NCD Coordinator

Pohnpei State Government
Department of Health and Social Services
P.O Box 189 | Kolonia, Pohnpei FSM, 96941|
W (691) 320-7423



To prevent, restore and maintain health conditions related to non-communicable diseases.


The NCD Program is responsible for implementing strategies to prevent the incidence of Diabetes Mellitus Type 11 and Hypertension and their related complications of cardiovascular and renal disease, among the people of Pohnpei State, and to treat and support persons who have been diagnosed with these diseases.

Chronic lung disease, cancers and injuries are also NCD’s which may be addressed by the Program in the future, but for which a Program has not yet been developed.


Diabetes Mellitus is a syndrome caused by an imbalance between insulin supply and demand. It is characterized by hyperglycemia and associated with abnormal carbohydrate, fat, and protein metabolism. These metabolic abnormalities lead to the development of specific forms of renal, ocular, neurological and cardiovascular complications.

Diabetes Mellitus includes 4 subclasses:-
- Type 1 – Insulin dependent Diabetes Mellitus (IDDM)
- Type 11 – Non-Insulin dependent Diabetes Mellitus (NIDDM)
- Secondary Diabetes
- Malnutrition related Diabetes

Diabetes Type 11

Diabetes Type 11 is a heterogeneous disorder involving both genetic and environmental factors.

Lifestyle factors are important in the development of Diabetes Type 11 - particularly overweight, physical inactivity and dietary factors. Past studies and studies in progress have demonstrated that lifestyle modification, especially increased physical activity and dietary modifications can prevent the development of Diabetes Type 11 in high risk individuals.

Reference - Guidelines for the Prevention and Management of Diabetes in the Federated States of Micronesia – A National Consensus Position, 2001.


Arterial Hypertension, or high blood pressure, is generally defined as a persistent elevation of systolic blood pressure of 140 mm Hg or above, and diastolic pressure of 90 mm Hg or above.

Hypertension is the single most important predictor of cardiovascular risk. Increased blood pressure level is related to increased severity of atherosclerosis, stroke, neuropathy, peripheral vascular disease, aortic aneurysms and congestive heart failure.


The responsibilities of the NCD Program are:-

• To educate the community on the prevention of non communicable diseases, e.g. Diabetes Type 11 and Hypertension - and their related complications of cardiovascular and renal disease - through health education, promotion and community awareness programs.

• To establish and maintain regular community health screening for early identification of disease and referral for treatment.

• To establish and maintain an accurate Registry of all known Diabetes and Hypertension clients in the community.

• To follow up all referrals of newly diagnosed clients from the Hospital Ward, OPD and community screening to ensure they receive regular health status monitoring and compliance support.

• To follow up clients who are not compliant with attendance at appointments at Public Health and/or DISPENSARIES Clinics.

• To educate clients/families/community in the care of Diabetes:-

- Regular monitoring of the disease
- Foot care
- Diet
- Physical Activity
- Healthy Lifestyle
- Medication compliance
- When to visit Clinic/OPD

• To prepare other PSDHS and DISPENSARIES staff to educate clients, family members and the community in the prevention and care of NCD’s



To ensure the NCD Program is effectively managed to fulfill all the program responsibilities to achieve the set program goals.


• The NCD Program is funded by the CDC through the FSM Government.

• The NCD Program is managed nationally by a NCD Coordinator in the FSM Department of Health, Education and Social Affairs.

• Funding for the Program includes the salary NCD Health Assistant , travel, disease preventative activities, supplies for health promotion activities, educational materials 

• The Pohnpei State NCD Program is managed by a Program Coordinator who is working towards a Diploma in Public Health. She reports to the Chief of Primary Health Care.

• The Program Coordinator assesses strategies required to prevent the incidence of NCD’s in the community and assesses the needs of clients diagnosed with the diseases. She sets goals, plans strategies, implements actions and evaluates outcomes.

• The Program Coordinator is assisted in Public Health by one CHA, Medex, Physician, who plan, organize and co-ordinate the NCD clinics.

• A Medical Officer is assigned to the NCD Program by the Chief of Primary Health Care and is responsible for medical treatment and referrals.

• Assistance to the NCD Program is provided in the DISPENSARIES’s by visiting physicians, Community Health Assistants.