The Healthcare System of Wallis and Futuna: Health Agency, Hospitals, Emergencies and Medical Evacuations

Wallis and Futuna has neither a health insurance fund nor a social security system covering health risk. The State services remind readers that health is funded by the State on the basis of Article 68 of the 1972 Finance Act. The Health Agency (ADS), created by the ordinance of 13 January 2000 and organised by the decree of 15 November 2001, is a public body with management autonomy under the supervision of the ministries for Overseas, Health and Finance; it employs about 200 people. It draws up the public health programme, provides diagnosis and treatment, organises transfers, dispenses medicines and medical devices on prescription and implements, by agreement with the territory, social action for older or disabled people.

The ADS operating budget is of the order of €50 million a year and is entered in programme 204 “Prevention, health safety and care provision”; Ségur de la santé credits and credits from the Ministry for Overseas are earmarked for investment. The territory’s Caisse des prestations sociales (social benefits fund) only manages pensions and family benefits (IGAS, the French social affairs inspectorate). The guide to health and social protection in Wallis and Futuna presents the whole institutional framework.

In law, the Agency’s board can set a contribution from users (Article L. 6431-8 of the Public Health Code), but the supervising ministries have consistently reaffirmed free care for residents. The crisis-exit protocol of 19 September 2024 recalls that “care remains free for residents of Wallis and Futuna” and that no plan to call this principle into question will be considered (IGAS).

The sources consulted do not define the notion of resident or the treatment of a passing visitor: the Agency’s website does not mention any access condition either. A newcomer asks the Health Agency before leaving (switchboard: (681) 72 07 00). The sources consulted describe no affiliation formality for care on site. For a non-civil-servant who transfers their residence, the Assurance Maladie (French public health insurance) states that no cover is possible in mainland France, for lack of a bilateral agreement: supplementary insurance for trips is advised by the State services.

There is no private practice or other care provision, public or private, outside that of the Agency (IGAS). First-line care is provided in four dispensaries: three in Wallis (Hahake, Mua and Hihifo) and one in Futuna. General medicine is consulted there by appointment Monday to Friday from 8 a.m. to 12 noon and from 3 p.m. to 5 p.m., and on Saturday from 8 a.m. to 12 noon at the Hahake dispensary only; appointments are made with each dispensary’s secretariat (Mua 72 27 74, Hahake 72 07 23, Hihifo 72 20 34, Futuna annex 72 39 03). The IGAS notes that the dispensaries close at 5 p.m., which shifts part of the demand to the emergency departments, and recommends extending hours to 6.30 p.m.

For a specialist opinion, the GP hands over a request that counts as a prescription; the dispensary secretary sends it to the specialist consultations secretariat, whose specialist doctor sets the priority, then the patient is contacted for an appointment. A mask is requested from patients with respiratory symptoms. The Wallis dispensaries carry out about 25,000 consultations a year, in steady decline, and about 12,000 consultations are carried out in Futuna.

Sia hospital, in Mata’Utu (Wallis), has 42 beds: 13 surgery, 14 medicine, 14 gynaecology-obstetrics and one intensive care bed. It has operating theatres, an imaging department (X-ray, ultrasound, CT scanner) and a medical analysis laboratory. Kaleveleve hospital (Futuna) has 9 beds and no surgical capacity: patients needing further care are transferred to Wallis, which amounts to more than 500 air transfers a year.

Staffing is limited: seven hospital doctors (including a radiologist and three emergency physicians) and eight GPs, most medical posts being single posts. Ophthalmology, ENT, cardiology, rheumatology, gastroenterology and psychiatry depend on temporary specialist missions, lasting 4 to 12 weeks on average, from Nouméa or mainland France; every year, a few cardiology and ophthalmology missions make more than a thousand consultations possible. Specialist opinions are also shared by teleconsultation (oncology, rheumatology). The IGAS recommends affiliating the Wallis emergency department with a mainland France facility and broadening hospital partnerships.

The Agency experienced industrial action in September 2024, which disrupted access to care and led to a crisis-exit protocol on 19 September 2024; the inspection mission makes governance and care-provision structuring recommendations.

Emergency departments operate 24 hours a day at Sia hospital (Wallis) and Kaleveleve hospital (Futuna). For a life-threatening emergency, the Agency asks you to call 15 immediately: a health professional assesses the situation and gives instructions. As the territory has no SAMU, rescue teams do not set out automatically: the caller contacts the fire brigade directly to arrange transport to the hospital. The Health Agency switchboard is (681) 72 07 00.

For gynaecological and obstetric emergencies (pregnancy, bleeding, post-operative complications), you must go to the emergency department or the maternity ward from 7 a.m. to 9 p.m., and only to the maternity ward from 9 p.m. to 7 a.m. The number of emergency visits in Wallis more than doubled in about fifteen years (more than 12,000 visits a year), and Futuna has about 8,000 a year.

When care is not available on site, the Agency can transfer the patient by air to a public or private facility outside the archipelago: New Caledonia, mainland France or, more occasionally, Australia. The evacuation covers medical costs at the receiving facility and transport; a companion is covered if the patient is a minor, disabled or dependent. The territorial assembly can grant aid to families. An evacuations secretariat and an ad hoc committee validate these transfers; urgent evacuations go through an outside aviation provider and scheduled evacuations by a regular flight twice a week.

• Volume: several hundred air evacuations a year, about 8% of them urgent and 92% scheduled, about 88% to New Caledonia and 10% to mainland France.
• Cost: more than €20 million a year, evacuations representing more than a third of the Agency’s annual budget; the transport share in the average cost has risen sharply.
• Accommodation: facilities host patients from Futuna transferred to Wallis, notably pregnant women near term; partners accompany families during distant evacuations.
• Mainland France: the State services mention an agreement with the Assurance Maladie providing for provisional registration of patients on arrival in Paris; its current status has not been checked.

Personal trips outside the territory have no local cover: see the page on healthcare reimbursement and repatriation assistance.

The Agency’s pharmaceutical service handles the management, supply, preparation, control and dispensing of medicines and medical devices. Health indicators are worrying according to the IGAS: diabetes prevalence close to 20% in the native population, fewer than 8% of the population with a normal fasting blood glucose, 61.3% of men aged 15 to 69 who smoke, a risk of gynaecological cancers 5 to 11 times higher than in mainland France. The Court of Audit cites 90% of the population overweight and 70% obese.

The tropical climate and isolation sustain communicable diseases such as dengue and leptospirosis. The sources consulted publish no vaccination schedule specific to the territory: the dispensary doctor and the Health Agency advise each newcomer. The general guide to healthcare systems around the world helps compare this organisation with other territories.