C ommo nwe a l t h memb e r c o u n t r i e s For Tonga to achieve its targets for the reduction of child mortality, which form MDG 4, it should have reduced under-five deaths per 1,000 live births to eight and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2012 under-five mortality stood at 13 deaths per 1,000 live births and measles immunisation stood at 95 per cent. Tonga has been progressively reducing child mortality, but it may not have met the target when the 2015 data is analysed. Measles immunisation has seen a decrease from 99 per cent to 95 per cent, making it unlikely that this target will be reached. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Tonga, the maternal mortality ratio should fall to 17 cases per 100,000 live births. In 2013 adjusted maternal mortality in Tonga was 120 deaths per 100,000 live births (this figure was estimated by UN agencies/ World Bank as 110 in 2010). Given that maternal mortality is currently more than seven times the target figure, Tonga is very unlikely to meet this part of MDG 5. Another part of MDG 5 stipulates that 100 per cent of births must be attended by a skilled health professional. In the year 2010 this figure stood at 99 per cent, so this target has virtually been achieved. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. Tonga has a low estimated incidence of TB, which has been gradually declining since 1990. The country is making progress towards the achievement of MDG 6. In November 2013 Tonga launched its Tonga Millennium Development Goals Acceleration Framework, with a particular focus on reducing the country’s levels of NCDs (MDG target 6c). The United Nations Development Programme is providing support in co-ordinating various agencies, service providers and development partners to implement an action plan for the new framework. It will also provide policy advisory services relating to the prevention and treatment of NCDs, help advocate for healthy lifestyles, and mobilise development partners and donors to address the resource gaps identified in the action plan. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Less than a fifth of health care in Tonga (16 per cent) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 5.4 per cent of GDP in 2012, of which 84 per cent (US$200 per capita) was covered by the government. A WHO report in 2012 found that access to health care is good for the majority of people in Tonga, with the exception of communities on the most remote islands. The Ministry of Health’s mission statement is: ‘To respond effectively to the health needs of the Tongan people by providing the appropriate range and level of high quality health services and being accountable for the outcomes of these services.’ In the longer term, it aspires for Tonga to become ‘the healthiest nation in the Pacific Rim’ by 2020. In particular, Tonga is working on building its capacity to prevent and control NCDs, particularly obesity and hypercholesterolaemia. Tonga is not a signatory to the International Covenant on Economic, Social and Cultural Rights, the covenant that commits signees to ensuring ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. Care of the elderly: Around 6,000 people in Tonga are over the age of 65 – six per cent of the total population (2013). At the age of 60 a person in Tonga can be expected to live for an additional 19 years, on average (2013). Overall, public pension spending is equivalent to 0.9 per cent of the country’s total economic output (2005). Like other Pacific nations, the elderly in Tonga have traditionally been cared for by younger generations of their extended family. But the growth of the cash economy, increasing rural–urban migration and population growth have seen this traditional ‘informal safety net’ weaken. Consequently, the government has been looking for other ways of supporting elderly people when they have been left in vulnerable circumstances. Tonga is part of the regional the programme Social Protection of the Vulnerable in the Pacific. The Tongan Ministry of Finance and National Planning, acting through the Asian Development Bank and the Japan Fund for Poverty Reduction, is working with nongovernmental organisation Ma’a Fafine Moe Famili on the Tonga Social Service Pilot, which began in 2012. The pilot project seeks to provide social services to the elderly on the island of Ha’apia and rural outer areas of Tongatapu, which will include, where required, home visits, annual health checks and medical referrals. Home visits range from regular basic care to visits from a nurse and delivery of medicine, if necessary. Further information Ministry of Health: www.health.gov.to Commonwealth Health Online: www.commonwealthhealth.org/health/pacific/tonga 278 Commonwealth Health Partnerships 2015 Population over 65 6%
Commonwealth Health Partnerships 2015
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