Tonga

Tonga does not publish dementia-specific clinical guidelines. In practice, clinicians commonly use brief cognitive screening tools such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) during clinic visits. Formal neuropsychological testing and dedicated memory clinics are not available in the country. NGOs such as Huelo Alzheimer’s Tonga may also use simple screening questions during community outreach to help identify people who may need medical evaluation.

Tonga has one CT scanner at Vaiola Hospital in Nukuʻalofa, introduced in 2012. MRI and PET scans are not available in the country, and patients who need these tests must be referred overseas, usually to Fiji, New Zealand, or Australia.

Genetic testing for Alzheimer’s disease (such as APOE, PSEN1/2, or APP testing) is not available in Tonga. Families seeking these tests must arrange private testing overseas, most commonly in Australia, New Zealand, or the United States.

Alzheimer’s disease biomarker testing, including CSF markers (Aβ42, tau, p-tau) and blood-based biomarkers, is not available in Tonga.

Tonga does not have a formal network of memory clinics or dedicated dementia units. Instead, virtually all specialist dementia-related services are concentrated in Vaiola Hospital in Nukuʻalofa, the country’s main referral center, where clinicians manage cognitive assessment, symptomatic treatment, and follow-up. Larger hospitals on Vavaʻu and Haʻapai also provide basic follow-up care but lack specialized geriatric or neurology services. While formal dementia services are limited, Huelo Alzheimer’s Tonga plays a critical role by offering caregiver education, community memory clinics, screening events, and referral support, helping families navigate a fragmented pathway.

Palliative care remains in early development and is primarily hospital-based as most of the clinical care is handled by Vaiola Hospital and a few private clinics. As reports indicate, Tonga has no dementia-appropriate psychiatric facility, no respite services, and only a single five-bed rest home run by a charity. In the absence of dedicated long-term care (LTC) legislation, older adults are vulnerable to abuse and neglect, and the lack of accredited training or a national quality-assurance system means that care standards cannot be consistently monitored or enforced. To improve its capacities, Tonga participates in several regional hospice training partnerships, especially through bilateral programs with New Zealand and initiatives supported by Pacific Health Fund of St. Vincent Hospital in Melbourne, Australia. At the same time, international NGOs, such as New Zealand-based Pasifika Medical Association (PMA) also provide support in strengthening Tonga’s health system.

The Tongan Ministry of Health provides free public health services at government facilities, including symptomatic dementia medications when in stock, outpatient consultations, and inpatient care. However, families often face indirect and non-medical costs, especially on outer islands. These include inter-island travel, boat or flight expenses, accommodation near Vaiola Hospital, and costs for accompanying relatives. When medicines are out of stock or families prefer faster access, purchasing symptomatic drugs through private pharmacies can shift expenses to households. A consultation at a private facility can cost between approximately 4.22 and 12.50 USD, with higher fees for advanced care. Moreover, referrals overseas for MRI or advanced diagnostics may also generate additional financial burden and require external funding pathways.

Tonga lacks direct state cash benefit specifically for dementia caregivers. The social protection system instead offers a universal pension for people aged 70+ and a disability benefit, which some families can access depending on functional impairment rules. In practice, most dementia-specific support is delivered by charities and NGOs that run support groups, caregiver skills workshops, awareness campaigns, helpline-style social media guidance, and community-based check-ins. These programs aim to improve home-based care capacities in a setting where formal long-term care services do not exist. Additional general caregiving support may occur informally through extended families, churches, and community groups, which is a common tradition in the Pacific Island societies. For example, a local charity, Ma’a Fafine mo e Famili, operates the country’s only national home-care program, reaching roughly 200 clients, while the Church of Nazarene’s Mango Tree Centre offers modest weekly rehabilitation.
To improve caregiver support the government started spending one 1.6 million USD per year on the Social Welfare Scheme for the Elderly in the 2010s. So far, it has implemented two distinct home-based care initiatives aimed at supporting vulnerable older people and persons with disabilities. The first, the Tonga Social Service Pilot, introduced under the Tonga Strategic Development Framework (TSDF) in 2017 provided structured home-care services to 150 high-needs clients in Tongatapu and Ha‘apai. Delivered by Ma‘a Fafine mo e Famili, the pilot included personal care, basic health assistance, household support, and regular check-ins to address isolation and safety concerns, demonstrating the feasibility of community-based care in a dispersed island setting. Additionally, the government established a National Aged Care Program, designed to offer ongoing home-based support to up to 200 individuals identified as having the highest care needs among an estimated 800–1,000 older adults and persons with disabilities nationwide. This program, also implemented by Ma‘a Fafine mo e Famili, similarly operates in Tongatapu and Ha‘apai and provides assistance with daily living, mobility, and caregiver guidance. Although independent of one another, these two initiatives together represent Tonga’s only structured long-term care services, highlighting both progress in reaching the most vulnerable and the substantial unmet need that remains across remote islands.

Tonga does not have a stand-alone national dementia plan, and dementia remains largely invisible in national health policy. Instead, dementia-relevant actions appear indirectly within broader frameworks, most notably the National Strategy for Prevention and Control of Non-Communicable Diseases (NCDs) 2021–2025, which emphasizes chronic-disease management, healthy ageing, and primary-care strengthening, but does not define dementia pathways or targets. Broader ageing policy scaffolding exists through the Tonga Strategic Development Framework (TSDF) 2015–2025, whose Organisational Outcome 2.7 commits the government to “better care and support for vulnerable people, ensuring the elderly, the young, disabled, and others with particular needs continue to be supported and protected despite shrinking extended families”. This framework, along with the Universal Health Policy providing free health and dental care for all older people, establishes a general rights-based environment but lacks dementia-specific policy instruments, clinical protocols, or a coordinated national plan.

While no dementia-focused strategy has been announced, several system-development processes may indirectly benefit dementia services. Current government priorities include health-system strengthening, digital health rollout (National Health Information System), and NCD service expansion supported by partners such as UNOPS and the World Bank. These investments are expected to improve referrals, data management, and continuity of care. The redevelopment of the Prince Wellington Ngu Hospital in Vava’u, Tonga, is a key component of the government’s Health Enhancement and Resilience in Tonga (HEART) project funded by World Bank and UNOPS. Its overarching goals are to combat NCDS and improve access to resilient health services, especially for remote populations in Tonga’s northern islands. The project will help dementia patients by improving overall healthcare infrastructure, strengthening primary care, and enhancing the health system’s ability to manage NCDs, which includes risk factors related to cognitive decline. However, none of these emerging policy areas currently address dementia explicitly, but they form a potential foundation for future integration.

Given the absence of dementia-specific technologies or local neurology research, Tonga’s primary innovations occur at the health-system level rather than at the disease level. The most significant developments include the rollout of a National Health Information System (NHIS) and broader e-government health projects, which aim to integrate patient data, strengthen referral tracking, and improve continuity of care across Tonga’s multi-island geography.