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BRIEF May 27, 2021

Samoa Returns to Community-based Approach to Contain Rise of Non-Communicable Diseases


Samoa re-engages the community to fight NCDs under the PEN Fa'a Samoa Program.

Photo: Samoa Ministry of Health

Like many island countries in the Pacific region, the Independent State of Samoa has one of the highest rates of non-communicable diseases (NCD) in the world. NCDs, such as diabetes, ischemic heart disease, cardiovascular disease, asthma, and chronic obstructive pulmonary disease account for 75 percent of the total disease burden. Alarmingly, the rates continue to rise.

One major contribution is the lack of systematic NCD disease management in the country, resulting in poor quality NCD services. Low screening rate, weak follow-up and referrals, and the lack of a patient tracking system are some of the gaps identified in the current NCD care model. Indeed, the World Bank’s Samoa Hypertension Cascade study found gaps at all stages of the care continuum. Early detection, referral, treatment, and care of NCD patients are vital and have a direct impact on the reduction of preventable disability and death.

The government of Samoa, in collaboration with the World Health Organization (WHO), initiated a Samoan version of the WHO’s Package of Essential Tools for Non-Communicable Disease Interventions known as PEN. This community engagement strategy highlights the country’s return to Fa’a Samoa or the Samoan way of delivering primary health care to its rural communities to lessen dependence on just a few main hospitals. The community-based intervention is anchored around a multi-disciplinary team based at the rural district hospital. It empowers and trains members of the Village Women’s Committees (VWC) to run health promotion activities that address NCD risk factors, measure key NCD metrics, and refer villagers with identified risks to district hospitals for further care.

The World Bank, through the Samoa Health System Strengthening Program, is also supporting the government of Samoa to scale up NCD screening in the communities with the School Nurse Program and the expansion of PEN Fa’a Samoa screening to rural villages.

The Advance UHC Multi-Donor Trust Fund (MDTF) provides technical assistance to the School Nurse Program whereby the nurses, as members of the multi-disciplinary team stationed at rural district hospitals, visit primary schools in their catchment areas regularly. School children are provided with health education and preventive and screening services. They also receive body mass index (BMI) screening at the start of the school year with continuous monitoring of child health indicators twice every year. Children who are overweight or obese and identified as being at risk of NCDs will be referred to special nutrition and physical activity programs which aim to change their diet and lifestyle and reduce their weight. These nutrition and physical activity sessions adopted a whole of community approach, going beyond the classroom to involve parents, teachers and other students.

"Rollout of PEN Fa’a Samoa to all villages is a government priority for prevention, early detection, and diagnosis of NCDs at the community level."

In Vaipua primary school, for example, children learn about health promotion intervention on SNAP (smoking, nutrition, alcohol, and physical activity), and have Zumba aerobic sessions along with their teachers. Awareness sessions on hand hygiene, Covid-19, and promotion of healthy eating for children are also provided for every class in between screening sessions.

As this is the first year of program implementation, the school nurse program has been rolled out to 13 primary schools in Upolu and Savaii with a total of 1,858 students screened. Out of which 46.8% are either overweighted or obese—underlining the importance of starting NCD interventions from a young age.

Meanwhile, the expansion of PEN Fa’a Samoa screening has been rolled out to 23 villages in four rural districts. In collaboration with rural district hospital nurses, the VWCs received rigorous capacity training on the objective of PEN Fa’a Samoa, how to use PEN tools (including hypertension and BMI charts, screening form, scales, and measurement tapes) to perform screening and conduct exercise classes. They also receive training on the negative impact of NCD risk factors on health and well-being, and how to make healthier life choices using alternatives that are readily available within their community.

The women then set up screening schedule that accommodate different times and settings in each village. Equipped with measurement equipment, charts and forms, they then visit each household to record critical NCD metrics. Once screened, potential patients will be referred to health facilities for diagnosis and NCD care and treatment, following NCD case management protocols.

In addition to screening, the VWCs also organize physical activity sessions for health promotion. Village residents can join a morning powerwalk in the village or Zumba lessons on weekdays.

This community-based NCD control program will be rolled out in Samoa during the five-year World Bank project implementation (2020-2025) to establish a people-centered, systemic NCD care model in the country. With the success of this community NCD prevention approach, Samoa’s Ministry of Health is looking to sustain its operation in communities to ensure quality of life is provided for its citizens with the right resources at hand.