health report 1997-99-solomon islands

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Ministry of Health National Health Report Review Evaluation of Health Status 1997 -99 ==============================================================

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Ministry of HealthSolomon Islands

NATIONAL HEALTH REPORT

1997-99

EVALUATION OF THE HEALTHSTATUS

March 2000



Ministry of Health National Health Report Review

Evaluation of Health Status 1997-99

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TABLE OF CONTENTS

Message From 3

The Minister of Health3

i. INTRODUCTION 3

SECTION I: GENERAL INFORMATION 3

1.1. Land (geography of provinces/ SI) 3

1.2. The demography (Population): 3

1.2.1. Size & Growth: 3

1.2.2. Age-group Composition: 3

1.2.3. Population density: 3

1.3. The Economy: 3

1.4. The Health Status by provinces and National: 3

SECTION II: INTERNAL REVIEW REPORT 32.1. REGIONAL (PROVINCIAL) SERVICE DISTRIBUTION; 32.1.1. Type of Services; 3Table (1) : The Health Care Referral System 32.1.2. DISTRIBUTION OF SERVICES: 3Graph (1) showing distribution of health facilities by provinces: 3Table (2) showing Health Clinics:Population* and Nurse: Population** Ratio: 32.2. INTERNAL STRUCTURAL AND MANAGEMENT ISSUES: 32.2.1. Organizational Structure: 3Figure 1 showing the existing organization’s structure: Ministry of Health: Nationaland Provincial level: 32.2.2. Centralization Vs Decentralization (Vertical versus Horizontal programs): 32.2.3. Activities (Inputs): 32.2.4. Findings (outputs): 3

2.3. HEALTH FINANCING & BUDGETING AND R ESOURCE ALLOCATION

F ACTORS: 3

Table (3) Total government budget and the allocations from 1988 to 1999: 3Table (4) Distribution of the Recurrent Health Budget 1991-1999 (SBD$’000) 3Table (5) showing selected health accounts indicators for selected countries in thepacific region; estimates for 1997: 32.4. Management and Supervision: 3

2.5. S TATUS OF HEALTH C ARE SERVICES DELIVERY : 3

2.6. DISTRIBUTION OF HEALTH C ARE W ORKFORCE; 3

2.6.1. SHORTAGE AND MANAGEMENT OF HEALTH WORKFORCE: 3Table (6) Shows the Gap Between Requirement Projection and Supply Projection onthe Medical Profession (Doctors): 3

SECTION III: HEALTH SERVICE PLANNING,MANAGEMENT AND SUPERVISION: 3

3.1. M ANAGEMENT & ADMINISTRATION: 3

3.1.1. Activities (Input) & Output: 3





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Table (7) below shows matrix of strategies implemented since 1997. 33.1.2. Analysis: 33.1.3. Output & Key Issues: 3

3.2. How Well Do the Solomon Islands Health System Performs? 33.2.1. Overall Level of Health: 3

Table (8) showing Basic Indicators for selected countries in the pacific region: 3Table (9) showing health attainment, level and distribution in selected countries in thepacific region; estimates 1997-99: 33.2.2. The distribution of health in the population: 33.2.3. Responsiveness of the health system: 33.2.4. Performance on health level (DALE) and Overall Performances: 3Table (10) shows ranking of selected countries in the pacific region on theirperformances on health level, and the overall performance: 3

3.3. Health Information System: 3

SECTION IV: ACCESSIBILITY AND QUALITY OFHEALTH SERVICES 3

4.1. Health Care (Curative) Services: 34.1.2. Activities (Input) 34.1.3. Outputs: 3Graph (2) showing Ratio of Registered Nurses, Nurse Aides and Total Nurses toPopulation in 1997-1999: 34.1.4. Primary Health Care- Health Facility: Population 3Table (11) showing Health Clinics:Population* and Nurse: Population** Ratio in1997-1999: 3Graph (3) showing ratio of population to a health facilities in the provinces: 34.2. PRIMARY HEALTH CARE (CLINICS): WORK LOAD. 3Table (12) PHC (A): Outpatient Visits by Type of Facility, 1997,1998,1999: 3

4.2.1. OPD visits per Facility: 3Bar Graph (4) showing workload at Area Health Centers, Rural Health Clinics andNurse Aid Posts 3Table(13) showing workload at Area Health Centres, Clinics and NurseAide Posts byprovinces 1997-99 34.2.2. OPD visit per person per year by provinces: 3Graph (5) showing average OPD visits per person per year: 3Table (14) Shows Average OPD Visit Per Person per day and year, by provinces,across all facilities: 3Table (15) Breakdown of Beds By Hospital (Government Owned Only) by end of 1999 3Table (16) Breakdown of Beds by Hospitals (Church Owned Only): 3

Table (17) Shows number of available beds to be filled per 1,000 population in theregion; 3Table (18) Shows the Flow of Patients in and Out of the Provincial Hospitals(including private centers): 3Graph (6) showing flow of patients in and out of the provincial hospitals: 34.3. Secondary Health Care: Hospital Utilization: 3Table (19) shows the Hospital Utilization Rates (number of admissions per 1,000population) 3Table (20) shows Hospital Utilization in the National Referral Hospital 3





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Graph (5) showing hospital utilization of National Referral Hospital 1997-1999 34.3.2. Bed Occupancy and Average Length of Stay: 3Graph (7) showing total admissions by provinces & NRH: 3Graph (8) showing bed occupancy rates (all beds) by provinces & NRH: 3Graph (9) showing trend of Average Lengths of Stay in provinces & NRH: 3

4.4. Pediatrics (Child Health) Services: 34.4.1. Findings & Outputs: 3Table (21) shows Hospital Utilization Rates in Paediatrics (Child health care servicesfor <4yrsin the provinces): 3Graph (10) showing trend of utilization of hospital utilization in pediatrics in theprovinces 3Graph (11) showing trend of bed occupancy rates in pediatrics by provinces & NRH:3Graph (12) showing trend of ALOS in pediatrics by provinces & NRH 34.5. OBSTETRICS & G YNAECOLOGY SERVICES: 3Table (22) shows Hospital Utilization in Maternity (maternal care services) in theprovinces: 3Graph (13) showing trend of hospital utilization in maternal care services in the

provinces: 3Graph (14) showing trend of Bed Occupancy Rate in Maternal Care by provinces &NRH: 3Graph (15) showing trend of ALOS in Maternal Care by provinces & NRH: 3Graph (16) showing trend of ALOS in Maternal Care by provinces & NRH: 3

4.6. Access to Essential Drugs: 3

4.7. Health Infrastructure development: 3

Tabel (23) : Level of Health infrastructure: 3

SECTION V: HEALTH IMPROVEMENT SERVICES: 3

5.1. THE HEALTHY ISLANDS, HEALTH CITY , INITIATIVES 35.2. Morbidity and Mortality Reduction: 3

5.2.1. Overview: 3Graph (17) showing diseases trend in SI from 1997-1999. 35.2.2. Infant Mortality: 3Graph (18) showing incidence of ARI by provinces 1997-99: 35.2.3. Acute Respiratory Infection (ARI): 3Graph (19) showing trend of incidence of ARI in SI 3Graph (20) showing incidence of ARI & Diarrhoea in children <5yrs in SolomonIslands 35.2.4. Diarrhea: 3Graph (21) showing trend of incidence of Diarrhoeal Diseases 1997-99: 3Graph (22) showing trend of incidence of diarrhoea by provinces: 35.2.5. Red eyes ( infections): 3Graph (23) showing incidence of red eyes by provinces 1997-99: 35.2.6. Yaws: 3Graph (24) showing incidence of Yaws in SI 3Graph (25) showing incidence of Yaws by provinces 1997-99. 35.2.7. Ear infections: 3Graph (26) incidence of ear infections by provinces & SI: 315.2.8. Vaccine preventable diseases: 3

5.2.8.1. National Disease Surveillance: 3





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Graph (27) showing incidence of vaccine preventable Illnesses in SI 1997-99 3Graph (28) showing incidence of vaccine preventable illnesses by provinces in 1997-99: 35.2.9. Sexually Transmitted Infections: 3Graph (29) showing incidence of STI in Solomon Isl: 3

Graph ( 30) showing incidence of STI by provinces: 35.2.10. M ALARIA: 3

5.2.10.1. Activities & Findings: 35.2.10.2. Accomplishments: 3Figure 2: Annual Incidence rate of malaria in Solomon Islands 1969-1999 35.2.10.3: Incidence in the provinces 3

Figure 4: Trends in the annual incidence rate of malaria in Honiara and theprovinces 1992-99: 35.2.10.4. Diagnosis & Treatment: 3

5.2.10.5. Key Issues & Problems Experienced: 35.2.10.6. Analysis of the Program: 3

5.2.11. TUBERCULOSIS: 3

5.2.11.1. Activities (Input): 35.2.11.2. Findings (Outputs): 3

5.2.12. Mental Health Services 3

5.2.12.1. ACTIVITIES (INPUTS ) 35.2.12.2. Findings (Outputs): 3Table (A): Total Cases Admitted to 3

National Psychiatric Unit, Kilu’ufi Hospital (only) IN 1997,1998,& 1999. 35.2.12.3.Analysis: 35.2.12.4. Major Issues/ problems & recommendations: 3

SECTION VI: ENVIRONMENT HEALTH SERVICES:3

6.0. HEALTH AND ENVIRONMENT 36.1. General protection of the environment 36.2. Air (pollution) 36.3. Water quality 36.4. Solid waste disposal 36.5. Food safety 36.6. Housing 36.7. Work place 36.8. Water supply and sanitation 36.8.1. Indicators 36.8.2. General 3

SECTION VII: HEALTH PROMOTION &EDUCATION: 3

7.0. Overview: 37.1. Community Health Education Activities 1997-99: 37.2. Evaluation of health education & promotion programs: 3

SECTION VIII: REPRODUCTIVE HEALTH ANDFAMILY PLANNING: 3





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8.1. Maternal Mortality: 3Table (23) showing Maternal Mortality Rate/ 100,000 births 3Table (24) Maternal Deaths by Provinces 1996-1999 (excluding those in thehospitals): 3Table (24) Proportion of Total deaths by National and Provinces (ie. No. of. maternal

deaths / total deaths reported by Clinic Monthly Reports in %: 38.2. Family Planning: 3Table (25) Family Planning Coverage (%) total users at end of December/wcba x100): 3Graph (29) showing FP coverage by end of December 1997,1998 & 1999: 3Table (26) % Supervised deliveries: 3Table (27) Antenatal Coverage: First antenatal attendance (% first visit / expectedbirths) 3Table (30) Total Fertility Rates 1986,1996,1998: 3Table (28) FERTILITY RATES BY PROVINCES FROM 1997 TO 1999 (births/ 1000 popWCBA 3

SECTION IX: DEVELOPING PARTNERSHIP3

9.0. Overview in brief: 39.2. Involvement of International developing or donor partners: 3

ANNEXURE 3

ANNEX Table (1) showing proportion of population to health workers in 1997-98: 3ANNEX Table (2) Female, Male, Pediatrics, and Obstetrics Beds-All HospitalsAdmissions and Occupancy Rates at 1997,1998,1999 bed capacity 3ANNEX Ta ble (3): Total Cases Admitted to National Psychiatric Unit, Kilu”ufiHospital (only) 1997,1998 & 1999: 3ANNEX Table (4): Total Cases seen and treated at the National Psychiatric Unit,Honiara, MOH/HQ in 1997, 1998 & 1999: 3ANNEX Table (5): Overall Total cases recorded at the National Psychiatric UnitsKiluufi Hospital and Honiara in 1997, 1998 & 1999: 3ANNEX Table (6) Matrix of donor activities impacting directly on the SolomonIslands health sector: 3





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Message From The Minister of Health

Let me repeat the questions Dr.Gro Harlem Bruntland Director-General of WHO raised in her statement in the World Health Report 2000. They were; whatmakes for a good health system? And how do we know whether our health system isperforming as well as it could?

The answer to the questions entails the conceptand principles behind this National Health ReportReview, which focuses on evaluation of the NationalHealth Status of the country for the period 1997 to1999. This is the second review of the health servicesfollowing The Comprehensive Review of HealthServices Report in March 1996.

I am very pleased and would like to

acknowledge the efforts by the Undersecretaries andthe divisional heads in compiling and providing information for the report.

The reporting period of 1997-99 was the most difficult years for the Ministry indelivering health services to the people of the country. The major external factors thataffected the health system’s performance were the economic down turn, which wassevered by the twenty months old ethnic tension. Nonetheless, primary and secondary health care services continued despite difficulties. The report shows that key healthindices such as the infant mortality and maternal mortality continue to improve.Naturally, the part of the reason for the improvement is attributed to the performanceof the health system of the country. Let me make myself clear that I am neither bias inmy statement nor I am compliancy. It is because there are many areas of weaknesses

within the health system revealed by the report. And one particular example is the needfor us to improve on our capacity to monitor and evaluate our own performances. Inthis report we have used objective reports from external sources such as WHO annualreports.

Another important issue revealed in the report is the issue of health inequalitiesby provinces. I would say that it confirms the hypothetical assumption that resourcesare not distributed equally. The level of health status varies a lot by provinces given thefact that the pattern of infectious diseases is similar through out the country. The levelof health service delivery activities and accessibility to health facilities varies. Whilst, theoverall health indices may look favorable, it is the internal aspect of health servicedelivery is equally important.

All of the above key health issues made up the driving factors for the policies

and strategies of the National Health Policies and Development Plans 1999-2003. Thereport also evaluates the health status against the key performance indicators in theNHPDP. However, due to lack of appropriate data and information the report is notable to evaluate all important indices against the objectives in the NHPDP. This is anissue itself to look into in the near future. The National Health Annual Review is amilestone in a long-term process. The measurement of health systems will be regularfeature of annual health reports.

Some important conclusions are clear from the report:





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There are demographic and behavioral changes. There is some degree of demographic transition. Growth rate and Total Fertility Rate has declined.Infant and maternal mortality rates also declined.

There are also health inequalities at different degrees in areas of distribution of services and resource allocation.

Therefore management and supervision of the health system needs reviewing and improvement. Especially in resources management, which includesmanpower, facilities and finance.

In conclusion, I hope this report will help policy-makers and operational managers of health institutions and programs of the Ministry and other stakeholders to make wisedecisions. We would like the environment created by the report to be of a learning one.My advice is for all health workers to remain committed the essential health services. Icommend you for maintaining health services during the height of the ethnic tension allthrough out the country. May God Bless you.

Hon. Allan Paul, MPMinister of Health

Solomon Islands





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i. INTRODUCTION

This is a National Health Reports Review of the status of national health services in 1997to end of 1999.

The purposes of the report are;

To report and evaluate health activities of 1997 to 1999.

To ascertain whether standards and the objectives of National Health Policiesand Development Plans 1999-2003 is attained.

To evaluate specific health services delivery packages.

Source of information for the purpose of (strategic) management andsupervision, planning and monitoring of health services delivery. (Identify

priority key health issues and problems through trend and pareto analysis, inorder for strategic planning for improvement)

Report on the national (and provincial) population health status

Section 1 concerns with the external social changes in relation to geography of thecountry, demography, socio-economy, and politics, which had significant impact on thehealth sector in the period 1997-99. Section 2 review the changes within the healthsector (Internal Review Report), in relation to health care referral system (structure),distribution of services by health facilities, human resource, and health financing. It alsocovers issues relating to management and supervision, and the organizational structure.Section 3 evaluates (policy 1), which aimed at improvement of health services planning,management and supervision. Section 4 evaluates (policy 2), which looked at

accessibility, quality of care and quality of health services delivery. Section 5 evaluateshealth improvement programs. Section 6 evaluates (policy 4) trend of morbidity andmortality reduction. Section 7 evaluates (policy 5) environment health services. Section8 evaluates (policy 6) health promotion and education. Section 9 evaluates (policy 7)reproductive and family planning. Section 10 evaluates (policy 8) developmentpartnership in health development.

The scope of the report confine to the activities undertaken in 1997-1999 the resourcesinput, results and achievements in terms of output, and the health status in terms of national health outcome. It also includes statistical figures in raw data, in graphs andanalysis of results.





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SECTION I: GENERAL INFORMATION

1.1. Land (geography of provinces/ SI) The effective delivery of health care is affected by the geographical nature of the Islands.Solomon Islands has a total land area of 28,369 sq. km from a sea area covering 1,632,964 sq. km. It is a widely scattered archipelago of rugged mountainous islands and

low lying coral atoll,stretching over some1,667 km in a southeastdirection between PapuaNew Guinea and theRepublic of Vanuatu, andNorth-East of Australia.On the Islands thelocation of villages arescattered. Many live along the coast, some inland

with sea access andothers live inland with limited access to the sea or road. It was found that majority of

villages in the country (52.0%) were situated in the coast, 32.9% live inland with no seaaccess, whilst 15.0% lived inland with sea access. Theses factors determines as well asundermine the plans put in place to deliver health care service delivery efficiently to theremote people, particularly those living more than 3 kilometer from a nearest healthclinic.

Geography factors have caused threats to health policies, aimed to address issues andproblems related to improving accessibility and equality to health care services. In suchcases understanding very well the diversity of the people and their needs are important inthe strategic planning. Geographical factors therefore correspondences with the

weaknesses within the organization. For example, coupled with untimely or non-paymentof health services grants, villages living more than 3 kilometers from a health facility orthose living inland with no access to roads are not reached by health care mobile teamsfrom rural clinics.

1.2. The demography (Population):

1.2.1. Size & Growth: The population of thecountry is a majorconcern to the healthcare services.Especially with regardsto the distribution of limited health resourceto meet the vast health

Table (2): Demographic Trends 1995 - 1999Year 1995 1996 1997 1998 1999

Population Projection

395848 409939 425488 441840

459380





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needs of the people. It is evident that our capability in getting families to adopt some ways of understanding and limited the family size is far from reaching our objectivetargets.

Solomon Islands has a population annual growth rate of 3.5%, a total fertility rate of 6.1,

crude birth rate of 42 per 1,000 per year, and crude death rate of 10 per 1,000 (1986census)

1. The estimated population in 1997 and 1999 was 425,488 and 459,380

respectively.

1.2.2. Age-group Composition:

Solomon Islands has a young population structure with 43.6% (1996 estimate) of totalpopulation in age-group 0-14 years. The number of children 0-4 years continue toincrease but at a declining rate. The population of female of childbearing ageconsiderably increases in the past ten years with more children entering adulthood afterthe 1999 census2. The population of age-group 0-14 by 19993 fell to 41.5% of the total,

which is less than age-group 15-44 with 45.2%. The base of the population pyramid

slight shrinks whilst it widen in the middle.

The health implication of these demographic trends is that the demand for health careservice by the age group of 0-4 and female of childbearing age remain high, and theMinistry needs to focus health services towards these category of age group. The ministry is faced with challenges of maintaining primary health care services at the community levels, and meeting the increasing demand for higher level of secondary and tertiary health care services at the capital and other urban areas.

Nonetheless, despite this negativism about the trend of demography of the country, therehas been some positivism in terms of the natural decline of certain age group. The trendof population is expected to increase but at a declining rate. The growth rate is expected

to decline to 2.9 between the period 2000-2050, and further to 2.6 by 20104

. Later in thepaper the analysis shows that whilst age group of children under 4 yrs increase and putsmore pressure to bed capacity of all provincial centers, the trend of WCBA decline giving opportunity for realignment or rationalization of health care services. The variationsbetween the trends of population of children and women of childbearing age (15-49)came about because of declining infant mortality rate and fertility rates.

1.2.3. Population density:

It is estimated that the population density will increase from 16 in 2000 to 21 in 2010. The increasing population density will have effect on the morbidity characteristics.

Trend of Population Density1986 2000 2010

1Statistics Unit, MHMS, 1999.

2National Census (1999). Take note that the details of the census was not available during the

compiling of the report. The majority of the data and infroamtion are based on 1986 estimates.3 Ibid4 SPC (2000). Oceania Population 2000, Demography/ Population Program, Secretariete of PacificCommunity, Noumea, New Caledonia





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15 16 21Source: Demography/Population Program, Secretariat of the Pacific Community,Noumea.

1.3. The Economy:

The subsistence and semi-subsistence economy is still the major means of survival formost families, but these traditional means of economic and social support in the ruralareas are weakening. Participation in the cash economy and formal employmentopportunities are limited. The main primary sector exports are copra, timber, cocoa,palm oil and fish. The current pattern of economic development is dominated by large-scale logging, mining, fisheries and agricultural projects financed by foreign capital.

The economy grew at an average 5% per year in the first half of the 1990s mostly due tostrong growth in forestry, fishery, construction, transport and communications. Theeconomy is dominated by commodity production, principally export of logs, fishing,

palm oils and kernels and copra. Per capital Gross National Product was estimated atUS$560 in 1992 ranking the country as a Least Developed Country (LDC). GrossDomestic product in 1995 was 7.0% (an increase of 5% from 1993 levels).

The trade balance recorded its first surplus of $47 million in 1995 and $118 million theyear after courtesy of the boom in log exports and declining imports. Log exports wentfrom $104 million in 1992 to $221.7 million in 1993 and $366 million in 1996. Thepersistent trade deficit prior to the advent of the log boom shows the heavy reliance onimported manufactures, machinery, and transport equipment. In 1995 Australiaaccounted for 41.4 per cent of total imports, Japan 11.8 per cent, Singapore 9.3 per centand New Zealand 9 per cent. Services payments has been higher than receipts since1990 although substantially offset by official transfers by the main donors in 1995 and

1996, being the European Union (European Development Fund, STABEX) and Australia (AusAID).

In 1999, the adverse effects of the unrest were partly offset by official transfers fromDevelopment Partners. By the end of 1999, the conflict was already having its toll on theeconomy. The pressure on the economy continued in the first half of 2000 until thecoup on June 5th. The coup only accelerated an already worsening situation in theSolomon Islands economy witnessed since mid 1999. Now however, the importantsectors of the economy have been knocked out leading to a substantial weakening of thestructure of the whole economy. So the effect of the social unrest on the SolomonIslands economy is much more severe and damaging than any crisis the country had everexperienced in the past. The impact of the crisis on the Solomon Islands is yet to be fully

realized. It would take several years before the damage to the economy is fully felt.Likewise, it would take even more years before the economy is restored and rebuilt to itspre tension levels. In some respects, the Solomon Islands society may have changedforever as a result of the social unrest on Guadalcanal.





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1.4. The Health Status by provinces and National:

Table 1 Solomon Islands Basic Health Indicators 1997 to 1999

INDICATORS 1996 1997 1999

Number of health facilities 334 252 411Total Population 410,36 425,488 459,380Population <1 year 15,209 15,772Population 1-4 years 56,432 58,516Population women 15 – 49

years 87,294 90,486

Population annual growth rate 3.5 in 86 [i.] 3.3 [ii]

Population density 14 15 16

Life expectancy M-62, F-64Infant Mortality/1000 live births

67 in 1976 38 in 1986 28 [iii]

Under 5 Mortality rate/1000 26 in 1995 [ iv.]

Maternal Mortality Rate/100,000

549 in 1986 209

Total Fertility rate/WCBA(15- 49)

6.1 in 1986 4.7*

GNP (USD) 870%GNP on Health 11.6Expenditure per health 11Doctor per population

R/Nurse per population Population access to safety water

65% in 1995 [iv.] 70% [vi.]

Population access to proper sanitation

9% in 1996 [vi.]

Contraceptive prevalence [iv.] 25% in 1995 Ante-natal coverage [iv.] 92% in 1995Supervised delivery [iv.] 85% in 1995Birth <250g [iv.] 20%

Expected births [v] 17,235 17,868Total deaths [v] 863 884

Total Births [v] 7,235 7,360Maternal Deaths [v] 8 5% Family Planning Coverage [v]

7.7 8.5

% Antenatal Coverage [v] 74.4 68.9% Postnatal Coverage [v] 36.6 39.9% Detected malnutrition [v] 1.6 1.5Touring Satellite Clinics [v] 2,309 2,068Touring Schools [v] 890 720





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Village Health Meetings [v] 1,600 1,767EPI [v] - BCG 58.1 % 69.4 %

- Measles 63.8 % 65.2 %- DPT3 71.9 % 68.6 %- TT2 + Booster 56.1 % 54.8 %

- Polio 3 69.0 % 69.2 %- Hepatitis B 3 68.3 % 69.6 %- DPT1 / DPT3 drop out 4.6 % 5.3 %- BCG / Measles drop

out - 9.8 % 6.0 %

Sources: [i.] 1986 National Census[ii] WHO World Health Report 2000, Annex Table 2 Basic indicators for all[iii] 1999 National Census[iv.] The State of World’s Children 2000, UNICEF, New York[v.] EPI figures are from the Health Information system, Statistics Unit MHMS 5i

[vi.] RWSS/MOH Report (2000).

Despite shortcomings in demographic and epidemiological information, it is generally held that major improvements in the health status of Solomon Islanders have beenachieved over the past two decades. The reported Infant Mortality Rate (IMR) has beenreduced from 67 deaths per 1000 live births in 1978 to 44 per 1000 in 1995. Otherstatistics, such as lower crude death rates and longer life expectancy, provide additionalindicators of improved health status.

While the IMR has decreased, infectious diseases and chronic under-nutrition continueto dominate morbidity and mortality in children. There is growing evidence, much of itclinical and anecdotal, that non-communicable diseases of youth and adults are becoming increasingly important as a traditional lifestyle is replaced by one that is more

westernized, with sedentary habits and diet. This is reflected in an increasing rate, albeit

relatively undocumented, of diabetes, hypertension, obesity, cancers and respiratory diseases. This inturn hasimplications forresource utilizationas the demandincreases for long-term care, tertiary interventions andcostly technologies.

The MHMS is

committed topreventing disease,protecting life andpromoting healthy lifestyles andchoices. TheNational Health

5 EPI figures used in the table are recorded by the HIS monthly reports. A verification report was donein Malaita 1999 to encountered under and over estimation reporting.





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Policies and Development Plan 1999-2003 articulate a systematic approach to furtherdevelop and strengthen the Ministry’s capacity and capability.

SECTION II: INTERNAL REVIEW REPORT

2.1. Regional (Provincial) Service Distribution;

2.1.1. Type of Services;

Table (1) : The Health Care Referral System

Level Authority Institution 1996* 1999

6 National National ReferralHospital

1 1

5 Provincial Provincial Hospitals 7 94 Area Council Area Health Center 14 233 Wards Rural Health Clinics 123 952 Wards Nurse aides Posts 61 1291 Village VHW Posts 128 154Total 334 411Source: *The Comprehensive Review of Health Services Report, 1996, MHMS, p.3.

Smaller hospitals such as Tulagi, Lata, Kirakira, Buala, Helena Goldie, Atoifi andSasamuga Hospitals offer slightly lower level of service than bigger hospitals like Gizo,Kiluufi and National Referral Hospital in Honiara. The levels of (health care) services are

delineated by the draft Guide to Role Delineation of Health Care Services in SolomonIslands 6. However, the Guide document is to be further developed into a meaningfulresource management.

Primary health services are primarily delivered at community level both at the urban andrural areas. Accessibility of health services has improved with the upgrading of healthfacilities and establishing additional through out the country. Approximately 70% of ruralcommunities are within an hours walking distance from a health facility (TheComprehensive Review of Health Services Report, March 1996). Health facility topopulation in at least 50% of the provinces in 1996 was 1:800 compared to 1,131 in1992. About half of the population (national average of 53.7%) lived within 3 kilometersfrom a health facility (1996). However still a sizeable population lived more than 5 km

away (19.4%). The majority of people (58.2% Nat. aver.) walk to health facilities andtherefore the cost to them in monetary terms is negligible. Nevertheless, remoteprovinces such as Temotu and Choiseul are vastly affected by distance and cost of travelto nearest clinic respectively.

6 MHMS (1998). Guide To Role Delineation of Health Care Services in Solomon Islands, Draft,Unpublished Paper, Honiara.





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Ren Bell 3 803 482 3 826 413 3 850 425Solomon I 245 1,737 249 1,774 249 1,845* not including VHW posts** Registered Nurses only

2.2. Internal Structural and management Issues:

In short, the major internal problems are as follows:

The inability to adapt to environmental changes and, to manage and cope withchange.

Financial sustainability

Institutional sustainability

Ineffective and inefficient management of health resources.

Ineffective implementation of health programs and projects

Quality assurance

2.2.1. Organizational Structure:

The organizational structure of the Ministry of Health has been unchanged for the pasttwo decades. There is very little accountability as most decisions and powers are centrally control by central agencies such as Department of Finance, Department of Planning, andDepartment of Public Services. Nonetheless, delegation of disciplinary power was givendown to the Permanent Secretary (impartially) with out much legal underpinning.

Internally there is confusion between policy and operational roles, between statutory andministerial obligations. The job descriptions are ill defined without much performanceindicators and proper staff appraisal in a consultative and learning incentives, which

would be helpful in performance management of departments and individual. Having

going through the structural difficulties with financing of health care services, training and development of health workers, recruitment and appointment, and disciplinary actions, it raises the question; whose values do we (public servants) exists? Is it the rulesand procedures that matter? Or is it our customers? Our local population? Thesequestions need answer that concerns with accountability and external autonomy to theMinistry of Health. Or even to other sister ministries. The existing health structure andits relation with the public service needs careful review and changes.





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Minist ry o f Hea lth N ationa l Hea lth Rep ort Review E va lu at ion o f Hea lth Status 1997-99 ==============================================================

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Figure 1 showing the existing organization’s structure: Ministry of Health: National and Provincial level:

MINISTER

Permanent Secretary

NATIONAL LEVEL

Undersecretary Health Care Undersecretary Health Improvement

Health Care / Curative Health CAO Health Improvement & ProtectionServices Paradigm Paradigm

Supporting Services Administration Accounts

PROVINCIAL LEVEL

Provincial Health Services

Curatve Health Services Health Improvement & Protection Programs





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2.2.2. Centralization Vs Decentralization (Vertical versus Horizontal programs):

Health services in Solomon Islands remained a centralized function of the Government withimplementing agencies in the province under the Provincial Agreement Act. Healthfinancing and manpower supply are centrally controlled and disbursed. Health servicesdelivery to the people uses the primary health care approach. There is mixture of horizontaland vertical health programs. Most public health programs such as the Malaria ControlPrograms, Environmental Health and Rural Water Supply programs, and health educationprograms are typical vertical programs.

2.2.3. Activities (Inputs):

The Health Strategies of the Ministry is stipulated under the National Health Policies andDevelopment Plans. Whilst the specific programs and activities are in the individual work

plans. These activities and programs are funded by the Health Recurrent Budget from theGovernment as wells as grants and external financial sources from international developing partners. The Ministry’s effort to sustain the minimal reasonable level of care to the peopleof the country supported by the limited resources of health workforce, financing andinfrastructure.

2.2.4. Findings (outputs):

There were two changes to the Minister of Health during the report period. In mid 1997around August, the Ministry had a new Health Minister (Hon. Dickson Waraohia, MP forEast AreAre) He is a member of the national coalition Government by the name of

Solomon Islands Alliance For Change (SIAC). After two and half years, a reshuffle took place, which took effect January 2000. The then Health Minister was Hon.Dr.Steve Sanga

Aumanu, MP for Baegu Asifola, Malaita Province. The Ministry official changes its namefrom Ministry of Health and Medical Services to MINISTRY OF HEALTH in 1999.

Bills andCabinet Papers

1997 1998 1999

1.ParliamentaryBills

(a) Passed 1.Pharmacy Practitioners

Act

(Amendment2.Pharmacy &Poisons Act(Amendment)3.Pure Food

Act4. Nursing Council





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Amendment(1997)

(b) Draft Stage 1.MentalHealth Act(proposedamendment)

2.Tobacco ProductsControl Bill (draft)

2.Cabinet Papers Not available 1.Indicative Health SectorProgram on DevelopmentStategies 1997-2001. (23.3.98,Cab(98)59).

1.Revised LocalSupplementationScheme (LSS) forforeing doctorsemployed by theS.I.G. (10.2.99,Cab(99)15).

2.Resolutions on Health for All into 21st century Reproductive Rights and

Responsibilities conferences,11-12.2.98,Canberra,Aust.(22.4.98, Cab(98)83N).

2. Submission for5% increase of SDAto Operating

Theatre & EyeNurses in thecountry. (18.2.99,Cab(99)16

3. MHMS to have its owntransport servicing & pooling system. (28.4.98, Cab(98)87).

3. Report on theStudy Tour to Japan& Brisbane by Minister of HMS.(30.4.99,Cab(99)64I).

4. Decision to terminate

Solomon Islands doctors withSIMA Medical Centre fromPublic Service be withdrawnand direction to resolve theissues. This matter wasdeferred but never discussedagain. (28.4.98, Cab(98)88).

4.The impact of the

current ethnictension on theHospital services atthe Central(National) ReferralHospital. (27.7.99,Cab(99)89).5. The MHMS 5year National HealthPolicies andDevelopment Plan

1999-2003). (27.7.99,Cab(99)1136. Report of theReview andRestructuring of theMHMS as part of the phase two of thepublic sector reform





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program. (2.8.99,Cab(99)120).7.ProposedSolomon IslandsHealth SectorDevelopmentProject. (15.9.99,Cab(99)159).8.Solomon IslandsHealth SectorDevelopmentProject PreviousPaper. (13.10.99,Cab(99)159.Early 2000:Reform in the

Health Sector Assisted by AusAID, (22.2.00,Cab(99)231).Change of namefrom the Ministry of Health & MedicalServices toMINISTRY OFHEALTH (MOH)(29.2.00, Cab(99)27).

2.3. Health Financing & Budgeting and Resource Allocation Factors:

The national government provides the major source of (recurrent) funding for healthservices at both the provincial and central levels. Successive governments have alwaysconsidered health services as an important political priority and a right of its citizen. This has

been reflected in the high proportion of government allocation to health.

Table (3) Total government budget and the allocations from 1988 to 1999:

Years

Total Govt. Rec.Budget SBD$M

Health Rec.BudgetSBD$M

Share toHealth(%)

HealthRevenuesSBD$M

PercapitaSBD$

1988 101.2 12.7 12.5 0.1 Nominal Real





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1989 125.2 14.8 11.8 0.2 42.5 27.5

1990 146.6 18.3 12.5 0.2 47.9 27.2

1991 162.8 20.5 12.6 0.2 57.4 29.9

1992 208.8 24.3 11.6 0.2 62.4 28.1

1993 231 26.9 11.6 0.2 71.7 28.9

1997 412.5 48.8 11.8 76.8 28.4

1998 532.5 54.3 14.41999 441.0 56.7 16.3Source: Account Section, MOH (2000.

Table (4) Distribution of the Recurrent Health Budget 1991-1999 (SBD$’000)

Sections 1991 1992 1993 1994 1995 1997 1998 1999 TotalCentral

11901.1 15907.8

16758.9

24525.1

23776.8

TotalProvince

6632 6994.4 8180 10044.2

14928.3

18963.6

21209.2

21306.1

TotalNational

185331.1

22307.2

24939.3

34569.3

38705.1

31290.5

34070.1

35439.6

%Provincial 35.8 28.7 32.8 29.1 39.6 37.73 38.36 37.21%Central 64.2 71.3 67.2 70.9 60.4 62.26 61.63 61.89

% National 100.0 100 100 100 100 100 100 100

Source: Account Section, MOH (2000).

One of the fundamental problems contributing to the management of finance is the lack of appropriate mechanisms or technology to monitor and evaluate the performancemanagement of the health budget. It is almost impossible to measure both the operationaland the impact of the health care services at the central and provincial level. Item budgeting rather than ‘output based’ budgeting is applied. The budget structure is driven by theDepartment of Finance’s objectives more than providing opportunity for big spenders likehealth to be accountable in cost saving incentives and cost-recovery. The health budgettherefore does not reflect the health care services, so as the allocation of resources in the

health sector 7. To reflect the above argument the National Referral Hospital aloneconsumes significant portion of 28.3% of the total health budget in 1999, followed by Ministry of Health Headquarter 15.2%, Pharmacy services (drugs & equipment coveredhere) 12.2%, whilst 10 provinces (including Honiara City) accounts for 37.21, which is SI$52(USD10) per-capita in province (excluding drugs costs). The level of health services grants

7 John Izard (1999). Solomon Islands Health Finance Review, ADB Consultant, MHMS/HQ, Honiara,May.





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to the provinces dropped from 43.5% in 1986 to 28.7% in 1992 8. In 1997 to 1998, it raised(since 1993) and stays around 37-38%. The implications of the current budget setting andallocation are an issue to be addressed in the near future plan.

Despite the Government’s commitment to health as reflected by an increase to 16.3% of total government budget from previous years, there is the need to review the issue of healthfinancing and management of health care delivery, particularly at the NRH. TheGovernment in its Solomon Islands Policy and Structural Reform in 1997 set the directiontowards increasing proportion of the recurrent health budget to community and publichealth programs, provincial health services, environmental services, and health education andpromotion.

Table (5) showing selected health accounts indicators for selected countries in the pacific region;estimates for 1997:

HEALTH EXPENDITURE (%) PER CAPITA HEALTH EXPENDITuntries Total

expenditure onhealthas% of GDP

Publicexpenditure as % of totalexpenditure onhealth.

Privateexpenditure as %of totalhealthexpenditure

Out-of-pocketexpenditure as % of totalexpenditure onhealth

Publichealthexpenditure onhealth as% of totalpublicexpenditure

Totalexpenditure at officialexchangerate

Out – of-pocketexpenditureat officialrate

TotalExpendit

ure ininternational dollars

Public-iture nationdollar

stralia 7.8 72.0 28.0 16.6 15.5 1730 287 1601 1153ew Zealand 8.2 71.7 28.3 22.0 12.7 1416 312 1911 999i 4.2 69.2 30.8 30.8 8.3 115 35 214 148lomon ands

3.2 99.3 0.7 0.7 5.2 19 ……. 83 83

G 3.1 77.6 22.4 22.4 7.5 36 8 77 59 anuatu 3.3 64.3 35.8 35.8 9.6 47 17 85 55

Normal type face indicates complete data with high reliability

Italics indicate s incomplete data with high to medium reliability ….. data not available

Source: WHO (2000). The World Health Report 2000, Annex Table 8, pp. 192-95.

From the 1997 estimates by WHO, Solomon Islands incurred 3.3% of the GNP on health,as compared to Fiji (4.2%GNP) and Australia (7.8%GNP). The question therefore is raised

8 Approved Recurrent Estimates and Solomon Islands Government Budget.





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is; Are we doing better we the current share of 3.2 % of the GNP? It is evident later in the report thatby WHO standard to some extend, Solomon Islands health system has a cost-effectivedelivery package through the primary health care approach. It is assumed and implied herethen that we are utilizing the limited input of financial resources and transforming it intohigher level of performance on health. This is not saying that the internal structure andfunctions of the health system is perfect. As the report will reveal later there are numeroushealth issues and problems related to structure and function needs to be reviewed andaddressed.

2.4. Management and Supervision:

The foremost important health issue in the period of 1997-99, is the lack proper and detailedmonitoring and evaluation of health care service delivery. This is partly due to lack of appropriate health management information, and lack of skilled manpower and facilities

(technology). Productivity and financial performances has never being careful monitoredand done, therefore problem solving and strategic planning is difficult. Proper accounting data for financial management is lacking or inadequate. The budget is far from a reflection of the health services delivered. There is no cost-sensitivity or incentives in placed. Thebudgeting procedure is traditionally cost-based. There is need to improve the financialmanagement system at the central ministry and hospital levels. Health policies are notevaluated seriously. There is no evidence based policy development.

There is no mechanism in place to access whether human resource for health is meeting therequirements of the country in terms of defined needs. It is difficult at this point in time tohave proper needs-analysis result because of lack of trained personnel and logistic support

facilities such as efficient health information system. Staffing of services and facilities is oftenthe basis of personnel deployment in the Solomon Islands.

2.5. Status of Health Care Services Delivery:

The Comprehensive Review of Health Services in 1995-96, made attempts to evaluate thecurrent status of health care service delivery in Solomon Islands, highlighted some concernsand weaknesses as well as strengths. About 59.7% of the respondents found that healthfacilities are located conveniently for them. It was noted that patients wait longer (1-2 hr.)Honiara Clinics than provincial clinics (< 1hr). Malaita, Isabel, Makira and Rennell & Bellona

wait only for 15 minutes. Therefore waiting hours is an issue for urban hospitals and clinicsto address. The presence of a health worker at the health facility at the time of patientpresentation ranges from 63.7 to 88%, the lowest in Makira. Generally with the existing health care service network, more than half, 61.8% (national average) satisfied with the

waiting time. It is also noted that most patients in Honiara (55.6% respondents are notsatisfied. Although majority of 81.2% is satisfied with attitudes of health workers, it is aconcern still in Makira, Temotu and Honiara. Despite difficulties, 65.5% are satisfied withavailability of medicine whilst sizable population of 31.7% are dissatisfied. The logistics of





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getting medicines to clinics is not easy. Natural forces such as bad weather and untimely shipping and ordering had threatened availability of medicines to the rural population.It is evident that there was a tremendous pressure in maintaining health care service delivery in 1997 to 1999. The level of output increased in relation to number of people receiving health care services at the Area Health Centers, Rural Health Clinics and Nurse Aide Posts.(See table 13 below). The increase was highest in Malaita followed by Western Province andGuadalcanal. It is also noted that the usage of health care services per person also increased.

However, there was marked differences between provinces in average outpatient visits perperson per year (See table 14 below). An individual of Western Province visited the clinicsmore, followed by Choiseul and Malaita. In 1999 the impact of the ethnic tension is evident,that the average number of individuals using the health care services dropped from twice (ormore) to once (1.58) per person. The exact reasons for the variations are to be fully investigated.

The shortage of local doctors is an ongoing concern. Of the 31.4% wanted to see a doctor at

first presentation only 1.2% actually saw a doctor. This implied that many people are moving towards a higher level of service. The demand to see doctor will increase. Whilst the numberlocal doctors graduating from medical schools in Fiji and Papua New Guinea increases,retaining them within the public sector will become a health care management issue.

2.6. Distribution of Health Care Workforce;

The rural population of eighty seven percent is currently served with a small proportion of relatively less qualified health workers especially in clinical areas and diagnostic services.In 1999, 70% of the health work force is in the provinces and the Honiara City, engaged in

primary health care. With the increasing need to decentralize more specialized services along with the need to improve quality of care, it is seen that hospital based services requireimprovement. About twenty four percent (24.3%) of the total health work force is in theNational Referral Hospital. However, deployment of qualified well-trained health workersand professionals centrally biased with 59.5% of the total qualified well-trained health

workers in the Central Hospital. More than seventy percent (72.9%) of total number of doctors in Solomon Islands are located at the National Referral Hospital. In relation toregistered nurses, 32.5% of nurses are also in the NRH, while 67.5% are in the provincesincluding HCC. Nevertheless, there is hospital-bias in relation of deployment of RegisteredNurses in the provinces by more than half (59.2%), excluding CIP, GP, CP, and HCC whoare without public hospitals. It is the universal picture that the nurses constitute the major

component of the health workforce. The implications are the need to strengthen the primary health care in terms of human resource development.

2.6.1. Shortage and management of health workforce:

The Shortage of qualified staff especially doctors is a known cause of the internal weaknesses, whilst allocation and development of nursing is a problem. Table (6) shows thegap between required numbers of doctors with the projected supply. It is also been observed





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that local doctors are leaving the public service to private sectors because of dissatisfaction with the conditions of the service. The issue of retaining qualified local doctors is a priority on the paper (policy) but low practically. Annex table (1) shows that the population todoctor ratio is very high.

Table (6) Shows the Gap Between Requirement Projection and Supply Projection on the MedicalProfession (Doctors):

N R H

W . P

M . P

I . P C . P

T P

M U P

G . P

CI P

R B P

H T C

T o t a l

GeneralSurgery

0 0 0 1 1 0 1 0 0 0 0 3

Orthop

ed.

1 1

Paediatri

0 0 0 1 1 1 1 1 0 0 0 5

Obst&G.

0 0 0 1 1 1 1 0 0 0 0 4

Int.Phy si

2 1 1 1 1 1 1 0 0 0 0 8

Radiolog

0 0

Patholog.

1 1

Anaesth 1 1 1 1 1 1 1 7Eye 0 0Psychiatrist

0 0 1 0 0 0 0 0 0 0 0 1

A&E/GP

3 2 3 1 1 1 1 1 1 1 1 16

Manager/CEO

0 1 1 1 1 1 1 1 1 1 1 10

Total 8 5 7 7 7 6 7 3 2 2 2 56





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SECTION III: HEALTH SERVICE PLANNING,MANAGEMENT AND SUPERVISION:

3.1. Management & Administration:

Health services is predominantly centralized in terms of overall health policy development,planning, management, training and evaluation of health services. Implementation of theNational Health Policies is being left to respective divisions and departments that made upthe Ministry of Health. However, MOH is trying its best to do away with the abovemanagement approach and to empower the heads of department and middle managers toplay more part in decision making in areas of management, planning, monitoring andevaluation of health services. In enabling that to work the fundamental basic structure mustbe conducive. Roles of job descriptions of staff must be understood and clarified. It is a

difficult task. However, contingency plans were made since 1997. In this report below subsequent feedback is made actions taken to achieve the objectives. The Ministry’s Policy Goals is to improve the capacity of the ministry to plan, implement, and evaluate the healthservices in the country.

3.1.1. Activities (Input) & Output:

Table (7) below shows matrix of strategies implemented since 1997.Priority Areas Input (Strategies) Output

Indicators1997 1998 1999

1.NationalHealth Policy Developments:

1.1.National HealthIndicative Strategies

The national healthindicativestrategies were

produced by theMOH.

accomplished

1.2.Medium TermDevelopment Strategy

The MTDS wasformulated withparticipation of MOH and all otherMinistry

accomplished

1.3.National HealthPolicies andDevelopment Plans1999-2003

Sequent of eventsleading to the finaldraft of theNHPDP

Review Or situationalanalysis done

Senior HealthOfficersConference met in

August 1998

Finalization of draft.Printing of thedocument isdelayed.

2.Health SectorReform

2.1.Restructuring MOH

- Restructuring the healthsector so thatit becomesefficient andeffective inthe delivery of healthservices.Main focuseson[1]

-Institutional

strengthening project.

-DraftRestructuredMOH.-Revised staffing structure.-Revised budgetstructure.

-An institutionalstrengthening

project completedand submitted totheMultidevelopmentpartners meeting held in Honiara.

-Draftrestructuring document

-An ADBconsultant, Mr.

John Izzard,reviewed theMOH Budgetstructure.

-A NZconsultantreviewed theHealth CareLegislation. Joy





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institutionalstrengthening

- [2] Staffing restructure

- [3] Budgeting restructure

- [4] Healthcarelegislationreview.

- Review functions, jobdescriptions,activitiesinvolved,

work loadanalysis.

-Revised HealthCare Legislation

completed butneeds furtherrefinement andmodification.

Liddicoat(September1999).

The healthsector’s

intention torestructure wasapproved by theCabinet.

3.Strengthening the MHMS’capacity to

plan, budget,evaluate,monitor andevaluate healthservicesdelivery

3.1.-All posts filled withappropriate qualifiedstaff.-Office automated &

equipped.-Training of staff

-All posts filled.-Office automated.-FMS-RAF.

-Regular financialreporting.-

Notaccomplished

Not accomplished Notaccomplished

3.2.Establishemnt of proper FinancialManagement System

-Properly structured financialmanagementsystem andguideline onmonitoring andcost analysis andbudgeting andresource allocation.

-Monthly financialreporting by accounts section.Regular (annual)National healthFinancial reporting and cost analysis.-Development of aappropriateresource allocationformula based ondemand, needs andpopulation

Notaccomplished


3.3.Strengthening of thehealth information

system by improving coordination andintegration of information data, andsoftware.Expand hospital-inpatient data.

-Accurate andtimely reporting

(response rate.-Hospital-informationsystem.

-Responserate from

clinics: (a)78.8%,(b) Pop.covered inreporting 88.2%

(a) 79.1%(b) 91.2%

(a) 76.7%(b) 87%

-Responserate fromHospital;poor.

Poor. Notaccomplished

Poor. Notaccomplished





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Notaccomplished

4.PartnershipDevelopment

4.1.Review currentmechanisms

4.1.DraftGuidelinecompleted

Notaccomplished


4.2.Developpartnerships andcollaboration withprivate sector

4.2.MOUestablished

Notaccomplished


5.Improveaccess &quality healthcare

5.1.Strengthening levelof health care at NRH& provincial hospitalsthrough:

Physicalupgrading inprogress

Physicalupgrading inprogress

-Continuous training, No. Of trainedpersonnel

In progress In progress In progress

-Upgrading of equipment,

Upgrading of equipment

Notaccomplisheddue to lack of funding

Not accomplisheddue to lack of funding

Notaccomplisheddue to lack of funding

-Upgrading of

infrastructure

Infrastructure

rehabilitation

Draft Guide to

Role delineation tcompleted

6. Developpolicy on(public) healthFinancing

6.1.Review currentregulations so thatalternative healthfinancing could bedeveloped.

- Cost recovery (user pay) policy

Notaccomplished


-Increased revenuecollection at theNational ReferralHospital;

Notaccomplished


6.2.More emphasis toHealth Improvementprograms.

-Increase budgetallocation to healthimprovement &protection.

-Increased of 10%to the healthbudget to healthimprovement &

protection.

-Donor inputs inpublic healthprograms.

3.1.2. Analysis:

The activities and input at the policy and executive level of the Ministry of Health are drivenby eight health policies that form the platform to ensure that the system achieves thefollowing key outcomes9;- Improves overall level of health- Equal distribution of health in the population- Overall level of responsiveness and distribution of responsiveness,- Distribution of financial contribution.

The key strategic inputs the Ministry undertook in the three years period was setting futuredirections through three key policy frameworks. They were the National Health IndicativeStrategies, which forms an integral part of the Government’s Medium Term DevelopmentStrategy (MTDS).

9 WHO (200) Measuring Goal Achievements in the World Health Report 2000; Health Systems: ImprovingPerformances, Chapter 1, pp27-35.





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The development of the National Health Policies and Development Plans begun in 1997 with sequence of events leading up to the finalization of the document in 1999. These eventsinclude review of the status of health services in the country, which coincides with theSenior Health Officers Conference in August 1998. The structural and management issues

were clearly raised by the conference as the major health issue the Ministry needs toprioritize in the future health developments. The Ministry then drew up a Cabinet paperexpressing the statement of intent for the ‘health sector reform’, which was, approved theCabinet in 1998.

3.1.3. Output & Key Issues:

The level of output of the activities of the Ministry is assessed to be very low, and affectedby the political and social problems experienced. The effect of the ethnic tension has beenthe major threat, which corresponds to the weaknesses of the health sector to effectively carry out the planned health reform. Most leading activities were not accomplished.Overseas developing partners were requested to assist and support the proposed reform by

the health sector, during a conference in 1998 organized by the Government. The key factors for the ineffective implementation of the national policy strategies are listed below;-

Time issue. -There is very little time for technical or professional developments suchas developing standards and specific policies, integrating more with staff and otherstakeholders internally and externally. It is therefore clear that coordination at theexecutive and divisional management level needs to be addressed. Clear guidelinesand job descriptions need to be developed or re-enforced if already present. It ishelpful if clear performance management process is developed with staff from theexecutive and downward.

Delay at the Central Agencies: - There is significant delay in administrationprocedures by central agencies. Human resource management procedures such asrecruitments have been very slow. This is not critize the central agencies but this ishow health development is been affected.

Lack of funding:- The overall Government’s cash flow problem affected theMinistry’s capacity to implement manage, and evaluate its programs. Supervisory

visits were not done. The capacity to implement project and plans of the HealthDevelopment Budget is none, either due to lack of funding or no one to implementthe plans at operational level. It is also because of lack of proper costing of plansinto a budget, which omits important health priorities. The budget process is

traditionally cost or itemized-based, and not program or output-based.

Lack of knowledge and skilled personnel. The lesson here is that new concepts mustbe transferred to the divisional heads and subordinates and reinforced in a learning manner. However, the rationale to re-look at the Ministry’s organizational structureand function is understood to some level. Workshops and conference were themajor venue for communication. Involvement of key staffs were involved right atthe planning level. This approach will be further promoted with the health sector.





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Outcome:

Whilst above issues are subjective, the objective perspective organization is also crucial andare related. In measuring the achievements of the Solomon Islands Health System the abovekey outcomes are used in this report. The WHO guide is applied in this context. TheMinistry’s forward planning is ensure that we could see the problems and achievementsourselves and not for someone else to do it for us. However, at this stage we could only rely on others’ judgment.

3.2. How Well Do the Solomon Islands Health System Performs?

3.2.1. Overall Level of Health:

The three conventional and partial health status is used. By end of 1999 the estimated annualgrowth rate declined to 3.3% as compared to 3.5% in 1986. The probability of a child dying under 5 years (per 1,000) in the Solomon Islands is higher (47-49/1,000) than Fiji (19-25) butless than Papua New Guinea (106-129). Similarly, adult Solomon Islander has a higherprobability of dying at between age 15-59 years (227-274/1,000pop) compared to Fiji (141-247) but less than Papua New Guinea (325-325) and Vanuatu (239-333)). According to thebasic indicators by WHO, Fijians live longer at Life Expectancy of female 69.2 and male64.0, than Solomon Islands, female 64 and male 62. Solomon Islanders expected to livelonger than Papua New Guineans and Vanuatuans See Table xxx).

Table (8) showing Basic Indicators for selected countries in the pacific region:

Countries Annualgrowthrates(%)1990-99

Total fertilityrates Probability of dying (per 1,000)Under 5 yrs

Probability of dying (per1,000).Between 15 and59 yrs1999

Life Expectancyat (yrs)1999

1990 1999 Male Female

Male Female

Male Female

Australia

1.1 1.9 1.8 7 5 94 53 76.8 82.2

Fiji 1.2 3.1 2.7 25 19 247 141 64 69.2

S.I 3.3 5.7 4.7 49 47 274 227 62 64PNG 2.3 5.1 4.5 129 106 377 325 53.4 56.6

Vanuatu

2.5 4.9 4.2 64 57 333 239 58.7 63

Source: WHO (2000): The World Health Report 2000; Annex Table 2, pp.156-163.





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Another measure that combines death rates and disability and reflects the overall status of population health as the ratio to the burden of diseases is Disability-Adjusted LifeExpectancy (DALE). It is been used by WHO to judge if good health is achieved. Theestimates for 1997-99 by WHO revealed Solomon Islands ranked 127 compared to Tongaand Fiji at 75 and 106 respectively. Vanuatu and PNG at 135 and 145 respectively.

Table (9) showing health attainment, level and distribution in selected countries in the pacific region;estimates 1997-99:

Disability-adjusted life expectancy(years)

Expectation of disability at birth

(years)

Males Females Males Females

Rank

Countries Total pop. @birth

At birth At 60 At birth At 602 Australia 73.2 70.8 16.8 75.5 20.2 6.0 6.7

75 Tonga 62.9 61.4 11.5 64.3 13.3 6.8 8.6106 Fiji 59.4 57.7 8.3 61.1 9.8 6.3 8.1127 Solomon

Islands54.9 54.5 8.8 55.3 9.2 7.5 8.7

135 Vanuatu 52.8 51.3 8.0 54.4 9.2 7.4 8.6145 PNG 47.0 45.5 8.2 48.5 8.7 7.8 8.1Source: WHO (2000): The World Health Report 2000; Annex Table 5, pp.176-183

Preventable health conditions remain predominant causes of illness burden to the people (asthe recipients of services) and the Government as the major supplier of health services.

3.2.2. The distribution of health in the population:

Health services reached the population through the Primary Health Care programs, and thereferral systems in relation to health care services delivery. The primary health caremechanism forms the template for service delivery in order to achieve Health For ALL by 2000. It is through these means that forms the platform or structure for responsiveness tothe peoples’ different health needs.

3.2.3. Responsiveness10 of the health system:

Solomon Islands health systems have shown evidence of meeting people’s satisfaction. A

national survey done in 199511

. There was a high percentage of level o satisfaction with theoverall performances of the health facility. High level of satisfactions was also found inselected activities such as waiting time (mainly in rural health facilities and not in Honiara),

10 WHO (Health Report 2000): Responsiveness is not meeting people’s needs but how systems performsrelative to non-health aspects, meeting or not meeting population’s expectation. Common complaints of public are attitudes of health workers towards their patients and waiting times.11 Ministry of Health, SI (1996). The Comprehensive Review of Health Services Report, pp.66-67





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attitude of health workers, explanation of diseases and treatments, availability of medicine,and referral to high level of care.

3.2.4. Performance on health level (DALE) and Overall Performances:

Table (10) shows ranking of selected countries in the pacific region on their performances on healthlevel, and the overall performance:

Performance on health level(DALE)

Overall Performance

Rank Countries Index Rank Countries Index20 Solomon Islands 0.892 32 Australia 0.87639 Australia 0.844 41 New Zealand 0.82780 New Zealand 0.766 80 Solomon Islands 0.705120 Vanuatu 0.665 96 Fiji 0.653124 Fiji 0.632 127 Vanuatu 0.559

146 Papua New Guinea 0.546 148 Papua New Guinea 0.467Source: WHO (2000): The World Health Report 2000; Annex Table 10, pp.200-203

It is therefore evident that the Solomon Islands Health System has performed reasonably well in the past decades. On the developments on health alone, S.I is ranked 20 ahead of twodeveloped country in the pacific, Australia and New Zealand. Even on overall performancesSI is ranked 80 out of 1991 members states of WHO.

Efficiency in health attainment(performance

on health level/ DALE) in selected countries

in the pacific region

0 20 40 60 80 100

Solomon Islands

Australia

New Zealand

Vanuatu

Fiji

Papua New Guinea

%

Overall Efficiency (overall

performance)

0 20 40 60 80 100

Australia

New Zealand

Solomon

Islands

Fiji

Vanuatu

Papua New

Guinea

%





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System’s Weaknesses:

Whilst the WHO guide to systems has revealed satisfactory performances, there are major weaknesses observed in the health systems. Theses weaknesses are mainly related to politicalstatus of the provincial government system and their commitment to health, health financialmanagement and accountability, and administration process in relation to human resourcemanagement, and other bureaucratic procedures, and the ability of the Ministry of Health inmonitoring and evaluating health services. Other problems are practical issues related tountimely payment of health grants to the provinces.

3.3. Health Information System:

The key sources for health information is the ‘Health Information System (HIS)’. It is the

monthly clinic report on health activities by provincial hospital outpatients, Area HealthCenters, Rural Health Clinics, and Nurse Aide posts. It reports on the activities of healthinstitutions, as the inputs in service delivery as well as output and outcomes to some extend.

Annual reports are other area of health information feedback from the provinces anddivisions and programs. It is (hope) through annual reports that feedback on issues related tohealth resources management is reviewed. Issues and problems are raised and discussed. It

was an important avenue for problem identification. Besides, conventional health indicessuch as morbidity rates experienced in the provinces, other management information is alsoincluded, though limited. Staff inventory, facilities and equipment inventories are some of the information included.

The major issue with Annual Health Reports is that there are no standards and requiredformats for directors and heads of programs and divisions to follow when reporting. Thus,the substances of the reports are often very descriptive without analytical meaning forevaluation and improvement purposes. Nonetheless, this report uses a lot of trend analysisas a means of evaluation of the health activities and program outputs and outcomes. Thereis overall failure of reporting by responsible health authorities in the provinces and divisionallevel in 1997-99. Nonetheless, there are few authorities producing reports annually. A few filled in gaps left by their predecessors. These few people are commended for their efforts.

Other sources of information are external to the Ministry. They are National Census, WHO,

Unicef, UNFPA, SPC and other organization. Nearly all the above are form of estimates with good accuracy.

3.3.1. Response Rates of Monthly Clinic HIS Reports:

It is clear from the table that the level of responding declined in the past three

Solomon Islands 1997 1998 1 999-Response rate from clinics 78.8%, 79.1% 76.7%

91.2% 87%





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years, 1997-99. The 20 months old ethic tension did had some significant impact on clinicsreport besides other reasons needing further review and improvement.

% of Reporting from Clinics by provinces 1997 1998 1999Choiseul 66.3 67.0 76

Western 85.1 81.5 75Isabel 64.0 64.8 66Central Islands 76.8 85.5 81Guadalcanal 73.7 82.0 79Malaita 83.8 77.0 73Makira 91.7 95.6 81

Temotu 83.3 82.1 67Rennell Bellona 52.1 64.6 35Honiara 100 100 83Source: Health Information System, Annual Feedback 1997,1998,1999, Statistics Unit, MOH

Graph showing % of reporting of Monthly Clinic Report by

provinces

0

20

40

60

80

100

120

C h o i s

e u l

W e s t e r n

I s a b e l

C e n t r

a lI s l a n d s

G u a d a l c

a n a l

M a l a i t a

M a k i r a

T e m o t u

R e n n

e l lB e l l o

n a

H o n i a

r a S I

%

1997 1998 1999

It is clear that level of reporting of monthly clinic HIS report varies between provinces.Honiara recorded the highest reporting percent followed by Makira Provinces. Thoseprovinces below 80% line need more effort put in reporting.

3.3.2. Response Rate of Annual Reports:

Provinces & ReportingOfficers

1997 1998 1999

Western Nil YesBy B.Sasa

YesBy Hosp. secretary





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Choiseul YesBy B.Sasa

Nil Nil

Isabel YesBy Dr. Roy

Nil Nil

CIP Nil Nil NilGuadalcanal Nil Nil NilMalaita Nil Nil NilMakira Yes

By Dr. Bala YesBy Dr. Bala

YesBy Dr. Bala

Rennell Bellona Nil Nil Nil Temotu Yes

By Dr. Araathon

Nil Yes *By Drs. Togamae &

TovosiaHoniara Town Council Nil Nil NilNational Psychiatric Unit(NPU)

Yes, by D.Boara

Yes, by D.Boara Yes, by D.Boara

By Programs &Reporting Officers

1997 1998 1999

Malaria Yes Yes YesReproductive Health Nil Nil NilRWSS Nil Nil Yes, by Peter Woperes *Disease Prevention &Control center

Yes, by K.Konare

Yes, by K,.Konare

Yes, by K.Konare

Health Education Yes, by A.Lovi

Yes, by A.Lovi Yes, by A.Lovi

Social Welfare Nil Nil Nil

NRH & ReportingOfficers

1997 1998 1999

NRH – Overall Report Nil Nil NilRehabilitation Yes, by

C.Laore Yes, by V.Hugo Nil

Pathology Yes, by A.DofaiSurgical Yes, by

Dr.D.Pikacha Yes, combined report by Dr.D.Pikacha

X-ray Yes, by S.Savakana

Private Sectors &Reporting Officers

1997 1998 1999

Helena Goldie Hospital Yes, by Dr.J.Xlow

Yes, by Dr.J.Xlow

Yes, by Dr.J.Xlow

Atoifi Hospital Yes*Note: * implies that report submitted were incomplete or partially. Not all activities arereported on.





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Obviously, the levels of reporting by responsible officers are very low. This is an area forimprovement. It is an opportunity to commend those officers who had taken all efforts toput in an annual health report. There is also need for proper reporting format to enableresponsible officers to know what kind of information is required in the reports.

There is no formal ‘Hospital Reporting’ at the moment. Reports are done at an ad-hoc basis.Hospital services reporting are crucial part of management, and planning. There wasattempts to develop a reporting format for Hospitals but was not implemented for severalreasons. It is the Ministry’s plan to address the issue. There had been some preliminary reviews done experts12. The findings of the review strongly emphasized putting in place aproper Health Information and Management System. Further development will be done inthis area.

SECTION IV: ACCESSIBILITY AND QUALITY OFHEALTH SERVICES

4.1. Health Care (Curative) Services:

It is the Ministry’s overall goal to provide reasonable minimal level of essential health care toall individuals and families, in an acceptable and cost-effective, affordable way, and with theirfull involvement.

The key strategic areas to achieve the above goals and objectives are;

Staff development & Training:

It includes recruitment of skilled staff for hospitals and clinics both at the urban andrural clinics. The undergraduate trainings of nurses, dentist and dental therapists,technicians in different diagnostic services, and doctors are dealth directly by theNational Training Unit, Ministry of Human Resource Development & Education inclose collaboration with the MOH. The postgraduate (inservice) training of health

workers is directly responsible of the MOH in collaboration of other stakeholderssuch as Public Service Department.

Upgrading of level of services in different health institutions and hospitals:

A challenging strategy put in place is the plan to improve level of services asaccording to the draft Guide to Role Delineation to Health Care Services. At this

12 Watso, P.,J.,WHO Consultant (1999).





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time of reporting, there still a need to review and improve on this strategy. Thisreport is not in a position to present an evaluation of the level of services.

Upgrading of health infrastructure, facilities and equipments:

This has been a very difficult task faced by the MOH in the past period mainly because of lack of funding. Lack of data does not allow this report to provide areport on this particular development.

4.1.2. Activities (Input)

Training of health workers including doctors, nurses, and paramedics continued in 1997,1998, and 1999. Again, because of lack of information, this report is not able to providedetails of how many health workers are trained and their placements.

The School of Nursing at SICHE could only take 35 students and not 50 as requested by the

MOH.

There is a slight increase in the number of new health facilities especially clinics by end of 1999. The MOH plan to rehabilitate and repair all health infrastructure never beenimplemented because of lack of funding.

4.1.3. Outputs:

Annex Table () summarizes the ratio of health workers topopulation. By end of 1999 there population per doctor inpractice was 1:10,488. (Not including the private

practitioners). The number of doctors to the population isdeclining as compared to 1:7031 in 1995. The MOH target isto improve the doctor:population ratio to 1:4,500. This is anarea needing special consideration by the Government.

The ratio of registered nurses to population remains constant at 1:836 as in 1995. Howeverthe total nurses (RNs and Nurse Aides) to population ratio is 1:489. See Annex Table ( )shows the proportion of health workers in 1997-99. The target of the Ministry by 2003 is 1registered nurse to five hundred populations (1:500).

The productivity of the Health Institutions (hospitals) is measured in terms its utilizationrates, bed capacity (Bed Occupancy Rates) and ALOS, and number of total admissions, which is outlined in Annex Table ().





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Graph (2) showing Ratio of Registered Nurses, Nurse Aides and Total Nurses to Population in 1997-1999:

Graph showing Registered Nurses, Nurse Aides & Total nurses to

Population, 1997-99

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

C h o

i s e u l

R N

N A

T o t a l

W e s t e

r n R N

N A

T o t a l

I s a b e

l R N

N A

T o t a l

C e n t r a

l I s l a

n d s

R N

N A

T o t a l

G u a d a l c

a n a l

R N

N A

T o t a l

M a l a i t a R

N N A

T o t a l

M a k i r a

U l a

w a

R N

N A

T o t a l

T e m o t u R

N N A

T o t a l

H o n i a

r a R N

N A

T o t a l

R e n

n e l l B

e l l o n a R

N N A

T o t a l

S O

L O M O N

I S L A

N D S

R N

N A

T o t a l P

o p u l a t i o n t o 1 n u r s e

1997 1998 1999

From the above graph (2), Guadalcanal and Malaita have higher number of population to anurse. In 1999 in Malaita the number of population to a nurse increases due to the ethnictension when there was a huge influx into Malaita. Honiara has the highest population to anurse but a readily accessible to all level of health care in the capital. However, it remains amanagement problem for the outpatient services in Honiara.

4.1.4. Primary Health Care- Health Facility: Population

The other measure of accessibility is health facility to population. From the table and thegraph, the current standing is that in Solomon Islands 1,643 population is for a healthfacility. However, this does not directly imply physical access to the health facility because of the variations in the geographical locations by provinces. The health facility to population

varies by provinces.





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Table (11) showing Health Clinics:Population* and Nurse: Population** Ratio in 1997-1999:

1997 1998 199913

Provinces No. of .Clinics

Facilities

Clinic:Pop

Nurse:Pop

No.of .

clinics

Clinic: Pop

Nurse:Pop

No. of Clinics

Clinic:Pop

Nurse:Pop

Choiseul 21 998 1,311 24 900 1,200 24 834 800 Western 38 1,609 - 38 1,637 1,016 38 1,651 1,162Isabel 28 716 717 28 740 609 28 729 638CentralIslands

31 725 1,604 31 746 1,445 31 696 1,199

Guadal. 20 3,928 2,806 21 3,902 2,826 21 2,870 1,722Malaita 56 1,833 1,488 56 1,875 1,500 56 2,190 1,670Makira 28 1,119 1,045 28 1,160 984 28 1,107 838 Temotu 12 1,613 745 12 1,656 686 12 1,576 700Honiara 8 8,314 2,293 8 8,954 2,311 8 6,138 1,584Ren Bell 3 803 482 3 826 413 3 792 396Solomon I 245 1,737 249 1,774 249 1,643 836Notes: 1. The above table and graph does not including VHW posts (therefore it includes Nurse Aide Postsand Rural Health Clinic run by Registered Clinics.

2. The nurse: population refer to Registered Nurses only

Guadalcanal has very high population to a health facility. The reasons would be related toclosure of some health facilities as a result of the ethnic tension. There is an offsetphenomenon observed between Guadalcanal and Malaita. Whilst Guadalcanal experienced a

decline in number of population to a health facility, Malaita experiences an increase. This isdirectly link to the ethnic tension in 1998-99.

13 National Census 1999 population figures used.





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Graph (3) showing ratio of population to a health facilities in the provinces:

Graph showing ratio of population to a health facility

0 2000 4000 6000 8000 10000

Choiseul

Western

Isabel

Central Islands

Guadal.

Malaita

Makira

Temotu

Honiara

Ren Bell

Solomon I

Population

1999

1998

1997

4.2. Primary Health Care (Clinics): Work Load.

Despite lack of data, the percentage of OPD visits seen at clinics is within the average of 80% as compared to OPD visits in the provincial hospitals and NRH.

Table (12) PHC (A): Outpatient Visits by Type of Facility, 1997,1998,1999:

1997 1998 1999Facility No

.OPD

Visits% No

.OPD

Visits% N0. OPD

Visits%

Choiseul

Hospital 1 1 7,776 1Clinics* 21 35,678 24 42,679 24 49,145

Total 22 25 25Western Hospital 2 12,767+ 2 7,874+ 2Clinic 48 186,703 50 165,223 55 178,397 Total 50 70 0Isabel





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Hospital 1 8,053 16.6 1 1Clinics 30 40,588 83.4 31 35,891 30 34,883 Total 31 48,641 32 31Central

Islands Hospital(TulagiMiniHosp)

1 1 1

Clinics 24 44,678 24 47,173 24 - Total 25 25 25Guadalcan al Hospital - - -Clinics 29 172,420 31 193,356 34 134,064 Total 29 31 34Malaita Hospital 2 2 2Clinics 56 207,042 56 186,725 56 223,893 Total 58 58 58Makira Hospital 1 Nk 1 Nk 1 Nk Clinics 29 45,730 29 54,685 29 43,341 Total 29 29 29Temotu Hospital 1 9,480 23.1 1 1Clinics 12 31,553 76.90 12 30,304 12 33,143 Total

13 41,033 13 13Rennell Bellona Clinics 3 3,687 3 4,819 3 3,543HTCClinics 9 99,062 64.0 9 108,050 78 9 87,848 63.0NRH 1 55,798 36.0 1 30,494 22 1 51,242 37.0

Total 10 154,860 10 138,544 139,090

* excluding Village Health Workers Posts but include Area Health Centers

4.2.1. OPD visits per Facility:

It is clear from the graph below that Area Health Centers have higher workload than RuralHealth Clinics and Nurse Aid Posts. Area Health Centers in Malaita have the highest

workload, which reached its highest peak in 1999. Guadalacanl and Western also showedhigher level of workload. All other provinces including HTC had OPD visits per AHC perday at an average of less than 100 for that period 1997-99.





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For Rural Health Clinics, except for Guadalcanal in 1998, all provinces had an average of OPD visits per RHC per day of less than 50.

The trend of OPD visits per facility per day varies by provinces.

Bar Graph (4) showing workload at Area Health Centers, Rural Health Clinics and Nurse Aid Posts





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by

Provinces.

Bar graph showing workload at Area Health Centers, Rural

Health Clinics and Nurse Aid Posts by provinces

0 50 100 150 200 250

Choiseul

AHC

RHC

NAP

Western

AHC

RHC

NAP

Isabel

AHC

RHC

NAP

Central Islands

AHC

RHC

NAP

Guadalcanal

AHC

RHC

NAP

Malaita

AHC

RHC

NAP

Makira

AHCRHC

NAP

Temotu

AHC

RHC

NAP

Honiara Town Council

RHC

Rennell Bellona

AHC

RHC

NAP

OPD visits per facility

1999

1998

1997





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Table(13) showing workload at Area Health Centres, Clinics and NurseAide Posts by provinces 1997-99

1997 1998 1999Provinces Facility A v.OPD

Visits/fac/Day

Av.OPD

Visits/staf f /day

Facility Av.OPD

Visits/fac/day

Av.OPD

Visits/staf f /day

Facility Av.OPD

Visits/fac/day

Av.OPD

Visits/staf f /day

Choiseul 35678 42,679 49,143 AHC 2 49 2 58.5 2 67.5RHC 7 14 9 13.0 9 15NAP 12 8 13 9 13 10.4

Western 186,703 165,223 178,397 AHC 4 128 4 113 4 122.5RHC 16 32 16 28 16 30.6NAP 18 28.5 18 25 18 27Isabel 40,588 35,891 34,883

AHC 3 37 3 33 3 32RHC 10 11 10 10 10 9.5NAP 15 7 15 6.5 15 6.4CentralIslands

44,678 47173

AHC 4 30.7 4 32 4RHC 15 8 15 8.6 15NAP 12 10 12 10.8 12Guadalcanal

172,420 193356 134064

AHC 3 157.9 4 132.4 4 92.1

RHC 10 47.4 10 53.0 10 36.8NAP 7 67.7 7 75.8 9 40.9Malaita 207,042 186,725 223,893

AHC 3 189.6 3 170.5 3 205.0RHC 20 28.4 20 25.6 20 30.8NAP 33 17.2 33 15.5 33 18.6Makira 45,730 54,685 43,341

AHC 3 41.9 3 49.9 3 39.7RHC 12 10.5 12 12.5 12 9.9NAP 14 9.0 14 10.7 14 8.5

Temotu 31,553 30304 33143

AHC 1 86.7 1 83.0 1 91.1RHC 5 17.3 5 16.6 5 18.2NAP 6 14.4 6 13.8 6 15.2Honiara

TownCouncil

99,062 108,050 87,848

RHC 9 30.2 9 32.9 9 26.8Rennell 3687 4819 3543





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Bellona AHC 1 10.1 1 13.2 1 9.7RHC 1 10.1 1 13.2 1 9.7NAP 1 10.1 1 13.2 1 9.7

TOTAL 867,141 814905 AHC 24 99.3 25 89.3 25RHC 105 22.9 107 20.9 107NAP 117 20.4 119 18.8 121

4.2.2. OPD visit per person per year by provinces:

Graph (5) showing average OPD visits per person per year:

Graph showing average OPD visits per

person per year

0

0.5

1

1.5

2

2.5

3

3.5

C h o i s

e u l

W e s t e r n

I s a b e l

C e n t r a l I s

l a n d s

G u a d a l c

a n a l

M a l a i t a

M a k i r a

T e m o t u

R e n n e l l

B e l l o

n a

O P D v i s i t s

1997

1998

1999

The measure of average OPD visits per person per year indicates the utilization of the healthfacility for that particular year. On average, in Western Province one person makes around 2-3 visits per year. Compared to Guadalcanal 1.5-2.4, and Malaita 1.7-2.0.





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Table (14) Shows Average OPD Visit Per Person per day and year, by provinces, across all facilities:

1997 1998 1999Provinces Pop. Av.OPD

Visits/person/Day

Av.OPD Visits/sperson/yr

Pop Av.OPD Visits/person/Day


Pop Av.OPD Visits/person/Day


Choiseul 20969 0.0046 1.7 21596 22241 Western 61146 0.0083 3.1 62982 0.0071 2.6 64869 0.0076 2.75Isabel 20074 0.0056 2.02 20714 0.0047 1.73 21376 0.0045 1.63CentralIslands

22461 0.0055 1.9 23113 0.0056 2.04 23784

Guadalcanal

78563 0.006 2.2 81941 0.0065 2.34 85461 0.0043 1.58

Malaita 102653

0.0055 2.0 105013

0.0049 1.78 107857

0.0057 2.075

Makira 31343 0.004 1.46 32471 0.0046 1.69 33638 0.0035 1.29

Temotu 19360 0.00447 1.63 19903 0.0042 1.5 20459 0.00445 1.62Honiara

TownCouncil

66508 71628 77141

RennellBellona

2410 0.0042 1.53 2479 0.0053 1.94 2550 0.0038 1.39

TOTAL

Table (15) Breakdown of Beds By Hospital (Government Owned Only) by end of 1999

Services andLevel of Services(LOS)

NationalReferralHospital,Honiara,Guadalcanal

KiluufiHospital,(Malaita)

GizoHospital(Western)

Kirakira(Makira)

LataHospital(Temotu)

Buala(Isabel)

Total

Medical(Beds)

56 11 15 19 8 8 117

TB beds 52 Nk Nk 12 12 Nk -LOS L3 L2 L1 L1 L1 L1 L1-3Paedistrics 45 22 10 16 8 8 109LOS L4 L2 L2 L2 L2 L2 L2-4

Surgical (incl.Orthop. for NRH

only )(Beds)56 20 15 18 8 8 125(incl.orthop)

LOS L3 L2 L2 L2 L2 L2 L2-3Orthopaedic(Beds)

(12) 0 0 0 0 0 12

LOS L4 - - - - -Maternity (Obst

50 24 14 21 8 15 149(incl.Gynae)





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Gynae 17 -LOS L6 L5 L4 L4 L4 L4 L4-6Private

Ward12 12

Others 42 - 6 2 44 Total Beds 330 130 60 86 46 39 568Source: MHMS, 1998; LOS - Level of Service

Table (16) Breakdown of Beds by Hospitals (Church Owned Only):

From table (15) theHoniara basedNational ReferralHospital is operating ata higher level of services with specialist

mostly levels 3 to 6.Malaita and Westernfollowed at levels 2 to4, while Makira, Isabeland Temotu operatemostly at levels 1 to 4.

Guadalcanal, CentralIslands, Rennell andBellona and Choiseul

Provinces use the National Referral Hospital as their main hospital. Choiseul Province uses

Gizo Hospital as its first point of referral. These provinces with an overall population of 124,400 (1997 estimates) depend on the primary health care as the major means of receiving health care services. About 29.3% of the total population of Solomon Islands depends onPrimary Health Care (PHC) services. The Comprehensive Review of Health Services Report(1996) reiterated the need for improvement of PHC is furthered by the fact that hospitalutilization rates at the provincial level varies by provinces. This variation is attributable to theexternal factors as well.

Services andLevel of Services(LOS)

SasamugaHospital(Choiseul)

AtoifiHospital,(Malaita)

HelenaGoldieHospital(Western)

Total

Medical(Beds)

Nk 24 12

Paedistrics Nk 12Surgical(Beds)

Nk 22 12

Orthopaedic(Beds)

0 0 0 0

Maternity (Obst

Nk 14 14





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Table (17) Shows number of available beds to be filled per 1,000 population in the region;

Choiseul Western Isabel Malaita Makira Temotu NRH((A)include

Guadalcanal,Central Islands &Rennell BellonaProvinces) (B)National

PublicHospitals

- 0.9 1.8 1.2 2.6 2.25 (a) 2.95(b) 0.72

Private ( Church )Hospitals

1.6 0.85 - 0.92 - - -

Overall 1.6 1.77 1.8 2.13 2.6 2.25 As above

Table (17) shows marked variation in number of available beds to be filled by 1,000 in theprovinces and Honiara. In 1999 the number of beds available in the provinces like Chosieul,

Western, Isabel, and Malaita is less than NRH. Makira and Temotu even they available bedsless than NRH, they are higher than Choiseul, Western, Isabel and Malaita. It is expected inten years time, should nothing is done, beds: population ration will decrease further as thepopulation increases. Thus, indicates that the bed: population ratio is an issue to beaddressed.

Table (18) Shows the Flow of Patients in and Out of the Provincial Hospitals (including privatecenters):

NRH Choiseul Western Isabel Central

Islands

Guadalca

nal

Malaita Makira Temotu Rennell

Bellona

HT

InFlow

1,411 310 1,058 18 354 0 1,804 463 1810 0

OutFlow

23 27 93 3 37 57 129 52 63 9 6

Graph (6) showing flow of patients in and out of the provincial hospitals:

Chart Showing Flow of Patients In and Out of the Provincial Hospitals

-500

0

500

1,000

1,500

2,000

N R H

C h

o i s

e u

l

We

s t e

r n

I s a

b e

l

C e n

t r a l I s l a

n d

s

G u a

d a

l c a n a

l

M a

l a i t a

M a

k i r a

T e m o

t u

R e

n n e

l l B

e l l o

n a

H T C

Provinces

N o . o f R e f e r r a l C a s e s

In Flow

Out Flow





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Table (10) and Chart (2) shows Malaita (Kiluufi Hospital) have the highest number of patients in and out, but more referrals in than out. Followed by National Referral Hospitaland Western.

In 1999, there were 1,411 patients referred in to the National Referral Hospital, Honiara,through both the Outpatient (Referral) and directly from provincial hospitals. Referrals outare all to overseas hospitals. Of the total 23 referrals, 69.6% (16) went to St. VincentHospital in Sydney, 21.7% (5) to various hospitals in New Zealand, and 8.7% (2) toBrisbane.

Self-sufficiency in all provinces in terms of basic level of health care is indicated by many referrals in than out.

Malaita and, Western have relatively higher referrals out than all others because variousreasons such as frequent regular shipping and fights. In Temotu the increasing number of referrals out is due to absence of a medical professional. The reason for more referrals toNRH from the two major centers is the presence if induce demand by (more) doctors inGizo and Auki.

It is obvious that the level of sufficiency in providing higher tertiary care is very low in theNational Referral Hospital as indicated by the type of cases referred overseas .





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4.3. Secondary Health Care: Hospital Utilization:

Table (19) shows the Hospital Utilization Rates (number of admissions per 1,000 population)

*The provinces included under the catchment population for NRH are Guadalcanal, Central Islands and RennellBellona, including Honiara. Theses provinces have no hospitals but assumed NRH as the center for admissions. The Catchment population for NRH is therefore 169,942

(1997), 179,161 (1998) and 188,936 (1999) respectively.

** excluding private hospitals

The overall trend of utilization of the hospital services in the country is between short rangesof 34 to 36 admissions per 1,000 populations. However there are differences within theregion. Choiseul and Temotu the two furthest provinces are experiencing trend of utilization whilst Western is declining and the others (NRH, Isabel, Malaita and Makira)experiencing fluctuations. However, NRH utilization increased markedly in 199 but Isabeldeclined in 1999. The utilization pattern did not follow or correspondence with the patient

flow in table (10) because the majority of inflow of patients to the provincial hospitals wentas far as outpatient department (OPD) only. In other words, they did not needed to beinpatient.

Provinces/Hospitals

1997 1998 1999 AverageNationalReferralHospital*

34.8 32.5 37.6

Choiseul(Sasamuga)

58.0 59.2 64.1

Western(Gizo)**

33.8 29.9 28.6

Isabeli

(Buala)

44.7 49.4 34.7

Malaita(Kilu’ufi)**

37.9 39.7 33.7

Makira(Kirakira)

34.0 29.6 30.5

Temotu(Lata)

44.1 44.8 53.2

SolomonIslands **

34.4 34.9 36.1 35.1





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Table (20) shows Hospital Utilization in the National Referral Hospital

1997 1998 1999NRH Medical 4.3 2.7 4.43

Surgical 4.8 4.3 5.3Pediatrics 22.8 22.4 31.0Maternity 82.7 86.2 77.6

Graph (5) showing hospital utilization of National Referral Hospital 1997-1999

Chart showing hospital utilization of National Referral

Hospital 1997-1999

4.8 4.3 5.3

22.8 22.4

31

82.786.2

77.6

0

10

20

30

40

50

60

70

80

90

100

1997 1998 1999

N o

. o f a d m / 1 , 0

0 0 p o p

Medical

Surgical

Paedatrics

Maternity





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4.3.2. Bed Occupancy and Average Length of Stay:

Graph (7) showing total admissions by provinces & NRH:

Graph showing tota admissions by provinces & NRH

1,216 1,278 1,426

3,746 3,766

5916 5830

7102

3,531

01,0002,0003,0004,0005,0006,0007,0008,000

1997 1998 1999

Years

N o . o f a d m i s s i o n s

Choiseul

Western

Isabel

Malaita

Makira

Temotu

NRH

Kiluufi Hospital in Malaita recorded highest number of admissions in the years 1997 to 1999.Followed by `Western and Choiseul. The data contained in the table above, alone, does notexclusively indicate the workload and productivity but other information below further ourunderstanding on the resource use implications.





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Graph (8) showing bed occupancy rates (all beds) by provinces & NRH:

Graph showing bed occupancy rates (all beds) by provinces & NRH

62.1

7579.5

46.3

55.158

36.7 36.941

62.7 64.7 65.9

29.2

19.6

32.9

40.7 40.54545.8

48.4

63.3

0

10

20

30

40

50

60

70

8090

Years

%

Choiseul

Western

Isabel

Malaita

Makira

Temotu

NRH

Choiseul 62.1 75 79.5

Western 46.3 55.1 58

Isabel 36.7 36.9 41

Malaita 62.7 64.7 65.9

Makira 29.2 19.6 32.9

Temotu 40.7 40.5 45

NRH 45.8 48.4 63.3

1997 1998 1999

All provincial hospitals experience an increasing bed occupancy rate. Choiseul (Sasamuga)records the highest, followed by Malaita and Western Province. The pressure on bedscapacity to the increasing demand is an issue to be addressed in the in the future. Choiseulalso has the increasing average length of stay in the hospital. It may be due to limitedresources in terms of facility and manpower to ensure patient’s problems are diagnosed andunderwent treatment quicker. Other quality issues can also implied for example infectionrate. However, this report is not going in detail.





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Graph (9) showing trend of Average Lengths of Stay in provinces & NRH:

Graph showing trend of Acerage Lengths of Stay in provinces &NRH

6.5

7.57.1

5.8 6 5.9

8.4 8.387.6

7

10

8.2

9.3

10.7

0

2

4

6

8

10

12

Years

A L O S ( n o . o f d a y s ) Choiseul

Western

Isabel

Malaita

Makira

Temotu

NRH

Choiseul 6.5 7.5 7.1

Western 6.1 7.2 7

Isabel 5.8 6 5.9

Malaita 8.4 8.2 8.3

Makira 8.6 6.4 7.8

Temotu 8 7.6 7

NRH 9.3 10 10.7

1997 1998 1999

All provincial hospitals have recorded fairly a constant ALOS within the period 1997-1999.NRH has the highest ALOS. The specific reasons are known and need to be investigated.However, it implies the efficiency and effectivity of the hospital. An area of concern tomanagers since the hospital incurred a significant portion of the budget 14.

4.4. Pediatrics (Child Health)Services:

CHILD HEALTH CARE SYSTEM

14 Health Budget , MHMS





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The National Health Policies and Development Plan articulate a systematic approach tofurther develop and strengthen the Ministry’s capacity and capability. In particular the Planrecognises the need to:

Improve level of paediatrics services

Strengthen primary health care services in rural areas and to more fully utiliseexisting facilities and resources; and

Engage in health reform, particularly in the areas of capacity building inmanagement and supervision, human resources development, infrastructuredevelopment, health information and services planning and health financing.

The National Health Policies are further translated into operational activities that focus on vulnerable populations which include women and children. The Reproductive HealthDivision is responsible for programs that related to children and women’s health. Certainpolicies and guidelines has been developed, these include:

Nutrition Policy (1992)

Breastfeeding Policy (1995)

EPI Policy (1995)

Paediatric Treatment Protocol (2nd Edition 1995)

Disease-specific Programs There are also disease-specific programs currently implemented in the Solomon Islandsinclude:

ARI / CDD

Malaria Control

EPI Growth Monitoring / Breast feeding (Nutrition)

Vitamin A supplementation

Coordination and Provision of Care The Ministry of Health is the sole Ministry responsible for regulation, policy formulation andprovision of health services in Solomon Islands. The Ministry operates 75% of healthfacilities, church organisations 17% and industry (plantation clinics) 8%. There is a growing private general practitioner and malaria diagnostic service in Honiara. The Ministry operates

within a health care referral system which consists of a network of six different levels of health facilities from village health worker posts to the National Referral Hospital. This

referral system forms the structural backbone of the health care system in the country.

All hospitals in the country (both public (618 beds) and private (190 beds)) account for atotal 808 hospital beds. There are a total of 326 health centres / clinics through out thepublic health care system and 6 general practitioners, mostly working in the urban centres of Honiara.





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Decentralisation of Care:

Provinces such as Guadalcanal, Central Islands Province, Rennell and Bellona and Choiseuluse the National Referral Hospital as their base hospital. The Choiseul Province uses GizoHospital as its first point of referral. These provinces with an overall population of 124,400(1997 estimates) depends on the primary health care as the major means of receiving healthcare services. About 29.3% of the total population of Solomon Islands depend on Primary Health Care (PHC) services, exclusively. However, the Comprehensive Review of HealthServices Report (1996) reiterated the need for improvement of PHC as utilisation rates at theprovincial level are low at around 60%. Basic health care are further provided in the AreaHealth centres and Rural Health Centres, covering a population of less than 500 people.

4.4.1. Findings & Outputs:

Table (21) shows Hospital Utilization Rates in Paediatrics (Childhealth care services for <4yrsin the provinces):

Hospital utilization inpaediatrics varies by provinces. Temotuexperienced anincreasing utilizationfrom 1997 to 1999.

Whilst, other provinces were fairly stable.Graph (10) showing trend of utilization of hospital utilization in pediatrics in the provinces

72.7 74.1 71.9

61.656.8

70.5

81

101.3

44 43.1

55.2

35.9

0

20

40

60

80

100

120

1997 1998 1999

Period 1997-1999

N o . p e d i a t r i c

s a d m / 1 0 0 0 p o p

Choiseul

Western

Isabel

Malaita

Makira

Temotu

1997 1998 1999

Choiseul 43.2

Western 42.9

Isabel 72.7 74.1 71.9

Malaita 61.6 56.8 55.2

Makira 39.1 35.9 35.9





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The average length of stay in paediatrics in the provincial hospitals ranged from 4 days to 7days.

Graph (12) showing trend of ALOS in pediatrics by provinces & NRH

4.5. Obstetrics & Gynaecology Services:

The Ministry’s overall goal is to improve and upgrade the quality of obstetrics &gynecological services in the country. The key performances areas are:

Upgrading and improving the level of services in key hospitals and primary healthcare centers.

Training and staff developments of doctors and nurses

Protection of mothers during pregnancy

Improve collaboration and coordination with MCH/FP programs

There are objective guides the Ministry has established16 at the policy level for obstetrics carein the hospital settings. The six provincial hospitals should incorporate 75-80% bedoccupancy rate. This is to allow 20-25% bed safety. In practical sense it would mean forexample in Gizo Hospital of the total 14 maternity beds, the management would ensure that3-4 beds are always spared for emergency. However, this is not a strict ruling but amanagement tool.

16 Ibid

Graph showing trend of ALOS in pediatrics by provinces & NRH

6.9 7.1 6.96.7

45.9

0

5

10

15

20

25

30

Years

A L O S ( n o . o f d a y s )

Choiseul

Western

Isabel

Malaita

Makira

Temotu

NRH

Choiseul6.8 6.9 6.9

Western 5.9 5.7 5.6

Isabel 5.3 6.5 5.6

Malaita 6.9 7.1 6.9

Makira 6.7 4 5.9

1997 1998 1999





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4.5.1. Findings & Outputs:

Table (22) shows Hospital Utilization in Maternity (maternal care services) in the provinces:

Graph (13) showing trend of hospital utilization in maternal care services in the provinces:

Graph (14) showing trend of Bed Occupancy Rate in Maternal Care by provinces & NRH:

1997 1998 1999Choiseul 30.5

Western 34.7 32.3 35.1

Isabel 60.8 61.9 57.6

Malaita 35.9 35.9 36.8

Makira 49.2 45.6 45.7

Chart showing trend of hospital utilization in maternal care services in the provinces

30.5 32.3

61.9

35.9

45.6

63.7

35.1

57.6

36.8

45.7

64.7

0

10

20

30

40

50

6070

80

Choiseul Western Isabel Malaita Makira Temotu

N o . o

f m a t e r n i t y a d m / 1 0 0 0 p o p

1997

1998

1999

53.1

72.9 73.3

51.651.7

49.5

27.3

17.9

38

82.3

76

92.1

55

0

87.8

40.737.3 37.2

46.4

81

67.6

0

10

20

30

40

50

60

70

80

90

100

% B

O R

Choiseul

Western

Isabel

MalaitaMakira

Temotu

NRH

Choiseul 53.1 72.9 73.3

Western 51.6 51.7 49.5

Isabel 27.3 17.9 38

1997 1998 1999





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Graph (15) showing trend of ALOS in Maternal Care by provinces & NRH:

The average length of stay in maternal care is higher in the provinces in the range from 3.9to 11.8 days. Makira for some reason have the highest average length of stay.

5.66.1 5.9

5.14.8 5

5.5 5.7 5.56

7

13

11.8

4.2 4.1 3.9

2.92.5

4.1

6.9

10.6

0

2

4

6

8

10

12

14

A L O S ( n o . o f d a y s )

Choiseul

Western

Isabel

Malaita

Makira

Temotu

NRH


Western 5.1 4.8 5

Isabel 5.5 5.7 5.5

1997 1998 1999





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Graph (16) showing trend of ALOS in Maternal Care by provinces & NRH:

5.66.1 5.9

5.14.8 5

5.5 5.7 5.56

7

13

11.8

4.2 4.1 3.9

2.92.5

4.1

6.9

10.6

0

2

4

6

8

10

12

14

Years

A L O S ( n

o . o f d a y s )


Western 5.1 4.8 5

Isabel 5.5 5.7 5.5Malaita 6.9 6 7

Makira 13 10.6 11.8

Temotu 4.2 4.1 3.9

NRH 2.9 2.5 4.1

1997 1998 1999





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4.6. Access to Essential Drugs:

The National Pharmacy Services in its objective to increase access of essential to the localcommunity, concurs with the WHO’s Drug Action Program (DAP), which seeks to

strengthen the capacity in developing and implementing national drug policies and policy plans in order to ensure the availability and accessibility to all people of essential drugs of acceptable quality and rational use of drugs.

4.6.1. Inputs:

The consolidation of the draft National Drug Policy (completed in 1997) include thefollowing tasks:

Activities (Input) Output Progress/ Comment1. Technical Assistance from

WHO WHO requested in 1999. Not accomplished. Negative

response

2. Review of Essential Drug List (EDL).

Subcommittees or taskforcesformed to review the EDL.

Two follow up meetings held.In 999

Not accomplished. No review documents ready or completed.

3. Review of the Standard Treatment Guideline (STG).

As above As above

4. Review of Pharmacy Legislation

A NZ consultant didpreliminary review in 1999.However, the review is focusedon the MHMS restructuring and not direct to the NationalDrug Policy.

No follow up work is done.

Work force Distribution:

In 1999 there were total of 28 established pharmacy workers 17, which is about 2.4% of thetotal of the total health work force. Majority of the pharmacy personnel are posted at theNational Referral Hospital whilst 32% (9) are posted at the provincial level.

4.6.2. Output:

The Pharmacy Practitioners Act was passed and enacted through the date of issue on 10 th

July 1997. The Act is to regulate the practice of pharmacy in Solomon Islands. The Act is animprovement of the Pharmacy and Poison’s Act 1991 and hereby repeals certain provisionsof the pharmacy and Poisons Act, and to provided for matters connected therewith orincidental thereto.

17 Public Service Division (1999). Approved Recurrent Established Establishment Register, SIG. Honiara,pp. 125-158.





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Access to essential drugs indicators:

From the current data, there is an absolute figure of 70% of rural population having access to essential drugs.

The remaining 30% access to drugs by outreach visits and the existing health carereferral system.

In terms of therapeutic access , there is availability and access of basic essential drugs developedand marketed for the health problems and conditions occurring in the country.

The increasing concern to the government now is the affordability of drugs ( financial access)purchased overseas. With the financial crisis difficulty in ensuring a timely payment of essential drugs overseas are experienced.

Antimicrobial resistance to drugs:

There is no formal study on the antimicrobial resistance to drugs despite the fact that thereare resistance to chloroquine clinically.

4.7. Health Infrastructure development:

The Ministry’s policy on health infrastructure is to consolidate existing health infrastructure

and facilities rather than establishing new ones. However, exemptions are made for new facilities that would meet the criteria set in the policy governing health infrastructure 18.

18 The draft of the Policy governing infrastructure is completed.





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Tabel (23) : Level of Health infrastructure:Choiseul Western Isabel Central Islands Guadalcanal Malaita MUP Temotu Rennell

Bellona97 98 99 97 98 99 97 98 99 97 98 99 97 98 99 97 98 99 97 98 99 97 98 99 97 9

overnment

ospitals 0 0 0 1 1 1 1 1 1 1* 1 * 1* - - - 1 1 1 1 1 1 1 1 0

HC 2 2 2 4 4 4 3 3 3 0 0 0 3 4 4 3 3 3 3 3 1 1 1 1

HC 6 8 8 16 16 16 10 10 10 4 4 4 10 10 10 20 20 20 12 12 5 5 5 1

AP 11 12 12 18 18 18 15 15 15 15 15 15 7 7 9 33 33 33 14 14 6 6 6 1

HW 10 11 11 40 40 40 9 9 9 12 12 12 3 0 0 54 54 54 14 14 0 0 0

vate/

GO:

ospital 1 1 1 1 1 1 - - - 1 1 1

HC 1 1 1 1 1 1

HC 1 1 1 1 1 1 1 1 1 5 5 6

AP 1 1 1 1 1 1 3 4 4

HW 0 0 0

tal 32 36 36 80 80 80 40 40 40 34 34 34 32 31 34 112 112 112 44 44 13 13 13 3

By end of 1999, there are 9 hospitals. Five (5) provincial government hospitals, 2 churchhospitals (Helena Goldie Hospital in Munda, Western Province, and Atoifi Hospital in EastKwaio). Two (2) are designated as provincial (Mini) Hospital, and they are Tulagi andSasamuga). Twenty-three (23) AHC (Area Health Centers, 95 Rural Health Clinics, 129Nurse Aides and 154 (Village Health Workers Posts). Total of 356 health facilities (notincluding the VHW posts. VHW posts are not included in the count because of theinstability of their existence in the provinces. Since their establishment of the VHW early in1990s, they are not recognized as formal health delivery structure because of the relatively

very low skill but deemed as first aid community health workers. Nonetheless, they havereceived great support and assistance by way of funding through some provincial healthservices, training and supply of essential medical supplies.

However, the conditions of most health infrastructure in the country have deteriorated inthe past ten years. The plan to rehabilitate these facilities is not possible due to lack of funding. The previous rehabilitation was done in 1992-94,which was funded by EEC. Someprovinces were not included. Other adhoc-based assistance in rehabilitation was done in

varies sites in the provinces, which were funded by the Canadian Aid.

The phase 3 rehabilitation of the National Referral Hospital started in 1998 with the funding

from the Government of Republic of China, and still in progress. Kilu’ufi Hospital had somerenovation done with the assistance from Rotary Club.

A national health infrastructure plan was drawn by the MOH in collaboration of Ministry of Development Planning in 1999 but was not implemented because of the lack of funding.

The ethnic tension significantly affected the possibility of acquiring funding.





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SECTION V: HEALTH IMPROVEMENTSERVICES:

Whilst health care and health improvement are technically overlapped and not separated, formonitoring and evaluation purposes they are considered independently in the report. Thekey role of the health improvement side of the health sector is prevention of diseases andprotection of health (not merely absence of disease but also well physical, social andmentally).

5.1. The Healthy Islands, Health City, Initiatives19

The Healthy Islands, Health City Initiatives is a new approach to ensure multiplestakeholders involvement in health developments to prevent illnesses and protect health inthe world. The settings represent social systems, which are deeply binding, involve frequentand sustained interactions, and are characterized by multiple forms of membership andcommunication. Settings, as a context for relationships, may also exert direct and indirecteffects on health, and acting on community-level influences may need to parallelinterventions with individuals.

The Fourth International Conference on Health Promotion, held in Jakarta in 1997 affirmedthe “settings” approach as an effective strategy for health promotion. The JakartaDeclaration also recognized that a multiplicity of interventions was most effective. Diverse

health realities, along with diverse social, economic, and political realities, demand that healthprotection and promotion efforts take into account the contexts for intervention as well asthe evidences base for effective interventions.

Recognizing that Healthy Islands/Cities initiatives is using the settings approach to promoteand advocate for supportive environment for health, Solomon Islands became a party to the“Yanuca Island Declaration” in 1995. This was reaffirmed in “The Raratonga Agreement” in 1997.In adopting this approach, Solomon Islands use the Malaria Control Program as the entry point.

It was shown through this approach that in 1999 the total number of cases recorded was

only 63,853 or the annual incidence rate was 145 cases per 1000 population, a decline of over67 percent. An intensified malaria control program in Honiara launched by WHO and theMinistry of Health in 1995 has reduced the incidence rate from 1072 cases per 1000population (1992) to 187 cases per 1000 population in 1999. This is a significant reduction of 82% in the capital city. Deaths due to malaria have also declined by 50 percent since 1995.

19 Dennie Iniakwala (2000). Report by Dr. D. Iniakwala during the Workshop on Health Islands Iniatiative,unpublished paper.





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Solomon Islands joined other Pacific Island Countries in endorsing the Palau ActionStatement in March 1999, Korror, Republic of Palau. The Palau Action Statement calls forcountries to set short-term targets and to increase efforts to involve private sector, especially in the areas of healthy work place, including tobacco and alcohol consumption. It also callson Countries, in collaboration with the World Health Organization (WHO) to address theissue of alcohol abuse and tobacco consumption.

Other activities following the Palau Meeting:

Following the Palau meeting in March 1999, the following short-term targets were adoptedby the Ministry of Health:

Establishment of the Honiara Healthy City Co-ordination Committee (HHCCC)

Establishment of the Honiara Youth Taskforce

Honiara Tree Planting

Legislation to Control Tobacco promotion, sale, and consumption

Establishment of the Honiara Healthy City Co-ordination Committee (HHCCC):

In June 1999, the HHCCC was established with members drawn from the Ministry of Health, Honiara City Council, Business, Media, Education and Police sectors. Series of meetings were held to coordinate activities in Honiara that related to healthy environment.

This includes issues like waste management, tree planting, malaria control and generalcleanliness.

Establishment of the Honiara Youth Taskforce:

Youth issues such as alcohol abuse has been on the rise, especially in Honiara and otherurban centers. A youth taskforce was established in May 2000. The taskforce is comprises of representatives of all youth groups in Honiara, including the churches and NGO’s.

The 1999 census indicated that almost 42 percent of the population were under 15 years andthe majority of the population was under 25 years. Yet this large population had beenconsistently ignored. The National Youth Policy (NYP) defines youth as those between theages of 14 and 29 years old. Like the Women’s Policy, the NYP cuts across various sectors.

Two major objectives of the NYP to ensure gender equity and equality for all young peoplein the access to education and training, and the promotion of health programs with specialfocus on unwanted pregnancies, STD/HIV/AIDS and other youth social problems. The

NYP also aims to promote population education, including family life education, throughthe formal education curricula.

Given the high growth rate of the population, high rate of school drop out and/or pushouts, and slower pace in new job creation, youth in Solomon Islands are particularly disadvantaged in getting employment in the formal sector. In all respects the ethnic tensionshave worsened the situation of youths. Most of the youngsters in the displaced families are





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not only disadvantaged from pursuing further education or securing job in the formal sector,but are now vulnerable to the various kinds of dangerous life styles.

As the social unrest intensified by mid 2000, it became difficult to organize or convene any meeting as most the youth are either join the militants or left Honiara.

Honiara Tree Planting:

Honiara Tree Planting has been organized by Chamber of Commerce and assisted by theHoniara City Council, Youth Groups and other NGO’s. By May 2000, several trees wereplanted along the Honiara main road and was launched by the Governor General.

Young people volunteered to look after the trees and several business houses offered tosupport the tree panting at various points along the main street. Due to the ethnic unrest,this activity was halted and although resumed by November 2000, it is difficult to continuebecause of lack of interest and destruction of the plants and inability to maintain law and

order in the City.

Legislation to control tobacco promotion, sale and consumption:

A draft Tobacco Product Control Bill approved by Cabinet in September 1999. This wasrevised following a review, which identified certain gaps and deficiencies. The re-drafted bill

was sent to the Attorney General Chambers to be reviewed by the Legal Draftsman. Sincethe social crisis intensified, the priority for government bill changes and hence the delay incompleting the final draft before it can be tabled in the parliament.

It is anticipated that following the passage of the bill, tobacco control activities will gain

momentum especially in the areas of promotion, sales and consumption.

5.2. Morbidity and Mortality Reduction:

5.2.1. Overview:

The conventional indicators such mortality and morbidity rates are used as the measure of the status of population health due to lack detailed measurements to capture the meaning of health as defined in WHO Constitution (“Health is a state of complete physical, mental andsocial well-being and not merely the absence of disease or infirmity”). However, themeasurement is also viewed to imply the demand for health primary care services in theprovinces.





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Infant Mortality Rate / 1000 live births

1976 1986 1999

IMR / 1000 70 38 28

Five Top Causes of Death in Infants (%)

Cause 1994 1997

1999

Complications of Delivery 32.6 13.6 42.9Pneumonia 8.7 34.6 9.5Malaria 13 3.7 14.3Diarrhoea 13 7.4 9.5Meningitis 4.3 12.3 7.1Others 28.4 28.4 16.7

Five Top Causes of Deaths in Children 1-5 yrs (%).

Cause 1994 1997 1999Malaria 41.7 33.3 25.0Pneumonia 16.7 12.8 16.7Diarrhoea/Dysentry16.7 10.3 16.7Accidents 8.3 7.7 7.9

Meningitis / Septicaemia 8.3 5.1 16.7

Graph (17) showing diseases trend in SI from 1997-1999.

Acute Respiratory Infections(ARI) is the commonestillness recorded in the three

years period 1997 to 1999.Fever is the commonestconventional symptomsuffered and presented withat the primary health carecenters such as the AreaHealth Centers, Rural HealthClinics, Nurse Aide Postsand Village Health Workers

Aid Posts. Followed by eyeinfections, yaws, diarrhea and

Sexually TransmittedDiseases. Vaccine-Preventable diseases are very low but remains potentialthreat to the children.

5.2.2. Infant Mortality:

The infant mortality rates (IMR), reflect major improvements during the past 2 decades,dropping from 70/1,000per live births in 1976 to

28/1,000 live-births, in1999. Infant mortality rate in Solomon Islandsis acceptably below TheGlobal Strategy forHealth for ALL by year2000 guiding target of IMR 50 per 1,000 livebirths. The major causesof mortality arecomplications of childbirth; pneumonia,

malaria, diarrhoea andmeningitis which,

accounted for 83% of infant death in 1999. It can also be noted that the most commoncause of infant death in 1999 was those related to complications of childbirth.

The childhood (<5 years) mortality rate is not known, however, the most common cause of deaths in children under 5 years is malaria, followed by pneumonia and diarrhoeal diseases. This trend isconsistent through the last five years. Malaria accounts

Graph showing diseases trends in Solomon Islands from 1997-99 (No. of new casesper 1,000 population).

0

100

200

300

400

500

600

700

1997 1998 1999

ARI (ALL)

ARI(Severe)

Diarrhoea(All)

Diarrhoea(withbloo&dysentry)Fever

Red eyes

Yaws

Skin diseases

Ear infections

Neonatal tetanus

Tetanus

Whooping cough

Suspected Polio

Measles

Penile discharges

Sources: HIS Annual Reports 1997-99, MOH (not ICD10 based).





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Graph (18) showing incidence of ARI by provinces 1997-99:

5.2.3. Acute Respiratory Infection (ARI):

Graph (19) showing trend of incidence of ARI in SI

The Acute Respiratory Infection has been thecommonest illness inchildren and adults. Inthe period 1997 to 1999incidence of ARI range

from 350 to 450/ 1,000populations. However,severity impact of theillnesses is well below 25cases /1,000 population.

All provinces recordedaround 300 cases per 1,000 population and above, within the three year period (see table)below. Isabel, Malaita, and Renell Bellona recorded highest cases per 1,000 population in1997, whilst Choiseul, Western Province, CIP and Temotu in 1999. Of all provinces,Rennell Bellona recorded the highest incidence of severe ARI in 1997. It was not confirmedat that time whether it was an epidemic.

Graph (20) showing incidence of ARI & Diarrhoea inchildren <5yrs in Solomon Islands

G r a p h s h o w i n g i n c i d e n c e o f A R I b y p r v o i n c e s 1 9 9 7 -

1 9 9 9

0

1 0 0

2 0 0

3 0 0

4 0 0

5 0 0

6 0 0

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

1 9 9 7

1 9 9 8

1 9 9 9

C h o i se u l W e s t e rn C IP Is a b e lG u a d a l ca n a lM a l a it a M a k i ra T e m o t u H o n i a ra R e n B e l l

I n c i d e n c e / 1 , 0

0 0 p o p

A R I ( A L L ) A R I (S e v e r e )

Graph showing trend of incidence rates of ARI in Solomon

Islands 1997-99

0

100

200300

400

500

ARI (ALL) ARI(Severe)

I n c i d e n c e

r a t e s /

1 , 0

0 0 p

o p .

1997

1998

1999





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Incidence of ARI inchildren under 5 yearsold is very high. Thehighest of the threeyears was recorded in1997.

5.2.4. Diarrhea:

Graph (21) showing trend of incidence of Diarrhoeal Diseases 1997-99:

0

10

20

30

40

50

No. of new cases/

1,000 pop

Diarrhoea(All) Diarrhoea(with

bloo&dysentry)

Chart showing trend of incidence of Diarhoeal Diseases 1997-99

1997

1998

1999

Graph showing incidence of ARI and Diarrhoea in chidlren

<5 yrs in SI

0

200

400

600

8001000

1200

1997 1998 1999 N o . o

f c a s e s / 1 , 0

0 0

p o p

< 5 y r s

ARI (ALL) Diarrhoea(All)





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during the period of 1997-99. Their provincial visits were regular with good coverage of theprovinces. Financial constraints were the limiting factor. The primary eye care training continued with provincial nurses trained in eye care.

Graph (23) showing incidence of red eyes by provinces 1997-99:

By end of 1999 there were smaller eye careunits at Gizo, Kiluufiand KirakiraHospitals, whichprovide basic primary care service to theprovinces.

Ranges of tertiary eyecare services were also

made availablethrough the PacificIslands Project by the

Royal Australasian College of Surgeons and funded by AusAID. The Phase 2 of the PIPstarted in 1 May 1998, after which ophthalmology visits to Solomon Islands took place in15-May 1998, and 15th-May 1999.

In 1997, of the total 133 eye swab examined by the Bacteriology unit of Medical Laboratory,NRH, 12% (i.e.16) were due to N.gonorrhoea, Staph.aureus 8%(11), Klebsiella 4.5% (6),pseudomonas 6.8% (9), heamophilus sp. 6% (8), strept. Pneumoni 3.8% (5) and E.Coli 6%

(8).

5.2.6. Yaws:

Yaws remain a health problem through out the country. Temotu, Western, Malaita andMakira reported higher number of new cases per 1,000 populations. There was no yawscampaign in the past years.

Graph (24) showing incidence of Yaws in SI

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Graph showing incidence rates of Yaws in SI

S1





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Graph (25) showing incidence of Yaws by provinces 1997-99.

5.2.7. Ear infections:

Graph (26) incidence of ear infections by provinces & SI:

Ear related problems were fairly constant between 40-60 cases per 1,000 population in thepast three years 1997-99, but varies by provinces. Western, Temotu and Honiara reportedhigher number of cases. In 1997 total of 112 ear swabs were examined at the MedicalLaboratory, NRH, of which 11.4% (i.e. 98) specimen were culture positive. Majority of theculture positives (50%) were due to pseudomonas (49), proteus (25), klebsiella (14), E.Coli(7), and Staph.aureus (7).

010203040506070

No. of

new

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00 pop

1997 1998 1999

years

Graph showing incidence rates of ear

infections in SI

SI

Graph showing incidence of Ear

infections by provinces, 1997-99

020406080

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Graph showing incidence of Yaws by provinces

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15.2.8. Vaccine preventable diseases:

5.2.8.1. National Disease Surveillance:

Guadalcanal recorded 29 cases of whooping cough in 1998 and 4 cases in the previous by nurses at the rural clinics. Malaita also reported one each cases of neonatal tetanus andtetanus respectively. However, all these two cases were not clinically confirmed. Thus, there

was doubt in the accuracy of the reporting.

Graph (27) showing incidence of vaccine preventable Illnesses in SI 1997-99

Source: HIS, MOH

Graph showing incidence of vaccine preventable

diseases in SI, 1997-99

0

0.01

0.02

0.03

0.04

0.05

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1997 1998 1999

I n c i d e n c e r a t e s Neonatal tetanus

Tetanus

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Measles





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% Immunization Coverage Rate (Cases)

1994 1995 1996 1997 1998 1999

BCG 76 77 73 73 72 64Hep B3 67 71 72 73 71 62DPT3 68 69 77 72 69 61Polio3 68 68 72 70 69 60Measles 61 68 67 68 64 59TT2 56 71 63 54 55 50

Immunization Coverage Surveyin Malaita (%)

1999

BCG 99.1Hep B3 99.1DPT3 86.7Polio3 84.6Measles 58.8

Graph (28) showing incidence of vaccine preventable illnesses by provinces in 1997-99:

Graph showing incidence of vaccine-preventable diseases by

provinces

0

0.05

0.1

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ChoiseulWestern CIP IsabelGuadalcanalMalaita Makira TemotuHoniaraRenBell

I n c i d e n c e r a t e s Neonatal tetanus

Tetanus

Whooping cough

Suspected Polio

Measles

5.2.8.2. Immunization Coverage:

Immunization coverage has remained high but decreasing over the last six years. It isbelieved that this could be due tothe over estimation of the

population. This has been verified through an immunizationcoverage survey in Malaita province in 1999. The overallimmunization coverage has remained over 80% compared to the reported coverage.





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5.2.9. Sexually Transmitted Infections:

Graph (29) showing incidence of STI in Solomon Isl:

Sexually transmitted Infectionremains a public healthproblem. There is under-reporting of cases.

Rennell Bellona, Temotu andHoniara reported highernumber of STI symptoms.

In 1998, total of 2,235 genitalspecimens (pus swab) werecollected from STI clinics inHoniara20. Of the totalspecimen collected 13.4% (300) were positive for N. Gonorrhoea. Fifty-five (55) positivespecimens were penicillin resistant (i.e. 18.3%).

20 Medical Laboraory, National Referral Hospital (1998): Annual Health Report.

Graph showing incidence of Sexually Transmitted

Diseases in S1, 1997-99 (by symptoms)

0

0.5

1

1.5

2

2.5

3

Penile discharges Vaginal discharges Genital ulcer

N o . o f n e w c a s e s / 1 , 0

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Graph ( 30) showing incidence of STI by provinces:

5.2.10. Malaria:

5.2.10.1. Activities & Findings:

Solomon Islands continue to make a good progress in the last three years with malaria-control activities21, 22. In 1999 the incident rate is down to 144/1000 pop, which is 64 pointsyet to reach 80/1000 pop as the program’s objective target for 2003. It implies furtherachievement of 16 points down with in the next four years. In 1999, in Honiara alone thereis a significant reduction of over 80 % . Rates of net re-treatment through out the country remain high. They stand at more than 80% in all provinces. This indicates that the modifiedre-treatment methods introduced in the past few years have been successful. For the country as a whole, more than 70% of the population is no w protected by nets. The program’sobjective is to have 95% of the population protected by nets in three years time. It impliesfurther strengthening and improvement of compliance towards bednets.

21 Kevin Palmer (2000). Mission Report, Solomon Islands 12-19 Feb.2000, Regional Office For theWestern Pacific of WHO, Manila22 SI Malaria Control Program (1999). Annual Report 1997,1998,1999. Unpublished Paper, MHMS.

Graph showing incidence of STD by provinces, 1997-99

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Choiseul Western CIP IsabelGuadalcanalMalaita Makira Temotu Honiara RenBell

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5.2.10.2. Accomplishments:

In 1992 there were 153,359 cases of malaria or 440.5 cases per 1000 population . In 1999 theannual incidence rate was 144 cases per 1000 population a decline of over 67 % compared to

1992 (Figures 1, 2 and 3).

Figure 2: Annual Incidence rate of malaria in Solomon Islands 1969-1999

Figure 2

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Annual Incidence Rate of malaria in Solomon Islands 1969-

1999.

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353347

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Figure 3

5.2.10.3: Incidence in the provinces

Figure 4 shows the trend in the annual incidence rate recorded in the provinces. Theincidence rate has decreased in all provinces except Central and Malaita.

Figure 4: Trends in the annual incidence rate of malaria inHoniara and the provinces 1992-99:

63 65

116

141

153

126131

118

85

68 73

64

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Trends in the Annual Incidence Rate of malaria in Honiara and the

provinces 1992-1999.

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Figure 5 shows the trend observed in the percentage of Plasmodium falciparum cases.Since 1992 the parasite formula index had reversed from being predominantly P. falciparumto a mixed situation with Plasmodium vivax being predominant in several provinces. But in

1998 and 1999 an increase in P. falciparum cases in all the provinces was recorded. P. vivaxcontinues to the dominant species in Isabel provinces. Further studies are in progress toarrest this trend.

Figure 5

The Slide Positivity Rate (SPR) had declined from 39% in 1992 to 20% in 1999 (Fig 6).

Figure 6

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Percentage of P. falciparum infection

% 62 62 70 63 62 60 63 61 52 55 66 69

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

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1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

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SLIDE POSITIVITY RATE IN SOLOMON ISLANDS





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5.2.10.4. Diagnosis & Treatment:

The prompt diagnosis and appropriate treatment of all malaria cases continues to be

the most important component of the National Malaria Control Programme.

Accomplishments:Malaria cases are diagnosed either clinically (based on symptoms) or by microscopic

examination. Where microscopy is available, slides are taken from all fever cases andsuspected cases of treatment failure. The proportion of suspected cases diagnosed by microscopic examination has increased as the number of microscopists in the country hasincreased from 67 in 1992 to 135 in 1999. Blood slides are read immediately and the resultsused for the treatment of patients.

All malaria microscopists have been trained to carry out in-vivo drug sensitivity testsas a way to constantly monitor the effectiveness of the drugs being used. This network wasstrengthened through increased supervision and further training courses in 1997-98.

A network of twenty surveillance agents was established in February 1997 in Honiara.It has been successful in supplementing the already effective diagnosis and treatmentservices provided by Central Hospital and nine Town Council clinics. The agents are able todetect and treat cases that do not seek treatment and to follow-up cases to ensure that eachcase is fully treated. They have also been able to identify and treat malaria cases that are new arrivals or visitors thereby reducing the source of imported cases.

The mass blood examinations conducted in Honiara during 1996 - 1999 were effectivein detecting and treating a large number of “inapparent malaria infections”. The operationin 1996 covered approximately 9,000 people living in the most highly malarious parts of Honiara. More than 6,000 slides were taken, 13% were positive. During 1997and 1998 the

population covered was expanded to approximately 32,000, 19,000 slides were taken, 13% were positive. In 1999 this programme was integrated along with the routine surveillanceoperations. Mass blood examinations are done regularly in residential schools at thebeginning of every year. Mass blood examinations are conducted in other provincial areas asan additional means of reducing the overall “parasite reservoir” in high incidence villages.

5.2.10.5. Key Issues & Problems Experienced :

Major problems are related to the lack of timely receipt of monthly grants by provinces from

central government. In many cases are more than six months late. This means that for shortperiods work comes to a halt, and in many provinces money is borrowed from themosquito-net fund just to maintain basic operations. All this is a consequence of the pooreconomic situation that the government is facing, partly as a result of recent ethnic tensions.

5.2.10.6. Analysis of the Program:





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The strength of the program since 1997 and even before that is the continued support from WHO and other developing partners such as AusAID, Rotary Club and SPC. Whilst theabove boosted the integrated malaria control program the improvement of MalariaReporting System is also noted.

As an accomplishment of its own, a computerized malaria information system (MIS) wasintroduced in Honiara and Guadalcanal Province in 1995. The system allows weekly reporting of malaria cases, automatic generation of monthly reports, and analysis of cases by age, sex and locality. The system was upgraded in 1997 to incorporate databases for massblood surveys, spraying, and mosquito net distribution. With this system, the Program isable to track reported cases and maintain a history of spraying and mosquito net distributionfor each household .In early 1998, a modified version of the MIS was setup in Western and Choiseul provincesand later extended to all other provinces. These provincial systems will eventually be linkedinto a national reporting and management network.

A system for the regular collection and quarterly reporting of information on malaria deaths will

be established in every province. This will include the establishment of a standard format forthe investigation of deaths. This mortality information will be reported quarterly.

The introduction of pre-packed drugs for both vivax and falciparum malaria, and theintroductions of primaquine in Honiara on a trial basis for the treatment of vivax malariahave both very successful. This will soon be expanded to cover the entire country. Asmentioned above great effort is still needed to expand the usage of bed-net to cover theentire population.

5.2.11. Tuberculosis:

TB and leprosy control programs are long established in the country. In 1990 the program was boosted by JICA completing the traditional donors such as WHO and Pacific Leprosy Foundation New Zealand

5.2.11.1. Activities (Input):

The strength of the National TB and Leprosy Control Program rests on a small TB/Leprosy unit under the umbrella of the Disease Control and Prevention Center (DCPC) of the

Ministry of Health. The latter with only a establishment strengthen of 4 health workers, thesupport and efficiency provided by the Provincial TB/Leprosy Coordinators and fellow nurses at the area health centers, rural health clinics, nurse aide posts and village health aidposts is crucial and has been very good. Further boost to the program was the inception of the Short Course Chemotherapy in 1996 and 1997, after a short trial in northern region of Malaita Province in 1995. The program has been supported (at adhoc basis) by the ResearchInstitute of Tuberculosis (RIT) in Tokyo, a WHO collaborating center for monitoring TBepidemiology in the Western Pacific Region. The program has been reviewed by external





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reviewers followed by a national conference, which deliberated, on the findings for thepurpose of strategic planning. Continuous health workers training and regular provincialtours were done to increase knowledge and skills of both the health workers and thecommunity on the problem. One of the main agenda of the trainings and supervisory visitsis the introduction and sustaining of the Direct Observation Therapy Strategy (DOTS). It isapparent that the DOTS coverage has been increasing and notes to be successful in the pastthree years.

5.2.11.2. Findings (Outputs):

Supervisory Tours:

1997 Coverage (%) 1998 Coverage (%) 1999 Coverage (%)

Nk Nk 8/10 80 8/10 80

. In 1999, the Cure rate for the National Tuberculosis Control Program has alsoincreased from 30% in 1996 to 83.3% in 199823. However, cure rate is just below 85%mark by WHO. The treatment successive rate is 92.0%. Nonetheless, individualprovinces like Western (87.5), RBP (100), Temotu (100), Makira (100), Choiseul (94.7),and Isabel Provinces (92.3) have cure rates more than 85% (higher than WHO mark).

The provinces needing further improvement are Guadalcanal (72.7), Malaita (79.3)Honiara City Council( 50), and CIP (83.3). The above results are unweighted against thenumber of case holdings.

There has been a significant decline over the past 13 years (1986-1999) irrespective the

fluctuation in between the period, from 102.1 new cases detection rate (NCDR) per100,000 pop down to 64.2/ 100,000 pop. (I.e. 225 new cases detected end of 1999). Of the total new cases 72% are PTB and 28% others.

Relapse of cases of TB amongst children is less frequently notified nowadays. Due tohigh treatment successive rate and BCG coverage.

It is apparent that the BCG coverage is underestimated in the Health InformationSystem. According to the Disease Prevention and Control Center (DPCC?MOH) theaccurate estimate would be more than 80%.

It is puzzling to variation to conversation rates between hospitals. Sasamuga, HGH,Kirakira, Buala and Atoifi Hospital have 100% completion rate end of 2 monthsinpatient. Whilst, Lata, NRH, Kiluufi Hospitals have less than 80% end of 2 months,but 100% end of three months (a month extra of treatment).

23 Ken Konare (1999).





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5.2.12.3.Analysis:

The access to mental health services is fairly limited in terms of mental health workers torural population.

Secondly, it is evident that the pressure onmental health services is increasing. Thetotal number of cases seen (as outpatient inHoniara Psychiatric Center) and admissionat the National Psychiatric Hospital Kilu’ufiHospital increased from 663 in 1997 to 915in 1999, with an average of 764 per year.

Thirdly, it also implied the impact of mental health illness on the local community has

increased. By 1999 in a population of 10,000 people 19.9 (about 20) people have came down with mental health problem. An increase from 15.6/ 10,000 population in 1997.

5.2.12.4. Major Issues/ problems & recommendations:

The main issue is the Ministry’s capability to sustain both institutionally and financially, thepsychiatric health services in the country in light of the limited resources.

Secondly, the issue of increasing accessibility through the primary health care approach hasbeen preferred. A problem experienced with the psychiatric outreach health visits to otherprovinces was the irregularities of tours because of untimely payment of grants (imprest),and limited qualified staff. Recruitment of a psychiatric was difficult process, which is partly due to lack of government’s commitment to the services.

Thus, the drive towards primary health care approach is crucial in light of the current limitedresources in terms of manpower and funding.

It would also be helpful for a detailed epidemiological study on mental health illnesses to becarried in the next few years to ascertain the attributable factors, so as to enable existence of

a preventable and health promotion program.

Table C:

Overall Total Casesrecorded at the National Psychiatric Unit,

Kiluufi Hospital & Honiara in 1997,1998,&1999.

1997 1998 1999 Total Admin &seen

663 715 915

New M 158F 79

Total new 237 222 117





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SECTION VI: ENVIRONMENT HEALTHSERVICES:

6.0. HEALTH AND ENVIRONMENT24

6.1. General protection of the environment

The Solomon Islands Government recognizes the importance of our environment to thehealth, welfare and economic development of this country. The Cabinet has endorsed in1991 the National Environmental Management Strategy, which is implemented by theEnvironment and Conservation Division of the Ministry of Forestry, Conservation andEnvironment.

The strategy itself is a step forward to ensuring sustainable economic development andenvironmental management for the Solomon Islands.

The Environment and Conservation and Environmental Health Divisions collaborate inensuring environmental impact assessments are conducted to assess impacts ondevelopment using local staff or overseas consultants.

6.2. Air (pollution)

The Environment and Conservation and Environmental Health Divisions have realized thatthere are potential effects air pollution can cause to the environment. At this stage thecountry does not have the means to undertake air quality monitoring.

6.3. Water quality

The Water Resources Management Division of the Ministry of Forestry, Mines and Mineralsis responsible for the monitoring of water resources in the country. The Division hastrained personnel and the Government has made equipment available with assistance fromoverseas donors.

The facilities for quality control for both bacteriological and chemical analysis is inadequate,this is particularly true for chemical analysis. The country is adopting the safe standards fordrinking water recommended by WHO.

6.4. Solid waste disposal

Solid waste disposal is becoming a problem in urban places like Honiara particularly for toxic wastes such as hospital and industrial wastes. There is a need for a new dumpsite to beidentified for Honiara as soon as possible and need for improvement in the managementtechniques of the dumpsite.

24 WHO, Honiara Office. Evaluation of the Implementation of the Strategy For Health For All By The Year2000, 3rd evaluation, Solomon Islands.





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6.5. Food safety

Food safety has been strengthened through the enactment of the Pure Food Act and theConsumer Protection Act by Parliament to be implemented by the Environmental HealthDivision of the Ministry of Health and Medical Services and the Consumer Affairs Divisions of the Ministry of Commerce Employment and Trade.

The Environmental Health Division has participated in the Codex Alimentarius Commissionthrough the South Pacific Commission.

All inspectors of the two ministries have been trained to perform food inspection.

The Public Health Laboratory with the MHMS has limited scope in the food analysis due tolack of adequate facilities and qualified staff.

The HTC Health Inspectors have been trained in the HACCP and have been running aprogram for selected food establishments in Honiara since 1995.

The HTC has had an educational program for the mothers in town in the hygienic preparationof food for sale to public. This program has often been disrupted by lack of financial support.

There has never been a major outbreak of food borne disease recorded in the country and thesituation is considered at present relatively safe.

6.6. Housing

The housing situation in the rural Solomon Islands is that every family has a house built of localmaterials, which is adequate in construction. Some well to do Solomon Islanders living in rural

villages have built themselves buildings of permanent structure.

In urban places such as Honiara and other centers the employers provide houses for the workers both with the public and private sectors. There are people who are unfortunate not tohave a house whereby they have to find a home with a friend or shift to the outskirts of thetownship to settle in the slums. This is increasing in Honiara. Some persons have access toloans from financial institutions to build their houses; this does not apply to most people in therural villages since they are not on regular earnings.

6.7. Work place

Those who are on regular employment both in the public and private sectors are protectedunder the Labor Act, which provides the conditions of service regarding wages, and housing and other benefits to which a worker is entitled. This is being implemented by the LaborDivision.





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The Safety at Work Act protects workers who are likely to be subjected to risks of occupationalhealth and is being implemented by the Labor Division of the MCET. The WorkersCompensation Act is currently under revision, particularly with regard to the medical conditionscovered under the Act.

For environmental issues such as air, radiation and chemicals the country does not have thenecessary equipment and expertise to deal with these and to a large extent depends on overseasconsultants should the need for such risk assessment arises.





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6.8. Water supply and sanitation

6.8.1. Indicators

1. Percentage of the population with safe drinking water available in the home, or withreasonable access:

By 1999, 70% of people have access to safe water as compared to 64% in 1996(estimate from RWSS, MHMS).

2. Percentage of the population with adequate excreta disposal facilities available:

By 1999, it is estimated that 25% of the population have access to proper sanitationas compared to 9% in 1996 (estimate from RWSS, MHMS)

6.8.2. General

In 1979 the Environmental Health Division of the Ministry of Health commenced theimplementation of a construction program to build safe and secure water supplies for rural

villagers throughout the country. Up to 1990 Governments of Australia and New Zealandand the UNDP and WHO were major contributors.

In 1990 the Solomon Islands Ministry of Health and Medical Services prepared a report onprogress and direction of the Rural Water Supply and Sanitation (RWSS) program, which

was submitted, to the Governments of Australia and New Zealand. In February 1995 aproject design document was prepared which describes a five-year RWSS project to runfrom 1995 to 2000, with project funding from GOA, GNZ and the Solomon Island

Government. A Project Memorandum of Understanding was signed on 31 August 1996.

The project is expected to increase the percentage of population with safe water to 70% by the year 2000 and the population with adequate sanitation facilities to 25%.

The project will also build capacity in the Environmental Health Division (RWSS) through:training of staff, establishment of database management system, construction of a new officeand establishing several new provincial Office/Store complexes, improving storage facilitiesand stock recording system, and provision of additional transport equipment. Emphasis willbe given to strengthening community awareness and participation so that communities havethe capacity to manage their own water supply and sanitation systems. The villagehealth/RWSS committees will be reactivated or established to play a central role in theplanning, management and maintenance of WSS facilities.

The RWSS project will receive funding from three sources: the Governments of SolomonIslands, Australia and New Zealand. The projected funding is expected to be SBD 40.4million with SBD 11.5 million from GOSI, SBD 27.6 million from GOA and SBD 1.2million from GONZ.

The major constraints faced by the Government are:





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1. Lack of trained professionals2. Inadequate organization and management

3. 4. Lack of community involvement

4. Insufficient health/hygiene education

5. Inadequate cost recovery framework

Table showing expected water supply and sanitation service coverage achievements – RWSSProject 1996-2001.

RWSSPresentSituation1996

Expected YearlyAchievement

Expected end of Project(Year 2001)Situation

Total Population 407,634¹ 467,770³

Rural Population 346,490² 397,605

Water Supply

Coverage 64% Increase 1% p.a. 70%

Population served 222,742 Approx. 11,00 p.a. 278,323

WS Maintenance/Repair

Coverage reduction (16%) Decrease 1% p.a. (10%)5

Population not served 55,686 Approx. 3,300 p.a. 41,748

Sanitation

Coverage 9% Increase 3% p.a. 25%

Population 31,180 Approx. 13,500 p.a. 99,400

Notes:1. Figure from Medical Statistics Division, MHMS (Review of national Health Plan

1990 – 1994)2. Assumes 85 per cent of population in rural areas.3. Assumes 3.5 per cent population growth per annum.4. Assumes 25 per cent of installed systems require maintenance.5. Assumes 15 per cent of installed systems will require maintenance.





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SECTION VII: HEALTH PROMOTION &EDUCATION:

7.0. Overview:

The Ministry’s mission is to encourage and help the people to improve and promote theirpersonal hygiene, live healthy lifestyle and take responsibilities for their own health. Thestrategic approach is the transition into a wider – sector approach, integrating as much aspossible with the communities, non-government organizations.

One of the key steps forward is to review the existing structure and roles of the HealthEducation Division of the Ministry of Health to be more proactive in advocating health

promotion. By end of 1998, there was a draft ‘Health Promotion Policy’ drawn up. It is yetto be finalized, as further work is needed to ensure the strategies are clear and practical.

As part of the move towards health promotion, a Memorandum of Understanding wasdeveloped with the Yooroang Garang, School of Indigenous Health Studies, University of Sydney, who trained health workers in skills of addressing community health issues related toindigenous people of Australia. Having studied the courses the Ministry agreed that there arenumerous similarities between the attitudes and behavior of the aboriginals and the peopleof Solomon Islands. Thus, three staff of the Health Education & Promotion Unit wereenrolled. The program is yet to be evaluated.

7.1. Community Health Education Activities 1997-99:

The key health education activities for the communities are school visits and villagemeetings. From the graph below, the trend of village meetings increased from 1997, whilstschools visits decline. Western Province did more school visits and village meetings than allother provinces. A major problem to these programs is lack funding to allow regular visits.





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At the national level in 1998,there were total of 101 trainingsand workshops planned. Of

which 76 (75%) were actually implemented. Thirty-eight (38%)percent were integrated health

workshops and thirty fourpercent (34.2%) wereMCH/FP/Sexual Health

Trainings.

School Health Education andPromotion:

A Health Promoting SchoolPolicy was developed andendorsed by the Cabinet in latter

half of 1998. The health education and promotion department have executed its schoolhealth education program in line with school activities. They provide general healthawareness talks ensuring that the environment is conducive and safe, provision of theneeded health information and collaborating with surrounding communities. The activitieshave been classified under; school health instruction, school health inspection, school healthservices and school community organization.

Graph showing Health Education Activities

(School visits & Community meetings) by

provinces

0 1000 2000 3000

1997

1998

1999

19971998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

1997

1998

1999

S I

C h o i s e u

l W e s

t e r n

I s a

b e

l

C I P

G u a

d a

l c a n a l M a

l a i t a

M a

k i r a

T e m o

t u H o n

i a r a

R e n

B e

l l

No. of activities

Meetings in thevillages

Schools visited





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7.2. Evaluation of health education & promotion programs:

Whilst there were no formal review and evaluation of health education programs by theMOH, the Health Education & Promotion Division took a forward step in the formation of a ‘National Health Education and Promotion Research and Evaluation Committee’. Thecommittee’s terms of reference involves coordinating research and evaluation of existing health education and promotion activities and programs. Unfortunately, the committee hasbeen defunct since the ethnic tension escalated. However, it is the division’s key priority toevaluate the programs in order to improve the health outcomes through providing information and advocating for healthy life style.

SECTION VIII: REPRODUCTIVE HEALTH ANDFAMILY PLANNING:

The Ministry’s policy on reproductive and family planning is to promote and maintain thedevelopment of a health family, reduce, maternal and peri-natal, and infant mortality, andraise the standard of living for mothers and children.

The key performance areas of the division responsible is to ensure that every mother has thebest opportunities for appropriate timing and spacing of pregnancies, safe delivery of ahealthy infant in an environment conducive to health with adequate antenatal care, sufficientnutrition and preparation of breast feeding her child.

8.1. Maternal Mortality:

There is marked improvement in reduction of the maternal mortality rate from 549/ 100,000live births to an estimate of 154/ 100,000 in 1999. It took about 13 years to reduce the levelin 1986 by more than half. The policy standard in the National Health Policies andDevelopment Plans 199-2003 is to reduce the maternal mortality rate by 50% at the end of the five year planned period. Most causes of maternal mortality are preventable.

Table (23) showing Maternal Mortality Rate/ 100,000 births

1986[i.] 1997[ii.] 1998[iii.] 1999[iv.]549 209 203 154Sources: [i.] 1986 census, [ii.] Reproductive Health Division/MOH 1997, [iv.]based on HIS/MOH

Table (24) Maternal Deaths by Provinces 1996-1999 (excluding those in the hospitals):

1997 1998 1999SolomonIslands

H=5, C=9 Total =14 H=7, C=9, Total = 16 H=11,C=1, Total=12.

ByProvinces:

Home Clinics Total Home Clinics Total Home Clinics Total





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Choiseul 1 3 4 0 1 1 0 0 0 Western 1 2 3 1 3 4 0 0 0Isabel 0 0 0 0 0 0 0 0 0Central

Islands

0 1 1 0 1 1 2 1 3

Guadalcanal 3 1 4 5 2 7 4 0 4Malaita 0 2 2 0 2 2 3 0 3MakiraUlawa

0 0 0 1 0 1 2 0 2

Temotu 0 0 0 0 0 0 0 0 0RenBell 0 0 0 0 0 0 0 0 0Honiara 0 0 0 0 0 0 0 0 0Source: HIS, MOH, 1997,1998,1999

Guadalcanal recorded thehighest number of maternaldeaths with 7 in 1998.

Western had 4 in that sameyear. There may beunderreporting of cases.

According to the localstatistics maternal deathsmade up 1.58% of the totaldeaths recorded in the

communities in 1997,1.86% and 1.18% in 1998and 1999 respectively (seetable below). Despite the

lower percent, it is very stressful when mothers die, leaving behind many children to care forby the husband and relatives.

Table (24) Proportion of Total deaths by National and Provinces (ie. No. of. maternal deaths / totaldeaths reported by Clinic Monthly Reports in %:

1997 1998 1999

SolomonIslands Total MD =14, All deaths=884,=1.58%

Total MD = 16, All deaths=861,=1.86%

Total MD=12, All deaths=1,018,=1.18%

By Provinces: TotalMD

Alldeaths

% TotalMD

Alldeaths

% TotalMD

Alldeaths

%

Choiseul 4 38 10.5(0.45)

1 61 1.6(0.12)

0 66 0

Graph showing maternal deaths 1997-1999 by provinces

3

4

0

1 1

3

4

7

4

2 2

3

1

0

1

2

3

4

5

6

7

8

1997 1998 1999

Years

N o . o f m a t e r n a l d e a t h s

Choiseul

Western

Isabel

Central Islands

Guadalcanal

Malaita

Makira Ulawa

Temotu

RenBell

Honiara





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Western 3 196 1.53((0.34)

4 172 2.3(0.46)

0 157 0

Isabel 0 38 0 0 33 0 0 40 0Central Islands 1 69 1.45

(0.11)1 55 1.8

(0.12)3 56 5.4

(0.29)Guadalcanal 4 116 3.4

(0.45)7 119 5.9

(0.81)4 131 3.05

(0.39)Malaita 2 260 0.77

(0.23)2 212 0.94

(0.23)3 365 0.82

(0.29)Makira Ulawa 0 103 0 1 141 0.7

(0.12)2 118 1.69

(0.19) Temotu 0 51 0 0 48 0 0 70 0RenBell 0 11 0 0 10 0 0 3 0Honiara 0 2 0 0 10 0 0 12 0Source: HIS, MOH, 1997,1998,1999

8.2. Family Planning:

Family planning contraceptives is widely available in the rural clinics. However, compliancefrom clients is observed to be declining. According to available statistics there is markeddrop in the contraceptive prevalence rate from 25% in 1986 to 18.625 in 1997. Table below clearly shows that level of family planning coverage in population of women of childbearing age is generally low. FP coverage declined in 1999. It varies by provinces. Isabel, CIP and

Temotu have higher coverage than other provinces.

Table (25) Family Planning Coverage (%) total users at end of December/wcba x 100):

1997 1998 1999Solomon Islands 8.5 8.6 6.5By Provinces: 1997 1998 1999Choiseul 6.9 5.0 7.8

Western 11.2 8.2 9.1Isabel 7.9 13.2 11.4Central Islands 6 15.7 17.9Guadalcanal 7.1 5.8 5.4Malaita 10.2 11.3 3.9Makira Ulawa 7.9 6.9 6

Temotu 14.2 12.3 13.5RenBell 3.3 5.3 2.5Honiara 5.6 5.6 2.7Source: HIS, clinic monthly reports

25 1997 Estimate by Reproductive Health Division, MOH





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Graph (29) showing FP coverage by end of December 1997,1998 & 1999:

0

5

10

15

20

%

Graph showing family planning coverage by December of 1997, 1998 &

1999

1997

1998

1999

1997 6.9 11.2 7.9 6 7.1 10.2 7.9 14.2 3 .3 5.6 8.51998 5 8.2 13.2 15.7 5.8 11.3 6.9 12.3 5.3 5.6 8.6

1999 7.8 9.1 11.4 17.9 5.4 3.9 6 13.5 2 .5 2.7 6.5

Choi

seul

Wes

tern

Isab

el

Cent

ral

Gua

dalc

Mal

aita

Maki

ra

Tem

otu

Ren

BellHon SI

Table (26) % Supervised deliveries:

1995 1997 1998 199985 86** - -Sources: **RHD/MOH, 1997

Table (27) Antenatal Coverage: First antenatal attendance (% first visit / expected births)

1997 1998 1999Solomon Islands 68.9 71.9 65.9By Provinces: 1997 1998 1999Choiseul 59.4 61.7 65.2

Western 79.8 75.3 74.5Isabel 54.6 60.4 68.8Central Islands 55.1 73.6 68.9Guadalcanal 66.0 72.4 52.1Malaita 70.6 72.8 73.6Makira Ulawa 54.6 71.7 56.2

Temotu 53.8 48.4 60.2

RenBell 46.5 38.5 31.1Honiara 78.0 80.5 68.8

Table (30) Total Fertility Rates 1986,1996,1998:

Total Fertality Rate declined from 6.1 in 1986to 4.8 in 1998. Majority of six provinces(Choiseul, Western, CIP, Malaia, Makira, and

Years 1986(Census)

1996 1998

TotalFertility Rate

6.1 5.8 4.8





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Temotu) have reached 100 births in 1,000 WCBA population mark during the period 1997-99. Isabel and Guadalcanal recorded levels below 100/1,000 WCBA pop. However,Guadalcanal is also known to have higher level of maternal mortality rate.

Table (28) FERTILITY RATES BY PROVINCES FROM 1997 TO 1999 (births/ 1000 popWCBA Province Year Births Fertility rate(births/1000pop WCBA)

Choiseul 1997 449 97.31998 555 116.81999 509 104.0

Western 1997 1,575 120.81998 1,591 118.51999 1,329 96.0

Isabel 1997 417 93.141998 377 81.61999 308 64.5

Central Islands 1997 397 89.31998 486 106.11999 584 124.0

Guadalcanal 1997 773 47.31998 932 54.71999 1048 59.0

Malaita 1997 2,600 115.71998 2,660 115.71999 2,917 123.9

Makira Ulawa 1997 682 103.6

0

20

40

60

80

100

120

140

No. of births/

1,000 wcba

Graph showing fertility rates by provinces

1997

1998

199

1997 97.3 120.8 93.14 89.3 47.3 115.7 103.6 107.7 0.7

1998 116.8 118.5 81.6 106.1 54.7 115.7 123.1 96.5 0.4

199 10.4 96 64.5 12.4 59 123.9 83.7 111.7 0.12

Choi

seul

West

ern

Isabe

l

Centr

al Isl.

Guad

alcan

al

Malai

ta

Makir

a

Temo

tu

Honi

ara





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1998 839 123.11999 591 83.7

Temotu 1997 438 107.71998 403 96.51999 480 111.7

Honiara 1997 10 0.71998 6 0.41999 2 0.12

Rennell Bellona 1997 19 39.51998 16 32.31999 10 19.6

Solomon Islands 1997 7360 81.31998 7,865 83.71999 7,778 79.7

*Total births / total pop of WCBA 15-44 x 1000Source: Health Information System, Annual Health Reports 1997,1998 & 1999, Statistics Unit, MOH.

In evaluating the national and provincial reproductive health services and program thefollowing approach could be used:

Program Inputs Commitment of the Government Social DevelopmentInstitutional Capacity Institutional Capacity Program efficiency

Program Outputs Service Access (proximity to services) Quality care (drop out)Behavioral changes Fertility rates, contraceptive prevalenceDemography changes TFR, Infant mortality rate, Maternal health

The Strengths:

There are both strengthens and weaknesses of the overall reproductive (& family planning)programs. On one hand the strengthens of the program lies in the institutional capacity through the primary health care and community health network which infiltrated as far asthe rural remote areas. There is an existing structure, which has both vertical and horizontalaspect of service delivery. The vertical aspect concerned with policy development, planning,supervision and monitoring, training and staff development (Reproductive Health Division,HQ, MOH). The horizontal aspect concerns with actual service delivery (Maternal ChildHealth /Family Planning activities in the provincial centers). The program has been very

effective in staff development. There were training workshops for different category of health workers in particularly the nurses.

The program’s output could be viewed by the following indices:

Clear policy directions and strategies at all levels

Number of nurses trained in family planning

Number of nurses trained in midwifery





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affected by external influences such as geography, and low socio-economical factors. Theethnic tension, which started around 1998, had adverse impact on the service delivery.

Traditional custom beliefs and high illiteracy rate among the target customers has beenrecognize as negativism to the performances of the service. Unfortunately, it is apparent thatunwanted competition is been experienced with the Department of Development Planning,

which assumed the policy role of population control. Lack of clear strategies of the NationalPopulation Policy does not help the program as the major stakeholder.

The Government’s commitment to reproductive health is literally there. The NationalPopulation Policy was drafted with little integration in implementation as expected.Involvement of relevant sectors is yet to be seen.

SECTION IX: DEVELOPING PARTNERSHIP

9.0. Overview in brief:

The Ministry’s vision in developing partnership is to involve participation of wide range of people in the community both local and international. Health affects every person one oranother therefore the policy aims at enhancing collaboration between different stakeholders.

There is a need to give formal recognition to community organization through development of aMemorandum of Understanding (MOU) between the Government and other Health Servicesproviders. Mechanisms of operation are to be included and must be clear and well understood by

various parties to the MOU.

9.1. Involvement of Non-Government Organizations locally:

The private sector is a key player inhealth developments in the country.Organizations such as Red Cross,Solomon Islands Planned Parenthood

Association, Family Health Center,Rotary Club, World Vision andSolomon Islands Development Trustand the Churches such as SeventhDay Adventists, United Church of Solomon Islands, Roman Catholic,SSEC and Church of Melanesiacontinued to supplement andcomplement health developmentsthrough their activities.





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Even business firms have shown initiative to assist the National Referral Hospital in minorprojects. In 1999, Mr. Robert Coh a well-known businessman in Honiara established aninformal relationship with the National Referral Hospital. Kiluufi Hospital through the‘Friends of the Hospital Committee’ have involved in upgrading of the hospital. Suchinformal partnership is very fruitful.

Churches:

Despite any formal memorandum of understanding with the Church hospitals in terms of performance management process, service delivery to the people served is great. The SIGcontinue to provide subsidy and assistance to church health services in return for theservices provided to the people of the country. The SIG continued to inject annual funding to church hospital budgets. The secondment of government salaried staff to churches alsocontinued. Provision of essential medical supplies continues free to church hospitals. SIGalso support staff development and training of church health services staff.

9.2. Involvement of International developing or donor partners:

The international donor agencies through their bilateral and unilateral diplomaticrelationship with the SIG continued to play vital and crucial role in health development inthe country in the years 1997 to 1999. Annex Table ( ) outlines the donor agencies input inthe health development of the country in the past years. Assistance and support are in thefollowing areas;

Human resource trainings and staff development (scholarships- undergraduate and

postgraduate) Technical Assistances

Specific health projects & programs -Rural Water Supply & Sanitation-Vector Borne Disease control programs(including malaria, hepatitis B)-AIDS/ STD

Community health projects and programs

Rural health infrastructure

Most form of assistances was either in-country or regional basis. There is no direct injectionof fund into the national health recurrent budget. There was a big shift from capital

assistance, which was accounted for about one and half of total assistance in 1989-1993 26.

26 World Bank Pacific Countries (1994). The Solomon Islands Health Sector Issues and Options (June 2,1994), East Asia and Pacific, Country Department III Population and Human Resources, section 86, p.31.





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1988 1990 1992 1994 1996 1997 1998 1999

Gov. recurrent budget 101.2 146.6 208.8 255 311.4 340.9 375 348.7Health recurrent budget 12.7 18.3 24.3 34.4 39.2 47.6 54 56.7% Health recurrent budget 12.5 12.5 11.6 13.5 12.6 14.0 14.4 16.3Donor 10.6 20.3 21.9 11.9 16.3 27.0 10.1% Donor 37% 46% 39% 23% 26% 33% 15%





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ANNEXURE

ANNEX Table (1) showing proportion of population to health workers in 1997-98:

Health Workers Ratio to Population 1997-1998:

Population/person inpractice

Province 1997 1998 199927

Choiseul 20,969 21,596 20,008

Total pop

Doctor : Pop 20,969 21,596 20,008

Nurse:Pop 1311 1,200 800

Nurse Aide:Pop 839 864 800

Total Nurse:Pop 511 502 400

Western 61,146 62,982 62,739

Doctor : Pop 157455 15,685

R/Nurse:Pop 1,016 1,162

Nurse Aide:Pop 829 980

Total Nurse:Pop 500 532

Isabel 20,074 20,714 20,421

Doctor : Pop 20,074 20,714 20,421

R/Nurse:Pop 717 609 638



Central Islands 22,461 23,113 21,577

Doctor : Pop 22,461 23,113 21,577

R/Nurse:Pop 1,604 1,445 1,199



Guadalcanal 78,563 81,941 60,275

Doctor : Pop 39,286 60,275

R/Nurse:Pop 2,806 2,826 1,722

Nurse Aide:Pop 2,619 2,731 1,944

Total Nurse:Pop 1,355 1,389 913

Malaita 102,653 105,013 122,620

Doctor : Pop 40,873

R/Nurse:Pop 1,488 1,500 1,670

Nurse Aide:Pop 1500 1,522 1,916


Makira Ulawa 31,343 32,471 31,006

Doctor : Pop 31,343 32,471 31,006

R/Nurse:Pop 1,045 984 838



Temotu 19,360 19,903 18,912

Doctor : Pop 18,912

27 The total population figures of 1999 National Census is used here.





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R/Nurse:Pop 745 686 700

Nurse Aide:Pop 1,210 905 1182


Honiara 66,508 71,628 49,107

Doctor : Pop 71,628 49,107*

R/Nurse:Pop 2,293 2,311 1,584Nurse Aide:Pop 6,046 6,512 4,464

Total Nurse:Pop 1,663 1,705 1,169

Rennell Bellona 2,410 2,479 2,377

Doctor : Pop - - -

R/Nurse:Pop 482 413 396



SOLOMON ISLANDS 409,042

Doctor : Pop 10,488

R/Nurse:Pop 836

Nurse Aide:Pop 1,175

Total Nurse:Pop 489

Source: Annual Nursing Management Report 1997,1998,1999.* Private practitioners not included.

ANNEX Table (2) Female, Male, Pediatrics, and Obstetrics Beds-All Hospitals Admissions andOccupancy Rates at 1997,1998,1999 bed capacity

1997 1998 1999Prov Hosp

Beds Adm %OR ALOS

Beds Adm %OR ALOS

Beds Adm %OR

ALOS

Choiseul(Sasamug

a) All Beds 35 1,216 62.1 6.5 35 1,278 75.0 7.5 35 1,426 79.5 7.1Male 8 236 62.4 7.7 8 258 63.6 7.2 8 307 73.8 7.0Female 8 271 64.2 6.9 8 216 51.8 7.0 8 315 74.5 6.9 Pediatrics 9 364 75.6 6.8 9 356 74.8 6.9 9 352 74.1 6.9 Maternity 10 345 53.1 5.6 10 448 72.9 6.1 10 452 73.3 5.9

Western(Gizo)**

All Beds 60 1,656 46.3 6.1 60 1,676 55.1 7.2 60 1811 58.0 7.0Male 15 331 44.9 7.4 15 364 47.9 7.2 15 395 49.9 6.9 Female 15 350 42.3 6.6 15 312 34.8 6.1 15 450 50.3 6.1Pediatrics 10 422 45.6 5.9 10 450 62.9 5.7 10 462 71.1 5.6 Maternity 14 553 51.6 5.1 14 550 51.7 4.8 14 504 49.5 5.0Others 6 nk 6 6

Isabel(Buala)

All Beds 39 898 36.7 5.8 39 876 36.9 6.0 39 987 41.0 5.9 Male 8 223 48.2 6.3 8 251 49.9 5.8 8 268 55.2 6.0Female 8 149 41.0 6 8 138 27.9 5.9 8 198 40.1 5.9 Pediatrics 8 254 46.2 5.3 8 315 70.1 6.5 8 320 61.5 5.6 Maternity 15 272 27.3 5.5 15 172 17.9 5.7 15 201 38.0 5.5 Malaita(Kiluufi)

All Beds 130 3,531 62.7 8.4 130 3,746 64.7 8.2 130 3,766 65.9 8.3





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Male 11 746 186 10. 11 789 195 9.9 11 854 213 10Female 20 918 129 10.2 20 852 119 10.2 20 866 117 9.8 Pediatrics 22 826 71.2 6.9 22 995 88.0 7.1 22 897 77.3 6.9 Obstetrics 24 1042 82.3 6.9 24 1110 76.0 6.0 24 1149 92.1 7.0Makira(Kirakira)

All Beds 86 1065 29.2 8.6 86 962 19.6 6.4 86 1,320 32.9 7.8 Male 18 188 21.2 7.4 18 211 22.8 7.1 18 251 28.3 7.4Female 19 212 22.3 7.3 19 233 26.9 8 19 265 26.3 6.5 Pediatrics 16 218 25.0 6.7 16 207 14.2 4 16 235 23.8 5.9 Maternity 21 324 55.0 13 21 311 - 21 569 87.8 11.8

Temotu(Lata)

All Beds 46 854 40.7 8 46 892 40.5 7.6 46 1089 45.0 7Male 8 213 86.3 11.8 8 198 71.2 10.5 8 264 93.4 10.3Female 8 112 22.7 5.9 8 131 23.3 5.2 8 177 32.8 5.4Pediatrics 8 239 55.8 6.8 8 282 54.1 5.6 8 363 68.6 5.5 Maternity 8 282 40.7 4.2 8 266 37.3 4.1 8 278 37.2 3.9

TB 12 4 5.0 55 12 13 16.4 54 12 2 2.5 54Isolation 2 4 2 2 2 3

NationalReferralHospital

Beds Adm %OR ALOS

Beds Adm %OR ALOS

Beds Adm %OR

ALOS

All Beds 330 5916 45.8 9.3 330 5830 48.4 10.0 330 7102 63.3 10.7Medical 56 723 31.6 8.9 56 475 63.6 14.7 56 837 64.0 15.6Surgical 56 812 40.2 10.1 56 774 86.0 45.7 56 995 77.0 15.8Pediatrics 45 673 31.2 7.6 45 699 62.4 27.7 45 1019 58.5 9.4Maternity 50 2914 46.4 2.9 50 3201 81.0 2.5 50 3027 67.6 4.1Gynae 17 444 35.9 5.0 17 362 71.2 4.6 17 673 73.8 6.8EMS 42 222 27.4 18.9 42 237 70.6 12.2 42 601 53.3 13.6

TB 52 27 7.8 54.8 52 43 58.6 213.9 52 62 62.8 192.2Private

Ward12 101 6.5 2.8 12 69 36.0 22.8 12 286 26.2 4.0

ANNEX Table (3): Total Cases Admitted to National Psychiatric Unit, Kilu”ufi Hospital (only)

1997,1998 & 1999:NEW OLD Total

NEW TotalOLD

TOTAL

Male Female

Male Female

1.Schizophrenia

1997 16 11 106 39 27 145 172

1998 3 4 11 10 7 21 281999 4 1 17 9 5 26 31

2. ManicDepression

1997 2 1 15 9 3 24 27

1998 5 4 5 3 9 8 171999 1 1 6 4 2 10 12

3.Neurosis 1997 16 2 2 2 18 4 221998 0 1 0 11 10 11 211999 3 3 2 0 6 2 8

4.Epilepsy with Psychosis

1997 2 2 8 4 4 12 16

1998 1 2 1 2 3 3 6





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1999 1 0 1 11 1 12 135.PsychosomaticDis

1997 6 1 11 2 7 13 20

1998 0 2 0 0 2 0 219996.SomatoformDis

1997 1 0 1 0 1 1 2

19981999

7.TransientOrgan.Psych

1997 3 2 2 4 5 6 11

(organic cause) 1998 12 0 10 6 12 16 281999 2 0 2 0 2 0 2

8.Brief

Reactive Psych

1997 20 11 6 4 31 10 41

19981999 2 5 2 3 7 5 12

9.Mentalretardation

1997 0

with psychosis 1998 1 1 2 3 2 5 71999 1 1 1 0 2 1 3

10.Posttraumatice Dis

1997 3 1 2 0 4 2 6

19981999

11.Attemptedsuicide

1997 1 3 0 0 4 0 4

19981999

12Dementia 1997 1 0 2 0 1 2 319981999

13.Others 1997 4 4 3 11 8 14 221998 4 5 1 0 9 1 101999 0





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ANNEX Table (4): Total Cases seen and treated at the National Psychiatric Unit, Honiara,MOH/HQ in 1997, 1998 & 1999:

NEW OLD TotalNEW

TotalOLD

TOTAL

Male Female

Male Female

1.Schizophrenia

*

1997 16 11 106 39 27 145 172

1998 17 7 186 74 24 260 2841999 8 3 284 68 11 352 363

2. ManicDepression*

1997 2 1 15 9 3 24 27

1998 10 3 38 30 13 68 811999 1 1 153 36 2 189 191

3.Neurosis 1997 16 2 2 2 18 4 221998 22 13 23 26 35 49 841999 14 10 15 15 24 30 54

4.Epilepsy

with Psychosis

1997 2 2 8 4 4 12 16

1998 2 2 36 3 4 39 431999 0 1 31 4 1 35 36

5.PsychosomaticDis

1997 6 1 11 2 7 13 20

1998 1 1 6 0 2 6 81999 2 0 18 11 2 29 31

6.SomatoformDis

1997 1 0 1 0 1 1 2

1998 0 0 0 0 0 0 0

1999 0 0 0 0 0 0 07.Organ.Psych 1997 4 2 4 4 6 8 14(organic cause) 1998 14 8 18 5 22 23 45

1999 4 2 2 13 6 15 218.Brief Reactive Psych

1997 20 11 6 4 31 10 41

1998 0 00 0 0 0 0 01999 0 1 0 7 1 7 8





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with Psychosis1998 3 4 37 5 7 42 491999 1 1 32 15 2 47 49

5.

PsychosomaticDis

1997

1998 1 3 6 0 4 6 101999

6.SomatoformDis

1997 7 4 6 8 11 14 25

1998 26 8 28 11 34 39 731999 6 2 4 13 8 15 23

7.TransientOrgan.Psych

1997

(organic cause) 1998

1999 2 6 2 10 8 12 208.Brief Reactive Psych

1997

19981999

9.Mentalretardation

1997

with psychosis 19981999

10.Posttraumatice Dis

1997

19981999

11.Attemptedsuicide

1997

19981999

12Dementia 199719981999

13.Substance Abuse

1997

1998 12 1 14 0 13 14 271999 5 1 10 1 6 11 17

14.Others 19971998 4 5 2 0 9 2 111999





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ANNEX Table (6) Matrix of donor activities impacting directly on the Solomon Islands health sector:

DONOR

AGENCY

LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE

BRIEF DESCRIPTION OF

PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

WorldBank

SolomonIslandsMakira andGuadalcanal

Provinces

SolomonIslands HeathSectorDevelopment

Project($4.5 – 5.9mloan)

This Project is fundedas a “Lear ning andInnovation Loan”project is at concept

stage. It will pilot styleactivities with closemonitoring andevaluationThe projectcommenced inFebruary 2000The priority issues to

be addressed include

Maternal care and

family planningincluding thedevelopment of midwifery training

Malaria preventionand control

Provincial healthprogrammanagement

Central capacitybuilding and projectsupport which will

include HealthManagementInformation SystemDevelopment tosupport the PilotProjects in the abovementioned servicedelivery

The WB Project iscollocated in theMHMS building withthe Planning and

Health Informationstaff. The most criticalpoint of overlap withthis Design and theWB Project exists inthe activitiesassociated with HealthManagementInformation Systems.It was earlier expectedthat the WB Project

would include thedevelopment of aHealth ManagementInformation Systemfor MHMS but it isnow being limited tothe pilot projects

Yes – formalco-ordinationon planningissues and

HealthManagementinformationSystem atleast will beessential.





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DONOR

AGENCY

LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE


PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

AusAID SolomonIslandsMinistry of Finance

InstitutionalStrengthening

Financial accountingsystems in Ministryand other line agencies

The SIG is intendingto introduce financialdelegations to“strategic levels”within MHMS andother ministries.Restructuring of MHMS and capacitybuilding within this

project will prepareMHMS for thisdevolution of authorityand accountability. .The development of managementdelegations andaccountabilities willcreate requirementsfor financialmanagement

information There willneed to be appropriateutilisation of the MoFaccounting systems inorder to accommodateMHMS requirements

Yes

AusAID SolomonIslandsOffice of the Auditor

General)

InstitutionalStrengtheningProject $2.5 M

The principle objective isto improve overallaccountability within thePublic Sector

Contact should bemaintained,particularly with thematters regarding

expenditure control,strengthened auditlegislation

Yes

AusAID SolomonIslands,

ScholarshipsProgram $0.6M

This program supportstraining of clinicalhealth staff including

Diploma of Nursing at SICHE

Close liaison needed,especially in relationto the healthworkforce planningand HR development

Yes





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DONOR

AGENCY

LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE


PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

Critical CareNursing at Qld Uni

Dental Surgery atFSM

Medicine/Surgeryat FSM

Post GradObs/Gyn at PNG

policies and programs,to be facilitated by theproposed new project.

Potential forcandidates to beidentified for trainingin support of theoperationalmanagement

initiatives of thisproject and theworkforce planningstrategies which willbe developed.

AusAIDandcofundedbyNZODA

SolomonIslands

Rural WaterSupply andSanitation$10.3m

Provision of PotableWater supply andsanitation facilities forrural communitiesThis project will be

drawing to close in2001.

The EnvironmentalHealth, HealthEducation and watersupply and sanitationmaintenance aspects

of this RWSS projectwill need to beinterfaced with theplanning, and policydevelopment aspectsof this project.Coordination andlearning fromexperience withmaintenance issueswill be useful for

operational planningand implementation inProvincial Healthservices.

Yes

AusAID(CASP)

SolomonIslands

MalariaControl,Healtheducation and

Annual provision of bed nets, anti malarialpharmaceuticals,larvicide and fogging

This vector Bornedisease controlprogram interlinkswith the MHMS

Informal





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DONOR

AGENCY

LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE


PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

Educationsupplies

chemicals policy developmentprocesses and theeffective operationalplanning andimplementation withinthe Provincial Healthservices.

AusAID Regionalprogramincluding

theSolomonIslands

Hepatitis BProject($2.0m)

Hepatitis Bimmunisation (1997-2000)

Hepatitis Bimmunisation

Informal

AusAID RegionalprogramincludingtheSolomonIslands

Vector-BorneDiseasesControl Project($10)

Assists withprogrammed medicaland environmentalhealth services andintroduction of vectorcontrol mechanisms.

Malaria and othervector-borne diseases

Informal

AusAID(Regional)

Regionalprogram

includingtheSolomonIslands

Pacific Actionfor Health

($3.4mil)

The project isdesigned to provide

preventive and healthpromotional support atcommunity, nationaland regional levels.

NCD’s particularlythose linked with

tobacco and alcohol

Informal

AusAID(Regional)

RegionalprogramincludingtheSolomonIslands

Pacific IslandsAIDS and STDPreventionProgramme)

Supports and TA tonational programs inrelation to STD andAIDFS education,prevention, treatmentand care.

STD and HIV/AIDS Informal

AusAID

(Regional)

Regional

ProgramincludingSolomonIslands

Integrated

CommunityHealth ProjectKia/Kotovaand Maringeareas councilsin IsabelProvince

Funding provide

through World Vision.Objective was toimprove quality of lifefor about 8000villagers through thedevelopment of anintegrated communityhealth programme.

Village health care,

access to watersupply,literacy, improvedagriculture andenvironmental health.

Informal





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DONOR

AGENCY

LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE


PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

Project will cease in2000

AusAID(Regional)

RegionalProgrammeincludingSolomonIslands

FamilyPlanningregionaldevelopment($0.63mil)

Project implementedby Family PlanningAustralia 1994-2000

Strengthening familyplanning organisationfinances training andadministration.

Informal

AusAID(Regional)

RegionalProgrammeincluding

SolomonIslands

FamilyPlanningregional

development(Proposed$2.7mil)

Project to be extendedto facilitate inclusionof family planning

training into formalcurriculum for nursesand teachers To beimplemented byFamily PlanningAustralia 1999-2004

Strengthening familyplanning organisationfinances training and

administration. Thishas policydevelopmentimplications and ruralhealth servicemanagement proposalswhich are relevant

Informal

AusAID(Regional)

RegionalProgramincludingSolomon

Islands

Tertiary HealthCare ProvisionProject

Volunteer medicalteams offeringspecialist services andlocal capacity building

through on-the-jobtraining in Plastic andreconstructive surgery,neurology, eye careand paediatric surgery

As the majority of these services areprovided in theNational Referral

hospital it will beessential to ensure thisprogram isaccommodated andnot disrupted by theNRH ManagementStrengtheningComponent of thisProject

Yes

NZODA Honiara andother urban

areasSolomonIslands

Family HealthProject ($0.3

Mil pa)

Reproductive healthand family planning

including programdevelopment and IECproduction

Sexual health forurban youth and peer

education in squattersettlements to beimplemented inassociation withchurches

Informal

NZODA SolomonIslands

TrainingScholarships

Scheme operatesthrough NationalTraining Unit in

Potential forcandidates to beidentified for training

Yes





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AGENCY

LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE


PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

Ministry of Educationand is targeted at nursetraining.

in support of theoperationalmanagementinitiatives of thisproject and theworkforce planningstrategies which willbe developed.

NZODA Solomon

Islands

To assist with

treatment of patientsfor which specialisttreatment is notavailable in SolomonIslands

Specialist treatment in

New Zealand. Need tomaintain liaison.

Informal

JICA SolomonIslands

Rural HealthFacilitiesRehabilitationProject $15 m

Construction andequipping of facilitiesincluding a possiblenew hospital atChoiseul Bay, a largernew hospital at Gizo

and selected upgradingof other ProvincialHealth facilities

Project Design andfunctional brief completed by MHMS.Project has policydevelopmentimplications and rural

health servicemanagement proposalswhich are relevant toProject. Eventualdesign needs to beunderstood by thisProject andappropriate co-ordination maintained.

Yes

ADB SolomonIslandsVillageareas

Population andFamilyPlanning

Reproductive Healthincluding developmentof IEC materials

It is understood thisproject will function incooperation with theNZODA to minimiseduplication and willinvolve churches.

Informal

ADB SolomonIslands

Public SectorExecutive

Managementeducation programme

Part of a larger PublicSector Reform Project

Yes





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DONOR

AGENCY

LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE


PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

developmentProgram

for Senior PublicServants.

operating from theInstitutionalStrengthening Unit of the Prime Minister’sDepartment tsupported by ADB

WHO SolomonIslands

WHO ongoingRole

Frameworks andtechnical assistance forprojects to promote:Healthy Islands,

Health PromotingSchools, NewHorizons in Health

Linkages exist with anumber of SHPcomponents.

Yes

WHO SolomonIslandsCountryProgramme

HumanResourcesDevelopment

Funding of fellowships Potential forcandidates to beidentified for trainingin support of theoperationalmanagementinitiatives of this

project and theworkforce planningstrategies which willbe developed.

Yes

WHO SolomonIslands

Vector BorneDiseaseProgramme($200k

Malaria control Informal

WHO SolomonIslands

Water Supplyand sanitation

($140k)

Funding of workshops,training and

fellowships for HealthInspectors.

Informal

WHO SolomonIslands

Primary HealthCare

Health education andpromotion includingdevelopment of IECmaterials. Providesfellowships, limited

Informal





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LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE


PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

supplies and materialsand WHO officerunning costs.

UNFPA SolomonIslands

ReproductiveHealth

Provision of contraceptive materialfor family planningtraining. Scholarshipsformidwifery/paediatricnurse training.

Population awarenessactivities in FamilyPlanning and Maternaland Child HealthNo authoritativedocumentationavailable

Informal


DispossessedYouth Project($44k)

No authoritativedocument available.

Pilot one year projectto targetunemployment,substance abuse andsexual health.


IEC Project(80k)

No authoritativedocument available

EuropeanUnion

SolomonIslands

HealthplanningUnit andNationalCensusOffice

NationalCensus

Demographic andhealth data collection

and analysis.

Census conductedduring November

1999 with preliminaryreports anticipated inmid 2000

Yes

Republicof China

SolomonIslandNationalreferralhospital

Phase IIIupgrade of NationalReferralHospital

($1.7mill)

To implement PhaseIII of the Hospitalrefurbishment andupgrading.

Scope of worksanticipated stillunclear. Vital that theplaning andoperational aspects of

this capital works areclearly appreciated bythis project. Projectshould be monitoredto determine if anycooperation possible

Yes

Save theChildren

SolomonIslands

ChildProtection

Incorporates childprotection, community

SCF normally operateswith a government or

Yes to learnfrom NGO





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AGENCY

LOCATION

OF ACTIVITY

PROJECT TITLE

& DOLLAR

VALUE


PROJECT (including

commencement &

completion date)

COMPLEMENTARY

COMPONENTS OR

ACTIVITIES WITH

SOLOMON ISLANDS

INSTITUTIONAL

STRENGTHENING

PROJECT

NEED FOR

FORMAL

COORDINATIO

N

Fund countryProgrammainlyfunded byAusAID

Project based rehabilitationand a youth outreachprogramme and familysupport centre.

NGO partner andprovides funding andproject managementand administrativesupport

arrangement

health report 1997-99-solomon islands

Documents