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Ministry of Health

National Health Report Review

Evaluation of Health Status 1997-99

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Ministry of Health Solomon Islands

Ministry of Health Solomon Islands NATIONAL HEALTH REPORT 1997-99 EVALUATION OF THE HEALTH

NATIONAL HEALTH REPORT

1997-99

EVALUATION OF THE HEALTH STATUS

March 2000

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TABLE OF CONTENTS

Message From

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The Minister of Health

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i. INTRODUCTION

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SECTION I: GENERAL INFORMATION

3

1.1. Land (geography of provinces/ SI)

3

1.2. The demography (Population):

3

1.2.1. Size & Growth:

3

1.2.2. Age-group Composition:

3

1.2.3. Population density:

3

1.3. The Economy:

3

1.4. The Health Status by provinces and National:

3

SECTION II: INTERNAL REVIEW REPORT

3

2.1.

REGIONAL (PROVINCIAL) SERVICE DISTRIBUTION;

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2.1.1.

Type of Services;

3

Table (1) : The Health Care Referral System

3

2.1.2.

DISTRIBUTION OF SERVICES:

3

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

3

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

3

2.2.

INTERNAL STRUCTURAL AND MANAGEMENT ISSUES:

3

2.2.1.

Organizational Structure:

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Figure1showingtheexistingorganization’sstructure:MinistryofHealth:National

and Provincial level:

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

3

2.2.3. Activities (Inputs):

3

2.2.4. Findings (outputs):

3

2.3. HEALTH FINANCING & BUDGETING AND RESOURCE ALLOCATION FACTORS:

3

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

3

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

3

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

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2.4.

Management and Supervision:

3

2.5. STATUS OF HEALTH CARE SERVICES DELIVERY:

3

2.6. DISTRIBUTION OF HEALTH CARE WORKFORCE;

3

2.6.1. SHORTAGE AND MANAGEMENT OF HEALTH WORKFORCE:

3

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

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SECTION III: HEALTH SERVICE PLANNING, MANAGEMENT AND SUPERVISION:

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3.1. MANAGEMENT & ADMINISTRATION:

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3.1.1.

Activities (Input) & Output:

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

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3.1.2. Analysis:

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3.1.3. Output & Key Issues:

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

3

3.2.1.

Overall Level of Health:

3

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

3

Table (9) showing health attainment, level and distribution in selected countries in the

pacific region; estimates 1997-99:

3

3.2.2. The distribution of health in the population:

3

3.2.3. Responsiveness of the health system:

3

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

3

Table (10) shows ranking of selected countries in the pacific region on their

performances on health level, and the overall performance:

3

3.3.

Health Information System:

3

SECTION IV: ACCESSIBILITY AND QUALITY OF HEALTH SERVICES

3

4.1.

Health Care (Curative) Services:

3

4.1.2. Activities (Input)

3

4.1.3. Outputs:

3

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

3

4.1.4. Primary Health Care- Health Facility: Population Table (11) showing Health Clinics:Population* and Nurse: Population** Ratio in

3

 

1997-1999:

3

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

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4.2.

PRIMARY HEALTH CARE (CLINICS): WORK LOAD.

3

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

3

4.2.1.

OPD visits per Facility:

3

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

3

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

provinces 1997-99

3

4.2.2.

OPD visit per person per year by provinces:

3

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

3

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

3

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

1999

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

3

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

3

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

3

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

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4.3.

Secondary Health Care: Hospital Utilization:

3

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

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

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

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4.3.2. Bed Occupancy and Average Length of Stay:

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

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

3

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

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4.4.

Pediatrics (Child Health) Services:

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4.4.1.

Findings & Outputs:

3

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

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Graph (10) showing trend of utilization of hospital utilization in pediatrics in the provinces Graph (11) showing trend of bed occupancy rates in pediatrics by provinces & NRH:3

3

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

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4.5.

OBSTETRICS & GYNAECOLOGY SERVICES:

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

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

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

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

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

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4.6. Access to Essential Drugs:

3

4.7. Health Infrastructure development:

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Tabel (23) : Level of Health infrastructure:

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SECTION V: HEALTH IMPROVEMENT SERVICES: 3

5.1.

THE HEALTHY ISLANDS, HEALTH CITY, INITIATIVES

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5.2.

Morbidity and Mortality Reduction:

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5.2.1.

Overview:

3

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

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5.2.2.

Infant Mortality:

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

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5.2.3.

Acute Respiratory Infection (ARI):

3

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

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

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5.2.4.

Diarrhea:

3

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

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

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5.2.5.

Red eyes ( infections):

3

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

3

5.2.6.

Yaws:

3

Graph (24) showing incidence of Yaws in SI

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

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5.2.7.

Ear infections:

3

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

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15.2.8. Vaccine preventable diseases:

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5.2.8.1. National Disease Surveillance:

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Graph (27) showing incidence of vaccine preventable Illnesses in SI 1997-99 Graph (28) showing incidence of vaccine preventable illnesses by provinces in 1997-

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99:

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5.2.9.

Sexually Transmitted Infections:

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

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Graph ( 30) showing incidence of STI by provinces:

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5.2.10.

MALARIA:

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5.2.10.1.

Activities & Findings:

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5.2.10.2.

Accomplishments:

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

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5.2.10.3: Incidence in the provinces

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

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5.2.10.4. Diagnosis & Treatment:

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5.2.10.5. Key Issues & Problems Experienced:

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5.2.10.6. Analysis of the Program:

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5.2.11.

TUBERCULOSIS:

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5.2.11.1. Activities (Input):

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5.2.11.2. Findings (Outputs):

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5.2.12.

Mental Health Services

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5.2.12.1.

ACTIVITIES (INPUTS)

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5.2.12.2.

Findings (Outputs):

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Table (A): Total Cases Admitted to

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NationalPsychiatricUnit,Kilu’ufiHospital(only)IN1997,1998,&1999.

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5.2.12.3.Analysis:

3

5.2.12.4.

Major Issues/ problems & recommendations:

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SECTION VI: ENVIRONMENT HEALTH SERVICES:

 

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6.0. HEALTH AND ENVIRONMENT

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6.1. General protection of the environment

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6.2. Air (pollution)

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6.3. Water quality

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6.4. Solid waste disposal

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6.5. Food safety

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6.6. Housing

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6.7. Work place

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6.8. Water supply and sanitation

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6.8.1. Indicators

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6.8.2. General

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SECTION VII: HEALTH PROMOTION & EDUCATION:

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7.0. Overview:

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7.1. Community Health Education Activities 1997-99:

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7.2. Evaluation of health education & promotion programs:

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SECTION VIII: REPRODUCTIVE HEALTH AND FAMILY PLANNING:

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8.1.

Maternal Mortality:

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Table (23) showing Maternal Mortality Rate/ 100,000 births Table (24) Maternal Deaths by Provinces 1996-1999 (excluding those in the

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hospitals):

3

Table (24) Proportion of Total deaths by National and Provinces (ie. No. of. maternal

deaths / total deaths reported by Clinic Monthly Reports in %:

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8.2.

Family Planning:

3

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

100):

3

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

3

Table (26) % Supervised deliveries:

3

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

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

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Table (28) FERTILITY RATES BY PROVINCES FROM 1997 TO 1999 (births/ 1000 popWCBA

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SECTION IX: DEVELOPING PARTNERSHIP

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9.0.

Overview in brief:

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9.2.

Involvement of International developing or donor partners:

3

ANNEXURE

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

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

3

ANNEX Table(3):TotalCasesAdmittedtoNationalPsychiatricUnit,Kilu”ufi Hospital (only) 1997,1998 & 1999:

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

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

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

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Message From The Minister of Health

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

performing as well as it could? The answer to the questions entails the concept and principles behind this National Health Report Review, which focuses on evaluation of the National Health Status of the country for the period 1997 to

1999. This is the second review of the health services following The Comprehensive Review of Health Services Report in March 1996.

I am very pleased and would like to

Report in March 1996. I am very pleased and would like to acknowledge the efforts by

acknowledge the efforts by the Undersecretaries and

the divisional heads in compiling and providing information for the report. The reporting period of 1997-99 was the most difficult years for the Ministry in delivering health services to the people of the country. The major external factors that affectedthehealthsystem’sperformanceweretheeconomicdownturn,whichwas

severed by the twenty months old ethnic tension. Nonetheless, primary and secondary health care services continued despite difficulties. The report shows that key health indices such as the infant mortality and maternal mortality continue to improve. Naturally, the part of the reason for the improvement is attributed to the performance of the health system of the country. Let me make myself clear that I am neither bias in my statement nor I am compliancy. It is because there are many areas of weaknesses within the health system revealed by the report. And one particular example is the need for us to improve on our capacity to monitor and evaluate our own performances. In this report we have used objective reports from external sources such as WHO annual reports.

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

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

and strategies of the National Health Policies and Development Plans 1999-2003. The report also evaluates the health status against the key performance indicators in the NHPDP. However, due to lack of appropriate data and information the report is not able to evaluate all important indices against the objectives in the NHPDP. This is an issue itself to look into in the near future. The National Health Annual Review is a milestone in a long-term process. The measurement of health systems will be regular feature of annual health reports. Some important conclusions are clear from the report:

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

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

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

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

Hon. Allan Paul, MP Minister of Health Solomon Islands

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i. INTRODUCTION

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

The purposes of the report are;

To report and evaluate health activities of 1997 to 1999.

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

To evaluate specific health services delivery packages.

Source of information for the purpose of (strategic) management and supervision, planning and monitoring of health services delivery. (Identify priority key health issues and problems through trend and pareto analysis, in order for strategic planning for improvement)

Report on the national (and provincial) population health status

Section 1 concerns with the external social changes in relation to geography of the country, demography, socio-economy, and politics, which had significant impact on the health sector in the period 1997-99. Section 2 review the changes within the health sector (Internal Review Report), in relation to health care referral system (structure), distribution of services by health facilities, human resource, and health financing. It also covers issues relating to management and supervision, and the organizational structure. Section 3 evaluates (policy 1), which aimed at improvement of health services planning, management and supervision. Section 4 evaluates (policy 2), which looked at accessibility, quality of care and quality of health services delivery. Section 5 evaluates health improvement programs. Section 6 evaluates (policy 4) trend of morbidity and mortality reduction. Section 7 evaluates (policy 5) environment health services. Section 8 evaluates (policy 6) health promotion and education. Section 9 evaluates (policy 7) reproductive and family planning. Section 10 evaluates (policy 8) development partnership in health development.

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

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SECTION I: GENERAL INFORMATION

1.1. Land (geography of provinces/ SI)

The effective delivery of health care is affected by the geographical nature of the Islands. Solomon Islands has a total land area of 28,369 sq. km from a sea area covering 1,632,964 sq. km. It is a widely scattered archipelago of rugged mountainous islands and low lying coral atoll, stretching over some 1,667 km in a southeast direction between Papua New Guinea and the Republic of Vanuatu, and North-East of Australia. On the Islands the location of villages are scattered. Many live along the coast, some inland with sea access and others live inland with limited access to the sea or road. It was found that majority of villages in the country (52.0%) were situated in the coast, 32.9% live inland with no sea access, whilst 15.0% lived inland with sea access. Theses factors determines as well as undermine the plans put in place to deliver health care service delivery efficiently to the remote people, particularly those living more than 3 kilometer from a nearest health clinic.

living more than 3 kilometer from a nearest health clinic. Geography factors have caused threats to

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

1.2. The demography (Population):

1.2.1. Size & Growth:

The population of the country is a major concern to the health care services. Especially with regards to the distribution of limited health resource to meet the vast health

Table (2): Demographic Trends 1995 - 1999

 

Year

1995

1996

1997

1998

 

1999

 

Population

395848

409939

425488

44184

45938

Projection

0

0

S

MHMS

i

f

1986 C

Th

P

l

i

fi

f

 

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

Solomon Islands has a population annual growth rate of 3.5%, a total fertility rate of 6.1, crude birth rate of 42 per 1,000 per year, and crude death rate of 10 per 1,000 (1986

census) 1 .

respectively.

population in 1997 and 1999 was 425,488 and 459,380

The estimated

1.2.2. Age-group Composition:

Solomon Islands has a young population structure with 43.6% (1996 estimate) of total population in age-group 0-14 years. The number of children 0-4 years continue to increase but at a declining rate. The population of female of childbearing age considerably increases in the past ten years with more children entering adulthood after the 1999 census 2 . The population of age-group 0-14 by 1999 3 fell to 41.5% of the total, which is less than age-group 15-44 with 45.2%. The base of the population pyramid slight shrinks whilst it widen in the middle.

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

Nonetheless, despite this negativism about the trend of demography of the country, there has been some positivism in terms of the natural decline of certain age group. The trend of population is expected to increase but at a declining rate. The growth rate is expected to decline to 2.9 between the period 2000-2050, and further to 2.6 by 2010 4 . Later in the paper the analysis shows that whilst age group of children under 4 yrs increase and puts more pressure to bed capacity of all provincial centers, the trend of WCBA decline giving opportunity for realignment or rationalization of health care services. The variations between the trends of population of children and women of childbearing age (15-49) came about because of declining infant mortality rate and fertility rates.

1.2.3. Population density:

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

Trend of Population Density

1986

2000

2010

1 Statistics Unit, MHMS, 1999.

2 National Census (1999). Take note that the details of the census was not available during the compiling of the report. The majority of the data and infroamtion are based on 1986 estimates.

3 Ibid

4 SPC (2000). Oceania Population 2000, Demography/ Population Program, Secretariete of Pacific Community, Noumea, New Caledonia

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15

16

21

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

1.3. The Economy:

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

The economy grew at an average 5% per year in the first half of the 1990s mostly due to strong growth in forestry, fishery, construction, transport and communications. The economy is dominated by commodity production, principally export of logs, fishing, palm oils and kernels and copra. Per capital Gross National Product was estimated at US$560 in 1992 ranking the country as a Least Developed Country (LDC). Gross Domestic product in 1995 was 7.0% (an increase of 5% from 1993 levels).

The trade balance recorded its first surplus of $47 million in 1995 and $118 million the year after courtesy of the boom in log exports and declining imports. Log exports went from $104 million in 1992 to $221.7 million in 1993 and $366 million in 1996. The persistent trade deficit prior to the advent of the log boom shows the heavy reliance on imported manufactures, machinery, and transport equipment. In 1995 Australia accounted for 41.4 per cent of total imports, Japan 11.8 per cent, Singapore 9.3 per cent and New Zealand 9 per cent. Services payments has been higher than receipts since 1990 although substantially offset by official transfers by the main donors in 1995 and 1996, being the European Union (European Development Fund, STABEX) and Australia (AusAID).

In 1999, the adverse effects of the unrest were partly offset by official transfers from Development Partners. By the end of 1999, the conflict was already having its toll on the economy. The pressure on the economy continued in the first half of 2000 until the coup on June 5 th . The coup only accelerated an already worsening situation in the Solomon Islands economy witnessed since mid 1999. Now however, the important sectors of the economy have been knocked out leading to a substantial weakening of the structure of the whole economy. So the effect of the social unrest on the Solomon Islands economy is much more severe and damaging than any crisis the country had ever experienced in the past. The impact of the crisis on the Solomon Islands is yet to be fully realized. It would take several years before the damage to the economy is fully felt. Likewise, it would take even more years before the economy is restored and rebuilt to its pre tension levels. In some respects, the Solomon Islands society may have changed forever as a result of the social unrest on Guadalcanal.

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1.4. The Health Status by provinces and National:

Table 1

Solomon Islands Basic Health Indicators 1997 to 1999

 

INDICATORS

1996

1997

1999

Number of health facilities

334

252

411

Total Population

410,36

425,488

459,380

Population <1 year Population 1-4 years Population women 15 49 years Population annual growth rate Population density Life expectancy Infant Mortality/1000 live births Under 5 Mortality rate/1000 Maternal Mortality

15,209

15,772

56,432

58,516

87,294

90,486

3.5 in 86 [i.]

3.3 [ii]

14

15

16

 

M-62, F-64

67 in 1976

38 in 1986

28 [iii]

26 in 1995 [iv.] 549 in 1986

209

Rate/100,000

 

Total Fertility rate/WCBA(15-

6.1 in 1986

4.7*

49)

GNP (USD) %GNP on Health Expenditure per health Doctor per population R/Nurse per population Population access to safety water Population access to proper sanitation Contraceptive prevalence [iv.] Ante-natal coverage [iv.] Supervised delivery [iv.] Birth <250g [iv.]

870

11.6

11

65% in 1995 [iv.]

70% [vi.]

9% in 1996 [vi.]

25% in 1995 92% in 1995 85% in 1995

20%

Expected births [v] Total deaths [v] Total Births [v]

17,235

17,868

863

884

7,235

7,360

Maternal Deaths [v]

8

5

%

Family Planning Coverage

7.7

8.5

[v]

% Antenatal Coverage [v]

74.4

68.9

% Postnatal Coverage [v]

36.6

39.9

% Detected malnutrition [v]

1.6

1.5

Touring Satellite Clinics [v]

2,309

2,068

Touring Schools [v]

890

720

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Village Health Meetings [v]

1,600

1,767

EPI [v]

- BCG

58.1 %

69.4 %

- Measles

63.8 %

65.2 %

- DPT3

71.9 %

68.6 %

- TT2 + Booster

56.1 %

54.8 %

- Polio 3

69.0 %

69.2 %

- Hepatitis B 3

68.3 %

69.6 %

- DPT1 / DPT3 drop out

4.6 %

5.3 %

- BCG / Measles drop

- 9.8 %

6.0 %

out

Sources: [i.] 1986 National Census [ii] WHO World Health Report 2000, Annex Table 2 Basic indicators for all [iii] 1999 National Census [iv.] TheStateofWorld’sChildren2000,UNICEF,NewYork [v.] EPI figures are from the Health Information system, Statistics Unit MHMS 5i [vi.] RWSS/MOH Report (2000).

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

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

westernized, with sedentary habits and diet. This is reflected in an increasing rate, albeit relatively undocumented, of diabetes, hypertension, obesity, cancers and respiratory

diseases.

This

in

turn has implications for resource utilization as the demand increases for long- term care, tertiary
turn
has
implications
for
resource utilization
as
the
demand
increases
for
long-
term
care,
tertiary
interventions
and
costly technologies.
The
MHMS
is
committed
to
preventing disease,
protecting
life
and
promoting
healthy
lifestyles
and
choices.
The
National
Health
5 EPI figures used in the table are recorded by the HIS monthly reports. A verification report was done
in Malaita 1999 to encountered under and over estimation reporting.

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======================================================= Policies and Development Plan 1999-2003 articulate a systematic approach to further developandstrengthentheMinistry’scapacityandcapability.

SECTION II: INTERNAL REVIEW REPORT

2.1. Regional (Provincial) Service Distribution;

2.1.1. Type of Services;

Table (1) : The Health Care Referral System

Level

Authority

Institution

1996*

1999

6

National

National Referral Hospital

1

1

5

Provincial

Provincial Hospitals

7

9

4

Area Council

Area Health Center

14

23

3

Wards

Rural Health Clinics

123

95

2

Wards

Nurse aides Posts

61

129

1

Village

VHW Posts

128

154

Total

334

411

Source: *The Comprehensive Review of Health Services Report, 1996, MHMS, p.3.

Smaller hospitals such as Tulagi, Lata, Kirakira, Buala, Helena Goldie, Atoifi and Sasamuga Hospitals offer slightly lower level of service than bigger hospitals like Gizo, Kiluufi and National Referral Hospital in Honiara. The levels of (health care) services are delineated by the draft Guide to Role Delineation of Health Care Services in Solomon Islands 6 . However, the Guide document is to be further developed into a meaningful resource management.

Primary health services are primarily delivered at community level both at the urban and rural areas. Accessibility of health services has improved with the upgrading of health facilities and establishing additional through out the country. Approximately 70% of rural communities are within an hours walking distance from a health facility (The Comprehensive Review of Health Services Report, March 1996). Health facility to population in at least 50% of the provinces in 1996 was 1:800 compared to 1,131 in

1992. About half of the population (national average of 53.7%) lived within 3 kilometers

from a health facility (1996). However still a sizeable population lived more than 5 km away (19.4%). The majority of people (58.2% Nat. aver.) walk to health facilities and therefore the cost to them in monetary terms is negligible. Nevertheless, remote provinces such as Temotu and Choiseul are vastly affected by distance and cost of travel to nearest clinic respectively.

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

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======================================================= From table (3), the number of health facilities has increased by 23% (77 additional facilities), which implied that 26 facilities have been established per year in the three periods 1997 to 1999. The increase is seen with Area Health Centers, Nurse Aide Posts, and Village Health Aides.

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

2.1.2. Distribution of Services:

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

 

Chart (1) Showing Distribution of Health Faciltites by Provinces

 
 

Temotu

Choiseul

 

Makira Ulawa

3%

9%

11%
11%

Western

20%

Choiseul

Western

Isabel

Central Islands

Guadalcanal

Malaita

Malaita

29%

Isabel

10%

Central Islands

 

Makira Ulawa

Temotu

 
 

Guadalcanal

9%

9%

Majority of basic health facilities are based in bigger provinces with larger populations (such as Malaita, Western, Guadalcanal, so that basic health care services are within the reach of the people. However, the level of services

differs between areas. Higher level of service are available at the Central Hospital Honiara, which the

National Referral Hospital. This is achievable when the need arises through the referral system or travel to Honiara at own will.

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

 

1997

1998

1999

Provinces

No.

of

Clinic:

Nurse:

No.

Clinic

Nurse:

No. of

Clinic:

Nurse:

.Clinics

Pop

Pop

of

.

: Pop

Pop

Clinics

Pop

Pop

Facilitie

clinic

s

s

Choiseul

21

998

1,311

24

900

1,200

24

926

890

Western

38

1,609

-

38

1,637

1,016

38

1,707

1,201

Isabel

28

716

717

28

740

609

28

763

668

Central

31

725

1,604

31

746

1,445

31

767

1,321

Islands

Guadal.

20

3,928

2,806

21

3,902

2,826

21

4,070

2,442

Malaita

56

1,833

1,488

56

1,875

1,500

56

1,926

1,477

Makira

28

1,119

1,045

28

1,160

984

28

1,201

909

Temotu

12

1,613

745

12

1,656

686

12

1,705

758

Honiara

8

8,314

2,293

8

8,954

2,311

8

9,643

2,488

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=======================================================

Ren Bell

3

803

482

3

826

413

3

850

425

Solomon I

245

1,737

 

249

1,774

 

249

1,845

 

* not including VHW posts ** Registered Nurses only

2.2. Internal Structural and management Issues:

In short, the major internal problems are as follows:

The inability to adapt to environmental changes and, to manage and cope with change.

Financial sustainability

Institutional sustainability

Ineffective and inefficient management of health resources.

Ineffective implementation of health programs and projects

Quality assurance

2.2.1. Organizational Structure:

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

Internally there is confusion between policy and operational roles, between statutory and ministerial obligations. The job descriptions are ill defined without much performance indicators and proper staff appraisal in a consultative and learning incentives, which would be helpful in performance management of departments and individual. Having going through the structural difficulties with financing of health care services, training and development of health workers, recruitment and appointment, and disciplinary actions, it raises the question; whose values do we (public servants) exists? Is it the rules and procedures that matter? Or is it our customers? Our local population? These questions need answer that concerns with accountability and external autonomy to the Ministry of Health. Or even to other sister ministries. The existing health structure and its relation with the public service needs careful review and changes.

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Figure1showingtheexistingorganization’sstructure: Ministry of Health: National and Provincial level:

MINISTER

Permanent Secretary

NATIONAL LEVEL

Undersecretary Health Care

Health Care / Curative Health Services Paradigm

PROVINCIAL LEVEL

CAO Supporting Services Administration Accounts
CAO
Supporting Services
Administration
Accounts
Undersecretary Health Improvement
Undersecretary Health Improvement

Health Improvement & Protection Paradigm

Curatve Health Services

Provincial Health Services

Health Improvement & Protection Programs
Health Improvement & Protection Programs

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

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

2.2.3. Activities (Inputs):

The Health Strategies of the Ministry is stipulated under the National Health Policies and Development Plans. Whilst the specific programs and activities are in the individual work plans. These activities and programs are funded by the Health Recurrent Budget from the Government as wells as grants and external financial sources from international developing partners.TheMinistry’sefforttosustaintheminimalreasonablelevelofcaretothepeople of the country supported by the limited resources of health workforce, financing and infrastructure.

2.2.4. Findings (outputs):

There were two changes to the Minister of Health during the report period. In mid 1997 around August, the Ministry had a new Health Minister (Hon. Dickson Waraohia, MP for East AreAre) He is a member of the national coalition Government by the name of Solomon Islands Alliance For Change (SIAC). After two and half years, a reshuffle took place, which took effect January 2000. The then Health Minister was Hon.Dr.Steve Sanga Aumanu, MP for Baegu Asifola, Malaita Province. The Ministry official changes its name from Ministry of Health and Medical Services to MINISTRY OF HEALTH in 1999.

Bills and

1997

1998

1999

Cabinet Papers

1.Parliamentary

     

Bills

(a) Passed

1.Pharmacy

   

Practitioners

Act

(Amendment

 

2.Pharmacy &

   

Poisons Act

(Amendment)

 

3.Pure Food

   

Act

 

4. Nursing

   

Council

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Amendment

   

(1997)

(b) Draft Stage

1.Mental

 

2.Tobacco Products Control Bill (draft)

Health Act

 

(proposed

 

amendment)

2.Cabinet Papers

Not available

1.Indicative Health Sector Program on Development Stategies 1997-2001. (23.3.98,

1.Revised Local Supplementation Scheme (LSS) for foreing doctors employed by the S.I.G. (10.2.99,

Cab(99)15).

Cab(98)59).

   

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

11-12.2.98,Canberra,Aust.

2.

Submission for

5% increase of SDA to Operating Theatre & Eye Nurses in the country. (18.2.99,

(22.4.98, Cab(98)83N).

Cab(99)16

   

3.

MHMS to have its own

3.

Report on the

transport servicing & pooling system. (28.4.98, Cab(98)87).

Study Tour to Japan

& Brisbane by Minister of HMS.

 

(30.4.99,

Cab(99)64I).

   

4.

Decision to terminate

4.The impact of the current ethnic tension on the Hospital services at the Central (National) Referral Hospital. (27.7.99,

Cab(99)89).

Solomon Islands doctors with SIMA Medical Centre from Public Service be withdrawn and direction to resolve the issues. This matter was deferred but never discussed again. (28.4.98, Cab(98)88).

     

5.

The MHMS 5

year National Health Policies and Development Plan 1999-2003). (27.7.99,

Cab(99)113

     

6.

Report of the

Review and Restructuring of the MHMS as part of the phase two of the public sector reform

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=======================================================

program. (2.8.99,

Cab(99)120).

7.Proposed

Solomon Islands

Health Sector

Development

Project. (15.9.99,

Cab(99)159).

8.Solomon Islands Health Sector Development Project Previous Paper. (13.10.99,

Cab(99)159.

Early 2000:

Reform in the Health Sector Assisted by AusAID, (22.2.00,

Cab(99)231).

Change of name from the Ministry of Health & Medical Services to MINISTRY OF HEALTH (MOH) (29.2.00, Cab(99)27).

2.3. Health Financing & Budgeting and Resource Allocation Factors:

The national government provides the major source of (recurrent) funding for health services at both the provincial and central levels. Successive governments have always considered health services as an important political priority and a right of its citizen. This has been reflected in the high proportion of government allocation to health.

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

Year

Total Govt. Rec.

Health Rec.

Share to

Health

Per

 

s

Budget SBD$M

Budget

Health

Revenues

capitaSBD$

SBD$M

(%)

SBD$M

1988

101.2

12.7

12.5

0.1

Nominal

Rea

l

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=======================================================

1989

125.2

14.8

11.8

0.2

42.5

27.

5

 

1990 146.6

18.3

12.5

0.2

47.9

27.

2

 

1991 162.8

20.5

12.6

0.2

57.4

29.

9

1992

208.8

24.3

11.6

0.2

62.4

28.

 

1

1993

231

26.9

11.6

0.2

71.7

28.

9

1997

412.5

48.8

11.8

 

76.8

28.

4

1998

532.5

54.3

14.4

     

1999

441.0

56.7

16.3

     

Source: Account Section, MOH (2000.

 

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

 

Sections

1991

 

1992

1993

1994

1995

1997

1998

1999

 

Total

11901.1

 

15907.

16758.

24525.

23776.

     

Central

8

9

1

8

Total

6632

 

6994.4

8180

10044.

14928.

18963.

21209.

21306.

Province

 

2

3

6

2

1

Total

185331.

 

22307.

24939.

34569.

38705.

31290.

34070.

35439.

National

1

2

3

3

1

5

1

6

%Provincial

35.8

 

28.7

32.8

29.1

39.6

37.73

38.36

37.21

%Central

64.2

 

71.3

67.2

70.9

60.4

62.26

61.63

61.89

% National

100.0

 

100

100

100

100

100

100

100

Source: Account Section, MOH (2000).

One of the fundamental problems contributing to the management of finance is the lack of appropriate mechanisms or technology to monitor and evaluate the performance management of the health budget. It is almost impossible to measure both the operational and the impact of the health care services at the central and provincial level. Item budgeting ratherthan‘outputbased’budgetingisapplied.Thebudgetstructureisdrivenbythe DepartmentofFinance’sobjectivesmorethanprovidingopportunityforbigspenders like health to be accountable in cost saving incentives and cost-recovery. The health budget therefore does not reflect the health care services, so as the allocation of resources in the health sector 7 . To reflect the above argument the National Referral Hospital alone consumes significant portion of 28.3% of the total health budget in 1999, followed by Ministry of Health Headquarter 15.2%, Pharmacy services (drugs & equipment covered here) 12.2%, whilst 10 provinces (including Honiara City) accounts for 37.21, which is SI$52 (USD10) per-capita in province (excluding drugs costs). The level of health services grants

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

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

DespitetheGovernment’scommitmenttohealthasreflectedbyanincreaseto16.3%of

total government budget from previous years, there is the need to review the issue of health financing and management of health care delivery, particularly at the NRH. The Government in its Solomon Islands Policy and Structural Reform in 1997 set the direction towards increasing proportion of the recurrent health budget to community and public health programs, provincial health services, environmental services, and health education and promotion.

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

 

HEALTH EXPENDITURE (%)

 

PER CAPITA HEALTH EXPENDITUR

untries

Total

Public

Private expendit

ure as % of total

Out-of-

Public

Total

Out of-

Total

Public exp

-iture in in

expendit

expenditur

pocket

expenditur

health

expenditur

e at official

pocket

expenditur

Expendit

ure in

e

as % of

expendit

national

ure on

total

health

expenditur

e

as % of

ure on

exchange

e

internatio

dollars

as% of

e

on

health expendit ure

total

health as

rate

at official

nal dollars

GDP

health.

expenditur

% of

rate

e

on

total

 

health

public

expendit

ure

stralia

7.8

72.0

28.0

16.6

15.5

1730

287

1601

1153

ew Zealand

8.2

71.7

28.3

22.0

12.7

1416

312

1911

999

ji

4.2

69.2

30.8

30.8

8.3

115

35

214

148

lomon

3.2

99.3

0.7

0.7

5.2

19

…….

83

83

ands

G

3.1

77.6

22.4

22.4

7.5

36

8

77

59

anuatu

3.3

64.3

35.8

35.8

9.6

47

17

85

55

Normal type face indicates complete data with high reliability Italics indicate s incomplete data with high to medium reliability

datanot

available

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

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

8 Approved Recurrent Estimates and Solomon Islands Government Budget.

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======================================================= is; Are we doing better we the current share of 3.2 % of the GNP? It is evident later in the report that by WHO standard to some extend, Solomon Islands health system has a cost-effective delivery package through the primary health care approach. It is assumed and implied here then that we are utilizing the limited input of financial resources and transforming it into higher level of performance on health. This is not saying that the internal structure and functions of the health system is perfect. As the report will reveal later there are numerous health issues and problems related to structure and function needs to be reviewed and addressed.

2.4. Management and Supervision:

The foremost important health issue in the period of 1997-99, is the lack proper and detailed monitoring and evaluation of health care service delivery. This is partly due to lack of appropriate health management information, and lack of skilled manpower and facilities (technology). Productivity and financial performances has never being careful monitored and done, therefore problem solving and strategic planning is difficult. Proper accounting data for financial management is lacking or inadequate. The budget is far from a reflection of the health services delivered. There is no cost-sensitivity or incentives in placed. The budgeting procedure is traditionally cost-based. There is need to improve the financial management system at the central ministry and hospital levels. Health policies are not evaluated seriously. There is no evidence based policy development.

There is no mechanism in place to access whether human resource for health is meeting the requirements of the country in terms of defined needs. It is difficult at this point in time to have proper needs-analysis result because of lack of trained personnel and logistic support facilities such as efficient health information system. Staffing of services and facilities is often the basis of personnel deployment in the Solomon Islands.

2.5. Status of Health Care Services Delivery:

The Comprehensive Review of Health Services in 1995-96, made attempts to evaluate the current status of health care service delivery in Solomon Islands, highlighted some concerns and weaknesses as well as strengths. About 59.7% of the respondents found that health facilities are located conveniently for them. It was noted that patients wait longer (1-2 hr.) Honiara Clinics than provincial clinics (< 1hr). Malaita, Isabel, Makira and Rennell & Bellona wait only for 15 minutes. Therefore waiting hours is an issue for urban hospitals and clinics to address. The presence of a health worker at the health facility at the time of patient presentation ranges from 63.7 to 88%, the lowest in Makira. Generally with the existing health care service network, more than half, 61.8% (national average) satisfied with the waiting time. It is also noted that most patients in Honiara (55.6% respondents are not satisfied. Although majority of 81.2% is satisfied with attitudes of health workers, it is a concern still in Makira, Temotu and Honiara. Despite difficulties, 65.5% are satisfied with availability of medicine whilst sizable population of 31.7% are dissatisfied. The logistics of

26

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

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

The shortage of local doctors is an ongoing concern. Of the 31.4% wanted to see a doctor at first presentation only 1.2% actually saw a doctor. This implied that many people are moving towards a higher level of service. The demand to see doctor will increase. Whilst the number local doctors graduating from medical schools in Fiji and Papua New Guinea increases, retaining them within the public sector will become a health care management issue.

2.6. Distribution of Health Care Workforce;

The rural population of eighty seven percent is currently served with a small proportion of relatively less qualified health workers especially in clinical areas and diagnostic services. In 1999, 70% of the health work force is in the provinces and the Honiara City, engaged in primary health care. With the increasing need to decentralize more specialized services along with the need to improve quality of care, it is seen that hospital based services require improvement. About twenty four percent (24.3%) of the total health work force is in the National Referral Hospital. However, deployment of qualified well-trained health workers and professionals centrally biased with 59.5% of the total qualified well-trained health workers in the Central Hospital. More than seventy percent (72.9%) of total number of doctors in Solomon Islands are located at the National Referral Hospital. In relation to registered nurses, 32.5% of nurses are also in the NRH, while 67.5% are in the provinces including HCC. Nevertheless, there is hospital-bias in relation of deployment of Registered Nurses in the provinces by more than half (59.2%), excluding CIP, GP, CP, and HCC who are without public hospitals. It is the universal picture that the nurses constitute the major component of the health workforce. The implications are the need to strengthen the primary health care in terms of human resource development.

2.6.1. Shortage and management of health workforce:

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

27

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

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

 

NRH

W.P

M.P

I.P

C.P

TP

MUP

G.P

CIP

RBP

HTC

Total

General

0

0

0

1

1

0

1

0

0

0

0

3

Surgery

Orthop

1

                   

1

ed.

Paediatr

0

0

0

1

1

1

1

1

0

0

0

5

i

Obst&

0

0

0

1

1

1

1

0

0

0

0

4

G.

Int.Phy

2

1

1

1

1

1

1

0

0

0

0

8

si

Radiolo

0

                   

0

g

Patholo

1

                   

1

g.

Anaesth

1

1

1

1

1

1

1

       

7

Eye

0

                   

0

Psychiat

0

0

1

0

0

0

0

0

0

0

0

1

rist

A&E/

3

2

3

1

1

1

1

1

1

1

1

16

GP

Manage

0

1

1

1

1

1

1

1

1

1

1

10

r/CEO

Total

8

5

7

7

7

6

7

3

2

2

2

56

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SECTION III: HEALTH SERVICE PLANNING, MANAGEMENT AND SUPERVISION:

3.1. Management & Administration:

Health services is predominantly centralized in terms of overall health policy development, planning, management, training and evaluation of health services. Implementation of the National Health Policies is being left to respective divisions and departments that made up the Ministry of Health. However, MOH is trying its best to do away with the above management approach and to empower the heads of department and middle managers to play more part in decision making in areas of management, planning, monitoring and evaluation of health services. In enabling that to work the fundamental basic structure must be conducive. Roles of job descriptions of staff must be understood and clarified. It is a difficult task. However, contingency plans were made since 1997. In this report below subsequent feedback is made actions taken to achieve the objectives. TheMinistry’sPolicy Goals is to improve the capacity of the ministry to plan, implement, and evaluate the health services in the country.

3.1.1. Activities (Input) & Output:

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

Priority Areas

Input (Strategies)

Output

1997

1998

1999

Indicators

1.National

1.1.National Health

The national health indicative strategies were produced by the MOH.

accomplished

   

Health Policy

Indicative Strategies

Developments:

 

1.2.Medium Term

The MTDS was formulated with participation of MOH and all other Ministry

accomplished

   

Development Strategy

 

1.3.National Health

Sequent of events leading to the final draft of the NHPDP

Review

Senior Health Officers Conference met in August 1998

Finalization of draft. Printing of the document is delayed.

Policies and

Or situational

Development Plans

analysis done

1999-2003

2.Health Sector

Reform

2.1.Restructuring MOH -

Restructuring the health sector so that it becomes efficient and effective in the delivery of health services. Main focuses on

   

-An institutional strengthening project completed and submitted to the Multidevelopment partners meeting held in Honiara.

-An ADB

-Institutional

consultant, Mr.

strengthening

John Izzard,

project.

reviewed the

MOH Budget

-Draft

structure.

Restructured

MOH.

-A NZ

-Revised staffing

 

consultant

structure.

-Draft

reviewed the

-Revised budget

restructuring

Health Care

[1]

structure.

document

Legislation. Joy

29

Ministry of Health

National Health Report Review

Evaluation of Health Status 1997-99

30 of 122

=======================================================

 

institutional

-Revised Health

 

completed but

Liddicoat

strengthening

Care Legislation

needs further

(September

- [2] Staffing

refinement and

1999).

restructure

modification.

- [3] Budgeting

The health sector’s intention to restructure was approved by the Cabinet.

restructure

- [4] Health

care

legislation

review.

- Review

 

functions, job

descriptions,

activities

involved,

work load

analysis.

3.

3.1.-All posts filled with appropriate qualified staff. -Office automated & equipped. -Training of staff

-All posts filled. -Office automated. -FMS -RAF. -Regular financial reporting.

Not

Not accomplished

Not

Strengthening

accomplished

accomplished

theMHMS’

capacity to

plan, budget,

evaluate,

monitor and

 

-

evaluate health

services

delivery

 

3.2.Establishemnt of

-Properly structured financial management system and guideline on monitoring and cost analysis and budgeting and resource allocation. -Monthly financial reporting by accounts section. Regular (annual) National health Financial reporting and cost analysis. -Development of a appropriate resource allocation formula based on demand, needs and population

Not

Not accomplished

Not

proper Financial

accomplished

accomplished

Management System

 

3.3.Strengthening of the health information system by improving coordination and integration of information data, and software. Expand hospital- inpatient data.

-Accurate and

-Response

(a)

79.1%

 

(a)

76.7%

timely reporting

rate from

(b)

91.2%

(b)

87%

(response rate.

clinics: (a)

   

-Hospital-

78.8%,

information