Tonga Health Profile 2012

Ministry of Health's mission, vision and objectives

Mission:
To support and improve the health of the nation by providing quality, effective and sustainable health services and being accountable for the health outcomes.

Vision:
By 2020, we are the healthiest nation compared with our Pacific neighbours, as judged by international determinants.

Objectives:

• 1. To fight the NCD epidemic and communicable diseases by using effective preventive measures, being good role models and developing public participation and commitment.
• 2. To deliver the range and quality of services needed to meet the basic health requirements of the public.
• 3. To provide appropriate health services to all the outer islands and community centres through effective resourcing.
• 4. To build staff commitment and development by demonstrating to staff that they are valued.
• 5. To deliver services in a professional and friendly manner.
• 6. To continue to improve the standard of existing facilities and ICT, and to construct new facilities and introduce new ICT where needed.
• 7. To improve the management of financial resources through: better revenue collection, balanced budgeting, compliance with procurement procedures, timely processing of payments, and compliance with proper financial procedures.

Organization of health services and delivery systems

The Ministry of Health works in four programme areas: (1) policy formulation and administration; (2) preventive health services; (3) curative health services; and (4) dental health services.

Government health services are provided free of charge and physical access to care is good for the majority of people, with the exception of small populations living on isolated islands. Primary curative care and preventive services are delivered through a system of 14 health centres.

There are four hospitals in Tonga: the tertiary Vaiola Hospital in Nuku’alofa, with 196 beds; and three district hospitals, Prince Ngu’s hospital in Vava’u, Niu’ui hospital in Ha’apai and Niu’eki hospital in Eua. The overall bed occupancy rate is low, 34% in 2003, an indication that the hospital system is oversized and has not adapted to the changes in the disease pattern and to improvements in physical access. However, transportation between islands remains difficult and acute referrals to the tertiary hospital are uncommon, making centralization of services problematic. The four hospitals also serve the populations on their respective islands with primary health care and they all run busy outpatient and emergency departments.

Patients requiring specialist care that is not available in Tonga can be referred to New Zealand under two treatment schemes, one funded by the Government of Tonga and one by the Government of New Zealand. The decision to refer is made on a case-by-case basis by the Medical Transfer Board. Specialist treatment teams in such areas as eye surgery, plastic surgery, corrective orthopaedic surgery and rheumatic heart disease visit Tonga regularly.
Health policy, planning and regulatory framework

Health care financing

Total health expenditure amounted to US$ 11.3 million in 2008. The Government covers 68.7% of total expenditure on health, while private expenditure covers 31.3%. When expenditure on traditional healers and international referrals is excluded, it becomes obvious that the Government covers the absolute majority of both curative and preventive care costs and that ‘out-of-pocket’ payments for health care are low, 27.3% in 2008. About 12% of the population have some kind of health insurance. The private sector is still small and consists mainly of traditional healers and ‘after-hours’ practising government-employed doctors. About 14% of total expenditure on health is for traditional healers, although they are mostly paid in kind. Expenditure on drugs accounts for approximately 7.8% of total expenditure on health. There is a health insurance system, but it only covers government employees.

Reduced prevalence of noncommunicable disease risk factors including:

• - Tobacco use: 2% decrease in prevalence of smokers by 2015
• - Obesity: 2% decrease in overall prevalence of obesity by 2015
• Budget for preventive health care reaches 10% of total public health operational budget by 2015
• Primary health care to all communities in Tonga to follow common national standards, including the utilization of the service.

There are also other examples of partnerships between the Ministry of Health and other organizations, such as the Health Promoting Church Partnerships and the Health Promotion Foundation. There is close collaboration with WHO in strengthening the health system, based on primary health care principles. The Ministry of Health also has very good working relationships with the governments of Australia, Japan, New Zealand the People’s Republic of China, and recently, the Government of Cuba assisted in providing medical training for students from Tonga. There are ongoing partnerships with the following organizations: the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the European Union, the Global Fund, the Asian Development Bank, and several others.

The increase in noncommunicable diseases (NCD) has now reached epidemic proportions. In addition to human suffering, NCD can have a negative impact on family economies. The loss of income due to disease and the cost of treating chronic conditions can put enormous strain on families and destroy years of work to improve a family’s situation. Ultimately there will be a negative impact on the country’s economic development as more resources have to be used for health care and productive and experienced middle-aged people in the workforce are lost to chronic disease or death. Identifying and implementing effective population-targeted preventive measures that can slow the increase of disease and, in the future, reverse the trend, are of the highest priority. The national multisectoral strategy for the control and prevention of noncommunicable diseases, developed in 2003, is a sign that the Government takes the issue very seriously. There are plans to establish a Health Promotion Foundation with funding from dedicated taxation on tobacco and alcohol. Such a mechanism could provide crucial resources for health promotion, an area of health that is currently heavily dependent on external support.

There is a recognized need to improve both the quality of and access to health care, particularly for NCD, in view of the increasing burden of the ageing population. A large proportion of patients with diabetes and cardiovascular disease remain undiagnosed and untreated. It is therefore a priority to both increase access to care and improve the quality of care for people with noncommunicable diseases. This must include solutions for financing the treatment of chronic conditions and for increasing patients’ knowledge of their condition and their responsibility for care. Active participation in treatment and patient empowerment are essential for successful treatment of chronic conditions.

There is a need to strengthen both the collection of information and the analysis and dissemination of health statistics for decision-making. The outcomes of investments in health care financing and prevention of NCD must be able to be evaluated so that strategies can be modified when needed. The information must be easily available, cheap and reliable, and should therefore be based on ongoing surveillance rather than repeated and costly surveys. A first step towards such a system is the strengthening of vital statistics on births and deaths, as well as a consistent hospital-based diagnosis registration system. The Government has already started important work in this area, but there is a need to strengthen the system of data collection as well as increase the capacity to process and interpret the information gathered. The Ministry of Health is expected to invest substantially in the area of health information in the coming years, partly with resources made available through a World Bank loan.