TE MARAE ORA

Ministry of Health
COOK ISLANDS

HEAD OFFICE
PO Box 109
Rarotonga
Cook Islands

Tel: 682 29 664

Fax: 682 23 109
Website: www.health.gov.ck

POLICY FOR EXPATRIATE WORKERS MEDICAL SCREENING

Policy Statement:
The intent of this policy is to protect the public from t he importation of infec tious
diseases into the Cook Islands including chronic diseases that will have a negative
impact on the resources of the Cook Islands. These diseases have the potential
to spread throughout the population and plac e a heavy burden on the countrys
resources. This policy applies to all pe rsons apply ing for or intending to apply for
entry permits to work in the Cook Islands for more than 31 days. In order to
minimize the negative impact on the resources, sponsors/e mployers w ill be
required t o execute an Agree ment with the Ministry of Health.
The Ministry of Hea lth is mandated by Part 11 (Notif iable Conditions and
Dangerous Conditions) and Sc hedule 2, of the Public Hea lth Ac t 2004 (as
amended) and by the Entry Res idence and Departure Ac t 1971 - 72 to sc reen
expatriate workers for any of t he diseases listed.
Reaso ns for the Policy:
The policy cites the Ministry of Healths miss ion of ac cessible and affordable
health care of the highest quality for all and its goal of protec ting public health
by prov iding quality health services.
A few expatriate workers arriv ing into the Cook Islands are from high-risk
countries for Tuberculosis (TB), HIV/AIDS, Hepatitis A, B, C, D, and Sexually
Transmitted Infections, notably Syphilis. This policy addresses the Ministrys
mission statement and prevents the entry of people with notifiable diseases into
the Cook Islands and allows for early identification to mitigate any consequenc es
of a person arriv ing with a notifiable disease.
Princ iples:
The Ministry s values and princ iples of Integrity, Respect, Equity, Acc ountability
and being Peo ple Foc ussed provides the bas is fo r this policy. All expatriate
workers are expec ted to have medical insurance to the sat isfaction of the
Ministry.
In the long term the Ministry may consider the lac k of medical
insurance cover, un-immunized children, severe mental diso rder and conduct
diso rder (alcohol, drug abuse, se rious sexual deviance) as legitimate reasons for
refusing entry into the Cook Islands.
Contact Information:

Policy Clarif ication

& Interpretation

Administration

Office

Te lephone

Webs ite

Direc tor of
Community Health
Services,
Ministry of Health,
Cook Islands
Administration
officer,

(682) 29110

www.health.gov.ck

(682) 29110

www.health.gov.ck

Community Health
Services
Direc torate,
Ministry of Health,
Cook Islands

Res ponsibility:

Res ponsible Party:

Res ponsibilities:

Applicant / Sponsor /
Employe r

1. Submit t he c ompleted Medical and Chest X-ray

(IMM18) form to Administration officer;
2. Original doc umentation only w ill be acc epted
(Medical and Chest X-ray (IMM) form, pass port
photos, laboratory, X-ray and relevant reports);
3. Ensure the t op of each page is signed by the
examining Doc tor; and that all sections of t he form
are c ompleted;
4. Incomplete forms or miss ing reports will be returned
for re-submiss ion;
5. Pay the necessary fees;
6. Provide proof of Medical Insurance to the
sat isfaction of the Ministry of Health.
7. In t he absenc e of medical insurance execute the
Agree ment for the pay ment of any and all hospital
fees for t he applicant / employee;
8. On the renewal of the annual work pe rmit with the
Depart ment of Immig ration the applicant is to
complete another medical check.

Medical Examine rs
Overseas

1. Provide Medical Registration number and plac e of

employ ment t o acc ompany medical form;
2. Complete all areas of t he medical form, sign the
top-right hand c orner of eac h page;
3. Provide a signed c hest X-ray report and laboratory
report;
4. All applicants aged 16 years and over are test ed for
HIV, Hepatitis B, Syp hilis and Mantoux;
5. Applicants under the age of 16 years must provide
an Immunization sc hedule with the Medical form;
6. Hand over t he c ompleted form a nd reports to the
applicant;
7. Provide further info rmation as required by t he
Medical referee.

Cook Islands registered

Medical Doc tors
including registered
Privat e Practitioners (in
country)

Administration officer

1. Rec eives and date-stamps applications rec eived

from t he applicant / sponsor / employe r;
2. Register the applicants in a log-book indicating
name, c ontact number of applicant / sponsor /
employe r, and date of rec eipt of application;
3. Collec t and receipt fees received;
4. Loc k money in a safe plac e;
5. At end of each business week, rec oncile and de posit
money with Finance division e nsuring rec eipt book is
signed by rec eiving Finance officer;
6. Verif ies Medical Examine rs registration prior t o
submiss ion of forms to Medical referee;
7. Rec eive checked forms from Medical referee;
8. If approve d by Medical refe ree, contact applicant /

sponso r / employer to collec t signed approva l letter

for Depart ment of Immig ration;
9. Check rec eipt of medical insurance policy and that it
meets the requirements for c over of the employee
while living in the Cook Islands. If there is no
medical insurance policy, the Deed of Agree ment is
executed;
10. Ensure sponso r / e mployer e xec utes Deed of
Agree ment for the pay ment of any and all hospital
fees for t he applicant / employee.
11. If not approved by Medical referee, c ontact
applicant / sponsor / employe r and request
info rmation required;
12. Ensure proper file management of all application
forms to assist with retrieval fo r possible
investigation if and when required.

Medical Referee
(Direc tor of Community
Hea lth Services or
appointed nominee)

1. Thoroughly reviews all applications acc ording to fees

paid:
$300 immediate;
$150 within 5 working days
$100 within 10 working days
$50 for eac h c hild of applicants under the age of
16 years
2. Due diligence must be applied to eac h medical
report.
3. Pay close attention to questions on infec tious and
chronic diseases, mental diso rders that may plac e a
burden on health serv ices and resources;
4. Rev iew laboratory, X-ray and spec ific HIV, Mantoux
and Consultant reports;
5. Request additional supporting info rmation as
required;
6. Approve application submitted;
7. Approval letter is provided t o the sponsor/employe r
for submiss ion to the Depart ment of Immigration;
8. If applications are to be dec lined a letter is
forwarded to applicant /sponsor/employe r t hat the
applicant failed to meet expec ted standards for
medical clearance;
9. Make time for personal or telephone inquiries to
applicant / sponsor / employe r and raise any iss ues
of concern;
10. Reject fraudulent applications outright (there is no
rec ourse for rec hecks).

Notifia ble a nd Chronic Diseases

Disease

Tuberculos is (TB)

Expected Results

1. Negative, reac tion < 5mm. PPD o r T uberculin o r

Mantoux t est .
2. Clear radiological (c hest xray) report.
3. For suspicious lesions or dormant t ubercles, an
electronic image is sent t o the WHO Tb consultant,
Australia, for a sec ond opinion.
4. The applicant may be required to supply the image.
NB. PP D t est is positive 6wks post-infection. It does not
info rm between active and dormant t b.

HIV (Huma n
immunodefic iency
Virus)

1. Non reac tive t o bot h HIV-1 and HIV-2.

NB. Most if not, all t est s detect the presence of antibodies
NOT antigens. Beware of t he window period*
Type 1 (USA) T ype 2 (West Africa)

Hepatitis B virus

1. Negative for Hepatitis B s urface antigen (HBsAg)

NB. Prese nce indicates active infection. Persistently high
levels is c onsidered a carrie r.
2. Presence of Hepatitis B surface antibody (HBsAb) signify
the end of acute phase or immunity.

Syphilis
Treponema
pallidum (a
spirochete)

1. Negative o r Non reac tive.

VDRL o r Wassermans test detects antibodies.
RPR more sens itive. Both are non-trepone mal spec ific t hus
have high false positive. V DRL is pos itive 2 wks aft er
inoculation.
2. T PHA test are performed in other c ountries.

Denotes the period between Inoc ulation and det ec tion of antibodies usually 12 weeks or more. T est s done during the window pe riod may
need to be repeated after 2-3 months, if there is strong sus picion of
infec tion.
In some cases Hepatitis B antigen may be negative for up to 3 months
follow ing exposure. Repeat t est if indicated.
Antibodies to Hepatitis C is detect able 8 weeks post exposure, however,
sero-conversion may take up to 6 months. Repeat t est if indicated.

AGREEMENT
THIS AGREEMENT is ma de on the

day of

20

BETWEEN:
Her Majesty the Queen in right of the Government of the Cook Islands by and
through the Minister of Health (the Ministry)
AND
(Name)
Island Addresses)

of

(Foreign

and

Cook

(the Sponsor/Employer)
WHEREAS:
A. The Sponsor/Employer w ishes to sponso r/employ an expatriate worker to
enter the Coo k Islands to work and res ide under a n entry permit status to
be issued by the Ministry of Foreign Affairs and Immigration.
B. The expatriate worker and that persons fa mily as appropriate does not
and will not have health or medical insurance during the time that person
is res ident in the Coo k Islands
IT IS AGREED AS FOLLOWS:
1. The Sponsor/Employe r must pay to or reimburse to the Ministry all
charges and fees inc urred fo r any medical, hospital or other health
services including any international referral fo r further care services
prov ided t o:
a. the expatriate worker during the t ime t hat t he expatriate worker is
resident in Cook Islands; and
b. any member of the expatriate workers fa mily during the time that
the members of the expatriate workers fa mily are resident in the
Cook Islands
2. For the purposes of this Agree ment, an expatriate worker is dee med to
reside in Cook Islands for the entire duration of the permit granted to the
worker, w hether or not the worker is ac tually prese nt in Cook Islands
during that period.
3. The sponsor/employe rs obligations under this agreement continues
despite the termination of the workers permit and the departure of the
worker from the Cook Islands until all charges or fees owing have been
paid.

Dated at Rarotonga this.day of.201

SIGNED

..
For the Secretary of Health

In t he presence of:

SIGNED,

..
Sponsor/Employe r

In t he presence of:

..