Application of the primary health care concept to Tonga
Creators: name: Kautoke, Busby Salesi
Publisher: name: University Of Tasmania
Year: 2023

description: This thesis examines the primary health care concept, experiences gained in its development and argues that it can be applied to Tonga in a manner congruent to the local setting. \Primary health care is a practical approach to making essential health care universally accessible to individuals and families in the community in an acceptable and affordable way with their full participation\". It also has social and sectoral dimensions requiring sectoral integration. It will be shown that conventional health care based in hospitals and professionals i.e. the secondary and upper levels of health care are expensive and cannot expand in themselves alone to provide accessible essential health care to everyone in Tonga. The poor island agricultural economy of Tonga cannot support further expansion of this expensive and often unresponsive model to make it accessible to the 76% of the population living in villages and scattered islands. Primary health care is beneficial to Tonga in two major ways. Firstly it can make essential health care accessible to the 76% of the population living in villages and scattered islands. Secondly the major diseases which if not treated especially in children result in death or dehydration do not require sophisticated medicine and primary health care would reshape priorities to this end. The use of paraprofessionals (village health workers traditional birth attendants sanitation workers) would be a major resource in applying primary health care to Tonga acting as front line workers. It has been found that they could take care of about 90% of conditions requiring medical treatment in peripheral areas. It will be explained that the biggest cause of morbidity and mortality in Tonga are the respiratory and diarrhoeal diseases. With more attention to early treatment and health education carried out by paraprofessionals most would be considerably less harmful than at present. Women make ideal volunteer paraprofessionals in Tonga and their \"kautaha\" or village women committees could organise compaigns for immunisation village sanitaton and family planning effectively. They are very influential in the Tonga society especially in the extended family system \"kainga\". Failures have occurred to health programmes that do not include women. Traditional healing practices in Tonga are a significant aspect of health care and will be shown that proved useful elements such as birth attendants can be incorporated into the health care system at the primary level. The effective application of the primary health care concept to Tonga requires significant restructure of the Ministry of Health. Hospitals and all the services at the secondary and upper levels of health care are essential but should not be permitted to expand so as to provide the only source of essential health care to everyone in Tonga. The peripheral health care services using the primary health care approach is to be expanded. The whole health care system would be oriented mainly to providing support to the peripheral health services and complementing their action by means of easy and timely referral of cases and problems beyond their competence. This support includes technical supervision training and provision of supplies. To maintain the clinical effectiveness of the present 33 number of doctors and allow primary health care to develop doctors and other professionals should remain in the four hospitals and reduce their hold of the overall health care system. Subprofessionals (Health Officers or medical assistants) should be increased in order to have one for every 2000 population. Sub-professional is at the lowest echelon of the bureaucracy of the Ministry of Health and they provide the linkage to the paraprofessionals and the rest of the community. At the same time the community should be involved through those of paraprofessionals and \"kautaha\" for training and educating themselves about their own health. The application of primary health care to Tonga will have far reaching consequences not only within the health sector but also other sectors at the community level. Advance planning is important to overcome obstacles in order to allow its smooth application. Doctors and nurses who are the traditional providers of health care can be successfully influenced by involving them and be persuaded that they are not relinquishing medical functions but gaining health responsibilities. Resistance from the public can be defused by discussions in communities and in the mass media along with practical examples of primary health care. Considering the local setting of Tonga it is more appropriate to retain the bureaucracy of the Ministry of Health but needs to be made more responsive to the people and prevent it from overcentralisation. This may be brought about by community development and politicisation i.e. more involvement in decision making and sharing of resources for the effective application of primary health care to Tonga."