National Health Report 2003-Solomon Islands

Report by the Ministry of Health (May 2004): 1
National Health Report 2003:

Evaluation of the National Health Policies and Development Plans 1999-2003
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MINISTRY OF HEALTH
SOLOMON ISLANDS
GOVERNMENT
NATIONAL HEALTH REPORT 2003
Evaluation of the National Health Policies and Development

Plans 1999-2003:
(Health Policies Objectives and Outputs-Achievements &

Constraints by end of 2003):
OURPEOPLE’
SHEALTH OURPASSI
ON
MAY 2004
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MAJOR HEALTH POLICY OBJECTIVES AND OUTPUTS-ACHIEVEMENTS & Constraints 2003.
Table of Contents:
NATIONAL HEALTH REPORT 2003 .......................................................................... 1

OUR PEOPLE’ SHEALTH OUR PASSION.................................................................. 1
I. PREAMBLE: ................................................................................................................... 4
1.0. INTRODUCTION: ........................................................................................................ 5
1.1. VISION AND MISSION: ............................................................................................... 5
1.2. THE HISTORICAL DEVELOPMENTS IN THE HEALTH CARE SYSTEM BY END OF 2003: 6
1.3. HEALTH STATUS: ...................................................................................................... 6
2.0. PROCESS AND OUTPUT EVALUATION OF THE NATIONAL HEALTH POLICIES 1999-
2003: ............................................................................................................................... 9
POLICY 1: IMPROVEMENT OF HEALTH SERVICE PLANNING, MANAGEMENT AND
SUPERVISION. ..................................................................................................................... 9
1.1.Overview:.............................................................................................................. 9
POLICY 2: ACCESSIBILITY, AND IMPROVEMENT OF CARE AND QUALITY OF SERVICES. 12
2.1. Curative Health Services: .................................................................................. 12
2.2.1. Medical Services:............................................................................................ 14
2.6.1. Accident & Emergency Services:.................................................................... 14
2.7.1. Access to Essential Medicines: ....................................................................... 16
2.8.1 Access to community health services through Primary Health Care:............. 17
2.9.1. Health Infrastructure Development:............................................................... 17
2.10.1. Dental & Oral Health Services: ................................................................... 22
2.11.1. Ophthalmology & Primary Eye Care Services:............................................ 22
2.12.1. Diagnostic Services at Hospitals:................................................................. 24
2.13.1. Rehabilitation Services: ................................................................................ 25
POLICY 3: HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT FOR HEALTH ......... 25
POLICY 4: MORBIDITY AND MORTALITY REDUCTION....................................................... 27
4.0. Overview:........................................................................................................... 27
4.1.Malaria: .............................................................................................................. 28
4.2. Acute Respiratory Infection: .............................................................................. 29
4.3. Malnutrition:...................................................................................................... 31
4.4.0. Diarrhoeal Diseases: ...................................................................................... 32
4.5.1 Diabetes (NCD): .............................................................................................. 32
4.5.2. Tobacco and its Impact and the control measures in Solomon Islands: ........ 42
4.6.0. Tuberculosis:................................................................................................... 53
4.7.0. Leprosy: .......................................................................................................... 60
4.8. Sexually Transmitted Infections ) including HIV: ............................................. 64
4.9. Mental Health Service: ...................................................................................... 66
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POLICY 5: ENVIRONMENTAL HEALTH SERVICES ............................................................. 67
POLICY 6: HEALTH EDUCATION AND PROMOTION........................................................... 69
POLICY 7: REPRODUCTIVE HEALTH & FAMILY PLANNING............................................... 72
Child Health Services & Expanded Program of Immunization (EPI):..................... 74
POLICY 8: DEVELOPING PARTNERHSIP IN HEALTH DEVELOPMENTS: ............................ 77
3.0. DISCUSSION ON IMPEDIMENTS/ DIFFICULTIES / ISSUES: .......................................... 80
Compiled by Dr George Malefoasi (Undersecretary Health Improvement) and Mr. Abraham

Namokari (Director Policy and Planning), Ministry of Health.
Copyright @ 2004
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I. Preamble:
The draft Report on Health Activities and Outputs for 2003 provides some basic information on the
evaluation on the health inputs or resources and the outputs or (the deliverables). The report also
provides the Government information of the achievements and constraints in 2003. Unfortunately
the limitations of the report are the unavailability of some update information on health events and
indicators. Nonetheless, the report is comprehensive enough in identifying some gaps between the
demand and supply of health services.
In general the report has identified areas of improvement in the past years as by end of 2003.
Obviously there are also areas of weaknesses within the health sector, which need specific as well
as general multi-sectoral concerted strategies and solutions.
The indicators for the key eight broad health policies were reviewed by end of 2003. In short, there
were outputs, which has positive impact on the population health, whilst there were constraints that
accentuated weaknesses of the existing system.
A paramount output for the Ministry of Health is the development of the National Health Plan 2004-
5, which entails the future directions and strategies and plans for the next twenty months.
The Health Institutional Strengthening Project funded by AusAid has impacted positively in building
local capacity at the national and provincial levels in management and supervision issues such as
planning, budgeting, resources management, coordination and communication.
This report will be complemented in detail by the National Health Review 2004 currently in
progress.
Dr George Manimu Hon. Benjamin P Una

Permanent Secretary Minister of Health
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1.0. Introduction:
This report is about measuring the outputs whether achievements or constraints by end of 2003. It
also inform the Government and other key stakeholders new developments in health as well as
emerging diseases such as the SARS and cancer of lungs due to smoking..
The main body of the report concerns with the review of indicators for the key broad eight policies
adopted and implemented to ensure that population health has improved in the past five year
period 1999-2003.
The report covers recent researches findings, which helped in appraising the situation of the
population health.
The report also attaches the approved list of hospitals and clinics by end 2003.
1.1. Vision and Mission:
Thi
si sa no ppo r
tunit
yt or eit
eratet heSo l
omo nIslan dsGo ver
n me
nt’
svi
si
onf
ort
heh
eal
t
hof
our
people and the mission in achieving the best health outcome.
Vision Statement:
At the Ministry or sectoral level it clear that:
The Ministry of Health endorses the World Health Organization Constitution that it is the
fundamental right of every human being without distinction to race, gender, religion,
political belief, and economic or social condition to enjoy the highest attainable standard
of health. In that context and through its efforts in the delivery of care, the Ministry of
He althh a savi s ionof“ Ahe al
thya ndpr oduc t
iveSol omonI slands”.
Mission Statement:
The mission set to achieve the vision of the Government is also clear at the Ministerial level, which
form basis for other national plans and strategies such as the Medium Term Development Strategy
(1999-2003)1, an the recent National Economic Recovery, Reform and Development Plan (2003-
2006)2.
The Ministry of Health aims to provide a high quality national health system that is
accessible; appropriate; responsive; and equitable. It must also continually upgrade that
1
SIG ( 1998): Medium Term Development Strategy (1999-2003) : Ministry of National Planning and Development ,
Honiara.
2
SIG (2003). National Economic Recovery, Reform and Development Plan. Department of National Reform and
Planning, Honiara.
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systemt oa chievei ts“ Mi ssion”of“ Promot ing,pr ote ct
ing ,a ndmai
ntai
ningtheg ood
health and well being, and hence improve the quality of life of all people in Solomon
Isl
ands ” .TheMi nist
rywi lldoi t
sbe s ttof ulfil
ltha tmi ssi
onwi t
hint
hecont
extofnational
health legislation and within the limits of resource availability.
In the National Economic National Economic Recovery, Reform and Development Plan (2003-
2006), the mission is to reduce health inequalities, and infant and maternal mortality.
1.2. The Historical Developments in the Health Care System by end of 2003:
There have been significant socio-political developments since the Independence in July
7th 1978 that had impact on the primary health care systems.
STAGE I: 1978-1989
Solomon Islands became Independent Nation –Provincial Government System adopted.
Decentralization of health care services administration
National Census
STAGE II: 1990-2000
Natural Disaster – Cylcone Namu hit Solomon Islands
Re-centralization of health care system administration
Malaria hits the highest level in 1992. Honiara the malarious town in the world.
Public Services Policy and Structural Policy emerged for the first time ever.
STAGE III: 1990-2003
Ethnic Tension/ PHC Crisis
National Census
RAMSI
National Recovery Plan
Reconstruction S/PHC-Re-establishment of PH services-Post-conflict
1.3. Health Status:
The general health status indicators for the people of Solomon Islands have been stable through
out the past five years (1999-2003).
Nonetheless, the infant and maternal mortality remains high. Annual growth and death rates are
also high by international standards.
It has been evident that the ethnic conflict has caused devastating effect on the social services
such as health. This is shown in the service delivery indicators to the provinces. The immunization
overages have been low below 80% in general (1999-2002). Outreach services were low and poor
health infrastructure despite an increase of the number of health facilities by end of 2003. There
has been an increase of malaria incidence by 19% by end of 2003. Sexually Transmitted Infections
has been reported to be increasing. The threat of HIV/AIDS epidemic has been eminent should
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nothing proactive done to stop new infections and transmission. Life-style behavioral diseases
such as diabetes and lung cancer lung due to tobacco smoking have been reported to be
increasing the past five years. Emerging of new diseases such as SARS and dengue has created
fear and pressure to the already debilitated health care system in 2003.
There are also positive signs such as the improvement of the life expectancy rates for both sexes
especially the female.
The level of deliverables (health services) ha been observed to be reduced in (1999-2001) due the
poor government financial situation. Fortunately, the emergency assistance to the health sector
from Australian Government (AusAID), New Zealand (NZODA), Japan, Republic of China, WHO
and other donors prevented total collapse of the health system during the crisis.
The Ministry of Health has vowed to re-establish health services in full through partnership with
donor partners and the local community.
1.3. Health Indicators by end of 2003:
Indicators 1996 1997 1999 2003

Number of health 256 252 247 275
facilities
Total Population 410,368 425,4 409,042 464,89
88 8
Population <1 year 15,209 15,77 13,513 14,568
2
Population 1-4 years 56,432 58,51 50,119 53,796
6
Population women 15 – 87,294 90,48 97,459 112,96
49 years 6 0
Expected births 17,235 17,86 13,907 17,480
8
Total deaths 863 884 804 850
Total Births 7,235 7,360 6,329 7,793
Annual Growth rate 3.6 2.8 3.2
(2002)[1]
Crude Birth rate 42 42 34 37.6

[2] (2001)[6]
Crude Death rate 5 4.9 9 Na

[2]
Maternal Deaths 8 5 na Na
Maternal Mortality/ Na Na 125 295
100,000pop (2001)[3]
Infant Mortality/ 1,000 Na Na 66 66
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live births (1999)[4]
Life Expectancy- Na Na M-63.6

Male: Female F-67.4
(2002)[2]
Total Fertility rate 4.7 4.7 4.7 4.05

[5] [6]
% Family Planning 7.7 8.5 8 10

Coverage [3]
% Antenatal Coverage 74.4 68.9 84.0 77.2

% Postnatal Coverage 36.6 39.9 44.3 41.2
% Detected malnutrition 1.6 1.5 1.1 1.4
Touring Satellite Clinics 2,309 2,068 1,655 Na
Touring Schools 890 720 509 Na
Village Health Meetings 1,600 1,767 1,907 Na
EPI - BCG (%) 58.1 % 69.4 69.4% 79
%
- Measles (%) 63.8 % 65.2 65.2% 69
%
- DPT3 (%) 71.9 % 68.6 68.6% 73
%
- TT2 + Booster(% 56.1 % 54.8 54.8% 56
%
- Polio 3(%) 69.0 % 69.2 69.2% 70
%
- Hepatitis B 3(%) 68.3 % 69.6 69.6% 78
%
- DPT1 / DPT3 4.6 % 5.3 % 5.3% Na
drop out(%)
- BCG / Measles - 9.8 % 6.0 % 6.0% Na
drop out
Note: Data for 2003 is incomplete at the time of writing the report.
Key sources of data/ information: [1] WHO Annual Report 2003,[2] WHO Annual Report 2002 [3] Reproductive Health Division, MOH, [4]National
Census 1999, SIG, [5] WHO Annual Report 1999, [6] The Work of WHO in the Western Pacific Region Report 2001-2002.
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2.0. Process and Output Evaluation of the National Health

Policies 1999-2003:
Policy 1: Improvement Of Health Service Planning, Management and Supervision.
1.1.Overview:
1.1. Objectives:
To develop efficient and effective organizational health structure within the plan period.
To improve networking and coordination of major public health divisions in particular, nursing,
Disease Prevention & Control Center, SIMTRI, Health Education Divisions.
To improve and strengthen the National health Information and Planning Division of MHMS.
To improve management and planning capabilities of heads of divisions within the plan period.
To improve monitoring and evaluation of health services.
1.2. Performance Indicators:
Fully documented and implemented structure

Improved integration and coordination
Improved planning documented at National, Provincial and Program levels
Improved Monitoring and Evaluation
Professional Staffing
1.3. Outputs-Achievements & Constraints:
Outputs (or Deliverables):
1.3.1 A key development in the health sector in the past two years since 2001, is the health
institutional strengthening (HISP) continued through the Phase 1 (2001 to September 2003)
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and 2 (September 2003 to August 2004) of the HISP funded by AusAID3. A report that entails
the detail outputs of the HISP is attached4.
1.3.2. Communication further strengthened through two National Conferences held in April and
November 2004 respectively. The first meeting was held especially to review the staffing and
health activities against the limited funding from the Health Sector Trust Account (HSTA)
funded by the AusAID. The Solomon Islands funding was never accessed.
1.3.3. The National Health Policies and Development Plans were implemented satisfactorily
despite significant difficulties as result of the two years ethnic tension.
Basic and minimal services continued to be provided by the Solomon Islands Government
through the direct budgetary funding support to the Ministry of Health.
1.3.4. The Health Institutional Strengthening Project funded by the AusAID provided the
emergency health financing of the health services as well as the capacity building to the
management and supervision of the national and provincial health services.
Improvement of the communication network with clinics begun in 2003 and is in progress. The
total of 45 new radios and support accessories such as terminals and solar installed at many
clinics. (A detail report on the outputs of the HISP can be obtained from MOH)
.
1.3.5. Policy Governing Establishment of new Health Facilities completed in 2002
implemented.
1.3.6. A patient satisfaction survey was done in 2001 with the assistance of the HISP project,
which helped to raise some key issues related to quality standard of care to the patients at the
hospitals. The survey was carried out at the NRH Honiara. Some of the findings will be used in
evaluating the workload and level of staffing, the operational structure and staff performances
at the hospitals.
Negatives:
 Limited output has been achieved in reforming or restructuring of the structure and the
function of the health sector.
 No implementation of the draft restructuring of the Nursing Structure Completed (HISP) in
2002.
 Non implementation of the revised doctors scheme of service approved in July 2002,
which provide strategies to retain local qualified specialist doctors.
1.2.1. Health Financing:
1.2.2. Objectives:
To contain production cost at the Central Hospital, National Referral Hospital below 40% of total
health expenditure by 2003.
To recover 50% of the production cost at the Hospitals within the plan period.
3
Health Institutional Strengthening Project (HISP) funded by AusAID, Ministry of Health (2003)
4
HISP (2004). Annual Report February 2003-February 2004: Prepared for the HISP PCC Coordinating
meeting 15th April 2004.
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To raise revenue collection at the NRH from 0.06% in 1994 to 25% of the health budget to NRH by
2003.
To increase in terms of nominal budget allocation for prevention and promotive health services
within the plan period.
1.2.3. Performance Indicators:
Annual NRH Expenditure.

Annual Health Budget [Estimates)
Annual Revenue Collection by NRH
Budgetary allocation to preventive and promotive health services
1.2.4. Outputs-Achievements & Constraints:
1.2.4.1 New Accounting System established – MYOB (HISP) fully implemented.

1.2.4.2. Resource Allocation Formula implemented in the 2003 budget.
1.2.4.3. Embassy of Republic of China approved a Primary Health Care Rehabilitation Project to
re-establish primary health care activities in the provinces. Total of SBD 5.2 M given and
deposited into the HSTA account.
1.2.4.4. Sources of revenue for the health services delivery were obtained from the World Bank,
AusAID, and ROC.
1.2.4.5. National Referral Hospital contained its service cost well below their acceptable level. The
1.2.4.6. NRH spend below 26% of the total Health Recurrent for 2003.
Negative;
 Revenue collection at the NRH remained low below planned 25% of the NRH 2003
budget. Partly because the Revised Fee Schedules approved by Cabinet in 2002 was
never implemented. This is it was not gazzetted.
1.3.1. Health Information System
1.3.2 Objectives:
To increase timely clinic reporting coverage form the current level to 100% by 2003
To design and implement a comprehensive HIS for SI within the plan period.
To establish a 100% computerized hospital information system in the NRH by 2003.
To extend this system to the 6 provincial hospitals, and 2 church hospitals by 2003.
1.3.3. Performance Indicators;
Clinic reporting coverage

Implemented Comprehensive HIS
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Implemented computerized hospital information system
Extended computerized system in provinces
 1.3.4.1. Health Information System- monthly clinic reporting from all clinics in the provinces
and HCC continued despite a low coverage still.
 1.3.4.2. Disease surveillances systems for TB, Psychiatry, Diabetes, STI/HIV, and Malaria.
 1.3.4.3. Database for Reproductive Health programs completed and piloted in 2003.
 1.3.4.4. HIS computerized system updated from windows 3.1 to Microsoft 2000.
Issues and Constraints:
 HIS Monthly reporting response still low at 60-70%5.

 Establishment of the Hospital Information System never been implemented due to failure
by the private consultant.
 The computerized Health Information System systems is under the process of
upgrading thus HIS data for 2003 is not available at the time writing this report.
Policy 2: Accessibility, And Improvement Of Care And Quality Of Services.
Ru ra lp eople’sa cc e ssibi
li
tyt ob asicr e asonabl
ep rima ryh e al
t
hca
res ervicesi sap riorit
y
importance as 80% of the population lives in the rural areas. Steps are envisaged to consolidate
existing health facilities (not to construct new ones) and to increase utilization, because of the
limited resources. Staff training and community motivation is vital.
2.0. Policy Statement:
It is the constitutional right of each individual of the community to have access and equity to a
minimum reasonable quality of health care, and essential medicine, and other public health
services. (Health For All Strategy).
2.1. Curative Health Services:
2.1.2. Objectives:
To improve doctor to population ratio from 1:7031 in1995 to 1:4500 by 2003.

To improve nurse to population ratio from 1:836 in 1995 to 1:500 by 2003.
To improve nurse aide to population ratio from 1:1208 in 1995 to 1:800 by 2003.
5
HIS Clinic Monthly Reports, Statistics Unit, MOH
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To improve hospital utilization rate in the provincial hospitals from 45-65% in 1995 to 90%by 2003.
To improve hospital utilization rate at the National Referral Hospital (Central Hospital) from 70% in
1995 to 80-90% by 2003.
To increase self-r
e l
ianc es pec i
a l
ist ca r
ei n2ma j
o rp rovi
n cial hospit
als(Ki
lu ’
ufiandGi zo )t
or ed
uc e
number of referrals by 50% by 2003.
2.1.3. Performance Indicators.
Doctor to Pop. Ratio

Registered Nurse to Pop. Ratio
Nurse Aide to Pop. Ratio
Hospital utilization Rate
No. Of referrals
2.1.4. Output-Achievements & Constraints:
 2.1.4.1. Total 8 hospitals were fully operational.

 2.1.4.2. Medicine supplies to the clinics and hospitals improved more than the 2002.
 2.1.4.3. Ongoing training for nurses continued overseas and locally at the SICHE and the
HISP management courses.
 2.1.4.4. Five (5) new graduates in the filed of Midwifery to the provinces.
 2.1.4.5. By end of 2003, there were total of 1,091 nurses6 (both established and direct
employed nurses in the provinces) with a Nurse: Population Ratio of 1:419 as compared to
1999, which was 1:836 in 1986.
 2.1.4.5. Tertiary or sub-specialist care of paediatrics surgery, eye, ENT, radiology, and
interplast have been provided locally through the Pacific Island Project (PIP) Phase 2
executed by Royal College of Australasia Surgeons (RACS)7.

 Access to doctors and nurses by the communities was low than the planned ratio by 2003.
Firstly, capacity of the School of Nursing at the SICHE could not allow for increase intakes
because limited resources. Secondly, the graduates from other school (Atoifi Nursing
School) has never been formal part of nursing training for the whole country.
 Migration of health professionals of the country away to neighboring countries has been
observed to accentuate the gap. In the past 12 months more than 5 nurses have moved
out to Marshall. Twenty percent (20%) of the national doctors seek jobs outside the
country8. This is a significant problem for the government to address.
 The plan to upgrade the Gizo and Kiluufi Hospital in sub-specialist hospital did not
eventuate because of limited resources.
6
HISP/ Nurse`Advisers Report (2003)
7
PIP/ RACS
8
G.Malefoasi & I.Avui (2003).Migration of skilled health professional: Country Report: Solomon Islands,
May.
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2.2.1. Medical Services:
2.2.2. Objectives:
To upgrade the Level of Service (LOS) at NRH to LOS 3 by 2003.

Tou pgrad eL e velof Ser vi
cea tGiz o&Ki lu’
u f
iHo sp i
tal
sf r
omL OS2t oL OS3b
y2003.
To upgrade Level of Service in Makira, Isabel, Temotu, Choiseul from LOS 1 in 1998 to LOS 2 by
2003.
To increase the bed capacity in the 6 government hospitals to 80% BOR by 2003, in order to
increase hospital utilization rate without increasing the number of beds.
To have at least two doctors permanently stationed at the 4 smaller provincial hospitals (Buala,
Lata, Kirakira, Tulagi)

Level of Services (LOS)
Bed Occupancy Rate %
Hospital Utilization Rate
Doctors posting in the province
2.2.4. Outputs/ Achievements & Constraints:
 2.2.4.1. Medical specialist services was provided to the provinces through the specialist
referral system between the NRH and the provincial hospital. In 2003 a consultant
physician was recruited from India under the Local Supplementation Scheme funded by
NZODA and the SIG.
 At this stage at the time of writing the report, unavailability of proper hospital information
data from all hospitals limits the ability to evaluate the productivity and efficiency of the
hospitals.
 All hospitals are not evaluated against their designated roles under the Policy Guiding the
Role Delineation to hospitals because of lack of a comprehensive hospital data and
information system. However, it is anticipated that data for this purpose should be
collected as part of the 2004 National Health Review, which is in progress.
 Thus, this report is not able to report comprehensively on outputs of the rest of this policy,
which covers Surgical, Obstetrics, Child health services and (paediatrics).
2.6.1. Accident & Emergency Services:
2.6.2. Objectives:
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To have at least one nurse specialist in Accident & Emergency at the NRH by 2003.
To train one local doctor in specialist Accident & Emergency at the NRH by 2003.

No. Of nurse specialist in A&E
No. Of doctor specialist in A&E
 2.6.4.1. A post-trauma course was held in 2003 and some nurses from the A& E
department attended.
 2.6.4.2. A registrar of the AED attended a short term attachment training with the
Emergency Department of the St.Vincent Hospital, Melbourne with the assistance of the
RE Ross Funding by AusAid through Royal Australasian College.
 2.6.4.3. In Honiara alone, road traffic injuries account for 0.2% to 2% of the total casualties
(trauma or injuries) recorded at the Accident and Emergency Department of the National
Referral Hospital from 1996 to 2003 (a period of 8 years). Of the total casualties or trauma
cases, between 3.3% to 27.3% of the Road Traffic Injuries were fatal (or dead).
 2.6.4.4. Looking at the trend in the past eight years (as of 1996 to 2003) in Honiara, at-
least an average of 65 cases of injuries related to Road Traffic Accidents, and of these
RTA, an average of at least 2 people suffering from RTA died. Not many people including
politicians are fully aware of the magnitude and severity of the road traffic injuries. Health
and social impact of road traffic crash has been studied and concluded to be numerous
and significant. Patients who sustained and survived road traffic injuries stayed longer in
the hospital with a mean length of stay around 20 days. These patients are also the
frequent users of operating theater, x-ray and physiotherapy departments for operations, x-
rays, physiotherapy and rehabilitation. Whilst there are medical costs and lost productivity,
the psychological losses associated road traffic accidents, either to those injured or to their
families are often undermined. Many patients suffer longer-term disabilities.
Table: Road Traffic Injuries or accidents recorded at the NRH 1996-2003:

Year Number % of total injuries due to Total OPDModified No. Death
of RT RT accidents Attendances trauma fig- Deaths rates due
injuries 10% of the RT
Total OPD Accidents
attendees (%)
were
trauma/injury
ALL
1996 112 1.93 58,111 5,811
1997 117 2.10 55,798 5,580
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1998 59 1.18 50,000 5,000
1999 91 1.82 50,000 5,000 3 3.3
2000 79 1.58 50,000 5,000 3 3.8
2001 11 0.22 50,000 5,000 3 27.3
2002 20 0.40 50,000 5,000 2 10.0
2003 29 0.58 50,000 5,000 2 6.9
Total 518 1.25 413,909 41,391 13 2.5
Average 65 51,739 2
per year
Source: Medical Records: NRH
2.7.1. Access to Essential Medicines:
2.7.2. Objectives:
To ensure that essential drugs are always available in 90-100% of rural clinics in a year for within
the plan period. In particular reliable and adequate supply to rural health care facilities.
Availability of essential drugs at the rural clinics

No. of trained pharmacy officers
Legislation reviewed

 2.7.4.1. National Drug Policy completed and endorsed.

 2.7.4.2. Scheme of services for the pharmacy officers and assistants accepted by PSD
and gradings revised accordingly.
 2.7.4.3. Medical supplies to the clinics and hospitals improved.
 2.7.4.4 EPI committee formed to boost the EPI campaign in 2003.
 2.7.4.5. Two (2) additional pharmacists graduated.
 2.7.4.6. Health Sector Trust Account funded by AusAID has provided direct budgetary to
pay for the medicines.
 2.7.4.7. By end of 2003 all clinics and hospitals are supplied with the basic and routine
medical supplies.
 2.7.4.8. Clinic supply kit fully implemented in 2003.
 Vacancy of Chief and Principal Pharmacist posts since 2002
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 National Pharmaceutical status not fully surveyed (due 2004)
 No implementation plan for Essential Medicines Policy (will follow survey)
 Regulatory Affairs section understaffed and under-trained
 Shortage of trained technical officers –POC course being restarted in 2004
 Poor IT tools for inventory management and medical supply (upgrade due in 2004)
 Lack of Pharmacy Board meetings to ensure professional standards
 Lack of attention to upgrading the poisons list and related schedules
 No officer to focus on research and development in rational use of medicines
The new Pharmacy Practitioners Act was one of the few pieces of legislation promulgated in 2000.
The main Act that controls medicines –the Pharmacy & Poisons Act - is still quite tenable.
However, the associated Poisons Rules, and the schedules to the Act and Rules, do need urgent
attention. Thus there are few structural problems, but the need is paramount to keep import control
up to date, and ensure that labeling rules, and other professional pharmacy matters are
appropriate for our current needs.
2.8.1 Access to community health services through Primary Health Care:
2.8.2. Objectives:
To have 123 clinics staffed by at least one registered nurse, and a nurse aide at all times in a year,
by 2003.
To have 61 Nurse Aide clinics staffed by a nurse aide at all times in a year, by 2003.

No. of registered nurses and nurse nurses posted at the clinics
2.8.4.Outputs-Achievements & Constraints:
 2.8.4.1. All clinics opened.

 2.8.4.2. Community nursing re-established at all primary health care centers.
 2.8.4.3. By end of 2003, total of 561 nurses (RNs and Nurse Aides) are placed at the
primary care centers (ie. clinics), whilst 533 nurses are placed at secondary care centers
(at hospitals). Total of 1,091 nurses are recorded, with a Nurse:Population Ratio of 1:419
2.9.1. Health Infrastructure Development:
2.9.2. Objectives:
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
To strengthen the primary health care activities at the community level at the rural as well as some
urban areas in the country.
To repair and maintain more than 80% of the total health facilities identified to be in poor physical
status in 1998, by year 2003.
To increase utilization of the health facilities to prevent further impact and severity (disability) of
preventable and curable illnesses affecting the vulnerable people particularly those in the
periphery, rural remote areas, and women and children.
No. Of health facilities repaired and fully operational
2.9.4.1. There were about 43 clinics renovated and refurbished in the past five years. By end of
2003 only about 46% of total clinics (94) prioritized since 1999 by the Ministry of Health. This is half
short the plan to rehabilitate more than 80% of the total clinics.
Funds available were directed to services delivery and not any substantial capital projects.
The Ministry has a master plan to refurbish all rural health clinics but lack funding to do all.
2.9.4.2. The donor agencies such as AusAID/ CPRF, EU Grass Roots projects and Oxfam have
been implementing these refurbishment works in the past. Unfortunately, no further information on
thesec l
ini
c sish e l
da tth eMi ni
str
y ’slevel.
2.9.4.3.The update list of renovated clinics is attached.
Ref. Province Location Type Activity Status

No.
1 Choiseul 1.Paqoe AHC Maintenance/ Done
Repair/
Renovation
2 2.Nuki RHC Done
3 3.Taro AHC “ In-progress
4 4.Susuka RHC “ Pending Funds
5 5.Polo RHC “ Pending Funds

6 6.Pasarae RHC “ Pending Funds
7 7.Voza RHC “ Pending Funds
8 8.Wagina RHC “ Pending Funds
9 9.Sirovanga RHC “ Pending Funds
10 10.Loloto NAP ‘
’ Pending Funds
11 11.Sasamuga Hosp Done
12 Western 1.Harapa RHC Maintenance/
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--------------------------------------------------------------------------------------------------------------------------------------------------------------
Province Repair/
Renovation
13 2.Vakobo Done
14 3.Falamae RHC “
15 4.Kolokolo RHC “ Done
16 5.Cheara RHC “
17 6.Poitete RHC “
18 7.Nila RHC “ Done
19 8.Vonunu RHC “
20 9.Emu RHC “
Harbour
21 10.0Keru Done
18 Malaita 1.Masupa RHC Maintenance/
Repair/
Renovation
19 2.Manawai RHC “ Done
20 3.Olomburi RHC Resiting/ Done
Extension
21 4.Rara NAP Maintenance/
Repair/
Renovation
22 5.Afenaba Done
23 6.Afio Done
24 7.Anomasu Done
25 8.Ata ’
a RHC “
26 9.Gounatolo RHC “ Done
27 10.Bi t
a’
ama RHC “ Done
28 11.Hauhui RHC “
29 12.Maluu AHC Done
30 13.Rohinari RHC “ Done
31 14.Kiu RHC “
32 15.Gwarata Done
33 16.Nafinua Done
34 17.Ote Done
35 Guadalcan 1.Doma AHC Resiting/ New
al
36 2.Aola RHC Resiting/New
37 3.GP/HQ/ Clinic Maintenance/ Site to be
clinic Repair/ identified
Renovation
38 4.Saro Done
39 5.AvuAvu RHC “ Proposed to ADB
40 6.Turarana RHC “
41 7.Malatoha RHC “ To be resited at
Konga
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42 8.Kolosulu NAP “
43 9.Grove Done
44 10.Tasimboko Done
45 11.Marara Done/New
46 12.Marau AHC To be rebuilt in
2004 by Worl
Bank project-
SIHSDP
47 13.Biti NAP Proposed for
ADB
48 14.Fox Bay NAP Proposed for
World Bank
project/ SIHSDP
49 Isabel 1.Momotu NAP
50 2.Nagolau NAP “
51 3.Sigana NAP “ Done
52 4.Vulavu RHC “
53 5.Tataba AHC “
54 6.Toelegu Done
55 7.Kalenga RHC “
56 8.Poro “
57 9.Susubona RHC “
10.Kolomola RHC “
58 11.Moloforu RHC “
59 12.Samasodu RHC “
60 13.Baolo RHC “
61 14.Bolotei AHC Done/ upgraded
62 15.Guguha RHC “
63 16.Nodana Done
64 Makira 1.Houpala AHC Maintenance/
Repair/
Renovation
65 2.Aorigi Done
66 3.Arinagana RHC “
67 4.He rainu ’
u Done
69 5.Marouvu RHC “
70 6.Mamuga RHC “
71 7.Kirakira Training “
Training Center
Center
72 8.Hunuta Done
73 9.Manasugu Done
74 10.Waihaga Done
75 Temotu 1.Manuopo AHC “
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--------------------------------------------------------------------------------------------------------------------------------------------------------------
76 2.Tukutaunga RHC “
77 3.Anuta Done
78 4.Tikopia Done
79 5.Nea/Noele Done
80 CIP 1.Yandina AHC Maintenance/
Repair/
Renovation
81 2.Leitongo RHC
82 3.Panueli RHC “
83 4.Koela Done
84 5.Maroloun Done
85 6.Koilovala Done
86 7.Borohinaba NAP “
87 8.Salesapa NAP “
88 9.Ravu Done
89 10.Narogu Done
90 11.Toga Done
91 12.Dende NAP “
92 RenBell 1.Tingoa RHC Maintenance/ Done
Repair/
Renovation
93 2.Tengano RHC “
94 3.Nuku RHC “
TOTAL
2.9.4.4. There has been an increase in the number of PHC facilities (clinics-AHC, RHC and
NAP) by end of 2003. By end of 2003 there are additional 49 PHC clinics (excluding
hospitals) (i.e.20% rise). There are many more AHC (30% increase) as compared to
RHC (25% increase) and NAP (20% increase)
Table showing number of health facilities in 1999 as compared to 2003:

All Hospitals Area Health Rural Nurse Total
Centers Health Aid Posts PHC
Clinics excluding
(RNs) hospitals)
(2003) 9 9 30 119 157 296
(1999)10 9 23 95 129 247
% increase 0 30 25 22 20
Annex Table 1 shows the list of approved clinics by end of 2003.

9
Health Institutional Strengthening Project (MOH) update on approved health facilities( Hospitals, Area
Health Centers, Rural Health Clinics and Nurse Aid Posts, 2003.
10
National Health Report Review, Ministry of Health (1999) in page 13: Sector 2: Types of services:
Table: The Health Care Referral System.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
2.10.1. Dental & Oral Health Services:
2.10.2. Objectives:
To increase the preventive dental health services in the next five year
No. Of health education activities

No. Of advocacy activities
No. Of school visits
 2.10.4.1 The number of dentist increased from 3 to 15 in the past five years. By end of
2003, another 4 graduated from the Fiji School of Medicine.
 Only 2 of the 15 dentists are posted in the provinces (one each to Gizo and Kiluufi
Hospitals). Major constraint faced at the provinces is lack of housing for the dentists.
2.11.1. Ophthalmology & Primary Eye Care Services:
2.11.2. Objectives:
To reduce the national blindness rate to less than 0.5% by 2003.

To upgrade the Level of Service (LOS) from LOS 4 at the National Referral Hospital in 1998 to
LOS 5 by 2003.
Tou pg r
a deL OSa t Gizoa ndKi l
u’u f
iHo spit
als from LOS 2 to LOS 3 by 2003.
To have another local doctor qualified in ophthalmology by 2003.
To train one more local doctor by 2003.
To increase the number of nurses trained in ophthalmology from---in 1998 to ---by 2003.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
National Blindness Rate %

LOS
No. of nurses trained in Eye specialty
2.11.4.Outputs-Achievements & Constraints:
 2.11.4.1. Primary Eye Care services continued despite no eye specialist in the country.
 2.11.4.2. Primary eye care was maintained by the local Eye Nurses at the NRH and the
provinces.
 2.11.4.3. Specialist eye care services received through two Eye visits from Australia
through the Pacific Islands Project by RACS and funded by AusAID.
 2.11.4.4. The primary eye care services has been maintained the local eye nurse
practitioners whilst there are no eye doctor.
 2.11.4.5. The Pacific Islands Project (PIP) funded by AusAID and executed by Royal
College of Australasia Surgeons (RACS) assisted in both stop gap and maintain eye care
to support the primary eye care nurses.
 2.11.4.6. The Prevalence Rate for diseases of the eye stands at 17.7 per 1,000 population,
whilst the incidence rate stands at 7.6 per 1,000population from 1999 to 200311.
 Table below shows the indicators for Eye infections recorded by the Eye Dept. of NRH
1999 2000 2001 2002 2003
ALL(new & old) 7,944 5,826 6,762 7,433 10,311
New 3,539 2,737 3,375 3,042 3,858
Major 554 353 427 432 380
Int 150 45 39 24 35
Minor 84 97 129 23 25
Total surgery 620 495 595 479 440
Population 409,042 420,856 433,035 445,591 457,153

Incidence 8.7 6.5 7.8 6.8 8.4
rate/1,000pop
Prevalence 19.4 13.8 15.6 16.7 22.6
rate/1000 pop
Cataract surgical 359 496 484 268

rate calculated by
Eye Unit
Average Prevalence 19.4 13.8 15.6 17.7
22.5
11
Eye Department Reports for 1999,2000,2001,2002,2003 compiled by Wanta Aluta for this report (April
2004)
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
rate/1000pop
Average incidence 8.7 6.5 7.8 7.6

rate/1000pop 8.4

2.11.4.2. Issues and Constraints:
 Since 2000 Solomon Islands was without a consultant eye specialist. The local eye
specialist and the registrar left the country because of the ethnic tension. Most major
surgeries are carried out by the visiting Eye Specialist Teams from overseas particularly
the EYE PIP (Pacific Islands Project) funded by AusAID and executed by RACS.
 (Unfortunately the data on blindness rate is not available at the time of writing the report).
2.12.1. Diagnostic Services at Hospitals:
2.12.2. Objectives:
To establish and develop network of Medical and Health Laboratory Services in support of Primary
Health Care by 2003.
Expansion of Provincial hospital establishment;
Kil
u’ufi - from 3 technicians in 1998 to 4 by 2003
Gizo-From 2 technicians in 1998 to 3 by 2003 Lata, Kirakira, Buala- To have at least 1 technician
and 1 medical laboratory assistant (MLA) by 2003.
Tulagi- To have 1 post by 2003
Sasamuga- Upgrade post to technician level by 2003
Posting of technicians in the provinces
 2.12.1. Pilot Tele-pathology project completed. Draft report available.

 2.12.2. All provincial hospital laboratories were staffed.
 2.12.3. Relatively a wide range Laboratory testing are done. This includes HIV/STI testing,
Biochemistry, Haematology, and Serology. Highly specialist testings are done through the
arrangement with the Royal Brisbane Hospital under the Queenslands Pathology Services
System. Specimen are sent for analysis in Australia.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
2.12.2. Issues and Constraints:
 Human resource objectives for the diagnostic services to the provinces was not achieved
as planned. The reasons are lack of training opportunities for undergraduates because of
financial constraints, and suspension of recruitments.
 Basic laboratory testing supplies were also short during the crisis period. The problem has
been slowly resolved. Change in the ordering and procurement process has been noted to
be having an effect but this issue is been discussed and solutions reached.
 (Details on the testing not available at the time of writing this report).
2.13.1. Rehabilitation Services:
2.13.2. Objectives:
Toi nc re a set heq ua l

ityan
dqu
ant
i
tyo
fse
rvi
cesp
rov
ide
dto‘
al
l’k
nowno
rre
gis
ter
edp
eop
lewi
t
h
disability in the country.
2.13.3. Performance Indicators
No. Of people with disability registered in CBR database.

No. Of activities and programs organized for people with disability and respective stakeholders.
2.13.4. Achievements:
 2.13.4. First Draft of the Disability Act completed.
 Draft Disability Act not followed up into a bill to be passed by the parliament.
Policy 3: Human Resource Management And Development For Health
3.1.1. Objectives:
To develop a workforce plan based on the needs, and implement 75% of its programs by 2003.
To increase the proportion of qualified skilled health workers at the provincial levels from 40.5% in
1999 to 60% by 2003.
Increase training opportunities in health promotion and preventive health within the plan period.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Implemented training programs

Proportion of qualified skilled health workers at the provinces
No. of training in health promotion and preventive health services
 3.1.4.1. Check list for selection of nominees from departments, drawn up by the Training &
Fellowship Committee (TFC), Ministry of Health.
 3.1.4.2. Training Plan for 2004-5 was drawn up and endorsed by the TFC/MOH.
 3.4.4.3. Draft Training Policy Guideline was developed by FTC/MOH.
 3.4.4.4. Total 80 candidates health staff were accepted by the FTC for training 2003. Fifty-
three percent (53%) (i.e.42) were successful in being sponsored. Twenty-nine health staff
successfully graduated end of 2003.
 3.4.4.5. Training Plan for Psychiatric nurses continued.
 3.4.4.6. Implementation of the training for doctors (postgraduate) continued. Ten doctors
trained into different specialties continued. One graduated end of 2003 as a specialist in
obstetrics and gynaecology (Dr K Bisili).
 Lack of integration of training for the health workforce with the National Training Unit of the
Ministry of Education and Human Resource Development.
 Lack of proper training needs assessment for the undergraduate for medicine and all other
health related disciplines.
------------------------------------------------------------------------------------------------------------
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Policy 4: Morbidity And Mortality Reduction
4.0. Overview:
Most indicators in this sector concerns with the health outcomes measured in rates.
The common uses of the indicators are:-
 Evaluate the impact of control measures aiming to at reducing the morbidity (illnesses) and
mortality (deaths) due to the common diseases in the country as well as emerging
illnesses.
 Measure the workload on health facilities due to the common diseases.
 Allocate resource to different treatment; and
 Evaluate different interventions and control programs.
However, due to lack of proper and timely data and information, the depth of the evaluation is not
complete. Nonetheless, the available information and data has significant lessons and evidence to
improve the public health programs, the primary health care, the management and supervision.
It is also important to note here that the objectives were set back in 1999 when the national health
policies and plans were developed.
As the indicators are reviewed in light of the National Health Policies and Development Plans,
other universal indicators are closely monitored locally. Indicators of Millennium Development
Go al
s( MDG’ s),theI nternati
ona lCo nfere nceo nPo pulat
ionsa n dDe velopme n
t(I
CPD)Go als and
the World Health Organizations targets for different disease control programs.
4.0.1. Policy Goals:
To decrease the transmission, morbidity and mortality due to the priority health problems.
To prevent or delay onset of the non-communicable diseases, including reduction in occupational
diseases, in order to maximize disability-free and productive lives in older age.
To promote environmentally sound practices and technologies for the effective prevention and
management of environmental health-related disease and disability.
To enhance people's quality of life by preventing disability, including blindness and deafness, and
by rehabilitating the handicapped, infirm and disabled.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
To ensure the rights of everyone to enjoy a good quality of life, and to promote equity in access to
resources necessary for optimal health.
4.1.Malaria:
Overview:
Malaria infection in the country rose by 19% in 2003. The reasons attributed to the increase are as
follows; Firstly the environmental factors such as soci-economical status of the country in the past
three years derailed communities from the momentum to protect themselves from malaria.
Secondly, due to the significant reduction in the intervention programs in all provinces because
diminished funding, resulting in shortage of larvicidal chemicals for spraying, and declining
mosquito treated bed use through out the country. Thirdly, there was limited malaria awareness
campaigns for communities to prevent malaria in their areas.
4.1.2. Objectives:
To reduce malaria incidence rate from 160 cases per 1000 population in 1997 to fewer cases less
than 80 cases/ 1000 by 2003.
To increase the insecticide treated bed net coverage from 70% end of 1997 to 95% of the
population by 2003.
To improve diagnostic services (microscopists coverage) to all provinces by 2003.
Malaria Incidence Rates

Bed net coverage Rate
Number of Malaria microscopy facilities in provinces
 4.1.4.1. Renovation of Solomon Islands Medical Training Institute was completed in 2003.
 4.1.4.2. The Revised Malaria Treatment Policy was completed, which re-introduced
primaquine in a safer dose to treat Malaria-PV malaria infections.
 4.1.4.3. The main activities implemented during 2003 were:
i) Bednet distribution and retreatment
ii) Residual spraying
iii) Larviciding
iv) Health education
v) Mass Blood Survey (MBS)
vi) Source reduction
vii) Community participation
------------------------------------------------------------------------------------------------------------
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 4.1.4.4. Continued support from WHO, Rotary and AusAid Trust Fund ensured that control
activities were selectively supported. These activities included|: management of
antimalaria drug policy including training for nurses and health workers, bednet distribution
and retreatment, residual house spraying, monitoring workshops for Guadalcanal and
Malaita; microscopy training for 3 provinces.
 4.1.4.5. Implementation of the new antimalaria drug policy;
 4.1.4.6. Implementation of the Global Funds for Malaria programme initiated
 4.1.4.7.Technical working groups for drug policy, vector control, monitoring and community
development/health promotion established.
Malaria incidence rate rose by 16% from 168 per 1,000 population in 2002 to 200 per 1,000
population. This indicator signifies the negative impact of the ethnics crisis and the poor economic
situation. The Vector Borne Disease Control Programme has faced insurmountable problems in
2003 and the result could be seen from the provincial malaria epidemiology and situation.
Problems faced by the Programme include the following: administration, socio-economic, financial
and technical obstacles. The seriousness of each problem varies with each province. However
with all the problems faced the VBDCP had managed to suppress malaria and did not allow it to go
uncontrolled.
Indicators 2002 2003 % Change
No. of patients tested for malaria 278,261 297,897 7% increase

No. of confirmed cases 74,865 91,606 18% increase
No. of Plasmodium falciparum positive 50,105 64,302 22% increase
cases
No. of Plasmodium vivax positive cases 24,736 27,234 9% increase
No. of admissions due to malaria 1887 1344*
No. of deaths 61 41*
No. of nets treated per year 79,538 55,435* 30% decrease
No. of persons protected by house spraying 18,899 32,213 41% increase
Annual incidence rate per 1000 population 168 200 16% increase
* excluding Choiseul, Central and Makira-Ulawa provinces as no reports were received
4.2. Acute Respiratory Infection:
Overview:
Acute respiratory infection has been a common cause of outpatient attendances in all provinces.
4.2.1. Objectives:
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
To reduce the incidence rate of ARI from 422/1,000 in 1993 to less than 100/1000 cases by 2003.
To reduce the incidence rate of ARI in children under 5 years from 1073/1000 to less than
500/1000 by 2003.
Incidence Rate of ARI/ 1000 pop.

Incidence Rate of ARI in children under 5 yrs/ 1000 population.
 4.2.1.There was a positive response to the SARS Outbreak in 2003. It was the first time
that integration and collaboration between different government sectors and the private
shipping and airline companies joined together to combat the international disease
outbreak in China and other parts of Asia and Canada.
 4.2.2. SARS prevented from spread into the country during the global outbreak Feb-June
2004. As SARS Prevention Task Force was formed to deal with the outbreak. The
taskforce develop public health strategies to prevent SARS imported through sea and air
travel routes. The WHO and the Government of Japan provide financial, expertise advises
and logistic support in preparation for a reported case.
 4.2.3. A thorough screening process was developed to quarantine all incoming traveling
passengers by air and sea. From the period of April to July, there were total of 3,557
passengers were screened by the Health Inspectors of the Environmental Health Division
of the Ministry of Health through a questionnaire contained in a flyer handed in the plane
before arrival in Honiara. Of the total 110 (3.1%) incoming travelers were quarantined.
Contacts were recorded and travelers advised to call a doctor or attend the Accident &
Emergency Department if felt sick after checking out. This 3.1% of the total travelers came
in the country from affected countries; majority of 46% (51) came in from Singapore, 26%
(29) from Taiwan, 14% (16) from Hong Kong, 12.7% (14) from Guandong, 3.6% (4) from
Hanoi in Vietnam, 1.8% (2) from Toronto. Fortunately, none (o) of travelers suffer from
SARS (or have met the diagnostic criteria for SARS by WHO). A full alert system was
established. Solomon Telekom management supported the efforts by providing for a toll
free SARS hotline.
 4.2.4. No dengue outbreak in 2003.
 An ARI outbreak was noticed in the country especially during the wet season of the Christ
Mass period. (At the time of the writing of the report, samples collected in April 2004 came
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
back positive for Influnzae type A (H3)12. Therefore the ARI outbreak is most likely due to
Influenzae A. This is the same type found in Australia and New Zealand.
‘
Oth
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pda
ted
ataa
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sonARI
inp
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’
4.3. Malnutrition:
4.3.1. Policy Statement:
The National Nutrition Survey of 1989/90 revealed that malnutrition is a problem of children and
women, with 23% of children being underweight, 7% women underweight and 39% overweight
(obese). Vitamin A deficiency is evident to be increasing and related to Malnutrition in children.
4.3.2. Objectives:
To reduce the proportion of children under weight from 23% in 1989/90 to less than 10% by 2003.
To reduce the proportion of women underweight from 7% underweight to less than 5% by 2003.
To reduce the proportion of women overweight from 39% in 1989/90 to less than 10% by 2003.
4.3.3. Indicators:
Proportion of children reported under weight %

Proportion of women reported underweight %
Proportion of women reported overweight %
Integrated in the IMCI approaches
‘
Oth
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ated
ataa
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tr
it
i
oni
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12
Report by Mr Andrew Darcy, Senior Medical Laboratory Officer, NRH.
------------------------------------------------------------------------------------------------------------
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4.4.0. Diarrhoeal Diseases:
4.4.1. Objectives:
To reduce episodes of diarrhea from 3.5 per year in 1992 to less than 2.0 per year by 2003.
To reduce deaths due to diarrhea from 1.7% deaths per 1,000 children per year to less than 1.0%
by 2003.
4.6.4. Indicators:
Episodes of diarrhea in children per year

Deaths due to diarrhea
No major epidemics recorded as compared to 2000.
‘
Oth
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pda
tedat
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siso
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ar
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’
4.5.1 Diabetes (NCD):
4.5.1. Objectives:
To improve information (IEC production) in diabetes in the next five years.

To improve clinical management and treatment of diabetes in the next five years.
To prevent disability due to diabetes through community awareness.
4.5.2. Indicators:
IEC production on diabetes.

Clinical Management and Treatment Protocol fully documented and implemented
Improved collaboration links with the community.
No. Of diabetic cases per year
No. Of diabetic foot ulcers reported
4.5.3.Output-Achievements & Constraints:
Introduction:
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
In 200313, we managed to settle down but we still encounter some obstacle. NCD Program for
example, as the current coordinator of the program, I was attending Advanced Diploma at the
college of higher education and at the same time, supervising the Program.
Though attending the advanced course at the college had causes disturbance in the running of the
Program, however the program also achieved some of its activities. Some of the achievements are
as follows-;
1. Attachment of three Provincial Diabetes Coordinator at New Castle Diabetes
Centre.
2. Printing of Pamphlets for the Provinces funded by World Health Organization
(WHO)
3. Supervisory tour to Isabel Province funded by Aus-Aid Trust fund.
4. Launching of World Diabetes Day at the Market funded by Aus-Aid fund.
Like wise, the analysis of Diabetes will be included in this Report.
STAFF TRAININGS.
There is a need of Training for both the Provincial Diabetes Coordinators and National NCD
coordinator.
In year 2002, Dr Bowen from New Castle Visit Solomon Islands. During his visit, we were looking
at ways on how we can improve diabetes program to work more efficiently and effectively. Some of
the outcome result of the visit was, each year; we should be sending candidates for attachment at
New Castle in Australia.
This year we already sent three Provincial coordinators for one-month attachment at New Castle
Diabetes Centre. This process should be continues for next five year if things turn out rightly.
Because, capacity building through training and workshops are the main component to increase
knowledge and skills of the health worker and program coordinators both at Provincial and at
National level.
However, I was also attending Adv. Diploma in Nursing at the College of Higher Education since
last year. This year I have completed the course and was graduated with required qualification. In
year 2004, I should be attending Degree course at UPNG.
TRAINING OF THE DIABETES GIUDE-LINE.
Training of the guideline is a Task needed to be carried out. Out of all the provinces in the Solomon
Islands, Choiseul, Makira Ulawa and Malaita are the only provinces that are yet to have workshops
on the guideline. Letters and faxes were sent to training officers and diabetes Coordinator of each
Province concerning training. Despite that no positive respond from them.
The provincial Management might blame the current situation that we were facing with our
financial, but that was not the fact. Under ROC Funding, the Ministry of Health had been allocated
money for each program.
Otherwise, those provinces that still to have workshops on diabetes Guideline will be done later
depend on the availability of funds.
13
Non-Communicable Disease Unit, Disease Prevention and Control Division, MOH Report, 2003.
------------------------------------------------------------------------------------------------------------
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WORKSHOPS.
Even though the NCD program manager was committed with other activities like attending course
at the College, dealing with student research etc., several attempts were made to negotiate with
provincial training officers of those whom that are yet to have workshop on the Diabetes Guideline.
As I have stated earlier on, there was no polite respond from them.
However, because of no respond from them, the other alternative was to divert that money
allocated for workshop for supervisory tour to Isabel Province. Again, it was funded by Aus-Aid
Trust fund.
WORLD DIABETES DAY
Each year on the 14th of November, everywhere in the world commemorates the world Diabetes
Day. Moreover, every year world Diabetes Day has a unifying theme. Since 2001, emphasis has
been placed upon Diabetes complications. In 2001, we aimed to highlight the link between
cardiovascular disease and Diabetes, while in 2002 we focused on diabetes related eye
complications. This years Diabetes day theme is Diabetes and kidney disease, and our campaign
title is Diabetes could cost you your kidneys: Act now!
Marching from the NRH to the market was organized and various methods were used to
disseminate information with emphasis on the Public at the Market. Health talks were the main
activity conducted. A Week before that day, we were using SIBC for the dissemination of Diabetes
Information. Issuing of diabetes pamphlets and random blood screening were also done at the
market. More than five hundred people attending during the launching of the program and few new
cases were detected.
Diabetes Information were also disseminated to students doing science research project (SISC)
and to other groups who wanted know about Diabetes, therefore including me in their program to
give health talk like Mothers Union for instance
A diabetes song was also composed by one of the diabetes coordinators in the provinces. Not only
that, Isabel province confirmed to us of their participations in launching WDD at their province.
Activities done on that day were diabetes awareness health talks, free blood screening, playing the
diabetes SONG and so on.
PROVINCIAL TOUR:
This year 2003 I could only able to make supervisory tour to Isabel Province. The aim of the tour
was to assess the work of the provincial diabetes coordinator. Basically to look at the
implementation of program activities at provincial level especially with regards to diagnosing,
treatment strategies and more over to initiate an effective system of reporting so that we could be
able to get correct diabetes data from the province and to ensure reports must be handed in on
time for compilation.
For programs to work effectively and efficiently, supervisory tour must be done regularly to the
provinces.
Provincial tours by the provincial diabetes coordinator to the clinics should be done twice yearly but
a gainit wil
l depe ndv erymu cho nt hea va i
labi
li
tyo ffun d .Cu rre ntl
yt her
es houldn’
t bea n yexc us es
from the provinces because already there were funds allocated for each activity in the provinces.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Some provinces, Directors were willing to listen to or accept plans from coordinators and would
normally support them while others not regarded diabetes in their priority. After all diabetes was
emerging rapidly in our country.
The outcome result of the supervisory tour was, reports have sent in at the right time and provincial
data will be included in this report.
DIABETES SITUATION:
In fact Diabetes in the Solomon Islands is on the rise based on the information received from
National Diabetic Center alone. If we are to combine reports from the provinces, we could be able
to get a huge number of new confirmed diabetes cases detected each year. Unfortunately it does
not eventuate as provincial coordinators are confused of what to do. Therefore there is a need for
improvement through quality of care through: -
1. Improving data collecting system.
2. Training of staff at the hospital and Rural Health Clinics.
3. Training of provincial diabetes coordinators and so fort.
However, all this activities need money. Because of that our reports will focus more only from
National Diabetes Center source. Data from Isabel will also be included.
New confirm cases by age grouping (Annex i)
Chart 1 describes two different years, last year and this year. If we are to compare the graph, their
implication is almost the same. Most of the newly confirmed cases are between the age of 31 and
60. For year 2002 the mode was between the age 51 and 55 while in year 2003 the mode was
occurred between the age of 46 and 50, the same as year 2001, which had a mode between the
ages 46-50.
New confirm cases by age group (2003)

chart 1 Source Diabetes Centre
40
35
30
25
No o f Cases
20
15
10
------------------------------------------------------------------------------------------------------------
5
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Daily patient seen in diabetes center /Race. (Annex ii):
We cannot deny the fact that all the big islands in our country are occupied by mostly Melanesian
race. Not only that but within the capital city itself, Melanesian is also the dominating race.
Therefore looking at the data the monthly attendances record of daily patient seen in Diabetes
center clearly indicated the dominating race in the Country.
However, most of the people who use the center are those that living in and around Honiara, those
who have the money from the provinces and have access to transportation to Honiara.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Daily patients seen in diabetes centre by race (2003)

chart 2
source diabetes centre
400
350
300
250
no of p atients
200
150
100
50
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
mel 167 185 192 186 246 244 295 305 299 268 242 208
poly 7 12 7 12 19 23 16 20 16 21 11 9
micro 3 3 7 8 12 5 7 12 9 18 3 12
others 3 4 0 2 3 2 3 1 6 7 4 1
total 180 204 206 208 280 274 321 338 330 314 260 230
cases seen permonth/race
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
New confirm cases by races (1998-2003)

Chart 4 Source diabetes centre
180
160
140
120
100
no of cases
80
60
40
20
0
1998 1999 2000 2001 2002 2003
Mel 65 109 100 174 104 167
Poly 1 6 8 8 3 7
Micro 3 7 12 8 14 3
Others 0 5 4 7 2 3
races per year
New confirm cases by Gender (1998-2003) (Annex v):
The newly confirmed cases by Gender per year since 1999-2003, male gender was recorded
highest through out. There was an increase in the number of newly confirmed cases compared to
last year.
This does not mean that male gender is more prone to have diabetes than female. In actual fact,
there is an equal chance for both. The number of new cases detected depends very much on how
people understand the disease and their willingness to come forward for blood screening.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Chart 5 New confirmcases bygender per year (1998-2003)

source diabetes centre.
180
160
140
120
100
noof patients
80
60
40
20
0
1998 1999 2000 2001 2002 2003
Male 33 74 73 127 70 180
Female 36 53 51 70 63 90
years
Therefore because, more adult male educated than female, they understand and aware of the
symptoms of the disease. They are more conscious about their own health. Whenever they felt the
symptoms of the disease, they would go to hospital for checking. This may contribute to the result
why male gender was higher than female.
Mind you that there are still others out in the provinces that have diabetes but are not aware that
they have diabetes until they have some complications like foot ulcers, eye problems etc. before
going to hospital for check up.
Diabetic Patients on treatment (1997-2003) (Annex vi):
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
From year 1997 to 2003, the data indicating that majority of the patients having diabetes were
taking glybenclimide treatment. According to the Diabetes practical guideline, glibenclimide is a
drug of choice for non-obese patients. This does not mean that those taking glibenclimide
treatment are all non- obese. Some obese patients are taking the drug because sometime
metformin drugs runs out from pharmacy so no option but to take glibenclimide. However those
patients who were taking drugs like glibenclimide, metformin and insulin are also encouraged
controlling their diet, exercise and regular check to the diabetic center.There are also patients
taking two drugs at the same time, for instance glibenclimide and metformin together but not
included in this chart.
Diabetic patients on treatment byyears (1997-2003)

Chart 6 Source Diabetes Centre.
160
140
120
100
No o f cases
80
60
40
20
0
1997 1998 1999 2000 2001 2002 2003
diet alone 5 12 25 31 22 35 45
metformin 7 6 29 24 20 29 35
glibenclimide 83 41 59 51 135 60 71
insulin 3 4 7 10 16 8 21
Treatments per year
New confirm cases by provinces (2000-2003) (Annex vii):
According to records (statistics) from diabetes center from year 2000 to 2003, Malaita province
recorded the highest number of newly confirmed cases all through those years.
However, the records were based only to those accesses to Diabetes Center alone. This was so,
because there was no report sent in by provincial diabetes coordinator.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Year 2003, newly detected cases record according to Province of origin -:
Malaita Province = 98 Guadalcanal prov = 9
Western Prov =29 Isabel Prov = 10
Makira/ Ulawa Prov = 14 Temotu Prov =2
Renbel Prov. =0 Central Island Prov =1
Choiseul Prov =12
Chart 7 New con firm cases by pro vinces (2000-2003)

Sou rce Diabetes Centre
120
100
80
no o f patien ts
60
40
20
0
2000 2001 2002 2003
MP 98 106 59 98
GUAD AL 6 17 18 9
WP 37 28 17 29
YP 3 7 7 10
MUP 6 6 9 14
TP 2 6 4 2
RENBEL 5 7 1 0
CIP 4 4 3 1
CHP 8 12 10 12
years
In 2003, only Isabel Province had sent in their report on diabetes. They had a record of 51 new
cases detected. Out of which, 31 were female and 21 were male. To add with the record stated
above, they should be totaled up to 61 cases. A well job done by Province diabetes coordinator
from Isabel.
Recommendations:
 Conducting training for Health workers on the practical guideline on Diabetes for the
Provinces must be carried out.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
 In order for programs to be effectively and efficiently implemented funds must available for
diabetes activities.
 Supervisory tour to the Provinces should be an on-going planned activity for program
managers in order to assess and assist Provincial coordinators to improve their daily
running of the programs.
 There is a need of further training for both national and provincial coordinators on job
specialization, especially diabetes management because in our country nowadays,
diabetes has becoming a major problem. Not only that looking after Diabetic patient is very
expensive for family members, community and also for the Government.
ACKNOWLEDGEMENT.
The National Non Communicable Disease coordinator wishes to acknowledge all provincial
coordinators for their effort and commitment to work. More especially for Sister Neverlyn Laesango
and Hilda for doing most of the curative and educational aspects about diabetes and also for
managing the National Diabetes Centre.
I would also like to extend my acknowledgement to Aus-Aid and WHO for providing financial
assistance for most of the program activities last year.
Lastly, extending acknowledge for my working colleagues and anyone whom I forgot to mention,
for whatever assistance provided toward my program.
4.5.2. Tobacco and its Impact and the control measures in Solomon Islands:
4.5.2.1. Tobacco a Health Burden in Solomon Islands:
Evidence is beginning to reveal how much Tobacco is damaging the health and social aspects of
the lives of the people of Solomon Islands. Little is known on the local context in the past. The
people have little and no knowledge at all of the negative impacts of tobacco on their socio-
economic and physical and mental health. There has been no research on tobacco prevalence in
Solomon Islands until recently.
The bad behavior of smoking is spreading widely in all age groups, ethnicity and within the
employment sectors. It is often a disease common among lowly educated and those with out any
form of employment. However, it is devastating to learn that in Solomon Islands significant percent
of employed workers smoke14. A study done found (with a private broad casting firm), 56.5% of the
staff interviewed smoke. Other related studies also found that 44% of government workers
smoke15, whilst 40% of outpatient attendants were found to be active smokers. In the 993
Nutritional Survey it was found that 25% of the female population smoke.
14
MOH (2002). Health Assessment Report: National SIBC, Honiara, Volume 1, Issue 2, January:
Unpublished Paper.
15
MOH. Unpublished paper.
------------------------------------------------------------------------------------------------------------
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A historical study was done recently16and found that 60.3% of patients smoking suffered from
respiratory diseases and admitted to the National Referral Hospital in Honiara between 1999 and
2003. Older people smoked (age group 50-65) followed by the productive age group of 21-49
years. Within the cohort of those admitted, 45.1% of teens or youths age group of 12-20 years old
smoked as compared to their non-smoking counter parts (54.9%). More male smokers (59.9%)
than female smokers (49.1%) were found.
Therefore the prevalence rate of smoking for Solomon Islands is about 40-60%. Solomon Islands
like other developing countries have a high prevalence rate of smoking.
Countries (WPR) Prevalence Rates Year

Table showing Fiji 30% (urban), 46% (rural).
prevalence rates for Guam 34.3% 2003
selected countries of Marshall Islands 9% (male students)
the WHO/WPR17 PNG 30% (All), 17.6% male, 8.5%
female
Vanuatu Youth 12-18 Male 58.2% and
Female 17.7%.
In Adults Male 49%, female
15%
Vietnam Adults: Male 56.1%, Female 2002
1.8%
Solomon Islands [1] Nutritional Survey-female [1] 1993
25%. [2] 2004
[2] NRH Study, Male 59.9%,
Female 49.1%
4.5.2.2. Tobacco causing Morbidity and Mortality:
Tobacco causing diseases and death is overwhelmingly proven and widely documented.
Local evidence showed that smoking primary causing factors for respiratory diseases and other
related systemic health conditions18 such as hypertension and CVA. The National Referral Hospital
study found that more smokers suffer from pneumonia (68.8% in smokers, 31.3% in non-smokers
admitted for respiratory diseases), chronic pulmonary diseases (55.8% in smokers, 44.2% in non-
16
Malefoasi G., Wale P., & J.Denty (2004). Smoking and Respiratory Diseases in Solomon Islands: 1999-
2003, Unpublished Paper, MOH, Honiara.
17
Country Reports of the Third Meeting for National Focal Points for Tobacco Free Initiative Meeting
Manila, 3-5th March 2004: Presentations.
18
(see foot note 8)
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
smokers), and cancer of lung (96.6% in smoker, 3.4% in non-smokers). The striking finding is that
the number of cancer of the lung due to smoking has been increasing. In the period from 1999 to
2003 a total of 28 cases of cancer of the lung was diagnosed and admitted to the NRH in Honiara.
Of the 28 cases, 96.6% were chronic smokers.
About seven percent (6.7%) of smokers died, whilst the same percent (6.7%) of smokers admitted
with respiratory diseases discharged at the terminal stage (they too die at home).
4.5.2.3. Proven Facts and Evidences:
Passive Smoke Worse in Workplace Than in Home. Passive smokers have twice the risk of
having cancer. Although people who lived with a smoker had almost twice the risk of lung cancer
as those without a puffing partner, the risk of lung cancer increased almost threefold for people
who worked with smokers compared with those who worked in a smoke-free environment (By
Alison McCook in the International Journal of Cancer 2002;100:706-713, August 30,2002.
Smoking on the increase in many commonwealth developing countries including the Pacific Island
Countries, while it decreases in the developed countries (By P Krishman and Magaret Mungherera,
Commonwealth Medical Association et al.).
4000 toxic chemicals at 40 of these are known causes of cancer.
Major causes of death –lung Cancer, Ischaemic Heart Diseases, Chronic Bronchitis, and
Emphysema.
Other Health Problems –stroke, Peptic Ulcers, Respiratory Disorders, Cataract, Osteoporosis,
Reproductive Disorders, Asthma exacerbation.; Physically unfit; Facial wrinkling; Gum diseases
and bad breath.
Smoking increases with little education and low incomes (Steven A. Schroeder MD).
Smoking common in young people between ages 18-24 years.
Mental illnesses and smoking closely linked.
There is coexisting psychiatric or substance-abuse disorders account for 44 % smoking cigarettes.
4.5.2.4. Tobacco causing increasing health expenditure:
Whilst research is yet to be done locally to establish that tobacco causing huge health expenditure,
overwhelming evidence elsewhere show that the expenditure on tobacco consumption is huge and
far more than the revenue it produce for governments and tobacco companies. Poor families suffer
from a smoker within that household as limited funds are spent on tobacco than essential basic
needs such as food.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
4.5.2.5. Tobacco Production Situation in Solomon Islands:
Overview of Tobacco Products:
Solomon Islands Tobacco Company (SITCO) is the only domestic manufacturer of tobacco
products in Solomon Islands.
Unable to get the total domestically produced tobacco, but in 1996, SITC produced domestic
tobacco products equivalent of SI$12.1 million.
Tobacco products are produced domestically in the form of roll-your-own, pipe, loose as well as
manufactured cigarettes.
It is sold by SITCO and retailers, including market venders
These products are sold in both packets as well as in loose forms.
Imported tobacco products are mainly in the form of cigarettes and cured tobacco leafs.
SITCO mostly imports tobacco products from Australia and main suppliers are WD&HO Wills,
Philip Morris, and Rothmans.
Philip Morris also ship directly to its agent in Solomon Islands from Australia, while Rothmans sells
to a number of individual traders and importers
Unable to obtain total volume of tobacco product imports, however in 1996, it accounts for a total
value equivalent to SI$3.9 million.
There is no present consumption of smokeless tobacco.
Main importing companies are SITCO, Y Sato, ABA Corporation, George Wu and Co, QQQ
Wholesale, Leon Gin and Co, Chang Wing, and Victory.
Tar levels of imported cigarettes is 16 mg. Unable to verify tar levels of domestically produced
cigarettes.
Overview of Advertising:
The tobacco products are advertised through print media, radio, bill boards, cinemas, inside and
outside retail outlets.
Print media –mainly the Solomon Star (twice weekly)
Radio –SIBC, Paoa FM on regular basis
Bill boards –SITCO building and sporting fields
Retail outlets –All retail outlets for tobacco products
Most of the advertisements are on cigarettes, few on roll-your-own packets (spear, emu, etc.)
Currently there are no restrictions at all on all forms of advertisement.
Language and Literacy Skills
Less than 25% of the SI population can read and write English. About 17% of the female
population are literate
More than 75% of population can speak pijin. Pijin is not used commonly in writing.
English is used for print media: News papers and Magazines
4.7.4.3.Overview of Print Media:
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
SI has its own daily news paper (Solomon Star) and weekly paper (Solomon Voice). The only SI
magazine that I am aware of is the Solomon Airlines quarterly in-flight magazine.
Most of the imported magazines are imported from Australia, namely news week, Womens weekly,
new ideas, Sports. There are no tobacco advertisement. All magazines are written in English. No
special editions of these magazines are produced for Solomon Islands.
4.5.2.6.Tobacco Sponsorship in Solomon Islands:
Sponsorship by Tobacco companies include Sporting and Cultural events, mainly by the local
Tobacco Company (SITCO).
Events: Solomon Cup soccer tournament, National Trade and Cultural show.
Net ball league in Honiara, the tobacco company sponsorship covers a 10 year period. Unable to
obtain contract content.
The r
ea r ep l
as t
icb ags( win f
iel
d ,dun hi
ll
,etc
)a nd“ T”sh i
rt
swh ichc a r
ryto baccot radema rksi n
Solomon Islands.
4.5.2.7. Contact with Relevant Industries in SI:
There are importers and the SITCO fully aware of the bill. They are intensifying their
advertisement. The SITCO has a copy of the recent approved Tobacco Control Bill.
There are no feed back from them on this.
Importers of the Magazines know about the bill.
4.5.2.8. Issues Raised by the Bill:
Retail outlets also sell tobacco outside such as the markets, stalls and on the street. Advertisement
in terms of price list would be sufficient.
No tobacco products sold through vending machines.
Yes, both sections 9&10 of the bill can be amalgamated.
Th ewo r
d“ Kn owin g ly”shou l
db ed e l
ete d.
Please do provide for regulation making power for inserts in cigarettes packets.
Currently there is no local laboratory in SI for analyzing tobacco products. This has to be done
overseas with ISO methods.
4.5.2.9. Health Warnings:
Information: Tar, Nicotine, CO (these are the ones that reported on the packets). Warnings
inc l
ude:“ Smo kingCa use sFa t
alDi seases”( Winfi
eld)
,“ Qu itt
ingSmo kingn owg rea t
lyred uces
serious risks to your health”(Pe t
erJa cks
o n)
. Nos eparatep ri
n t
sa red onef orcigar
ettesi mportsto
SI.
Only English is used for health warnings

Warning in Pijin:“
SIMOK BAE KI LIMI U”,“ SIMOK HEMICOSI ML UNG KENSA”
,“TAEM I
U
BABUL EANDSI MOKE, BAEI USPOI LEMPI KININI”
Both graphical and pinjin information on the packaging may be used.
“
He althAu tho ri
tyWa rning ”a t
tr
ibutio
n
------------------------------------------------------------------------------------------------------------
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Color of warning: Black on white
The same messages for cigarettes should be used on other classes of tobacco products
Toxic constituents be stated for narrower class only
ISO standards measurement of constituents for only manufactured cigarettes.
Peter Jackson is using ISO methods, Winfield is using Government approved method (?which one)
Returns:
It would be sufficient for time being, the returns in weight of additives by products.
4.5.2.10. Transitional Provisions:
The options should be similar to Fiji, where they give ample time for full awareness and this takes
them 12 months. This means if the bill is passed in May 2000, it will come into effect from May
2001. Other areas that require a lot of adjustment may require appropriate transitional period.
Domestically produced tobacco will take may be 10 months to put in health warnings.
Advertisement at retail outlets, I agree with your suggestion.
Immediate ban on non-tobacco product branding is feasible.
I suggest first annual returns to be in by 31 May 2002.
Sponsorship: This an area that requires a lot of government support as well putting a place other
funding sources, example non-tobacco companies sponsoring sports or cultural events.
I suggest that all regulations must be in place before the bill is made law. Now that we have a new
Minister of Health, a medical doctor by profession, this an opportunity to get the bill through with
the regulations. Future introduction of part of regulations may not be feasible as we have been
struggling with bill for the last 8-10 years already.
4.5.2.11. Existing Health Policies and Legislation on Tobacco-SWOT Analysis
It is evident that there has been a transition of the disease pattern in Solomon Islands like other
developing countries from predominantly communicable infectious diseases to non-communicable
disease. According to the death registry at the Medical Statistics Unit Ministry of Health [], the trend
of the ten leading causes of death has changed. In the early 1990s malaria and pneumonia were
leading causes of death. However in the late 90s, CVA and cancer has taken over as the leading
causes of death. The health sector is response to the problem initiated and established related
policies such as the National Diabetic Management Guidelines, the National Diabetic Clinic and
other health education programs. These programs run into difficult financial constraints that impede
their functions.
The Ministry of Health in the past five years has developed a draft Tobacco Legislation,
which is yet to be tabled in the parliament. The delay of the proposed Tobacco Bill is an issue the
health sector is attempting to address. Dialogue with key stakeholders such, as the
parliamentarians are the key limiting factors observed. Solomon Islands among all the WHO
members states have signed the Frame Work Convention Tobacco Control but yet to rectify this
declaration.
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
The capacity building in research has been emphasized in the future directions for the
health sector 2004-5.
Ongoing health education and promotion has been part of the priority health programs funded in
the past years. However how effective are these programs is a big question to answer.
4.5.2.12. The National Tobacco Control Policy.
In 2002 a draft National Tobacco Control Policy was developed. It was presented and endorsed in
the 2002 National Health Conference, when the draft was discussed by all the senior health
officers including the NGOs health providers.
[1]1 Objectives of National Tobacco Product Control Policy:
(a) To protect the health of the people in view of conclusive evidence implicating exposure to
tobacco smoke in the development of numerous debilitating and fatal diseases;
(b) To encourage non-smokers, particularly young people and others, not to start smoking and
protect them from persuasion and/or inducements to use tobacco products and consequent
dependence on them;
(c) To enhance public awareness of the hazards of tobacco use by ensuring the effective
communication of accurate and relevant information to consumers of tobacco products;
(d) To protect people to the extent deemed reasonable and possible from the hazards of
involuntary exposure to tobacco smoke; and
(e) To encourage and assist smokers to give up smoking, to promote good health and the
prevention of illness.
[2] Policy Focus Areas
Sale and Promotion of Tobacco Products
Licensing of Tobacco Products Wholesalers
Constituents of Tobacco Products
Environmental Tobacco Smoke (ETS)
Involvement of Stakeholders
[3] The Policy
Sale and Promotion of Tobacco Products
Issue:
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Effective tobacco advertising and promotion is aimed to: (a) make smoking socially acceptable; (b)
influence smokers to smoke more; (c) influence non-smokers to start smoking and (d) discourage
smokers from giving up.
Policy
Public promotion and advertisement of tobacco products in Solomon Islands will be banned.
[4] Licensing of Tobacco Product Wholesalers:
Issue:
There is inadequate control of tobacco manufacturing, retailing and sales in Solomon Islands,
which promotes easily accessibility of the population to Tobacco products, even the young
children. The control on types of the products including its constituents does not exist. Importers of
the tobacco products also offered import duty concession, which leads to cheaper prices thus
increase affordability.
Policy:
Wholesale imported and outlets of tobacco products in Solomon Islands will be monitored through
licensing procedures and appropriate price control measures.
Constituents of Tobacco Products:
Issue:
Within seconds after tobacco smoke is inhaled, some 4,000 byproducts are being absorbed into
t
heb l
o odstr
eama ndt rans
p or
tedtoev eryc ellofthesmo ker’
sb ody.
Policy:
Labeling of all tobacco products must be identify true content of Tar, Nicotine and Carbon
Monoxide, including appropriate clear health messages.
Environmental Tobacco Smoke (ETS):
Issue:
During one hour in a smoke-filled room, a non-smoker may inhale nitrosamines in quantities
equivalent to smoking 15 filtered cigarettes. Nicotine, carbon dioxide and ammonia are also found
in higher concentrations in side stream smoke.
Policy:
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
All public transport, buildings and amenities must be smoke free with certain areas designated for
smoking.
Involvement of Stakeholders:
Issue:
Addressing tobacco related health problems requires support from other various organizations with
government, NGOs and private sectors. Activities have to be coordinated from all fronts including
legislation, educations, finances and consumers themselves.
Policy:
A multi-sectoral body will be formed to coordinate various strategies and activities in promoting
healthy life styles and combating the promotion of tobacco.
The effectivity of Tobacco Control Policy:
How effective are these policies developed recently? The answer at this moment is little or none at
all. This is due the following reasons:-
There are no restrictions to tobacco consumption. The proposed legislation is yet to be passed at
the parliament level. It has passed through the Cabinet level.
There is very little information on tobacco and its impact on health in the country.
The anti-tobacco campaigns are weak and not happening due to lack of drive from responsible
health authorities, even though the health directions are clear [].
Lack of appropriate knowledge and mechanism to monitor and evaluate the program. The recent
development of the Essential Public Health Functions (EPHF) [] is a appropriate and opportunity to
help evaluate the programs effectivity.
To ba ccoi sd ee p lyr oo t
e dint hep eopl
e ’sl ifea ndc u l
ture.Ad i
ff
e renttaskt od
e -root the practice and
norm that tobacco is part and puzzle of living in this developing country. Changing and reforming a
culture is very difficult challenge even it is evident that changes do occur.
4.5.2.13. History of the fight against Tobacco in SI:
Tremendous efforts had been made by the Ministry of Health and other key stakeholders such as
t
h eL egalDr aft
sma na ttheAt t
orn eyGe neral’
sCh amb er
sinto developing and drafting of the
proposed Tobacco Control Bill.
There had been wide consultations including a radio talk-back show in 2003.
Some of the events are listed below:-
 Minister of Health request AG Chambers to commence the legal drafting of the bill:
/December 1996.
 Min i
s tero fHe a l
tha skedfo rf
l
exi
bi
li
t
yon“ t
oor est
ri
ct
iv
e”c l
ause sint hep rocesso fl
eg a l
drafting on 19th March 1997.
------------------------------------------------------------------------------------------------------------
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 Undersecretary Health request AG Chambers for legal review of new clauses before
submitting to Cabinet for another approval on 28th March 2000.
 Approved the revised bill in September 2000.
 On the 15th December 2000 the Undersecretary Health follow up letter on matters raised in
the 28 March 2000 letter
 Legal draftsman responded to US/Health and admits that work on the bill not progressing
due to a lot of other pressing legal matters on the 17th December 2000.
 First draft Tobacco Control Regulation Bill 2000 ready in April 2000.
 Undersecretary Health Improvement (National Focal Point for Tobacco Control, SI
attended the Second Meeting on the National Focal Person for Tobacco-Free Initiative in
Western Pacific Region on the 23-25th August 2000 in Manila.
 US/Health pursuing the legal drafting to be done by A&H Lawyers in the light of the heavy
work commitment at AG Chambers on the 28th March 2001.
 A&H Lawyers obtained the Bill from Legal Draftsman on the 27th June 2001.
 A&H Lawyers in consultation with the Ministry of Health redrafted the bill in 2001.
 Minister of Health, Hon. Benjamin P Una joined all other commonwealth Ministers agreed
to pass the verdict on WHO first international treaty to protect public health, the
FrameWork Convention for Tobacco. Solomon Islands joined all other member states to
endorse the FCTC in May 2002 during the 55th World Health Assembly in Geneva.
 Health Seminar for Ministers and Permanent Secretaries on the 1st October 2002 :National
Tobacco Product Control Policy.
 National Health Conference 11-13th November 2002: National Tobacco Product Control
Policy. Resolution: National Tobacco Control Policy endorsed.
 Radio Talk back on Tobacco related issues in 2003.
 At t
o r
n eyGe ne
ral Chamb er’sreque st
edb yMOHt or evi
ewt hed raftTob accoCon t
ro lBil
lin-
light of the FCTC in February 2004.
 Cabinet Paper was submitted to Cabinet for endorsement to ratify the FCTC in February
2004.
 A Rapid Research into Smoking and Respiratory and other related diseases was design
and undertook 2-6th February 2004.
(Cabinet endorses the FCTC in April 2004 after it being deferred twice. Thus, Solomon Islands is
ready to ratify the FCTC.)
4.5.2.14. Future Directions for Tobacco Control in Solomon Islands:
Below are measures to be implemented by the Ministry of Health and its development partners,
international and locally. These are measures to actually engineer and implement the strategies in
the National Tobacco Control Policy.
4.5.2.14. 1: Immediate Measures;
1. Rapid Research on Smoking and Respiratory Disease in Solomon Islands.
2. Rapid Research/ Smoking prevalence survey in Households in Honiara.
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3. Design meetings for parliamentarians and NGOs to involve them in tobacco control.
4. Review the draft Tobacco Legislation in-light of the Framework Convention for Tobacco Control.
And ratify the FCTC.
5. Table the proposed Tobacco Control Legislation in the forthcoming parliament sittings.
6.Ev al
u at
et h eMi
ni
st
ryo
fHe
alt
h’
sro
leo
fth
eTo
bac
coCo
ntr
olu
sin
gth
eEs
sen
ti
alPu
bli
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alt
h
Function Tool.
7. Develop feasible and appropriate Tobacco Control Programs/ activities to implement the policy.
4.5.2.14. 2. Medium Measures:
1. Tobacco companies to be held publicly, accountable at the national level through legislation,
litigation and other means.
2. Development of mechanism or institution to monitor and enforce implementation of tobacco

control laws and regulations.
3. Increase taxation on locally produced and imported tobacco.
4.5.2.14. 3. Long Term Measures:
1. Revise the Financial Instruction to allow revenue from tobacco control measures such as
taxation to be used for further Tobacco Control and Health Promotion.
2. Restrict all public transport, buildings and amenities to be smoke free with certain areas
designated for smoking though legislation.
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4.6.0. Tuberculosis:
4.6.1. Overview:
Tuberculosis and Leprosy Control Programs still remain as one of the main public health problems
in the country19. It is for this reason that the Ministry of Health through the National TB/Leprosy
Co nt
r ol
Prog r
a mc on t
inu edt op utt
hema so neof i
t’sp ri
o ri
t
yh e al
thc ontr
o lprogr
amsa nd has put a
lot of emphasis to try to achieve our global targets set by WHO both at the National and in the
Provinces. With a lot of assistance from our donor agencies like the WHO, Ausaid, ROC, Pacific
Leprosy Foundation and now the Global Funds, the National TB and Leprosy Control Program
continued to maintain the TB and Leprosy surveillance system both at the national and provincial
level.
In 2002, the National TB Control Program has not been able to produce an annual report due to
some unforeseen circumstances beyond our control. There was a sudden change in the NTP
management especially at the national level. As a consequence, some of the activities and
functions performed by the National TB and Leprosy Coordinator were jeopardized. In spite of this,
corrective strategies were taken by the ministry to ensure that the program continued to function.
In year 2003, despite having gone through those difficult and challenging times, the National TB
and Leprosy Control Program had put a lot of efforts in try ingtop utth ep r
ogra mo ni t
’sr ightfooting
on where it was before. In the absence of the National TB and Leprosy Coordinator for about eight
months, the Provincial Coordinators continued to execute their planned activities in their respective
provinces despite the many financial difficulties the country had gone through.
Besides keeping track of new patients, a computer print out of active TB patients currently on
treatment was sent to the provincial TB and Leprosy Coordinators to up date on the status of
patients under treatment with Short Course Chemotherapy (SCC) using DOTS strategy and also
for patients on Multi-drug Therapy (MDT). The respond from the Provincial Coordinators was quiet
good while some were still wondering as to whom was the new national program manager. A
cohort analysis for 2002 was done with regards to treatment outcome using the standard indicators
4.6.2. Objectives:
To improve cure rate

To reduce mortality rate
4.6.3. Indicators:
Cure Rate
Mortality Rate
Treatment Completion Rate
19
Report by the Disease Prevention and Control Unit (2004): Annual Report 2003
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4.6.4 Output-Achievements & Constraints:
4.6.4.1. Outputs (or Deliverables):
4.6.4.1.A: New TB Case Notification.
The TB Control Program has some important key strategies for controlling tuberculosis. The Direct
Observed Therapy Short course (DOTS) is the basic strategy to stop TB and it has five key
components in the overall strategic framework to control TB. Such strategic framework is a guide
and should not be overlooked by program managers at all levels. The key strategy is DOTS and
used to control TB as a public health problem, not only that but there are beneficiaries such as
curing of the illness, prevention of drug resistance, death and reducing the incidence of the TB in
the communities.
New TB Case Notification Rates 1990 - 2003
150
TBNR 1 per 100,000
100
50
0 90 91 92 93 94 95 96 97 98 99 0 1 2 3
All Cases 117 91 107 104 70 94 80 77 64 64 75 70 62 64
Smear (+) 37 27 39 44 31 30 28 26 40 21 27 29 26 33
Figure 1.
Figure 1 above showed the result of case finding as well as providing a trend of new case
notification rates for All cases and Sputum Smear positive cases since 1990 up until recently. As
clearly shown on the graph, the overall trend of TB case notification is declining. The case
notification rate for all cases declined from 117 per 100,000 population in 1990 to 64 per 100,000
population in 2003 while the case notification rate for Sputum smear positive cases ranges from 37
per 100,000 population to 33 per 100,000 population for the same period.
In 2003, there are 268 cases notified to the Central Registry. This includes relapse cases and new
cases of TB. Of the total (268), 136 are classified as sputum positives, which represents 51% of all
cases notified. As indicated in Figure 1 there is a slight increase in the smear positive rate although
not exceptionally high compared to the past years. It is important that strategies to reduce TB
incidence in the communities are undertaken with concerted efforts by all health workers. Thus it is
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very important that thorough active case finding and contact tracing be continuously carried out
among the contacts of sputum positive patients along with aggressive community health
awareness in foci areas in a given locality.
4.6.4.1.B: New TB Case Notification by Provinces.
The number of cases reported to the Central Registry by provinces varies. Some provinces have
more cases notified than others, but the notification rates as illustrated in Figure 2 below showed
that TB is still prevalent even in some smaller provinces like Isabel and Temotu Provinces. The
rate of TB against their total population is quiet high compared to bigger provinces like Malaita,
Western and Guadalcanal Provinces. This means that a lot of work are yet to done by all Provincial
Coordinators to try and reduce the TB burden in the provinces and communities.
TB Notification Rate -All cases by Provinces 2003
YP 126
TP 99
MP 76
HTC 70
SI 65
MUP 64
GP 48
WP 44
RBP 42
CIP 41
CHP 40
0 20 40 60 80 100 120 140
Figure 2.
4.6.4.1.C: TB Case-holding and Treatment Outcome.
In order for the NTP to monitor and assess the progress of DOTS strategy, it has to have some set
targets and see if these target have been achieved in a given time frame or not. Targets for
controlling TB as mentioned in Box 1 are very important and should be the main indicators for
monitoring the success of the TB Control Program (NTP) both at the provincial and national
annually. These targets have been documented in the National Tuberculosis Control Program
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Manual and also advocated by the WHO/WPRO Stop TB initiative for the period 2000 –2005 as
main indicators to monitor TB control activities with regards to achieve global targets and program
objectives
Box 1. Targets for DOTS implementation.

 To ensure that 100% of detected new smear positive cases are enrolled
under DOTS
 To cure more than 85% of smear-positive pulmonary cases under
DOTS
 To detect 70% of estimated new smear-positive cases. (Pacific Strategic
Plan to Stop TB 2000) WHO
In comparison to the above targets set by WHO to what the NTP had achieved with regards to
case holding and treatment outcome, it has always been the Policy that all TB patients regardless
of their category be hospitalized for 2-3 months on intensive treatment before they are discharged
to continue their treatment for 6-8 months at their nearest health facility. This has facilitated and
strengthened the TB Control Program with regards to applying DOTS. Currently, DOTS coverage
is 100% nationwide. This strategy is already having an impact in rendering a high sputum
conversion after 2 & 3 months of the initial treatment phase. Our previous records showed that
more than 85% conversion rate was achieved after 2 months of intensive treatment and more than
90% after 3 months.
4.6.4.1.D: National Cure and Success Rates:
Cure and Treatment Success Rate 1996 - 2002
100
90
80
70
Percentage (%)
60
50
40
30
20
10
0
96 97 98 99 0 1 2
Cure Rate 30.8 74.3 83.3 78.4 68.4 68.4 71.3
Treatment Success Rate 87.5 92.4 92 86.3 92.1 92.1 92.6
Figure 3.
Figure 3 above illustrated the results of Cure and Treatment Success Rates for the period from
1996 to 2002. It showed that the Treatment success Rate (TSR) has been steadily high around
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90% while the Cure Rate had increased in the first 3 years of implementation and later declined
due to the interruption of the program by social-unrest which started in 1999 as well as other
factors such as poor case follow up and failure to collect follow up sputum.
However, in 2002 it started to pick momentum again by attaining 71.3%. These results showed
that dual strategy has to be taken, where it possible sputum should be collected from all sputum
smear-positive patients for monitoring of cure rates. This calls for a concerted effort on the part of
health workers in rural areas to improve DOTS strategy in every where possible. Provincial Cohort
analysis for sputum smear positive for year 2002 is shown in Table 1 below.
Table 1. Provincial Cohort Analysis for smear positive cases for Year –2002.
Prov Cure Complete Transfer Died Default/Lost Total
No % No % No % No % No % No %
CHP 5 100% 0 0 0 0 0 0 0 0 5 100%

TSR 5 (100%)
CIP 2 100% 0 0 0 0 0 0 0 0 2 100
TSR 2 (100%)
GP 6 75% 2 25% 0 0 0 0 0 0 8 100%
TSR 8 (100%)
HTC 1 8.3% 10 83.3% 0 0 0 0 1 8.3% 12 100%
TSR 11 (91.6%)
MUP 8 100% 0 0 0 0 0 0 0 0 8 100%
TSR 8 (100%)
MP 45 84.9% 3 5.7% 1 1.8% 4 7.5% 0 0 53 100%
TSR 48 (90.6%)
TP 0 0 0 0 0 0 0 0 0 0 0 0
TSR 0 (0)
WP 9 47.3% 8 42.1% 2 10.5% 0 0 0 0 19 100%
TSR 17 (89.4%)
YP 1 100% 0 0 0 0 0 0 0 0 1 100%
TSR 1 (100%)
RBP 0 0 0 0 0 0 0 0 0 0 0 0
TSR 0 (0)
Solomon 77 71.3% 23 21.3% 3 2.7% 4 3.7% 1 0.9% 108 100%
Islands
TSR 100 ( 92.6%)
With the results shown on the table above, it is pleasing to note that four out of ten provinces had
continued to achieve 100% in their cure rates while Malaita Province for the first time able to
achieve at least 85%. Western Province did have problem with their laboratory facility which did not
allow them to check sputum. Arrangements have been made for the specimen to be sent to Helena
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Goldie Hospital laboratory for checking. Temotu and Rennel & Bellona Provinces somehow did not
register any patient cured at the end of the year.
Table 2. Cohort Analysis for Extra-Pulmonary and Sputum Negatives –2002.
Province Completed Transferred Died Default/ Lost Total
No % No % No % No % No %
CHP 5 100% 0 0 0 0 0 0 5 100%

CIP 4 100% 0 0 0 0 0 0 4 100%
GP 15 100% 0 0 0 0 0 0 15 100%
HTC 15 68.2% 2 9% 0 0 5 22.7% 22 100%
MUP 17 94.4% 0 0 1 5.5% 0 0 18 100%
MP 51 87.9% 1 1.7% 4 6.8% 2 3.4% 58 100%
TP 2 100% 0 0 0 0 0 0 2 100%
WP 17 94.4% 0 0 1 5.5% 0 0 18 100%
YP 3 100% 0 0 0 0 0 0 3 100%
RBP 1 100% 0 0 0 0 0 0 1 100%
Solomon 130 89% 3 2.1% 6 4.1% 7 4.8% 146 100%
Islands
Cohort analysis for sputum negative and extra-pulmonary TB for the year 2002 as illustrated above
were quiet satisfactory with 89% of the total cases registered had completed their treatment, and
less than 4% of patients died whist on treatment for both categories of patients (smear (+) and
negative and extra-pulmonary cases). This is a good sign for the program with regards to patients
compliance
4.6.4.1.E: Capacity building –in country workshops and overseas training:
In 2003, a TB external review and workshop was conducted for the Provincial TB and Leprosy
Coordinators. The review of the program was conducted by three Short Term Consultants from
WHO/ WPRO in Manila with funding assistance for the workshop was also from WHO. This review
workshop was very important in that it gave us a clear picture of where we are now and also it was
the first time for the new National TB Coordinator to organize such an event and had given him the
opportunity to explore and discussed issues that are paramount importance to the success of the
program. A separate report on findings and recommendation compiled by the consultants had
already been submitted to the Ministry for action.
This type of activity should be an annual event and has contributed a lot to the progress of the
program especially to strengthen the program at different levels of integration within the health care
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system and also provided an opportunity for provincial Coordinators to come together and discuss
the results of their program and make resolutions for improvement.
Capacity building in terms of training is an on-going program organized by Ministry. In 2003,

although no refresher training for health workers on TB was conducted in the country, we did have
one specialized training in TB for the new National TB Coordinator in RIT/ Japan for 3 months. This
training was sponsored by JICA and hopefully one of the provincial TB Coordinators will be sent
next year. Such training has improved the work performance of the provincial TB managers who
have already attended and have shown much improvement in their case-holding activities.
4.6.4.1.F: TB Public Campaigns and Promotions:
TB awareness to public is one of the very important aspects in trying to control the spread of TB in
the communities. Last year, although we did very little in our health awareness program, we did
manage to organize some activities during the World TB Day which falls the on 24th of March
ev er
yy ear.Th et h emef or2 003Wo rldTBDa ywa s‘DOTSc uredme ,itwi l
lc urey outo o”wa s
highlighted during the day after the official launching by the Permanent Secretary of Health at the
SIBC and then followed by health education talks in most Honiara Town Council clinics and some
primary schools
4.6.4.2. Issues/Constraints:
4.6.4.2 A: Drug Supply
Last year was a terrible year for the NTP with regards to drug supply and logistics. There was
shortage of some anti-TB drug experienced throughout the country especially Rifampici and
Isoniazid. This is the first time the country have gone through this problem due to the problem of
finances. The drug shortage resulted with some patients had to be treated with only two drugs.
Although the problem has been rectified from the immediate help from WHO, the issue of drug
calculation and ordering should be dealt with seriously with the Medical Stores to avoid the incident
happen again.
4.6.4.2.B: Recording and Reporting System
Recording and reporting system of TB patients is still a concern especially from provinces to the
national level. Currently only about 80% of the reports received just in time and another 20%
received very late or no report at all. A lot of training has been conducted to try and address this
problem but little improvement noted. We need to develop some sort of system that would solve
this problem in the future.
4.6.4.2: C: Inadequate Facility/ Equipment:
While it has been noted with some concern that some remote provinces and even with bigger
provinces, lack of proper facility for TB investigation and transport difficulties are the main
obstacles faced by program officers resulting in having low or even no cure had been registered.
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Unless some diagnostic centers are established to facilitate AFB testing at Area Health Centers
level, the problem of having low cure rates or not registering any smear positive cases will continue
to exist in these provinces.
4.7.0. Leprosy:
4.7.1. Objectives:
To reduce the prevalence rate of leprosy from 0.6/10,000 pop in 1998 to less than 0.3/10,000 pop
by 2003.
4.7.3. Indicators:
Prevalence Rate of Leprosy
4.7.3.1. Outputs (or Delivrables):
4.7.3.1.A: New Leprosy Case Notification.
The number of new Leprosy case notified in the year 2003 was very low compared to the number
of cases notified and registered in the previous years. Only 5 new leprosy cases were detected and
registered compared to 28 new cases in 2002. This is due to insufficient funds secured from Pacific
Leprosy Foundation to do elimination campaigns in high foci areas. Most of the cases notified were
from Guadalcanal, Honiara City Council and Malaita provinces. As illustrated in Figure 4 below, the
trend of leprosy case notification since 1996 was declining except for 2002 when it showed a slight
increase.
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New Leprosy case Notification from 1996 - 2003
30
25
20
Number
15
10
0
96 97 98 99 0 1 2 3
New Leprosy Cases 24 21 14 12 9 7 28 5
Figure 4.
With the decreasing trend of cases notified each year, program officers and nurses in rural areas
where the prevalence of leprosy in the past was high are again reminded to actively carry out
Leprosy Elimination Campaign (LEC) activities in their areas and provinces. The continuous
implementation of LEC strategy is important to ensure that Elimination Target set by WHO is
achieved and maintained at low level. It is therefore crucial that basic knowledge of leprosy is
continuously taught in the Nursing School or even during refresher trainings to maintain a high
level of index among health workers.
In leprosy control Program, there are certain operational indicators for case finding which are used
to monitor the progress and success of the program. These indicators as stated in Box 2 below
reflects the impact of case finding and progress of MDT with regards to patients compliance. In
2003, although we did not register any case of leprosy among children under 14 years and those
having deformities it is very crucial that active case finding along with LEC must be initiated and
sustained to suppress leprosy prevalence rate.
Box 2. Operational indicators for case finding in Leprosy Control.
Operational indicators for case finding that reflects the impacts of case
finding strategies are:
 Number of children less than 14 years infected. –an indication
for leprosy transmission in the communities.
 Physical deformities of newly diagnosed patients –delay in case
finding at the community level- low index of the health workers.
 MDT Coverage (what proportion of patients are on MDT)
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4.7.3.1.B: National Leprosy Prevalence Rate:
Solomon Islands has reached below the WHO target mark of 1/10,000 population, at 0.6/10,000
population
The use of Multi- Drug Therapy (MDT) has been effective in reducing the leprosy case-loads. As
can be seen in Figure 5, the prevalence rate of leprosy has declined from 4 per 10,000 population
in 1990 to 0.67 per 10,000 population in 2003. It was in 1995 that the Leprosy Control Program had
achieved the prevalence rate of less than 1 per 10,000 population as required by WHO. The global
target for the elimination of leprosy as a public health problem is less than 1 per 10,000 population.
Although the program did maintain a low prevalence rate for the last eight (8) years, extra effort is
still required to identify possible new cases in high prevalence areas of Guadalcanal, Honiara City
Council and Malaita Provinces.
Natinal Leprosy Prevalence Rate from 1990 - 2003
4.5
4
3.5
PR 1 per 10,000 pop.
3
2.5
2
1.5
1
0.5
0
90 91 92 93 94 95 96 97 98 99 0 1 2 3
Leprosy Prevalence 4 3 3 2 1.1 0.6 0.7 1 0.5 0.2 0.5 0.2 0.7 0.1
Figure 5.
Besides reducing the prevalence rate to as low as 1 per 10,000 population and reducing the
caseload, it is important to assess the MDT program. The indicator provided in Box 3 would
facilitate the calculation of MDT coverage
Box 3. Assessing Progress with MDT implementation
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 Cured with MDT –this is the cumulative number of patients who have
completed MDT since the implementation of the program.
This is expressed in absolute numbers.
Using the above indicator, the Leprosy Control Program has treated a cumulative total of 568
patients with MDT since the program was initiated in 1987. Although we could not verify the exact
number of patients released from control but most of these patients had been released from
treatment which indicated a good treatment management and compliance.
4.7.3.1.C: Leprosy Public campaign and Promotion.
Because Leprosy is no longer been regarded as major public health problem, much of the health
awareness campaigns have geared towards other programs. Never the less, this should not be
seen as a barrier. Much of the awareness activities on leprosy were done during leprosy
elimination campaigns which is an integral part of the program to accelerate leprosy elimination. In
the past years only Malaita, Guadalcanal and Honiara City Council health staffs conducted some
LEC activities in designated leprosy foci areas which yielding more new cases. Such approach
should pursued with innovation to detect any hidden cases and also to increase community
awareness.
4.7.3.1.D: Leprosy Rehabilitation.
This is one of the major component of the Leprosy Control Program as far as leprosy patients with
disability are concerned. The Community Based Rehabilitation Program (CBR) Unit within the
Ministry of Health plays an important role in assisting leprosy patients on humanitarian ground.
This means that any leprosy patient with grade 2 disability are eligible for some sort of assistance
like housing, school fees for their children, income generating projects that would assist them to
earn some living. Leprosy patients are advised to channel their request to the CBR Unit who on
their behalf make request to Pacific Leprosy Foundation in Christchurch –New Zealand for funds.
Currently there are several housing projects in Malaita and Guadalcanal Provinces that are need to
be completed. School fees for children is still been catered for by the PLF.
4.7.3.2. Issues & Constraints:
In spite of the progress and advance in program development, there are few weakness and
constraints experienced by the programs. This had hindered the smooth implementation of the
program activities both at the national and provincial level. Below are some of the major constraints
and weakness:
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 Although there is government commitment to support the implementation of the programs,
there is still inadequate funds for administration and support services and also for
conducting refresher training for health workers and also for conducting supervisory tours
by both national and provincial coordinators.
 Communication between national and provincial coordinators is still a main set back in
term urgent matters that need to be communicated to the provinces. At the moment it is
very difficult to communicate with the provinces.
 There is inadequate supervisory tours conducted by the national and provincial

coordinators to provinces and rural clinics to boost staff morale and provide technical
advice to improve performance due to financial difficulties.
 Recording and Reporting system is still at a very low level. Provinces need to improve the
current system.
 There is inadequate supply of anti-TB drug and logistics experienced in the country.
 There is lack of transport facilities experienced by all provinces which is the main set backs
for case follow up and also for conducting supervisory tours
 There is inadequate supply of IEC material available for TB and Leprosy. Some IEC
materials need to improved and edited for better understanding to the general public.
4.8. Sexually Transmitted Infections ) including HIV:
HIV/AIDS Status:
 The current testing strategy for are:
-All Hospital laboratories can do HIV testing.

-Test used Serodia particle agglutination test.
-Trial some rapid test included :HIV spot and HIV determine
- For all rapid test reactive were re-tested on Serodia. Reactive samples were sent to Royal
Brisbane laboratories for confirmation.
 Current Reporting strategy:
None of the Laboratory did case reporting

None of the initial reactive results are reported
All confirmed cases of HIV are sent back to the requesting Doctor & copies kept at laboratory.
All laboratory reports aggregate data in their annual report, which is compiled in the National
referral hospital laboratory
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 HIV Surveillance :
There were observed disadvantage of Case reporting. The Second Generation Surveillance is
recommended.
Recently about 4000 testing were done at NRH Honiara, mostly medical checks for the pre-
employment and Overseas visas, and Clinical suspects.
More than 18,000 blood donors tested mostly most young male adults in and around Honiara.
Pre-risk behaviors elimination questionnaires administered. About 4,000 STI (Sexually active
population (Range12-50yrs), mostly 19-25 age group were included.
Table below shows summary of Tests done:

More than 27,000 HIV testing was done since 1989 in the country.
STI Sp.
Year Bdonor Patient surv Studies Total
1989-1998 11951 2309 2159 0 16419
1999 1163 492 490 0 2145
2000 1029 831 588 0 2448
2001 1706 304 361 0 2371
2002 1061 132 20 1002 2215
2003 1585 210 1795
Total 18495 4278 3618 1002 27393
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Graph below shows the number of confirmed HIV cases in the Pacific Islands: Please take note
that by end of 2003 SI only recorded one (1) and not two as recorded below. Solomon Islands
second case was confirmed early 2004. The graph excludes PNG, which recorded more than
Number of Confirmed HIV in PIC as of Dec 2003

(SPC)
300
246
250 229
200 168
No.of HIV
149
150
100
41
50 25
2 0 11 9 1 0 4 0 12 2 0 13 9 3 2
0
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7,000 HIV cases.
There has been an increasing STI recorded. Unfortunately the update figures are not available at
the time of compiling this report.
4.9. Mental Health Service:
4.9.1. Policy Statement:
Over the past years the number of people seeking psychiatric treatment increases. It is expected to
increase further in the next five years. The gap between the demand for services and the limited
supply will further. The utilization of this service is very low compared to general medical services,
because of limited access to the services. Most other provincial hospitals do not offer any
psychiatric counseling or treatment but do follow-ups, and supply psychiatric drugs. Unless
something is done, the situation will be even difficult. Social problems such as alcohol and drug
abuse are now recognized in the communities as significant problems. Criminal offences are in the
rise. The need for psychiatric counseling and treatment is great.
The ministry through the National Psychiatric Board resolved that the Primary Health Care
Approach would be maintained to address the issue of accessibility and equity. The people should
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be accessible to certain level of psychiatric services. The ministry sees the importance of
rehabilitation of psychiatric patients in the community, and would like further strengthening it by
involving communities.
4.9.3. Objectives:
To improve National Psychiatry Services using the Primary Health Care approach within the next
five years.
To in-built Social Psychotherapy (or community rehabilitation) in the National Psychiatric Services
by 2003.
4.9.4. Indicators:
Fully documented and implemented primary health care approach in the National Psychiatric
Services.
Fully documented and implemented Social Psychotherapy component of the
4.9.6. Outputs/ Achievements:
4.9.6.1. Funds secured for training of a national doctor in psychiatry in 2002

4.9.6.2. Specialized nurse trained in psychiatry is under going training in Australia
Policy 5: Environmental Health Services
Summary Report by: Mr. Robinson Fugui, Director Environment Health Division
5.2.Objectives:
To improve productivity of the Environmental Health Division and Rural Water Supply & Sanitation
Project (EHD/RWSS) in the next five years.
To increase environmental public health activities in food hygiene, inspections and quarantine, and
occupational health and safety at work in the next five years.
5.3. Indicators:
No. of EHD Activities

No. Water supply & Sanitation projects constructed
Water Supply coverage
Sanitation coverage
No. Of Public Health Activities implemented
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5.4. Achievements:
5.4.1. 70% of the total population have access to clean and safe water.
5.4.2. 30% of total population have access to proper sanitation.
5.4.3. Quarantine Health Services continued to be busy through last year. Their participation
provide in April to June 2003 during the SARS out-break.
5.4.4. The quarantine health Unit of the Environmental Division recorded total of 79 vessels and
ten aircrafts underwent health quarantine inspections and clearance from January to August 2003.
These inspections are aimed at identifying and preventing diseases imported into the country from
overseas.
5.4.5. Efforts to strengthen food safety and quality control progressed very well in 200320. Activities
undertook included gazette of the Pure Food Act No. 4 of 1996 with a commencement date for the
Act as 1st January 2003. The Fishery Product Regulations under the Pure Food Act No. 6 of 1996
was reviewed by external consultants in liaison with the local staff. The draft is pending clearance
afterv etti
n gb yth eAG’ sCh amb ers.T h eFo o dHy gien eAc tisp endinga c t
ionb yAG’ sCh amb e r
s.
EHD is the legitimated competent authority in ensuring international standards for food processing
and trade.
Capacity building continued in 2003. Additional skills were acquired on regulatory inspection,
Retorting, basic food analysis, and imported food control and inspection. The skill transfer was
done through attendance of divisional staff to the different workshops held in 2003.
 Lack of funding is expressed as hindering some of the divisional activities. There is no

clear budget line for the divisional to undertake its planned activities for 2003 efficiently.
 No donor assistance was forthcoming in 2003, which accentuate the gap after AusAID
stopped funding of the RWSS Program in 2001.
 Logistical support to the provinces were affected.
 The public health laboratory lack required equipments and facilities to ensure a quality and
reliable public health functions as stipulated under the Pure Food Act.
 Delay in vetting of draft legislations and regulations is a concern causing slow progress in
implementing the regulatory functions.
 Wide spread freezing of recruitments and promotions and other related personal matters
by the Public Service Division have implication on the staffing and incentives to the
division.
Note: Update data and information not available at the time this report was compiled.
20
Environmental Health Division (2003). EHD Annual Health Report 2003.
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Policy 6: Health Education and Promotion
This section only focuses on the activities of the Health Education and Promotion Division Head
Quarter, Honiara.
6.1. Objectives:
To increase focus and reorient commitment to enhance preventive and promotion health services
to the local community, especially the vulnerable people, the women and children, in the next five
years.
To carry out more health education and promotion activities in the rural clinics from 37.3% in 1995
to 80% by 2003.
Increase integration of IEC into all health programs within the ministry as well as other stake
holders (NGOs) in the next five years
To promote family health from within the village to encourage and support efforts of parents to
make responsible decisions regarding family size and family health.
To strengthen capacity of the health workers to plan, coordinate, implement and evaluate health
promotion activities/ programs in the next five years.
6.2. Indicators:
No. Of health education and health promotion activities

Fully documented and implemented orientation
No. Of health promotion activities implemented.
Individuals, and families aware, informed and more responsible for their own health and family'
health.
Integration of IEC into all health programs and other stakeholders (NGOs) involved.
Families aware, informed and more responsible for their own family health.
Human resource development which reflects new health promotion orientation
Improved planning, implementation and evaluation
Key nurses and health educators up to date on promotion on current health issues and problems.
6.3.1. Outputs (or Deliverables:

I. INTRODUCTION
National Health Policy No 6
Health Promotion a New Concept
Health Promotion Mouth Piece of MHMS
Supplement National Health Program
Implementation Rate Increased
2. MAJOR FUNCTIONS
Capacity Building
Healthy Setting
Media And IEC Production
Research And Development
General Administration
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3. SPECIFIC PROGRAM ACTIVITIES
A. Capacity Building
Pre-service training
In-service training
Community training/workshops
B. Healthy Settings
Health Promoting School
Health Promoting Health Care Facility
Healthy Promoting Town
Health Promoting Work place
Health Promoting Village
C. Media And IEC Production
Media Advocacy
IEC Production
AVA equipment procurement/maintenance
D. Research And Development
Pretesting
Community Profiling
Impact Assessment
E. General Administration
D. Policy Structure Review

Workforce development
Program Development
Financial Management
Reporting
5. PROGRAM ACTIVITIES ACCOMPLISHMENT
A. Capacity Building
Pre-service training –1
In-service training –1
Community training/workshops (conducted) –46
Community training/workshops (R/Personnel) –5
B. Healthy Settings
Health Promoting School –(Primary/Secondary/Tertiary)
Health Instruction –126

Health Inspection - 92
Total Students - 11,114
Health Promoting Clinic/Hospital
Health talks/ film shows - 302
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Health Promoting Town
Health campaigns and talks –37
Health Promoting Village
Village Inspection –101

Village Meetings - 181
Village Talks/film shows –265
Village Implementation Programs –14
C. Media And IEC Production
Media Advocacy
Radio Health - 300 programs

Newspaper - 10 columns
Television (ABC)- 2 Clips
IEC Production
Health posters –
Health leaflets
Health calendars
Health banners -
Health T-shirts –
Health video –
Health Cassettes dubbed -
D. Healthy Settings
Health Promoting School –(Primary/Secondary/Tertiary)
Health Instruction –126

Health Inspection –92
Total Students - 5
6.3.2. Issues and Constraints:
 Inadequate Financial Support

 Lack of IEC materials
 Lack of Research And Evaluation
 Inadequate Communication And Supervision
 Low morale of HP staff –Province
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Policy 7: Reproductive Health & Family Planning
7.1. Objectives:
To reduce maternal mortality rate from 357/100,000 live births by 50% by 2003.
To have one trained midwife per shift by 2003 at NRH, and 7 provincial hospitals.
To have one trained midwife at all 14 Area Health Centers by 2003.
To reduce teenage pregnancy from 9% in 1999 to less than 2% by 2003.
To increase contraceptive prevalence from 18.7% to 25% by 2003.
To increase supervised deliveries from 80% to 90% by 2003.
To increase first antenatal attendance in the first trimester from 25% by 2003.
To increase ANC visits from 79% to 90-100% by 2003.
To decrease the perinatal mortality rate from 40/1,000 to 30/1,000 by 2003.
To decrease neonatal mortality from 20/1,000 to 15/1,000 by 2003.
To have 95% of all health workers trained in contraceptive technology update and adolescent
reproductive health by 2003.
7.2. Performance Indicators:
Maternal Mortality Rate

No. of midwives trained
Teenage pregnancy rate
Contraceptive prevalence Rates
% Supervised deliveries
First antenatal attendance
ANC coverage rate
Perinatal Mortality Rate
Neonatal Mortality Rate
% Health workers trained in contraceptive update
7.3.1. Outputs (or Deliverables):
 The health indicators provided us guide to plan, monitor and evaluate our activities for
improvement of the health status of our mothers and children (as advocated by the
Convention of the Rights of the Children (CRC) and the Millennium Declaration Goals
(MDG) by the UN.
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Health Indicators are as listed in the table below:-
Indicators ICDP Targets WHO MOH/SIG Current Status Comments

Target Targets
Deliveries attended by 60 90 87 Improved
trained personnel (%) Source [1]
Population Access to 60 80 Satisfactory
Reproductive Health
(%) Source [1]
Contraceptive rate (%) 55 25 8 Need strengthening and
improvement.
Source [2]
Infant Mortality Rate/ 50 50 <50 66 (1999) Need strengthening and
per 1,000 live births improvement.
Source [3]
Maternal Mortality Rate 100 <178 195 (2001) Need strengthening and
/ Per 100,000 pop. improvement.
[2]
Teenage Pregnancy <2% 10 (2001) Source [2]
(%)
Female literacy (%) 77 Source [3]
Sources:
[1] UNFPA (2004).
[2] Reproductive Health Division/ MOH/SI (2004).
[3] National Census SIG 1999.
[4] Recent indicators are yet to be finalized. Improvement of the reporting system for reproductive
health in Solomon Islands is in progress and hopefully update indicators can be ready by end of
2004.
 By end of 2003:-
-Maternal Mortality rate stands at 295 100,000 live births.

-Infant Mortality Rate at 66 per 1,000 live births.
 A Condom Social Marketing Feasibility Study was done in Solomon Islands in 200321. The
report concluded that there is a need for and reasonable feasibility of implementing
condom social marketing interventions for HIV/AIDS and STI prevention. STI is been
increasing since 1992. Syphilis and gonorrhea are the main Sexually Transmitted
Infections. Total of 504,000 condoms have been ordered in 2003, but the usage is very low
and limited because there was no policy to mandate distribution to young and
adolescences.
21
UNFPA (2003). Report on Social Marketing Assessment for HIV/STI Prevention in the South Pacific:
Population Services International (PSI).
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 An Adolescence Reproductive Health (ARH) Project was formed outside the MOH and
funded by the UNFPA. The project focuses on educating out-or-school youth, in school
youth, churches, and using the multi-media.
 SIPPA distributed 101,664 condoms in 2002.
 Other NGOs such as Solomon Islands Development Trust (SIDT), Voice belong Meri and
Family Planning Australia is also running programs on advocacy and awareness on
reproductive and adolescence health in the country.
Child Health Services & Expanded Program of Immunization (EPI):
The Child health services is a integral component of the Reproductive Health Division. Most
activities in promoting child health and protection of the child from being sick is implemented
through the primary health care services.
 All clinics operate a well-baby clinics, which includes vaccination of children under 5 years
old.
 Growth monitoring also took place at all clinics.
 Measles catch up campaign started in 2003 and continued in early 2004. (At the time of
wr i
tin gt her epo rttwop r
ovince sh av en’
ts u bmi t
tedt hei
rr ep ort
s .Th e ya reMa lait
aa n d
Rennell Bellona.
Expanded Program for Immunization (EPI):
By End of 2003:
National coverages:-
 BCG coverage was at 79%.

 DPT3 coverage was 73%.
 OPV3 coverage was 70%.
 1st Measles coverage was 69%.
 HepB3 coverage was 78%.
 Tetanus Toxoid 2 coverage was 56%.
In general the coverage of vaccination was below 80% line by end of 2003. The highest coverage
was seen in BCG coverage. The trend (see graph below) shows decline from 2001-2002 (Partly
due to incomplete data.)
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Graph showing Trends for vaccine coverages 1999-2003
90
80
70
60
50
40
30
20
10
0
TT2&Preg HB 3 Measles 1 OPV3 DPT3 BCG
Preg
1999 2000 2001 2002 2003
Table 2:showing National Coverage of Infants (under one year) in %: 1999-2003
Years BCG DPT3 OPV3 1ST 2nd HB Birth HB3 TT2 &
Measles Measles Preg.
Campign wOMEN
2003 79 73 70 69 76 78 56
2002 76 71 68 67 68 49
2001 85 78 80 74 78 52
2000 84 81 83 78 73 60
1999 64 62 60 59 63 50
 The Provincial Immunization coverage has improved significantly after the EPI catch up
campaign in 2003. Malaita and Renell Bellona yet to complete theirs.
 Some provinces such as Isabel, CIP, Makira, and Honiara reached 99-100 coverage fro
different immunization coverage rates. The two provinces concern is Malaita and Guadalcanal.
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Table 1: showing Infant Immunization <1 yesr by Provinces 2003 (%)

Province BCG DPT3 OPV3 1ST 2nd HB Birth HB3 TT2 &
Measles Measles Preg.
Campign wOMEN
Choiseul 79 92 92 73 95 75 99 55
Makira 93 89 85 87 96 99 107 65
Isabel 82 82 76 79 100 89 83 71
Honiara 99 81 73 74 85 96 91 82
Temotu 92 79 64 79 98 82 103 70
Western 67 70 88 69 95 56 70 60
Guadalcanal 76 76 60 66 86 62 78 62
Malaita 60 48 59 48 0 60 53 40
CIP 63 61 60 60 100 64 57 72
RenBell 0 0 0 0 88 0 0 0
Reported Cases of EPI Preventable Diseases:
From the table below there was no record of any EPI preventable diseases. However, in 2001 60
cases of Pertusis were recorded in children. Detail information of the cases is not available.
Year AFP Measles Tetanus Petusis Diptheria TB

All NT TB M TB B
2003 0 0 0 0 0 0 na Na
2002 0 0 0 0 0 0 0 0
2001 3 0 0 0 60 0 4 1
2000 3 0 0 0 0 0 0 0
1999 0 0 0 0 0 0 0 0
EPI Significant accomplishment or innovation in 2003:
 Development of EPI curriculum in SI Nursing school -UNICEF

 Development of Cold chain policy-WHO
 National EPI and Cold Chain workshop-
 EPI local adaptation with IMCI
 National measles and Catch-up campaign.
 Establishment of VDC-10 RCW50 EG-JICA
 Cold chain inventory
 IACC meeting-continue well
 Cold chain proposals sent to JICA.
 Secure Funding for vaccine supply 2004
 No outbreak of EPI target diseases
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Important Constraints & Challenges-2003:
 Political Instability causing difficulties in implementing EPI program

 Insuffcient funds from SI Government to support Cold chain to the provinces-(need to a lot
funds)
 Vaccine supply to clinics very low. (out for 2months except HB)
 Transport and Communication-very difficult.
 Vaccines procurement sustainabilty-2004 budget.
 The priority identified needs/activities to be strengthen in EPI (2004-2008)
 Strengthening of Cold chain system/VDC

 Improve Vaccine supplies and procurements -(2004 budget)
 Strengthen AFP surveillance/RHD Surveillance
 Improve Safe injection practice
 Complete the cold / EPI policy and Mid term Plan
 RHD Surveillance system ( Pilot)
 Supervisory tours to provinces/training
 Increase vaccination coverage in provinces- 98% by 2008
Policy 8: Developing Partnerhsip in Health Developments:
8.1. Objective:
To enhance and improve collaboration and coordination between the Government and developing
partners with in the planned period.
8.2. Indicators:
More collaboration links through MOU developed with local NGOs, and international developing
partners.
More donor assistance available for health.
Greater participation of NGOs in providing health and related services secured.
8.3.1. Outputs (or Deliverables):
 Partnership has been developed between the Ministry of Health and the donors and local
NGOs.
 Table below summarizes the different organizations with whom partnership has been
developed (Details of the donor support is attached):
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Partner Project type: Funding source for MOU Expected Output
Organization Service type the activities under
(External and the partnership
Internal)
External:
Australian Company Health Institutional AusAID Formal Improved
& MOH Strengthening management and
Project (HISP)- implementation of
Phase 2 health services
(increased effectivity
and efficiency)
AusAID & MOH & Health Sector Trust AusAID Formal Increase coverage of
Provincial Health Account: direct health services;
Services Budgetary support to inmprove health
the Health Sector attainment/
achievements;
improved health
outcome.
World Bank & MOH Solomon Islands World Bank MOU : Soft Loan Reduction of
& Makira and Health Sector morbidity and
Guadalcanal Development Project mortality of mothers,
Provincial Health (SIHSDP): children, and malaria
services Reproductive Health, incidence and
Malaria, Capacity burden.
Building. (Two
provinces involved
Makira and
Guadalcanal) & Civil
works
UNFPA & MOH & HR Development- UNFPA MOU Strengthening of
Provincial Health Trainings Reproductive health
Services (midwifery), services in Solomon
activities/ services Islands: Reduce
delivery maternal and infant
mortality.
UNICEF & MOH & Integrated UNICEF MOU Reduced infant
Provincial Health Management of mortality.
Services Childhood Illnesses
(IMCI)-Pilot raining
ROC & MOH & National Referral ROC MOU Reduced
National Referral Hospital Phase 3 preventable deaths.
Hospital development project Improved quality of
care
WHO WHO/Solomon WHO Technical incountry Increase
Islands country support professional
Budget 2004-5 competency
Japanese Immunization JICA Technical incountry Increased
Catchup/ Cold Chain support immunization
restoration for rural coverage. Prevent
communities in SI outbreaks.
Secretariat to Pacific Pacific Public Health SPC Technical incountry Improved
Community (SPC) Network (PACNET) support communication and
public health
surveillance. Reduce
morbidity and
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mortality due to
emerging diseases
and epidemics.
Local partnership:
Churches: Primary health care: Ad hoc basis: No formal MOU Improved access to
SDA Catholic, Provincial hospitals Routine. exists. health services:
SSEC, COM and Rural clinics Improve health
outcome and
population health
through the Primary
Health Care system.
National Disaster Health Sector NDC Health a member of Reduce morbidity
Council (NDC) Disaster the NDC and Mortality due to
Management with disaster.
NDC
NGOs: Reproductive health Annual grants from Statutory body of the
SIPPA care: Maternal care: MOH MOH
FP: STI; counseling
etc.
Red Cross Society & Blood supply Annual grants from Statutory body of the Reduce mordidity
MOH advocates. MOH MOH: and mortality due to
MOU & Joint Policy blood borne
on Blood Safety and diseases such as
Supply HIV/AIDS, Hepatitis
etc.
 Community Participation for Health was promoted in Isabel Province. Consequently a

Healthy Village Model was developed from Isabel Province (with the support from AusAID
Advisers). The challenge is for the expansion of such model to other provinces.
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3.0. Discussion on Impediments/ Difficulties / Issues:
3.1. Financial Resources:
The direct budgetary support to the health sector from AusAID by way of the Health Sector Trust
Fund/Account (HSTA) has enable the Government to pay for essential medicines and other
pharmaceutical supplies for the country. The HSTA helped to maintained direct health employees
work force by paying for the wages.
There were key issues surrounding health financing in 2003. Firstly, how long the HSTA will
continue to fund the health system of the country is being questioned, because funding form the
SIG for health services in 2003 was not forthcoming. Secondly program budgeting was not
implemented effectively to ensure that all programs are funded and evaluated.
Health Information System:
Data and information needed for effective surveillance, monitoring and evaluation of health status
and performance continue to be a general weakness in most disease control programs and the
management of the health sector.
Medical Supplies and Equipment
Skilled health worker cannot provide effective curative and preventive health services without the
essential elements such as drugs and equipment. The irregular supply of drugs and deteriorating
condition of equipment affects the services provided. Approximately one third of surveyed clinics
reported a need for new or replacement equipment and 45% of those clinics surveyed indicated
non-functioning sterilization equipment.
Transportation
Transportation is badly affected and inadequate. Transportation is essential for referral of cases,
outreach services, medical supplies, and supervision and training. About 50% of health facilities
reported that transports are not working.
Inadequate Communication
Radio communication systems in the health referral facilities supports the system in many
important ways including clinical support, management, and administrative support, staff support
and health promotion. About 68% of clinics surveyed were experiencing difficulties with radio
communication.
In 2003, 49 radios ere installed in the rural provincial clinics.
Human Resource Management
Management of human resources in health sector are often difficult as the Ministry does not have
the authority to management them. Procedures are cumbersome and various levels of
consultations make it difficult to implement effective decision.
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Due to delay in payment of salary, a lot of health workers are not willing to continue to work and
resort to other means of supporting their families.
Slow Progress in the Public Sector Reform
The long-term capacity of the Ministry of Health to manage the sector effectively will depend on the
systemic upgrading of the skills and capacities of its staff and systems. The general lack of the
progress of the public service reform agenda, creates a problem for the Ministry in its own efforts to
obtain more autonomy to manage its own affairs. The Public Service Division, has not been pro-
active in supporting the changes required by the Ministry, especially in establishing the key
positions with the Ministry.
Given the autonomy, the Ministry of health would also be able to management its industrial
relations effectively.
ANNEXT TABLE 1: list of approved clinics by END OF 2003:
Prov.
Province Code Area Code Clinic Code Facility Category
Central Islands 05 01 03 Belaga NAP NAP
Central Islands 05 02 03 Borohinaba RHC RHC

Central Islands 05 02 02 Boromole NAP NAP
Central Islands 05 01 05 Dende RHC RHC
Central Islands 05 05 03 Ilua NAP NAP
Central Islands 05 03 03 Koagele NAP NAP
Central Islands 05 Koela NAP NAP
Central Islands 05 01 06 Koilovala NAP NAP
Central Islands 05 04 01 Leitongo RHC RHC
Central Islands 05 05 04 Louna NAP NAP
Central Islands 05 03 02 Panueli RHC RHC
Central Islands 05 05 02 Pepesala RHC RHC
Central Islands 05 04 03 Ravu NAP NAP

Central Islands 05 01 02 Salesapa RHC RHC
Central Islands 05 01 01 Siota NAP NAP
Central Islands 05 02 01 Taroniara RHC RHC
Central Islands 05 04 04 Tathi NAP NAP
Central Islands 05 04 02 Toga NAP NAP
Central Islands 05 03 01 Tulagi Mini Hospital HOSP

Central Islands 05 04 05 Vura NAP NAP
Central Islands 05 01 04 Vuturua NAP NAP
Central Islands 05 05 01 Yandina AHC AHC
Central Islands 05 Marulaou NAP NAP
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Central Islands 05 Mboromomole NAP NAP
Central Islands 05 Narogu NAP
Central Islands 05 03 04 Sasage Marina NAP NAP
Choisel 06 02 08 Boeboe NAP NAP
Choisel 06 Choiseul Bay NAP
Choisel 06 01 05 Ghaghara RHC RHC
Choisel 06 Loimuni NAP NAP
Choisel 06 Lukuvaru NAP NAP
Choisel 06 02 07 Loloko RHC RHC

Choisel 06 02 05 Luti NAP NAP
Choisel 06 Moli RHC
Choisel 06 Mbangara RHC RHC
Choisel 06 Ngarione RHC RHC
Choisel 06 Nukiki NAP NAP
Choisel 06 01 03 Nuatabu RHC RHC
Choisel 06 03 07 Ogho NAP NAP
Choisel 06 01 01 Pangoe AHC AHC
Choisel 06 02 02 Papara RHC RHC
Choisel 06 03 03 Polo RHC RHC
Choisel 06 02 03 Posorae RHC RHC
Choisel 06 03 06 Sagigae NAP NAP
Choisel 06 02 06 Sepa NAP NAP
Choisel 06 03 02 Sirovanga RHC RHC

Choisel 06 Soranamola NAP NAP
Choisel 06 01 02 Susuka RHC RHC
Choisel 06 03 01 Taro AHC AHC

Choisel 06 03 05 Voza RHC RHC
Choisel 06 01 04 Vurango NAP NAP
Choisel 06 02 04 Wagina RHC RHC
Choisel 06 02 01 Sasamunga Mini Hospital HOSP

Guadalcanal 01 03 04 Aola AHC AHC
Guadalcanal 01 02 07 Avuavu RHC (Weathercoast) RHC
Guadalcanal 01 02 08 Balolava RHC(Weathercoast) RHC
Guadalcanal 01 Belaha RHC RHC
Guadalcanal 01 Biti NAP (Weathercoast) NAP

Guadalcanal 01 03 03 Bolale NAP NAP
Guadalcanal 01 03 05 Bubunuhu NAP NAP
Guadalcanal 01 02 02 Fox Bay RHC (Weathercoast) RHC

Guadalcanal 01 Grove AHC AHC
Guadalcanal 01 Haipara NAP NAP
Guadalcanal 01 03 06 Kolosulu NAP NAP
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Guadalcanal 01 Koleasi RHC RHC
Guadalcanal 01 02 05 Kuma RHC (Weathercoast) RHC

Guadalcanal 01 01 05 Lambi AHC AHC
Guadalcanal 01 Luguvasa NAP NAP
Guadalcanal 01 Lunga RHC RHC
Madakacho RHC
Guadalcanal 01 02 06 (Weathercoast) RHC
Guadalcanal 01 Marasa (Weathercoast) NAP
Guadalcanal 01 Marapa NAP NAP
Guadalcanal 01 Makina AHC AHC
Mbabanakira RHC
Guadalcanal 01 Nagho NAP NAP
Guadalcanal 01 03 07 New Tenabuti RHC RHC
Guadalcanal 01 Numbu NAP NAP
Guadalcanal 01 Pitukoli RHC RHC
Guadalcanal 01 03 08 Ruavatu RHC RHC
Guadalcanal 01 Saro NAP (Weathercoast) NAP

Guadalcanal 01 01 04 Selwyn College NAP NAP
Guadalcanal 01 Tamboko NAP NAP
Tangarare RHC
Guadalcanal 01 Konga RHC RHC
Guadalcanal 01 03 01 Totongo RHC RHC
Guadalcanal 01 04 02 Turarana RHC RHC
Guadalcanal 01 Vatilau RHC RHC

Guadalcanal 01 03 02 Vatulava NAP NAP
Guadalcanal 01 01 02 Visale AHC AHC
Guadalcanal 01 02 04 Viso RHC (Weathercoast) RHC
Guadalcanal 01 Marumbo NAP (Weathercoast) NAP

Guadalcanal 01 01 03 Kohimarama NAP NAP
Guadalcanal 01 NRH HOSP

HCC 09 02 01 Kukum UHC UHC
HCC 09 02 02 Mataniko UHC UHC
HCC 09 03 03 Mbokona UHC UHC
HCC 09 02 03 Mbokonavera UHC UHC
HCC 09 01 01 Naha UHC UHC
HCC 09 03 01 Rove AHC AHC
HCC 09 01 02 Vura UHC UHC
HCC 09 03 02 White River UHC UHC
Isabel 07 04 02 Allardyce NAP NAP
Isabel 07 04 03 Babahairo NAP NAP
Isabel 07 04 05 Baolo RHC RHC
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Isabel 07 01 04 Bara NAP NAP
Isabel 07 04 06 Bolotei AHC AHC
Isabel 07 01 01 Buala Hospital HOSP
Isabel 07 03 09 Dedeu NAP NAP
Isabel 07 01 02 Goveo NAP NAP
Isabel 07 02 05 Hageula NAP NAP
Isabel 07 01 05 Hoffi NAP NAP
Isabel 07 03 06 Kalenga RHC RHC
Isabel 07 02 03 Kamaosi NAP NAP
Isabel 07 04 01 Kia AHC AHC
Isabel 07 03 04 Kilokaka NAP NAP
Isabel 07 01 06 Kmaga NAP NAP
Isabel 07 Koisisi NAP
Isabel 07 03 02 Kolomola RHC RHC
Isabel 07 Kolopakisa NAP NAP
Isabel 07 03 01 Kolotubi NAP NAP
Isabel 07 Konide AHC AHC
Isabel 07 03 07 Lelegia NAP NAP
Isabel 07 Midoru NAP NAP
Isabel 07 Moluvoru RHC RHC
Isabel 07 Nagolau NAP NAP
Isabel 07 02 02 Poro RHC RHC
Isabel 07 04 04 Ritamala NAP CLOSED
Isabel 07 03 08 Samasodu RHC RHC
Isabel 07 02 04 Sigana RHC RHC

Isabel 07 04 07 Sisiga NAP NAP
Isabel 07 04 08 Suavanao RHC CLOSED
Isabel 07 03 03 Susubona RHC RHC
Isabel 07 02 01 Tatamba AHC AHC
Isabel 07 Tolegu Kastom Clinic NOT MOH

Isabel 07 03 05 Vulavu RHC RHC
Isabel 07 03 10 Koge NAP NAP
Isabel 07 01 03 Guhuhu NAP NAP
Isabel 07 Muana NAP NAP
Isabel 07 Gnulahage VAP
Isabel 07 Kolosori VAP
Isabel 07 Koregui VAP
Isabel 07 Mablosi VAP
Isabel 07 Talise VAP
Isabel 07 01 07 Nodana RHC (SDA) RHC

Makira 08 Aorigi NAP NAP
Makira 08 03 01 Aringana RHC RHC
Makira 08 Aua RHC RHC
Makira 08 05 02 Gupuna RHC RHC
Makira 08 02 01 Haupala AHC AHC
Makira 08 Heraniau'u NAP NAP
Makira 08 Hunuta NAP NAP
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Makira Hauta NAP NAP
Makira 08 01 04 Karie RHC RHC
Makira 08 Kerepei RHC
Makira 08 01 01 Kirakira Hospital HOSP
Makira 08 Kaonasugu NAP NAP

Makira 08 Maerongasia NAP NAP
Makira 08 Makorukoru NAP NAP
Makira 08 01 02 Manasugu RHC RHC

Makira 08 Maniwiriwiri NAP NAP
Makira Marogu RHC RHC
Makira 08 Naharahau NAP NAP
Makira 08 01 03 Narame RHC RHC
Makira 08 03 04 Ngarigohu RHC RHC
Makira 08 04 02 Parego RHC RHC
Makira Su'ulopo NAP NAP
Makira 08 Taheramo RHC RHC
Makira 08 04 04 Tetere RHC RHC
Makira 08 03 02 Ubuna RHC RHC
Makira 08 04 01 Waihaga RHC RHC

Makira 08 Waimapuru NSS NSS
Makira 08 Namuga AHC AHC
Makira 08 03 03 Tawaraha AHC AHC
Makira 08 Tawaiabu NAP NAP
Makira 08 Borodao NAP NAP
Makira 08 Tawairamo NAP NAP
Makira 08 Wanahata (Narate) NAP NAP

Makira 08 Pamua NSS NSS
RenBel 10 01 03 Nuku RHC RHC
RenBel 10 01 02 Tengano RHC RHC
RenBel 10 01 01 Tingoa AHC AHC
Temotu 04 04 01 Emua RHC RHC
Temotu 04 01 01 Lata Hospital HOSP
Temotu 04 02 01 Dendu RHC RHC
Temotu 04 03 01 Manuopo AHC AHC
Temotu 04 03 02 Nuoba RHC RHC
Temotu 04 05 01 Tukutaunga RHC RHC
Temotu 04 Luasalemba NAP NAP
Temotu 04 01 02 Kala Bay NAP NAP
Temotu 04 Kati NAP NAP
Temotu 04 Otomongi NAP NAP
Temotu 04 No'ole NAP NAP
Temotu 04 04 03 Ngauta NAP NAP
Temotu 04 04 02 Nembao NAP NAP
Temotu 04 Lagoon NAP NAP
Western 02 Aleang NAP NAP
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Western 02 04 04 Arara NAP NAP
Western 02 03 09 Baniata NAP NAP
Western 02 04 05 Batuna RHC RHC
Western 02 03 02 Buni RHC RHC
Western 02 04 06 Cheara RHC RHC

Western 02 06 03 Dovele RHC RHC
Western 02 Emu Harbour AHC AHC
Western 02 03 11 Enoghae RHC RHC
Western 02 05 03 Falamae RHC RHC
Western 02 05 07 Gaomai NAP NAP
Western 02 05 02 Harapa RHC RHC
Western 02 03 15 Hopongo NAP NAP
Western 02 06 04 Iringgila RHC RHC
Western 02 05 06 Kariki NAP NAP
Western 02 04 02 Keru RHC RHC
Western 02 06 02 Kolokolo RHC RHC
Western 02 01 02 Kukundu RHC RHC
Western 02 02 03 Lale RHC RHC
Western 02 03 10 Lokuru NAP NAP
Western 02 06 09 Maravari NAP NAP
Western 02 04 09 Merusu RHC RHC
Western 02 05 01 Nila AHC AHC
Western 02 03 03 Noro RHC RHC
Western 02 03 04 Paradise RHC RHC
Western 02 02 02 Pienuna RHC RHC
Western 02 04 08 Penjuku RHC RHC
Western 02 01 04 Poitete RHC RHC
Western 02 01 03 Ringi Cove RHC RHC
Western 02 04 01 Seghe AHC AHC
Western 02 Sobiro NAP NAP
Western 02 05 04 Toumoa RHC RHC
Western 02 02 04 Tumbi RHC RHC
Western 02 03 08 Ughele RHC RHC
Western 02 04 03 Viru RHC RHC
Western 02 06 01 Vonunu AHC AHC
Western 02 03 01 Helena Goldie Hospital HOSP
Western 02 02 06 Kara NAP NAP
Western 02 03 14 Nusa Roviana NAP NAP
Western 02 03 06 Nusahope NAP NAP
Western 02 01 05 Ghatere NAP NAP
Western 02 06 06 Karaka NAP NAP
Western 02 02 05 Mondo NAP NAP
Western 02 06 05 Varese NAP NAP
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Western 02 04 07 Tingge NAP NAP
Western 02 06 07 Paramata NAP NAP
Western 02 01 06 Rarumana NAP NAP
Western 02 06 08 Lambu Lambu NAP NAP
Western 02 03 13 Dunde NAP NAP
Western 02 04 11 Kavolavata NAP NAP
Western 02 03 07 Biulu CHS NAP NAP
Western 02 Vaza NAP NAP
Western 02 Vanga NAP NAP
Western 02 04 10 Vakambo NAP NAP
Western 02 01 01 Gizo Hospital HOSP
Malaita 02 Afenakwai Clinic NAP
Malaita 03 04 01 Afio AHC AHC
Malaita 03 03 07 Ambeo NAP NAP
Malaita 03 Anomasu NAP

Malaita 03 03 06 Apuapu NAP NAP
Malaita 03 01 16 Arao NAP NAP
Malaita 03 02 02 Ata'a RHC RHC
Malaita 03 01 01 Auki AHC AHC
Malaita 03 02 03 Bita'ama RHC RHC

Malaita 03 01 09 Buma NAP NAP
Malaita 03 01 10 Busufoasae NAP NAP
Malaita 03 01 17 Busurata NAP NAP
Malaita 03 Dala South NAP NAP
Malaita 03 01 02 Fauabu RHC RHC

Malaita 03 02 08 Fo'ondo NAP NAP
Malaita 03 Foubaita NAP NAP
Malaita 03 Gwaiau NAP NAP
Malaita 03 01 06 Gwano'oa NAP NAP
Malaita 03 Gwaunabusu NAP NAP
Malaita 03 Gwaunakwai NAP NAP
Malaita 03 02 07 Gwaurata NAP NAP

Malaita 03 02 04 Gwaunatolo RHC RHC
Malaita 03 01 12 Hauhui RHC RHC
Malaita 03 04 10 Haukasi NAP NAP
Malaita 03 01 11 Kilu'ufi Hospital HOSP
Malaita 03 01 14 Kiu NAP NAP
Malaita 03 02 05 Kwailabesi RHC RHC
Malaita 03 Maerogasia NAP NAP
Malaita 03 04 15 Malou NAP NAP
Malaita 03 02 01 Malu'u AHC AHC
Malaita 03 03 08 Mamulele NAP NAP
Malaita 03 03 02 Manawai RHC RHC

Malaita 03 01 03 Maoa NAP NAP
------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
Malaita 03 Maroupaina NAP NAP
Malaita 03 03 12 Muki NAP NAP
Malaita 03 03 03 Nafinua AHC AHC

Malaita 03 03 09 Namolaelae NAP NAP
Malaita 03 05 02 Ndai Island NAP NAP
Malaita 03 Ohio NAP NAP
Malaita 03 Okwala NAP
Malaita 03 03 04 Olomburi RHC RHC

Malaita 03 01 08 Oneone & Usufosae NAP NAP
Malaita 03 Oneoneabu NAP
Malaita 03 04 02 Ote NAP NAP

Malaita 03 Ote NAP NAP
Malaita 03 Pipisu NAP NAP
Malaita 03 Roapuo NAP NAP

Malaita 03 Rafufu NAP NAP
Malaita 03 01 13 Rohinari RHC RHC
Malaita 03 04 08 Rokera NAP NAP
Malaita 03 04 04 Sa'a RHC RHC
Malaita 03 03 10 Sango RHC RHC
Malaita 03 01 04 Sinamauri RHC RHC
Malaita 03 Sinarangu NAP
Malaita 03 03 11 Langefasu NAP NAP
Malaita 03 01 15 Su'u NAP NAP
Malaita 03 04 05 Takataka RHC RHC
Malaita 03 02 06 Takwa RHC RHC
Malaita 03 01 05 Talakali RHC RHC
Malaita 03 04 03 Taramata RHC RHC
Malaita 03 04 06 Tarapaina RHC RHC
Malaita 03 04 14 Tawanaora NAP NAP
Malaita 03 04 07 Tawaro RHC RHC
Malaita 03 04 12 Uhu NAP NAP
Malaita 03 03 01 Atoifi Hospital HOSP
Malaita 03 Rararo NAP NAP
Malaita 03 Ro'one VHA NAP
Malaita 03 04 13 Honoa NAP NAP

Malaita 03 05 01 Luaniu RHC RHC
Malaita 03 05 03 Pelau NAP NAP
Malaita 03 05 04 Sikaina RHC RHC
Malaita 03 Fulisango NAP NAP
Malaita 03 Adaua PSS NAP
Malaita 03 Suafa NAP
The End
Oooo0000oooo
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National Health Report 2003-Solomon Islands

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National Health Report 2003-Solomon Islands

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Report by the Ministry of Health (May 2004): 1

National Health Report 2003:

NATIONAL HEALTH REPORT 2003

Evaluation of the National Health Policies and Development

(Health Policies Objectives and Outputs-Achievements &

MAJOR HEALTH POLICY OBJECTIVES AND OUTPUTS-ACHIEVEMENTS & Constraints 2003.

NATIONAL HEALTH REPORT 2003 .......................................................................... 1

Compiled by Dr George Malefoasi (Undersecretary Health Improvement) and Mr. Abraham

Dr George Manimu Hon. Benjamin P Una

1.1. Vision and Mission:

At the Ministry or sectoral level it clear that:

1.3. Health Status:

1.3. Health Indicators by end of 2003:

Indicators 1996 1997 1999 2003

Crude Birth rate 42 42 34 37.6

Crude Death rate 5 4.9 9 Na

Infant Mortality/ 1,000 Na Na 66 66

Life Expectancy- Na Na M-63.6

Total Fertility rate 4.7 4.7 4.7 4.05

% Family Planning 7.7 8.5 8 10

% Antenatal Coverage 74.4 68.9 84.0 77.2

2.0. Process and Output Evaluation of the National Health

1.2. Performance Indicators:

Fully documented and implemented structure

1.3. Outputs-Achievements & Constraints:

Outputs (or Deliverables):

1.2.1. Health Financing:

1.2.3. Performance Indicators:

Annual NRH Expenditure.

1.2.4. Outputs-Achievements & Constraints:

Outputs (or Deliverables):

1.2.4.1 New Accounting System established – MYOB (HISP) fully implemented.

1.3.1. Health Information System

1.3.3. Performance Indicators;

Clinic reporting coverage

1.3.4. Outputs-Achievements & Constraints:

Outputs (or Deliverables):

Issues and Constraints:

 HIS Monthly reporting response still low at 60-70%5.

Policy 2: Accessibility, And Improvement Of Care And Quality Of Services.

2.0. Policy Statement:

2.1. Curative Health Services:

To improve doctor to population ratio from 1:7031 in1995 to 1:4500 by 2003.

2.1.3. Performance Indicators.

Doctor to Pop. Ratio

2.1.4. Output-Achievements & Constraints:

Outputs (or Deliverables):

 2.1.4.1. Total 8 hospitals were fully operational.

Issues and Constraints:

2.2.1. Medical Services:

To upgrade the Level of Service (LOS) at NRH to LOS 3 by 2003.

2.2.3. Performance Indicators:

2.2.4. Outputs/ Achievements & Constraints:

Outputs (or Deliverables):

Issues and Constraints:

2.6.1. Accident & Emergency Services:

2.6.3. Performance Indicators:

2.6.4. Outputs-Achievements & Constraints:

Outputs (or Deliverables):

Table: Road Traffic Injuries or accidents recorded at the NRH 1996-2003:

2.7.1. Access to Essential Medicines:

2.7.3. Performance Indicators:

Availability of essential drugs at the rural clinics

2.7.4. Outputs-Achievements & Constraints: