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Equitable access to quality health services for our Pa Enua

Equitable access to quality health services for our Pa Enua. Leaving no one behind.

Over the past year, Te Marae Ora – Cook Islands Ministry of Health (TMO) has established and developed the flying doctors and dentists programme, in to what is now a more integrated, structured, and comprehensive mobile health service: Kaveinga Ora.

Kaveinga Ora ensures the delivery of quality health services in the Pa Enua, complementing Nurse Practitioner-led services on these islands, as well as in Aitutaki where doctors are based. Dr Josephine Herman, Secretary of Health says, “Nurses are the backbone of our health system, and we appreciate and value the resilience of our nurse practitioners and nurses, as well as our clinical support and general support staff, who work in such remote and challenging settings.”

Furthermore, our Pa Enua nurse practitioners practise with clinical oversight provided by our doctors and senior nurses. Improved technology through phone and internet (email/electronic patient medical records) helps connect our Pa Enua workforce with Rarotonga so that nurse practitioners can access clinical advice from the lead doctors of the various speciality areas. Regarding patient referrals from the Pa Enua to Rarotonga, “We run an efficient service” states Dr May, Director Hospital Health Services. “The patient referrals committee that approves the transfer of patients to Rarotonga follows a diligent process to ensure an efficient and safe clinical decision-making process.” A critical factor is the integration of services across the health system.

The Kaveinga Ora Team comprises doctors, dentists, nurses, health protection and health promotion officers and public health nurses. The range of health services now available to the Pa Enua has expanded beyond medical and nursing services to include public health services. “Health security and border health services are key to protecting our Pa Enua populations from threats such as dengue and flu…” Dr Herman continues “…we are working hard to ensure our people have access to safe and quality drinking water and sanitation. Kaveinga Ora is further strengthened with an increased number of training opportunities for the Pa Enua health staff to travel to Rarotonga for upskilling.

It is recommended that health services should aim to have one doctor for every 1,000 people. Apart from Aitutaki, all of the Pa Enua populations are less than 1,000. This has resulted in the training and placement of nurse practitioners to lead health services delivery on the smaller islands of the Pa Enua. Kaveinga Ora helps address the medical workforce gaps in the Pa Enua through regular doctor visits to the islands.

TMO plans to provide regular doctor and dentist visits to the three Ngaputoru islands of Mitiaro, Aitu and Mauke, Mangaia, and the Northern group islands. In November 2019, the first cohort of dental technicians will graduate and return to their islands to work. “I am pleased with the training programme we have established for our dental technicians and primary oral health care workers” says Dr Areai. The new graduates will help provide preventative oral health services on their islands. Dentists visits to the Pa Enua will continue. “The Pa Enua are a priority” says Dr Herman. She adds, “the NCD/Obesity epidemic poses a major threat to our health system and with our people living longer, our health services need to be agile and responsive to our people’s health needs, regardless of age, gender or where they live.

Earlier this year, TMO established the Cook Islands Emergency Management Team (KukiMAT) who comprise Rarotonga-based health professionals with special skills and training to respond to health emergencies. This has included retrieval services to the Northern group islands of Nassau, Pukapuka, Penrhyn, Rakahanga and Manihiki, with some of these requiring multiagency coordination of air and sea transport. KukiMAT has recently provided surgical services in Aitutaki for an emergency caesarean section, along with retrieval flights to other Pa Enua in the Southern Group islands. “KukiMAT has allowed us to focus on strengthening our emergency response systems and services, not just for the Pa Enua but also for our High Dependency Unit where we care for our very sick patients”, says Dr Tai Maea, lead anaesthetist.

TMO is planning a ‘round the rock’ trip to the Northern Group islands of the Cook Islands. Dr Uka, Director Community Health Services is overseeing this programme. He notes, “Kaveinga Ora is our flagship outreach arm for TMO and I know that if we work together with our communities, we will achieve our objectives.” Dr Herman agrees, “We have thought carefully about the most cost-effective way we can deliver equitable and safe quality health services in the Pa Enua. Kaveinga Ora is an important mechanism, and over time, our learnings will help shape its design so that we provide the best care for our people.”