Tonga's Ministry of Health aims to manage diabetes rather than dialysis Featured
17 February, 2017. The Tongan government does not have the finances to provide dialysis treatment but is aiming to address rates of renal failure and kidney disease by managing rates of diabetes first.
Dialysis treatment is currently unavailable in the country despite around 200 people being diagnosed with chronic kidney failure each year, and about a third of those needing such treatment.
This week the Tonga Dialysis Foundation said it has waited for over a year for a government letter of support so private funders could release finances to open a clinic in the country.
Ministry of Health CEO Siale 'Akauola said the majority of kidney disease cases develop from diabetes.
He said the government was focussed on prevention and management of diabetes rather than dialysis.
"That's the focus, to promote good healthy living so that people do not develop diabetes in the first place and then the second one of course, if you have diabetes, then aggressively manage diabetes to a very good level you will never develop renal disease. We've had diabetics who are well managed, they live healthy lives even into their 70s and 80s."
Dr Siale 'Akauola said the government 'in principle' would support a private dialysis facility.
-RNZI
15 comments
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Sione
'Oku ou fakamalo atu ho'o tuku taimi kake vahevahe mai 'a e fakamatala mahino aupito koeni, pea oku feunga ia mo e kakai na'e ako'i. Kou faka'amu ange mai na'e kei fai 'a e appointment 'o e kau Minisita ke fokotu'u koe ia keke fetongi 'a Saia Piukala. Malo mo e 'Ofa. -
Sione Latu I salute you and thank you for sharing this very important information. I suggest that this information should be distributed to all media and let the people of Tong know about the other side of the story. Now I can see why the former government rejected the the proposal for a dialysis facility in Tonga. Malo Sione Latu
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That's is not correct Vili. We do not refer patients overseas for dialysis - civil servants or otherwise. If you see the NZ Immigration visa application form, kidney failure is an exclusion criterion. The Ministry of Health has done a feasibility study on dialysis here in Tonga. Costings for peritoneal dialysis (PD) is about NZD $35,000 p.a. and NZD $60,000 for haemodialysis (HD). There's a pool of 50-60 patients with end stage kidney failure requiring some form of renal replacement therapy of which dialysis is one option and kidney transplant is the other.
Ministry of Health gets an annual budget of $20 million to run the different health services. If you do the maths, it's about $3 million p.a. to provide PD to 50 patients. Now you tell me it's OK to spend close to 20% of your budget on just 50 people (0.05% of population) while services for the other 100,000 will obviously suffer as you only have $17 million left for them. In democracy, we talk about equitable distribution of resources. Spending an exorbitant amount of money on a very tiny group of people is not financially savvy. Interventions to benefit a bigger group of people have been proven worldwide to be more cost-effective for low income countries like ours. Interventions targeting close to 100,000 e.g. NCD interventions for obesity as close to 94% of Tongans are overweight (primary level) or strengthening management of diabetes (secondary level) for the 13,000 odd diabetics makes more sense.
Fiji does not have a government funded dialysis facility. It's run privately for obvious reasons of costs when their ministry has a budget 8 times more than ours! Treating people with kidney failure with dialysis is like trying to catch people as they fall off a cliff. It makes more sense to prevent them from falling off the cliff first which is where primary and secondary levels of interventions come into play. Diabetes is a lifestyle disease (often a conscious choice by the patient) and diabetics who develop kidney failure are patients who often do not heed advice and look after their diabetes well. Now you want us to look after them when they don't want to look after themselves. With the health budget, it comes to TOP
$200 per head. You want us to increase this amount spent per head (but only on 50 patients) by 300 times to TOP $60,000 (at current exchange rate for NZD $35,000 for PD)! We cannot compromise care for the majority (100,000) just for a small group of people (50). Other services e.g. immunisation for babies/kids can suffer if we are going to direct close to 20% of our annual budget on dialysis.
Diabetes is a priority area but kidney failure is NOT. We are not a rich country and we need to invest our energy and resources in areas/levels where we can afford those services and get the best returns for our investments! It's called triaging, we forget about those that are going to die now (medic does this when running through battlefield assessing injured soldiers) and invest in those that we can prevent from dying (those who does not have diabetes so that they do not get diabetes and manage those with diabetes well so that they do not develop kidney failure)!
Within the current financial climate, dialysis here in Tonga needs to be privately funded. That's just the reality of life with kidney failure is here in Tonga!
Malo áupito -
Ko e kidney failure kuo hoko ko e mate'anga, pea ko 'eku toki sio eni ki ha Potungaue Mo'ui, 'oku 'ikai fai ha tokanga ia kiai. Kuo ha pe aa ke mou fakamatala mai 'oku fai e ngaue kiai, kae fu'u pehe'i mai hange ia ku meimei personal. Kaikehe, ko e nanunga ia 'o e Pule'anga 'o e Kakai ko hono tamate'i pe 'o e Kakai.
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And when those in government need dialysis they go on fully funded medical referral to NZ! Forget about the poor people who need dialysis!
Good health is not always about prevention. We also need to cure the sick!