comorbid with HIV) from tuberculosis (TB) in the period 1990–2012. In 2013 the estimated incidence of TB in the country was 18 per 100,000 people and estimated mortality (when mortality data excludes cases comorbid with HIV) was 3.2 per 100,000 people. The most commonly diagnosed mental illnesses in Samoa are bipolar disorder and drug-induced psychosis. Diagnosed cases of depression are also on the increase. Causes of depression are cited as increased urbanisation and migration causing the break-up of traditional support structures, and the increasing stresses of economic hardship. The country’s mental health act was passed in 2006. Health systems: In 2012 government expenditure on health was six per cent of GDP, equivalent to US$217 per capita. In the most recent survey, conducted between 1997 and 2010, there were 48 doctors, and 185 nurses and midwives per 100,000 people. Additionally, in 2009, 81 per cent of births were attended by qualified health staff and in 2013, 99 per cent of one-year-olds S amo a were immunised with one dose of measles. In 2012, 99 per cent of people had access to adequate sanitation facilities and 92 per cent had access to an improved source of water. Samoa’s national hospital, the Tupua Tamasese Meaole Hospital, is located at Motootua, in Apia, and supported by district hospitals and health centres. Samoan tertiary care is limited and mainly provided through arrangement with New Zealand’s health care system. Publicly funded health care is delivered through the National Health Service. For medical emergencies or specialist treatment beyond the scope of Samoa’s health services, patients are usually airlifted to Australia, New Zealand or Hawaii. All foreign nationals are required to pay for health services in Samoa, and Samoan health care facilities and doctors normally expect cash payment before carrying out any treatment. The private health care sector has expanded in recent years, but it is mostly confined to Apia, and consists of small hospitals and clinics able to offer only a limited range of medical services. Samoa imports almost all of its pharmaceutical requirements. The country has no independent drug regulatory authority. Global pharmaceutical organisations have interests in the anti-HIV drug Prostialin, which originated from the Samoan rainforest, and some have, in turn, donated revenues to the local people. Diabetes Respiratory diseases Commonwealth Health Partnerships 2015 253 Under-five mortality 35 30 25 20 15 1990 1995 2000 2005 2010 2015 Under-five mortality per 1,000 live births 2015 MDG 4 target 10 Life expectancy 1980 1990 2000 2013 Life expectancy 80 70 Life expectancy in years 60 50 Mortality by cause of death (% of all deaths), 2008 Other NCDs Communicable, maternal, perinatal and nutritional Injuries Cardiovascular 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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