Image copyright Open Heart International
Dr Lisiate Ulufonua's key to universal health coverage in the Kingdom of Tonga
by David Gilchrist
Former Superintendent Vaiola Hospital, Nuku'alofa, Dr Lisiate Ulufonua believes that developing robust family health services is key to the Kingdom of Tonga reaching the quality standard of national health indicators that are typically associated with developed countries.
Those standards include Tonga finding improvements in areas like maternal and child health, neonatal health and chronic diseases.
However, Dr Ulufonua has long believed that improving primary health care in remote locations was essential for improving health standards within Tonga. It is a goal that Lisiate Ulufonua had long considered.
“I wanted to develop a career path for doctors who were actually working out in the remote islands in Tonga,” he said.
He said many Tongan doctors working in remote locations often devote their lives to working for remote communities despite, “not being recognise with any formal training or any rewards by the ministry of health. So, I wanted to develop the career pathway for doctors in the future.”
His dream for Tonga to meet first-world health indicator standards meant finding a way to rebalance medical training away from the Tongan hospital-centric model of health education that he believes has reduced the medical workforce in remote clinics.
His goal started to take shape in 2017.While looking for a solution, Dr Ulufonua’s colleagues in the Cook Islands talked to him about the Cook Islands’ general practitioners’ pathway through the Otago University.
Video copyright Australian College of Rural and Remote Medicine
Cairns Conference creates change
They suggested he visit the 2017, World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians, World Rural Health Conference. The WONCA conference was hosted in the North Queensland city Cairns.
During the conference Dr Ulufonua met Rocketship co-founder’s Dr Sam Jones and Dr Lachlan McIver who talked about the philosophy and approach of Rocketship. Although they had not, at that stage, helped establish the Family Medicine programme through Fiji National University, they had experience helping Vanuatu develop a medical bridging program for Cuban medical trainees which caught Dr Ulufonua's attention. He had also considered the concept of a medical bridging program.
McIver, Jones and Ulufonua considered how an agreed regional vision of “Healthy Islands” across the Pacific had expanded overseas training opportunities for Pacific island medical students has been to correct the widespread centralization and maldistribution of the medical workforce in PICs and improve health access and quality of care in rural areas by deploying the new graduates to outer-island facilities.
McIver and Jones had recognised that the return of these new graduates in several Pacific Island Countries had produced an urgent need for the development of specific postgraduate programmes providing pathways to vocational training and specialization in rural medicine appropriate to the Pacific region. Dr Ulufonua listened as McIver and Jones went on to talk about Rocketship’s work in Vanuatu.
“I wanted someone who has got some experience in the Pacific Islands, that was aware of the Pacific Islands and could actually deliver what I was looking for,” he said. The two convinced him that Rocketship, with a rural and remote emphasis, was the correct strategy for Tonga.
That conversation resulted in new postgraduate Family Medicine courses being established in Tonga. That provided training for rural and remote health family medicine as well as addressing providing a generalist training pathway.
Now a Rocketship Board Director Lisiate Ulufonua is optimistic about the potential of the Family Medicine programme saying that he believes it is a sustainable initiative that will produce “a happier workforce, and will have a healthier nation.”
He said, "Universal Health Coverage set by WHO has been adopted by Tonga as it's strategic goal where appropriate workforce is necessary to achieve it. In my opinion, Family Medicine is an attempt to train doctors that have appropriate skills and knowledge to achieve Universal Health Coverage in Tonga."
Dr Ulufonua says that programme can achieve that result, but believes it will be a generational change. Nonetheless, he looks to Tongan medical history to feel optimistic about the future. He says, historically Tonga planned the placement of medical facilities across the remote regions of the country that he believes means that even the most remote locations are no more than an hour travel time away from a healthcare. And that gives him hope that Tonga is capable of successfully implementing a plan for comprehensive primary healthcare training around Family medicine that will significantly boost the countries progress towards universal health coverage.