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Taito Phillip Field - Cooks Islands Health Conf.

Taito Phillip Field - Cooks Islands Health Conference

2004 Cooks Islands Health Conference, Rarotonga

Hon Taito Phillip Field, speaking on behalf of Health Minister Annette King, stressed the value of countries working together regionally and said there was much to gain from a collaborative approach.


It is a real privilege to have been invited to speak at the 2004 Cooks Islands Health Conference.

I am extremely disappointed not to be able to attend personally, and to be able to catch up with so many of my "friends in health", but I am very pleased that Hon Taito Phillip Field has travelled to Rarotonga to present this speech on my behalf.

The longer I stay in the health portfolio, and I have now been Health Minister since 1999, the more I appreciate the collegiality of meeting other Health Ministers, the sharing of experiences, successes and the inevitable disappointments.

The collegiality grows deeper the better you get to know some of the other Ministers, and in my case the collegiality I enjoy most is that which I share with my Pacific colleagues. In terms of health, I believe there is a very special relationship between New Zealand and its Pacific neighbours, and I will continue to do my utmost to nurture it.

I want to thank Kiki Maoate for arranging this invitation to speak. Kiki is chairing tomorrow's session on paediatrics, and there is no real need for me to tell you how much he is valued in Christchurch Hospital's department of paediatric surgery.

The theme of this conference is health partnerships, and that theme of partnership is clearly apparent in the practical and community focus of the workshops and discussion sessions.

I view New Zealand's relationship with its Pacific neighbours as a continuing partnership in which we share our experiences and ideas.

We have long worked together, of course, on an individual country-to-country basis, regionally and internationally to further our mutual health interests.

>From my point of view, one of the real pleasures of working together is New Zealand's annual hosting of the lunch for Pacific Ministers at the World Health Assembly in Geneva in May.

After five years, the lunch is now a tradition, and gives us all an opportunity to share ideas in a far more intimate forum than in the Assembly itself. We always have frank and helpful discussions, and this year's lunch, attended by Dr Peter Piot from UNAIDS, was no exception. I will return to the issue of HIV/AIDS later in this address.

Whether formally, or less formally, as with the lunch, New Zealand is keen to continue developing and maintaining partnerships because our countries have so many health interests in common. Some 6.5 per cent of New Zealanders are from the Pacific, and there is a considerable flow of people between our nations for a variety of reasons.

Our shared interests are in the management of communicable diseases, of course, but also in the management of non-communicable diseases and chronic conditions that can affect us all. Obesity, heart disease, diabetes and renal disease are all issues we are increasingly facing within our health systems.

As you know, New Zealand is involved in a considerable number of partnership initiatives and programmes in the Pacific.

New Zealand is a significant source of training for Pacific health practitioners, for example. Some 25 to 30 Pacific Island fellows each year update or extend their skills in New Zealand hospitals or training institutions, and other training opportunities are designed in home countries to best match training needs to actual working conditions. New Zealand is also involved in a number of World Health Organisation activities that are significant for the Pacific, including the Framework Convention on Tobacco Control and the Global Strategy on Diet, Physical Activity and Health.

Other activities have included the WHO vaccination workshop held in Auckland in February this year, with many Pacific participants, and extra-budgetary funding of the WHO STEPS programme in the Pacific, designed to enhance the surveillance of risk factors for noncommunicable diseases in the Pacific.

The New Zealand government's aid agency, NZAID, is funding a $230,000 two-year project called Building Regional Capacity for Tobacco Control. The project supports efforts by the Cook Islands and Tonga to counter adverse health, social and economic impacts of tobacco use by building capacity in tobacco control, health promotion and smoking cessation.

NZAID funds a number of partnership projects providing practical support to help Pacific countries manage problems in your own way --- in the fight against HIV/AIDS, for example, and in the management of infectious diseases and health workforce development.

For more than 25 years NZAID has also funded the Medical Treatment Scheme, providing specialist medical treatment in New Zealand, and in Fiji for people from Tuvalu, for people from several Pacific Island countries where treatment is not available in their own countries. Patients selected under the scheme have a life threatening or seriously debilitating medical condition, but a good prognosis.

The scheme also includes a Visiting Medical Specialist Scheme. Medical specialists travel to Samoa and Tonga if this is a more cost-effective option than bringing people to New Zealand.

New Zealand also backs a range of multilateral international activities that benefit the Pacific region, and we will continue to do so because such activities improve the Pacific's ability to influence multilateral decision-making that can affect us all.

Recent examples of such multilateral activities include chairing WHO Kobe Centre's 3rd Global Symposium on Health and Welfare Systems Development in 2002, and attending the APEC Health Ministers' meeting on SARS in Thailand in 2003, and the APEC Health Taskforce meeting in Taiwan. Such contacts ensure larger countries are aware of the issues facing all the countries in our region.

I would like to discuss briefly specific service partnerships that could become the basis for long-term and sustainable relationships.

The Middlemore Hospital / Cook Islands partnership is an excellent example. Counties-Manukau District Health Board has had a Memorandum of Understanding with the Cook Islands since 2000 that aims to build technical, clinical and managerial competency in the Cook Islands health service, to build key clinical relationships, and to identify areas where collaboration will benefit future development of health service planning and policy development teams for the Cook Islands people.

In practical terms this partnership has so far involved specialists travelling to the Cook Islands to work with medical teams in areas such as general medicine, gastroentorology/urology, ear nose and throat, orthopaedics, mammography and obstetrics/gynaecology. It has also involved a nursing exchange with Cook Islands nurses coming to New Zealand, and a feasibility study of a haemodialysis unit and mental health services in the Cook Islands.

In 2004/05 Dr Bob Eason, a specialist general physician, Dr Peter Gow, a rheumatology and quality development specialist, and Dr Keith Allenby, a women's health, gynaecology and obstetrics specialist, will visit the Cook Islands, and New Zealand is also in the process of confirming the practice status of nursing so that Cook Island nurses can practice in New Zealand as part of their training.

The Memorandum of Understanding is in the process of being renewed and agreed with the Cook Islands Department of Health. There are a number of challenging issues emerging for the District Health Board, including increasing expectations in the Cook Islands, concerns around responsibility for medical error, and perceptions of queue-jumping in New Zealand, but I have no doubt that such partnerships offer the prospect of considerable benefits.

Counties-Manukau also has a Memorandum of Understanding with the Tongan Department of Health that has not yet progressed to service provision, and which is more complex because Tongans are not citizens of New Zealand, but the board says it sees its role as an important provider of services and advice that contribute to better Pacific health.

Importantly, it says that it believes that its understanding of the health of its own Pacific population in Counties-Manukau will be enhanced by a richer understanding of Pacific health in the wider Pacific region.

A second excellent example is the Richmond Fellowship/Cook Islands mental health partnership.

Many Pacific countries share similar problems in delivering mental health services. People are often widely scattered in small, diverse and relatively poor communities where there is a very low level of information on the prevalence of mental illness, and there is often some tension between the application of western clinical models and non-western interpretations of the cause and cure of mental illness that emphasise spiritual and community links.

The Richmond Fellowship has been working with the Cook Islands to address service delivery. It has built up a local, cost-effective solution from the ground up, focusing on providing support for a well-trained local nurse and visits from consultant psychiatrists from New Zealand.

The Cook Islands service attempts to provide multi-faceted coverage, including community support and education, de-stigmatisation, early diagnosis, assessment and treatment, and follow-up work with families and communities.

The Are Pa Ta'unga mental health service is unique to the Pacific. As the New Zealand partner, the Richmond Fellowship believes that the model of local leadership and low-key assistance holds the best hope for sustainable improvement in mental health services in many small Pacific Island communities, and also has merit for a range of emerging economies. I said I would return to the issue of HIV/AIDS. There is no doubt that United Nations and World Health Organisation initiatives to combat HIV/AIDS are vitally important for our whole region.

A devastating communicable disease like HIV/AIDS is no respecter of borders, even in our island states. Working together on this issue will help all of us help each other, and will reinforce the effectiveness of international approaches like the WHO's three by five initiative.

At the Pacific lunch in Geneva I announced that New Zealand is to contribute a further $3 million to fight the threat of HIV/AIDS. The money will be shared equally between the Joint United Nations Programme for HIV/AIDS (UNAIDS), the Global Fund on HIV/AIDS, Tuberculosis and Malaria, and the UN Population Fund (UNFPA) to address reproductive health issues, including HIV/AIDS. New Zealand has asked the UN to focus the extra funding on the Pacific region.

While the rates are relatively low in Pacific Island countries, other than Papua New Guinea, the HIV rate is increasing in New Zealand, and there are indications of sharp increases in countries like Kiribati, Tuvalu and the Marshall Islands, reflecting a potential spread in the region, with devastating human and economic cost.

Right now we have an opportunity to prevent this threat from becoming a reality. What is needed is a concerted effort by governments, church groups, NGOs and the international community. Prevention and treatment will only work if we are honest about who is at risk. We need to ensure the removal of discrimination against and stigmatisation of vulnerable groups and to ensure that they are resourced to take action in a supportive environment.

The key to success is leadership and partnership between governments, civil society and community groups. Hiding behind traditional taboos about prostitution, sex before marriage, condom use, homosexuality and injecting drug users will simply doom millions of people. Heterosexual transmission is the major challenge worldwide, and that is why it is essential to listen to women's voices. Women often become infected due to a lack of access or acceptance of contraception or lack of power to say yes or no to sex.

Our partnership approach toward the threat of HIV/AIDS brings me to the most important point I want to raise today - that is, the value of countries working together regionally. It is natural for ministers to focus primarily on our own country's concerns, but there is much to gain in terms of key regional issues from combining efforts and resources.

A major theme of this meeting is fostering and developing sustainable long-term relationships. Regional partnerships can help to share cost burdens and help us to get the best out of resources such as specialist workforces. A number of specialists from New Zealand and Australia are attending this conference, and many have worked in other ways with our hosts and with other countries in the Pacific.

We can also collaborate regionally to influence international activities, with HIV/AIDS a prime example.

Many of you are aware that an amendment to the World Health Organization constitution (resolution WHA51.23) would give the Western Pacific Region an additional seat on the Executive Board. If passed, the four seats we now have would increase to five and ensure greater representation of the views of the Western Pacific Region in the WHO's governance and work programme.

The New Zealand and Australian delegations at last month's Assembly vigorously encouraged WHO members, who are not yet signatories, to ratify the resolution. At least six countries gave positive signals, with many others also interested, and New Zealand and Australia will continue direct approaches to other countries in coming months to gain the final 26 signatures needed to pass the resolution.

New Zealand has not been on the Executive Board of WHO for 20 years, and we are interested in nominating for the additional position. We were delighted to support our friend from Tonga, Bill Tangi, for his position, and New Zealand would like to serve alongside him to help ensure the region's interests are best represented.

Thank you again for inviting me to your conference. I cannot imagine a better theme than partnerships for a Pacific meeting such as this. Our countries and our peoples are partners in so many ways already that it is only natural and commonsense to pool our resources and ideas whenever it is practical to do so.


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