Process of developing Country Cooperation Strategy in Tanzania, as an effective tool for aligning WHO's support to the member state in achieving health and health-related sustainable development goal.

Introduction: an organization's long-term success and relevance are linked with compelling strategic development. To that end, the country office of WHO in the United Republic of Tanzania, in collaboration with stakeholders, developed a 6-year Country Cooperation Strategy (CCS), 2022-2027. This paper describes the various steps taken in developing the CCS for the United Republic of Tanzania. Methods: we reviewed the global guideline for the development of CCS. In addition, we analysed documents on the national health sector strategic plan, the 13th Global Program of Work for WHO (GPW13), and the Sustainable Development Goal (SDG). We also reviewed data from routine HMIS, the Global Burden of Disease (GBD), and assessment results of the UN on the status of SDGs through the Common Country Assessment (CCA). Results: the performance on the overall Universal Health Coverage (UHC) effective coverage index, on a scale of 0-100, for Tanzania improved from 45.2 in 2010 to 55.2 in 2019. Strengthening health systems, protecting communities against public health emergencies, reducing or controlling exposure of individuals to risk factors, and better health governance, leadership, and accountability were the identified priorities for the CCS. Conclusion: the process of alignment of the CCS document with the national and global strategic goals would help the WHO to support and lead the country's effort towards achieving health-related SDGs. We believe the process we employed will lead to having detailed operational plans for implementation for achieving SDG targets. Keywords: Country cooperation strategy (CCS), sustainable development goal (SDG), strategic document, 13th global program of work (GPW13), health sector strategy, stakeholders, Tanzania.

Exploring health literacy in relation to noncommunicable diseases in Samoa: a qualitative study.

BACKGROUND: Samoa is suffering from alarming rates of noncommunicable diseases (NCDs). To address this epidemic, tackling health literacy is important. A qualitative study was conducted with the aim to explore health literacy in Samoa in relation to NCDs. METHODS: Six focus groups were conducted, with a total sample size of 73 participants aged over 18 years. The semi-structured interview guide was based on the conceptual model of the European Health Literacy project (HLS-EU). Data was translated, transcribed, coded, and categorized as part of the qualitative analysis. RESULTS: The analysis resulted in one overarching category and seven sub-categories based on 19 themes. It revealed that health literacy in Samoa is strongly influenced by the culture. Personal responsibility is lacking. The family circle is central to health in a community where support is provided through the church and local groupings. Basic knowledge of NCDs was present in the population, but a deeper understanding of chronic disease implications was lacking. Difficulties with regards to medication adherence for chronic diseases arose as a topic, and traditional healers are still strongly embedded in the local society. Finally, the health system's performance, especially primary care services at the local level, is suffering from the high burden of NCDs and has been challenged to respond to the needs of the community it serves. CONCLUSION: The findings of this study show how health literacy in Samoa is influenced by culture and suggest employing participatory, culture-sensitive, public health interventions which address the family as a whole, building on health literacy to address major public health problems like NCDs and remove barriers in the health system.

Achieving UHC in Samoa through Revitalizing PHC and Reinvigorating the Role of Village Women Groups.

The increasing prevalence of NCDs such as cardio-vascular diseases, diabetes and kidney failure represents a threat to sustainable development in Samoa. The aim of this commentary is to describe the important role played by women in the community in relation to public health and to detail the lessons learnt and results of a community-based NCD prevention and management package that utilizes the strengths of community engagement at primary care level to accelerate progress towards UHC. The impetus of reforms in Samoa is to strengthen community-based care and rebuild its foundation-Primary Health Care (PHC). In doing so, the government is reinvigorating the role of women's village committees in identifying and referring people with high risks factors for non-communicable diseases. In 2015, an attempt to reinvigorate the role of Komiti Tumama in health was undertaken to address the high burden of non-communicable diseases. The government together with WHO launched a demonstration project, "NCD early detection and self-management through community participation (PEN Fa'a Samoa)", which aimed to address key issues on NCDs through an approach of contextualizing universal health coverage. Preliminary results of the program implementation are positive. PEN Fa'a Samoa achieved a high level of population screening coverage in the demonstration villages, in which the women's committee representatives played a key role. Samoa has shown in this example how such action can strengthen its health system, by utilizing critical human resources at a community level, which have proven to be essential to support the functioning of health services.

Developing a context-specific nutrient profiling system for food policy in Samoa.

The objective of this study was to develop a transparent system for defining 'less healthy' foods to underpin effective policy to reduce noncommunicable diseases in Samoa, replacing a fatty-meat ban lifted for accession to the WTO. In the absence of nutrition survey data, we calculated nutrient availability using food acquisition data from Samoa's Household Income and Expenditure Surveys. Together with published literature and local food composition data, we identified foods and nutrients (i) consumed in amounts greater than those recommended for good health and (ii) with a demonstrated causal link to health conditions of concern. Nutrient thresholds were developed based on desired level of decrease per nutrient per person necessary to reduce population intake in line with specific targets. We found average energy and sodium consumption to be higher than recommended, and foods high in sugar and saturated fat being consumed in large amounts. We selected a threshold-based, category-specific model to provide straightforward policy administration and incentivise healthy production and import, and then applied and tested nutrient thresholds across 7 threshold groups. The validation process indicated that the development of a nutrient profiling system to identify less healthy food items in Samoa provided a stronger basis for local policymaking. This study contributes to global understanding of approaches to developing a robust and transparent basis for policies to improve diets in lower income countries, and is relevant to other settings with high rates of noncommunicable diseases and similar resource and data constraints.

Adapting the WHO package of essential noncommunicable disease interventions, Samoa.

PROBLEM: Samoa has been struggling to address the burden of noncommunicable diseases at the health system, community and individual levels. APPROACH: The World Health Organization (WHO) package of essential noncommunicable disease interventions for primary health care in low-resource settings was adopted in seven villages throughout Samoa in 2015. The National Steering Committee Members designed and implemented a screening process, and local facilitators and health-care workers collected health and lifestyle data. The WHO/International Society of Hypertension risk assessment was used on villagers older than 40 years to identify people at high risk of noncommunicable disease. LOCAL SETTING: Samoa is a small island developing state with increasing morbidity and mortality due to noncommunicable diseases. A national representative survey indicated that 50.1% (595/1188) of the Samoan adult population is at high risk of such diseases. High numbers of noncommunicable diseases are undiagnosed or untreated, because of shortage of health-care staff and lack of awareness of risk factors. RELEVANT CHANGES: The teams collected data from 2234 adults. For people older than 40 years, 6.7% (54/804) were identified as being at high-risk and were encouraged to seek treatment or manage risk factors. Community members developed an awareness programme to improve understanding of lifestyle risk factors. LESSONS LEARNT: Engaging community members was crucial in conducting a successful screening campaign. By identifying those villagers at high risk of developing noncommunicable diseases, early intervention was possible. Education improved awareness of the symptom-free nature of early-stage noncommunicable diseases.