This report provides an overview of health systems in the Pacific region, focusing on three countries: the Republic of the Marshall Islands (RMI), the Kingdom of Tonga, and the Republic of Vanuatu across seven health systems domains.
The Pacific Islands Countries and Territories (PICTs) face several unique and interconnected developmental challenges, including unreliable and expensive transport, small and fragile economies, vulnerability to climate change and natural disasters, resource limitations, and human resource constraints. These factors hinder sustainability and resilience not only in health but also in economic development and climate change response. Despite these obstacles, most islands have been working toward achieving universal health coverage (UHC), focusing appropriately on primary healthcare and public health while also engaging in strong regional collaboration to meet international standards for population health and health promotion.
The Partnership for Health System Sustainability and Resilience (PHSSR) has conducted an international research effort to enhance global health and facilitate regional dialogue by using a research framework developed by the London School of Economics and further adapted for the Asia-Pacific region by the Center for Asia-Pacific Resilience and Innovation (CAPRI), the Asia-Pacific Hub of PHSSR. This report provides an overview of health systems in the Pacific region, focusing on the three countries: the Republic of the Marshall Islands (RMI), the Kingdom of Tonga, and the Republic of Vanuatu.
Population health has improved in recent years among PICTs, with declining death rates and an average life expectancy at birth of 69 years in 2021. However, life expectancy at birth in some island nations has plateaued or declined due to noncommunicable diseases (NCDs). Despite a median population age of 20–30 years, the burden of NCDs remains significant, accounting for three-quarters of premature and preventable deaths. Rates of obesity and people who are overweight in PICTs are among the world’s highest.
The climate crisis is the most important threat to the lives and livelihoods of people in the Pacific Islands, despite their minimal contribution to global greenhouse gas emissions. These areas face severe weather events, water scarcity, rising sea levels, increasing ocean temperatures, and ocean acidification, all of which have adverse impacts on both livelihoods and health. Reduced fishing and agricultural yields, for example, have led to increased reliance on imported and highly processed foods, contributing to the rise in NCDs.
Ensuring the appropriate number of trained healthcare workers (HCWs) to sustainably meet current and future healthcare needs is a critical challenge in the Pacific region. These shortages are driven by a mix of “push” factors (e.g., heavy workloads, low compensation, lack of professional development opportunities, and challenging working conditions in the Pacific Islands) and “pull” factors (e.g., higher remuneration, better working conditions, and greater opportunities for advancement abroad). HCW shortages disproportionately affect rural and outer island communities.
In conclusion, the report highlights the strengths and weaknesses of health systems in PICTs and proposes policy recommendations at the national, regional, and global levels. The report suggests that more resources are required to fully implement national and regional plans to achieve global and regional NCD targets. Additionally, proactive policy measures, such as Fiji’s health plan, are still required in more PICTs to tackle the climate crisis. Finally, the report recommends several strategies aimed at retaining HCWs, such as deploying various types of HCWs in primary healthcare settings.