The Kingdom of Tonga health system review

Overview

The Kingdom of Tonga has had one of the best overall levels of health within the Pacific as a result of a dramatic reduction in communicable diseases and maternal and child mortality since the 1950s. It is also on target to achieve the Millennium Development Goals (MDG) around maternal and child mortality reflecting an effective primary health-care system, good public health infrastructure and comprehensive antenatal and postnatal care, immunization, water, sanitation and waste disposal programmes.

The government is the main financer of the health system, providing close to half (47%) of financing in 2007/2008, supplemented by a large degree of donor and development partner funding (38%) and an average of 10% of total health expenditure coming from household out of pocket payments (OOPs). Since 2000, government expenditure on health as a proportion of total health expenditure has averaged above 80%, at an average 4% of GDP and with the health sector consistently receiving a relatively large portion (12%) of total government funding.

Health services are provided by a network of 34 maternal and child health clinics, 14 health centres, three district hospitals and the tertiary referral hospital, Vaiola Hospital, located in the capital city, Nuku’alofa. The four hospitals also provide primary health care to the populations of their respective island groups through outpatient and emergency departments; in fact, over 90% of health services are delivered from the hospitals.

Tonga has workforce densities which are higher than other low- and middle-income countries (LMICs) in the Pacific but significantly below high-income neighbours, and suffers from “brain drain”, particularly for in-demand medical specialists such as surgeons and anaesthetists. Key deficiencies have been filled with funding from the Australian Aid-funded Tonga Health Systems Support Program (THSSP). However, this is a costly option and a more sustainable method must be established.

The emergence of lifestyle diseases, particularly diabetes and cardiovascular disease, poses a huge challenge to the health system and the overall health of the nation, with an alarming 99.9% of the adult population estimated to be at moderate to high risk of developing a noncommunicable disease (NCD). Tonga was the first country in the Pacific to launch a National Strategy to Prevent and Control NCDs. However, despite many preventative strategies implemented over the past decade, NCD risk factors continue to rise. The real challenge now is for Tonga to adapt its strong primary health-care system to deal with the range of emerging issues, particularly the large financial burden associated with chronic and noncommunicable diseases.

Another major challenge for Tonga is ensuring that quality primary health-care services can be maintained in remote areas. Despite the Ministry of Health ascertaining that 100% of the population can access appropriate health-care services with a regular supply of essential drugs within a one-hour walk, quality and scope of services is an issue in rural areas.