Community Leadership Driving a Healthy Samoa

If you need something done in a Samoan village, the local women’s committee can make it happen.

“If anyone needs help, they call me as they all know my number,” says Mata Ah Chong.

Mata is the women’s committee representative in Saleilua village, and it turns out that plenty of people need her help. Her committee — and others like them around the country — are a centrepiece for Samoa’s efforts to curb the rising number of non-communicable diseases (NCDs) like diabetes and heart disease.  

According to the World Health Organization, NCDs cause nearly three quarters of deaths in the world. Six Pacific nations sit in the global top 10 list of countries where premature death from NCDs is most likely. For Samoa, NCDs account for more than 75% of the disease burden and this figure has been increasing, impacting the community, the healthcare system, and the economy.

To tackle the crisis, Samoa developed a whole-of-country approach to improve the prevention, management and control of NCDs. The focus has been to decentralise health resources, strengthen outreach services, and empower community development by implementing a package of NCD interventions known as PEN Fa’a Samoa.

With support from the World Bank and the governments of Australia and New Zealand, the Samoan Government’s Health System Strengthening Program (HSSP) is expanding PEN Fa’a Samoa so more communities can access health screening and promotion activities and rural district hospitals are better equipped to support their patients.

Finding and helping those at risk

“The introduction of the PEN [has been] very useful,” says Mata. “We measure blood pressure, blood sugar and weigh everyone. We reached over 400 individuals in our village.”

Faala’a Epate, a Nurse Manager at Foailalo District Hospital, says the community screening is reaching those who may not normally seek health services or who have difficulty accessing it.

“Coming out to the community is very crucial for … people that do not come to the hospital, like [people living with] disabilities,” says Faala’a.

When it was first introduced, two districts trialled PEN Fa’a Samoa with support from the World Health Organization. Three years into the project, 14 out of the 34 districts prioritized by the Ministry of Health have become involved, with 10 districts reporting that they have successfully reached their targets of at least 70 percent of the adult population and 60 percent of the male population having been screened for NCDs and referred on for treatment where needed.  

Improving frontline health services

To further strengthen frontline healthcare and improve the quality of NCD management in communities, on-site health teams in rural district hospitals have expanded to include more doctors and nurses, as well as environmental health officers and data officers.

“I go to villages to do outreach programs,” says Falu Seiuli, a Public Health Nurse at Safotu District Hospital. “It is a good opportunity to work in communities and schools. It’s challenging, but doing the work has brought me more confidence, especially when I’m out in villages, you really have to engage.”

Recent reports indicate that 4 of Samoa’s 8 rural district hospitals now have fully expanded health teams in place and recruitment is underway to finalise vacant positions in the other 4.

Prevention is better than a cure

Preventing NCDs before they require treatment is also part of the plan. There is an impressive campaign underway to teach and model healthy behaviours for all Samoans.

“Health promotion is a process ... enabling the people to take ownership of their health,” says Faga Simi, the Principal Health Promotion Officer with the Ministry of Health. “[It] has been highly considered as the key area to address NCDs.”

Exposure to the health promotion program starts in school, where students from Grades 1-8 are weighed and assessed for their risk of developing NCDs. Children who are at risk are placed on a 10-week program, which improves their knowledge of how to have a healthy lifestyle and gets them involved in physical activities. In the first 3 years of implementation, Samoa’s healthy eating and active living program reached 49 primary schools in 17 districts with more than 80 percent of students screened for risk factors and targeted support provided to manage their nutritional and physical health.

To spread the message about healthy living more widely, the Ministry of Health developed the “change for life” campaign. These ads cover topics like smoking, obesity and the need to exercise and eat fresh food. They are played in hospital waiting rooms throughout the country and were even broadcast during the 2021 Rugby League World Cup, when the entire nation followed Samoa’s first World Cup finals appearance.  

Back in Saleilua village, the nation-wide ad campaign is brought to life by Mata and her women’s committee, who are busy planting vegetable gardens and setting up activities to help people get active, like volleyball, rugby and Zumba.

“Everyone looks forward to the Zumba. The ladies finish their chores quickly when it’s Zumba day!” says Mata. “A lot of people have lost weight and are much healthier.”

The campaigns are working. A knowledge, awareness and practice survey conducted in 2023 showed that 97% of respondents had improved understanding of NCD risk factors.

Nurturing a healthy environment

While health screening and Zumba classes are taking place at a community-level, the broader environment — including the price and availability of food — needs to support these health initiatives.

“One of the challenges for health promotion is the enabling environment. Even if we have lots of programs and activities to push for education on healthy eating ... if one village only sells chicken or turkey tails in their stores, that's all they can eat,” says Faga.

District hospitals are employing environmental officers, like Puipui Matifi Pili Vailara, who is working to ensure that shops, schools and markets are following legal requirements to help Samoans make good health choices.  

“I cover 24 villages,” says Puipui. “So, all those food businesses and schools, I cover inspections regarding sanitation, food safety, and environmental aspects.”

After moving away from home to study and work, Puipui is proud to back in her community, helping her friends and family live healthier lives.

“It's my first time working in the community where I was born and raised. And it's a privilege and honour for me to come back after studies and serve where I came from.

“I am passionate about my people. And my goal is to not leave them behind.”