1. Summary Findings of USAPI NCD Capacity Assessments and Ways Forward
Stacy De Jesus
Islands Coordinator
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
August 31, 2016

2. How It All Began
NCCDPHP has provided funding, guidance, and technical assistance to PIJs for at least two decades
A more coordinated approach was needed to change the tide of chronic disease
Jurisdictions were asked for input on “how CDC can help change the tide” at an August meeting on strengthening NCD capacity
Priorities:
Communication
Surveillance
Capacity Building
Partnerships
A workgroup was formed in 2012 with CDC representatives from tobacco, diabetes, heart disease, cancer, population health, and global health promotion to brainstorm ideas on how to better serve the Island Jurisdictions
Coordinated and strategic action plan that responds to the needs of each Jurisdiction
A new approach is the only way forward. CDC has supported both regions for at least 2 decades, rates of chronic diseases have soared, the burden is higher and the funds continue to shrink or stay the same. In 2013 we began our fact finding mission and we asked you “how we could help change the tide.
Results from the fact finding and meetings, we need coordination, strategic plans and you made your priorities communication, surveillance, capacity building and partnerships.

3. Cooperative Agreement DP14-1406
Public Health Actions to Prevent and Control Diabetes, Tobacco Use, Heart Disease, and Associated Chronic Disease Risk Factors and Improve Health in the US Affiliated Pacific Islands, Virgin Islands, and Puerto Rico
We began improving coordination through a funding opportunity announcement- DP , of which we will discuss futher later this morning.

4. DP Aims
Support implementation of cross-cutting, unified approaches that:
promote health
prevent and control tobacco use, diabetes, heart disease
promote healthy pregnancy and infancy through primary and secondary prevention of NCDs
Coordinate activities that increase capacity and address common risk factors
reduce administrative and reporting requirements
Develop NCD plans and establish organizational structure to collect and use surveillance data and develop evaluation plans

5. Two Prong Approach Capacity Building Phase – Years 1-2
Develop NCD plans
Establish organizational structure
Develop monitoring and surveillance plans and identify surveillance needs
Develop evaluation plans
Implementation Phase – Years 3-5
Increase cross-cutting approaches
epidemiology
surveillance
environmental approaches
clinical-community linkages
Still focusing on communication, surveillance, capacity building, and partnerships

6. NCD Capacity Assessments
Conducted in 2014 – 2015
Tool developed by CDC to evaluate the following:
Demographics and NCD burden
Health system infrastructure and primary care services
Workforce capacity building
Surveillance and health information
Planning, policy, and program management
Partnerships

7. NCD Country Capacity Tool Description
Objective overview of a country’s capacity to address NCDs
Composed of two parts:
Online questionnaire which is sent to the primary contact within health department who works with NCDs
Interview to discuss more in-depth questions
Objective measures (figures, surveillance reports, close-ended questions) and qualitative data (interviews and briefings) – provides a comprehensive perspective on how NCDs are structured in the jurisdictions
Interviews were usually held over 2 days

8. NCD Capacity Assessment Topics
Type of healthcare system, organization of NCD control departments, specific budget and resource allocation for NCDs
Available data: vital statistics, civil registration, surveillance systems related to NCDs and its risk factors and how the data are processed and managed
Workforce: availability of trained individuals working with NCDs, availability with training links with other academic institutions for training MOH staff
Planning, policy, programs: national NCD strategic plan, availability of national guidelines for prevention and treatment and associated risk factors

9. Summary Results NCD burden high
Accounts for a significant percentage of mortality and morbidity and health budgets
Heart disease, cancer, and diabetes are in the top 5 causes of death for most of the jurisdictions
Life expectancy similar across the USAPIs and ranged from
Youth smoking ranges from 8% - 47%
Adult smoking ranges from 13% - 32%
Youth (high school students) overweight/obesity ranges from 24% - 60%
Adult overweight/obesity ranges from 63% - 94%

10. Health system, Prevention, Primary Care
System structure and coverage
Delivery of healthcare is often mixed, with predominantly public with some private providers
Usually one hospital and federally funded community health centers (CHCs)
NCD Unit
All jurisdictions have some form of an NCD Unit, where the tobacco and diabetes programs supported by 1406 are housed.
NCD plans available in most jurisdictions, some still need to be finalized. Plans are a deliverable for 1406.
Some behavioral health related programs may sit in a different section of the department/ministry of health.
NCD Coalition
Status of NCD Coalition varies across the USAPIs. Some were already established prior to 1406 and have since been enhanced. Some have created new coalitions. An NCD Coalitions are a deliverable for 1406
Budget
Majority of the budget for NCDs come from U.S. federal funds

11. Workforce Capacity
Number of core NCD staff members can vary in size, often because organizational structure
Education levels of staff can vary
NCD staff may not have specific training and/or education in public health, so there is a need for on-the-job training
Most have a Territorial epidemiologist, but no epidemiologist dedicated to NCDs
Training needs identified include:
Leadership training for managers
Financial and grant management training
Program management training
Policy/advocacy
Program evaluation
Data/epidemiology training

12. Health Information Systems
All have Vital Statistics, but sometimes incomplete (challenges with outer islands)
Coding challenges
Medical records vary from paper-based to EHRs
Behavioral Risk Factor Surveillance System – self-reported
Not all USAPIs are funded and those that are, often have challenges and data may not be usable.
In jurisdictions that have reliable and usable BRFSS data, the need for physical measurements would be useful
All have Cancer Registries
Almost all have YRBS (every 2 years)
Some have GYTS (every 4 y ears)
STEPS – sporadic and delays with reporting
All jurisdictions usually have some sort of local assessment/efforts (community health surveys)

13. Planning, Policy, and Programs
All have NCD Strategic plans, but some need to be finalized
Most have developed monitoring and surveillance plans
NCD programs usually include:
Tobacco
Diabetes
Comprehensive Cancer
Breast and Cervical Cancer
Cancer registry
Racial and Ethnic Approaches to Community Health (REACH)
All have endoresed The Policy Commitment Package from PIHOA – made up of 15 essential policies

14. Resources, Partnerships, and Collaborations
Collaborate with other local government agencies
Often collaborate with local community colleges, University of Guam, Fiji National University, University of Hawaii, and other outside universities
All have strong partnerships with local NGOs
Partnerships with international agencies, such as WHO, PIHOA, SPC

15. Opportunities and Priority Areas for CDC
Data/epidemiology training
Data for Decision Making
Operational Research Training
Working to strengthen vital statistics data and underlying causes of death
NCD Dashboards/reports
Surveillance and data
Support Regional Epidemiologist (Dr. Haley Cash)
NCD Hybrid Survey
Pilot test #1 in CNMI – data collection complete, over 1000 surveys completed, dissemination workshop planned for late October
Pilot test #2 in Palau – ongoing, data collection about 40% complete, will have over 2000 completed surveys

16. Opportunities, Priority Areas for CDC, con’t
Health education and programs
Chronic Disease Self-Management Program (CDSMP) – will train 24 people from the USAPIs to become Master Trainers from September 12-16, 2016 in Honolulu
CDSMP is for community members with ANY chronic disease and teaches them how to better manage their conditions
Master trainers are expected to complete at least 2 workshops per year and at least 1 Leader training
Peer exchanges  NCD Hybrid survey
Ongoing technical assistance
Training opportunities through National meetings, other identified opportunities
Grants management training
Stronger coordination and integration within CDC to reduce burden
Identifying what is working and what is NOT working, so CDC can better tailor our cooperative agreements
Support for regional approaches to address the burden of NCDs in the USAPIs