The. Cook Islands. Health Strategy

Transcription

1 The Cook Islands Health Strategy July 2006

2 The Cook Islands Health Strategy Hon Dr Terepai Maoate Minister of Health July 2006 The Cook Islands Health Strategy ii

3 Published in July 2006 By the Ministry of Health P O Box 109, Avarua, Cook Islands The Cook Islands Health Strategy iii

4 Foreword Kia orana The Cook Islands Health Strategy builds on previous health related policies and plans and will guide the future development of health services to better meet the needs of all Cook Islanders. It highlights the priorities the Government considers to be most important in order to improve the health outcomes for all Cook Islanders and secure the future of our children and nation. I want to emphasise the principle that to reduce the incidence and impact of illness and disease, we require a strong focus on prevention, health promotion and healthier environments. Furthermore, health services need to reflect our cultural and historical values including traditional medicine and to be evidence based, cost effective and sustainable. The success of this Strategy will rely on a high degree of cooperation and collaboration between our Ministry, the people we serve, other government departments, as well as non governmental organisations. This can be achieved firstly through all our health workers working as a team and doing the right thing, by providing leadership, being role models and living healthier lives, and secondly engaging all Cook Islanders and stakeholders to work with us to improve our health services. I encourage us all to work together to achieve our vision of Healthier Cook Islanders achieving their aspirations through this Strategy and move towards enjoying a healthier future. Kia manuia. Hon Dr Terepai Maoate Minister of Health The Cook Islands Health Strategy iv

5 The Cook Islands Health Strategy v

6 Contents Foreword... iv Contents... vi Executive Summary... vii Introduction...1 Our Country.Our people..our health....3 Health Services...4 Health Status...5 Our Vision...6 Our Mission...6 Guiding Principles...7 Values...8 Priorities...9 Objectives Population Health Gain Goal: Improve and protect the health of all Cook Islanders Objective 1: To improve the health of children by reducing the mortality and morbidity rate Objective 2: To improve the health of young people through reducing the incidence and impact of risk taking activities Objective 3: To improve the health of women and mothers through preventing maternal mortality and reducing morbidity Objective 4: To improve the health of men through reducing the incidence and impact of non communicable diseases, tobacco, cancer, alcohol and trauma Objective 5: To strengthen health support services for older people Objective 6: To strengthen health services which support independence for people with disabilities Goal: Encourage healthier lifestyles and safer environments Objective 7: To strengthen mental health services including alcohol, drug, tobacco cessation and gambling cessation services Objective 8: To reduce the impact of non communicable diseases and injury with an emphasis on diabetes, cardiovascular disease, respiratory disease, cancer and oral health. 22 Objective 9: To reduce the impact of communicable diseases with an emphasis on STIs/HIV/AIDS, vector borne diseases, hepatitis and tuberculosis Objective 10: To improve environmental health focusing on food safety, safe water, clean air, sanitation and waste management Goal: Support community development Objective 11: To support families and communities to lead healthier lives Strengthened infrastructure and health systems Objective 12: To strengthen the infrastructure of the health system to ensure it has sufficient capacity to meet the health needs of the population Objective 13: To enhance human resources and research capacity Acknowledgements Guiding principles Glossary The Cook Islands Health Strategy vi

7 Executive Summary The Cook Islands Health Strategy identifies the Government s priority areas for Health. It will guide the development and delivery of health services for the next 10 years and will ensure that all efforts are focused on supporting Cook Islanders to collectively take ownership and responsibility for the health of our people and the environment that we live in. The strategy will focus on delivering services that are people focused and quality driven and ensures that people are empowered through information to reduce future risks to their health. It recognises the need to provide a robust infrastructure for health services which will support the future development of the health sector in the Cook Islands. The strategy aims to provide a framework which will deliver improved health outcomes for all Cook Islanders. It has been developed following a process of consultation and discussion with community groups, non governmental organisations, professional groups and health workers. It recognises that the major determinants which influence the health status of the population include poverty, housing, employment, education, and lifestyle factors. The health sector has a unique and important contribution to make to improve the health status of the population however individuals and communities, non governmental organisations and other sectors equally have an important role and responsibility to participate in this process. The strategy identifies as its Vision: Healthier Cook Islanders achieving their aspirations The Mission statement: "To provide accessible and affordable health care of the highest quality, by and for all in order to improve the health status of the people of the Cook Islands The strategy is guided by the same Principles articulated in the Cook Islands National Sustainable Development Plan It has identified six Values which provide for the foundation for the development and delivery of health services now and into the future: Respect People focused Equity Quality Integrity Accountability The Cook Islands Health Strategy vii

8 The strategy highlights the following Priorities: 1. Population health gain Improving the health of the population through focusing on the prevention, early intervention and treatment of communicable and non-communicable diseases and injury prevention. 2. Infrastructure and systems The development of infrastructure which will support the future development of the health sector by investing in information technology, telecommunication systems, workforce, developing and maintaining facilities, developing quality systems and processes, ensuring a sound legislative regulatory framework and ensuring sustainable health financing. 3. Effective communication Improving communication with individuals and communities, within the health sector between the Ministry of Health and operational services, and between Departments to ensure the effective and efficient delivery of health services. 4. Intersectoral partnerships To strengthen partnerships locally with civil society, Non Governmental Organisations (NGO s), community and church groups, internationally with health service providers, research organisations and donors which contribute to the improvement in the health status of Cook Islanders. 5. Health sector responsiveness The further development of disaster response and emergency management capacity in the health sector and community. To enhance the capacity to respond in a timely and effective manner to global health issues as they arise such as Avian Influenza 13 Strategic Health Objectives for the health sector to focus on have been selected for the impact they will have on improving the health status of the population 1. To improve the health of children by reducing the mortality and morbidity rate 2. To improve the health of young people through reducing the incidence and impact of risk taking activities 3. To improve the health of women and mothers through reducing maternal mortality and morbidity 4. To improve the health of men through reducing the incidence and impact of non-communicable diseases, cancer, alcohol and trauma. 5. To strengthen health support services for older people. The Cook Islands Health Strategy viii

9 6. To strengthen health services which support independence for people with disabilities. 7. To strengthen mental health services including alcohol, drug, tobacco cessation and gambling cessation services. 8. To reduce the impact of non communicable diseases and injury with an emphasis on obesity, diabetes, cardiovascular disease, respiratory disease, oral health, and cancer. 9. To reduce the impact of communicable diseases with an emphasis on Sexually Transmitted Infections (STI s), HIV/AIDS, vector borne diseases and the emergence of new infectious diseases. 10. To improve environmental health focusing on food safety, safe water, clean air, improved sanitation, and waste management. 11. To support families and communities to lead healthier lives. 12. To strengthen the infrastructure of the health system to ensure it has sufficient capacity to meet the health needs of the population. 13. To enhance human resources and research capacity. The objectives identify the areas which will have most impact on improving health outcomes for the population. These need to be supported by detailed annual planning and work plans and budgets in each area In summary, we have developed a challenging 5-10 year Health Strategy which will lead us into a future with a health system we can be proud of, quality health services we have confidence in and a health workforce which leads by example. Join us on our journey. The Cook Islands Health Strategy ix

10 Introduction The Cook Islands Health Strategy identifies the Government s priority areas for Health. It will guide the development and delivery of health services for the next 10 years and will ensure that all efforts are focused on supporting Cook Islanders to collectively take ownership and responsibility for the health of our people and the environment that we live in. The strategy will focus on delivering services that are people focused and quality driven and ensures that people are empowered through information to reduce future risks to their health. It recognises the need to provide a robust infrastructure for health services which will support the future development of the health sector in the Cook Islands. The strategy aims to provide a framework which will deliver improved health outcomes for all Cook Islanders. It has been developed following a process of consultation and discussion with community groups, non governmental organisations, professional groups and health workers. It recognises that the major determinants which influence the health status of the population include poverty, housing, employment, education, and lifestyle factors. The health sector has a unique and important contribution to make to improve the health status of the population however individuals and communities, non governmental organisations and other sectors equally have an important role and responsibility to participate in this process. The strategy also recognises the role of the Cook Islands as a member of the international community to contribute to the achieving the Millennium Development Goals (MDGs) to progress poverty elimination. While all MDGs are indirectly linked to improved health outcomes, three MDGs which relate specifically to the health sector are: 1 MDG 4. Reduce Child Mortality 2 MDG 5. Improve Maternal Health 3 MDG 6. Combat HIV/AIDS and other diseases. On a national level, the strategy is aligned with the Cook Islands National Sustainable Development Plan (NSDP) in particular: 1 NSDP Goal 2 Well educated, Healthy and Productive people. The sustainable funding of health services is a priority for government. This requires prudent and responsible management of resources to ensure that service planning, funding and prioritisation processes are efficiently and effectively organised. The Cook Islands Health Strategy 1

11 The Cook Islands Health Strategy 2

12 Our Country.Our people..our health. The Cook Islands cover 240 square kilometers and covers a broad geographical area from the Northern Group of Manihiki, Nassau, Palmerston, Penrhyn, Pukapuka, Rakahanga and Suwarrow; and to the Southern Group of Aitutaki, Atiu, Mangaia, Manuae, Mauke, Mitiaro, Rarotonga and Takutea. The geographically dispersed islands and relatively small numbers of people on isolated islands provide a challenging environment in which to plan and develop health services. The total population is estimated to be 18,000 with an annual population growth rate of 1.1% (2001). 52% are male and 48% are female. 68% of the total population resides on Rarotonga, 22% on the other Southern Group Islands and 10% on the Northern Group Islands. In Rarotonga 26.8% of the population were aged 0-14 years, 47.4% of the population aged years, 15.6% aged years with the remaining 10.2% aged 60 years and over. In the other Southern Group islands 35.4% were aged 0-14 years, 37.5% aged years and 27.1% 45 years and over. In the Northern Group islands 40.1% were aged 0-14 years, 42.9% of the population aged years, 8.8% aged years and age group 60 years and over comprising 8.2%. In addition, there are 52,000 Cook Islanders resident in New Zealand and 30,000 in Australia who regularly visit the Cook Islands impacting on the delivery of health services in the Cook Islands. Annual visitor numbers to the Cook Islands average 7000 per year. Location and Map of The Cook Islands The Cook Islands Health Strategy 3

13 Life expectancy has been steadily improving and in 2004 was 68 years for males and 74 years for females. The average number of births over was 303 with 80% of these births being on Rarotonga. The fertility rate in 2004 was 2.9 as compared to 3.5 in the early 1990s. GDP per capita (PPP) is US$ (2001) GDP growth rate is 7.1% (2001) 1 Total Health expenditure per capita is $697 (2002) Total health expenditure as a % of GDP is 4.6% (2002) Health Services The health services in the Cook Islands range from public health services (inclusive of primary care) to secondary care services. The services are provided by private and publicly funded providers. These services are supplemented by Visiting Specialist teams. Access to tertiary services is through referral to overseas providers. The main referral hospital is located in Rarotonga with smaller hospitals and health centers located in the outer islands. There are a total of 127 hospital beds, 9 out patient clinics, 10 dental clinics, 6 health centers, 50 child welfare clinics, 4 private clinics, 2 private dental clinics and 4 private pharmaceutical outlets. 1 Source Government Statistics The Cook Islands Health Strategy 4

14 Health Status The health status of the population is steadily improving. The infant mortality rate (per 1000 live births) over averaged The maternal mortality rate over was zero. From there were 2,743 registered non communicable disease cases, an annual increase of 2%. The main increase is due to more hypertension with 66.8%, 15.3% have both hypertension and diabetes and 17% have diabetes. There were 2,220 admissions to Rarotonga hospital in The main reasons for admissions are diseases of the respiratory system, injuries and poisoning. Most injuries are the result of transport accidents and falls. Diseases of the circulatory system account for 11% of admissions and diseases of the respiratory system 11.6% The most common infectious diseases are acute respiratory tract infections, influenza, pneumonia, skin sepsis, conjunctivitis and gastroenteritis. 111 cases of cancer were reported for of which 53 were male and 58 were female. The majority of cancer is identified in the age group with cancer of the breast and prostate being the most prevalent among women and men respectively. The immunisation rate is 100% ( ). Dental caries in age groups 0 5 years has a mean decay, missing and filled teeth (dmft) of 9.0 (WHO standard is <3) The leading causes of death are diseases of the circulatory system, diabetes, and cancer. The increasing numbers of people with non communicable diseases, the rising prevalence of obesity in the population, the threats to the environment all combine to present a challenge for the health sector and community. 2 Ministry of Health Statistical Bulletin 2003 The Cook Islands Health Strategy 5

15 Our Vision All Cook Islanders living healthier lives and achieving their aspirations Our Mission "To provide accessible and affordable health care of the highest quality, by and for all in order to improve the health status of the people of the Cook Islands The Cook Islands Health Strategy 6

16 Guiding Principles The Cook Islands Health Strategy is guided by the principles of the National Sustainable Development Plan * 1. Sustainable development is a national responsibility for all Cook Islanders 2. Democratic principles, basic human rights, respect for cultural, religious and ethnic diversity and the rule of law 3. Equitable economic development and universal access to basic health and education and environmental sustainability are essential prerequisites for poverty alleviation, social harmony and national security 4. Special needs of the outer islands and disadvantaged groups are recognised 5. National development that reflect appropriate regional and international commitments 6. Good governance promoted through participatory decision-making process at all levels involving key stakeholders, including community, non-government organisations, and government agencies 7. Coordinated and harmonised access to, and effective use of, national resources and development partner support from bilateral, multilateral development partners and regional organisations 8. International and regional foreign relationships and partnerships must be based on mutual respect in the interest of the Cook Islands * Refer to Appendix for further details. The Cook Islands Health Strategy 7

17 Values These values provide the foundation for the development and delivery of health services now and into the future: Respect Acknowledging a person s dignity and rights with compassion and confidentiality People focused Ensuring that our people s welfare remain our priority and that they are well served Equity Providing timely and equitable access to health care services for all Cook Islanders Quality Striving for best practice and excellence in all aspects of our work Integrity Being truthful, sincere, fair and consistent Accountability Our systems are transparent and reflect responsible governance and management The Cook Islands Health Strategy 8

18 Priorities 1. Population health gain Improving the health of the population through focusing on the prevention, early intervention and treatment of communicable and non-communicable diseases and injury prevention. 2. Infrastructure and systems The development of infrastructure which will support the future development of the health sector by investing in information technology, telecommunication systems, workforce, developing and maintaining facilities, developing quality systems and processes, ensuring a sound legislative regulatory framework and ensuring sustainable health financing. 3. Effective communication Improving communication with individuals and communities, within the health sector between the Ministry of Health and operational services, and between Departments to ensure the effective and efficient delivery of health services. 4. Intersectoral partnerships To strengthen partnerships locally with civil society, Non Governmental Organisations (NGO s), community and church groups, internationally with health service providers, research organisations and donors which contribute to the improvement in the health status of Cook Islanders. 5. Health sector responsiveness The further development of disaster response and emergency management capacity in the health sector and community. To enhance the capacity to respond in a timely and effective manner to global health issues as they arise such as Avian Influenza The Cook Islands Health Strategy 9

19 Objectives 13 Strategic Health Objectives for the health sector to focus on have been selected for the impact they will have on improving the health status of the population 1. To improve the health of children by reducing the mortality and morbidity rate 2. To improve the health of young people through reducing the incidence and impact of risk taking activities 3. To improve the health of women and mothers through reducing maternal mortality and morbidity 4. To improve the health of men through reducing the incidence and impact of non-communicable diseases, cancer, alcohol and trauma. 5. To strengthen health support services for older people. 6. To strengthen health services which support independence for people with disabilities. 7. To strengthen mental health services including alcohol, drug, tobacco cessation and gambling cessation services. 8. To reduce the impact of non communicable diseases and injury with an emphasis on obesity, diabetes, cardiovascular disease, respiratory disease, oral health, and cancer. 9. To reduce the impact of communicable diseases with an emphasis on Sexually Transmitted Infections (STI s), HIV/AIDS, vector borne diseases and the emergence of new infectious diseases. 10. To improve environmental health focusing on food safety, safe water, clean air, improved sanitation, and waste management. 11. To support families and communities to lead healthier lives. 12. To strengthen the infrastructure of the health system to ensure it has sufficient capacity to meet the health needs of the population. 13. To enhance human resources and research capacity. The objectives identify the areas which will have most impact on improving health outcomes for the population. These need to be supported by detailed annual planning and work plans and budgets in each area In summary, we have developed a challenging 5-10 year Health Strategy which will lead us into a future with a health system we can be proud of, quality health services we have confidence in and a health workforce which leads by example. Join us on our journey. The Cook Islands Health Strategy 10

20 Population Health Gain The Cook Islands Health Strategy 11

21 Goal: Improve and protect the health of all Cook Islanders Objective 1: To improve the health of children by reducing the mortality and morbidity rate The Cook Islands population has a high proportion of children with 33% of the population being 0-14 years. The leading causes of death in children 0-14 years in 2004 were: a. Infectious diseases - 1 b. Disease of the circulatory system - 1 c. Disease of the nervous system - 1 The leading causes of hospitalisation for children 0 14 years in 2004 were: a. Disease of the respiratory system b. Disease of the digestive system - 28 c. Certain infectious diseases - 25 Whilst the current immunization rate is 100% for children under 2 years it will be important in the future to continue to monitor the rate to ensure it is maintained, review the immunisation schedules and ensure that all children have access to Well Child programs. Breast feeding ensures a healthy start to children in the first years of life. It is recognised that breast milk provides an infant s complete nutritional needs along with a reduced risk of infectious diseases and food allergies. The promotion of breast feeding and ensuring all environments are child friendly will help the growth of children. An ongoing program preventing child obesity will be the focus of reducing non communicable diseases in the older age groups. Preventing accidental or non accidental injuries will remain an area of focus and will strengthen through community action programs. The Cook Islands Health Strategy 12

22 Objective 1: To improve the health of children by reducing the mortality and morbidity rate Action Role Completion date 1.1 Reduce infant mortality to below 9 per 1000 births by (WHO recommended rate: 6 8 per 1000) Maintain the current 100% immunisation rate for children under 2 years 2006 Annual 1.3 Ensure 100% Well Child checks for children under 5 years by Achieve exclusive breastfeeding for all babies up to 6months by Achieve child friendly accreditation for all health services by Determine the incidence and prevalence of accidental and non-accidental injuries in children. Ministry Statistical Unit Expand and strengthen the child obesity prevention program for the Cook Islands. 1.8 To achieve a dmft of < 3 for children under 5 years The Cook Islands Health Strategy 13

23 Objective 2: To improve the health of young people through reducing the incidence and impact of risk taking activities The health status of young people in the Cook Islands has progressively improved. However there are still inherent concerns that affect the health of our young people that need to be addressed. Road traffic crashes are by far the leading cause of morbidity and mortality amongst young people which are often associated with alcohol and high speed. Substance abuse, drugs and smoking continue to be a problem amongst adolescents. Teenage pregnancy continues to be a major concern, although statistics have shown a gradual decline in numbers since There is still an ongoing need to address the issue of teenage pregnancy and counseling of teenage mothers and fathers. Fortunately, there has been no reported case of HIV/AIDS in the Cook Islands involving young people and a proactive public awareness campaign has alerted people of the dangers of unprotected sex, especially with the mobile Cook Islands and Tourist population. Improving the health of young people requires an approach to service delivery which is youth friendly; where young people are supported in an environment that values their belief systems. Many approaches will require collaboration with other sectors such as education and law & order. The Cook Islands Health Strategy 14

24 Objective 2: To improve the health of young people through reducing the incidence and impact of risk taking activities Action Role Completion date 2.1 Reduce the incidence of sexually transmitted infections 2.2 Reduce the rate of teenage pregnancy 2.3 Reduce the mortality, morbidity and injury rate from suicide and road traffic crashes 2.4 Achieve youth friendly environment for all health services 2.5 Strengthen awareness programs in relation to the dangers involved with alcohol, tobacco and drugs The Cook Islands Health Strategy 15

25 Objective 3: To improve the health of women and mothers through preventing maternal mortality and reducing morbidity Women comprise 48% of the population and commonly prioritise the health needs of the family over themselves. Utilising breast and cervical screening services remains variable with women continuing to be diagnosed late with cancer which affects their health outcomes. The utilisation of urology and gynaecology services is poor resulting in some women suffering from conditions which can be treated effectively. Contraception is available to all women. On average, 294 babies are born each year in the Cook Islands, the majority of which are through natural deliveries supported by qualified health workers. Utilisation of antenatal care remains low during the first trimester but increases during the second and third trimester. Post natal care is available and well utilised. Action Role Completion date 3.1 Maintain zero maternal mortality. 3.2 Reduce the incidence and impact of cervical and breast cancer Improve the quality and utilisation of reproductive health care Improve the utilisation of specific health services for women The Cook Islands Health Strategy 16

26 Objective 4: To improve the health of men through reducing the incidence and impact of non communicable diseases, tobacco, cancer, alcohol and trauma. Men comprise 52% of the population. Life expectancy remains at 68 years compared with women at 74.3 years. Men have high rates of diabetes, hypertension and cardiovascular disease. Often present late to health services with cancers and they also have high rates of trauma relating to road traffic related injury and alcohol. Action Role Completion date 4.1 Develop and implement a men s health program to educate and support men to live healthier lifestyles Introduce a screening program for cancers Reduce tobacco and alcohol related harm for and by men Reduce the rate of road traffic related injuries The Cook Islands Health Strategy 17

27 Objective 5: To strengthen health support services for older people. Older people comprise 8% of the population with population projections expecting this proportion to increase. Older people generally have higher health needs than younger people and the challenge for the health sector is to develop health services which maintain older people s health status and support them to remain independent in their own homes and with families. Key health needs include access to primary care and assessment services, support to access rehabilitation services and the ability to contribute to the family and community. Action Role Completion date 5.1 Improve utilisation of primary care services by older people. 5.2 Support providers to deliver services which maintain independence for older people The Cook Islands Health Strategy 18

28 Objective 6: To strengthen health services which support independence for people with disabilities. Disability is the outcome of the interaction between a person with an impairment and the environmental and attitudinal barriers he/she may face. (WHO definition) With the advent of the Cook Islands National Policy on Disability (2003) & National Action Plan ( ), the updated comprehensive Disability data base for all islands and the progress of the Disability Action Team within the Ministry of Internal Affairs, the Ministry of Health s disability support services must be better coordinated and planned in concert with those of other agencies. We can improve the health outcomes of people with disabilities by ensuring that all health services are responsive to people with disabilities and including them in the planning of future health services. Action Role Completion date 6.1 Improve utilisation of primary health care services by people with disabilities Support providers to deliver services which promote and maintain independence for people with disabilities Ensure a more concerted approach in the integration of the Ministry s disability support services with those of other agencies through the Disability Action Team and the Cook Islands National Council for the Disabled. National Council for the disabled 2007 The Cook Islands Health Strategy 19

29 Goal: Encourage healthier lifestyles and safer environments Objective 7: To strengthen mental health services including alcohol, drug, tobacco cessation and gambling cessation services. Mental health services are often one of the last services to be developed and adequately resourced in smaller health systems. The diversity of mental health needs in the community requires a core number of mental health services to meet these needs. The principles of mental health service development include developing services that empower consumers, their families and care givers, building the strengths of a person to support the recovery process and ensuring service delivery is strongly focused in the community. Recent advances in mental health services in the Cook Islands have seen the development of two non governmental mental health services. These agencies have provided essential support services to people with mental health issues. However, a comprehensive mental health strategy is required to ensure that the development of services to meet the mental health needs of the population is undertaken in a comprehensive and systematic manner. Excessive tobacco use and alcohol consumption continues to impact on individuals, families and communities and the increasing participation in gambling activities is impacting on small communities. The emerging and concerning trends in drug use particularly in the young population who are often initially exposed to drug use while overseas requires a future mental health service which can be responsive to these changing health needs. The Cook Islands Health Strategy 20

30 Objective 7: To strengthen mental health services including alcohol, drug, tobacco cessation and gambling cessation services. Action Role Completion date 7.1 Develop and implement a comprehensive mental health, drug and alcohol, tobacco and gambling cessation strategy. 7.2 Establish a Mental Health Unit Ensure all mental health services are accessible to the population Ensure mental health, alcohol and drug, tobacco and gambling legislation is in place. 7.5 Ensure that schools and health services are smokefree. 7.6 Collect data, monitor and analyse the prevalence of mental illness. Ministry Ministry Ministry Statistical Unit The Cook Islands Health Strategy 21

31 Objective 8: To reduce the impact of non communicable diseases and injury with an emphasis on diabetes, cardiovascular disease, respiratory disease, cancer and oral health. Non communicable diseases such as diabetes, cancer, cardiovascular disease, obesity and oral health represent the greatest burden to the health of the community and put pressure on the health system. Diabetes is anticipated to increase in the Cook Islands related primarily to two factors; an aging population and an increasing rate of obesity. For a person with diabetes the harmful effects of diabetes relate to complications from the disease including retinopathy, kidney failure, diabetic foot disease and periodontal disease. Damage to peripheral nerves including diabetic foot disease is responsible for a high percentage of amputations. The most common respiratory illnesses are asthma and chronic obstructive respiratory disease. These admissions can be reduced or prevented with good self management plans and early identification of the development of acute episodes. Cardiovascular disease is the leading cause of mortality in the Cook Islands and attempts will be made to reduce incidence Information on the incidence of cancer in the Cook Islands is contained in the national cancer registry. The statistics indicate an increasing incidence of cancers, in particular the high rate in the 35 to 54 age group. Late presentation leading to poor outcomes is a concern. Early detection and diagnosis of cancer can affect a cure and extend the survival time and quality of life. Deciduous decay rates is one of the worst diseases affecting school children. There is a high decay, missing and filled (dmft) rate for 5 year-olds that is over 6 dmft compared to the World Health Organisation rate which is 3. The edentulous (toothless) rate is high in the older population, particularly the year olds. The burden of non communicable diseases can be reduced and outcomes improved through lifestyle changes such as improving nutrition, increasing physical activity, reducing smoking, better oral health care and ensuring people have access to good primary care and specialist services. Improved injury preventative measures will also enable the reduction in injuries in the population. The Cook Islands Health Strategy 22

32 Objective 8: To reduce the impact of non communicable diseases and injury with an emphasis on diabetes, cardiovascular disease, respiratory disease, cancer and oral health. Action Role Completion date 8.1 Reduce the prevalence of obesity in the population Reduce the incidence and impact of diabetes, cardiovascular disease and respiratory illness in the population. 8.3 Develop a cancer control strategy and enhance the cancer registry. 8.4 Reduce the prevalence of tooth decay in young children and the edentulous rate in adults. Statistical Unit Reduce the incidence and impact of injury 2008 The Cook Islands Health Strategy 23

33 Objective 9: To reduce the impact of communicable diseases with an emphasis on STIs/HIV/AIDS, vector borne diseases, hepatitis and tuberculosis. The Cook Islands are included in regional programs in partnership with donors for the eradication of several communicable diseases. These include filariasis, tuberculosis, measles, HIV/AIDS and STIs. HIV/AIDS remain a major threat to small Pacific countries and the need to continually educate, reinforce key messages and break down stigma surrounding HIV/AIDS is constant. We currently have positive HIV cases and ongoing vigilance will be required to ensure that the situation does not worsen through targeted programs. Vector borne diseases (especially dengue fever and filariasis) and hepatitis continue to be the major communicable disease challenge. The approach will need to strengthen public health strategies to reduce the incidence and spread of these diseases. The recent SARs epidemic and the emerging bird flu epidemic and influenza pandemic reinforces the view that the Cook Islands is a member of the global community and global health issues impact on the health of the community. Dengue fever in particular is a risk to the economy with the potential impact of reducing the tourism trade with repeated outbreaks. The approach to all these issues is a combination of population engagement, education and responsiveness to rapidly emerging threats. The Cook Islands Health Strategy 24

34 Objective 9: To reduce the impact of communicable diseases with an emphasis on STIs/HIV/AIDs, Vector borne diseases, hepatitis and tuberculosis. Action Role Completion date 9.1 Complete and implement a public health strategy for communicable diseases 9.2 Ensure the Ministry of Health is in a state of readiness to respond to emerging epidemics and disasters locally, regionally and globally. 9.3 Maintain low HIV/AIDS infection rate 9.4 Reduce the incidence of STIs 9.5 Reduce the incidence of vector borne diseases Ministry Reduce the incidence of hepatitis Eradicate Filariasis 2009 The Cook Islands Health Strategy 25

35 Objective 10: To improve environmental health focusing on food safety, safe water, clean air, sanitation and waste management. The health of the environment has an immediate effect on the health of the population. The key issues are food safety, access to safe water, including drinking water and water in the lagoons and rivers, improved sanitation for all communities, and access to a safe waste disposal system. The Ministry of Health s role in these areas is to ensure compliance to standards and monitoring the quality of the environment. Fish poisoning has been identified as an emerging health issue with increasing hospital admissions as well as asbestos particularly in building materials throughout the Cook Islands. Action Role Completion date 10.1 Facilitating and enforcing the maintenance of a healthy environment by working in partnership with other agencies Improve access to safe water for all communities Facilitate the enforcement of food safety legislation 10.4 Facilitate the enforcement of sewerage regulations to ensure 100% compliance with sanitation standards by Improve access to safe waste disposal systems for all communities Assess the impact of fish poisoning Ministry of Environment services Ministry of works Ministry of Works Ministry of Works Statistical Unit The Cook Islands Health Strategy 26

36 Goal: Support community development Objective 11: To support families and communities to lead healthier lives The key to improved health outcomes is to have healthier families and communities, where families and communities take responsibility for their own health. They will be provided information and advice to support them in maintaining better health. Family violence impacts significantly on communities leading to poorer health outcomes for families and communities. Action Role Completion date 11.1 Develop a comprehensive public health plan Improve access for families to strengthening family and parenting programs Support the increase of positive role models within the Ministry of Health and in Society Ensure public health activities are integrated into daily life. 3.5 Strengthen counseling and support services for family violence Ministry Punanga tauturu The Cook Islands Health Strategy 27

37 Strengthened infrastructure and health systems The Cook Islands Health Strategy 28

38 Objective 12: To strengthen the infrastructure of the health system to ensure it has sufficient capacity to meet the health needs of the population The infrastructure is the foundation which supports a quality health service. It embraces: - facilities to meet the needs of the community; - information systems which provide data, enhance communication between health workers and provide access to information for patients; - quality systems to provide confidence for the population that services meet standards and benchmarks; - research to ensure that future health needs and interventions are being met and are effective; and - effective communication networks within the health sector as well as with external agencies and the community - working partnerships with civil society, NGOs, the private sector, the community at large and overseas institutions. Underpinning all these is the need for a sustainable financing model, prudent financial management systems and a legislative framework which supports the work of the sector. The Cook Islands Health Strategy 29

39 Objective 12: To strengthen the infrastructure of the health system to ensure it has sufficient capacity to meet the health needs of the population Action Role Completion date 12.1 Develop a facilities development plan including maintenance and asset replacement by Complete the implementation of the electronic patient record and management system by Review and develop the financial management system. Ministry Ministry Improve the medical referral system Develop a quality system for monitoring and conduct audits Strengthen communication networks and support effective engagement with communities and external agencies 12.7 Seek greater participation by private sector, civil society and NGOs in the health sector 12.8 Investigate options for sustainable health financing for the future Review the legislative framework for health legislation and, where necessary, ensure new legislation is in place. Ministry Ministry Ministry Ministry Ministry Ministry of Finance and Economic management Ministry The Cook Islands Health Strategy 30

40 Objective 13: To enhance human resources and research capacity. Workforce development is very complex and challenging as we continue to train, retain and sustain the personnel in maintaining quality health services. The ongoing migration of skilled health workers coupled with an aging workforce is also a challenge for the provision of health services. The health workforce must meet the expectations and needs of the people through evidence-based practices. The Ministry of Health has 303 employees comprising: Ministry of Health Staff Clinical Medical Officers 28 Nursing 116 X-Ray 4 Laboratory 8 Pharmacy 6 Physiotherapy 2 Domestic 17 Drivers/Security/Orderlies 13 Groundsman 12 ICT 2 Kitchen 9 Statistics 4 Theatre Assistant 2 Dental Dental Therapists 4 Dental Officers 10 Dental Technicians 2 Public Health Public Health Inspectors 20 Public Health Nurses 18 Receptionists 9 Administration officers 3 Finance officers 4 Policy 10 TOTAL MOH STAFF 303 The Cook Islands Health Strategy 31

41 Objective 13: To enhance human resources and research capacity Action Role Completion date 13.1 Complete and implement the Ministry of Health s workforce plan Implement the National Health Research Strategy. Ministry 2007 Ministry 2007 The Cook Islands Health Strategy 32

42 Acknowledgements I extend sincere appreciation to the many individuals and groups who contributed their time and knowledge in ensuring that this long awaited National Health Strategy truly reflects the vision and convictions of our people in relation to the direction of services in the health sector over the next five to ten years. They include: the members of the Health Sector Working Group of the National Development Task Force working through the Office of the Prime Minister s Policy Coordination Unit in 2003; the members of that Task Force and staff of that Unit; the participants at the 2003 National Development Forum; the participants at the 2004 Health Advance workshop especially those from Civil Society, NGOs and our private sector; and the participants at the 2005 Strategy Consultations. We are grateful for the contribution from our colleagues in other government agencies in particular thank the contributions of the Ministry of Finance and Economic management (MFEM) through its Statistics Office and Policy/Planning Unit, and the Ministry of Internal Affairs through its dedicated Unit working with those with Disabilities. We have also been most fortunate in securing the assistance of Cook Islands doctors residing in New Zealand in formulating this Strategy: Dr Aumea Herman, Dr Francis Agnew, Dr Joseph Williams and Mrs Metua Faasisila. To Debbie Sorensen of Sorensen and Associates in New Zealand and Dr Kiki Maoate who contributed so much to this Strategy, we are most grateful. To the staff, the Directors, clinical staff and senior officers, thank you for the sharing of expertise and generous contributions to the strategy. Finally, we are grateful for the guidance and leadership of the Minister of Health and Deputy Prime Minister, the Hon Dr Terepai Maoate, which was invaluable in the final form of this Strategy. We look forward to working together with everyone in the Cook Islands as well as our friends and partners from overseas in realising our vision of Healthier Cook Islanders achieving their aspirations. Vaine Teokotai SECRETARY OF HEALTH The Cook Islands Health Strategy 33

43 Guiding principles The Cook Islands Health Strategy is guided by the principles of the National Sustainable Development Plan Sustainable Development Is A National Responsibility For All Cook Islanders means that all people of the Cook Islands have a responsibility to ensure that the three pillars of sustainable development economic growth, social cohesion and environmental protection are given balanced treatment to guide the future development of the Cook Islands 2. Democratic Principles, Basic Human Rights, Respect for Cultural, Religious and Ethnic Diversity And The Rule Of Law means that every Cook Islander has fundamental rights, which should be respected 3. Equitable Economic Development And Universal Access To Basic Health And Education And Environmental Sustainability Are Essential Prerequisites For Poverty Alleviation, Social Harmony And National Security means that only when every Cook Islander has an equal opportunity to benefit from economic development, basic public services, and environment sustainability, can we expect to live a peaceful existence free of hardship, conflict and instability 4. Special Needs of the Outer Islands and Disadvantaged Groups Are Recognised means that special consideration is necessary to address the development needs of the outer islands and disadvantaged groups 5. National Development That Reflect Appropriate Regional And International Commitments means that development should respond to the needs and aspirations of all people of the Cook Islands, while at the same time, be mindful of commitments that have been made by the Government at the regional and international levels 6. Good Governance Promoted Through Participatory Decision-Making Process At All Levels Involving Key Stakeholders, Including Community, Non-Government Organizations, and Government Agencies means that decisions made, and actions taken, by all levels of Government and community are transparent and accountable 7. Coordinated And Harmonized Access To, And Effective Use Of, National Resources And Development Partner Support From Bilateral, Multilateral Development Partners And Regional Organizations means that national resources and development assistance are efficiently and effectively used 8. International And Regional Foreign Relationships And Partnerships Must Be Based On Mutual Respect In The Interest Of The Cook Islands means that relationships with other nations are based, first and foremost, on what s in the best interest of the Cook Islands The Cook Islands Health Strategy 34

44 Glossary DMFT HIV/AIDS GDP MDGs NGOs Northern Group Southern Group SARS STIs WHO Decayed, Missing and Filled Teeth Human Immuno Deficiency Virus / Acquired Immune Deficiency Syndrome Gross Domestic Product Millennium Development Goals Non Governmental Organisations Islands in the northern part of the Cook Islands which are all atolls namely: Manihiki, Nassau, Palmerston, Penrhyn, Pukapuka, Rakahanga and Suwarrow Islands in the southern part of the Cook Islands which vary in structure from volcanic islands to raised atolls namely: Aitutaki, Atiu, Mangaia, Manuae, Mauke, Mitiaro, Rarotonga and Takutea Severe Acute Respiratory Syndrome Sexually Transmitted Infections World Health Organisation The Cook Islands Health Strategy 35

45 The Cook Islands Health Strategy 36