National Health Report 2003-solomon Islands

Report by the Ministry of Health (May 2004):

1 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

MINISTRY OF HEALTH SOLOMON ISLANDS GOVERNMENT

NATIONAL HEALTH REPORT 2003

Evaluation of the National Health Policies and Development Plans 1999-2003:

(Health Policies Objectives and Outputs-Achievements & Constraints by end of 2003):

OURPEOPLE’ SHEALTH OURPASSI ON

MAY 2004

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Report by the Ministry of Health (May 2004):

2 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

MAJOR HEALTH POLICY OBJECTIVES AND OUTPUTS-ACHIEVEMENTS & Constraints 2003. Table of Contents: NATIONAL HEALTH REPORT 2003 .......................................................................... 1 OUR PEOPLE’ SHEALTH OUR PASSION.................................................................. 1 I. PREAMBLE: ................................................................................................................... 4 1.0. INTRODUCTION: ........................................................................................................ 5 1.1. VISION AND MISSION: ............................................................................................... 5 1.2. THE HISTORICAL DEVELOPMENTS IN THE HEALTH CARE SYSTEM BY END OF 2003: 6 1.3. HEALTH STATUS: ...................................................................................................... 6 2.0. PROCESS AND OUTPUT EVALUATION OF THE NATIONAL HEALTH POLICIES 19992003: ............................................................................................................................... 9 POLICY 1: IMPROVEMENT OF HEALTH SERVICE PLANNING, MANAGEMENT AND SUPERVISION. ..................................................................................................................... 9 1.1.Overview:.............................................................................................................. 9 POLICY 2: ACCESSIBILITY, AND IMPROVEMENT OF CARE AND QUALITY OF SERVICES. 12 2.1. Curative Health Services: .................................................................................. 12 2.2.1. Medical Services:............................................................................................ 14 2.6.1. Accident & Emergency Services:.................................................................... 14 2.7.1. Access to Essential Medicines: ....................................................................... 16 2.8.1 Access to community health services through Primary Health Care:............. 17 2.9.1. Health Infrastructure Development:............................................................... 17 2.10.1. Dental & Oral Health Services: ................................................................... 22 2.11.1. Ophthalmology & Primary Eye Care Services:............................................ 22 2.12.1. Diagnostic Services at Hospitals:................................................................. 24 2.13.1. Rehabilitation Services: ................................................................................ 25 POLICY 3: HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT FOR HEALTH ......... 25 POLICY 4: MORBIDITY AND MORTALITY REDUCTION....................................................... 27 4.0. Overview:........................................................................................................... 27 4.1.Malaria: .............................................................................................................. 28 4.2. Acute Respiratory Infection: .............................................................................. 29 4.3. Malnutrition:...................................................................................................... 31 4.4.0. Diarrhoeal Diseases: ...................................................................................... 32 4.5.1 Diabetes (NCD): .............................................................................................. 32 4.5.2. Tobacco and its Impact and the control measures in Solomon Islands: ........ 42 4.6.0. Tuberculosis:................................................................................................... 53 4.7.0. Leprosy: .......................................................................................................... 60 4.8. Sexually Transmitted Infections ) including HIV: ............................................. 64 4.9. Mental Health Service: ...................................................................................... 66 ------------------------------------------------------------------------------------------------------------

Report by the Ministry of Health (May 2004):

3 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

POLICY 5: ENVIRONMENTAL HEALTH SERVICES ............................................................. 67 POLICY 6: HEALTH EDUCATION AND PROMOTION........................................................... 69 POLICY 7: REPRODUCTIVE HEALTH & FAMILY PLANNING............................................... 72 Child Health Services & Expanded Program of Immunization (EPI):..................... 74 POLICY 8: DEVELOPING PARTNERHSIP IN HEALTH DEVELOPMENTS: ............................ 77 3.0. DISCUSSION ON IMPEDIMENTS/ DIFFICULTIES / ISSUES: .......................................... 80 Compiled by Dr George Malefoasi (Undersecretary Health Improvement) and Mr. Abraham Namokari (Director Policy and Planning), Ministry of Health. Copyright @ 2004

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Report by the Ministry of Health (May 2004):

4 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

I. Preamble: The draft Report on Health Activities and Outputs for 2003 provides some basic information on the evaluation on the health inputs or resources and the outputs or (the deliverables). The report also provides the Government information of the achievements and constraints in 2003. Unfortunately the limitations of the report are the unavailability of some update information on health events and indicators. Nonetheless, the report is comprehensive enough in identifying some gaps between the demand and supply of health services. In general the report has identified areas of improvement in the past years as by end of 2003. Obviously there are also areas of weaknesses within the health sector, which need specific as well as general multi-sectoral concerted strategies and solutions. The indicators for the key eight broad health policies were reviewed by end of 2003. In short, there were outputs, which has positive impact on the population health, whilst there were constraints that accentuated weaknesses of the existing system. A paramount output for the Ministry of Health is the development of the National Health Plan 20045, which entails the future directions and strategies and plans for the next twenty months. The Health Institutional Strengthening Project funded by AusAid has impacted positively in building local capacity at the national and provincial levels in management and supervision issues such as planning, budgeting, resources management, coordination and communication. This report will be complemented in detail by the National Health Review 2004 currently in progress.

Dr George Manimu Permanent Secretary

Hon. Benjamin P Una Minister of Health

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Report by the Ministry of Health (May 2004):

5 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

1.0. Introduction: This report is about measuring the outputs whether achievements or constraints by end of 2003. It also inform the Government and other key stakeholders new developments in health as well as emerging diseases such as the SARS and cancer of lungs due to smoking.. The main body of the report concerns with the review of indicators for the key broad eight policies adopted and implemented to ensure that population health has improved in the past five year period 1999-2003. The report covers recent researches findings, which helped in appraising the situation of the population health. The report also attaches the approved list of hospitals and clinics by end 2003.

1.1. Vision and Mission: Th i si sa no p p o r t u n i t yt or e i t e r a t et h eSo l o mo nI s l a n d sGo v e r n me n t ’ sv i s i o nf o rt h eh e a l t ho f o u r people and the mission in achieving the best health outcome. Vision Statement: At the Ministry or sectoral level it clear that: The Ministry of Health endorses the World Health Organization Constitution that it is the fundamental right of every human being without distinction to race, gender, religion, political belief, and economic or social condition to enjoy the highest attainable standard of health. In that context and through its efforts in the delivery of care, the Ministry of He a l t hh a savi s i onof“ Ahe a l t hya ndpr oduc t i veSol omonI s l a nds ” . Mission Statement: The mission set to achieve the vision of the Government is also clear at the Ministerial level, which form basis for other national plans and strategies such as the Medium Term Development Strategy (1999-2003)1, an the recent National Economic Recovery, Reform and Development Plan (20032006)2. The Ministry of Health aims to provide a high quality national health system that is accessible; appropriate; responsive; and equitable. It must also continually upgrade that SIG ( 1998): Medium Term Development Strategy (1999-2003) : Ministry of National Planning and Development , Honiara. 2 SIG (2003). National Economic Recovery, Reform and Development Plan. Department of National Reform and Planning, Honiara. 1

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Report by the Ministry of Health (May 2004):

6 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

sys t e mt oa c hi e vei t s“ Mi s s i on”of“ Pr omot i ng,pr ot e c t i ng ,a ndma i nt a i ni ngt heg ood health and well being, and hence improve the quality of life of all people in Solomon I s l a nds ” .TheMi ni s t r ywi l ldoi t sbe s tt of ul f i l lt h a tmi s s i onwi t hi nt hec ont e xtofna tional health legislation and within the limits of resource availability. In the National Economic National Economic Recovery, Reform and Development Plan (20032006), the mission is to reduce health inequalities, and infant and maternal mortality.

1.2. The Historical Developments in the Health Care System by end of 2003: 7th

There have been significant socio-political developments since the Independence in July 1978 that had impact on the primary health care systems. STAGE I: 1978-1989 Solomon Islands became Independent Nation –Provincial Government System adopted. Decentralization of health care services administration National Census STAGE II: 1990-2000 Natural Disaster – Cylcone Namu hit Solomon Islands Re-centralization of health care system administration Malaria hits the highest level in 1992. Honiara the malarious town in the world. Public Services Policy and Structural Policy emerged for the first time ever. STAGE III: 1990-2003 Ethnic Tension/ PHC Crisis National Census RAMSI National Recovery Plan Reconstruction S/PHC-Re-establishment of PH services-Post-conflict

1.3. Health Status: The general health status indicators for the people of Solomon Islands have been stable through out the past five years (1999-2003). Nonetheless, the infant and maternal mortality remains high. Annual growth and death rates are also high by international standards. It has been evident that the ethnic conflict has caused devastating effect on the social services such as health. This is shown in the service delivery indicators to the provinces. The immunization overages have been low below 80% in general (1999-2002). Outreach services were low and poor health infrastructure despite an increase of the number of health facilities by end of 2003. There has been an increase of malaria incidence by 19% by end of 2003. Sexually Transmitted Infections has been reported to be increasing. The threat of HIV/AIDS epidemic has been eminent should

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Report by the Ministry of Health (May 2004):

7 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

nothing proactive done to stop new infections and transmission. Life-style behavioral diseases such as diabetes and lung cancer lung due to tobacco smoking have been reported to be increasing the past five years. Emerging of new diseases such as SARS and dengue has created fear and pressure to the already debilitated health care system in 2003. There are also positive signs such as the improvement of the life expectancy rates for both sexes especially the female. The level of deliverables (health services) ha been observed to be reduced in (1999-2001) due the poor government financial situation. Fortunately, the emergency assistance to the health sector from Australian Government (AusAID), New Zealand (NZODA), Japan, Republic of China, WHO and other donors prevented total collapse of the health system during the crisis. The Ministry of Health has vowed to re-establish health services in full through partnership with donor partners and the local community. 1.3. Health Indicators by end of 2003: Indicators

1996

1997

1999

2003

Number of health

256

252

247

275

410,368

425,4

409,042

464,89

facilities Total Population

88 Population <1 year

15,209

15,77

8 13,513

14,568

50,119

53,796

97,459

112,96

2 Population 1-4 years

56,432

58,51 6

Population women 15 –

87,294

49 years Expected births

90,48 6

17,235

17,86

0 13,907

17,480

8 Total deaths

863

884

804

850

Total Births

7,235

7,360

6,329

7,793

3.6

2.8

3.2

Annual Growth rate

(2002)[1]

Crude Birth rate Crude Death rate

42 5

42 4.9

34

37.6

[2]

(2001)[6]

9

Na

[2]

Maternal Deaths Maternal Mortality/

8

5

na

Na

Na

Na

125

295 (2001)[3]

100,000pop Infant Mortality/ 1,000

Na

Na

66

66

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Report by the Ministry of Health (May 2004):

8 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 -------------------------------------------------------------------------------------------------------------------------------------------------------------(1999)[4]

live births Life Expectancy-

Na

Na

M-63.6

Male: Female

F-67.4 (2002)[2]

Total Fertility rate

4.7

4.7

4.7

[5]

% Family Planning

7.7

4.05 [6]

8.5

8

10 [3]

Coverage % Antenatal Coverage

74.4

68.9

84.0

77.2

% Postnatal Coverage

36.6

39.9

44.3

41.2

% Detected malnutrition

1.6

1.5

1.1

1.4

Touring Satellite Clinics

2,309

2,068

1,655

Na

890

720

509

Na

1,600

1,767

1,907

Na

58.1 %

69.4

69.4%

79

65.2%

69

68.6%

73

54.8%

56

69.2%

70

69.6%

78

Touring Schools Village Health Meetings EPI

- BCG (%)

% - Measles (%)

63.8 %

65.2 %

- DPT3 (%)

71.9 %

68.6 %

- TT2 + Booster(%

56.1 %

54.8 %

- Polio 3(%)

69.0 %

69.2 %

- Hepatitis B 3(%)

68.3 %

69.6 %

- DPT1 / DPT3

4.6 %

5.3 %

5.3%

Na

- 9.8 %

6.0 %

6.0%

Na

drop out(%) - BCG / Measles drop out Note: Data for 2003 is incomplete at the time of writing the report. Key sources of data/ information: [1] WHO Annual Report 2003,[2] WHO Annual Report 2002 [3] Reproductive Health Division, MOH, [4]National Census 1999, SIG, [5] WHO Annual Report 1999, [6] The Work of WHO in the Western Pacific Region Report 2001-2002.

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Report by the Ministry of Health (May 2004):

9 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

2.0. Process and Output Evaluation of the National Health Policies 1999-2003: Policy 1: Improvement Of Health Service Planning, Management and Supervision.

1.1.Overview: 1.1. Objectives: To develop efficient and effective organizational health structure within the plan period. To improve networking and coordination of major public health divisions in particular, nursing, Disease Prevention & Control Center, SIMTRI, Health Education Divisions. To improve and strengthen the National health Information and Planning Division of MHMS. To improve management and planning capabilities of heads of divisions within the plan period. To improve monitoring and evaluation of health services. 1.2. Performance Indicators: Fully documented and implemented structure Improved integration and coordination Improved planning documented at National, Provincial and Program levels Improved Monitoring and Evaluation Professional Staffing 1.3. Outputs-Achievements & Constraints: Outputs (or Deliverables): 1.3.1 A key development in the health sector in the past two years since 2001, is the health institutional strengthening (HISP) continued through the Phase 1 (2001 to September 2003)

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Report by the Ministry of Health (May 2004):

10 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

and 2 (September 2003 to August 2004) of the HISP funded by AusAID3. A report that entails the detail outputs of the HISP is attached4. 1.3.2. Communication further strengthened through two National Conferences held in April and November 2004 respectively. The first meeting was held especially to review the staffing and health activities against the limited funding from the Health Sector Trust Account (HSTA) funded by the AusAID. The Solomon Islands funding was never accessed. 1.3.3. The National Health Policies and Development Plans were implemented satisfactorily despite significant difficulties as result of the two years ethnic tension. Basic and minimal services continued to be provided by the Solomon Islands Government through the direct budgetary funding support to the Ministry of Health. 1.3.4. The Health Institutional Strengthening Project funded by the AusAID provided the emergency health financing of the health services as well as the capacity building to the management and supervision of the national and provincial health services. Improvement of the communication network with clinics begun in 2003 and is in progress. The total of 45 new radios and support accessories such as terminals and solar installed at many clinics. (A detail report on the outputs of the HISP can be obtained from MOH) . 1.3.5. Policy Governing Establishment of new Health Facilities completed in 2002 implemented. 1.3.6. A patient satisfaction survey was done in 2001 with the assistance of the HISP project, which helped to raise some key issues related to quality standard of care to the patients at the hospitals. The survey was carried out at the NRH Honiara. Some of the findings will be used in evaluating the workload and level of staffing, the operational structure and staff performances at the hospitals. Negatives:  Limited output has been achieved in reforming or restructuring of the structure and the function of the health sector.  No implementation of the draft restructuring of the Nursing Structure Completed (HISP) in 2002.  Non implementation of the revised doctors scheme of service approved in July 2002, which provide strategies to retain local qualified specialist doctors.

1.2.1. Health Financing: 1.2.2. Objectives: To contain production cost at the Central Hospital, National Referral Hospital below 40% of total health expenditure by 2003. To recover 50% of the production cost at the Hospitals within the plan period. 3

Health Institutional Strengthening Project (HISP) funded by AusAID, Ministry of Health (2003) HISP (2004). Annual Report February 2003-February 2004: Prepared for the HISP PCC Coordinating meeting 15th April 2004. 4

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Report by the Ministry of Health (May 2004):

11 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

To raise revenue collection at the NRH from 0.06% in 1994 to 25% of the health budget to NRH by 2003. To increase in terms of nominal budget allocation for prevention and promotive health services within the plan period. 1.2.3. Performance Indicators: Annual NRH Expenditure. Annual Health Budget [Estimates) Annual Revenue Collection by NRH Budgetary allocation to preventive and promotive health services 1.2.4. Outputs-Achievements & Constraints: Outputs (or Deliverables): 1.2.4.1 New Accounting System established – MYOB (HISP) fully implemented. 1.2.4.2. Resource Allocation Formula implemented in the 2003 budget. 1.2.4.3. Embassy of Republic of China approved a Primary Health Care Rehabilitation Project to re-establish primary health care activities in the provinces. Total of SBD 5.2 M given and deposited into the HSTA account. 1.2.4.4. Sources of revenue for the health services delivery were obtained from the World Bank, AusAID, and ROC. 1.2.4.5. National Referral Hospital contained its service cost well below their acceptable level. The 1.2.4.6. NRH spend below 26% of the total Health Recurrent for 2003. Negative;  Revenue collection at the NRH remained low below planned 25% of the NRH 2003 budget. Partly because the Revised Fee Schedules approved by Cabinet in 2002 was never implemented. This is it was not gazzetted. 1.3.1. Health Information System 1.3.2 Objectives: To increase timely clinic reporting coverage form the current level to 100% by 2003 To design and implement a comprehensive HIS for SI within the plan period. To establish a 100% computerized hospital information system in the NRH by 2003. To extend this system to the 6 provincial hospitals, and 2 church hospitals by 2003. 1.3.3. Performance Indicators; Clinic reporting coverage Implemented Comprehensive HIS ------------------------------------------------------------------------------------------------------------

Report by the Ministry of Health (May 2004):

12 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Implemented computerized hospital information system Extended computerized system in provinces 1.3.4. Outputs-Achievements & Constraints: Outputs (or Deliverables):  1.3.4.1. Health Information System- monthly clinic reporting from all clinics in the provinces and HCC continued despite a low coverage still.  1.3.4.2. Disease surveillances systems for TB, Psychiatry, Diabetes, STI/HIV, and Malaria.  1.3.4.3. Database for Reproductive Health programs completed and piloted in 2003.  1.3.4.4. HIS computerized system updated from windows 3.1 to Microsoft 2000. Issues and Constraints:  HIS Monthly reporting response still low at 60-70%5.  Establishment of the Hospital Information System never been implemented due to failure by the private consultant.  The computerized Health Information System systems is under the process of upgrading thus HIS data for 2003 is not available at the time writing this report. Policy 2: Accessibility, And Improvement Of Care And Quality Of Services. Ru r a lp e o p l e ’ sa c c e s s i b i l i t yt ob a s i cr e a s o n a b l ep r i ma r yh e a l t hc a r es e r v i c e si sap r i o r i t y importance as 80% of the population lives in the rural areas. Steps are envisaged to consolidate existing health facilities (not to construct new ones) and to increase utilization, because of the limited resources. Staff training and community motivation is vital. 2.0. Policy Statement: It is the constitutional right of each individual of the community to have access and equity to a minimum reasonable quality of health care, and essential medicine, and other public health services. (Health For All Strategy).

2.1. Curative Health Services: 2.1.2. Objectives: To improve doctor to population ratio from 1:7031 in1995 to 1:4500 by 2003. To improve nurse to population ratio from 1:836 in 1995 to 1:500 by 2003. To improve nurse aide to population ratio from 1:1208 in 1995 to 1:800 by 2003. 5

HIS Clinic Monthly Reports, Statistics Unit, MOH

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Report by the Ministry of Health (May 2004):

13 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

To improve hospital utilization rate in the provincial hospitals from 45-65% in 1995 to 90%by 2003. To improve hospital utilization rate at the National Referral Hospital (Central Hospital) from 70% in 1995 to 80-90% by 2003. To increase self-r e l i a n c es p e c i a l i s t c a r ei n2ma j o rp r o v i n c i a l h o s p i t a l s( Ki l u ’ u f i a n dGi z o )t or e d u c e number of referrals by 50% by 2003. 2.1.3. Performance Indicators. Doctor to Pop. Ratio Registered Nurse to Pop. Ratio Nurse Aide to Pop. Ratio Hospital utilization Rate No. Of referrals 2.1.4. Output-Achievements & Constraints: Outputs (or Deliverables):  2.1.4.1. Total 8 hospitals were fully operational.  2.1.4.2. Medicine supplies to the clinics and hospitals improved more than the 2002.  2.1.4.3. Ongoing training for nurses continued overseas and locally at the SICHE and the HISP management courses.  2.1.4.4. Five (5) new graduates in the filed of Midwifery to the provinces.  2.1.4.5. By end of 2003, there were total of 1,091 nurses6 (both established and direct employed nurses in the provinces) with a Nurse: Population Ratio of 1:419 as compared to 1999, which was 1:836 in 1986.  2.1.4.5. Tertiary or sub-specialist care of paediatrics surgery, eye, ENT, radiology, and interplast have been provided locally through the Pacific Island Project (PIP) Phase 2 executed by Royal College of Australasia Surgeons (RACS)7. Issues and Constraints:  Access to doctors and nurses by the communities was low than the planned ratio by 2003. Firstly, capacity of the School of Nursing at the SICHE could not allow for increase intakes because limited resources. Secondly, the graduates from other school (Atoifi Nursing School) has never been formal part of nursing training for the whole country.  Migration of health professionals of the country away to neighboring countries has been observed to accentuate the gap. In the past 12 months more than 5 nurses have moved out to Marshall. Twenty percent (20%) of the national doctors seek jobs outside the country8. This is a significant problem for the government to address.  The plan to upgrade the Gizo and Kiluufi Hospital in sub-specialist hospital did not eventuate because of limited resources. 6

HISP/ Nurse`Advisers Report (2003) PIP/ RACS 8 G.Malefoasi & I.Avui (2003).Migration of skilled health professional: Country Report: Solomon Islands, May. 7

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Report by the Ministry of Health (May 2004):

14 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

2.2.1. Medical Services: 2.2.2. Objectives: To upgrade the Level of Service (LOS) at NRH to LOS 3 by 2003. Tou p g r a d eL e v e l o f Se r v i c ea t Gi z o&Ki l u ’ u f i Ho s p i t a l sf r o mL OS2t oL OS3b y2 0 0 3 . To upgrade Level of Service in Makira, Isabel, Temotu, Choiseul from LOS 1 in 1998 to LOS 2 by 2003. To increase the bed capacity in the 6 government hospitals to 80% BOR by 2003, in order to increase hospital utilization rate without increasing the number of beds. To have at least two doctors permanently stationed at the 4 smaller provincial hospitals (Buala, Lata, Kirakira, Tulagi) 2.2.3. Performance Indicators: Level of Services (LOS) Bed Occupancy Rate % Hospital Utilization Rate Doctors posting in the province 2.2.4. Outputs/ Achievements & Constraints: Outputs (or Deliverables):  2.2.4.1. Medical specialist services was provided to the provinces through the specialist referral system between the NRH and the provincial hospital. In 2003 a consultant physician was recruited from India under the Local Supplementation Scheme funded by NZODA and the SIG. Issues and Constraints:  At this stage at the time of writing the report, unavailability of proper hospital information data from all hospitals limits the ability to evaluate the productivity and efficiency of the hospitals.  All hospitals are not evaluated against their designated roles under the Policy Guiding the Role Delineation to hospitals because of lack of a comprehensive hospital data and information system. However, it is anticipated that data for this purpose should be collected as part of the 2004 National Health Review, which is in progress.  Thus, this report is not able to report comprehensively on outputs of the rest of this policy, which covers Surgical, Obstetrics, Child health services and (paediatrics). 2.6.1. Accident & Emergency Services: 2.6.2. Objectives: ------------------------------------------------------------------------------------------------------------

Report by the Ministry of Health (May 2004):

15 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

To have at least one nurse specialist in Accident & Emergency at the NRH by 2003. To train one local doctor in specialist Accident & Emergency at the NRH by 2003. 2.6.3. Performance Indicators: No. Of nurse specialist in A&E No. Of doctor specialist in A&E 2.6.4. Outputs-Achievements & Constraints:

Outputs (or Deliverables):  2.6.4.1. A post-trauma course was held in 2003 and some nurses from the A& E department attended.  2.6.4.2. A registrar of the AED attended a short term attachment training with the Emergency Department of the St.Vincent Hospital, Melbourne with the assistance of the RE Ross Funding by AusAid through Royal Australasian College.  2.6.4.3. In Honiara alone, road traffic injuries account for 0.2% to 2% of the total casualties (trauma or injuries) recorded at the Accident and Emergency Department of the National Referral Hospital from 1996 to 2003 (a period of 8 years). Of the total casualties or trauma cases, between 3.3% to 27.3% of the Road Traffic Injuries were fatal (or dead).  2.6.4.4. Looking at the trend in the past eight years (as of 1996 to 2003) in Honiara, atleast an average of 65 cases of injuries related to Road Traffic Accidents, and of these RTA, an average of at least 2 people suffering from RTA died. Not many people including politicians are fully aware of the magnitude and severity of the road traffic injuries. Health and social impact of road traffic crash has been studied and concluded to be numerous and significant. Patients who sustained and survived road traffic injuries stayed longer in the hospital with a mean length of stay around 20 days. These patients are also the frequent users of operating theater, x-ray and physiotherapy departments for operations, xrays, physiotherapy and rehabilitation. Whilst there are medical costs and lost productivity, the psychological losses associated road traffic accidents, either to those injured or to their families are often undermined. Many patients suffer longer-term disabilities. Table: Road Traffic Injuries or accidents recorded at the NRH 1996-2003: Year Number % of total injuries due to Total OPDModified No. Death of RT RT accidents Attendances trauma fig- Deaths rates due injuries 10% of the RT Total OPD Accidents attendees (%) were trauma/injury ALL 1996 1997

112 117

1.93 2.10

58,111 55,798

5,811 5,580

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Report by the Ministry of Health (May 2004):

16 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

1998 1999 2000 2001 2002 2003 Total

59 91 79 11 20 29 518

1.18 1.82 1.58 0.22 0.40 0.58 1.25

Average 65 per year Source: Medical Records: NRH

50,000 50,000 50,000 50,000 50,000 50,000 413,909

5,000 5,000 5,000 5,000 5,000 5,000 41,391

51,739

3 3 3 2 2 13

3.3 3.8 27.3 10.0 6.9 2.5

2

2.7.1. Access to Essential Medicines: 2.7.2. Objectives: To ensure that essential drugs are always available in 90-100% of rural clinics in a year for within the plan period. In particular reliable and adequate supply to rural health care facilities. 2.7.3. Performance Indicators: Availability of essential drugs at the rural clinics No. of trained pharmacy officers Legislation reviewed 2.7.4. Outputs-Achievements & Constraints: Outputs (or Deliverables):  2.7.4.1. National Drug Policy completed and endorsed.  2.7.4.2. Scheme of services for the pharmacy officers and assistants accepted by PSD and gradings revised accordingly.  2.7.4.3. Medical supplies to the clinics and hospitals improved.  2.7.4.4 EPI committee formed to boost the EPI campaign in 2003.  2.7.4.5. Two (2) additional pharmacists graduated.  2.7.4.6. Health Sector Trust Account funded by AusAID has provided direct budgetary to pay for the medicines.  2.7.4.7. By end of 2003 all clinics and hospitals are supplied with the basic and routine medical supplies.  2.7.4.8. Clinic supply kit fully implemented in 2003. Issues and Constraints:  Vacancy of Chief and Principal Pharmacist posts since 2002

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Report by the Ministry of Health (May 2004):

17 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

       

National Pharmaceutical status not fully surveyed (due 2004) No implementation plan for Essential Medicines Policy (will follow survey) Regulatory Affairs section understaffed and under-trained Shortage of trained technical officers –POC course being restarted in 2004 Poor IT tools for inventory management and medical supply (upgrade due in 2004) Lack of Pharmacy Board meetings to ensure professional standards Lack of attention to upgrading the poisons list and related schedules No officer to focus on research and development in rational use of medicines

The new Pharmacy Practitioners Act was one of the few pieces of legislation promulgated in 2000. The main Act that controls medicines –the Pharmacy & Poisons Act - is still quite tenable. However, the associated Poisons Rules, and the schedules to the Act and Rules, do need urgent attention. Thus there are few structural problems, but the need is paramount to keep import control up to date, and ensure that labeling rules, and other professional pharmacy matters are appropriate for our current needs.

2.8.1 Access to community health services through Primary Health Care: 2.8.2. Objectives: To have 123 clinics staffed by at least one registered nurse, and a nurse aide at all times in a year, by 2003. To have 61 Nurse Aide clinics staffed by a nurse aide at all times in a year, by 2003. 2.8.3. Performance Indicators: No. of registered nurses and nurse nurses posted at the clinics 2.8.4.Outputs-Achievements & Constraints: Outputs (or Deliverables):  2.8.4.1. All clinics opened.  2.8.4.2. Community nursing re-established at all primary health care centers.  2.8.4.3. By end of 2003, total of 561 nurses (RNs and Nurse Aides) are placed at the primary care centers (ie. clinics), whilst 533 nurses are placed at secondary care centers (at hospitals). Total of 1,091 nurses are recorded, with a Nurse:Population Ratio of 1:419

2.9.1. Health Infrastructure Development: 2.9.2. Objectives:

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To strengthen the primary health care activities at the community level at the rural as well as some urban areas in the country. To repair and maintain more than 80% of the total health facilities identified to be in poor physical status in 1998, by year 2003. To increase utilization of the health facilities to prevent further impact and severity (disability) of preventable and curable illnesses affecting the vulnerable people particularly those in the periphery, rural remote areas, and women and children. 2.9.3. Performance Indicators: No. Of health facilities repaired and fully operational 2.9.4. Outputs-Achievements & Constraints: Outputs (or Deliverables): 2.9.4.1. There were about 43 clinics renovated and refurbished in the past five years. By end of 2003 only about 46% of total clinics (94) prioritized since 1999 by the Ministry of Health. This is half short the plan to rehabilitate more than 80% of the total clinics. Funds available were directed to services delivery and not any substantial capital projects. The Ministry has a master plan to refurbish all rural health clinics but lack funding to do all. 2.9.4.2. The donor agencies such as AusAID/ CPRF, EU Grass Roots projects and Oxfam have been implementing these refurbishment works in the past. Unfortunately, no further information on t h e s ec l i n i c si sh e l da t t h eMi n i s t r y ’ sl e v e l . 2.9.4.3.The update list of renovated clinics is attached. Province

Location

Type

Activity

Status

Choiseul

1.Paqoe

AHC

Maintenance/ Repair/ Renovation

Done

2 3 4

2.Nuki 3.Taro 4.Susuka

RHC AHC RHC

5 6 7 8 9 10 11

5.Polo 6.Pasarae 7.Voza 8.Wagina 9.Sirovanga 10.Loloto 11.Sasamuga

RHC RHC RHC RHC RHC NAP Hosp

“ “ “ “ “ ‘ ’

1.Harapa

RHC

Maintenance/

Ref. No. 1

12

Western

“ “

Done In-progress Pending Funds Pending Funds Pending Funds Pending Funds Pending Funds Pending Funds Pending Funds Done

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Province 13 14 15 16 17 18 19 20 21 18

Malaita

Repair/ Renovation 2.Vakobo 3.Falamae 4.Kolokolo 5.Cheara 6.Poitete 7.Nila 8.Vonunu 9.Emu Harbour 10.0Keru 1.Masupa

Done RHC RHC RHC RHC RHC RHC RHC

“ “ “ “ “ “ “

RHC

Maintenance/ Repair/ Renovation “ Resiting/ Extension Maintenance/ Repair/ Renovation

2.Manawai 3.Olomburi

RHC RHC

21

4.Rara

NAP

22 23 24 25 26 27 28 29 30 31 32 33 34 35

5.Afenaba 6.Afio 7.Anomasu 8 . At a ’ a 9.Gounatolo 1 0 . Bi t a ’ a ma 11.Hauhui 12.Maluu 13.Rohinari 14.Kiu 15.Gwarata 16.Nafinua 17.Ote 1.Doma

36 37

2.Aola 3.GP/HQ/ clinic

38 39 40 41

4.Saro 5.AvuAvu 6.Turarana 7.Malatoha

Done

Done

19 20

Guadalcan al

Done

Done Done

Done Done Done RHC RHC RHC RHC AHC RHC RHC

“ “ “ “ “ “

Done Done Done Done Done Done Done

AHC

Resiting/ New

RHC Clinic

Resiting/New Maintenance/ Repair/ Renovation

RHC RHC RHC

“ “ “

Site to identified

be

Done Proposed to ADB To be resited at Konga

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42 43 44 45 46

8.Kolosulu 9.Grove 10.Tasimboko 11.Marara 12.Marau

NAP

47

13.Biti

NAP

48

14.Fox Bay

NAP

1.Momotu 2.Nagolau 3.Sigana

NAP NAP NAP

“ “

RHC AHC

“ “

RHC

“ “ “ “ “ “ “

Makira

4.Vulavu 5.Tataba 6.Toelegu 7.Kalenga 8.Poro 9.Susubona 10.Kolomola 11.Moloforu 12.Samasodu 13.Baolo 14.Bolotei 15.Guguha 16.Nodana 1.Houpala

Temotu

2.Aorigi 3.Arinagana 4 . He r a i n u ’ u 5.Marouvu 6.Mamuga 7.Kirakira Training Center 8.Hunuta 9.Manasugu 10.Waihaga 1.Manuopo

49 50 51

Isabel

52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 69 70 71 72 73 74 75

“ Done Done Done/New To be rebuilt in 2004 by Worl Bank projectSIHSDP Proposed for ADB Proposed for World Bank project/ SIHSDP

AHC

Done

Done RHC RHC RHC RHC RHC AHC RHC

Done/ upgraded “ Done

AHC

Maintenance/ Repair/ Renovation Done

RHC

“

RHC RHC Training Center

“ “ “

Done

Done Done Done AHC

“

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76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 TOTAL

RHC

CIP

2.Tukutaunga 3.Anuta 4.Tikopia 5.Nea/Noele 1.Yandina

RHC RHC

RenBell

2.Leitongo 3.Panueli 4.Koela 5.Maroloun 6.Koilovala 7.Borohinaba 8.Salesapa 9.Ravu 10.Narogu 11.Toga 12.Dende 1.Tingoa 2.Tengano 3.Nuku

RHC RHC

“ Done Done Done

AHC

Maintenance/ Repair/ Renovation “ Done Done Done

NAP NAP

“ “ Done Done Done

NAP RHC

“ Maintenance/ Repair/ Renovation “ “

Done

2.9.4.4. There has been an increase in the number of PHC facilities (clinics-AHC, RHC and NAP) by end of 2003. By end of 2003 there are additional 49 PHC clinics (excluding hospitals) (i.e.20% rise). There are many more AHC (30% increase) as compared to RHC (25% increase) and NAP (20% increase) Table showing number of health facilities in 1999 as compared to 2003: All Hospitals Area Health Rural Nurse Total Centers Health Aid Posts PHC Clinics excluding (RNs) hospitals) 9 (2003) 9 30 119 157 296 (1999)10 9 23 95 129 247 % increase 0 30 25 22 20 Annex Table 1 shows the list of approved clinics by end of 2003. 9

Health Institutional Strengthening Project (MOH) update on approved health facilities( Hospitals, Area Health Centers, Rural Health Clinics and Nurse Aid Posts, 2003. 10 National Health Report Review, Ministry of Health (1999) in page 13: Sector 2: Types of services: Table: The Health Care Referral System.

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2.10.1. Dental & Oral Health Services: 2.10.2. Objectives: To increase the preventive dental health services in the next five year 2.10.3. Performance Indicators: No. Of health education activities No. Of advocacy activities No. Of school visits 2.10.4. Outputs-Achievements & Constraints:  2.10.4.1 The number of dentist increased from 3 to 15 in the past five years. By end of 2003, another 4 graduated from the Fiji School of Medicine. Issues and Constraints:  Only 2 of the 15 dentists are posted in the provinces (one each to Gizo and Kiluufi Hospitals). Major constraint faced at the provinces is lack of housing for the dentists.

2.11.1. Ophthalmology & Primary Eye Care Services: 2.11.2. Objectives: To reduce the national blindness rate to less than 0.5% by 2003. To upgrade the Level of Service (LOS) from LOS 4 at the National Referral Hospital in 1998 to LOS 5 by 2003. Tou p g r a d eL OSa t Gi z oa n dKi l u ’ u f i Ho s p i t a ls from LOS 2 to LOS 3 by 2003. To have another local doctor qualified in ophthalmology by 2003. To train one more local doctor by 2003. To increase the number of nurses trained in ophthalmology from---in 1998 to ---by 2003. 2.11.3. Performance Indicators: ------------------------------------------------------------------------------------------------------------

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23 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

National Blindness Rate % LOS No. of nurses trained in Eye specialty 2.11.4.Outputs-Achievements & Constraints: Outputs (or Deliverables):  2.11.4.1. Primary Eye Care services continued despite no eye specialist in the country.  2.11.4.2. Primary eye care was maintained by the local Eye Nurses at the NRH and the provinces.  2.11.4.3. Specialist eye care services received through two Eye visits from Australia through the Pacific Islands Project by RACS and funded by AusAID.  2.11.4.4. The primary eye care services has been maintained the local eye nurse practitioners whilst there are no eye doctor.  2.11.4.5. The Pacific Islands Project (PIP) funded by AusAID and executed by Royal College of Australasia Surgeons (RACS) assisted in both stop gap and maintain eye care to support the primary eye care nurses.  2.11.4.6. The Prevalence Rate for diseases of the eye stands at 17.7 per 1,000 population, whilst the incidence rate stands at 7.6 per 1,000population from 1999 to 200311.  Table below shows the indicators for Eye infections recorded by the Eye Dept. of NRH 1999 2000 2001 2002 2003 ALL(new & old) 7,944 5,826 6,762 7,433 10,311 New 3,539 2,737 3,375 3,042 3,858 Major 554 353 427 432 380 Int 150 45 39 24 35 Minor 84 97 129 23 25 Total surgery 620 495 595 479 440 Population Incidence rate/1,000pop Prevalence rate/1000 pop Cataract surgical rate calculated by Eye Unit Average Prevalence

409,042 8.7

420,856 6.5

433,035 7.8

445,591 6.8

457,153 8.4

19.4

13.8

15.6

16.7

22.6

359

496

484

268

13.8

15.6

17.7

19.4

22.5

11

Eye Department Reports for 1999,2000,2001,2002,2003 compiled by Wanta Aluta for this report (April 2004)

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rate/1000pop Average incidence rate/1000pop

8.7

6.5

7.8

7.6 8.4

 2.11.4.2. Issues and Constraints:  Since 2000 Solomon Islands was without a consultant eye specialist. The local eye specialist and the registrar left the country because of the ethnic tension. Most major surgeries are carried out by the visiting Eye Specialist Teams from overseas particularly the EYE PIP (Pacific Islands Project) funded by AusAID and executed by RACS.  (Unfortunately the data on blindness rate is not available at the time of writing the report).

2.12.1. Diagnostic Services at Hospitals: 2.12.2. Objectives: To establish and develop network of Medical and Health Laboratory Services in support of Primary Health Care by 2003. Expansion of Provincial hospital establishment; Ki l u ’ u f i - from 3 technicians in 1998 to 4 by 2003 Gizo-From 2 technicians in 1998 to 3 by 2003 Lata, Kirakira, Buala- To have at least 1 technician and 1 medical laboratory assistant (MLA) by 2003. Tulagi- To have 1 post by 2003 Sasamuga- Upgrade post to technician level by 2003 2.12.3. Performance Indicators: Posting of technicians in the provinces 2.12.4. Output-Achievements & Constraints: Outputs (or Deliverables):  2.12.1. Pilot Tele-pathology project completed. Draft report available.  2.12.2. All provincial hospital laboratories were staffed.  2.12.3. Relatively a wide range Laboratory testing are done. This includes HIV/STI testing, Biochemistry, Haematology, and Serology. Highly specialist testings are done through the arrangement with the Royal Brisbane Hospital under the Queenslands Pathology Services System. Specimen are sent for analysis in Australia.

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2.12.2. Issues and Constraints:  Human resource objectives for the diagnostic services to the provinces was not achieved as planned. The reasons are lack of training opportunities for undergraduates because of financial constraints, and suspension of recruitments.  Basic laboratory testing supplies were also short during the crisis period. The problem has been slowly resolved. Change in the ordering and procurement process has been noted to be having an effect but this issue is been discussed and solutions reached.  (Details on the testing not available at the time of writing this report).

2.13.1. Rehabilitation Services: 2.13.2. Objectives: Toi n c r e a s et h eq u a l i t ya n dq u a n t i t yo fs e r v i c e sp r o v i d e dt o‘ a l l ’k n o wno rr e g i s t e r e dp e o p l ewi t h disability in the country. 2.13.3. Performance Indicators No. Of people with disability registered in CBR database. No. Of activities and programs organized for people with disability and respective stakeholders. 2.13.4. Achievements: Outputs (or Deliverables):  2.13.4. First Draft of the Disability Act completed. 2.13.4.2. Issues and Constraints:  Draft Disability Act not followed up into a bill to be passed by the parliament.

Policy 3: Human Resource Management And Development For Health 3.1.1. Objectives: To develop a workforce plan based on the needs, and implement 75% of its programs by 2003. To increase the proportion of qualified skilled health workers at the provincial levels from 40.5% in 1999 to 60% by 2003. Increase training opportunities in health promotion and preventive health within the plan period.

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3.1.2. Performance Indicators: Implemented training programs Proportion of qualified skilled health workers at the provinces No. of training in health promotion and preventive health services 3.1.4. Output-Achievements & Constraints: Outputs (or Deliverables):  3.1.4.1. Check list for selection of nominees from departments, drawn up by the Training & Fellowship Committee (TFC), Ministry of Health.  3.1.4.2. Training Plan for 2004-5 was drawn up and endorsed by the TFC/MOH.  3.4.4.3. Draft Training Policy Guideline was developed by FTC/MOH.  3.4.4.4. Total 80 candidates health staff were accepted by the FTC for training 2003. Fiftythree percent (53%) (i.e.42) were successful in being sponsored. Twenty-nine health staff successfully graduated end of 2003.  3.4.4.5. Training Plan for Psychiatric nurses continued.  3.4.4.6. Implementation of the training for doctors (postgraduate) continued. Ten doctors trained into different specialties continued. One graduated end of 2003 as a specialist in obstetrics and gynaecology (Dr K Bisili). 3.1.4.2. Issues and Constraints:  Lack of integration of training for the health workforce with the National Training Unit of the Ministry of Education and Human Resource Development.  Lack of proper training needs assessment for the undergraduate for medicine and all other health related disciplines.

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Policy 4: Morbidity And Mortality Reduction 4.0. Overview: Most indicators in this sector concerns with the health outcomes measured in rates. The common uses of the indicators are: Evaluate the impact of control measures aiming to at reducing the morbidity (illnesses) and mortality (deaths) due to the common diseases in the country as well as emerging illnesses.  Measure the workload on health facilities due to the common diseases.  Allocate resource to different treatment; and  Evaluate different interventions and control programs. However, due to lack of proper and timely data and information, the depth of the evaluation is not complete. Nonetheless, the available information and data has significant lessons and evidence to improve the public health programs, the primary health care, the management and supervision. It is also important to note here that the objectives were set back in 1999 when the national health policies and plans were developed. As the indicators are reviewed in light of the National Health Policies and Development Plans, other universal indicators are closely monitored locally. Indicators of Millennium Development Go a l s( MDG’ s ) ,t h eI n t e r n a t i o n a l Co n f e r e n c eo nPo p u l a t i o n sa n dDe v e l o p me n t( I CPD)Go als and the World Health Organizations targets for different disease control programs. 4.0.1. Policy Goals: To decrease the transmission, morbidity and mortality due to the priority health problems. To prevent or delay onset of the non-communicable diseases, including reduction in occupational diseases, in order to maximize disability-free and productive lives in older age. To promote environmentally sound practices and technologies for the effective prevention and management of environmental health-related disease and disability. To enhance people's quality of life by preventing disability, including blindness and deafness, and by rehabilitating the handicapped, infirm and disabled.

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To ensure the rights of everyone to enjoy a good quality of life, and to promote equity in access to resources necessary for optimal health. 4.1.Malaria: Overview: Malaria infection in the country rose by 19% in 2003. The reasons attributed to the increase are as follows; Firstly the environmental factors such as soci-economical status of the country in the past three years derailed communities from the momentum to protect themselves from malaria. Secondly, due to the significant reduction in the intervention programs in all provinces because diminished funding, resulting in shortage of larvicidal chemicals for spraying, and declining mosquito treated bed use through out the country. Thirdly, there was limited malaria awareness campaigns for communities to prevent malaria in their areas. 4.1.2. Objectives: To reduce malaria incidence rate from 160 cases per 1000 population in 1997 to fewer cases less than 80 cases/ 1000 by 2003. To increase the insecticide treated bed net coverage from 70% end of 1997 to 95% of the population by 2003. To improve diagnostic services (microscopists coverage) to all provinces by 2003. 4.1.3. Performance Indicators: Malaria Incidence Rates Bed net coverage Rate Number of Malaria microscopy facilities in provinces 4.1.4. Achievements: Outputs (or Deliverables):  4.1.4.1. Renovation of Solomon Islands Medical Training Institute was completed in 2003.  4.1.4.2. The Revised Malaria Treatment Policy was completed, which re-introduced primaquine in a safer dose to treat Malaria-PV malaria infections.  4.1.4.3. The main activities implemented during 2003 were: i) Bednet distribution and retreatment ii) Residual spraying iii) Larviciding iv) Health education v) Mass Blood Survey (MBS) vi) Source reduction vii) Community participation

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 4.1.4.4. Continued support from WHO, Rotary and AusAid Trust Fund ensured that control activities were selectively supported. These activities included|: management of antimalaria drug policy including training for nurses and health workers, bednet distribution and retreatment, residual house spraying, monitoring workshops for Guadalcanal and Malaita; microscopy training for 3 provinces.  4.1.4.5. Implementation of the new antimalaria drug policy;  4.1.4.6. Implementation of the Global Funds for Malaria programme initiated  4.1.4.7.Technical working groups for drug policy, vector control, monitoring and community development/health promotion established.

4.1.2.2. Issues and Constraints: Malaria incidence rate rose by 16% from 168 per 1,000 population in 2002 to 200 per 1,000 population. This indicator signifies the negative impact of the ethnics crisis and the poor economic situation. The Vector Borne Disease Control Programme has faced insurmountable problems in 2003 and the result could be seen from the provincial malaria epidemiology and situation. Problems faced by the Programme include the following: administration, socio-economic, financial and technical obstacles. The seriousness of each problem varies with each province. However with all the problems faced the VBDCP had managed to suppress malaria and did not allow it to go uncontrolled. Indicators No. of patients tested for malaria No. of confirmed cases No. of Plasmodium falciparum positive cases No. of Plasmodium vivax positive cases No. of admissions due to malaria No. of deaths No. of nets treated per year No. of persons protected by house spraying Annual incidence rate per 1000 population

2002

2003

% Change

278,261 74,865 50,105

297,897 91,606 64,302

7% increase 18% increase 22% increase

24,736 1887 61 79,538 18,899 168

27,234 1344* 41* 55,435* 32,213 200

9% increase 30% decrease 41% increase 16% increase

* excluding Choiseul, Central and Makira-Ulawa provinces as no reports were received 4.2. Acute Respiratory Infection: Overview: Acute respiratory infection has been a common cause of outpatient attendances in all provinces. 4.2.1. Objectives:

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To reduce the incidence rate of ARI from 422/1,000 in 1993 to less than 100/1000 cases by 2003. To reduce the incidence rate of ARI in children under 5 years from 1073/1000 to less than 500/1000 by 2003. 4.2.2. Performance Indicators: Incidence Rate of ARI/ 1000 pop. Incidence Rate of ARI in children under 5 yrs/ 1000 population. 4.2.3. Outputs-Achievements & Constraints: Outputs (or Deliverables):  4.2.1.There was a positive response to the SARS Outbreak in 2003. It was the first time that integration and collaboration between different government sectors and the private shipping and airline companies joined together to combat the international disease outbreak in China and other parts of Asia and Canada.  4.2.2. SARS prevented from spread into the country during the global outbreak Feb-June 2004. As SARS Prevention Task Force was formed to deal with the outbreak. The taskforce develop public health strategies to prevent SARS imported through sea and air travel routes. The WHO and the Government of Japan provide financial, expertise advises and logistic support in preparation for a reported case.  4.2.3. A thorough screening process was developed to quarantine all incoming traveling passengers by air and sea. From the period of April to July, there were total of 3,557 passengers were screened by the Health Inspectors of the Environmental Health Division of the Ministry of Health through a questionnaire contained in a flyer handed in the plane before arrival in Honiara. Of the total 110 (3.1%) incoming travelers were quarantined. Contacts were recorded and travelers advised to call a doctor or attend the Accident & Emergency Department if felt sick after checking out. This 3.1% of the total travelers came in the country from affected countries; majority of 46% (51) came in from Singapore, 26% (29) from Taiwan, 14% (16) from Hong Kong, 12.7% (14) from Guandong, 3.6% (4) from Hanoi in Vietnam, 1.8% (2) from Toronto. Fortunately, none (o) of travelers suffer from SARS (or have met the diagnostic criteria for SARS by WHO). A full alert system was established. Solomon Telekom management supported the efforts by providing for a toll free SARS hotline.  4.2.4. No dengue outbreak in 2003. 4.2.3.2. Issues and Constraints:  An ARI outbreak was noticed in the country especially during the wet season of the Christ Mass period. (At the time of the writing of the report, samples collected in April 2004 came

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back positive for Influnzae type A (H3)12. Therefore the ARI outbreak is most likely due to Influenzae A. This is the same type found in Australia and New Zealand. ‘ Ot h e ru p d a t ed a t aa n a l y s i so nARI i np r o g r e s sa n dn o t a v a i l a b l ea t t h et i meo f wr i t i n gt h er e p o r t ’

4.3. Malnutrition: 4.3.1. Policy Statement: The National Nutrition Survey of 1989/90 revealed that malnutrition is a problem of children and women, with 23% of children being underweight, 7% women underweight and 39% overweight (obese). Vitamin A deficiency is evident to be increasing and related to Malnutrition in children. 4.3.2. Objectives: To reduce the proportion of children under weight from 23% in 1989/90 to less than 10% by 2003. To reduce the proportion of women underweight from 7% underweight to less than 5% by 2003. To reduce the proportion of women overweight from 39% in 1989/90 to less than 10% by 2003. 4.3.3. Indicators: Proportion of children reported under weight % Proportion of women reported underweight % Proportion of women reported overweight % 4.3.4. Achievements: Integrated in the IMCI approaches ‘ Ot h e ru p d a t ed a t aa n a l y s i so nMa l n u t r i t i o ni np r o g r e s sa n dn o ta v a i l a b l ea tt h et i meo fwr i t i n gt h e r e p o r t ’

12

Report by Mr Andrew Darcy, Senior Medical Laboratory Officer, NRH.

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4.4.0. Diarrhoeal Diseases: 4.4.1. Objectives: To reduce episodes of diarrhea from 3.5 per year in 1992 to less than 2.0 per year by 2003. To reduce deaths due to diarrhea from 1.7% deaths per 1,000 children per year to less than 1.0% by 2003. 4.6.4. Indicators: Episodes of diarrhea in children per year Deaths due to diarrhea 4.4.2. Achievements: No major epidemics recorded as compared to 2000. ‘ Ot h e ru p d a t ed a t aa n a l y s i so nDi a r r o h o e a l Di s e a s e si np r o g r e s sa n dn o ta v a i l a b l ea tt h et i meo f wr i t i n gt h er e p o r t ’ 4.5.1 Diabetes (NCD): 4.5.1. Objectives: To improve information (IEC production) in diabetes in the next five years. To improve clinical management and treatment of diabetes in the next five years. To prevent disability due to diabetes through community awareness. 4.5.2. Indicators: IEC production on diabetes. Clinical Management and Treatment Protocol fully documented and implemented Improved collaboration links with the community. No. Of diabetic cases per year No. Of diabetic foot ulcers reported 4.5.3.Output-Achievements & Constraints: Introduction:

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In 200313, we managed to settle down but we still encounter some obstacle. NCD Program for example, as the current coordinator of the program, I was attending Advanced Diploma at the college of higher education and at the same time, supervising the Program. Though attending the advanced course at the college had causes disturbance in the running of the Program, however the program also achieved some of its activities. Some of the achievements are as follows-; 1. Attachment of three Provincial Diabetes Coordinator at New Castle Diabetes Centre. 2. Printing of Pamphlets for the Provinces funded by World Health Organization (WHO) 3. Supervisory tour to Isabel Province funded by Aus-Aid Trust fund. 4. Launching of World Diabetes Day at the Market funded by Aus-Aid fund. Like wise, the analysis of Diabetes will be included in this Report. STAFF TRAININGS. There is a need of Training for both the Provincial Diabetes Coordinators and National NCD coordinator. In year 2002, Dr Bowen from New Castle Visit Solomon Islands. During his visit, we were looking at ways on how we can improve diabetes program to work more efficiently and effectively. Some of the outcome result of the visit was, each year; we should be sending candidates for attachment at New Castle in Australia. This year we already sent three Provincial coordinators for one-month attachment at New Castle Diabetes Centre. This process should be continues for next five year if things turn out rightly. Because, capacity building through training and workshops are the main component to increase knowledge and skills of the health worker and program coordinators both at Provincial and at National level. However, I was also attending Adv. Diploma in Nursing at the College of Higher Education since last year. This year I have completed the course and was graduated with required qualification. In year 2004, I should be attending Degree course at UPNG. TRAINING OF THE DIABETES GIUDE-LINE. Training of the guideline is a Task needed to be carried out. Out of all the provinces in the Solomon Islands, Choiseul, Makira Ulawa and Malaita are the only provinces that are yet to have workshops on the guideline. Letters and faxes were sent to training officers and diabetes Coordinator of each Province concerning training. Despite that no positive respond from them. The provincial Management might blame the current situation that we were facing with our financial, but that was not the fact. Under ROC Funding, the Ministry of Health had been allocated money for each program. Otherwise, those provinces that still to have workshops on diabetes Guideline will be done later depend on the availability of funds.

13

Non-Communicable Disease Unit, Disease Prevention and Control Division, MOH Report, 2003.

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WORKSHOPS. Even though the NCD program manager was committed with other activities like attending course at the College, dealing with student research etc., several attempts were made to negotiate with provincial training officers of those whom that are yet to have workshop on the Diabetes Guideline. As I have stated earlier on, there was no polite respond from them. However, because of no respond from them, the other alternative was to divert that money allocated for workshop for supervisory tour to Isabel Province. Again, it was funded by Aus-Aid Trust fund. WORLD DIABETES DAY Each year on the 14th of November, everywhere in the world commemorates the world Diabetes Day. Moreover, every year world Diabetes Day has a unifying theme. Since 2001, emphasis has been placed upon Diabetes complications. In 2001, we aimed to highlight the link between cardiovascular disease and Diabetes, while in 2002 we focused on diabetes related eye complications. This years Diabetes day theme is Diabetes and kidney disease, and our campaign title is Diabetes could cost you your kidneys: Act now! Marching from the NRH to the market was organized and various methods were used to disseminate information with emphasis on the Public at the Market. Health talks were the main activity conducted. A Week before that day, we were using SIBC for the dissemination of Diabetes Information. Issuing of diabetes pamphlets and random blood screening were also done at the market. More than five hundred people attending during the launching of the program and few new cases were detected. Diabetes Information were also disseminated to students doing science research project (SISC) and to other groups who wanted know about Diabetes, therefore including me in their program to give health talk like Mothers Union for instance A diabetes song was also composed by one of the diabetes coordinators in the provinces. Not only that, Isabel province confirmed to us of their participations in launching WDD at their province. Activities done on that day were diabetes awareness health talks, free blood screening, playing the diabetes SONG and so on. PROVINCIAL TOUR: This year 2003 I could only able to make supervisory tour to Isabel Province. The aim of the tour was to assess the work of the provincial diabetes coordinator. Basically to look at the implementation of program activities at provincial level especially with regards to diagnosing, treatment strategies and more over to initiate an effective system of reporting so that we could be able to get correct diabetes data from the province and to ensure reports must be handed in on time for compilation. For programs to work effectively and efficiently, supervisory tour must be done regularly to the provinces. Provincial tours by the provincial diabetes coordinator to the clinics should be done twice yearly but a g a i ni t wi l l d e p e n dv e r ymu c ho nt h ea v a i l a b i l i t yo f f u n d . Cu r r e n t l yt h e r es h o u l d n ’ t b ea n ye x c u s e s from the provinces because already there were funds allocated for each activity in the provinces. ------------------------------------------------------------------------------------------------------------

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Some provinces, Directors were willing to listen to or accept plans from coordinators and would normally support them while others not regarded diabetes in their priority. After all diabetes was emerging rapidly in our country. The outcome result of the supervisory tour was, reports have sent in at the right time and provincial data will be included in this report. DIABETES SITUATION: In fact Diabetes in the Solomon Islands is on the rise based on the information received from National Diabetic Center alone. If we are to combine reports from the provinces, we could be able to get a huge number of new confirmed diabetes cases detected each year. Unfortunately it does not eventuate as provincial coordinators are confused of what to do. Therefore there is a need for improvement through quality of care through: 1. Improving data collecting system. 2. Training of staff at the hospital and Rural Health Clinics. 3. Training of provincial diabetes coordinators and so fort. However, all this activities need money. Because of that our reports will focus more only from National Diabetes Center source. Data from Isabel will also be included. New confirm cases by age grouping (Annex i) Chart 1 describes two different years, last year and this year. If we are to compare the graph, their implication is almost the same. Most of the newly confirmed cases are between the age of 31 and 60. For year 2002 the mode was between the age 51 and 55 while in year 2003 the mode was occurred between the age of 46 and 50, the same as year 2001, which had a mode between the ages 46-50.

chart 1

New confirm cases by age group (2003) Source Diabetes Centre

40

35

30

No o f Cases

25

20

15

10

5

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Daily patient seen in diabetes center /Race. (Annex ii): We cannot deny the fact that all the big islands in our country are occupied by mostly Melanesian race. Not only that but within the capital city itself, Melanesian is also the dominating race. Therefore looking at the data the monthly attendances record of daily patient seen in Diabetes center clearly indicated the dominating race in the Country. However, most of the people who use the center are those that living in and around Honiara, those who have the money from the provinces and have access to transportation to Honiara.

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Daily patients seen in diabetes centre by race (2003) source diabetes centre

chart 2 400 350

no of p atients

300 250 200

150 100

50 0

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

mel

167

185

192

186

246

244

295

305

299

268

242

208

poly

7

12

7

12

19

23

16

20

16

21

11

9

micro

3

3

7

8

12

5

7

12

9

18

3

12

others

3

4

0

2

3

2

3

1

6

7

4

1

180

204

206

208

280

274

321

338

330

314

260

230

total

cases seen permonth/race

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New confirm cases by races (1998-2003) Source diabetes centre

Chart 4 180 160 140 120 100 no of cases 80 60 40 20 0

1998

1999

2000

2001

2002

2003

Mel

65

109

100

174

104

167

Poly

1

6

8

8

3

7

Micro

3

7

12

8

14

3

Others

0

5

4

7

2

3

races per year

New confirm cases by Gender (1998-2003) (Annex v): The newly confirmed cases by Gender per year since 1999-2003, male gender was recorded highest through out. There was an increase in the number of newly confirmed cases compared to last year. This does not mean that male gender is more prone to have diabetes than female. In actual fact, there is an equal chance for both. The number of new cases detected depends very much on how people understand the disease and their willingness to come forward for blood screening.

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New confirmcases bygender per year (1998-2003) source diabetes centre.

Chart 5

180 160

140 120

100 noof patients 80

60 40

20 0

1998

1999

2000

2001

2002

2003

Male

33

74

73

127

70

180

Female

36

53

51

70

63

90

years

Therefore because, more adult male educated than female, they understand and aware of the symptoms of the disease. They are more conscious about their own health. Whenever they felt the symptoms of the disease, they would go to hospital for checking. This may contribute to the result why male gender was higher than female. Mind you that there are still others out in the provinces that have diabetes but are not aware that they have diabetes until they have some complications like foot ulcers, eye problems etc. before going to hospital for check up.

Diabetic Patients on treatment (1997-2003) (Annex vi):

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From year 1997 to 2003, the data indicating that majority of the patients having diabetes were taking glybenclimide treatment. According to the Diabetes practical guideline, glibenclimide is a drug of choice for non-obese patients. This does not mean that those taking glibenclimide treatment are all non- obese. Some obese patients are taking the drug because sometime metformin drugs runs out from pharmacy so no option but to take glibenclimide. However those patients who were taking drugs like glibenclimide, metformin and insulin are also encouraged controlling their diet, exercise and regular check to the diabetic center.There are also patients taking two drugs at the same time, for instance glibenclimide and metformin together but not included in this chart.

Diabetic patients on treatment byyears (1997-2003) Source Diabetes Centre.

Chart 6 160

140

120

No o f cases

100

80

60

40

20

0 diet alone

1997

1998

1999

2000

2001

2002

2003

5

12

25

31

22

35

45

metformin

7

6

29

24

20

29

35

glibenclimide

83

41

59

51

135

60

71

insulin

3

4

7

10

16

8

21

Treatments per year

New confirm cases by provinces (2000-2003) (Annex vii): According to records (statistics) from diabetes center from year 2000 to 2003, Malaita province recorded the highest number of newly confirmed cases all through those years. However, the records were based only to those accesses to Diabetes Center alone. This was so, because there was no report sent in by provincial diabetes coordinator. ------------------------------------------------------------------------------------------------------------

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Year 2003, newly detected cases record according to Province of origin -: Malaita Province = 98 Guadalcanal prov = 9 Western Prov =29 Isabel Prov = 10 Makira/ Ulawa Prov = 14 Temotu Prov =2 Renbel Prov. =0 Central Island Prov =1 Choiseul Prov =12

Chart 7

New con firm cases by pro vinces (2000-2003) Sou rce Diabetes Centre

120

100

no o f patien ts

80

60

40

20

0

2000

2001

2002

2003

MP

98

106

59

98

GUAD AL

6

17

18

9

WP

37

28

17

29

YP

3

7

7

10

MUP

6

6

9

14

TP

2

6

4

2

RENBEL

5

7

1

0

CIP

4

4

3

1

CHP

8

12

10

12

years

In 2003, only Isabel Province had sent in their report on diabetes. They had a record of 51 new cases detected. Out of which, 31 were female and 21 were male. To add with the record stated above, they should be totaled up to 61 cases. A well job done by Province diabetes coordinator from Isabel. Recommendations:  Conducting training for Health workers on the practical guideline on Diabetes for the Provinces must be carried out.

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 In order for programs to be effectively and efficiently implemented funds must available for diabetes activities.  Supervisory tour to the Provinces should be an on-going planned activity for program managers in order to assess and assist Provincial coordinators to improve their daily running of the programs.  There is a need of further training for both national and provincial coordinators on job specialization, especially diabetes management because in our country nowadays, diabetes has becoming a major problem. Not only that looking after Diabetic patient is very expensive for family members, community and also for the Government.

ACKNOWLEDGEMENT. The National Non Communicable Disease coordinator wishes to acknowledge all provincial coordinators for their effort and commitment to work. More especially for Sister Neverlyn Laesango and Hilda for doing most of the curative and educational aspects about diabetes and also for managing the National Diabetes Centre. I would also like to extend my acknowledgement to Aus-Aid and WHO for providing financial assistance for most of the program activities last year. Lastly, extending acknowledge for my working colleagues and anyone whom I forgot to mention, for whatever assistance provided toward my program.

4.5.2. Tobacco and its Impact and the control measures in Solomon Islands: 4.5.2.1. Tobacco a Health Burden in Solomon Islands: Evidence is beginning to reveal how much Tobacco is damaging the health and social aspects of the lives of the people of Solomon Islands. Little is known on the local context in the past. The people have little and no knowledge at all of the negative impacts of tobacco on their socioeconomic and physical and mental health. There has been no research on tobacco prevalence in Solomon Islands until recently. The bad behavior of smoking is spreading widely in all age groups, ethnicity and within the employment sectors. It is often a disease common among lowly educated and those with out any form of employment. However, it is devastating to learn that in Solomon Islands significant percent of employed workers smoke14. A study done found (with a private broad casting firm), 56.5% of the staff interviewed smoke. Other related studies also found that 44% of government workers smoke15, whilst 40% of outpatient attendants were found to be active smokers. In the 993 Nutritional Survey it was found that 25% of the female population smoke. 14

MOH (2002). Health Assessment Report: National SIBC, Honiara, Volume 1, Issue 2, January: Unpublished Paper. 15 MOH. Unpublished paper.

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A historical study was done recently16and found that 60.3% of patients smoking suffered from respiratory diseases and admitted to the National Referral Hospital in Honiara between 1999 and 2003. Older people smoked (age group 50-65) followed by the productive age group of 21-49 years. Within the cohort of those admitted, 45.1% of teens or youths age group of 12-20 years old smoked as compared to their non-smoking counter parts (54.9%). More male smokers (59.9%) than female smokers (49.1%) were found. Therefore the prevalence rate of smoking for Solomon Islands is about 40-60%. Solomon Islands like other developing countries have a high prevalence rate of smoking. Table showing prevalence rates for selected countries of the WHO/WPR17

Countries (WPR) Fiji Guam Marshall Islands PNG Vanuatu

Prevalence Rates 30% (urban), 46% (rural). 34.3% 9% (male students) 30% (All), 17.6% male, 8.5% female Youth 12-18 Male 58.2% and Female 17.7%.

Year 2003

In Adults Male 49%, female 15% Vietnam Solomon Islands

Adults: Male 56.1%, Female 1.8% [1] Nutritional Survey-female 25%.

2002 [1] 1993

[2] 2004

[2] NRH Study, Male 59.9%, Female 49.1%

4.5.2.2. Tobacco causing Morbidity and Mortality: Tobacco causing diseases and death is overwhelmingly proven and widely documented. Local evidence showed that smoking primary causing factors for respiratory diseases and other related systemic health conditions18 such as hypertension and CVA. The National Referral Hospital study found that more smokers suffer from pneumonia (68.8% in smokers, 31.3% in non-smokers admitted for respiratory diseases), chronic pulmonary diseases (55.8% in smokers, 44.2% in non16

Malefoasi G., Wale P., & J.Denty (2004). Smoking and Respiratory Diseases in Solomon Islands: 19992003, Unpublished Paper, MOH, Honiara. 17 Country Reports of the Third Meeting for National Focal Points for Tobacco Free Initiative Meeting Manila, 3-5th March 2004: Presentations. 18 (see foot note 8)

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smokers), and cancer of lung (96.6% in smoker, 3.4% in non-smokers). The striking finding is that the number of cancer of the lung due to smoking has been increasing. In the period from 1999 to 2003 a total of 28 cases of cancer of the lung was diagnosed and admitted to the NRH in Honiara. Of the 28 cases, 96.6% were chronic smokers. About seven percent (6.7%) of smokers died, whilst the same percent (6.7%) of smokers admitted with respiratory diseases discharged at the terminal stage (they too die at home). 4.5.2.3. Proven Facts and Evidences: Passive Smoke Worse in Workplace Than in Home. Passive smokers have twice the risk of having cancer. Although people who lived with a smoker had almost twice the risk of lung cancer as those without a puffing partner, the risk of lung cancer increased almost threefold for people who worked with smokers compared with those who worked in a smoke-free environment (By Alison McCook in the International Journal of Cancer 2002;100:706-713, August 30,2002. Smoking on the increase in many commonwealth developing countries including the Pacific Island Countries, while it decreases in the developed countries (By P Krishman and Magaret Mungherera, Commonwealth Medical Association et al.). 4000 toxic chemicals at 40 of these are known causes of cancer. Major causes of death –lung Cancer, Ischaemic Heart Diseases, Chronic Bronchitis, and Emphysema. Other Health Problems –stroke, Peptic Ulcers, Respiratory Disorders, Cataract, Osteoporosis, Reproductive Disorders, Asthma exacerbation.; Physically unfit; Facial wrinkling; Gum diseases and bad breath. Smoking increases with little education and low incomes (Steven A. Schroeder MD). Smoking common in young people between ages 18-24 years. Mental illnesses and smoking closely linked. There is coexisting psychiatric or substance-abuse disorders account for 44 % smoking cigarettes. 4.5.2.4. Tobacco causing increasing health expenditure: Whilst research is yet to be done locally to establish that tobacco causing huge health expenditure, overwhelming evidence elsewhere show that the expenditure on tobacco consumption is huge and far more than the revenue it produce for governments and tobacco companies. Poor families suffer from a smoker within that household as limited funds are spent on tobacco than essential basic needs such as food.

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4.5.2.5. Tobacco Production Situation in Solomon Islands: Overview of Tobacco Products: Solomon Islands Tobacco Company (SITCO) is the only domestic manufacturer of tobacco products in Solomon Islands. Unable to get the total domestically produced tobacco, but in 1996, SITC produced domestic tobacco products equivalent of SI$12.1 million. Tobacco products are produced domestically in the form of roll-your-own, pipe, loose as well as manufactured cigarettes. It is sold by SITCO and retailers, including market venders These products are sold in both packets as well as in loose forms. Imported tobacco products are mainly in the form of cigarettes and cured tobacco leafs. SITCO mostly imports tobacco products from Australia and main suppliers are WD&HO Wills, Philip Morris, and Rothmans. Philip Morris also ship directly to its agent in Solomon Islands from Australia, while Rothmans sells to a number of individual traders and importers Unable to obtain total volume of tobacco product imports, however in 1996, it accounts for a total value equivalent to SI$3.9 million. There is no present consumption of smokeless tobacco. Main importing companies are SITCO, Y Sato, ABA Corporation, George Wu and Co, QQQ Wholesale, Leon Gin and Co, Chang Wing, and Victory. Tar levels of imported cigarettes is 16 mg. Unable to verify tar levels of domestically produced cigarettes. Overview of Advertising: The tobacco products are advertised through print media, radio, bill boards, cinemas, inside and outside retail outlets. Print media –mainly the Solomon Star (twice weekly) Radio –SIBC, Paoa FM on regular basis Bill boards –SITCO building and sporting fields Retail outlets –All retail outlets for tobacco products Most of the advertisements are on cigarettes, few on roll-your-own packets (spear, emu, etc.) Currently there are no restrictions at all on all forms of advertisement. Language and Literacy Skills Less than 25% of the SI population can read and write English. About 17% of the female population are literate More than 75% of population can speak pijin. Pijin is not used commonly in writing. English is used for print media: News papers and Magazines 4.7.4.3.Overview of Print Media:

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SI has its own daily news paper (Solomon Star) and weekly paper (Solomon Voice). The only SI magazine that I am aware of is the Solomon Airlines quarterly in-flight magazine. Most of the imported magazines are imported from Australia, namely news week, Womens weekly, new ideas, Sports. There are no tobacco advertisement. All magazines are written in English. No special editions of these magazines are produced for Solomon Islands. 4.5.2.6.Tobacco Sponsorship in Solomon Islands: Sponsorship by Tobacco companies include Sporting and Cultural events, mainly by the local Tobacco Company (SITCO). Events: Solomon Cup soccer tournament, National Trade and Cultural show. Net ball league in Honiara, the tobacco company sponsorship covers a 10 year period. Unable to obtain contract content. Th e r ea r ep l a s t i cb a g s( wi n f i e l d ,d u n h i l l ,e t c )a n d“ T”s h i r t swh i c hc a r r yt o b a c c ot r a d ema r k si n Solomon Islands. 4.5.2.7. Contact with Relevant Industries in SI: There are importers and the SITCO fully aware of the bill. They are intensifying their advertisement. The SITCO has a copy of the recent approved Tobacco Control Bill. There are no feed back from them on this. Importers of the Magazines know about the bill. 4.5.2.8. Issues Raised by the Bill: Retail outlets also sell tobacco outside such as the markets, stalls and on the street. Advertisement in terms of price list would be sufficient. No tobacco products sold through vending machines. Yes, both sections 9&10 of the bill can be amalgamated. Th ewo r d“ Kn o wi n g l y ” s h o u l db ed e l e t e d . Please do provide for regulation making power for inserts in cigarettes packets. Currently there is no local laboratory in SI for analyzing tobacco products. This has to be done overseas with ISO methods. 4.5.2.9. Health Warnings: Information: Tar, Nicotine, CO (these are the ones that reported on the packets). Warnings i n c l u d e :“ Smo k i n gCa u s e sFa t a lDi s e a s e s ”( Wi n f i e l d ) ,“ Qu i t t i n gSmo k i n gn o wg r e a t l yr e d u c e s serious risks to your health ”( Pe t e rJ a c k s o n ) . Nos e p a r a t ep r i n t sa r ed o n ef o rc i g a r e t t e si mp o r t st o SI. Only English is used for health warnings Warning in Pijin:“ SI MOK BAE KI L I MI U” ,“ SI MOK HEMICOSI ML UNG KENSA” ,“ TAEM I U BABUL EANDSI MOKE, BAEI USPOI L EMPI KI NI NI ” Both graphical and pinjin information on the packaging may be used. “ He a l t hAu t h o r i t yWa r n i n g ” a t t r i b u t i o n ------------------------------------------------------------------------------------------------------------

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Color of warning: Black on white The same messages for cigarettes should be used on other classes of tobacco products Toxic constituents be stated for narrower class only ISO standards measurement of constituents for only manufactured cigarettes. Peter Jackson is using ISO methods, Winfield is using Government approved method (?which one) Returns: It would be sufficient for time being, the returns in weight of additives by products. 4.5.2.10. Transitional Provisions: The options should be similar to Fiji, where they give ample time for full awareness and this takes them 12 months. This means if the bill is passed in May 2000, it will come into effect from May 2001. Other areas that require a lot of adjustment may require appropriate transitional period. Domestically produced tobacco will take may be 10 months to put in health warnings. Advertisement at retail outlets, I agree with your suggestion. Immediate ban on non-tobacco product branding is feasible. I suggest first annual returns to be in by 31 May 2002. Sponsorship: This an area that requires a lot of government support as well putting a place other funding sources, example non-tobacco companies sponsoring sports or cultural events. I suggest that all regulations must be in place before the bill is made law. Now that we have a new Minister of Health, a medical doctor by profession, this an opportunity to get the bill through with the regulations. Future introduction of part of regulations may not be feasible as we have been struggling with bill for the last 8-10 years already.

4.5.2.11. Existing Health Policies and Legislation on Tobacco-SWOT Analysis It is evident that there has been a transition of the disease pattern in Solomon Islands like other developing countries from predominantly communicable infectious diseases to non-communicable disease. According to the death registry at the Medical Statistics Unit Ministry of Health [], the trend of the ten leading causes of death has changed. In the early 1990s malaria and pneumonia were leading causes of death. However in the late 90s, CVA and cancer has taken over as the leading causes of death. The health sector is response to the problem initiated and established related policies such as the National Diabetic Management Guidelines, the National Diabetic Clinic and other health education programs. These programs run into difficult financial constraints that impede their functions. The Ministry of Health in the past five years has developed a draft Tobacco Legislation, which is yet to be tabled in the parliament. The delay of the proposed Tobacco Bill is an issue the health sector is attempting to address. Dialogue with key stakeholders such, as the parliamentarians are the key limiting factors observed. Solomon Islands among all the WHO members states have signed the Frame Work Convention Tobacco Control but yet to rectify this declaration.

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The capacity building in research has been emphasized in the future directions for the health sector 2004-5. Ongoing health education and promotion has been part of the priority health programs funded in the past years. However how effective are these programs is a big question to answer. 4.5.2.12. The National Tobacco Control Policy. In 2002 a draft National Tobacco Control Policy was developed. It was presented and endorsed in the 2002 National Health Conference, when the draft was discussed by all the senior health officers including the NGOs health providers. [1]1 Objectives of National Tobacco Product Control Policy: (a) To protect the health of the people in view of conclusive evidence implicating exposure to tobacco smoke in the development of numerous debilitating and fatal diseases; (b) To encourage non-smokers, particularly young people and others, not to start smoking and protect them from persuasion and/or inducements to use tobacco products and consequent dependence on them; (c) To enhance public awareness of the hazards of tobacco use by ensuring the effective communication of accurate and relevant information to consumers of tobacco products; (d) To protect people to the extent deemed reasonable and possible from the hazards of involuntary exposure to tobacco smoke; and (e) To encourage and assist smokers to give up smoking, to promote good health and the prevention of illness. [2] Policy Focus Areas Sale and Promotion of Tobacco Products Licensing of Tobacco Products Wholesalers Constituents of Tobacco Products Environmental Tobacco Smoke (ETS) Involvement of Stakeholders [3] The Policy Sale and Promotion of Tobacco Products Issue:

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Effective tobacco advertising and promotion is aimed to: (a) make smoking socially acceptable; (b) influence smokers to smoke more; (c) influence non-smokers to start smoking and (d) discourage smokers from giving up. Policy Public promotion and advertisement of tobacco products in Solomon Islands will be banned. [4] Licensing of Tobacco Product Wholesalers: Issue: There is inadequate control of tobacco manufacturing, retailing and sales in Solomon Islands, which promotes easily accessibility of the population to Tobacco products, even the young children. The control on types of the products including its constituents does not exist. Importers of the tobacco products also offered import duty concession, which leads to cheaper prices thus increase affordability. Policy: Wholesale imported and outlets of tobacco products in Solomon Islands will be monitored through licensing procedures and appropriate price control measures. Constituents of Tobacco Products: Issue: Within seconds after tobacco smoke is inhaled, some 4,000 byproducts are being absorbed into t h eb l o o ds t r e a ma n dt r a n s p o r t e dt oe v e r yc e l l o f t h es mo k e r ’ sb o d y . Policy: Labeling of all tobacco products must be identify true content of Tar, Nicotine and Carbon Monoxide, including appropriate clear health messages. Environmental Tobacco Smoke (ETS): Issue: During one hour in a smoke-filled room, a non-smoker may inhale nitrosamines in quantities equivalent to smoking 15 filtered cigarettes. Nicotine, carbon dioxide and ammonia are also found in higher concentrations in side stream smoke. Policy:

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All public transport, buildings and amenities must be smoke free with certain areas designated for smoking. Involvement of Stakeholders: Issue: Addressing tobacco related health problems requires support from other various organizations with government, NGOs and private sectors. Activities have to be coordinated from all fronts including legislation, educations, finances and consumers themselves. Policy: A multi-sectoral body will be formed to coordinate various strategies and activities in promoting healthy life styles and combating the promotion of tobacco. The effectivity of Tobacco Control Policy: How effective are these policies developed recently? The answer at this moment is little or none at all. This is due the following reasons:There are no restrictions to tobacco consumption. The proposed legislation is yet to be passed at the parliament level. It has passed through the Cabinet level. There is very little information on tobacco and its impact on health in the country. The anti-tobacco campaigns are weak and not happening due to lack of drive from responsible health authorities, even though the health directions are clear []. Lack of appropriate knowledge and mechanism to monitor and evaluate the program. The recent development of the Essential Public Health Functions (EPHF) [] is a appropriate and opportunity to help evaluate the programs effectivity. To b a c c oi sd e e p l yr o o t e di nt h ep e o p l e ’ sl i f ea n dc u l t u r e . Ad i f f e r e n t t a s kt od e -root the practice and norm that tobacco is part and puzzle of living in this developing country. Changing and reforming a culture is very difficult challenge even it is evident that changes do occur. 4.5.2.13. History of the fight against Tobacco in SI: Tremendous efforts had been made by the Ministry of Health and other key stakeholders such as t h eL e g a lDr a f t s ma na tt h eAt t o r n e yGe n e r a l ’ sCh a mb e r sinto developing and drafting of the proposed Tobacco Control Bill. There had been wide consultations including a radio talk-back show in 2003. Some of the events are listed below: Minister of Health request AG Chambers to commence the legal drafting of the bill: /December 1996.  Mi n i s t e ro fHe a l t ha s k e df o rf l e x i b i l i t yo n“ t o or e s t r i c t i v e ”c l a u s e si nt h ep r o c e s so fl e g a l drafting on 19th March 1997. ------------------------------------------------------------------------------------------------------------

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 Undersecretary Health request AG Chambers for legal review of new clauses before submitting to Cabinet for another approval on 28th March 2000.  Approved the revised bill in September 2000.  On the 15th December 2000 the Undersecretary Health follow up letter on matters raised in the 28 March 2000 letter  Legal draftsman responded to US/Health and admits that work on the bill not progressing due to a lot of other pressing legal matters on the 17th December 2000.  First draft Tobacco Control Regulation Bill 2000 ready in April 2000.  Undersecretary Health Improvement (National Focal Point for Tobacco Control, SI attended the Second Meeting on the National Focal Person for Tobacco-Free Initiative in Western Pacific Region on the 23-25th August 2000 in Manila.  US/Health pursuing the legal drafting to be done by A&H Lawyers in the light of the heavy work commitment at AG Chambers on the 28th March 2001.  A&H Lawyers obtained the Bill from Legal Draftsman on the 27th June 2001.  A&H Lawyers in consultation with the Ministry of Health redrafted the bill in 2001.  Minister of Health, Hon. Benjamin P Una joined all other commonwealth Ministers agreed to pass the verdict on WHO first international treaty to protect public health, the FrameWork Convention for Tobacco. Solomon Islands joined all other member states to endorse the FCTC in May 2002 during the 55th World Health Assembly in Geneva.

 Health Seminar for Ministers and Permanent Secretaries on the 1st October 2002 :National Tobacco Product Control Policy.  National Health Conference 11-13th November 2002: National Tobacco Product Control Policy. Resolution: National Tobacco Control Policy endorsed.  Radio Talk back on Tobacco related issues in 2003.  At t o r n e yGe n e r a l Ch a mb e r ’ sr e q u e s t e db yMOHt or e v i e wt h ed r a f t To b a c c oCo n t r o l Bi l l i n light of the FCTC in February 2004.  Cabinet Paper was submitted to Cabinet for endorsement to ratify the FCTC in February 2004.  A Rapid Research into Smoking and Respiratory and other related diseases was design and undertook 2-6th February 2004. (Cabinet endorses the FCTC in April 2004 after it being deferred twice. Thus, Solomon Islands is ready to ratify the FCTC.) 4.5.2.14. Future Directions for Tobacco Control in Solomon Islands: Below are measures to be implemented by the Ministry of Health and its development partners, international and locally. These are measures to actually engineer and implement the strategies in the National Tobacco Control Policy. 4.5.2.14. 1: Immediate Measures; 1. Rapid Research on Smoking and Respiratory Disease in Solomon Islands. 2. Rapid Research/ Smoking prevalence survey in Households in Honiara.

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Report by the Ministry of Health (May 2004):

52 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

3. Design meetings for parliamentarians and NGOs to involve them in tobacco control. 4. Review the draft Tobacco Legislation in-light of the Framework Convention for Tobacco Control. And ratify the FCTC. 5. Table the proposed Tobacco Control Legislation in the forthcoming parliament sittings. 6 .Ev a l u a t et h eMi n i s t r yo fHe a l t h ’ sr o l eo ft h eTo b a c c oCo n t r o l u s i n gt h eEs s e n t i a l Pu b l i cHe a l t h Function Tool. 7. Develop feasible and appropriate Tobacco Control Programs/ activities to implement the policy. 4.5.2.14. 2. Medium Measures: 1. Tobacco companies to be held publicly, accountable at the national level through legislation, litigation and other means. 2. Development of mechanism or institution to monitor and enforce implementation of tobacco control laws and regulations. 3. Increase taxation on locally produced and imported tobacco. 4.5.2.14. 3. Long Term Measures: 1. Revise the Financial Instruction to allow revenue from tobacco control measures such as taxation to be used for further Tobacco Control and Health Promotion. 2. Restrict all public transport, buildings and amenities to be smoke free with certain areas designated for smoking though legislation.

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Report by the Ministry of Health (May 2004):

53 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

4.6.0. Tuberculosis: 4.6.1. Overview: Tuberculosis and Leprosy Control Programs still remain as one of the main public health problems in the country19. It is for this reason that the Ministry of Health through the National TB/Leprosy Co n t r o l Pr o g r a mc o n t i n u e dt op u t t h e ma so n eo f i t ’ sp r i o r i t yh e a l t hc o n t r o l p r o g r a msa n d has put a lot of emphasis to try to achieve our global targets set by WHO both at the National and in the Provinces. With a lot of assistance from our donor agencies like the WHO, Ausaid, ROC, Pacific Leprosy Foundation and now the Global Funds, the National TB and Leprosy Control Program continued to maintain the TB and Leprosy surveillance system both at the national and provincial level. In 2002, the National TB Control Program has not been able to produce an annual report due to some unforeseen circumstances beyond our control. There was a sudden change in the NTP management especially at the national level. As a consequence, some of the activities and functions performed by the National TB and Leprosy Coordinator were jeopardized. In spite of this, corrective strategies were taken by the ministry to ensure that the program continued to function. In year 2003, despite having gone through those difficult and challenging times, the National TB and Leprosy Control Program had put a lot of efforts in try i n gt op u t t h ep r o g r a mo ni t ’ sr i g h t f o o t i n g on where it was before. In the absence of the National TB and Leprosy Coordinator for about eight months, the Provincial Coordinators continued to execute their planned activities in their respective provinces despite the many financial difficulties the country had gone through. Besides keeping track of new patients, a computer print out of active TB patients currently on treatment was sent to the provincial TB and Leprosy Coordinators to up date on the status of patients under treatment with Short Course Chemotherapy (SCC) using DOTS strategy and also for patients on Multi-drug Therapy (MDT). The respond from the Provincial Coordinators was quiet good while some were still wondering as to whom was the new national program manager. A cohort analysis for 2002 was done with regards to treatment outcome using the standard indicators 4.6.2. Objectives: To improve cure rate To reduce mortality rate 4.6.3. Indicators: Cure Rate Mortality Rate Treatment Completion Rate

19

Report by the Disease Prevention and Control Unit (2004): Annual Report 2003

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54 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

4.6.4 Output-Achievements & Constraints: 4.6.4.1. Outputs (or Deliverables): 4.6.4.1.A: New TB Case Notification. The TB Control Program has some important key strategies for controlling tuberculosis. The Direct Observed Therapy Short course (DOTS) is the basic strategy to stop TB and it has five key components in the overall strategic framework to control TB. Such strategic framework is a guide and should not be overlooked by program managers at all levels. The key strategy is DOTS and used to control TB as a public health problem, not only that but there are beneficiaries such as curing of the illness, prevention of drug resistance, death and reducing the incidence of the TB in the communities. New TB Case Notification Rates 1990 - 2003

TBNR 1 per 100,000

150 100 50 0

90

91

94

95

96

97

98

99

0

1

2

3

All Cases 117 91 107 104 70

94

80

77

64

64

75

70

62

64

Smear (+) 37

30

28

26

40

21

27

29

26

33

27

92

39

93

44

31

Figure 1. Figure 1 above showed the result of case finding as well as providing a trend of new case notification rates for All cases and Sputum Smear positive cases since 1990 up until recently. As clearly shown on the graph, the overall trend of TB case notification is declining. The case notification rate for all cases declined from 117 per 100,000 population in 1990 to 64 per 100,000 population in 2003 while the case notification rate for Sputum smear positive cases ranges from 37 per 100,000 population to 33 per 100,000 population for the same period. In 2003, there are 268 cases notified to the Central Registry. This includes relapse cases and new cases of TB. Of the total (268), 136 are classified as sputum positives, which represents 51% of all cases notified. As indicated in Figure 1 there is a slight increase in the smear positive rate although not exceptionally high compared to the past years. It is important that strategies to reduce TB incidence in the communities are undertaken with concerted efforts by all health workers. Thus it is

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Report by the Ministry of Health (May 2004):

55 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

very important that thorough active case finding and contact tracing be continuously carried out among the contacts of sputum positive patients along with aggressive community health awareness in foci areas in a given locality. 4.6.4.1.B: New TB Case Notification by Provinces. The number of cases reported to the Central Registry by provinces varies. Some provinces have more cases notified than others, but the notification rates as illustrated in Figure 2 below showed that TB is still prevalent even in some smaller provinces like Isabel and Temotu Provinces. The rate of TB against their total population is quiet high compared to bigger provinces like Malaita, Western and Guadalcanal Provinces. This means that a lot of work are yet to done by all Provincial Coordinators to try and reduce the TB burden in the provinces and communities. TB Notification Rate -All cases by Provinces 2003 YP

126

TP

99

MP

76

HTC

70

SI

65

MUP

64

GP

48

WP

44

RBP

42

CIP

41

CHP

40 0

20

40

60

80

100

120

140

Figure 2.

4.6.4.1.C: TB Case-holding and Treatment Outcome. In order for the NTP to monitor and assess the progress of DOTS strategy, it has to have some set targets and see if these target have been achieved in a given time frame or not. Targets for controlling TB as mentioned in Box 1 are very important and should be the main indicators for monitoring the success of the TB Control Program (NTP) both at the provincial and national annually. These targets have been documented in the National Tuberculosis Control Program

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56 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Manual and also advocated by the WHO/WPRO Stop TB initiative for the period 2000 –2005 as main indicators to monitor TB control activities with regards to achieve global targets and program objectives Box 1. Targets for DOTS implementation.  To ensure that 100% of detected new smear positive cases are enrolled under DOTS  To cure more than 85% of smear-positive pulmonary cases under DOTS  To detect 70% of estimated new smear-positive cases. (Pacific Strategic Plan to Stop TB 2000) WHO In comparison to the above targets set by WHO to what the NTP had achieved with regards to case holding and treatment outcome, it has always been the Policy that all TB patients regardless of their category be hospitalized for 2-3 months on intensive treatment before they are discharged to continue their treatment for 6-8 months at their nearest health facility. This has facilitated and strengthened the TB Control Program with regards to applying DOTS. Currently, DOTS coverage is 100% nationwide. This strategy is already having an impact in rendering a high sputum conversion after 2 & 3 months of the initial treatment phase. Our previous records showed that more than 85% conversion rate was achieved after 2 months of intensive treatment and more than 90% after 3 months. 4.6.4.1.D: National Cure and Success Rates: Cure and Treatment Success Rate 1996 - 2002 100 90 80 Percentage (%)

70 60 50 40 30 20 10 0

96

97

98

99

0

1

2

Cure Rate

30.8

74.3

83.3

78.4

68.4

68.4

71.3

Treatment Success Rate

87.5

92.4

92

86.3

92.1

92.1

92.6

Figure 3. Figure 3 above illustrated the results of Cure and Treatment Success Rates for the period from 1996 to 2002. It showed that the Treatment success Rate (TSR) has been steadily high around

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57 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

90% while the Cure Rate had increased in the first 3 years of implementation and later declined due to the interruption of the program by social-unrest which started in 1999 as well as other factors such as poor case follow up and failure to collect follow up sputum. However, in 2002 it started to pick momentum again by attaining 71.3%. These results showed that dual strategy has to be taken, where it possible sputum should be collected from all sputum smear-positive patients for monitoring of cure rates. This calls for a concerted effort on the part of health workers in rural areas to improve DOTS strategy in every where possible. Provincial Cohort analysis for sputum smear positive for year 2002 is shown in Table 1 below.

Table 1. Provincial Cohort Analysis for smear positive cases for Year –2002. Prov

Cure

Complete

Transfer

No

%

No

%

No

%

No

%

No

%

5 100% 0 TSR 5 (100%) CIP 2 100% 0 TSR 2 (100%) GP 6 75% 2 TSR 8 (100%) HTC 1 8.3% 10 TSR 11 (91.6%) MUP 8 100% 0 TSR 8 (100%) MP 45 84.9% 3 TSR 48 (90.6%) TP 0 0 0 TSR 0 (0) WP 9 47.3% 8 TSR 17 (89.4%) YP 1 100% 0 TSR 1 (100%) RBP 0 0 0 TSR 0 (0) Solomon 77 71.3% 23 Islands TSR 100 ( 92.6%)

0

0

0

0

0

0

0

5

100%

0

0

0

0

0

0

0

2

100

25%

0

0

0

0

0

0

8

100%

83.3%

0

0

0

0

1

8.3%

12

100%

0

0

0

0

0

0

0

8

100%

5.7%

1

1.8%

4

7.5%

0

0

53

100%

0

0

0

0

0

0

0

0

0

42.1%

2

10.5%

0

0

0

0

19

100%

0

0

0

0

0

0

0

1

100%

0

0

0

0

0

0

0

0

0

21.3%

3

2.7%

4

3.7%

1

0.9%

108

100%

No CHP

%

Died

Default/Lost

Total

With the results shown on the table above, it is pleasing to note that four out of ten provinces had continued to achieve 100% in their cure rates while Malaita Province for the first time able to achieve at least 85%. Western Province did have problem with their laboratory facility which did not allow them to check sputum. Arrangements have been made for the specimen to be sent to Helena

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58 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Goldie Hospital laboratory for checking. Temotu and Rennel & Bellona Provinces somehow did not register any patient cured at the end of the year.

Table 2. Cohort Analysis for Extra-Pulmonary and Sputum Negatives –2002. Province Completed

CHP CIP GP HTC MUP MP TP WP YP RBP Solomon Islands

Transferred

Died

Default/ Lost

Total

No

%

No

%

No

%

No

%

No

%

5 4 15 15 17 51 2 17 3 1 130

100% 100% 100% 68.2% 94.4% 87.9% 100% 94.4% 100% 100% 89%

0 0 0 2 0 1 0 0 0 0 3

0 0 0 9% 0 1.7% 0 0 0 0 2.1%

0 0 0 0 1 4 0 1 0 0 6

0 0 0 0 5.5% 6.8% 0 5.5% 0 0 4.1%

0 0 0 5 0 2 0 0 0 0 7

0 0 0 22.7% 0 3.4% 0 0 0 0 4.8%

5 4 15 22 18 58 2 18 3 1 146

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Cohort analysis for sputum negative and extra-pulmonary TB for the year 2002 as illustrated above were quiet satisfactory with 89% of the total cases registered had completed their treatment, and less than 4% of patients died whist on treatment for both categories of patients (smear (+) and negative and extra-pulmonary cases). This is a good sign for the program with regards to patients compliance 4.6.4.1.E: Capacity building –in country workshops and overseas training: In 2003, a TB external review and workshop was conducted for the Provincial TB and Leprosy Coordinators. The review of the program was conducted by three Short Term Consultants from WHO/ WPRO in Manila with funding assistance for the workshop was also from WHO. This review workshop was very important in that it gave us a clear picture of where we are now and also it was the first time for the new National TB Coordinator to organize such an event and had given him the opportunity to explore and discussed issues that are paramount importance to the success of the program. A separate report on findings and recommendation compiled by the consultants had already been submitted to the Ministry for action. This type of activity should be an annual event and has contributed a lot to the progress of the program especially to strengthen the program at different levels of integration within the health care

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59 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

system and also provided an opportunity for provincial Coordinators to come together and discuss the results of their program and make resolutions for improvement. Capacity building in terms of training is an on-going program organized by Ministry. In 2003, although no refresher training for health workers on TB was conducted in the country, we did have one specialized training in TB for the new National TB Coordinator in RIT/ Japan for 3 months. This training was sponsored by JICA and hopefully one of the provincial TB Coordinators will be sent next year. Such training has improved the work performance of the provincial TB managers who have already attended and have shown much improvement in their case-holding activities. 4.6.4.1.F: TB Public Campaigns and Promotions: TB awareness to public is one of the very important aspects in trying to control the spread of TB in the communities. Last year, although we did very little in our health awareness program, we did manage to organize some activities during the World TB Day which falls the on 24th of March e v e r yy e a r .Th et h e mef o r2 0 0 3Wo r l dTBDa ywa s‘ DOTSc u r e dme ,i twi l lc u r ey o ut o o ”wa s highlighted during the day after the official launching by the Permanent Secretary of Health at the SIBC and then followed by health education talks in most Honiara Town Council clinics and some primary schools 4.6.4.2. Issues/Constraints: 4.6.4.2 A: Drug Supply Last year was a terrible year for the NTP with regards to drug supply and logistics. There was shortage of some anti-TB drug experienced throughout the country especially Rifampici and Isoniazid. This is the first time the country have gone through this problem due to the problem of finances. The drug shortage resulted with some patients had to be treated with only two drugs. Although the problem has been rectified from the immediate help from WHO, the issue of drug calculation and ordering should be dealt with seriously with the Medical Stores to avoid the incident happen again. 4.6.4.2.B: Recording and Reporting System Recording and reporting system of TB patients is still a concern especially from provinces to the national level. Currently only about 80% of the reports received just in time and another 20% received very late or no report at all. A lot of training has been conducted to try and address this problem but little improvement noted. We need to develop some sort of system that would solve this problem in the future. 4.6.4.2: C: Inadequate Facility/ Equipment: While it has been noted with some concern that some remote provinces and even with bigger provinces, lack of proper facility for TB investigation and transport difficulties are the main obstacles faced by program officers resulting in having low or even no cure had been registered. ------------------------------------------------------------------------------------------------------------

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60 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Unless some diagnostic centers are established to facilitate AFB testing at Area Health Centers level, the problem of having low cure rates or not registering any smear positive cases will continue to exist in these provinces. 4.7.0. Leprosy: 4.7.1. Objectives: To reduce the prevalence rate of leprosy from 0.6/10,000 pop in 1998 to less than 0.3/10,000 pop by 2003. 4.7.3. Indicators: Prevalence Rate of Leprosy 4.7.3. Outputs-Achievements & Constraints: 4.7.3.1. Outputs (or Delivrables): 4.7.3.1.A: New Leprosy Case Notification. The number of new Leprosy case notified in the year 2003 was very low compared to the number of cases notified and registered in the previous years. Only 5 new leprosy cases were detected and registered compared to 28 new cases in 2002. This is due to insufficient funds secured from Pacific Leprosy Foundation to do elimination campaigns in high foci areas. Most of the cases notified were from Guadalcanal, Honiara City Council and Malaita provinces. As illustrated in Figure 4 below, the trend of leprosy case notification since 1996 was declining except for 2002 when it showed a slight increase.

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Report by the Ministry of Health (May 2004):

61 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 -------------------------------------------------------------------------------------------------------------------------------------------------------------New Leprosy case Notification from 1996 - 2003 30 25

Number

20 15 10 5 0 New Leprosy Cases

96

97

98

99

0

1

2

3

24

21

14

12

9

7

28

5

Figure 4. With the decreasing trend of cases notified each year, program officers and nurses in rural areas where the prevalence of leprosy in the past was high are again reminded to actively carry out Leprosy Elimination Campaign (LEC) activities in their areas and provinces. The continuous implementation of LEC strategy is important to ensure that Elimination Target set by WHO is achieved and maintained at low level. It is therefore crucial that basic knowledge of leprosy is continuously taught in the Nursing School or even during refresher trainings to maintain a high level of index among health workers. In leprosy control Program, there are certain operational indicators for case finding which are used to monitor the progress and success of the program. These indicators as stated in Box 2 below reflects the impact of case finding and progress of MDT with regards to patients compliance. In 2003, although we did not register any case of leprosy among children under 14 years and those having deformities it is very crucial that active case finding along with LEC must be initiated and sustained to suppress leprosy prevalence rate. Box 2. Operational indicators for case finding in Leprosy Control. Operational indicators for case finding that reflects the impacts of case finding strategies are:  Number of children less than 14 years infected. –an indication for leprosy transmission in the communities.  Physical deformities of newly diagnosed patients –delay in case finding at the community level- low index of the health workers.  MDT Coverage (what proportion of patients are on MDT) ------------------------------------------------------------------------------------------------------------

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62 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

4.7.3.1.B: National Leprosy Prevalence Rate: Solomon Islands has reached below the WHO target mark of 1/10,000 population, at 0.6/10,000 population The use of Multi- Drug Therapy (MDT) has been effective in reducing the leprosy case-loads. As can be seen in Figure 5, the prevalence rate of leprosy has declined from 4 per 10,000 population in 1990 to 0.67 per 10,000 population in 2003. It was in 1995 that the Leprosy Control Program had achieved the prevalence rate of less than 1 per 10,000 population as required by WHO. The global target for the elimination of leprosy as a public health problem is less than 1 per 10,000 population. Although the program did maintain a low prevalence rate for the last eight (8) years, extra effort is still required to identify possible new cases in high prevalence areas of Guadalcanal, Honiara City Council and Malaita Provinces.

Natinal Leprosy Prevalence Rate from 1990 - 2003 4.5

PR 1 per 10,000 pop.

4 3.5 3 2.5 2 1.5 1 0.5 0 Leprosy Prevalence

90 91 92 93 94 95 96 97 98 99 4

3

3

2

0

1

2

3

1.1 0.6 0.7 1 0.5 0.2 0.5 0.2 0.7 0.1

Figure 5.

Besides reducing the prevalence rate to as low as 1 per 10,000 population and reducing the caseload, it is important to assess the MDT program. The indicator provided in Box 3 would facilitate the calculation of MDT coverage Box 3. Assessing Progress with MDT implementation

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63 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

 Cured with MDT –this is the cumulative number of patients who have completed MDT since the implementation of the program. This is expressed in absolute numbers.

Using the above indicator, the Leprosy Control Program has treated a cumulative total of 568 patients with MDT since the program was initiated in 1987. Although we could not verify the exact number of patients released from control but most of these patients had been released from treatment which indicated a good treatment management and compliance.

4.7.3.1.C: Leprosy Public campaign and Promotion. Because Leprosy is no longer been regarded as major public health problem, much of the health awareness campaigns have geared towards other programs. Never the less, this should not be seen as a barrier. Much of the awareness activities on leprosy were done during leprosy elimination campaigns which is an integral part of the program to accelerate leprosy elimination. In the past years only Malaita, Guadalcanal and Honiara City Council health staffs conducted some LEC activities in designated leprosy foci areas which yielding more new cases. Such approach should pursued with innovation to detect any hidden cases and also to increase community awareness. 4.7.3.1.D: Leprosy Rehabilitation. This is one of the major component of the Leprosy Control Program as far as leprosy patients with disability are concerned. The Community Based Rehabilitation Program (CBR) Unit within the Ministry of Health plays an important role in assisting leprosy patients on humanitarian ground. This means that any leprosy patient with grade 2 disability are eligible for some sort of assistance like housing, school fees for their children, income generating projects that would assist them to earn some living. Leprosy patients are advised to channel their request to the CBR Unit who on their behalf make request to Pacific Leprosy Foundation in Christchurch –New Zealand for funds. Currently there are several housing projects in Malaita and Guadalcanal Provinces that are need to be completed. School fees for children is still been catered for by the PLF. 4.7.3.2. Issues & Constraints: In spite of the progress and advance in program development, there are few weakness and constraints experienced by the programs. This had hindered the smooth implementation of the program activities both at the national and provincial level. Below are some of the major constraints and weakness:

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64 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

 Although there is government commitment to support the implementation of the programs, there is still inadequate funds for administration and support services and also for conducting refresher training for health workers and also for conducting supervisory tours by both national and provincial coordinators.  Communication between national and provincial coordinators is still a main set back in term urgent matters that need to be communicated to the provinces. At the moment it is very difficult to communicate with the provinces.  There is inadequate supervisory tours conducted by the national and provincial coordinators to provinces and rural clinics to boost staff morale and provide technical advice to improve performance due to financial difficulties.  Recording and Reporting system is still at a very low level. Provinces need to improve the current system.  There is inadequate supply of anti-TB drug and logistics experienced in the country.  There is lack of transport facilities experienced by all provinces which is the main set backs for case follow up and also for conducting supervisory tours  There is inadequate supply of IEC material available for TB and Leprosy. Some IEC materials need to improved and edited for better understanding to the general public.

4.8. Sexually Transmitted Infections ) including HIV: HIV/AIDS Status:  The current testing strategy for are: -All Hospital laboratories can do HIV testing. -Test used Serodia particle agglutination test. -Trial some rapid test included :HIV spot and HIV determine - For all rapid test reactive were re-tested on Serodia. Reactive samples were sent to Royal Brisbane laboratories for confirmation.  Current Reporting strategy: None of the Laboratory did case reporting None of the initial reactive results are reported All confirmed cases of HIV are sent back to the requesting Doctor & copies kept at laboratory. All laboratory reports aggregate data in their annual report, which is compiled in the National referral hospital laboratory

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65 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

 HIV Surveillance : There were observed disadvantage of Case reporting. The Second Generation Surveillance is recommended. Recently about 4000 testing were done at NRH Honiara, mostly medical checks for the preemployment and Overseas visas, and Clinical suspects. More than 18,000 blood donors tested mostly most young male adults in and around Honiara. Pre-risk behaviors elimination questionnaires administered. About 4,000 STI (Sexually active population (Range12-50yrs), mostly 19-25 age group were included. Table below shows summary of Tests done: More than 27,000 HIV testing was done since 1989 in the country.

STI Bdonor Patient surv

Year

Sp. Studies Total

1989-1998

11951

2309

2159

0

16419

1999

1163

492

490

0

2145

2000

1029

831

588

0

2448

2001

1706

304

361

0

2371

2002

1061

132

20

1002

2215

2003

1585

210

18495

4278

Total

1795 3618

1002

27393

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Report by the Ministry of Health (May 2004):

66 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Graph below shows the number of confirmed HIV cases in the Pacific Islands: Please take note that by end of 2003 SI only recorded one (1) and not two as recorded below. Solomon Islands second case was confirmed early 2004. The graph excludes PNG, which recorded more than Number of Confirmed HIV in PIC as of Dec 2003 (SPC) 300 200

149

168

150 100

Tuva lu Va n u a tu Wall is an d Fu tu n a

Solo

arian

Nort he

rn M

4 0 12 2 0 13 9 3 2 mon Islan ds Toke lau I slan ds Tong a

25

Niue a Isla nds

0

Nau ru New Cale donia

Fiji lynes ia Gu a m Kirib ati Mars hall Islan ds h Po

Fren c

Sa m oa I s la Sta te n ds s of Micr ones ia

9 1

Fede rated

Am e rican

0

2 0 11

Pala u Pitca irn Sa m oa

41

50

Coo k

No.of HIV

246

229

250

7,000 HIV cases. There has been an increasing STI recorded. Unfortunately the update figures are not available at the time of compiling this report. 4.9. Mental Health Service: 4.9.1. Policy Statement: Over the past years the number of people seeking psychiatric treatment increases. It is expected to increase further in the next five years. The gap between the demand for services and the limited supply will further. The utilization of this service is very low compared to general medical services, because of limited access to the services. Most other provincial hospitals do not offer any psychiatric counseling or treatment but do follow-ups, and supply psychiatric drugs. Unless something is done, the situation will be even difficult. Social problems such as alcohol and drug abuse are now recognized in the communities as significant problems. Criminal offences are in the rise. The need for psychiatric counseling and treatment is great. The ministry through the National Psychiatric Board resolved that the Primary Health Care Approach would be maintained to address the issue of accessibility and equity. The people should

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Report by the Ministry of Health (May 2004):

67 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

be accessible to certain level of psychiatric services. The ministry sees the importance of rehabilitation of psychiatric patients in the community, and would like further strengthening it by involving communities. 4.9.3. Objectives: To improve National Psychiatry Services using the Primary Health Care approach within the next five years. To in-built Social Psychotherapy (or community rehabilitation) in the National Psychiatric Services by 2003. 4.9.4. Indicators: Fully documented and implemented primary health care approach in the National Psychiatric Services. Fully documented and implemented Social Psychotherapy component of the 4.9.6. Outputs/ Achievements: 4.9.6.1. Funds secured for training of a national doctor in psychiatry in 2002 4.9.6.2. Specialized nurse trained in psychiatry is under going training in Australia Policy 5: Environmental Health Services Summary Report by: Mr. Robinson Fugui, Director Environment Health Division 5.2.Objectives: To improve productivity of the Environmental Health Division and Rural Water Supply & Sanitation Project (EHD/RWSS) in the next five years. To increase environmental public health activities in food hygiene, inspections and quarantine, and occupational health and safety at work in the next five years. 5.3. Indicators: No. of EHD Activities No. Water supply & Sanitation projects constructed Water Supply coverage Sanitation coverage No. Of Public Health Activities implemented

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Report by the Ministry of Health (May 2004):

68 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

5.4. Achievements: Outputs (or Deliverables): 5.4.1. 70% of the total population have access to clean and safe water. 5.4.2. 30% of total population have access to proper sanitation. 5.4.3. Quarantine Health Services continued to be busy through last year. Their participation provide in April to June 2003 during the SARS out-break. 5.4.4. The quarantine health Unit of the Environmental Division recorded total of 79 vessels and ten aircrafts underwent health quarantine inspections and clearance from January to August 2003. These inspections are aimed at identifying and preventing diseases imported into the country from overseas. 5.4.5. Efforts to strengthen food safety and quality control progressed very well in 200320. Activities undertook included gazette of the Pure Food Act No. 4 of 1996 with a commencement date for the Act as 1st January 2003. The Fishery Product Regulations under the Pure Food Act No. 6 of 1996 was reviewed by external consultants in liaison with the local staff. The draft is pending clearance a f t e rv e t t i n gb yt h eAG’ sCh a mb e r s .T h eFo o dHy g i e n eAc ti sp e n d i n ga c t i o nb yAG’ sCh a mb e r s . EHD is the legitimated competent authority in ensuring international standards for food processing and trade. Capacity building continued in 2003. Additional skills were acquired on regulatory inspection, Retorting, basic food analysis, and imported food control and inspection. The skill transfer was done through attendance of divisional staff to the different workshops held in 2003.

Issues and Constraints:  Lack of funding is expressed as hindering some of the divisional activities. There is no clear budget line for the divisional to undertake its planned activities for 2003 efficiently.  No donor assistance was forthcoming in 2003, which accentuate the gap after AusAID stopped funding of the RWSS Program in 2001.  Logistical support to the provinces were affected.  The public health laboratory lack required equipments and facilities to ensure a quality and reliable public health functions as stipulated under the Pure Food Act.  Delay in vetting of draft legislations and regulations is a concern causing slow progress in implementing the regulatory functions.  Wide spread freezing of recruitments and promotions and other related personal matters by the Public Service Division have implication on the staffing and incentives to the division. Note: Update data and information not available at the time this report was compiled.

20

Environmental Health Division (2003). EHD Annual Health Report 2003.

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Report by the Ministry of Health (May 2004):

69 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Policy 6: Health Education and Promotion This section only focuses on the activities of the Health Education and Promotion Division Head Quarter, Honiara. 6.1. Objectives: To increase focus and reorient commitment to enhance preventive and promotion health services to the local community, especially the vulnerable people, the women and children, in the next five years. To carry out more health education and promotion activities in the rural clinics from 37.3% in 1995 to 80% by 2003. Increase integration of IEC into all health programs within the ministry as well as other stake holders (NGOs) in the next five years To promote family health from within the village to encourage and support efforts of parents to make responsible decisions regarding family size and family health. To strengthen capacity of the health workers to plan, coordinate, implement and evaluate health promotion activities/ programs in the next five years. 6.2. Indicators: No. Of health education and health promotion activities Fully documented and implemented orientation No. Of health promotion activities implemented. Individuals, and families aware, informed and more responsible for their own health and family' health. Integration of IEC into all health programs and other stakeholders (NGOs) involved. Families aware, informed and more responsible for their own family health. Human resource development which reflects new health promotion orientation Improved planning, implementation and evaluation Key nurses and health educators up to date on promotion on current health issues and problems. 6.3. Outputs-Achievements & Constraints: 6.3.1. Outputs (or Deliverables: I.

2.

INTRODUCTION National Health Policy No 6 Health Promotion a New Concept Health Promotion Mouth Piece of MHMS Supplement National Health Program Implementation Rate Increased MAJOR FUNCTIONS Capacity Building Healthy Setting Media And IEC Production Research And Development General Administration

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Report by the Ministry of Health (May 2004):

70 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

3.

SPECIFIC PROGRAM ACTIVITIES A.

Capacity Building Pre-service training In-service training Community training/workshops

B.

Healthy Settings Health Promoting School Health Promoting Health Care Facility Healthy Promoting Town Health Promoting Work place Health Promoting Village

C.

Media And IEC Production Media Advocacy IEC Production AVA equipment procurement/maintenance

D.

Research And Development

E.

Pretesting Community Profiling Impact Assessment General Administration

D.

5.

Policy Structure Review Workforce development Program Development Financial Management Reporting

PROGRAM ACTIVITIES ACCOMPLISHMENT A.

Capacity Building Pre-service training –1 In-service training –1 Community training/workshops (conducted) –46 Community training/workshops (R/Personnel) –5

B.

Healthy Settings Health Promoting School –(Primary/Secondary/Tertiary) Health Instruction –126 Health Inspection - 92 Total Students - 11,114 Health Promoting Clinic/Hospital Health talks/ film shows - 302

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Report by the Ministry of Health (May 2004):

71 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 -------------------------------------------------------------------------------------------------------------------------------------------------------------Health Promoting Town Health campaigns and talks –37 Health Promoting Village Village Inspection –101 Village Meetings - 181 Village Talks/film shows –265 Village Implementation Programs –14 C.

Media And IEC Production Media Advocacy Radio Health - 300 programs Newspaper - 10 columns Television (ABC)2 Clips IEC Production Health posters – Health leaflets Health calendars Health banners Health T-shirts – Health video – Health Cassettes dubbed -

D.

Healthy Settings Health Promoting School –(Primary/Secondary/Tertiary) Health Instruction –126 Health Inspection –92 Total Students - 5

6.3.2. Issues and Constraints:    



Inadequate Financial Support Lack of IEC materials Lack of Research And Evaluation Inadequate Communication And Supervision Low morale of HP staff –Province

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Report by the Ministry of Health (May 2004):

72 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Policy 7: Reproductive Health & Family Planning 7.1. Objectives: To reduce maternal mortality rate from 357/100,000 live births by 50% by 2003. To have one trained midwife per shift by 2003 at NRH, and 7 provincial hospitals. To have one trained midwife at all 14 Area Health Centers by 2003. To reduce teenage pregnancy from 9% in 1999 to less than 2% by 2003. To increase contraceptive prevalence from 18.7% to 25% by 2003. To increase supervised deliveries from 80% to 90% by 2003. To increase first antenatal attendance in the first trimester from 25% by 2003. To increase ANC visits from 79% to 90-100% by 2003. To decrease the perinatal mortality rate from 40/1,000 to 30/1,000 by 2003. To decrease neonatal mortality from 20/1,000 to 15/1,000 by 2003. To have 95% of all health workers trained in contraceptive technology update and adolescent reproductive health by 2003. 7.2. Performance Indicators: Maternal Mortality Rate No. of midwives trained Teenage pregnancy rate Contraceptive prevalence Rates % Supervised deliveries First antenatal attendance ANC coverage rate Perinatal Mortality Rate Neonatal Mortality Rate % Health workers trained in contraceptive update 7.3. Outputs-Achievements & Constraints: 7.3.1. Outputs (or Deliverables):  The health indicators provided us guide to plan, monitor and evaluate our activities for improvement of the health status of our mothers and children (as advocated by the Convention of the Rights of the Children (CRC) and the Millennium Declaration Goals (MDG) by the UN.

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Report by the Ministry of Health (May 2004):

73 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Health Indicators are as listed in the table below:Indicators

ICDP Targets

Deliveries attended by trained personnel (%) Population Access to Reproductive Health (%) Contraceptive rate (%)

60

Infant Mortality Rate/ per 1,000 live births

50

Maternal Mortality Rate / Per 100,000 pop.

100

WHO Target

MOH/SIG Targets

Current Status

Comments

90

87

Improved Source [1] Satisfactory

60

80

55

Teenage Pregnancy (%) Female literacy (%)

50

25

8

<50

66 (1999)

<178

195 (2001)

<2%

10 (2001)

Source [1] Need strengthening and improvement. Source [2] Need strengthening and improvement. Source [3] Need strengthening and improvement. [2] Source [2]

77

Source [3]

Sources: [1] UNFPA (2004). [2] Reproductive Health Division/ MOH/SI (2004). [3] National Census SIG 1999. [4] Recent indicators are yet to be finalized. Improvement of the reporting system for reproductive health in Solomon Islands is in progress and hopefully update indicators can be ready by end of 2004.  By end of 2003:-Maternal Mortality rate stands at 295 100,000 live births. -Infant Mortality Rate at 66 per 1,000 live births.  A Condom Social Marketing Feasibility Study was done in Solomon Islands in 200321. The report concluded that there is a need for and reasonable feasibility of implementing condom social marketing interventions for HIV/AIDS and STI prevention. STI is been increasing since 1992. Syphilis and gonorrhea are the main Sexually Transmitted Infections. Total of 504,000 condoms have been ordered in 2003, but the usage is very low and limited because there was no policy to mandate distribution to young and adolescences.

21

UNFPA (2003). Report on Social Marketing Assessment for HIV/STI Prevention in the South Pacific: Population Services International (PSI).

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Report by the Ministry of Health (May 2004):

74 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

 An Adolescence Reproductive Health (ARH) Project was formed outside the MOH and funded by the UNFPA. The project focuses on educating out-or-school youth, in school youth, churches, and using the multi-media.  SIPPA distributed 101,664 condoms in 2002.  Other NGOs such as Solomon Islands Development Trust (SIDT), Voice belong Meri and Family Planning Australia is also running programs on advocacy and awareness on reproductive and adolescence health in the country.

Child Health Services & Expanded Program of Immunization (EPI): The Child health services is a integral component of the Reproductive Health Division. Most activities in promoting child health and protection of the child from being sick is implemented through the primary health care services.  All clinics operate a well-baby clinics, which includes vaccination of children under 5 years old.  Growth monitoring also took place at all clinics.  Measles catch up campaign started in 2003 and continued in early 2004. (At the time of wr i t i n gt h er e p o r tt wop r o v i n c e sh a v e n ’ ts u b mi t t e dt h e i rr e p o r t s .Th e ya r eMa l a i t aa n d Rennell Bellona. Expanded Program for Immunization (EPI): By End of 2003: National coverages:     

BCG coverage was at 79%. DPT3 coverage was 73%. OPV3 coverage was 70%. 1st Measles coverage was 69%. HepB3 coverage was 78%. Tetanus Toxoid 2 coverage was 56%.

In general the coverage of vaccination was below 80% line by end of 2003. The highest coverage was seen in BCG coverage. The trend (see graph below) shows decline from 2001-2002 (Partly due to incomplete data.)

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Report by the Ministry of Health (May 2004):

75 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Graph showing Trends for vaccine coverages 1999-2003

90 80 70 60 50 40 30 20 10 0 TT2&Preg Preg

HB 3

1999

Measles 1

2000

OPV3

2001

DPT3

2002

BCG

2003

Table 2:showing National Coverage of Infants (under one year) in %: 1999-2003 Years

BCG

DPT3

OPV3

1ST Measles

2003 2002 2001

79 76 85

73 71 78

70 68 80

69 67 74

2000 1999

84 64

81 62

83 60

78 59

2nd Measles Campign

HB Birth

HB3

76

78 68 78

TT2 & Preg. wOMEN 56 49 52

73 63

60 50

 The Provincial Immunization coverage has improved significantly after the EPI catch up campaign in 2003. Malaita and Renell Bellona yet to complete theirs.  Some provinces such as Isabel, CIP, Makira, and Honiara reached 99-100 coverage fro different immunization coverage rates. The two provinces concern is Malaita and Guadalcanal.

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Report by the Ministry of Health (May 2004):

76 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 -------------------------------------------------------------------------------------------------------------------------------------------------------------Table 1: showing Infant Immunization <1 yesr by Provinces 2003 (%) BCG DPT3 OPV3 1ST 2nd HB Birth HB3 Measles Measles Campign 79 92 92 73 95 75 99 93 89 85 87 96 99 107 82 82 76 79 100 89 83 99 81 73 74 85 96 91 92 79 64 79 98 82 103 67 70 88 69 95 56 70 76 76 60 66 86 62 78 60 48 59 48 0 60 53 63 61 60 60 100 64 57 0 0 0 0 88 0 0

Province Choiseul Makira Isabel Honiara Temotu Western Guadalcanal Malaita CIP RenBell

TT2 & Preg. wOMEN 55 65 71 82 70 60 62 40 72 0

Reported Cases of EPI Preventable Diseases: From the table below there was no record of any EPI preventable diseases. However, in 2001 60 cases of Pertusis were recorded in children. Detail information of the cases is not available. Year

AFP

Measles

2003 2002 2001 2000 1999

0 0 3 3 0

0 0 0 0 0

All 0 0 0 0 0

Tetanus NT 0 0 0 0 0

Petusis

Diptheria

0 0 60 0 0

0 0 0 0 0

TB TB M TB B na Na 0 0 4 1 0 0 0 0

EPI Significant accomplishment or innovation in 2003:           

Development of EPI curriculum in SI Nursing school -UNICEF Development of Cold chain policy-WHO National EPI and Cold Chain workshopEPI local adaptation with IMCI National measles and Catch-up campaign. Establishment of VDC-10 RCW50 EG-JICA Cold chain inventory IACC meeting-continue well Cold chain proposals sent to JICA. Secure Funding for vaccine supply 2004 No outbreak of EPI target diseases

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Report by the Ministry of Health (May 2004):

77 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Important Constraints & Challenges-2003:  Political Instability causing difficulties in implementing EPI program  Insuffcient funds from SI Government to support Cold chain to the provinces-(need to a lot funds)  Vaccine supply to clinics very low. (out for 2months except HB)  Transport and Communication-very difficult.  Vaccines procurement sustainabilty-2004 budget.  The priority identified needs/activities to be strengthen in EPI (2004-2008)        

Strengthening of Cold chain system/VDC Improve Vaccine supplies and procurements -(2004 budget) Strengthen AFP surveillance/RHD Surveillance Improve Safe injection practice Complete the cold / EPI policy and Mid term Plan RHD Surveillance system ( Pilot) Supervisory tours to provinces/training Increase vaccination coverage in provinces- 98% by 2008

Policy 8: Developing Partnerhsip in Health Developments: 8.1. Objective: To enhance and improve collaboration and coordination between the Government and developing partners with in the planned period. 8.2. Indicators: More collaboration links through MOU developed with local NGOs, and international developing partners. More donor assistance available for health. Greater participation of NGOs in providing health and related services secured. 8.3. Outputs-Achievements & Constraints: 8.3.1. Outputs (or Deliverables):  Partnership has been developed between the Ministry of Health and the donors and local NGOs.  Table below summarizes the different organizations with whom partnership has been developed (Details of the donor support is attached):

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Report by the Ministry of Health (May 2004):

78 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 -------------------------------------------------------------------------------------------------------------------------------------------------------------Partner Project type: Funding source for MOU Expected Output Organization Service type the activities under (External and the partnership Internal) External: Australian Company Health Institutional AusAID Formal Improved & MOH Strengthening management and Project (HISP)implementation of Phase 2 health services (increased effectivity and efficiency) AusAID & MOH & Health Sector Trust AusAID Formal Increase coverage of Provincial Health Account: direct health services; Services Budgetary support to inmprove health the Health Sector attainment/ achievements; improved health outcome. World Bank & MOH Solomon Islands World Bank MOU : Soft Loan Reduction of & Makira and Health Sector morbidity and Guadalcanal Development Project mortality of mothers, Provincial Health (SIHSDP): children, and malaria services Reproductive Health, incidence and Malaria, Capacity burden. Building. (Two provinces involved Makira and Guadalcanal) & Civil works UNFPA & MOH & HR DevelopmentUNFPA MOU Strengthening of Provincial Health Trainings Reproductive health Services (midwifery), services in Solomon activities/ services Islands: Reduce delivery maternal and infant mortality. UNICEF & MOH & Integrated UNICEF MOU Reduced infant Provincial Health Management of mortality. Services Childhood Illnesses (IMCI)-Pilot raining ROC & MOH & National Referral ROC MOU Reduced National Referral Hospital Phase 3 preventable deaths. Hospital development project Improved quality of care WHO WHO/Solomon WHO Technical incountry Increase Islands country support professional Budget 2004-5 competency Japanese Immunization JICA Technical incountry Increased Catchup/ Cold Chain support immunization restoration for rural coverage. Prevent communities in SI outbreaks. Secretariat to Pacific Pacific Public Health SPC Technical incountry Improved Community (SPC) Network (PACNET) support communication and public health surveillance. Reduce morbidity and

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Report by the Ministry of Health (May 2004):

79 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 -------------------------------------------------------------------------------------------------------------------------------------------------------------mortality due to emerging diseases and epidemics. Local partnership: Churches: Primary health care: Ad hoc basis: No formal MOU Improved access to SDA Catholic, Provincial hospitals Routine. exists. health services: SSEC, COM and Rural clinics Improve health outcome and population health through the Primary Health Care system. National Disaster Health Sector NDC Health a member of Reduce morbidity Council (NDC) Disaster the NDC and Mortality due to Management with disaster. NDC NGOs: Reproductive health Annual grants from Statutory body of the SIPPA care: Maternal care: MOH MOH FP: STI; counseling etc. Red Cross Society & Blood supply Annual grants from Statutory body of the Reduce mordidity MOH advocates. MOH MOH: and mortality due to MOU & Joint Policy blood borne on Blood Safety and diseases such as Supply HIV/AIDS, Hepatitis etc.

 Community Participation for Health was promoted in Isabel Province. Consequently a Healthy Village Model was developed from Isabel Province (with the support from AusAID Advisers). The challenge is for the expansion of such model to other provinces.

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Report by the Ministry of Health (May 2004):

80 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

3.0. Discussion on Impediments/ Difficulties / Issues: 3.1. Financial Resources: The direct budgetary support to the health sector from AusAID by way of the Health Sector Trust Fund/Account (HSTA) has enable the Government to pay for essential medicines and other pharmaceutical supplies for the country. The HSTA helped to maintained direct health employees work force by paying for the wages. There were key issues surrounding health financing in 2003. Firstly, how long the HSTA will continue to fund the health system of the country is being questioned, because funding form the SIG for health services in 2003 was not forthcoming. Secondly program budgeting was not implemented effectively to ensure that all programs are funded and evaluated. Health Information System: Data and information needed for effective surveillance, monitoring and evaluation of health status and performance continue to be a general weakness in most disease control programs and the management of the health sector. Medical Supplies and Equipment Skilled health worker cannot provide effective curative and preventive health services without the essential elements such as drugs and equipment. The irregular supply of drugs and deteriorating condition of equipment affects the services provided. Approximately one third of surveyed clinics reported a need for new or replacement equipment and 45% of those clinics surveyed indicated non-functioning sterilization equipment. Transportation Transportation is badly affected and inadequate. Transportation is essential for referral of cases, outreach services, medical supplies, and supervision and training. About 50% of health facilities reported that transports are not working. Inadequate Communication Radio communication systems in the health referral facilities supports the system in many important ways including clinical support, management, and administrative support, staff support and health promotion. About 68% of clinics surveyed were experiencing difficulties with radio communication. In 2003, 49 radios ere installed in the rural provincial clinics. Human Resource Management Management of human resources in health sector are often difficult as the Ministry does not have the authority to management them. Procedures are cumbersome and various levels of consultations make it difficult to implement effective decision.

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Report by the Ministry of Health (May 2004):

81 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Due to delay in payment of salary, a lot of health workers are not willing to continue to work and resort to other means of supporting their families. Slow Progress in the Public Sector Reform The long-term capacity of the Ministry of Health to manage the sector effectively will depend on the systemic upgrading of the skills and capacities of its staff and systems. The general lack of the progress of the public service reform agenda, creates a problem for the Ministry in its own efforts to obtain more autonomy to manage its own affairs. The Public Service Division, has not been proactive in supporting the changes required by the Ministry, especially in establishing the key positions with the Ministry. Given the autonomy, the Ministry of health would also be able to management its industrial relations effectively. ANNEXT TABLE 1: list of approved clinics by END OF 2003:

Province

Prov. Code Area Code Clinic Code

Facility

Category

Central Islands

05

01

03

Belaga NAP

NAP

Central Islands

05

02

03

Borohinaba RHC

RHC

Central Islands

05

02

02

Boromole NAP

NAP

Central Islands

05

01

05

Dende RHC

RHC

Central Islands

05

05

03

Ilua NAP

NAP

Central Islands Central Islands

05 05

03

03

Koagele NAP Koela NAP

NAP NAP

Central Islands

05

01

06

Koilovala NAP

NAP

Central Islands

05

04

01

Leitongo RHC

RHC

Central Islands

05

05

04

Louna NAP

NAP

Central Islands

05

03

02

Panueli RHC

RHC

Central Islands

05

05

02

Pepesala RHC

RHC

Central Islands

05

04

03

Ravu NAP

NAP

Central Islands

05

01

02

Salesapa RHC

RHC

Central Islands

05

01

01

Siota NAP

NAP

Central Islands

05

02

01

Taroniara RHC

RHC

Central Islands Central Islands

05 05

04 04

04 02

Tathi NAP Toga NAP

NAP NAP

Central Islands

05

03

01

Tulagi Mini Hospital

Central Islands

05

04

05

Vura NAP

NAP

Central Islands

05

01

04

Vuturua NAP

NAP

Central Islands Central Islands

05 05

05

01

Yandina AHC Marulaou NAP

AHC NAP

HOSP

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Report by the Ministry of Health (May 2004):

82 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Central Islands

05

Mboromomole NAP

NAP

Central Islands

05

Narogu

NAP

Central Islands

05

03

04

Sasage Marina NAP

NAP

Choisel

06

02

08

Boeboe NAP

NAP

Choisel

06

Choisel

06

Choisel

Choiseul Bay

NAP

Ghaghara RHC

RHC

06

Loimuni NAP

NAP

Choisel

06

Lukuvaru NAP

NAP

Choisel

06

02

07

Loloko RHC

RHC

Choisel

06

02

05

Luti NAP

NAP

Choisel

06

Moli

RHC

Choisel

06

Mbangara RHC

RHC

Choisel Choisel

06 06

Ngarione RHC Nukiki NAP

RHC NAP

Choisel

06

01

03

Nuatabu RHC

RHC

Choisel

06

03

07

Ogho NAP

NAP

Choisel

06

01

01

Pangoe AHC

AHC

Choisel

06

02

02

Papara RHC

RHC

Choisel

06

03

03

Polo RHC

RHC

Choisel

06

02

03

Posorae RHC

RHC

Choisel

06

03

06

Sagigae NAP

NAP

Choisel

06

02

06

Sepa NAP

NAP

Choisel

06

03

02

Sirovanga RHC

RHC

Choisel

06

Soranamola NAP

NAP

Choisel

06

01

02

Susuka RHC

RHC

Choisel

06

03

01

Taro AHC

AHC

Choisel

06

03

05

Voza RHC

RHC

Choisel

06

01

04

Vurango NAP

NAP

Choisel

06

02

04

Wagina RHC

RHC

Choisel

06

02

01

Sasamunga Mini Hospital

Guadalcanal

01

03

04

Aola AHC

AHC

Guadalcanal

01

02

07

Avuavu RHC (Weathercoast)

RHC

Guadalcanal

01

02

08

Balolava RHC(Weathercoast)

RHC

Guadalcanal

01

Belaha RHC

RHC

Guadalcanal

01

Biti NAP (Weathercoast)

NAP

Guadalcanal

01

03

03

Bolale NAP

NAP

Guadalcanal

01

03

05

Bubunuhu NAP

NAP

Guadalcanal

01

02

02

Fox Bay RHC (Weathercoast)

RHC

Guadalcanal

01

Grove AHC

AHC

Guadalcanal

01

Haipara NAP

NAP

Guadalcanal

01

Kolosulu NAP

NAP

01

03

05

06

HOSP

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Report by the Ministry of Health (May 2004):

83 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Guadalcanal

01

Koleasi RHC

RHC

Guadalcanal

01

02

Guadalcanal

01

01

05

Kuma RHC (Weathercoast)

RHC

05

Lambi AHC

Guadalcanal

AHC

01

Luguvasa NAP

NAP

Guadalcanal

01

Lunga RHC

RHC

Guadalcanal

01

Madakacho RHC (Weathercoast)

RHC

Guadalcanal

01

Marasa (Weathercoast)

NAP

Guadalcanal

01

Marapa NAP

NAP

Guadalcanal

01

Makina AHC

AHC

Guadalcanal

01

Mbabanakira RHC (Weathercoast)

RHC

Guadalcanal

01

Guadalcanal

01

Guadalcanal Guadalcanal

01 01

Guadalcanal

01

Guadalcanal

01

Guadalcanal

01

Guadalcanal

01

Guadalcanal

01

Guadalcanal

01

Guadalcanal

01

03

Guadalcanal

01

04

Guadalcanal

01

Guadalcanal

01

03

02

Vatulava NAP

NAP

Guadalcanal

01

01

02

Visale AHC

AHC

Guadalcanal

01

02

04

Viso RHC (Weathercoast)

RHC

Guadalcanal

01

Marumbo NAP (Weathercoast)

NAP

Guadalcanal

01

01

03

Kohimarama NAP

NAP

Guadalcanal

01

HCC

09

02

01

Kukum UHC

UHC

HCC

09

02

02

Mataniko UHC

UHC

HCC

09

03

03

Mbokona UHC

UHC

HCC

09

02

03

Mbokonavera UHC

UHC

HCC

09

01

01

Naha UHC

UHC

HCC

09

03

01

Rove AHC

AHC

HCC

09

01

02

Vura UHC

UHC

HCC

09

03

02

White River UHC

UHC

Isabel

07

04

02

Allardyce NAP

NAP

Isabel

07

04

03

Babahairo NAP

NAP

Isabel

07

04

05

Baolo RHC

RHC

02

02 03

06

03

Nagho NAP

NAP

New Tenabuti RHC

RHC

Numbu NAP Pitukoli RHC

NAP RHC

Ruavatu RHC

RHC

Saro NAP (Weathercoast)

NAP

Selwyn College NAP

NAP

Tamboko NAP

NAP

Tangarare RHC (Weathercoast)

RHC

Konga RHC

RHC

01

Totongo RHC

RHC

02

Turarana RHC

RHC

Vatilau RHC

RHC

07

03

08

01

04

02

01

NRH

HOSP

------------------------------------------------------------------------------------------------------------

Report by the Ministry of Health (May 2004):

84 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Isabel

07

01

04

Bara NAP

NAP

Isabel

07

04

06

Bolotei AHC

AHC

Isabel

07

01

01

Buala Hospital

Isabel

07

03

09

Dedeu NAP

NAP

Isabel

07

01

02

Goveo NAP

NAP

Isabel

07

02

05

Hageula NAP

NAP

Isabel

07

01

05

Hoffi NAP

NAP

Isabel

07

03

06

Kalenga RHC

RHC

Isabel

07

02

03

Kamaosi NAP

NAP

Isabel

07

04

01

Kia AHC

AHC

Isabel

07

03

04

Kilokaka NAP

NAP

Isabel

07

01

06

Kmaga NAP

NAP

Isabel

07

Koisisi

NAP

Isabel

07

Kolomola RHC

RHC

Isabel

07

Kolopakisa NAP

NAP

Isabel

07

Kolotubi NAP

NAP

Isabel

07

Konide AHC

AHC

Isabel

07

Lelegia NAP

NAP

Isabel

07

Midoru NAP

NAP

Isabel

07

Moluvoru RHC

RHC

Isabel

07

Nagolau NAP

NAP

Isabel

07

02

02

Poro RHC

RHC

Isabel

07

04

04

Ritamala NAP

Isabel

07

03

08

Samasodu RHC

RHC

Isabel

07

02

04

Sigana RHC

RHC

Isabel

07

04

07

Sisiga NAP

NAP

Isabel

07

04

08

Suavanao RHC

CLOSED

Isabel

07

03

03

Susubona RHC

RHC

Isabel

07

02

01

Tatamba AHC

AHC

Isabel

07

Isabel

07

03

05

Vulavu RHC

RHC

Isabel

07

03

10

Koge NAP

NAP

Isabel

07

01

03

Guhuhu NAP

NAP

Isabel

07

Muana NAP

NAP

Isabel

07

Gnulahage

VAP

Isabel

07

Kolosori

VAP

Isabel

07

Koregui

VAP

Isabel

07

Mablosi

VAP

Isabel

07

Talise

VAP

Isabel Makira

07 08

01

07

Nodana RHC (SDA) Aorigi NAP

RHC NAP

Makira

08

03

01

Aringana RHC

RHC

Makira

08

Aua RHC

RHC

Makira

08

05

02

Gupuna RHC

RHC

Makira

08

02

01

Haupala AHC

AHC

Makira

08

Heraniau'u NAP

NAP

Makira

08

Hunuta NAP

NAP

03

02

03

01

03

07

Tolegu Kastom Clinic

HOSP

CLOSED

NOT MOH

------------------------------------------------------------------------------------------------------------

Report by the Ministry of Health (May 2004):

85 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Makira Makira

08

Makira

08

Makira

08

Makira

01 01

04

NAP

Karie RHC

RHC

Kerepei

RHC

Kirakira Hospital

HOSP

08

Kaonasugu NAP

NAP

Makira

08

Maerongasia NAP

NAP

Makira

08

Makorukoru NAP

NAP

Makira

08

Manasugu RHC

RHC

Makira

08

Maniwiriwiri NAP

NAP

Marogu RHC

RHC

01

01

Hauta NAP

02

Makira Makira

08

Naharahau NAP

Makira

08

01

NAP

03

Narame RHC

RHC

Makira

08

03

04

Ngarigohu RHC

RHC

Makira

08

04

02

Parego RHC

RHC

Makira

Su'ulopo NAP

NAP

Taheramo RHC

RHC

04

Tetere RHC

RHC

02

Ubuna RHC

RHC

01

Waihaga RHC

RHC

Makira

08

Makira

08

04

Makira

08

03

Makira

08

04

Makira

08

Waimapuru NSS

NSS

Makira

08

Namuga AHC

AHC

Makira

08

Tawaraha AHC

AHC

Makira

08

Tawaiabu NAP

NAP

Makira

08

Borodao NAP

NAP

Makira

08

Tawairamo NAP

NAP

Makira

08

Wanahata (Narate) NAP

NAP

Makira

08

Pamua NSS

NSS

RenBel

10

01

03

Nuku RHC

RHC

RenBel

10

01

02

Tengano RHC

RHC

RenBel

10

01

01

Tingoa AHC

AHC

Temotu

04

04

01

Emua RHC

RHC

Temotu

04

01

01

Lata Hospital

Temotu Temotu

04 04

02 03

01 01

Dendu RHC Manuopo AHC

RHC AHC

Temotu

04

03

02

Nuoba RHC

RHC

Temotu

04

05

01

Tukutaunga RHC

RHC

Temotu

04

Luasalemba NAP

NAP

Temotu

04

Kala Bay NAP

NAP

Temotu

04

Kati NAP

NAP

Temotu Temotu

04 04

Otomongi NAP No'ole NAP

NAP NAP

Temotu

04

04

03

Ngauta NAP

NAP

Temotu

04

04

02

Nembao NAP

NAP

Temotu

04

Lagoon NAP

NAP

Western

02

Aleang NAP

NAP

03

01

03

02

HOSP

------------------------------------------------------------------------------------------------------------

Report by the Ministry of Health (May 2004):

86 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Western

02

04

04

Arara NAP

Western

02

03

09

Baniata NAP

NAP NAP

Western

02

04

05

Batuna RHC

RHC

Western

02

03

02

Buni RHC

RHC

Western

02

04

06

Cheara RHC

RHC

Western

02

06

03

Dovele RHC

RHC

Western

02

Emu Harbour AHC

AHC

Western

02

03

11

Enoghae RHC

RHC

Western

02

05

03

Falamae RHC

RHC

Western

02

05

07

Gaomai NAP

NAP

Western

02

05

02

Harapa RHC

RHC

Western

02

03

15

Hopongo NAP

NAP

Western

02

06

04

Iringgila RHC

RHC

Western Western

02 02

05 04

06 02

Kariki NAP Keru RHC

NAP RHC

Western

02

06

02

Kolokolo RHC

RHC

Western

02

01

02

Kukundu RHC

RHC

Western

02

02

03

Lale RHC

RHC

Western

02

03

10

Lokuru NAP

NAP

Western

02

06

09

Maravari NAP

NAP

Western Western

02 02

04 05

09 01

Merusu RHC Nila AHC

RHC AHC

Western

02

03

03

Noro RHC

RHC

Western

02

03

04

Paradise RHC

RHC

Western

02

02

02

Pienuna RHC

RHC

Western

02

04

08

Penjuku RHC

RHC

Western

02

01

04

Poitete RHC

RHC

Western

02

01

03

Ringi Cove RHC

RHC

Western Western

02 02

04

01

Seghe AHC Sobiro NAP

AHC NAP

Western

02

05

04

Toumoa RHC

RHC

Western

02

02

04

Tumbi RHC

RHC

Western

02

03

08

Ughele RHC

RHC

Western

02

04

03

Viru RHC

RHC

Western

02

06

01

Vonunu AHC

Western

02

03

01

Helena Goldie Hospital

Western

02

02

06

Kara NAP

NAP

Western

02

03

14

Nusa Roviana NAP

NAP

Western

02

03

06

Nusahope NAP

NAP

Western

02

01

05

Ghatere NAP

NAP

Western

02

06

06

Karaka NAP

NAP

Western

02

02

05

Mondo NAP

NAP

Western

02

06

05

Varese NAP

NAP

AHC HOSP

------------------------------------------------------------------------------------------------------------

Report by the Ministry of Health (May 2004):

87 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Western

02

04

07

Tingge NAP

NAP

Western

02

06

07

Paramata NAP

NAP

Western

02

01

06

Rarumana NAP

NAP

Western

02

06

08

Lambu Lambu NAP

NAP

Western

02

03

13

Dunde NAP

NAP

Western

02

04

11

Kavolavata NAP

NAP

Western

02

03

07

Biulu CHS NAP

NAP

Western

02

Vaza NAP

NAP

Western Western

02 02

04

10

Vanga NAP Vakambo NAP

NAP NAP

Western

02

01

01

Gizo Hospital

Malaita

02

Malaita

03

04

Malaita

03

Malaita

03

Malaita

HOSP

Afenakwai Clinic

NAP

01

Afio AHC

AHC

03

07

Ambeo NAP

NAP

Anomasu

NAP

03

03

06

Apuapu NAP

NAP

Malaita

03

01

16

Arao NAP

NAP

Malaita

03

02

02

Ata'a RHC

RHC

Malaita

03

01

01

Auki AHC

AHC

Malaita

03

02

03

Bita'ama RHC

RHC

Malaita

03

01

09

Buma NAP

NAP

Malaita

03

01

10

Busufoasae NAP

NAP

Malaita

03

01

17

Busurata NAP

NAP

Malaita

03

Dala South NAP

NAP

Malaita

03

01

02

Fauabu RHC

RHC

Malaita

03

02

08

Fo'ondo NAP

NAP

Malaita

03

Foubaita NAP

NAP

Malaita

03

Gwaiau NAP

NAP

Malaita

03

Gwano'oa NAP

NAP

Malaita

03

Gwaunabusu NAP

NAP

Malaita

03

Gwaunakwai NAP

NAP

Malaita

03

02

07

Gwaurata NAP

NAP

Malaita

03

02

04

Gwaunatolo RHC

RHC

Malaita

03

01

12

Hauhui RHC

RHC

Malaita

03

04

10

Haukasi NAP

Malaita

03

01

11

Kilu'ufi Hospital

Malaita

03

01

14

Kiu NAP

NAP

Malaita

03

02

05

Kwailabesi RHC

RHC

Malaita

03

Maerogasia NAP

NAP

Malaita

03

04

15

Malou NAP

NAP

Malaita

03

02

01

Malu'u AHC

AHC

Malaita

03

03

08

Mamulele NAP

NAP

Malaita

03

03

02

Manawai RHC

RHC

Malaita

03

01

03

Maoa NAP

NAP

01

06

NAP HOSP

------------------------------------------------------------------------------------------------------------

Report by the Ministry of Health (May 2004):

88 National Health Report 2003: Evaluation of the National Health Policies and Development Plans 1999-2003 --------------------------------------------------------------------------------------------------------------------------------------------------------------

Malaita

03

Maroupaina NAP

NAP

Malaita

03

03

12

Muki NAP

NAP

Malaita

03

03

03

Nafinua AHC

AHC

Malaita

03

03

09

Namolaelae NAP

NAP

Malaita

03

05

02

Ndai Island NAP

NAP

Malaita

03

Ohio NAP

NAP

Malaita

03

Okwala

NAP

Malaita

03

03

04

Olomburi RHC

RHC

Malaita

03

01

08

Oneone & Usufosae NAP

NAP

Malaita

03

Oneoneabu

NAP

Malaita

03

Ote NAP

NAP

Malaita

03

Ote NAP

NAP

Malaita

03

Pipisu NAP

NAP

Malaita

03

Roapuo NAP

NAP

Malaita

03

Rafufu NAP

NAP

Malaita

03

01

13

Rohinari RHC

RHC

Malaita

03

04

08

Rokera NAP

NAP

Malaita

03

04

04

Sa'a RHC

RHC

Malaita

03

03

10

Sango RHC

RHC

Malaita

03

01

04

Sinamauri RHC

RHC

Malaita

03

Sinarangu

NAP

Malaita

03

03

11

Langefasu NAP

NAP

Malaita

03

01

15

Su'u NAP

NAP

Malaita

03

04

05

Takataka RHC

RHC

Malaita

03

02

06

Takwa RHC

RHC

Malaita

03

01

05

Talakali RHC

RHC

Malaita

03

04

03

Taramata RHC

RHC

Malaita

03

04

06

Tarapaina RHC

RHC

Malaita

03

04

14

Tawanaora NAP

NAP

Malaita

03

04

07

Tawaro RHC

RHC

Malaita

03

04

12

Uhu NAP

NAP

Malaita

03

03

01

Atoifi Hospital

Malaita

03

Rararo NAP

NAP

Malaita

03

Ro'one VHA

NAP

Malaita

03

04

13

Honoa NAP

NAP

Malaita

03

05

01

Luaniu RHC

RHC

Malaita

03

05

03

Pelau NAP

NAP

Malaita

03

05

04

Sikaina RHC

RHC

Malaita

03

Fulisango NAP

NAP

Malaita

03

Adaua PSS

NAP

Malaita

03

Suafa

NAP

04

02

HOSP

The End Oooo0000oooo

------------------------------------------------------------------------------------------------------------