Political will and local partnerships stall Zika outbreak and help combat NCDs in Tonga

Jun 20, 2016

Root crops are the staple diet in Pacific islands. (Photo: UNDP/Kumar M Tiku)

Nuku’alofa, Tonga: The Kingdom of Tonga in the South-western Pacific has many firsts to its credit. Tongans believe their land is the first to see the dawn of day, every day. While Samoa, New Zealand and even Japan would be the other claimants to the title of the ’land of the rising sun’, there is no dispute on the other fact: this picturesque small island country is leading the pack of Pacific Island countries in responding to the burden of ‘lifestyle’ diseases laying low this island country. 

For well over a decade now, public health in general and non-communicable diseases (NCDs) in particular have stayed consistently on top of the national political and development agenda. Making the Kingdom a frontline state in the fight against NCDs. Hardly surprising then, that in a week’s time from now, Tonga will be host to the first-ever Pacific NCD Summit, to be held in the capital Nuku’alofa, from 20-22 June 2016.  

Hala Fiona, the Tonga National Strategy for Prevention and Control of NCDs 2015-2020 is in place and on track for implementation. The current strategy is the third of a series and builds on two previous strategies that covered 2004 to 2009 and from 2009 to 2014, respectively. In 2004, Tonga became the first island country to have a strategy on NCDs. The country has built a strong foundational base in translating goals and aspirations into tangible action by embracing a multi-sectoral action and cooperation approach to the governance of NCDs. The United Nations Development Programme (UNDP) has assisted the multi-sectoral coordination for implementing the Strategy through the MDGs Acceleration Framework (MAF) since 2012. 

NCDs have been identified as the leading cause of death worldwide. They accounted for at least 60 per cent of all deaths, or three of every five deaths. Half of those who die of chronic NCDs are in the prime of their productive years, and thus the disability imposed and the lives lost are also endangering the global competitiveness of the Tongan industry. 

The prevalence of diabetes is in Tonga is estimated at over 16 per cent with no significant difference between men and women for the population in the age group of 25 and 64 years. 

It is not just the Ministry of Health or even the five other core Ministries of the Kingdom (agriculture, education, internal affairs and finance and national planning) that are at the heart of leading a transformational response to overcome the common challenge that NCDs pose to the Kingdom. Church leaders, emergency relief groups, school forums, work places groups and even minority groups such as the transgender organizations are all part of a seamless architecture driving awareness raising and health promotion practices in Tonga. International partners such as the United Nations Development Programme (UNDP) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) have rallied right behind this approach and offered capacity and assistance to make it work.

Energy, Ideas, Partnerships

Energy, ideas and ground-level partnerships for local action are at the heart of the implementation approach towards dealing with the public health challenge in the Kingdom that comprises the main island of Tongatapu where over 70 per cent of its estimated 105,000 inhabitants live and other populated outlying island groups of Haápai, Vavaú, Éva, Niua’toputapu and Niuafo’ou. 

When the Zika virus outbreak struck the country in January 2016, it was the same partnership-centered response led by the Public Health division of the Tongan Ministry of Health that helped bring the outbreak under control. The success of the country’s response to Zika was accomplished through swift, purposive action involving field-level support from a network of Tonga Red Cross volunteers and the royal armed forces in the Kingdom.

In Tonga, the first case was officially recorded at the state-run Vaiola Hospital in Nuku’alofa on 1 January 2016 in an 11-month old female infant with a history of low grade fever and rash.  Following this case, the Tongan Ministry of Health identified an increasing number of people who reported to the outpatient department with complaints of fever and body rashes. From January 4 to the 24, 118 cases were reported. At its peak, over 600 cases were reported in the country. 

The Public Health Division of the Ministry of Health was directed to prepare a Response Plan. A fully costed and budgeted plan, with a comprehensive situational analysis, was prepared and sent to the National Emergency Management Committee for endorsement and finally to the Cabinet for approval. The response plan received full support of the Deputy Prime Minister, who is also the Chair of the National Emergency Management Committee. 

The Response Plan approved by the Cabinet centered on a comprehensive National Campaign and focused on major gaps such as shortage of insecticide supplies and equipment; human resource constraints for environmental control; transport deficiencies that constrained access to communities; limitation of funds to undertake risk communication and awareness.

A combined partnership was finalized with the Ministry of Health, the Ministry of Internal Affairs, His Majesty’s Armed Forces, Waste Authority Limited and Tonga Red Cross Society

The risk awareness campaign that ran on radio and TV got the message across that that people need to avoid the mosquito bite. “We made people aware that they needed to be particularly careful about the day biters among the mosquitoes, those that stung in the morning and before the evening”, said a volunteer. The on-the-ground response to deal with the Zika virus threat started sometime in early February. With support of the Ministry of Health, volunteers, armed forces and community groups helped disseminate risk awareness messages to the communities at risk, focusing on the disease symptoms and modes of transmission and prevention measures. Mosquito nets for pregnant woman across the Kingdom were also distributed. The campaign ensured that the most affected areas were accessing information about the Aedes mosquito, Zika symptoms and vector control, and more on difference between Zika and Chikungunya. 

Simultaneously, collaborative action on the part of the National Emergency Management Office, the Ministry of Health, district and town officers, Red Cross Volunteers and community leaders helped in enhancing public sanitation and in removing possible breeding grounds for the mosquitoes. Broadcast, online and social media networks as well as billboards and posters were deployed in strength to roll out a communication campaign to inform and educate the citizens about the signs and symptoms of the infection. 

Thanks to the holistic approach to the response and the resulting partnerships that deepened programmatic outreach to all the vulnerable locations, the Kingdom of Tonga was able to reduce the number of cases in a relatively short period of time. 

High-Level Commitment

Response to the Zika outbreak also benefitted from strong inter-ministerial coordination, such as that provided by the National Country Coordination Mechanism (CCM) as it did from learnings from the earlier campaigns centered around other vector borne diseases. 

Emergency relief organizations such the Tonga Red Cross are a partner of the Ministry of Health. The partnership delivered dividends in dealing with the first-ever Zika virus outbreak in Tonga

Sione Taumoefola, Director General of Tonga Red Cross and Deputy Chair of the National CCM Chair of the National Tobacco Advisory Committee describes how the lessons learnt from on the response to the dengue epidemic that hit Tonga in January 2015 were useful in the response to dealing with the Zika virus outbreak. 

Red Cross VolunteersTonga Red Cross Volunteers ready with first aid support at a Rugby Tournament in Nuku’Alofa. (Photo: UNDP / Kumar M Tiku)

Successful Intervention

The results were striking, with not a single reported Zika virus case reported in the entire month of May. The Ministry of Health is on the cusp on declaring Tonga Zika-free. Over 9000 tons of rubbish were removed from neighborhoods over a three-month period between February and April 2016.The public sanitation and risk awareness campaign was concluded in all affected areas including Nukualofa, Hahake, Nukunuku and Hihifo districts by 8 April, a whole month ahead of the planned conclusion date. 

Within three months of an all-round concerted effort, the country is reckoned as Zika-free, a notable achievement. No further infections have been reported at health centres in Tongatapu or in outlying areas over a 30-day period in May.

The successful mobilization of government and non-government action to deal with the Zika virus outbreak in Tonga provides a window into a partnership-centered health promotion approach that will be key to tackling the NCDs in Tonga, and indeed across Pacific Island countries. 

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