INJURY PREVENTION FOR THE CHILDREN OF SAMOA POLICY PAPER

Ministry of Health/NZAID Child Health Project INJURY PREVENTION FOR THE CHILDREN OF SAMOA POLICY PAPER Version 6: July 2002

TABLE OF CONTENTS 1 INTRODUCTION... 1 2 PURPOSE... 1 3 PROGRAMME GOAL... 1 4 PROGRAMME OBJECTIVES... 1 5 BACKGROUND... 2 5.1 THE INJURY PREVENTION POLICY GROUP... 2 5.2 KEY IPPG OUTPUTS... 3 Situational injury analysis report... 3 Road related deaths and injuries... 4 Health education and promotional resources... 4 Child injury prevention mass media awareness campaign... 4 6 POLICY AND PROGRAMME DEVELOPMENT CONSIDERATIONS... 4 6.1 ADOPT A CO-ORDINATED APPROACH TO INJURY PREVENTION... 5 6.2 MAINTAIN / INCREASE PUBLIC AWARENESS OF CHILDREN S INJURIES... 5 6.3 MAINTAIN AN INTERSECTORAL APPROACH TO INJURY PREVENTION... 6 7 RECOMMENDATIONS... 7 8 CONCLUSION... 7 9 REFERENCES... 8 APPENDIX 1: ACTION PLAN... I APPENDIX 2: INJURY PREVENTION POLICY GROUP MEMBERS... II i

1 INTRODUCTION Samoa is a signatory to the United Nations Convention on the Rights of the Child, as such, the Government has a responsibility to improve and protect the health and development of all children in Samoa. The Government s vision for Samoa, as stated in its Health Sector Strategic Plan 1998 2003, indicates that: By the year 2003 all Samoans will be living in safe, healthy environments, well informed on, and participating in health matters, living healthy lifestyles and accessing essential primary, secondary and tertiary services provided by the most appropriate health care provider in a safe, ethical, caring and empowering environment. Hence, the Government of Samoa is committed to improving and protecting the health and development of Samoan children and their families. Injuries to children are a major cause of death and hospital admissions in this country and many of these injuries are preventable. In November 2001, the Ministry of Health, in collaboration with the New Zealand Agency for International Development (NZAID), started developing the child-targeted injury prevention programme as part of the Fanau Ma Aiga Manuia/Child Health Project. 2 PURPOSE The main purpose of this policy paper is to describe the key components of a three-year injury prevention programme targeted to children 0-18 years. 3 PROGRAMME GOAL To improve, promote and protect the health and development of Samoan children and their families. 4 PROGRAMME OBJECTIVES To reduce death and disability rates from injuries among children aged 0-18 years To reduce incidence of injuries occurring in homes, schools, work places and other public places To raise awareness in the community about injury prevention through the development of health promotion resources and activities. 1

. 5 BACKGROUND A needs analysis, conducted in 1999 on behalf of the Child Health Project, found injury and poisonings were the leading causes of death in children aged 1-14 years and the second leading cause of hospitalisation for 5 14 year-olds. 1 Injury prevention was subsequently identified as a child health priority and became one of key three components of the Child Health Project s four-year work programme. International experience suggests that injury prevention activities will be most effective when: the multiple factors contributing to injury are addressed behavioural and environmental changes are encouraged activities are spread across a variety of sectors (e.g. health, police, churches) programmes are maintained and reinforced over time. Factors influencing injuries are many and varied. The relationship between these influences is similarly complex, involving socio-economic factors, lifestyle, and social, cultural, occupational and community influences. The programme of activities proposed to prevent children s injuries in this paper is based on this knowledge and experience. 5.1 The Injury Prevention Policy Group The Injury Prevention Policy Group (IPPG) was established in April 2001 under the auspices of the Ministry of Health. The IPPG is an intersectoral advisory group. Its membership includes representatives from the: Accident Compensation Board Ministry of Commerce, Industry & Labour National Council of Women Ministry of Women, Community & Social Development Ministry of Education, Sports & Culture Ministry of Police, Prisons and Fire Services Komiti Tumama Ministry of Health (mainly the HEAPS and Environmental Health sections and the Child Health Project) National Hospital, Outpatient and Emergency Department (OPED) National Council of Churches NZAID Child Health Project (when in country). 1 McClellan VE, Eastwood J. 1999. Samoa Child Health Needs Analysis: An information paper. Department of Health/NZODA Fanau ma Aiga Manuia/Child Health Project. (Unpublished). 2

During the two-year development phase of the child health injury prevention programme, the IPPG s main role was to oversee the: Development of a situational analysis to identify priorities for injury prevention Identification of injury priorities on the basis of that analysis Development of health education resources specific to those priorities Launch of a national mass media awareness campaign Development of a continued programme of injury prevention activities. In addition to these advisory and monitoring roles IPPG members also provided: Collaborative linkages with the government and non-government organisations (NGOs) and the community Information and reports to support the situational analysis Practical support and assistance for the village and hospital-based surveys. 5.2 Key IPPG outputs The IPPG s three key outputs included the: Situational injury analysis report The situational analysis of injuries to children was completed in 2001. 2 Data collected for the analysis from the Tupua Tamasese Maeole Hospital and the village health centres showed children were over-represented, with more than half the total number of injuries occurring in children aged 0-19 years. Males sustained three times more injuries than females. The study also found the most common injuries to children were caused by: Sharp objects (mainly knives) Falls Dog bites, and Road related injuries. Other frequent causes of injuries included poisoning, burns and fights. The analysis also indicated that the head, followed by the foot were the most frequently injured body parts. The survey found that most of these injuries to children occurred around the home, and on the road. 2 Irving LM. 2002. The Children of Samoa: An analysis of Injuries. Ministry of Health/NZAID Fanau ma Aiga Manuia / Child Health Project. (Unpublished) 3

Road related deaths and injuries Between 1996-2000, 49 children, aged 1-18 years, died as a result of motor vehicle crashes, an average of 10 fatalities per year. Road-related injuries for this age group over the same period found that of the total 244 injuries, 41 percent occurred in 1-18 yearolds. 3 Two thirds (63%) of the children injured were males, while 37 percent were females. Most (34%) of the child-specific road injuries occurred on roads in the Apia town area. The next highest proportion (29%) of children s injuries occurred on roads on Savai i (29%). Most children (47%) were injured when crossing the road, 27 percent were injured as vehicle passengers and 15 percent while walking on the side of the road. Health education and promotional resources Based on the results of the situational analysis, HEAPS, assisted by Child Health Project Team members and some IPPG representatives, undertook extensive concept- and pretesting, prior to developing health education resources. The education and promotional materials that were subsequently developed included a poster, a flip chart, key rings and T-shirts. Child injury prevention mass media awareness campaign The injury prevention mass media awareness campaign was launched by the Minister of Health, on 24 April 2003 at the Samoa Nurses Association Hall at Moto otua. Campaign activities extended over one-week and included: Media promotions, mainly radio and television spots, an injury prevention programme special produced for 2AP. The injury prevention launch was also covered by Televisi Samoa Placement of an injury prevention banner at the Apia town clock Distribution of health education resources to relevant settings The launch of a specifically composed youth song to promote injury prevention (the result of a school competition). 6 POLICY AND PROGRAMME DEVELOPMENT CONSIDERATIONS The IPPG were given several programme options to consider, along with costings for each of the options. Based on the IPPG s feedback and consideration of the resource implications of the possible options the IPPG opted for a continued programme of injury prevention activity based on the following approaches. 3 Togafau NM. 2001. An analysis of motor vehicle accident injuries involving children (1-18 years) in Samoa, from the records of the Accident Compensation Board. A report prepared for the Child Injury Prevention Policy Group: Accident Compensation Board. 4

6.1 Adopt a co-ordinated approach to injury prevention Effective co-ordination is an acknowledged critical organisational factor in successful overseas injury prevention programme models. The appointment of a specific coordinator or alternatively designating the role of co-ordination to a specific government or NGO entity or person does help to ensure that: Activities are sustained beyond the development and launch phase of a programme Appropriate activities are scheduled and acted upon in accordance with the shape and direction of the ongoing injury prevention programme. Resource implications The IPPG considered the cost of appointing a full-time, designated, coordinator to coordinate injury prevention activities were too high (between $20,000-$25,000 per annum). The IPPG recommended instead that the HEAPS IPPG representative be assigned the responsibility of coordinating ongoing injury prevention activities. This option poses no additional costs to the Ministry of Health. It has the added advantage of HEAPS staff having built up considerable knowledge and experience in relation to injury prevention through its work on the recent Injury Prevention Launch and resources and through its Health Promoting Schools and Healthy Island work. 6.2 Maintain / increase public awareness of children s injuries This programme activity involves HEAPs using its existing injury prevention resources and promotional materials, plus any new materials the group might subsequently developed, on an ongoing basis to help maintain / increase public awareness of the: High incidence of children s injuries in Samoa, particularly in the home and the road Types of injuries involved and Practical measures that the public / families can take to prevent such accidents occurring. A suggested programme of activities and initiatives might include: 1 Holding an annual National Child Injury Prevention Day 2 Continuing to use the mobile health clinic, on an ongoing basis, to take home injury prevention messages out to the rural areas 3 Providing train-the-trainer sessions, for health workers such as community nurses and village Komiti Tumama 4 Including injury prevention activities and use of the newly developed into all its usual health promotion settings and intersectoral initiatives such as the Healthy Islands and the Health promoting Schools initiatives. 5

Resource implications Having recently mounted the highly successful mass media injury prevention campaign, HEAPS now the capacity and resources to mount future campaigns. HEAPS also has the capacity to develop specific resources for any future campaigns or initiatives targeted to prevent specific types of childhood injuries and settings where these injuries occur, for example the home where the majority of children s injuries occur. The cost of developing resources, such as posters and flyers, is between $15,000- $20,000. The cost of mounting a mass media campaigns, over a one-week period are high and would require sponsorship. The one-day mass media, awareness campaign option, is therefore deemed the most practicable and is therefore recommended. The cost of a oneday campaign, using the same TV and radio advertisements developed for the April 2003 campaign would be around $5,350. This would need to be built into HEAPS 2004-2005 budget. 6.3 Maintain an intersectoral approach to injury prevention International experience, coupled with that of the IPPG s own knowledge and experience, clearly demonstrates the value and effectiveness of the intersectoral approach for tackling complex issues such as children s injuries. The prevention of road and home-related injuries to children, such as those caused by knives, dogs and vehicles, is not just a health matter. A reduction in these types of children s injuries is more likely if the intersectoral and multifaceted approach is maintained. It is proposed that an intersectoral approach to injury prevention in childhood be maintained in order to: 1 Maintain the momentum achieved through the IPPG s recent injury prevention activities 2 Maintain its present linkages as well as continue to develop linkages with all relevant agencies individual and collective injury prevention/safety promotion initiatives, e.g. the Healthy Islands and Health Promoting School s Initiative 3 Maintain and further develop injury prevention activities that promote community involvement. The IPPG has met regularly since its establishment in April 2001. What it has achieved over the subsequent two-year period is commendable. A decision is now required as to whether the IPPG should: 1 Continue in its present form, with a modified terms of reference and change of title, in that its policy development assistance role will be completed once the policy paper is ratified and the policy is put into practice 2 Disband completely having fulfilled its original purpose. 6

Resource implications The costs of maintaining the IPPG s activities to date have been relatively low with an estimated cost of $1000 a year for IPPG meeting refreshments. The government and NGO representatives have contributed their time as part of their everyday work activities, while the administrative and resource costs have been covered by the Ministry of Health/NZAID Child Health Project budget. 7 RECOMMENDATIONS Based on consideration of the options, it is recommended that: 1 Responsibility for the Ministry of Health s injury prevention health promotion activities be transferred to and coordinated by HEAPS 2 HEAPS coordinate the suggested programme of injury prevention activities including mounting a one-day mass media, awareness, campaign in 2004-2005 unless sponsorship can be found to mount a one-week campaign 3 HEAPs maintain the established intersectoral approach to injury prevention although in a modified form to take account of the IPPG s changed role, or alternatively through an existing body, such as the Healthy Islands or Health Promoting Schools initiatives. 8 CONCLUSION The programme of injury prevention activities overseen by the IPPG over the past two years has done much to put children s injury prevention on the map in Samoa. It is important that the momentum achieved is both maintained and strengthened. This policy paper makes the case for maintaining the intersectoral approach to oversee future injury prevention in this country because the approach is generally acknowledged as the most effective approach to addressing the complex cultural, social and economic factors underpinning injuries. Injury prevention is not just a health issue. It is important that all sectors continue to work together and be available to support each other s injury prevention and safety activities. The paper also argues for maintaining a co-ordinated approach to injury prevention in order to build on to the successes already achieved under the IPPG s stewardship. The HEAPS Division of the Ministry of Health is involved on practically a day-to-day basis with injury prevention activities through the Fanau Ma Aiga Manuia mobile clinic, the Healthy Islands and the Health Promoting Schools initiatives. It is strongly recommended therefore that HEAPs take over the co-ordinating role of the injury prevention programme to ensure that the proposed public awareness and health promotion programme activities are realised and continue. 7

9 REFERENCES Irving LM. 2002. The Children of Samoa: An analysis of Injuries. Ministry of Health/NZAID Fanau ma Aiga Manuia / Child Health Project. (Unpublished) McClellan VE, Eastwood J. 1999. Samoa Child Health Needs Analysis: An information paper. Department of Health/NZODA Fanau ma Aiga Manuia/Child Health Project. (Unpublished). Ozanne-Smith J. 1995. The Principles of Injury Prevention. In Ozanne-Smith J, Williams F. (eds) Injury Research and Prevention: A Text. Melbourne: Monash University Accident Research Centre. 8

APPENDIX 1: DRAFT ACTION PLAN 1 Submit draft children s injury prevention policy paper to the IPPG (completed) 2 IPPG to select policy options (completed) 3 Revise the paper to include the options selected by the IPPG and the advice of the policy group (completed) 4 Sign off policy 5 Arrange meeting to report back to on decisions 6 Transfer injury prevention activities to HEAPS 7 NZAID Evaluation (January-March 2004) i

APPENDIX 2: INJURY PREVENTION POLICY GROUP MEMBERS 1 National Hospital, Clinical Services Dr Limbo Fiu (chairperson) 2 Accident Compensation Board Nanai Tongafau 3 Ministry of Commerce, Industry & Labour Mose Tagiilima 4 National Council of Women Fale Tuiletufuga 5 Ministry of Women, Community & Social Development Palanitina Toelupe 7 Ministry of Police, Prisons & Fire Services Eunice Sio 9 Health Education and Promotion Services Section, Ministry of Health Paula Leota 10 National Council of Churches Rev Fepai Kolia 11 Komiti Tumama Tapusalaia Faatonu Faletoese 12 Environmental Health Section, Ministry of Health Vailolo Toeaso 13 Ministry of Education, Sports & Culture Candice Apelu 14 National Hospital Emergency/Outpatients Department 15 NZAID Child Health Project, Ministry of Health Saufua Sio Joseph Tangatauli ii