Given the French territory's struggle to provide adequate healthcare to all, Agence Française de Développement has stepped in to help.
Of New Caledonia’s population of 28,000, some patients have had to find care in neighboring Australia. For certain serious diseases, others make the long trip to mainland France.
“The rise in the number of chronic illnesses, which is partly related to an ageing population, is resulting in a permanent increase in healthcare needs, says Camille Perreand, Health and Social Protection project manager at AFD. “This has prompted us to reflect on the healthcare we need to provide to meet these needs.”
In addition, old, dilapidated and limited equipment, combined with a dispersion of facilities over several sites, jeopardized the safety of some procedures, especially for maternal and newborn care.
Sharp territorial inequalities
These deficiencies have been exacerbated by territorial inequalities in access to healthcare. Disparities continue to exist on the island between the capital Nouméa in the south – the hub of administration and economic activity, where the vast majority of doctors are to be found – and the isolated north and remote islands.
The northern province relies on two hospitals, in the municipality of Poindimié and in Koumac. However, they are both difficult to access and have a much more limited range of healthcare services than in Nouméa. Most residents prefer to go to the hospitals in the capital, despite the distance.
This situation has given rise to an uneven quality of healthcare for New Caledonians. To address these issues, AFD has supported several structural projects that aim to transform the hospital landscape.
- New referral hospital on the outskirts of Nouméa
A new hospital in the capital, which includes a radiotherapy and cancer center, opened its doors in December 2016. With a capacity of more than 560 beds, the goal is to provide new services and improve existing care.
It offers new specialized medical units (such as the geriatric acute care unit) and can accommodate teams from mainland France for on-the-spot operations.
“This new technical platform groups together activities that used to be dispersed and improves the quality of medical care”, says Camille Perreand.
Resources are concentrated, making logistics easier, with the hospital specialized in mental health and geriatrics.
• Flagship operation: Koné Hospital in the North
To balance healthcare provision between the North and South, the authorities also wanted to equip the municipality of Koné, the administrative capital and gateway city of the Northern province, with a hospital delivering obstetric and medical-surgical activities.
The objective is for residents to benefit from appropriate treatment for certain diseases on site, without having to travel to Nouméa. AFD has contributed to financing this new hospital, which opened its doors in late 2018 and has a capacity of 63 beds.
Medical, surgical and obstetric activities at the Koumac and Poindimié hospital sites have been grouped together at Koné hospital. These two existing healthcare facilities have been converted into downstream hospitals, providing follow-up care and rehabilitation, as well as a few activities that do not require a sophisticated technical platform.
The Koné and Nouméa hospitals are also contributing to an integrated medical project, in particular in obstetrics: “There are rotating teams in this branch of medicine, which means that know-how can be pooled and it ensures that there is the same quality of healthcare throughout the territory”, explains Camille Perreand.
- Rethinking private healthcare
In New Caledonia, as in mainland France, a large proportion of the population relies on private healthcare. Indeed, the private sector carries out a significant number of surgical procedures. It also has specialties that are not found in hospitals, especially in urology. This is why AFD has also supported the merger of three existing private clinics into a single facility with 210 beds, which has been rebuilt near downtown Nouméa. This contributes to providing a multidisciplinary hospital complex with modern on-site facilities tailored to needs.
What are the future challenges?
- Structuring the medical-social sector
While this reorganization has completely upgraded healthcare and rebalanced provision in New Caledonia, there are still many challenges, especially in the sectors of disability and dependence: “At this time, care for the elderly still needs to be improved”, confirms Camille Perreand. “In the medium term, setting up new facilities and services and integrated care for the elderly is a real challenge. Otherwise, this lack of healthcare provision will, as in mainland France, fall back on hospitals with the risk of elderly patients overwhelming emergency departments and services.”
AFD got involved in improving care for the elderly when it financed the construction of a long-term care facility (EHPAD) in Nouméa, in partnership with SEM Agglo and Mutuelle du Bien Vieillir. It has also contributed to a study that aims to conduct a diagnostic of the care pathway of the elderly in New Caledonia, combined with recommendations on how to improve care for the over 60s in the territory.
The disability sector is currently only covered by charities and associations, which have traditionally been formed around disabled people’s families. There is still a lack of facilities, despite years of attempts to re-structure and professionalize the sector.
Here too, AFD is helping to improve the sector, as Camille Perreand explains: “AFD is providing financial support for the construction of a specialized nursing home north of Nouméa for people suffering from serious mental disorders. We are also appraising financing for the New Caledonian Association for the Disabled to support the upgrading of a daycare center for children with severe disabilities.”
- Sustainability of health expenditure
The sustainability of healthcare expenditure is another challenge. “Total medical consumption has increased by over 20% in the last five years,” says Ambre Eono, who is responsible for the health sector at AFD in New Caledonia.
“Major investments in the hospital sector, combined with the development of healthcare provision in the medical-social sector, where necessary, continue to be the main determinants of a structural increase in health expenditure.”
Such expenditures may be difficult to sustain, despite plans to control health expenditure. This is why AFD has decided to assist local public authorities with the application of the Do Kamo Health Plan, which aims to revise its economic model, build a new governance system and improve its efficiency, by combining healthcare provision with enhanced prevention services.