Te Marae Ora is the main provider of health care in the Cook Islands and has a regulatory function through various legislation in protecting Public Health. Health services range from Public Health (inclusive of primary care) to secondary care. Overall, the Cook Islands are relatively well equipped to provide basic primary and secondary level care.
The Cook Islands delivers an adequate range of general clinical services in the core areas of Surgery, Medicine, Anaesthesia, Obstetrics, Gynaecology, Ophthalmology and Paediatrics. These services are supplemented by visiting specialist teams and access to tertiary services is through referral to overseas health providers. There are a small number of private providers. For administrative and management purposes, health facilities and health services are classified into 5 levels in the Cook Islands.
The 70 bed Rarotonga Hospital is the principal curative health facility and also offers an Outpatient, General Practice and Emergency Services. The Clinical departments and services include –Surgical, Medical, Paediatrics, Ophthalmology, Obstetrics and Gynaecology, Anaesthesia, High Dependency Unit. Allied Health Services include Radiology, Laboratory; Pharmacy; Physiotherapy and Ambulance. The Hospital is well equipped for a facility of its size in the Pacific and also accommodates training centres for the nursing school and the POHLN facility.
Aitutaki Hospital is a 28 bed facility that caters for primary and secondary health care. Clinical departments and services include GOPD, ward areas for adults, paediatric and maternity patients. There is limited diagnostic (X-ray and Laboratory), dental and ambulance capability and a fully functional pharmacy which complement the services.
Primary Health Care Services
Tupapa Community Clinic
This primary health care facility is located in the town area and close to the TMO Headquarters. Primary healthcare services includes Outpatients, Maternal Child Health, Family Planning, Rheumatic Heart Disease, Mental health and NCD clinic. Counselling services for Nutrition, Tobacco and family health (child, youth, men and women) are also provided.
Dental Health Services:
Dental services are located within the Tupapa Community Clinic. Dental clinical services includes the diagnosis of oral disease entities and the delivery of a broad range of restorative (fillings) care, minor oral surgery procedures such as simple tooth extractions, impacted third molar extractions, simple periodontal treatments and provision of removable prosthesis.
Most recently, the prosthetic care, orthodontic, endodontic and less complicated oral maxillo-facial surgery services has been expanded to cater the demand for such care here in the Cook Islands. The public health arm of the service deals with preventative aspect of care in schools and the wider community. This is a crucial component in addressing oral health issues at the community level.
Other Health Services
Other key services include school health programs, health promotion, public health nursing services, food safety, water safety and quality, sewage and sanitation, emergency surveillance response, border control, and vector borne diseases. As the countries health system moves towards a more preventative focus the Community Health Services will become even more important. Non Communicable Diseases is a focus area of concern and priority and funding for services that will help in this area will continue to be directed as appropriate.
Pa Enua Health Centers
Pa Enua health centers provide basic services in primary health care. Patients with serious or complicated medical conditions are transferred to Rarotonga.
Referral services, secondary and tertiary care
Rarotonga Hospital is the primary referral centre in the Cook Islands for further secondary care. Non-urgent cases requiring tertiary care or a specialist opinion may be placed on a waiting list to be seen by an overseas visiting medical, surgical or other specialist. Patients with more serious conditions or requiring urgent treatment not available in-country may be eligible for international referral to Auckland, New Zealand. The TMO has a policy to guide decisions on eligibility of international referrals funded by government. Domestic transfers from the Pa Enua are catered for in Rarotonga Hospital and if needed, referred to Auckland following standard procedures.
Private Health Providers
The private health providers in the Cook Islands are mainly located on Rarotonga. There are four medical practices, four pharmaceutical outlets and one dental clinic in operation. There is one medical practice in Aitutaki. Over-the-counter medications (but not prescription drugs) are available in the supermarket and in many small stores. The Ministry of Health (Pharmacy & Therapeutic Products) Regulation 2013 governs the procurement, sale and use of medicinal drugs in health facilities, private clinics and commercial outlets.