Fa'a Samoa – island families come together to combat NCDs

October 2015

In a creative new initiative to improve health and save lives in villages across Samoa, women's groups are mobilizing their communities to prevent and control noncommunicable diseases (NCDs). Led by the Ministry of Health and the National Health Service, the WHO’s Package of Essential NCD interventions (PEN) has been adapted to reflect local culture and customs and rolled out over the last year in demonstration projects across the country.

WHO/S. McCarthy

The aptly named PEN Fa’a Samoa, literally meaning ‘PEN the Samoan way’, applies a village-based model for NCD prevention and control that emphasizes community participation and ownership. Early feedback has been positive. A significantly higher numbers of people are being screened for NCD risk factors and those who show symptoms are being given timely referrals for management of their condition.

In Samoa, half of all adults are at high risk of developing NCDs such as cancer, diabetes and heart disease. Despite improvements in overall health over the past few decades, the prevalence of NCDs in Samoa is high and growing. An estimated 94% of the adult population is overweight and 75% is obese. In addition, almost half of the population surveyed had diabetes. Despite these findings, a significant proportion of the population has not undergone routine screening for blood pressure or blood glucose.

In response to this public health threat, PEN Fa'a Samoa, with support from WHO, was rolled-out in November 2014 in several demonstration sites. PEN is a set of protocols developed by WHO for implementation at the primary care level in low resource settings. PEN Fa'a Samoa has 3 main pillars: early detection of NCDs, NCD management and increased community awareness. The model takes advantage of existing community structures, where extended families continue to play a significant role in daily life and culture.

Women's groups drive programme

The role of women's groups proved pivotal to its early success and acceptance by the community. Each village in Samoa has a women's committee representative, whose role is to liaise with government agencies on women’s and children’s issues. Capitalizing on this existing structure, PEN Fa'a Samoa works with the representatives to facilitate early detection of NCDs. Members of the community with abnormal findings are subsequently referred to a management team at the district health facility and seen by a physician who discusses a management and treatment plan with the patient and prescribes medication and changes in lifestyle.

"The whole idea is to engage with our community to ensure ownership and sustainability by enabling them to look after themselves," shares Dr Loudeen Lam, Medical Director at the Tuasivi Hospital. "PEN Fa'a Samoa establishes an early warning system for people to be more alert of red flags. It encourages them to seek help early rather than coming in later on with complications."

In communities where the pilot project has been implemented, over 92% of the target population has been reached. This is thanks in large part to efforts by the women's committee representatives to inform and encourage villagers to participate. Of those who underwent screening, 45% were found to have risk factors for NCDs and nearly one fifth reported experiencing possible symptoms of cardiovascular disease and diabetes (e.g. chest pain, weakness of one side of the face or body and fatigue).

Community participation

Community leader Li'uliu Simona from the village of Vaisaulu notes that the initiative has been effective in promoting the health of the community. "The village council fully supports PEN Fa'a Samoa and encourages the entire community to participate. It makes our community stronger and healthier," he adds. Ms Failautusi Piula, President of the Vaisaulu Women's Committee, echoes his support, "We have been with this project from the very beginning and we are excited to continue supporting it."

Through community participation and ownership, PEN Fa'a Samoa has mobilized entire villages to address the burden of NCDs. Significant progress has been made with over 90% of target populations undergoing early detection measures and 100% of identified high risk individuals referred for management. The next challenge is to scale-up the initiative to more locations and eventually roll it out across the entire country.

"I am so thankful for this program - thankful because it helps improve the health of men and women in my community. Personally, I think it should be rolled out to the whole country so that everyone would benefit from it," said Mauga Poufa Piula, who benefitted from the initiative.