2.1 Communicable and noncommunicable diseases, health risk factors and transition

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1 1. CONTEXT 1.1 Demographics The Futuna and Wallis Islands are located in the Oceania Islands in the South Pacific Ocean, about twothirds of the way from Hawaii to New Zealand. The total area is 142 square kilometres and includes Ile Uvea (Wallis Island), Ile Futuna, Ile Alofi 20 islets. The estimated population of Wallis and Futuna was in About 29.4% are 0-14 years old, 63.0% are years old and 7.6% are 65 years and older. 1.2 Political situation The Futuna island group was discovered by the Dutch in 1616 and Wallis by the British in 1767, but it was the French who declared a protectorate over the islands in In 1959, the inhabitants of the islands voted to become a French overseas territory. The Chief of State is President Nicolas Sarkozy of France (since 16 May 2007), represented by the High Administrator, who is appointed by the French President on the advice of the French Ministry of the Interior. The High Administrator has been Phillippe Paolantoni since 28 July The head of government is the President of the Territorial Assembly, currently Victor Brial (since 4 February 2009). The Council of the Territory consists of three kings with limited powers, appointed by the High Administrator on the advice of the Territorial Assembly. The presidents of the Territorial Government and the Territorial Assembly are elected by the members of the Assembly. 1.3 Socioeconomic situation The economy is limited to traditional subsistence agriculture, with about 80% of the labour force involved in agriculture (coconuts and vegetables), livestock (mostly pigs) and fishing. About 4% of the population is employed by the Government. Revenues come from subsidies from the French Government, licensing of fishing rights to Japan and the Republic of Korea, import taxes and remittances from expatriate workers in New Caledonia. Gross domestic product (GDP) per capita was estimated at US$ 3800 in Risks, vulnerabilities and hazards 2. HEALTH SITUATION AND TREND 2.1 Communicable and noncommunicable diseases, health risk factors and transition The leading noncommunicable diseases are: diabetes, obesity, rheumatism/gout and dental caries. For communicable diseases, they are leptospirosis, brucellosis, dengue, filariasis, tuberculosis, leprosy, hepatitis B, shigellosis and salmonella. 2.2 Outbreaks of communicable diseases In 2002/2003, 2045 cases of dengue were reported in Wallis and Futuna, including 1535 suspected cases, 166 confirmed cases, 280 hospitalized cases and two cases resulting in death. 2.3 Leading causes of mortality and morbidity COUNTRY HEALTH INFORMATION PROFILES 507

2 2.4 Maternal, child and infant diseases The estimated infant mortality rate was 5.9 per 1000 live births in In 2009, immunization coverage for infants was 100% for DTP3, POL3, hepatitis B III and BCG. Only 86% of infants received measles immunization in In 2002, about 70% of pregnant women were immunized with tetanus toxoid. 2.5 Burden of disease 3. HEALTH SYSTEM 3.1 Ministry of Health's mission, vision and objectives 3.2 Organization of health services and delivery systems In 2009, there were one hospital and three dispensaries in Wallis, and one hospital and two dispensaries in Futuna. All treatment, including inpatient care, is free of charge. Wallis hospital comprises an emergency ward, one medical ward with 21 beds, one surgical ward with 16 beds and two operating rooms, one delivery ward with two delivery rooms, one laboratory, one X-ray unit, two ultrasound rooms, one outpatient ward, one education room, and one pharmacy. Futuna hospital comprises one emergency ward, one internal medicine ward with 15 beds, one postdelivery ward with seven beds, one labour ward, one laboratory, one X-ray and ultrasound unit, one pharmacy, one dental unit, and one medical evacuation unit. 3.3 Health policy, planning and regulatory framework 3.4 Health care financing The French Government provides funding to support the health services. In 2008, the Government spent an estimated US$ 35.2 million on health, 24% of total government expenditure. 3.5 Human resources for health There are currently 125 medical staff in Wallis and Futuna. 3.6 Partnerships 3.7 Challenges to health system strengthening 4. PROGRESS TOWARDS THE HEALTH MDGs 5. LISTING OF MAJOR INFORMATION SOURCES AND BASES Title 1 : Pacific Island Populations - Estimates and projections of demographic indicators for selected years, Updated April Operator : Secretariat of the Pacific Community Statistics and Demography Programme 508 COUNTRY HEALTH INFORMATION PROFILES

3 Title 2 : Pacific Regional Information System (PRISM) Operator : Secretariat of the Pacific Community Web address : Title 3 : SPC Statistics and Demographic Programme Web address : Title 4 : Service territorial de la statistique Web address : Title 5 : World factbook Wallis and Futuna Web address : 6. ADDRESSES MINISTRY OF HEALTH Postal Address : B.P. 4G Mata Utu Uvea Official Address : sante@adswf.org Fax : (681) WHO REPRESENTATIVE IN THE SOUTH PACIFIC Office Address : Level 4 Provident Plaza One Downtown Boulevard, 33 Ellery Street, Suva Postal Address : PO Box 113, Suva, Fiji. Official Address : who@sp.wpro.who.int Telephone : (679) Fax : (679) / Office hours : COUNTRY HEALTH INFORMATION PROFILES 509

4 COUNTRY HEALTH INFORMATION PROFILE WALLIS AND FUTUNA WESTERN PACIFIC REGION HEALTH BANK, 2010 Revision Demographics 1 Area (1 000 km2) Estimated population ('000s) a 6.62 a 6.72 a 2009 est 2 3 Annual population growth rate (%) est 1 4 Percentage of population years years - 65 years and above 8.22 b 8.48 b 7.97 b 2009 est b b b 2009 est b 6.98 b 8.16 b 2009 est 2 5 Urban population (%) est 3 6 Crude birth rate (per 1000 population) Crude death rate (per 1000 population) Rate of natural increase of population (% per annum) 1.35 b Life expectancy (years) - at birth - Healthy Life Expectancy (HALE) at age fertility rate (women aged years) est 1 Socioeconomic indicators 11 Adult literacy rate (%) c c c Per capita GDP at current market prices (US$) Rate of growth of per capita GDP (%) 14 Human development index Environmental indicators Urban Rural 15 Health care waste generation (metric tons per year) Communicable and noncommunicable diseases Number of new cases Number of deaths 16 Selected communicable diseases Hepatitis viral - Type A - Type B - Type C - Type E - Unspecified Cholera Dengue/DHF Encephalitis Gonorrhoea Leprosy Malaria C: 2009 D: Plague Syphilis Typhoid fever 17 Acute respiratory infections - Among children under 5 years 510 COUNTRY HEALTH INFORMATION PROFILES

5 Communicable and noncommunicable diseases Number of new cases Number of deaths 18 Diarrhoeal diseases - Among children under 5 years 19 Tuberculosis - All forms - New pulmonary tuberculosis (smear-positive) 2 d d Cancers All cancers (malignant neoplasms only) - Breast - Colon and rectum - Cervix - Leukaemia - Lip, oral cavity and pharynx - Liver - Oesophagus - Stomach - Trachea, bronchus, and lung 21 Circulatory All circulatory system diseases - Acute myocardial infarction - Cerebrovascular diseases - Hypertension - Ischaemic heart disease - Rheumatic fever and rheumatic heart diseases 22 Diabetes mellitus 23 Mental disorders 24 Injuries All types - Drowning - Homicide and violence - Occupational injuries - Road traffic accidents - Suicide Leading causes of mortality and morbidity Number of cases Rate per population 25 Leading causes of morbidity (inpatient care) COUNTRY HEALTH INFORMATION PROFILES 511

6 Number of deaths Rate per population 26 Leading causes of mortality Maternal, child and infant diseases Percentage of women in the reproductive age group using modern contraceptive methods Percentage of pregnant women immunized with tetanus toxoid (TT2) Percentage of pregnant women with anaemia 30 Neonatal mortality rate (per 1000 live births) 31 Percentage of newborn infants weighing less than 2500 g at birth 32 Immunization coverage for infants (%) - BCG - DTP3 - Hepatitis B III - MCV2 - POL Number of cases Number of deaths 33 Maternal causes - Abortion - Eclampsia - Haemorrhage - Obstructed labour - Sepsis 34 Selected diseases under the WHO-EPI - Congenital rubella syndrome - Diphtheria - Measles - Mumps - Neonatal tetanus - Pertussis (whooping cough) - Poliomyelitis - Rubella - Tetanus Health facilities 35 Facilities with HIV testing and counseling services 512 COUNTRY HEALTH INFORMATION PROFILES

7 Health facilities Number Number of beds 36 Health infrastructure Public health facilities - General hospitals Specialized hospitals - District/first-level referral hospitals - Primary health care centres e Private health facilities - Hospitals - Outpatient clinics Health care financing 37 health expenditure - amount (in million US$) - total expenditure on health as % of GDP - per capita total expenditure on health (in US$) Government expenditure on health - amount (in million US$) - general government expenditure on health as % of total expenditure on health - general government expenditure on health as % of total general government expenditure External source of government health expenditure - external resources for health as % of general government expenditure on health Private health expenditure - private expenditure on health as % of total expenditure on health - out-of-pocket expenditure on health as % of total expenditure on health Exchange rate in US$ of local currency is: 1 US$ = Health insurance coverage as % of total population 39 Human resources for health Urban Rural Public Private Physicians - Number 16 f Ratio per 1000 population 1.10 b Dentists - Number Ratio per 1000 population 0.21 b Pharmacists - Number Ratio per 1000 population 0.07 b Nurses - Number 43 g Ratio per 1000 population 2.97 b Midwives - Number 10 h Ratio per 1000 population 0.69 b Paramedical staff - Number Ratio per 1000 population 3.48 b Community health workers - Number 40 Annual number of graduates - Ratio per 1000 population Physicians Dentists Pharmacists COUNTRY HEALTH INFORMATION PROFILES 513

8 Urban Rural Public Private 40 Annual number of graduates Nurses Midwives Paramedical staff 41 Community health workers Workforce losses/ Attrition Physicians Dentists Pharmacists Nurses Midwives Paramedical staff Community health workers Health-related Millennium Development Goals (MDGs) 42 Prevalence of underweight children under five years of age 43 Infant mortality rate (per 1000 live births) est 8 44 Under-five mortality rate (per 1000 live births) 45 Proportion of 1 year-old children immunised against measles Maternal mortality ratio (per live births) 47 Proportion of births attended by skilled health personnel 48 Contraceptive prevalence rate 49 Adolescent birth rate 50 Antenatal care coverage - At least one visit - At least four visits 51 Unmet need for family planning 52 HIV prevalence among population aged years 53 Estimated HIV prevalence in adults 54 Percentage of people with advanced HIV infection receiving ART 55 Malaria incidence rate per population 56 Malaria death rate per population 57 Proportion of population in malaria-risk areas using effective malaria prevention measures 58 Proportion of population in malaria-risk areas using effective malaria treatment measures 59 Tuberculosis prevalence rate per population Tuberculosis death rate per population Proportion of population using an improved drinking water source NA Proportion of population using an improved sanitation facility 65 - Percentage of deliveries at home by skilled health personnel (as % of total deliveries) - Percentage of deliveries in health facilities (as % of total deliveries) Proportion of tuberculosis cases detected under directly observed treatment short-course (DOTS) Proportion of tuberculosis cases cured under directly observed treatment short-course (DOTS) Proportion of population with access to affordable essential drugs on a sustainable basis Urban Rural 514 COUNTRY HEALTH INFORMATION PROFILES

9 Notes: est NA a b c d e f g h s: Data not available Estimate Not applicable Estimated population as of 1 July 2009 Computed by Information, Evidence and Research Unit of the WHO Regional Office for the Western Pacific. Figure applies to aged 19 years and above. Figure based on notified TB cases (New and relapse number, smear positive number), DOTS and non-dots combined, in Global Tuberculosis Control 2009, WHO Figure refers to dispensaries. Figure refers to physicians and specialists. Figure includes 1 anaesthesiology nurse and excludes unauthorized nurses Figure excludes 1 unauthorized midwife Pacific Island Populations - Estimates and projections of demographic indicators for selected years, Updated April Secretariat of the Pacific Community (SPC), Statistics and Demography Programme. Accessed on June Population by 1 and 5 year age groups, February Secretariat of the Pacific Community (SPC) - Statistics and Demography (SDP) Programme. [ Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision and World Urbanization Prospects: The 2009 Revision. [ Service de la statistique de wallis et futuna. Accessed from Service territorial de la statistique ( Information furnished by the WHO Representative to the South Pacific, 3 June WHO Regional Office for the Western Pacific, data received from technical units. Service territorial de la statistique ( Progress on Sanitation and Drinking Water: 2010 Update. World Health Organization and United Nations Children's Fund Joint Monitoring Programme for Water Supply and Sanitation (JMP). UNICEF, New York and WHO, Geneva, [ COUNTRY HEALTH INFORMATION PROFILES 515