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

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Ministry of Health
Solomon Islands

NATIONAL HEALTH REPORT


1997-99

EVALUATION OF THE HEALTH


STATUS

March 2000

___________________________________________________________________________________
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TABLE OF CONTENTS

Message From 3
The Minister of Health 3
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 3
2.1. REGIONAL (PROVINCIAL) SERVICE DISTRIBUTION; 3
2.1.1. Type of Services; 3
Table (1) : The Health Care Referral System 3
2.1.2. DISTRIBUTION OF SERVICES: 3
Graph (1) showing distribution of health facilities by provinces: 3
Table (2) showing Health Clinics:Population* and Nurse: Population** Ratio: 3
2.2. INTERNAL STRUCTURAL AND MANAGEMENT ISSUES: 3
2.2.1. Organizational Structure: 3
Fig ure1s howi ngt hee x i
s t
ingorga n
ization’ss truc t
ure:Mi n i
str
yo fHe al
th:Na tional
and Provincial level: 3
2.2.2. Centralization Vs Decentralization (Vertical versus Horizontal programs): 3
2.2.3. Activities (Inputs): 3
2.2.4. Findings (outputs): 3
2.3. HEALTH FINANCING & BUDGETING AND RESOURCE ALLOCATION
FACTORS: 3
Table (3) Total government budget and the allocations from 1988 to 1999: 3
Table (4) Distribution of the Recurrent Health Budget 1991-1 9 9 9(SBD$’ 00 0 ) 3
Table (5) showing selected health accounts indicators for selected countries in the
pacific region; estimates for 1997: 3
2.4. Management and Supervision: 3
2.5. STATUS OF HEALTH CARE SERVICES DELIVERY: 3
2.6. DISTRIBUTION OF HEALTH CARE WORKFORCE; 3
2.6.1. SHORTAGE AND MANAGEMENT OF HEALTH WORKFORCE: 3
Table (6) Shows the Gap Between Requirement Projection and Supply Projection on
the Medical Profession (Doctors): 3
SECTION III: HEALTH SERVICE PLANNING,
MANAGEMENT AND SUPERVISION: 3
3.1. MANAGEMENT & ADMINISTRATION: 3
3.1.1. Activities (Input) & Output: 3

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Table (7) below shows matrix of strategies implemented since 1997. 3
3.1.2. Analysis: 3
3.1.3. Output & Key Issues: 3
3.2. How Well Do the Solomon Islands Health System Performs? 3
3.2.1. Overall Level of Health: 3
Table (8) showing Basic Indicators for selected countries in the pacific region: 3
Table (9) showing health attainment, level and distribution in selected countries in the
pacific region; estimates 1997-99: 3
3.2.2. The distribution of health in the population: 3
3.2.3. Responsiveness of the health system: 3
3.2.4. Performance on health level (DALE) and Overall Performances: 3
Table (10) shows ranking of selected countries in the pacific region on their
performances on health level, and the overall performance: 3
3.3. Health Information System: 3
SECTION IV: ACCESSIBILITY AND QUALITY OF
HEALTH SERVICES 3
4.1. Health Care (Curative) Services: 3
4.1.2. Activities (Input) 3
4.1.3. Outputs: 3
Graph (2) showing Ratio of Registered Nurses, Nurse Aides and Total Nurses to
Population in 1997-1999: 3
4.1.4. Primary Health Care- Health Facility: Population 3
Table (11) showing Health Clinics:Population* and Nurse: Population** Ratio in
1997-1999: 3
Graph (3) showing ratio of population to a health facilities in the provinces: 3
4.2. PRIMARY HEALTH CARE (CLINICS): WORK LOAD. 3
Table (12) PHC (A): Outpatient Visits by Type of Facility, 1997,1998,1999: 3
4.2.1. OPD visits per Facility: 3
Bar Graph (4) showing workload at Area Health Centers, Rural Health Clinics and
Nurse Aid Posts 3
Table(13) showing workload at Area Health Centres, Clinics and NurseAide Posts by
provinces 1997-99 3
4.2.2. OPD visit per person per year by provinces: 3
Graph (5) showing average OPD visits per person per year: 3
Table (14) Shows Average OPD Visit Per Person per day and year, by provinces,
across all facilities: 3
Table (15) Breakdown of Beds By Hospital (Government Owned Only) by end of
1999 3
Table (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 the
region; 3
Table (18) Shows the Flow of Patients in and Out of the Provincial Hospitals
(including private centers): 3
Graph (6) showing flow of patients in and out of the provincial hospitals: 3
4.3. Secondary Health Care: Hospital Utilization: 3
Table (19) shows the Hospital Utilization Rates (number of admissions per 1,000
population) 3
Table (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 3
4.3.2. Bed Occupancy and Average Length of Stay: 3
Graph (7) showing total admissions by provinces & NRH: 3
Graph (8) showing bed occupancy rates (all beds) by provinces & NRH: 3
Graph (9) showing trend of Average Lengths of Stay in provinces & NRH: 3
4.4. Pediatrics (Child Health) Services: 3
4.4.1. Findings & Outputs: 3
Table (21) shows Hospital Utilization Rates in Paediatrics (Child health care services
for <4yrsin the provinces): 3
Graph (10) showing trend of utilization of hospital utilization in pediatrics in the
provinces 3
Graph (11) showing trend of bed occupancy rates in pediatrics by provinces & NRH:3
Graph (12) showing trend of ALOS in pediatrics by provinces & NRH 3
4.5. OBSTETRICS & GYNAECOLOGY SERVICES: 3
Table (22) shows Hospital Utilization in Maternity (maternal care services) in the
provinces: 3
Graph (13) showing trend of hospital utilization in maternal care services in the
provinces: 3
Graph (14) showing trend of Bed Occupancy Rate in Maternal Care by provinces &
NRH: 3
Graph (15) showing trend of ALOS in Maternal Care by provinces & NRH: 3
Graph (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 3
5.2. Morbidity and Mortality Reduction: 3
5.2.1. Overview: 3
Graph (17) showing diseases trend in SI from 1997-1999. 3
5.2.2. Infant Mortality: 3
Graph (18) showing incidence of ARI by provinces 1997-99: 3
5.2.3. Acute Respiratory Infection (ARI): 3
Graph (19) showing trend of incidence of ARI in SI 3
Graph (20) showing incidence of ARI & Diarrhoea in children <5yrs in Solomon
Islands 3
5.2.4. Diarrhea: 3
Graph (21) showing trend of incidence of Diarrhoeal Diseases 1997-99: 3
Graph (22) showing trend of incidence of diarrhoea by provinces: 3
5.2.5. Red eyes ( infections): 3
Graph (23) showing incidence of red eyes by provinces 1997-99: 3
5.2.6. Yaws: 3
Graph (24) showing incidence of Yaws in SI 3
Graph (25) showing incidence of Yaws by provinces 1997-99. 3
5.2.7. Ear infections: 3
Graph (26) incidence of ear infections by provinces & SI: 3
15.2.8. 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 3
Graph (28) showing incidence of vaccine preventable illnesses by provinces in 1997-
99: 3
5.2.9. Sexually Transmitted Infections: 3
Graph (29) showing incidence of STI in Solomon Isl: 3
Graph ( 30) showing incidence of STI by provinces: 3
5.2.10. MALARIA: 3
5.2.10.1. Activities & Findings: 3
5.2.10.2. Accomplishments: 3
Figure 2: Annual Incidence rate of malaria in Solomon Islands 1969-1999 3
5.2.10.3: Incidence in the provinces 3
Figure 4: Trends in the annual incidence rate of malaria in Honiara and the
provinces 1992-99: 3
5.2.10.4. Diagnosis & Treatment: 3
5.2.10.5. Key Issues & Problems Experienced: 3
5.2.10.6. Analysis of the Program: 3
5.2.11. TUBERCULOSIS: 3
5.2.11.1. Activities (Input): 3
5.2.11.2. Findings (Outputs): 3
5.2.12. Mental Health Services 3
5.2.12.1. ACTIVITIES (INPUTS) 3
5.2.12.2. Findings (Outputs): 3
Table (A): Total Cases Admitted to 3
Na tiona lPsychia tr
icUn it
, Kil
u ’uf
iHo spi
tal(o nly)IN1 997 ,
1 99 8,
&1 999 . 3
5.2.12.3.Analysis: 3
5.2.12.4. Major Issues/ problems & recommendations: 3
SECTION VI: ENVIRONMENT HEALTH SERVICES:
3
6.0. HEALTH AND ENVIRONMENT 3
6.1. General protection of the environment 3
6.2. Air (pollution) 3
6.3. Water quality 3
6.4. Solid waste disposal 3
6.5. Food safety 3
6.6. Housing 3
6.7. Work place 3
6.8. Water supply and sanitation 3
6.8.1. Indicators 3
6.8.2. General 3
SECTION VII: HEALTH PROMOTION &
EDUCATION: 3
7.0. Overview: 3
7.1. Community Health Education Activities 1997-99: 3
7.2. Evaluation of health education & promotion programs: 3
SECTION VIII: REPRODUCTIVE HEALTH AND
FAMILY PLANNING: 3

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8.1. Maternal Mortality: 3
Table (23) showing Maternal Mortality Rate/ 100,000 births 3
Table (24) Maternal Deaths by Provinces 1996-1999 (excluding those in the
hospitals): 3
Table (24) Proportion of Total deaths by National and Provinces (ie. No. of. maternal
deaths / total deaths reported by Clinic Monthly Reports in %: 3
8.2. Family Planning: 3
Table (25) Family Planning Coverage (%) total users at end of December/wcba x
100): 3
Graph (29) showing FP coverage by end of December 1997,1998 & 1999: 3
Table (26) % Supervised deliveries: 3
Table (27) Antenatal Coverage: First antenatal attendance (% first visit / expected
births) 3
Table (30) Total Fertility Rates 1986,1996,1998: 3
Table (28) FERTILITY RATES BY PROVINCES FROM 1997 TO 1999 (births/
1000 popWCBA 3
SECTION IX: DEVELOPING PARTNERSHIP 3
9.0. Overview in brief: 3
9.2. Involvement of International developing or donor partners: 3
ANNEXURE 3
ANNEX Table (1) showing proportion of population to health workers in 1997-98: 3
ANNEX Table (2) Female, Male, Pediatrics, and Obstetrics Beds-All Hospitals
Admissions and Occupancy Rates at 1997,1998,1999 bed capacity 3
ANNEX Tab l
e( 3):To t
alCas esAdmi tte
dt oNa t
iona lPsych i
atricUn i
t,Ki l
u ”u
fi
Hospital (only) 1997,1998 & 1999: 3
ANNEX Table (4): Total Cases seen and treated at the National Psychiatric Unit,
Honiara, MOH/HQ in 1997, 1998 & 1999: 3
ANNEX Table (5): Overall Total cases recorded at the National Psychiatric Units
Kiluufi Hospital and Honiara in 1997, 1998 & 1999: 3
ANNEX Table (6) Matrix of donor activities impacting directly on the Solomon
Islands 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; what
makes for a good health system? And how do we know whether our health system is
performing as well as it could?
The answer to the questions entails the concept
and principles behind this National Health Report
Review, which focuses on evaluation of the National
Health Status of the country for the period 1997 to
1999. This is the second review of the health services
following The Comprehensive Review of Health
Services Report in March 1996.
I am very pleased and would like to
acknowledge the efforts by the Undersecretaries and
the divisional heads in compiling and providing
information for the report.
The reporting period of 1997-99 was the most difficult years for the Ministry in
delivering health services to the people of the country. The major external factors that
affec t
edt hehe a
lths ystem’ spe rforma ncewe ret hee conomi cd ownt urn,whi c hwa s
severed by the twenty months old ethnic tension. Nonetheless, primary and secondary
health care services continued despite difficulties. The report shows that key health
indices such as the infant mortality and maternal mortality continue to improve.
Naturally, the part of the reason for the improvement is attributed to the performance
of the health system of the country. Let me make myself clear that I am neither bias in
my 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 need
for us to improve on our capacity to monitor and evaluate our own performances. In
this report we have used objective reports from external sources such as WHO annual
reports.
Another important issue revealed in the report is the issue of health inequalities
by provinces. I would say that it confirms the hypothetical assumption that resources
are not distributed equally. The level of health status varies a lot by provinces given the
fact that the pattern of infectious diseases is similar through out the country. The level
of health service delivery activities and accessibility to health facilities varies. Whilst, the
overall health indices may look favorable, it is the internal aspect of health service
delivery 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. The
report also evaluates the health status against the key performance indicators in the
NHPDP. However, due to lack of appropriate data and information the report is not
able to evaluate all important indices against the objectives in the NHPDP. This is an
issue itself to look into in the near future. The National Health Annual Review is a
milestone in a long-term process. The measurement of health systems will be regular
feature 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 includes
manpower, 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 wise
decisions. 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. I
commend you for maintaining health services during the height of the ethnic tension all
through out the country. May God Bless you.

Hon. Allan Paul, MP


Minister 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 1997
to 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 Policies
and Development Plans 1999-2003 is attained.
 To evaluate specific health services delivery packages.
 Source of information for the purpose of (strategic) management and
supervision, planning and monitoring of health services delivery. (Identify
priority key health issues and problems through trend and pareto analysis, in
order 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 the
country, demography, socio-economy, and politics, which had significant impact on the
health sector in the period 1997-99. Section 2 review the changes within the health
sector (Internal Review Report), in relation to health care referral system (structure),
distribution of services by health facilities, human resource, and health financing. It also
covers 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 evaluates
health improvement programs. Section 6 evaluates (policy 4) trend of morbidity and
mortality reduction. Section 7 evaluates (policy 5) environment health services. Section
8 evaluates (policy 6) health promotion and education. Section 9 evaluates (policy 7)
reproductive and family planning. Section 10 evaluates (policy 8) development
partnership in health development.

The scope of the report confine to the activities undertaken in 1997-1999 the resources
input, 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 and
analysis 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 some
1,667 km in a southeast
direction between Papua
New Guinea and the
Republic of Vanuatu, and
North-East of Australia.
On the Islands the
location of villages are
scattered. Many live along
the coast, some inland
with sea access and
others 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 sea
access, whilst 15.0% lived inland with sea access. Theses factors determines as well as
undermine the plans put in place to deliver health care service delivery efficiently to the
remote people, particularly those living more than 3 kilometer from a nearest health
clinic.

Geography factors have caused threats to health policies, aimed to address issues and
problems related to improving accessibility and equality to health care services. In such
cases understanding very well the diversity of the people and their needs are important in
the strategic planning. Geographical factors therefore correspondences with the
weaknesses within the organization. For example, coupled with untimely or non-payment
of health services grants, villages living more than 3 kilometers from a health facility or
those living inland with no access to roads are not reached by health care mobile teams
from rural clinics.

1.2. The demography (Population):


1.2.1. Size & Growth:
Table (2): Demographic Trends 1995 - 1999
The population of the Year 1995 1996 1997 1998 1999
country is a major
concern to the health
care services.
Population 395848 409939 425488 44184 45938
Especially with regards
Projection 0 0
to the distribution of
limited health resource
Source: MHMS Estimate from 1986 Census. The Population figure from
to meet the vast health

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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 objective
targets.

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 (1986
1
census) . 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 total
population in age-group 0-14 years. The number of children 0-4 years continue to
increase but at a declining rate. The population of female of childbearing age
considerably increases in the past ten years with more children entering adulthood after
the 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 care
service by the age group of 0-4 and female of childbearing age remain high, and the
Ministry 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, there
has been some positivism in terms of the natural decline of certain age group. The trend
of 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 the
paper the analysis shows that whilst age group of children under 4 yrs increase and puts
more pressure to bed capacity of all provincial centers, the trend of WCBA decline giving
opportunity for realignment or rationalization of health care services. The variations
between 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 Density


1986 2000 2010

1
Statistics Unit, MHMS, 1999.
2
National 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
Ibid
4
SPC (2000). Oceania Population 2000, Demography/ Population Program, Secretariete of Pacific
Community, Noumea, New Caledonia
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15 16 21
Source: 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 for
most families, but these traditional means of economic and social support in the rural
areas are weakening. Participation in the cash economy and formal employment
opportunities 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 to
strong growth in forestry, fishery, construction, transport and communications. The
economy is dominated by commodity production, principally export of logs, fishing,
palm oils and kernels and copra. Per capital Gross National Product was estimated at
US$560 in 1992 ranking the country as a Least Developed Country (LDC). Gross
Domestic 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 the
year after courtesy of the boom in log exports and declining imports. Log exports went
from $104 million in 1992 to $221.7 million in 1993 and $366 million in 1996. The
persistent trade deficit prior to the advent of the log boom shows the heavy reliance on
imported manufactures, machinery, and transport equipment. In 1995 Australia
accounted for 41.4 per cent of total imports, Japan 11.8 per cent, Singapore 9.3 per cent
and New Zealand 9 per cent. Services payments has been higher than receipts since
1990 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 from
Development Partners. By the end of 1999, the conflict was already having its toll on the
economy. The pressure on the economy continued in the first half of 2000 until the
coup on June 5th. The coup only accelerated an already worsening situation in the
Solomon Islands economy witnessed since mid 1999. Now however, the important
sectors of the economy have been knocked out leading to a substantial weakening of the
structure of the whole economy. So the effect of the social unrest on the Solomon
Islands economy is much more severe and damaging than any crisis the country had ever
experienced 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 its
pre tension levels. In some respects, the Solomon Islands society may have changed
forever 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 334 252 411


Total Population 410,36 425,488 459,380
Population <1 year 15,209 15,772
Population 1-4 years 56,432 58,516
Population women 15 –49 87,294 90,486
years
Population annual growth rate 3.5 in 86 [i.] 3.3 [ii]
Population density 14 15 16
Life expectancy M-62, F-64
Infant Mortality/1000 live 67 in 1976 38 in 1986 28 [iii]
births
Under 5 Mortality rate/1000 26 in 1995 [iv.]
Maternal Mortality 549 in 1986 209
Rate/100,000
Total Fertility rate/WCBA(15- 6.1 in 1986 4.7*
49)
GNP (USD) 870
%GNP on Health 11.6
Expenditure per health 11
Doctor per population
R/Nurse per population
Population access to safety 65% in 1995 [iv.] 70% [vi.]
water
Population access to proper 9% in 1996 [vi.]
sanitation
Contraceptive prevalence [iv.] 25% in 1995
Ante-natal coverage [iv.] 92% in 1995
Supervised delivery [iv.] 85% in 1995
Birth <250g [iv.] 20%

Expected births [v] 17,235 17,868


Total deaths [v] 863 884
Total Births [v] 7,235 7,360
Maternal Deaths [v] 8 5
% Family Planning Coverage 7.7 8.5
[v]
% Antenatal Coverage [v] 74.4 68.9
% Postnatal Coverage [v] 36.6 39.9
% Detected malnutrition [v] 1.6 1.5
Touring Satellite Clinics [v] 2,309 2,068
Touring Schools [v] 890 720

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Village Health Meetings [v] 1,600 1,767
EPI [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 - 9.8 % 6.0 %
out

Sources: [i.] 1986 National Census


[ii] WHO World Health Report 2000, Annex Table 2 Basic indicators for all
[iii] 1999 National Census
[iv.] Th eSta
teo f
Wo rld’
sCh i
ldre
n20 00 ,UNI CEF, Ne wYo r
k
[v.] EPI figures are from the Health Information system, Statistics Unit MHMS5i
[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 been
achieved over the past two decades. The reported Infant Mortality Rate (IMR) has been
reduced from 67 deaths per 1000 live births in 1978 to 44 per 1000 in 1995. Other
statistics, such as lower crude death rates and longer life expectancy, provide additional
indicators of improved health status.

While the IMR has decreased, infectious diseases and chronic under-nutrition continue
to dominate morbidity and mortality in children. There is growing evidence, much of it
clinical 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 in
turn has
implications for
resource utilization
as the demand
increases for long-
term care, tertiary
interventions and
costly technologies.

The MHMS is
committed to
preventing disease,
protecting life and
promoting healthy
lifestyles and
choices. The
National Health
5
EPI figures used in the table are recorded by the HIS monthly reports. A verification report was done
in Malaita 1999 to encountered under and over estimation reporting.
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Policies and Development Plan 1999-2003 articulate a systematic approach to further
deve l
opa ndstr
engthentheMi nist
ry’
sc apaci
tya ndc apabili
ty.

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 Referral 1 1


Hospital
5 Provincial Provincial Hospitals 7 9
4 Area Council Area Health Center 14 23
3 Wards Rural Health Clinics 123 95
2 Wards Nurse aides Posts 61 129
1 Village VHW Posts 128 154
Total 334 411
Source: *The Comprehensive Review of Health Services Report, 1996, MHMS, p.3.

Smaller hospitals such as Tulagi, Lata, Kirakira, Buala, Helena Goldie, Atoifi and
Sasamuga 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 Solomon
Islands 6. However, the Guide document is to be further developed into a meaningful
resource management.

Primary health services are primarily delivered at community level both at the urban and
rural areas. Accessibility of health services has improved with the upgrading of health
facilities and establishing additional through out the country. Approximately 70% of rural
communities are within an hours walking distance from a health facility (The
Comprehensive Review of Health Services Report, March 1996). Health facility to
population in at least 50% of the provinces in 1996 was 1:800 compared to 1,131 in
1992. About half of the population (national average of 53.7%) lived within 3 kilometers
from 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 and
therefore the cost to them in monetary terms is negligible. Nevertheless, remote
provinces such as Temotu and Choiseul are vastly affected by distance and cost of travel
to 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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From table (3), the number of health facilities has increased by 23% (77 additional
facilities), which implied that 26 facilities have been established per year in the three
periods 1997 to 1999. The increase is seen with Area Health Centers, Nurse Aide Posts,
and Village Health Aides.

During the period of 1997-99, the number of population cared for by a health facility
clinic declined from 1:1,737 in 1997 to 1:1,643 because of the slight increase in the
number of health facilities especially the rural health clinics.

2.1.2. Distribution of Services:

Graph (1) showing distribution of health facilities by provinces:

Majority of basic Chart (1) Showing Distribution of Health Faciltites by Provinces

health facilities are


based in bigger Makira Ulawa
Temotu
3%
Choiseul
9%

provinces with larger 11%

populations (such as W estern

Malaita, Western, 20% Choiseul


Western
Isabel

Guadalcanal, so that Central Islands


Guadalcanal
Malaita
basic health care Malaita
29%
Makira Ulawa
Temotu

services are within Isabel


10%
the reach of the
people. However, the Guadalcanal
9%
Central Islands
9%

level of services
differs between areas.
Higher level of service are available at the Central Hospital Honiara, which the
National Referral Hospital. This is achievable when the need arises through the
referral system or travel to Honiara at own will.

Table (2) showing Health Clinics:Population* and Nurse: Population** Ratio:

1997 1998 1999


Provinces No. of Clinic: Nurse: No. Clinic Nurse: No. of Clinic: Nurse:
.Clinics Pop Pop of . : Pop Pop Clinics Pop Pop
Facilitie clinic
s s
Choiseul 21 998 1,311 24 900 1,200 24 926 890
Western 38 1,609 - 38 1,637 1,016 38 1,707 1,201
Isabel 28 716 717 28 740 609 28 763 668
Central 31 725 1,604 31 746 1,445 31 767 1,321
Islands
Guadal. 20 3,928 2,806 21 3,902 2,826 21 4,070 2,442
Malaita 56 1,833 1,488 56 1,875 1,500 56 1,926 1,477
Makira 28 1,119 1,045 28 1,160 984 28 1,201 909
Temotu 12 1,613 745 12 1,656 686 12 1,705 758
Honiara 8 8,314 2,293 8 8,954 2,311 8 9,643 2,488
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Ren Bell 3 803 482 3 826 413 3 850 425
Solomon 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 with
change.
 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 past
two 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, and
Department of Public Services. Nonetheless, delegation of disciplinary power was given
down to the Permanent Secretary (impartially) with out much legal underpinning.

Internally there is confusion between policy and operational roles, between statutory and
ministerial obligations. The job descriptions are ill defined without much performance
indicators 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 rules
and procedures that matter? Or is it our customers? Our local population? These
questions need answer that concerns with accountability and external autonomy to the
Ministry of Health. Or even to other sister ministries. The existing health structure and
its relation with the public service needs careful review and changes.

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Fi
gur
e1s
howi
ngt
hee
xis
tingor
gani
zat
ion’
sst
ruc
ture: 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 & Protection


Services 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 with
implementing agencies in the province under the Provincial Agreement Act. Health
financing and manpower supply are centrally controlled and disbursed. Health services
delivery to the people uses the primary health care approach. There is mixture of horizontal
and vertical health programs. Most public health programs such as the Malaria Control
Programs, Environmental Health and Rural Water Supply programs, and health education
programs are typical vertical programs.

2.2.3. Activities (Inputs):

The Health Strategies of the Ministry is stipulated under the National Health Policies and
Development 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 the
Government as wells as grants and external financial sources from international developing
pa rt
ne rs.TheMi nistry’sefforttosustaint hemi nima lr
easona blelevelofc a r
et ot hepe ople
of the country supported by the limited resources of health workforce, financing and
infrastructure.

2.2.4. Findings (outputs):

There were two changes to the Minister of Health during the report period. In mid 1997
around August, the Ministry had a new Health Minister (Hon. Dickson Waraohia, MP for
East 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 name
from Ministry of Health and Medical Services to MINISTRY OF HEALTH in 1999.

Bills and 1997 1998 1999


Cabinet Papers
1.Parliamentary
Bills
(a) Passed 1.Pharmacy
Practitioners
Act
(Amendment
2.Pharmacy &
Poisons Act
(Amendment)
3.Pure Food
Act
4. Nursing
Council

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Amendment
(1997)
(b) Draft Stage 1.Mental 2.Tobacco Products
Health Act Control Bill (draft)
(proposed
amendment)
2.Cabinet Papers Not available 1.Indicative Health Sector 1.Revised Local
Program on Development Supplementation
Stategies 1997-2001. (23.3.98, Scheme (LSS) for
Cab(98)59). foreing doctors
employed by the
S.I.G. (10.2.99,
Cab(99)15).
2.Resolutions on Health for 2. Submission for
st
All into 21 century 5% increase of SDA
Reproductive Rights and to Operating
Responsibilities conferences, Theatre & Eye
11-12.2.98,Canberra,Aust. Nurses in the
(22.4.98, Cab(98)83N). country. (18.2.99,
Cab(99)16
3. MHMS to have its own 3. Report on the
transport servicing & pooling Study Tour to Japan
system. (28.4.98, Cab(98)87). & Brisbane by
Minister of HMS.
(30.4.99,
Cab(99)64I).
4. Decision to terminate 4.The impact of the
Solomon Islands doctors with current ethnic
SIMA Medical Centre from tension on the
Public Service be withdrawn Hospital services at
and direction to resolve the the Central
issues. This matter was (National) Referral
deferred but never discussed Hospital. (27.7.99,
again. (28.4.98, Cab(98)88). Cab(99)89).
5. The MHMS 5
year National Health
Policies and
Development Plan
1999-2003). (27.7.99,
Cab(99)113
6. Report of the
Review and
Restructuring of the
MHMS as part of
the phase two of the
public sector reform

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program. (2.8.99,
Cab(99)120).
7.Proposed
Solomon Islands
Health Sector
Development
Project. (15.9.99,
Cab(99)159).
8.Solomon Islands
Health Sector
Development
Project Previous
Paper. (13.10.99,
Cab(99)159.
Early 2000:
Reform in the
Health Sector
Assisted by
AusAID, (22.2.00,
Cab(99)231).
Change of name
from the Ministry of
Health & Medical
Services to
MINISTRY OF
HEALTH (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 health
services at both the provincial and central levels. Successive governments have always
considered 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:

Year Total Govt. Rec. Health Rec. Share to Health Per


s Budget SBD$M Budget Health Revenues capitaSBD$
SBD$M (%) SBD$M
1988 101.2 12.7 12.5 0.1 Nominal Rea
l

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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 14.4
1999 441.0 56.7 16.3
Source: Account Section, MOH (2000.

Table (4) Distribution of the Recurrent Health Budget 1991-1


999(
SBD$
’00
0)

Sections 1991 1992 1993 1994 1995 1997 1998 1999


Total 11901.1 15907. 16758. 24525. 23776.
Central 8 9 1 8
Total 6632 6994.4 8180 10044. 14928. 18963. 21209. 21306.
Province 2 3 6 2 1
Total 185331. 22307. 24939. 34569. 38705. 31290. 34070. 35439.
National 1 2 3 3 1 5 1 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 performance
management of the health budget. It is almost impossible to measure both the operational
and the impact of the health care services at the central and provincial level. Item budgeting
rathert han‘ ou t
pu tba s
ed’bu dg eti
ngi sa ppl ied.Thebu dgets tructur ei sdr i
venbyt he
De pa r
tme ntofFi nanc e’
sobj ectivesmor et ha npr ovidingoppor tunityf orbi gs penders like
health to be accountable in cost saving incentives and cost-recovery. The health budget
therefore 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 alone
consumes significant portion of 28.3% of the total health budget in 1999, followed by
Ministry of Health Headquarter 15.2%, Pharmacy services (drugs & equipment covered
here) 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 19928. In 1997 to 1998, it raised
(since 1993) and stays around 37-38%. The implications of the current budget setting and
allocation are an issue to be addressed in the near future plan.

De spi t
et heGov ernme nt’sc ommi tme ntt ohe a l
thasrefle ctedbya ni ncreaset o1 6 .
3% of
total government budget from previous years, there is the need to review the issue of health
financing and management of health care delivery, particularly at the NRH. The
Government in its Solomon Islands Policy and Structural Reform in 1997 set the direction
towards increasing proportion of the recurrent health budget to community and public
health programs, provincial health services, environmental services, and health education and
promotion.

Table (5) showing selected health accounts indicators for selected countries in the pacific region;
estimates for 1997:
HEALTH EXPENDITURE (%) PER CAPITA HEALTH EXPENDITURE (U
untries Total Public Private Out-of- Public Total Out –of- Total Public expend
expendit expenditur expendit pocket health expenditur pocket Expendit -iture in inter
e as % of
ure on total
ure as % expenditur expendit e at official expenditur ure in national
health expenditur of total e as % of ure on exchange e internatio dollars
as% of e on health total health as rate at official nal dollars
GDP health. expendit expenditur % of rate
ure e on total
health public
expendit
ure
stralia 7.8 72.0 28.0 16.6 15.5 1730 287 1601 1153
ew Zealand 8.2 71.7 28.3 22.0 12.7 1416 312 1911 999
ji 4.2 69.2 30.8 30.8 8.3 115 35 214 148
lomon 3.2 99.3 0.7 0.7 5.2 19 ……. 83 83
ands
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
…. . d atanot 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 that
by WHO standard to some extend, Solomon Islands health system has a cost-effective
delivery package through the primary health care approach. It is assumed and implied here
then that we are utilizing the limited input of financial resources and transforming it into
higher level of performance on health. This is not saying that the internal structure and
functions of the health system is perfect. As the report will reveal later there are numerous
health issues and problems related to structure and function needs to be reviewed and
addressed.

2.4. Management and Supervision:

The foremost important health issue in the period of 1997-99, is the lack proper and detailed
monitoring 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 monitored
and 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. The
budgeting procedure is traditionally cost-based. There is need to improve the financial
management system at the central ministry and hospital levels. Health policies are not
evaluated seriously. There is no evidence based policy development.

There is no mechanism in place to access whether human resource for health is meeting the
requirements of the country in terms of defined needs. It is difficult at this point in time to
have 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 often
the 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 the
current status of health care service delivery in Solomon Islands, highlighted some concerns
and weaknesses as well as strengths. About 59.7% of the respondents found that health
facilities 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 clinics
to address. The presence of a health worker at the health facility at the time of patient
presentation 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 not
satisfied. Although majority of 81.2% is satisfied with attitudes of health workers, it is a
concern still in Makira, Temotu and Honiara. Despite difficulties, 65.5% are satisfied with
availability 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 and
Guadalcanal. 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 per
person per year (See table 14 below). An individual of Western Province visited the clinics
more, 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 (or
more) 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 number
local 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 require
improvement. About twenty four percent (24.3%) of the total health work force is in the
National Referral Hospital. However, deployment of qualified well-trained health workers
and 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 to
registered nurses, 32.5% of nurses are also in the NRH, while 67.5% are in the provinces
including HCC. Nevertheless, there is hospital-bias in relation of deployment of Registered
Nurses in the provinces by more than half (59.2%), excluding CIP, GP, CP, and HCC who
are 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 the
gap 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 to
doctor ratio is very high.

Table (6) Shows the Gap Between Requirement Projection and Supply Projection on the Medical
Profession (Doctors):
NRH

W.P

M.P

I.P

C.P

TP

MUP

G.P

CIP

RBP

HTC

Total
General 0 0 0 1 1 0 1 0 0 0 0 3
Surgery
Orthop 1 1
ed.
Paediatr 0 0 0 1 1 1 1 1 0 0 0 5
i
Obst& 0 0 0 1 1 1 1 0 0 0 0 4
G.
Int.Phy 2 1 1 1 1 1 1 0 0 0 0 8
si
Radiolo 0 0
g
Patholo 1 1
g.
Anaesth 1 1 1 1 1 1 1 7
Eye 0 0
Psychiat 0 0 1 0 0 0 0 0 0 0 0 1
rist
A&E/ 3 2 3 1 1 1 1 1 1 1 1 16
GP
Manage 0 1 1 1 1 1 1 1 1 1 1 10
r/CEO
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 the
National Health Policies is being left to respective divisions and departments that made up
the Ministry of Health. However, MOH is trying its best to do away with the above
management approach and to empower the heads of department and middle managers to
play more part in decision making in areas of management, planning, monitoring and
evaluation of health services. In enabling that to work the fundamental basic structure must
be 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. TheMi nist
ry’sPolicy
Goals is to improve the capacity of the ministry to plan, implement, and evaluate the health
services in the country.

3.1.1. Activities (Input) & Output:

Table (7) below shows matrix of strategies implemented since 1997.


Priority Areas Input (Strategies) Output 1997 1998 1999
Indicators
1.National 1.1.National Health The national health accomplished
Health Policy Indicative Strategies indicative
Developments: strategies were
produced by the
MOH.
1.2.Medium Term The MTDS was accomplished
Development Strategy formulated with
participation of
MOH and all other
Ministry
1.3.National Health Sequent of events Review Senior Health Finalization of
Policies and leading to the final Or situational Officers draft.
Development Plans draft of the analysis done Conference met in Printing of the
1999-2003 NHPDP August 1998 document is
delayed.
2.Health Sector 2.1.Restructuring MOH
Reform - Restructuring -An institutional -An ADB
the health -Institutional strengthening consultant, Mr.
sector so that strengthening project completed John Izzard,
it becomes project. and submitted to reviewed the
efficient and the MOH Budget
effective in -Draft Multidevelopment structure.
the delivery Restructured partners meeting
of health MOH. held in Honiara. -A NZ
services. -Revised staffing consultant
Main focuses structure. -Draft reviewed the
on -Revised budget restructuring Health Care
[1] structure. document Legislation. Joy

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institutional -Revised Health completed but Liddicoat
strengthening Care Legislation needs further (September
- [2] Staffing refinement and 1999).
restructure modification.
- [3] Budgeting The health
restructure sector’s
- [4] Health intention to
care restructure was
legislation approved by the
review. Cabinet.
- Review
functions, job
descriptions,
activities
involved,
work load
analysis.
3. 3.1.-All posts filled with -All posts filled. Not Not accomplished Not
Strengthening appropriate qualified -Office automated. accomplished accomplished
theMHMS ’ staff. -FMS
capacity to -Office automated & -RAF.
plan, budget, equipped. -Regular financial
evaluate, -Training of staff reporting.
monitor and -
evaluate health
services
delivery
3.2.Establishemnt of -Properly Not Not accomplished Not
proper Financial structured financial accomplished accomplished
Management System management
system and
guideline on
monitoring and
cost analysis and
budgeting and
resource allocation.
-Monthly financial
reporting by
accounts section.
Regular (annual)
National health
Financial reporting
and cost analysis.
-Development of a
appropriate
resource allocation
formula based on
demand, needs and
population
3.3.Strengthening of the -Accurate and -Response (a) 79.1% (a) 76.7%
health information timely reporting rate from (b) 91.2% (b) 87%
system by improving (response rate. clinics: (a)
coordination and -Hospital- 78.8%,
integration of information (b) Pop.
information data, and system. covered in
software. reporting
Expand hospital- 88.2%
inpatient data.
-Response Poor. Not Poor. Not
rate from accomplished accomplished
Hospital;
poor.

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Not
accomplished
4.Partnership 4.1.Review current 4.1.Draft Not Not accomplished Not
Development mechanisms Guideline accomplished accomplished
completed
4.2.Develop 4.2.MOU Not Not accomplished Not
partnerships and established accomplished accomplished
collaboration with
private sector
5.Improve 5.1.Strengthening level Physical Physical
access & of health care at NRH upgrading in upgrading in
quality health & provincial hospitals progress progress
care through:
-Continuous training, No. Of trained In progress In progress In progress
personnel
-Upgrading of Upgrading of Not Not accomplished Not
equipment, equipment accomplished due to lack of accomplished
due to lack of funding due to lack of
funding funding
-Upgrading of Infrastructure Draft Guide to
infrastructure rehabilitation Role delineation t
completed
6. Develop 6.1.Review current - Cost recovery Not Not accomplished Not
policy on regulations so that (user pay) policy accomplished accomplished
(public) health alternative health
Financing financing could be
developed.
-Increased revenue Not Not accomplished Not
collection at the accomplished accomplished
National Referral
Hospital;
6.2.More emphasis to -Increase budget -Increased of 10% -Donor inputs in
Health Improvement allocation to health to the health public health
programs. improvement & budget to health programs.
protection. improvement &
protection.

3.1.2. Analysis:

The activities and input at the policy and executive level of the Ministry of Health are driven
by eight health policies that form the platform to ensure that the system achieves the
following 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 future
directions through three key policy frameworks. They were the National Health Indicative
Strategies, which formsa nintegralpa rtoft heGov ernme nt’sMe dium Te rm De v el
opme nt
Strategy (MTDS).

9
WHO (200) Measuring Goal Achievements in the World Health Report 2000; Health Systems: Improving
Performances, 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 events
include review of the status of health services in the country, which coincides with the
Senior 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 to
prioritize in the future health developments. The Ministry then drew up a Cabinet paper
expr essingt hes tateme ntofi ntentf orthe‘ hea l
ths ectorr e f
orm’,whic hwa s
,a pprov edthe
Cabinet 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 affected
by the political and social problems experienced. The effect of the ethnic tension has been
the 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 such
as developing standards and specific policies, integrating more with staff and other
stakeholders internally and externally. It is therefore clear that coordination at the
executive and divisional management level needs to be addressed. Clear guidelines
and job descriptions need to be developed or re-enforced if already present. It is
helpful if clear performance management process is developed with staff from the
executive and downward.

 Delay at the Central Agencies: - There is significant delay in administration


procedures by central agencies. Human resource management procedures such as
recruitments have been very slow. This is not critize the central agencies but this is
how health development is been affected.

 Lack of funding:- Theov erallGov ernme nt’


sc a shf low pr oblema ff
ectedt he
Mi ni st
ry’
sc a pacityt oi mpl ementma nage, and evaluate its programs. Supervisory
visits were not done. The capacity to implement project and plans of the Health
Development Budget is none, either due to lack of funding or no one to implement
the plans at operational level. It is also because of lack of proper costing of plans
into 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 must
be transferred to the divisional heads and subordinates and reinforced in a learning
manner. However, the rationale to re-l ooka ttheMi ni
stry’
sor g ani
z a
tiona lstruc tu
re
and function is understood to some level. Workshops and conference were the
major venue for communication. Involvement of key staffs were involved right at
the 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 and
are related. In measuring the achievements of the Solomon Islands Health System the above
key outcomes are used in this report. The WHO guide is applied in this context. The
Mi nistry’sf orwardpl anni ngi se nsuret hatwec ou l
ds e et hepr oblems and achievements
ourselves and not for someone else to do it for us. However, at this stage we could only rely
onot he rs
’ 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 annual
growth 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) but
less than Papua New Guinea (106-129). Similarly, adult Solomon Islander has a higher
probability 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 the
basic indicators by WHO, Fijians live longer at Life Expectancy of female 69.2 and male
64.0, than Solomon Islands, female 64 and male 62. Solomon Islanders expected to live
longer than Papua New Guineans and Vanuatuans See Table xxx).

Table (8) showing Basic Indicators for selected countries in the pacific region:
Countr Annua Total fertility Probability of Probability of Life Expectancy
ies l rates dying (per 1,000) dying (per at (yrs)
growth Under 5 yrs 1,000). 1999
rates Between 15 and
(%) 59 yrs
1990- 1999
99
1990 1999 Male Femal Male Femal Male Femal
e e e
Austra 1.1 1.9 1.8 7 5
94 5376.8 82.2
lia
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 64
PNG 2.3 5.1 4.5 129 106 377 325 53.4 56.6
Vanuat 2.5 4.9 4.2 64 57 333 239 58.7 63
u
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 Life
Expectancy (DALE). It is been used by WHO to judge if good health is achieved. The
estimates for 1997-99 by WHO revealed Solomon Islands ranked 127 compared to Tonga
and 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:
Ran Countries Total Disability-adjusted life expectancy Expectation of
k pop. @ (years) disability at birth
birth (years)
Males Females Males Female
s
At birth At 60 At birth At 60
2 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 8.6
106 Fiji 59.4 57.7 8.3 61.1 9.8 6.3 8.1
127 Solomon 54.9 54.5 8.8 55.3 9.2 7.5 8.7
Islands
135 Vanuatu 52.8 51.3 8.0 54.4 9.2 7.4 8.6
145 PNG 47.0 45.5 8.2 48.5 8.7 7.8 8.1
Source: 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 (as
the 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 the
referral systems in relation to health care services delivery. The primary health care
mechanism 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 to
the peoples’ diffe
renthe alt
hne eds.

3.2.3. Responsiveness10 of the health system:

Sol omonI s l
andshe alt
hs y
stemsha ves howne vi
de nceofme etingpe ople’ssa ti
sfac
ti
on.A
national survey done in 199511 . There was a high percentage of level o satisfaction with the
overall performances of the health facility. High level of satisfactions was also found in
selected activities such as waiting time (mainly in rural health facilities and not in Honiara),

10
WHO (Health Report 2000): Responsiveness is no tme etingp eo
p le’sn eedsbuthows
yst
e msp erfor
ms
relative to non-h ealt
ha s
p ects,meetingo rno tme e tingpo pu lati
on’se xp ectat
ion.Commoncomp lain
tsof
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 health
level, and the overall performance:
Performance on health level Overall Performance
(DALE)
Rank Countries Index Rank Countries Index
20 Solomon Islands 0.892 32 Australia 0.876
39 Australia 0.844 41 New Zealand 0.827
80 New Zealand 0.766 80 Solomon Islands 0.705
120 Vanuatu 0.665 96 Fiji 0.653
124 Fiji 0.632 127 Vanuatu 0.559
146 Papua New Guinea 0.546 148 Papua New Guinea 0.467
Source: WHO (2000): The World Health Report 2000; Annex Table 10, pp.200-203

Efficiency in health attainment(performance Overall Efficiency (overall


on health level/ DALE) in selected countries performance)
in the pacific region
Papua New
Guinea
Papua New Guinea
Vanuatu
Fiji
Fiji
Vanuatu
Solomon
New Zealand Islands

Australia New Zealand

Solomon Islands Australia

0 20 40 60 80 100 0 20 40 60 80 100
%
%

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 two
developed country in the pacific, Australia and New Zealand. Even on overall performances
SI is ranked 80 out of 1991 members states of WHO.

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Sy
ste
m’sWeakne
sse
s:

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 political
status of the provincial government system and their commitment to health, health financial
management and accountability, and administration process in relation to human resource
management, and other bureaucratic procedures, and the ability of the Ministry of Health in
monitoring and evaluating health services. Other problems are practical issues related to
untimely payment of health grants to the provinces.

3.3. Health Information System:

Thek eys ou rce sforhe althi nforma t


ioni st he‘ He althI nf
or ma t
ionS yst
em( HI S)
’.Itisthe
monthly clinic report on health activities by provincial hospital outpatients, Area Health
Centers, Rural Health Clinics, and Nurse Aide posts. It reports on the activities of health
institutions, 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 and
divisions and programs. It is (hope) through annual reports that feedback on issues related to
health resources management is reviewed. Issues and problems are raised and discussed. It
was an important avenue for problem identification. Besides, conventional health indices
such as morbidity rates experienced in the provinces, other management information is also
included, 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 required
formats 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 for
evaluation and improvement purposes. Nonetheless, this report uses a lot of trend analysis
as a means of evaluation of the health activities and program outputs and outcomes. There
is overall failure of reporting by responsible health authorities in the provinces and divisional
level 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:

Solomon Islands 1997 1998 1999 It is clear from the table that the level of
-Response rate from clinics 78.8%, 79.1% 76.7% responding declined in the past three
Pop. covered in 88.2% 91.2% 87%

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

% of Reporting from Clinics by provinces 1997 1998 1999


Choiseul 66.3 67.0 76
Western 85.1 81.5 75
Isabel 64.0 64.8 66
Central Islands 76.8 85.5 81
Guadalcanal 73.7 82.0 79
Malaita 83.8 77.0 73
Makira 91.7 95.6 81
Temotu 83.3 82.1 67
Rennell Bellona 52.1 64.6 35
Honiara 100 100 83
Source: Health Information System, Annual Feedback 1997,1998,1999, Statistics Unit, MOH

Graph showing % of reporting of Monthly Clinic Report by


provinces

120

100

80
%

60

40

20

0
a
l

ra
el

ds

SI
ta

ira
rn
eu

na

n
ot
ab

ai

ia
te

an

llo
ak
is

m
al

on
es

lc
Is
ho

Be
sl

Te
M
da

H
W

lI
C

ll
tr a

ua

ne
en

en
C

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. Those
provinces below 80% line need more effort put in reporting.

3.3.2. Response Rate of Annual Reports:

Provinces & Reporting 1997 1998 1999


Officers
Western Nil Yes Yes
By B.Sasa By Hosp. secretary

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Choiseul Yes Nil Nil
By B.Sasa
Isabel Yes Nil Nil
By Dr. Roy
CIP Nil Nil Nil
Guadalcanal Nil Nil Nil
Malaita Nil Nil Nil
Makira Yes Yes Yes
By Dr. Bala By Dr. Bala By Dr. Bala
Rennell Bellona Nil Nil Nil
Temotu Yes Nil Yes *
By Dr. By Drs. Togamae &
Araathon Tovosia
Honiara Town Council Nil Nil Nil
National Psychiatric Unit Yes, by Yes, by D.Boara Yes, by D.Boara
(NPU) D.Boara
By Programs & 1997 1998 1999
Reporting Officers
Malaria Yes Yes Yes
Reproductive Health Nil Nil Nil
RWSS Nil Nil Yes, by Peter Woperes *
Disease Prevention & Yes, by Yes, by Yes, by K.Konare
Control center K.Konare K,.Konare
Health Education Yes, by Yes, by A.Lovi Yes, by A.Lovi
A.Lovi
Social Welfare Nil Nil Nil

NRH & Reporting 1997 1998 1999


Officers
NRH – Overall Report Nil Nil Nil
Rehabilitation Yes, by Yes, by V.Hugo Nil
C.Laore
Pathology Yes, by A.Dofai
Surgical Yes, by Yes, combined report by
Dr.D.Pikacha Dr.D.Pikacha
X-ray Yes, by S.Savakana

Private Sectors & 1997 1998 1999


Reporting Officers

Helena Goldie Hospital Yes, by Yes, by Yes, by Dr.J.Xlow


Dr.J.Xlow Dr.J.Xlow
Atoifi Hospital Yes*
Note: * implies that report submitted were incomplete or partially. Not all activities are
reported on.

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

The reisnoforma l‘Hos pi


talRe porti
ng ’atthemome nt. Reportsar
edonea ta na d-hoc basis.
Hospital services reporting are crucial part of management, and planning. There was
attempts to develop a reporting format for Hospitals but was not implemented for several
reasons .I ti
stheMi nistry’
spl ant oa ddr essthei ssue.The r
eha dbe ens omepr eli
mi nary
reviews done experts12. The findings of the review strongly emphasized putting in place a
proper Health Information and Management System. Further development will be done in
this area.

SECTION IV: ACCESSIBILITY AND QUALITY OF


HEALTH SERVICES
4.1. Health Care (Curative) Services:
Iti st heMi nistry’
sov era llg oal to provide reasonable minimal level of essential health care to
all individuals and families, in an acceptable and cost-effective, affordable way, and with their
full 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 and
rural clinics. The undergraduate trainings of nurses, dentist and dental therapists,
technicians in different diagnostic services, and doctors are dealth directly by the
National Training Unit, Ministry of Human Resource Development & Education in
close collaboration with the MOH. The postgraduate (inservice) training of health
workers is directly responsible of the MOH in collaboration of other stakeholders
such 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 as


according 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. This
report 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 a
report 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 provide
details 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 been
implemented because of lack of funding.

4.1.3. Outputs:

Annex Table () summarizes the ratio of health workers to


population. By end of 1999 there population per doctor in
practice was 1:10,488. (Not including the private
practitioners). The number of doctors to the population is
declining as compared to 1:7031 in 1995. The MOH target is
to improve the doctor:population ratio to 1:4,500. This is an
area needing special consideration by the Government.

The ratio of registered nurses to population remains constant at 1:836 as in 1995. However
the 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 1
registered nurse to five hundred populations (1:500).

The productivity of the Health Institutions (hospitals) is measured in terms its utilization
rates, 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
Population to 1 nurse

7,000

6,000

5,000

4,000

3,000

2,000

1,000

0
l

ds

ra
RN
NA

RN
NA

l
RN
NA

RN
NA

al
RN
NA

RN
NA

RN
NA

RN
NA

RN
NA

RN
NA

RN
NA
We al
rn

tal

tal

alc l

Ma l

a U al

tal
tu

tal

tal
na

tal
DS

tal
a
eu

be

ta

ta

law
lait
t

an

mo

nia
ste

an
To

To

To

To

To

To

To

To

To

To

To
llo
ois

Isa

AN
Isl

Be
Ho
Te
Ch

ISL
ad
al

kir

ell
ntr

Gu

N
Ma

nn

MO
Ce

Re

LO
SO
1997 1998 1999

From the above graph (2), Guadalcanal and Malaita have higher number of population to a
nurse. In 1999 in Malaita the number of population to a nurse increases due to the ethnic
tension when there was a huge influx into Malaita. Honiara has the highest population to a
nurse but a readily accessible to all level of health care in the capital. However, it remains a
management 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 the
graph, the current standing is that in Solomon Islands 1,643 population is for a health
facility. 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 Clinic: Nurse: No. Clinic Nurse: No. of Clinic: Nurse:
.Clinics Pop Pop of . : Pop Pop Clinics Pop Pop
Facilitie clinic
s s
Choiseul 21 998 1,311 24 900 1,200 24 834 800
Western 38 1,609 - 38 1,637 1,016 38 1,651 1,162
Isabel 28 716 717 28 740 609 28 729 638
Central 31 725 1,604 31 746 1,445 31 696 1,199
Islands
Guadal. 20 3,928 2,806 21 3,902 2,826 21 2,870 1,722
Malaita 56 1,833 1,488 56 1,875 1,500 56 2,190 1,670
Makira 28 1,119 1,045 28 1,160 984 28 1,107 838
Temotu 12 1,613 745 12 1,656 686 12 1,576 700
Honiara 8 8,314 2,293 8 8,954 2,311 8 6,138 1,584
Ren Bell 3 803 482 3 826 413 3 792 396
Solomon I 245 1,737 249 1,774 249 1,643 836
Notes: 1. The above table and graph does not including VHW posts (therefore it includes Nurse Aide Posts
and 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 to
closure of some health facilities as a result of the ethnic tension. There is an offset
phenomenon observed between Guadalcanal and Malaita. Whilst Guadalcanal experienced a
decline in number of population to a health facility, Malaita experiences an increase. This is
directly 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

Solomon I

Ren Bell

Honiara

Temotu

Makira
1999
Malaita 1998
Guadal. 1997
Central Islands

Isabel

Western

Choiseul

0 2000 4000 6000 8000 10000


Population

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 1999
Facility No OPD % No OPD % N0. OPD %
. Visits . Visits Visits
Choiseul
Hospital 1 1 7,776 1
Clinics* 21 35,678 24 42,679 24 49,145
Total 22 25 25
Western
Hospital 2 12,767+ 2 7,874+ 2
Clinic 48 186,703 50 165,223 55 178,397
Total 50 70 0
Isabel

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Hospital 1 8,053 16.6 1 1
Clinics 30 40,588 83.4 31 35,891 30 34,883
Total 31 48,641 32 31
Central
Islands
Hospital 1 1 1
(Tulagi
MiniHosp)
Clinics 24 44,678 24 47,173 24 -
Total 25 25 25
Guadalcan
al
Hospital - - -
Clinics 29 172,420 31 193,356 34 134,064
Total 29 31 34
Malaita
Hospital 2 2 2
Clinics 56 207,042 56 186,725 56 223,893
Total 58 58 58
Makira
Hospital 1 Nk 1 Nk 1 Nk
Clinics 29 45,730 29 54,685 29 43,341
Total 29 29 29
Temotu
Hospital 1 9,480 23.1 1 1
Clinics 12 31,553 76.90 12 30,304 12 33,143
Total 13 41,033 13 13
Rennell
Bellona
Clinics 3 3,687 3 4,819 3 3,543
HTC
Clinics 9 99,062 64.0 9 108,050 78 9 87,848 63.0
NRH 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 Rural
Health 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 showed
higher level of workload. All other provinces including HTC had OPD visits per AHC per
day 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

Bar graph showing workload at Area Health Centers, Rural


Health Clinics and Nurse Aid Posts by provinces

NAP
RHC
AHC
Rennell Bellona
RHC
Honiara Town Council
NAP
RHC
AHC
Temotu
NAP
RHC
AHC
Makira
NAP
RHC
AHC
Malaita
NAP 1999
RHC 1998
AHC 1997
Guadalcanal
NAP
RHC
AHC
Central Islands
NAP
RHC
AHC
Isabel
NAP
RHC
AHC
Western
NAP
RHC
AHC
Choiseul

0 50 100 150 200 250


OPD visits per facility
Provinces.

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Table(13) showing workload at Area Health Centres, Clinics and NurseAide Posts by provinces 1997-
99
1997 1998 1999
Provinces Facility Av.OPD Av.OPD Facility Av.OPD Av.OPD Facility Av.OPD Av.OPD
Visits/fac Visits/staf Visits/fac Visits/staf Visits/fac Visits/staf
/ f / f / f
Day /day day /day day /day
Choiseul 35678 42,679 49,143
AHC 2 49 2 58.5 2 67.5
RHC 7 14 9 13.0 9 15
NAP 12 8 13 9 13 10.4
Western 186,703 165,223 178,397
AHC 4 128 4 113 4 122.5
RHC 16 32 16 28 16 30.6
NAP 18 28.5 18 25 18 27
Isabel 40,588 35,891 34,883
AHC 3 37 3 33 3 32
RHC 10 11 10 10 10 9.5
NAP 15 7 15 6.5 15 6.4
Central 44,678 47173
Islands
AHC 4 30.7 4 32 4
RHC 15 8 15 8.6 15
NAP 12 10 12 10.8 12
Guadalca 172,420 193356 134064
nal
AHC 3 157.9 4 132.4 4 92.1
RHC 10 47.4 10 53.0 10 36.8
NAP 7 67.7 7 75.8 9 40.9
Malaita 207,042 186,725 223,893
AHC 3 189.6 3 170.5 3 205.0
RHC 20 28.4 20 25.6 20 30.8
NAP 33 17.2 33 15.5 33 18.6
Makira 45,730 54,685 43,341
AHC 3 41.9 3 49.9 3 39.7
RHC 12 10.5 12 12.5 12 9.9
NAP 14 9.0 14 10.7 14 8.5
Temotu 31,553 30304 33143
AHC 1 86.7 1 83.0 1 91.1
RHC 5 17.3 5 16.6 5 18.2
NAP 6 14.4 6 13.8 6 15.2
Honiara 99,062 108,050 87,848
Town
Council
RHC 9 30.2 9 32.9 9 26.8
Rennell 3687 4819 3543

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Bellona
AHC 1 10.1 1 13.2 1 9.7
RHC 1 10.1 1 13.2 1 9.7
NAP 1 10.1 1 13.2 1 9.7
TOTAL 867,141 814905
AHC 24 99.3 25 89.3 25
RHC 105 22.9 107 20.9 107
NAP 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

3.5

2.5
OPD visits

2 1997
1998
1.5
1999
1

0.5

0
na
ta
ds
l

al

Te a
tu
rn
eu

tra abe

ir
an

ai

ne mo
te

an

llo
ak
is

al
es

lc
ho

Be
sl

M
M
I

da
W

lI
C

ll
ua
en

en
C

The measure of average OPD visits per person per year indicates the utilization of the health
facility 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 1999
Provinces Pop. Av.OPD Av.OPD Pop Av.OPD Av.OPD Pop Av.OPD Av.OPD
Visits/pe Visits/spe Visits/pe Visits/spe Visits/pe Visits/spe
rson/ rson rson/ rson rson/ rson
Day /yr Day /yr Day /yr
Choiseul 20969 0.0046 1.7 21596 22241
Western 61146 0.0083 3.1 62982 0.0071 2.6 64869 0.0076 2.75
Isabel 20074 0.0056 2.02 20714 0.0047 1.73 21376 0.0045 1.63
Central 22461 0.0055 1.9 23113 0.0056 2.04 23784
Islands
Guadalca 78563 0.006 2.2 81941 0.0065 2.34 85461 0.0043 1.58
nal
Malaita 10265 0.0055 2.0 10501 0.0049 1.78 10785 0.0057 2.075
3 3 7
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 1.62
Honiara 66508 71628 77141
Town
Council
Rennell 2410 0.0042 1.53 2479 0.0053 1.94 2550 0.0038 1.39
Bellona
TOTAL

Table (15) Breakdown of Beds By Hospital (Government Owned Only) by end of 1999
Services and National Kiluufi Gizo Kirakira Lata Buala Total
Level of Referral Hospital, Hospital (Makira) Hospital (Isabel)
Services Hospital, (Malaita) (Western) (Temotu)
(LOS) Honiara,
Guadalcanal
Medical 56 11 15 19 8 8 117
(Beds)
TB beds 52 Nk Nk 12 12 Nk -
LOS L3 L2 L1 L1 L1 L1 L1-3
Paedistrics 45 22 10 16 8 8 109
LOS L4 L2 L2 L2 L2 L2 L2-4
Surgical (incl. 56 20 15 18 8 8 125
Orthop. for NRH (incl.orthop)
only)(Beds)
LOS L3 L2 L2 L2 L2 L2 L2-3
Orthopaedic (12) 0 0 0 0 0 12
(Beds)
LOS L4 - - - - -
Maternity 50 24 14 21 8 15 149
(Obst (incl.Gynae)

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Gynae 17 -
LOS L6 L5 L4 L4 L4 L4 L4-6
Private 12 12
Ward
Others 42 - 6 2 44
Total Beds 330 130 60 86 46 39 568
Source: MHMS, 1998; LOS - Level of Service

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


From table (15) the
Honiara based
Services and Sasamuga Atoifi Helena Total
National Referral
Level of Hospital Hospital, Goldie
Hospital is operating at
Services (Choiseul) (Malaita) Hospital
(LOS) (Western) a higher level of
services with specialist
Medical Nk 24 12
(Beds) mostly levels 3 to 6.
Paedistrics Nk 12 Malaita and Western
followed at levels 2 to
Surgical Nk 22 12
(Beds) 4, while Makira, Isabel
and Temotu operate
Orthopaedic 0 0 0 0
(Beds) mostly at levels 1 to 4.
Maternity Nk 14 14
Guadalcanal, Central
(Obst
Islands, Rennell and
Private Nk 2 -
Bellona 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 on
Primary 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 hospital
utilization rates at the provincial level varies by provinces. This variation is attributable to the
external factors as well.

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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 Bellona
Provinces) (B)
National
Public - 0.9 1.8 1.2 2.6 2.25 (a) 2.95
Hospitals (b) 0.72
Private ( 1.6 0.85 - 0.92 - - -
Church )
Hospitals
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 the
provinces 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 beds
less than NRH, they are higher than Choiseul, Western, Isabel and Malaita. It is expected in
ten years time, should nothing is done, beds: population ration will decrease further as the
population increases. Thus, indicates that the bed: population ratio is an issue to be
addressed.

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

NRH Choiseul Western Isabel Central Guadalca Malaita Makira Temotu Rennell HTC
Islands nal Bellona
In 1,411 310 1,058 18 354 0 1,804 463 181
Flow 0 0

Out 23 27 93 3 37 57 129 52 63 9 6
Flow

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


No. of Referral Cases

2,000
1,500
1,000 In Flow
500 Out Flow
0
NRH

Malaita

Makira

Rennell Bellona

HTC
Choiseul

Guadalcanal
Isabel

Central Islands

Temotu
Western

-500

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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 Hospital
and 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 out
are all to overseas hospitals. Of the total 23 referrals, 69.6% (16) went to St. Vincent
Hospital in Sydney, 21.7% (5) to various hospitals in New Zealand, and 8.7% (2) to
Brisbane.

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 various
reasons 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 to
NRH from the two major centers is the presence if induce demand by (more) doctors in
Gizo and Auki.

It is obvious that the level of sufficiency in providing higher tertiary care is very low in the
National 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)

Provinces/
Hospitals
1997 1998 1999 Average
National 34.8 32.5 37.6
Referral
Hospital*
Choiseul 58.0 59.2 64.1
(Sasamuga)
Western 33.8 29.9 28.6
(Gizo)**
Isabeli 44.7 49.4 34.7
(Buala)
Malaita 37.9 39.7 33.7
(Ki l
u’u f
i)
* *
Makira 34.0 29.6 30.5
(Kirakira)
Temotu 44.1 44.8 53.2
(Lata)
Solomon 34.4 34.9 36.1 35.1
Islands **

*The provinces included under the catchment population for NRH are Guadalcanal, Central Islands and Rennell
Bellona, 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 ranges
of 34 to 36 admissions per 1,000 populations. However there are differences within the
region. 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 Isabel
declined 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 went
as far as outpatient department (OPD) only. In other words, they did not needed to be
inpatient.

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

1997 1998 1999


NRH Medical 4.3 2.7 4.43
Surgical 4.8 4.3 5.3
Pediatrics 22.8 22.4 31.0
Maternity 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

100

90
86.2
82.7
80
77.6
Medical
70
No. of adm/1,000pop

Surgical
60 Paedatrics
Maternity
50

40

30 31
22.8 22.4
20

10
4.8 4.3 5.3
0
1997 1998 1999

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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

8,000 7102
No. of admissions

7,000 5916 5830


6,000 Choiseul
5,000 Western
3,531 3,746 3,766
4,000 Isabel
3,000 Malaita
2,000 1,216 1,278 1,426
1,000 Makira
0 Temotu
1997 1998 1999 NRH
Years

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 not
exclusively indicate the workload and productivity but other information below further our
understanding 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

90
80 79.5
75
70
64.7 65.9
63.3 Choiseul
62.7
62.1
60 58 Western
55.1
50 Isabel
48.4
46.3
45.8
%

45 Malaita
40 40.7 40.5 41
36.7 36.9 Makira
32.9 Temotu
30 29.2
NRH
20 19.6

10
0
1997 1998 1999
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
Years

All provincial hospitals experience an increasing bed occupancy rate. Choiseul (Sasamuga)
records the highest, followed by Malaita and Western Province. The pressure on beds
capacity to the increasing demand is an issue to be addressed in the in the future. Choiseul
also has the increasing average length of stay in the hospital. It may be due to limited
resou rc
e sint ermsoff aci
lityandma npowe rt oe ns
urepat
ient’
spr oblemsa re diagnosed and
underwent treatment quicker. Other quality issues can also implied for example infection
rate. 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

12
10.7
10 10
9.3
Choiseul
ALOS (no. of days)

8.4 8.2 8.3


8 8
7.6 Western
7.5
7.1
7 Isabel
6.5
6 5.8 6 5.9 Malaita
Makira
4 Temotu
NRH

0
1997 1998 1999
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
Years

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 to
managers 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 to
furthe
rde velopa nds tre
ngt
hentheMinistry’
scapaci
tya ndc apa bi
lit
y.I npa rticul
arthePl an
recognises the need to:

 Improve level of paediatrics services


 Strengthen primary health care services in rural areas and to more fully utilise
existing facilities and resources; and
 Engage in health reform, particularly in the areas of capacity building in
management and supervision, human resources development, infrastructure
development, 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 Health
Div isi
oni srespons i
blef orpr ogramst hatr el
atedt oc hildr
ena ndwome n’ she alth.Ce rtain
policies 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 Islands
include:
 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 and
provision of health services in Solomon Islands. The Ministry operates 75% of health
facilities, 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 a
total 808 hospital beds. There are a total of 326 health centres / clinics through out the
public 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 Choiseul
use the National Referral Hospital as their base hospital. The Choiseul Province uses Gizo
Hospital 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 health
care services. About 29.3% of the total population of Solomon Islands depend on Primary
Health Care (PHC) services, exclusively. However, the Comprehensive Review of Health
Services Report (1996) reiterated the need for improvement of PHC as utilisation rates at the
provincial level are low at around 60%. Basic health care are further provided in the Area
Health 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 (Child


health care services for <4yrsin the provinces):

Hospital utilization in 1997 1998 1999


paediatrics varies by Choiseul 43.2
provinces. Temotu Western 42.9
experienced an Isabel 72.7 74.1 71.9
increasing utilization Malaita 61.6 56.8 55.2
from 1997 to 1999. Makira 39.1 35.9 35.9
Whilst, other provinces
were fairly stable.
Graph (10) showing trend of utilization of hospital utilization in pediatrics in the provinces

120
No. pediatrics adm/1000pop

100 101.3

80 81 Choiseul
72.7 74.1 71.9 Western
70.5
61.6 Isabel
60 56.8 55.2 Malaita
44 Makira
40 43.1
35.9 Temotu

20

0
1997 1998 1999
Period 1997-1999

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The Ministry has offered a guide15 of 75% bed occupancy rate for the six provincial
hospitals. This is because of the higher hospital utilization in some provinces. It also allows
25% of the bed capacity some safety net should an epidemic of childhood illnesses arise.
Malaita and Chosieul recorded a bed capacity of 71 –88% BOR. Western and Isabel had bed
capacity in pediatrics of the range 45-71% BOR. Makira has the lowest range of BOR. In
practical sense it means that for Malaita in 1999 of the total of 22 pediatrics beds, 17 beds
are always filled at any one time. In Western of the total 10 pediatrics bed, 7 beds are always
filled at any one time as compared to Makira only 4 beds of the total 16 pediatrics beds are
filled.

Graph (11) showing trend of bed occupancy rates in pediatrics by provinces & NRH:

100
90
80
Choiseul
70
Western
60 Isabel
%

50 Malaita
Makira
40
Temotu
30 NRH
20
10
0
1997 1998 1999
Choiseul 75.6 74.8 74.1
Western 45.6 62.9 71.1
Isabel 46.2 70.1 61.5
Malaita 71.2 88 77.3
Makira 25 14.2 23.8
Temotu 55.8 54.1 68.6
NRH 62.4 58.5
Years

15
National Health Policies and Development Plans 1999-2003; an objective.

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

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

Graph showing trend of ALOS in pediatrics by provinces & NRH

30
ALOS (no. of days)

25

20

15
Choiseul
10
6.9
6.7 7.1 6.9
Western
5 5.9
4 Isabel
0
1997 1998 1999 Malaita
Makira
Choiseul 6.8 6.9 6.9
Temotu
Western 5.9 5.7 5.6
NRH
Isabel 5.3 6.5 5.6
Malaita 6.9 7.1 6.9
Makira 6.7 4 5.9
Years

4.5. Obstetrics & Gynaecology Services:

TheMi ni
stry’sov eral
l goa listoimpr ovea ndu pgr a
detheq ua l
ityofobs t
etr
ic
s&
gynecological services in the country. The key performances areas are:

 Upgrading and improving the level of services in key hospitals and primary health
care 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 care
in the hospital settings. The six provincial hospitals should incorporate 75-80% bed
occupancy rate. This is to allow 20-25% bed safety. In practical sense it would mean for
example in Gizo Hospital of the total 14 maternity beds, the management would ensure that
3-4 beds are always spared for emergency. However, this is not a strict ruling but a
management tool.

16
Ibid

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4.5.1. Findings & Outputs:

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

1997 1998 1999


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

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

80
No.of maternity adm/1000pop

70
61.9 64.7
63.7
60
57.6
50 1997
45.7
45.6 1998
40 1999
35.1 36.8
35.9
30 30.5 32.3

20

10

0
Choiseul Western Isabel Malaita Makira Temotu

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

100

90 92.1
87.8
80
82.3 81
76
72.9 73.3
70 Choiseul
67.6
Western
60
% BOR

55 Isabel
53.1
51.6 51.7
50 49.5 Malaita
46.4
Makira
40 40.7
37.3 38
37.2 Temotu
30 NRH
27.3
20
17.9
10

0 0
1997 1998 1999
Choiseul 53.1 72.9 73.3
Western 51.6 51.7 49.5
62
Isabel 27.3 17.9 38
Malaita 82.3 76 92.1
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Graph (15) showing trend of ALOS in Maternal Care by provinces & NRH:

14
13

12 11.8

10.6
10
ALOS (no. of days)

8 Choiseul
6.9 7 Western
Isabel
6 6.1
6 5.9
5.6
5.5 5.7 5.5 Malaita
5.1 4.8 5 Makira
4.2 4.1 4.1 Temotu
4 3.9
NRH
2.9
2.5
2

0
1997 1998 1999
Choiseul 5.6 6.1 5.9
Western 5.1 4.8 5
Isabel 5.5 5.7 5.5
Malaita 6.9 6 7

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

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

14
13
12 11.8

10.6
10
ALOS (no. of days)

6.9 7
6 6.1
6 5.9
5.6
5.5 5.7 5.5
5.1 5
4.8
4 4.2 4.1 4.1
3.9
2.9
2.5
2

0
1997 1998 1999
Choiseul 5.6 6.1 5.9
Western 5.1 4.8 5
Isabel 5.5 5.7 5.5
Malaita 6.9 6 7
Makira 13 10.6 11.8
Temotu 4.2 4.1 3.9
NRH 2.9 2.5 4.1
Years

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4.6. Access to Essential Drugs:
The National Pharmacy Services in its objective to increase access of essential to the local
commu nity,conc urswi tht heWHO’ sDr ugAc tionPr og ram( DAP) ,whi chs eek sto
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 the
following tasks:

Activities (Input) Output Progress/ Comment


1. Technical Assistance from WHO requested in 1999. Not accomplished. Negative
WHO response
2. Review of Essential Drug Subcommittees or taskforces Not accomplished. No review
List (EDL). formed to review the EDL. documents ready or completed.
Two follow up meetings held.
In 999
3. Review of the Standard As above As above
Treatment Guideline (STG).
4. Review of Pharmacy A NZ consultant did No follow up work is done.
Legislation preliminary review in 1999.
However, the review is focused
on the MHMS restructuring
and not direct to the National
Drug Policy.

Work force Distribution:

In 1999 there were total of 28 established pharmacy workers17, which is about 2.4% of the
total of the total health work force. Majority of the pharmacy personnel are posted at the
National 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 10th
July 1997. The Act is to regulate the practice of pharmacy in Solomon Islands. The Act is an
impr oveme ntoft hePha rma cya ndPoi son’ sAc t1991a ndhe r
e byr
epe alscertainprovis i
ons
of the pharmacy and Poisons Act, and to provided for matters connected therewith or
incidental 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 care
referral system.

In terms of therapeutic access, there is availability and access of basic essential drugs developed
and 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 there
are resistance to chloroquine clinically.

4.7. Health Infrastructure development:

TheMi ni st
ry ’
spolicyonhe althi nf rastru cturei stoc onsoli
datee xisti
nghe al
thi nfrastr uc
tur
e
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 infrastructure18.

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
Bellona
97 98 99 97 98 99 97 98 99 97 98 99 97 98 99 97 98 99 97 98 99 97 98 99 97 98 99
overnment
ospitals 0 0 0 1 1 1 1 1 1 1* 1* 1* - - - 1 1 1 1 1 1 1 1 0 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 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 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 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
rivate/
GO:
ospital 1 1 1 1 1 1 - - - 1 1 1
HC 1 1 1 1 1 1
HC 1 1 1 1 1 11 1 1 5 5 6
AP 1 1 1 1 1 1 3 4 4
HW 0 0 0
otal 32 36 36 80 80 80 40 40 40 34 34 34 32 31 34 112 112 112 44 44 13 13 13 3 3

By end of 1999, there are 9 hospitals. Five (5) provincial government hospitals, 2 church
hospitals (Helena Goldie Hospital in Munda, Western Province, and Atoifi Hospital in East
Kwaio). Two (2) are designated as provincial (Mini) Hospital, and they are Tulagi and
Sasamuga). Twenty-three (23) AHC (Area Health Centers, 95 Rural Health Clinics, 129
Nurse Aides and 154 (Village Health Workers Posts). Total of 356 health facilities (not
including the VHW posts. VHW posts are not included in the count because of the
instability of their existence in the provinces. Since their establishment of the VHW early in
1990s, 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 have
received great support and assistance by way of funding through some provincial health
services, training and supply of essential medical supplies.

However, the conditions of most health infrastructure in the country have deteriorated in
the 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. Some
provinces 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’ufiHos pitalha dsome
renovation 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 IMPROVEMENT


SERVICES:

Whilst health care and health improvement are technically overlapped and not separated, for
monitoring and evaluation purposes they are considered independently in the report. The
key role of the health improvement side of the health sector is prevention of diseases and
protection of health (not merely absence of disease but also well physical, social and
mentally).

5.1. The Healthy Islands, Health City, Initiatives19

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

The Fourth International Conference on Health Promotion, held in Jakarta in 1997 affirmed
the“ setti
ng s”a pproacha sa ne ffectiv es t
rat
eg yf orhe alth pr omot i
on. TheJ akarta
Declaration also recognized that a multiplicity of interventions was most effective. Diverse
health realities, along with diverse social, economic, and political realities, demand that health
protection and promotion efforts take into account the contexts for intervention as well as
the evidences base for effective interventions.

Recognizing that Healthy Islands/Cities initiatives is using the settings approach to promote
and advocate for supportive environment for health, Solomon Islands became a party to the
“Ya nu c
aIs
landDe c
lar
ati
on”in 1995. This was reaffirmed in “ TheRa ratongaAg r
eement”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 over
67 percent. An intensified malaria control program in Honiara launched by WHO and the
Ministry of Health in 1995 has reduced the incidence rate from 1072 cases per 1000
population (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 Action
Statement in March 1999, Korror, Republic of Palau. The Palau Action Statement calls for
countries 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 calls
on Countries, in collaboration with the World Health Organization (WHO) to address the
issue 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 adopted
by 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 general
cleanliness.

Establishment of the Honiara Youth Taskforce:

Youth issues such as alcohol abuse has been on the rise, especially in Honiara and other
urban centers. A youth taskforce was established in May 2000. The taskforce is comprises of
representatives of all yout
hgroupsinHoni ar a
,inc l
udingthec hurche sandNGO’ s.

The 1999 census indicated that almost 42 percent of the population were under 15 years and
the majority of the population was under 25 years. Yet this large population had been
consistently ignored. The National Youth Policy (NYP) defines youth as those between the
age sof1 4a nd2 9y earsold.Li k
et heWome n’sPolicy,theNYPc utsa cr
ossv ariouss ectors.
Two major objectives of the NYP to ensure gender equity and equality for all young people
in the access to education and training, and the promotion of health programs with special
focus on unwanted pregnancies, STD/HIV/AIDS and other youth social problems. The
NYP also aims to promote population education, including family life education, through
the formal education curricula.

Given the high growth rate of the population, high rate of school drop out and/or push
outs, 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 tensions
have 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 the
Honi araCi tyCou nci
l,You t
hGr ou psa ndot he rNGO’ s.ByMa y2 000 ,s
evera ltr
eeswe
re
planted 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 to
support 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 continue
because 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 was
revised 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. Since
the social crisis intensified, the priority for government bill changes and hence the delay in
completing 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 definedinWHO Cons ti
tution( “He althi sastateofcompl etephy sical,mentaland
social well-be i
nga ndnotme r
elyt hea bsenc eofdi seaseori nf ir
mi ty”). Howe ver,t he
measurement is also viewed to imply the demand for health primary care services in the
provinces.

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

Graph showing diseases trends in Solomon Islands from 1997-99 (No. of new cases Acute Respiratory Infections
per 1,000 population). (ARI) is the commonest
700
illness recorded in the three
years period 1997 to 1999.
600
ARI (ALL) Fever is the commonest
ARI(Severe)
conventional symptom
suffered and presented with
Diarrhoea(All)
500 Diarrhoea(with
bloo&dysentry)
Fever at the primary health care
400
Red eyes
centers such as the Area
Health Centers, Rural Health
Yaws

Skin diseases

300 Ear infections Clinics, Nurse Aide Posts


Neonatal tetanus
and Village Health Workers
Aid Posts. Followed by eye
Tetanus
200
W hooping cough

Suspected Polio infections, yaws, diarrhea and


100 Measles
Sexually Transmitted
Penile discharges

Vaginal discharges
Diseases. Vaccine-
0
1997 1998 1999
Preventable diseases are very
low but remains potential
Sources: HIS Annual Reports 1997-99, MOH (not ICD10 based). threat to the children.

5.2.2. Infant Mortality:

The infant mortality rates (IMR), reflect major improvements during the past 2 decades,
dropping from 70/1,000
Infant Mortality Rate / 1000 live births per live births in 1976 to
28/1,000 live-births, in
1976 1986 1999
1999. Infant mortality
IMR / 1000 70 38 28 rate in Solomon Islands
is acceptably below The
Five Top Causes of Death in Infants (%)
Global Strategy for
Cause 1994 1997 Health for ALL by year
1999 2000 guiding target of
IMR 50 per 1,000 live
Complications of Delivery 32.6 13.6 42.9
Pneumonia 8.7 34.6 9.5 births. The major causes
Malaria 13 3.7 14.3 of mortality are
Diarrhoea 13 7.4 9.5 complications of
Meningitis 4.3 12.3 7.1
Others 28.4 28.4 16.7 childbirth; pneumonia,
malaria, diarrhoea and
meningitis which,
accounted for 83% of infant death in 1999. It can also be noted that the most common
cause 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
Five Top Causes of Deaths in Children 1-5 yrs (%).
pneumonia and diarrhoeal diseases. This trend is
Cause 1994 1997 1999 consistent through the last five years. Malaria accounts
Malaria 41.7 33.3 25.0
Pneumonia 16.7 12.8 16.7
Diarrhoea/Dysentry16.7 10.3 16.7
Accidents 8.3 7.7 7.9 71
Meningitis / Septicaemia 8.3 5.1 16.7
Others 8.3 30.8 17.0
Ministry of Health National Health Report Review
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for 25% of deaths in 1999 compared to 16.7% each for diarrhoeal diseases and pneumonia.

Review of the causes of admissions and deaths in children at the National Referral Hospital
National Referral Hospital (Paediatric Ward)
also reflect the similar trend of the
% Selected Causes of Admissions (1998-1999) causes morbidity and mortality in the
0-5 years
National Referral Hospital (Paediatric Ward)
Admissions 1998 1999
% Selected Causes of Deaths (1998-1999)
Malaria 10.7 15.7
0-5 years
Pneumonia 19.7 20.7
Cause of Deaths 1998 1999
Meningitis 5.4 14.8
Malaria 8.3 18.1
Gastroenteritis 13.8 5.3
Pneumonia 12.5 15.1
TB 0.8 0.5
Meningitis 4.2 6.0
community. Gastroenteritis 0 9.0
Malaria and pneumonia still remain the predominant causes of deaths in under-five years old
children in the paediatric ward of the National Referral hospital. Neonatal sepsis is the
National Referral Hospital (Neonatal Ward) predominant cause of
% Selected Causes of Morbidity and Mortality in Neonate (1998-1999) morbidity and while pre-term is
Morbidity Mortality the predominant cause of death
1998 1999 2000 1998 1999
Neonatal Sepsis 6.6 6.9 9.6 4.8 11.5 in the neonatal ward of the
Jaundice 9.5 10.6 8.2 4.8 7.7 0 National Referral Hospital.
Pre-term 5.9 6.9 10.9 14.3 26.9 Other major concern is the
Aspiration 6.8 3.6 6.3 9.5 3.8
Reactive VDRL 22.3 24.5 19.9 0 7.7 increasing morbidity related to
LBWt 11.7 7.2 12.9 4.8 0 meningitis, rheumatic fevers and
septicaemia in children.
Meningitis has been the third most common cause for admission and deaths in under fives
in the hospital. Malnutrition in children under 5 years of age is an increasing concern for the
Ministry of Health. There was a high prevalence of moderate under nutrition among children
0-4 years. About 23 % were underweight, and the prevalence of under nutrition was highest
between 9 and 24 months. Growth faltering commenced at 4-5 months and continued
thereafter.

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

G r a p h s h o w in g in c id e n c e o f A R I b y p r v o in c e s 1 9 9 7 -
1999

600
Incidence/ 1,000pop

500
400
300
200
100
0
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
1997
1998
1999
C h o is e u l W e s te r n C IP Is a b e lG u a d a lc a n aM
l a la ita M a k ir a T e m o tu H o n ia ra R e n B e ll

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

5.2.3. Acute Respiratory Infection (ARI):

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


The Acute Respiratory
Infection has been the Graph showing trend of incidence rates of ARI in Solomon
commonest illness in Islands 1997-99
children and adults. In
the period 1997 to 1999
Incidence rates/

500
incidence of ARI range 400
1,000pop.

1997
from 350 to 450/ 1,000 300
populations. However, 1998
200
severity impact of the 100 1999
illnesses is well below 25 0
cases /1,000 population. ARI (ALL) ARI(Severe)

All provinces recorded


around 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 in
1997, 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 confirmed
at that time whether it was an epidemic.
Graph (20) showing incidence of ARI & Diarrhoea in
children <5yrs in Solomon Islands

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Incidence of ARI in
children under 5 years Graph showing incidence of ARI and Diarrhoea in chidlren
old is very high. The <5 yrs in SI
highest of the three

No.of cases/1,000pop
1200
years was recorded in
1000
1997.
800

<5yrs
600
400
200
0
1997 1998 1999

ARI (ALL) Diarrhoea(All)

5.2.4. Diarrhea:

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

Chart showing trend of incidence of Diarhoeal Diseases 1997-99

50

40

No. of new cases/


30
1997
1,000 pop
20 1998
1999
10

0
Diarrhoea(All) Diarrhoea(with
bloo&dysentry)

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Graph (22) showing trend of incidence of diarrhoea by provinces:

Graph showing trend of incidence of Diarrhoea by


provinces 1997-99
No. of cases/1,000pop

120
100
80 1997
60 1998
40 1999
20
0
l

ra
IP
l

al

ta

ira

ll
rn

e
eu

Be
ot
ab

an

ai

ia
te

ak
is

m
al

on

en
es

Is

c
ho

Te
al

R
W

d
C

ua
G

Rennell Bellona recorded the highest incidence of diarrhoea, in 1997. Western experienced
high cases in 1997 and 1998 than other provinces.

5.2.5. Red eyes ( infections):

The trend of eye infections increased in 1998 and 1999.


Unfortunately the report
Graph showing incidence of red eyes (infections) in SI: is not able provide the
incidence of blindness.
45
Western, Choiseul and
40 Malaita recorded higher
incidence of eye
No.of cases/1000 pop

35
30 infections.
25
20 The National Primary
15 Eye Care program by the
10 Eye Department of the
5 National Referral
0
Hospital went very well
1997 1998 1999
years

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during the period of 1997-99. Their provincial visits were regular with good coverage of the
provinces. 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 care
No.of new cases/ 1,000pop

80
70
units at Gizo, Kiluufi
60 and Kirakira
50 1997 Hospitals, which
40 1998 provide basic primary
30 1999 care service to the
20
10
provinces.
0
Ranges of tertiary eye
IP

ta

H tu
es l

da el

Te a

R ra

ll
al
rn
u

care services were also

Be
ir
e

b
an

o
ai

ia
C
te

ak
is

m
al

on

en
Is

lc
ho

M
M

made available
W
C

ua

through the Pacific


G

Islands Project by the


Royal Australasian College of Surgeons and funded by AusAID. The Phase 2 of the PIP
started in 1 May 1998, after which ophthalmology visits to Solomon Islands took place in
15-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 and
Makira reported higher number of new cases per 1,000 populations. There was no yaws
campaign in the past years.

Graph (24) showing incidence of Yaws in SI

Graph showing incidence rates of Yaws in SI

60
50
40
No.of new
30
cases/ 1000 pop S1
20
10
0
1997 1998 1999
years

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

Graph showing incidence of Yaws by provinces


No. of new cases/ 1,000 pop

120
100
80 1997
60 1998
40 1999
20
0
ta
IP

el

ll
l

al

ira

ra
n
eu

Be
ot
r

ab

an

ai

ia
C
te

ak
is

m
al

en
on
es

Is

lc
ho

Te
M
da

R
H
W
C

ua
G

5.2.7. Ear infections:

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

Graph showing incidence rates of ear


Graph showing incidence of Ear
infections in SI
infections by provinces, 1997-99
No. of new cases/ 1,000

120 70
100 1997 60
80 No. of 50
pop

60 1998 new
40 40
20 1999 cases/10 30
0 SI
00 pop 20
10
M l

ra
l

da P

H ra
eu

a
ua C I

0
an

ia
i
ak
is

on
lc
ho

1997 1998 1999


C

years

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

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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 and
tetanus 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

Graph showing incidence of vaccine preventable


diseases in SI, 1997-99

0.07 Source: HIS, MOH


0.06

0.05
Neonatal tetanus
Incidence rates

0.04 Tetanus
Whooping cough
0.03 Suspected Polio
Measles
0.02

0.01

0
1997 1998 1999

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

Graph showing incidence of vaccine-preventable diseases by


provinces

0.4

0.35

0.3
Incidence rates

Neonatal tetanus
0.25
Tetanus
0.2 Whooping cough
Suspected Polio
0.15
Measles
0.1

0.05

0
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
1997
1998
1999
ChoiseulWestern CIP Isabel
Guadalcanal
Malaita Makira TemotuHoniaraRenBell

5.2.8.2. Immunization Coverage:

Immunization coverage has remained high but decreasing over the last six years. It is
believed that this could be due to
% Immunization Coverage Rate (Cases)
the over estimation of the
1994 1995 1996 1997 1998 1999 Immunization Coverage Survey
in Malaita (%)
BCG 76 77 73 73 72 64
Hep B3 67 71 72 73 71 62 1999
DPT3 68 69 77 72 69 61 BCG 99.1
Polio3 68 68 72 70 69 60 Hep B3 99.1
Measles 61 68 67 68 64 59 DPT3 86.7
TT2 56 71 63 54 55 50 Polio3 84.6
Measles 58.8
population. This has been verified through an immunization
coverage survey in Malaita province in 1999. The overall
immunization 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 Infection


remains a public health Graph showing incidence of Sexually Transmitted
problem. There is under- Diseases in S1, 1997-99 (by symptoms)
reporting of cases.
3

Rennell Bellona, Temotu and No. of new cases/ 1,000 pop


2.5

Honiara reported higher 2


SI 1997
number of STI symptoms. 1.5 SI 1998
SI 1999
1

0.5

In 1998, total of 2,235 genital 0


specimens (pus swab) were Penile discharges Vaginal discharges Genital ulcer

collected from STI clinics in


Honiara20. Of the total
specimen collected 13.4% (300) were positive for N. Gonorrhoea. Fifty-five (55) positive
specimens were penicillin resistant (i.e. 18.3%).

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

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Graph ( 30) showing incidence of STI by provinces:

Graph showing incidence of STD by provinces, 1997-99

16

14

12
No.of cases / 1,000 pop

10

0
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
1997
1998
1999
Choiseul Western CIP IsabelGuadalcanalMalaita Makira Temotu Honiara RenBell

Penile discharges Vaginal discharges Genital ulcer

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 points
ye tt or ea ch8 0/1 0 0 0popa st hepr ogram’ sobj e
cti
vet argetfor2 003.I timpl iesf urt
he r
achievement of 16 points down with in the next four years. In 1999, in Honiara alone there
is 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 modified
re-treatment methods introduced in the past few years have been successful. For the country
as a whole, more than 70% of the population is now pr otec
tedbyne t
s.Thepr og r
am’ s
objective is to have 95% of the population protected by nets in three years time. It implies
further strengthening and improvement of compliance towards bednets.

21
Kevin Palmer (2000). Mission Report, Solomon Islands 12-19 Feb.2000, Regional Office For the
Western Pacific of WHO, Manila
22
SI Malaria Control Program (1999). Annual Report 1997,1998,1999. Unpublished Paper, MHMS.

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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 the
annual 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

Annual Incidence Rate of malaria in Solomon Islands 1969-


1999.

450
Annual Incidence Rate/1000

400
350
300
population

250
200
150
100
50
0
1969

1972

1975

1978

1981

1984

1987

1990

1993

1996

1999
Year
Figure 2

Annual malaria incidence rate in Solomon Islands since 1992

441
450

400
Annual incidence rate per 1000 population

353
347
350
301
300

250 207

200 160 165


144
150

100

50 82

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Figure 3

Total number of malaria cases in Solomon Islands

160 153
141
140 131
126
118
Total number of cases (000)

116
120

100
85

80 68 73
63 65
64
60

40

20

0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
Year

5.2.10.3: Incidence in the provinces

Figure 4 shows the trend in the annual incidence rate recorded in the provinces. The
incidence rate has decreased in all provinces except Central and Malaita.
Figure 4: Trends in the annual incidence rate of malaria in
Honiara and the provinces 1992-99:

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


provinces 1992-1999.

1200

1000
AIR/1000 population

800

600

400

200

0
HON CP IP WP MP GP MUP TP CHP
83
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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. falciparum
to 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. vivax
continues to the dominant species in Isabel provinces. Further studies are in progress to
arrest this trend.

Figure 5

Percentage of P. falciparum infection

70

60

50

40

30

20

10

0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
% 62 62 70 63 62 60 63 61 52 55 66 69

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

Figure 6

SLIDE POSITIVITY RATE IN SOLOMON ISLANDS

40

35

30

25

20

15

10

0 84
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999
YEARS
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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 and
suspected cases of treatment failure. The proportion of suspected cases diagnosed by
microscopic examination has increased as the number of microscopists in the country has
increased from 67 in 1992 to 135 in 1999. Blood slides are read immediately and the results
used for the treatment of patients.

All malaria microscopists have been trained to carry out in-vivo drug sensitivity tests
as a way to constantly monitor the effectiveness of the drugs being used. This network was
strengthened 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 treatment
services provided by Central Hospital and nine Town Council clinics. The agents are able to
detect and treat cases that do not seek treatment and to follow-up cases to ensure that each
case 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 effective
inde t
e ct
inga ndt r
eatingal argenu mbe rof“ i
na pparentma l
ariainfections”.Theope rat
ion
in 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 surveillance
operations. Mass blood examinations are done regularly in residential schools at the
beginning of every year. Mass blood examinations are conducted in other provincial areas as
ana dditi
ona lme ansofr educingt heov era
ll“
pa rasi
ter eservoi
r”inhi g hinc i
denc evillages.

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 short
periods work comes to a halt, and in many provinces money is borrowed from the
mosquito-net fund just to maintain basic operations. All this is a consequence of the poor
economic 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 the
above boosted the integrated malaria control program the improvement of Malaria
Reporting System is also noted.

As an accomplishment of its own, a computerized malaria information system (MIS) was


introduced 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 mass
blood surveys, spraying, and mosquito net distribution. With this system, the Program is
able to track reported cases and maintain a history of spraying and mosquito net distribution
for each household .
In early 1998, a modified version of the MIS was setup in Western and Choiseul provinces
and later extended to all other provinces. These provincial systems will eventually be linked
into 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 for
the investigation of deaths. This mortality information will be reported quarterly.

The introduction of pre-packed drugs for both vivax and falciparum malaria, and the
introductions of primaquine in Honiara on a trial basis for the treatment of vivax malaria
have both very successful. This will soon be expanded to cover the entire country. As
mentioned above great effort is still needed to expand the usage of bed-net to cover the
entire 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, the
support 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 aid
posts 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 Research
Institute of Tuberculosis (RIT) in Tokyo, a WHO collaborating center for monitoring TB
epidemiology 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 the
purpose of strategic planning. Continuous health workers training and regular provincial
tours were done to increase knowledge and skills of both the health workers and the
community on the problem. One of the main agenda of the trainings and supervisory visits
is the introduction and sustaining of the Direct Observation Therapy Strategy (DOTS). It is
apparent that the DOTS coverage has been increasing and notes to be successful in the past
three 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 also
increased 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, individual
provinces 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 the
number 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) per
100,000 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 to


high treatment successive rate and BCG coverage.

 It is apparent that the BCG coverage is underestimated in the Health Information


System. According to the Disease Prevention and Control Center (DPCC?MOH) the
accurate 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 months
inpatient. 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. Mental Health Services
It is the Ministry mission to increase accessibility to basic mental health services through the
pr ima ryhe al
thc ar
ea ppr oa c
h. Itisa l
wa ysac onc ernt hatpa t
ients’ r
ight sarer etaineda nd
rec og nizedbyt hecommu ni
t y.TheNa t
iona lPs ychiatri
cUni ta tKi lu’ufiHos pit
a l,andthe
Honiara psychiatric unit are the only two service providers. However, irregular provincial
tours do occur.

5.2.12.1. Activities (Inputs)

The Honiara Psychiatric unit had an average staffing level of three psychiatric nurses. The
Honiara unit did outpatient services, screening, counseling and referral of patients of patients
needing admissions. In 1997 only two provinces were toured. Subsequent years were
affected by the ethnic tension. The unit also did visits to the Rove Central Prison. The
National Psychiatric Unit is the main admitting center for inpatients. The staffing level is
always around 18 (including 3 domestic workers, a cook and a driver). The condition of the
unit has run down in the past years and needs urgent repair. The Ministry had great difficult
in recruiting a psychiatrist because of several reasons. Firstly, there were no applicants
despite several advertisements overseas. Secondly, there is lack of commitment from higher
authorities, as recruitments were freezed by the Public Service. Thirdly, the issues of financial
constraints were some of the answers the Ministry received. Nonetheless, the psychiatric
nurses were trained and had the capacity to manage the NPU and the Honiara Unit. This
report highly commend the Principal Nursing Officer, Psychiatric Services and the staff for
maintaining the basic level of service with out a qualified psychiatric, after the only one left
in 1997.

5.2.12.2. Findings (Outputs):


Table (A): Total Cases Admitted to
Na ti
ona lPs ychia t
ri
cUni t,Kil
u’uf iHos
pit
al(
onl
y)I
N . Table B: Total Cases seen and
1997,1998,& 1999. Treated by the National Psychiatric
Unit, Honiara, MHMS,HQ, in 1997,1998 &
1997 1998 1999 1999
Total Admin 358 177 84
New M 79 50 19
1997 1998 1999
F 38 42 11
Total Cases Seen 354 598 830
Total new 117 92 30
New M 79
Old M 164 36 34
F 41
F 75 49 29
Total new 117 130 87
Total old 239 85 54
Old M 162
Point 8.4 4.0 1.8
F 75
prevalence
rate
Per 10,000
pop

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Table C: 5.2.12.3.Analysis:
Overall Total Cases
recorded at the National Psychiatric Unit,
The access to mental health services is fairly
Kiluufi Hospital & Honiara in 1997,1998,& limited in terms of mental health workers to
1999. rural population.

1997 1998 1999 Secondly, it is evident that the pressure on


Total Admin & 663 715 915 mental health services is increasing. The
seen total number of cases seen (as outpatient in
New M 158 Honiara Psychiatric Center) and admission
F 79 att heNa t
iona lPs ychiatri
cHos pitalKi l
u ’
ufi
Total new 237 222 117 Hospital increased from 663 in 1997 to 915
Old M 276 in 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:

Thema i
ni ss
u ei stheMi ni stry’
sc apability to sustain both institutionally and financially, the
psychiatric health services in the country in light of the limited resources.

Secondly, the issue of increasing accessibility through the primary health care approach has
been preferred. A problem experienced with the psychiatric outreach health visits to other
provinces 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
duet ola ckofg ov ernme nt ’scommi t
me ntt ot hes ervi
c es.

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

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

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SECTION VI: ENVIRONMENT HEALTH
SERVICES:
6.0. HEALTH AND ENVIRONMENT24

6.1. General protection of the environment

The Solomon Islands Government recognizes the importance of our environment to the
health, welfare and economic development of this country. The Cabinet has endorsed in
1991 the National Environmental Management Strategy, which is implemented by the
Environment and Conservation Division of the Ministry of Forestry, Conservation and
Environment.

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

The Environment and Conservation and Environmental Health Divisions collaborate in


ensuring environmental impact assessments are conducted to assess impacts on
development using local staff or overseas consultants.

6.2. Air (pollution)

The Environment and Conservation and Environmental Health Divisions have realized that
there are potential effects air pollution can cause to the environment. At this stage the
country 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 Minerals
is responsible for the monitoring of water resources in the country. The Division has
trained personnel and the Government has made equipment available with assistance from
overseas 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 for
drinking 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 be
identified for Honiara as soon as possible and need for improvement in the management
techniques of the dumpsite.

24
WHO, Honiara Office. Evaluation of the Implementation of the Strategy For Health For All By The Year
2000, 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 the
Consumer Protection Act by Parliament to be implemented by the Environmental Health
Division 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 Commission
through 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 to
lack of adequate facilities and qualified staff.

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

The HTC has had an educational program for the mothers in town in the hygienic preparation
of 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 the
situation 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 local
materials, 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 to
have a house whereby they have to find a home with a friend or shift to the outskirts of the
township to settle in the slums. This is increasing in Honiara. Some persons have access to
loans from financial institutions to build their houses; this does not apply to most people in the
rural 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 protected
under 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 Labor
Division.

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The Safety at Work Act protects workers who are likely to be subjected to risks of occupational
health and is being implemented by the Labor Division of the MCET. The Workers
Compensation Act is currently under revision, particularly with regard to the medical conditions
covered under the Act.

For environmental issues such as air, radiation and chemicals the country does not have the
necessary equipment and expertise to deal with these and to a large extent depends on overseas
consultants 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 with
reasonable 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 sanitation
as 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 the
implementation 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 Zealand
and the UNDP and WHO were major contributors.

In 1990 the Solomon Islands Ministry of Health and Medical Services prepared a report on
progress 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 a
project design document was prepared which describes a five-year RWSS project to run
from 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 office
and establishing several new provincial Office/Store complexes, improving storage facilities
and stock recording system, and provision of additional transport equipment. Emphasis will
be given to strengthening community awareness and participation so that communities have
the capacity to manage their own water supply and sanitation systems. The village
health/RWSS committees will be reactivated or established to play a central role in the
planning, management and maintenance of WSS facilities.

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

The major constraints faced by the Government are:

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1. Lack of trained professionals


2. 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 –RWSS
Project 1996-2001.
Present Expected Yearly Expected end of Project
RWSS Situation Achievement (Year 2001)
1996 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:

TheMi nistr
y’smi s
sionist oe nc ourag eandhe l
pt hepe oplet oi mpr oveand promote their
personal hygiene, live healthy lifestyle and take responsibilities for their own health. The
strategic approach is the transition into a wider –sector approach, integrating as much as
possible with the communities, non-government organizations.

One of the key steps forward is to review the existing structure and roles of the Health
Education Division of the Ministry of Health to be more proactive in advocating health
promot ion.Bye ndof1 9 98
,the rewa sadr a f
t‘He a l
thPr omot i
onPol icy’drawnu p.I tisy
et
to 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 was


developed with the Yooroang Garang, School of Indigenous Health Studies, University of
Sydney, who trained health workers in skills of addressing community health issues related to
indigenous people of Australia. Having studied the courses the Ministry agreed that there are
numerous similarities between the attitudes and behavior of the aboriginals and the people
of Solomon Islands. Thus, three staff of the Health Education & Promotion Unit were
enrolled. 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 village
meetings. From the graph below, the trend of village meetings increased from 1997, whilst
schools visits decline. Western Province did more school visits and village meetings than all
other provinces. A major problem to these programs is lack funding to allow regular visits.

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At the national level in 1998,


Graph showing Health Education Activities
(School visits & Community meetings) by
there were total of 101 trainings
provinces and workshops planned. Of
which 76 (75%) were actually
implemented. Thirty-eight (38%)
Malaita Makira Temotu Honiara RenBell

1999
1998 percent were integrated health
1997 workshops and thirty four
1999
1998
percent (34.2%) were
1997 MCH/FP/Sexual Health
1999 Trainings.
1998
1997
1999
1998
1997
1999
1998
1997
CIP Guadalcanal

Meetings in the
1999
villages
1998
1997 Schools visited
1999
1998
1997
1999
ChoiseulWestern Isabel

1998
1997
1999
1998
1997
1999
1998
1997
1999
School Health Education and
SI

1998
1997 Promotion:
0 1000 2000 3000
A Health Promoting School
No. of activities
Policy was developed and
endorsed by the Cabinet in latter
half of 1998. The health education and promotion department have executed its school
health education program in line with school activities. They provide general health
awareness talks ensuring that the environment is conducive and safe, provision of the
needed health information and collaborating with surrounding communities. The activities
have been classified under; school health instruction, school health inspection, school health
services and school community organization.

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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 the
MOH, the Health Education & Promotion Division took a forward step in the formation of
a‘ Na t
ionalHe alt
hEduc at
iona ndPr omot ionRe sea
rchandEv al
uationCommi tt
e e’.The
commi tt
ee’st er
msofr eferenc einv olve sc oor dina
ti
ngresea
rchande v aluati
onofe xis
ting
health education and promotion activities and programs. Unfortunately, the committee has
been defunct since the ethnic tension escalated. Howe ve
r,i
tisthediv i
sion’sk eypr
ior it
yt o
evaluate the programs in order to improve the health outcomes through providing
information and advocating for healthy life style.

SECTION VIII: REPRODUCTIVE HEALTH AND


FAMILY PLANNING:
TheMi ni str
y’spolicy on reproductive and family planning is to promote and maintain the
development of a health family, reduce, maternal and peri-natal, and infant mortality, and
raise the standard of living for mothers and children.

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

8.1. Maternal Mortality:

There is marked improvement in reduction of the maternal mortality rate from 549/ 100,000
live births to an estimate of 154/ 100,000 in 1999. It took about 13 years to reduce the level
in 1986 by more than half. The policy standard in the National Health Policies and
Development 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.]
549 209 203 154
Sources: [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 1999
Solomon H=5, C=9 Total =14 H=7, C=9, Total = 16 H=11,C=1, Total=12.
Islands
By Home Clinics Total Home Clinics Total Home Clinics Total
Provinces:

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Choiseul 1 3 4 0 1 1 0 0 0
Western 1 2 3 1 3 4 0 0 0
Isabel 0 0 0 0 0 0 0 0 0
Central 0 1 1 0 1 1 2 1 3
Islands
Guadalcanal 3 1 4 5 2 7 4 0 4
Malaita 0 2 2 0 2 2 3 0 3
Makira 0 0 0 1 0 1 2 0 2
Ulawa
Temotu 0 0 0 0 0 0 0 0 0
RenBell 0 0 0 0 0 0 0 0 0
Honiara 0 0 0 0 0 0 0 0 0
Source: HIS, MOH, 1997,1998,1999

Graph showing maternal deaths 1997-1999 by provinces


Guadalcanal recorded the
highest number of maternal
8 deaths with 7 in 1998.
7 7 Choiseul
Western had 4 in that same
6
Western year. There may be
No. of maternal deaths

5
Isabel
Central Islands
underreporting of cases.
Guadalcanal
4 4 4 4
According to the local
Malaita

statistics maternal deaths


3 3 3 Makira Ulawa
Temotu
2 2 2
RenBell made up 1.58% of the total
1 1 1 Honiara
deaths recorded in the
0 0 communities in 1997,
1997 1998 1999
Years
1.86% and 1.18% in 1998
and 1999 respectively (see
table below). Despite the
lower percent, it is very stressful when mothers die, leaving behind many children to care for
by the husband and relatives.

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

1997 1998 1999


Solomon Total MD =14, Total MD = 16, Total MD=12,
Islands All deaths=884, All deaths=861, All deaths=1,018,
=1.58% =1.86% =1.18%
By Provinces: Total All % Total All % Total All %
MD deaths MD deaths MD deaths
Choiseul 4 38 10.5 1 61 1.6 0 66 0
(0.45) (0.12)

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Western 3 196 1.53 4 172 2.3 0 157 0
((0.34) (0.46)
Isabel 0 38 0 0 33 0 0 40 0
Central Islands 1 69 1.45 1 55 1.8 3 56 5.4
(0.11) (0.12) (0.29)
Guadalcanal 4 116 3.4 7 119 5.9 4 131 3.05
(0.45) (0.81) (0.39)
Malaita 2 260 0.77 2 212 0.94 3 365 0.82
(0.23) (0.23) (0.29)
Makira Ulawa 0 103 0 1 141 0.7 2 118 1.69
(0.12) (0.19)
Temotu 0 51 0 0 48 0 0 70 0
RenBell 0 11 0 0 10 0 0 3 0
Honiara 0 2 0 0 10 0 0 12 0
Source: HIS, MOH, 1997,1998,1999

8.2. Family Planning:

Family planning contraceptives is widely available in the rural clinics. However, compliance
from clients is observed to be declining. According to available statistics there is marked
drop 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 1999
Solomon Islands 8.5 8.6 6.5
By Provinces: 1997 1998 1999
Choiseul 6.9 5.0 7.8
Western 11.2 8.2 9.1
Isabel 7.9 13.2 11.4
Central Islands 6 15.7 17.9
Guadalcanal 7.1 5.8 5.4
Malaita 10.2 11.3 3.9
Makira Ulawa 7.9 6.9 6
Temotu 14.2 12.3 13.5
RenBell 3.3 5.3 2.5
Honiara 5.6 5.6 2.7
Source: 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:

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


1999

20

15

% 10

1997
5 1998
1999
0
Choi Wes Isab Cent Gua Mal Maki Tem Ren
Hon SI
seul tern el ral dalc aita ra otu Bell
1997 6.9 11.2 7.9 6 7.1 10.2 7.9 14.2 3.3 5.6 8.5
1998 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

Table (26) % Supervised deliveries:

1995 1997 1998 1999


85 86** - -
Sources: **RHD/MOH, 1997

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

1997 1998 1999


Solomon Islands 68.9 71.9 65.9
By Provinces: 1997 1998 1999
Choiseul 59.4 61.7 65.2
Western 79.8 75.3 74.5
Isabel 54.6 60.4 68.8
Central Islands 55.1 73.6 68.9
Guadalcanal 66.0 72.4 52.1
Malaita 70.6 72.8 73.6
Makira Ulawa 54.6 71.7 56.2
Temotu 53.8 48.4 60.2
RenBell 46.5 38.5 31.1
Honiara 78.0 80.5 68.8

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

Years 1986 1996 1998 Total Fertality Rate declined from 6.1 in 1986
(Census) to 4.8 in 1998. Majority of six provinces
(Choiseul, Western, CIP, Malaia, Makira, and
Total 6.1 5.8 4.8
Fertility
Rate 100
Source: UNFPA
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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.

Graph showing fertility rates by provinces

140
120
100
No. of births/ 80
1,000 wcba 60
1997
40
1998
20
199
0
Guad
Choi West Isabe Centr Malai Makir Temo Honi
alcan
seul ern l al Isl. ta a tu ara
al
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

Table (28) FERTILITY RATES BY PROVINCES FROM 1997 TO 1999 (births/ 1000 popWCBA
Province Year Births Fertility rate
(births/1000pop
WCBA)
Choiseul 1997 449 97.3
1998 555 116.8
1999 509 104.0
Western 1997 1,575 120.8
1998 1,591 118.5
1999 1,329 96.0
Isabel 1997 417 93.14
1998 377 81.6
1999 308 64.5
Central Islands 1997 397 89.3
1998 486 106.1
1999 584 124.0
Guadalcanal 1997 773 47.3
1998 932 54.7
1999 1048 59.0
Malaita 1997 2,600 115.7
1998 2,660 115.7
1999 2,917 123.9
Makira Ulawa 1997 682 103.6

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1998 839 123.1
1999 591 83.7
Temotu 1997 438 107.7
1998 403 96.5
1999 480 111.7
Honiara 1997 10 0.7
1998 6 0.4
1999 2 0.12
Rennell Bellona 1997 19 39.5
1998 16 32.3
1999 10 19.6
Solomon Islands 1997 7360 81.3
1998 7,865 83.7
1999 7,778 79.7

*Total births / total pop of WCBA 15-44 x 1000


Source: Health Information System, Annual Health Reports 1997,1998 & 1999, Statistics Unit, MOH.

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

Program Inputs Commitment of the Government Social Development


Institutional Capacity Institutional Capacity Program efficiency
Program Outputs Service Access (proximity to services) Quality care (drop out)
Behavioral changes Fertility rates, contraceptive prevalence
Demography 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 as
the rural remote areas. There is an existing structure, which has both vertical and horizontal
aspect 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 Child
Health /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.

Thepr
ogr
am’
sou
tpu
tcoul
dbev
iewe
dbyt
hef
oll
owi
ngi
ndi
ces
:

 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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 Number of training workshops
 Service delivery indicators; contraceptive prevalence, F.P coverage, % supervised
deliveries, % ANC attendances,

The program developed a clear policy, which is documented in the National Health Policies
and Development Plans 1999-2003. Underneath the policy are the strategies to achieve the
policy objectives. In 1997-1999 number of trainings and staff development were carried out
both locally and overseas.

Thepr
ogram’santic i
patedou tcome sa rev iewe da s;
 Behavioural changes –Total Fertility rates and contraceptive prevalence
 Demographic changes-TFR, Infant Mortality and Maternal Mortality rates.

There has been favourable as well as unfavourable outcomes experienced by the program.
Firstly, there are definite indications of behavioral changes. The TFR has declined from 6.1
in 1986 to 4.8 in 1998. However, the contraceptive prevalence has dropped according to the
available information. Secondly, there are also positive signs that demographic changes are
happening. Infant mortality and maternal mortality declined in the past thirteen years since
1986.

Weaknesses:

However, are the above changes due to the Reproductive Health Programs? Or if these
positive changes are taking place in the past 13 years, what were the driving forces for the
changes? Special care needs to be taken in answering the question. Firstly, because
measurement of changes in behavioral is not only difficult but very lengthy. It would take
more than twenty years before any real change in behavior is seen. Simple questions like
‘wha twa st hei mpa ctoft hev il
lag
et a l
konf ami lypl anningwedi di nt hev illage?Oneof
weaknesses of many public health programs including the reproductive health is the lack of
proper monitoring and evaluation of programs involving behavioral changes. There is need
for epidemiological researches to help answer some of the above hypothetical questions.
Secondly, there is no evaluation done on the program efficiency and cost-benefit of the
programs. Thirdly, lack of coordination of multiple donors has been a weak point.

There are inequalities among provinces in areas of maternal health outcomes and
accessibility to MCH/FP care. These are important issues and lessons for provincial health
service planning.

Potential Threats:

In the past experiences, there were threats to the reproductive health programs, which
correspond to the above weaknesses of monitoring and evaluation. The institutional capacity
to evaluate the program efficiency is due to lack of resources such as funding and skill to do
it. There were also other obvious threats to the program. Service delivery was significantly

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affected by external influences such as geography, and low socio-economical factors. The
ethnic tension, which started around 1998, had adverse impact on the service delivery.
Traditional custom beliefs and high illiteracy rate among the target customers has been
recognize as negativism to the performances of the service. Unfortunately, it is apparent that
unwanted competition is been experienced with the Department of Development Planning,
which assumed the policy role of population control. Lack of clear strategies of the National
Population Policy does not help the program as the major stakeholder.

TheGov ernme nt’sc ommi tme ntt or eproductive health is literally there. The National
Population 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 Minis try’


sv isioni nde velopingpa rtnershipist oi nv ol
v epa r
ti
cipationofwi der angeof
people in the community both local and international. Health affects every person one or
another therefore the policy aims at enhancing collaboration between different stakeholders.

There is a need to give formal recognition to community organization through development of a


Memorandum of Understanding (MOU) between the Government and other Health Services
providers. 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 in


health developments in the country.
Organizations such as Red Cross,
Solomon Islands Planned Parenthood
Association, Family Health Center,
Rotary Club, World Vision and
Solomon Islands Development Trust
and the Churches such as Seventh
Day Adventists, United Church of
Solomon Islands, Roman Catholic,
SSEC and Church of Melanesia
continued to supplement and
complement health developments
through their activities.

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Even business firms have shown initiative to assist the National Referral Hospital in minor
projects. In 1999, Mr. Robert Coh a well-known businessman in Honiara established an
informal relationship with the National Referral Hospital. Kiluufi Hospital through the
‘Friendsoft heHos pi talCommi tt e
e’ha
veinv olv edi nu pg r
adingoft hehos pi tal
.S uch
informal 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 SIG
continue to provide subsidy and assistance to church health services in return for the
services 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 also
continued. Provision of essential medical supplies continues free to church hospitals. SIG
also 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 diplomatic
relationship with the SIG continued to play vital and crucial role in health development in
the country in the years 1997 to 1999. Annex Table ( ) outlines the donor agencies input in
the health development of the country in the past years. Assistance and support are in the
following 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 injection
of 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 1989-199326.

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 101.2 146.6 208.8 255 311.4 340.9 375 348.7
Health 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 16.3
Donor 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 in
practice
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
Nurse Aide:Pop 772 767 704
Total Nurse:Pop 372 340 335
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
Nurse Aide:Pop 749 770 696
Total Nurse:Pop 510 502 440
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
Total Nurse:Pop 772 755 895
Makira Ulawa 31,343 32,471 31,006
Doctor : Pop 31,343 32,471 31,006
R/Nurse:Pop 1,045 984 838
Nurse Aide:Pop 871 833 795
Total Nurse:Pop 475 451 408
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
Total Nurse:Pop 461 390 476
Honiara 66,508 71,628 49,107
Doctor : Pop 71,628 49,107*
R/Nurse:Pop 2,293 2,311 1,584
Nurse 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
Nurse Aide:Pop 803 0 792
Total Nurse:Pop 268 413 264
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 and
Occupancy Rates at 1997,1998,1999 bed capacity
1997 1998 1999
Prov Beds Adm %OR ALO Beds Adm %OR ALO Beds Adm %O ALO
Hosp S S R S
Choiseul
(Sasamug
a)
All Beds 35 1,216 62.1 6.5 35 1,278 75.0 7.5 35 1,426 79.5 7.1
Male 8 236 62.4 7.7 8 258 63.6 7.2 8 307 73.8 7.0
Female 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 7.0
Male 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 6.1
Pediatrics 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 5.0
Others 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 6.0
Female 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 10
Female 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 7.0
Makira
(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 7.4
Female 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 7
Male 8 213 86.3 11.8 8 198 71.2 10.5 8 264 93.4 10.3
Female 8 112 22.7 5.9 8 131 23.3 5.2 8 177 32.8 5.4
Pediatrics 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 54
Isolation 2 4 2 2 2 3

National Beds Adm %OR ALO Beds Adm %OR ALO Beds Adm %O ALO
Referral S S R S
Hospital
All Beds 330 5916 45.8 9.3 330 5830 48.4 10.0 330 7102 63.3 10.7
Medical 56 723 31.6 8.9 56 475 63.6 14.7 56 837 64.0 15.6
Surgical 56 812 40.2 10.1 56 774 86.0 45.7 56 995 77.0 15.8
Pediatrics 45 673 31.2 7.6 45 699 62.4 27.7 45 1019 58.5 9.4
Maternity 50 2914 46.4 2.9 50 3201 81.0 2.5 50 3027 67.6 4.1
Gynae 17 444 35.9 5.0 17 362 71.2 4.6 17 673 73.8 6.8
EMS 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 62.8 192.2
Private 12 101 6.5 2.8 12 69 36.0 22.8 12 286 26.2 4.0
Ward
ANNEXTa ble(3 )
:Tot
alCa
sesAdmi
tt
edt
oNa
tiona
lPs
ychi
atr
icUni
t,Ki
lu”
ufiHos
pit
al(
onl
y)
1997,1998 & 1999:
NEW OLD Total Total TOTA
NEW OLD L
Male Femal Male Femal
e e
1. 1997 16 11 106 39 27 145 172
Schizophrenia
1998 3 4 11 10 7 21 28
1999 4 1 17 9 5 26 31
2. Manic 1997 2 1 15 9 3 24 27
Depression
1998 5 4 5 3 9 8 17
1999 1 1 6 4 2 10 12
3.Neurosis 1997 16 2 2 2 18 4 22
1998 0 1 0 11 10 11 21
1999 3 3 2 0 6 2 8
4.Epilepsy 1997 2 2 8 4 4 12 16
with Psychosis
1998 1 2 1 2 3 3 6

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1999 1 0 1 11 1 12 13
5. 1997 6 1 11 2 7 13 20
Psychosomatic
Dis
1998 0 2 0 0 2 0 2
1999
6.Somatoform 1997 1 0 1 0 1 1 2
Dis
1998
1999
7.Transient 1997 3 2 2 4 5 6 11
Organ.Psych
(organic cause) 1998 12 0 10 6 12 16 28
1999 2 0 2 0 2 0 2
8.Brief 1997 20 11 6 4 31 10 41
Reactive Psych
1998
1999 2 5 2 3 7 5 12
9.Mental 1997 0
retardation
with psychosis 1998 1 1 2 3 2 5 7
1999 1 1 1 0 2 1 3
10.Post 1997 3 1 2 0 4 2 6
traumatice Dis
1998
1999
11.Attempted 1997 1 3 0 0 4 0 4
suicide
1998
1999
12Dementia 1997 1 0 2 0 1 2 3
1998
1999
13.Others 1997 4 4 3 11 8 14 22
1998 4 5 1 0 9 1 10
1999 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 Total Total TOTA


NEW OLD L
Male Femal Male Femal
e e
1. 1997 16 11 106 39 27 145 172
Schizophrenia
*
1998 17 7 186 74 24 260 284
1999 8 3 284 68 11 352 363
2. Manic 1997 2 1 15 9 3 24 27
Depression*
1998 10 3 38 30 13 68 81
1999 1 1 153 36 2 189 191
3.Neurosis 1997 16 2 2 2 18 4 22
1998 22 13 23 26 35 49 84
1999 14 10 15 15 24 30 54
4.Epilepsy 1997 2 2 8 4 4 12 16
with Psychosis
1998 2 2 36 3 4 39 43
1999 0 1 31 4 1 35 36
5. 1997 6 1 11 2 7 13 20
Psychosomatic
Dis
1998 1 1 6 0 2 6 8
1999 2 0 18 11 2 29 31
6.Somatoform 1997 1 0 1 0 1 1 2
Dis
1998 0 0 0 0 0 0 0
1999 0 0 0 0 0 0 0
7.Organ.Psych 1997 4 2 44 6 8 14
(organic cause) 1998 14 8 18 5 22 23 45
1999 4 2 2 13 6 15 21
8.Brief 1997 20 11 6 4 31 10 41
Reactive Psych
1998 0 00 0 0 0 0 0
1999 0 1 0 7 1 7 8

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9.Mental 1997 0 0 0 0 0 0 0
retardation
with psychosis 1998 0 0 0 0 0 0 0
1999
10.Post 1997 3 1 2 0 4 2 6
traumatice Dis
1998 0 0 0 0 0 0 0
1999 0 0 2 0 0 2 2
11.Attempted 1997 1 6 0 0 7 0 7
suicide
1998
1999
12.Postpartum 1997
Psychosis
1998 0 1 0 2 1 2 3
1999 0 0 0 1 0 1 1
13.Substance 1997
Abuse
1998 12 1 14 0 13 14 27
1997 5 1 10 1 6 11 17
13.Others 1997 4 4 3 11 8 14 22
1998 0 0 1 0 0 1 1
1999 4 15 24 13 19 37 56

ANNEX Table (5): Overall Total cases recorded at the National Psychiatric Units Kiluufi Hospital
and Honiara in 1997, 1998 & 1999:

NEW OLD Total Total TOTA


NEW OLD L
Male Femal Male Femal
e e
1. 1997 32 22 212 78 54 290 344
Schizophrenia
1998 20 11 197 84 31 281 312
1999 12 4 301 77 16 378 394
2. Manic 1997 4 2 30 18 6 48 54
Depression
1998 15 7 43 33 22 76 98
1999 2 2 159 40 4 199 203
3.Neurosis 1997 32 4 4 4 36 8 44
1998 22 14 23 37 45 60 105
1999 17 13 17 15 30 32 62
4.Epilepsy 1997

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with Psychosis
1998 3 4 37 5 7 42 49
1999 1 1 32 15 2 47 49
5. 1997
Psychosomatic
Dis
1998 1 3 6 0 4 6 10
1999
6.Somatoform 1997 7 4 6 8 11 14 25
Dis
1998 26 8 28 11 34 39 73
1999 6 2 4 13 8 15 23
7.Transient 1997
Organ.Psych
(organic cause) 1998
1999 2 6 2 10 8 12 20
8.Brief 1997
Reactive Psych
1998
1999
9.Mental 1997
retardation
with psychosis 1998
1999
10.Post 1997
traumatice Dis
1998
1999
11.Attempted 1997
suicide
1998
1999
12Dementia 1997
1998
1999
13.Substance 1997
Abuse
1998 12 1 14 0 13 14 27
1999 5 1 10 1 6 11 17
14.Others 1997
1998 4 5 2 0 9 2 11
1999

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

DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR


AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT
World Solomon Solomon This Project is funded The WB Project is Yes –formal
Bank Islands Islands Heath asa“ Le a r
ning and collocated in the co-ordination
Makira and Sector Innov a tionLoa n” MHMS building with on planning
Guadalcanal Development project is at concept the Planning and issues and
Provinces Project stage. It will pilot style Health Information Health
($4.5 –5.9m activities with close staff. The most critical Management
loan) monitoring and point of overlap with information
evaluation this Design and the System at
The project WB Project exists in least will be
commenced in the activities essential.
February 2000 associated with Health
The priority issues to Management
be addressed include Information Systems.
It was earlier expected
 Maternal care and that the WB Project
family planning would include the
including the development of a
development of Health Management
midwifery training Information System
 Malaria prevention for MHMS but it is
and control
now being limited to
 Provincial health
the pilot projects
program
management
 Central capacity
building and project
support which will
include Health
Management
Information System
Development to
support the Pilot
Projects in the above
mentioned service
delivery

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DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR
AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT

AusAID Solomon Institutional Financial accounting The SIG is intending Yes


Islands Strengthening systems in Ministry to introduce financial
Ministry of and other line agencies delegations to
Finance “stra t
e giclev els”
within MHMS and
other ministries.
Restructuring of
MHMS and capacity
building within this
project will prepare
MHMS for this
devolution of authority
and accountability. .
The development of
management
delegations and
accountabilities will
create requirements
for financial
management
information There will
need to be appropriate
utilisation of the MoF
accounting systems in
order to accommodate
MHMS requirements

AusAID Solomon Institutional The principle objective is Contact should be Yes


Islands Strengthening to improve overall maintained,
accountability within the
Office of Project $2.5 M Public Sector
particularly with the
the Auditor matters regarding
General) expenditure control,
strengthened audit
legislation
AusAID Solomon Scholarships This program supports Close liaison needed, Yes
Islands, Program $0.6 training of clinical especially in relation
M health staff including to the health
 Diploma of workforce planning
Nursing at SICHE and HR development

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DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR
AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT
 Critical Care policies and programs,
Nursing at Qld Uni to be facilitated by the
 Dental Surgery at proposed new project.
FSM
 Medicine/Surgery Potential for
at FSM candidates to be
 Post Grad identified for training
Obs/Gyn at PNG in support of the
operational
management
initiatives of this
project and the
workforce planning
strategies which will
be developed.

AusAID Solomon Rural Water Provision of Potable The Environmental Yes


and Islands Supply and Water supply and Health, Health
cofunded Sanitation sanitation facilities for Education and water
by $10.3m rural communities supply and sanitation
NZODA This project will be maintenance aspects
drawing to close in of this RWSS project
2001. will need to be
interfaced with the
planning, and policy
development aspects
of this project.
Coordination and
learning from
experience with
maintenance issues
will be useful for
operational planning
and implementation in
Provincial Health
services.
AusAID Solomon Malaria Annual provision of This vector Borne Informal
(CASP) Islands Control, bed nets, anti malarial disease control
Health pharmaceuticals, program interlinks
education and larvicide and fogging with the MHMS

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DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR
AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT
Education chemicals policy development
supplies processes and the
effective operational
planning and
implementation within
the Provincial Health
services.
AusAID Regional Hepatitis B Hepatitis B Hepatitis B Informal
program Project immunisation (1997- immunisation
including ($2.0m) 2000)
the
Solomon
Islands
AusAID Regional Vector-Borne Assists with Malaria and other Informal
program Diseases programmed medical vector-borne diseases
including Control Project and environmental
the ($10) health services and
Solomon introduction of vector
Islands control mechanisms.
AusAID Regional Pacific Action The project is NCD’ spa rti
cular l
y Informal
(Regional) program for Health designed to provide those linked with
including ($3.4mil) preventive and health tobacco and alcohol
the promotional support at
Solomon community, national
Islands and regional levels.
AusAID Regional Pacific Islands Supports and TA to STD and HIV/AIDS Informal
(Regional) program AIDS and STD national programs in
including Prevention relation to STD and
the Programme) AIDFS education,
Solomon prevention, treatment
Islands and care.
AusAID Regional Integrated Funding provide Village health care, Informal
(Regional) Program Community through World Vision. access to watersupply,
including Health Project Objective was to literacy, improved
Solomon Kia/Kotova improve quality of life agriculture and
Islands and Maringe for about 8000 environmental health.
areas councils villagers through the
in Isabel development of an
Province integrated community
health programme.

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DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR
AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT
Project will cease in
2000
AusAID Regional Family Project implemented Strengthening family Informal
(Regional) Programme Planning by Family Planning planning organisation
including regional Australia 1994-2000 finances training and
Solomon development administration.
Islands ($0.63mil)
AusAID Regional Family Project to be extended Strengthening family Informal
(Regional) Programme Planning to facilitate inclusion planning organisation
including regional of family planning finances training and
Solomon development training into formal administration. This
Islands (Proposed curriculum for nurses has policy
$2.7mil) and teachers To be development
implemented by implications and rural
Family Planning health service
Australia 1999-2004 management proposals
which are relevant
AusAID Regional Tertiary Health Volunteer medical As the majority of Yes
(Regional) Program Care Provision teams offering these services are
including Project specialist services and provided in the
Solomon local capacity building National Referral
Islands through on-the-job hospital it will be
training in Plastic and essential to ensure this
reconstructive surgery, program is
neurology, eye care accommodated and
and paediatric surgery not disrupted by the
NRH Management
Strengthening
Component of this
Project
NZODA Honiara and Family Health Reproductive health Sexual health for Informal
other urban Project ($0.3 and family planning urban youth and peer
areas Mil pa) including program education in squatter
Solomon development and IEC settlements to be
Islands production implemented in
association with
churches
NZODA Solomon Training Scheme operates Potential for Yes
Islands Scholarships through National candidates to be
Training Unit in identified for training

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DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR
AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT
Ministry of Education in support of the
and is targeted at nurse operational
training. management
initiatives of this
project and the
workforce planning
strategies which will
be developed.

NZODA Solomon To assist with Specialist treatment in Informal


Islands treatment of patients New Zealand. Need to
for which specialist maintain liaison.
treatment is not
available in Solomon
Islands
JICA Solomon Rural Health Construction and Project Design and Yes
Islands Facilities equipping of facilities functional brief
Rehabilitation including a possible completed by MHMS.
Project $15 m new hospital at Project has policy
Choiseul Bay, a larger development
new hospital at Gizo implications and rural
and selected upgrading health service
of other Provincial management proposals
Health facilities which are relevant to
Project. Eventual
design needs to be
understood by this
Project and
appropriate co-
ordination maintained.

ADB Solomon Population and Reproductive Health It is understood this Informal


Islands Family including development project will function in
Village Planning of IEC materials cooperation with the
areas NZODA to minimise
duplication and will
involve churches.
ADB Solomon Public Sector Management Part of a larger Public Yes
Islands Executive education programme Sector Reform Project

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DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR
AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT
development for Senior Public operating from the
Program Servants. Institutional
Strengthening Unit of
thePr i
meMi ni
st
er ’
s
Department t
supported by ADB
WHO Solomon WHO ongoing Frameworks and Linkages exist with a Yes
Islands Role technical assistance for number of SHP
projects to promote: components.
Healthy Islands,
Health Promoting
Schools, New
Horizons in Health

WHO Solomon Human Funding of fellowships Potential for Yes


Islands Resources candidates to be
Country Development identified for training
Programme in support of the
operational
management
initiatives of this
project and the
workforce planning
strategies which will
be developed.

WHO Solomon Vector Borne Malaria control Informal


Islands Disease
Programme
($200k
WHO Solomon Water Supply Funding of workshops, Informal
Islands and sanitation training and
($140k) fellowships for Health
Inspectors.

WHO Solomon Primary Health Health education and Informal


Islands Care promotion including
development of IEC
materials. Provides
fellowships, limited

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DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR
AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT
supplies and materials
and WHO office
running costs.
UNFPA Solomon Reproductive Provision of Population awareness Informal
Islands Health contraceptive material activities in Family
for family planning Planning and Maternal
training. Scholarships and Child Health
for No authoritative
midwifery/paediatric documentation
nurse training. available

UNFPA Solomon Dispossessed No authoritative Pilot one year project


Islands Youth Project document available. to target
($44k) unemployment,
substance abuse and
sexual health.
UNFPA Solomon IEC Project No authoritative
Islands (80k) document available

European Solomon National Demographic and Census conducted Yes


Union Islands Census health data collection during November
Health and analysis. 1999 with preliminary
planning reports anticipated in
Unit and mid 2000
National
Census
Office
Republic Solomon Phase III To implement Phase Scope of works Yes
of China Island upgrade of III of the Hospital anticipated still
National National refurbishment and unclear. Vital that the
referral Referral upgrading. planing and
hospital Hospital operational aspects of
($1.7mill) this capital works are
clearly appreciated by
this project. Project
should be monitored
to determine if any
cooperation possible
Save the Solomon Child Incorporates child SCF normally operates Yes to learn
Children Islands Protection protection, community with a government or from NGO

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DONOR LOCATION PROJECT TITLE BRIEF DESCRIPTION OF COMPLEMENTARY NEED FOR
AGENCY OF ACTIVITY & DOLLAR PROJECT (including COMPONENTS OR FORMAL
VALUE commencement & ACTIVITIES WITH COORDINATIO
completion date) SOLOMON ISLANDS N
INSTITUTIONAL
STRENGTHENING
PROJECT
Fund country Project based rehabilitation NGO partner and arrangements
Program and a youth outreach provides funding and
mainly programme and family project management
funded by support centre. and administrative
AusAID support

122