Pacific health ministers respond to health crises
COVID-19 is a big opportunity for Pacific countries to transform their health systems, the region’s health ministers have heard.
COVID-19, non communicable diseases and climate change were the focus of the recent Pacific Health Ministers Meeting.
Global health crises meant it was the perfect moment to make a real difference for the whole Pacific, the meeting’s chair, Tuvalu’s Health Minister Isaia Taape told his counterparts.
“Many of our countries have small health teams, so if there are opportunities to kill two, three, four birds with one stone, then we should do that. Strengthening laboratory capacity, for example, will help countries now during the pandemic, but will also be helpful in responding to many other diseases in future, such as tuberculosis, dengue and measles. This meeting therefore came at the right time to share ideas, think strategically and identify the key actions needed to set up our health systems to save lives now, and also long after the pandemic,” said Minister Taape.
“COVID is actually a big opportunity for Pacific countries. Because of the focus on health and the support for strengthening the COVID response in the Pacific, there’s actually a big opportunity to strengthen capacities in the health system that won’t just be useful for the pandemic response, but it will be useful for many years ahead and for many different issues,” agreed Dr Marc Jacobs, Director of WHO Technical Support for the Pacific.
Dr Jacobs emphasised that every country’s health system—not just those in the Pacific—have been struggling to deal with COVID-19, and have had to reprioritise some of their services and reassign staff temporarily, which has affected the delivery of other health services.
During the meeting, Minister Taape highlighted his nation’s quick response to WHO’s guidelines. Tuvalu remains one of the few places on earth not to record any COVID positive cases. “I’m proud to say that Tuvalu heeded WHO’s warning back in early 2020 and acted immediately to [protect] our population. We launched our COVID-19 task force in late January 2020; we closed our borders to high risk countries in February 2020, and then closed our borders to all international [flights] in March 2020,” Taape said.
However, Tuvalu remains vigilant.
“We are also lucky that we are able to keep our borders closed, not every country has that luxury. We know that one day COVID-19 will arrive [on] our shores and we will be ready,” Taape stressed.
Temperature check: Health improvements
The COVID response has led to improved lab and testing facilities across the region. Dr Berlin Kafoa, Director of the Public Health Division, at the Pacific Community (SPC) said for example in Solomon Islands, they can now ask the “next level of question” in terms of genome sequencing and having the testing capability.
Pacific health ministers and their development partners are also reassessing health spending, with an eye towards greater sustainability.
For example, the Papua New Guinea government announced a huge 39% increase in its 2022 budget announcement at the end of last year. A significant proportion of this is going to capital expenditure, but Alyssa Leng and Stephen Howes writing at the DevPolicy blog observe that “Greater capital spending on health is undoubtedly important to improve the provision of health services and deepen capacity. But the urgent need is to increase spending on salaries, and goods and services (such as drugs, basic equipment, fuel for outreach and so on). Spending on these operational expenses does go up in the budget – salaries by 19% and goods and services by 42% – but fails to meaningfully improve on spending in 2019 or 2020 after accounting for inflation.”
In Kiribati, the share of development-partner contributions channelled through government systems increased from 28% to 42% from 2015 to 2019, giving the government much better oversight and control of national health plans and budgets.
However, despite substantial increases in both domestic and external funding to support responses to the pandemic, the tracking of health expenditures, both on and off system has deteriorated since 2020 in most countries, the meeting heard.
Meanwhile Dr Jacobs said the pandemic response has seen innovation in telemedicine, the introduction of digital vaccination records and increasing availability of psychosocial support. Following WHO’s guidance, a number of Pacific nations have launched e-registries for COVID vaccinations such as Fiji’s vaccine pass, to “strengthen surveillance, strengthen capacities, get access to vaccines and then deliver the vaccines to people right across the country,” said Dr Jacobs.
Having such measures in place give countries more options in terms of protecting the health of their people, while also dealing with the broader socio-economic impacts of having their borders closed for extended periods, Dr Jacobs said.
In light of increased repatriation flights, WHO acknowledges that the quarantine system is limited in its effectiveness. “Even with very strict quarantine and testing arrangements, no quarantine system can 100% protect the country from the virus coming in. And when we started to see Omicron in particular, which is a very infectious strain, we started seeing some leakage from the quarantine system and that was not surprising,” Dr Jacobs said.
NCDs: a political and policy issue
Despite the crisis of COVID, non communicable diseases (NCDs) remain the Pacific’s greatest killers.
Most Pacific Island countries and territories are not on track to meet the global Sustainable Development Goals relating to NCDs due to the pandemic, natural disasters and other competing priorities, a paper to the meeting stated.
Around 75% of deaths in PICs are caused by NCDs, posing a major threat to health and development. Heart disease, cancer, diabetes and hypertension, are responsible for about three quarters of avoidable deaths in Pacific Island countries, Jacobs confirmed. Recent studies have shown that people living with NCDs are more vulnerable to COVID-19. “COVID-19 has brought new urgency to the fight against non-communicable diseases because as I think we all understand, people with NCDs are more likely to develop serious illness or die from COVID-19,” Dr Jacobs said.
“Fundamentally, effective action on NCDs is a whole of government action and also action that actively engages with communities – it’s not all top-down… it’s just as much bottom-up being driven by local communities. It’s not telling people they should eat less and exercise more, it’s not about that. It’s about making it easier for people to make healthy choices,” Dr Jacobs told Islands Business.
“A lot of what we would call the social health determinants, the drivers of non communicable diseases, often, are not actually direct health issues. They are issues around access to food supply or concern about violence if people go exercise or what the taxation policies are like in a particular country,” he added.
The ministers endorsed the Pacific Legislative Framework for Non-communicable Diseases at the meeting; a guide to legislation, taxes and policies to encourage Pacific Islanders to make healthier choices. Minister Taape said law enforcement on NCD prevention is a “very serious issue” and he believes it is the responsibility of health ministers to oversee all food imports in their respective countries as a measure to prevent NCDs.
“The Pacific has got an opportunity now to improve legislation, improve policies and so on, on NCD risk factors like tobacco, alcohol and nutrition, and to work with communities to make it easier for people to make healthier choices. This is really a unique opportunity for bold action, the political will exists, the financial support exists.”
A recent paper by Samoan doctor and academic, Toleafoa Dr Viali Lameko stressed the need for legislative action, writing “obesity is a political as well as a policy issue.”
“If the Government of Samoa is to offset the rising cost of treating NCDs, it will have to adopt a more active multi-sectoral approach which could include laws, taxes, tariffs, and subsidies to increase consumption of fresh local food and decrease consumption of imported food,” he writes.
“But such measures will be politically unpopular, especially with local importers, wholesalers, retailers, and manufacturers.
“Unless carefully applied, such measures may make food too expensive for public consumption. Local manufacturers produce beer, soft drinks, ice cream, and various snack foods made from ingredients imported via global supply chains. Local merchants import hundreds of similar inexpensive products.”
Putting health at the heart of climate change
In response to climate change threats to Pacific lives, livelihoods and health care facilities, nine PICs (Fiji, Kiribati, the Marshall Islands, the Federated States of Micronesia, Palau, Samoa, Solomon Islands, Tuvalu and Vanuatu) have made progress in the development of Health National Adaptation Plans (H-NAPs) or their equivalents. Others have considered climate change resilience in their national disaster risk-reduction plans. However, the health ministers heard there are still gaps that need to be addressed, including translating the plans into practical action and investing in human and financial resources for health adaptation and mitigation measures.
The priorities laid out in the Pacific Islands Action Plan on Climate Change and Health and the WHO vision paper, For the Future: Towards the Healthiest and Safest Region, merge around four focus areas:
- advocacy to bring health into the centre of the climate change discussion;
- building resilience into health systems to face the climate crisis;
- strengthening regional and national scientific work to monitor the impact of climate change and the environment on health to inform evidence-based interventions and actions; and,
- applying a climate change and environment lens to all areas of the health sector’s work.
Dr Jacobs believes health systems should be ready to meet these rising health needs into the future, and ensure facilities can continue treating patients even in the face of our changing climate.
He adds the health sector must shine a light on climate action, and the intersections between health and other sectors. “The transport sector, for example, might be looking at ways of encouraging people to not drive their car so much and use public transport more, or use bikes more, so doing that produces some benefits from a transport sector perspective, but it also can reduce air pollution. It also can increase people’s physical activity. So all of those different sorts of things are additional health benefits of the action that the other sector wants to take,” Dr Jacobs said. “The health sector [also] needs to think about its own carbon footprint and how it can be reduced. Because I think there [are] estimates that suggest that about 5% of global greenhouse gas emissions are from the health sector. So we do need to be thinking about walking the talk ourselves as well,” Dr Jacobs added.
Related:
The State of Pacific health (Nov 2021)
A fraying lifeline: chronically under-funded and lacking resources (Nov 2021)
