Annual Report Gp4

Annual Report -2000

Guadal Canal Province II Om-Shri II

GOVERNMENT OF THE SOLOMON ISLANDS Ministry of Health and Medical Services

ANNUAL REPORT - 2000

Health & Medical Services Guadal Canal Province By:

Dr.H.K.Balachandra Director of Health & Medical Services

March 31, 2001

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“Safe Blood starts with me” WHO Slogan for the year - 2000

"Safe Blood starts with me" - WHO Slogan for the year -2000

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Guadal Canal Province

Solomon Islands

Hon’ble Minister for Health,

Mr. Allan Paul

“Commitment from the community and their participation towards "Safe Blood starts with me" - WHO Slogan for the year -2000

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health service delivery is the need of today” Table of Contents 1

PREFACE...................................................................................................................................................... 6

2

ACKNOWLEDGEMENTS.............................................................................................................................. 7

3

EXECUTIVE SUMMARY............................................................................................................................... 8

4 PART I-INTRODUCTION............................................................................................................... 9 4.1

Solomon Islands.........................................................................................................................................................10

4.2 Guadal Canal Province.............................................................................................................................................11 4.2.1 Population............................................................................................................................................................11 4.2.2 Socio-Economic Factor.......................................................................................................................................14 4.2.3 Natural Environment:..........................................................................................................................................14 4.2.4 Political environment:..........................................................................................................................................14 4.2.5 Ethnic Crisis........................................................................................................................................................14 4.2.6 Health Status........................................................................................................................................................15 4.3 5

Provincial Health System:.........................................................................................................................................17 PART II -RESOURCE ANALYSIS............................................................................................................... 19

5.1 Health facilities..........................................................................................................................................................20 5.1.1 Introduction.........................................................................................................................................................20 5.1.2 Health Centres:....................................................................................................................................................20 5.1.3 Existing Health Facilities:...................................................................................................................................20 5.2 Health personnel........................................................................................................................................................21 5.2.1 Organisational Structure......................................................................................................................................21 5.3 Nursing Management................................................................................................................................................23 5.3.1 Clinic Nurses GPHQ / Referral Health Centre....................................................................................................23 5.3.2 GP Referral Clinic at National Referral Hospital................................................................................................23 5.3.3 Supervisory Tour/Training Workshops................................................................................................................23 5.3.4 Impacts of the Ethnic Tension.............................................................................................................................23 5.3.5 Costing Containment Strategies..........................................................................................................................24 5.4

Wages and service Grant..........................................................................................................................................27

5.5

Expenditure................................................................................................................................................................27

6

PART III-PRIMARY HEALTH CARE ELEMENTS.......................................................................................29

6.1 Treatment of common diseases & injuries..............................................................................................................30 6.1.1 Out Patient Services.............................................................................................................................................30 6.1.2 Emergency services.............................................................................................................................................30 6.1.3 Psychiatric Health Programme............................................................................................................................30 "Safe Blood starts with me" - WHO Slogan for the year -2000

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6.2 MCH and Family Planning activities.......................................................................................................................30 6.2.1 Introduction.........................................................................................................................................................30 6.2.2 Women’s Right....................................................................................................................................................30 6.2.3 Women's Reproductive life and Sexual health....................................................................................................31 6.2.4 Organisation of the MCH/FP unit........................................................................................................................31 6.2.5 Total Number of Health Promotion & Disease prevention activities..................................................................31 6.3

Expanded Programme of Immunization.................................................................................................................37

6.4 Health education........................................................................................................................................................38 6.4.1 Health education..................................................................................................................................................38 6.4.2 Training / workshops...........................................................................................................................................38 6.4.3 School Health Education.....................................................................................................................................38 6.4.4 Community Information Education communication...........................................................................................38 6.4.5 Campaigns...........................................................................................................................................................38 6.4.6 Health Committee and Implementation...............................................................................................................39 6.4.7 Audio Visual Aid Production...............................................................................................................................39 6.5 Provision of essential drugs......................................................................................................................................39 6.5.1 NGO-World Vision..............................................................................................................................................39 6.6 Control of communicable diseases...........................................................................................................................40 6.6.1 Malaria: Vector Bourne Disease Control Program..............................................................................................40 6.6.2 Tuberculosis Situation.........................................................................................................................................46 6.6.3 Leprosy Situation.................................................................................................................................................50 6.7

Safe water supply & basic sanitation.......................................................................................................................50

6.8

Environmental Health Division................................................................................................................................51

7 7.1

PART IV-MANAGEMENT & SUPPORT ACTIVITIES..................................................................................58 Administration & Management...............................................................................................................................59

7.2 Human Resource Medical Training Centre............................................................................................................59 7.2.1 Introduction.........................................................................................................................................................59 7.2.2 Training Activities...............................................................................................................................................59 7.2.3 Training Overseas:...............................................................................................................................................60 7.3 Supervisory Tours......................................................................................................................................................60 7.3.1 Introduction.........................................................................................................................................................60 7.3.2 Objective..............................................................................................................................................................60 8

CONCLUSION............................................................................................................................................. 61

9

KEY HEALTH INDICATORS........................................................................................................................ 62

10

ACRONYMS............................................................................................................................................ 63

11

References............................................................................................................................................... 63

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1 Preface The development of health services in Solomon Islands has gone through many stages from the colonial days to the present situation. According to WHO’s Constitution, “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being”. Development has often been described as being concerned with growth and structural change. It has also been referred to as a process or a state or situation where the production goods and services is raised in quantity and quality and the benefits consequent to this improved production is distributed to the most number of people, paying special attention to the less privileged members of society. All over the world the health care situation is characterized by an increasing demand for health services and by decreasing financial resources. Many countries have been forced to redress the balance between the amount they spend and the amount of money they have at their disposal for health care sector. With the advent of these technologies the costs of National health care rise every year, amount over and above the previous years figures, upsetting national health programmes, raising public anger against governments demanding more services and funds. We are at the end of the century and entering a new millennium. The priorities of half a century ago are still remain the same. 25 years ago when the World Health Assembly called for “the attainment by all citizens of the world by the year 2000 of a level of health that would permit them to lead a socially and economically productive life” has come to a reality. In the year 1978 the International Conference in Alma-Ata, declared that Primary health care was the key to reaching that target by the end of the century. The drive for primary health care had been a drive to provide a network of basic health services that were both available and accessible to everyone. Healthy living standards and universal access to affordable health care were the basis on which the campaign for “health for all by the end of century” was built. Primary health care refers to the kind of care that is provided at the first point of contact with the health care system. Thus, it has more to do with the community in which people live than with high-technology hospitals. It means ensuring eight basic elements – safe water supply and sanitation, nutrition, health education, immunization, provision of essential drugs, maternal and child care, prevention communicable diseases, and treatment of common diseases and injuries. Primary health care also refers to the provision of health care that is characterized by equity, intersectoral action, and community participation. "Safe Blood starts with me" - WHO Slogan for the year -2000

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This report is aimed at the health administrators of the health ministry at the national level, and other architects of health system, to provide a clear picture of the strength and weaknesses of the health system in the Guadal Canal Province. Report focuses the performance of the implementation of the health policy and strategies, and the extent to which these policies and strategies have translated into action in the province. Reader will be able to gain an insight of the pattern, trends and health impact upon the population, of the health developmental activities in the province for the year 1998. The overall objective is to draw the attention of the policy makers at the centre, the needs and the priorities of health in the province, so as to facilitate them for their developmental activities.

Dr.H.K.Balachandra Director of Health & Medical Services Guadal Canal Province 31 March 2001

2 Acknowledgements This successful task has been made possible by the efforts and co-operation by the entire staff of Guadal Canal Medical division and Above all I thank the God Almighty for having given this opportunity of presenting this report to the best of my ability. I am grateful to following distinguished personalities:  Hon’ble Ezekiel Alibua – Hon’ble Premier Guadal Canal Province  Mr. Eliam Tangirongo - Provincial Secretary in giving all the administrative support and guiding force in the day-to-day affairs.  Mr.George Maebata -CNO, for all the assistance in the administration through out the year. I will be failing in my duty if I do not acknowledge the following staff: Mr.Batram Manu-PNO and his team Mr.Gabriel Vagi -SNO (Training) and his staff Ms.Alice Watoto SNO Mr.Noel-SNO, Mr.Soram-NO, and all the other nursing staff. Mr.EddyLeamae-SAMO Mr.Aloysis Vakeke-SHE Mr.Leonard Olivera -PHI,Mr.George Titiulu-AHI, Mr.Francis Sade-AHI, Ms.Methoda-HI Mr.Benson Anisi Senior Accountant, Ms.Christina Legumana, Ms.Jane Roy Last but not the least the multipurpose man Mr.John Mupphet Driver.

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My special thanks goes to my close friend Dr.Bharat G Patel, Los Angeles, California, who gifted a Digital Camera, which enabled me to incorporate actual photographs in this document.

Staff of Guadal Canal Province - Medical Division

3 Executive Summary The aim of this report is to diagnose, evaluate, appraise the situation analysis of the prevailing health in the community in the province and its appropriateness of the health delivery system with regard to PHC, and to ascertain the extent to which the national and provincial policies and strategies have been translated into action throughout the province. The objective description of this report from the standpoints of Public Health Management has following features: 1. Performance to indicate how the national health policies and strategies were being implemented, the conditions that facilitated the progress, and various challenges faced by the health providers in the implementation. 2. A current situation of population, health status, health resources and the socioeconomic factors. 3. Trends in the pattern of specific diseases. 4. Community diagnosis The goals of the ministry of health and medical services is to:  Improve health management, supervision, health financing and strategic planning in the health sector. "Safe Blood starts with me" - WHO Slogan for the year -2000

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Reorganize the management structure to enable them to be effectively and efficiently respond to the issues related to the health sector. Achieve an efficient and cost-effective health care service delivery to the populace. Develop multidimensional approach towards integrated health promotional activity.

Part I-Introduction

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4.1Solomon Islands

he Solomon Islands, are an archipelago consisting of six main islands and many smaller ones extending over 1600 kilometres, with a total land area of 28,450 square kilometres, in the South Pacific Ocean, east of Papua New Guinea.

T    

Latitudes: 8:00 South and Longitudes 159:00 East Climate: tropical monsoon; few extremes of temperature and weather. Terrain: mostly rugged mountains with thick vegetation and some low coral atolls. Natural resources: fish, forests, gold, bauxite, phosphates, lead, zinc, and nickel.

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Land use: forests and woodland 88% and remaining distributed for crops, pastures and others. Natural hazards: typhoons, more than the destruction the transportation gets affected; geologically active region with frequent earth tremors; volcanic activity. Environment-current issues: deforestation; soil erosion; much of the surrounding coral reefs are dead or dying. Environment -international agreements: party to: Bio-diversity, Climate Change, Environmental Modification, Law of the Sea, Marine Dumping, Marine Life Conservation, Ozone Layer Protection. Population: 409,039 (1999 Census) Growth rate: 2.8% Birth rate: 36.62 births/1000 population Death rate: 4.21 deaths/1000 population Infant mortality rate: 23.93 deaths/1000 live births

Guadal Canal Island is the main island constituting provincial boundary. The capital town of Solomon Islands-Honiara is situated in this island and constitutes its own town council boundary and its health service delivery for the inhabitants of the town. Honiara is urbanized town with modern road, water supply and electric supply round the clock. The government of Solomon Islands being a member country to WHO, holds itself responsible to cater to its citizen, a simple, effective, efficient, accessible, and affordable (free at the point of delivery) health delivery system based on the principles of Primary Health Care for our country is certainly a matter of great challenge. The Ministry of Health and Medical services through the Director of Health and Medical services, governs the provincial health activities chiefly outside the boundary of Honiara Town council round the island through the network of health infrastructure comprising of health personnel and facilities. Head quarters of Guadal Canal medical division based in Honiara, comprising of semi permanent building situated in a half an acre of land facing the northern coast of pacific ocean. Unfortunately entire building and its contents were destroyed during ethnic conflict between people of Guadal Canal and Malaita. Health service delivery activities to the people of Guadal Canal, largely rural dwellers are carried out with the Government established peripheral centres- 3 Area Health Centres, 13 Rural Health Clinics, and 13 Nurse Aide Posts. National Referral hospital situated in Honiara consists of 220 beds in the various disciplines. Medical, Surgical, Orthopaedic, O&G and Paediatric including Accidents & Emergency department’s functions in its fullest capacity. NRH is also forms a base hospital for Guadal Canal Province, as the province does not have a separate hospital of its own. Besides, serving the inhabitants of Honiara, in and around Guadal Canal, also serves as main referral centre for the other provincial hospital.

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4.2Guadal Canal Province 4.2.1

Population

In 2000, the estimated Guale population was 62,083(Projection based on 1999 Census - Ministry of National Planning and Development). About one third was over 35 years of age. More than 90% of the population lived in rural areas. Population density in Guadalcanal is around 11 persons per square kilometer – a bit lower than the national figure of 13 persons per square kilometer. According to the 1999 Census, the population of Guadalcanal Province iii was 60,275 – a significant drop from the estimated 78,563 cited in the National Health Status report. This reflects both a slowing of population growth due to lower fertility rates but the main impact was from the exodus of Malaitans during the ethnic tension. Estimates of the number of people from other provinces leaving Guadalcanal over the past two years vary, but are in the order of 20,000. The population remains concentrated around the coast, with larger populations in the north.

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Population by wards 1999 Census

East Ghaobata

609 729

West Ghaobata

1338 2601

1240 1361

Malango Vulolo

2716

1292 1424

East Tasimboko

582 650 536 562

1232 1098 2271

1093 1178 515 459

974

Moli 955 1015

Talise

1023 991

Vatukulau

1066 1047

1970 2014 2113 3163

1532 1631

Wanderer Bay

1394 1486

Tangarare

1381 1532

Saghalu

3534

1750 1784

AvuAvu

Savulei

2869

1407 1462

Birao

Duidui

3527

1720 1807

Longgu

Tetekanji

2584

1268 1316

Aola

Valasi

2880 2913 2199

1036 1163

3372

1572 1800

Tandai

0

4832

2309 2523

Paripao

Kolokarako

4105

1874 2231

2698

2000 Male

5970 3272

4000

Female

6000

8000

Total

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Some shifts are known to have occurred after the census, particularly around the time of crisis in mid 2000, but these have not been formally recorded. Population mobility continues, as villages and houses are rebuilt and Honiara returns to a state of ‘normalcy’. Around 1,200 births p.a. were reported in both 1999 and 2000. HIS data from the province show that birth registrations in Guadalcanal increased by 23% between 1999 and 2000. (See table at Attachment 1) These data exclude births at the NRH. While the overall increase is believed to reflect population shifts away from Honiara and a reduction in Guadalcanal Province resident births at NRH, the changes in distribution of births may also indicate population shifts. The low birth rates per 1000 in some wards suggest under-reporting, possibly due to people living in more isolated hill villages. The Guadalcanal Province population, like most of the Solomons is very young, with 42% of people aged 14 years or less in 1999. Women of childbearing age made up 22% of the population. This highlights the importance of reproductive and child health services. The figure below shows the age distribution of the population in 1999.

60+ 45-59 15-44

Females Males

5-14 1-4 0 -

5,000

10,000

15,000

Figure 1: Guadalcanal population age distribution, 1999

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15 Estimated Population Chart

62,500 62,000 61,500 61,000 60,500 60,000 59,500 59,000

62,083

60,275

1999

4.2.2

2000

Socio-Economic Factor

Habitat of the people here are predominantly rural—depend on subsistence farming and, majority live on the coasts, thrive on fishing. Very scarce population lives in the bush up in the highland not more than 1000 feet above the sea level. Diets are composed of various kinds of marine life, and plants such as taro, cassava, yams, breadfruit, bananas, and several other fruits. The coconut palm grows in abundant and an important plantation, as each and every part is put to use. Coconut water is a commonly used beverage, and the milk extracted from the fruit is used for cooking in day-to-day life, and also made use in festivities for making a special kind of pudding. Clothing is typically lightweight, and often is being shared by the contemporaries among younger generation and it is social obligation and a custom. Houses on the islands are typically constructed from sago palm leaves. Education standard is quite low as compared to the any country in the Pacific Islands, and Guadal Canal Province is no exception. Literacy rate in Men <30% and Women <16 %. Low educational and literacy levels affect patterns of use of health services, and limit the impact of health education and information. Occupation is chiefly logging, fishing, Copra, and Cocoa farming, besides subsistence agriculture.

4.2.3

Natural Environment:

Climate is tropical monsoon few extremes of temperature and weather. Cyclone during the wet season supposedly between November and April occasionally account for the destruction, with some geologically active region with frequent earth tremors. Geographical area is mostly rugged mountains terrain with thick vegetation and some low coral atolls. Natural resources are chiefly fish, forests, gold, bauxite, phosphates, lead, zinc, and nickel. Forests and woodland accounts for 88%

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and thus logging is of the main occupation and remaining distributed for crops, pastures and others.

4.2.4

Political environment:

A democratic system of government exists in the center as well as in province. The people elect members of Parliament, as well as provincial members. As Rural Health clinics are tangible and the only activity centre in the villages, which forms a part and parcel of life in the village community, thus the local politicians leverage this factor for the development of health clinics in their constituency.

4.2.5

Ethnic Crisis

Almost 22 months old ethnic conflict finally ended in “Peace” on 15 th of October 2000, in Townsville Australia with signing of peace agreement by the two warring faction in Solomon Islands. Warring militants were ‘Isatabu Freedom Movement’ from Gaudal Canal Province, and ‘Malaita Eagle Force’ from Malaita Province. Gradual occupation of sizable piece of land in Gaudal Canal by the hard working enterprising Malaitans over a long period time led to dissatisfaction amongst the younger generation of people of Gaudal Canal, and hence the dispute for compensation in cash or kind. In the initial stages then emerged a militant group known as Gaudal Canal Revolutionary Army (GRA), began to chase all the Malaitan settlers at the gunpoint from the outskirts of Honiara who were mainly labour oriented people working in SIPL and GOLD ridge mine. In retaliation to this Malaitans formed a MEF and began to drive all the people of GP from Honiara. This led to check-post manned by the two militants group to prevent each other from crossing the border formed by these militants. At several occasions there were exchange of gunfire leading to a total casualty of 70 from both sides. MEF put up a sort of an embargo on the people of GP, in the sense they restricted all services to be carried out by the Government or NGOs. This also affected Health & Medical Services to a large extent in the GP. Militants destroyed the offices of the Provincial Government, including the Headquarters and Clinic of Health services of Guadal Canal located in the heart of Honiara. Eastern side a bridge was damaged and western side a water tank was destroyed putting a loss of potable water supply to the inhabitants of western portion Honiara. Some private properties were damaged and seized at the gunpoint for their use, mainly vehicles and fuel. The capital town of Honiara is located in G Province and largely dominated by Malaitans, practically holding key positions in Government and managing several private enterprise.

4.2.6

Health Status

Malaria remains to be still one of the major causes of the morbidity in the province. Maternal and Child health care needed additional focus of attention. Rise in the Sexually transmitted diseases in young adolescents, unhealthy sexual habits, and unwanted pregnancies were a matter of concern for the rising population of the Solomon Islands. Tuberculosis still remains a cause of concern, despite International support and DOTS strategy.

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2000 recorded 115 cases of malaria per 1000 population, drastic decrease in the incidence rate. Previous years recorded 1995-337, 1996-242, 1997-235, 1998253, 1999 -163 cases of malaria per 1000 population 21 cases of TB were detected in the year 2000. One of the lowest rates of deliveries in Year 2000 health facilities, with only about half S/Birth 16 of all deliveries occurring in clinics 8 or health centres. NND Family planning coverage is low Others < 1 year (HIS reports a rate of 6-7% compared with 18% Total deaths 151 nationally). A major cause of infant mortality is M/Deaths complications of delivery. The total numbers of Total Deliveries 1299 deliveries were 1299. The IMR was 33 per 1000 Live births births, and MMR was 3 per 100,000 IMR/1000 births. 24 The Sexually Transmitted MMR/100,000 80 Diseases recorded 5 positive cases out of 15 suspected adolescent males aged between 10 and19 years. 3 positive cases out of 21 suspected adolescent females aged between 10 and 19 years.

The two years of ethnic tension in GP is expected to have some adverse effects of health. Over this period, some preventive activities such as malaria control, environmental health and satellite clinics providing antenatal care, immunisation etc. have been substantially reduced. Touring medical services have been irregular and have been totally suspended since the latter part of 2000. Access to diagnostic and treatment services has been restricted by the loss of health transport (OBM canoes and vehicles) and restricted access to other transport providers. There is anecdotal evidence that rural services have been less able and patients less willing to use the NRH for cases of serious illness or obstetric complications. Even travel to rural health clinics has been restricted due to fear of hostilities. These factors are expected to have some impact on health in the affected areas. At national level, gains have been made in life expectancy and in areas such as malaria and TB control, immunization coverage and maternal and infant mortality. It is fair to assume that these trends will be reflected in Guadalcanal Province. However, the provincial population still has higher rates of malaria and maternal and infant mortality than the Solomon Islands as a whole.

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Health Indicators 25

24

20 15

14 2000

10 5 0

1.7 CBR CDR

0.3 0.8 IMR CMR MMR

4.3Provincial Health System: A comprehensive range of health activities based on principles of primary health care, in a well-defined population living within a clearly delineated administrative and geographical area. Providing health care in the province is through a network of health workers and health facilities. This ranges from a village health worker’s post - a basic health facility as the first point of contact with the community at the peripheral level, to "Safe Blood starts with me" - WHO Slogan for the year -2000

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provincial hospital - the first referral level hospital, in order to assess the patient’s condition, either to treat him directly or to pass on for further course of management at the higher level. Apart from the treatment of individual patients, provincial hospital is also involved in the planning, co-ordination and evaluation of the implementation of the eight elements of Primary health care. Therefore, a provincial health system consists of large variety of inter-related elements that contribute to health in homes, schools, work places and communities. One of the key features of the provincial health system is that it is people centred, emphasising all the health-related elements of their behaviour and their environment, and their right to shape their own health care with professional health. Provincial planning usually starts analysis of the current situation often called situational analysis. Therefore provincial health directors and other senior health officer’s need a comprehensive and integrated view of the health needs of the entire population of the province. A provincial health profile containing range of essential indicators serves to choose the provincial priorities and agreeing future programme goals and objectives. It also examines the possibilities of various strategies to implement it successfully in the health care system, and a possible solutions for the changes that might needed to bring the average nearer the best in the year ahead.

Resource s Human Material Technical Financial

Organisation & Management  Planning, implementati on, monitor, evaluation  HRM  Materials management  Information systems

Primary Health Care

Health of the Community

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No women should die in childbirth The tragedy of maternal death has multiple causes and requires a comprehensive strategy comprising community mobilization, parental care, clean and safe delivery with trained assistance and, most critically, first referral care for management of complications…… Quality of care is essential in ensuring that women enjoy good reproductive health throughout their lives. Such care is based on respect of women and their particular needs, participation of women in the design and delivery of services, and the provision of information which allows women to make informed choices about their sexual and reproductive lives.  Women's health: towards a better world. Report of the First meeting of the Global Commission on Women's Health. Geneva, World Health Organization, 1994 pp.18, 19 (document WHO/ DGH/94.4). p.55, Vol. 16, No. 1, 1995 , World Health Forum.

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5 Part II -Resource Analysis

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5.1Health facilities 5.1.1

Introduction

A comprehensive range of health activities providing health care in the province is through a network of health workers staffed at various health centres. This range from aide post - a basic health facility as the first point of contact with the community at the peripheral level, to provincial hospital - the first referral level hospital.

5.1.2

Health Centres:

These are designed to provide comprehensive, integrated health services. These include curative, promotional and preventive care, and community-based rehabilitation. They are also responsible for health development in their respective catchments areas through community activities and innovative approaches. One of the key features of the provincial health system is that it is people centred, emphasising all the health-related elements of their behaviour and their environment, and their right to shape their own health care with professional health.

5.1.3

Existing Health Facilities:

GP Head Quarters/Referral & Management Health Centre – based in Honiara, capital town of Solomon Islands. The Establishment had an Office at the head quarter levels to host General Medical Staff, Environmental Staff, Health Education and Malaria staff, Storage centre, Clinic for carrying out day-to-day Out Patient service and the facility for Family Planning. A. Area Health Centre - Three  Grouve NO-Ms.Noami Vouza, RN- Kerry Alekuata, RN-Glence Faka RN-Philip Neisa  Lambi ANO-Ms.Ethel Tinoni, RN-Jackson Beikera, NA-Julian Beikera NA- Francis Lagui  Marau NO-Soram Osifera, ANO-Ms.Maria Hamarasi, RN-Bartholemew Fonotau, NA-Ms.Rose Tovosia B. Rural Health Centre - Fourteen  Visale RN-Ms.Theresa Vinano, NA-Ms.Michaela Keni  Tangarare RN-Mark Caleb, NA-Ms.Mensensa Caleb  Foxbay RN-Ms.Jesinta Labacha, NA-Ms.Alice Kavigau  MBabanakira RN-Ms.Albetta Veo, NA-Ms.Delrose Chiria  Viso RN-Ms.Bethphage Buapechi, NA-Gordon Liu  Kuma RN-Ms.Vinaka Pitchakinbo, NA-Vacant  Madakacho(SDA) RN-Ms.Marylin Kavoara  AvuAvu RN- Bartholemew Fonotau, NA-Ms.Rose Anea, NAMs.Josephine Saia  Balolava (SDA) RN- NA-Ms.Rose Tovosia  Totongo RN- Ms.Junelyn Thugea

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Aola Alwin Pini New-Tenabuti Ruvavatu Turarana

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ANO-Jimmy Leni, RN-Vivian Leni, RN-John Tagabasoe, NARN-Ms.Vivian Jim, RN-Ms.June Topilu RN-Samuel Topilu, RN-Ms.Julia Topilu, RN-Ms.Sharon RN-Peter Kakamo, NA-Philip Ngosakobu

C. Nurse Aide Posts - Sixteen

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               

Tamboko NA-Ms.Emma Frenold Kohimarama (COM) RN-Dorothy Korakau, NA-Abraham Hou Selwyn College(COM) RN-Ms.Hilda Roikera, NA-Ms.Alice Matenagai Marumbo Under Renovation and Upgrading to Permanent Structure Mbiti NA-Edwin Kakau Nagho NA-Jeremiah Loise Saro NA-Ms .Jessy Rickson, NA-Ms.Prudence Koni Marapa RN-Adrian Manikera Luguvasa NA-Lazarus Galua Vatulava NA-Ms.Eunice Niaba Bolale NA-John Ligi Bubunuhu NA-Samuel Paralonga Kolosulu NA-Robert Pitua Haiparia(SDA) NA-VHW Mr.Joshua Koti Numbu(Community) NA-Ms.Everlyn Thao (Com) Lunga RN-Ms.Christina Sau

5.2Health personnel 5.2.1

Organisational Structure H o s p it a l O r g a n is a t io n a l S t r u c t u r e D r . H .K .B al ac h an d r a D i r ec t o r o f H eal th & M ed i c al S er v i c es

N u r si n g

P ar am ed

A dm n

G eo r g e M aeb at a C N O

L eo n ar d O l i v er a P H I

E d d y L em ae S. M O

A l o y si s V ai k ek e S .H .E .O

B en so n A n i si A c c t .C l er k

B at r am M an u P N O

V ac an t H I

A sst M .O

M R .A d r i an L eam an a A sst .E .O .

T y p i st s/ C l er k s

M ai n t . O ffi c er / D r i v er

N o el I to g o SN O

G ab er i al V ag i SN O

N o am i N O

J i m m y L en i A N O

A l i c e W at o t o SN O

F . S ad e A .H I

M eth o d a H .A

S o u r am O si f er a N O

E th el T i n o n i A N O

R eg i st er ed N u r ses

N u r se A i d es

G .T i tu l u A .H I

C h an n i el l a A N O

M i c r o sco p i st/ E n t o m o l o g i st / T ec h n i c i an

Annual Report -2000 Table no 1.

Table no: 5.1 Staffing in the Guadal Canal Province

Staff Director Medical Doctors CNO PNO SNO NO ANO RNs Nurse Aides Principle Field Officer Senior Field Officer Field Officers Assistant Field Officers Field Assistant Feild Technician 1 Assistant Lab Officer Lab Technician Assistant Monitoring Officer Principle Health Education Officer (PHEO) Senior Health Education Officer (SHEO) Health Education Officer (HEO) Health Education Assistant (HEA) Chief Health Inspector Health Inspector Assistant Health Inspector Environmental Health Assistant Supportive Staff TOTAL Table no 2.

Guadal Canal Province

25

Table no: 5.2

Establishment 1 2 1 1 2 3 4 26 30 1 1 2 4 1 1 1 1 1 1

Actual 1 0 1 1 2 3 4 24 28 0 1 1 3 1 1 1 1 0 0

1 1 1 1 1 1 2 1 93

1 1 1 0 1 1 1 1 72

Staffing in the Provincial Direct Employees

Staff Nurse Aides Malaria Technicians Dental Therapist Pharmacist Pharmacy Asst. Health Educators Environmental Health Worker (Officers) Env.Supporting Staff Clerical Staff Transport

Establishment 30 11 1 1 1 2 3 6 3 1

“Safe Blood starts with me" WHO Slogan for the year - 2000

Filled 28 11 1 1 1 2 3 6 1 1

Annual Report -2000

Guadal Canal Province

26

Domestic TOTAL

1 60

1 56

5.3Nursing Management 5.3.1

Clinic Nurses GPHQ / Referral Health Centre.

All the nurses based at GPHQ/ Ref. Health Center were deployed to Honiara City Council clinics both seconded and direct employee. The idea of the deployment exercise had been implemented in the light that Guale patients would be using the Honiara City Council Health facilities for Medical care.

5.3.2

GP Referral Clinic at National Referral Hospital.

During the height of the ethnic tension Mondays and Fridays Guadal Canal Referral clinic at the National Referral Hospital was suspended for indefinite period. The suspension then lifted for the normal referral clinic after the signing of the Peace Agreement in the month of November 2000. Dr’s weekly visit to Ghorou AHC on the east and western parts of Guadalcanal on the roadside clinics was scheduled effectively after the signing of TPA.

5.3.3  

Supervisory Tour/Training Workshops.

Supervisory visit to the clinics was hampered due to the effect of two years ethnic unrest. An integrated health team comprising of all Divisional representatives conducted a weeklong health assessment and immunization programme on two separate occasions at Marapa health post.



The International Red Cross vessel the M.V Princess made a trip to weather coast to make a rapid health assessment headed by Dr.Herman Oberly and SNO G. Vagi performed the cold chain distribution and assessment programme.



Inland Rapid Health Assessment also carried out by SNO G. Vagi Malaria Health.



Another survey was conducted at Veraboli and carried out EPI and bed net distribution.

5.3.4 

Impacts of the Ethnic Tension

A total destruction of Marau Area Health Center and staff accommodation. “Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

27

Guadal Canal Province



GPHQ Health Management / Referral Health Center also left into destruction following intended one when the Para military and Malaita Eagle force took over the premises.



Medical essential supplies were distributed to the appropriate health facilities through airlift, sea and land transports in the early stage of ethnic tension appeared to have been operational effectively, thus following the restriction movement which had been enforced by the militants for the east/ west Honiara boundaries the essential medical supplies could only guarantee for discrimination to intended destination under a negotiated approach.



The health workers could not perform their routine duties to the expected standard mainly out of fear and disturbances.



Outreach programme had to be suspended.

5.3.5

Costing Containment Strategies.

5.3.5.1 NON – Clinical     

Reimbursement of Patients to & fro fares was abolished. Usage of fuel was cut down to a great extent. Touring allowances was minimized. Stationary purchase was curtailed and control usage of existing stationeries. Community was made to take up the responsibility and to participate in the evacuation of emergency patients.

5.3.5.2 Human Resources    

Direct employees sent on unpaid leave. Allowances ceased and medical drivers overtime. In-Service Training for nurses was suspended. Redeployment of nurses to most needed health facilities and Health Authorities to serve Guadal Canal patients.

5.3.5.3 Staff HEALTH FACILITY GPHQ Health Management

POS T CNO PNO SNO SNO NO NO

NAME

RESPONSIBILITY

G. Maebata B. Manu G. Vagi N. Itogo A. Watoto S. Osifera

Overall Nursing Management P/Admin activities Prov. Training Coordinator TB/ Lep, Eye CBR MCH/ FP EPI/STD.

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000 Referral Health Center

Ghorou AHC Balasuna

Temporary

Lambi AHC

28

ANO RN RN RN NA NA NA in NO RN RN RN ANO RN NA

B. Keumeru A. Vakeke E. Marahare B. Kafo L. Sanga A. Tahiuru N. Hasi N. Vouza K. Alekuata G. Faka P. Neisa E. Tinoni J. Beaker J. T. Beaker

Guadal Canal Province Clinic/ supervisor

outreach

Unpaid Leave Health Center Supervisor

Center Supervisor

Tang rare RHC

RN NA

M. Caleb M. Caleb

Fox bay RHC

RN NA

J. Labacha A.Kavigau

Mbabanakira RHC

RN NA

A. Veo D. Chiria

Viso RHC

RN NA

B. Buapechi G. Liu

Kuma RHC

RN RN

D. Voli V. Pitchakibo

Madakacho RHC (SDA)

RN

M. Kavura

Avuavu RHC

RN NA NA

B. Fonotau R. Anea J. Saia

Balolava RHC (SDA)

RN RN NA

N. Vozoto H. Vozoto R. Tovusia

Marapa health Post

RN ANO

A. Manekera M. Hamarasi

Resumed duty May 2001 Post out to NR Hospital

Totongo RHC

RN NA

J. Thugea R. Rotasi

On unpaid leave

Resigned 2001

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

29

Aola RHC

ANO RN RN NA

J. Leni V. Leni J. Tagabasoe A. Pini

Ruavatu RHC

RN RN RN

S. Topilu J. Topilu S. Philip

NewTenabuti RHC

RN RN

V. Jim J. Topilu

Turarana RHC

RN NA

P. Kakamo P. Ngosakobu

Visale RHC

RN NA

T. Vinano M. Keni

Kolosulu NAP

NA

R. Pitua

Bubunuhu NAP

NA

S. Paralonga

Bolale NAP

NA

J. Ligi

Vatulava NAP

NA

E. Niaba

Luguvasa NAP

NA

L. Galua

Saro NAP

NA NA

J. Rickson P. Koni

Nagho NAP

NA

J. Louis

Lunga NAP

RN

Tamboko NAP

NA

B. Sau C. E. Frenold

Numbu NAP

NA

E. Thao

Kohimarama NAP (COM)

RN NA

D.B. Korakau A. Hou

Selwyn College NAP (COM)

RN NA

H. Ruinikera F. Lagui

Guadal Canal Province PHC/ Health Promotion

2001 in coming posting

Nurse Aid Posts

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

30

Haiparia NAP (SDA)

NA

A. Matenigai

NA

Joshua

Guadal Canal Province

Name

Post

Course Training Overseas

Achievement

Noel Itogo

SNO

ADV. DIP in Community Obtained Adv Dip in Nursing in PNG. Community Nursing year 2000.

Ethel Tinoni

ANO

ADV DIP in Midwifery in PNG

Obtained Adv Dip Midwifery year 1999.

Mark Caleb

RN

Dip in Paediatric in PNG

Still abroad on training 1 year 2001

Georgina Mau

RN

ADV. DIP in Midwifery in PNG

Still abroad on training 1 year.

in

5.3.5.4 Kudos to Vagi A commendable task by SNO Gabriel Vagi in the provision of health services through out the tension in the most critical area, where the exchange of gunfire was taking place. He courageously faced all the consequences and his approach with the warring parties proved him successfully to be seen as a neutral person who worked closely with the Red Cross to meet the objective.

5.4Wages and service Grant. The division through its wages and services grants directly finances the delivery of health and medical services. The grants are payable directly to the division on a monthly basis However due to the current cash flow problem that the central government is facing, wages and services grant were delayed for payments since September 2000. This has a significant implication besides others to the services of the division.

5.5 Expenditure Head

Subhead

310 110/01 310 110/02

Actual

Medical h. Environmental “Safe Blood starts with me" WHO Slogan for the year - 2000

$13,177.46 $6,185.00

Annual Report -2000

31

310 110/03 h. Education 310 110/04 Finance 310 110/05 Paramedics 310 110/06 Director Travelling, transport. 310 112/01 Medical 310 112/02 h. Environmental 310 112/03 H education 310 112/04 Paramedics 310 112/05 Director Uniform 310 113/01 Medical 310 113/02 h. Environmental 310 113/03 h. Education Telephone telegrams 310 114/01 Medical 310 114/02 h. Environmental 310 114/03 h. Education 310 114/04 Director 310 115/ h. Environmental 310 116/ Clinic supplies 310 117/ Patients travelling 310 118/ 119/ Shipping charter 310 120/ Education supplies 310 121/01 Main eng canoe 310 121/02 " " " Environmental 310 121/03 " " " Education 310 122/01 " " " Building 310 122/02 " " " Environmental 310 122/03 " " " Education 310 123/01 " " " Vehicles 310 123/02 " " " Environmental 310 123/03 " " " Education 310 123/04 " " " Director 310 124/ Training workshop 310 125/ Rows workshop 310 126/ Main m/cycle Pol 310 127/01 Medical 310 127/02 h. Environmental 310 127/03 h. Education Paramedics Director

Guadal Canal Province $3,906.45 $2,303.00 $455.05 $28,827.21 $25,327.42 $4,595.00 $160.00 $533.00 $824.80 $5,857.29 $4,053.11 $3,130.35 $1,849.98 $2,353.40 $46,791.27 $12,968.65 $520.00 $3,473.05 $110.00 $7,544.85 $2,344.01 $111.80 $34,204.12 $4,715.67 $15.00 $658.40 -

“Safe Blood starts with me" WHO Slogan for the year - 2000

$3,603.00 $43,452.72 $7,194.15 $1,208.05 $250.00

Annual Report -2000 310 128/ 310 129/ 310 130/ 310 131/ Vbdcp 310 132/ 310 133/ 310 134/ 310 135/ 310 136/

32

Service develop

Guadal Canal Province -

Utilities

Building rent Purchase 1 computer printer Purchase 1 25 hp Purchase 1 hf radio Purchase 1 canoe

$32,667.15

$9,800.00 $14,704.00 $332,276.36

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

33

Guadal Canal Province

6 Part III-Primary Health Care Elements

6.1Treatment injuries

of

common

diseases

&

6.1.1 Out Patient Services The Outpatient service offered to Guadal Canal patients as Referral clinics on Monday and Friday, besides daily out patients at GP HQ clinic. Expert opinion and complicated cases were routinely referred to National Referral Hospital, which is situated close to the GPHQ.

6.1.2 Emergency services Emergency and casualties’ patients were directly taken to the National Referral hospital by virtue of its location and availability of 24 “Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

34

Guadal Canal Province

hours service, as there is no provincial hospital exclusively for Guadal Canal Province.

6.1.3

Psychiatric Health Programme

6.1.3.1 Impact: The psychological disturbances in any given population can lead disturbed peace and harmony in a community or a family. Sporadic cases of Schizophrenia and suspected PTSD were brought to the notice of National Psychiatric Centre at Honiara.

6.1.3.2 Priorities Psychiatric health care should not be neglected, as it is one of the important components of the public health. Hence, it was essential on part of health workers in our province as a Public Health point of view to refer all the suspected cases of Psychosis and Suspected PTSDs arose out of ethnic tension to NPU.

6.2MCH and Family Planning activities 6.2.1 Introduction Women’s health in the world is that many individuals fall far below the ideal definitions of health. Women are systematically denied basic human rights such as the right to information, the right to adequate nutrition, the right to health services including family planning, as well as to basic primary care throughout their lives.

6.2.2 Women’s Right All women should have access to basic maternity care during pregnancy and delivery.iii This comprises quality antenatal care and clean and safe delivery whether the delivery takes place at home or in a health facility. It also includes early postpartum care for mother and infant to detect and manage complications, and to promote healthy behaviors, including offering support for breast-feeding. Appropriate care during the continuum of pregnancy, delivery and the postpartum period helps to reduce complications and mortality in mother and baby.

6.2.3

Women's Reproductive life and Sexual health

In most of the world, the majority of young women become sexually active during their teenage years. In some societies, women begin having sex during adolescence because they are expected to marry and begin child bearing at an early age. Regardless of the norms that influences young woman, beginning sexual activity during the teenage years carries certain risks. Women who marry young often have little say in fertility-related decisions and limited opportunity to obtain education and job-related skills. Literacy amongst women is 16% in Solomon “Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

Guadal Canal Province

35

Islands, least in the South Pacific region. Besides risks involved in the teenage pregnancies, married and unmarried women are vulnerable to sexually transmitted diseases.

6.2.4

Organisation of the MCH/FP unit In our province, this programme conducted under auspices of Community Health Services in the Nursing Sub-division, in which the PNOCommunity, who is also the PHC coordinator being the incumbent. The unit were managed by the provincial MCH/FP coordinator SNO Alice Watoto, and assisted by RN Edna Titiulu.

6.2.5 Total Number of Health Promotion & Disease prevention activities Table no 3.

Deliveries

Total Deliveries

1200 1000 800

746

873

840

1030

972

600 400 200 0 1994

1995

1996

1997

1998

6.2.5.1 Family planning Total Family Planning coverage was 5 %. One of the major causes of unavailability of health services due to tension.

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

Guadal Canal Province

36

Table no 4. Table Part III-Primary Health Care Elements.26 Contraception 1999 No. of Cases Coverage %

Method

various methods of

2000 No. of Cases Coverage %

699 116 45 2 0 862

Depo-Provera Pills Condom IUCD Vasectomy Tubal-Ligation Total

4 6 0.2 0.0 0 5%

Family Planning Coverage

5%

0% 0% 0%

13%

Depo-Provera Pills Condom IUCD Vasectom y Tubal-Ligation 82%

6.2.5.2 Antenatal Coverage The Antenatal check up serves as one of the important component in the prevention and reduction of morbidity and mortality amongst mother and child. Categorically the attendance preferably is one in each trimester and fourth between 36 and 40 weeks of pregnancy. The first visit in the first trimester serves to detect the risks involved early and enables the health worker to take appropriate action. The ANC coverage recorded here were only a single visit by the mother in any trimester. Table no 5.

Table Part III-Primary Health Care Elements.17

ANC Coverage

1992

1993

1994

1995

1996

1997

1998

1999

2000

63.3%

51.6%

65.9%

61.8%

69.1%

66%

73.7%

55.8%

47.2%

Table no 6.

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

Guadal Canal Province

37 ANC Coverage

80.00% 70.00%

69.10% 66% 65.90% 61.80% 51.60%

73.70%

63.30%

60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 1992

1993

1994

1995

1996

1997

55.80% 47.20%

1998

1999

2000

ANC

Table no 7.

1992 1993 1994 1995 1996 1997 1998 1999 2000

Total Child Births in the Province-1997

ANC 1Visit 1614 1361 1825 1875 2186 2176 2537 2004 1768

Table no 8. Coverage

A/N Cov 63.3% 51.6% 65.9% 61.8% 69.1% 66.0% 73.7% 55.8% 47.2%

PNC 1 Visit 2136 1162 1210 1425 583 951 1084 956 770

P/N Cov 83.8% 43.8% 43.7% 47.0% 18.4% 28.8% 31.5% 26.6% 20.6%

Ave Visit 4.25 4.05 4.16 4.35 4.32 4.15 4.48 4.28 3.92

Home 444/22 389/13 425/10 337/14 458/10 406/1 518/11 513/24 669/12

Births HC 319/3 230/7 269/7 312/14 341/7 359/7 398/11 538/11 606/12

Table Part III-Primary Health Care Elements.29

Tot 788 639 711 677 816 773 938 1086 1299

PNC

1992

1993

1994

1995

1996

1997

1998

1999

2000

83.8%

43.8%

43.7%

47%

18.4%

28.8%

31.5%

26.6%

20.6%

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

Guadal Canal Province

38 PNC Coverage

90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00%

1992

1993

1994

1995

1996

1997

1998

1999

2000

PNC 83.80%43.80%43.70%47.00%18.40%28.80%31.50%26.60%20.60%

6.2.5.3 Selwyn College TBA Workshop. 6.2.5.3.1

Introduction.

A five days TBA training workshop was conducted at Maravovo area from 11 th December to 15th December 2000. The motivation behind this workshop emerged out of the necessity of provision of safe delivery under a trained hand and better facility, due to the fact that a large number of deliveries were being conducted outside clinics. Then under the leadership of SNO Gabriel Vagi of Guadalcanal Province was conducted the TBA Training workshop in the communities marked out. 6.2.5.3.2

Aims.

To help the existing untrained birth assistants to enhance and widen their sphere of knowledge and to have better understanding of the concept of hygienic and safe delivery of Pregnant mothers in the community. 6.2.5.3.3

Objectives.

At the end of the TBA workshop, the participants were in a position to identify the normal sign of a healthy mother and child, the high-risk signs of an ill mother and child. To empower the participants in their role of provision of safe delivery. 6.2.5.3.4

Venue.

The workshop was conducted at Vura School, which was a bit inland from the main road. The venue, peaceful environment and it has all the needed materials for learning such as boards to write on chalk, desks and stools to sit on. This area is under the catchments of Selywin college clinic. 6.2.5.3.5

Participants. “Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

39

Guadal Canal Province

The participants were those women of the community who were helping and assisting the mothers already during delivery at home and others were totally fresh candidates, who were eager and willing to learn to assist mothers and children during delivery. There were also some elderly women who had shared their experiences. 6.2.5.3.6

   

Methods Adopted

Lecturing Question and Answer session Group work & Presentation Demonstration

6.2.5.3.7 Resource Personnel.

   

1. 2. 3. 4.

Gabriel Vagi Ethel Tinoni Francis Lagui Naomi Vouza

(SNO GP and Training Officer) (ANO GP) Lambi Clinic. (N/A GP) (ANO GP) Balasuna clinic

The officer stressed the importance of early antenatal care, which should commence in the 1st trimester. She also highlighted that the role of TBA to encourage the mother to go for antenatal care in the clinic. She also stressed to the participants that if they happen to sight any mother who has signs of Abnormal Pregnancy to play out her part in advising and encourage the mother to go to clinic to avoid difficulties. 6.2.5.3.8

Growth Monitoring. (Presented by ANO E. Tinoni)

She explained the important of knowing the 3 curves in the growth chart. The most important thing to know is if the child is growing. These 3 curves are important to know which direction the child is growing: The curve is going up from last month. The child is growing. A straight line. No growth from last month. Something is wrong. The curve is going down. There is no growth. This is a dangerous sign.

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

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40

6.2.5.3.9 Family Planning/Importance/Problems/Modern Methods. (Presented by ANO E. Tinoni & N. Vouza)

The two officers explained that Family Planning is a daily planning of the family, whether it be planning to make a garden, or planning a family budget etc. It is not a thing to stop having children as many- may have heard from friends or wantoks. So it is same that a married couple in their household, they should plan for how many children should be in the family and the spacing they have for each child. This is for the good health of the child and mother. The problems of no family planning will affect the whole family: There would be not enough money to meet each member’s needs. Health problems will increase, overcrowding in the house and food and clothing will not be enough for everyone. The modern methods were talked about and were shown to the participants, explaining the advantages and disadvantages of each method. It was for the time that such methods e.g. Loop insertion was witnessed by some participants 6.2.5.3.10

Conclusion.

The workshop was found to be very successful to fulfil the goal and objective. The contribution, co-operation and support by participants all through the workshop enriched everyone. LIST OF PARTICIPANTS. NAMES Ellen Taveko Harriet Tada Beverly Ise Priscilla Fakafu Pauline Lolopo Irene Tada Evarlyn Vitale Regina Kenihau Irene Kovohi Melda Taruga Dora Kauli Maria Noela Savani Alice Basile Joycelyn Lise Bernadeth Raymond Sesarina Vou Veronica Kesale Batistina Kotova Mary Odlia Logo

AGE 43 23 44 37 28 29 21 28 29 25 40 30 31 31 28 24 48 52 34

SEX F F F F F F F F F F F F F F F F F F F

OCCUPATION House wife House wife Teacher House wife House wife House wife House wife House wife House wife House wife House wife House wife House wife House wife House wife House wife House wife House wife House wife

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

Guadal Canal Province

41

6.3 Expanded Programme of Immunization 6.3.1.1 Introduction The objective of EPI programme is to reach as many infants as possible to immunise before the child attains first birthday.

6.3.1.2 Immunization Coverage Table no 9.

Table no: 6.34

Vaccines

BCG Measles D.P.T I II III O.P.V. I II III Hepatitis B I II III

Immunization coverage for 9 years C 1994

o v e 1995 1996

r a g 1997 1998

e 1999

2000

69.1 % 55%

56.7 % 61.1 % 66.8 %

46.4 % 59%

69.4 % 60.6 % 73.9 %

56.5 % 59.3 % 73.6 %

36.7 % 53.6 % 57.8 %

37.9 % 39.3 % 44.6 %

60.8 % 68.7 %

63%

68.1 % 70.9 %

66.4 % 72%

67.4 % 73.4 %

54.7 % 57.3 %

38.1 % 44%

48.4 % 25.1 %

60.6 % 67.5 %

63%

68.5 % 48.4 %

66.5 % 71.7 %

67.4 % 58%

55.6 % 36.9 %

38.9 % 35.5 %

40%

59.9 61.1 67.6 65.3 % % % % Ante natal Mothers

68.6 %

55%

37.8 %

1992

1993

38.5 % 60.2 % 71.9 %

26%

67.7 % 71.6 %

48.5 % 50.8 %

67.3 % 38.8 % 53.6 %

42.3 % 51.7 %

68.6 %

67.2 %

57.2 %

73.5 %

“Safe Blood starts with me" WHO Slogan for the year - 2000

200 1

Annual Report -2000

42

Guadal Canal Province

Tet. Toxoid I II Booster Expected Births

Women’s income: Studies highlight the fact that women’s earnings not only increase the aggregate income levels of the poorest households, but that they also contribute a much larger share to basic family maintenance. Increases in female earning power translate more directly into better child health and nutritional status, with important short-term effects of reducing the incidence and severity of morbidities at household level and positive long-term generational effects on the quality of human capital. The enhancement of women’s economic productivity is, therefore, to be regarded as an important strategic necessity for improving the condition of those in poverty. * Women,health and development in the South-East Asia Region, N.Delhi, WHO regional office for South-East Asia, 1992: p. 14 ( SEARO Regional Health Papers, No.22)

6.4 6.4.1

Health education Health education

The aim of the Health Education division was to encourage good health for individuals and population groups through various awareness programmes about the health in wider dimension as stated by WHO. Health education is not just the adding of new knowledge, but the rational appraisal of traditional customs. Strategy adopted was involving community themselves to participate in health promotion activities. The division participated along with other divisions of our health centre in carrying out the “Integrated Community Health Talk” programme.

6.4.2

Training / workshops

In this year 8 workshops was conducted, 5 on reproductive health and 3 on nutrition. All training was informal, relying on group discussion and audiovisual aids rather than classroom lectures. The ultimate object was to increase the knowledge and awareness about the health, personal hygiene, nutrition, and reproductive health in the community. Women comprised the target audience amongst 531 participants. As they were responsible for the care of “Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000

Guadal Canal Province

43

families, the houses they lived in, and their surroundings. Childbearing group was paid special attention because of their role in Childcare and welfare.

6.4.3

School Health Education

The general policy was to place a high priority to promote “Health Values” in Primary and Secondary Schools. The division was able to manage to conduct health talks and educate 1,370 pupils in 7 Primary Schools. The Sexual health and knowledge about sexually transmitted diseases was emphasized to higher primary classes such as 5 and 6 standards. Three Secondary schools namely Burns Creek, Selwyn College, Betikama High School, and Potau’u were visited for the AIDS awareness and Sex education programme and 1150 participated the events. Schools did not function to its fullest capacity in terms of providing education and running the classes due to ethnic unrest.

6.4.4

Community Information Education communication

Table no 10.

Village and Clinic

Type of Activity

Number Achieved 20 20

Ward/Area

Total Attended

Village Inspection Burao/Tasimate 1000 Village Meetings Tasimauri/Geawa 1000 Village Health Talks Clinic/Hospital 100+ GPHQ Clinic 2000+ Talks The division managed to conduct various programmes in the community to cover approximately of 1320 population.

6.4.5

Campaigns

Type of Activity Health Campaigns Radio Programmes

6.4.6

Number Achieved 4 63

Ward/Area

Total Attended

Honiara Honiara

800+ National Coverage

Health Committee and Implementation

Though the Health Committee was formed but was unable to sustain to progress and work along with the Health Educational team due various constraints.

6.4.7

Audio Visual Aid Production

The year 2000 marked a great achievement with respect to the publicity and awareness programme. Health education messages in the mass media are frequently valuable in creating an awareness of problems but do not always result in improved behaviour or the consolidation of healthy behaviour.

“Safe Blood starts with me" WHO Slogan for the year - 2000

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Guadal Canal Province

The Posters usually carries an illustration presenting the solution to a problem. They are displayed in public places so that people can study them in their own time; they serve as visual reminders to behave in a certain way. The Flip Charts contains illustrations that pose the problem. They are displayed only to groups of people who have been brought together to engage in discussion.

6.5

Provision of essential drugs

The supply of drugs to Provincial Health Clinics in any given year is largely determined on the basis of orders made during the preceding year rather than on requirements estimated from such criteria as past consumption, prevailing diseases, standard treatment schedules and the sizes of the populations served. National Medical Store was efficient through out the year despite the tension in supplying drugs, however impediments curtailed their task. The Drug and Therapeutics Committee of the MHMS, Honiara published in 1996 a user-friendly list of drugs and vaccines, considered essential for treatment of patients and prevention of diseases commonly occurring in Solomon Islands. A standard drug treatment schedule together with dosage forms and strengths for the use of the health worker at all levels, commonly known as "Green Book" was also instituted to facilitate the health worker in administration of therapeutic drugs.

6.5.1

NGO-World Vision

World Vision an NGO donated 40 kits (Boxes) of the basic medical Drugs and Medicines to the peripheral Clinics in the Guadal Canal Province in December 2000. Director is seen in the above picture receiving the donation from Tevihta Ravumaidama, WV Country Program Manager, SI. World Vision is a non-profit Christian international humanitarian relief and development organization working with the poorest of the poor in more than one hundred countries around the world. World Vision is a partnership of nations with the objective to help alleviate the living conditions of the most under-privileged people in different parts of the world. World Vision established its presence in the Solomon Islands since 1982. Community development projects have addressed the issues of primary health, child survival, education, adult literacy, street children rehabilitation, water supply and sanitation, vocational skills training, appropriate technology and leadership development at grass root level. In September 1999, WV Solomon Islands with the assistance of Asia-Pacific regional office along with the European Union a joint venture funded for a rehabilitation programme to assist the internally displaced people (IDPs) of Guadalcanal and Malaita. Both EU and WV had identified 2,000 families in both provinces to be assisted with the provision of some basic food, medical kits, housing tools and materials, seeds and agriculture tools.

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6.6

Control of communicable diseases

6.6.1

Malaria: Vector Bourne Disease Control Program

6.6.1.1 History Malaria is a protozoal disease transmitted by the Anopheles mosquito, caused by minute parasitic protozoa of the genus Plasmodium, which infect human and insect hosts alternatively. It is a very old disease and prehistoric man is thought to have suffered from malaria. It probably originated in Africa and accompanied human migration to the Mediterranean shores, India and South East Asia. In the past it used to be common in the marshy areas around Rome and the name is derived from the Italian, (mal-aria) or "bad air"; it was also known as Roman fever. Today some 500 hundred million people in Africa, India, South East Asia and South America are exposed to endemic malaria and it is estimated to cause two and a half million deaths annually, one million of which are children. Fishermen and traders, long before British colonisation, probably introduced the disease into northern Australia and in the past malaria were not uncommon in the northern parts of the country. In Western Australia an explosive outbreak of falciparum malaria occurred at Fitzroy Crossing in 1934, which at first was mistaken for influenza and resulted in 165 deaths. WHO declared Australia free of malaria in 1981, however since that time 9 patients have contracted locally acquired malaria. The so called "airport malaria" has become a problem in recent years. A publican working in an establishment close to London's Heathrow Airport became acutely ill and was found to be suffering from falciparum malaria, he had never been out of the country. A lady driving her car past the same airport became ill with malaria although she too had never been out of the country. Four workers unloading a cargo plane at Amsterdam airport became infected with malaria. It is assumed that infected mosquitoes were carried on planes from Africa and released at the destination airport.

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Guadal Canal Province

WORLD DISTRIBUTION OF MALARIA

While it was recognised that the Anopheles mosquito played a key role in the transmission of the disease it was not until 1948 that all the stages in its life cycle were identified. The parasite undergoes a development stage in the mosquito and the female of the species requires a blood meal to mature her eggs. She bites a human and injects material from her salivary glands, which contains primitive malarial parasites called sporozoites, before feeding. These sporozoites circulate in the blood for a short time and then settle in the liver where they enter the parenchymal cells and multiply; this stage is known as pre-erythrocytic schizogony. After about 12 days there may be many thousands of young parasites known as merozoites in one liver cell, the cell ruptures and the free merozoites enter red blood cells. In the case of P. vivax, and P.ovale the liver cycle continues and requires a course of primaquine to eliminate it. P.falciparum on the other hand does not have a continuing liver cycle. In the red blood cells the parasites develop into two forms, a sexual and an asexual cycle. The sexual cycle produces male and female gametocytes, which circulate in the blood and are taken up by a female mosquito when taking a blood meal. The male and female gametocytes fuse in the mosquito's stomach and form oöcysts in the wall of the stomach. These oöcysts develop over a period of days and contain large numbers of sporozoites, which move to the salivary glands and are ready to be injected into man when the mosquito next takes a meal. In the asexual cycle the developing parasites form schizonts in the red blood cells, which contain many merozoites, the infected red cells rupture and release a batch of young parasites, merozoites, which invade new red cells. In P.vivax, P.ovale and probably P.malariae, all stages of development subsequent to the liver cycle can be observed in the peripheral blood. However, in the case of P.falciparum only ring forms and “Safe Blood starts with me" WHO Slogan for the year - 2000

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gametocytes are usually present in the peripheral blood. Developing forms appear to stick in the blood vessels of the large organs such as the brain and restrict the blood flow with serious consequences. While all four species have a haemolytic component i.e. when a new brood of parasites break out of the red blood cell this is usually of little consequence. The exception is falciparum malaria where the parasites multiply very rapidly and may occupy 30% or more of the red blood cells causing a very significant level of haemolysis. One reason for this is that P.falciparum invades red cells of all ages whereas P.vivax and P.ovale prefer younger red cells, while P.malariae seeks mature red cells.

6.6.1.2 Introduction: Malaria is by far the world's most important tropical disease, and kills more people than any other communicable disease except tuberculosis. Malaria is a public health problem today in more than 90 countries, inhabited by a total of some 2,400 million people-40% of the world's population. Mortality due to malaria is estimated to be over 1 million deaths each year. The disease is endemic in 100 countries. The aim of the current global malaria strategy was to reduce mortality by at least 20% compared to 1995 in at least 75% of affected countries by the year 2000iv. We have entered a new millennium with the same figure to combat with. Malaria remains a critical public health problem in Solomon Islands, despite extensive work to eradicate, contain and control measures were adopted since 40 years. Efforts at control began in the 1960s, with residual spraying with DDT. The success of several pilot efforts resulted in the initiation of a national

6.6.1.3 Overall Objectives: 



To reduce clinical malaria and prevent mortality by providing early diagnosis and effective treatment in suspected cases, as well as

confirmed malarial ones. To reduce morbidity, especially in children and pregnant mothers through applying appropriate malaria control measures.

6.6.1.4 Specific Strategies:    

To continue with Bed net sales, distribution and retreatment of old mosquito nets. To carry out indoor residual spraying to all problem villages. To continue malaria educational programme through meetings to communities. To strengthen the use of other control measures as larvicidings and source reductions.

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6.6.1.5 Epidemiological report: Table no 11. Table no: Part III-Primary Health Care Elements.37 Malaria Annual Report-1995-2000 SPECIES

Year

Total +ve 25605 18214 24863 20804 13397

PF

PV

1995 1996 1997 1998 1999

Total Slides 55031 62266 55561 50065 32760

19094 12582 13975 16452 10777

2000

16579

6,931

5,376

INFANT

EPI-DATA

SPR % 46.5 29.2 44.7 41.7 40.0

IR/1000

6511 5632 4773 4035 2620

Rate % 29 27 25 39.7 36.5

337 242 235 253 163

PFRate % 74 69 56 79.7 79.6

1,581

38.4

41.8

115

77.6

6.6.1.6 Number of Hospital Admission Data

Paediatric Admission in 2000 at NRH

7 6 5 4 3 2 1 Dec

Nov

Oct

Sep

Aug

July

June

May

Apr

Mar

Feb

0 Jan

Number of Cases

8

Month

Malaria

Meningitis

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500 400 300 200 100

Month

Honiara

Henderson Airport

Guadal Canal Province: Total population 60,021 Total malarial slides: 16,579 3000

2500

2000

1500

1000

500

0

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Total Slides

2200 2692

2553 1809 1768

794

235

344

571

1057

1612

944

Total Positive

911

1215

326

99

122

183

378

768

450

1004

744

731

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Dec

Nov

Oct

Sep

Aug

July

June

May

Apr

Mar

Feb

0 Jan

Rainfall in millimeter

Rainfall in Solomon Islands in 2000

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50

Percentage PF Positive in Malarial slides 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

1995

1996

1997

1998

1999

2000

PF RATE

74%

69%

56%

79.70%

79.60%

77.60%

Infant Rate

29%

27%

25%

39.70%

36.50%

38.40%

Malaria-one of the most important tropical disease in the world. Globally the malaria situation is serious and getting worse. About 10 % of hospital admissions and 20-30 % of outpatient consultations are due to Malaria. Malarial morbidity among children and pregnant women is quite high. It also affects the working capacity of adults. Malaria is a curable disease if promptly diagnosed and adequately treated.

6.6.1.7 Incidence per 1000 population Malaria remains to be still one of the major causes of the morbidity in our province. However, the Incidence per thousand populations was gradually decreasing. In 1998 -253, 1999-163, were the cases of malaria per 1000 population, where as in 2000-115 though a slight decrease in the IR the morbidity remains very high especially P. falciparum. Globally P.falciparum accounts for the majority of infections and is the most lethal. In our province P.falciparum had the highest infection rate, on an average 75 %.

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51 Annual Malaria Incidence 1995-2000

350

337

300 242

250

253

235

200

163

Cases/1000 Pop 150

115

100 50 0 Incidence rate

1995

1996

1997

1998

1999

2000

337

242

235

253

163

115

6.6.1.8 Vector Control 6.6.1.8.1 Mosquito habitat

No of Positive Slides

Anopheline mosquitoes transmit malaria; the number and type of which determine the extent of transmission in a given area. Transmission of malaria is affected by climate and geography, and often coincides with the rainy season. The most important environmental factors are temperature and water, with wind, phases of the moon and human activity having lesser effects. Temperature determines the length of developmental cycle of the parasite and the survival of the mosquito vector. Tropical regions, altitude alters the temperature, and therefore, highland areas have less incidence of malaria. The mosquito being a fragile flyer is easily 1000 800 600 400 200 0

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

PF 696 775 961 595 613 229

82

75

PV 215 229 254 148 118

17

43

97

139 286 580 345 44

92

215 105

blown by the wind, sometimes to its advantage but generally to its disadvantage. “Safe Blood starts with me" WHO Slogan for the year - 2000

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Nocturnal mosquitoes are sensitive to light so, on a moonlit night the number is found to be reduced. Table no 12. PF & PV infection rate in 2000

6.6.1.9 Bed net Distribution Supplied the new bed nets in the year 2000:  Single bed mosquito nets: 302  Double bed mosquito nets: 909  Family size mosquito nets: 725

21% 21% 21% 20% 20% 20% 20% Cov erage

1999

2000

21%

20.30%

Table no 13. Bed net coverage in 1999-2000

6.6.2

Tuberculosis Situation

6.6.2.1 Global Trend Tuberculosis is responsible for over 2 million deaths each year worldwide. The situation is further complicated in developing countries by the breakdown in health services, poorly managed programmes, the spread of HIV/AIDS and the emergence of multidrug resistance. Countries most affected are India, China, Indonesia, Bangladesh, Pakistan, Nigeria, Philippines, South Africa, Ethiopia, Russian Federation, Viet Nam, Democratic Republic of Congo, Brazil, United Republic of Tanzania, Kenya, Thailand, Myanmar, Afghanistan, Uganda, Peru, Zimbabwe and Cambodia.

6.6.2.2 Personnel -TB Co-ordinator: The TB Co-ordinator SNO Mr.Noel Itago was sponsored by WHO for further studies and successfully completed Post Graduate Diploma in Community Health Nursing Administration of one year duration in the year 2000, at College of Allied Health Science, University of Papua-New Guinea at Port Moresby.

6.6.2.3 Public Health Management Support for tuberculosis research capacity building restricted to the 22 high-burden countries mentioned above, which account for 80% of new cases. Areas of greatest interest for capacity building are: health system and services research to improve TB control operations and to expand the DOTS strategy (directly –observed “Safe Blood starts with me" WHO Slogan for the year - 2000

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treatment, short-course); public-private partnership experiments including community-based programmes; field-site preparation for diagnostic and therapeutic trials (which would involve improvement of surveillance and control coverage, development of data management and analysis expertise, better documentation systems, improved communication, etc); policy research and costeffectiveness studies; TB control in special situations; and evaluation of multidrug resistance and second-line treatment.v TB was declared by WHO to be a global emergency in April 1993. Worldwide, TB is the leading cause of death due to a single infectious agent. Table no 14. Table Part III-Primary Health Care Elements.35 Tuberculosis Cases.

1999 2000

Population

Total Cases

60275 (Census) 62083(Estimat ed)

37 21

Newly Reported

Case Rate Per 1,000 Pop. 0.61 0.3

6.6.2.4 Resurgence of TB The main reasons for the resurgence of the TB are the neglect of the disease by the governments has allowed TB control systems to deteriorate or even disappear in many parts of the world. Poorly managed and incorrectly conceptualised TB control programmes have contributed to an increase in the burden of the disease as well as to the emergence of multi-drug resistant TB. The link between TB and HIV co-infection has lead to an explosion of TB cases in HIV endemic areas; HIV activates TB in individuals who are TB infected, accelerating the breakdown from infection to disease.

6.6.2.5 Guadal Canal Province Situation During the year 2000, there were total no of 21 cases of Tuberculosis diagnosed.  PTB (+ve)-9 cases, PTB (-ve) -4 cases  Extra pulmonary cases - 8 cases  From the no of PTB (+ve) cases diagnosed, 5 cases released from treatment.  For PTB (-ve) cases, only one released from treatment. Table no 15. NUMBER OF TB CASES BY CLINICS FOR 2000.

HEALTH CENTRES Grove Turarana Tangarare Foxbay Newtenabuti Selwyn

PTB +ve 1 0 0 2 1 1

PTB –ve 1 1 0 1 0 0

GTB

BJTB

TBM

MTB

1 0 0 0 0 0

1 0 1 0 0 1

0 0 0 0 0 0

0 0 0 1 0 0

“Safe Blood starts with me" WHO Slogan for the year - 2000

OTHER S 0 0 0 0 0 0

TOTA L 4 1 1 4 1 2

Annual Report -2000 Viso MBabanakira AvuAvu Balolava Marau Tamboko Total

0 1 1 2 0 1 10

Table no 16.

Disease type PTB GTB BJTB TBM MTB Others Total

Guadal Canal Province

54

0 1 0 0 0 0 4

0 0 0 0 0 0 1

1 0 0 0 0 0 4

0 0 0 0 0 0 0

0 0 0 0 1 0 2

0 0 0 0 0 0 0

1 2 1 2 1 1 21

TB Cases by Age group

0-14 M 0 1 0 0 0 0 1

F 3 0 0 0 0 0 3

1524 M F 1 0 0 1 0 1 0 0 0 1 0 0 1 3

2534 M F 0 4 0 0 1 0 0 0 0 0 0 0 1 4

3544 M F 1 3 0 0 0 0 0 0 1 0 0 0 2 3

4554 M F 0 1 0 0 0 0 0 0 0 0 0 0 0 1

5564 M F 0 0 0 0 1 1 0 0 0 0 0 0 1 1

>65 M 0 0 0 0 0 0 0

F 0 0 0 0 0 0 0

Total M 2 1 2 0 1 0 6

F 11 1 2 0 1 0 15

Short-course treatment regimens for tuberculosis:

The last twenty years have seen substantial improvements in tuberculosis treatment, with the development of highly efficacious treatment regimens. As a result of large-scale programmes of carefully controlled clinical trials, the duration o treatment has been progressively reduced from 18-24 months to 9 months, and now 6 months. However, in order for this intensive, short-course regimens to be effective, antituberculosis drugs must be available to patients. This requires an efficient and effective system of drug procurement and distribution, as well as the availability of health workers to ensure that patients continue to receive these drugs until cured. 

Treatment of tuberculosis. Guidelines for national programmes. Geneva, World Health Organization, 1993: p.2. P 51, Vol.16, No. 1, 1995, World Health Forum.

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55 Agewise Distribution of TB 0-14 7% >65 14%

15-24 3% 25-34 14%

55-64 17%

45-54 14%

35-44 31%

6.6.2.6 DOTS Strategy The resurgence of TB in recent years has made an effective control strategy indispensable. The strategy is known as DOTS- Directly Observed Treatment Shortcourse. The same strategy is being adopted in our province under the guidance of the National TB control unit. Table no 17.

RATIO OF PULMONARY WITH EXTRA-PULMONARY No. of New TB Cases by Category

8

13 Pulm onary

Extra-Pulm onary

6.6.2.7 WHO’s goal The DOTS system is that it makes it possible to set precise and attainable goals for public health services. WHO’s worldwide goal is to treat successfully 85 % of all new active (Smear -positive) TB cases and to detect 70 % of such cases by the year 2000. In 1999 Guadal Canal province the Cure rate was 50 %. “Safe Blood starts with me" WHO Slogan for the year - 2000

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Table no 18. Categories in Pulmonary 10 8 6 4 2 0

SPT +ve

SPT -ve

SPT not done

New

9

4

0

Com pleted RX

5

1

0

Table no 19. Number of All Pulmonary cases & PTB Sputum Positive by Age Group

4 3 2 1 0

0-14 15-24 25-34 35-44 45-54 55-64

>65

All PTB

3

3

3

1

0

2

0

PTB SPT +ve only

1

1

2

4

1

0

0

6.6.2.8 BRIEF REMARKS. The year 2000 created a history in Solomon Islands, especially on Guadalcanal. Guns again came into action after the Guadal Canal battle in 1944 WW II. The result of the ethnic conflict ended in the suspension of all the Health activities around the Island. Medical supplies were supplied to peripheral clinics only through the International Red Cross organisation. Hence, the TB/Leprosy programmes were also was badly affected. The temporary officer NO Mr.Soram Osifera as an acting coordinator of TB/Leprosy programmes, who had only means of communication was through radio with the nurses, for all the activity pertaining to the programme. Few sick patients suspected to be TB were transferred to the base hospital through the ICRC transportation. Although things were difficult as transport, the team did manage to detect 21 cases of TB (all cases) for the whole year. The number could have been higher if there were no crisis. The total no of TB cases in the year 2000, was 16 less than the cases detected during 1999. “Safe Blood starts with me" WHO Slogan for the year - 2000

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Due to displacement and migration of the people from their villages to various different locations up in the mountainous region, became a difficult task for the nurses to reach. Some patients with PTB (+ve) were among those that fled from the place of settlement during the heat of the ethnic crisis, which resulted in delay of follow up treatment.

6.6.3

Leprosy Situation

The following were cases of Leprosy detected and undergone on treatment at the end of 2000.

N o

Name

Ag e

Se x

Addre ss

Clinic

1

Martin P

38

M

Grove

2

Joseph C

13

M

Marau

MB

3

Victor T

25

M

Tutum u Purala va Sungi na

Disea se Type MB

Turara na

MB

6.7

Typ e Ne w Ne w Ne w

Rx Regime n MDT MDT MDT

Date Starte d 17/1/ 00 20/1/ 00 04/4/ 00

Date Complet ed Dec 2000 Dec 2000 Apr 2001

Stat us Activ e Activ e Activ e

Safe water supply & basic sanitation

As we enter the new millennium, the bounties of technology are going to pave the way for a new, modern tomorrow. But are such technological innovations going to be shared equitably throughout the world? UNESCO has been focusing on environment and development issues for the past 50 years. Water, the source of life and human civilization is set to become one of the major issues of the 21st century. Regions of the world facing water shortages are increasing. In the next millennium, one hopes that the demands of the environment and development be transformed into a partnership between the two, so that the goal of sustainable development is met with. Another area of prime concern “GLOBAL WARMING” is the preservation of the biosphere. As Pacific countries are the foremost victims of this changes. Using biosphere reserves, countries can address issues such as the conservation of genetic resources and landscapes, and the ways whereby local people and different institutions can work together to plan and manage a given land area. "To reduce health risks caused by basic sanitation deficiencies in the environment people live"

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The Program on Basic Sanitation (HES) supports country efforts to provide infrastructure and services required by the population to meet their basic environmental health needs. The activities are aimed at: Reducing environmental risks associated with diarrhoeal diseases by increasing access to water and sanitation services, improving drinking water quality, and strengthening the institutions of the sector. Improving health and life quality conditions by increasing coverage of public cleaning services, strengthening responsible organizations, and upgrading waste final disposal. Strengthening the capability of national institutions to face health and housing problems, as well as promoting the importance of a healthy housing and the establishment of centers specialized in housing hygiene.

6.8Environmental Health Division The environmental health division that functions under the Ministry of Health and Medical services in Guadalcanal province is one of the major components of the health delivery system in the province. Until up to the period of the ethnic tension, the division had been keeping a good pace on the development of its services to the rural population of Guadalcanal province. People have continued to benefit from services such as rural water supplies, installation of improved sanitary systems through its awareness and implementation program. This was an increase of coverage of water supply and sanitation facilities of 60% since 1996. The monitoring of environmental health problems that were arising due to commercial and industrial developments on Guadalcanal province was also one of the major roles of the division. The division therefore plays an important part in the development of preventive and promotional health in the overall agenda of health services in the country.

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The need to revitalize and to resume the delivery of health and social services on Guadalcanal province particularly, the provision of water supply and sanitation facilities, and medical supplies should be a priority, despite the desperate situation the government and its department agency were facing, in terms of finance, law and order and the uncertainties surrounding the peace process. The national government through the ministries of health and medical services is committed to rehabilitate and revitalize health services in Guadalcanal Province. This commitment were reflected in the Environmental health division (MHMS) internal re-adjustment and strengthening program. (July-October 2000) While the division was from time and again maintained its commitment, the financial uncertainty has put enormous pressure on the division to take some drastic steps to ensure that services is back to the communities. The environmental health division (MHMS) in its internal re-adjustment and strengthening program highlighted its commitment to assist the environmental health division (Guadalcanal Province) in achieving this goal. Part of the program was the, 1. Reorganization of the EHD Guadalcanal Province and Manpower strengthening. 2. Re-construct storage shed and re-stock materials and supplies. 3. Conduct rapid assessment of damaged water supply systems, displaced population and resettlement camps 4. Repair/ reconstruct of damaged water supply systems and provision of water supply for displaced population 5. Resume the implementation of approved RWSS projects

6.8.1.1 Rationale The uncertainty surrounding the peace process and the underlying needs to provide health services to the rural communities was not compromised. Further to that, the greater movement or displacement of people for the last two years due to the social unrest was directly affecting the distribution of services, and which required the redirection of services in many cases. To achieve this the division realized the great need for the availability of information for planning and delivery of services on Guadalcanal Province. Thus, it is because of the need and importance of information at this time that, the director of environmental health, (MHMS) had arranged for this survey and assessment. The description is an overview of the situation of Guadalcanal Province environmental health division and discusses important issues here to highlighted. “Safe Blood starts with me" WHO Slogan for the year - 2000

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6.8.1.2 Staff movements and relocations during the tension To ensure the safety of ethnic composition of workforce, following measures were taken to relocate and post them at the same division in different provinces: 

The Principal Health Inspector, Mr. Leonard Olivera, from Guadalcanal was given temporary posting to Isabel province where he remained for a period of one and half years.



Two health workers from Malaita were removed from their respective substations to the Headquarter and one staff and a health worker of Guadalcanal origins from the head quarter were transferred to substations outside Honiara.

In the absence of the Principal Health Inspector, Assistant Health Inspector, George Titiulu was mandated to be in charge of the division. When the office at the Guadalcanal provincial headquarters was destroyed, the division operation was transferred to the Environmental Health Division Headquarters. This arrangement remained in place until the government unpaid leave exercise, whereby two staff and four direct employees of the division were affected. Upon recalling staff after the peace celebrations, an arrangement was made by the Director of Environmental Health (MHMS) for an office space at the HQ RWSS project office. Health workers were recalled in December 2000 for a briefing and resume duties. Since 1998, project activities were continuing though at a slower phase because of regular disturbance from militant activities. When the tension was at its height no more activities was done leaving a number of projects only partly done. In summary, the division suffered a setback not only in its programs, but also the organizational set up that occurred as a result, of the destruction of office buildings and staff accommodation. Table no 20. Table 1.0 Strength Manpower 1. Leonard Olivera 2. George Titiulu 3. Francis Sade 4. Methoda Boli 5. Rini Suia 6. Daniel Taurikeni 7. James Boli

Summary of Manpower Allocation (EHD) 1998-2000

Designation Principal Health Inspector Assistant Health Inspector Assistant Health Inspector Health Assistant Health Worker Health Worker Health Worker

Level 8 5 5 3 4 3 3

Category Seconded-SIG.MHMS Seconded “ Seconded ” Seconded “ Directed-GProvince Directed “ Directed “

“Safe Blood starts with me" WHO Slogan for the year - 2000

Annual Report -2000 8. 9. 10. 11. 12. 13.

Joshua Martin Alfred Vili Samson Ezekiel Jack Abel Rowley Alatala Jimmy Sanga

Guadal Canal Province

61

Health Worker Health Worker Health Worker Health Worker Health Worker Health Worker

3 3 2 2 4 3

Directed “ Directed “ Directed “ Directed “ Directed “ Non-established MHMS

Note: Two seconded staff transferred in 1999, however the substantial post was not affected. Table no 21. Internal staff postings and logistics EHD Guadalcanal Province 1998-2000 Location

No. & Category of staff on post 4 Staff and 4 direct employees

Office Space & Accommodation Accommodation rented from province by staff and workers. One two rooms office accommodation One shed office Materials storage facilities and working space.

Work Assets and other facilities. 1 x 3 ton truck 1 mini bray boat 1 large bray boat Computer sets Furniture

Marau Substation

2 Direct employees

1 x 25 hp OBM engine 1x 21 ft Alum boat

Aola Substation

1 direct employee

Avuavu

1 direct employee

2 permanent tie up house accommodation 1 storage and working shed One Leaf house accommodation 1 working shed 1 leaf house Accommodation

GP headquarters

1 x 15 hp OBM engine 1 x 15 hp OBM engine 1 x 18 ft fibreglass canoe

Table no 22. Table 1.2 RWSS Project Submission 1994-1999 Projects Bolale Papangu BelahaSchool Beaufort bay School Ghombuale Rere/Susu Mbabasu Tulagi Rarata Aruligo

Year or submission 1994 1995 1995 1995

Locatio n Ward 14 Ward 21 Ward 20 Ward 4

1995 1995 1995 1998 1998 1998

Ward Ward Ward Ward Ward Ward

4 15 15 4 20Ya 2

Type

Cost

Gravity Hand pump FC FC

$13,2741 $14,083 $28,969 $31,350

Gravity Extension FC Ram pump Gravity hand pump/Tank Gravity

$10,584 $10,7959 $20,3281 $36,905 $3,404 $1,773

6.8.1.3 Damaged and stolen properties. During the take over of the Guadalcanal Provincial headquarter on June 2000, the division had lost numerous items, either stolen or damaged. However, efforts were made to recover some of the valuable assets from the division at GP headquarter and Marau. “Safe Blood starts with me" WHO Slogan for the year - 2000

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Table no 23. abl 2.0

T e

Damaged and stolen properties during June- October 2000 Property/Item description 2 staff Houses

Location

Stolen/Damaged

Marau

Shed and storage house.

Marau

Completely Burned down Completely burned down Partly Damaged

Headquarter Office 100 bags x 40 kg cement 6 rolls x 40 mm polythene pipe 60 x 50 mm GI pipe 10 x wire mesh sheets 50 lengths steel rods 339 x 50 mm PVC pipes I computer chair 1 craw bar 3 spades 10 sheets X 14 ft roofing iron Water supply fittings 1 office table 1 office cabinet

GP headquarter works compound GP HQ compound

Completely damaged

Estimated total value in SI$ 50,000.00 25,000.00 30,000.00 25,000.00

HQ Shed and Marau

Stolen

3,500.00

HQ shed

Stolen

3,900.00

HQ shed

Stolen

12,000.00

HQ shed

Stolen

2,000.00

HQ shed

Stolen

1,400.00

HQ shed

Stolen

10,200.00

Store house Ranadi

Stolen

GP HQ shed

Stolen

3,000.00 400.00 360.00 980.00

GP HQ shed

Stolen

2,000.00

GP HQ shed GP HQ shed

Stolen Stolen

500.00 1,000.00

TOTAL VALUE

$171,240.00

The following projects have been resubmitted for the next six months (July – December 2001) construction program, Papangu, Belaha, Beaufort Bay, Reresusu, Babasu, Tulagi and Rarata, and would depend very much on the availability of material from the project management. “Safe Blood starts with me" WHO Slogan for the year - 2000

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The following projects have been surveyed and awaiting funds from World Vision. They were,Tetupa, Tavisana, Kaotina, and Bubuli/Tenamaota. Work on these projects depends on confirmation of funding. Projects should be included in the construction program for this year and will be as substitute for the above Table 2.1 Activities/Project Outline for year 2001 N o 1

Project

Activities

Duratio n 12 months

Cost

Location

New water supply

Construction of 8 water supply

2

Maint /Ext of Existing System 10 sanitation Projects

16,000

Carry out repair & maintenance.

12 Months

10,000

Implementatio n

12 Months

24,000

Water supply & sanitation Assessme nt

Conduct Survey & Assessment

12 Months

8,000

Mbabanakira NAC Talaura Tetupa, Komuisia, Titinge Tetupa Chelamamata. Paru-Naro, Kombuale, Visale Tasahe Aruiligo Lumuiko. Bulukalai Beautfortbay Sch Tamboko Obobo Suhgu West Guad/Primary Sch. Mbabanakira Tiaro. Belaha. Around Guadalcanal

4

5

Awarenes s

2 Months

6,500

Project Site

RWSS

6

Public Health Inspection

Conduct 4 Training workshop Conduct & Monitor Industrial & Food Premises

3 Months

2,000

Following Complaint

EHD

7

Office Building

Construction Of EHD Office G. Province

6 Months

70,000

?

RWSS SI.Govt

3

Implement er RWSS, World Vision, NZ High Com

Variable indicator Numbers of water supply Completed.

AusAid RWSS

Numbers of water supply Completed. Numbers of sanitation Projects Completed.

RWSS AusAid

RWSS

6.8.1.4 Social Survey. “Safe Blood starts with me" WHO Slogan for the year - 2000

Numbers of sanitation Projects Assessed and, report Submitted. Numbers of Training Completed Numbers of Inspection conducted and actions taken. Completion

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There are 400 village communities involved in the survey with a total population of around 5000 people. The table below presents community responses Table 3.0 Social Survey response for community EHD /01/01

ISSUES Displaced Repatriation Peace Process Service by EHD Support for EHD Programs Deployment of Staff Staff Safety Importance of Services Community Contribution Water Supply

RESPONSE O N/O N/S

Y N 143 7 140 0

45

100

E

N/E

(S)/E I

30

111

9

V/I

5

150 80 60

20 30

50 60 100

50

150 20

Table 3.1 Social Survey response for community EHD /01/02

ISSUES Y Displaced 101 Repatriation 126 Peace Process Service by EHD Support for EHD Programs 130 Deployment of Staff Staff Safety Importance of Services by EHD Community Contribution Water Supply 60

N 29

RESPONSE O N/O N/S

26

82 86

21

E

N/E

(S)/E I

20

92

15

V/I

43

13 9

35 35 23

107

123 7 70

Keys: Y=yes N=No O= Ok N/O= Not Ok N/S=Not Sure E=Enough N/E=Not Enough (S)/E= Some Effort I=Important V=Very Important Table 3.2 Social Survey response for community EHD /01/03

ISSUES Y Displaced 22 Repatriated 21 Peace Process Service by EHD Support for EHD Programs 25 Deployment of Staff Staff Safety Importance of Services Community Contribution 25 Water Supply 5

N 3

O

18

RESPONSE N/O N/S E

V/I

7 10

20 22

N/E (S)/E

7

8

5 3

Keys: Y=yes N=No O= Ok N/O= Not Ok N/S=Not Sure E=Enough N/E=Not Enough “Safe Blood starts with me" WHO Slogan for the year - 2000

25

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Guadal Canal Province

(S)/E= Some Effort I=Important V=Very Important

6.8.1.5 Discussion It costed the division an exorbitant amount of money, manpower and logistics to provide its services to the communities due the tension. The financial loss incurred by the division in terms of materials, equipments, and assets valued to, more than ½ a million dollars. This includes damages to water supply systems, damaged or stolen materials, equipment and assets, and the delays attributed to the constructions of water and sanitation facilities for the past two years and repair and maintenance of equipments. Besides the costs, the division is facing financial constraints. As figured out in the review, health and medical services, wages and services grants is badly affected by the governments cash flow problem. This will have great implications on the rehabilitation and the re-adjustments program of the Environmental Health Division (MHMS). Already an unpaid leave exercise will affect 30% of the workforce of the division, a set back to the revitalization and resumption of environmental health services. Shipping services around Guadalcanal Province is yet to make regularly services. However, the division had managed to ship some of the water supply materials to project sites in the last few weeks. Fortunately, the underline accounts of the division from sales of toilet slab, culverts, and some materials from the division’s store, have greatly assisted the division to continue providing some of the services. This includes payments of wages, freights, and others such as fuel. The effects of the ethnic tension, has had its social implications on the services of the division. For instance, the greater internal movement of people has had its implication on the distribution and delivery of services, such as health and medical, schools, and other social services. This is clearly indicated by the demand for water supply in many communities and the shortage of medicine in most clinics. According to the survey, there is an increase of 15% of the population in most communities. Thus, it means, an extra demand exerted on existing services such as water supply and sanitation, and medical services. On the other hand, 6% reduction in local population is attributed in some areas. This will have greater implication on the planning of services in the future. The need to revitalize and resume environmental health services to the communities is realized by the division, but the need have really been felt by the communities. This however, is indicated by the high response to such needs by the communities, in terms of repair and maintenance of damaged and aging water supply systems in their areas. Further to that, the enormous response in support for the EHD PROGRAMS and their awareness of the community contribution has indicated their willingness to assist the division in its programs. Finally, the effect of the ethnic tension on the rural people is clearly indicated by their response in terms of their views on the peace process. While 38 % of the “Safe Blood starts with me" WHO Slogan for the year - 2000

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respondents have agreed that, the peace process is progressing, an overwhelming 60% are not sure what direction the peace process is heading. This view had been highly attributed to the slow progress of the disarmament process.

6.8.1.6 Recommendations The successful implementation of environmental health programs will be attributed to the level of participation of both the communities and the division. Thus, the division will have to re-iterate the importance and significant of community participation and the levels of cooperation needed to complete the work successfully. However, the division should commit itself for the implementation of the community participation strategies. Thus, this report recommends the following, 1. Health awareness and workshops should be included in all projects as a component of the project. Thus, funds should be secured for this purpose. 2. Despite the setbacks and constraints, services should resume at whatever means and cost. 3. Actions plan to be drawn up and schedule. The plan should focus and address areas on assessment of damages to existing water supply systems, and sanitation demand as result of resettlement of people. 4. Conduct rapid assessment of damaged water supply systems, displaced population and resettlement camps 5. Repair/ reconstruct of damaged water supply systems and provision of water supply for displaced population 6. Resume the implementation of approved RWSS projects

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7 Part IV-Management & Support activities

7.1Administration & Management Dr.H.K.Balachandra was transferred by the ministry of health from Makira Ulawa Province to Guadal Canal Province as Director of health and assumed the office on September 12, 2000 in the light of ethnic situation to have neutrality amongst health provider. He succeeded Dr.Lipson Sissiolo, who in turn was transferred to Choiseul Province. CNO Mr.George Maebata managed the office efficiently in the absence of the Director. He also worked continuously and tirelessly through out the ethnic tension. PNO Batram Manu took charge whenever found necessary. Mr.Benson Anisi accountant all strived hard all through the year.

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Resource

Medical

Training

Introduction

World Health Assembly in 1987 urged its Member states "to ensure that human resources be not only adequately planned for and trained, but also skillfully managed, including the improvement of career development and incentive schemes, to ensure its most effective utilization" vi. Provincial health services largely depend on auxiliary health personnel. It has been described as "Skill pyramid" in which skills in health care are widely distributed amongst those who provide health services, and not restricted to doctors and senior nurses who have had intensive medical and clinical training. Training needs to be 'built in' as part of the normal activity of the province, and not seen solely as something which takes place in training schools. It was reported that the main focus and the priority were given to MCH/FP unit and non-availability of the fund to address the refresher courses for registered nurses, and nurse-aides.

7.2.2

Training Activities

Following training were conducted before the crisis and after the signing of Townsville Peace Agreement Table no 24.

Staff Training

DATE

VENUE

TOPIC

CONDUCTED BY

(a)

22/2/00

Tamboko

MCH/ Sr Vika

(b)

29/3/00

Tamboko

(c)

11/11/00

Tetere Parish

Reproductive Health Forming Health Committee STI & Reproductive Traditional birth attendance Traditional birth attendance Traditional birth attendance

GP Med. Team

20/11/ 24/11/00 (e) 27/11/00 -1/12/00 (f) 11/12/00 -14/12/00 (d)

Balasuna COC Centre Kolina Maravovo

GP Med Team GP Med Team

GP Medical Team GP Medical Team

Table no 25. Overseas training

a

Perio d 2000

Name

Course

Institution

Noel Itogo

Diploma in Nursing

Collage of Allied health Science

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b

2000

Mark Caleb

Paediatric

Depo MHMS

c

2000

Christine Sau

Paediatric

Depo MHMS

7.2.3

Training Overseas:

One of our senior staff SNO Mr.Noel Itago successfully completed Post Graduate Diploma in Community Health Nursing Administration of one year duration in the year 2000, at College of Allied Health Science, University of Papua-New Guinea at Port Morsby.

7.3Supervisory Tours 7.3.1

Introduction The supervisory tour, one of the important out-reach activities in the management of Curative, Preventive and Rehabilitative process in the Provincial Health Services delivery. It also examines the possibilities of highlighting the neglected issues, and to strengthen the health worker and the community on the whole.

The main island mountainous interior virtually all settlements along the coast, but southwest (weather coast) is very exposed making travel along it difficult dangerous.

7.3.2

has and are the and

Objective

Purpose of the tour to these areas Marau – Marapa clinic and Makina was on the request from the community in that remote part of the island become a main concern to their leaders that the Health problems had increased to a significant level, after the Nurse left the clinic in that area. Team left Honiara on Wednesday at 2 pm 09/05/2000 by OBM/Canoe, which took 4 hours, and reached late in the evening. The clinic sessions commenced the next day Thursday 10/5/2000.

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The main focus was the children’s immunization schedules, besides screening for general illnesses. Immunizations was followed by ante-natal checkup and the general outpatients clinic for all minor illnesses and other health problems.

8 Conclusion Health is the outcome of a combination of various factors--biological, genetic, environmental and socioeconomic. The elements that condition people’s health go beyond physiological factors to include gross national product, wealth distribution and access to income-earning capacity and opportunities, availability of and access to educational resources, the urban and rural living environment and physical infrastructure, and, for instance, political structures through which individuals and groups can influence distribution of resources that affect health status.vii The numerical data on disease distribution is necessary to determine the priorities for the health services and to ensure that the activities of medical staff are in accord with these priorities. Public health studies can help to guide physicians to the proper diagnosis, treatment and prevention of disease in individual patients. Prevention may be applied at various stages of the disease process. Primary prevention works during the susceptibility stage of disease by minimizing exposure or altering immunity. Secondary prevention tries to identity cases in the pre-clinical and early clinical stages through early detection and treatment. Pap smears would be an example of the secondary prevention of cervical cancer. Tertiary prevention aims to limit disability from the advanced stages of disease and restore function. Good health makes to economic activity - this is not fully understood. Health expenditures are still too often considered to be a drain on national and community resources, and another misconception is the idea that prosperity will automatically improve health and welfare, whereas in reality this is not the case. There is thus a need for research on health in relation to various social, economic, environmental and demographic factors. Research must be carried out in collaboration with other sectors such as agriculture, education, employment, industry and transport. Commitment from the community and their participation towards health service delivery is the need of today. “Safe Blood starts with me" WHO Slogan for the year - 2000

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The spiritual and scientific legacy of Sir Ronald Ross: It was the spiritual and scientific legacy left by Ross [ whose discoveries led to identification of the carrier and mode of transmission of malaria in 1897-1898] that inspired the WHO when, in May 1955, it decided to "take the initiative, provide technical guidance, and encourage research and coordination of resources in the implementation of a programme having as its ultimate objective the worldwide eradication of malaria"

-From an address by Dr M.G. Candau, Director - General of WHO, in June 1957 on the hundredth anniversary of the birth of Sir Ronald Ross. In: Chronicle of the WHO, 1957, 11: 302.

9 Key Health Indicators  Population with safe water in the home or with reasonable access…………65 %  Population with adequate facilities for excreta disposal. …(1996)………… 9.0 %  Immunisation performed during the last 5 years:-

 Population with access to local health care and essential drugs…….. 65- 70 % Criteria involved: - Availability of treatment for common diseases and injuries. - A regular supply of essential drugs - Health facility with 1 hour walk/travel.  Expected number of births(n)…………………………………….……………….. 1299  No. of pregnant women seen by trained personnel………………………….. 76 %  No. of deliveries attempted by trained personnel…………………………….

80 %

 New born infants with birth weight <2.5kg. …………………………………..

7%

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 Children below 5 years of age below reference value of weight for age…… 11 %  Cases of Diarrhoea below 5 years………………………………..Mild………. 12.7 % Moderate….… 2.2 % Severe ….….. 5 % .

10 Acronyms

“Safe Blood starts with me" WHO Slogan for the year - 2000

AFB-Acid Fast Bacilli AHC-Area Health Centre ANC-Ante Natal Care ANO-Assistant Nursing Officer BCG-Bacillus Calmette Gurine CHT-Community Health Team CNO-Chief Nursing Officer DHMS-Director of Health & Medical Services DOTS-Directly Observed Treatment Shortcourse DPT-Diphtheria Polio Tetanus EHD-Environment Health Division EPI-Expanded Programme of Immunization ESR-Erythrocyte Sedimentation Rate EU-Eoropeon Union FP-Family Planning GP-Guadal Canal Province GPHQ-Guadal Canal Province Head Quarters Medical Division HIV-Human Immunodefiency Virus IDP – Internally displaced people IR-Incidence Rate MB-Multibacillary MCH-Mother & Child Health MDT – Multi Drug Therapy

11 References

MHMS-Ministry of Health & Medical Services MUP-Makira/Ulawa Province NA-Nurse Aide NAP-Nurse Aide Post NO-Nursing Officer OBM-Out Board Motor OPD-Out patient Department OPV-Oral Polio Vaccine PB-Pauci Bacillary PF-Plasmodium Falsiparum PHC-Primary Health Care PNC-Post Natal Care PNO-Principal Nursing Officer PTB-Pulmonary Tuberculosis PV-Plasmodium Vivax RHC-Rural Health Clinic RN-Registered Nurse RWSS-Rural Water Supply & Sanitation SAMO-Senior Anti-Malaria Officer SNO-Senior Nursing Officer TB-Tuberculosis TPA-Townsville Peace Agreement VDRL-Venereal Disease Research Laboratory VHW-Village Health Worker WHO-World Health Organisation WV – World Vision

i

This excludes Honiara City Council, which had a population of just over 49,000 in 1999.

ii

World Health Organization (WHO). Mother and Baby Package:Implementing safe motherhood in countries (WHO/FHE/MSM/94.11 Rev.1). Geneva, 1996. iii

Disease trends," Life in the 21st century - A vision for all", World Health Report 1998 Executive Summary, http://www.who.int/whr/1998/exsum98e.htm iv

v

Weekly epidemiological record, No.37, 2000, 75, page 303. http://www.who.int/wer

Fortieth World Health Assembly, Geneva, 4-15 May 1987, resolutions and decisions, WHO document WHA40/1987/REC/1, Geneva, 1987. vi

vii

Health dimensions of economic reform. Geneva, WHO, 1992.

Thank you