The critical role of Komiti Tumama and the challenge of containing non-communicable diseases

AR
By Alexander Rheeney, 14 January 2019

Local solutions for local problems. That is what the article “Experts call for ‘Komiti Tumama’ role to tackle non-communicable disease crisis” in today’s edition of the Samoa Observer basically highlights. 

Samoa’s Ministry of Health and the World Health Organisation (WHO) should be commended for the decision to bring back the Komiti Tumama, and to make it relevant in the fight against non-communicable diseases (NCD). If the Komiti was so effective in terms of health delivery outcomes during the New Zealand colonial administration, then it makes sense to revive, strengthen and support them to face the country’s new health crisis.

“In Samoa, women’s groups (Komiti Tumama) have historically played a vital role in the delivery of public health and improving access to health services.

“Created under the New Zealand administration (1921–1962), Komiti remain in operation until the present day, though their role and influence as agents of public health have diminished,” stated the report.

And it is not a surprise to hear of the success by the Komiti since they began their work in 2015.

“Preliminary results of the programme 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. In this regard, PEN Fa’a Samoa utilizes the concept that the women in villages themselves take care of NCD risk factors for their own communities. 

“Following nomination, women’s committee representatives demonstrated considerable enthusiasm in informing and requesting village members to attend fixed sites for screening, which has resulted in remarkable screening coverage,” stated the report.

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Coincidentally, there was a story in yesterday’s edition of the newspaper, on the departure of members of the first Chinese medical team after a six-month stint. Their presence in Samoa, no doubt, saved a lot of lives — but it is the sharing of knowledge and skills with their local colleagues, which should have a positive impact on health outcomes in the country going forward.

With the increasing upskilling of local Samoan medical professionals — thanks to various agreements between the Government of Samoa and its international friends such as China, coupled with the intervention at the community level through groups such as the ‘Komiti Tumama’ — the health outcomes of the country’s citizens appear to be in good hands.

But in the fight against non-communicable diseases, no stone should be left unturned, therefore the connection between NCDs and poverty should not be downplayed.

A World Bank report released in July 2014 titled “NCD Road Map Report” concluded: “NCDs account for around 70-75 per cent of all deaths in the Pacific Islands. Many of these NCD-related deaths are premature (before age 60 years) and are preventable. Most of the trends and risk factors point to a worsening of the situation: the top 10 countries with the highest rates of diabetes in the world are in the Pacific Islands; 52.45 per cent of adult males in Tonga are estimated to be obese; in Kiribati, Federated State of Micronesia, Tonga and Samoa adult female obesity is estimated to be 50 per cent or more.”

“NCDs impose large but often preventable financial costs on already overstretched government health budgets. Several NCD-related programmes in the Pacific Islands are already unsustainable financially. However, there are proven, affordable, and cost-effective interventions. Some cost-saving interventions can pay for themselves over the longer term.”

“Multiple factors inside and beyond the health sector are driving the rise in NCDs, so a multi-sectoral approach is essential. Health challenges that involve factors beyond the health sector include: availability of water and sanitation, the level and quality of girls’ education, policing of traffic violations, and domestic violence.”

“Given risk factors in the Pacific and available use of cost effective actions (often referred to as ‘best buys’ for the available funding), each country should now finalize its own short country-specific NCD Roadmap that would include these four key strategies common to all countries in the Pacific: Strengthening tobacco control; Reducing consumption of food and drink directly linked to obesity; Improving the efficiency and impact of the health sector for prevention and early treatment; Strengthening monitoring and evaluation around activities; and the effective implementation of the recommendations in this roadmap is the most likely way of ‘bending’ the cost curve for NCD treatments.”

Perhaps this is the missing part of the equation in Samoa: taking into consideration these strategies highlighted in the World Bank Report and acting on them. 

Strengthening tobacco control and reducing the consumption of food and drink directly linked to obesity could be a start. 

What do you think? Have a wonderful Tuesday Samoa and God bless. 

AR
By Alexander Rheeney, 14 January 2019

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