at birth (years) [65+ years] 11.21% est 8.09 % of population served with safe water 0.00 % of population with adequate sanitary facilities 0.

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1 1. DEMOGRAPHICS, GENDER AND POVERTY The population of Niue decreased from a peak of 5194 in 1966, to 2322 in 1991, 1788 in 2001 and an estimated 1600 in In 2005, the estimated population rose slightly to There is substantial emigration to New Zealand because of Niue s lack of natural resources, its isolation and insufficient social and economic development, and because Niueans hold New Zealand citizenship. The 2001 New Zealand census listed Niueans in the New Zealand population. Population density is estimated at six persons per square kilometre, with 34.0% living in urban areas. Children under the age of 15 years make up 25.1% of the population, and adults 65 years and older 11.2%. The crude birth rate is 17.9 per 1000 population and the crude death rate 8.0 per Table 1. Core population and health data (2005) Population Crude birth rate (per 1000 population) Crude death rate (per 1000 population) Infant mortality rate (per 1000 live births) Maternal mortality ratio (per live births) est - Estimate [Total] 1730 est Life expectancy [Both] (2001) [0-14 years] 25.14% est at birth (years) [Male] (2001) [65+ years] 11.21% est [Female] (2001) Total fertility rate 3.01 (2001) 8.09 % of population served with safe water 0.00 % of population with adequate sanitary facilities 0.00 [Total] (2003) [Urban] [Rural] [Total] (2003) [Urban] [Rural] 2. POLITICAL AND SOCIOECONOMIC SITUATION 2.1 Political situation Niue is a self-governing nation in free association with New Zealand. The head of government is Premier Young Viviani of the Niue People's Party. The chief of state is Queen Elizabeth II of the United Kingdom of Great Britain and Northern Ireland. The Legislative Assembly is Niue s supreme law-making body. It has 20 members, six elected from a common roll and 14 as village representatives. The Legislative Assembly is responsible for electing the Premier. Elections are held every three years by secret ballot under a system of universal suffrage. 2.2 Economic situation The economy is dependent on limited agricultural exports and the sale of fishing rights. The sale of postage stamps to foreign collectors is also an important source of revenue. The gap between domestic production and demand for goods and services is very wide. The resulting trade deficit makes the economy heavily dependent on foreign aid, most of which comes from New Zealand, and remittances from Niueans living abroad. COUNTRY HEALTH INFORMATION PROFILES 225

2 In 2003, the gross domestic product (GDP) at current prices was NZD (US$ ); per capita GDP stood at NZD (US$ 7070). The New Zealand High Commissioner s Office, the only diplomatic mission in Niue, manages the projects of the New Zealand Official Development Assistance (NZODA). Niue also receives aid from the Australian Agency for International Development (AusAID), the Government of Japan and other international agencies. WHO contributed US$ in , and US$ in With a deficit of NZD (US$ ), the Government is facing a financial crisis. The monthly boat between New Zealand and Niue, which provides essential supplies for daily living, illustrates Niue s isolation. Plans to develop tourism are under way, but are necessarily limited by a dependence on other countries airlines to service Niue. Royal Tonga operates a small twin otter aircraft for passenger service three times a week between Nukualofa, Tonga and Niue. Polynesian Airlines has started a new service from Apia to Auckland via Niue twice a week. 3. HEALTH SITUATION 3.1 Health trends In general, health indicators are good, consistent with the country s high literacy rate (100% in 2003) and its well educated population. Infant mortality is low and no maternal death was recorded from 1999 to Average life expectancy in 2001 was 70.1 years, 69.8 years for men and 71.2 years for women. The fertility rate is 3.01 (2001). The incidence of teenage pregnancy is relatively high (8%). Common childhood illnesses and traditional communicable diseases, such as tuberculosis and leprosy, have been substantially contained. The programme on elimination of filariasis is ongoing, with high coverage (>80% eligible population) of mass drug administration (MDA). Niue has a 0.2% antigenemia rate and is targeting filariasis elimination by No case of HIV/AIDS has been reported and sexually transmitted infections are rare. With support from WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Department of Health has been active in working with communities, nongovernmental organizations and the private sector to increase public awareness on reproductive health and HIV/ AIDS. Although the prevalence of vectorborne parasitic diseases has been negligible in the last five years, mosquito control activities are ongoing. Because the mosquito population is large, control measures require strengthening. Lifestyle-related health problems are increasing and the prevalence of risk factors for chronic diseases is high. In a 1997 census, 30.8% of males and 13.6% of females smoked cigarettes. Alcohol consumption is also reported to be high: casual drinking (43%) and heavy drinking (3.2%). The National Nutritional Survey in 1987 noted a concern about the high consumption of sugar snacks and the low intake of vegetables and fruits. In 2001, the major causes of morbidity were hypertension, diabetes mellitus, infections of the skin and subcutaneous tissue, upper respiratory tract infections and influenza. The five leading causes of mortality were injuries from gunshots, diabetes and hypertension complications (cardiovascular and cerebrovascular diseases), premature births, pneumonia (one case) and accidental drowning (one case). Cancer incidence remains very low. Cervical screening procedures are available and women are encouraged to practise breast self-examination. Elderly males aged 55 and over are routinely checked for early signs of prostate problems. 226 COUNTRY HEALTH INFORMATION PROFILES

3 The groundwater supply is safe and potable for human consumption and coverage of safe water sanitation facilities is 100% (2005). AusAID supported the development of the national waste management plan. The Government is committed to the Healthy Islands programme and the Tobacco Free Initiative, which are supported by WHO. The Moui Olaola Project (a Healthy Islands health promotion project) was started in Health systems The only hospital, Lord Liverpool Hospital, was destroyed by Cyclone Heta in January Hospital services were set up subsequently in a youth centre in Fonuakula, Alofi, which is near the airport. A new hospital was constructed in Kaimiti, an inland location rather than a coastal area. Lord Liverpool Hospital had been the centre for all preventative and curative health services, dentistry services and school health services since the early 1990s and, from June 2001 to May 2002 the hospital underwent a US$ 2 million renovation project, with financial assistance provided by WHO, the New Zealand Agency for International Development (NZAID) and AusAID. The new hospital, constructed in 2005 with funding from WHO, the European Union and NZAid, is named Niue Foou Hospital. Foou literally means new. Community outreach is maintained through village visits by public health nurses and regular village inspections by public health officers. While medical services are free for local residents, payment is required for some prescribed medicines, such as contraceptives. The Department of Health is run by the Director of Health and a complement of three medical officers, two dental officers, one dental nurse, two technicians and one chair-side assistant, 15 nurses (one principal nursing officer, 13 hospital nurses and one maternal and child health nurse), four paramedical staff, two public health officers, one health promotion coordinator, one health service manager, two office assistants and four drivers (2005). The workforce development plan for the health sector ( ), which was prepared for the Niue Training and Development Council in June 2000, identified training needs. The government budget for non-trading expenditures for the fiscal year was NZD (US$ ), down from NZD (US$ ) for The budget for health expenditures also dropped, from NZD (US$ ) for , to NZD (US$ ) (13.5% of non-trading expenditures) for Education gets more or less the same budget as health. Total government non-trading expenditures for personnel (364 employees) amounts to NZD (US$ ), and for health personnel (49 employees) NZD (US$ ). Health expenditures are distributed as follows: administration, NZD (US$ ); medical, NZD (US$ ); nursing, NZD (US$ ); public health, NZD (US$ ); and dental, NZD (US$ ). The health revenue from administration is NZD (US$ ). 4. NATIONAL HEALTH PLAN AND PRIORITIES National health priorities are focused on public health prevention strategies to reduce risk factors associated with causes of morbidity/mortality and lifestyle diseases. The national priorities are: to make Niue the healthiest country in the Pacific in terms of having healthy people and a healthy environment; to pursue health promotion, disease prevention and injury prevention strategies with more vigour; and to strengthen the capacity of human resources to effectively deliver primary care services and public health programmes. COUNTRY HEALTH INFORMATION PROFILES 227

4 5. MAJOR INFORMATION SOURCES Boladuadua A. Mission report on primary health care services development. Manila, WHO Western Pacific Regional Office, Estimates of expenditure and revenue for year 2002/2003. Government of Niue, Report on the Nationwide Health Survey, May Health Department, Health Department statistics Niue statistics, Niue Sustainable Human Development Situation Analysis, New York, UNDP, ADDRESSES DEPARTMENT OF HEALTH Office Address : Postal Address : Official Address : Telephone : Fax : Office Hours : Website : WHO REPRESENTATIVE IN SAMOA Office Address : Ioane Viliamu Building Beach Road, Apia, Western Samoa Postal Address : P.O. Box 77 Apia, Samoa Official Address : who@sma.wpro.who.int Telephone : (685) Fax : (685) Office Hours : Website : 228 COUNTRY HEALTH INFORMATION PROFILES

5 COUNTRY HEALTH INFORMATION PROFILE WESTERN PACIFIC REGION HEALTH DATABANK, 2006 Revision Total Male Female 1 Area (1 000 km 2 ) Estimated population ('000s) est 1 3 Annual population growth rate (%) Percentage of population years est years est 11 5 Urban population (%) Crude birth rate (per population) Crude death rate (per population) Rate of natural increase of population (% per annum) Life expectancy (years) - at birth Health-adjusted Life Expectancy (HALE) at age Adult literacy rate (%) Neonatal mortality rate (per live births) Infant mortality rate (per live births) Under-five mortality rate (per live births) Total fertility rate (women aged years) Maternal mortality ratio (per live births) Percentage of newborn infants weighing at least 2500 g at birth Prevalence of underweight children under five years of age Percentage of pregnant women with anaemia Immunization coverage for infants (%) b - BCG DTP OPV Measles Hepatitis B III MCH coverage (pregnancies, deliveries, infant care) - Percentage of pregnant women cared for by skilled health personnel Percentage of pregnant women immunized with tetanus toxoid (TT2) NR Percentage of deliveries at home by skilled health personnel (as % of total deliveries) Percentage of deliveries in health facilities (as % of total deliveries) Percentage of women in the reproductive age group using modern contraceptive methods Condom use rate of the contraceptive prevalence rate (%) HIV prevalence among year-old pregnant women Number of children orphaned by HIV/AIDS ab

6 25 Proportion of population with sustainable access to an improved water source Total Urban Rural Proportion of population with access to improved sanitation Proportion of the population using solid fuels for cooking or heating (%) Proportion of households with access to secure tenure 29 Proportion of vehicles using unleaded gasoline (%) 30 Health care waste generation (metric tons per year) 31 Human development index Per capita GDP at current market prices (NZ$) Rate of growth of per capita GDP (%) 6.88 a Health expenditure Total health expenditure - amount (in million US$) - total health expenditure on health as % of GDP - per capita total expenditure on health (in US$) Government expenditure on health - amount (in million NZ$) 1.42 FY general government expenditure on health as % of total expenditure on health - general government expenditure on health as % of total general government expenditure External source of government health expenditure - external resources for health as % of general government expenditure on health Private health expenditure - private expenditure on health as % of total expenditure on health a FY Exchange rate in US$ of local currency is: 1 US$ = 1.73 (average) Health insurance coverage as % of total population 36 Health workforce Total Male Female Total Male Female Number Rate per population - physicians p 11 - dentists p 11 - pharmacists p 11 - nurses p 11 - midwives p 11 - other nursing / auxiliary staff - other paramedical staff (e.g. medical assistants, laboratory technicians, X-ray technicians) - other health personnel (health inspectors, assistant sanitarians, traditional workers, etc.) 37 Yearly new graduates physicians p p Yearly new graduates nurses p

7 COUNTRY HEALTH INFORMATION PROFILE Total Male Female Total Male Female 39 Ten leading causes of morbidity Number Rate per population 1. Hypertension Diabetes mellitus Infection of the skin and subcutaneous tissue 4. Upper respiratory tract infection, unspecified Influenza Myalgia and myositis Other disease of the skin Open wounds Bronchitis Sprains and strains of joints and adjacent muscles Five leading causes of mortality Number Rate per population 1. Injuries from gunshots Diabetes and hypertension complications Premature births Pneumonia Accidental drowning Selected diseases under the WHO- EPI Number of cases Number of deaths - Diphtheria Pertussis (whooping cough) Tetanus Neonatal tetanus Poliomyelitis Hib meningitis Measles Mumps Rubella Congenital rubella syndrome Selected communicable diseases Number of cases aa Number of deaths Hepatitis viral Type A Type B Type C Type E - Unspecified Cholera Typhoid fever Encephalitis Plague Syphilis Gonorrhoea (gonococcal infections) Leprosy Malaria Dengue/DHF

8 Total Male Female Total Male Female 43 Malaria Prevalence rates Death rates - Rates associated with malaria (per population) - Proportion of population in malaria-risk areas using effective malaria prevention measures c - Proportion of population in malaria-risk areas using effective malaria treatment measures d 44 Tuberculosis Number of cases Number of deaths - All types New pulmonary tuberculosis (smear-positive) - Rates associated with tuberculosis (per population) - Proportion of tuberculosis cases detected and cured under directly observed treatment, short-course (DOTS) Prevalence rates Death rates Detection rates Success rates b Number of cases Number of deaths 45 Acute respiratory infections 46 Diarrhoeal diseases 47 Cancers All cancers (malignant neoplasms only) - Trachea, bronchus, and lung - Stomach - Colon and rectum - Lip, oral cavity and pharynx - Liver - Cervix - Leukaemia 48 Circulatory All circulatory system diseases - Ischaemic heart disease - Acute myocardial infarction - Rheumatic fever and rheumatic heart diseases - Cerebrovascular diseases - Hypertension Maternal causes - Haemorrhage - Abortion - Eclampsia - Sepsis - Obstructed labour 50 Diabetes mellitus Mental disorders 232

9 COUNTRY HEALTH INFORMATION PROFILE 52 Injuries Total Male Female Total Male Female Number of cases Number of deaths - All types - Motor and other vehicle accidents - Suicide - Homicide and violence - Occupational injuries 53 Proportion of population with access to affordable essential drugs on a sustainable basis 54 Health infrastructure Number Number of beds Notes: Red text FY aa Public health facilities - General hospitals Specialized hospitals - District/first-level referral hospitals - Primary health care centres Private hospitals Millennium Development Goals (MDG) indicators Data not available The financial year refers to the span from July 1 of respective year to June 30 next year. Figures refer to number of new reported cases. ab a b c d Proxy indicator for MDG indicator 20: Ratio of school attendance of orphans and school attendance of non-orphans age years. Computed by Health Information and Evidence for Policy Unit of the WHO Regional Office for the Western Pacific. Revised data. Prevention is measured by the percentage of children ages 0 59 months sleeping under insecticide-treated bednets. Treatment is measured by the proportion of children ages 0 59 months who were ill with the fever in the two weeks before the survey and who received appropriate antimalarial drugs. Sources: 1 Pacific island populations Secretariat of the Pacific Community ( 2 Demographic tables for the Western Pacific Region Manila, WHO Regional Office for the Western Pacific, Statistics Niue ( 4 Information furnished by WHO Representative in Samoa, 13 March Niue sustainable human development situation analysis New York, United Nations Development Programme, WHO Regional Office for the Western Pacific, data received from technical units. 7 The world health report Changing history. Geneva, World Health Organization, Pacific islands Regional Millennium Development Goals report Secretariat of the Pacific Community and UN/CROP MDG Working Group, November Pacific human development report (creating opportunities). New York, United Nations Development Programme, Statistics Nuie ( 11 Niue Foou Hospital Data Sources,