Overseas Medical Referral: the health system challenges for Pacific Island Countries

The delivery of specialised clinical services in the small Island nations of the Pacific region is an increasing challenge in the context of a rising burden of non-communicable diseases. Resources are limited and case-loads too low to support local specialists. This article focuses on the common practice of Overseas Medical Referral (OMR), which is an increasing challenge in the region. We collected interview and secondary data across 16 Pacific Island Countries. We found that OMR policies are often weak or incomplete, systems inadequate and reforms needed. Integrating OMR fully into national health referral systems and national strategic planning and prioritisation processes is needed. There is an additional need for collection of routine data on OMR service providers in the recipient countries and the outcomes of clinical care. With these reforms, a move towards increased regional cooperation and some form of strategic purchasing is possible.