public sector, followed by cancer surgery. A wide variation of countries and areas in the Region (34–91%) reported having essential medicines generally available for management of the main NCDs in the public health sector. Aspirin (100 mg) and thiazide diuretics are the most readily available medicines while nicotine replacement therapy and oral morphine are the least available. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 xi Palliative care was reported to be generally available in 23 countries and areas in the Region, majority of which are HICs, with most providing community- or home-based care. Cardiovascular risk stratification at primary care facilities is available in 26 of the 35 countries and areas in the Western Pacific Region, but only 13 reported coverage of more than half of the target population. Provision of care for acute stroke is slightly more prevalent than rehabilitation of stroke patients in the public sector facilities in the Region. Most PICs (75%) reported having a register of patients who have rheumatic fever and rheumatic heart disease, compared to one fourth of the HICs and none of the LMICs. All the HICs in the Region reported availability of retinal photocoagulation, renal replacement therapy by dialysis, renal replacement by transplantation, coronary bypass, stenting and thrombolytic therapy, while these are available in at least a third of the LMICs. In the Pacific, there is variation in availability (10–55% of the PICs), with thrombolytic therapy and retinal photocoagulation as the most available of these treatment procedures. The progress monitoring indicators that were most achieved in the Region – either fully or partially – are: having a recent STEPwise approach to surveillance (STEPS) or a comprehensive health examination survey (fully achieved by 15 countries and areas); having evidence-based national guidelines/protocols/standards for the management of the major NCDs (fully achieved by 12 countries and areas); and having a set of time-bound national targets based on WHO guidance (fully achieved by 14 countries and areas). The progress monitoring indicators that are least achieved in the Region are: bans and restrictions on exposure to alcohol advertising; measures to reduce unhealthy diets; and a functioning system for generating reliable cause-specific mortality data on a routine basis. In terms of progress, more countries and areas have improved their 2015 assessment in 2017, especially in the two indicators for health systems to address NCDs. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017xii Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 1 INTRODUCTION Noncommunicable diseases (NCDs), mainly cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, are the leading cause of death and are responsible for 71% of deaths worldwide and 86% in the WHO Western Pacific Region (1). These NCDs share behavioural risk factors that are modifiable, such as tobacco use, unhealthy diet, lack of physical activity and the harmful use of alcohol, which in turn lead to four metabolic/ physiologic changes – raised blood pressure, overweight and obesity, raised blood glucose and raised cholesterol. In response to the NCD epidemic, global and regional commitments were made which include the United Nations (UN) Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases in September 2011 (2), the WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020 (3) and the Western Pacific Regional Action Plan for the Prevention and Control of NCDs 2014–2020 (4). The WHO Global Monitoring Framework for NCDs was also developed and endorsed to monitor the progress in the prevention and control of NCDs. The framework includes the nine voluntary global NCD targets and 25 indicators to be achieved by 2025. In 2014, the High-level Meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of NCDs was held to evaluate the progress made on NCD prevention and control, which resulted in the Outcome Document (5) and establishment of the four time-bound commitments. To monitor the progress and achievements of countries in expanding national capacities to respond to the NCD epidemic, WHO has conducted the NCD Country Capacity Survey (CCS) since 2001– and its latest round was in 2017. Countries and areas in the Western Pacific Region have participated in the NCD CCS since the second round in 2005 and the succeeding rounds in 2010, 2013, 2015 and 2017. As was the case in the previous rounds, the survey collects information related to NCD governance and infrastructure, policy response, surveillance, and health systems response at the national level, with some modifications to the questions to make them consistent with the global NCD indicators. The results of the 2015 and 2017 surveys will be included in the report on progress at the Third High-level Meeting of the United Nations General Assembly on the prevention and control of NCDs in 2018. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country Capacity Survey 2017 presents the data gathered from the NCD CCS 2017 and provides a comparison between the previous rounds. Results of the survey will be used to better guide countries and areas in the Western Pacific Region in further strengthening national capacities to respond to the NCD epidemic. CHAPTER 1 Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 20172 STATUS OF RESPONSE TO PREVENT AND CONTROL NCDs IN THE WESTERN PACIFIC REGION IN 2017 The 2017 NCD CCS is a global survey conducted by WHO to assess the strengths and weaknesses related to NCD governance and infrastructure, policy response, surveillance and health systems response. Data collection and validation were carried out in the Western Pacific Region from February to September 2017. The 2017 NCD CCS questionnaire (Annex 1) was developed by WHO through a consultative process with relevant technical departments in WHO headquarters and all WHO regional offices. The web-based questionnaire is composed of four modules, as listed below, and includes a set of detailed instructions and a glossary to guide countries in completing the survey: • Public health infrastructure, partnerships and multisectoral collaboration for NCDs and their risk factors; • Status of NCD-relevant policies, strategies and action plans; • Health information systems, surveillance and surveys for NCDs and their risk factors; and • Capacity for NCD early detection, treatment and care within the health system. Official communication was sent to all countries and areas in the Region, except the Pitcairn Islands, to nominate a focal point from each who can serve as representatives from their respective ministries of health responsible for the NCD unit or a related unit handling NCDs. Once the nominations were received, unique access codes were sent to the focal points to log in to the survey. The focal points were also encouraged to work collaboratively with colleagues and relevant offices to obtain the most updated and accurate responses. For validation and verification responses, supporting documents were requested to be submitted and uploaded to the online portal for some questions as indicated. Responses were considered as “No” or not achieved if the required supporting document or documents were not submitted. Upon completion of the survey and as part of the validation process, the designated staff from the WHO regional offices and WHO headquarters reviewed the submissions of countries and areas for completeness, discrepancies with existing data sources and missing supporting documents. The existing data sources included GLOBOCAN from the International Agency CHAPTER 2 Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 3 High-income countries and areas (N=8) Low- and middle-income countries (N=7) Pacific island countries and areas v(N=20) Australia Cambodia American Samoa Niue Brunei Darussalam China Cook Islands Northern Mariana Islands (Commonwealth of the) Hong Kong SAR (China) Lao People’s Democratic Republic Fiji Palau Japan Malaysia French Polynesia Papua New Guinea Macao SAR (China) Mongolia Guam Samoa New Zealand Philippines Kiribati Solomon Islands Republic of Korea Viet Nam Marshall Islands Tokelau Singapore Micronesia(Federated States of) Tonga Nauru Tuvalu New Caledonia Vanuatu Table 1. Countries and areas in the Western Pacific Region that participated in the NCD CCS 2017, by World Bank income level and subregion for Research on Cancer (IARC), WHO mortality database and the list of WHO-supported NCD risk factor surveys from WHO headquarters. Submissions were also compared to the 2015 NCD CCS responses to determine whether the differences in responses indicated progress or corrections of a previous responses. A clarification request with a list of queries and comments was sent to the NCD focal points for them to address or clarify, as needed. However, due to some limitations, not all countries were able to address the queries raised and/or submit the required supporting documents. In the Western Pacific Region, 35 of the 36 countries and areas completed the 2017 NCD CCS, giving a response rate of 97%. The response rate in 2017 was higher than the 89% response rate in 2015. Moreover, of the 35 countries and areas that responded to the survey, 27 countries and areas completed the validation process during the allotted period. The information submitted by countries and areas was extracted from the web-based platform to an Excel-readable file. Data cleaning was performed to ensure consistency between answers in the questions and sub-questions. Data analysis was conducted per module using Microsoft Excel. Countries and areas that participated in the 2017 NCD CCS were grouped in the analysis based on income status – high-income countries (HICs) and low- and middle-income countries (LMICs) (6) – while Pacific island countries and areas (PICs), including Papua New Guinea, were grouped as one subregion (Table 1). The first part of the report presents the results of the 2017 NCD CCS based on the 35 countries and areas (8 HICs, 7 LMICs and 20 PICs) that responded to the survey, and this number was also used as the denominator in the descriptive analysis to avoid fluctuating denominators between the survey questions and sub-questions. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 20174 Funding mechanisms The most-funded NCD or risk factor activities/functions are health care and treatment (34/35) and health promotion (34/35), followed by primary prevention (33/35), early detection/screening (32/35) and surveillance, monitoring and evaluation (31/35) as reported in the survey. The least-funded NCD activities/functions are research (24/35), capacity- building (27/35) and palliative care (27/35). The availability of funding increased in all the NCD activities/functions asked about in the survey, with the most for primary prevention; early detection/screening; surveillance, monitoring and evaluation; and palliative care, for which Fiji, Hong Kong SAR (China), the Lao People’s Democratic Republic, Niue and Vanuatu indicated positive change in the allocation. In decreasing order of frequency, the following are reported to be the major sources of funding for NCDs in the Western Pacific Region: general government revenues (54%), international donors (29%), health insurance (11%), earmarked taxes (8%) and national donors (6%). General government revenues are the major sources of funding for NCDs and their risk factors in HICs (6/8) and LMICs (5/7). In PICs, international donors remain the major source of funding for NCDs and risk factors (9/18) (Fig. 1). Cambodia, New Caledonia, Niue and Vanuatu have reported change of major sources of funding from international and national donors to general government revenues and earmarked taxes. Fig. 1. Major sources of funding for NCDs and their risk factors A. Public health infrastructure, partnership and multisectoral collaboration for NCDs and their risk factors Unit, branch or department responsible for NCDs In the Western Pacific Region, 33 of the 35 countries and areas reported having a unit, branch or department responsible for NCDs within the ministry of health or its equivalent. More than half (66%) of countries and areas in the Region reported having at least 6–10 full-time technical staff on NCDs. Since 2015, Kiribati has institutionalized an NCD unit, while Fiji, Guam, Mongolia, New Caledonia and Niue have increased the number of full-time equivalent technical or professional staff in the NCD unit. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 5 Multisectoral commissions, agencies or mechanisms Almost half of the countries and areas in the Region (49%) reported having a national multisectoral commission, agency or mechanism to oversee NCD engagement, policy coherence and accountability of sectors beyond health; however, only 11 are operational while three are under development and three are not in effect. The most common members of the national multisectoral commission are other non-health government ministries (11/35), followed by nongovernmental organizations (NGOs) (7/35) and the private sector (7/35) (Fig. 3). Fig. 2. Percentage of countries and areas with fiscal interventions to address NCD risk factors Fiscal interventions Thirty-three of the 35 countries and areas in the Region reported at least one fiscal intervention (Fig. 2). Taxation on tobacco is the most reported fiscal intervention (32/35), followed by taxation on alcohol (28/35). Three fourths of the HICs, LMICs and PICs in the Region have existing fiscal measures on both alcohol and tobacco. While fiscal interventions related to physical activity and diet are the least-reported fiscal interventions in the Region, a few countries in the Region have newly enacted taxation on sugar-sweetened beverages (Brunei Darussalam and Marshall Islands); taxation on foods high in fat, sugar or salt (French Polynesia); and price subsidies for healthy foods (Fiji, Marshall Islands and French Polynesia) since 2015. When asked whether any of the fiscal interventions are allocated for health promotion or health service, one third of the countries and areas in the Region reported the allocation (13/35). Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 20176 B. Status of NCD-relevant policies, strategies and action plans National policies, strategies and action plans In the Western Pacific Region, 31 of the 35 countries and areas (8/8 HICs, 6/7 LMICs, 17/20 PICs) reported that NCDs are included in their national health plans, while only 19 countries and areas (4/8 HICs, 5/7 LMICs, 10/20 PICs) reported that NCDs are included in their national development plans. Thirty out of the 35 countries and areas that fully responded to the survey reported having a national integrated NCD policy, strategy or action plan, however, only 25 are operational. Of the 25 operational integrated NCD policies, strategies or action plans, 22 are reported to be multisectoral in nature. All countries and areas that responded as having an operational national integrated NCD policy, strategy or action plan addressed unhealthy diet and physical inactivity, while only 22 and 24 countries and areas addressed harmful use of alcohol and tobacco, respectively. For detection, treatment and care of NCDs, almost all of the operational NCD policies, strategies or action plans addressed early detection, treatment and care for diabetes and cardiovascular disease (CVD) (21/25), followed by cancer (20/25) and chronic respiratory diseases (CRDs) (13/25). Palliative care – as part of the operational NCD policy, strategy or action plan – is covered in 10 of the 25 countries and areas (3/7 HICs, 3/6 LMICs and 4/12 PICs). Three fourths of the countries and areas in the Region (26/35) reported having time-bound national targets and indicators for NCDs based on the nine voluntary global targets from the WHO Global Monitoring Framework for NCDs (Fig. 4). Fig. 3. Percentage of countries and areas with members in their national multisectoral commission, agency or mechanism Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 7 Fig. 4. Number of countries and areas with a set of time-bound national targets and indicators for NCDs Specific policies, strategies and action plans Table 2 shows that more than half of the countries and areas had an integrated or specific policy on the major NCDs and risk factors except for CRDs (40%). Policies, strategies or action plans addressing the NCD risk factors were widely prevalent in the Region, with at least 75% of the countries and areas addressing the harmful use of alcohol, unhealthy diet, physical inactivity and tobacco, as well as the major NCDs such as cancer and diabetes. Table 2. Percentage of countries with a policy, plan or strategy addressing the major NCDs and risk factors Source: WHO Source: WHO % of countries/areas with NCD policy, strategy or action plan that integrates an NCD or risk factor % of coutries/areas with a specific policy, strategy or action plan on an NCD or risk factor HICs LMICs PICs Total HICs LMICs PICs Total Cardiovascular disease 75% 86% 55% 66% 25% 29% 25% 26% Cancer or particular cancer types 75% 86% 50% 63% 88% 86% 60% 71% Diabetes 75% 86% 55% 66% 50% 43% 35% 40% Chronic respiratory disease 50% 71% 25% 40% 13% 29% 0% 9% Harmful use of alcohol 63% 86% 60% 66% 75% 57% 15% 37% Physical inactivity 88% 86% 60% 71% 75% 57% 15% 37% Tobacco use 75% 86% 60% 69% 88% 43% 45% 54% Unhealthy diet 88% 86% 60% 71% 88% 43% 30% 46% Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 20178 Overweight and obesity (29%) and oral health (40%) were the risk factors least addressed in the Region. Research policy or plan Almost half of the countries and areas in the Region (15/35) have a policy or plan for NCD- related research that includes community-based research and evaluation of the impact of interventions and policies, however, two are not operational research policies. Policies and strategies to reduce unhealthy diets In the Western Pacific Region, 10 countries and areas reported having a policy to reduce the impact of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt. Slightly more countries reported policies that were voluntary/ self-regulated compared to those with government regulation (six versus four countries/ areas). Governments were also reported to oversee enforcement and complaints in seven countries and areas. None of these countries/areas reported inclusion of steps to address the effects of cross-border marketing of foods and non-alcoholic beverages on children. Eight out of the 35 countries and areas (five HICs and three LMICs) reported implementing a national policy that limits saturated fatty acids and virtually eliminates industrially produced trans-fats in the food supply. Voluntary or self-regulated policies (three HICs and two LMICs) were more predominant compared to some that were government-legislated (two HICs and one of the LMICs). None of the PICs reported having such a policy. Policies to reduce population salt consumption were reported to be implemented in seven HICs, three LMICs and four PICs. Of all the 14 countries with salt-reduction policies, public awareness programmes are the most common strategy (12/14), followed by nutrition labelling (10/14) and product reformulation by industry across the food supply (8/14). Regulation of salt content of foods is the least implemented strategy on salt reduction in the Region (6/14). National public awareness programmes National public awareness programmes on diet are more predominant (25/35) than national public awareness programmes on physical activity (16/35). PICs have the least number of awareness programmes on both diet and physical activity, with only half and one third, respectively, of the PICs reporting such a programme. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 9 C. Health information systems, surveillance and survey for NCDs and their risk factors Surveillance responsibility Surveillance is an important component in the prevention and control of NCDs. Only two HICs and four PICs reported having an office within the ministry of health dedicated exclusively to NCD surveillance. Most of the countries and areas in the Region reported that the responsibility for NCD surveillance is shared across several offices, departments and administrative divisions within the health ministry, with five out of eight HICs and 12 out of 20 PICs having such a mechanism. One HIC, four LMICs and four PICs reported that the responsibility lies within an office/department/division within the health ministry that is not exclusively dedicated to NCD surveillance. Civil and vital registration systems reporting mortality by cause Thirty-two of the 35 countries and areas that responded to the survey reported having a system for collecting mortality data by cause of death on a routine basis (Table 3). Of these, 30 have a civil/vital registration system, while 14 have a sample registration system; these are mostly LMICs (3/7) and PICs (9/20). Almost all the countries and areas (31/32) with a system for collecting mortality data can disaggregate the data by age and gender (31/32), while 23 countries and areas can report their mortality data by other sociodemographic variables. No. Country/area System for collecting mortality data by cause of death on a routine basis Civil/vital registration Sample registration HIGH-INCOME COUNTRIES AND AREAS 1 Australia Yes Yes No 2 Brunei Darussalam Yes Yes Yes 3 Hong Kong SAR (China) Yes Yes No 4 Japan Yes Yes No 5 Macao SAR (China) Yes Yes Yes 6 New Zealand Yes Yes No 7 Republic of Korea Yes Yes No 8 Singapore Yes Yes No Table 3. Countries and areas with a system for collecting mortality data Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201710 No. Country/area System for collecting mortality data by cause of death on a routine basis Civil/vital registration Sample registration LOW- AND MIDDLE-INCOME COUNTRIES 9 Cambodia No Yes 10 China Yes Yes Yes 11 Lao People's Democratic Republic No 12 Malaysia Yes Yes No 13 Mongolia Yes Yes Yes 14 Philippines Yes Yes No 15 Viet Nam No PACIFIC ISLAND COUNTRIES AND AREAS 16 American Samoa Yes Yes 17 Cook Islands Yes Yes Don't know 18 Fiji Yes Yes Yes 19 French Polynesia Yes Yes No 20 Guam Yes Yes Yes 21 Kiribati Yes Yes Yes 22 Marshall Islands Yes Yes Don't know 23 Micronesia (Federated States of) Yes Yes Yes 24 Nauru Yes Yes Yes 25 New Caledonia Yes Yes No 26 Niue Yes Yes No 27 Northern Mariana Islands Yes Yes Don't know 28 Palau Yes Yes Yes 29 Papua New Guinea Yes Don't know Yes 30 Samoa Yes Yes No 31 Solomon Islands Yes No No 32 Tokelau Yes Yes No 33 Tonga Yes Yes No 34 Tuvalu Yes Yes Yes 35 Vanuatu Yes Yes Yes Table 3. Countries and areas with a system for collecting mortality data (continued) Source: WHO Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 11 System for recording patient information Thirty-one out of 35 countries and areas in the Region (7/8 HICs, 6/7 LMICs, 18/20 PICs) reported having a system for recording patient information that includes NCD status (Table 4). Of these, 24 countries and areas indicated that electronic medical records/health records system were used. More than half (18/31) reported having national coverage and these are mainly HICs (4/8) and PICs (13/20), with very few LMICs (1/6). No. Country/area System for recording patient information Electronic medical records/ health records systems Coverage HIGH-INCOME COUNTRIES AND AREAS 1 Australia Yes Yes National 2 Brunei Darussalam Yes Yes National 3 Hong Kong SAR (China) Yes Yes Subnational 4 Japan No 5 Macao SAR (China) Yes Yes Subnational 6 New Zealand Yes No National 7 Republic of Korea Yes Yes Subnational 8 Singapore Yes Yes National LOW- AND MIDDLE-INCOME COUNTRIES 9 Cambodia Yes No Subnational 10 China Yes Yes Subnational 11 Lao People's Democratic Republic No 12 Malaysia Yes Yes Subnational 13 Mongolia Yes Yes National 14 Philippines Yes Yes Subnational 15 Viet Nam Yes Yes Subnational Table 4. Countries and areas with a system for recording patient information that includes NCD status Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201712 Table 4. Countries and areas with a system for recording patient information that includes NCD status (continued) Facility survey Only six countries (two HICs, two LMICs and two PICs) reported having conducted a facility survey to assess the availability of services and readiness for NCDs, and these surveys were all conducted in the past five years. Brunei Darussalam, the Lao People’s Democratic Republic and the Republic of Korea had national coverage of the facility survey, while Solomon Islands, Tuvalu and Viet Nam had subnational coverage. No. Country/area System for recording patient information Electronic medical records/ health records systems Coverage PACIFIC ISLAND COUNTRIES AND AREAS 16 American Samoa Yes Yes National 17 Cook Islands Yes Yes National 18 Fiji No 19 French Polynesia Yes Yes National 20 Guam Yes Yes Subnational 21 Kiribati Yes No National 22 Marshall Islands Yes Yes Subnational 23 Micronesia (Federated States of) Yes Yes National 24 Nauru Yes No National 25 New Caledonia Yes Yes National 26 Niue Yes Yes National 27 Northern Mariana Islands Yes Yes Subnational 28 Palau Yes Yes Subnational 29 Papua New Guinea No 30 Samoa Yes Yes National 31 Solomon Islands Yes No National 32 Tokelau Yes No National 33 Tonga Yes Yes National 34 Tuvalu Yes Yes Subnational 35 Vanuatu Yes No National Source: WHO Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 13 Disease registries All HICs, six LMICs and 15 PICs reported having a cancer registry (Table 5). Population- based cancer registries are available in seven out of eight HICs, five out of six LMICs and three out of 15 PICs. In comparison, diabetes registries are present in 23 countries and areas in the Region (5/8 HICs, 6/7 LMICs and 12/20 PICs). Of these registries, only five are population-based registries on diabetes. Table 5. Countries and areas with cancer and diabetes registries No. Country/Area Cancer registry Diabetes registry HIGH-INCOME COUNTRIES AND AREAS 1 Australia Yes, population-based Yes, population-based 2 Brunei Darussalam Yes, population-based No 3 Hong Kong SAR (China) Yes, population-based Yes, hospital-based 4 Japan Yes, population-based No 5 Macao SAR (China) Yes, hospital-based No 6 New Zealand Yes, population-based Yes, other 7 Republic of Korea Yes, population-based Yes, hospital-based 8 Singapore Yes, population-based Yes, population-based LOW- AND MIDDLE-INCOME COUNTRIES 9 Cambodia No Yes, hospital-based 10 China Yes, population-based Yes, population-based 11 Lao People's Democratic Republic Yes, other Yes, hospital-based 12 Malaysia Yes, population-based Yes, other 13 Mongolia Yes, population-based Yes, population-based 14 Philippines Yes, population-based Yes, other 15 Viet Nam Yes, population-based No Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201714 Table 5. Countries and areas with cancer and diabetes registries (continued) No. Country/Area Cancer registry Diabetes registry PACIFIC ISLAND COUNTRIES AND AREAS 16 American Samoa Yes, hospital-based No 17 Cook Islands Yes, hospital-based Yes, hospital-based 18 Fiji Yes, hospital-based No 19 French Polynesia Yes, other No 20 Guam Yes, population-based No 21 Kiribati No Yes, hospital-based 22 Marshall Islands Yes, hospital-based Yes, hospital-based 23 Micronesia (Federated States of) Yes, hospital-based Yes, other 24 Nauru No Yes, other 25 New Caledonia Yes, other No 26 Niue Yes, hospital-based Yes, hospital-based 27 Northern Mariana Islands Yes, population-based No 28 Palau Yes, population-based Yes, hospital-based 29 Papua New Guinea Yes, hospital-based No 30 Samoa No No 31 Solomon Islands Yes, hospital-based Yes, hospital-based 32 Tokelau No Yes, hospital-based 33 Tonga Yes, hospital-based Yes, population-based 34 Tuvalu No Yes, hospital-based 35 Vanuatu Yes, other Yes, hospital-based Risk factor surveys Adolescent survey Twenty-one countries and areas in the Region (5/8 HICs, 6/7 LMICs and 10/20 PICs) have collected recent information (i.e. for the last five years) on the five NCD risk factors (harmful alcohol use, low fruit and vegetable consumption, physical inactivity, tobacco use, overweight and obesity) among adolescents (Fig. 5). Two fifths of the PICs do not have a recent national adolescent risk factor survey. For half of the countries and areas that reported having collected information on overweight and obesity in adolescents, the data were self-reported. Source: WHO Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 15 Fig. 5. Percentage of countries and areas covering 0–5 risk factors in recent, national adolescent NCD risk factor surveys Adult survey In terms of adults, 21 countries and areas in the Region (6/8 HICs, 5/7 LMICs and 10/20 PICs) have collected recent information on the main nine NCD risk factors (harmful alcohol use, low fruit and vegetable consumption, physical inactivity, tobacco use, overweight and obesity, raised blood pressure, raised blood glucose, raised cholesterol, and sodium intake) (Fig. 6). Most HICs and LMICs have collected data on all nine main risk factors, while one third of the PICs do not have a recent national adult risk factor survey. Fig. 6. Percentage of countries and areas covering 0–9 risk factors in recent, national adult NCD risk factor surveys When considering surveillance activity by risk factor, surveys on tobacco and alcohol are the most common in both adult and adolescent surveys. The least-reported risk factor in adult risk factor surveys is salt/sodium intake. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201716 D. Capacity for NCD early detection, treatment and care within the health system NCD-related guidelines and referral criteria Evidence-based national guidelines/protocols/standards for the management of diabetes are the most commonly available guideline in the Western Pacific Region (31/35) followed by guidelines on CVDs (28/35) (Table 6). Guidelines for the management CRDs are the least available, with only half of HICs, LMICs and PICs reporting having the guideline. Guidelines for the management of diabetes (19/35) and CVDs (18/35) were the most utilized guidelines in at least 50% of health-care facilities in countries and areas of the Region. Countries and areas were also asked if the guidelines include criteria for the referral of patients from primary care to a higher level of care. Almost 80% of existing guidelines on CVD, diabetes and cancer have referral criteria, while that for CRDs have the least, with 70% of existing guidelines having referral criteria. A higher percentage of LMICs have referral guidelines than HICs and PICs in all disease categories. Availability of tests and procedures for early detection, diagnosis/monitoring and treatment of NCDs The majority of the countries and areas in the Western Pacific Region reported having the basic technologies to measure blood pressure, height, weight and blood glucose generally available in both the public and private health sectors (Table 7). The least available tests in the Region are those used to measure diabetes complications, asthma and chronic obstructive pulmonary disease (COPD). More than half of the countries and areas in the Region have the basic technologies for early detection, diagnosis and monitoring of CVDs, such as those for measuring blood pressure and total cholesterol and urine strips for albumin assay. Table 6. Availability and full implementation of evidence-based clinical guidelines/protocols/ standards for the management (diagnosis and treatment) of major NCDs Clinical guidelines HICs (N=8) LMICs (N=7) PICs (N=20) Total (N=35) Protocol (%) Utilization* (%) Protocol (%) Utilization* (%) Protocol (%) Utilization* (%) Protocol (%) Utilization* (%) CVD 88% 50% 86% 57% 70% 55% 77% 54% Diabetes 88% 50% 86% 57% 90% 60% 89% 57% Cancer 63% 50% 86% 43% 45% 35% 57% 40% CRD 50% 25% 57% 29% 55% 40% 54% 34% * Utilization in at least 50% of health facilities. Source: WHO Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 17 While the availability of basic technologies for early detection, diagnosis and monitoring of NCDs such as the measurement of height, weight, blood pressure, blood glucose and HbA1c are generally available in the primary care facilities of the public and private sectors in the Region, there is variation in their availability in HICs, LMICs and PICs; HbA1c and total cholesterol measurement were reported to be not generally available in one third of the LMICs and PICs. Table 7. Percentage of countries and areas with basic technologies for early detection, diagnosis and monitoring of NCDs generally available* in the primary care facilities of the public and private health sector * Defined as present in 50% or more of health-care facilities. Activity HICs (N=8) LMICs (N=7) PICs (N=20) Total (N=35) Public sector Private sector Public sector Private sector Public sector Private sector Public sector Private sector Overweight and obesity Measuring of weight 100% 100% 86% 86% 95% 65% 94% 77% Measuring of height 100% 100% 86% 86% 90% 55% 91% 71% Diabetes mellitus Blood glucose measurement 100% 100% 71% 86% 90% 70% 89% 80% Oral glucose tolerance test 100% 100% 43% 57% 40% 25% 54% 49% HbA1c test 100% 100% 43% 57% 55% 40% 63% 57% Dilated fundus examination 100% 88% 29% 43% 30% 30% 46% 46% Foot vibration perception by tuning fork 100% 88% 29% 43% 30% 45% 46% 54% Foot vascular status by Doppler 88% 75% 14% 29% 15% 15% 31% 31% Urine strips for glucose and ketone measurement 100% 100% 57% 71% 50% 45% 63% 63% Cardiovascular disease Blood pressure measurement 100% 100% 100% 100% 95% 70% 97% 83% Total cholesterol measurement 100% 100% 57% 86% 60% 50% 69% 69% Urine strips for albumin assay 100% 100% 57% 86% 45% 40% 60% 63% Asthma and COPD Peak flow measurement spirometry 100% 75% 29% 43% 35% 35% 49% 46% Source: WHO Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201718 Procedures for treating NCDs All HICs reported to have NCD treatment procedures (such as retinal photocoagulation, renal replacement therapy by dialysis, coronary bypass, stenting and thrombolytic therapy for acute myocardial infarction) generally available in the publicly funded health system, except for renal replacement by transplantation, with one area not having it generally available (Fig. 7). Almost half of the LMICs reported to have NCD treatment procedures except for renal replacement by transplantation. Of all the procedures for the treatment of NCDs, thrombolytic therapy for acute myocardial infarction and retinal photocoagulation were reported to be generally available in most PICs. Availability of medicine in the public health sector Availability of NCD-related medicines varies significantly in the Region among country groups, with aspirin (100 mg) and thiazide diuretics being the most available of all the medicines asked about in the survey (Table 8). Nicotine replacement therapy and oral morphine were reported to be generally available in just a third and half, respectively, of the countries and areas in the Region. Three of eight HICs, none of the seven LMICs and four of the PICs have all these NCD medicines generally available in the primary care facilities of the public health sector in their countries. Fig. 7. Percentage of countries and areas with procedures for treating NCDs generally available* in the public health system * Defined as present in 50% or more of health-care facilities. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 19 Availability of tests and procedures for cancer screening, diagnosis and treatment In the early detection and treatment of cancers, a national screening programme is essential. In the Region, screening programmes for cervical and breast cancers were reported to be the most prevalent in HICs, LMICs and PICs (Fig. 8). Three out of four countries that have screening programmes for cancers of the breast and cervix reported these as organized, population-based screening. Mammography is the most widely used method to screen for breast cancer as reported by 13 countries and areas (mostly HICs), while clinical breast exam is the most widely used in four countries and areas. Pap smear is the most common method used for cervical cancer screening in 18 countries and areas in the Region, while three countries use visual inspection and one area reported human papillomavirus (HPV) testing as the most widely used screening method. Table 8. Percentage of countries and areas with medicines generally available* in the primary care facilities of the public health sector Medicines HICs (N=8) LMICs (N=7) PICs (N=20) Total (N=35) Insulin 100% 43% 70% 71% Aspirin (100mg) 100% 86% 90% 91% Metformin 100% 71% 85% 86% Thiazide diuretics 100% 86% 85% 89% ACE inhibitors 100% 71% 75% 80% Calcium channel blockers 100% 71% 80% 83% Beta blockers 100% 86% 80% 86% Statins 100% 57% 75% 77% Oral morphine 63% 43% 45% 49% Steriod inhaler 100% 43% 55% 63% Bronchodilator 100% 57% 80% 80% Sulphonylurea(s) 100% 57% 80% 80% Benzathine penicillin injection 63% 71% 85% 77% Nicotine replacement therapy 88% 0% 25% 34% * Defined as present in 50% or more of pharmacies Source: WHO Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201720 Fig. 8. Percentage of countries and areas with national screening programme by cancer site HPV vaccination programmes are present in the Region (7/8 HICs, 3/7 LMICs and 12/20 PICs). At least 50% of the targeted population is covered by the HPV vaccination programme in five HICs, one of the LMICs and four PICs. Only half of the countries and areas in the Western Pacific Region (8/8 HICs, 4/7 LMICs and 5/20 PICs) reported that cancer centres or cancer departments at tertiary level were generally available in the public sector. Pathology services for cancer diagnosis are generally available in 22 of the 35 countries and areas in the Region (8/8 HICs, 2/7 LMICs and 12/20 PICs). Treatment procedures, specifically cancer surgery (19/35), subsidized chemotherapy (16/35) and radiotherapy (15/35), are also available, with all HICs and less than half of the LMICs and PICs having these treatments generally available. Other NCD services Palliative care is generally available (reaches 50% or more patients) in more than half of the countries and areas in the Region (8/8 HICs, 2/7 LMICs and 13/20 PICs). Community- or home-based palliative care is generally available in all HICs, one of seven LMICs and 12 of 20 PICs, while palliative care, as provided in primary health care, is generally available in five of eight HICs, two of seven LMICs and nine of 20 PICs. Only one fourth of the countries and areas reporting to have a breast cancer screening programme indicated that more than half of the target population is covered by the screening programme. For cervical and colon cancer screening, more than half of the target population is covered in 40% of the countries and areas that reported to have a screening programme. Screening coverage of more than 50% of the target population is mostly in HICs. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 21 Cardiovascular risk stratification is available at primary care facilities in 26 of 35 countries and areas (5/8 HICs, 15/20 LMICs and 6/7 PICs) in the Western Pacific Region, but coverage of more than half of the target population occurs only in 13 countries and areas (four HICs, seven LMICs and two PICs). Among the countries with cardiovascular risk stratification available, the most widely used chart is the WHO/International Society of Hypertension (ISH) risk prediction charts. Provision of care for acute stroke is slightly more prevalent in the public sector facilities in seven of eight HICs, three of seven LMICs and 14 of 20 PICs, than for rehabilitation of stroke patients, which was reported as being generally available in seven HICs, four LMICs and 10 PICs. Only one fourth of the HICs, none of the LMICs and three fourths of the PICs reported to have a register of patients who have rheumatic fever and rheumatic heart disease. Most of these countries and areas (15/17) reported that they have a system for follow-up and recall to deliver long-term penicillin prophylaxis. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201722 KEY FINDINGS AND PROGRESS IN COUNTRY CAPACITY FOR THE PREVENTION AND CONTROL OF NCDs CHAPTER 3 A. Key findings Public health infrastructure, partnerships and multisectoral collaboration for NCDs and their risk factors Majority of the countries and areas in the Region (33/35) have an NCD unit in place, with more than half (23/35) having at least six to 10 full-time technical staff for NCD. Funding for NCD activities is most commonly available for health care and treatment, health promotion, primary prevention and early detection/screening. General government revenues are the major sources of funding in the Region, while tobacco taxes are the most reported fiscal intervention, followed by alcohol taxes. Almost a third of the countries and areas in the Region (11/35) have an operational national multisectoral commission for NCDs. Status of NCD-relevant policies, strategies and action plans NCDs are included in most national health plans (31/35) in the Region; however, only half have included NCDs in their national development plans. Three fourths of the countries and areas in the Region (27/35) have operational multisectoral national policies and plans integrating the major NCDs and risk factors. A significant proportion of countries and areas in the Region also have stand-alone policies – in addition to the integrated NCD policy – that address cancer (25/35) mainly for the NCDs and tobacco control (19/35) for the NCD risk factors. Health information systems, surveillance and surveys for NCDs and their risk factors Civil/vital registration systems are available in majority of the countries and areas in the Region; however, only a small proportion of these meet the acceptable criteria for a functioning system that can generate reliable cause-specific mortality data on a routine basis. Periodic national adult risk factor surveys for the main nine NCD risk factors (harmful alcohol use, low fruit and vegetable consumption, physical inactivity, tobacco use, overweight and obesity, raised blood pressure, raised blood glucose, raised blood cholesterol and high Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 23 B. Progress in country capacity for the prevention and control of NCDs sodium intake) are conducted in most of the countries and areas in the Region (21/35) and the least collected information is on salt/sodium intake. Almost half of the countries and areas in the Region have a population-based cancer registry (15/35) while only five countries have a population-based diabetes registry. Capacity for early detection, treatment and care within the health system Evidence-based national guidelines, protocols or standards for the management of diabetes and CVDs are the most commonly available guidelines in the Region; however, the utilization of these guidelines in at least 50% of health facilities is present in at least half of the countries and areas in the Region. Majority of the countries and areas in the Region have cost-effective basic technologies such as those that measure weight, height, blood pressure and blood glucose. Aspirin and thiazide diuretics are the most available NCD medicines in the primary care facilities of the public health sector, while nicotine replacement therapy and oral morphine are the least available. The most common cancer screening programmes in the Region are those for breast and cervical cancers. While CVD risk stratification exists in 26 of the 35 countries in the Region, population coverage is suboptimal, with only 13 countries and areas covering more than half of the primary care facilities offering such service in countries. In comparison with previous rounds, the response rate increased in the fifth round of the NCD CCS in 2017, with 35 countries and areas participating in the survey compared to 32 countries and areas in 2015. All HICs and LMICs in the Region responded to the survey, while 20 of the 21 PICs responded. Table 9 presents information from the five rounds of the NCD CCS on selected indicators that may be compared from 2004 to 2017. Noting that there are varying numbers of responding countries and areas in each round of the survey, slight increases and decreases may be observed in the reporting of some indicators. A more robust validation process was initiated for 2015 and was also implemented in 2017. Some progress may be observed from 2015 to 2017 in the number of countries and areas with a national NCD unit and on having a stand-alone risk factor–specific or NCD-specific policy. Surveillance systems on NCD risk factors have also improved, with almost all the countries and areas collecting information on most of the NCD risk factors, except for the measurement of total cholesterol. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201724 Year of survey 2004 2010 2013 2015 2017 Number of tools sent 37 37 37 36 36 Number of responses 28 35 36 32 35* Response rate 78% 94% 97% 89% 97% NCD policy and programme infrastructure Number of countries with a national NCD entity 14 (50%) 32 (91%) 36 (100%) 29 (91%) 33 (94%) Number of countries with an integrated NCD policy/strategy or action plan 15 (54%) 28 (80%) 33 (92%) 28 (88%) 27 (77%) Number of countries with policies, strategies, action plans specific to: Tobacco control 22 (79%) 29 (83%) 31 (86%) 24 (75%) 24 (69%) Harmful use of alcohol 12 (43%) 19 (54%) 22 (61%) 15 (47%) 19 (54%) Nutrition/Unhealthy diet 17 (61%) 23 (66%) 25 (69%) 20 (63%) 19 (54%) Physical activity 9 (32%) 21 (60%) 23 (64%) 13 (41%) 15 (43%) Overweight and obesity - 18 (51%) 21 (58%) 9 (28%) 13 (37%) Cancer 12 (43%) 23 (66%) 26 (72%) 21 (66%) 26 (74%) Surveillance and monitoring Number of countries with surveillance system for: Tobacco use 17 (61%) 31 (89%) 36 (100%) 32 (100%) 35 (100%) Harmful use of alcohol 13 (46%) 29 (83%) 34 (94%) 32 (100%) 35 (100%) Unhealthy diet 12 (43%) 30 (86%) 35 (97%) 32 (100%) 35 (100%) Physical inactivity 12 (43%) 27 (77%) 36 (100%) 32 (100%) 35 (100%) Diabetes 18 (64%) 28 (80%) 34 (94%) 31 (97%) 35 (100%) Hypertension 17 (61%) 29 (83%) 34 (94%) 30 (94%) 35 (100%) Overweight and obesity 15 (54%) 30 (86%) 35 (97%) 32 (100%) 35 (100%) Dyslipidaemia 10 (29%) 25 (71%) 31 (86%) 28 (88%) 33 (94%) Clinical interventions Number of countries with clinical protocols or guidelines for: Diabetes 18 (64%) 33 (94%) 33 (92%) 28 (88%) 31 (89%) Cancer 12 (43%) 23 (66%) 26 (72%) 22 (69%) 20 (57%) Availability of statins - 24 (69%) 31 (86%) 25 (78%) 27 (77%) Table 9. Comparison of country capacity indicators in 2004, 2010, 2013, 2015 and 2017 * In the 2015 and 2017 CCS, a more rigorous validation process was employed during data collection; hence, only 27 of the 35 countries and areas completely validated their submissions. This is higher compared to the validation in 2015, where only 15 of the 32 responding countries and areas were fully validated. Source: WHO Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 25 TEN PROGRESS MONITORING INDICATORS WHO published an NCD Progress Monitor in 2015 and in 2017. These outline the progress of countries in implementation of the four time-bound commitments included in the 2014 United Nations Outcome Document on NCDs, specifically on the 10 progress monitoring indicators (Fig. 9). CHAPTER 4 In addition to the 27 Member States with country profiles included in the NCD Progress Monitor 2017, the eight areas in the Region that participated in the survey were also reviewed and assessed and included in the summary in Table 10. For each indicator, the following symbols denote achievement: The data used in the assessment of the NCD progress monitor indicators were primarily from the 2017 NCD CCS and additional sources from the WHO mortality database, WHO Report on the Global Tobacco Epidemic, WHO Global Survey on Alcohol and Health, and the Marketing of Breast-milk Substitutes: National Implementation of the International Code Status Report 2016. A detailed description of the indicators and country status are presented in Annex 2. In the time-bound commitment on setting NCD targets for 2025, countries and areas in the Region have made considerable progress in having a set of time-bound NCD targets based on the NCD Global Monitoring Framework for NCDs, with 14 countries and areas that have fully achieved this indicator, while 12 have partially achieved it. Reliable cause-specific mortality data are generated from a functioning system on a routine basis mostly in HICs (7/8) that have fully achieved the indicator, while only four LMICs have partially achieved it; none of the LMICs have fully achieved this indicator. In the PICs, only one country has fully achieved the indicator on mortality while two countries have partially achieved the requirements of this indicator. Most LMICs (6/7) have conducted a periodic adult NCD risk factor survey in the last five years that collected information on harmful use of alcohol, physical inactivity, tobacco use, raised blood glucose/diabetes, raised blood pressure/ hypertension, overweight/obesity and salt/sodium intake, while only half of HICs (4/8) and a fifth of PICs (4/21) have fully achieved the NCD surveillance indicator. = fully achieved, = partially achieved, = not achieved, * = no data, DK = don't know● ◐ ○ Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201726 Fig. 9. Progress monitoring indicators on NCDs Source: http://www.who.int/nmh/events/2015/ncd-handout.pdf Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 27 Table 10. Achievement status of the NCD progress monitoring indicators in the Western Pacific Region, 2017 No. Country / Area PROGRESS MONITORING INDICATOR 1 2 3 4 5A 5B 5C 5D 5E 6A 6B 6C 7A 7B 7C 7D 8 9 10 HIGH-INCOME COUNTRIES AND AREAS 1 Australia ◐ ● ◐ ◐ ◐ ● ● ◐ ● ◐ ○ ◐ ◐ ● ● ○ ● ● DK 2 Brunei Darrussalam ● ● ● ● NA ● ● ◐ ○ ● ● ● DK ○ ○ ○ ● ◐ ● 3 Hong Kong SAR (China) ○ ● ● ● ◐ ● ● ● ● ◐ ○ ○ ◐ ● ● ○ ● ◐ ● 4 Japan ● ● ● ● ◐ ○ ◐ ○ ○ ◐ ○ ◐ ◐ ○ ○ ○ ● DK DK 5 Macao SAR (China) ○ * ◐ ● * * * * * * * * ◐ ○ ○ * ● ◐ ◐ 6 New Zealand ○ ● ◐ ○ ◐ ● ● ◐ ● ◐ ○ ◐ ◐ ● ● ○ ○ ● ● 7 Republic of Korea ● ● ● ◐ ◐ ◐ ◐ ○ ● ◐ ○ ◐ ● ● ● ◐ ● ◐ ● 8 Singapore ◐ ● ◐ ◐ ◐ ◐ ● ◐ ● ● ○ ● ● ● ● ○ ● ● DK LOW- AND MIDDLE-INCOME COUNTRIES 1 Cambodia ◐ ○ ● ○ ○ ● ● ◐ ● ○ ○ ◐ ○ ○ ○ ◐ ○ ○ ○ 2 China ● ◐ ● ● ◐ ○ ◐ ◐ ● ◐ ● ◐ ● ● ○ ◐ ○ ● ○ 3 Lao People'sDemocratic Republic ◐ ○ ◐ ● ○ ● ● ◐ NR ◐ ● ◐ ○ ○ ○ ◐ ○ ● ○ 4 Malaysia ● ◐ ● ◐ ◐ ○ ● ◐ ● ◐ ◐ ◐ ● ● ● ○ ● ● ● 5 Mongolia ● ◐ ● ● ○ ● ● ● ○ ◐ ○ ◐ ● ● ● ◐ ● ◐ ○ 6 Philippines ○ ◐ ● ○ ◐ ◐ ● ◐ ● ◐ ○ ◐ ○ ○ ○ ● ● ◐ ○ 7 Viet Nam ● ○ ● ● ○ ◐ ● ◐ ● ◐ ○ ◐ ○ ○ ○ ● ○ ● ○ PACIFIC ISLAND COUNTRIES AND AREAS RIES 1 American Samoa ◐ * ◐ * * * * * * * * * DK DK DK * - - DK 2 Cook Islands ◐ ◐ ◐ ● ◐ ◐ ◐ ◐ ○ NR NR NR ○ ○ ○ ○ ○ ● ● 3 Fiji ● ● ◐ ◐ ○ ◐ ● ◐ ● NR NR NR ○ ○ ○ ● ● ◐ ◐ 4 French Polynesia ○ * ◐ ○ * * * * * * * * ○ ○ ● * ● ● ◐ 5 Guam ● * ◐ ● * * * * * * * * ◐ ○ ○ * ● ◐ ◐ 6 Kiribati ◐ ◐ ● ○ ○ ◐ ◐ ● ● ◐ ○ ◐ ○ ○ ○ ○ ● ◐ DK 7 Marshall Islands ● ○ ○ ○ ◐ ● ○ ○ ○ ◐ ○ ● ○ ○ ○ ○ ○ ○ ○ 8 Federated States of Micronesia ◐ ○ ◐ ○ ◐ ○ ○ ○ ○ NR NR NR ○ ○ ○ NR ○ ◐ ○ 9 Nauru ● ○ ◐ ● ◐ ● ◐ ◐ ○ NR NR NR ◐ ○ ○ NR ○ ● ◐ 10 New Caledonia ○ * ◐ ○ * * * * * * * * - ○ - * - - ◐ 11 Niue ○ ○ ◐ ○ ● ○ ○ ○ NR NR NR NR ○ ○ ○ NR ● ● ◐ 12 Commonwealth of the Northern Mariana Islands ○ * ● ○ * * * * * * * * ○ ○ DK * ● ◐ ● 13 Palau ◐ ○ ◐ ◐ ◐ ◐ ○ ◐ NR NR NR NR NR NR NR ● NR ● ● 14 Papua New Guinea ◐ ○ ◐ ◐ ○ ● ○ ◐ ○ NR NR NR ○ ○ ○ ◐ ○ ◐ ○ 15 Samoa ○ ○ ● ○ ◐ ◐ ● ◐ NR ● ○ ● ○ ○ ○ ○ ○ ◐ ○ 16 Solomon Islands ● ○ ● ● ○ ◐ ● ◐ NR NR NR NR ○ ○ ○ ◐ ○ ◐ ○ 17 Tokelau ◐ * ◐ ○ * * * * * * * * ○ ○ ○ * ● DK ● 18 Tonga ● ○ ◐ ● ◐ ◐ ◐ ◐ ● NR NR NR ○ ○ ○ NR ● ◐ ○ 19 Tuvalu ◐ ○ ● ○ ◐ ◐ ◐ ● ○ NR NR NR ○ ○ ○ ○ ○ ◐ ◐ 20 Vanuatu ● ○ ◐ ● ◐ ○ ● ● ○ ◐ ○ ● ◐ ○ ● ○ ○ ◐ ○ 21 Wallis and Futuna NR * NR NR * * * * * * * * NR NR NR * NR NR NR Fully achieved 14 8 15 14 1 10 15 5 13 3 3 5 5 8 9 4 18 12 9 Partially achieved 12 6 19 7 18 12 8 18 0 14 1 12 8 0 0 7 0 17 8 Not achieved 9 14 1 13 8 6 5 5 10 1 14 1 18 25 22 13 14 2 13 ○ = not achieved ◐ = partially achieved ● = fully achieved — = documentation not available * = no data DK = don't know NR = no response NA = not applicable Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201728 Fourteen countries and areas have developed an operational multisectoral national strategy or action plan that integrates all the major NCDs and their risk factors, while seven countries and areas have partially achieved this indicator, integrating at least two of the four major NCDs and two of the four main NCD risk factors in their NCD strategies or action plans. Implementation of plain or standardized packaging and/or large graphic warnings on all tobacco packages remains the most widespread demand-reduction measure of the WHO Framework Convention on Tobacco Control (WHO FCTC) in the Region, with 15 and 8 countries and areas fully and partially achieving this indicator, respectively. Effective public mass media campaigns on the harms of smoking and second-hand smoke are the second most common demand-reduction measure of the Convention, while the elimination of exposure to second-hand tobacco smoke places third. More work is needed on tobacco taxation and advertising in countries and areas in the Region. For alcohol harm reduction, most of the regulations on commercial and public availability (14/35) and taxation (12/35) of alcohol have been partially achieved; only three countries in the Region have fully achieved these alcohol indicators. Bans or comprehensive restrictions on exposure to alcohol advertising are the least achieved alcohol reduction measure, with only three countries that have fully achieved this indicator and one country partially achieving it. Among the measures to reduce unhealthy diets, policies to reduce the impact on children of marketing of foods and non-alcoholic beverages and policies that limit saturated fatty acids are the most common approaches adopted in the Region. However, countries and areas in the Region have to implement more legislations or policies on unhealthy diet, such as on implementation of the code on breast-milk substitutes and reduction of population salt/ sodium consumption. Of all the NCD progress monitoring indicators, having a national public awareness programme on physical activity is the most widely implemented intervention in the Region, with half of the countries and areas (18/35) implementing a programme within the past five years. Under health systems strengthening to address NCDs through people-centred primary health care and universal health coverage, evidence-based guidelines for the management of the major NCDs are prevalent in the Region, with a third of the countries and areas in the Region (12/35) having guidelines on all the major NCDs while almost half (17/35) have guidelines on at least two of the four major NCDs. Provision of drug therapy and counselling for eligible persons at high risk to prevent heart attacks and strokes has also advanced in the Region, with nine countries and areas that have fully achieved this indicator and eight countries and areas meeting the partially achieved assessment. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 29 Overall, public awareness programmes on diet and/or physical activity remain the most widely implemented and fully achieved indicator (18/35) amongst the 10 progress monitoring indicators in the Western Pacific Region. A significant third of the countries and areas in the Region have fully achieved the indicators on having NCD targets, integrated NCD policy, plain/standardized packaging of tobacco products and periodic NCD risk factor surveys, with a noteworthy number of countries and areas partially achieving these indicators as well. Some progress is also noted on the policies that reduce the impact on marketing of unhealthy foods and non-alcoholic beverages to children, as well as on limiting saturated fatty acids, in countries and areas in the Region. While more countries and areas have yet to implement the recommended interventions for health systems strengthening to address NCDs, significant progress was observed on the provision of drug therapy and counselling, as well as having evidence-based guidelines on the management of the major NCDs, with more countries and areas fully and partially achieving these indicators from 2015 to 2017. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201730 REGIONAL RESPONSE AND WAY FORWARD CHAPTER 5 A. Regional response WHO supported Member States of the Region in developing multisectoral action plans or strategies for NCD prevention and control. National plans were endorsed in eight countries: Cook Islands, Fiji, Nauru, Palau, Papua New Guinea, Tonga, Vanuatu and Viet Nam. A joint mission of the United Nations Interagency Task Force on NCD prevention and control was dispatched to Tonga in 2015, to Mongolia in 2015 and 2016, and to Viet Nam in 2016. In June 2017, the United Nations Global Joint Programme on Cervical Cancer Prevention and Control conducted a mission in Mongolia to develop and sustain high-quality comprehensive cervical cancer control programmes. Four countries were selected for accelerated implementation of multisectoral action plans to reduce risk factors and manage NCD cases at the primary care level with integrated support and expertise from the three organizational levels of WHO. This is supported by the “One WHO” NCD mechanism. Mongolia, the Philippines, Tonga and Viet Nam have committed to making fast-track progress in 2017 and 2018 towards achieving the nine voluntary global targets for NCDs by 2025 and the NCD-related targets of the Sustainable Development Goals by 2030. The Regional Workshop on Strengthening Leadership and Advocacy for the Prevention and Control of Noncommunicable Diseases (LeAd-NCD), launched in 2013, is the first and only regional leadership programme on NCD prevention and control. Recent topics covered by LeAd-NCD include childhood obesity and physical activity. Capacity-building for cancer control is a priority in the Western Pacific Region and the yearly Workshop on Leadership and Capacity-Building for Cancer Control (CanLEAD) that also started in 2013 has focused on cervical cancer and early cancer diagnosis. Since the second workshop, this initiative has expanded to include global participants in 2016 and 2017. To emphasize prevention and strengthen initiatives to address NCD risk factors, national Health Promotion Leadership (ProLead) workshops were held in China in 2015, Macao SAR (China) in 2015 and 2016, and the Northern Pacific (Guam, Federated States of Micronesia, Commonwealth of the Northern Mariana Islands and Palau) in 2016 and 2017. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 31 Action on risk factors is a priority for all countries. Technical assistance was provided on tobacco control efforts and was focused on three areas as per the Regional Action Plan for the Tobacco Free Initiative in the Western Pacific (2015–2019). For strengthening sustainable institutional capacity, subregional preparatory meetings were held before the Seventh Conference of the Parties and workshop on the Protocol to Eliminate Illicit Trade in Tobacco Products, as well as a workshop on the Protocol to Eliminate Illicit Trade in Tobacco Products that led to the signing of a memorandum of understanding between WHO and the Oceania Customs Organisation to prevent illicit trade in the Pacific. Countries in the Region were also supported in the development and enactment of legislations and regulations based on the MPOWER package. In terms of enforcement of tobacco control measures, working with relevant stakeholders is continuously being supported. Technical support on the implementation of the WHO set of recommendations on marketing of foods and non-alcoholic beverages to children was provided for the development of policy in the Philippines. A background document was also developed that led to the endorsement of the resolution on Protecting Children from the Harmful Impact of Food Marketing. PICs (Nauru, Kiribati, Tuvalu and Solomon Islands) were also supported in the inclusion of nutrition-related questions, which include questions on the consumption of sugar- sweetened beverages. Salt-reduction activities are also gaining popularity as a means to meet the commitment to the associated global targets on salt/sodium and raised blood pressure. Countries particularly supported by the Regional Office in salt-reduction activities include China, Federated States of Micronesia, Mongolia and Viet Nam. Brunei Darussalam and Malaysia have piloted a technical package developed by WHO headquarters to increase population physical activity. Healthy Settings initiatives were also intensified in the Region, including health-promoting schools (Cambodia, Fiji, Tonga and Viet Nam), healthy cities (Cambodia, China and the Philippines), healthy islands and villages (Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Solomon Islands and Vanuatu), and healthy restaurants (Brunei Darussalam). WHO continues to support Member States in the implementation of the Package of Essential NCD Interventions (PEN). Beyond this, the Regional Office has pioneered new approaches to NCD management to address local demand and low-resource settings. In collaboration with WHO headquarters, the Global HEARTS initiative – an expansion of PEN – was launched at the General Assembly in September 2016 and is currently being demonstrated in one district in the Philippines. Results from this demonstration site will be shared in 2018. The HEARTS package has also been introduced in the Mekong countries and PICs. A milestone innovation of the Region that has the potential for global use is the NCD education manual for primary health care professionals and patients, developed in collaboration with the Ministry of Health and Welfare of the Republic of Korea, consisting of 15 modules with simple and user-friendly information on the prevention and control of hypertension and diabetes for health workers in primary health-care facilities. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201732 WHO is at the forefront of the development of HeartCare, also another product with potential for scaled-up use. HeartCare is a software application to be used at the primary level to identify individuals at high risk for CVD and to provide standardized counselling and management, while at the same time establishing a central database. To further strengthen capacity in countries in addressing pain management and palliative care, the WHO Collaborating Centre for Training in Hospice and Palliative Care in Seoul, Republic of Korea – the Research Institute for Hospice and Palliative Care, Catholic University of Korea College of Nursing – conducts International Workforce Training Workshops with participation from Member States of the Western Pacific and African Regions. Surveillance systems to monitor NCD risk factors and disease trends have been strengthened for planning, implementation, reporting and dissemination of NCD risk factor surveys such as the WHO STEPwise approach to surveillance (STEPS) survey and the Global School- based Student Health Survey (GSHS). Instruments for NCD surveillance at the subnational level, particularly in cities and islands, have been developed and piloted in the Philippines. Known as “local integration options for NCD-essential surveillance systems” (LIONESS), the instruments include NCD risk factor surveys for adolescents, schools, adults and health facilities. The Region has been a pathfinder in the use of technology for improvement of NCD surveillance. For example, Cambodia was the first country in the Region to use new technology for data collection on the STEPS survey with the Android-based eSTEPS. Tonga, during their third national STEPS, piloted the first objective measurement of physical activity in the world, aimed at a sample of 750 participants wearing pedometers for five consecutive days. To ensure high-quality, reliable NCD data, a regional workshop has been held on NCD surveillance and monitoring every two years since 2014 to update progress on the four time-bound national commitments and the nine voluntary global targets for NCD. Cancer registration was also strengthened in the Region, with workshops organized from 2014 onwards in Cambodia, Fiji, French Polynesia, the Lao People’s Democratic Republic, Nauru, Papua New Guinea, the Philippines, Samoa, Solomon Islands, Tonga and Viet Nam. In-country training support for cancer registration was also provided from 2014 to 2016 to Brunei Darussalam, Fiji, Papua New Guinea and Viet Nam. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 33 B. Way forward As Member States recall the commitments they agreed to during the 2011 High-level Meeting on NCDs, some countries and areas are to be commended on their progress thus far. However, looking at the overall current status in the Region, bolder actions are still needed from governments to meet the global target on the reduction of premature NCD mortality. Development of coherent policies across government sectors through a Health in All Policies approach to address NCDs is recommended. Dialogues with lawmakers and with sectors beyond health and non-state actors are crucial to the development, implementation and enforcement of legislations and regulations related to NCDs and their risk factors. Member States are encouraged to consider prioritizing and accelerating the implementation – according to national context – of the most cost-effective, affordable and evidence-based interventions that address the NCD risk factors. Increased financing is also critical in the implementation of these interventions and is an urgent issue governments should put in place. Provision of essential population-level, people-centred public health functions, including that for the prevention and management of NCDs, is fundamental to achieving universal health coverage. Strengthening the surveillance and monitoring systems in countries is also crucial as they enable the reporting of progress against the global targets for NCDs. In the third UN High-level Meeting on NCDs later this year, Member States will once again renew their commitments on NCD prevention and control. Governments may also consider evaluating their current efforts and plans to ensure that their national policies, strategies and actions are well aligned to achieve the global target of reducing premature mortality from NCDs by one third by 2030. The unwavering political commitment of the Member States in the Western Pacific Region is anticipated to make all these actions possible, along with the continuous support provided by WHO. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201734 REFERENCES CHAPTER 6 Causes of death, by WHO region [online database]. In: Global Health Observatory (GHO) data [website]. Geneva: WHO; 2016 (http://www.who.int/gho/mortality_burden_disease/causes_death/region/en/, accessed 25 May 2018). Resolution A/RES/66/2. Political declaration of the high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. In: Sixty- sixth United Nations General Assembly, New York; 19–20 September 2011 (http://www.un.org/Docs/asp/ws.asp?m=A/RES/66/2, accessed 5 April 2018). Global action plan for the prevention and control of NCDs 2013–2020. Geneva: WHO; 2013 (http://apps.who.int/iris/handle/10665/94384/, accessed 5 April 2018). Western Pacific regional action plan for the prevention and control of noncommunicable diseases (2014–2020). Manila: WHO Regional Office for the Western Pacific; 2014 (http://apps.who.int/iris/handle/10665/208175, accessed 5 April 2018). Resolution A/Res/68/300. Outcome document of the high-level meeting of the General Assembly on the comprehensive review and assessment of the progress achieved in the prevention and control of non-communicable diseases. In: Sixty- eighth United Nations General Assembly, New York; 10–11 July 2014 (http://www.un.org/es/comun/docs/index.asp?symbol=A/RES/68/300&referer=/ spanish/&Lang=E, accessed 5 April 2018). World Bank list of economies. Washington, DC: The World Bank; June 2017 (http://databank.worldbank.org/data/download/site-content/CLASS.xls, accessed December 2017). (1) (2) (3) (4) (5) (6) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 35 ANNEX 1 NCD COUNTRY CAPACITY SURVEY 2017 QUESTIONNAIRE Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201736 2017 Country Profile of Capacity and Response to Noncommunicable Diseases (NCDs) MODULES: I PUBLIC HEALTH INFRASTRUCTURE, PARTNERSHIPS AND MULTISECTORAL COLLABORATION FOR NCDs AND THEIR RISK FACTORS II STATUS OF NCD-RELEVANT POLICIES, STRATEGIES AND ACTION PLANS III HEALTH INFORMATION SYSTEMS, MONITORING, SURVEILLANCE AND SURVEYS FOR NCDs AND THEIR RISK FACTORS IV CAPACITY FOR NCD EARLY DETECTION, TREATMENT AND CARE WITHIN THE HEALTH SYSTEM The purpose of this survey is to gauge your country’s capacity for responding to noncommunicable diseases. It will guide Member States, WHO Regional Offices and WHO HQ in planning future actions and technical assistance required to address NCDs and their risk factors. This is also the basis for ongoing assessment of changes in country capacity and response. The information collected through this survey will also be used to produce some of the indicators that Member States have agreed to monitor and will be held accountable to the United Nations General Assembly (UNGA) and World Health Assembly (WHA); Use of standardized questions allows comparisons of country capacities and responses. We have divided this survey into four modules, assessing four key aspects of NCD prevention and control. The four main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. The main risk factors for NCDs are harmful use of alcohol, tobacco use, unhealthy diet, and physical inactivity. Capacity assessment related to some specific risk factors is also captured in other topic- specific assessments – e.g. for tobacco through the WHO Report on the Global Tobacco Epidemic. The survey is intended to assess national level capacity and response to NCDs. If responsibility for health is decentralized to sub-national levels, it can also be applied at sub-national levels. A focal point or survey coordinator will need to be identified to coordinate and ensure survey completion. However, in order to provide a complete response, a group of respondents with expertise in the topics covered in the modules will be needed. Please use the table provided to indicate the names and titles of all of those who have completed the survey and which sections they have completed. Please also add any additional information on other sources you may have consulted in developing your response. Please note that while there is space to indicate “Don’t know” for most questions, there should be very few of these. If someone is filling in numerous “Don’t knows”, another person who is more aware of this information should be found to complete this section. In order to validate responses, documentation will be requested for affirmative responses throughout the questionnaire. Please make every effort to provide electronic copies of the requested documentation. If documentation has been provided previously and is available in the NCD Document Repository (https://extranet.who.int/ncdccs/documents), please indicate this. If you are unable to provide electronic copies through the provided links, please ask your regional focal point for an alternative means to submit documentation. Purpose • • • • • • • • • Process Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 37 Information on those who completed the survey Who is the focal point for completion of this survey? Name: __________________________________________________________________ Position: __________________________________________________________________ Contact Information: __________________________________________________________________________ Sections completed: __________________________________________________________________________ Name and contact information of others completing survey Sections completed Additional information sources consulted: Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201738 Public health infrastructure, partnerships and multisectoral collaboration for NCDs and their risk factorsI. This module includes questions related to the presence of a unit or division in the ministry of health dedicated to NCDs and risk factors, staff and funding. It also includes an assessment of the existence of fiscal interventions as incentives to influence health behaviour and/or to raise funds for health-related activities. Finally, it assesses the existence of a formal multisectoral mechanism to coordinate NCD-related activities in sectors outside of health. Responses to these questions enable reporting against NCD Global Action Plan process indicators and UN High Level Meeting national commitment progress indicators. 1) Is there a unit/branch/department in the ministry of health or equivalent with responsibility for NCDs and their risk factors? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 2 1a) Please indicate the number of full-time-equivalent technical/professional staff in the unit/branch/department. 􀀀 0 􀀀 1 􀀀 2-5 􀀀 6 - 10 􀀀 11 or more 􀀀 Don’t know 2) Is there funding allocated in the government budget for the following NCD and risk factor activities/functions? i) Primary prevention 􀀀 Yes 􀀀 No 􀀀 Don’t know ii) Health promotion 􀀀 Yes 􀀀 No 􀀀 Don’t know iii) Early detection/screening 􀀀 Yes 􀀀 No 􀀀 Don’t know iv) Health care and treatment 􀀀 Yes 􀀀 No 􀀀 Don’t know v) Surveillance, monitoring and evaluation 􀀀 Yes 􀀀 No 􀀀 Don’t know vi) Capacity building 􀀀 Yes 􀀀 No 􀀀 Don’t know vii) Palliative care 􀀀 Yes 􀀀 No 􀀀 Don’t know viii) Research 􀀀 Yes 􀀀 No 􀀀 Don’t know If at least one Yes to above questions: 2a) What are the major sources of regular funding for NCDs and their risk factors? More than one can apply, rank order them where: 1=Largest source; 2=Next largest; 3=Others 􀀀 General government revenues 􀀀 Health insurance 􀀀 International donors 􀀀 National donors 􀀀 Earmarked taxes on alcohol, tobacco, etc. 􀀀 Other (specify) ________________________________ 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 39 3) Is your country implementing any of the following fiscal interventions? (for taxes, please respond “Yes” only if excise taxes and/or special VAT/sales tax rates are applied) taxation on alcoholic beverages 􀀀 Yes 􀀀 No 􀀀 Don’t know taxation on tobacco (excise and non-excise taxes) 􀀀 Yes 􀀀 No 􀀀 Don’t know taxation on sugar sweetened beverages 􀀀 Yes 􀀀 No 􀀀 Don’t know taxation on foods high in fat, sugar or salt 􀀀 Yes 􀀀 No 􀀀 Don’t know price subsidies for healthy foods 􀀀 Yes 􀀀 No 􀀀 Don’t know taxation incentives to promote physical activity 􀀀 Yes 􀀀 No 􀀀 Don’t know others (specify) 􀀀 Yes 􀀀 No 􀀀 Don’t know If Yes to at least one of the above, other than price subsidies: 3a) Are any of these funds earmarked for health promotion or health service provision? 􀀀 Yes 􀀀 No 􀀀 Don’t know 4) Is there a national multisectoral commission, agency or mechanism to oversee NCD engagement, policy coherence and accountability of sectors beyond health? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to MODULE II 4a) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational or under development: 4b) Please provide name: _____________________________________________________ 4c) Which of the following are members? (Check all that apply) 􀀀 Other Government Ministries (non-health, e.g. ministry of sport, ministry of education) 􀀀 United Nations Agencies 􀀀 Other international institutions 􀀀 Academia (including research centres) 􀀀 Nongovernmental organizations/community-based organizations/civil society 􀀀 Private Sector 􀀀 Other (specify) _____________________________________________________ 􀀀 Don’t know IF “Private Sector” is one of the members: 4d) Is the tobacco industry's participation to the consultations and decision making process excluded from the national multisectoral commission? 􀀀 Yes 􀀀 No 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201740 This module includes questions relating to the presence of policies, strategies, or action plans - the questions differentiate between integrated policies/strategies/action plans that address several risk factors or diseases, and policies/strategies/action plans that address a specific disease or risk factor. Additional questions address the existence of specific policies related to the cost-effective interventions for NCDs. Responses to these questions enable reporting against NCD Global Action Plan process indicators and UN High Level Meeting national commitment progress indicators. 1a) Are NCDs included in the outcomes or outputs of your current national health plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 1b) Are NCDs included in the outcomes or outputs of your current national development agenda? 􀀀 Yes 􀀀 No 􀀀 Don’t know 2) Are there a set of time-bound national targets for NCDs based on the 9 voluntary global targets from the WHO Global Monitoring Framework for NCDs? 􀀀 Yes 􀀀 No 􀀀 Don’t know If Yes: 2a) Are there a set of national indicators for these targets based on the indicators from the WHO Global Monitoring Framework for NCDs? 􀀀 Yes 􀀀 No 􀀀 Don’t know II A: INTEGRATED POLICIES, STRATEGIES, AND ACTION PLANS 3) Does your country have a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors? Please note that disease- and risk factor-specific policies, strategies, and action plans will be reported in other questions later in this module. 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 4 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it multisectoral? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it multi-stakeholder? 􀀀 Yes 􀀀 No 􀀀 Don’t know Please provide the following information about the policy, strategy or action plan: 3a) Title: ___________________________________________________________________ II. Status of NCD-relevant policies, strategies and action plans Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 41 3b) Does it address one or more of the following major risk factors? Harmful use of alcohol 􀀀 Yes 􀀀 No 􀀀 Don’t know Unhealthy diet 􀀀 Yes 􀀀 No 􀀀 Don’t know Physical inactivity 􀀀 Yes 􀀀 No 􀀀 Don’t know Tobacco 􀀀 Yes 􀀀 No 􀀀 Don’t know 3c) Does it include early detection, treatment and care for: Cancer 􀀀 Yes 􀀀 No 􀀀 Don’t know Cardiovascular diseases 􀀀 Yes 􀀀 No 􀀀 Don’t know Chronic respiratory diseases 􀀀 Yes 􀀀 No 􀀀 Don’t know Diabetes 􀀀 Yes 􀀀 No 􀀀 Don’t know 3d) Does it include palliative care for patients with NCDs? 􀀀 Yes 􀀀 No 􀀀 Don’t know 3e) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 3e-i) What was the first year of implementation? ________________________ 3e-ii) What year will it expire? _____________________________________ II B: POLICIES, STRATEGIES, ACTION PLANS FOR SPECIFIC KEY NONCOMMUNICABLE DISEASES The questions in this sub-section only refer to policies, strategies and action plans that are specific to key NCDs. If your integrated policy, strategy or action plan addresses the NCD, you do not need to re-enter that information. 4) Is there a policy, strategy, or action plan for cardiovascular diseases in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 5 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 4a) Write the title _____________________________________________________ 4b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201742 If Operational: 4b-i) What was the first year of implementation? ________________________ 4b-ii) What year will it expire? _____________________________________ 5) Is there a policy, strategy, or action plan for cancer or some particular cancer types in your country? 􀀀 Yes for all cancers or cancer in general 􀀀 Yes but only for specific cancers (specify: ____________________________________) 􀀀 No 􀀀 Don’t know IF NO: Go to Question 6 If yes, provide the following for the general cancer policy/strategy/action plan or, if there isn’t one, for the most important specific cancer policy/strategy/action plan: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 5a) Write the title _____________________________________________________ 5b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 5b-i) What was the first year of implementation? ________________________ 5b-ii) What year will it expire? _____________________________________ 6) Is there a policy, strategy, or action plan for diabetes in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 7 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 6a) Write the title _____________________________________________________ 6b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 6b-i) What was the first year of implementation? ________________________ 6b-ii) What year will it expire? _____________________________________ Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 43 7) Is there a policy, strategy, or action plan for chronic respiratory diseases in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 8 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 7a) Write the title _____________________________________________________ 7b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 7b-i) What was the first year of implementation? ________________________ 7b-ii) What year will it expire? _____________________________________ 8) Is there a policy, strategy, or action plan for oral health in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 9 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 8a) Write the title _____________________________________________________ 8b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 8b-i) What was the first year of implementation? ______________________________ 8b-ii) What year will it expire? ___________________________________________ 9) Is there a policy, strategy, or action plan for another non-communicable disease of importance in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 10 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201744 Please provide the following information about the policy / strategy / action plan. If there is more than one, please provide the information for the most recent one. Please specify which NCD: ______________________________________________ 9a) Write the title _____________________________________________________ 9b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 9b-i) What was the first year of implementation? ________________________ 9b-ii) What year will it expire? _____________________________________ II C: POLICIES, ACTION PLANS, STRATEGIES FOR NCD RISK FACTORS The questions in this sub-section only refer to policies, strategies and action plans that are specific to an NCD risk factor. If your integrated policy, strategy or action plan addresses the risk factor, you do not need to re- enter that information. 10) Is there a policy, strategy, or action plan for reducing the harmful use of alcohol in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 11 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 10a) Write the title ____________________________________________________ 10b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 10b-i) What was the first year of implementation? _______________________ 10b-ii) What year will it expire? ____________________________________ 11) Is there a policy, strategy, or action plan for reducing overweight / obesity in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 12 Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 45 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 11a) Write the title ____________________________________________________ 11b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 11b-i) What was the first year of implementation? _______________________ 11b-ii) What year will it expire? _____________________________________ 12) Is there a policy, strategy, or action plan for reducing physical inactivity and/or promoting physical activity in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 13 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 12a) Write the title ____________________________________________________ 12b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 12b-i) What was the first year of implementation? _______________________ 12b-ii) What year will it expire? _____________________________________ 13) Is there a policy, strategy, or action plan to decrease tobacco use in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 14 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 13a) Write the title ____________________________________________________ Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201746 13b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 13b-i) What was the first year of implementation? _______________________ 13b-ii) What year will it expire? _____________________________________ 14) Is there a policy, strategy, or action plan for reducing unhealthy diet related to NCD and/ or promoting a healthy diet in your country? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 15 If yes: Is it a policy/strategy? 􀀀 Yes 􀀀 No 􀀀 Don’t know Is it an action plan? 􀀀 Yes 􀀀 No 􀀀 Don’t know 14a) Write the title ____________________________________________________ 14b) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know If Operational: 14b-i) What was the first year of implementation? _______________________ 14b-ii) What year will it expire? _____________________________________ II D: SELECTED COST-EFFECTIVE POLICIES FOR NCDS AND RELATED RISK FACTORS NB: Only selected policies are captured here as information on some policy measures, e.g. for tobacco and alcohol, are included in other assessment tools. 15) Is there a policy and/or plan on NCD-related research including community-based research and evaluation of the impact of interventions and policies? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 16 If yes: 15a) Indicate its stage: 􀀀 Operational 􀀀 Under development 􀀀 Not in effect 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 47 16) Is your country implementing any policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 17 If yes: 16a) Are the policies: 􀀀 Voluntary/self-regulating 􀀀 Government legislation 􀀀 Don't know 16b) Who is responsible for overseeing enforcement and complaints? 􀀀 Government 􀀀 Food Industry 􀀀 Independent regulator 􀀀 Other, please specify: _______________________________________________ 16c) Do they include steps taken to address the effects of cross-border marketing of food and non-alcoholic beverages on children? 􀀀 Yes 􀀀 No 􀀀 Don’t know 16c-i) If yes, please provide details: __________________________________ 17) Is your country implementing any national policies that limit saturated fatty acids and virtually eliminate industrially produced trans-fats (i.e. partially hydrogenated vegetable oils) in the food supply? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 18 17a) If yes, are the policies: 􀀀 Voluntary/self-regulating 􀀀 Government legislation 􀀀 Don’t know 18) Is your country implementing any policies to reduce population salt consumption? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 19 18a) Are these targeted at: Product reformulation by industry across the food supply 􀀀 Yes 􀀀 No 􀀀 Don’t know Regulation of salt content of food 􀀀 Yes 􀀀 No 􀀀 Don’t know Public awareness programme 􀀀 Yes 􀀀 No 􀀀 Don’t know Nutrition labeling 􀀀 Yes 􀀀 No 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201748 18b) If yes to product reformulation or regulation of salt content, is the policy: 􀀀 Voluntary/self-regulating 􀀀 Government legislation 􀀀 Don’t know 19) Has your country implemented any national public awareness programme on diet within the past 5 years? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 20 19a) If yes, please provide details of the public awareness programme(s): ___________________________________________________________________ 20) Has your country implemented any national public awareness programme on physical activity within the past 5 years? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to MODULE III 20a) If yes, please provide details of the public awareness programme(s): ___________________________________________________________________ The questions in this module assess surveillance relating to the mortality, morbidity and risk factor reporting systems of each country and whether NCD mortality, morbidity and risk factor data were included in their national health reporting systems. Responses to these questions enable reporting against NCD Global Action Plan process indicators and UN High Level Meeting national commitment progress indicators. 1) In your country, who has responsibility for surveillance of NCDs and their risk factors? 􀀀 An office/department/administrative division within the MOH exclusively dedicated to NCD surveillance 􀀀 An office/department/ administrative division within the MOH not exclusively dedicated to NCD surveillance 􀀀 Responsibility is shared across several offices/departments/administrative divisions within the MOH 􀀀 Coordination is by an external agency, such as an NGO or statistical organization 􀀀 No one has this responsibility 􀀀 Don’t know III. Health information systems, monitoring, surveillance and surveys for NCDs and their risk factors Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 49 III A: DATA INCLUDED IN THE NATIONAL HEALTH INFORMATION SYSTEM (National health information system refers to the annual or regular reporting system of the National Statistical Office or Ministry of Health) 2) Does your country have a system for collecting mortality data by cause of death on a routine basis? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 3 IF YES: 2a) Is there a civil/vital registration system? 􀀀 Yes 􀀀 No 􀀀 Don’t know 2b) Is there a sample registration system? 􀀀 Yes 􀀀 No 􀀀 Don’t know 2c) What is the latest year for which data are available? _________________________ 2d) Can the data collected be disaggregated by: Age 􀀀 Yes 􀀀 No 􀀀 Don’t know Gender 􀀀 Yes 􀀀 No 􀀀 Don’t know Other sociodemographic factor 􀀀 Yes 􀀀 No 􀀀 Don’t know 3) Does your country have a cancer registry? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 4 IF YES: 3a) Are the data collected population-based, hospital-based, or other? 􀀀 population-based 􀀀 hospital-based 􀀀 Other (specify: _____________________________________________________) 􀀀 Don’t know 3b) Is the coverage of the registry national or subnational? 􀀀 National (covers the whole population of the country) 􀀀 Subnational (covers only the population of a defined region, not the whole country) 􀀀 Don’t know 3c) What is the latest year for which data are available? ___________________________________________________________________ 4) Does your country have a diabetes registry? 􀀀 Yes 􀀀 No 􀀀 Don’t know | IF NO: Go to Question 5 IF YES: 4a) Are the data collected population-based, hospital-based, or other? 􀀀 population-based 􀀀 hospital-based 􀀀 Other (specify: _____________________________________________________) 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201750 4b) Is the coverage of the registry national or subnational? 􀀀 National (covers the whole population of the country) 􀀀 Subnational (covers only the population of a defined region, not the whole country) 􀀀 Don’t know 4c) Does the registry include data on any chronic complications which are updated as the patient’s complications status changes? 􀀀 Yes 􀀀 No 􀀀 Don’t know 4d) What is the latest year for which data are available? __________________________________________________________________ 5) Does your country have a system for recording patient information that includes NCD status? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 6 IF YES: 5a) Is it an electronic medical records/health records system? 􀀀 Yes 􀀀 No 􀀀 Don’t know 5b)What is the coverage of the system? 􀀀 National (covers the whole population of the country) 􀀀 Subnational (covers only the population of a defined region or regions or only certain segments of the population) 􀀀 Don’t know 6) Has your country conducted a survey of facilities to assess service availability and readiness for NCDs? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to Question 7 6a) Year of last survey _________________________________________________ 6b) Coverage of last survey: 􀀀 National 􀀀 Subnational 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 51 III B: RISK FACTOR SURVEILLANCE 7a) Harmful alcohol use 7b) Low fruit and vegetable consumption 7c) Physical inactivity 7d) Tobacco use 7) Have population-based surveys of risk factors (may be a single RF or multiple) been conducted in your country for any of the following: (Please fill in all columns, start in the first row, going left to right, and then continue left to right across the second row.) For the questions on surveys on adolescents, please include here only surveys specifically targeting adolescents (i.e. do not repeat adult surveys that may have covered part of the adolescent age range). 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to next column. IF YES: i) Was there a survey on adolescents? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: i-1) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know i-2) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know i-3) When was the last survey conducted? (give year) _____ ii) Was there a survey on adults? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: ii-1) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know ii-2) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know ii-3) When was the last survey conducted? (give year) _____ 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to next column. IF YES: i) Was there a survey on adolescents? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: i-1) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know i-2) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know i-3) When was the last survey conducted? (give year) _____ ii) Was there a survey on adults? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: ii-1) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know ii-2) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know ii-3) When was the last survey conducted? (give year) _____ 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to next column. IF YES: i) Was there a survey on adolescents? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: i-1) Was it: 􀀀 Measured 􀀀 Self-reported 􀀀 Don’t know i-2) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know i-3) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know i-4) When was the last survey conducted? (give year) _____ ii) Was there a survey on adults? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: ii-1) Was it: 􀀀 Measured 􀀀 Self-reported 􀀀 Don’t know ii-2) Did it assess physical activity for work/in the household, for transport and during leisure time? 􀀀 Yes 􀀀 No 􀀀 Don’t know ii-3) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know ii-4) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know ii-5) When was the last survey conducted? (give year) ___________ 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to next column. IF YES: i) Was there a survey on adolescents? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: i-1) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know i-2) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know i-3) When was the last survey conducted? (give year) _____ ii) Was there a survey on adults? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: ii-1) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know ii-2) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know ii-3) When was the last survey conducted? (give year) _____ Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201752 7) cont. 7e) Raised blood glucose/ diabetes 7f) Raised total cholesterol 7g) Raised blood pressure/ Hypertension 7h) Overweight and obesity 7i) Salt / Sodium intake 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to next column. IF YES: i) Was it: 􀀀 Measured 􀀀 Self-reported 􀀀 Don’t know ii) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know iii) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know iv) When was the last survey conducted? (give year) _____ 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to next column. IF YES: i) Was it: 􀀀 Measured 􀀀 Self-reported 􀀀 Don’t know ii) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know iii) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know iv) When was the last survey conducted? (give year) _____ 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to next column. IF YES: i) Was it: 􀀀 Measured 􀀀 Self-reported 􀀀 Don’t know ii) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know iii) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know iv) When was the last survey conducted? (give year) _____ 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to next column. IF YES: i) Was there a survey on adolescents? 􀀀 Yes 􀀀 No 􀀀 Don't know IF YES: i-1) Was it: 􀀀 Measured 􀀀 Self-reported 􀀀 Don’t know i-2) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know i-3) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know i-4) When was the last survey conducted? (give year) _____ ii) Was there a survey on adults? 􀀀 Yes 􀀀 No 􀀀 Don't know IF YES: ii-1) Was it: 􀀀 Measured 􀀀 Self-reported 􀀀 Don’t know ii-2) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know ii-3) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know ii-4) When was the last survey conducted? (give year) _______ 􀀀 Yes 􀀀 No 􀀀 Don’t know IF NO: Go to MODULE IV. IF YES: i) Was it: 􀀀 Measured by 24-hr urine collection 􀀀 Measured by 12-hr urine collection 􀀀 Measured by spot urine collection 􀀀 Measured by combination of methods 􀀀 Self-reported 􀀀 Don’t know ii) Was it: 􀀀 National 􀀀 Subnational 􀀀 Don’t know iii) How often is the survey conducted? 􀀀 Ad hoc 􀀀 Every 1 to 2 years 􀀀 Every 3 to 5 years 􀀀 Other 􀀀 Don’t know iv) When was the last survey conducted? (give year) _____ Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 53 The questions in this module assess the health care systems capacity related to NCD early detection, treatment and care within the health care sector. Specific questions focus on availability of guidelines or protocols to treat major NCDs, and the tests, procedures and equipment related to NCDs within the health-care system. It also assesses the availability of palliative care services for NCDs. Responses to these questions enable reporting against NCD Global Action Plan process indicators and UN High Level Meeting national commitment progress indicators. 1) Please indicate whether evidence-based national guidelines/protocols/standards are available for the management (diagnosis and treatment) of each of the major NCDs through a primary care approach recognized/approved by government or competent authorities. Where guidelines/ protocols/standards are available, please indicate their implementation status, when they were last updated and whether they contain standard criteria for the referral of patients from primary care to a higher level of care (secondary/tertiary). Cardiovascular Disease Diabetes Cancer Chronic Respiratory Disease 1a) Are they available? 􀀀 Yes 􀀀 No 􀀀 Don’t know 􀀀 Yes 􀀀 No 􀀀 Don’t know 􀀀 Yes (specify cancer types) 􀀀 No 􀀀 Don’t know 􀀀 Yes 􀀀 No 􀀀 Don’t know 1b) Are they being utilized in at least 50% of health care facilities 􀀀 Yes 􀀀 No 􀀀 Don’t know 􀀀 Yes 􀀀 No 􀀀 Don’t know 􀀀 Yes 􀀀 No 􀀀 Don’t know 􀀀 Yes 􀀀 No 􀀀 Don’t know 1c) When were they last updated? 1d) Do they include referral criteria? 􀀀 Yes 􀀀 No 􀀀 Don’t know 􀀀 Yes 􀀀 No 􀀀 Don’t know 􀀀 Yes 􀀀 No 􀀀 Don’t know 􀀀 Yes 􀀀 No 􀀀 Don’t know IV. Capacity for NCD early detection, treatment and care within the health system Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201754 2) Indicate the availability of the following basic technologies for early detection, diagnosis/ monitoring of NCDs in the primary care facilities of the public and private health sector where: Generally available=1; Generally not available = 2, Don't know = 3. 3) Please indicate if there is a national screening program targeting the general population for the following cancers and, if yes, provide details. Availability in the primary care facilities of the public health sector (1, 2, or 3) Availability in the primary care facilities of the private health sector (1, 2, or 3) Overweight and obesity 2a) Measuring of weight 2b) Measuring of height Diabetes mellitus 2c) Blood glucose measurement 2d) Oral glucose tolerance test 2e) HbA1c test 2f) Dilated fundus examination 2g) Foot vibration perception by tuning fork 2h) Foot vascular status by Doppler 2i) Urine strips for glucose and ketone measurement Cardiovascular disease 2j) Blood pressure measurement 2k) Total cholesterol measurement 2l) Urine strips for albumin assay Asthma and chronic obstructive pulmonary disease 2m) Peak flow measurement spirometry Initial screening method (indicate only one, the most widely used) Population targeted by the program Type of program Screening coverage Breast 􀀀 Yes 􀀀 No 􀀀 Don’t know If NO: Go to next row 􀀀 Clinical breast exam 􀀀 Mammography screening 􀀀 Don’t know Women aged …….. to ……. Other, specify: 􀀀 Don’t know 􀀀 Organised population-based screening 􀀀 Opportunistic screening 􀀀 Don’t know 􀀀 Less than 10% 􀀀 10% to 50% 􀀀 more than 50% but less than 70% 􀀀 70% or more 􀀀 Don’t know Cervix 􀀀 Yes 􀀀 No 􀀀 Don’t know If NO: Go to next row 􀀀 Visual inspection 􀀀 PAP smear 􀀀 HPV test 􀀀 Don’t know Women aged …….. to ……. Other, specify: 􀀀 Don’t know 􀀀 Organised population-based screening 􀀀 Opportunistic screening 􀀀 Don't know 􀀀 Less than 10% 􀀀 10% to 50% 􀀀 more than 50% but less than 70% 􀀀 70% or more 􀀀 Don’t know * Generally available: in 50% or more of health care facilities Generally not available: in less than 50% of health care facilities Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 55 Initial screening method (indicate only one, the most widely used) Population targeted by the program Type of program Screening coverage Colon 􀀀 Yes 􀀀 No 􀀀 Don’t know If NO: Go to next row 􀀀 Faecal test 􀀀 Colonoscopy/ sigmoidoscopy 􀀀 Don’t know People aged …….. to ……. Other, specify: 􀀀 Don’t know 􀀀 Organised population-based screening 􀀀 Opportunistic screening 􀀀 Don’t know 􀀀 Less than 10% 􀀀 10% to 50% 􀀀 more than 50% but less than 70% 􀀀 70% or more 􀀀 Don’t know Other cancer type(s) 􀀀 Yes 􀀀 No 􀀀 Don’t know If NO: Go to next row 4) Please indicate if early detection of the following cancers by means of rapid identification of the first symptoms is integrated into primary health care services and if there is a clearly defined referral system from primary care to secondary / tertiary care for suspect cases (in low- and middle- income countries this set of measures may be designated as an "early diagnosis" programme): 5) Is there a national HPV vaccination programme under implementation? 􀀀 Yes 􀀀 No 􀀀 Don’t know If NO: Go to Question 6. If yes, please provide the following details of the programme: 5a) Who is targeted by the programme? 􀀀 Girls aged ____ to ____ 􀀀 Other (specify: ______________________________________________________) 􀀀 Don’t know Breast Cervix Colon Other cancer type(specify: ___________) Programme/ guidelines to strengthen early diagnosis of first symptoms at primary health care level 􀀀 Yes 􀀀 No 􀀀 Don't know 􀀀 Yes 􀀀 No 􀀀 Don't know 􀀀 Yes 􀀀 No 􀀀 Don't know 􀀀 Yes 􀀀 No 􀀀 Don't know Clearly defined referral system from primary care to secondary and tertiary care 􀀀 Yes 􀀀 No 􀀀 Don't know 􀀀 Yes 􀀀 No 􀀀 Don't know 􀀀 Yes 􀀀 No 􀀀 Don't know 􀀀 Yes 􀀀 No 􀀀 Don't know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201756 5b) What year did the programme begin? ____________________________________ 5c) What is the immunization coverage of the programme? 􀀀 Less than 10% 􀀀 10% to 50% 􀀀 More than 50% but less than 70% 􀀀 70% or more 􀀀 Don’t know 6) Describe the availability* of the medicines below in the primary care facilities of the public health sector, where: Generally available=1; Generally not available = 2, Don't know = 3. 7) Indicate the availability* of the following procedures for treating NCDs in the publicly funded health system, where: 1=Generally available; 2=Generally not available; 3=Don't know. Generic drug name Availability* 6a) Insulin 6b) Aspirin (100 mg) 6c) Metformin 6d) Thiazide diuretics 6e) ACE Inhibitors 6f) Calcium channel blockers 6g) Beta blockers 6h) Statins 6i) Oral morphine 6j) Steroid inhaler 6k) Bronchodilator 6l) Sulphonylurea(s) 6m) Benzathine penicillin injection 6n) Nicotine replacement therapy Procedure name Availability* 7a) Retinal photocoagulation 7b) Renal replacement therapy by dialysis 7c) Renal replacement by transplantation 7d) Coronary bypass 7e) Stenting 7f) Thrombolytic therapy (streptokinase) for acute myocardial infarction * Generally available: in 50% or more pharmacies Generally not available: in less than 50% of pharmacies * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 57 8) Detail the availability* of cancer diagnosis and treatment services in the public sector: 9) How many pathology laboratories for cancer diagnosis are there in the country? Number of public laboratories: ___________ 􀀀 Don't know Number of private laboratories: ___________ 􀀀 Don't know PALLIATIVE CARE FOR PATIENTS WITH NCDS: 10) Indicate the availability* of palliative care for patients with NCD in the public health system: 10a) In primary health care facilities: 􀀀 Generally available 􀀀 Generally not available 􀀀 Don't know 10b) In community or home-based care: 􀀀 Generally available 􀀀 Generally not available 􀀀 Don't know * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need (If you don’t know the exact number, just give an interval, for example “between 2 and 5”.) * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need Service Availability* Cancer centres or cancer departments at tertiary level 􀀀 Generally available 􀀀 Generally not available 􀀀 Don’t know Pathology services (laboratories) 􀀀 Generally available 􀀀 Generally not available 􀀀 Don’t know Cancer surgery 􀀀 Generally available 􀀀 Generally not available 􀀀 Don’t know Subsidized chemotherapy 􀀀 Generally available 􀀀 Generally not available 􀀀 Don’t know Radiotherapy 􀀀 Generally available 􀀀 Generally not available 􀀀 Don’t know Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201758 CARDIOVASCULAR DISEASE: 11) What proportion of primary health care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke? 􀀀 None 􀀀 Less than 25% 􀀀 25% to 50% 􀀀 More than 50% 􀀀 Don’t know If more than none: 11a) Which CVD risk scoring chart is used? 􀀀 WHO/ISH risk prediction charts 􀀀 Others (specify ______________________________________________________________) 􀀀 Don’t know 12) Indicate the availability* of services for stroke in the public health system: 12a) Provision of care for acute stroke: 􀀀 Generally available 􀀀 Generally not available 􀀀 Don't know 12b) Rehabilitation for stroke patients: 􀀀 Generally available 􀀀 Generally not available 􀀀 Don't know 13) Is there a register of patients who have had rheumatic fever and rheumatic heart disease? 􀀀 Yes 􀀀 No 􀀀 Don’t know IF YES: 13a) Are there systems for follow-up/recall to deliver long-term penicillin prophylaxis? 􀀀 Yes 􀀀 No 􀀀 Don’t know * Generally available: reaches 50% or more patients in need Generally not available: reaches less than 50% of patients in need Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 59 Academia: Refers to educational institutions, especially those for higher education. Broadcast media: Media which is broadcast to the public through radio and television. Cancer: A generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasms. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and spread to other organs. Cancer registry: A systematic collection of data about cancer cases in a certain region or a certain hospital. The first aim is to count cancer cases to get an idea of the magnitude of the problem. WHO advises national coverage by population-based registry in small countries only. Capacity-building: The development of knowledge, skills, commitment, structures, systems and leadership to enable effective action. Cardiovascular diseases: A group of disorders of the heart and blood vessels that includes coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism. Cardiovascular risk assessment: Use of risk prediction charts to indicate the risk of a fatal or non- fatal major cardiovascular event in the next 5 to 10 years. Based on the assessment people can be stratified into different levels of risk, which will help in management and follow-up. Chronic respiratory diseases: Diseases of the airways and other structures of the lung. Some of the most common are: asthma, chronic obstructive pulmonary disease, occupational lung diseases and pulmonary hypertension. Civil registration: The system by which a government records the vital events of its citizens and residents, such as births, deaths and marital status, and cause of death. Collaboration: A recognized relationship between different groups with a defined purpose. Community: A specific group of people, often living in a defined geographical area, who share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community exhibit some awareness of their identity as a group, and share common needs and a commitment to meeting them. Cross-border marketing: Marketing originating in one country that crosses national borders through broadcast media and internet, print media, sponsorship of events and programmes or any other media or communication channel. It includes both in-flowing and out-flowing cross-border marketing. GLOSSARY Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201760 Diabetes: A disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Legislation: A law or laws which have been enacted by the governing bodies in a country. Marketing: Any form of commercial communication or message that is designed to, or has the effect of, increasing the recognition, appeal and/or consumption of particular products and services. It comprises anything that acts to advertise or otherwise promote a product or service. Multisectoral: Involving different sectors, such as health, agriculture, education, finance, infrastructure, transport, trade, etc. Multisectoral collaboration: A recognized relationship between part or parts of different sectors of society (such as ministries (e.g. health, education), agencies, nongovernmental agencies, private for-profit sector and community representation) which has been formed to take action to achieve health outcomes in a way that is more effective, efficient or sustainable than might be achieved by the health sector acting alone. Multistakeholder: Involving stakeholders from across the public sector, civil society, NGOs and the private sector. National Cancer Screening Programme: A government-endorsed programme where screening is offered. NGO-led programmes or national recommendations to go for screening at one’s own cost, do not qualify as national screening programmes. National focal point, unit or department: i. National focal point: the person responsible for the prevention and control of chronic diseases in a ministry of health or national institute. ii. Unit or department: a unit or department with responsibility for NCD disease prevention and control in a ministry of health or national institute. National health reporting system, survey and surveillance: i National health reporting system: The process by which a ministry of health produces annual health reports that summarize data on, for example, national health human resources, population demographics, health expenditures, and health indicators such as mortality and morbidity. Includes the process of collecting data from various health information sources, e.g. disease registries, hospital admission or discharge data. ii National survey: A fixed or unfixed time interval survey on the main chronic diseases, or major risk factors common to chronic diseases. iii Surveillance: The systematic collection of data (through survey or registration) on risk factors, chronic diseases and their determinants for continuous analysis, interpretation and feed-back. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 61 National integrated action plan: A concerted approach to addressing a multiplicity of issues within a chronic disease prevention and health promotion framework, targeting the major risk factors common to the main chronic diseases, including the integration of primary, secondary and tertiary prevention, health promotion and diseases prevention programmes across sectors and disciplines. National policy, strategy, action plan: i. Policy: A specific official decision or set of decisions designed to carry out a course of action endorsed by a political body, including a set of goals, priorities and main directions for attaining these goals. The policy document may include a strategy to give effect to the policy. ii. Strategy: a long-term plan designed to achieve a particular goal. iii. Action plan: A scheme of course of action, which may correspond to a policy or strategy, with defined activities indicating who does what (type of activities and people responsible for implementation), when (time frame), how and with what resources to accomplish an objective. National protocols/guidelines/standards for chronic diseases and conditions: A recommended evidence-based course of action to prevent a chronic disease or condition or to treat or manage a chronic disease or condition aiming to prevent complications, improve outcomes and quality of life of patients. NGO: Non governmental organization. Noncommunicable diseases (NCDs): The four main types of noncommunicable diseases are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. Noncommunicable diseases prevention and control: All activities related to surveillance, prevention and management of the chronic noncommunicable diseases. Not in effect: Any policy, strategy or plan of action which has been previously developed and is no longer under development, but for various reasons is not being implemented. Nutrition labelling: A description intended to inform consumers of the nutritional properties of food. Nutrition labelling consists of two components: (a) nutrient declaration; (b) supplementary nutrition information. Operational: A policy, strategy or plan of action which is being used and implemented in the country, and has resources and funding available to implement it. Also applies to a multisectoral commission/ mechanism which is functional and meets on a regular basis. Palliative care: Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201762 Partnership for health: An agreement between two or more partners to work cooperatively towards a set of shared health outcomes. Price subsidies: Economic benefit provided by the government (such as a tax allowance or duty rebate) to keep the price of healthy foods low. Primary health care: Refers to core functions of a nation’s health system. Encompassing front-line health service delivery (primary care) as well as health system structure; governance and financing; the intersectoral policy environment; and social determinants of health, primary health care provides essential health interventions according to a community’s needs and expectations. Primary prevention: Measures directed towards preventing the initial occurrence of a disease or disorder. Print media: Communicating with the public through printed materials such as magazines, newspapers and billboards. Product reformulation by industry: Refers to the process of changing the composition of processed foods to be healthier and reduce the salt content. Public awareness programme: A comprehensive effort that includes multiple components (messaging, grassroots outreach, media relations, government affairs, budget, etc.) to help increase public understanding about the importance of an issue. Public health sector: Publicly funded health care sector. Rehabilitation: A set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments. Risk factors associated with noncommunicable diseases The four main risk factors for NCDs are tobacco use, harmful use of alcohol, unhealthy diet and low levels of physical activity. Sample registration system: A method and procedure for estimating vital statistics in national and regional populations by intensively registering and verifying vital events in population samples. For instance, in India more than 4,000 rural and 2,000 urban sample units, with a total of more than 6 million persons, i.e., less than 1% of the total national population, are included in a sample registration system that provides a reasonably reliable picture of the national pattern of vital events at a cost that is feasible and reasonable. Saturated fats: Fats found in animal products, including meat and whole milk dairy products, as well as certain plant oils like palm, palm kernel and coconut oils. Screening: Measures preformed across an apparently healthy population in order to identify individuals who are at high risk or in the early stages of disease, but do not yet have symptoms. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 63 Screening coverage: The proportion of people in the population targeted by the programme who actually received screening in the time frame defined by the programme. (For example, if a country recommend mammography screening every 2 years for women aged 50 to 60. The screening coverage is the number of women aged 50 to 60 who benefitted from mammography thanks to the programme in the past 2 years, divided by the total number of women aged 50 to 60 in the country.) Self-regulation: In this context refers to when a group or private sector entity governs or polices itself without outside assistance or influence. Target: A specific aim to be achieved, should be time bound, and define a ‘desired’, ‘promised’, ‘minimum’ or ‘aspirational’ level of achievement. Taxation incentives to promote physical activity: Involve removing the tax (or a portion of the tax) in order to promote increased use of goods or services to encourage physical activity. Trans-fatty acids (trans fats): A form of fatty acids. While trans fats do occur in tiny amounts in some foods, almost all the trans fats come from an industrial process that partially hydrogenates (adds hydrogen to) unsaturated fatty acids. Trans fats, then, are a form of processed vegetable oils. Under development: Something which is still being developed or finalized and is not yet being implemented in the country. VAT/Sales Tax: “Value-added tax” (VAT) is a “multi-stage” tax on all consumer goods and services applied proportionally to the price the consumer pays for a product. Although manufacturers and wholesalers also participate in the administration and payment of the tax all along the manufacturing/ distribution chain, they are all reimbursed through a tax credit system, so that the only entity who pays in the end is the final consumer. Most countries that impose a VAT do so on a base that includes any excise tax and customs duty. Example: VAT representing 10% of the retail price. Some countries, however, impose sales taxes instead. Unlike VAT, sales taxes are levied at the point of retail on the total value of goods and services purchased. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201764 Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 65 ANNEX 2 INDICATOR DEFINITIONS AND SPECIFICATIONS STATUS OF COUNTRIES AND AREAS Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201766 Country has set national NCD targets. The NCD-related targets should be time-bound and based on the nine voluntary global targets and the WHO Global Monitoring framework. WHO NCD Country Capacity Survey tool - The NCD CCS is completed by a team at the country level to ensure that a comprehensive response is compiled. This indicator is considered fully achieved if a country responds "Yes" to the question "Are there a set of time-bound national targets for NCDs based on the nine voluntary global targets from the WHO Global Monitoring Framework for NCDs", and provides the needed supporting documentation. Targets must be time-bound, based on the nine global targets, and need to address NCD mortality, as well as key risk factors in the country and/or health systems. This indicator is considered partially achieved if the country responds "Yes" to the question "Are there a set of time-bound national targets for NCDs based on the nine voluntary global targets from the WHO Global Monitoring Framework for NCDs", but the targets do not cover two of the three areas addressed in the nine global targets (including mortality or they are not time-bound. Countries are asked to submit a copy of their targets when submitting their response to the NCD CCS. WHO will confirm that document provided is indeed a set of national NCD targets, addressing NCD mortality, as well as key risk factors in the country, and/or health systems, based on the nine global targets, and that these targets are time-bound (e.g. include such language as "by 2025"). Where discrepancies are noted, these are referred back to the country for clarification and modification. Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 1 Member State has set time-bound national targets based on WHO guidance Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 67 Indicator 1. Country or area has set time-bound national targets and indicators based on WHO guidance – = documentation not available No. Country / Area 2015 2017 1 Australia Partially achieved Partially achieved 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) Not achieved Not achieved 4 Japan Fully achieved Fully achieved 5 Macao SAR (China) Not achieved Not achieved 6 New Zealand Not achieved Not achieved 7 Republic of Korea Fully achieved Fully achieved 8 Singapore Fully achieved Partially achieved % Fully Achieved: HICs (N=8) 4 (50%) 3 (38%) 1 Cambodia Partially achieved Partially achieved 2 China Fully achieved Fully achieved 3 Lao People's Democratic Republic Partially achieved Partially achieved 4 Malaysia Fully achieved Fully achieved 5 Mongolia Fully achieved Fully achieved 6 Philippines Not achieved Not achieved 7 Viet Nam Fully achieved Fully achieved % Fully Achieved: LMICs (N=7) 4 (57%) 4 (57%) 1 American Samoa No data Partially achieved 2 Cook Islands No data Partially achieved 3 Fiji Fully achieved Fully achieved 4 French Polynesia Not achieved Not achieved 5 Guam Fully achieved Fully achieved 6 Kiribati Partially achieved Partially achieved 7 Marshall Islands Fully achieved Fully achieved 8 Micronesia (Federated States of) Partially achieved Partially achieved 9 Nauru Not achieved Fully achieved 10 New Caledonia – Not achieved 11 Niue Partially achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) Not achieved Not achieved 13 Palau Partially achieved Partially achieved 14 Papua New Guinea Partially achieved Partially achieved 15 Samoa No data Not achieved 16 Solomon Islands Fully achieved Fully achieved 17 Tokelau No data Partially achieved 18 Tonga Fully achieved Fully achieved 19 Tuvalu Fully achieved Partially achieved 20 Vanuatu Not achieved Fully achieved 21 Wallis and Futuna Islands – No data % Fully Achieved: PICs (N=21) 6 (29%) 7 (33%) TOTAL (N = 36) 14 (39%) 14 (39%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201768 Country has a vital registration system that captures deaths and the causes of death routinely. The International form of Medical Certificate of the Death is completed by certifiers. The International Classification of Diseases (ICD) is used to code the causes of death. The data compiled are made available to policy-makers and researchers. The WHO collects mortality date, including cause of death, from civil registration systems in the WHO mortality database through a routine annual call for data. Data are considered to generate reliable cause- specific mortality data on a routine basis if: • Data from the five most recent reporting years are, on average, at least 70% usable. Usability is calculated as (Completeness (%))*(1-Proportion Garbage)1. • At least five years of cause-of-death data have been reported to the WHO in the last 10 years. • The most recent year of data reported to the WHO is no more than five years old. This indicator is considered fully achieved if the country meets all of the above criteria. The indicator is considered partially achieved if the country does not meet all of the above criteria but has submitted same vital registration data to WHO. Data submitted are verified and inconsistencies are referred back to countries to resolve. Yearly http://www.who.int/healthinfo/tool_cod_2010.pdf Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 2 Member State has a functioning system for generating reliable cause-specific mortality data on a routine basis 1 For further details, see page 5 of the following document: http://www.who.int/healthinfo/global_burden_disease/GlobalCOD_ method_2000_2015.pdf Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 69 Indicator 2: Country or area has a functioning system for generating reliable cause-specific mortality data on a routine basis * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Fully achieved Fully achieved 2 Brunei Darussalam Partially achieved Fully achieved 3 Hong Kong SAR (China) Fully achieved* Fully achieved* 4 Japan Fully achieved Fully achieved 5 Macao SAR (China) No data No data 6 New Zealand Fully achieved Fully achieved 7 Republic of Korea Fully achieved Fully achieved 8 Singapore Fully achieved Fully achieved % Fully Achieved: HICs (N=8) 6 (75%) 7 (88%) 1 Cambodia Not achieved Not achieved 2 China Partially achieved Partially achieved 3 Lao People's Democratic Republic Not achieved Not achieved 4 Malaysia Partially achieved Partially achieved 5 Mongolia Partially achieved Partially achieved 6 Philippines Fully achieved Partially achieved 7 Viet Nam Not achieved Not achieved % Fully Achieved: LMICs (N=7) 1 (14%) 0 (0%) 1 American Samoa No data No data 2 Cook Islands Partially achieved Partially achieved 3 Fiji Partially achieved Fully achieved 4 French Polynesia No data No data 5 Guam No data No data 6 Kiribati Partially achieved Partially achieved 7 Marshall Islands Not achieved Not achieved 8 Micronesia (Federated States of) Not achieved Not achieved 9 Nauru Not achieved Not achieved 10 New Caledonia No data No data 11 Niue Not achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) No data No data 13 Palau Not achieved Not achieved 14 Papua New Guinea Not achieved Not achieved 15 Samoa Not achieved Not achieved 16 Solomon Islands Not achieved Not achieved 17 Tokelau No data No data 18 Tonga Not achieved Not achieved 19 Tuvalu Not achieved Not achieved 20 Vanuatu Not achieved Not achieved 21 Wallis and Futuna Islands No data No data % Fully Achieved: PICs (N=21) 0 (0%) 1 (5%) TOTAL (N = 36) 7 (19%) 8 (22%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201770 Country has completed a STEPS survey or another risk factor survey which includes physical measurements and biochemical assessments covering the key behavioural and metabolic risk factors for NCDs. Country must indicate that survey frequency is at least every 5 years. WHO NCD Country Capacity Survey tool – The NCD CCS is completed by a team at the country level to ensure a comprehensive response is compiled. This indicator is considered fully achieved if the country responded “Yes” to each of the following for adults: “Have surveys of risk factors (may be a single RF or multiple) been conducted in your country for all of the following:” “Harmful alcohol use” (optional for the Member States where there is a ban on alcohol), “Physical inactivity”, “Tobacco use”, “Raised blood glucose/diabetes”, “Raised blood pressure/ hypertension”, “Overweight and obesity”, and “Salt / Sodium intake”. For risk factors "Raised blood glucose/diabetes", "Raised blood pressure/hypertension", and "Overweight and obesity", the data must be measured, not self- reported. Additionally, for each risk factor, the country must indicate that the last survey was conducted in the past 5 years (i.e. 2012 or later for the 2017 CCS survey responses) and must respond "Every 1–2 years" or "Every 3–5 years" to the subquestion "How often is the survey conducted?". The country must also provide the needed supporting documentation. This indicator is considered partially achieved if the country responds that at least three, but not all, of the above risk factors are covered, or the surveys were conducted more than five years ago but less than ten years ago. Countries are asked to submit a copy of their survey report(s) when submitting their response to the NCD CCS. Where discrepancies are noted, these are referred back to the country for clarification and modification. Data are also checked against the STEPS tracking system which records details of STEPS survey undertaken by countries. Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 3 Member State has a STEPS survey or a comprehensive health examination survey every 5 years Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 71 Indicator 3: Country or area has a STEPS survey or a comprehensive health examination survey every 5 years * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Fully achieved Partially achieved 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) Partially achieved Fully achieved* 4 Japan Fully achieved Fully achieved 5 Macao SAR (China) Partially achieved Partially achieved 6 New Zealand Fully achieved Partially achieved 7 Republic of Korea Fully achieved Fully achieved 8 Singapore Fully achieved Partially achieved % Fully Achieved: HICs (N=8) 6 (75%) 4 (50%) 1 Cambodia Fully achieved Fully achieved 2 China Fully achieved Fully achieved 3 Lao People's Democratic Republic Fully achieved Partially achieved 4 Malaysia Fully achieved Fully achieved 5 Mongolia Fully achieved Fully achieved 6 Philippines Fully achieved Fully achieved 7 Viet Nam Fully achieved* Fully achieved % Fully Achieved: LMICs (N=7) 7 (100%) 6 (86%) 1 American Samoa No data Partially achieved 2 Cook Islands No data Partially achieved 3 Fiji Fully achieved Partially achieved 4 French Polynesia Partially achieved Partially achieved 5 Guam Partially achieved Partially achieved 6 Kiribati Not achieved Fully achieved 7 Marshall Islands Not achieved Not achieved 8 Micronesia (Federated States of) Partially achieved Partially achieved 9 Nauru Not achieved Partially achieved 10 New Caledonia Partially achieved Partially achieved 11 Niue Partially achieved Partially achieved 12 Northern Mariana Islands (Commonwealth of the) Partially achieved Fully achieved 13 Palau Partially achieved Partially achieved 14 Papua New Guinea Partially achieved Partially achieved 15 Samoa No data Fully achieved 16 Solomon Islands Partially achieved Fully achieved 17 Tokelau No data Partially achieved 18 Tonga Partially achieved Partially achieved 19 Tuvalu Partially achieved Fully achieved 20 Vanuatu Partially achieved Partially achieved 21 Wallis and Futuna Islands Partially data No response % Fully Achieved: PICs (N=21) 1 (5%) 5 (24%) TOTAL (N = 36) 14 (39%) 15 (42%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201772 Country has a multisectoral, national integrated NCD and risk factor policy/ strategy/action plan that addresses the four main NCDs (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases) and their main risk factors (tobacco use, unhealthy diet, physical inactivity, harmful use of alcohol). “Multisectoral” refers to engagement with one or more government sectors outside of health. “Operational” refers to a policy, strategy or action plan which is being used and implemented in the country, and has resources and funding available to implement it. WHO NCD Country Capacity Survey tool – The NCD CCS is completed by a team at the country level to ensure a comprehensive response is compiled. This indicator is considered fully achieved if the country responded “Yes” to the questions “Does your country have a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors?” and to the subquestion “ Is it multisectoral?”. Countries also had to respond “operational” to the subquestion “Indicate its stage” and “Yes” to all of the subquestions pertaining to the four main risk factors and four main NCDs: “Does it address one or more of the following major risk factors?” “Harmful use of alcohol” (optional for the Member States where there is a ban on alcohol), “Unhealthy diet”, “Physical inactivity”, “tobacco” (all four must have “Yes”) and “Does it combine early detection, treatment and care for:” “Cancer”, “Cardiovascular diseases”, “ Chronic respiratory diseases” and “Diabetes” (all four must have “Yes”). Country must also provide the needed supporting documentation. This indicator is considered partially achieved if the country responded “Yes” to the questions “Does your country have a national NCD policy, strategy or action plan which integrates several NCDs and their risk factors?” and to the subquestion “ Is it multisectoral?”. Countries also have to respond “operational” to the subquestion “Indicate its stage” and “Yes” to at least two of the four main risk factors and at least two of the 4 main NCDs. Countries are asked to submit a copy of their policy/ strategy/action plan when submitting their response to the NCD CCS. Where discrepancies are noted, these are referred back to the country for clarification and modification. Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 4 Member State has an operational multisectoral national strategy/action plan that integrates the major NCDs and their shared risk factors Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 73 Indicator 4: Country or area has an operational multisectoral national strategy/action plan that integrates the major NCDs and their shared risk factors No. Country / Area 2015 2017 1 Australia Fully achieved Partially achieved 2 Brunei Darussalam Partially achieved Fully achieved 3 Hong Kong SAR (China) Fully achieved Fully achieved 4 Japan Fully achieved Fully achieved 5 Macao SAR (China) Fully achieved Fully achieved 6 New Zealand Not achieved Not achieved 7 Republic of Korea Partially achieved Partially achieved 8 Singapore Not achieved Partially achieved % Fully Achieved: HICs (N=8) 4 (50%) 4 (50%) 1 Cambodia Not achieved Not achieved 2 China Fully achieved Fully achieved 3 Lao People's Democratic Republic Not achieved Fully achieved 4 Malaysia Not achieved Partially achieved 5 Mongolia Fully achieved Fully achieved 6 Philippines Fully achieved Not achieved 7 Viet Nam Fully achieved Fully achieved % Fully Achieved: LMICs (N=7) 4 (57%) 4 (57%) 1 American Samoa No data No data 2 Cook Islands No data Fully achieved 3 Fiji Partially achieved Partially achieved 4 French Polynesia Not achieved Not achieved 5 Guam Fully achieved Fully achieved 6 Kiribati Fully achieved Not achieved 7 Marshall Islands Not achieved Not achieved 8 Micronesia (Federated States of) Fully achieved Not achieved 9 Nauru Not achieved Fully achieved 10 New Caledonia Not achieved Not achieved 11 Niue Partially achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) Not achieved Not achieved 13 Palau Partially achieved Partially achieved 14 Papua New Guinea Not achieved Partially achieved 15 Samoa No data Not achieved 16 Solomon Islands Fully achieved Fully achieved 17 Tokelau No data Not achieved 18 Tonga Partially achieved Fully achieved 19 Tuvalu Not achieved Not achieved 20 Vanuatu Not achieved Fully achieved 21 Wallis and Futuna Islands Not achieved No response % Fully Achieved: PICs (N=21) 4 (19%) 6 (29%) TOTAL (N = 36) 12 (33%) 14 (39%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201774 Country has total taxes set at a level that accounts for more than 75% at the retail price of tobacco products. Data collected from government for the production of the WHO Report on the Global Tobacco Epidemic. Total taxes (including excise tax, value added / sales tax, import duties (where applicable) and any other taxes levied) are calculated as a proportion of the price of the tobacco product. Currently this is calculated in relation to the most sold brand of cigarettes. This indicator is considered fully achieved if the country has total taxes more than 75% of the price of the most sold brand of cigarettes. This indicator is considered partially achieved if the country has total taxes from 51% up to 75% of the retail price of the most sold brand of cigarettes. WHO assessment is shared with national authorities for review and approval. Every two years http://www.who.int/tobacco/global_report/ http://www.who.int/tobacco/global_report/2017/technical_note_I. pdf?ua=1 Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 5A Member State has implemented measures to reduce affordability by increasing excise taxes and prices on tobacco products Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 75 Indicator 5A: Country or area has implemented measures to reduce affordability by increasing excise taxes and prices on tobacco products * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Not achieved Partially achieved 2 Brunei Darussalam Partially achieved Not applicable 3 Hong Kong SAR (China) Fully achieved* Partially achieved* 4 Japan Partially achieved Partially achieved 5 Macao SAR (China) No data No data 6 New Zealand Partially achieved Partially achieved 7 Republic of Korea Partially achieved Partially achieved 8 Singapore Partially achieved Partially achieved % Fully Achieved: HICs (N=8) 1 (13%) 0 (0%) 1 Cambodia Not achieved Not achieved 2 China Not achieved Partially achieved 3 Lao People's Democratic Republic Not achieved Not achieved 4 Malaysia Partially achieved Partially achieved 5 Mongolia Not achieved Not achieved 6 Philippines Partially achieved Partially achieved 7 Viet Nam Not achieved Not achieved % Fully Achieved: LMICs (N=7) 0 (0%) 0 (0%) 1 American Samoa No data No data 2 Cook Islands Partially achieved Partially achieved 3 Fiji Not achieved Not achieved 4 French Polynesia No data No data 5 Guam No data No data 6 Kiribati Fully achieved Not achieved 7 Marshall Islands Not achieved Partially achieved 8 Micronesia (Federated States of) Not achieved Partially achieved 9 Nauru No data Partially achieved 10 New Caledonia No data No data 11 Niue Not achieved Fully achieved 12 Northern Mariana Islands (Commonwealth of the) No data No data 13 Palau Partially achieved Partially achieved 14 Papua New Guinea Not achieved Not achieved 15 Samoa Not achieved Partially achieved 16 Solomon Islands Not achieved Not achieved 17 Tokelau No data No data 18 Tonga Partially achieved Partially achieved 19 Tuvalu Not achieved Partially achieved 20 Vanuatu Not achieved Partially achieved 21 Wallis and Futuna Islands No data No data % Fully Achieved: PICs (N=21) 1 (5%) 1 (5%) TOTAL (N = 36) 2 (6%) 1 (3%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201776 Country has all public places completely smoke-free (or at least 90% of the population covered by complete subnational smoke-free legislation). "Completely" means that smoking is not permitted, with no exemptions allowed, except in residences and indoor places that serve as equivalents to long-term residential facilities, such as prisons and long-term health and social care facilities such as psychiatric units and nursing homes. Ventilation and any form of designated smoking rooms and/or areas do not protect from the harms of second-hand tobacco smoke, and the only laws that provide protection are those that result in the complete absence of smoking in all public places. Legal instruments are analysed for the production of the WHO Report on the Global Tobacco Epidemic. Legislation is assessed to determine whether smoke-free laws provided for a complete indoor smoke-free environment at all times, in all the facilities of each of the following eight places: health-care facilities; educational facilities other than universities; universities; government facilities; indoor offices and workplaces not considered in any other category; restaurants or facilities that serve mostly food; cafés, pubs and bars or facilities that serve mostly beverages; public transport. This indicator is considered fully achieved if all public places in the country are completely smoke-free (or at least 90% of the population covered by complete subnational smoke-free legislation). The indicator is considered partially achieved if three to seven public places are completely smoke-free, or the law allows designated smoking rooms with strict technical requirements in five or more place. WHO assessment is shared with national authorities for review and approval Every two years http://www.who.int/tobacco/global_report/ http://www.who.int/tobacco/global_report/2017/technical_note_I.pdf?ua=1 Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 5B Member State has implemented measures to eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places and public transport Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 77 Indicator 5B: Country or area has implemented measures to eliminate exposure to second-hand tobacco smoke in all indoor workplaces, public places and public tranport * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Fully achieved Fully achieved 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) Fully achieved* Fully achieved* 4 Japan Not achieved Not achieved 5 Macao SAR (China) Partially achieved* No data 6 New Zealand Fully achieved Fully achieved 7 Republic of Korea Not achieved Partially achieved 8 Singapore Partially achieved Partially achieved % Fully Achieved: HICs (N=8) 4 (50%) 4 (50%) 1 Cambodia Partially achieved Fully achieved 2 China Not achieved Not achieved 3 Lao People's Democratic Republic Partially achieved Fully achieved 4 Malaysia Not achieved Not achieved 5 Mongolia Fully achieved Fully achieved 6 Philippines Partially achieved Partially achieved 7 Viet Nam Partially achieved Partially achieved % Fully Achieved: LMICs (N=7) 1 (14%) 3 (43%) 1 American Samoa No data No data 2 Cook Islands Partially achieved Partially achieved 3 Fiji Partially achieved Partially achieved 4 French Polynesia No data No data 5 Guam No data No data 6 Kiribati Partially achieved Partially achieved 7 Marshall Islands Fully achieved Fully achieved 8 Micronesia (Federated States of) Not achieved Not achieved 9 Nauru Fully achieved Fully achieved 10 New Caledonia No data No data 11 Niue Not achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) No data No data 13 Palau Partially achieved Partially achieved 14 Papua New Guinea Fully achieved Fully achieved 15 Samoa Partially achieved Partially achieved 16 Solomon Islands Partially achieved Partially achieved 17 Tokelau No data No data 18 Tonga Not achieved Partially achieved 19 Tuvalu Partially achieved Partially achieved 20 Vanuatu Not achieved Not achieved 21 Wallis and Futuna Islands No data No data % Fully Achieved: PICs (N=21) 3 (14%) 3 (14%) TOTAL (N = 36) 8 (22%) 10 (28%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201778 Country mandates plain / standardized packaging and/or large graphic warnings with all appropriate characteristics. Appropriate characteristics for large graphic warnings include: • specific health warnings mandated; • appearing on individual packages as well as on any outside packaging and labelling used in retails sale; • describing specific harmful effects of tobacco use on health; • are large, clear, visible and legible (e.g. specific colours and font style and sizes are mandated); • rotating health warnings and/or messages; • pictures or pictograms; and • written in (all) the principal language(s) of the country. Appropriate characteristics for plain/standardized packaging include: • restrictions or prohibitations on the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and font style; • standardized shape, size and materials of tobacco packaging; and • no advertising or promotion inside or attached to the package or tobacco product. Legislation is assessed to determine the size of the warnings (the front and back of the cigarette pack are averaged to calculate the percentage of the total pack surface area covered by warnings) and warning characteristics. The indicator is considered fully achieved if the country has plain/standardized packaging and/or large graphic health warnings which are defined as covering on average at least 50% of the front and back of the package with all appropriate characteristics as detailed above. The indicator is considered partially achieved if there are medium-size warnings, which are defined as covering on average between 30 and 49% of the front and back of package, with some or all appropriate characteristics, or large warnings that are missing some appropriate characteristics. WHO assessment is shared with national authorities for review and approval Every two years http://www.who.int/tobacco/global_report/ http://www.who.int/tobacco/global_report/2017/technical_note_I.pdf?ua=1 Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 5C Member State has implemented plain/standardized packaging and/or large graphic health warnings on all tobacco packages Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 79 Indicator 5C: Country or area has implemented plain/standardized packaging and/or large graphic health warnings on all tobacco packages * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Fully achieved Fully achieved 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) Fully achieved* Fully achieved* 4 Japan Partially achieved Partially achieved 5 Macao SAR (China) Fully achieved* No data 6 New Zealand Fully achieved Fully achieved 7 Republic of Korea Partially achieved Partially achieved 8 Singapore Fully achieved Fully achieved % Fully Achieved: HICs (N=8) 6 (75%) 5 (63%) 1 Cambodia Partially achieved Fully achieved 2 China Partially achieved Partially achieved 3 Lao People's Democratic Republic Partially achieved Fully achieved 4 Malaysia Fully achieved Fully achieved 5 Mongolia Fully achieved Fully achieved 6 Philippines Fully achieved Fully achieved 7 Viet Nam Fully achieved Fully achieved % Fully Achieved: LMICs (N=7) 4 (57%) 6 (86%) 1 American Samoa No data No data 2 Cook Islands Partially achieved Partially achieved 3 Fiji Fully achieved Fully achieved 4 French Polynesia No data No data 5 Guam No data No data 6 Kiribati Partially achieved Partially achieved 7 Marshall Islands Not achieved Not achieved 8 Micronesia (Federated States of) Not achieved Not achieved 9 Nauru Partially achieved Partially achieved 10 New Caledonia No data No data 11 Niue Not achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) No data No data 13 Palau Not achieved Not achieved 14 Papua New Guinea Not achieved Not achieved 15 Samoa Fully achieved Fully achieved 16 Solomon Islands Fully achieved Fully achieved 17 Tokelau No data No data 18 Tonga Partially achieved Partially achieved 19 Tuvalu Partially achieved Partially achieved 20 Vanuatu Fully achieved Fully achieved 21 Wallis and Futuna Islands No data No data % Fully Achieved: PICs (N=21) 4 (19%) 4 (19%) TOTAL (N = 36) 14 (19%) 15 (42%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201780 Country has a ban on all forms of direct and indirect advertising. Direct advertising bans include: national television and radio; local magazines and newspapers; billboards and outdoor advertising; and point of sale. Indirect advertising bans include: free distribution of tobacco products in the mail or through other means; promotional discounts; non-tobacco products identified with tobacco brand names (brand stretching); brand names of non-tobacco products used for tobacco products (brand sharing); appearance of tobacco brands (products placement) or tobacco products in television and/or films; and sponsorship (contributions and/ or publicity of contributions). Legislation is assessed to determine whether the law completely bans all forms of direct and indirect tobacco advertising, promotion and sponsorship. This indicator is considered fully achieved if the country has a ban on all forms of direct and indirect advertising. This indicator is considered partially achieved if the country has a ban on national TV, radio and print media, but not on all other forms of direct and /or indirect advertising. WHO assessment is shared with national authorities for review and approval Every two years http://www.who.int/tobacco/global_report/ http://www.who.int/tobacco/global_report/2017/technical_note_I. pdf?ua=1 Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 5D Member State has enacted and enforced comprehensive bans on tobacco advertising, promotion and sponsorship Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 81 Indicator 5D: Country or area has enacted and enforced comprehensive bans on tobacco advertsing, promotion and sponsorship * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Partially achieved Partially achieved 2 Brunei Darussalam Partially achieved Partially achieved 3 Hong Kong SAR (China) Fully achieved* Fully achieved* 4 Japan Not achieved Not achieved 5 Macao SAR (China) Fully achieved* No data 6 New Zealand Partially achieved Partially achieved 7 Republic of Korea Not achieved Not achieved 8 Singapore Partially achieved Partially achieved % Fully Achieved: HICs (N=8) 2 (25%) 1 (13%) 1 Cambodia Partially achieved Partially achieved 2 China Partially achieved Partially achieved 3 Lao People's Democratic Republic Partially achieved Partially achieved 4 Malaysia Partially achieved Partially achieved 5 Mongolia Partially achieved Fully achieved 6 Philippines Partially achieved Partially achieved 7 Viet Nam Partially achieved Partially achieved % Fully Achieved: LMICs (N=7) 0 (0%) 1 (14%) 1 American Samoa No data No data 2 Cook Islands Partially achieved Partially achieved 3 Fiji Partially achieved Partially achieved 4 French Polynesia No data No data 5 Guam No data No data 6 Kiribati Fully achieved Fully achieved 7 Marshall Islands Not achieved Not achieved 8 Micronesia (Federated States of) Not achieved Not achieved 9 Nauru Partially achieved Partially achieved 10 New Caledonia No data No data 11 Niue Not achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) No data No data 13 Palau Partially achieved Partially achieved 14 Papua New Guinea Partially achieved Partially achieved 15 Samoa Partially achieved Partially achieved 16 Solomon Islands Partially achieved Partially achieved 17 Tokelau No data No data 18 Tonga Partially achieved Partially achieved 19 Tuvalu Fully achieved Fully achieved 20 Vanuatu Fully achieved Fully achieved 21 Wallis and Futuna Islands No data No data % Fully Achieved: PICs (N=21) 3 (14%) 3 (14%) TOTAL (N = 36) 5 (14%) 5 (14%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201782 Country has implemented a national anti-tobacco mass media campaign designed to support tobacco control, of at least three weeks duration with all appropriate characteristics. Appropriate characteristics include: • Campaign was part of a comprehensive tobacco control programme. • Before the campaign, research was undertaken or reviewed to gain a thorough understanding of the target audience. • Campaign communications materials were pre-tested with the target audience and refined in line with campaign objectives. • Air time (radio, television) and/or placement (billboards, print advertising, etc.) was obtained by purchasing or securing it using either the organization's own internal resources or an external media planner or agency (this information indicates whether the campaign adopted a thorough media planning and buying process to effectively and efficiently reach its target audience). • The implementing agency worked with journalists to gain publicity or news coverage for the campaign. • Process evaluation was undertaken to assess how effectively the campaign has been implemented. • An outcome evaluation process was implemented to assess campaign impact. • The campaign was aired on television and/or radio. Eligible campaigns are assessed according to the appropriate characteristics to determine whether it signifies the use of a comprehensive communication approach. This indicator is considered fully achieved if the country has a campaign conducted with at least seven appropriate characteristics including airing on television and/or radio. This indicator is considered partially achieved if the country has a campaign conducted with one to six of the appropriate characteristics. WHO assessment is shared with national authorities for review and approval Every two years http://www.who.int/tobacco/global_report/ http://www.who.int/tobacco/global_report/2017/technical_note_I.pdf?ua=1 Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 5E Member State has implemented effective mass media campaigns that educate the public about the harms of smoking/tobacco use and second-hand smoke Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 83 Indicator 5E: Country or area has implemented effective mass media campaigns that educate the public about the harms of smoking/tobacco use and second hand smoke No. Country / Area 2017 1 Australia Fully achieved 2 Brunei Darussalam Not achieved 3 Hong Kong SAR (China) Fully achieved* 4 Japan Not achieved 5 Macao SAR (China) No data 6 New Zealand Fully achieved 7 Republic of Korea Fully achieved 8 Singapore Fully achieved % Fully Achieved: HICs (N=8) 5 (63%) 1 Cambodia Fully achieved 2 China Fully achieved 3 Lao People's Democratic Republic No response 4 Malaysia Fully achieved 5 Mongolia Not achieved 6 Philippines Fully achieved 7 Viet Nam Fully achieved % Fully Achieved: LMICs (N=7) 5 (71%) 1 American Samoa No data 2 Cook Islands Not achieved 3 Fiji Fully achieved 4 French Polynesia No data 5 Guam No data 6 Kiribati Fully achieved 7 Marshall Islands Not achieved 8 Micronesia (Federated States of) Not achieved 9 Nauru Not achieved 10 New Caledonia No data 11 Niue No response 12 Northern Mariana Islands (Commonwealth of the) No data 13 Palau No response 14 Papua New Guinea Not achieved 15 Samoa No response 16 Solomon Islands No response 17 Tokelau No data 18 Tonga Fully achieved 19 Tuvalu Not achieved 20 Vanuatu Not achieved 21 Wallis and Futuna Islands No data % Fully Achieved: PICs (N=21) 3 (14%) TOTAL (N = 36) 13 (36%) * Revised based on additional inputs from national focal point. Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201784 Country has a licensing system or monopoly on retail sales of beer, wine, spirits. Country has restrictions for on-/off-premise sales of beer, wine, spirits regarding hours, days and locations of sales. Country has legal age limits for being sold and served alcoholic beverages. Data is collected through the WHO Global Survey on Alcohol and Health. This indicator is considered fully achieved if: • a licensing system or monopoly exists on retail sales of beer, wine, and spirits; • restrictions exist for on-and off-premise sales of beer, wine, and spirits regarding hours and locations of sales and restrictions exist for off-premise sales of beer, wine, and spirits regarding days of sales; and • legal age limits for being sold and served alcoholic beverages are 18 years or above for beer, wine, and spirits. Focal points, officially nominated by the Ministry of Health, respond to the Global Survey on Alcohol and Health. Responses are reviewed and validated by WHO, and subsequently endorsed by the Member States. Every 3-4 years http://www.who.int/entity/substance_abuse/activities/survey_alcohol_ health_2016.pdf?ua=1 Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 6A Member State has enacted and enforced restrictions on the physical availablility of retailed alcohol (via reduced hours of sale) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 85 Indicator 6A: Country or area has enacted and enforced restrictions on the physical availability of retail alcohol (via reduced hours of sale) * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Partially achieved Partially achieved 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) Partially achieved* Partially achieved* 4 Japan Partially achieved Partially achieved 5 Macao SAR (China) No data No data 6 New Zealand Fully achieved* Partially achieved 7 Republic of Korea Partially achieved Partially achieved 8 Singapore Partially achieved Fully achieved % Fully Achieved: HICs (N=8) 2 (25%) 2 (25%) 1 Cambodia Not achieved Not achieved 2 China Partially achieved Partially achieved 3 Lao People's Democratic Republic Partially achieved Partially achieved 4 Malaysia Partially achieved Partially achieved 5 Mongolia Partially achieved Partially achieved 6 Philippines Partially achieved Partially achieved 7 Viet Nam Partially achieved Partially achieved % Fully Achieved: LMICs (N=7) 0 (0%) 0 (0%) 1 American Samoa No data No data 2 Cook Islands Fully achieved No response 3 Fiji Partially achieved No response 4 French Polynesia No data No data 5 Guam No data No data 6 Kiribati Partially achieved Partially achieved 7 Marshall Islands No data Partially achieved 8 Micronesia (Federated States of) Partially achieved No response 9 Nauru Partially achieved No response 10 New Caledonia No data No data 11 Niue Partially achieved No response 12 Northern Mariana Islands (Commonwealth of the) No data No data 13 Palau Partially achieved No response 14 Papua New Guinea Fully achieved No response 15 Samoa No data Fully achieved 16 Solomon Islands No data No response 17 Tokelau No data No data 18 Tonga Fully achieved No response 19 Tuvalu Fully achieved No response 20 Vanuatu No data Partially achieved 21 Wallis and Futuna Islands No data No data % Fully Achieved: PICs (N=21) 4 (19%) 1 (5%) TOTAL (N = 36) 6 (17%) 3 (8%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201786 Country has regulatory or co-regulatory frameworks for alcohol advertising through different channels (public service/national TV, commercial/private TV, national radio, local radio, print media, billboards, points of sale, cinema, internet, social media). Country has a detection system for infringements on marketing restrictions. Data is collected through the WHO Global Survey on Alcohol and Health. This indicator is considered fully achieved if: • restrictions exist on alcohol advertising for beer, wine, and spirits through all channels; and • detection system exists for infringements on marketing restrictions. This indicator is considered partially achieved if there are restrictions on at least public service/national TV, national radio and billboards but no detection system exists for infringements. Focal points, officially nominated by the Ministry of Health, respond to the Global Survey on Alcohol and Health. Responses are reviewed and validated by WHO, and subsequently endorsed by the Member States. Every 3-4 years http://www.who.int/entity/substance_abuse/activities/survey_alcohol_ health_2016.pdf?ua=1 Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 6B Member State has enacted and enforced bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 87 Indicator 6B: Country or area has enacted and enforced bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media) * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Partially achieved Not achieved 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) Partially achieved* Not achieved* 4 Japan Not achieved Not achieved 5 Macao SAR (China) No data No data 6 New Zealand Partially achieved Not achieved 7 Republic of Korea Not achieved Not achieved 8 Singapore Not achieved Not achieved % Fully Achieved: HICs (N=8) 1 (13%) 1 (13%) 1 Cambodia Not achieved Not achieved 2 China Not achieved* Fully achieved 3 Lao People's Democratic Republic Not achieved Fully achieved 4 Malaysia Partially achieved Partially achieved 5 Mongolia Partially achieved Not achieved 6 Philippines Partially achieved Not achieved 7 Viet Nam Partially achieved Not achieved % Fully Achieved: LMICs (N=7) 0 (0%) 2 (29%) 1 American Samoa No data No data 2 Cook Islands Partially achieved No response 3 Fiji Not achieved No response 4 French Polynesia No data No data 5 Guam No data No data 6 Kiribati Not achieved Not achieved 7 Marshall Islands No data Not achieved 8 Micronesia (Federated States of) Partially achieved No response 9 Nauru No data No response 10 New Caledonia No data No data 11 Niue Not achieved No response 12 Northern Mariana Islands (Commonwealth of the) No data No data 13 Palau Not achieved No response 14 Papua New Guinea Partially achieved No response 15 Samoa No data Not achieved 16 Solomon Islands No data No response 17 Tokelau No data No data 18 Tonga Not achieved No response 19 Tuvalu Partially achieved No response 20 Vanuatu No data Not achieved 21 Wallis and Futuna Islands No data No data % Fully Achieved: PICs (N=21) 0 (0%) 0 (0%) TOTAL (N = 36) 1 (3%) 3 (8%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201788 Country has excise tax on beer, wine, spirits. Country adjusts level of taxation for inflation for alcoholic beverages. Data is collected through the WHO Global Survey on Alcohol and Health. This indicator is considered fully achieved if: • excise tax on all alcoholic beverages (beer, wine, and spirits) is implemented; • there are no tax incentives or rebates for production of other alcoholic beverages; and • adjustments of level of taxation for inflation for beer, wine, and spirits is implemented. This indicator is considered partially achieved if there is excise tax on alcoholic beverages as specified above. Focal points, officially nominated by the Ministry of Health, respond to the Global Survey on Alcohol and Health. Responses are reviewed and validated by WHO, and subsequently endorsed by the Member States. Every 3-4 years http://www.who.int/entity/substance_abuse/activities/survey_alcohol_ health_2016.pdf?ua=1 Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 6C Member State has increased excise taxes on alcoholic beverages Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 89 Indicator 6C: Country or area has increased excise taxes on alcoholic beverages * Revised based on additional inputs from national focal point. No. Country / Area 2015 2017 1 Australia Not achieved Partially achieved 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) Not achieved* Not achieved* 4 Japan Partially achieved Partially achieved 5 Macao SAR (China) No data No data 6 New Zealand Fully achieved Partially achieved 7 Republic of Korea Partially achieved Partially achieved 8 Singapore Partially achieved Fully achieved % Fully Achieved: HICs (N=8) 2 (25%) 2 (25%) 1 Cambodia Partially achieved Partially achieved 2 China Partially achieved* Partially achieved 3 Lao People's Democratic Republic Not achieved Partially achieved 4 Malaysia Partially achieved Partially achieved 5 Mongolia Partially achieved Partially achieved 6 Philippines Partially achieved Partially achieved 7 Viet Nam Partially achieved Partially achieved % Fully Achieved: LMICs (N=7) 0 (0%) 0 (0%) 1 American Samoa No data No data 2 Cook Islands Partially achieved No response 3 Fiji Partially achieved No response 4 French Polynesia No data No data 5 Guam No data No data 6 Kiribati Not achieved Partially achieved 7 Marshall Islands No data Fully achieved 8 Micronesia (Federated States of) Not achieved No response 9 Nauru No data No response 10 New Caledonia No data No data 11 Niue Not achieved No response 12 Northern Mariana Islands (Commonwealth of the) No data No data 13 Palau Not achieved No response 14 Papua New Guinea Partially achieved No response 15 Samoa No data Fully achieved 16 Solomon Islands No data No response 17 Tokelau No data No data 18 Tonga Partially achieved No response 19 Tuvalu Fully achieved No response 20 Vanuatu No data Fully achieved 21 Wallis and Futuna Islands No data No data % Fully Achieved: PICs (N=21) 1 (5%) 3 (14%) TOTAL (N = 36) 3 (8%) 5 (14%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201790 Country has implemented national policies to reduce population salt/sodium consumption, including reformulation of food products; establishment of a supportive environment in public institutions to enable lower sodium options to be provided; behaviour change communication and mass media campaigns; and front-of-pack labelling. WHO NCD Country Capacity Survey tool – The NCD CCS is completed by a team at the country level to ensure that a comprehensive response is compiled. This indicator is considered fully achieved if the country responds "Yes" to the question "Is your country implementing any policies to reduce population salt consumption?" and to the subquestions "Are these targeted at: product reformulation by industry across the food supply; regulation of salt content of food; public awareness programme; nutrition labelling? (must have "Yes" to product reformulation by industry across the food supply and/or regulation of salt content of food, and "Yes" to public awareness programme and nutrition labelling"). Country must also provide the needed supporting documentation. This indicator is considered partially achieved if the country responds "Yes" to the question "Is your country implementing any policies to reduce population salt consumption?", and "Yes" to at least one of the four subquestions "Are these targeted at: product reformulation by industry across the food supply; regulation of salt content of food; public awareness programme; nutrition labelling?". Countries are asked to submit a copy of their policy(ies) when submitting their response to the NCD CCS. Responses are cross-validated with data obtained through the Global Nutrition Policy Review and the WHO Global database on the Implementation of Nutrition Action (GINA). Where discrepancies are noted, these are referred back to the country for clarification and modification Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 7A Member State has adopted national policies to reduce population salt/sodium consumption Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 91 Indicator 7A: Country or area has adopted national policies to reduce population salt/sodium consumption DK=don't know; – =documentation not available No. Country / Area 2015 2017 1 Australia Fully achieved Partially achieved 2 Brunei Darussalam Not achieved DK 3 Hong Kong SAR (China) Fully achieved Partially achieved 4 Japan – Partially achieved 5 Macao SAR (China) Not achieved Partially achieved 6 New Zealand Fully achieved Partially achieved 7 Republic of Korea Fully achieved Fully achieved 8 Singapore Fully achieved Fully achieved % Fully Achieved: HICs (N=8) 5 (63%) 2 (25%) 1 Cambodia Not achieved Not achieved 2 China Fully achieved Fully achieved 3 Lao People's Democratic Republic Not achieved Not achieved 4 Malaysia – Fully achieved 5 Mongolia Not achieved Fully achieved 6 Philippines Not achieved Not achieved 7 Viet Nam Not achieved Not achieved % Fully Achieved: LMICs (N=7) 1 (14%) 3 (43%) 1 American Samoa No data DK 2 Cook Islands No data Not achieved 3 Fiji Fully achieved Not achieved 4 French Polynesia Not achieved Not achieved 5 Guam Fully achieved Partially achieved 6 Kiribati – Not achieved 7 Marshall Islands – Not achieved 8 Micronesia (Federated States of) Fully achieved Not achieved 9 Nauru Not achieved Partially achieved 10 New Caledonia – – 11 Niue Not achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) Not achieved Not achieved 13 Palau Fully achieved No response 14 Papua New Guinea Not achieved Not achieved 15 Samoa No data Not achieved 16 Solomon Islands Not achieved Not achieved 17 Tokelau No data Not achieved 18 Tonga Not achieved Not achieved 19 Tuvalu Fully achieved Not achieved 20 Vanuatu Not achieved Partially achieved 21 Wallis and Futuna Islands Not achieved No response % Fully Achieved: PICs (N=21) 5 (24%) 0 (0%) TOTAL (N = 36) 11 (31%) 5 (14%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201792 Country has implemented a policy(ies) to limit saturated fatty acids and virtually eliminate industrially produced trans-fats in the food supply. WHO NCD Country Capacity Survey tool – The NCD CCS is completed by a team at the country level to ensure a comprehensive response is compiled. This indicator is considered fully achieved if the country responds "Yes" to the question "Is your country implementing any national policies that limit saturated fatty acids and virtually eliminate industrially produced trans-fats (i.e. partially hydrogenated vegetable oils) in the food supply?", and provides the needed supporting documentation. Countries are asked to submit a copy of their policy(ies) when submitting their response to the NCD CCS. Responses are cross-validated with data obtained through the Global Nutrition Policy Review and the WHO Global database on the Implementation of Nutrition Action (GINA). Where discrepancies are noted, these are referred back to the country for clarification and modification. Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 7B Member State adopted national policies that limit saturated fatty acids and virtually eliminate industrially produced trans fatty acids in the food supply Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 93 Indicator 7B: Country or area adopted national policies that limit saturated fatty acids and virtually eliminate industrially produced trans fatty acids in the food supply – =documentation not available; DK = don't know No. Country / Area 2015 2017 1 Australia Fully achieved Fully achieved 2 Brunei Darussalam Not achieved Not achieved 3 Hong Kong SAR (China) Not achieved Fully achieved 4 Japan – Not achieved 5 Macao SAR (China) Not achieved Not achieved 6 New Zealand Fully achieved Fully achieved 7 Republic of Korea – Fully achieved 8 Singapore Fully achieved Fully achieved % Fully Achieved: HICs (N=8) 3 (38%) 5 (63%) 1 Cambodia Not achieved Not achieved 2 China Not achieved Fully achieved 3 Lao People's Democratic Republic Not achieved Not achieved 4 Malaysia Not achieved Fully achieved 5 Mongolia Not achieved Fully achieved 6 Philippines Not achieved Not achieved 7 Viet Nam Not achieved Not achieved % Fully Achieved: LMICs (N=7) 0 (0%) 3 (43%) 1 American Samoa No data Don't know 2 Cook Islands No data Not achieved 3 Fiji Not achieved Not achieved 4 French Polynesia Not achieved Not achieved 5 Guam Not achieved Not achieved 6 Kiribati Not achieved Not achieved 7 Marshall Islands Not achieved Not achieved 8 Micronesia (Federated States of) Not achieved Not achieved 9 Nauru Not achieved Not achieved 10 New Caledonia Not achieved Not achieved 11 Niue Not achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) Not achieved Not achieved 13 Palau Not achieved No response 14 Papua New Guinea Not achieved Not achieved 15 Samoa No data Not achieved 16 Solomon Islands Not achieved Not achieved 17 Tokelau No data Not achieved 18 Tonga Not achieved Not achieved 19 Tuvalu Not achieved Not achieved 20 Vanuatu Not achieved Not achieved 21 Wallis and Futuna Islands Not achieved No response % Fully Achieved: PICs (N=21) 0 (0%) 0 (0%) TOTAL (N = 36) 3 (8%) 8 (22%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201794 Country has implemented a policy(ies) to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt. WHO NCD Country Capacity Survey tool – The NCD CCS is completed by a team at the country level to ensure a comprehensive response is compiled. This indicator is considered fully achieved if the country responds "Yes" to the question "Is your country implementing any policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars, or salt?", and provides the needed supporting documentation. Countries are asked to submit a copy of their policy(ies) when submitting their response to the NCD CCS. Responses are cross-validated with data obtained through the Global Nutrition Policy Review and the WHO Global database on the Implementation of Nutrition Action (GINA). Where discrepancies are noted, these are referred back to the country for clarification and modification. Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 7C Member State has implemented the WHO set of recommendations on marketing of foods and non- alcoholic beverages to children Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 95 Indicator 7C: Country or area has implemented the WHO set of recommendations on marketing of foods and non-alcoholic beverages to children DK= don't know; – =documentation not available No. Country / Area 2015 2017 1 Australia Not achieved Fully achieved 2 Brunei Darussalam Not achieved Not achieved 3 Hong Kong SAR (China) Not achieved Fully achieved 4 Japan Not achieved Not achieved 5 Macao SAR (China) Not achieved Not achieved 6 New Zealand Fully achieved Fully achieved 7 Republic of Korea Fully achieved Fully achieved 8 Singapore Fully achieved Fully achieved % Fully Achieved: HICs (N=8) 3 (38%) 5 (63%) 1 Cambodia Not achieved Not achieved 2 China Not achieved Not achieved 3 Lao People's Democratic Republic Not achieved Not achieved 4 Malaysia Fully achieved Fully achieved 5 Mongolia Not achieved Fully achieved 6 Philippines Not achieved Not achieved 7 Viet Nam Not achieved Not achieved % Fully Achieved: LMICs (N=7) 1 (14%) 2 (29%) 1 American Samoa No data DK 2 Cook Islands No data Not achieved 3 Fiji Fully achieved Not achieved 4 French Polynesia Not achieved Fully achieved 5 Guam Not achieved Not achieved 6 Kiribati – Not achieved 7 Marshall Islands Not achieved Not achieved 8 Micronesia (Federated States of) Not achieved Not achieved 9 Nauru Not achieved Not achieved 10 New Caledonia Not achieved – 11 Niue Not achieved Not achieved 12 Northern Mariana Islands (Commonwealth of the) Not achieved DK 13 Palau Not achieved No response 14 Papua New Guinea Not achieved Not achieved 15 Samoa No data Not achieved 16 Solomon Islands Not achieved Not achieved 17 Tokelau No data Not achieved 18 Tonga Not achieved Not achieved 19 Tuvalu Not achieved Not achieved 20 Vanuatu – Fully achieved 21 Wallis and Futuna Islands Not achieved No response % Fully Achieved: PICs (N=21) 1 (5%) 2 (10%) TOTAL (N = 36) 5 (14%) 9 (25%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201796 Country has implemented legislation/regulations that fully implement the International Code of Marketing of Breast-milk Substitutes. Copies of legislation and regulations on the International Code of Marketing of Breast-milk Substitutes are compiled by WHO every two years. In 2015/16, countries were asked to submit copies. Additionally, copies of legislation were obtained from UNICEF and IBFAN/ICDC and legal databases (Lexis/Nexis and FAO-LEX), EUR-LEX, national gazettes and internet search engines. This indicator is considered fully achieved if the country is assessed as having national legal measures categorized as "full provisions in law", whereby countries have enacted legislations or adopted regulations, decrees or other legally binding measures encompassing all or nearby all provisions of the Code and subsequent WHA resolutions. This indicator is considered partially achieved if the country is assessed as having national legal measures categorized as "many provisions in law" or "few provisions in law", whereby countries have enacted legislation or adopted regulations, decrees or other legally binding measures encompassing many or few provisions of the Code and subsequent WHA resolutions. WHO, UNICEF, and IBFAN/ICDC analyse all legislation and regulations to determine which provisions of the Code were covered. All three organizations agree upon the categorization based on the provisions included. Every two years http://www.who.int/nutrition/publications/infantfeeding/code_report2016/ en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 7D Member State has legislation/regulations fully implementing the International Code of Marketing of Breast-milk Substitutes Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 97 Indicator 7D: Country or area has legislation/regulations fully implementing the International Code of Marketing of Breast-milk Substitutes * Revised based on additional inputs from national focal point; – = documentation not available; DK = don't know No. Country / Area 2015 2017 1 Australia Fully achieved Not achieved 2 Brunei Darussalam Not achieved Not achieved 3 Hong Kong SAR (China) Not achieved Not achieved* 4 Japan Not achieved Not achieved 5 Macao SAR (China) Not achieved No data 6 New Zealand Fully achieved Not achieved 7 Republic of Korea Not achieved Partially achieved 8 Singapore Not achieved Not achieved % Fully Achieved: HICs (N=8) 2 (25%) 0 (0%) 1 Cambodia Fully achieved Partially achieved 2 China Not achieved Partially achieved 3 Lao People's Democratic Republic Not achieved Partially achieved 4 Malaysia Fully achieved Not achieved 5 Mongolia Fully achieved Partially achieved 6 Philippines Fully achieved Fully achieved 7 Viet Nam Fully achieved Fully achieved % Fully Achieved: LMICs (N=7) 5 (71%) 2 (29%) 1 American Samoa No data No data 2 Cook Islands No data Not achieved 3 Fiji Fully achieved Fully achieved 4 French Polynesia Fully achieved No data 5 Guam Not achieved No data 6 Kiribati – Not achieved 7 Marshall Islands Not achieved Not achieved 8 Micronesia (Federated States of) – No response 9 Nauru Not achieved No response 10 New Caledonia – No data 11 Niue Not achieved No response 12 Northern Mariana Islands (Commonwealth of the) Not achieved No data 13 Palau Fully achieved Fully achieved 14 Papua New Guinea Fully achieved Partially achieved 15 Samoa No data Not achieved 16 Solomon Islands Fully achieved* Partially achieved 17 Tokelau No data No data 18 Tonga Not achieved No response 19 Tuvalu DK Not achieved 20 Vanuatu Not achieved Not achieved 21 Wallis and Futuna Islands Not achieved No data % Fully Achieved: PICs (N=21) 5 (24%) 2 (10%) TOTAL (N = 36) 12 (33%) 4 (11%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 201798 Country has implemented at least one recent (within the past 5 years) national public awareness programme on physical activity. WHO NCD Country Capacity Survey tool – The NCD CCS is completed by a team at the country level to ensure a comprehensive response is compiled. This indicator is considered fully achieved if the country responds "Yes" to the following question. "Has your country implemented any national public awareness programme on physical activity within five years?", and provides the needed supporting documentation. Countries are asked to submit a copy of any documentation of the programme and/or a link to the programme website when submitting their response to the NCD CCS. Where discrepancies are noted, these are referred back to the country for clarification and modification. Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 8 Member State has implemented at least one recent national public awareness programme and motivational communication for physical activity, including mass media campaigns for physical activity behavioural change Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 99 Indicator 8: Country or area has implemented at least one recent national public awareness programme and motivational communication for physical activity, including mass media campaigns for physical activity behavioural change * Revised based on additional inputs from national focal point; – =documentation not available No. Country / Area 2015 2017 1 Australia Fully achieved Fully achieved 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) Fully achieved Fully achieved 4 Japan Fully achieved Fully achieved 5 Macao SAR (China) Fully achieved Fully achieved 6 New Zealand Fully achieved* Not achieved 7 Republic of Korea Fully achieved Fully achieved 8 Singapore Fully achieved Fully achieved % Fully Achieved: HICs (N=8) 8 (100%) 7 (88%) 1 Cambodia Fully achieved Not achieved 2 China Fully achieved Not achieved 3 Lao People's Democratic Republic Not achieved Not achieved 4 Malaysia Fully achieved Fully achieved 5 Mongolia Fully achieved Fully achieved 6 Philippines Fully achieved Fully achieved 7 Viet Nam Fully achieved Not achieved % Fully Achieved: LMICs (N=7) 6 (86%) 3 (43%) 1 American Samoa No data – 2 Cook Islands No data Not achieved 3 Fiji Fully achieved Fully achieved 4 French Polynesia Fully achieved Fully achieved 5 Guam Fully achieved Fully achieved 6 Kiribati Fully achieved Fully achieved 7 Marshall Islands – Not achieved 8 Micronesia (Federated States of) Fully achieved Not achieved 9 Nauru Fully achieved Not achieved 10 New Caledonia Fully achieved – 11 Niue Fully achieved Fully achieved 12 Northern Mariana Islands (Commonwealth of the) Fully achieved Fully achieved 13 Palau – No response 14 Papua New Guinea Not achieved Not achieved 15 Samoa No data Not achieved 16 Solomon Islands – Not achieved 17 Tokelau No data Fully achieved 18 Tonga Fully achieved Fully achieved 19 Tuvalu Fully achieved Not achieved 20 Vanuatu – Not achieved 21 Wallis and Futuna Islands Fully achieved No response % Fully Achieved: PICs (N=21) 12 (57%) 8 (38%) TOTAL (N = 36) 26 (72%) 18 (50%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017100 Government approved evidence-based national guidelines/protocols/ standards for the management (diagnosis and treatment) of the four main NCDs – cardiovascular diseases, diabetes, cancer and chronic respiratory diseases. WHO NCD Country Capacity Survey tool – The NCD CCS is completed by a team at the country level to ensure a comprehensive response is compiled. This indicator is based on the number of countries who indicate that national guidelines/protocols/standards exist for all four NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases). The indicator is considered fully achieved if national guidelines/protocols/ standards exist for all four NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases), and the country provides the needed supporting documentation. This indicator is considered partially achieved if the country has guidelines/ protocols/standards for at least two of the four NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases), but not for all four. Countries are asked to submit a copy of the guidelines/protocols/ standards when submitting their response to the NCD CCS. Where discrepancies are noted, these are referred back to the country for clarification and modification. Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 9 Member State has evidence-based national guidelines/ protocols/standards for the management of major NCDs through a primary care approach, recognized/approved by government or competent authorities Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 101 Indicator 9: Country or area has evidence-based national guidelines/protocols/standards for the management of major NCDs through a primary care approach, recognized/approved by government or competent authorities * Revised based on additional inputs from national focal point; – =documentation not available; DK = don't know No. Country / Area 2015 2017 1 Australia Partially achieved Fully achieved 2 Brunei Darussalam Fully achieved Partially achieved 3 Hong Kong SAR (China) Partially achieved Partially achieved 4 Japan – DK 5 Macao SAR (China) Partially achieved Partially achieved 6 New Zealand Fully achieved* Fully achieved 7 Republic of Korea Fully achieved Partially achieved 8 Singapore Fully achieved Fully achieved % Fully Achieved: HICs (N=8) 4 (50%) 3 (38%) 1 Cambodia Not achieved Not achieved 2 China Fully achieved Fully achieved 3 Lao People's Democratic Republic Not achieved Fully achieved 4 Malaysia Fully achieved Fully achieved 5 Mongolia Partially achieved Partially achieved 6 Philippines Partially achieved Partially achieved 7 Viet Nam Fully achieved* Fully achieved % Fully Achieved: LMICs (N=7) 3 (43%) 4 (57%) 1 American Samoa No data – 2 Cook Islands No data Fully achieved 3 Fiji Partially achieved Partially achieved 4 French Polynesia Not achieved Fully achieved 5 Guam Fully achieved Partially achieved 6 Kiribati – Partially achieved 7 Marshall Islands – Not achieved 8 Micronesia (Federated States of) Partially achieved Partially achieved 9 Nauru DK Fully achieved 10 New Caledonia – – 11 Niue Not achieved Fully achieved 12 Northern Mariana Islands (Commonwealth of the) – Partially achieved 13 Palau Fully achieved Fully achieved 14 Papua New Guinea – Partially achieved 15 Samoa No data Partially achieved 16 Solomon Islands Partially achieved* Partially achieved 17 Tokelau No data DK 18 Tonga Partially achieved Partially achieved 19 Tuvalu Partially achieved Partially achieved 20 Vanuatu Partially achieved Partially achieved 21 Wallis and Futuna Islands Partially achieved No response % Fully Achieved: PICs (N=21) 2 (20%) 5 (24%) TOTAL (N = 36) 9 (25%) 12 (33%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017102 Country has provision of drug therapy (including glycaemic control for diabetes, mellitus and control of hypertension using a total risk approach), and counselling to individuals who have had a heart attack or stroke and to persons with high risk (≥30%, or ≥20%) of a fatal and non- fatal cardiovascular event in the next 10 years. WHO NCD Country Capacity Survey tool – The NCD CCS is completed by a team at the country level to ensure a comprehensive response is compiled. This indicator is based on the number of countries who respond "more than 50%" to the question "What proportion of primary health care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke?". Additionally, countries must have said all the following drugs were "generally available" in the primary care facilities of the public health sector: insulin, aspirin, metformin, thiazide diuretics, ACE inhibitors, CC blockers, statins, and sulphonylurea(s). The indicator is considered fully achieved if the country reports that more than 50% of primary health care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke and that all drugs listed above were generally available in the primary care facilities of the public health sector. This indicator is considered partially achieved if the country reports that between 25% to 50% of primary health care facilities are offering cardiovascular risk stratification for the management of patients at high risk for heart attack and stroke and that all drugs listed above were generally available in the primary care facilities of the pubic health sector. NCD focal points, officially nominated by the Ministry of Health, provide the official response to WHO through the NCD Country Capacity Survey tool. Every two years http://www.who.int/ncds/surveillance/ncd-capacity/en/ Definition Data collection tool and achievement criteria Data validation process Expected frequency of data collection Links to tool INDICATOR 10 Member State has provision of drug therapy, including glycaemic control, and counselling for eligible persons at high risk to prevent heart attacks and strokes, with emphasis on the primary care level Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017 103 Indicator 10: Country or area has provision of drug therapy, including glycaemic control, and counselling for eligible persons at high risk to prevent heart attacks and strokes, with emphasis on the primary care level DK = don't know No. Country / Area 2015 2017 1 Australia DK DK 2 Brunei Darussalam Fully achieved Fully achieved 3 Hong Kong SAR (China) DK Fully achieved 4 Japan DK DK 5 Macao SAR (China) Not achieved Partially achieved 6 New Zealand Fully achieved Fully achieved 7 Republic of Korea Not achieved Fully achieved 8 Singapore Dk DK % Fully Achieved: HICs (N=8) 2 (25%) 4 (50%) 1 Cambodia Not achieved Not achieved 2 China Not achieved Not achieved 3 Lao People's Democratic Republic Not achieved Not achieved 4 Malaysia Fully achieved Fully achieved 5 Mongolia Not achieved Not achieved 6 Philippines Not achieved Not achieved 7 Viet Nam Not achieved Not achieved % Fully Achieved: LMICs (N=7) 1 (14%) 1 (14%) 1 American Samoa No data DK 2 Cook Islands No data Fully achieved 3 Fiji Not achieved Partially achieved 4 French Polynesia Partially achieved Partially achieved 5 Guam Partially achieved Partially achieved 6 Kiribati No data DK 7 Marshall Islands DK Not achieved 8 Micronesia (Federated States of) Not achieved Not achieved 9 Nauru Partially achieved Partially achieved 10 New Caledonia Not achieved Partially achieved 11 Niue Partially achieved Partially achieved 12 Northern Mariana Islands (Commonwealth of the) DK Fully achieved 13 Palau Fully achieved Fully achieved 14 Papua New Guinea Not achieved Not achieved 15 Samoa No data Not achieved 16 Solomon Islands Not achieved Not achieved 17 Tokelau No data Fully achieved 18 Tonga Not achieved Not achieved 19 Tuvalu Not achieved Partially achieved 20 Vanuatu Not achieved Not achieved 21 Wallis and Futuna Islands Not achieved No response % Fully Achieved: PICs (N=21) 1 (5%) 4 (19%) TOTAL (N = 36) 4 (11%) 9 (25%) Progress on the Prevention and Control of Noncommunicable Diseases in the Western Pacific Region: Country capacity survey 2017104