Before the Department of Health was split into the Ministry of Health and the National Health Service, Public Health was in every way, the poor cousin of Clinical Health. The Health Sector merge currently underway threatens to push Public Health right back down the priority list, to a point that can cost Samoa hundreds if not thousands of preventable deaths.

Just before the split in 2007, Public Health Physicians were continuously hassled to work up at the hospital as if community surveillance and controlling the spread of dengue, typhoid, meningitis and TB were less important than treating individual patients.

The Environmental Health Officers were also not entitled to any overtime for the 24 hour service of clearing of ports and attending to disease outbreaks, with some accumulating up to almost 6 months leave with pay. Most had not received any up-skilling in the form of training or attachments, and graduates had lost interest and moved on to other areas of work.

Community Nurses were not able to align their work with these professions for these reasons, and to top it off, management meetings would be so overwhelmed with the massive issues faced by the hospitals,  that several hours later, everyone was exhausted, and Public Health issues would just fell off the agenda.

People’s attitudes towards Clinical Health versus Public Health is a bit like Global Warming.

The richer countries know what to do, but choose to wait, then provide heroic rescue efforts after floods and hurricanes, enjoying the political popularity that comes with it. In comparison governments tend to invest heavily and spend more time with Clinical Health because of course saving a life is always the more popular measure.

Forget about all the public health efforts to help ensure you don’t end up in hospital in the first place! (i.e food and water safety, sanitation, vector, community surveillance and disease control, port health, healthy nutritional services, Health Promotion awareness and prevention programmes).

And forget also about how much the Health Budget can be decreased dramatically if it was invested more so in prevention! The trick seems to be, allow them to get sick, spend lots of money to treat them, and then make them feel thankful and guilty for being so unhealthy.

We are dealing with an NDC epidemic, and when dealing with an epidemic, we are talking about a Public Health Issue. Addressing a Public Health Issue as if it were a Clinical problem will be disastrous for our communities.

Sadly this is about to be our imminent reality. To judge whether or not health services are doing well purely on hospital clinical performance is comparable to calling men out only for beating or raping their women, but not for the underpinning sexist values that makes men feel it is ok to trivialise female abuse in the very first instance. The cause and spread of the illness remains, and it will only be a matter of time before the beatings and rapes continue.

Public Health Accounts Reports over the years tell us that we’ve never truly invested enough in Public health, where attention is most needed.  And just like how we’ve ignored key priorities like the Health Information system that would accurately tell us what’s really going on in terms of disease patterns and forecasts, we’ve short changed ourselves to believe we are destined to becoming sick anyway, and have instead invested in kidney foundations and diabetes centres, which in reality will become more of an economic burden as more people become affected continue to grow exponentially.

It is frustrating that after 10 years a re-merge has been forced upon the health sector without a proper independent review.

One can only surmise that running alongside the ongoing health sector reform, is the real engine currently responsible for change; that of  professional agendas, personality clashes, and cluelessness as to what is actually going on or needs to be done.


Andrew Peteru

Andrew’s educational background includes sociology and health social science. He has worked with the Ministry of Health for over 10 years in the health promotion and preventive health divisions. He has also worked in the Pacific Region with civil society technical organisations, and the United Nations in the areas of community development, health, and education. Like the best of us, he has an opinion for almost everything. He believes though that ending them on a positive note, is important. Andrew currently resides in Auckland.


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