Diabetes prevention through support for children at risk - the Pacific Ending Childhood Obesity (P-ECHO) initiative

Objectives

To reduce diabetes prevalence via primary and secondary obesity prevention in children, in Fiji, Vanuatu, Niue, Nauru, Wallis and Futuna.

Approach

This project integrates childhood obesity surveillance and diabetes prevention across primary health care and education systems in five Pacific countries, strengthening early detection, intervention, and long-term system sustainability through coordinated data systems, service delivery, and policy embedding.

Main activities

• Establishing digital child growth platforms that consolidate routine maternal and child health and school health data to enable early identification of at-risk children. These systems are aligned with World Health Organization Pacific Childhood Obesity Surveillance Initiative (WHO P-COSI) protocols and are embedded within each country’s existing Health Information System (HIS) and Education Management Information System (EMIS) to ensure sustainability and scalability.

• Delivering a universal, school-based “Healthy Child, Promising Future” programme targeting children aged 6–9 years, alongside community and maternal and child health outreach for children aged 0–5 years, to promote healthy nutrition and physical activity across early life stages.

• Implementing selective, family-centred interventions for children living with overweight or obesity, including multidisciplinary counselling using a locally adapted lifestyle manual and motivational interviewing approaches.

• Introducing risk-based metabolic screening from age 6 to enable early detection of type 2 diabetes, prediabetes, and other non-communicable disease risk factors, supported by standardised referral and follow-up pathways within primary health care services.

• Strengthening routine data use, quality assurance mechanisms, and feedback loops within health and education facilities to improve service delivery and continuous monitoring.

• Institutionalising all programme components within national systems and policies through coordinated leadership by Ministries of Health and Medical Services, Ministries of Education, the Pacific Community (SPC), the Children’s Programme on Obesity, Non-communicable Diseases, and Nutrition (C-POND), with technical and scientific support by Uppsala University, WHO, and UNICEF.

• Implementing a phased, multi-country roll-out, including inception phases with country-specific planning, as well as baseline and endline assessments in schools (ages 6–9 years) and maternal and child health settings (ages 0–5 years), using harmonised protocols to ensure cross-country comparability.

• Delivering targeted capacity building through training of trainers and cascaded mentoring approaches on growth monitoring, digital data entry, lifestyle counselling, metabolic screening, and referral workflows, complemented by embedded supervision and regular refresher training.

Expected results

• Integrated childhood obesity surveillance and diabetes prevention systems implemented across five Pacific countries, reaching both primary health care and education sectors.

• 5 integrated childhood obesity surveillance and diabetes prevention systems established across primary health care and education sectors in Fiji, Vanuatu, Niue, Nauru, and Wallis and Futuna.

• 5 project governance structures established, and 5 national implementation plans developed to support coordinated multi-country implementation.

• 10 baseline and endline assessments conducted across school and maternal and child health settings using harmonised WHO P-COSI protocols.

• 3,420 children aged 6–9 years reached through school-based healthy living programmes.

• 1,326 children identified for selective or secondary obesity and diabetes prevention interventions and referred for follow-up support.

• 3,420 children screened for overweight, obesity, and metabolic risk factors through integrated school and primary health care services.

• 5 digital child growth monitoring and reporting platforms established or strengthened within national Health Information Systems and Education Management Information Systems.

• 250 health care workers, school health staff, and community workers trained in growth monitoring, counselling, metabolic screening, referral pathways, and digital data entry.

• 5 national monitoring and evaluation systems strengthened through routine reporting, data quality audits, supervision, and feedback mechanisms.

• 5 national referral and follow-up pathways established for children identified with overweight, obesity, prediabetes, or type 2 diabetes risk factors.

• 5 sets of national guidelines, protocols, or operational manuals developed or adapted for healthy living promotion, growth monitoring, metabolic screening, and referral workflows.

• Strengthened monitoring and evaluation systems established across all sites, including baseline and endline assessments, routine biannual reporting, facility-level data audits, and predefined indicators covering data quality, counselling coverage, screening rates, and growth and metabolic outcomes, enabling continuous learning and mid-course programme adjustments.