malaria. There has been a significant overall reduction in both estimated incidence of and estimated mortality (when mortality data excludes cases comorbid with HIV) from tuberculosis (TB) in the period 1990–2013. The most commonly diagnosed mental illnesses in Tonga are cases linked to substance misuse (drugs and alcohol). Health systems: In 2012 government expenditure on health was 4.5 per cent of GDP, equivalent to US$200 per capita. In the most recent survey, conducted in the period 1997–2010, there were 56 doctors, and 388 nurses and midwives per 100,000 people. Additionally, in the period 2007–12, 98 per cent of births were attended by qualified health staff and in 2013, 99 per cent of oneyear olds were immunised with one dose of measles. In 2011, 99 per cent of people were using an improved drinking water source and 92 per cent had access to adequate sanitation facilities. The most recent survey, conducted in the period 2000–11, reports that Tonga has 15 pharmaceutical personnel per 100,000 people. To n g a The Ministry of Health controls Tonga’s national health care system, which provides health care and medication free of charge. Tonga has 12 health centres and seven health clinics, which are staffed by a health officer and nurses. The centres are supported by five hospitals – one on each of the main islands. There are also a small number of private health care providers – these tend to be either traditional healers or private clinics run after hours by government doctors. Tongan hospitals usually have limited outpatient and emergency facilities. There are no pharmaceutical manufacturers or wholesalers in Tonga – the country imports all of its pharmaceutical requirements. The pharmaceutical sector in Tonga is not extensively regulated and there are no legal restrictions on pharmaceutical sales to licensed outlets. This is set to be overhauled under the WHO Country Co-operation Strategic Agenda (2013–17), one of the strategic priorities of which is to establish a national regulatory framework for laboratory services with monitoring and evaluation mechanisms, and a medicines regulatory system, including medicines management beginning with Viola Hospital. There is dedicated mental health legislation in the Mental Health Act, which was initiated and last revised in 2001. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. Commonwealth Health Partnerships 2015 277 Under-five mortality 25 20 15 10 1990 1995 2000 2005 2010 2015 Under-five mortality per 1,000 live births 2015 MDG 4 target 5 Life expectancy 1980 1990 2000 2013 Life expectancy Life expectancy in years 80 70 60 Mortality by cause of death (% of all deaths), 2008 Other NCDs Communicable, maternal, perinatal and nutritional Injuries Cardiovascular diseases Diabetes Respiratory diseases Cancer Tuberculosis: Incidence and mortality 1990 2000 2010 Mortality excluding cases comorbid with HIV (per100,000 people) Incidence of tuberculosis (per 100,000 people) – including cases comorbid with HIV 40 35 30 25 20 15 10 5 0
Commonwealth Health Partnerships 2015
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