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The embryology and development of healthcare systems in the South Pacific Islands

Crystal Gao, Editorials and Publications Team PMSA


In our editorials, it has often been documented that the quality of healthcare can vary even within a country – so, it is no surprise that the South Pacific Islands demonstrate a great degree of cultural and developmental diversity, despite the geographical closeness of its various island countries. Perhaps the best explanation for this variation lies in the historical division of the Pacific Island Countries (PICs) into three groups based on their affiliation with France, USA or the Commonwealth respectively (Table 1)(1, 2).



To date, the healthcare systems of the various PICs are generally modelled on that of the affiliated country, with many of its practises and policies being adopted by the local government. As a result, the quality and accessibility of healthcare is largely dependent on the level of funding and resources offered by these affiliated nations.

For example, in the French-affiliated areas and territories, universal healthcare is made available to all people with full funding from the French Government. Similarly, the US-affiliated countries are fully supported by the US administration and enjoy some of the highest health expenditure per capita of all the PICs. In contrast, those countries affiliated with the Commonwealth do not receive full financial funding but are able to maintain their own healthcare system with support from Australia and New Zealand. As a result, most primary health services in the PICs are free owing to the heavy subsidising by affiliated Governments.(3)

The provision of adequate healthcare in the PICs is challenging at best, due to the scattered distribution of its islands and inhabitants. The different political affiliations of the various Pacific Islands add an extra layer of complexity to the situation, with the differences in funding and healthcare models undoubtedly creating disparities amongst the different island countries. Although the provision of funding from foreign Governments is a first step forward in ensuring adequate healthcare is available to its people. In the long-term, it would perhaps be more ideal for the PICs to establish and sustain their own healthcare systems with support from their affiliated nations; this could potentially reduce the discrepancies in healthcare standards across the different islands and ensure better equity of healthcare across the entire region.

1. Costa M, Sharp R. The Pacific Island Countries Fiji, Papua New Guinea (PNG), Samoa, Solomon Islands, Vanuatu and Tuvalu. 2011.

2. WHO. Health systems deveopment in the Pacific 2018.

3. Gani A. Health care financing and health outcomes in Pacific Island countries. Health Policy and Planning. 2009;24(1):72-81.

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