1. “Managing Regionalism for Health” RMI Kumiti Presentation 52 nd Meeting of the Pacific Islands Health Officers Association June 11-15, 2012 Guam

2. Objectives Burden of Diabetes Planning process w/documents Weaknesses Strengths Recommendations

3. Burden of Diabetes Leading cause of death in the RMI since 2008 Leading cause of hospital admissions since 2008 Leading cause of inter island referrals Accounts for more than 50% of the MoH’s budget Affects the productivity and livelihood of the RMI population 90% of all TB relapse are diabetic patients Co-infection of HIV and TB Evident in younger age groups Can be controlled, reversed and prevented Lifestyle and Behavior Change

4. Update on NCD-Diabetes Declaration of Month of November as National Diabetes Month Strengthening of PHC programs/services - outreach/house-to-house initiatives: OI - integration of PHC at the clinical services - “wellness” programs: school health programs, physical activities in schools, communities

5. Update (cont) Community support for NCD activities - Creation of the “kumit” concept with NGOs support - Strong health promotions/health education: community awareness Weaknesses - ‘shared’ health responsibility concept - MOH still responsible for health - others challenges

6. RMI Planning Documents Vision 2018 National Strategically Developmental Framework  Subscribing to the principles of democracy  Mutual understanding and respect for one another  Prudent use of resources and an environmentally friendly population  High regard for moral and ethical standards  Sensitivity to the culture and pride in the Marshallese cultural heritage  Equality, professionalism and a strong commitment to quality standards  Healthy life style  Striving for excellence and confidence  Communal sharing and caring Ministry’s (MOH) Strategic Plan 2012- 2014.

7. NCD Strategy 2008-2012: The Kumit Plan

8. Process - National Departmental/Agency Heads Planners/Statisticians Review data/statistics Prioritize Timelines Development of goals and objectives Consultants

9. Process (cont) MOH Strategic Plans ◦ Senior staff, middle managers, medical providers, & consultants ◦ Plans are used for developing annual performance based- budgeting ◦ Plans are used for strategic plans for MOH

10. Weaknesses Plans are sometimes not monitored on a regular basis: challenges on HRH Not all the right people are involved in planning process Plans are sometimes not fully understood and so are not fully utilized Lack of feedback on planning documents HIS/quality data

11. Weaknesses (cont) Challenges in personnel, finances, economy, - negative impact Changes in political leadership – negative and positive impact on health plans/activities

12. Weaknesses (cont) Weak in health promotions/health education activities Lack of involvement of community/civil society – ‘communications’ Set agenda (consultancy) ‘Regionalism’ – not part of the national plans; “no one-size fits all” regionalism concept Regional partners ‘confusion’

13. Strengths Ownership of plans – having the right/skilled staff in the planning process Staff/personnel from outside health involved in the planning process Development of mechanism to monitor progress of plans Monitoring/reviewing progress of plans with the right staff Making the right changes accordingly based on challenges: personnel, finances, etc Consultants: thinking process, support

14. Recommendations Established multi-sectoral body to develop and oversee implementation of the Plan Ensure adequate health system support: personnel, financial, policies, political leadership Streamlining of NGO support for healthy lifestyle programs Traditional support

15. Recommendations (cont) Involving the right people in development of plan Advocacy for support: all levels including communities Development appropriate and specific protocols/legislation Multi-disciplinary approach Adequate HRH Strengthen the “sense of ownership”

16. Kommool Tata