But several barriers continue to impede Pacific islands' healthcare systems
By Jayvee Vallejera
The vision of universal health coverage—where anyone can just walk into a local hospital or clinic and avail of quality health services for free or at a meager cost—is still a distant ideal for most Pacific island nations but they are working toward achieving it amid the overwhelming challenges facing them.
The Marshall Islands, Tonga and Vanuatu are making strides toward achieving universal health care by offering government-funded services to residents either free of charge or with minimal copayments, according to a new report titled "Sustainability and Resilience in Pacific Island Health Systems."
The report pointed out, however, that there is more work to be done, noting that the locations of isolated and scattered communities in the Pacific present unique challenges and entail high costs of delivering health care.
The report, which will be presented in Auckland, New Zealand on Nov. 28, gives an overview of health systems in the Pacific region, with a focus on the Marshall Islands, Tonga and Vanuatu.
The report’s launch in Auckland, which is expected to draw world experts, will be an opportunity for healthcare professionals, policymakers, and researchers from the region to connect and build networks, said one of the report’s authors, Sir Collin Tukuitong of the University of Auckland.
According to a press statement announcing the report’s launch, Pacific island countries and territories are making strides toward achieving universal health coverage by focusing on primary health care and public initiatives while working with neighboring countries to meet international standards for population health and health promotion.
The goal, however, is impeded by unique and interconnected challenges such as unreliable and expensive transportation, small and fragile economies, constant extreme weather and natural disasters, and few medical professionals.
The report evaluates health systems across seven areas: population health, environmental sustainability, workforce, medicines and technology, service delivery, financing and governance.
Training an adequate number of health workers to meet current and future needs is a critical challenge.
Rural and outer island communities are particularly affected by this shortage, the report notes, attributing it to a combination of factors including heavy workload, low pay and lack of professional development opportunities in the Pacific compared to higher pay and better working conditions abroad.
Pacific island nations often rely on visiting medical teams for health care services.
The report noted that some strategies to retain health workers, such as bonding students to government services, have shown limited success, while other promising initiatives, such as deploying health workers in primary healthcare settings, are beginning to emerge.
The report noted that some island nations have old and fragile health equipment, while others are not equipped at all to deliver comprehensive care.
These countries’ limited budgets for medicines result in inconsistent supplies.
Because of such a predicament, they rely on development partners for funding and equipment donations.
Telehealth—the concept of consulting doctors virtually—holds promise, but the report notes that this option is defeated by poor internet connectivity and a lack of digital literacy in these nations.
The Pacific Health Information Network has been created to boost this effort, but most nations still lack well-functioning systems for data collection and management, the report adds.
People in the outer islands often have minimal access to quality care. The report notes that specialized services, such as those for cancer, cardiology and other surgical specialties are inconsistently available and residents often rely on visits by medical specialist teams.
Then there is the issue of money. The report notes that many Pacific island nations allocate less than 5 percent of their GDP to health care. That limits their capacity to provide health services.
The fact that the governments of these island nations are the main sources of healthcare financing and delivery also means any disruption, such as frequent elections, high turnover of political leaders and inadequate funding, affect healthcare, including long-term commitments.
Another area of major concern is climate change. Tukuitonga said Pacific island nations are particularly vulnerable. It’s not just about healthcare facilities being flooded by high tides and washed out by increased rainfall.
The report noted that ocean warming, acidification and changes in rainfall patterns destabilize fishery and agricultural systems. Subsequently, traditional diets consisting of local seafood and crops are changing. More people are eating more imported and processed foods, causing increased incidence of obesity, diabetes and other noncommunicable diseases that the overburdened health systems are not equipped to address.
Achieving sustainability and resilience among the Pacific Islands will depend on national, regional, and global commitments across health, economic, and ecological systems, the report said.
Its many recommendations—as outlined in the report—are key to addressing the interconnected challenges that were identified across the seven domains.
“Nationally, meeting NCD targets and accelerating [universal healthcare] will involve significantly increased investments in health and a skilled workforce that can consistently deliver health services,” the report said.
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