Multistakeholder action to improve health and wellbeing by reducing health inequity through the first Healthy Island initiative in the Eastern Mediterranean Region

In Oman, noncommunicable diseases (NCDs) are responsible for 72% of all deaths with nearly one in five adults dying from NCDs before the age of 70 1. To combat risk factors for NCDs including tobacco use, physical inactivity and unhealthy diets, the government of Oman launched the Healthy Island initiative on Masirah Island in 2022 in collaboration with the World Health Organization (WHO). This initiative is the first of its kind in the WHO Eastern Mediterranean Region and aims to address social determinants of health through multisectoral action and community empowerment aiming to create an enabling environment for adopting healthier lifestyles. Despite challenges posed by the COVID-19 pandemic, the Healthy Island Initiative has had a positive impact through activities such as co-funding and constructing a harbour for local fishermen, developing a small market area productive families and economically disadvantaged women and constructing walkways and playgrounds to promote physical activity among island dwellers including children and adolescents. It is anticipated that the comprehensive systems approach adopted will lead to a decrease in NCDs across the island, particularly in underserved and disadvantaged populations.

How did Oman, with the support of the WHO Secretariat, achieve this?

The Ministry of Health (MoH) in Oman has taken a proactive stance to address the social determinants of health with a policy statement that paved the way for health and non-health measures. Its community-based initiative (CBI) enabled a department to be established with WHO’s financial and technical support in the early 1980s. Over the past two decades, the CBI has endeavoured to equitably improve health and socioeconomic development via Healthy Lifestyles, Healthy City, and Healthy Village projects across Oman.

WHO’s Healthy Island initiative seeks to create healthier environments for people to live, work and play through evidence-based advocacy, policy development, leadership, multisectoral planning, partnerships and community participation. While the vision has served as a unifying theme for health protection and health promotion in the Pacific, it had not previously been implemented in the Eastern Mediterranean Region. In 2022, WHO Oman collaborated with Oman’s MoH to launch the Healthy Island initiative on the largest and most populous island of the Gulf Cooperation Council (GCC) states, Masirah Island. Early in 2022, WHO Oman catalysed the approach through advocacy at the subnational level. WHO Oman organized meetings with Masirah Island’s local governor and health committee and, in September 2022, held a national workshop that was attended by more than 40 local governors and supported by the regional office. The workshop was an opportunity for learning key principles of the Healthy City approach and share knowledge from their practical experience.

To develop governance and leadership capacity to deploy a comprehensive and integrated approach at the subnational level, WHO Oman and the WHO Regional Office for the Eastern Mediterranean provided financial, logistical and technical support to design and deliver training sessions that were delivered to health committees, the MoH and local community leaders. The trainings focused on problem identification, solution development, fundraising, implementation and evaluation of health outcomes. WHO Oman provided technical expertise to the MoH’s CBI on how to apply a specific 80 criteria and indicators developed by WHO for monitoring and evaluation. WHO Oman also provided practical recommendations to improve documentation of achievements and ensure inclusion of key success factors for implementation. To further promote data-driven decision-making, WHO support included developing an electronic survey platform to improve baseline assessment of villages, cities and islands, and to enhance analysis and interpretation of results. This platform will ensure long-term accountability through monitoring and evaluation and enable data dissemination through a centralized database and dashboard for data visualization.

Partnerships between community organizations and the government enable continuous identification and resolution of priority issues. By providing technical advice to the MoH, WHO Oman facilitates the selection, development and implementation of initiatives that address the social determinants of health. WHO Oman also provides ongoing technical expertise and guidance to steer projects at the subnational level through an executive board and health committee. This enables an evidence-informed approach that is guided by global guidelines and standards, such as the Eastern Mediterranean Region’s guide to implementing the Healthy City programme. For example, WHO Oman advocated for the importance of achieving the related indicators under community emergency preparedness activities in Healthy Island activities, given Oman’s vulnerability to cyclones.

Health interventions are most effective “ when they are tailored to meet local needs. In Oman, the World Health Organization has been working alongside local communities so that, together, we can ensure that all people have the opportunity to lead healthier lives.” - Dr Jean Jabbour, WHO Representative in Oman

Communities now participate in the planning, financing and implementation of activities, with community leaders playing a key role in communication: this was demonstrated in 2021 when local communities collaborated with the local government and civil society organizations to successfully generate demand for COVID-19 vaccination.

The involvement of multiple stakeholders has made the Healthy Island Initiative a powerful tool for addressing NCDs in Oman through multisectoral action and addressing social determinants of health. This is of utmost importance given the country’s large area and dispersed population, which has posed a challenge to effective coordination in the past.

Knowledge

WHO country stories: delivering for all

“This impact story was published as part of the WHO country stories: delivering for all report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2022-2023.”