The Healthcare System in Tokelau: Atoll Hospitals, Transfer to Apia or New Zealand, Vaccines and Insurance

Tokelau’s health system is public. The Department of Health of the Government of Tokelau runs it, with a Director of Health whose position appears in the government directory, and it draws up strategic plans based on four objectives: protecting the population’s health, protecting the environment, building an effective health system and developing staff. The independent evaluation of Tokelau’s health services, published by New Zealand’s MFAT, describes three hospitals that mainly deliver primary care: Fenuafala hospital (Tai) and a clinic at Fale, in Fakaofo, St Joseph’s Hospital in Nukunonu and Lomaloma hospital in Atafu.

According to this document, St Joseph’s Hospital was developed as the national referral hospital and reports directly to the Department of Health, while the services of Fakaofo and Atafu are run by their village councils. The evaluation notes that daily consultations often involve fewer than fifteen patients and that, during its authors’ visit week, two hospitals had no inpatients. No private establishment was identified in the official sources read. The territory’s funding rests on New Zealand’s budget support and on fishing licences (MFAT).

No contribution-based health insurance fund is described in the official sources read, and no fee schedule for visitors was found: the possible cost of a consultation or hospital stay for a traveller should be requested from Tokelau’s Department of Health before departure. The patient referral scheme, for its part, has a defined audience. It is aimed at Tokelauans living on the atolls and, according to the Department of Health policy cited by the MFAT evaluation, at people who have lived there for more than six months, medical locums and government contractors; it is also open to Tokelauan staff and students in Apia. Tokelauans who ordinarily live abroad are excluded. A French visitor does not appear on this list.

The people of Tokelau are New Zealand citizens and have access to New Zealand’s publicly funded services (Health New Zealand). A French national is eligible for these services if they meet the visa conditions set by New Zealand; otherwise they pay for their care. ACC, New Zealand’s accident compensation scheme, covers residents and travellers in the event of an accident, but does not replace travel insurance (France Diplomatie).

Each hospital is headed by a doctor, assisted by a nurse in charge and nurses, according to the MFAT evaluation, which notes a high ratio of care staff per inhabitant for the region, thanks to the nurses. The Department of Health asks any traveller who feels unwell (headache, sore throat, joint pain, nausea, vomiting, difficulty breathing or diarrhoea) to inform the local doctor immediately. Clinical care is delivered by the three hospitals, and the consultation therefore takes place at the atoll’s hospital.

For a chronic treatment, the Department of Health specifies that travellers bring their medication for the full length of the trip and a clinical summary. The MFAT evaluation indicates that at the time of its work the department had neither a pharmacist nor a pharmacy technician and that the choice of medicines was limited: treatment with a particular molecule cannot therefore always be replaced on site. Having the list of one’s medicines, under their international non-proprietary name, makes any consultation abroad easier (France Diplomatie).

The MFAT evaluation specifies that the three establishments are officially hospitals but do not correspond to a secondary care hospital in the New Zealand sense: only basic blood tests and a portable X-ray machine, in one of the hospitals, are cited as secondary-level tests, and procedures such as basic surgery or caesarean sections were not available at the time of its work. In Nukunonu, the operating theatre of St Joseph’s Hospital was in service at the end of the evaluation work and had been used by a visiting specialist ophthalmology team. In Fakaofo, a new twelve-bed inpatient building was operating at the same date.

These elements change with health programmes: capacities should be checked with the Department of Health before a long stay. For a pregnancy, the evaluation indicates that pregnant women are sent to Apia from about 28 weeks to give birth at the hospital, and directly to New Zealand if there is a risk of very premature delivery. The page healthcare reimbursement in Tokelau details maternity cover.

No emergency number valid for the three atolls was found in the official sources read: in case of illness, you contact the local doctor at the atoll’s hospital. Medical evacuations are by boat: the passenger vessel has a sick bay for the transfer of patients from the atolls, and the Department of Transport specifies that its schedule can be disrupted by unplanned medical evacuations from the villages to Apia, with passengers then staying ashore until the ship returns. The journey to Apia takes about 24 to 30 hours depending on the atoll of departure.

Patients are referred to Apia, where France Diplomatie mentions Samoa’s national hospital, or to New Zealand (MFAT). For a French traveller, these transfers and medical repatriation are not funded by a public scheme: France Diplomatie states that it is imperative to have an assistance contract or insurance covering medical costs and repatriation, and that the French embassy never covers these costs. The contract should be chosen with evacuation cover from the atolls, as explained in repatriation and assistance.

France Diplomatie reminds travellers that the vaccinations recommended in France are equally essential abroad, notably against diphtheria, tetanus, polio, whooping cough and measles. For transit through Samoa, it describes dengue, which has no curative treatment and for which anti-inflammatories should be avoided, and Tokelau’s Department of Health notes that typhoid is present in drinking water in Apia: bottled or boiled water and rigorous hand hygiene. It also recommends repellent, plasters, a skin antiseptic and sunscreen, which travellers are responsible for, and not scratching mosquito bites.

The World Health Organization notes, for its part, a rise in non-communicable diseases, almost complete vaccination coverage and vector control priorities. On arrival in Apia, travellers bring their health forms to the department, which organises a check on departure and arrival. See also the page health insurance in Tokelau.