Please write a XXXXXXXXXXword executive summary touching on each building block of the assignment attached. Basically our group assignment consists of 6 building blocks which are provided. You will...

1. Executive Summary
The following assignment deals with the Cook Island health system, which has been cu
ently challenged by many healthcare issues like epidemics, natural disaster and infectious diseases. The necessary change was needed to address the issue, these changes has been introduced in governance, health delivery services, health workforce, health information system, health financing, and medicine, vaccine and technology.
Governance deals with the plan laid to handle the situation of the island. In year 2007, government of the Cook Island has laid down the national sustainable development plan (NSDP), which aims to improve the healthcare system of the island along with the active governance and organisations, which play crucial role in the healthcare system. In the past ten years, government work hard to fulfil the goals set in the NSDP. Necessary policy changes had been conducted to ensure that demand of the workforce is meet and medicines have been secured. There are certain indicators used to measure the efficiency of the governmental policies, which include household expenditure survey and census.
Health workforce deals with the issues faced by the health workers of the island. One of the major issues faced by them is shortage of resources, fragile environment, shortage of skilled force and remote location. There has been pattern of massive migration of workforce observed on the island. The unequal distribution of the workforce becomes the added problem for the islanders. The island faced many challenges in keeping the workforce on the island. Its remote location and fragile environment make it least favourite place for the people to work in the area.
Health information system (HIS) reviewed the cu
ent status of the system and the challenged face in including the good system. As per the WHO, health information system ensures production, analysis, dissemination and allows the reliable and timely information about the healthcare determinants. Island HIS is an existing collection of the statistics managed by the ministry of health. There is no formal policy on the HIS, although other subsidiary
anches also supported the ministry of health. The island health information system scored 15 out of 30 on health information system performance index. Poor performance of the HIS is a result of the financial and human resources constrain. Poor infrastructure, lack of awareness and lack of skilled person to handle the system are the main problem identified.
Health financing covers the spending on the healthcare by islanders. Cook Island is the upper middle-class country, which spend around 3.4% of its gross domestic product on healthcare services. Islanders are willing to spend 5-6% of GDP to achieve the universal health coverage and minimal financial catastrophe. It has been suggested that proper future planning of finance is needs to be done, so that healthcare system can be make financially done.
Under medicine, vaccine and technology, the provision to provide the patent for the manufacturing of medicine and its distribution is explained. Cu
ently, Cook Island lacks the medicine manufactures. All its medicines are imported from Australia and New Zealand. Country lacks the legal provision to control the distribution of the medicine in the market. The public procurement policy is available to ensure the quality of medicine. There has been mandatory training for the pharmacists in the Island.
2. GOVERNANCE, STEWARDSHIP
Leadership and Governance: Cook Island
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Cook Island uses a national health care system. Health Care is governed by their Ministry of Health, Te Marae Ora (TMO).  
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The Ministry of Health is divided into 3 directorates: Community Health Services, Hospital Health Services, Funding and Planning.

Introduction
In 2007 the Government of Cook Islands National began their National Sustainable Development plan (NSDP) for 2007-2020. This plan listed goals and strategies framed for the islands’ present and future challenges in national sustainability. It also addressed the need for improving the accountability of the government and the interconnectedness with communities. The NSDP provided the framework to improve the government operated national healthcare system. Over the last 10 years Cook Islands government have made large efforts to improve on several aspects of their healthcare according to their goals listed in their NSDP. Cook Islands have taken on policy changes to ensure that essential medicines were extensively secured, opened nursing school to meet the demands of the workforce,
The Te Marae Ora Ministry of Health (TMO), the government
anch in charge of the national health care and water sanitation for Cook Islands, (CK IsD website) developed a 2012-2016 National Health Strategy. This strategy focused on cu
ent problems: amount of government spending, the need for larger health care workforce and for health information system, a platform and budget for public health surveillance, and research budget.
From objectives of the National Health Strategy, the TMO gathered stakeholders, local organizations, religious groups, non-government organizations including WHO, created the Clinical Health Workforce Plan 2015-2020. This plan addressed the nation’s overall issues: the rise of non-communicable diseases on the islands, sustainable healthcare and workforce retention for the outer islands. Their workforce plan also proposed strategies to keep healthcare cost within the constraints of the country’s budget (ClN WFP 2015-2020).
 
Rules-based/Outcome-based indicators for Measuring Health System
Governance Determinants
The Ministry of Health strategize with Ministry of Finance and Economic Management, the Ministry of Education to find more effective ways to extract information on the country. In the Household Expenditure Survey of 2005-2006, questions on education and health expenditure were added to the survey. The Ministries found opportunities to ascertain the
oader needs the citizens through the questions in the country’s census. Future census now accounts for specific areas of social surveillance including: health of the household, labour and income, workforce, education, water quality. This opportunity in the led to better constructed questions, sampling methods, data gathering and information management in later census surveillance (Cook Island Population Census 2006). These changes guided Cook Islands government towards effective goals, indicators and strategies to drive decisions that help establish laws and policies. Furthermore, these changes drove the need for the fluidity of the questions in future census surveying as needs change over time.
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Dissemination of this data gave insight for the need for several different databases to track the workforce entry/exit, facilities management, labour productivity and earnings, Database management????

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The frequency of the census is often enough to have a good picture of the Health/workforce of the Country and idea of Country’s budget???


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All of which lead to the goals set for the Country and the strategies need to obtain those goals and indicators by which to measure those goals for further improvement.

Core Indicators
Recently, in 2015-16 the Ministry of Finance for Cook Islands conducted the second Household Income Expenditure Survey in the planning of the Clinical Health Workforce Plan 2015-2020.
 
Recommendations:
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Stability in the Country’s budget for surveillance and data management
3 *HEALTH SERVICE DELIVERY (disclosed still numbered) *
4 HEALTH WORKFORCE
Health Workforce of Cook Islands
 
Shortages
Cook Islands’ development is challenged by its na
ow economic base, limited natural resources, fragile environment, shortage of skilled labour and relatively remote location (DFAT, 2019). The shortage of skilled workforce is due to either the internal or international migration pattern (emigration and immigration) of health workforce. Emigration of Pacific Island SHWs (Skilled Health Workforces) occurs at all occupational levels, and especially among those with postgraduate and specialist qualifications (Doyle & Roberts, 2013). Cook Islands is one of the Pacific Islands countries which experienced a loss of health workforces. They are enhanced to leave Cook Islands and migrate to NZ (New Zealand) easily because of the strong cultural tradition to move to NZ and also as a result of dual citizenship.
It has been reported recently that the migration of SHWs from the selected PICs (Pacific Island Countries) is not well documented and that there are cu
ently no formal processes in place specifically designed to collect migration and mobility data (Doyle et al. 2012). In Cook Islands, the availability of migration data is partially recorded (see appendix …). Information and procedures regarding training overseas (pre-service, post-basic or postgraduate) for individuals, health practitioners, and other health workers are gained through the Human Resource Division, The Ministry of Health of Cook Islands, while there is no data for national emigration policy.
Internal migration, including the movement of SHWs from rural to u
an centres, has been described as ‘ubiquitous’ throughout countries within the Asia Pacific region [Connell 2010 p. 15].  The rural and remote areas are the critical challenge to affect the health systems being firmly performed. The health workforces are facing working difficulties, feeling being isolated and uncomfortable living conditions. That factors hamper the retention of staff in outlying areas. Another form of internal migration is the movement of SHWs from the public to private sector. The Cook Islands has a pool of private health practitioners consisting of 3 medical practitioners, 1 dentist and 1 pharmacist [Cook Islands MoH n.d.b]), flows of health workers to the private sector have been in evidence. Gallina in 2010 mentioned that the Human Mobility Report also notes that education and training often became the reason of migrating health workforces, with sizable flows from a number of PICs (Pacific Island Countries) including Cook Islands, Samoa, Solomon Islands and Vanuatu to the University of the South Pacific.
Distribution?
Compared to the Western Pacific region with 14.5 doctors per 10,000 population, Cook Islands is considered a country with a low density of health workforces which only had 12 doctors per 10,000 population over 2000 to 2010. Highly dispersed population becomes the challenge for the distribution of the health workforces.
 
Rarotonga is the island with the densest population where majority of the health workforce is concentrated (78%). In the same time, Aitukaki with only 9% of the total workforce is maintaining a small workforce together with other islands focusing on health protection and dental services. A small pool of medical officers are allocated in the outer islands to lead health services (nurse practitioners and registered nurses).
 
Disparities between the Main Island and outer islands in relation to access to healthcare reflect differences in the health workforce. During recent years, the Ministry of Health has concentrated on providing sufficient general practitioners to provide health services in the outer islands. Whilst four islands (Pukapuka, Penrhyn, Mitioro and Rakahanga) have health officers they do not have a resident doctor.
 
As of September 2012, Cook Islands has approximately 294 medical staff distributed throughout the population. Nurses, much like many other Pacific nations, are the largest workforce within...