TONGA CASE STUDY Financing of NCD prevention in LMICs: Tonga Case Study

Objective: To estimate spending on NCD prevention in Tonga and identify the enablers, challenges and dynamicsunderpinning population-level NCD prevention spending, with particular focus on tobacco use, harmful use ofalcohol, unhealthy diets and physical inactivity.Methods: Primary and secondary data collection was used to examine processes and organisational contexts thatshape the formulation of policy and financial frameworks for NCD prevention. The methodology was categorizedinto three tiers; an academic literature review, scrutiny and analysis of official policy documents and budgetary dataon health and NCDs, and in-depth stakeholder interviews with key government officials leading NCD programmes.Government and government-routed donor spending on population level prevention was gauged to estimate NCDprevention spending. Where possible, impact of prevention programmes on disease incidence and risk factors wasgauged through available outcome indicators.Results: Tonga spent an estimated T$ 3.23 million (US$ 1.41 million) on NCD population prevention in 2018-19,constituting around 5.98% of total government health spending for the year. Donor spending constitutes asignificant proportion of population-level NCD prevention spending. Enablers include increased tobacco taxes,inter-sectoral coordination, political leadership and use of the ‘settings’ approach. Challenges include rising levelsof obesity, high costs of healthy diets and allocative and technical inefficiencies in fiscal and administrative systems.Conclusion: Tonga has made considerable progress in focusing policy attention and resources on NCD preventionand risk factors, at nearly 6% of government health spending. Increased population-level NCD prevention spendingcan help address the growing NCD burden and create economic benefits.“People used to eat papaya and tropical fruits, and walk to plantations but now they have western diet and go in acar even if it is 100 meters, children throw away the traditional diet and only have burgers” – Minister of Health,TongaKeywords: Child, Noncommunicable Diseases, Tobacco, Behaviour, Automobiles, Clergy, Diet, Healthy, Fruit,Employees, Incidence, Leadership, Risk Factors Obesity, Taxes