TOKELAU–WHO Country Cooperation Strategy 2018–2022
OVERVIEW Tokelau has been a Polynesian Trust Territory of New Zealand since 1925. Consisting of three small atolls – Atafu, Nukunonu and Fakaofo – Tokelau is located about 480 kilometres north of its closest neighbour, Samoa, accessible only by boat. The atolls are about 3 to 5 metres above sea level and span less than 200 kilometres, making the small island nation very prone to the effects of climate change. The population was 1411 in 2011, with each atoll inhabited by 400 to 500 people. Governance in Tokelau is conducted through the General Fono (assembly), headed by a chairperson designated by the Taupulega (atoll) hosting the assembly of elected representatives from each of the three atolls. Executive power is exercised by a cabinet comprised of the three elected heads and three elected mayors of each village. The office of Ulu (titular head of government) rotates annually between the three atolls. The isolation of Tokelau limits participation in economic markets and constrains sustainable economic growth and development. The only real income opportunity is fishery licensing over the very large Exclusive Economic Zone.
HEALTH AND DEVELOPMENT The 2014 STEPS survey confirmed an increase in noncommunicable diseases (NCDs) and their risk factors, including smoking, alcohol consumption, poor nutrition, physical inactivity, overweight or obesity, and raised blood pressure, blood glucose and blood lipids. Additional challenges in service delivery include geographical isolation, the vulnerability of the atolls to natural disasters, climate change and global warming, and the decentralization of hospitals under the different Taupulega. Human resource and financial constraints limit the potential of the Department of Health to deliver health-care services in Tokelau. Health service delivery is via locally employed staff, with one hospital on each atoll; staffed by a medical officer, a mix of nursing staff, midwives and hospital aides. Tokelau has plans to recentralize health services under the Department of Health and establish Nukunonu as a national referral hospital. This will require improvements of infrastructure and reorganization of clinical and public health services on all three atolls, all requiring significant resources.
NATIONAL STRATEGIC PRIORITIES WHO AND THE GOVERNMENT 2018–2022 The World Health Organization (WHO), working with partners, will support the Government in pursuing its national strategic priorities. Each strategic activity is linked to at least one of the subregional focus areas that are detailed in the Pacific Island Countries and Areas–WHO Cooperation Strategy 2018–2022: 1. To set the strategic public health agenda 1.1 Support a midterm review and an evaluation of the Tokelau Health Strategic Plan (2016–2020) against specified targets and indicators. 1.2 Develop the next national health plan congruent with the Healthy Islands vision, the Sustainable Development Goals (SDGs) and universal health coverage. 1.3 Conduct policy dialogue through a high-level multisectoral Health Summit focusing on NCD control, specifically strategies to reduce exposure to, and consumption of, unhealthy food and non-alcoholic beverages, including reducing sodium in food. 2. To plan and operationalize implementation of health policies and strategies 2.1 Ensure surveillance systems are in place to monitor NCD risk factors and interventions as well as other health indicators identified in the Health Strategic Plan. 2.2 Update treatment guidelines and protocols across the continuum of care for management of cardiovascular diseases, diabetes, sexually transmitted infections and HIV, TB and emerging diseases. 2.3 Develop a framework for pharmaceutical supply chain management to ensure availability and accessibility of essential medicines given the geographical challenges. 3. To develop capacity in public health and service delivery to achieve policy objectives 3.1 Use the strategic plan to inform continuing professional development opportunities (e.g. through Pacific Open Learning Health Network, fellowships and specialized training). 3.2 Implement the tobacco control policy “Tobacco Free Tokelau by 2020” through capacitybuilding for tobacco control and enforcement and health education and awareness for health professionals, communities, border officials, and tradespeople. 3.3 Build capacity for planning and sustaining routine immunization and the introduction of new vaccines.
NATIONAL HEALTH POLICY The vision of the Tokelau Health Strategic Plan 2016-2020 is “A Healthy Tokelau: Today for Tomorrow”. The vision looks beyond its national boundaries by linking and aligning its mission to the global sustainable development framework, specifically SDG 3. The plan proposes a set of outcomes that are divided into long- (2020 and beyond), medium- (2018–2020) and shortterm (2016–2018) outcomes. These are built into an indicator framework with 36 indicators and targets.
PARTNERS In implementing this strategy, WHO and the Government will work with other sectors, academia, civil society, other United Nations agencies, bilateral development partners, regional and global health initiatives, philanthropic foundations and others in support of planned national health priorities.
HEALTHY ISLANDS INDICATORS Number of skilled health workers* per 10 000 population Per capita total expenditure on health at average exchange rate (US$) Total expenditure on health as a percentage of gross domestic product (%) Tuberculosis incidence (per 100 000 population) Life expectancy at birth (both sexes) Under-five mortality rate (per 1000 live births) Absolute number of maternal deaths Maternal mortality ratio (per 100 000 live births) Adult mortality rate from NCDs at ages 30–69 years (%) Number of suicides Immunization coverage rate for diphtheria-tetanus-pertussis (three doses) (DTP3) (%) Immunization coverage rate for measles-containing vaccine (first dose) (MCV1) (%) Current tobacco smoking among persons 15 years of age and over (%) Population using improved drinking-water sources (%) Population using improved sanitation facilities (%) Proportion of endemic neglected tropical diseases (NTDs) having reached elimination goals envisaged in the global NTD Roadmap to 2020 (%) – target 100% NA = not available *Skilled health workers are defined as physicians, nurses and midwives
26 800 NA 0 69 0 0 0 NA 0 100 72 51.1 100 90 NA
2012 2010-11
2012 1990 2011 2006-09 2006-09 2006-09 2015 2015 2015 2006 2015 2015
WPRO/2017/DPM/022 © World Health Organization 2017 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. Photo credits Cover: ©AFP
facebook.com/whowpro
@ whowpro
youtube.com/whowpro