The country's small population is scattered over 18 islands and 45 settlements averaging roughly 400 people. Poor roads and limited transport often make access to schools and clinics problematic. Walking to a school or a clinic can take an hour or more. Communications between headquarters and outer island officers is infrequent and expensive. High transportation costs undermine cost-effective distribution of books, building materials and drugs, regular visits by specialist medical staff, and upgrading of housing, water supplies and amenities.
Economies of scale are largely nonexistent in the outer islands.
The average preschool size is 15 students. The average primary school has an enrolment of 135 pupils. In urban areas, waste management and water supply are inadequate. This is a threat to the health of the population on Rarotonga and to the growth and sustainability of the tourism sector, which is the mainstay of the economy.