National Health Report 2005
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View National Health Report 2005 as PDF for free.
More details
- Words: 72,177
- Pages: 250
MINISTRY OF HEALTH Solomon Islands
NATIONAL HEALTH REPORT 2005
June 2006
Ministry of Health: National Health Report 2005 Page 2 of 250 --------------------------------------------------------------------------------------------------------------------------------
CHAPTER 1 1.1 1.2 1.3 1.4
BACKGROUND:................................................................................................................................................... 7 AIM .................................................................................................................................................................... 7 OBJECTIVES ....................................................................................................................................................... 7 REPORT PROCESS AND STRUCTURE .................................................................................................................... 7
CHAPTER 2 2.1 2.2 2.3 2.4
INTRODUCTION.............................................................................................................................. 7
SOLOMON ISLANDS DEMOGRAPHIC AND HEALTH STATUS INDICATORS ................ 8
DEMOGRAPHIC, GENDER AND POVERTY:........................................................................................................... 8 FERTILITY AND POPULATION GROWTH:.............................................................................................................. 8 LIFE EXPECTANCY :............................................................................................................................................ 8 AGE AND SEX STRUCTURE .................................................................................................................................. 9
CHAPTER 3
HEALTH SYSTEM AND NATIONAL RESPONSE: .................................................................. 11
3.1 SOLOMON ISLAND’S GOVERNMENT’S MAJOR ROLE IN ENSURING HEALTH FOR ALL ........................................ 11 3.2 ORGANIZATIONAL CHANGE IN THE STRUCTURE IN 2005: ................................................................................. 11 3.3 NATIONAL GOALS AND STRATEGIES FOR 2005: MINISTRY OF HEALTH OPERATIONAL PLANS 2005: .............. 14 3.3.1 Operational Planning:................................................................................................................................ 14 3.4 KEY GOVERNMENT’S NATIONAL HEALTH POLICIES: PLANS AND PRIORITIES: ................................................ 16 3.4.1 Solomon Islands Government Leadership .................................................................................................. 16 3.4.2 MOH Vision and Mission Statement........................................................................................................... 16 3.5 3.5. MINISTRY OF HEALTH’S COOPERATE PLAN 2006-8: ................................................................................. 16 3.6 3.6. MINISTRY OF HEALTH NATIONAL GOALS AND STRATEGIC PLANS:: ......................................................... 16 3.6.1 Revised National Goals and Strategies (in 2005, for 2006); ...................................................................... 16 3.7 MEETING UP WITH THE MILLENNIUM ............................................................................................................... 16 3.7.1 Development Goals: ................................................................................................................................... 16 3.7.1.1.1..............................................................................................................................................................................16
3.8 HEALTH INSTITUTIONAL STRENGTHENING PROJECT ........................................................................................ 16 3.8.1 Key Outcomes ............................................................................................................................................. 16 3.8.2 Constraints.................................................................................................................................................. 16 3.8.3 Future directions......................................................................................................................................... 16 CHAPTER 4 (DEMAND):
HEALTH SYSTEMS: HEALTH SERVICE DELIVERY AND EPISODES OF SERVICE 16
4.1 DEMAND ON THE PRIMARY HEALTH CARE: ..................................................................................................... 16 4.1.1 Access: ........................................................................................................................................................ 16 4.2 DEMAND ON HEALTH CARE INSTITUTIONS AND SERVICES: ............................................................................. 16 4.2.1 National Referral Hospital ......................................................................................................................... 16 4.2.2 Nursing in Solomon Islands:....................................................................................................................... 16 4.2.3 SI Nursing Council: .................................................................................................................................... 16 4.2.4 National Medical Imaging Division............................................................................................................ 16 4.2.5 National Pathology Services....................................................................................................................... 16 4.2.6 Dental (Oral) Services 2005 ....................................................................................................................... 16 4.2.7 Rehabilitation Division National Referral Hospital ................................................................................... 16 4.2.8 Distance Education Program: Ongoing Education for Nurses: ................................................................. 16 CHAPTER 5
HEALTH BURDEN......................................................................................................................... 16
5.1 OVERVIEW: ...................................................................................................................................................... 16 5.2 THERE ARE SEVERAL MAJOR HEALTH ISSUES AFFECTING SOLOMON ISLANDS.................................................. 16 5.3 COMMUNICABLE DISEASES:............................................................................................................................. 16 5.3.1 Acute Respiratory Infection: ....................................................................................................................... 16 5.3.2 Clinical Malaria ......................................................................................................................................... 16 5.3.3 Yaws and Skin Disease ............................................................................................................................... 16 5.3.4 Ear Infection ............................................................................................................................................... 16 5.3.5 Red Eye:...................................................................................................................................................... 16 5.3.6 Diarrhoea ................................................................................................................................................... 16 5.4 TUBERCULOSIS AND LEPROSY CONTROL PROGRAM ........................................................................................ 16 5.4.1 Tuberculosis Control Program:.................................................................................................................. 16 5.4.2 Objectives of the National TB Program (NTP): ......................................................................................... 16 5.4.3 General Objective:...................................................................................................................................... 16
Ministry of Health: National Health Report 2005 Page 3 of 250 -------------------------------------------------------------------------------------------------------------------------------5.4.4 Specific Objectives...................................................................................................................................... 16 5.4.5 Activities Conducted in 2005 ...................................................................................................................... 16 5.4.6 Health Education / Community Awareness ................................................................................................ 16 5.4.7 World TB Day Commemoration – 2005 ..................................................................................................... 16 5.4.8 Monitoring and Supervision: ...................................................................................................................... 16 5.4.9 Annual TB/ Leprosy Review........................................................................................................................ 16 5.4.10 TB Situation by 2005 .............................................................................................................................. 16 5.4.11 New Case Detection Rate:...................................................................................................................... 16 5.4.12 Case Notification by Provinces .............................................................................................................. 16 5.4.13 Age and Sex Distribution of New Sputum Smear Positive Cases ........................................................... 16 5.4.14 TB Infection by Site ................................................................................................................................ 16 5.4.15 Case Holding and Treatment Outcome .................................................................................................. 16 5.4.16 Tuberculosis Death................................................................................................................................. 16 5.4.17 Leprosy Control Program ...................................................................................................................... 16 5.4.18 New Leprosy Case Notification .............................................................................................................. 16 5.4.19 National Leprosy Prevalence ................................................................................................................. 16 5.4.20 Capacity Building in Leprosy ................................................................................................................. 16 5.4.21 Constraints and Weakness...................................................................................................................... 16 5.4.22 Recommendations: ................................................................................................................................. 16 5.4.23 Acknowledgement ................................................................................................................................... 16 5.4.24 Compiled By:.......................................................................................................................................... 16 5.4.25 Core Indicators for TB Program in 2005:.............................................................................................. 16 5.5 ENVIRONMENTAL HEALTH............................................................................................................................... 16 5.5.1 Overview:.................................................................................................................................................... 16 5.5.2 Priority Strategy/Action .............................................................................................................................. 16 5.5.3 Immediate ................................................................................................................................................... 16 5.5.4 Long Term Objectives ................................................................................................................................. 16 5.5.5 Strategies for 2005...................................................................................................................................... 16 5.5.6 Solid Waste ................................................................................................................................................. 16 5.5.7 Net Working with NGOs ............................................................................................................................. 16 5.5.8 Integrated Research on Approaches ........................................................................................................... 16 5.5.9 Food Safety and Quality Control- ICU....................................................................................................... 16 5.5.10 Health Quarantine Services.................................................................................................................... 16 5.5.11 EHD Training Report 2005 .................................................................................................................... 16 5.6 NON- COMMUNICABLE DISEASES .................................................................................................................... 16 5.7 COMMUNITY-BASED SERVICES:....................................................................................................................... 16 5.8 SOCIAL WELFARE DIVISION:............................................................................................................................ 16 5.8.1.1 5.8.1.2 5.8.1.3 5.8.1.4 5.8.1.5 5.8.1.6 5.8.1.7 5.8.1.8 5.8.1.9 5.8.1.10 5.8.1.11 5.8.1.12
Brief Background/Introduction:...........................................................................................................................16 Social Welfare Data Summary (Brief):................................................................................................................16 Organization & Staff: Social Welfare Office:......................................................................................................16 Trainings Undertaken During the Year:...............................................................................................................16 Organisation Structure: ........................................................................................................................................16 Activities Taken During the Year: .......................................................................................................................16 Activities and Achievements: ..............................................................................................................................16 Annual Health Outcomes (relates to Goals/Outputs/Indicators: ..........................................................................16 HR. Issues:...........................................................................................................................................................16 Infrastructure/Maintenance/Equipment Issues:....................................................................................................16 Issues for Consideration in Future Planning: .......................................................................................................16 Any Other Comments: .........................................................................................................................................16
5.9 HEALTH PROMOTION: ...................................................................................................................................... 16 5.9.1 Activities and Accomplishments.................................................................................................................. 16 5.9.1.1 5.9.1.2 5.9.1.3 5.9.1.4 5.9.1.5
National Level .....................................................................................................................................................16 Provincial Level...................................................................................................................................................16 Financial Information ..........................................................................................................................................16 Issues for Consideration In Future Planning........................................................................................................16 Constraints and Possible Strategies/Actions ........................................................................................................16
CHAPTER 6
SYSTEMS PERFORMANCE- MONITORING AND EVALUATION: .................................... 16
6.1 MINISTRY OF HEALTH: PERFORMANCE EVALUATION ...................................................................................... 16 6.1.1 The Scan of the Public Administration Functions....................................................................................... 16 6.1.1.1.1
Fig 25 and Table 6 shows the ratings for the MOH: 1 –lowest, and 5-highest................................................16
6.2 PRIMARY HEALTH CARE CLINICS UTILISATION ................................................................................................. 16 6.2.1 Solomon Islands Primary Health Care Clinics Utilisation Review ............................................................ 16 6.2.1.1
Major discussion points: ......................................................................................................................................16
Ministry of Health: National Health Report 2005 Page 4 of 250 -------------------------------------------------------------------------------------------------------------------------------6.2.1.2
Recommendations Clinic Utilisation Review ......................................................................................................16
6.3 ROLE DELINEATION FOR PHC CLINICS AND HOSPITALS: .................................................................................. 16 6.3.1 Introduction ................................................................................................................................................ 16 6.3.2 What are packages of care?........................................................................................................................ 16 6.3.3 How do packages of care articulate with role delineation? ....................................................................... 16 6.3.4 Continuum of Care...................................................................................................................................... 16 6.4 PHC QUALITY CHECK : ................................................................................................................................... 16 6.4.1 MOH Infrastructure -Issues:...................................................................................................................... 16 6.4.2 National Infrastructure Management: ........................................................................................................ 16 6.4.3 Provincial Infrastructure Management: ..................................................................................................... 16 6.4.4 Local Infrastructure Management .............................................................................................................. 16 6.4.5 Health Infrastructure Reviews .................................................................................................................... 16 6.4.6 Provincial Hospitals & housing.................................................................................................................. 16 6.4.7 AHC Rehabilitation Plans........................................................................................................................... 16 6.4.8 RHC Clinic Review:.................................................................................................................................... 16 6.4.9 Unfit or inappropriate birthing facilities .................................................................................................... 16 6.4.9.1
Need for upgrade of equipment & furniture: .......................................................................................................16
6.5 PROGRAM PERFORMANCE:............................................................................................................................... 16 6.5.1 Program achievements of Outputs in 2006:................................................................................................ 16 6.5.1.1 6.5.1.2 6.5.1.3 6.5.1.4 6.5.1.5 6.5.1.6 6.5.1.7
Environmental Health Division- : ........................................................................................................................16 HIV/STI Prevention- Disease Prevention and Control Unit ................................................................................16 NCD Prevention: Disease Prevention and Control Unit ......................................................................................16 Community Based Rehabilitation ........................................................................................................................16 Distance Education Program: ..............................................................................................................................16 Social Welfare .....................................................................................................................................................16 TB and Leprosy Prevention and Control. ............................................................................................................16
CHAPTER 7
PROVINCIAL HEALTH SERVICES ........................................................................................... 16
7.1 CHOISEUL PROVINCE: ...................................................................................................................................... 16 7.2 HEALTH BURDEN IN CHOISEUL 1996-2005...................................................................................................... 16 7.2.1 Introduction ................................................................................................................................................ 16 7.2.2 Major Health Issues.................................................................................................................................... 16 7.3 WESTERN PROVINCE ........................................................................................................................................ 16 7.3.1 Health Burden in Western........................................................................................................................... 16 7.4 ISABEL PROVINCES .......................................................................................................................................... 16 7.5 CENTRAL ISLANDS PROVINCE .......................................................................................................................... 16 7.6 GUADALCANAL ................................................................................................................................................ 16 7.7 MALAITA ......................................................................................................................................................... 16 Fig 35 Population of Malaita by Gender 7 yr trend ..................................................................................................................16
7.8................................................................................................................................................................................. 16 7.9 MAKIRA:.......................................................................................................................................................... 16 7.10 TEMOTU . ......................................................................................................................................................... 16 7.11............................................................................................................................................................................... 16 7.12 RENNELL BELLONA ......................................................................................................................................... 16 7.13 HONIARA ......................................................................................................................................................... 16 CHAPTER 8
RESOURCE UTILISATION .......................................................................................................... 16
8.1 FUNDING FOR HEALTH IN 2005:....................................................................................................................... 16 8.1.1 Issues: ......................................................................................................................................................... 16 8.2 HUMAN RESOURCE FOR HEALTH IN 2005 ........................................................................................................ 16 8.3 ISSUES:............................................................................................................................................................. 16 CHAPTER 9 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10
HEALTH LEGISLATION.............................................................................................................. 16
HEALTH CARE LEGISLATION REVIEW:............................................................................................................. 16 HEALTH SERVICES ACT 1979........................................................................................................................... 16 THE HEALTH SERVICES (HOSPITALS) REGULATIONS 1980 .............................................................................. 16 ENVIRONMENTAL HEALTH ACT 1980 .............................................................................................................. 16 MENTAL HEALTH ACT 1970: ........................................................................................................................... 16 HEALTH WORKERS ACT 1982:......................................................................................................................... 16 MEDICAL AND DENTAL PRACTITIONERS ACT 1988 ......................................................................................... 16 NURSING COUNCIL ACT 1987 .......................................................................................................................... 16 PHARMACY AND POISONS ACT 1941................................................................................................................ 16 PHARMACY PRACTITIONERS ACT 1997............................................................................................................ 16
Ministry of Health: National Health Report 2005 Page 5 of 250 -------------------------------------------------------------------------------------------------------------------------------9.11 OVERVIEW:: KEY HEALTH PROBLEMS .............................................................................................................. 16 9.12 ISSUES RAISING AND FACT (EVIDENCE) FINDING: ............................................................................................ 16 9.12.1 10.2.2. Findings: .................................................................................................................................... 16 9.12.2 Pattern of resorts: .................................................................................................................................. 16 9.12.3 Barriers to seeking health care .............................................................................................................. 16 9.12.4 Usual attitude towards health: ............................................................................................................... 16 9.12.5 Factors affecting provider choice........................................................................................................... 16 9.12.6 Cultural barriers to specific disease –Malaria....................................................................................... 16 9.12.7 Cultural barriers to – i. Reproductive health ......................................................................................... 16 9.12.8 Problems with service delivery and human resource issues: ................................................................. 16 9.13 THE WAY FORWARD:....................................................................................................................................... 16 CHAPTER 10 10.1 10.2
KEY ACTIVITIES FOR 2006 ........................................................................................................ 16
OVERVIEW ....................................................................................................................................................... 16 SOME OF THE KEY ACTIVITIES FOR 2006 ......................................................................................................... 16
Ministry of Health: National Health Report 2005 Page 6 of 250 -------------------------------------------------------------------------------------------------------------------------------AHC ARI CHP CIP EHD GP HCC HISP HISP
Area Health Clinics Acute Respiratory Infection Choiseul Province Central Islands Province
Environmental Health Division Guadalcanal Province Honiara City Council Health Institutional Strengthening Project Health Information System Human Immunodeficiency Virus and Sexually Transmitted HIV/STI Infections HR Human Resource ICPD International Convention Population Development ICU infection Control Unit MDG Millennium Development Goals MOH Ministry of Health MP Malaita Province MUP Makira Ulawa Province NAP Nurse Aide Post NCD Non-Communicable Diseases NGOs Non-Governmental Organizations NHR National Health Review NRH National Referral Hospital OP Operational Plan PHC Primary Health Care PHD Provincial Health Directors RBP Rennell Bellona Province RHC Rural Health Clinic RWSS Rural Water Supply and Sanitation TB Tuberculosis TP Temotu Province WHO World Health Organization WP Western Province YP Ysabel Province
Ministry of Health: National Health Report 2005 Page 7 of 250 --------------------------------------------------------------------------------------------------------------------------------
Chapter 1 1.1
Introduction
Background:
The purpose of this report is to provide information and feedback on the local activities undertook by the divisions and disease control programs both at the national and provincial levels in order to achieve a highest quality of care and to ensure that the health and well being of the people in the country is guaranteed and attained. The “National Health Report 2005 (NHR)”, details trends and changes in diseases of public health importance in Solomon Islands and describes some aspects of health service delivery, against national and international health indicators. By doing so the report provides information for development of the revised National Goals and Strategies in 2005 and hints on MOH National Health Strategic Plan 2006-2010 and sets baselines against which future change can be measured. The report attempts as close as possible reporting on available information as it emphasizes on ‘evidencebased’ policy and decision making as pivot for future directions on health. This report is primarily build on the, “Solomon Islands Health Status Assessment 20051
1.2
Aim
To report the health of Solomon Islands people in the period 1993-2005 against Solomon Islands MOH and appropriate international indicators, and systems performance in 2005.
1.3
Objectives
Identify and utilize available MOH division health data sets for the health status report Identify and utilize available data and information from researches and studies on health systems and human resource performances. Identify MOH and international health indicators against which to report data (as permitted by available data) To present the national and provincial health data for the decade 1995-2005 so that trends in disease incidence can be reported To identify and utilizes sources of issues affecting the health status and system in 2005 and the past years. To present some of the broad strategies developed in addressing the issues and flag the way forward.
1.4
Report process and structure
The National Health Report 2005 takes a slightly different turn in featuring; Brief overview of provincial health burden and the response by the provincial health services Chapter 7. Review of existing health legislation in Chapter 9 The report begun with reviewing the demographic and health status indicator in 2005 in Chapter 2. In Chapter 3 the report highlighted two key changes in the organizational structure of the Ministry of Health. Also in the same Chapter, Solomon Islands standing MDGs2. The report covers the demand on health care system of the country in Chapter 4. In Chapter 5 the update on the health burden of the country is covered. Further review of the trend of the common illnesses was presented in detail in Chapter 7. Chapter 8 briefly covers the resources utilized for health services delivery in 2005. Chapter 10 summarizes the broad issues in a presentable way, and the like strategies developed to solve or alleviate the health problems and issues identified. Chapter 11 briefly concerns with the key activities for the first half of 2006.
1 2
Health Institutional Strengthening Project / MOH (2005): “Solomon Islands Health Status Assessment 20051 Millennium Development Goals
Ministry of Health: National Health Report 2005 Page 8 of 250 --------------------------------------------------------------------------------------------------------------------------------
Chapter 2 2.1
Solomon Islands Demographic and Health Status Indicators
Demographic, Gender and Poverty:
Solomon Islands population is fast growing and remained very young. It is evident that the young population health demand on the system is ever growing in the past decades and at present.
“A key indicator of concern is the high maternal deaths at around 236 in 2005”
Table 1. Core population and health data (2005) Population
[Total]
471,266 [1]
[0-14 years]
225,615 (47..9%) [1]
[65+ years]
3.12% [1]
Crude birth rate (per 1000 pop) Crude death rate (per 1000 pop)
23.2 [1] 6.7 [2]
Infant mortality rate (per 1000 live births)
16.3 [1]
Maternal mortality rate (per 100 000 live births)
236 [1]
2.2
Life expectancy at birth (years)
Total fertility rate % of population served with safe water % of population with adequate sanitary facilities
Fertility and population growth:
According to the various available data on population growth Total fertility rate in 1987-1999 was 4.8 (decreased from 6.1 in 1984-1986). TFR has been estimated to be reduced to 4.053 in 2003 and now to 3.794. Crude birth rate is 36 per 1,000 Crude death rate 9 per 1,000 (9.6/1000 males, 8.4/1000 females) Total population growth 2.7 percent in 1999 Average population growth 2.8 percent 1986-1999
2.3
3
Life expectancy :
Figure for the Annual Health Report 2003
[Both]
63.4
[Male]
62.6
[Female]
64.3 3.79
[Total]*
71
[Urban]*
94
[Rural]* [Total]*
65 34
[Urban*]
98
[Rural]*
18
Ministry of Health: National Health Report 2005 Page 9 of 250 -------------------------------------------------------------------------------------------------------------------------------Life expectancy at birth 1999 males 60.6 years Life expectancy at birth 1999 females 61.6 years
2.4
Age and sex structure
Sex ratio 107 males/100 females at birth Median age in 1999, 18.7 years (18.6 males, 18.9 females) Population aged less than 15 years, 41.5% of the total population and 2) The population less than 15 has declined from 47.3% in 1986 reflecting decreasing fertility Figure 1 - the proportion of population by age group C h a r t S h o w in g p r o p o r tio n b y a g e -g r o u p 600000 500000
65+
Pop
400000
5 0 -6 4
300000
1 5 -4 9
200000
0 -1 4
100000 0 2001
2002
2003
2004
2005
Y e ars
Issues/ constraints/ challenges:
Evidence
Population projections5
This is best demonstrated through vaccination rates of infants. In some provinces vaccination coverage rates exceed 100% across several vaccination types indicating that the estimated cohort for the particular province is too low. Nationally the number of infants vaccinated falls in a range that never exceeds 12,000, less than the 13,000 + estimated < 1 year old population. This may indicate that the under 1 cohort is overestimated or that a number of children are never vaccinated. The 1999 – 2004 population projections, derived from census data, were estimated according to the national medium high projection variant (N2). Based on past and current (at the time of writing in 1999) population trends, this was considered by census authors the most likely variant to plausibly indicate future population growth, gave the closest population forecast and so was recommended for planning use. Methods for estimating population projections and their limitations are discussed in the census analysis document. While the census authors do not give similar recommendations for provincial population figures (these may not be as accurate, given economic and political change), these were used as denominators in this report as they are the best estimate available. As a result of possible inaccuracies of these provincial projections, rates of disease may be over or underestimated. Options & Strategies: Despite the difficulties observed, a single standard set of population projections based on the most recent evidence available (1999 census), need to be adopted by MOH and each division to ensure that there is consistency of denominators when calculating rates of disease.
5HISP/MOH
(2005) Issues of population projection flagged in the , “Solomon Islands Health Status Assessment 2005
Ministry of Health: National Health Report 2005 Page 10 of 250 -------------------------------------------------------------------------------------------------------------------------------Figure 2 - Population by 5 year age group and sex, Solomon Islands, 1999
80-84 70-74 60-64 50-54 40-44 30-34 20-24 10-14 0-4 -10
-8
-6
-4
-2 M%
0
2 F%
4
6
8
10
Ministry of Health: National Health Report 2005 Page 11 of 250 --------------------------------------------------------------------------------------------------------------------------------
Chapter 3 3.1
Health System and National Response:
Solomon Island’s Government’s Major role in ensuring health for all
“Existing Health The Solomon Islands Government is a major health provider, funder Legislation needs and regulator of health services for the people in the country. The updated” governing legislation for health services delivery is enacted under the Health Services Act 1988, which is outdated and need significant changes. In the past few years Government’s role as a key funder was denied by the economic crisis due to the past ethnic tension. Fortunately the economic recovery has enabled the return of health services as it is evident in the reports from the provinces. Nonetheless, whilst we have improved in increasing Solomon Islands Government’s share in the health expenditure in 2005 and also in 2006, all the cost of the medicines and other essential “HSTA to pharmaceutical supplies are currently paid by the AusAID funded Health transfer some Sector Trust Fund. SIG is still faced with USD120,000 debt to UNICEF for costs to SIG in vaccines used since early 1990s. This is are some outstanding financial issues, which has cost our incredibility to external supporting organizations. The Ministry of Health Executive soon be making a decision on how to transfer the costs into the SIG funds as the HSTA will be reduced. The total cost of all medicines the Ministry orders and purchase for the country is around SDB16-20 Million.
3.2
Organizational change in the structure in 2005:
In 2005 there are two organization changes to the structure of the Ministry of Health. (1) is the realignment and re-emphasis on Health Improvement which is the public health programs in the national provincial and community levels, and the national and provincial curative services under the Health Care paradigm, and extra emphasis on the logistic and administration and management support to the health care (HC) and the health improvement programs at the national strategic and provincial operational and implementation levels. The changes have been discussed in all major health meetings and conferences in 2005. (2) The second change is really to the signify and to institutionalized effectively the public health functions of the Governments’ Ministry of Health in order to respond effectively and efficiently to common and emerging diseases that causes illnesses and death to the people of the Solomon Islands. In 2004 and then in 2005 national health conference in December 2005 the Public Health Vision6 declaration was endorsed for adoption and further strengthening and development.
6
Ministry of Health (2005): USHI presentation on the Public Health Vision
Ministry of Health: National Health Report 2005 Figure 3 - Organization Chart: Ministry of Health with position holders in 2005
Minister of Health Permanent Secretary Dr. Judson Leafasia Under Secretary Health Improvement Dr.G.Malefoasi
Under Secretary Health Care (by Dr.G.Malefoasi)
National Prevention & Control Programs: Environmental Health (Mr. Robinson Fugui) Health Promotion (Mr. Alby Lovi) Vector Born Disease Control (Mr. Bernard Bakotee) HIV/STI (Dr J. Paulsen) TB & Leprosy (Mr. N. Itogo) Non Communicable Diseases (Ms. N.Laesango) Reproductive/Child Health (Dr.J.Pikacha) SIMTRI (Public Health Training & Research) (Mr. M.Tuni) Epidemiology & Disease Surveillance (Vacant) Provincial Health Services: Provincial Primary Health Care (vacant) Honiara City Council (Dr. Scott Siota Community Based Services: Social Welfare (P.Fia) Community Based Rehabilitation (Ms.D.Yates) Mental Health (Mr. W.Same) Coordination: Partner development Coordination (churches,
Professional Boards: Nursing & Medical services Specialist Care Services: National Referral Hospital (Mr. R.Suinao) Provincial Hospitals (Prov. Directors) National Psychiatric Unit (Dr. Judie) Paramedical Services: Diagnostic Services (X-Ray, Laboratory, Tele-pathology) Dental Services (Dr. C. Alependava) Pharmacy (Mr.R.Skinner) Physiotherapy (Mr.C.Gauba) Monitoring & Evaluation: Health Information Systems (Ms. Bakaai) Coordination: Aid-Donor Coordination Cross-sectoral Development Planning:; Policy Development; Health Legislation
Under Secretary Administration (vacant) National Policy & Planning (Mr. A.Namokari) Coordination & Integration with External Stakeholders Health Asset Management & Planning National Medical stores Information Technology Human Resources Management Human Resources Development Finance: Financial Management Resource Allocation Formula Coordination: Aid-Donor Coordination Cross-sectoral Development Planning: Policy Development; Health Legislation
Ministry of Health: National Health Report 2005 Page 13 of 250 --------------------------------------------------------------------------------------------------------------------Figure 4 Public Health Vision for Strengthening and Improvement
Undersecretary Health Improvement Secretary-admin + management All Notifiable Diseases – Disease Prevention and Control
Reproductive Health Psycho-Social Welfare
Communicable Diseases (CD)
NCD (Non-communicable Diseases)
Env health
Health Promotion
Provincial CD programs
National Capacity Development ARI/ Influenza
Vector Borne Disease
HIV/ STI Control Prevention
HIV/STI
IMCI
TB + Leprosy Planning +Coordination ME)
Diarrhoea Disease
Staffing
Staffing
Nutrition
Service delivery PHC-Clinics
Service delivery PHC-Clinics
Epidemic-Disaster Alert & Response
Community Partnership
Community Partnership
Information + Surveillance Public Health Laboratory NGO/ Civil Society partnership
CBR
Mental Health
Ministry of Health: National Health Report 2005 Page 14 of 250 ---------------------------------------------------------------------------------------------------------------------
3.3 3.3.1
National Goals and Strategies for 2005: Ministry of Health Operational Plans 2005: Operational Planning:
In 2005 further development and improvement were made in the operational plans of the divisions and specific programs: The operational plan framework7 include the following as summarized in the diagram below:
Division/Department: National Goal: Outcome Indicator: Strategy: Objective: Activity Input Input Resource Funding When & Person Output Staff Resources Costs Source Location Responsible Indicator
Date Achieved
Table 2 Operational Planning Guideline and Templates Source: HISP:
Evidence Issues raised on operational planning of health services: Supporting Evidence: Level of implementation has been very low8 Program Implementation by Divisions by end of Sep 2005
90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
90% 80% 69%
64%
1ST 2ND
44% 36%
33% 24%
3RD
20% 6%
a gr ro lP tro on C se ea is D I ne SH or U rB re th o lfa al ct Ve We He al tive ci n uc tio th So d o al ro m He ep Pro R l lth nta ea me tio H n en v ro D re vi C P tio En -N TI ta U S ili / y ab PC HIV ros D eh U Lep R ed PC B/ D /T Bas U PC nity D u m om C
In
2005 the overall implementation of the Ministry of Health national programs was just below fifty percent (i.e. 36%) by end of the third quarter. Provincial health services and national programs are to meet regularly as teams to monitor Op plans; activities are reprioritized Further assistance required with translation of goals, strategies, objectives – some confusion & further knowledge on outputs & outcomes
7 8
Ministry of Health/ HISP: USHI/ MOH (2005) ME implementation rates: Presentation by USHI at the National Health Conference 2005 November.
Ministry of Health: National Health Report 2005 Page 15 of 250 --------------------------------------------------------------------------------------------------------------------Need for Op plan activities to be linked to budget [this is the most significant feedback] further training in budget management required Within the operational plan need for more information on quality improvement and service/program integration Need for further consultation with health teams, communities, etc – consultation while touring, with village health committees & village meetings Feedback on Op plans essential and request one on one feedback For 2007 – no significant changes, focus on activities with budget with a simplification of the operational plan template as well as HR & budget templates; developing the op plans as a team. Many programs and divisions have implemented genuine and (many other authorized activities). Options & Strategies For 2006: The Operational Planning Guidelines was strengthened and linked to the Budgeting process for 20069. The National Goals and Strategies were revised and strengthened along First Steps Get basic
Describe Core Core Business Budget
Divisional Establishm t
Describe Planned Initiatives
+
+
Marginal Costs of Planned
SIG Recurrent B d t
=
=
Operational Pl
Total Divisional Budget
Developme nt Budget
Output & Outcome I di t
Planning Flow Chart10 (Quantify what we plan to do): The National Goals and Strategies were revised and strengthened along with the budget.11 Executive Development Program12 was planned and resourced. The purpose is to buld the capacity of senior health managers and middle managers to manage, plan and supervise their program and divisional activities.
HISP/MOH: Operational and Budgeting Guidelines and Templates: For 2006 operational and budgeting process. Planning Flow Chart was presented by Mr. Abraham Namokari during the National Health Conference 7-11 November 2005. 11 Ministry of Health (2005): MOH 2006 Operational Plans and Budget. 12 HISP/MOH (2005): Executive Development Program developed by HISP and run by the University of NSW. 9
10
Ministry of Health: National Health Report 2005 Page 16 of 250 ---------------------------------------------------------------------------------------------------------------------
3.4 3.4.1
Key Government’s National Health Policies: Plans and Priorities: Solomon Islands Government Leadership
The changes incorporated within the MOH structure and the efforts through the HISP describes the task of defining new strategic directions for the Government health sector as integral to the search for a new and comprehensive health and well-being paradigm for the Solomon Islands. This search enlivens the MHMS vision and mission statement and creates the motivation to move towards meeting that challenge..
3.4.2
MOH Vision and Mission Statement
The MOH endorses the Solomon Islands Constitution (and the WHO definition of health) as the fundamental right of every human being without distinction of race, gender, religion, political belief, economic or social condition to enjoy the highest attainable standard of health. The MOH envisions “open, healthy, happy and productive Solomon Islander people” and continually upgrades its activities to fulfill its mission of “promoting, protecting, and maintaining the good health and well being and hence improve the quality of life of all people in the Solomon Islands” The MOH will strive to fulfill that mission within the context of National Health Legislation and within the limits of resource availability. Our guiding principle is “the people’s health is our passion” and the MOH will do all its best with the resources available to serve our people with love, commitment and dedication so that the health of our nation becomes an asset rather than a liability.
3.5
3.5. Ministry of Health’s Cooperate Plan 2006-8:
The Ministry of Health and Medical Services developed a “Corporate Plan for 2006-2008”13 based on the gain during 2004 and 2005 with the following eight priority areas. Improvement of management and supervision of services; Improved access to quality care; Management and development of human resources for health care; Mortality and morbidity reduction; Maintain healthy environments; Promote healthy living and lifestyles; Improve reproductive health and family planning and; Forge partnerships in health development. This plan entails the future directions in terms of strategies and plans for the next three years demonstrating the Government’s commitment to meeting the MDG Goals. However, improving of Public Health and Primary Health Care functions, focusing on the prevention and control of no communicable diseases and STI/HIV/AIDS will be among the top priority programmes.
3.6
3.6. Ministry of Health National Goals and Strategic Plans::
In April 2005, the national goals and strategies during a planning workshop14. The review is done in light of review of the health status report in 2004, the new goals and strategies will be implemented in the 2006 operational plans.
13 14
Ministry of Health (2005) Corporate Plan 2006-8 (The Ministry of Health has planned and already into a National Health MOH (2005): National Strategic Workshop 11-15 April 2005: National Health Status Report presentation by Dr G Malefoasi
Ministry of Health: National Health Report 2005 Page 17 of 250 --------------------------------------------------------------------------------------------------------------------3.6.1 Revised National Goals and Strategies (in 2005, for 2006); Reduce Maternal Mortality Rate from 184/100,000 live births to 125/100,000 live births by 2010 Reduce morbidity and mortality rate of children below 5 years of age due to common childhood illnesses and vaccine preventable diseases. Reduce impact (morbidity) and severity (epidemics, mortality) of Communicable diseases in Solomon Islands. Implement the ‘National HIV Policy and Multi sect oral strategic plan 2005-10’15 with the aim to sensitize people through informed HIV awareness and behavioral change interventions to stop the transmission of HIV, and to ensure accessibility to quality voluntary, confidential, counseling and testing as the entry point for continuum of quality care, including anti retro-viral treatment, for people living with HIV/AIDS. Reduce incidence of preventable skin diseases by 2010. Promote clean water, proper sanitation (including waste disposal), food quality and food safety (incl. food hygiene) Reduce the incidence of Malaria from 184/1000 people in 2004 to 80/1000 people by 2010. Reduce impact (morbidity) and severity (disability, mortality) of all Non Communicable Diseases in Solomon Islands. Reduce prevalence of dental caries in all children by 2010 Raise public and health service provider awareness on the impact of substance misuse and assess the level of psycho-social problems resulting from substance abuse. Reduce incidence of suicide in SI over next 10 years. Provide essential primary health care to all individuals and families, in an acceptable and costeffective, affordable way, and with their full involvement ensuring best practice, high quality and improved patient/client/community care. Enhance behavioral change which promotes a healthy lifestyle and family health, especially related to reproductive health, child health, NCD’s, mental health and Communicable Diseases like malaria and HIV/STIs. Improve access to required essential drugs, medical equipment and medical supplies of appropriate quality at all levels of health service Improve infection control practices at all levels of health services with the aim of reducing infections acquired within health settings. Ensure appropriate referral between all levels of health service. Improve continuum of patient care by strengthening the admission and discharge processes (including communication) at all levels of health service. Ensure early diagnosis and consequently appropriate treatment for patients. Provide quality patient care to a level consistent with best practice with the aim of reducing length of stay in hospital. Provide appropriate level of patient care in hospital settings by ensuring minimal level of services and minimum staffing requirements Provide a safe environment for patients and staff Undertake evidence based health service planning and management Increase capacity of all managers and their health teams to be involved in operational planning and its use to ensure appropriate, effective and efficient health service delivery Ensure funds allocated in the budget are spent appropriately and in a timely manner to ensure planning and implementation of appropriate health services Improve the management of health assets and equipment at all levels of the health care system Improve management and supervision of health services/health workers in order to manage and sustain positive change in health service delivery Establish a MOH information center where information can be accessed by all stakeholders Enhance development of partnerships with stakeholders to ensure effective delivery of health services Improve health infrastructure to support health service provision.
15
National HIV Policy and Multi sectoral strategic plan 2005-10 Solomon Islands, January 2005, 3rd edition
Ministry of Health: National Health Report 2005 Page 18 of 250 ---------------------------------------------------------------------------------------------------------------------
3.7 3.7.1
Meeting up with the Millennium Development Goals:
The Solomon Islands Government through the Ministry of Health is committed in meeting the MDG. The Ministry of Health continued to report against the MDG’s indicators.
Goal 1: Eradicate hunger and poverty Goal 4: Reduce child mortality Goal 5: Improve maternal mortality Goal 6: Combat HIV/AIDS, Malaria and other diseases Goal 7: Ensure environmental sustainability Goal 8: Develop a global partnership for development National Health Policies & Development Goals 1999-2003: and 2004-5 Work Plans Policy 1: Policy 2: Policy 3: Policy 4: Policy 5: Policy 6: Policy 7: Policy 8:
Improvement of management and supervision of service. Access and Improvement of Care and Quality of service Human Resource Development for Health Morbidity and Mortality Reduction Environmental Health Health Promotion and Education Reproductive Health, Family Planning and Population Concerns. Developing Partnership in Health Development
3.7.1.1.1 Diagram 1: MDGs and ICPDS and National Health Policy Goals:
Table 3 showing updates of the MDGs, ICPDs and National Health Policies Goals Indicators:
MDGs Goal
ICPD Goals/ Target
Reduce Child Goal: Mortality Mortality reduction Infant mortality rate: 50 infant deaths per 1,000 per live births
National Health Goals/ Target
2004 Indicators
2005 Indicators
To reduce infant mortality from 42.7% in 1990 to less than 30% by 2003.
17 per 1,000 live births
16.3 per 1,000 live birth
To reduce child mortality rate (1-4) from 7.1% to less than 5% by 2003. 0.9/1,000 population 1-4 yrs
Improve maternal mortality
Maternal mortality ratio: 100 maternal deaths per 100,000 live births
To reduce maternal mortality rate from 357/100,000 live births by 50% by 2003 (less than 178/ 100,000 live birth).
276 per 100,000 live births
1.8 per 1,000 pop 1-4 yrs 236 per 100,000 live births
Ministry of Health: National Health Report 2005 Page 19 of 250 --------------------------------------------------------------------------------------------------------------------MDGs Goal ICPD Goals/ National Health Goals/ 2004 Indicators 2005 Indicators Target Target Combat HIV/AIDS, Malaria and other diseases.
HIV/STI: To reduce the morbidity rate of STI from 1,464 cases in 1995 by 50% by 2003. To prevent HIV/ AIDS infection.
STI cases increased >2,000 in 2003. Four (4) new HIV positive people detected in 2004.
STI rate per 1,000 pop adults increased from 11 per 1,000 pop in 2001 to 17 per 1,000 pop in 2005. In 2005 one new infected person: Cumulative total of 6. HIV Prevalence – 0.13 per 10,000 population
Malaria: 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.
Malaria incidence rose in 2004 to 184/1,000 pop. (microscopists also doubled).
Clinical Malaria 340 per 1,000 population.
Treated bed net coverage below 80%.
In short, whilst there is some improvement in reducing maternal and infant mortality in 2004, the level of STI and Malaria incidences is till not within control or elimination. More attention is required in-terms of reviewing the existing strategies and plans to combat these diseases.
3.8
Health Institutional Strengthening Project
Objective of the Health Institutional Strengthenthing Project The objective of the AusAID funded Health Institutional Strengthenthing Project (HISP) is to improve the management and operational capacity of the Solomon Islands Ministry of Health (MOH) to deliver essential health services leading to improved health outcomes for the Solomon Islands population. 3.8.1
Key Outcomes
Reviewing the history of the MOH and HISP working together, much progress has been made to improve capacity of the MOH to manage the health system at all levels. Specifically progress has been made in the key areas outlined below: Operational planning and the monitoring and evaluation of these plans by means of bi-annual reports.
Ministry of Health: National Health Report 2005 Page 20 of 250 --------------------------------------------------------------------------------------------------------------------Increase in integrated outreach activities for primary and public health in all provinces. Budgets for national divisions and provinces developed. Health services management and governance including primary health care strengthened. National Strategic Health Plan developed with involvement of key stakeholders. Evidence based planning and decision making at national and provincial level with an increased focus on outcome, in addition to inputs and outputs. Revised Scheme of Service for Medical Doctors resulted in an increased return of doctors working in the Ministry. Increased capacity of MOH staff to use relevant computer applications. Installation and support of the Health Radio Network (approximately 200 radio’s). Support for building a national public health laboratory. Strengthening of hospital management at both the National Referral Hospital and provincial hospitals. 3.8.2
Constraints
Public Service Division recruitment processes continue to be slow and the ongoing vacancy of key roles has impeded MOH service delivery. For HISP, the vacancy of key counterpart roles has at times required operational outputs by the Project and has been an obstacle to institutional strengthening throughout the five year life of the Project. Strategies for timely recruitment need to be discussed by all SIG stakeholders. 3.8.3
Future directions
HISP will conclude its current form on 6 August 2006 and there is in principle support for an extension to Phase Four until August 2007. It is the intention for Australian and World Bank assistance to the health sector to transition to a Sector Wide Approach (SWAp). This will allow for greater harmonisation between donors and allow the MOH to take the driving seat in the management of donor assistance as support is provided to the MOH identified priorities in the National Health Strategic Plan. HISP Phase 4 aims for sustainability of capacity building and procedures put in place during the previous 5 years as well as provide support to the MOH to transition towards a SWAp.
Ministry of Health: National Health Report 2005 Page 21 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 4 4.1
Health Systems: Health service delivery and episodes of service (Demand):
Demand on the Primary Health Care:
Primary Health Care in Solomon Islands is delivered by a network of over 323 PHC clinics – NAP, rural health centres (RHC), area health centres (AHC) and urban clinics (UC) and by outpatients clinics based at provincial and the national hospitals. These provide acute care “Demand on outpatient services, maternal care (antenatal visits, births and post natal care) and PHC clinics child health services (vaccinations and growth monitoring), outreach satellite increases but clinics, health education and inpatient services (with the exception of hospital are managed outpatient clinics which would admit directly to the provincial or national hospital). well in the PHC clinics are the main providers of health care nationally, apart from small past 5 years” numbers of private practitioners who are based largely in the national capital. Table 3: National and provincial PHC outpatient contacts (x10,000) – new and return cases and maternal and child health activities, Solomon Islands, 1995-2005.
National Renbel Temotu Choiseul Makira Western Guadalcanal Honiara Central Isabel Malaita
1995 129.22 0.66 5.88 5.96 8.23 26.41 21.86 12.80 6.35 6.49 32.87
1996 134.71 0.46 5.40 6.43 6.67 24.61 21.21 10.98 6.88 6.66 42.72
1997 121.11 0.62 4.56 5.42 7.22 24.70 22.62 12.12 5.88 6.03 29.00
1998 121.66 0.74 4.66 6.15 8.69 22.25 26.27 13.00 6.14 5.06 24.03
1999 112.74 0.45 4.74 5.80 7.13 21.02 19.55 9.69 6.41 5.12 30.73
2000 115.38 0.73 5.46 5.70 8.27 22.13 13.51 8.60 6.30 5.89 36.93
2001 113.41 0.72 5.45 7.03 7.41 19.87 8.20 11.67 5.39 6.33 33.72
2002 100.33 0.51 5.50 5.90 6.82 16.97 11.34 10.09 6.98 5.92 27.77
2003 106.75 0.75 5.23 6.75 9.04 18.05 16.42 11.48 4.68 6.34 23.23
2004 121.48 0.59 5.88 6.23 10.53 21.73 17.09 14.84 6.39 6.94 31.16
Fig 5: National and provincial PHC outpatient contacts (x10,000) – new and return cases and maternal and child health activities, Solomon Islands, 1995-2005. 45 40 35 30 25 20 15 10 5 0 1995 Renbel
1996 Temotu
1997 Choiseul
1998 Makira
1999 Western
2000
2001
Guadalcanal
2002
2003
Honiara
Central
2004 Isabel
2005 Malaita
2005 82.0 0.41 3.9 4.0 6.9 13.4 12.5 11.1 4.8 4.3 20.7
Ministry of Health: National Health Report 2005 Page 22 of 250 --------------------------------------------------------------------------------------------------------------------In 2005, PHC clinics reported over 0.8 million clinical contacts nationwide, slightly lesser than in 2004 around 1.2 million (Fig. 3). This is the highest total since 1996 and 200,000 more than the lowest reported in last year, and a national average of 2.6 per capita. Of all provinces, the largest increase in contacts in recent years have been in Honiara and Guadalcanal Following declines beginning in 2001, PHC outreach activities by clinics exceeded 295716 in 2004, with largest increases in village meetings and satellite clinics. The number of school visits also increased but have yet to reach the totals reached in 1996. It should be noted that increased numbers of NAPs constructed in recent years may have reduced the number of satellite clinics required, however, as there is no record of the total satellite points it is unclear what level should be achieved. Areas far from clinics we get to them through outreach or satellite clinics. This is also a formal way of getting people access to essential health care. Fig 6: Health outreach activities PHC clinics (excluding Western Province), Solomon Islands 1995-2004.
3500
Tota l a c tiv itie s
3000 2500 2000 1500 1000 500 0 1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year Total outreach
School health
Village meetings
Satellite clinics
Western outreach activities are excluded from this total as 6 clinics account for 60% of reported outreach (several hundred outreach activities each) showing a reporting problem in the HIS software or by clinics. Thus national total outreach activities are underreported.
16
Ministry of Health: National Health Report 2005 Page 23 of 250 --------------------------------------------------------------------------------------------------------------------Figure 7 Health outreach activities PHC clinics Solomon Islands 2001- 2005.
2500 2000 1500 1000 500 0 2001
2002
2003
Outreach
Satellite
2004 School
2005
Village meeting
Inpatient admissions to PHC clinics continued to strengthen and referrals to AHC and RHC increased considerably in 2004 (Fig 3). Child welfare activities were maintained even when service delivery decreased overall and the number of infants born in PHC clinics continues to increase. Figure 8: Annual numbers of referrals to AHC, RHC, provincial and national referral hospitals, Solomon Islands 1995-2004
10000
N um ber of re ferrals
9000 8000 7000 6000 5000 4000 3000 2000 1000 0 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year Referrals to AHC's
Referrals to RHC's
Referrals to province
Referrals to central hospital
Overall the picture is one of increasing provision of clinical services by PHC clinics and improved referral patterns in line with the MOH Primary Health Care Strategy (PHCS) which recommends patient referral from NAP to RHC to AHC.
Ministry of Health: National Health Report 2005 Page 24 of 250 --------------------------------------------------------------------------------------------------------------------Referrals to provincial hospitals and the NRH also increased, though reasons for “Transport this are unclear. There are no data about the nature of referrals (eg for acute ation cost medical emergency, surgical review, medical review, eye check). impact Increased capacity, in fuel and canoes, may be part of the explanation or change negatively in type of presentations at PHC clinics (eg. suspected chronic disease or condition) on people that cannot be managed without medical support or review. The practicality of data accessing collection about the reason for referrals needs to be discussed and considered health further by MOH Executive. services, may explain The greatest increases in service delivery in recent years have been in acute care increase services for new cases of disease. More than 900,000 new cases were reported in inpatient 2004. Return visits for care were just 6.3% of total clinic contacts continuing a downward trend that commenced in 1994. Reasons for decreasing numbers of return visits are unknown but may signify effective treatment of conditions. Presenting condition Other Malaria slide (negative) Pain (body, joint, back) Skin sores Worm infestations Chest pain Headache Anaemia Abdo Pain Trauma Chronic chest Totals
February 90 105 41 61 23 5 34 16 11 27 3 416
% 21.6% 25.2% 9.9% 14.7% 5.5% 1.2% 8.2% 3.8% 2.6% 6.5% 0.7%
August 117 100 57 99 17 3 35 17 17 28 1 491
% 23.8% 20.4% 11.6% 20.2% 3.5% 0.6% 7.1% 3.5% 3.5% 5.7% 0.2%
Table 4: Other reasons for attendance to PHC clinic, PHC AHC Solomon Islands, February and August 2004.
Hon Minister the demand for primary health care services in the clinics come from people that suffer from Acute respiratory illnesses, fever and clinical malaria. The trend have continued to be the most commonly reported new cases. Skin diseases reported have declined considerably, red eye less so. Ear diseases and yaws have continued to account for similar proportions of clinic contacts each year As highlighted above when we quantify and aggregate the total visits (demand) per year it amounts up to millions) And it also means that a person in Solomon Islands in a year is sick 2.6 times or more as an average. Earlier studies found that there is economic loss when a person is absent from work due to malaria. And in our vision and mission we promised to ensure that our people is happy, healthy and productive.
Ministry of Health: National Health Report 2005 Page 25 of 250 --------------------------------------------------------------------------------------------------------------------Figure 9 (a): Diarrhoea, red eye, yaws, skin diseases, ear infections as % total new cases, Solomon Islands, 1995-2004.
14% 12%
Percent
10% 8% 6% 4% 2% 0% 1993
1994
1995
1996
1997
Diarrhoea
1998
Red eyes
1999 Year Yaw s
2000
2001
2002
Skin diseases
2003
2004
Ear infection
Figure (9b): Diarrhoea, red eye, yaws, skin diseases, ear infections as rate per 1,000 population Solomon Islands, 19952005.
120.0 100.0 80.0
65
60.0
56.2 47
40.0
32.0 30
20.0
49 46.7
50.7
57.6 51
26.3 25
30 23.8
34 26.7
63.1 50 36.2
0.0 2001 Red eye
2002 Ear infection
2003 skin disease
2004 yaw s
2005 Total diarrhoea
Ministry of Health: National Health Report 2005 Page 26 of 250 --------------------------------------------------------------------------------------------------------------------Figure 10: ARI, fever, clinical malaria and other illness as % of total new cases, Solomon Islands 1995-2004.
40% 35%
Percentage
30% 25% 20% 15% 10% 5% 0% 1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year ARI
Fever
Clinical malaria
Other
4.1.1 Access: The report is only being able to provide access in terms of population per facility. As this point of time, it is anticipated that many more community (>70%) are within one kilometer of walk to the nearest clinic or within one hour travel. In 2005 and shown in Fig 11 and Table 5 clinics in Malaita and Guadalcanal are serving more people than others. These two provinces rely much of their basic health on clinics. Obviously, the travel time will be of some consideration. 7,028 1,945 1,655 1,459 1,355 1,265 1,087 919 895 851 631
Honiara Malaita Guadalcanal National Temotu Western Makira Central Ren Bell Choiseul Isabel
There has been improvement in the access of people to primary health care in the clinics. In 1997 one clinic is to 1,737. In 2005 it is 1,459 people per health clinic. Honiara has the highest population per facility, however residents of the city has more access to higher level of health care and other choice of service providers.
Ministry of Health: National Health Report 2005 Page 27 of 250 ---------------------------------------------------------------------------------------------------------------------
8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0
7,028
1,655
895
1,459
S I
919
C G IP ua da lc an al
851
R B P
1,945
M ak ira W es te rn C ho is eu l M al ai ta
H C
1,355 1,087 1,265
Is ab el Te m ot u
631
C
Ratio: Population per clinic
Fig 11.and Table 5 Ratio of population per clinic in 2005. Source: Medical Statistics Unit, MOH (2005);
The question to ask, therefore, is should there be additional clinics in the provinces or should it be improving quality of health care and more outreach and expanding the level of services17 to include a more preventive role on top the exiting curative responsibilities.
17
Also raised by the Clinic Utilization Review: See below
Ministry of Health: National Health Report 2005 Page 28 of 250 ---------------------------------------------------------------------------------------------------------------------
4.2 4.2.1
Demand on Health Care Institutions and Services: National Referral Hospital
Introduction: CORPORATE SUPPORT SERVICES: Annual Report 2005 ‘Completed by each Divisional Director & Provincial Health Director in liaison with each other ‘ Due:
10th March 2006
To:
MoH Permanent Secretary
Brief Background: The Hospital Corporate Support services under the direction and supervision of the Executive Management Committee headed by the chief Executive Officer, Raymond Suinao, has pledge their support in working closely with the Ministry of Health and development partners of this organization. The Institution is vested with responsibilities to provide secondary and tertiary standard of clinical, administration and management to care for the sick people who enter and seeking medical treatment. The NRH provides the following services:- Surgery, Medicine, Obstetric and Gynaecology, Paediatric (children care), Anaesthetics services, Radiology Services, Medical & Laboratory services, Pharmacy services, Accident and Emergency & Ambulatory services, Dental Services, Physiotherapy, Rehabilitation and Prostheses, Referral Specialists and Clinical Services, Eye Services , Nursing Services and Corporate Support Services which includes the following:Administration, Accounts , Domestic stores, Catering, Laundry, Medical Library, Transport, Communication, Security Services, Medical Records, Domestic and Grounds Cleaning Services, Engineering, Biomedical & Electrical Repair Services, Carpentry, Plumbing Section and Porterage. The Clinical and Diagnostic Services departments are headed by the Medical Superintendent; the Nursing by the Nursing Superintendent and Corporate Support Services by the Hospital Secretary together with the Chief Executive Officer and the Hospital Advisor forms the National Referral Hospital Executive Management Committee, which is directly responsible to the Permanent Secretary, Ministry of Health. Health data Summary (Brief) with analytical interpretation based on best data/evidence only: Collecting and entering data and reporting against Operational plans are new to most of the Support Service Managers. Whilst some can, others are familiar with but do not keep proper records and lack how to write reports. Also appropriate data base spreadsheets need to be installed in respective divisions. In due respect, I am committed to try and establish some form of the hospital data collection and entry in all divisions and ensure staff are trained to be able to use and provide us with required information on a monthly basis or when required. HR Expertise assistance in establishing these spreadsheets in their respective settings will be required from HISP or MOH. The only division who has a system installed for recording of their work activity by an advisor is the Building and Engineering apart from Accounts, Stores and Medical Records, who have been trialing on the new system with the assistance of Elizabeth Moss (MRA). The catering maintains manual records with regards to food orders and usage. But the problem is, not all staff is able to use and lack the analytical interpretation skills. See table below under activity report for task performance extracted from the Building & Engineering data base entries. Activity Report – progress against Operational Plan / Budget (include % for the year): Administration One of the main disadvantages in this hospital setting is the one basket of money with no direct divisional allocations, whereby managers are able to trace and monitor their progresses against their operational plans and normal activities easily. Only a very few were given special allocations
Ministry of Health: National Health Report 2005 Page 29 of 250 --------------------------------------------------------------------------------------------------------------------However, since some of our plans are absorbed within the operational budget, the expenditure budget charts below can be seen as progresses and failures as a whole. Others were specific. Accounts Most of the objectives indicated inside the 2005 National Operational Plan written by FMA, HQ (which is also applicable to NRH Accounting) is still to be implemented. A one time Budget Advisor, Chris Donovan was going to start with all of that but he left in a rush, leaving myself and the accounts suspense, not knowing what to do. With due respect, I am requesting that a Budget advisor be identified and posted to us to improve the procurement and service delivery at the NRH. The under spending and overspending as indicated below are apparent indicators of the poor and non compliance by Managers of operational plans to allocated budgets. In some cases, clarification needs to be done. Also, there is need to mention that the one basket budget may not be the best option for NRH as expressed by the support service managers and other clinical mangers as well. It may need future considerations to departmental allocations whereby, divisional managers have ownership and appropriate usage of their yearly allocations and according to their approved operational plans. The expenditure below is not necessarily by division but by line items only. Divisional future strategic planning and managerial decision making would be very difficult. Currently, only the very demanding costs like Catering have been separated .The expenditure graphs were inserted to show and support this idea. The graphs and tables are obtained from the NRH Budget 2005, report compiled by Ron Hickey, Hosp Adviser. Expenditure by existing cost centers is outlined below. Account – NRH 01-01-05 through 30-06-05 Budget
Proportion
Actual
Variance
Income SIG - Health Service Funds NRH AusAID – HSTA Untied Funds Patient Fees and Charges Rental Fees & Charges Misc Fees - Other Revenue FR – Donations Miscellaneous Income
$0 $5,500,000 $2,750,000 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
$7,650 $3,943,228 $30,117 $1,925 $4,629 $5,595 $25,146
Total Income
$5,500,000 $2,750,000 $4,018,290
Expenses Bank & Finance Charges Building Repairs and Maintenance Catering Services Communication Costs Conference Expenses Equipment Repairs & Maintenance Equipment Replacements
$2,953 $41,813 $1,304,993 $7,406 $33,158 $70,937 $161,920
-$1,193,228
-$1,193,228
Ministry of Health: National Health Report 2005 Page 30 of 250 --------------------------------------------------------------------------------------------------------------------External Services $27,950 Fuel & Lubricant $11,014 Functions and Entertainment $5,049 Insurance & Registration – Mis $1,694 Med Referral : To NRH $7,891 Med Referral : From NRH $756,382 Med Referral : Charter to NRH $29,070 Medical Stationary : Health Su $50,536 Msupp - Drugs – Rawmat $254 Msupp - Other – Gases $72,104 Msupp - Laboratory – Sundries $26 Motor Vehicle : Fuel & Oil $98,416 Motor Vehicle : R&M $93,029 Motor Vehicle : Other $34 Rates & Charges $1,500 Supplies Gen - Cleaning Equipm $9,306 Supplies Gen - Laundry Service $545 Supplies Gen - Bedding & Linen $4,040 Supplies Gen - Furniture & Fit $7,824 Supplies Gen – Misc $30,095 Supplies Office - Computer Sup $6,336 Supplies Office - Equipment & $2,228 Supplies Office - Stationery & $112,387 Supplies Office – Misc $41,587 Supplies Distribution – Sea $2,760 Supplies Distribution – Air $1,725 Supplies Distribution – Shippi $624 Staff Housing & Accomodation $97,118 Staff Other Costs $1,600 Staff Remuneration - Other All $24,954 Staff Remuneration – NPF $492 Staff Training – General $1,044 Staff Training - Student Fees $65,550 Staff Travel – Compassionate $880 Staff Travel - Local (Work) $6,406 Staff Travel – Misc $2,794 Staff Uniforms – Theatre $245 Staff Uniforms – Nursing $216 Staff Uniforms – Misc $18,109 Telephone/Email/Internet $289,616 Waste Disposal Costs $4,455 Total Expenses
$3,511,062
Ministry of Health: National Health Report 2005 Page 31 of 250 --------------------------------------------------------------------------------------------------------------------PROGRESSIVE ACTUAL EXPENDITURE vs BUDGET PROPORTION TOTAL BUDGET - 2005 $ $ $ $ $ $ $ $ $
9 8 7 6 5 4 3 2 1
,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0
0 0 0 0 0 0 0 0 0 $
0 0 0 0 0 0 0 0 0 0
A c tu a l B u dg e t
J u n
To End Jun End Jul End Aug End Sep End Oct End Nov End Dec
Budget $8,422,000 $8,422,000 $8,422,000 $8,422,000 $8,422,000 $8,422,000 $8,422,000
J u l
A u g
Actual $3,727,209 $4,473,016 $5,224,199 $5,951,454 $6,696,419 $7,346,096 $7,913,966
S e p t
O c t
Proportion $4,211,000 $4,912,833 $5,614,667 $6,316,500 $7,018,333 $7,720,167 $8,422,000
N o v
D e c
Under Spent $453,791 $439,817 $390,468 $365,046 $321,914 $374,071 $508,034
% 10.78% 8.95% 6.95% 5.78% 4.59% 4.85% 6.03%
OPERATIONAL COMPONENT - 2005 $ $ $ $ $ $ $ $
8 7 6 5 4 3 2 1
,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0
0 0 0 0 0 0 0 0 $
0 0 0 0 0 0 0 0 0
A c tu a l B u dg e t J u n
To End Jun End Jul End Aug End Sep End Oct End Nov End Dec
Budget $5,500,000 $5,500,000 $5,500,000 $5,500,000 $5,500,000 $5,500,000 $5,500,000
J u l
A u g
Actual $3,511,062 $4,050,009 $4,689,817 $5,218,188 $5,735,043 $6,239,251 $6,807,121
S e p t
O c t
Proportion $2,750,000 $3,208,333 $3,666,667 $4,125,000 $4,583,333 $5,041,667 $5,500,000
N o v
D e c
Overspend $761,062 $841,676 $1,023,150 $1,093,188 $1,151,710 $1,197,584 $1,307,121
% 27.67% 26.23% 27.90% 26.50% 25.13% 23.75% 23.77%
Ministry of Health: National Health Report 2005 Page 32 of 250 --------------------------------------------------------------------------------------------------------------------MEDICAL REFERRALS EXPENDITURE PROFILE FROM THE NRH AS A PERCENTAGER OF THE TOTAL EXPENDITURE June to December 2005 2 2 2 2 2 2 2 2 2 2
5 4 4 3 3 2 2 1 1 0
% % % % % % % % % % J u n
Jun 05 21.54%
J u l
Jul 05 22.17%
A u g
Aug 05 22.06%
S e p
Sep 05 22.14%
O ct
N o v
Oct 05 22.3%
D e c
Nov 05 22.69%
Dec 05 23.87%
ACTUAL EXPENDITURE BY MONTH - 2005 June to December 2005 $ 2 5 0 ,0 0 0 $ 2 0 0 ,0 0 0 $ 1 5 0 ,0 0 0 $ 1 0 0 ,0 0 0 $ 5 0 ,0 0 0 $ 0 J u n
Jun 05 $127,672
Jul 05 $141,515
J u l
A u g
Aug 05 $139,290
S e p
Sep 05 $120,588
O ct
Oct 05 $126,696
N o v
D e c
Nov 05 $145993
Dec 05 $214,950
Catering The Cost of Food The Executive has undertaken an extensive examination of the Catering Services Department with the ultimate involvement of the Office of the Auditor General following the completion of a report on activities. The expenditure on Food within the hospital has been at totally unacceptable levels and significant reductions in costs have been made in the last quarters of 2005 and into 2006.
Ministry of Health: National Health Report 2005 Page 33 of 250 --------------------------------------------------------------------------------------------------------------------Although we had done a fair bit in trying to control the costs, a lot more still needs to be done in 2006 and we should be able to provide information on this including 2006 goals by the end of the new year. CATERING EXPENDITURE PROFILE AS A PERCENTAGE OF THE TOTAL EXPENDITURE June to December 2005 4 3 3 2 2 1 1
0 5 0 5 0 5 0 5 0
% % % % % % % % % J u n
Jun 05 37.17%
J u l
Jul 05 34.69%
A u g
Aug 05 33.33%
S e p
Sep 05 32.23%
O ct
N o v
Oct 05 31.69%
D e c
Nov 05 30.96%
Dec 05 30.08%
ACTUAL EXPENDITURE BY MONTH - 2005 June to December 2005 $ 3 0 0 ,0 0 0 $ 2 5 0 ,0 0 0 $ 2 0 0 ,0 0 0 $ 1 5 0 ,0 0 0 $ 1 0 0 ,0 0 0 $ 5 0 ,0 0 0 $ 0 J u n
Jun 05 $283,078
Jul 05 $110.764
J u l
A u g
Aug 05 $147,585
S e p
Sep 05 $118,261
O ct
Oct 05 $136,112
N o v
D e c
Nov 05 $114,072
Dec 05 $115,750
Building & Engineering The accounts processing for this component is managed by the NRH & MoH and the latest figures available are for the period to end Dec 2005. Expenditure plus the value of orders placed (shown under Commitments) is detailed below: The advantage of this division is it had a separate budget allocation from the operational cost therefore, it is manageable. But in view of the 2006 draft copy , there is no separate budget for them. CAPITAL / ENGINEERING & MAINTENANCE COMPONENT - 2005
Ministry of Health: National Health Report 2005 Page 34 of 250 ---------------------------------------------------------------------------------------------------------------------
A c tu a l B u dg e t
$ 3 ,5 0 0 ,0 0 0 $ 3 ,0 0 0 ,0 0 0 $ 2 ,5 0 0 ,0 0 0 $ 2 ,0 0 0 ,0 0 0 $ 1 ,5 0 0 ,0 0 0 $ 1 ,0 0 0 ,0 0 0 $ 5 0 0 ,0 0 0 $ 0 J u n
To End Jun End Jul End Aug End Sep End Oct End Nov End Dec
J u l
Budget $2,922,000 $2,922,000 $2,922,000 $2,922,000 $2,922,000 $2,922,000 $2,922,000
A u g
Actual $246,147 $423,007 $534,382 $733,266 $961,376 $1,106,845 $1,106,845
S e p t
O c t
Proportion $1,461,000 $1,704,500 $1,948,000 $2,191,500 $2,435,000 $2,678,500 $2,922,000
N o v
D e c
Under spent $1,214,853 $1,281,493 $1,413,618 $1,458,234 $1,473,624 $1,571,655 $1,815,155
% 83.15% 75.18% 72.57% 66.54% 60.52% 58.68% 62.12%
Task Performance Table: Division
Work Orders Received
Electrical Biomedical Maintenance
275 55 120 data up to June only due to computer breakdown 61 data up to June only , reason as above
Plumbing
Work Orders Completed 275 55 80
% 100% 100% 66%
47
77%
Annual Health Outcomes (relates to goals/outputs/indicators): Also, there is need to mention that operational planning is new and that most of the Support Service Managers were unable to complete their 2005 Operational Plans to submit in time. However, they were able to work on 2006 National Goals with some assistance. Only Admin, Catering and Building & Engineering divisions were able to complete their 2005 Operational Plans Admin Goal No. 1 With the arrival of the Infection Control 3 ton pick truck, part of the domestic waste disposal is being addressed. The clinical waste disposal from wards to collection points still needs improvement in their packaging and in a timely manner. Because they are not properly closed and sometimes late, it is very unsafe being along the main corridors overnight. Also, the clinical waste disposal to Ranandi is still a problem. The Honiara City Council is responsible for this area. Goal No. 2 More of my staff and especially managers are being selected and have attended some in- service / induction courses at the IPAM. This will continue into 2006.
Ministry of Health: National Health Report 2005 Page 35 of 250 --------------------------------------------------------------------------------------------------------------------We were able to improve the registry setting as proposed but adherence to rules is still a problem. The retrenchment exercise endorsed by NRH Executive was not approved by MoH or may have been overlooked, thus a fresh submission will be made in 2006. More effort is still to be done to the reduction or elimination of overtime claims incurred at the NRH. Goal No.3 Infrastructure Hospital corridor was not completed due to shortage of funds .Allocated funds for this was used in the operational costs to level the overspending incurred. Fencing project was completed Painting of the hospital as a whole was completed using ward changes allocated funds because specially donated funds for this by HISP were inadequate. Under ward changes, the Gebbie wing was renovated to be used by all first on calls overnight in an effort to reduce transport expenses and patient service be delivered in a timely manner. Also, the re-establishment of the Telepath logy office and its lab, the cashiers office and the tiling of the new medical record and new domestic stores offices were made possible. Goal NO. 4 The Security Service still needs more improvement. Although, more effort was injected in controlling the flow of visitors by erecting the seafront fence, the infrastructure works being carried out at the NRH by outside contractors still makes it difficult to control ( rear fences are pulled down and eastern main entrance control by contractor securities). Therefore, we are unable to measure the outcome of our efforts with regards to this. Goal No 5 Communication of information to divisional managers has improved a lot. Quick responses from some managers to delegated duties and requirements are an indication of this. This was a very big problem identified when first assumed duties. Goal No. 6 More awareness programs needs to be conducted for both the Support Service staff and the clinical staff. Patient approach at times is still not acceptable. Personal interest might be a contributing factor. Catering The crucial situation in this division becomes evident in the second quarter of the year. Instead of implementing the Operational plan, 2005 proposal, the division was actually far from the plans. Following immediate actions by the NRH Executive to remove the Manager, it became stabilize again and the Supervising manager was able to follow and implement the plans following instructions from the office of the Hospital Secretary and NRH Executive. The improvements could be seen in the reducing figures on the actual expenditures during the 3rd and 4 th quarter, on the Catering expenditure charts above. This office is still to receive a register of all the assets in the division. Building and Engineering
Ministry of Health: National Health Report 2005 Page 36 of 250 --------------------------------------------------------------------------------------------------------------------This section consists of four divisions namely, electrical, engineering & biomedical, carpentry and plumbing. These divisions also need a lot of improvement before we are able to measure against goal 1. The overcrowding of the various sections under one roof is not acceptable. Their practical application of goal 6 is evident from their work activity report above. But their timeliness and cost effectiveness cannot be measured. Although their working conditions and settings are not of required standard, these officers still perform at their best. HR issues: The Corporate Support Service has a staffing which consists of 59 established and 74 nonestablished posts, a total of 133. One hundred and seventeen (117) had been substantively filled and 16 still vacant. Certain recruitments that were endorsed by the NRH Executive were submitted to your office mid this year are still pending results either from your office or PSD. Also, position descriptions for vacant positions submitted to your office mid this year are still pending advertisement or results. Recruitment Promotions
- 4 newly appointed staff and 9 casual workers joined these services this year. - 7 officers also received promotions from PSD.
The Transport and Security Services were regarded as rather tough to manage; therefore the NRH Executive had proposed outsourcing these divisions in the future. The idea will be reviewed and forwarded to the MOH Executive for further deliberations. Also, the NRH Executive sees the need to have able and capable staff at the most demanding division of this expanding and growing services and organization, the Switchboard. It had been unfortunate that former managements sees it fit to employ disable personnel to Mann this division The retrenchment list which will be resubmitted for consideration covers a wide range of staff from various support service divisions. The recommendations for each vary as well from non performing to compulsory retirement age. The return of ARC’s to my office had been slow or none at all. Reason expressed was, many forms had been filled over the past years and nothing has happened. I in turn follow up with PAO’s office, HQ and PSD for recent submissions. Some of the latest promotions received were direct result of my follow ups to PSD. Appraisals in respect of some upgrading with regards to the non- established staff will be submitted in due course as well. The Engineering and Building staff being frequently requested by Provincial Health Director’s for repair and maintenance of their biomedical equipment needs clarification from the Permanent Secretary, MoH, HQ. These officers may have become victims of an arrangement by the former managements but the current management at NRH is not happy with that. Number Supervision tours conducted
12
Proportion of staff with ACR completed
5%
Infrastructure / maintenance / equipment issues: Infrastructure The refurbished wards were completed and occupancy has just begun and should be fully occupied by the earmarked wards in the next couple of week or so, this movement also includes
Ministry of Health: National Health Report 2005 Page 37 of 250 --------------------------------------------------------------------------------------------------------------------the telepath logy, transport, electrical, domestic stores, medical records and the switch board respectively. Work has resumed following the release of more than $800,000 and it was agreed upon by the contractor that the building should be completed within one month of receiving the cash. I understand the payment was made last week. We are not directly responsible for this, but follow ups are frequent with the DID officers responsible but less response from them. Maintenance & Equipment We are also concerned about the fact that this division is understaffed both in general maintenance, biomedical equipment and electrical. The Provinces have been using the NRH staff for all their repairs without proper arrangements. Inappropriate remunerations have been raised by the staff themselves and given the many daily rising and outstanding tasks at the NRH , it is rather odd to release them for several days as has been, in most cases. Inventory last updated on: Assets Inventory Completed? Unable to tell because of various inventories NO, I am still to receive asset registers from kept in different divisions. Proposing that a either the domestic stores or whichever central inventory be appropriate and probably divisions have been keeping their own within domestic stores division. inventories. Issues for consideration in future planning: Terms and conditions surrounding and affecting work performance of the corporate staff, especially the ones required to work on weekends, on call and standby. Overtime and other related allowances Basic salary/ remunerations does not match work performed Outsourcing of Transport and Security Services A separate vehicle for Admin and Accounts Division. Clinical and Support Service divisional allocations in the yearly budgets A budget advisor be identified and posted to NRH Provinces to cater for biomedical technicians in their manpower and budgeting Any other comments: The only thing I wish to make additional comment on is the slowness or the non replying from the MoH on many of our queries or submissions with ease as experienced. Because I have to make several follow ups before action I feel this is wastage of time and effort. The follow ups and attempts are time consuming. This can be eliminated and reduced by injecting more commitment to work by appropriate staff at all levels. Also, in the event of relaying messages on formal queries must be documented for future reference. The telephone seems to be taking over the documentation process. I understand the telephone is appropriate in some cases only. However, with the introduction of the email system within the NRH and among the NRH Executive members and some Head of Departments, I am very glad that movement of information is very fast and effective. I would like to thank all who have assisted me in these necessary training, though I am slow. Summary of Major Constraints
Strategies / Action plan for the way forward
Some Support Service managers lack managerial and academic skills
Additional & appropriate training and recruitment of able and capable managers A budget advisor be identified and posted to NRH
Non compliance to budget limits Requisition and Procurement processes improved
To be reviewed ,improved and centralized within the NRH and perhaps to Domestic Stores & Accounts Steps to be reviewed and improved
Recruitment processes very slow
Ministry of Health: National Health Report 2005 Page 38 of 250 ---------------------------------------------------------------------------------------------------------------------
Signature:
Rachel Tigita
4.2.2
Nursing in Solomon Islands:
4.2.3
SI Nursing Council:
Position:
Hospital Secretary
Date:
27th Dec, 2005
Brief Background/introduction: Solomon Island Nursing Council is the legal body of the nursing profession. It exist purposely to monitor and guide the nurses in their professional role in caring for the public, it is not to terminate the nurse but to guide her back into her expected practices as required within the boundary of the professional discipline. Health data Summary (Brief) with analytical interpretation based on best data/evidence only: 2005 has been a very tough year. The Retirement of the two very experienced and senior staff in the Department left on retirement. Three vacant posts which were eventually filled at the beginning at year 2006. The existing manpower 2005 was two. Despite that, the council managed to Graduate, 43 nurses. Also facilitated two provincial workshop mainly Nursing Council Awareness in collaboration with the national Nursing Division head (Nursing management skills). Activity Report – progress against Operation Plan/Budget (include% for the year): Nursing Council meetings 4 times a year - 100% Nursing Council awareness only two programmes - 20% (Two Provinces, Western and Isabel) Registration target x 1 group 100% No investigation done only follow ups. Clinical attachment/community x 2 groups Filling and documentation – little has been done Nursing Council Regulation draft – funded by AUSAID – in the process Council Board yet to be Gazetted.
Ministry of Health: National Health Report 2005 Page 39 of 250 --------------------------------------------------------------------------------------------------------------------Annual Health Outcomes (relates to goals/outputs/indicators): The Solomon Island Nursing Council has exhausted its budget before the year ends. We have achieved few goals but not all. We will have to relook at our Operational plan for the year 2006. We have a full manpower so we hope to do better this year 2006. HR issues: Structure:
2 staff Discussion Address constraints to the right channels Don’t sit back but always seeking advices from the experienced, the skillful and those in Authority. Number Supervision tours conducted
Nil
Proportion of staff with ACR completed
Nil %
Infrastructure/maintenance/equipment issues: Concrete Building – ground level, 5 rooms allocated for the council sharing with the Nursing Director Mental Health x 5 tables, 1 computer, a chair each. X 14 old cabinets (4 drawers each) without keys. Filling system yet to be up-dated. No inventory system record. May need more in infrastructure to accommodate Probation Nurse trainings. Issues for consideration in future planning: Teaching in the programme for nurses is an important issue – teaching tools, conference room in the MHMS Structure RWSS is always busy, this is to avoid extra spending for hiring venues for the block sessions in the probation programme. Photocopy machine would be helpful. Helpful if the Nursing Council is in the ‘Internet’ RWSS is charging usage $50-00 per day. Any other comments The nursing council welcomes any helpful suggestion from everybody for its welfare towards those whom their purpose it served. Training locally with regards to legal aspects. Summary of Major Constraints Resources Training Power Point Vehicle
Strategies/Action plan for the way forward 2005 – only 2 staff – 3 vacancies 2006 Jan all filled. Data-base More computing skills On job training with regards to legal aspect. Teaching purposes Easy to travel, collect stationary Hilux would be better.
Ministry of Health: National Health Report 2005 Page 40 of 250 --------------------------------------------------------------------------------------------------------------------4.2.4 National Medical Imaging Division Brief Background/Introduction: The National Medical Imaging Services is one of the main Diagnostic arms of the Ministry of health and Medical Services in the Solomon Islands. It establishes its departments in six of the nine provinces plus the National Referral Hospital. Eg: NRH, Gizo, Kilu'ufi. Buala. Kirakira, Lata, Taro. It also provided technical and. services support to the church Hospitals, Atoifi, HGH and Sasamunga. The main aim of the Division is to provide and maintain an acceptable, affordable and accessible level of Medical Imaging services to the Medical officers and the people of the Solomon Islands so that they can improve their quality and standard of life. Health data Summary (Brief) with analytical interpretation based on best data/evidence only: At all the Hospital departments, the division has provided three main services. They are the General radiography, Radiology and ultrasonography services. The total statistical examination data in all the services provided at NRH and Provincial Hospital department in year 2005 were as follows. 1. NRH = 15'642. Examinations - This performance statistical data shows a marked increase when compared to that of the year 2004 which is only about 14,357 examinations. 2. For four Provincial Departments. = 7'457 examinations. This has also increased when compared to that of the 2004 statistical performances This marked increase of services can be seen in all the departments. These increases can be attributed to various factors some of which were as follows. The increase demands from the medical Officers and the patients for the services. Improve services due to installations of new equipments in most of the main provincial hospitals and at NRH. Good and improved working performances of all the medical imaging staff. It is hope that this increase will continue this year 2006. Activity Report – progress against Operational Plan / Budget (include % for the year): At the end of the year 2005 the Division has accomplish most of its planned programs under its National operational plan to about 90% success. It overspent its oversea Supplies budget at the NMS for oversea purchase which is only $900,000.00. It spent about $1.2M. This is due to the increase demand to. Replace allot of smaller equipments, stocks and supplies which were running out during the past years. The divisions also spent allot of its local national division budgets for local purchases but due to the slow release of funds from the MOF, it wasn't able to spend all of it. It if hope that this will continue to improve this year 2006. Annual Health Outcomes (relates to goals/outputs/indicators): Goals: 1. The Division aims to Strengthen the National administration. Including prepare 2006 operational plan and work program with budget and human resource requirement plus monitoring and evaluation of the whole services.. This has been all accomplished last year 2005. Year 2006 operational plan, Budget plane, establishment plans were completed and submitted to the MHMS Goal2/3/4. To strengthened the Main services delivery (Radiography, Radiology, Ultrasonography).
Ministry of Health: National Health Report 2005 Page 41 of 250 --------------------------------------------------------------------------------------------------------------------This goal has been successfully undertaken last year where all the above services were available in all provincial dept. and at NRH. Workshops and conferences were conducted for staffs to strengthened the delivery of the above services. Goal 5. To Improve the operational status of the Medical imaging equipment. This goal aims at providing proper repair and maintenance to medical imaging equipment. Although we were success in some places. There are a lot that need to be done on this area. Lack of properly trained biomedical engineer is the main constraint. A number of provincial and NRH equipment have been repaired last year 2005 while others still need to be repaired. We hop to continue it this year 2006. Goal6. Improve provincial supervision & tours. Almost all provincial Hospital have been visited last year especially by the quality control officer who check and document all quality practices in all provincial medical imaging department. Goal 7. To improve supply support to MID. This goals aims at purchasing and distribution of national medical imaging supplies from oversea with the National Medical Store. The Division is very successful in this goal and overspent its budget allocation of $900,000-00 to $1.2M . Allot of very important supplies and accessories have been purchase under this program in 2005. Goal 8. This goal aims to ensure safe radiation environment at the MID. This goals has been successfully implemented where all staff have been given radiation monitoring badges and all dose reports received from oversea laboratory analysis in 2005 were within safe levels. Goal 9.To improve all computerize patient registry and data information systems. The main aim of this goal is to fully computerize all patient registry database in GIizo, Kirakira and Kilu'ufi Hospital. The department is 100% successful in completing this project in 2005, Goal 10. Develop and improve MID workforce that is professionally effective, efficient and productive. The aim of this goal is to review and maintain the staff establishment and standard performances of all staff through review of job descriptions, posting of staff, promotion, and improve entitlement and condition of services. Last year 2005, this goal was slightly difficult to successfully accomplish. This is due mainly to the following reason: - Not enough qualified manpower trained for the service to be posted to provincial Hospital. - All Promotion recommendation made to the MHMS for the Public service Division approval was not materialized. About 70% of the staffs in the division are not in their correct post levels. - Paramedical scheme of services (SOS) were not acted upon by the MHMS and the public service. Inspite of the above problems, the Medical Imaging staff have improved and increased their working performances last year 2005. It is hoe that they will continue this year 2006. Goal 11.Staffs continue educational & training. National training plan has been prepared and submitted to the MHMS. Staff submission for training has been done for oversea training. Two students have been trained locally at NRH under local radiography attendant program and have completed it successfully. - No new student were sent oversea for trainings The MHMS needs to support the division in the area of training for Radiographers. Goal 12. Replacement of all old x-ray equipment and accessories. The division is very successful in replacing most of its old machines last year 2005. New Large x-ray machine for - NRH, Kilu'ufi, Gizo, Atoifi. (Valued at about $1.5M) Mobile x-ray machine to: Lata, Buala, Kirakira, Kilu'ufi
Ministry of Health: National Health Report 2005 Page 42 of 250 --------------------------------------------------------------------------------------------------------------------New film processor to: Kilu'ufi, Gizo, Buala, Kirakira, Taro, Sasamunga, Atoifi. Two Ultrasound machines has been donated to NRH. There were allot of other smaller equipment and accessories that have been successfully replaces under HSTA funding through the NMS.. It is hope that this program of equipment replacement will continue this year 2006. Goal 13. Improvement of Divisional communications. This was successfully implemented. A new telephone line and E-mail was installed at the Head of Radiography's office which now made all communications from / to provincial departments easier and fast. Goal 14. Improve all standard stationary supplies within the division. This was successfully undertaken when all the standard stationeries supplies used within the division were printed and distributed to all provincial departments. Goal 15. Safe Holiday passage for staff. All holiday passages were met successfully last year 2005. Goaf 16. Quality control and assurance program within the division.. This was successfully implemented when all the provincial departments were visited and all equipments and standard of practice were assesses. Quality control workshops and training were conducted. HR issues: Pre-service Training of new Radiographers is lacking for the past years including 2005. There is a need to improve the intake of student for training as Radiographer. Promotion of staff to their correct post levels was NIL even though ACR forms are completed and recommendations were made for every staff each year including 2005. Allot of Radiographers are still acting and not on their correct post levels. Approval and implementations of the Paramedical Scheme of service which can improve the standard of performances and entitlement of each staff is still lacking. The MOH must support and address this issue. Lack of accommodation for some radiographers in provincial hospital centers. The MOH and provincial Directors need to provide proper accommodation for radiographers. The MOH must improve and correct the above anomalies within the system if it wanted to improve the outcome of the health delivery system which depends on if human resource Number Supervision tours conducted
5
Proportion of staff with ACR completed
99%
Infrastructure / maintenance / equipment issues: The Medical Imaging Division is fortunate to replace some of its x-ray equipment last year 2005. eg: NRH, Gizo Kilu'ufi,& Atoifi. Seven x-ray film processors have been replaced. Three ultrasound machines have been donated to the NRH. The main need now is to build a now department at Kilu'ufi Hospital which is too small and also to replace all old x-ray equipment at Buala and Kirakira Hospital. Service and maintenance of these equipment is at its very critical stages because no qualifies Biomedical engineer is available and with knowledge to repair those equipment. Maintenance of department building in most provincial hospital is still a priority, Assets Inventory Completed? = Yes Inventory last updated on:- . 2004
Ministry of Health: National Health Report 2005 Page 43 of 250 --------------------------------------------------------------------------------------------------------------------YES / NO Building of staff accommodation at Honiara and provincial Hospital centers. Any other comments: The Medical Imaging Division and its entire staff have worked very hard to implement the operational plan last year 2005. It is hope that the MOH will support them this year 2006 to do the same. Summary of Major Constraints
Strategies / Action plan for the way forward
1. Limited funding available to purchase new equipment to replace the old ones
continue to Request to increase funding from SIG /HST
2. Inadequate training of human resources including trainings of Radiographers.
Continue to request the MOH & NTU to allocate sponsorship for Radiographers for oversea trainings. ( inservice and pre-service)
3. Lack of Improvement on the staff entitlements and condition of service such as the paramedical scheme of services and the approval of all promotional recommendation made every year including last year 2005 through the ACR forms.
Request the MOH to approve and endorse the Paramedical scheme of service this year 2006. And all promotional recommendations. This issue urgently needs to be address by the MOH. / Permanent secretary.
4. Lack of qualified Biomedical engineers to repair and maintain all medical imaging equipment.
Request the MOH to send and train a Bio-medical engineer to be train on how to repair x-rays and other medical imaging equipment.
5. Lack of Staff accommodation in provincial hospitals. Provinces / Divisions Training Database updated Please circle All activity acquittals completed and balance of cash returned to Accountant By : Sendah Savakana
Position:
Head of Radiography.
YES YES
Date: 10-3-2006.
Organisation and Staffing- 2005 Division/Section
Medical Imaging Division Doctors Head of Radiology Sen. Registrar. Rad Nurses Radiographers Head of Radiography Chief
Grade
Established posts/number
Filled posts Male
Female
1 1
Total
Vacant Posts number
SS1/2 12/13
1 1
1 1
7/8
1
12/13
1
1
10/11
1
1
1
1
Non – established posts number
Ministry of Health: National Health Report 2005 Page 44 of 250 --------------------------------------------------------------------------------------------------------------------Radiographer Prin. Radiographer 9/10 1 1 senior 8/9 5 2 1 3 2 radiographer Radiographers 7/8 2 1 1 1 Asst. Radiographer 6/7 5 1 1 2 3 Radiography Asst. 5/6 1 1 1 Radiography Asst. 4/5 5 2 1 3 2 2 TOTAL EST. POST Domestic/cleaner REMARKS
4.2.5
24
6
4
12
13
2 1 1 1 1 More than half of the staff in the division are just acting against their post and are not yet promoted to their correct levels, therefore their post is still considered Vacant.
National Pathology Services
Introduction: The laboratory services are essential to health care delivery and thus it forms an important role in the Ministry of health. They address both the preventative and curative activities. They are also an indispensable tool in the surveillance and control of diseases. This is through improved disease recognition, accurate reporting and the resultant effective national health planning. The Solomon Islands Pathology Services Division is responsible for the Pathology laboratory services in the country. Its key role is to provide: Framework for laboratory regulations, policies and guidelines on the services provided. Provide pathology staff development plan, training and staff competency improvement programmes and on going staff support in the work place. Management of national pathology finance & budgeting. Management of equipment & supplies Ensuring quality services by utilizing quality tools like standardized documentation, external & national quality assurance programmes through effective communication. The hospital based laboratories both in the provinces as well as the national referral hospital are well distributed through out the country. The key functions they provide are guided by the role delineation document of the MoH. Each hospital based laboratory strive to provide A complete test menu as prescribed by the role delineation guideline. Efficient transfusion services and consultation with the Solomon Islands Red Cross Society Consultation for use and interpretation of laboratory tests Continuing education to students, physicians and hospital staff Laboratory services to patients, hospital employees and regional clients Laboratory statistics to the medical, administrative and interdepartmental teams Quality test results in a time frame to support treatment
Ministry of Health: National Health Report 2005 Page 45 of 250 --------------------------------------------------------------------------------------------------------------------Activity Report 2005. Staff Development The level of trainings both basic and on going is an important component of providing quality laboratory services. The trainings undertaken by laboratory personals in 2005 are in table 1. & 1.1. They are mostly quality management training and lack the professional and technical improvement that the service desperately needs. Table1
In country trainings and workshops undertaken in 2005.
Types of training
Field of training
No Trained
Who
IPAM
3
NRH Management
2 3
NRH IOC staff New recruits
3 1
NRH staff NRH staff
USP MHMS
Human resources management Multi disciplinary Public service procedures Basic Computing Intermediate computer training Corporate governance Quality Workshops
1 2
HIV
Operational planning workshops VCCT Counseling
HOD National Pathology services National Pathology services Gizo, Kiluufi
Computer literacy training
2 2
Rate
2/3 2/3
Table 1.1 Professional/Technical training undertaken in 2005
Types of training
Institution
Field of training
Safe blood transfusion 3 weeks
Attachments
Malaysia, National Blood Transfusion Center Royal Brisbane Hospital Pathology Laboratory Services
Cytology
Duration
6 months 3 months
Who Denton Jimmy Elliot Puiahi Michael Aike Anna Mosese
Parasitology & Mycology Workshop. Australian Microbiology Society Conferences
2 days Guest speaker at the ASM Tristate conference, Darwin, Attachment at (IMVLS) TB reference laboratory & guest speaker SA ASM branch Guest speaker ASM
Andrew Darcy 3 days
1 day
Ministry of Health: National Health Report 2005 Page 46 of 250 --------------------------------------------------------------------------------------------------------------------Queensland branch Global Fund HIV Presenting SGS report 1 week Elliot Puiahi Project for Solomon Islands Pan Pacific Presentation on HIV 1 week Elliot Puiahi HIV/AIDS SGS in Solomon Conference Islands Pacific Laboratory Quality 4 weeks Violine Aruafu SHORT Paramedical System Management TRAININGS Training Center Therapeutic Good Blood & Blood product 1 week Andrew Darcy Administration of regulations Australia (TGA) EBOS (NZ) Equipment Training 1 week Ansa Wate Douglas Rerese Management of Laboratory Supplies The National Pathology Services is managing a budget of $ 800,000 at the National Medical store to procure laboratory supplies and small equipment replacement. This is obvious not enough as the commitment made in 2005 is very above this budget. The purchase commitment of the National Pathology is in table 2. Table 2. Purchase orders through the National Medical Store 2005.
Date PO Reference Supplier 21/01/2005 NMS2005-02 EBOS 2/03/2005
NMS2005-14
2/03/2005 16/03/2005 27/04/2005 20/05/2005 16/06/2005 2/09/2005
NMS2005-15 NMS2005-22 NMS2005-33 NMS2005-42 PO:48 PO-136
7/09/2005 PO:128 22/09/2005 PO-139 31-Oct-05
PO-192
Decription Amt (AUD) Amt SBD Biochemistry/Haematology $ 98,612.95 $ 571,669.26 Reagents B&M HIV,Anisole,ESR,Carbol $ 15,469.00 $ 92,851.14 fucshin, B&M RPR, HBsAg Reagents $ 3,495.00 $ 26,679.39 B&M PTI cards $ 6,482.00 $ 39,284.85 B&M INR Machine & Reagents $ 6,257.60 $ 37,247.62 EBOS Atoifi instalation $ 6,250.00 $ 34,171.68 EBOS Easylyte repair $ 3,258.60 $ 15,641.28 EBOS PTI manual,Hemocue,PT, $ 14,957.40 $ 74,263.49 Blood agar B&M HIV,HBsAg,PTI reagents $ 7,330.50 $ 40,669.61 South Austral Chemicals, Stains, $ 47,915.00 $ 261,973.76 Reagents & Consumables EBOS Biochemistry reagents $ 105,210.12 $ 575,236.33 Total committed in 2005
$
315,238.17
$ 1,769,688.41
Laboratory Equipment Laboratory equipment are expensive and technology constantly changes. The National Pathology is trying to standardize laboratory equipment and is facing a very difficult time trying to find the best machine that will cater for the conditions of the country. There is also a need to have back up system that will ensure that the services may slow down but still functioning. Thus for every machine purchase the national pathology must also a manual system for back up. Equipment Repair
Ministry of Health: National Health Report 2005 Page 47 of 250 --------------------------------------------------------------------------------------------------------------------A major hurdle for the pathology services is the lack of equipment service back up in the country. A lot of times a very small fault resulted in equipment replacement or a visit from which cost almost the same as the machine. A number of these equipment are still sitting in the laboratories awaiting repairs. Repairing these machine by getting someone from overseas to come and do them here will incur cost as in table 3.1 Table 2.1 Cost of repair or installation.
Date
Reference No Supplier Detail Cost of an extra trip to cover installation of Biochemistry machine at Atoifi 20/05/2005 NMS2005-42 EBOS Cost of repairing an electrolyte machine 16/06/2005 PO:48 EBOS (Easylyte) sent to NZ.
Cost (foreign)
Cost SBD
$
6,250.00
$
34,171.68
$
3,258.60
$
15,641.28
Table 2.12 Repairs covered under warranty in 2005
Date April 19/04/05
Installation Repairing trip
Equipment Echo plus, NRH Kiluufi & Gizo Echo plus Atoifi Coulter Counter Also service Act 2 Gizo, Act8 Atoifi Echo plus NRH Easylyte (Kiluufi)
Supplier EBOS EBOS EBOS Under warranty EBOS Under warranty EBOS Under warranty
Under warranty $15 641.28 NZD Done by Roger Caine
Yet to be fixed
At the end of the warranty period the laboratory will have to look into the cost of these repair trips or it must look at ways to train its local biomedical to be capable of handling these equipment. Table 2.13 Laboratory equipment that needs repair end of 2005.
Machine type Biochemistry Reflotron analyser
Qty 4
institution Gizo, Kilu’ufi, Atoifi, NRH
Biological Safety Cabinet
4
Autoclave Echo plus Easylyte Coulter Act2
1 1 1 1
Atoifi, Kiluufi, HGH, NRH NRH Lab NRH Lab Kilu’ufi Atoifi
Coulter Act 5
1
NRH
Remarks Needs a service engieneer to have them fixed and redistributed to other provinces. Filter change & service maintenance overdue Not working for 3 years now Under warranty Under warranty Needs board replacement & adjustment Needs constant attention due to power sensitivity. (Under warranty in 2005)
Ministry of Health: National Health Report 2005 Page 48 of 250 --------------------------------------------------------------------------------------------------------------------New equipment acquired The equipment acquired in 2005 through SIG are mostly tools for the improvement of communication and management. There are a number of essential basic equipment that need urgent replacement. The Pathology services would like to thank WHO for facilitating the acquirement of the most basic but essential equipment for the service Table 2.23
New equipment acquired 2005.
Equipment type 2 x Computer
Cost center National Pathology services
Programme NRH Lab Administration & Data collection National Pathology Services
1 x Lap top 1x LCD projector
National Pathology Services (NMS) WHO Funding
3 x Centrifuges
WHO
1 x Computer 10 x Auto-pipettor (20200ul) 10x Auto-pipettor (2001000ul) 10x Auto-pipettor (100ul) Scanner
HIV programme WHO
National Pathology Services Training Replacement for Gizo, Kiluufi, NRH Serology data collection- NRH Replacement to all laboratory
WHO
Replacement to all laboratory
WHO
Replacement to all laboratory
SIG
National Pathology Services
Laboratory Policies/Regulation/Guidelines The National Pathology services still finds it very difficult to make policies and regulation at this stage. There is only one Policy being drafted and is yet to be see it through the MoH executive. The process of making policies and the framework needed to use as a cross cutting department who serve a lot of programme yet based under the National Referral Hospital is not easy. Most programme are yet to come up with their policies and thus it is difficult to write laboratory guideline based on existing policies and or standards. The other area of great importance to providing the quality service is the clarification of regulation that governs the pathology services professionals and services in the Solomon Islands. Provision of Quality service to laboratory users A network of laboratories are well spread within the country to provide laboratory services for the user of the services. These laboratory are based at the hospitals as they are the biggest user of the service. The public health component of the laboratory also exist and they are very instrumental in TB/Leprosy, HIV/STI and Pap smear screening programme. Whenever needed the Pathology laboratory are used for outbreak investigation and monitoring. Laboratory data are an important base line data to see specific problems in any programme. There is a level of referral within the country and a network of reference laboratories outside the country can be utilized should the need arise. These ultimately intends to provide the best quality services for its users. Activities relating to the services provided in the country is summarized in Section 4 of the report.
Ministry of Health: National Health Report 2005 Page 49 of 250 --------------------------------------------------------------------------------------------------------------------Table 2.4 Showing laboratories in the country
Center NRH Sasamunga Gizo Hellena Goldie Hospital Buala Atoifi Kilu’ufi Kirakira Lata
Zone Honiara, Guadalcana, Renbel, CIP Choiseul Province Western Province Western Province
No of staff 24
Level of service Level 4
1 2 2
Level 1 Level 3 Level 2
Isabel East Malaita Malaita MUP Temotu
1 1 4 1 1
Level 2 Level 2 Level 3 Level 2 Level 2
Table 2.41 The Reference Laboratories currently being used.
Institute Royal Brisbane Hospital Pathology Laboratories QHSS Arbovirus Lab Influenza Center VIDRL IMVS Pasteur Institute, Noumea Mataika House Fiji
Test referred All histology, cytology, hormonal, and any other test not done locally Arboviruses Influenza surveillance Measles surveillance TB Surveillance Leptospirosis reference center Proposed HIV surveillance confirmation center
Cost The service is done but charged to Solomon government. WHO Collaborating Center WHO Collaborating Center WHO Collaborating Center WHO programme PPHSN level 2 laboratory PPHSN level 2 laboratory
Management of Finance & Budgeting The National Pathology was fortunate to be recognized as a cost center in 2005. The budget provided in 2005 are activity based while the core budget is still handled by the NRH cost center. With only 2 staff running the office as well as running the NRH laboratory operational supervision, it is not possible to implement all the activities as planned. A system to make available funds when needed is the biggest obstacle in the management of the fund. As it is our first budget it has no history and so it’s a great learning curve for the division. The biggest portion of the laboratory allocation is spent on laboratory fee being referred to Queensland Health as shown in the graph below. The budget estimate for the programme in 2005 is $500 000 and the actual spending is $800 000. A draft guideline proposed to guide the test referred and possible cost recovery on private sector is not being implemented because it is yet to be approved.
Ministry of Health: National Health Report 2005 Page 50 of 250 --------------------------------------------------------------------------------------------------------------------Graph3.5 showing cost of test done in QHSS in AUD currency. Laboratory Overseas Test Fee-RBHPLS $30,000.00
$25,000.00
$20,000.00
$15,000.00
$10,000.00
$5,000.00
05 .J an .9 78 04 .D ec .5 22 04 .N ov .8 66 04 .O ct .1 20 1 04 .S ep .1 02 9 04 .A ug .1 32 3 04 .J ul .1 64 0
05 .J un .7 26 05 .M ay .8 86 05 .M ar .1 02 3 05 .F eb .1 13 1
05 .O ct .7 29 05 .S ep .1 57 05 .A ug .1 08 8 05 .J ul .2 90 1
06 .F eb .1 08 0
06 .J an .1 13 3 05 .D ec .1 38 7 05 .N ov .1 25 0
$0.00
Laboratory Quality Assurance The assurance that the service obtained are of quality is the paramount importance to the user of the service. The National Referral Hospital laboratories participated in an external quality assurance programme. Having participated in the EQA NRHLab should then be involved in providing similar EQA to the provincial hospitals. Unfortunately this is not happening in 2005 due to severe shortage of staff and difficulty in getting available funds to run these programme. A proposed QA & training officer at the National division office will really get this going in 2006. A regulatory framework that will set a standard for laboratory services in the country is very much needed. It should be able to provided the minimum standard that all laboratory should operate on and a possible accreditation recognition.
Ministry of Health: National Health Report 2005 Page 51 of 250 --------------------------------------------------------------------------------------------------------------------Graph 2.6. The NRH EQA score compared to the rest of the Pacific (average participants score)
Haematology Score 100 80 60
Average
40
NRH
20 0 1
2
Serology Score 105 100 95 90 85
Average NRH 1
2
The above result shows that we have a better than average standard of services in both the Serology & Hematology sections. This should give confidence to the users of the service in these area. There is a great need to spread the same confidence to the technologist in the provinces who are often neglected in both training and support. Microbes Identification
Antibiotic Sensitivity prediction
P ercen tag e S co re
100 80 60
Average
40
NRH
20 0 1
2
3
90 80 70 60 50 40 30 20 10 0
Average NRH
1
2
3
Microbiology is still struggling in their QA performances with our identification and antibiotic sensitivity prediction well below the average score. An encouragement is that in the last EQA we did improve our sensitivity prediction to almost the average level indicating our commitment to excellence. Due to the continuous breakdown of the newly installed machine in biochemistry the Solomon does not participate in the EQA. It would be interesting to find out the QA for the 3 other machine
Ministry of Health: National Health Report 2005 Page 52 of 250 --------------------------------------------------------------------------------------------------------------------installed in the province which does not experience break down. Biochemistry however have a strict internal QC that was done before any testing is done. Annual Health Output Provision of quality laboratory services to the users of the services: Serology Laboratory Services The Serology services include serological testing of hepatitis B virus, HIV Syphilis in patients and blood donors. The national pathology with technical input from NRH Serology are responsible for the test standardization, and they work very closely with the National Medical Store for their availability throughout the country. The minimum cost of the test used is HIV HBsAg RPR TPHA
(2.80 AUD) (1.05 AUD) (0.60 AUD) (1.70 AUD)
$12.00 SBD $6.00SBD $3.00SBD $8.00 SBD
The HIV testing strategy is being drafted following a workshop organised by the HIV programme. This will certainly assist the laboratory to standardized testing protocol. Some of the activities in Serology are summarized in table 4.1/4.2 Table 4.1 National Referral Hospital Serology Tests done in 2005 TESTS Pos RPR TOT RPR Pos TPHA TOT TPHA Pos HBsAg TOT HBsAg IR HIV TOT HIV TOT Tested
Jan 98 756 92 92 27 180 0 124 1369
Feb 190 603 74 224 14 79 0 94 1020
Mar 63 267 144 347 23 195 0 120 1159
Apr 75 685 99 134 27 196 2 172 1390
May 96 924 91 91 27 164 0 118 1511
Jun 86 876 92 92 24 146 0 77 1377
Fig 4 Showng the proportion of test done at NRH serology laboratory Serology test done in 2005 NRH N=15198
TOT HIV; 12% TOT HBsAg; 15% TOT TPHA; 10%
TOT RPR; 63%
Jul 89 756 81 81 31 161 1 141 1323
Aug 73 848 66 66 55 218 3 180 1491
Sep 50 752 52 45 24 174 1 122 1220
Oct 47 657 44 44 41 199 2 157 1191
Nov 56 695 54 54 32 159 6 151 1185
Dec 48 578 47 47 17 117 2 106 962
TOT 971 8397 936 1317 342 1988 17 1562 15198
Ministry of Health: National Health Report 2005 Page 53 of 250 --------------------------------------------------------------------------------------------------------------------Blood Transfusion Services The National safe blood policy was drafted and deliberated in 2003 during a technical workshop. This policy together with its guideline and Standard operation procedures is yet to be fully implemented. An MOU was signed between the MoH and the Solomon Island Red cross Society (SIRCS)on the area but this too doesn’t seem to work because SIRCS has not yet replaced the two personnel made redundant in 2004. The authoritative body to deal with blood activities in the policy is the National Blood Counsel of Solomon Islands. This body has yet to meet since its inception and in 2005 there is no meeting. Proportion of donor blood grouping 2005 N= 1040 A Rh Positive 25%
B Rh Positive 11% AB Rh Positive 1%
O Rh Positive 63%
National Referral Hospital Blood Transfusion Services The National referral hospital transfusion service is the main blood bank in the country and they have traditionally use the services of the SIRCS to do recruitment and awareness. This is no longer possible in a regular basis and thus the service has yet to meet its objective of 100% nonrenumerated volunteer blood donor services. In 2005 the majority of donation is still family replacement thus blood safety and confidentiality is very much compromised. NRH Blood Transfusion Services 600
500
400 Units Collected Tot. Units Requested Units Used Units X-matched Tot. X-match Requests
300
200
100
0 Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
There is a slight recovery in the blood bank after the delivery of a bus to National Pathology that can be used for mobile blood collection. The increase in demand for use of blood however is no where near the amount of blood collected. As seen in the graph the number of blood requested at
Ministry of Health: National Health Report 2005 Page 54 of 250 --------------------------------------------------------------------------------------------------------------------NRH of 4240 is five times more than the units used in 2005 of 864. A lot work is still needed to put in strategy in both the collection of blood and quality rationale use of blood in the Solomon. TB/Leprosy Programme One of the national programme heavily relying on the laboratory to support its activities. The success of the programme depends on early detection and continuous monitoring of the infectivity during intensive dots treatment. The laboratory have been struggling to get quality stain since JICA has left the programme. Its takes a consultant and a National TB workshop in 2003 that the problem was identified and steps taken to solve it. The year therefore started off with good stains available but still some administrative problem with distribution of these stain to the provinces. This year the drug sensitivity surveillance was re-started with Institute for Medical & Veterinary Science (IMVS) in Adelaide. A total of 93 cultures were sent for investigation, five of them were either contaminated or can not be recovered. There are only 2 which is not MTBC. The sensitivity fortunately is still sensitive to the five drug tested (S,I,R,E,Z). National Referral TB Laboratory Serves the National referral hospital as well as the base laboratory for HTC, Guadalcanal, Renbel as well as CIP. Despite this the working space in the laboratory does not allow for two technologists to work at the same time. The laboratory was also expected by the national programme to provide National quality programme as well as training support. Apart from training laboratory trainee as well as Renbel nurse, the later function of the laboratory is yet to be fully implemented. Workload for TB NRH Laboratory TB Work load analysis
Oct
38
38 314
136
Nov
35
265
Dec
73
240
Sep
68
103
Aug
55
150
Jul
44
213
Jun
73
227
May
60
216
Apr
61
266
Mar
0
50
29
Jan
25
169 162
Feb
100
150
200 Total Smears
250
300
350
400
TB Culture
The yearly average AFB positivity rate seen at NRH is New cases Follow ups Total Pos.rate Total Pos.rate NRH 804 9% 122 20% Buala 346 3.5% 15 0% Kiluufi 1042 21%
Old Total 49 none
Pos.rate 16%
Ministry of Health: National Health Report 2005 Page 55 of 250 ---------------------------------------------------------------------------------------------------------------------
Ministry of Health: National Health Report 2005 Page 56 of 250 --------------------------------------------------------------------------------------------------------------------Microbiology Services Isolation of infectious agent (bacteria) in patients specimen and testing them invitro for antibiotic susceptibility is an important aspect of microbiology services. The application of microbiology is for confirmation of etiological agent in a suspected patient. This can lead to early detection of outbreak diseases and accurate treatment of cases. National Referral Hospital The National Referral Hospital laboratory, Gizo and Kilu’ufi are currently equipped to do culture isolation and sensitivity testing. They are doing microscopy and culture in clinical specimens as well monitoring the STI syndromic management. NRH microbiology statistic is not available when the report is compiled. Biochemistry Services Nationally the Biochemistry services actually expanded with the purchase of 4 new wet chemistry analysers (Echo plus) in 2004. These machine were installed at Gizo, NRH ,Kilu’ufi & Atoifi in April 2005. While the machines for the provinces are doing fine after installation, the one for the NRH develop problem maybe due to the workload. It appears that the machine is not so suitable for the high workload in NRH. Until the problem in NRH is fixed there is no way of knowing what the real work load demand is for Biochemistry in the Solomon Islands. The NRH Biochemistry data was not available during compilation. Total Provincial Biochemistry Test 2005
4000 Gizo
Atoifi
6000 Kilu'ufi
135
2000
2409
0
633
5059
1
8000
10000
Lata
Histology Histology laboratory investigation is all done at Royal Brisbane Hospital Pathology Laboratories and they are doing the service at a cost to the MoH. These test can not be done locally because we do not yet have a pathologist. While a pathologist is currently being trained it is also important to start working on a pathology laboratory to cater for his return. A temporary site has been identified at the NRH to accommodate histology service but a concrete solution must be found sooner than later. There is very little Telepathology being done in 2005 as the makeshift room used was not safe and National Pathology office has moved in to use the room.
Ministry of Health: National Health Report 2005 Page 57 of 250 --------------------------------------------------------------------------------------------------------------------Anatomical Pathology Specimens 80
70
60
50 Province NRH
40
30
20
10
0
1
2
3
4
5
6
7
8
9
10
11
Province
3
0
9
11
12
3
18
0
13
1
18
12 8
NRH
13
71
60
46
63
42
49
26
61
31
52
24
Cytology Services The cytology service in the country is in an infant stage but has taken a very important role in the cancer diagnosis. Pap smear screening, the primary health care programme for cervical cancer is still making up the bulk of the cytology specimens. Fine Needle Aspirate (FNAB) is increasingly contributing to the total workload. It has became the first line of diagnosis before surgery and should be encourage more. Pap Smear Screening 2005
47 52 105 58
32
4 108
56
41
9
39
38
4
18
0
40
1 3 6
Jan
24
7 71
20
29
Feb
19
4
33
Mar
29
10
Apr
61
19 8
43
29
May
53
49 27
43
22
Jun
9
38 12
17
Jul
12
18
Aug
13
22 11
8
23
Sep
5
18
Oct
12
27
Nov
6
22
4
Dec
50
100 Gynae
150 Province
HTC
Private
SIPPA
200
250
Ministry of Health: National Health Report 2005 Page 58 of 250 --------------------------------------------------------------------------------------------------------------------FNA & Non Gynae Cytology 40
35
30
25
2004 2005
20
15
10
5
0 Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Haematology Services The Hematology department is one of the high through put testing service in the division. They are responsible for test that include hematopoiesis evaluation, erythrocyte studies, leukocyte studies, hemostatis and test of hemostatic function. The full blood count is the first line of investigation and treatment monitoring. NRH Hematology The NRH is the busiest hematology laboratory in the country. They started started the year without a machine and thus they are doing all test manually. A Coulter Act 5 was installed in April but this developed problem sometime later due to the power disruption. A back up machine was repaired and is currently being used. No data is available during compilation of this report. HR issues: Human personnel are the most important asset of the division. It can not run without its qualified competent personnel. It is therefore important that the issues surrounding the personnel are vital to ensure the smooth running of the service. Strengthened National Management Body The current establishment structure does not encourage the pathology services to be able properly manage and regulate itself as a profession. The lack of the Directors post in the establishment sees the department lacking direction. It would be very important the division must play an active role in the national issues both clinically as well as preventative. This can not be done while the department is still headed by the Medical superintendent of the NRH and NRH manager being the highest post in the technical cadre. A clear line of command that has all the hospital entities answerable to will greatly help in the management and independent administration of each laboratory services. Staff Quality & Quantity The laboratory is always being associated with the testing personals of the wide range of professionals needed in the running of the services. The group most unlikely to be mentioned in the cycle is the technical consultants for each specialist area. These professional are graduate scientist with post graduate qualification in their field. These technical consultants are very
Ministry of Health: National Health Report 2005 Page 59 of 250 --------------------------------------------------------------------------------------------------------------------important personals needed to ensure quality procedures are research and authorized for use in the laboratory. It is sad that of these type of training is seen done in the ministry and yet we expect high standard of service to be provided from each division. The division aim to have at least one technical/professional consultant in each field of pathology laboratory services and to have enough testing personnel for each service. It is now possible to estimate the quantity of testing personnel required by using the MoH HR model and the annual statistics of the division. The real issues that need to be addressed is the initial training of the right mix of personnel so that we will have personnel to work. Staff motivation & incentives The current grouping of the pathology laboratory personnel with the rest of the paramedical has disadvantaged the laboratory very much. The abolishment of overtime and a blanket 25% SDA for paramedical has not properly renumerated the people who works the longest, as well as the hardest in the group. Medical laboratory staff were called almost every night to deal with life saving test. While the new Paramedical scheme of services has been seen as the most important motivational factor, the pathology division still see the after hour aspect of the document as unfair. The division agrees to pursue it with the group in the understanding that this will be reviewed within two year and this matter dealt with in a more acceptable way. Quality of service is mostly influenced by the quality of training one get before and during employed. The lack of formal in-service training for the Medical laboratory staff is not helping in the improvement of the service. Further more there hardly any degree graduate laboratory scientist that can be employed and thus the gap between other professional whom we supposed to advise widens. Staff development & career pathway. The staff career pathway is not very clear in the present structure. The present promotion is mainly due to default rather than in service career development and plan. Again the proposed structure in the submitted SOS is trying to address this. It hoped to encourage professionals to stay in the field rather than getting into the administration. Organisation and Staffing Division/Section
Grade
National Pathology Services Head of Laboratory 12/13 Services Laboratory Coordinator 10/11
Filled posts Established posts/number Male Female
Abolished in 2005 1
National Referral Hospital Laboratory Chief Medical 11/12 1 Technologist Principal Medical 8/9 8 Technologist Senior Medical 7/8 8 Technologist Medical Technologist 6/7 4 Ass.Med.Lab.Technologist 5/6 5
Total
Vacant Posts number
0
0
0
0
1
0
1
0
1
0
1
0
3
2
5
3
3
1
4
4
4 1
2 2
6 3
-2 2
Non – established posts number
Ministry of Health: National Health Report 2005 Page 60 of 250 --------------------------------------------------------------------------------------------------------------------Central Reception 4/5 1 0 0 0 1 Manager Laboratory Domestic 2 2 0 1 1 1 Nonestablished Medical Lab. Technologist 2 3 0 3 -1 NonTrainee established Provincial Hospital Laboratory Chief Technologist 9/10 Principal Medical 8/9 Technologist Senior Medical Technologist Medical Technologist
1 0
0 1
1 1
1
7/8
2 1 Gizo post abolished in 2005 5
1
2
3
2
6/7
4
1
0
1
3
Remarks. All vacant post in NRH (except for 3xmalaria & Central reception manager) are filled with personnel acting up on their post. This has been going on for two years and despite the paper works being done no promotion has been received yet. The Malaria has been activated for advertisement but as of Dec 2005 no recruitment is yet to be done. The provincial vacancies have attracted some application but as of Dec31, 2005 nor recruitment has been done. The vacancies in the lab are mostly based on potential availability of qualified personnel in the market instead of the needs analysis due to unavailability of trained personnel in the market. Infrastructure / maintenance / equipment issues: The Medical Laboratory Technologist performs all duties in compliance with all current provincial and national legislation for the protection of patients, health care providers and the general public. This also means that the facility & equipment they are using must comply with the current national safety standards. Unfortunately a lot of the laboratories in the country does not meet even the WHO Biosafety level 1. A purpose built laboratory is much safer than BSC cabinet that can not be serviced in the country. Equipment maintenance Lack of preventative maintenance is the current biggest laboratory problem. Machine are bought with out proper maintenance plan. Spares are not stocked and there is no regular preventative maintenance programme. Operational budget usually is being used to cater for emergency repair. As the personnel needed to do the usually are brought into the country it is often very expensive. Assets Inventory Completed? YES / NO
Inventory last updated on: 2001
Issues for consideration in future planning: Guideline for teaching by laboratory staff The laboratory staff has been requested and have been providing teaching session to SIMTRI public health programme, SICHE School of nursing programme, and midwifery programme. The current use of the laboratory testing personal in those programme has put a lot of pressure on the
Ministry of Health: National Health Report 2005 Page 61 of 250 --------------------------------------------------------------------------------------------------------------------laboratory services. A guideline is needed to clarify the role of health experts in providing teaching service to other programmes needs to be drawn in order to plan absenteeism and compensation. Overseas Laboratory Referral Costs. The issue of the cost of sending specimens overseas needs to be addressed. A referral criteria must be confirmed and enforced so that we can control the laboratory spending on unnecessary tests. Furthermore a set criteria is needed to continue the service to the private sector at a cost recovery revolving scheme. This will mean that the budget can be gone over but the actual fund is paid for by the user. Histology / Cytology Laboratory There is need to establish the histopathology laboratory in country to provide a work place for the new graduate pathologist. Site planning must be done now than later so as not to discourage the new graduate. Telepathology must be encouraged to reduce the cost of the overseas laboratory fees. Laboratory Standards Quality systems requires standard and regulation to enforce this standard. The laboratory needs a review of the Acts, regulation & policies governing this to ensure that there is a framework available to do this in the country. Any other comments: Constraints & Strategies Summary of Major Constraints
Strategies / Action plan for the way forward
Inadequate supply of safe blood in the hospitals
Review & relook into the 2003 workshop recommendation in blood recruitment for Solomon Islands. (see annex 1) Recruit 2 nurses to assist in the awareness & volunteer blood donor recruitment. Need a review of the top management of the laboratory To have a APW for a consultant or to recruit a Laboratory administration adviser to attached with the division for 1 year.
Need to strengthened the National Pathology Services management. There no clear regulatory policies that provided independence and empowerment to provide QA – No enough personnel in the National office to do QA and training of staff
Provide in the National pathology Services establishment a post for a QA and training officer.
Training- No enough trained personnel to recruit and fill the post required by the service
Establish a needs analysis and forward to planning or Ministry of Education for student training. Establish an Assistant Medical Technology Programme in the National Pathology Services to cater for the gap in the testing category. Establish a system to cater for equipment repair.
Equipment repair- Lack of systematic preventive maintenance & replace protocol for all laboratory equipment Inadequate qualified personnel to recruit
Proper analysis of Doctor work generated ratio and plan for the pathology support services personnel.
Ministry of Health: National Health Report 2005 Page 62 of 250 --------------------------------------------------------------------------------------------------------------------Fair distribution of in-service scholarship. Provinces / Divisions Training Database updated
Please circle
All activity acquittals completed and balance of cash returned to Accountant
YES
NO
YES
NO
Blood Donor Recruitment in Solomon Islands Introduction Blood donor recruitment which involves awareness and promotion in the Solomon Island is found to be victimised by the lack of clear definition on the role of the MOH and Solomon Island Red Cross society (SIRC). While SIRC is being assumed to be responsible for donor recruitment, promotion and awareness this is not often possible due to lack of trained personnel and priorities. Red Cross recruitment personnel are only available in Honiara and the provinces are often confused as to which role they should assume. Furthermore Provincial laboratory staff are often manned by only one staff and are often too busy doing other diagnostic services to be involved in quality recruitment of donors. The following is being formulated in the workshop on Blood Bank held at the FFA conference center 10th –13th Feb 2003. Recommendation The Ministry of Health & Medical services and the Solomon Island Red Cross Society to clearly define the role of each partners in the recruitment of blood donor. 4.2.6
Dental (Oral) Services 2005
Services: Dental service in the past is mostly taken up by provision of pain relief, or emergency type of treatment. Very little emphasis is given on the preventive aspect of dental service thus the incident of dental problems are increasing in Solomon Island and without a proper national survey done on dental diseases no proper evidence based report will be given on the real picture of dental diseases and its prevalence in Solomon Islands. With the introduction of OP and its implementation, budgeting and prioritizing of activities with the best dental service outcome a new chapter to dental service in SI is being put in place. The introduction of computers, emailing and internet communication is made easy then ever before.. The skills of linking Operational Planning to the Budget process is gradually improving. The clinic infrastructure is deteriorating and needs a face uplift and renovation unless a new dental complex is being built. Statistics: NRH – Based on written data collected Approximately 10,156 patients seen at the NRH dental department in 2005. This includes both the adult and the children.
Ministry of Health: National Health Report 2005 Page 63 of 250 --------------------------------------------------------------------------------------------------------------------More then 50% of the patients seen are female. The commonest dental disease seen is dental caries, and treatment mainly carried out is dental extraction. Out reach programs 9 communities in the provinces. 7 school visits to HCC. 5 antenatal clinic visit and talks given 3 days a week dental out patient talks. Provinces - Provinces show the same pattern trend of cases and treatments .Integrated touring is one of the activities done in the provinces plus school visitations. Activity Report – progress against Operational Plan / Budget (include % for the year): Activities Completed. Training of Dental Assistants July and October 2005. Implementation of IC procedures Dental Health talk conducted in communities both Honiara and provinces (communities in Provinces visited AHA) Most time during the year is taken up by out patient duties. Activities Incomplete. Supervision tour Publicity and Promotion Electronic data collection system not in place yet. ACR forms although written not processed yet. Training – Only one officer / year need to send 3-4 officers for post graduate studies. Budget spending against OP. Report from Chief Accountant – MOH From the report it shows that only 19.2% of our budget of $240,000 is spent in 2005. The above summary report is not consistent with the requisition raised from the Dental Directors office. The amount raised from requisition does not match the cheques received. The problem faced is to raise requisition well in time before the actual activity commences. It is taking to long for money to be allocated. Health Outcomes (relates to goals/outputs/indicators): Goal – Increase primary oral health awareness program by 2010. Not all HCC schools visited – Transport problem. Health awareness by NGO – medical dental tours conducted ( Ngela, Auki, Ulawa, Santa Ann, Kirakira,Simbo, Ranoga) Adventist Health Association plus churches – 2005. Provinces – Integrated touring done Goal – To develop dental workforce, professionally efficient, responsible and productive. Strategies – Create incentives. Staff still not confirmed and promoted. ACR forms not processed to SPD Accommodation a problem affecting performance Paramedical scheme of service not implemented. All the above contributes to staff not
Ministry of Health: National Health Report 2005 Page 64 of 250 --------------------------------------------------------------------------------------------------------------------performing as expected. Training of Dental Assistants - Achieved Certificate given – dissemination of IC information to staff and implementation. Goal- By 2015 50% of dental manpower update on professional skills – provision of quality dental care. Number of Officers going for postgraduate training to increase to 2-3 / year. Only 1 officer going / year. Due to the above up to date knowledge and skills lacking within dental Service. Goal – To improve dental supplies delivery system to provinces by 2015. Computer install for dental supplies Training on how to do inventory. Provision of Computers to provinces dental service. Internet connected for access to dental catalogue to find out prices of materials and equipments. Not all our goals were met in 2005. Not the best dental health out come gain. However this is gradual. Hope to improve in 2006, with a more comprehensive and manageable OP HR issues: Directors post needs to be confirmed – still acting Oral Surgeons post needs to be filled – for the time acting . Dental establishment all post still on acting bases. Urgent need to train dental technician and therapists. Need to create Dental chair side Assistant posts to 6 provinces with dental officers. 22% Number Supervision tours nil Proportion of staff with ACR conducted completed 100% filled but only 9 submitted. Infrastructure / maintenance / equipment issues NRHCurrent infrastructure does not allow for full utilization of dental service. Purpose of a Referral hospital cannot be met. Some provinces operating space to small thus IC procedures cannot be fully met . Maintenance – Equipments use in dental need more specialized person to repair. Equipment - Current Dental settings in SI cannot cater for new equipped dental chairs. Only very basic chairs should be bought. Assets Inventory Completed? Inventory last updated on: NIl NO Issues for consideration in future planning 1. To reduce the no of out patients seen in NRH and to start implement more of specialized dental service 2. This will mean open dental clinics in HCC. 3. Change of current dental clinic setting. 4. Training of Dental Technician and Therapist, and continuous post graduate training of Dentist. 5. To improve on our current data collecting system.
Any other comments: To ensure that the new dental complex eventuate in the 4th phase of Hospital building constructions.
Ministry of Health: National Health Report 2005 Page 65 of 250 --------------------------------------------------------------------------------------------------------------------Summary of Major Constraints Strategies / Action plan for the way forward 1. Training of dental staff.
To review the training plan for the department.
2. Infrastructure
-Continuous dialogue with NRH administration regarding the new dental complex. - short term plan to improve Kukum dental clinic with HCC - To resubmit all ACR forms on a group bases.
3. Confirmation and promotion of all dental staff 4. Instrument shortage. 4.2.7
Prioritizing ordering of dental supplies.
Rehabilitation Division National Referral Hospital
Service Demand The most common demand on the acute rehabilitation services is the orthopedic. The unit also serves as may referral rehabilitation site for other centers. Total New On-going 1021 792 229 78% 29% In 2005, there were total of 1,021 treated. Of the total, 78% were newly diagnosed patients. The staff worked a total of 254 working days. 284 Orthopedic 116 Others 112 Fractures 103 Neck and Back pain 81 Neurological (other) 40 Pulmonary conditions 18 Diabetic 14 Chest Physio (post op) 12 Amputations 6 Spinal Cord injury 5 Burns 1 Gynae 792 Average case load per month attendances -275 Averages monthly case load -85 Average daily attendance per therapist -15 Number of patients treated in rehab unit -467 In 2005, the orthopaedic workshop under the Rehabilitation Division manufactured 15 prosthetics and repaired 11 (total of 26 done). Total of 246 were either manufactured (227) and repaired (18). Total of 16 calipers done, and 85 foot wears repaired. Issues/ Challenges Increasing need for specialist acute rehabilitation care at the hospital level. In 2005, 284 underwent orthopedic procedures were rehabilitation followed by 112 fractures, 103 necks and back pain, 81 neurological cases, 40 pulmonary conditions, 16 diabetics and 12 amputates18.
18
Source of data/ information: Gauba, C (2005). Rehabilitation Annual Report 2005, Ministry of Health.
Ministry of Health: National Health Report 2005 Page 66 of 250 --------------------------------------------------------------------------------------------------------------------Recommendations 1. To implement lower back pain and soft tissue injury awareness to the community.
Ministry of Health: National Health Report 2005 Page 67 of 250 --------------------------------------------------------------------------------------------------------------------4.2.8 Distance Education Program: Ongoing Education for Nurses: Background: The Ministry of Health and Medical Services has always provided some form of continuing education program for its staff in rural areas. The continuous need to update nurses’ knowledge and provide specialized training based on the following arguments Health is a changing science and much of what is taught during the basic training is forgotten with in five years. Knowledge can be forgotten. Professional isolation can cause deterioration in skills Roles change as nurses are promoted and take on new jobs. Roles also change as staff move between clinical hospital services and community health in rural areas Distance Education Program in Solomon Islands has grown from strength to strength since 1994 when it started with 15 students and materials were printed on stencil duplicator. The distance education program has moved on calm seas with the increasing number of enrolment and the waiting list. The program continues to enrol students in the five courses, which are Nursing Management, Obstetrics, and Family Planning, Community Health and Paediatric courses. Since 2000 there are over 209 students enrolled in five different courses and as many as 40% to 50 % of the Registered nurses and Nurse Aides have requested to participate in the program. This report will cover program activities from period beginning January 2005 to December 2005. The report will also high light the main activities which were carried out during the year. Activity Report-progress against Activities:
Operational Plan/ Budget (include % for the year: 2005)
Enrol new students in January /February in each course to maintain level at 20 active students per year. Database of students applications maintained Support continuing students to complete courses Students enrolled in three courses (FP pilot still being done) Management students to complete course before enrollment of students Ordering of textbooks for the students: Piloting the Family Planning Practicum in collaboration with RHD Conducted assessment of clinics/hospitals for Family Planning attachment – Choiseul province, Makira/Ulawa Province, Guadalcanal Province, Malaita Province and Honiara City Council. Conducted Family Planning Practicum Training in Isabel, Makira/Ulawa and the Western Provinces. Annual Health Outcomes )relates to Goals/ Indicators” Total of 21 nurses trained in comprehensive Family Planning Practicum course 15 graduates from the five courses offered by Distance Education Centre
Ministry of Health: National Health Report 2005 Page 68 of 250 --------------------------------------------------------------------------------------------------------------------HR Issues: The Program needs to have another staff – there is a vacant post for the position of a Senior Program officer that needs to be filled. Number Supervision tours conducted-6 Infrastructure Maintenance / equipment issuesCurrently the Distance Education office is located in the Planning building. However, the program needs space for tutorial and consultation purposes. The radio currently is okay however due to shortage of space it has been used as a storage area as well. There is a need for a photocopier to produce modules, it is included in the 2006 budget but there is no space to locate it. There is a computer and a printer – current status working Other major maintenance on the Equipment is carried out under the planning division. Assets Inventory Completed? YES Inventory last updated on: 2004 Issues for Consideration in future planning: The outcome of evaluation to be conducted in 2006 will influence future planning Anticipate writing up of Diabetes module and the Mental Health Course 2006/2007 Post of Senior Program Officer to be filled Completing of the pilot Training of the Family Planning Practicum in Malaita Province, Choisuel Province, Guadalcanal/Honiara City Council and Makira /Ulawa Province in 2006. Staff time for preparing and delivering training needs to be budgeted for in the future. Summary of Major Constraints Strategies / Action plan for the way forward Text books out of Print Books not arriving on time The need for a Senior Program Officer Low supply of Modules for students
Search and locate a new supplier/publisher Early submission of orders for text books Vacancy to be filled Need for a photocopy machine to produce modules when needed
Provinces / Divisions Training Database updated Please circle All activity acquittals completed and balance of cash returned to Accountant
YES YES
Ministry of Health: National Health Report 2005 Page 69 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 5 5.1
Health Burden
Overview:
This Chapter in its very brief, gives you some basic picture on the kinds of health burden and the contributing factors causing both negative and positive impact our people’s health. The health burden in the report is defined or related to the outputs or outcomes of the health status, whether it be the incidence of diseases due to a causative agent or physical, mental and social origin. The main source of data and information is the national Health Information System. It is due to limited data from the hospitals that the report concerns with illnesses causing burden to the individuals, families and communities. The population health is determined by the social origins of illnesses within the communities.
5.2
There are several major health issues affecting Solomon Islands
Malaria Acute respiratory infections STI/HIV High maternal mortality Diarrhea Skin diseases and yaws TB and leprosy NCD’s such as diabetes Mental health problems Access to sustainable clean water supply and sanitation
500 450 Rate per 1,000pop
400 350 300 250 200 150 100 50 0 ARI
clinical malaria
f ever
skin disease
Ear inf ection
yaw s
Diarrhoea
Red eye
Fig. 12 Commonest illnesses in 2005 in Solomon Islands in PHC Clinics: Fig. 12 provides evidence that the commonest illnesses suffered among the communities in the Solomon Islands which is Acute Respiratory Infections, follow by malaria (clinical diagnosed mainly by nurses at the clinics), fever (as recorded as non-specific), skin diseases and ear infections. Whilst there is limited information of the primary causative agents to the ARI history has shown in 2003 outbreaks that the cause of ARI was due to Influenza type A similar strain identified in Queensland. The issue of concern is the ongoing occurrence of skin diseases and ear infections. There are evidences that skin diseases as
Ministry of Health: National Health Report 2005 Page 70 of 250 ---------------------------------------------------------------------------------------------------------------------
5.3 5.3.1
Communicable Diseases: Acute Respiratory Infection:
ARI are important cause of morbidity in Solomon Islands, exceeded only by malaria In 2005 responsible for 25.5% of acute care contacts Population rate increased in 2005 (417 to 470/1000) (Fig 13). Rates in infants <1 have remained essentially unchanged. In children 1-4 increased in 2005 (Fig 14).
Rate per 1,000 population
2500 2000 1500 1000 500 0 2001
2002
2003
2004
2005
year total pop
<1
1 to 4
5+
Fig. 13 ARI Rate in SI, 2001-2005: Source HIS data/ Med Statistics, MOH 800 700 600 500 400 300 200 100 0
Guadalca nal
Makira
Temotu
Malaita
Renbel
Choiseul
Isabel
Honiara
Western
2001
180
349
531
363
576
588
601
469
420
2002
267
309
489
282
391
413
531
349
341
2003
331
320
450
218
639
480
493
383
304
2004
350
461
656
324
671
478
665
461
432
2005
527
465
634
339
549
399
539
535
458
Rate pe r 1,0001-4 pop
Fig. 14 ARI rate per 1,000 populations in 1-4 years age-group by provinces.
5.3.2
Clinical Malaria
Important cause of attendances at PHC for acute care services. In 2005 clinical malaria and fever were responsible 28% of acute care attendances (Fig. 15). Major cause of mortality in children and infants (Fig 16) The rate of malaria in pregnancy has remain essentially unchanged according to one measure (HIS) and has been found to be higher by another (Solomon Islands Reproductive Health Surveillance System) (approximately 8%)
Ministry of Health: National Health Report 2005 Page 71 of 250 --------------------------------------------------------------------------------------------------------------------Difficulties is assessing true rate due to problems with measurement (reporting by PHC clinics varies). Nonetheless the level of Malaria infection remains very high. Very high among children, and issue of public health concern still.
Rate per 1,000 population
750 600 450 300 150 0 2001
2002
2003
2004
2005
Ye ar fe ve r
c lin ic a l m a la r ia
F e v e r a n d c lin ic a l m a la r ia
Fig 15 Clinical Malaria rate per 1,000 populations 180,000
160,101
160,000 140,000 120,000 100,000
73,600
80,000
62,128
60,000 40,000
11,472
20,000 0 Clinical malaria total
Total in Children
No. cases 1-10
Total cases <1
Fig 16 Clinical malaria cases by age group in 2005 It is overwhelming that malaria infection in children and even worse under 1 year old remain a major health problem. This evidence calls for targeted point of service delivery on the various malaria control strategies. However, there are still issues surrounding the diagnosis of malaria as to differencing malaria infections from other febrile illness such as influenza and general clinical manifestations of other diseases.
5.3.3
Yaws and Skin Disease
Goal: reduce incidence of preventable skin diseases by 2010 (target yaws in children <5 reduce from 6.5 to 3%, skin diseases total pop. 9.6 to 3%): In 2005 slight reduction in yaws (this may not be sustainable based on previous trends) Skin diseases – increased population rate from 96 to 107 cases/1000 (10.7%)
Longer term implications of minor diseases e.g. skin diseases not well understand and may be harmful later in life as evident in Rheumatic heart and kidney diseases.
Ministry of Health: National Health Report 2005 Page 72 of 250 ---------------------------------------------------------------------------------------------------------------------
160 140
R a te p e r 1 ,0 0 0 p o p
120 100 80 60 40 20 0
Guadalca Makira nal
Temotu
Malaita
Renbel Choiseul
Isabel
Honiara Western
2001
24
47
48
61
78
20
18
21
64
2002
38
51
145
55
37
19
16
34
58
2003
74
77
141
65
55
40
24
49
77
2004
62
57
40
65
46
14
19
44
44
2005
62
67
41
56
27
21
18
39
40
Fig 17 Yaws Rate per 1,000 pop by provinces 2001-2005
5.3.4
Ear Infection 160 140
Rateper 1,000pop
120 100 80 60 40 20 0
2001
2002
2003
2004
2005
<1year
121
99
114
115
125
1 to 4 years
141
123
135
140
0
42
34
37
44
47
5+ years
Fig 18 Ear diseases rate per 1,000 pop by age-group The rate of ear infections also increased with 3 provinces - Guadalcanal, Honiara and Choiseul, the source of the majority of increased cases.
Ministry of Health: National Health Report 2005 Page 73 of 250 --------------------------------------------------------------------------------------------------------------------5.3.5 Red Eye: National rates of red eye rose from 26.7 to 33.9 per 1,000 between 2004-2005. Rates of red eyeye increased in Guadalcanal, Makira, Malaita and Honiara (Fig.19)
rateper 1,000population
70 60 50 40 30 20 10 0 2001
2002
2003 ye ar
2004
Re d e ye
2005
Ear infe ction
Fig 19 Rate per 1,000 pop Eye and Ear infections 5 yr trend. 60.0
R ateper1,000pop
50.0 40.0 30.0 20.0 10.0 0.0
Guadalca nal
Makira
Temotu
Malaita
Renbel
Choiseul
Isabel
Honiara
2001
14.5
28.1
29.4
30.0
24.7
43.0
47.8
20.8
2002
23.3
22.5
31.5
24.2
16.6
41.5
37.7
15.3
2003
36.2
29.6
21.0
17.9
23.5
34.5
29.9
15.6
2004
35.2
26.9
17.8
23.6
11.3
36.8
30.8
19.7
2005
41.1
43.3
27.1
32.3
20.5
27.6
40.0
25.5
Fig 20 Red Eye rate per 1,000 pop 5 yr trend by population.
5.3.6
Diarrhoea
Following a decade during which diarrhoeal disease rates more than halved (1995-2004), 2005 saw increased incidence (new cases) of diarrhoea and importantly, widespread increases of bloody diarrhoea It is likely that the bloody diarrhoea cases, indicate several outbreaks of disease Morbidity is highest in children <5 years
Ministry of Health: National Health Report 2005 Page 74 of 250 --------------------------------------------------------------------------------------------------------------------Fig 21 Diarrhoea (watery and bloody) Rate per 1,000 pop 5 yr Trend.
Rateper1,000population
60 50 40 30 20 10 0 2001
2002
2003 Ye ar
Total w ate ry
2004
Total bloody
2005 Total diar r hoe a
Fig 22 Diarrhoea Rate per 1,000 pop 5 yr Trend by provinces.
Rateper1,000population
30 25 20 15 10 5 0 2001
2002
2003 ye ar
Te m otu
M alaita
Re nbe l
2004
2005
Honiar a
We s te r n
2004
2005
Fig 23 Diarrhoea Rate per 1,000 pop 5 yr Trend by age group
Rate per 1,000 population
250 200 150 100 50 0 2001 < 1
5.4 5.4.1
2002
2003 ye ar
1 to 4
T o tal < 5
5+
Tuberculosis and Leprosy Control Program Tuberculosis Control Program:
Introduction The National Tuberculosis and Leprosy Control Programs have continued to be one of the priority public health programs of the Ministry of Health. The management and execution of program
Ministry of Health: National Health Report 2005 Page 75 of 250 --------------------------------------------------------------------------------------------------------------------activities are coordinated from the Disease Prevention and Control Unit by two seconded officers who report direct to the Under Secretary Health Improvement on matters related to the program Year 2005 has been a challenging but eventful year for the National TB and Leprosy Control Program where we saw the continued support from our existing partners like the Global Funds, World Health Organization (WHO), and Australian Agency for International Development (AusAID) and the Pacific Leprosy Foundation (PLF). Global Fund however is withdrawing its assistance from the TB Program as soon as phase two lapses The National Tuberculosis Control Program has continued to implement activities geared towards achieving the National and Regional targets. Our National and Regional targets which include: to increase case detection to 70% and to increase cure rate of newly diagnosed sputum smears positive cases to 85% has continued to be our focus of implementation Efforts continued to be made to ensure that the activities are implemented according to the approved operational plans and the link between the program and laboratory is maintained and well supported. For example, the DOTS strategy is maintained and continued to be applied during the intensive and continuation phases for monitoring of treatment. DOTS strategy as has always been said is the basic strategy to stop TB and the beneficiaries for using DOTS must be attained such as curing of illness, prevention of death, drug resistance and reducing the incidence of TB in the communities. Laboratory is the very important component in NTP as it plays an important role, not only to diagnose TB patients but also to monitor the progress of these patients (sputum smear positive cases) during treatment and to determine their cure. The Leprosy Control Program has also continued to implement activities that will maintain the elimination target of less than 1/10,000 population in the country. The Multi-Drug Therapy (MDT) strategy has been the core intervention measure to control leprosy and its impact must be well documented especially when the declining trend of leprosy prevalence has been noted for years. This annual report aimed to express the achievements and activities conducted by both the National Tuberculosis and Leprosy Control Programs at the national level and in the provinces during 2005. 5.4.2
Objectives of the National TB Program (NTP):
5.4.3
General Objective:
To reduce the mortality, morbidity and transmission of TB until it is no longer regarded as public health problem 5.4.4
Specific Objectives
To increase the cure rate of newly diagnosed sputum smear positive cases to at least 85% and To increase case detection to 70% of estimated incidence. Strategies of NTP Intensification of health education/promotion by using multi-media to increase community awareness about TB Expand and continue to implement Directly Observed Treatment Short course (DOTS) strategy up to community level Early case detection through direct sputum microscopy of chest symptomatic patients attending health services Regular supervision and monitoring of NTP activities at all levels.
Ministry of Health: National Health Report 2005 Page 76 of 250 --------------------------------------------------------------------------------------------------------------------Capacity building. 5.4.5
Activities Conducted in 2005
5.4.6
Health Education / Community Awareness
Community awareness on TB was further accelerated through community awareness meetings, workshops and the use of media to disseminate information. In 2005, we have only engaged the SIBC to broadcast our daily TB spots while community awareness meetings and workshops had been conducted in some Provinces including Honiara by different stakeholders: We have also developed a TB/ Video tape which featured mainly about the disease TB. Three of our Provincial TB Coordinators have conducted community awareness meeting each in Choiseul, Central and Makira/Ulawa provinces 6 community awareness meetings were held in some identified areas in Malaita, Guadalcanal and Central Provinces and were conducted by NGO groups especially the church women’s groups 4 community meetings were held in Honiara City Council Suburbs by the health team of Honiara City Council 5.4.7
World TB Day Commemoration – 2005
The Commemoration of the world TB day was held here in Honiara at the Honiara Central Market on the 24/03/2005. The slogan for the year 2005 was “Find TB, Cure TB. Cure starts with detection”. The slogan focused more on improving our case detection strategies to increase detection rates and putting them on treatment using our famous DOTS strategy. This slogan would like to see the improvement of our set targets which are stated below: Increase case detection rate of sputum smear positive cases to at least70% Increase cure rate of new diagnosed sputum smear positive cases to at least 85% or more In commemorating the day, several activities were conducted including speeches from the MoH and the World Health Organization Officials. Some other activities like – publication of TB articles on the Solomon Star, dramas, speech contest and distribution of leaflets on TB to the general public were also conducted during the day. Capacity building – In country workshops and Overseas training Capacity building was one of the on-going programs organized annually by the Ministry through our Department to strengthen and also to improve the knowledge and skills of health workers to enable them to perform their duties more effectively and efficiently. In 2005 the following training/workshops were conducted locally: One DOTS training for all Provincial TB Coordinators was conducted in May 2005 by Dr Ichiro Itoda -WHO Consultant was based in Suva – Fiji An annual review and planning workshop was also conducted in early December 2005 for all Provincial Health Directors, TB/Leprosy Coordinators. Three (3) Provinces namely Isabel, Makira/Ulawa and Central Provinces have managed to conduct one DOTS training each for their nurses in 2005 On overseas training and workshops - see Table 1. below: Table . International Training and attendance of meeting/workshops.
No.
Name and Designate
Duration
1.
Dr John Paulsen – Medical Officer -
30/03/05
Attended Course or Meeting Second Stop TB meeting
Ministry of Health: National Health Report 2005 Page 77 of 250 --------------------------------------------------------------------------------------------------------------------for PICT – Nadi Fiji DPCU to Noel Itogo – National TB/ Leprosy Coordinator 02/04/05 Raymond Zonnie – TB Coordinator – Western Province Silas Tuita – TB Coordinator – Makira/Ulawa Province 2. Oliver Sokana – TB Advocacy 12/04/05 Epidemiology training Facilitator to course on TB - Vietnam 30/04/05 5.4.8
Monitoring and Supervision:
Regular monitoring and supervision of program activities should be an on going activity to be provided by both the national and provincial program coordinators. This is done to monitor and assess the work performed by health workers, update of TB and Leprosy data in the provinces and also to provide guidance and support in terms on the job training on areas that need immediate attention. In 2005, the National TB Coordinator managed to conduct five (5) supervisory tours to 5 out of 9 provinces. These tours were conducted mainly in, Isabel, Malaita, Makira/Ulawa and Central Provinces. Tours by the Provincial TB coordinators within their own provinces showed a lot of improvement. The number of tours conducted depends entirely on their work commitment. Some provinces managed to visit all their clinics while others conducted their visits by zones. Others need to conduct supervision visits to their clinics as no excuses of funds will be accepted because funds for such activity have always been available. 5.4.9
Annual TB/ Leprosy Review
In 2005, the National TB/Leprosy Control Program conducted an Annual Review and Planning workshop which brought together all Provincial Health Directors and TB Coordinators to review and made operational plans for 2006. At the workshop did we see the provinces submitted their operational plan with budgets and what they plan to do. A lot of recommendations were made for the NTP to see and do in order to further improve the program 5.4.10 TB Situation by 2005 5.4.11 New Case Detection Rate: Case finding activities in most provinces were still not well implemented as most patients were detected through passive case finding. This has indicated by the number of cases reported to the central level from the provinces varies. Malaita reported the highest with about 43% of the total reported cases. The total number of TB cases (All cases) detected and reported to the Central Registry increased from 340 cases in 2004 to 397 cases in 2005giving a NCDR of 82 per 100,000 populations. A similar trend is also noted for Sputum smear positive by showing a small increase from 152 in 2004 to 174 in 2005 with a NCDR of 35 per 100,000 populations. The New Case Detection Rate (NCDR) in 2005 was about 82% for all cases and about 35% for Sputum Smear positive cases. Figure1 below illustrates the result of case finding as well as providing the trend of new case notification rates for all cases and sputum smear positive cases from 1996 to 2005.
Ministry of Health: National Health Report 2005 Page 78 of 250 ---------------------------------------------------------------------------------------------------------------------
National TB Notification Rate 1996 - 2005
Per 100,000 pop
100 80 60 40 20 0
96
97
98
99
0
1
2
3
4
5
All cases
80
77
64
70
74
70
62
64
72
82
PTB + ve
28
26
40
22
26
29
26
31
32
35
Table x National TB Notiication Rate 1996-2005
5.4.12 Case Notification by Provinces The number of cases notified to the Central Registry in 2005 by Provinces varies. Some provinces especially the bigger provinces like Malaita, Makira, HTC, and Western have detected more cases than others. The notification rates by provinces as shown in Figure 2 below probably indicate that a lot of TB infection is still around and we need to do extra work to reduce it transmission TB Notification Rate by Province 2005 (All cases) CHP
21
IP
33
CIP
36
Provinces
GP
39
TP
43
RBP
71
WP
77
SI
82
HTC
99
MP
113
MUP
115 0
20
40
60
80
100
120
140
Per 100,000 pop
Fig x TB Notification Rate by Province 2005 (All cases)
5.4.13 Age and Sex Distribution of New Sputum Smear Positive Cases By age and sex distribution affects almost all the age groups but when see the age and Sex distribution of new sputum smear positive TB cases reported to the NTP in 2005, it occur more frequent in age group 15 to 24 and 25 to 34. This is the most mobile and productive age groups in terms of family earnings. The overall standing for male to female ratio showed that more females had TB than male. There are many reasons for this, but females tend to stay most of the time at home in some confine environment where transmission could be high.
Ministry of Health: National Health Report 2005 Page 79 of 250 --------------------------------------------------------------------------------------------------------------------See (Annex 1) for age and sex distribution. 5.4.14 TB Infection by Site TB infection by site for 2005 as illustrated in (Annex2), showed that pulmonary TB represents more than 84% of the total cases reported to the central registry and 16% represents extrapulmonary cases that includes, Bone/Joint TB, Miliary TB, TB Meningitis and Others form of TB. Of the total pulmonary cases reported, 52% are sputum smear positive cases and 48% are smear negative cases. With this high number of sputum smear positives cases, transmission could could be high in the communities. This call for more effort in conducting contact tracing among the contacts of smear positive cases. See (Annex 2) for TB infection by site. 5.4.15 Case Holding and Treatment Outcome For standardization, targets for DOTS implementation must be adhered to by the Provincial TB Coordinators in monitoring the progress of DOTS strategy in the country. These targets which are mentioned in Box 1 were also documented in the National Tuberculosis Control Program Manual and also advocated by the WHO 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
To compare the above targets to what NTP has achieved with regards to case holding and treatment outcome, it has been the Policy for many years now that all TB patients should be hospitalized. This has facilitated and strengthened the TB program with regards to applying DOTS. In Solomon Islands, DOTS is currently 100% coverage nationwide. DOTS strategy is continuing to have impact on sputum conversion. Our records showed that in the National Referral Hospital alone more than 85% conversion rate was achieved after 2 months and 90% after 3 months of intensive treatment.
Ministry of Health: National Health Report 2005 Page 80 of 250 --------------------------------------------------------------------------------------------------------------------Cure and Treatment Success Rate - 1996 - 2004 100 90 80
Percentages
70 60 50 40 30 20 10 0
96
97
98
99
0
1
2
3
4
Cure Rate
30.8
74.3
83.3
78.4
68.4
68.4
71.3
72
58
Treatm ent Succes s Rate
87.5
92.4
92
86.3
92.1
92.1
92.6
90
87.2
Fig. x Cure and Treatment Success Rate 1996-2004
Figure 3 above illustrates the result of cure and Treatment Successive Rates (TSR) for the period from 1996 to 2004. It showed that the Treatment Successive Rate has dropped from 90% in 2003 to 87.2% in 2004.The Cure rate for 2004 dropped to 58%. These results showed that dual strategy had to be taken and where possible, sputum should be collected from all sputum smear positive patients for monitoring of cure rates. Again this calls for a concerted effort on the part of program coordinators and health workers in rural areas to improve DOTS strategy in every where possible. Table x. Provincial Cohort Analysis for new smear positive cases for year – 2004
Province
Cure No
CHP CIP GP HTC MUP MP TP WP YP RBP
%
1 50% TSR 1(50%) 3 50% TSR 5(83.3%) 8 50% TSR 16(100%) 19 90% TSR 19 (90%) 7 88% TSR 8 (100%) 34 46% TSR 58 (79%) 4 57% TSR 6(86%) 5 45% TSR 11 (100%) 4 100% TSR 4(100%) 1 100%
Complete
Transfer
Died
Default/Lost
Total
No
%
No
%
No
%
No
%
No
%
0
0
0
0
1
50%
0
0
2
100%
2
33.3%
1
16.6 %
0
0
0
0
6
100%
8
50%
0
0
0
0
0
0
16
100%
0
0
0
0
0
0
2
10%
21
100%
1
12%
0
0
0
0
0
0
8
100%
24
33%
0
0
5
7%
10
14%
73
100%
2
29%
0
0
1
14%
0
0
7
100%
6
55%
0
0
0
0
0
0
11
100%
0
0
0
0
0
0
0
0
4
100%
0
0
0
0
0
0
0
0
1
100%
Ministry of Health: National Health Report 2005 Page 81 of 250 --------------------------------------------------------------------------------------------------------------------TSR 1 (100%) Solomon 86 58% 44 30% 1 1% 7 5% 11 7% 149 100% Islands TSR 130 (88%) While it is pleasing to note that nationally, a high treatment successive rate was achieved, unfortunately provincial achievements vary considerably as indicated in Table 2 above compared to the global target of more than 85% cure rate. Actually provinces with more patients under case holding achieve less than 85%. Again provincial TB coordinators need to put more emphasis sputum monitoring at 5 months and at the end of treatment. This would give them a better chance of increasing their cure rates. Table x. Cohort Analysis for Extra- Pulmonary and Sputum Negatives – 2004
Province
CHP CIP GP HTC MUP MP TP WP IP RBP Solomon Islands
Completed
Transferred
Died
No
%
No
%
No
17 2 17 17 10 34 4 28 4 4 137
94% 67% 94% 89% 91% 68% 80% 80% 100% 100% 82%
0 0 0 0 0 2 0 1 0 0 3
0 0 0 0 0 4% 0 3% 0 0 2%
1 0 1 0 1 5 1 6 0 0 15
Default/lost
Total
%
No
%
No
%
6% 0 6% 0 9% 10% 20% 17% 0 0 9%
0 1 0 2 0 9 0 0 0 0 12
0 33% 0 11% 0 18% 0 0 0 0 7%
18 3 18 19 11 50 5 35 4 4 167
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Cohort analysis for sputum negative and extra-pulmonary TB cases for 2004 as shown on table 3 above was quiet satisfactory with 82% of the total cases had completed their treatment. The only concern here was the number of default and lost cases, which showed an increase from 7% in 2003 to 7% in 2004. Again this calls for proper recording and reporting and follow up of cases by program coordinators and health workers in rural clinics. 5.4.16 Tuberculosis Death. Death due to TB was also declining since 1997, though the cause of death was un-known. The results were derived from the cohort analysis from 1996 ~ 2004 and can be seen in (Annex 3). The number of TB deaths reported in 1996 was more than 10%, which was quite high compare to other years. The cause of death was unknown, but it was believed that some of the patients detected very late and died soon after the start of chemotherapy. Delay in case finding is still a problem, with cases diagnosed in advanced stages. The number of TB patients died on TB treatment while on treatment in 2004 was about 5.5% 5.4.17 Leprosy Control Program 5.4.18 New Leprosy Case Notification The number of new leprosy cases notified in 2005 was higher than that of 2004. About 25 new cases mainly from GP and HTC were notified. Other provinces did not report any case which may be due to no campaigns conducted in their areas. Leprosy Elimination Campaign is the strategy to increase community awareness that will foster new cases. This strategy should be carried out in areas in the provinces that are known to have high case loads in the past so to detect any new
Ministry of Health: National Health Report 2005 Page 82 of 250 --------------------------------------------------------------------------------------------------------------------case that may come out from those areas. The areas where campaigns were carried out were in Tetekaji and Belanimanu areas on Guadalcanal Province and in the Fishing Village area in Honiara City Council. Figure 4 below illustrated the trend of leprosy case notification from 1996 to 2005. The trend shows a fluctuation trend which indicated that a lot cases are still around and need to be detected New Leprosy Notification from 1996 - 2005 30 25
Number
20 15 10 5 0 New Leprosy cases
96
97
98
99
0
1
2
3
4
5
24
21
14
12
9
7
28
5
18
25
Fig. x New Leprosy Notification 1996-2005:
With this fluctuation trend, a lot of new cases may be still present in the communities which need to be detected. Again this call for concerted efforts on the part of program coordinators and health workers to conduct leprosy elimination campaign in the areas that were known to have high leprosy prevalence in the past. In 2005, the numbers of notified leprosy cases under 14 years old were only 4 cases which could indicate that a lot transmission has been taking place in the communities where these children were. None of these notified cases have developed any deformity which means that most of the cases were detected early and MDT has been very effective. 5.4.19 National Leprosy Prevalence It has been noted that the use of MDT has been very effective in the treatment and control of leprosy. In Figure 5 below illustrated the national prevalence rate of leprosy from 1993 – 2005. The trend showed a declining trend from 2/10,000 population in 1993 to 0.5/10,000 population in 2005. This showed a remarkable achievement by program.
Ministry of Health: National Health Report 2005 Page 83 of 250 --------------------------------------------------------------------------------------------------------------------National Leprosy prevalence Rate from 1993 - 2005 2.5
Per 10,000 pop
2 1.5 1
0.5 0 Leprosy prevalence
93 2
94
95
96
97
1.1 0.6 0.7
1
98
99
0
1
2
3
4
5
0.5 0.2 0.5 0.2 0.7 0.1 0.4 0.5
Fig x National Leprosy Prevalence Rate 1993-2005
The Global target to reduce the prevalence of leprosy to less than 1/10,000 population has already achieved this since 1995 as can be seen on the graph above, but at provincial level, especially on Guadalcanal and HTC, the prevalence of leprosy has not always been maintained at lower level as required. It’s always fluctuating. Extra effort is still required to identify those hidden cases in high prevalence areas of Guadalcanal, HTC and Malaita Provinces. 5.4.20 Capacity Building in Leprosy In 2005, we have managed to conduct another 4 days leprosy training workshop for all provincial TB and Leprosy Coordinators in October 2005 This workshop was conducted by a WHO consultant who was base in Manila – Philippines. The aim of the workshop was to strengthen the capacity of provincial program coordinators on Leprosy elimination. It increased their knowledge on how to diagnose and classify leprosy. It also helped them on how to plan and conduct leprosy elimination campaigns in their provinces. The training workshop was sponsored by the World Health Organization 5.4.21 Constraints and Weakness The TB and Leprosy Control Programs despite having achieved some progress and good results, are like any other programs of the Ministry of Health also has gone through some constraints and weakness which in some other ways hinder the progress of these two programs both at the National and Provincial levels. Below are few of these constraints faced: There is inadequate manpower and frequent changes of Provincial TB Coordinators. At National level we now have two staff looking after the whole program while at the Provincial level; we have gone through few changes. Six provinces have new coordinators and these people have to be trained before they could do their job as required Recording and reporting between national and provinces is still one of the set back in TB program. It’s difficult to get reports in time from some provinces where transport again is another problem. Lack of TB beds in some Provincial Hospitals is a big concern because patients have been discharged too early causing difficulty for nurses to manage in clinics especially when patients are still in phase1 or intensive phase of treatment..
Ministry of Health: National Health Report 2005 Page 84 of 250 --------------------------------------------------------------------------------------------------------------------5.4.22 Recommendations: These recommendations are broad but are important as they should provide a frame work for reactivation of program activities which could be the set back in the progress of these programs. All Provincial TB/ Leprosy coordinators be given at least two years to look after the program before allowed to change or post to other provinces. Posting should be done on swap basis with the other coordinators Promotion for all Provincial TB/Leprosy Coordinators should be reviewed by all provincial heads so that all coordinators be at the same level. Strengthen the record and reporting system at the provincial level by providing E-mail system to all provinces so reports could be sent electronically to avoid delays. The IEC unit of the Ministry be given provision to review all IEC materials and develop the required amounts require by each programs. 5.4.23 Acknowledgement The National TB/Leprosy Coordinator wish to acknowledge all the Provincial Program Coordinators, Doctors, Laboratory Technicians, nurses and those who have contributed to the overall implementation of the two program activities in the provinces and looking forward for better collaboration and integration of activities in the years to come. 5.4.24 Compiled By: Noel Itogo National TB & Leprosy Coordinator Ministry of Health & Medical Services Honiara, Solomon Islands. 5.4.25 Core Indicators for TB Program in 2005: Table x: CI: Age and Sex Distribution of New Smear Positive cases 2005
AGE GROUP ( YEARS) Provinces 0 - 14 15 - 24 25 - 34 M F M F M F CHP 0 0 0 0 0 0 CIP 0 0 2 1 0 2 GP 1 0 0 1 1 5 HTC 0 2 5 10 4 3 MP 3 5 5 7 7 7 MUP 0 2 0 2 1 1 RBP 0 0 0 0 2 0 TP 0 0 0 1 2 3 WP 0 0 2 0 1 0 YP 0 0 0 1 0 0 SI 4 9 14 23 18 21
35 - 44 M F 0 0 0 0 1 0 2 0 5 6 1 2 0 0 0 2 0 1 0 1 9 12
45 - 54 M F 0 0 0 0 1 1 0 2 8 3 3 2 0 0 2 0 1 2 0 1 15 11
55 - 64 M F 0 0 0 0 1 0 3 1 4 7 3 1 0 0 1 0 0 0 0 0 12 9
65 + M F 0 0 0 0 2 0 2 0 4 0 1 0 0 0 1 0 1 1 0 0 11 1
Total M F 0 0 2 3 7 7 16 18 36 35 9 10 2 0 6 6 5 4 0 3 83 86
Ministry of Health: National Health Report 2005 Page 85 of 250 --------------------------------------------------------------------------------------------------------------------Fig x C2: TB Infection by site 2005
TB Infection by Site 2005
2% 2% 5%MTB, OTHERS,GTB, 6% BJTB,
PTB, 84%
Fig x C1 3: TB Death Rate from 1996 - 2004
TB Death Rate from 1996 - 2004 14 Percentages
12 10 8 6 4 2 0 Death Rate
96
97
98
99
0
1
2
3
4
11.8
4.7
3.9
4.1
3.1
3.1
3.9
5.5
5.5
Years
5.5 5.5.1
Environmental Health Overview:
Environmental Health Division implements it plan of action for 2005 with the aim of fulfilling its policy statement of “Safe and healthy environmental is the ultimate outcome for the people of this country.” To achieve this approach is to be holistic in the development and implementation of the health initiatives that are consistent with the themes of New Horizons in Health and the Yannca Island Declaration of Health in the 21st Century. EHD has set the policy goal to strengthen it services in particular on these areas: Promotion of safe and clean water. Promotion of proper sanitation and waste disposal Food hygiene and quality (Inspection & certification) Sanitary inspections (General)
Ministry of Health: National Health Report 2005 Page 86 of 250 --------------------------------------------------------------------------------------------------------------------Sea and Airport health quarantine services Health and safety at work place Human resources development Review and develop health regulations. 5.5.2
Priority Strategy/Action
5.5.3
Immediate
Construction of proper water supply and sanitary disposal of human excreta in the rural villages and in urban settings. Vetting of Food Hygiene and Fish and Fishery Regulations for gazette and put to use. Strengthen food safety programmes and functions of the Health Competent Authority (Inspection & certification) Implement regulatory activities in accordance to the provision of: Environmental Health Act, Health Quarantine Act Pure Food Acts and subsidiary legislations. Gazette SARS and HIV AIDS as notifiable diseases under the Environmental Health Act. Community awareness on food safety and hygiene and safe water. Construction of Public Health Laboratory and supply of equipment for laboratory uses. Up-date EHD human resources development. 5.5.4 Long Term Objectives Public Health Laboratory to be Separate Division form EHD Health Competent Authority to be a unit within EHD Establish Occupational Health Unit to deal with all workplaces and homes. Establish solid and Industrial waste management unit within EHD National RWSS program to be sustainable in it’s operation Review existing legislation and introduce relevant regulations 5.5.5
Strategies for 2005
The Government’s policy and decision to support RWSS programme and to fulfil the regulatory activities as provided for under the Principal Acts on environmental health issues and to respond adequately to the impending environmental problems of pollution, and waste disposal and management of hazard and industrial wastes EHD has within its organization the following units developed and set in motion to deal with specific issues: RWSS Unit Food Safety and Quality Control – (Inspection & Certification Unit’ Health Quarantine Services Public Health Laboratory Training & IEC Administration and Management. RWSS (Rural Water Supply and Sanitation) Construction of rural water supply and sanitary facilities for rural communities as shown in the attach report for 2005 The programme objectives were to complete the outstanding rural water supply projects funded under the followings:
Ministry of Health: National Health Report 2005 Page 87 of 250 --------------------------------------------------------------------------------------------------------------------a) EU – Micro Scheme, b) Japanese Grass root Programme c) ROC d) Other donors e.g. Canada Funds . Refer to report attached for achievement in population coverage. Production of posters and use of health promotion radio programme on health related issues has captured topic on water and sanitation and food safety issues as part of awareness programme to the general public. Provincial Environmental Health outfits continue to organize pre-construction and post construction awareness talks to communities who have their water supply project completed and commissioned for use Collaborative programmes with provincial Health Promotion staff in the province on sanitary disposal of human excreta and hygiene use of sanitary latrine of water sealed technology continue to gain momentum. This has been measured by the number of request for the supply of PVC water seals from provinces. 1000 units of PVC water sealed latrine ordered in 2005 fall short of meeting the demand by provinces. Incorporation of hygiene practice in the early childhood education project under New Zealand Government Assistances has seen the Curriculum Division of the Ministry of Education developed materials for use in the primary schools throughout the country. Community participation in the construction of water supply and sanitation has been good and education on the maintenances and operation has formed the part of the post awareness programmes by construction teams. 5.5.6
Solid Waste
Joint efforts with Honiara City Council (HCC) Environmental Health Division has been very good, assistances to improve situation by spreading the huge refuse crudely damped at the site with a dozer was a short term measure. Lack of funds could not allow for long and permanent hire of dozer for this work. However, the problem of space to allow for more waste to be damped at the site was partially resolved, though temporary in nature. The permanent solution of available land for a new dump site is still far from over therefore, other measures have to be employed such as the current method of compacting refuse to an acceptable height above the ground level. This is what is being done at the dump site which appears to contain the current problem but the question of available land for the new site must be addressed as this is the only permanent solution to the problem at hand. Financial constrain with HCC could not allow for regular collection of city refuse, hiring of private contractors for refuse collection was good but need proper supervision as the exercise was experimented to supplement HCC’s own programme. Coordination with SPREP has resulted in New Zealand Govt. support to fund waste control and management, campaign to be launched early 2006. Problem of waste management at provincial headquarters due mainly to lack of available land and financial resources. Crude damping is still practiced in all centres. The scavengers at Ranadi damp were all sent home at the end of 2005 with assistance for them to make new life at their respective village. Question of available land for new dump site for Honiara and Provincial Centres still not resolve by the office of the Commission of Lands therefore, no submission done to the National Planning for capital project to address solid waste management situation in Honiara and Provincial HQs. in 2005.
Ministry of Health: National Health Report 2005 Page 88 of 250 --------------------------------------------------------------------------------------------------------------------5.5.7 Net Working with NGOs EHD maintain its networking with NGO’s in its effort to be successful with rural water supply and sanitation programme in the rural villages World Vision Solomon Islands has supported water and sanitation programme in the Marau area and south Guadalcanal by putting finance and its workforce under its management to construct water supply and sanitation projects. During 2005 some skilled workers from EHD of Guadalcanal Province was released on unpaid leave for a specific period to serve with World Vision Solomon Islands in managing its water and sanitation programme. Statistic on the number of projects completed for 2005 was not available to me right at this time but I should get it in the course of the week. SIDT with its village education programme often used when required and funding is available. EHD was not able to use their services due to resources constrain particularly finance during 2005. 5.5.8
Integrated Research on Approaches
Integrated research into healthy approaches to sanitation in villages was carried out by graduate students at Fiji School of Medicine in 2005 as a project (thesis) for a BSc degree in Environmental Health Science. This study was done in Guadalcanal during 2005 and the officer will organzine series of talks on his studies to staffs of EHD in a hope to devise new approaches to sanitation in rural Solomon Islands in 2006. National EHD and Guadalcanal Province EHD had supported this staff with logistics while conducting research locally and to complete the field studies in the time allowed before returning to Fiji school of medicine for write up. The officer returned from overseas studies end of 2005. 5.5.9
Food Safety and Quality Control- ICU
This is systematic surveillance and monitoring of food production, processing, handling and distribution for sale / export. The system ensures that local and imported food stuff meets the standard and conformance of the country of origin and that of Codex Alimentarius Commission. Solomon Islands have adopted the Codex standards for food processing and manufacturing both for local and international markets. Series of activities on this was curried in 2005 leading to opening of international markets for Soltai and Fish Processing Co to export tuna loins to Italy and Spain. The project to provide technical services to the Environmental Health Division, MHMS known as “ Strengthening the Sanitary Production of Fishery Products (SSPFP) was finalized with the Project Management Unit (PMU) for funding by EU in 2005. Minister for National Planning and Aid Coordination has approved the project being the Authorising Authority July 2005. Tenders were called for and decided by the committee comprising of various experts using EU rules to decide the wining bidder. “Gillett and Preston and Associate Inc” was awarded the consultancy for a period of 18 month to assist EHD develops the Competent Authority so as to be better able to perform its functions. One major task to achieve during the life of this project is for the EU to recognise the Solomon Islands ‘C A’ to rule on sanitary standards for fish and fishery products. The recognition of EHD-‘CA’ will allow the Solomon Islands from among the ACP countries to be elevated from Group II to group I in order that Solomon Islands can have wider trading scope than when the country remain in Group II. This project commence in November 2005 under the supervision of the Director for the EHD, MHMS whilst the PMU is the Managing Authority for this project. The Team Leader and consultants have occupied an office within the Environmental Health office Building to work closely with the Project Supervisor and the staff of “CA” A review of the licensing and registration of food establishments in Honiara revealed 65 in procession of valid licence to prepare and sell food to public including Hotels, restaurants and snack-Bars. Those who are not registered but engage in the sale of food in the streets or target offices had been warned to discontinue or face legal action.
Ministry of Health: National Health Report 2005 Page 89 of 250 --------------------------------------------------------------------------------------------------------------------Inspectors have been trained on “hazard analysis critical control point (HACCP) and to conduct health auditing on industries involve in the preparation, processing and packaging of food projects for local sale / export. Under the current SSPFP training of inspectors and laboratory staff (PHI) will be arranged in 2006 with overseas laboratories food manufacturing co, on work attachment Food samples for micro tests have been analysed at the Public Health Laboratory while for chemical tests samples had been sent to USP / Australian laboratories. The SSPFP will assist with supply and calibration of equipment and training of staff in 2006. Laboratory testing plays a vital role in the quality and control measures applied in the food trade. WHO has supported local training of food handlers and food processing workers from factory, hotels and restaurants through workshops organised by EHD. Similar workshops had been organized in the provinces for mothers who involve in the home preparation of food for sale so as to be issued with certificate of recognition. There were total of five workshops conducted in 2005. 5.5.10 Health Quarantine Services Sea and airport health quarantine services continue to play its roles in the monitoring of vessels arriving in Solomon Islands on international voyages and aircrafts arriving at the international aerodromes. Honiara has two staff while Gizo, Noro, Lata and Tulagi has one staff each at the declared ports of entries. Honiara being the main port of entry to Solomon Islands recorded the highest number of foreign vessels entering Solomon Islands. There were three hundred and fifty (350) vessels declared under the Maritime Declaration of Health as required under the international health regulation. There was no threat of spread of quarantinable diseases but due to threat of bird flu foreign ships are subjected to thorough inspection for storage of life birds on board and to prevent such form getting on shore. Custom, plants Health Quarantine are collaborating very well in this activity. The activities will continue on in 2006 until such time the threat is removed. 5.5.11 EHD Training Report 2005 This annual report covered three area of training: a) The overseas scholarship, b) Local training courses / workshop in food Safety and IPAM courses. c) The Food Safety and Hygiene workshop for awareness in Provinces as planned under the WHO local Budget for 2004/2005. Request for overseas scholarships usually submitted EHD annually to MHMS Training and Fellowship Committee as outlined below: 1. IPAM Courses NO 1.
COURSE Human Resources Management
PARTICIPANTS David Ho’ota Jack Filiomea Emmanuel Rarumae
DATE/DURATION 17th - 23rd May 2005
2. Food Safety and Hygiene Training Workshop-2005 No 1. 2. 3
TRAINIG WORKSHOP Food Safety Food Safety Food Safety (2)
PROVINCE Lata/Temotu Taro/ Choiseul HCC/Honiara
WORKSHOP FACILIATOR (S) Ethel Mapolu Jocab Makini & Mark Arimalanga Ethel Mapolu, Mark, Patricia
Ministry of Health: National Health Report 2005 Page 90 of 250 --------------------------------------------------------------------------------------------------------------------Scholarship Training-2003 – 2005 NAME Joe A Maeohu Jay Semah Kabei Atkin Vilaka Edward Sarifu Ethel Mapolu
COURSE BSc Environmental Health BSc Food Technology Dip. Environmental Health Dip. Engineering BSc Environmental Dip Food Tech
INSTITUTE FSM –Fiji
DURATION 1 yrs 2004
University of Sydeny FSM-Fiji
1 yrs 2004
FIT-Fiji FSM UWS Hawkesbury
3yrs 20032005 2 yrs 20042006 2yrs 2006
REMARKS Must complete final project Course completed Course ends 2005 Course 2006 Begins 2006
2007 Chris Ruku
BSc Applied Science in Environmental Health
UWS Hawkesbury
Bobby Patterson Fred Napthalai
BSc Environmental Health BA Community Planning & Development
FSM- Fiji
George Titiulu
BSc Environmental Health
FSM -Fiji
2008
LAT TROBE University Victoria
2yrs 20062007 2008 2006
Awaiting MHMS/PSD decision Begins 2006 Awaiting MHMS/PSD decision Begins 2006
Appointments to Senior Positions There are senior positions for Chief Health Inspectors post for Malaita, Honiara City Council and Western Province have had ACRs and appraisal forms completed in 2005 but the appointments were not eventuated. The delay has demoralised officers hence we need to get this done. Officers earmarked for these posts are all graduates. EHD had total budget for 2005 of SBD 470,400-00 excluding donor direct support to rural water supply projects where communities applied to donors for funding of their water supply projects and approved by EHD/RWSS for implementation. The EHD wish to express its disappointment when told in 2005 that we had exhausted our 2005 allocation only to be advised later there was a cut off point in the budget that we were not allowed to go beyond that. We would appreciate clear advice from chief accountant on issues of this kind in future.
5.6
Non- Communicable Diseases
The challenges with dealing with NCD problems:Chronic non-communicable diseases such as diabetes require lifelong care: Billed people with NCD stay in the hospital for longer time, therefore having a huge demand on finance, beds to keep them. Early detection and management before the onset of symptoms can reduce long term problems In Solomon Islands rising rates of NCD especially diabetes are contributing to renal failure that requires costly interventions
Other NCD problems: Diabetes
“NCD increasing, and thus needs more efforts in prevention, care and control”
Ministry of Health: National Health Report 2005 Page 91 of 250 --------------------------------------------------------------------------------------------------------------------Renal diseases Hypertensive problems Heart diseases Trauma/ Injuries Psychosocial problems Substance abuse-marijuana Mental Health- Increasing neuropsychiatry conditions- due to alcohol use and self-harm. 17.6% of the total disease burden is due to neuropsychiatry conditions, with 5.5% due to problems related to Alcohol use. Another 2.6% is due to intentional self-harm.
Leading causes of morality 1990:1999:2003 Leading Causes of Death in SI 1990-2003 14 12.9
Specific death rates (%)
12
Cancer (all)
11.7 10.8
10
Malaria
9.5
8.9
CVA
8
8 7.6
8
6.3
6
6.1 6 5.6
4.8
4.7 4
3.2 2.6 2.0 1.2
2
2.9 2.6 2.1
1.6 1.5 1
1.4 1.4
0.79
0.7
0.2 0.0
0
4.4
4.1 3.9 3.4 2.8 2.5
3.6
1990
5.5
1991
1999
3.7 3.1 1.8
Pneumonia/ meningitis Hepatitis/ Suicide Renal Failure/diarrhoea Trauma/ cardiac failure
1.2 2003
TB/ Neonatal causes
Diarrhoea
Pneumonia
Neonatal causes
Total cancers
Malaria
Tuberculosis
CVA
Septicaemia
Trauma
Suicide/Homicide
Meningitis
Diabetes
malnutrition
Mycardial infarct
Hepatitis
Asthma
Renal failre
Cardiac Failure
6
Fig 24 Leading Causes of death: NCD
5.7
Community-Based Services:
5.8
Social Welfare Division:
5.8.1.1
Brief Background/Introduction:
Social Welfare Service as the State Service was introduced in mid 1960s. Urbanization and growth in Honiara Town had not only brought about economic and social benefits but also introduced changes that had negative impact on people’s life. Many young people and women moved to Honiara and other urban centers seeking employment. Most of them had left their villages, schools or control of parents, family or traditional social safety net for the first time therefore were vulnerable to new changes and environment. Initially Social Welfare work targeted women, youth/children and destitute. These are vulnerable groups. As a result of this concern, following legislation was enforced:The Affiliation, Separation & Maintenance Act 1971;
Ministry of Health: National Health Report 2005 Page 92 of 250 --------------------------------------------------------------------------------------------------------------------The Juvenile Offenders Act 1972; Adoption Act; Education Act – Remission of School Fees; Policy Paper on Probation Service in Solomon Islands 1992; Provide Child Protection; 5.8.1.2
Social Welfare Data Summary (Brief):
In 2005, the number of custody cases dealt with by the Family Welfare Section has decreased compared to year 2004. This was so because in that year, Law and Order in this nation is very weak and many men had left their wives and marry their 02s. In the Juvenile Justice Section there is also a decrease in the number of cases dealt with compared to the 2004 records due to the gradual return of Law and order. Last year has also seen a rise in the number of self-referral cases due to the confidence and trust individuals have and placed on the Ramsi and SI Police. Custody Cases (Family) 15 cases Self Referrals 65 cases Juvenile 21 cases Adoption 1 case School Fee Remissions 10 cases 5.8.1.3 Organization & Staff: Social Welfare Office: HQ 5 established staff 1 Secretary Typist Male 2 Female 4 Gizo Office1 Male Total = 7 Movement of Staff Recruitment Nil Retirement Nil Redundancy Nil 5.8.1.4
Trainings Undertaken During the Year:
Paul Aaron
-
None None
Joana Ahikau Human Resources Management Course (IPAM) From 16/05/2005 to 20/5/2005; Introduction to Laws of SI from 8/8/2005 to 12/8/2005 Hellen Kotty: Human Resources Management Course (IPAM) From 16/05/2005 to 20/5/2005; Introduction to Laws of SI from 8/8/2005 to 12/8/2005 Judy Basi: Introduction to Laws of SI 8/8/2005 – 12/8/2005 Overseas travel during the year – None
Ministry of Health: National Health Report 2005 Page 93 of 250 ---------------------------------------------------------------------------------------------------------------------
Ministry of Health: National Health Report 2005 Page 94 of 250 --------------------------------------------------------------------------------------------------------------------5.8.1.5
Organisation Structure:
ESTAB 2005 1 1 1 1 1 1 1 1 1 1
ESTAB 2006 1 1 1 1 1 1 1 1 1 1
10
10
5.8.1.6
POST Head Social Welfare Chief Social Welfare Officer Child Protection Specialist Senior Social Welfare Officer Senior Social Welfare Officer Social Welfare Officer Child Protection Trainer/Advocator Probation Officer/Supervisor Probation Officer/Supervisor Secretary/Typist
GRADE LEVEL 12/13 9/10 8/9 7/8 7/8 6/7 6/7 6/7 6/7 5/6
NOTES
Vacant Post
Vacant Post Vacant Post Vacant Post
Activities Taken During the Year:
Family Court: Report Writing Home Visits Court Attendance (b) Juvenile Court: Report Writing Home Visit Court Attendance (c) Adoption: Report Writing Home Visit Court Attendance (d) Destitution: Cases and asking for Assistance from Red Cross;
è
Assessing Destitute
(e) Education Act: Remission of School Fees: Assessing applicants and submitting reports to the Ministry concerned and the two Gov’t Schools or to Other School Boards; To provide Child Protection; To provide Community Service Sentencing Alternative to Young Offenders; To play an effective and supportive role in raising Awareness and Advocacy on issues and problems affecting women, children and other disadvantaged groups; 5.8.1.7
Activities and Achievements:
Ministry of Health: National Health Report 2005 Page 95 of 250 --------------------------------------------------------------------------------------------------------------------On 12/05/2005 – Social Welfare Division purchased a through the recurrent budget. Now it is easier for us to see our clients, make home visits and to run other office activities. The Social Welfare Consultant (Mr. Allen Stewart) came last year to make a review of Social Welfare and to make new Strategic directions for the Division. The job done by this Consultant was funded by Save the Children Australia. He was working closely with the Head of Division, (Paul Fia). What has not been Achieved? To develop Child Protection Policy for S.I. (Draft) not Endorsed; To get two Probation Officers/Supervisors; To get one Child Protection Specialist; To get Child Protection Trainer/Advocator; 5.8.1.8 Annual Health Outcomes (relates to Goals/Outputs/Indicators: Goals: To provide Child Protection Services; To provide Community Service Sentencing; Alternative to Young Offenders; To ensure effective provision of functions and services; To play an effective and supportive role in raising awareness and advocacy on issues and problems affecting women, children and other disadvantaged groups; To ensure effective Probation and Juvenile Services; The number of cases recorded last year were the only cases been referred to the Division by the Magistrate/High Court and the Police. 5.8.1.9
HR. Issues:
In year 2005, Social Welfare Division has a total staff of 7. As of early this year, two of our top officers (Paul Fia and Aaron Olofia) had resigned to run in the upcoming election and there leaves only two of us (Hellen and Joana) to do operation and at the sametime acting the post of Director and the Chief Social Welfare. Last year Judy Basi was given a hand with the two sections of the Division and this was really helpful. As of this month, it was suggested by our previous Chief Social Welfare Officer that Judy should be posted to Gizo due to some personal family problem. Timothy Tabare (L5 Officer) was manning the Gizo Office. This officer is mentally sick and he needs a doctor to assess his situation and do something about it. As of 13/12/05, this officer had been adviced by the Provincial Secretary to stop working until further notice. This was due to an incident that happened between this officer and the Health Provincial Minister. At the moment he is on suspension. There is need that Malaita, Makira and Ysabel’s posts should be filled if its been budgeted for. In Honiara there is need for the posts of the Director and the Chief Social Welfare Officer to be filled immediately. Also we need two extra new staff to help out. At the moment only two of us are working and its too much for us. What we are doing now is just doing our routine job. Number Supervision tours Conducted
Proportion of staff with ACR completed 3
% 0
Ministry of Health: National Health Report 2005 Page 96 of 250 --------------------------------------------------------------------------------------------------------------------5.8.1.10
Infrastructure/Maintenance/Equipment Issues:
Social Welfare Office is been renovated and it was good. But I think if we are to get extra staff then there is need for an extension of this office. Also we need some new chairs to replace the old ones to look more like an office. We also need one typist’s chair. Assets Inventory Completed? YES/NO
Inventory last updated on: NO
5.8.1.11 Issues for Consideration in Future Planning: Inventory of all office assets; Keep proper record of tours annual confidential reports; All vacancy must be filled especially provinces; Training for In-Service Staff; We need 2 computers; 5.8.1.12
Any Other Comments:
The Post of the Director and the Chief Social Welfare Officer must be filled immediately with the other two additional posts.
5.9
Summary of Major Constraints
Strategies/Action Plan for the Way forward
Some of the things that hinders The division from achieving. Some of their goals/activities is lack of consultation between Government Ministries and NGOs and also lack of funding.
Social Welfare Division should work closely with other Government Ministries and MHMS, Divisions and with all Non-Government Organisations who are dealing with Youths, Women and Children.
Health Promotion:
5.9.1 5.9.1.1
Activities and Accomplishments National Level
The Operational Plan 2005 was subdivided into Administration and Management, Human Resource Development, Community Settings, Media and IEC and Research and Development. Under the Administration and Management, the department was able to implement only 64 percent 9/14 of the planned activities. Four of the activities which required (STC) were not implemented because of their non availability. For the Human Resource and Development, the department was only able to implement 78 percent 7/9 of the planned activities. The only two activities not implemented were policy related needing the (STC).
Ministry of Health: National Health Report 2005 Page 97 of 250 --------------------------------------------------------------------------------------------------------------------For the Community Settings component, the department was only able to implement 50 percent 7/14 of the planned activities. The difficulty encountered was to do with the delays in the securing of funding and the non availability of the coordinator. For the Media and IEC component, the department was able to partially implement 86 percent 13/15 of the planned activities. The two activity not implemented relates to IEC training (WHO) and (STC) policy related activity. Of the 13 activities, only 54 percent was implemented completely. We do not have the capacity in 2005. And finally for Research and Evaluation component, only 32 percent 2/6 of the planned activities were implemented. Low implementation rate is due largely to non availability of a social research officer we long for years now. 5.9.1.2
Provincial Level
Firstly the Provincial Operational Plans were developed entirely by the provincial health promotion staff and their Director of Health Services. Health promotion departments at the provincial level do submit annual reports to the national level. A reporting template have been designed and provided for the provincial annual reports. In the 2005, provincial health promotion annual report were compiled under four subjects Community trainings and Workshops, Community Settings, Media and IEC and Research and Evaluation. The community trainings and workshops conducted data reported and compiled was 68 altogether. This figure had dropped markedly by almost 66 percent from 2004. The huge drop was attributed to non availability of funding for needed community training activities. For the health promoting school programs, there was increase in the number of model schools from 1 in 2004 to 14 in 2005, health instructions and health inspections was 208, health services was 20 and community school organizations was 25 altogether. The increase in activities is indicative the better understanding of the health promoting school concept and need to address school health problems. In the work place settings, health promotion units were able to organize over 100 nutrition and health talks with video shows, medical examination (weight & height, BP and Glucose) and physical exercise for workers. A healthy workforce in a healthy work environment is the target. In the market place setting, health promoters were able to conduct 104 health talks, coordinate cooking demonstrations, health campaigns and distribution of IEC materials with health video shows. This is a good learning opportunity for the market authorities, producers and buyers. In the primary health care facilities and hospitals the health promotion staffs were able to coordinate and conduct 89 health talks and video shows targeted at visiting ANC mothers, PNC mothers, child welfare clinics, general out-patients and in the wards. These captive audience learn a lot from the health information disseminated. For the healthy town, three of the provinces were able to conduct (19) healthy town activities ranging from clean up campaigns, public health talks and video shows and inter departmental soccer competitions. All residents are targeted to empower them to make informed choices in life. Finally the healthy village and settlements the promotion staff were able to implement the following health activities in the communities. Village health inspections with health meeting (319), village health talks with video shows (247), village health campaigns (59), village implementation programs (174) and village health committees (41). These should empower the people participate fully in improving their health status.
Ministry of Health: National Health Report 2005 Page 98 of 250 --------------------------------------------------------------------------------------------------------------------The increase in the community settings activities is indicative of the health promotion staff understanding of the Settings concept to empower the communities to enable them to find solution for their own health problems. Media and IEC is another provincial activity reported in the 2005 annual reports. Notably only two provinces had reported the use of radio and newspaper. Honiara, City Council reported producing (112) radio programs and the Western Province reported (31) programs. These programs in the mass media can reach large population and influence people’s behavior. Further more only one province the HCC has produced 38 health columns in the Solomon Star paper for the general public in 2005. More over all provinces do not any production of IEC materials but they reported receiving from the national level. None of the provinces had reported having conducted any research or evaluation activities. The only M & E activity conducted was training post test and pretest, community profiling and pretesting of IEC materials. 5.9.1.3
Financial Information
This information was retrieved from the Ministry of Health Accounts Division. A budget of SBD $478,500 was approved for the National Health Promotion department. Only SBD $258,337.85 or 54 percent was expended in 2005. Budgeted activities not expended were research, IEC Training (WHO), Communication & Teaching skills and IEC production (video/print). Entry errors were identified under sub-heads (fuel & Oil, vehicle maintenance) which we were incorrectly advised to have been exhausted but still has outstanding balances. Constraints experienced with the budget was to do with repeated delays of funding request, infrequent statement of expenditures, non-availability of STC, in adequate capacity for research and IEC production in 2005. 5.9.1.4
Issues for Consideration In Future Planning
The 2005 Operational Plan for the National Health Promotion was too ambitious and not within the capacity the department has in 2005. There is a dire need to have a mechanism in place to monitor the Operational Plan implementation throughout the year. Resource allocation for health promotion activities at the provincial level must be improved to enable the staff to implement the settings activities. The funding request process at national level must be seriously addressed to avoid bureaucratic delays thus delays activity implementation. 5.9.1.5
Constraints and Possible Strategies/Actions
Summary of Major Constraints
Strategies/ Action Plan
Inadequate IEC capacity
Improve the IEC Production Unit. Recruit qualified IEC personnel Install proper production Unit & Resource
Ministry of Health: National Health Report 2005 Page 99 of 250 --------------------------------------------------------------------------------------------------------------------Centre. Inadequate Research & Evaluation Capacity.
Recruit a Social Research Officer Research Officer to drive the Health Promotion Research Committee activities.
Inadequate Funding
Provide more funding & resources to Provincial HP Units to mobilize community settings approach.
Inadequate knowledge of HP Concept
Training on Health Promotion Concept to all Health Managers.
Improve Communication , Coordination And Supervision
Improve communication from Program Managers to US/PS vise-versa. Improve communication from National to Province. Improve coordination and supervision of programs and staff.
Ministry of Health: National Health Report 2005 Page 100 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 6 6.1 6.1.1
Systems Performance- Monitoring and Evaluation:
Ministry of Health: Performance Evaluation19 The Scan of the Public Administration Functions
“Scan should help Ministry of Health to improve areas of low score or weaknesses” However, the MOH may need support from central agencies as the issues are of central control”
In 2005 the SIG Cabinet approved a reform of public administration functions across the SIPS that would be based on a Conceptual Model incorporating features of public sector governance and organizational capability. The Ministry of Health Executive welcomed the scan as it is an opportunity for an external and independent performance evaluation. This has been very timely as the Ministry of Health is undergoing a national health review in light of the longer term national strategic plan for 2006-2010. The scan is deemed as complementary to the Health Institutional Strengthening Project coming to its end in August 2006. Fig 17 is a brief of the admin scan.
Health 5
4.5
4.4 4.2
4
3.8 3.6
3.5
3.3
3
2.8
2.5 2.2 2 2
1.5
1
0.5
0 Strategy - Corporate Plan
Resource allocation
Strategy - Corporate Plan Resource allocation Systems & Procedures Strategy - Work Plan Structures People Capability Legislation Culture & Work Ethic
19
Systems & Procedures
Strategy - Work Plan
Structures
People Capability
Legislation
Culture & Work Ethic
4.4 4.2 3.8 3.6 3.3 2.8 2.2 2
RAMSI Governance Support Facility (2006): SUMMARY ANALYSIS PUBLIC ADMINISTRATION FUNCTIONS SCAN NOVEMBER – DECEMBER 2005.
Ministry of Health: National Health Report 2005 Page 101 of 250 ---------------------------------------------------------------------------------------------------------------------
6.1.1.1.1 Fig 25 and Table 6 shows the ratings for the MOH: 1 –lowest, and 5highest. 8 scales of Public Administration functions:
Comments
Each scale is rated from 1 to 5 on very broad criteria. 1 is the lowest score usually indicating that there was no evidence at all that the function was operating, and 5 is the highest rating indicating that the function was operating well and effectively.
1. Strategy – Corporate Planning
The rating of 4.4 is the highest rating of any of the public administration functions in this Department. Possibly because this agency has had considerable technical aid support over many years, the status of strategy setting and planning is very strong. They have a very sound current Corporate Plan with very good performance measures, although one of the US respondents believes that these could be improved. The linkage between Plans and Budgets is very sound, and reviews are completed once the budget is actually handed down so that targets are aligned. There is also a conscious management strategy to link the corporate directions down into both Annual work plans and Divisional operational plans, although again, there is a perception that some of the directors are not strong on this process and there could be improvements.
2. Resource Allocation.
This Department was one of the only two departments to consult extensively with clients and stakeholders during the development of strategic directions statements and plans The function of allocating scarce resources appears to be managed quite effectively, based on the rating of 4.2. During both the operational planning and the budget development processes there are discussions around what facilities, staff and funds are allocated to various output indicators, however the executive believe that this process could still be improved. In terms of adequacy of resources, most staff who need computers and other important equipment have access to them and in general the Department believes that its resources are adequate, with the assistance of AusAID. Transport, health clinics and housing both in Honiara and the Provinces all need serious improvement. Establishment vacancies are relatively high. However in comparison to many other departments the staff resourcing situation is reasonable. The budget allocation for training and capability building is
Ministry of Health: National Health Report 2005 Page 102 of 250 --------------------------------------------------------------------------------------------------------------------strategically used for the important needs and for example there was a Leadership and Management course during 2005 out of this allocation. 3. Systems and The rating of 3.8 for this function of having effective Procedures. systems and procedures to support the management of the Department is only just above average, but is higher than in almost all other Departments. Again this might reflect the result of a number of years of technical assistance and the current Corporate Services advisory team’s efforts. This function was sub clustered into 7 groups: Information Management, HRM, Procedures & Guidelines, Monitoring and Reporting, Budget processes, Communication and Systems Support. Information Management: Because of the health related functions within this Department there are a number of efficient data bases and Health Information Stats developed. However it appears that many of the systems are not networked and many others are still manual. General records management is in a similar state to most other departments and needs to be reviewed and upgraded. Human Resource Mgmt: The HRMIS is currently being upgraded within the HISP project to replace the general 2 file systems. Until this is completed, any staff statistics is manually collated. There is a very extensive and convoluted process for identifying priority professional development and training needs, but this needs to be streamlined to improve the currency of capability improvement. Records of this training however, are not comprehensive nor complete. Procedures & Guidelines: There have been a few internal procedures and manuals developed in relation to general administration, in addition to a range of procedures relating to clinical practice. There was a perception that there was little enthusiasm from line managers for ensuring that work standards were developed and implemented as a general practice. Monitoring & Reporting: Reporting against Corporate and annual plans is only done at the request of the PS / US and is not a routine management function. Line managers report annually on performance against budget spending
Ministry of Health: National Health Report 2005 Page 103 of 250 --------------------------------------------------------------------------------------------------------------------System Support: Given the intensity of donor investment within this Department the support for management systems was adequate. However, the shortage and unreliability of photocopiers in the headquarters office was an impediment. Budget Processes: All line managers are involved in the development of budget estimates, and they set activities against the budgeted programs for the following year. There is then a review of these activities after the actual budget has been allocated. Each manager is also provided with a budget expenditure spreadsheet monthly, however the reporting back on these at quarterly intervals is perceived to be a management weakness. Communication: There are regular meetings at the Divisional Heads level on both administrative and professional matters. However, the weakness is at the within-division level where only a few Divisional Heads have regular staff meetings with operational staff. Summary: Given the rating for People Capability analysed later in this Report, the Department would benefit if the entire HRM function could be strengthened. This no doubt is being addressed by the current HISP team. Performance monitoring and reporting against planned targets and measures needs to be strengthened to improve the overall management of the department. Similarly, line managers could benefit if they were more aware of setting standards and procedures for required performance levels to meet service delivery goals. Performance Management generally could be improved if Divisional Heads were more committed to communicating with their operational staff on all matters related to standards and quality of service delivery. As the general trend across all departments indicates, this department could also benefit from a professionalisation of its records and data management systems. While the budget development process is a much stronger management function in this department than in most others, the full benefit of this is not realized because of the lack of ongoing management monitoring and reporting against expenditure.
Ministry of Health: National Health Report 2005 Page 104 of 250 ---------------------------------------------------------------------------------------------------------------------
4. Strategy – Work Plans and Policy.
Overall the Health Department does have a stronger rating on this function than all other departments, and this indicates that managers generally are being supported by relatively effective administrative functions. However, as the above comments suggest all seven sub-functions could be improved, particularly in the areas of managing and monitoring performance within Divisions. The rating of 3.6 indicates the need for some directors to improve their development and implementation of operational plans. While there are many who carry out this function effectively, it is not an accross-department strength. Those whose operational plans are incorporated into ongoing work activities do have sound performance measures and report back to the Executive at least quarterly on progress. Those divisions that are perceived to be performing well, have informal discussions with the US more frequently than the formal Quarterly reports. Those same Directors tend to also link these plans, and the National Health Strategic Plan, down into individual staff work targets. But again, this function is patchy in its effectiveness. There is a perception that nearly 80% of line managers are not using their plans to guide daily operations, nor do they report on them as an aspect of strategically managing the Department. In particular, there is a need to build in Workforce Planning and Resource planning into these Work Plans. There is currently work being done on a workforce plan to replace the existing Training needs plans, and they are currently recruiting an Asset Manager who will be tasked with developing a full equipment needs analysis to update the 2004 assessment. There have been a number of internal departmental policies developed to support the strategic directions that conform with the GOs, such as Patient Care and Referral Guidelines, Delegations Manual etc.
5. Structures.
In general there is an ongoing need for improving this function to ensure consistency of Strategy across the department The rating of 3.3 indicates that the Department could benefit from a closer alignment between its overall structure, the way the priority work is formed into jobs, and its strategic direction and performance targets. It is very difficult to achieve corporate targets when the internal flow of operational activity is not strategically aligned with those targets. There is a current Organisational Chart and a couple of the Divisions have developed specific structural charts.
Ministry of Health: National Health Report 2005 Page 105 of 250 --------------------------------------------------------------------------------------------------------------------However, these would only be familiar to executives and line managers. Few staff would have much idea of the existence of such documents or of where they would fit into the chart. Few staff, particularly those under the vertical programs such as the Vector Borne Disease Program and the Provincial structures, would be fully aware of their formal reporting lines. However, those staff in national programs would be more aware of their internal structures. Since the HISP project in 2000 the Department has not carried out even a superficial review of its structure to align it with the Corporate Plan or the annual working plans, nor is there any review of how jobs are designed to meet planned targets, despite there being 99 vacant positions within health services. While there is currently a review of some job descriptions, in general staff are not aware of what their JD actually contains other than the title of their positions, but when asked what their role is most people are able to say what is being expected of them. This does not result in achieving desired targets or results however, but this is more a factor of lack of supervision than a ‘not knowing what to do’.
6. People Capability.
The Department could expect to see a marked improvement in performance if this one function received some attention to align the structure of work with work targets. The rating of 2.8 indicates that the overall levels of skills and abilities of staff are probably causing serious impediments to the standards of service delivery required by the executive. To improve this situation, line managers could be assisted if they developed performance development plans for individual staff that would align their skills and knowledge with the priority work targets. These Plans would then inform the annual training or professional development plans linked to the budget. Further if staff could see that they had even a basic career path within their work place that their development was preparing them for, their overall commitment to their work might improve. In addition, the centralized performance appraisal system is not the most effective mechanism to improve individual staff capability to meet specific service delivery targets. The Departmental performance generally, but Divisional work units particularly would be assisted if staff had some process whereby they were able to receive feedback, both positive and developmental, on their performance. This then assists them to be more committed to whatever development plan has been formed for them. Given the professions employed in the Health sector, it is
Ministry of Health: National Health Report 2005 Page 106 of 250 --------------------------------------------------------------------------------------------------------------------not surprising that there was a general rating of 3 to 4 on the Dependency Scale of Staff Capacity, as almost all of these roles require formal qualifications. To ensure a basic succession strategy, a targeted Graduate recruitment program would probably benefit the clinically related Divisions.
7. Legislation.
8. Culture & Work Ethic.
One of the strengths supporting the existing performance of people is the evidence for a high level of cooperative team work across most of the Divisions. The rating of 2.2 indicates that most of the specific acts and regulations relating to the Health and Medical Services portfolio is considered by the executive to be out of date (1988) and have not kept up with the new directions in service delivery and what the department is currently drying to do. The existing legislation is not useful in providing community based health services, and the executive and staff have to try to deliver services based on this philosophy, but within conflicting acts and regulations. Most of the executive and decision making managers are aware of the various pieces of specific legislation, but feel constrained by them. As found in all other departments, the central agency legislation – Public Service and Public Finance Acts – are not incorporated into management functions and few executives are even aware that there are obligations for them contained within these Acts. The rating of 2.0 was the lowest rating function for this Department, and indicates that executive directors may need to pay attention to the general work morale and commitment within the Divisions. In terms of a formally defined set of work values which leaders then manage, the Department does not have any, apart from professional codes of ethics relating to the medical professions. Informally some of the more committed Divisional Heads attempt to role model a set of positive work values, but many others are seen not to be good role models themselves. This flows on to a situation where some Divisions do have very positive work cultures and high morale, where as others do not. For most people in this Department the Public Service does not provide them with a desirable career, and the poor standards of wages contribute strongly to this. Many staff are forced to take on second or part time jobs to achieve even a basic standard of living. In such situations it is unlikely that the work culture will be very positive.
Overall Analysis of the Department of Health. The overall rating for Public Administration functions within the Health & Medical Services Department is 3.29. This means that the department generally and executive mangers specifically are being
Ministry of Health: National Health Report 2005 Page 107 of 250 --------------------------------------------------------------------------------------------------------------------fairly adequately supported by their internal administrative systems. However, a rating between 3.0 and 4.0 indicates that there is room for improvement if the department desires to strengthen its internal operating efficiencies, and the closer to Rating 3 the score is, the more improvements can be achieved. The status of many of the public administration functions in this Department indicated sound implementation. There was evidence that the corporate planning component of the Strategy function was operating effectively across the Ministry, closely supported by a targeted allocation of Resources. To a lesser extent internal Systems & Procedures and the Strategy sub-function Operational or Annual Work plans were also supporting line managers, but there was evidence that there is real room for strengthening both of these processes to achieve sustainable performance improvement. Of particular priority is a strengthened management ability to implement sound performance management systems and processes. A closer Structural alignment could certainly assist the executive ensure that the flow of work and job requirements were clearly designed to maximize efficiencies. Of serious concern are the two functions People Capability and Work Culture, as well as the Strategy sub-function of Legislation. In this regard it is suggested that line mangers and executive could benefit if they adopted a stronger leadership and public management role in their Divisions. The best Corporate Plans can not deliver the required level of services to the community if the staff who actually work at the operational level do not have the necessary commitment to that work, or the required skills and knowledge. Similarly, without the relevant legislative base decision makers are impeded in their tasks of ensuring that the priority services are delivered in the manner expected by the public.
6.2
Primary health care clinics utilisation20
At November 2005, there were 323 PHC clinics and 10 hospital outpatients departments providing Primary Health Care (PHC) services across Solomon Islands. A review of PHC clinic utilistation was conducted in 2005 with a view to making recommendations for health service rationalization21 Due to complexity of the report finding, Nurse Aid Posts (NAP) and Rural Health Centres (RHC) that fail to reach or exceed benchmarks should be reviewed in the full report. For most adjustments of designation or staffing levels can be considered The results presented in this summary are for RHC and Area Health Centres (AHC) that require upgrade to AHC or mini hospital status as these have major implications for health infrastructure development and human resources planning. These are the major utilisation considerations for the NHSP
6.2.1
Solomon Islands Primary Health Care Clinics Utilisation Review
“PHC Clinic utilization review highlighted clinic management issues to services delivery and resources, and implicates on infrastructure planning”
Data Source: Data for the review was obtained from the MOH HIS. Data suitable for assessment of clinic utilisation were:
20
Primary Source for the Clinic Utilization from: HISP/MOH 2006:
Solomon Islands National Health Review – February 2006 21 This review was completed by the HISP NHRA in December 2005
Ministry of Health: National Health Report 2005 Page 108 of 250 --------------------------------------------------------------------------------------------------------------------Total outpatient contacts (new and return cases of disease) Reproductive health contacts (antenatal and postnatal care, family planning) Child welfare contacts (growth monitoring and vaccination) Number of inpatients (defined as “any person admitted to the clinic for any form of medical treatment or bed rest for one night or more”)22 Number of clinic births: 2004 utilisation data was chosen as it was complete, information previously collected about the number of months individual clinics were open for the year were available and the monthly reports completion rate of all clinics was reliably known. The data were visually scanned to identify problems and difficulties. These were rectified and annual and average weekly statistics for the above calculated and tabulated.
Clinic benchmarks: \ A set of simple utilisation benchmarks, based on the average number of patient contacts a week, clinic births and inpatients, were developed against which to assess clinic utilisation. (Table 4). These operate as a guide that indicate when variations of clinics designation or staffing/skill mix need to be considered by MOH and Nursing Executives and PHD and Senior Nurses in provinces. The benchmarks are not suitable for application to urban health services where there is demand for ambulatory care services but not birthing or inpatient services. The number of clinic births and inpatients are indicators of the need for access to more complex care and management or additional training to manage maternity care and birthing and can be used as indicators of when change of clinic designation or staff skills mix should be considered. Each clinic assessed by the review was measured against the utilisation benchmarks and on this basis was rated as having met or exceeded the benchmark for their current designation (AHC, RHC, NAP) or if this was unclear this is stated.
Benchmark Number of weekly contacts – outpatients, reproductive health, child welfare Annual clinic births Annual inpatients (total including births)
NAP RHC AHC Mini Hospital 30 to 70 70 to 150 150 + No limit ≤20 ≤40
≤70 ≤150
≤200 ≤500
≥200 ≥ 500
Table 7: Solomon Islands PHC clinics utilisation benchmarks
Mapping and location: With the assistance of the staff at Solomon Islands Ministry of Lands and Solomon Islands Institutional Strengthening of Land Administration Project (SIISLAP) all known PHC clinics were mapped on topographic maps that also detailed population density and distribution. These maps are important for understanding distance between clinics, their distribution and isolation and the information they provided was considered in the discussion of individual clinics and suggested actions.
Limitations Disaggregated data were not available for 89 PHC clinics because these clinics have not been individually listed/added to the HIS database. Data for these are aggregated (combined) with data of 47 clinics listed in the HIS. Eight of these 47 contain aggregate data for 2 or more additional clinics. In total there are no disaggregated data available for 136 (43%) clinics, hampering interpretation of utilisation data23. Until the
Guidelines on the monthly reporting on health activities – Statistics Unit MOH, 1994 For epidemiological analysis and reporting aggregated data are not a problem as the goal is to report total cases of disease at provincial and national levels.
22 23
Ministry of Health: National Health Report 2005 Page 109 of 250 --------------------------------------------------------------------------------------------------------------------PHC HIS is redeveloped this problem will continue to worsen and repeating this review of utilisation using the same methodology will be difficult or impossible.
Results summary: PHC clinic utilisation of 232 clinics was compared with the utilisation benchmarks. Of these, 95 (41%) were assessed as meeting one or more benchmarks, 33 (14%) exceeded the benchmarks for current designation, 55 (24%) met no benchmarks and for 49 (21%) the situation was unclear. A small number of clinics are very poorly utilised and should be considered for closure as they do not appear to be sufficiently isolated to maintain a full time clinical service. Identification (tables) and discussion of clinics failing to meet or exceeding benchmarks is included in the main document. Two clinics reached the upgrade criteria for mini hospital both in Malaita, 4 RHC met the upgrade criteria for AHC, all in Malaita. An additional 4 were approaching the AHC upgrade criteria, 2 Malitan clinics, 1 Central and 1 in Western (see recommendations following). 52% of clinics exceeding benchmarks are in Malaita province. 78% of clinics identified for upgrade from RHC to AHC or AHC to mini hospital are also in Malaita. Clinics reaching benchmarks for upgrade to Area Health Centre and mini hospital status
Area health centre to mini hospital status: Two north Malaitan clinics met the inpatients and clinic births criteria for upgrade to mini hospital status, Mau’lu AHC and Fau’abu RHC (Table 5). Grove AHC (Table 5), located on the Guadalcanal plains, does not yet meet the criteria however the 2003 June 2005 utilisation trend demonstrates rapid progression toward it. Numbu NAP data is included in Grove AHC and its contribution cannot be assessed. A mini hospital is currently being constructed at Grove with assistance from Don Bosco.
Name
2005 (Jan-June data) 2004 2003 Province Inpatients Clinic Home Inpatients Clinic Home Inpatients Clinic Home births births births births births births
Grove GP Mau’lu MP Fau’abu MP
242 1097 629
113 107 103
62 49 37
251 2115 1437
142 237 212
108 117 36
197 2143 771
89 271 217
81 81 51
Table 8: Clinic utilisation data Grove AHC, Mau’lu AHC and Fau’abu RHC 2003-2005
Rural health centre to area health centre status: On recent utilisation trends, Biti’ama RHC in north west Malaita, Gwanuatolo RHC and Takwa RHC in north east Malaita and Maoa RHC on the central west Malaitan coast all exceed the inpatient criteria for upgrade to AHC status (Table 6). Maoa is approximately 40kms south of Auki and more than 90kms north of the next closest AHC Afio. Takwa is between Gwanatolo RHC (which is about 12 kms south) and Mau’lu AHC to the north west. Bita’ama is north of Fau’abu and south west of Mau’lu AHC. (Table 6). Increasing the capacity of Mau’lu, Fau’abu and Gwanatolo to manage inpatients may reduce the inpatient burden on Bita’ama and Takwa RHC. Maoa needs to be considered for AHC upgrade.
2005 (Jan-June data)
2004
2003
Ministry of Health: National Health Report 2005 Page 110 of 250 --------------------------------------------------------------------------------------------------------------------Name Provinc Inpatient Clini Hom Inpatient Clini Hom Inpatient Clini Hom s c e s c e e s c e birth birth birth birth birth birth s s s s s s Bita’ama Gwanuatol o Maoa Takwa
MP MP
159 134
39 71
14 23
238 237
51 117
10 31
99
11
23
MP MP
105 98
27 25
10 11
155 195
69 118
45 2
130 155
68 93
33 16
Table 9: Clinic utilisation data Bitiama RHC, Gwanautolo RHC , Maoa RHC, Takwa RHC 2003-2005 2004 data for Batuna RHC in Western province, Tarapaina RHC and Talakali RHC in Malaita province and Taroniara RHC in Central province indicated these clinics met at least one benchmark for upgrade to AHC. (Table 8). Review of data from 2003-2005 do not support upgrade of Batuna at the current time however utilisation should be monitored over the next 1-2 years. Taroniara has almost reached the AHC threshold however the impact of utilisation data from Narogu NAP, (which is recorded in Taroniara), needs further assessment. Data for Tarapaina suggest that the AHC upgrade threshold will be exceeded in 2005 for births and possibly inpatients. The discrepancy between 2004 and 2005 inpatient data for Talakali suggests a change in reporting practice rather than a change in trend. This clinic should be monitored as it is approaching the upgrade threshold.
2005 (Jan-June data)
2004
2003
Name
Provinc e
Inpatient s
Clini c birth s
Hom Inpatient e s births
Clini c birth s
Hom Inpatient e s births
Clini c birth s
Hom e birth s
Taroniar a
CIP
68
30
0
179
50
3
184
77
6
Batuna Tarapain a
WP MP
70 77
26 44
4 0
257 238
51 82
1 6
175 169
66 69
2 7
Talakali
MP
28
53
16
130
86
61
128?
103
49
Table 10: Clinic utilisation data Taroniara RHC, Batuna RHC and Tarapaina RHC 2003-200
Linkages with MOH infrastructure review: The recent report “Primary Health Care Facility Infrastructure Rehabilitation Plan – Stage 1 Area Health Centers”24 identified several clinics to be considered for upgrade to AHC status. Choiseul: Wagina RHC data do not support development of an AHC at the current time, however supervision and support needs of clinics in the south east and south west of Choiseul and distance to other health centers may outweigh current utilization statistics. Makira: Marogu RHC utilization data do not support upgrade to AHC at the current time however geographic location and supervision support needs may outweigh statistics.
24
HISP 2005
Ministry of Health: National Health Report 2005 Page 111 of 250 --------------------------------------------------------------------------------------------------------------------Malaita: Malu’u AHC and Fau’abu RHC are discussed above. Current utilization statistics do not support upgrade of Afio AHC to mini hospital status at this time. Collection of additional data about referrals against the MOH referrals policy would be helpful to assess why they are made and whether alternatives to referral to NRH exist. Utilisation for Rohinari RHC, Sinamauri RHC and Ata’a do not support upgrade at the current time. Talakali is approaching upgrade benchmarks as discussed above. Western Province: Utilisation data support Noro Taiyo and Noro public clinics merging to form a single Urban Health Centre, with consideration given to maintaining a birthing service and limited inpatients. Batuna is approaching upgrade benchmarks as discussed above; Ughele RHC does not meet benchmarks for a RHC. Temotu: Dendu RHC does not currently reach, nor is it approaching AHC benchmarks.
6.2.1.1
Major discussion points:
The results of the clinic utilisation review demonstrate different trends and great variability in use of health services across individual provinces and between provinces. Clinics not meeting benchmarks require review of staff numbers and skills mix against local health need, distance and proximity to the nearest clinics. Methods for increasing clinic productivity need exploration, for example increased outreach and health promotion in response to local health needs. Results support future posting and training of specialist staff according to clinic workloads, skill mix needed to meet individual clinic demand and skill mix at adjacent clinics. This argues for adoption of a flexible clinics designation (e.g. ‘health clinic’ rather than a NAP/RHC) and staffing model based on need rather than population parameters. The role delineation for PHC clinics developed in December 2005 also supports this approach as the PHC levels are skill rather than population based. Because many clinics demonstrate low utilisation and as there are growing numbers of clinics the policy governing establishment of new health facilities needs to be reviewed. In particular the 3km radius of service delivery for clinics could be increased. The HIS from which data used were drawn from cannot readily supply utilisation data in the future. Programs for health facilities utilisation and planning need to be programmed into future health information systems.
6.2.1.2
Recommendations Clinic Utilisation Review
Recommendation 1: PHD and senior nurses in each province review clinics not meeting utilisation benchmarks with a view to determining reasons for poor utilisation and exploring options for increased productivity, closure or change in staff numbers.
Recommendation 2: PHD and senior nurses review and further investigate RHC approaching or meeting benchmarks for AHC upgrade to determine whether high demand for inpatient services could be reduced through increased public health activity. Priority clinics for investigation and monitoring are:
Talakali RHC Malaita Province Tarapaina RHC Malaita Province Takwa RHC Malaita Province Biti’ama RHC Malaita Province Batuna RHC Western Province Taroniara RHC Central Province Recommendation 3: MOH executive and Malaitan PHD prioritise: Upgrade of Mau’lu AHC to mini hospital Upgrade of Fau’abu RHC to mini hospital or at a minimum AHC Upgrade of Gwanatolo RHC to AHC Upgrade of Maoa RHC to AHC
Ministry of Health: National Health Report 2005 Page 112 of 250 --------------------------------------------------------------------------------------------------------------------MOH executive and PHD to monitor impact of any future upgrade of Malu’u AHC, Fau’abu RHC and Gwanatolo RHC on Takwa RHC Malaita Province and Bita’ama RHC Malaita Province before these clinics are upgraded.
Recommendation 4: MOH executive use results of this report, especially findings for RHC to AHC upgrade to priorities health infrastructure projects.
Recommendation 5: National nursing executive, provincial senior nurses and PHD use the utilisation statistics to guide nursing staff postings, skill mix and training plans25. In particular clinics with high numbers of clinic births or RHC exceeding the clinic births benchmark be prioritised for training and placement of trained midwives.
Recommendation 6: The approval process for development of new clinics be revised and include elements listed in the discussion section of the document.
Recommendation 7: Consideration be given to calling NAP and RHC ‘health clinics’ and staffing these in response to community health needs26
Recommendation 8: The HIS (software and data collection processes) be urgently redeveloped so that it provides information that can be used for ongoing assessment of clinic utilisation.
Recommendation 9: The clinic benchmarks developed for this review be evaluated within 2 years for ongoing utility.
Recommendation 10: Maps of health clinic location be reviewed and updated annually at the National Health Conference.
6.3
Role delineation for PHC clinics and hospitals:
In December 2004 the primary health clinics and hospitals role delineation was redeveloped by HISP27 and accompanies the PHC clinic utilisation review. This section of the report presents the complete role delineation document as it cannot be summarised. One of the recommendations made by the utilisation reports is for RHC and NAP to be called by a generic name ‘health clinic’ and be staffed according to health care need. The role delineation supports this approach by defining NAP and RHC according to the skills base of staff. Thus a facility staffed by at least one registered nurse corresponds to a rural health centre in the role delineation and can offer packages of essential health care appropriate to the nurses training level.
6.3.1
Introduction
This analysis should be linked with WHO WISN human resource management approaches currently being implemented by HISP Reference the Solomon Islands Health Facilities Role Delineation developed by HISP in 2005, which supports this via a skill based approach to PHC clinics role and designations 27 By the roving Primary Health Care Advisor (PHA) for Guadalcanal, Honiara, Renbel and Isabel provinces 25 26
Ministry of Health: National Health Report 2005 Page 113 of 250 --------------------------------------------------------------------------------------------------------------------In 2001 the Ministry of Health released a policy entitled “Role delineation of Health Care Services in Solomon Islands”. The aim of the policy was to improve and upgrade management, supervision and distribution of health care resources across Solomon Islands. A time frame of 5 years following implementation was set for review of the policy. In January 2006, the policy was reviewed and re-developed to frame health services role delineation in terms of which elements of the ‘packages of essential health care’, they deliver. The new model has five levels of health service delivery: three primary health care, one general hospital and one specialist hospital level. The packages of care selected encompass the major communicable causes of morbidity and mortality in Solomon Islands, emerging health threats and health transition diseases. The selection also encompasses reproductive and child health needs, rehabilitation, mental health, emergency care, referral and outreach for services not offered by local or provincial health services. The packages of care and role delineation outlined in the document will support MOH executive, PHD and Directors of Nursing (DON) to plan, staff and manage Solomon Islands hospitals, PHC clinics and integrated public health functions.
6.3.2
What are packages of care?
‘Packages of care’ are essential health care interventions or groups of interventions and services provided by government and/or the private sector to meet the health care needs of the population. Information to guide selection and development of packages of care for a country, province, health district or area can be sought from: Epidemiological and public health data about disease incidence, prevalence, trends and how these impact on health services demand Technical information about disease control and prevention interventions including vaccination, vector control and health promotion Documented evidence supporting implementation of health programs shown to decrease morbidity and mortality (eg pregnancy care and births assisted by trained health providers) International health trends and evidence (eg rising incidence of mental health disorders) Evidence of a health transition (eg rising incidence of non-communicable disease in countries with continued high incidence of communicable diseases) Emerging health threats (eg HIV/AIDS and avian influenza) Information about new program approaches to health issues (eg men as partners) New packages of care can be added to a role delineation matrix as the need arises. Need may be demonstrated by changing health indicators locally or internationally, new evidence supporting change of interventions or implementation of new interventions, international health alerts or progression of the health transition with increasing incidence of non-communicable diseases.
6.3.3
How do packages of care articulate with role delineation?
Packages of care outline the main health care interventions that are implemented in response to a particular health condition or problem, from simple low technological interventions through to those that are more complex or specialist in nature. Put simply health facility role delineation determines what parts of each package of care each level of the health care system delivers. Health facilities with low technological availability, few staff or less skilled staff deliver those parts of the package of care that are not reliant on technological interventions or more highly skilled or specialist staff, for example a nurse aide post or rural health centre. Health care facilities with infrastructure, equipment and appropriately trained staff to support technologically complex interventions offer those parts of the package that require these additional technologies or staff skills. An example is caesarian section, an intervention that can only be offered at health facilities (hospitals) with a theatre, medical and anaesthetics trained staff. In contrast pregnancy care can be offered at all levels and women with risk factors or problems can be referred.
Ministry of Health: National Health Report 2005 Page 114 of 250 --------------------------------------------------------------------------------------------------------------------6.3.4 Continuum of Care The packages of care developed for Solomon Islands recognize and incorporate a continuum of care from health promotion and prevention activities through to acute care and maintenance as appropriate for the package. Each health program in the matrix has a core health promotion focus and where applicable, millennium development indicators are outlined. The aim of a continuum of care is to highlight that health interventions begin, and have importance, before the onset of acute disease and that public (population) health approaches that concentrate on disease prevention and early diagnosis, before onset of complications, are as important as acute care interventions. A continuum of care also recognises that health interventions do not end with acute care interventions and for some illnesses must continue through until cure, death or rehabilitation goals are achieved.
6.2.2.5. A continuum of care incorporates: Health promotion and disease prevention activities (for example HIV/STI prevention campaigns, healthy diet/lifestyle advice) Early intervention and management (for example screening of individuals with high risk of diabetes, early diagnosis and management, voluntary confidential counselling and testing for HIV) Acute treatment and care services – outpatient and inpatient (for example treatment of medical conditions and diseases such as malaria, acute respiratory infections, asthma and surgical conditions, conditions related to AIDS) Rehabilitation and sub-acute care (follow up care of aged, disabled of post illness/surgery) Maintenance and palliative care (eg cancer patients, HIV positive, diabetes)
6.4
PHC Quality Check 28:
Between February and May 2004, the MOH conducted a survey of PHC clinics to gather information about a range of factors that potentially impact on provision of care by PHC clinics. Accordingly transport availability, communications (radios), infection control infrastructure and equipment, standard treatment protocols and supplies (essential drugs and EPI) were assessed. Each of the areas assessed provides information about PHC clinics capacity to provide quality PHC health care services and health programs. The survey also sought to quantify number of PHC clinics that conducted health education/promotion outreach activities and had active health committees. The survey report is available from the HISP team in Honiara and MOH.
Key Findings:
“Essential supplies to clinics remain an issue”
Infection control: “Infection control needs
63% of clinics reported access to a steriliser. Of these 65% had a more effort to improve at all primus to heat the steriliser. 66% of clinics with a primus had fuel at clinic levels” the time of survey. NAP had lowest coverage of sterilisers (48%). 71% reported availability of gloves (surgical) at all times, 23% had gloves sometimes. Water was piped into 116 clinics (54%) and described as always working by 60%
Transport: 50% (9) AHCs29had access to a canoe. Only 4 of these reported a working outboard motor (OBM). Distribution of canoes was lower at RHC
28 29
“Lack of transport was the most commonly cited reason for lack of outreach, followed by lack of staff and
JTA/HISP/MOH (2006): Primary Health Care Survey 2004: in the SI National Health Review Contents defined by MOH Reproductive Health Unit
Ministry of Health: National Health Report 2005 Page 115 of 250 --------------------------------------------------------------------------------------------------------------------35% (26) having a canoe, and 17 a working OBM. 5% (3) NAP had canoes, 2 with a working OBM
Clinical care protocols: Overall there was poor availability of standard treatment protocols. 37% of clinics had women’s health protocols, 57% had family planning, 57% paediatric, 44% adult and 75% malaria protocols. The lowest availability of protocols was in NAP.
Clinic equipment and supplies: “Basics 75% of clinics had a full delivery kit30, 61% had adequate equipment for lacking or activities and 53% had run short of supplies or drugs in the 3 months inadequate survey. NAPs and UHC most commonly reported shortfalls of drugs or at the PHC There was a good distribution of EPI fridges across Solomon Islands, results demonstrated that a large proportion did not have a 3 month fuel supply
day to day prior to the supplies. however
Health outreach and health committees Health outreach activities were conducted by 52% of clinics. Lack of transport was the most commonly cited reason for lack of outreach, followed by lack of staff and distance. Most clinics had health committees but these met irregularly.
Major discussion points: The PHC clinics survey identified several areas for action to improve the quality and delivery of health care services across Solomon Islands. Some can be addressed through provincial action, for example purchase or redistribution of canoes to AHC, improvement of clinic water supplies and ensuring availability of EPI fuels to support cold chain and minimise vaccine wastage. Redevelopment and distribution of clinical protocols requires a national lead from MOH and support of provinces. The current poor distribution of clinical protocols does not support nurses and nurse aides as practitioners in remote areas and increases the risks for making drug administration and treatment errors. An additional consideration is that protocols in use date from the early 1990’s. Drug names, types and best practice approaches may have changed in the intervening period and new approaches such as ‘integrated management of childhood illness’ have been introduced, leading to overlap of protocols and potential to create confusion. Difficulties persist with availability of drugs and medical sundries to clinics and may indicate problems with timely ordering by clinics staff, delays in preparation of supplies by National Medical Store or transport problems. Adoption of the clinic minimum standards guidelines and “Overall there was increasing use of the clinic quality improvement checklists by clinic poor availability of nurses and supervisors may help to improve these difficulties.
standard treatment
6.4.1
MOH Infrastructure -Issues:
Challenges facing ‘MOH Infrastructure’ fall into two categories, upgrading and renovating existing facilities and increasing the capacity of the MOH to manage health facilities. Up to 70% of PHC clinics require significant upgrade, repair or renovation. The degradation of health facilities has happened over decades. There are many varied projects underway, but work of this is needed for many years to come.
6.4.2 30
National Infrastructure Management:
“The current poor distribution of clinical protocols does not support nurses and nurse aides as practitioners in remote areas and increases the risks for making drug d i i t ti d
nature
Ministry of Health: National Health Report 2005 Page 116 of 250 --------------------------------------------------------------------------------------------------------------------The recruitment of a National Health Facilities Manager is again underway but as yet no suitable applicants have been received. The is a key role for a number of reasons including; The development of a maintenance program, which would be run at provincial level. Co-ordination of capital works programs and donor activity. Implementation of policies and guidelines such as the “Minimum Standard for Clinic Infrastructure.” Represent MOH on important government and donor initiatives such as the “SIG Housing taskforce” or Global Fund, “VBDC Works Projects”. As there is no indication the Department of Works will be strengthened in the near future more responsibility will continue to fall on the Ministry of Health. The temporary ‘Project Manager’ position will help to manage consultation, liaison with regulatory authorities, procurement, tender and project management of capital works. Unless a large Capital Works program is taken up by SIG or a donor the need for this role will continue for more much longer, assuming that health facilities in need of repair will continue to be rehabilitated. Requests have been made for technical assistance for projects such as the upgrade of, pharmacies, microscopy labs, storage sheds and entire clinic or hospital upgrades for which government and donor funds are becoming available.
6.4.3
Provincial Infrastructure Management:
Much of the work managing infrastructure is falling on the shoulders of the Provincial Health Direcors such as emergency maintenance and preparing infrastructure proposal for donors. More work can be done to develop “Provincial Infrastructure Plans” to include Provincial Hospitals, PHC Clinics and housing. There needs to be a continuation of a strategic focus as well and operational planning on how go about improving facilities and managing recurrent cost such as maintenance.
6.4.4
Local Infrastructure Management
The development of preventative maintenance programs (i.e. white ant detection) and increasing the ability of clinic staff and the community to fix problems when they arise or notify someone is important. Working with the local community and village health committees which provide support and resources is also vital.
6.4.5
Health Infrastructure Reviews
By the end of April 2006 we will know, in detail, the condition of all AHCs and RHCs. It is important that the new RHC infrastructure needs are incorporated into the Provincial Infrastructure Plans. Further evaluation of provincial hospitals, NAP, Nurse Training Facilities and housing is needed.
6.4.6
Provincial Hospitals & housing
The shortage of adequate housing and ambiguous housing policy is still a major problem. The funds available to the MOH, and commitments by donors are not meeting the needs. Implementation of the Regional Assistance Mission to Solomon Islands (RAMSI)/SIG Housing Review’ recommendations may solve this problem. Some work is commencing at provincial hospitals, however only limited master-planning, integrated design, or facility analysis has been done. There are at present no guidelines for design or construction with much important works needed at all provincial hospitals.
6.4.7
AHC Rehabilitation Plans
Following the AHC Infrastructure review in August 2005, there are plans to improve six of the 19 AHCs needing improvement.
Ministry of Health: National Health Report 2005 Page 117 of 250 --------------------------------------------------------------------------------------------------------------------Consequently, following further review of the 3 HCC clinics and two AHCs projects dropped by the Solomon Islands Health Sector Development Program (SIHSDP) there are at present 18 AHCs in need of some infrastructure work, six of which are in a bad state of repair. There have been improvements in the form of solar lighting and radio installation. At bare minimum each of the remaining 18 AHCs need an incinerator, sealed rubbish pit, clean and dirty utilities, a functioning toilet and shower, a reliable water supply and eradication of white ant infestation.
6.4.8
RHC Clinic Review:
The preliminary results from the RHC infrastructure review are showing the same trends as those found in the AHC review. The problems directly linked to poor infrastructure include; Poor water, power supply and sanitation Poor housing (or no housing, posted staff returning to villages) Bad location & poor access to some clinics Poor Infection control, hygiene & waste disposal Overcrowded OPD and lack of adequate treatment areas.
6.4.9
Unfit or inappropriate birthing facilities
Lack of infrastructure for PHC activities such as outreach, antenatal classes, health education, counselling, HIV and STI awareness, condom distribution & integrated medical tours (mostly held in small crowded outpatients departments or under a tree, lack of privacy etc.)
6.4.9.1
Need for upgrade of equipment & furniture:
Lack of storage for medical supplies, pharmacy, fuel & equipment. Physical deterioration of buildings due to age, weather and white ant s. It is also recommended that funding be made available or donors found for the upgrade of the six most urgent clinics with-in the next year.
6.5
Program Performance:
6.5.1 6.5.1.1
Program achievements of Outputs in 2006: Environmental Health Division- 31:
By 2005, since 2003, of the total 14 water supply projects funded under EU, 12 (86%) were completed Only 2 projects are pending completion. By 2005 10 projects (sanitation projects) funded under ROC completed. Gazette of Food Hygiene and Fish and Fishery Regulation done. Office space and health center at Airport completed and in use: Space at Port under negotiation. 6.5.1.2
HIV/STI Prevention- Disease Prevention and Control Unit
VCCT Sites established and operating at SIPPA, Rove Clinic, HIV Prevention Unit and National Referral Hospital. Auki and Gizo sites visited. BSS/HIV/STI Surveillance done and report available.
31
Environmental Health Division: 2006 Quarterly Report (3rd Quarter)
Ministry of Health: National Health Report 2005 Page 118 of 250 --------------------------------------------------------------------------------------------------------------------Draft HIV VCCT Protocol completed for finalization. Stakeholder meetings held regularly. Solomon Islands National AIDS Council meetings held. Training of additional 20 VCCT counselors (nurses) begun. 6.5.1.3
NCD Prevention: Disease Prevention and Control Unit
Regional Assistance from NZAID through David and Allen Clark of NZ signed and project commenced in 2005. Training (s) of health workers (nurses and doctors) on diabetes held. A video on smoking and related health problems produced. Radio spots on NCD prevention continued. Two supervising tours done: Choiseul and Makira 6.5.1.4
Community Based Rehabilitation
Refresher training for 16 Rehabilitation Aides done. Draft Legislation on Disability completed, discussed during a one day workshop: Pending further discussion Training: Teach Blind people to read and write Braille at least 5 persons per class: (including Purchase a new Braille equipment and Purchase Braille paper and other materials for the training) done. 6.5.1.5
Distance Education Program:
Enrolled 20 students ( nurses) for Pediatric, community Health, Obstetrics. Enrolled students for Family Planning. Enrolled 15 students for Nursing Management. Support to the Pacific Online Health Network continued. 6.5.1.6
Social Welfare
Major review of the Social Welfare Division done. Social Welfare Strategy and Operational Directions done and accepted for implementation by Ministry of Health. 6.5.1.7
TB and Leprosy Prevention and Control.
Completed TOT for coordinators on DOTS. Choiseul, West, Makira and Malaita completed. TB Video developed.2 and distributed. Radio spots (cough too long go to clinic, if stop treatment early TB recurs easily, sharing cigarettes spread TB). Community awareness, leproy screening done in HCC & GP: Additional new cases found 9 in GP and 4 in Fishing Village.. Another training done Provincial Leprosy Coordinator held August 8-10. Leprosy IEC done by FSM students and to be pre-tested later. All new cases of leprosy on treatment-Pauci and Multi-bacillary treatment inclduing contract tracing.
Ministry of Health: National Health Report 2005 Page 119 of 250 ---------------------------------------------------------------------------------------------------------------------
Ministry of Health: National Health Report 2005 Page 120 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 7
Provincial Health Services
Chapter gives a very brief overview of the current status of demography, health burden and the provincial responses.
7.1
Choiseul Province:
Demography: Gender and Poverty: 25,000 20,000
P op
15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005
Population total 19,787 20,422 21,053 21,680 21,853 22,090 22,974 Population <1
705
684
682
682
670
681
707
Population 1-4
2,554 2,614 2,652 2,690 2,673 2,704 2,697
Population <5
3,259 3,298 3,334 3,372 3,344 3,385 3,404
Fig 26 Population of Choiseul 7 year trend 1999-2005. Choiseul has a stable and slow increasing population. About 15% of the total population of 22,974 in 2005 were children of less than 5 years old. About 48% are age group of 15-49 years old.
12,000 10,000
P op
8,000 6,000 4,000 2,000 0 WCBA
1999
2000
2001
2002
2003
2004
2005
4,455
4,667
4,883
5,096
5,093
5,155
5,446
730
723
717
710
703
703
702
Males >5
8,433
8,675
8,920
9,167
9,415
9,541
9,939
Females >5
8,095
8,449
8,799
9,142
9,095
9,164
9,631
Total 15-49
9001
9379
9762
10141
10309
10467
11,035
4 46
4 12
48 9
04
216
621
88
Expected births
Fig 27 Population of Choiseul by gender 7 year trend 1999-2005.
Ministry of Health: National Health Report 2005 Page 121 of 250 ---------------------------------------------------------------------------------------------------------------------
7.2
Health Burden in Choiseul 1996-2005
7.2.1
Introduction
In Solomon Islands the main source of information about health status of Solomon Island people is collected through the Primary Health Care Information System (MOH statistics). Other health information are also maintained by SIMTRI, CBR, Reproductive health while some data are now being collected by the National Referral Hospital. In 2005, a major health review for Solomon Islands was conducted and health indicators were measured against the MOH and millennium development goals. 900.0 800.0
Rate per 1,000 pop
700.0 600.0 500.0 400.0 300.0 200.0 100.0 0.0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
298.5
379.9
393.8
337.8
471.1
408.9
587.5
413.4
479.7
477.8
399.1
Diarrho ea
61.2
74.8
48.9
50.1
56.2
57.0
45.5
35.0
47.8
43.8
44.6
Fever
793.1
734.9
541.7
566.4
433.4
338.7
375.4
348.3
475.1
359.8
287.5
Red Eyes
42.2
116.0
38.5
36.3
56.5
40.2
43.0
41.5
34.5
36.8
27.6
Yaws
10.6
29.2
21.1
17.1
18.0
11.8
19.9
18.6
40.2
14.2
21.2
Skin Diseases
285
258
213
209
198
180
187
162
161
151
118
70
79
71
69
74
97
108
77
89
82
98
13.6
12.0
9.4
8.2
10.0
17.6
10.5
A RI
Ear disease STI rate in 15-49 years Clinical malaria
260.8
436.8
272.2
369.5
247.6
223.3
295.2
266.1
324.7
213.1
132.7
Others Diseases
413.5
516.5
429.5
646.8
659.3
749.8
806.5
684.4
747.3
747.9
741.4
This report will present the progress of health status of Choiseul people in the period 1995 to 2005 against national figures and Solomon Islands MOH and appropriate international indicators. The aim of this report is to present Choiseul health data for period 1996 – 2005 so that trends in disease incidence can be reported. 7.2.2
Major Health Issues
There are several major health issues affecting Solomon Islanders. Some of these are communicable for example, acute respiratory infection (ARI), malaria, skin diseases and yaws, sexually transmitted diseases and HIV, diarrhoea, and TB and leprosy. Others are chronic noncommunicable such as, diabetes and mental, which are becoming increasingly important and demand attention by health service planners as they require long term care for those affected. Each of these health issues provide challenges for health care planners particularly to reduce high levels of morbidity and mortality caused by them.
Ministry of Health: National Health Report 2005 Page 122 of 250 --------------------------------------------------------------------------------------------------------------------Fig 28 Common illness per 1,000 population 11 years trend 1995-2005 in Choiseul: Source HIS MOH (2006).
300
R ate p er 1,000 p o p
250 200 150 100 50 0 1995 1996 1997
1998 1999
2000 2001 2002
2003 2004 2005
Diarrhoea
Red Eyes
Yaw s
Skin Diseases
Ear disease
STI rate in 15-49 years
Fig 29 Lesser common illnesses rate per 1,000 pop 11 yr trend 1995-2005 in Choiseul
Disease Incidence Trend of Choiseul 1996-2005: Figure 1 below demonstrates the proportion of acute care contacts in Choiseul by common diseases. It is obvious that other disease has gain importance as a major cause of attendance at any primary health care clinic in Choiseul during the last decade.
Ministry of Health: National Health Report 2005 Page 123 of 250 --------------------------------------------------------------------------------------------------------------------Fig 1. Proportion of new cases by major disease, Choisuel 1996-2005 45% 40% 35%
percent
30% 25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI Yaw s Clinical malaria
Diarrhoea Skin diseases Other diseases
Fever Ear infection
Red eyes STI diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Choiseul, ARI has been the major cause of attendance at any primary health care clinics. In 2005, ARI was responsible for 26% of all acute care contacts in Choiseul. Figure 2 below demonstrate the incidence rate of ARI in Choiseul and Solomon Islands over the past 10 years. The graph illustrates that in the early years of last decade, incidence rate of ARI for Choiseul was below national average. However, between 1998 and 2005 the situation was reversed. The highest incidence rate of ARI in Choiseul occurred in 2001 reaching 586 cases per 1000 population. The trend of ARI rate in Choiseul had continued to increased between 2002 and 2005.
Ministry of Health: National Health Report 2005 Page 124 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence rate of ARI, Choisuel & Solomon Is
700.0
ra te p e r 1 ,0 0 0
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Choisuel
ARI, Solomon Is
Incidence rate of ARI by age group – Choiseul
Fig 3. Incidence rate of ARI by age group, Chosiuel 1996-2005 2500
rate per 1,000
2000
1500
1000
500
0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 3 above demonstrates the incidence rate of ARI in Choiseul by age – group. The graph reveals that in Choiseul the rates of ARI are highest in babies and in recent years, that is, between 2001 and 2005, the rate has exceeded 2000 cases per 1000 population annually. This would mean that between 2001 and 2005 every baby in Choiseul had been presented more than once with ARI at any primary health care clinic. The graph also shows that in 2005 the incidence rate of ARI in Choiseul in the age group 1-4 has shown a markedly increased from 1199 cases per 1000 in 2004 to 1740 cases per 1000 in 2005.
Ministry of Health: National Health Report 2005 Page 125 of 250 --------------------------------------------------------------------------------------------------------------------Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Choiseul, malaria is responsible for 24% of all acute care contacts in 2005. Fig. 4 Incidence rate of clinical malaria, Choiseul and Solomon Islands 1996-2005 700.0 600.0
rate per 1000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years Clinical malaria - Choiseul
Clinical malaria - Solomon Is.
Figure 4 demonstrates the incidence rate of clinical malaria in Choiseul and Solomon Islands.
The graph shows that the incidence rate of clinical malaria in Choiseul had remained below national averages since 1999. Between 2003 and 2005 clinical malaria rate in Choiseul had declined from 325 cases per 1000 in 2003 to 168 cases per 1000 population in 2005. Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Choiseul for the past 10 years. It is clear from the graph that over the 10 year period, the trend of fever and clinical malaria in Choiseul has declined while the rate for slide confirmed malaria had increased. The graph also shows that between 2003 and 2005 slide confirmed malaria rate had exceeded demonstrating a highest slide confirmed rate in 2004 before it declined to 300 cases per 1000 population in 2005.
Ministry of Health: National Health Report 2005 Page 126 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 5 Incidence rate of clinical malaria, fever, slide confirmed, Choisuel 1996-2005 800.0 700.0
rate per 1,000
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
fever
slideconfirmed
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Choiseul, diarrhoea in particular with no blood and no dehydration is more common (see figure 6 below). Fig 6. Incidence rate of diarrhoea by type, Choisuel 1996-2005 70.0 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody Diarrhoea by age group Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group in Choiseul. The graph shows that in Choiseul bloody diarrhoea is more common in children less than 5 years and more importantly in babies. Over the past 10 years incidence rate of bloody diarrhoea in babies in Choiseul has increased markedly. Though the graph shows a decline in bloody diarrhoea rates in babies between 2000 and 2004, in 2005 the rate increased dramatically. In 2004, the rate also increased significantly in babies however, in 2005 a slight decline was noted.
Ministry of Health: National Health Report 2005 Page 127 of 250 --------------------------------------------------------------------------------------------------------------------Fig 7. Incidence rate of bloody diarrhoea by age group, Choisuel 1996-2005 30.0
rate per 1,000
25.0 20.0 15.0 10.0 5.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Choiseul, yaws and more importantly skin disease are also common health problems in the people aged more than 1. Fig 8. Incidence rate of yaw s and skin disease, Choisuel & Solomon Is 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Choisuel
yaw s, Solomon Is
skin disease, Choisuel
skin disease, Solomon Is
Figure 8 demonstrates the incidence rate of yaws and skin disease in Choiseul and Solomon Islands over the past 10 years. The graph shows that the trend of yaws and skin disease incidence rate in Choiseul and Solomon Islands had declined over the past 10 years. The graph also reveals that while yaws incidence rate in Choiseul had remained below national average during the past 10 years, skin disease rate demonstrates the opposite. As depicted in the graph, the rate of skin disease in Choiseul remained above national average through out the 10 year period. Yaws by age group
Ministry of Health: National Health Report 2005 Page 128 of 250 --------------------------------------------------------------------------------------------------------------------Figure 9 below demonstrates the incidence rate of yaws in Choiseul by age group. The graph shows that incidence rate of yaws in Choiseul was more prominent in children aged 1 – 4 followed by people aged 5 years and over. The graph also reveals that yaws is not a common health problem for babies in Choiseul. Fig 9. Incidence rate of yaw s by age group, Choisuel 1996-2005 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 9 also reveals that in Choiseul the trends of yaws rate particularly in children aged 1-4 between 1996 and 2000 had declined. Then between 2000 and 2005 the graph shows are very fluctuating pattern of yaws rate amongst children aged 1-4 reaching it highest point in 2004 where the rate was 50 cases per 1000 population. The fluctuating pattern of yaws incidence rate in Choiseul particularly in the aged groups 1-4 indicates clearly that though incidence rate of yaws had declined in some years it had remained to be a problem amongst children aged 1-4 in recent years. Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Choiseul. The graph reveals that in Choiseul skin disease was more common in children aged 1-4 and people 5 years and over. The graph also shows that over the past 10 years the trend of skin disease rate in Choiseul for all age group has declined.
Fig 10. Incidence rate of skin disease by age group, Choisuel 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 129 of 250 --------------------------------------------------------------------------------------------------------------------Red Eye Figure 11 demonstrates the incidence rate of red eye in Choiseul and Solomon Islands for the past 10 years. The graph shows that incidence rate of red eye in Choiseul had declined markedly from 116 cases per 1000 population in 1996 to 32 cases per 1000 population in 2005. Fig 11. Incidence rate of red eye, Choisuel & Solomon Is 1996-2005 140.0
rate p er 1 ,00 0
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Choisuel
red eye, Solomon Is
The graph also shows that in Choiseul the highest rate of red eye occurred in 1996 then it dropped significantly in 1997 reaching 40 cases per 1000 population. In 1998 the rate increased again before it dropped from 57 cases per 1000 population in 1999 to 40 cases per 1000 in 2000. Between 2000 and 2005 the rate of red eye in Choiseul had moderately declined.
Red Eye by Age Group Figure 12 below demonstrates the incidence rate of red eye in Choiseul over the past 10 years. The graph shows that in Choiseul red eye was more common in children under 5. The graph also shows that the trend of red eye for all aged group in Choiseul experienced a significant dropped from 1996 to 1997. Then it had remained below 100 cases per 1000 all through out the 10 year period. Fig 12. Incidence of red eye by age group, Choisuel 1996-2005 250.0
rate per 1,000
200.0
150.0
100.0
50.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 below demonstrates the incidence rate of ear infection in Choiseul and Solomon Islands. The graph shows that the rate of ear infection in Choiseul had been higher than national average since 1998.
Ministry of Health: National Health Report 2005 Page 130 of 250 --------------------------------------------------------------------------------------------------------------------The graph also shows that the trend of ear infection rate in Choiseul had increased from 82 cases per 1000 population in 2004 to 116 cases per 1000 population in 2005. Fig 13. Incidence rate of ear infection, Choisuel & Solomon Is 1996-2005 140.0 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection
ear infection, Solomon Is
Ear infection by age-group Figure 14 below demonstrates the incidence rate of ear infection by age group in Choiseul. From the graph it is obvious that in Choiseul ear infection is more common in children aged 1-4. The incidence rates of ear infection in this age group has increased over the years from 131 cases per 1000 population in 1996 to it highest point 230 cases per 1000 in 2005. The graph also shows that in Choiseul the incidence rate of ear infection in the aged 1-4 had declined slightly between 1996 and 1998. This was followed by a continuous increased between 1998 and 2002 reaching 200 cases per 1000 population in 2002. Then between 2002 and 2004 incidence rate of ear infection for aged group 1-4 dropped from 200 cases per 1000 population in 2002 to 140 cases per 1000 population in 2004 before it increased in 2005 reaching 230 cases per 1000 population. Fig 14. Incidence rate of ear infection by age group, Choisuel 1996-2005 250.0
rate per 1,000
200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Summary: Acute Respiratory Infections and other febrile illnesses are commonest cause of health burden to the people of Choiseul as well as demand to the primary health care services. In 2005, ARI accounts for 399 per 1,000 population whilst fever causes 288 per 1,000 population to attend clinics in the provinces.
Ministry of Health: National Health Report 2005 Page 131 of 250 --------------------------------------------------------------------------------------------------------------------Interesting enough record on clinical malaria has declined although it was fluctuating in the past five years. In 2005 it was recorded at around 133 per 1,000 populations. It was understood that there was an intense malaria control program funded by Rotary Club in the past years. Migration or cross border issues with Bougainville has raised alarm especially in light on HIV transmission. Whilst there hasn’t been contextual evidence. The National HIV Policy has flagged concerns around HIV and migration.
Provincial Response: In 2005 Choiseul has total of 27 registered clinics (and one Village Health Worker’s Post). There are two hospitals. Taro was recently upgraded to a mini-hospital status. The other is Sasamuga. Choiseul reached the ratio of 1 clinic to 851 population as compared to the national figure of 1:1,459.
Clinics Clinic Province Hospital ANC UH RHC NAP VHW Total Total clinics without closed requires Clinic VHW formal upgrade Choiseul 2
1
11
13
1
28
27
4 to RHC + 2 NAP
No of MOH Health Radios in Province 14
Ministry of Health: National Health Report 2005 Page 132 of 250 --------------------------------------------------------------------------------------------------------------------Map 1: Location of Clinics in Choiseul Province in 2005: Source: Ministry of Lands
Ratio: I clinic to population 1,459 851
Solomon Islands Choiseul
Ministry of Health: National Health Report 2005 Page 133 of 250 ---------------------------------------------------------------------------------------------------------------------
7.3
Western Province
Demography: Gender and Poverty: Core population and Health datas on Western Province:
1995 857 462 290 218 117 99 69
2000 Fever
557
ARI 376 Skin Diseases 333 Clinical malaria 102 Ear Disease 83 Diarrhoea 77 Yaws 44
2005 Clinical malaria
458
ARI
191
Fever Skin Diseases Ear Disease Yaws Diarrhoea
165 110 77 54 40
ARI Clinical malaria Fever Skin Diseases Ear Disease Diarrhoea Yaws
80,000
Po p
60,000 40,000 20,000 0
1999
2000
2001
2002
2003
2004
2005
Population total 62,039
66,727
65,146
66,727
68,608
71,846
72,124
Population <1
2,003
1,908
1,902
1,931
1,988
2,159
2,187
Population 1-4
7,550
7,613
7,641
7,704
7,836
8,269
7,966
Population <5
9,552
9,520
9,543
9,634
9,824
10,428
10,153
Pop-15-49 All
30316
31392
32474
33557
34790
36339
37,188
Fig 30 Population of Western 7 year trend 1999-2005 Western Province is the second largest populated province in Solomon Islands. In 2005 the estimated population was around 72,124 people. Children under 5 years old make up 14%, whilst majority of 51.6% are within the age-group of 15-49.
Ministry of Health: National Health Report 2005 Page 134 of 250 --------------------------------------------------------------------------------------------------------------------40,000 35,000 30,000 Pop
25,000 20,000 15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005
14,107 14,597 15,100 15,613 16,272 17,003 17,456
WCBA
2,205
Expected births
2,211
2,216
2,222
2,228
2,233
2,238
Males >5
27,854 28,689 29,496 30,267 31,012 32,470 32,608
Females >5
24,633 25,374 26,107 26,825 27,772 33,937 29,363
total 15-49
30,316 31,392 32,474 33,557 34,790 36,339 37,188
males 15-49
16,209 16,795 17,374 17,944 18,517 19,335 19,732
Fig 31 Population of Western by gender 7 year trend 1999-2005
900 800 Rateper 1,000pop
700 600 500 400 300 200 100 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 462
440
593
457
470
376
420
341
304
432
99
79
82
74
53
44
36
31
32
44
54
Fever
857
650
555
408
340
333
331
243
234
203
165
Yaw s
69
84
72
75
68
77
64
58
77
44
40
Skin Diseases
290
163
172
122
94
102
81
89
90
98
110
Ear Disease
117
107
113
105
86
83
74
59
68
84
77
Clinical malaria
218
584
469
485
473
557
482
345
272
257
191
ARI Diarrhoea
Fig 31 Common illness per 1,000 population 11 years trend 1995-2005 in Western: Source HIS MOH (2006).
7.3.1
Health Burden in Western
Disease Incidence Trend of Western Province 1996-2005
458
Ministry of Health: National Health Report 2005 Page 135 of 250 --------------------------------------------------------------------------------------------------------------------Figure 1 below demonstrates the proportion of acute care contacts in Western by common diseases. It is obvious from the graph that ARI has been the major cause of attendance at any primary health care clinic in Western during the last decade. Fig 1. Proportion of new cases by major disease, Western 1996-2005 70%
60%
percent
50%
40%
30%
20%
10%
0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Western, ARI has been the major cause of attendance at any primary health care clinics. In 2005, ARI was responsible for 51% of all acute care contacts in Western. Figure 2 below demonstrate the incidence rate of ARI in Western and Solomon Islands over the past 10 years. The graph shows that the trend of ARI incidence rate for both Western and Solomon Islands is pretty much the same. Though a decline in the incidence rate of ARI for both Western and Solomon Islands was noted between 1997 and 2003, the situation has been reversed between 2003 and 2005.
Ministry of Health: National Health Report 2005 Page 136 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence rate of ARI, Western & Solomon Is 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Western
ARI, Solomon Is
Incidence rate of ARI by age group – Western
Fig 3. Incidence rate of ARI by age group, Western 1996-2005 2500
rate per 1,000
2000 1500
1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 3 demonstrates the incidence rate of ARI by age group in Western. The graph reveals that in Western ARI has become a more common health problem in children aged less than five and more importantly infant. It also shows that the trend of ARI incidence rate has remained beyond a 1500 cases per 1000 population. Though the rate in infants had declined between 2001 and 2003, in 2004 the rate went up again and then decline slightly in 2005. However, for children aged 1-4, the incidence rate of ARI had continued to rise between 2003 and 2005 after a constant declined that occurred between 2001 and 2003. The highest incidence rate of ARI in infant and children aged 1-4 occurred in 1997 reaching 1868 cases per 1000 population and 1031 cases per 1000 population respectively. Malaria
Ministry of Health: National Health Report 2005 Page 137 of 250 --------------------------------------------------------------------------------------------------------------------In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Western, malaria is responsible for 19% of all acute care contacts in 2005. Fig 4. Incidence rate of clinical malaria, Western & Solomon Is 1996-2005 700.0 600.0
percent
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Western
Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Western and Solomon Islands. The graph shows that incidence rate of clinical malaria in Western is lower than national averages in the past 10 years. The graph also shows that the trend of clinical malaria in Western and in Solomon Islands has declined over the last ten years. Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Western for the past 10 years. It is obvious from the graph that the trend of the incidence rate for fever, clinical malaria and slide confirmed malaria in Western has declined over the years. The graph also shows that over the years the incidence rate of slide confirmed malaria was below that of clinical malaria.
Ministry of Health: National Health Report 2005 Page 138 of 250 --------------------------------------------------------------------------------------------------------------------Fig 5. Incidence rate of clinical malaria, fever, slide confirmed, Western 19962005 700.0
rate per 1,000
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
fever
slide confirmed
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Western, diarrhoea in particular with no blood and no dehydration is more common (see figure 6 below). Fig 6. Incidence rate of diarrhoea by type, Western 1996-2005 80.0 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody Diarrhoea by age group Figure 7a and 7b below demonstrates the incidence rate of Bloody diarrhoea by Age group. The graph reveals that bloody diarrhoea was more common in children aged less than 5 years. The graph also shows that in 2005 there was a significant increase in the incidence rate of bloody diarrhoea amongst children aged less than five.
Ministry of Health: National Health Report 2005 Page 139 of 250 --------------------------------------------------------------------------------------------------------------------Fig 7a. Incidence rate of bloody diarrhoea by age group, Western 1996-2005 45.0 40.0
rate per 1,000
35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Fig. 7b Incidence rate of bloody diarrhoea by age group, Western 1996-2005 45
rates per 1000 population
40 35 30 25 20 15 10 5 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years rates <5
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Western, yaws and more importantly skin disease are common health problems amongst it people.
Ministry of Health: National Health Report 2005 Page 140 of 250 --------------------------------------------------------------------------------------------------------------------Fig 8. Incidence rate of yaw s and skin disease, Western & Solomon Is 19962005 200.0 180.0
rate per 1,000
160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Western
yaw s, Solomon Is
skin disease, Western
skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Western and Solomon Islands. The graph shows that the trend of yaws and skin disease rate has declined over the past 10 years for both Solomon Islands and Western. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws in Western by age group. The graph shows that rate of yaws in Western was more prominent in children aged 1 – 4 followed by people aged 5 years and over. The graph also reveals that yaws is not a common health problem for babies in Western. Fig 9. Incidence rate of yaw s by age group, Western 1996-2005 160.0 140.0
rate per 1,000
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 9 reveals that in Western the trend of yaws rate particularly in the aged group 1-4 has declined between 1996 and 2005. However, it is also evident that over the past 10 years the situation that is the incidence of yaws particularly in the aged group 1-4 had never been improved. This is demonstrated clearly in figure 9 where yaws incidence
Ministry of Health: National Health Report 2005 Page 141 of 250 --------------------------------------------------------------------------------------------------------------------rate in the aged group 1-4 had shown a fluctuating pattern in the years between 1996 and 2005. This pattern may strongly indicate that vaccine coverage had not been adequate to prevent the disease from spreading. Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Western. The graph shows clearly that skin disease in Western Province was more common in children aged 1-4. It also shows that over the years, the rate of skin disease in Western has declined particularly in the aged group 1-4 and 5 years and over. However, for infants the situation has been the opposite. The graph also shows that in recent years, that is, between 2003 and 2005, the rate of skin disease in infants has demonstrated the highest increase than any of the other age groups. Fig 10. Incidence rate of skin disease by age group, Western 1996-2005 300.0
rateper 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Red Eye Figure 11 demonstrates the incidence rate of red eye in Western and Solomon Islands for the past 10 years. The graph shows that over the past 10 years the trend of red eye incidence rate had declined by more than halved for both Western and Solomon Islands.
Ministry of Health: National Health Report 2005 Page 142 of 250 --------------------------------------------------------------------------------------------------------------------Fig 11. Incidence rate of red eye, Western & Solomon Is 1996-2005 100.0 90.0 80.0
rateper 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year red eye, Western
red eye, Solomon Is
2004
2005
Ministry of Health: National Health Report 2005 Page 143 of 250 --------------------------------------------------------------------------------------------------------------------Red Eye by Age Group Figure 12 below demonstrates the incidence rate of red eye by age group in Western, for the past 10 years. The graph shows that in Western red eye was more prominent in children less than 5 years but more importantly in babies. In 1998, the graph shows that there was an outbreak of red eye in babies reaching 274 cases per 1000 population. In 1999 the rate significantly dropped to 139 cases per 1000 population. The graph also shows that in recent years that is between 2003 and 2005 the rate of red eye in all aged groups had experienced a slight increased. Fig 12. Incidence rate of red eye by age group, Western 1996-2005 300.0
rate per 1,000
250.0 200.0
150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Western and Solomon Islands. The graph also shows that the trend of ear infection rate in Western and Solomon Islands had declined over the past 10 years reaching it lowest level in 2002 before it increased again between 2002 and 2005. In 2005, while ear infection rate in Solomon Islands experienced a constant increase, the rate of ear infection in Western had experienced a moderate decline that is from 84 cases per 1000 in 2004 to 77 cases per 1000 population in 2005.
Ministry of Health: National Health Report 2005 Page 144 of 250 --------------------------------------------------------------------------------------------------------------------Fig 13. Incidence rate of ear infection, Western & Solomon Is 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection
ear infection, Solomon Is
Ear infection by age-group Figure 14 below demonstrates the incidence rate of ear infection by age group in Western. From the graph, it is obvious that in Western ear infection is more common in children aged less than five but more importantly in children aged 1-4. The graph also shows that between 2002 and 2005 the rate of ear infection particularly in children aged 1-4 has been constantly increasing reaching 168 cases per 1000 population in 2005. Fig 14. Incidence rate of ear inf ection by age group, Western 1996-2005 250.0
rate per 1,000
200.0
150.0
100.0
50.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Conclusion: The disease burden in the Western Province is not different from that of Choiseul Province and other provinces. In both provinces the trend of clinical malaria has steadily declined (Fi.g 31).
Ministry of Health: National Health Report 2005 Page 145 of 250 --------------------------------------------------------------------------------------------------------------------There is no clear reason for this reduction but malaria control program in Western and Choiseul Province were supported financially by Rotary Club. ARI remains the commonest acute illness. There was an increasing trend of clinical malaria in the past five years, from 1995 to 2000, however the trend has been declined significantly from 557 to 191 per 1,000 populations.
Provincial Response: Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade Western
2
5
23
27
1
TOTAL
10
29
TOTAL 2005
10
2004
10
58
5
106
173
14
29
5
106
173
323
-1 30
5
-5 111
15 158
314
57
6 to RHC 7
No of MOH Health Radios in Province 32 149
323
The people of the Western Province have access to both primary and secondary health care services. The provincial health service also provide public health programs such as the Environmental health division ensuring safe water and proper sanitary facilities as well as the commercial support activities like environmental and health quarantine duties to the foreign liners. The primary health care service comprises of total of 58 clinics (including one Village Health Workers Post. There are two hospitals (one Government and one Church owned). In 2005, the ratio of a clinic to population is 1: 1,265. There are many more people served by one clinic. Obviously islands and villages are geographically more scattered. The recent clinic utilization review supports two clinics in Western Province namely Noro Taiyo and Noro public to merge into a single Urban clinic.
Ratio of 1 clinic to pop in 2005 1,459 National 1,265 western
Health Workforce In 2005 Western Province employed total of 177 direct employees from the province to join 104 seconded staff from National mother Ministry to drive the health services in the province. Of the total 300 position allocated for the WP, 94% (281 positions were filled).
Ministry of Health: National Health Report 2005 Page 146 of 250 --------------------------------------------------------------------------------------------------------------------Medical, 4 Pharmacy , 4 Health Promotion, 8
Radiography, 4
Environmental Hlth, 15
Laboratory, 2 Physiotherapy, 1 Dental, 0 Social Service , 0
Support services , 36
Vector Borne Disease Control, 43
Nursing , 164
Fig 32 Proportion of category of health workers in Western Province
Key issues in 2005(32) Two maternal deaths were recorded in 2005. Twenty two infant deaths were recorded, an increase from 15 in 2004. the crude birth rate continues its slow increase in Western Province contributed to by a steadily increasing adolescent fertility rate which more than doubled between 2004 and 2005 and continuing low contraceptive prevalence rates.
Sexual : Overall there appears to be a continuing increase in sexually transmitted infections. No cases of HIV have been detected in Western Province to date. Vaccine Preventable: A small outbreak of whooping cough in August 2005 was quickly stemmed with treatment and immunization catch-up. Under 1 year immunization 2005 coverage, based on available data is shown in Graph 1 below. These data must view cautiously given the probable underreporting of immunizations in 3 health zones.
32
Western Province Health Service Annual Health Report 2005.
Ministry of Health: National Health Report 2005 Page 147 of 250 ---------------------------------------------------------------------------------------------------------------------
Map 2: Location of Clinics in Western Province in 2005: Source: Ministry of Lands
Ministry of Health: National Health Report 2005 Page 148 of 250 ---------------------------------------------------------------------------------------------------------------------
7.4
Isabel Provinces
Demography: Gender and Poverty 25,000 20,000 Pop
15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005 23,364
20,198
20,642
21,099
21,563
22,225
21,875
Population <1
692
677
665
641
616
596
613
Population 1-4
2,385
2,430
2,454
2,470
2,500
2,463
2,491
Population <5
3,077
3,107
3,119
3,112
3,117
3,059
3,104
Pop 15-49
9,247
9,550
9,869
10,202
10,637
10,535
12,172
Population total
Fig 33 Population of Isabel 7 year trend 1999-2005. 25,000 20,000
Pop
15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005
20,198
4,819
4,965
5,116
5,357
5,248
5,727
657
670
683
697
711
727
744
Males >5
8,707
8,910
9,135
9,382
9,646
9,604
10,237
Females >5
8,414
8,625
8,845
9,070
9,462
9,212
10,023
total 15-49 years
9,247
9,550
9,869
10,202 10,637 10,535 12,172
WCBA Expected births
Fig 33 Population of Isabel Province by gender 7 year trend 1999-2005. There is no disparity in proportion of male to females (about 1;1) Fig 33, however, there are differences in cultural recognition of gender especially women in different provinces in terms of land ownerships and decision making by provinces which may affect and influence how health services are distributed. The Isabel is an interesting province with a maternal influence in land ownership. There has been evidence of community partnership within themselves and a strong recognition and adherence to their chief system33.
There are evidence building to affirm this nortion of strong community partnership having an positive impact of health status of the people.
33
Ministry of Health: National Health Report 2005 Page 149 of 250 --------------------------------------------------------------------------------------------------------------------Health Burden Disease Incidence Trend of Isabel Figure 1 below demonstrates the proportion of acute care contacts in Isabel by diseases. From the graph it is obvious that malaria and ARI are major common health problems affecting Isabel people. Fig 1. Proportion of new cases by major disease, Isabel 1996-2005 45.0% 40.0% 35.0%
percent
30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI Skin diseases
Diarrhoea Ear infection
Fever STI diseases
Red eyes Clinical malaria
Yaw s Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Isabel, ARI is second only importance to ‘Other’ disease category. In 2005, ARI was responsible for 29% of all acute care contacts in Isabel. Figure 2 below demonstrates the incidence rate of ARI in Isabel and Solomon Islands over the past 10 years. The graph shows that the trend of ARI incidence rate in Isabel has increased from 478 cases per 1000 in 1996 to 639 cases per 1000 in 2005. Over the years, ARI has remained to be a common illness for Isabel people.
Ministry of Health: National Health Report 2005 Page 150 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence rate of ARI, Isabel & Solomon Is 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Isabel
ARI, Solomon Is
Incidence rate of ARI by age group – Isabel Figure 3 demonstrates the incidence rate of ARI by age group in Isabel for the past 10 years. The graph reveals that ARI incidence rate is higher in children aged less than 5 and more importantly in infants. The graph also shows the increasing trend of ARI in infants while a slight increase was observed in children aged 1-4 and the trend remained constant in the aged group 5 years and older over the years. The graph also depicted that ARI rate in infants has exceeded more than 2000 cases per 1000 population all through out the 10 year period. In 2005, the trend of ARI in infants has dropped from it highest 665 cases per 1000 population in 2004 to 539 cases per 1000 population in 2005. Fig 3. Incidence rate of ARI by age group, Isabel 1996-2005 4500 4000
rate per 1,000
3500 3000 2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care
Ministry of Health: National Health Report 2005 Page 151 of 250 --------------------------------------------------------------------------------------------------------------------Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Isabel, malaria is responsible for 22% of all acute care contacts in 2005. Fig 4. Incidence rate of clinical malaria, Isabel & Solomon Is 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Isabel
Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria in Isabel and Solomon Islands in the past 10 years. The graph shows that incidence rate of clinical malaria in Isabel has remained below national average all through out the 10 year period. Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Isabel for the past 10 years. The graph shows that the trend of the rates for fever, clinical malaria and slide confirmed malaria in Isabel has declined over the past 10 years. The rate of slide confirmed malaria has remained below clinical malaria and fever rates. Fig 5. Incidence rate of clinical malaria, f ever, slide conf irmed, Isabel 19962005 500.0 450.0
rate per 1,000
400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
Year clinical malaria
Diarrhoeal disease
fever
slide confirmed
2005
Ministry of Health: National Health Report 2005 Page 152 of 250 --------------------------------------------------------------------------------------------------------------------Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Isabel, diarrhoea and more importantly with no blood and no dehydration is more common (see figure 6 below). Fig 6. Incidence rate of diarrhoea by type, Isabel 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody Diarrhoea by age group Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group over the past 10 years. The graph reveals that bloody diarrhoea was more common in children aged less than 5 years but more importantly in infants. The trend of bloody diarrhoea in infants has increased in recent years that is, between 2001 and 2005. An increasing trend was also observed in the age group 1-4 in 2005. Fig 7. Incidence rate of bloody diarrhoea by age group, Isabel 1996-2005 35.0
rate per 1,000
30.0 25.0 20.0 15.0 10.0 5.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Isabel, yaws and more importantly skin disease are common health problems amongst it people. The graph shows a decreasing trend of skin disease for Isabel and Solomon Islands while a constant trend was observed in the yaws rate for the two.
Ministry of Health: National Health Report 2005 Page 153 of 250 --------------------------------------------------------------------------------------------------------------------Fig 8. Incidence rate of yaw s and skin disease, isabel & Solomon Is 1996-2005 200.0 180.0 160.0 rate per 1,000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Isabel
yaw s, Solomon Is
skin disease, Isabel
skin disease, Solomon Is
Figure 8 above also demonstrates that yaws rate in Isabel has remained below national averages all through out the 10 year period while skin disease rates has reflects no significant difference in Isabel and Solomon Islands especially between 2000 and 2005. Between 1996 and 1998 the rate for skin disease in Isabel has shown a significant dropped from 184 cases per 1000 population in 1996 to 100 cases per 1000 population in 1998. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws in Isabel by age group. The graph shows that the incidence rate of yaws in Isabel was higher in children aged 1 – 4 followed by people aged 5 years and over then in infants. The graph also shows a declining trend of yaws rate in both age group 1-4 and 5 years and over. However the decline was more significant in the age group 1-4.
Ministry of Health: National Health Report 2005 Page 154 of 250 --------------------------------------------------------------------------------------------------------------------Fig 9. Incidence rate of yaw s by age group, Isabel 1996-2005 70.0 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Isabel for the past 10 years. From the graph it is clear that incidence rate of skin disease in Isabel was more common the age group 1-4 followed by infants then people 5 years and over. The highest rate of skin disease was observed in children aged 1-4 reaching 400 cases per 1000 population in 1996. This has significantly declined to 166 cases per 1000 population in 1998, then a slight increased was observed in the next two years reaching 246 cases per 1000 in 2000. Between 2000 and 2002 the rate of skin disease for children aged 1-4 dropped again to 156 cases per 1000 population and between 2002 and 2005 skin disease rate in this age group has shown an increasing trend reaching 221 cases per 1000 in 2005. Fig 10. Incidence rate of skin disease by age group, Isabel 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
Red Eye
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 155 of 250 --------------------------------------------------------------------------------------------------------------------Figure 11 demonstrates the incidence rate of red eye in Isabel and Solomon Islands for the past 10 years. The graph demonstrates clearly the declining trend of red eye incidence rate for both Solomon Islands and Isabel in the past 10 years. The highest incidence rate of red eye experienced in both these places was in 1996. The graph also shows that between 2003 and 2005, the rate of red eye in both places has experienced a slight increase. Fig 11. Incidence rate of red eye, Isabel & Solomon Is 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Isabel
red eye, Solomon Is
Red Eye by Age Group Figure 12 below demonstrates the incidence rate of red eye by age group in Isabel for the past 10 years. The graph shows that the incidence rate of red eye in Isabel was higher in children aged less than 5 years followed by people 5 years and over. From the graph it is obvious that red eye incidence rate has shown a decreasing trend over the past 10 years, however in 2005 a slight increase in the rate was observed in children less than 5 years. Fig 12. Incidence rate of red eye by age group, Isabel 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 156 of 250 --------------------------------------------------------------------------------------------------------------------Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Isabel and Solomon Islands for the past 10 years. The graph demonstrates that trend of ear infection rate in Isabel was higher than national averages particularly in the early years of last decade and between 2000 and 2005. The graph also shows that between 2003 and 2005 the trend of ear infection rate has dropped from it highest 85 cases per 1000 population in 2003 to 64 cases per 1000 population in 2005. Fig 13. Incidence rate of ear inf ection, Isabel & Solomon Is 1996-2005 90 80
rate per 1,000
70 60 50 40 30 20 10 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear inf ection, Isabel
ear inf ection, Solomon Is
Ear infection by age-group Figure 14 demonstrates the incidence rate of ear infection by age group in Isabel for the past 10 years. From the graph, it is obvious that in Isabel ear infection is common health problem in children aged 1-4 followed by infants. The graph also shows that incidence rate of ear infection remained to be seen in children aged less than 5 all throughout the 10 year period. The highest rate of ear infection occurred in 2003 reaching 243 cases per 1000 in the aged group 1-4 and 169 cases per 1000 population in infants. The graph also reveals that an outbreak of ear infection was experienced in 2003 where more than 20% of children aged 1-4 where infected whereas 15% of infants were infected too in the same year. However, between 2003 and 2005 the trend of ear infection rate for both these age groups has declined.
Ministry of Health: National Health Report 2005 Page 157 of 250 --------------------------------------------------------------------------------------------------------------------Fig 14. Incidence rate of ear infection by age group, Isabel 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Conclusion: Acute Respiratory Infection is recorded the highest commonest illnesses like Choiseul and Western Province. However, the prevalence is very high than the two former provinces. In 2004-5 the level of 540 to 665 per 1,000 population (Fig. 34). However, the interesting finding is that clinical malaria is far lower than the two above provinces. In 2005 the incidence of clinical malaria was 145 per 1,000 population. Choiseul and Western are showing decline in trend in the incidence of clinical malaria, however, Isabel has been stable around and below 200 per 1,000 population.
Ministry of Health: National Health Report 2005 Page 158 of 250 --------------------------------------------------------------------------------------------------------------------700
600
Rate per 1,000 pop
500
400
300
200
100
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 453
478
512
358
476
509
601
531
493
665
88
92
56
50
47
69
48
36
51
57
55
535
474
412
302
303
308
350
361
315
348
260
Eye
95
98
46
36
38
35
48
38
30
31
40
Yaw s
41
34
29
24
14
17
18
16
24
19
18
217
184
131
99
104
121
90
84
97
90
96
ARI Diarrhoea Fever
Skin diseases
539
Ear disease
69
78
80
49
48
61
65
53
82
75
64
Clinical malaria
79
172
129
106
100
97
134
153
202
201
145
Fig 34 Common illness per 1,000 population 11 years trend 1995-2005 in Isabel: Source HIS MOH (2006
Provincial Response: In responding to the common illnesses and related issues, Isabel Province have built 43 clinics (including 6 Village Health Workers Posts). In 2005 the measure of access is 1 clinic to 631 people. Table 11 Number of clinics in Isabel Province in 2005: MOH Clinic database (2005)
Province
Hospital
ANC
Isabel
1
4
TOTAL
10
29
TOTAL 2005
10
2004
10
UH Clinic
RHC
NAP
VHW
Total clinics
Total without VHW
Clinics closed
11
21
6
43
37
1
No of MOH Health Radios in Province 15
5
106
173
14
7
149
29
5
106
173
323
-1 30
5
-5 111
15 158
314
323
Ministry of Health: National Health Report 2005 Page 159 of 250 ---------------------------------------------------------------------------------------------------------------------
Map 3: Location of Clinics in Isabel Province in 2005: Source: Ministry of Lands
7.5
Central Islands Province
Demography: Gender and Poverty:
Ministry of Health: National Health Report 2005 Page 160 of 250 --------------------------------------------------------------------------------------------------------------------30,000 25,000
Pop
20,000 15,000 10,000 5,000 0
Population total
1999
2000
2001
2002
2003
2004
2005
21,337 21,872 22,419 22,976 23,593 23,045 24,802
Population <1
703
677
676
679
687
678
737
Population 1-4
2,541
2,598
2,634
2,673
2,716
2,667
2,772
3,244
3,276
3,310
3,352
3,403
3,345
3,509
Population <5 Total 15-49
10,169 10,497 10,812 11,124 11,468 11,238 12,172
Fig 35 Population of CIP 7 y trend 14,000 12,000 10,000 Pop
8,000 6,000 4,000 2,000 0 WCBA Expected births Males >5
1999
2000
2001
2002
2003
2004
2005
4,961
5,119
5,274
5,431
5,612
5,479
5,960
766
773
781
788
796
806
9,355
9,609
9,869
10,137
10,414
10,223
11,000
Females >5
8,738
8,987
9,239
9,488
9,776
9,477
10,293
Total 15-49
10,169
10,497
10,812
11,124
11,468
11,238
12,172
males 15-49
5,208
5,378
5,538
5,694
5,856
5,759
6,211
Fig 36 Population of CIP by Gender 7 yr trend.
Health Burden in Central Islands Province 1996-2005 Disease Incidence Trend of CIP Figure 1 below demonstrates the proportion of acute care contacts in Central by diseases. From the graph it is obvious that malaria (fever and clinical malaria) and ARI are cause of attendance at primary health care clinics.
Ministry of Health: National Health Report 2005 Page 161 of 250 --------------------------------------------------------------------------------------------------------------------Fig 1. Proportion of new cases by major disease, central 1996-2005 45% 40% 35%
percent
30% 25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear inf ection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Central, ARI is second only importance to malaria. In 2005, ARI was responsible for 21% of all acute care contacts in Central. Figure 2 below demonstrates the incidence rate of ARI in Central and Solomon Islands over the past 10 years. The graph shows that the trend of ARI incidence rate in Central is remain below national average all through out the ten year period.
Ministry of Health: National Health Report 2005 Page 162 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence of ARI, Central & Solomon Is 1996-2005 500.0 450.0
rate per 1,000
400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year ARI, Central
ARI, Solomon Is
2004
2005
Ministry of Health: National Health Report 2005 Page 163 of 250 --------------------------------------------------------------------------------------------------------------------Incidence rate of ARI by age group – Central Figure 3 demonstrates the incidence rate of ARI by age group in Central. The graph reveals that in Makira ARI was more common in children under 5 but more importantly in babies. The graph also reveals that except in 2003 and 2005 incidence rate of ARI in babies exceeded 2000 cases per 1000, indicating that for every Central baby they have been presented with ARI at any primary health care clinics two times in a year. The graph also demonstrates that ARI rate in children aged 1-4 was also high through out the 10 year period. The incidence rate of ARI in people aged 5 years or more had remained constantly low through out the 10 year period. Fig 3. Incidence rate of ARI by age group, Central 1996-2005 3000
rate per 1,000
2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Central, malaria (fever and clinical malaria) is responsible for 54% of all acute care contacts in 2005. This clearly indicates that fever and clinical malaria are leading causes of morbidity in Central.
Ministry of Health: National Health Report 2005 Page 164 of 250 --------------------------------------------------------------------------------------------------------------------Fig 4. Proportion of clinical malaria, Central & Solomon Is 1996-2005 35% 30%
perc ent
25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Central
Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Central and Solomon Islands. The graph clearly demonstrates an increasing trend of clinical malaria in Central over the past 10 years.
Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Central for the past 10 years. From the graph it is obvious that slide confirmed malaria had remained below incidence rate of fever and clinical malaria through out. The graph also shows the increased trend for slide confirmed malaria over the past 7 years. Fig 5. Incidence rate of clinical malaria, fever, slide confirmed, Central 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year clinical malaria
fever
slide confirmed
2004
2005
Ministry of Health: National Health Report 2005 Page 165 of 250 --------------------------------------------------------------------------------------------------------------------Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Central, diarrhoea and more importantly with no blood and no dehydration is more common (see figure 6 below). Figure 6 below also shows a declining trend of diarrhoea (no blood no dehy.) over the past 10 years. Fig 6. Incidence rate of diarrhoea by type, Central 1996-2005 70.0 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody Diarrhoea by age group Figure 7 below demonstrates the incidence rate of Bloody diarrhoea by Age group in Central. The graph reveals that bloody diarrhoea in Central was more common in children aged less than 5 years. There’s no significant difference observed in the incidence rate of bloody diarrhoea in the aged group 1-4 and infants. Figure 7 also reveals that an outbreak of bloody diarrhoea in children aged less than 5 occurred in 2005. For aged group 5 years and over a slight increase in bloody diarrhoea rate was also observed in 2005. Fig 7. Incidence rate of bloody diarrhoea by age group, Central 1996-2005 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
Skin disease and Yaws
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 166 of 250 --------------------------------------------------------------------------------------------------------------------Skin disease and Yaws are common health problems in Solomon Islands. In Central, yaws and more importantly skin disease are common health problems amongst it people. Fig 8. Incidence rate of yaw s and skin disease, Central & Solomon Is 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Central
yaw s, Solomon Is
skin disease, Central
skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Central and Solomon Islands in the past 10 years. The graph shows that yaws incidence rate for Central was lower than national average, while the rate of skin disease was slightly over national average. Figure 8 also demonstrate a declining trend for skin disease rate while yaws rate for both Solomon Islands and Central had remained constant through out the ten year period. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws in Central by age group. The graph shows that the incidence rate of yaws in Central was higher in children aged 1 – 4 followed by people aged 5 years and over then aged group less than one year old. Fig 9.
Incidence rate of yaw s by age group, Central 1996-2005
100.0 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 167 of 250 --------------------------------------------------------------------------------------------------------------------Figure 9 clearly demonstrates that between 1996 and 2001 the rate of yaws in the age group 1-4 had varied considerably, demonstrating high incidence in one year followed by significant dropped in the next year and so on. This inconsistent pattern of yaws rate clearly indicates that vaccine coverage must be improved in order to prevent the disease from occurring. However, between 2001 and 2004 yaws rate in this age group has constantly increased then slightly decline in 2005. Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Central. The graph demonstrates clearly that in Central the incidence rate of skin disease is higher in children aged 1 – 4, followed by infants then people aged 5 years or more. Fig 10. Incidence rate of skin diseases by age group, Central 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 10 also demonstrates a declining trend in incidence rate of skin disease in Central in all age groups. Red Eye Figure 11 demonstrates the incidence rate of red eye in Central and Solomon Islands for the past 10 years. The graph demonstrates that the incidence rate of red eye had remained somewhat higher than national average through out the 10 year period. It is also clear that in 1997 there was a significant dropped in the incidence of red eye in Central then a decline in the trend of red eye incidence rate was noted all through out to 2005.
Ministry of Health: National Health Report 2005 Page 168 of 250 --------------------------------------------------------------------------------------------------------------------Fig 11. Incidence rate of red eye, Central & Solomon Is 1996-2005 140.0 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Central
red eye, Solomon Is
Red Eye by Age Group Figure 12 below demonstrates the incidence rate of red eye by age group in Central, for the past 10 years. The graph shows that in Central the incidence rate of red eye was higher in babies, followed by children aged 1-4 then people aged 5 years and over. The graph also shows a decline trend of red eye rate in all age groups. Fig 12. Incidence rate of red eye by age group, Central 1996-2005 400.0 350.0
rate per 1,000
300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Central and Solomon Islands. The graph also demonstrates that the incidence rate of ear infection rate in Central was below national averages during the past 10 years. The graph also shows that ear infection rate for Central had increased between 2003 and 2005.
Ministry of Health: National Health Report 2005 Page 169 of 250 --------------------------------------------------------------------------------------------------------------------Fig 13. Incidence rate of ear inf ection, Central & Solomon Is 1996-2005 80.0 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear inf ection, Central
ear inf ection, Solomon Is
Ear infection by age-group Figure 14 demonstrates the incidence rate of ear infection by age group in Central. It reveals that the incidence rate of ear infection is in Central is higher in children aged 1-4 followed by infants then people aged 5 years or more. The graph also shows that the trend in ear infection rate in infants and children 1-4 does not reflect much difference. It is also revealed in the graph that ear infection rate in infants and children aged 1-4 has experienced a significant increase between 2003 and 2005. Fig 14. Incidence rate of ear inf ection by age group, Central 1996-2005 180.0 160.0
rate per 1,000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
As opposite to the first three provinces, incidence of clinical malaria is higher and increasing in Central Islands. Like other provinces, febrile illnesses such as Acute Respiratory infections have increased. Other less common diseases remained in the communities at a lower incidence around 50 per 1,000 population or lesser. There has been a steady decline in the skin diseases and yaws.
Provincial Response: In response to the common illnesses affecting the population of Central, the province has a total of 27 clinics. The ratio of clinic to population stands at 1 clinic to 919 population. (Table 12).
Ministry of Health: National Health Report 2005 Page 170 of 250 --------------------------------------------------------------------------------------------------------------------Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade Central Island TOTAL TOTAL 2005 2004
1
1
10 10
29 29
10
-1 30
7
18
5 5
106 106
173 173
5
-5 111
15 158
27
27
323
323
2 to RHC 7
14
314
Table 12 Number of clinics in Central Province in 2005: MOH Clinic database (2005)
7.6
Guadalcanal
Demography: Gender and Poverty: Guadalcanal has the third largest population of 69,527 in 2005 with a higher proportion of around 50% of age group of 15-49 years. In 2005, Gudalcanal recorded some of the worse health status indicators such as high maternal mortality and an out break whooping cough. 80,000 70,000 60,000 Pop
50,000 40,000 30,000 20,000 10,000 0
1999
2000
2001
2002
2003
2004
2005
Population total
59,611
61,205
62,821
64,456
66,137
68,931
69,527
Population <1
2,204
2,142
2,116
2,069
2,011
2,069
2,035
Population 1-4
7,541
7,742
7,873
7,983
8,082
8,428
8,084
Population <5
9,745
9,885
9,989
10,052
10,092
10,497
10,119
total 15-49 years
28,768
29,795
30,840
31,911
33,009
34,331
35,237
No of MOH Health Radios in Province 10 149
Ministry of Health: National Health Report 2005 Page 171 of 250 --------------------------------------------------------------------------------------------------------------------Fig 37 Population of Guadalcanal 7 y trend 40,000 35,000 30,000
Pop
25,000 20,000 15,000 10,000 5,000 0
WCBA
1999
2000
2001
2002
2003
2004
2005
13,898
14,365
14,843
15,334
15,845
16,548
16,894
2,110
2,182
2,251
2,318
2,381
2,439
Males >5
25,983
26,737
27,522
28,340
29,186
30,359
30,918
Females >5
23,884
24,583
25,310
26,064
26,859
28,075
28,490
total 15-49 years
28,768
29,795
30,840
31,911
33,009
34,331
35,237
males 15-49 years
14,870
15,431
15,997
16,577
17,164
17,781
18,343
Expected births
Fig 38 Population of Guadalcanal by Gender 7 yr trend
Health Burden in Guadalcanal 1996-2005 It should be noted also that the social unrest that prevailed in the country between 1999 until the arrival of Regional Assistance Mission to Solomon Islands (RAMSI) in 2003 had great impact on the provision and delivery of health services to Guadalcanal people. The effect of the social unrest is revealed in Figure 1 and furthermore in all graphs under each headings below.
Ministry of Health: National Health Report 2005 Page 172 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 1 Incidence rate of major diseases, Guadalcanal 1996-2005
900.0 800.0 700.0
ra te p e r 1 0 0 0
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Figure 1 demonstrates incidence rates of all major diseases affecting the health of Guadalcanal people. From the graph it is obvious that between 1998 and 2001 the incidence rates of all causes of illnesse in Guadalcanal dropped severely reaching it lowest point in 2001. The decline in incidence rates may reflects the effect of social unrest on the health service delivery in Guadalcanal. Disease Incidence Trend of Guadalcanal Figure 2 below demonstrates a very clear pattern of the main causes of attendance at primary health care clinics over the past 10 years in Guadalcanal. It is obvious that apart from ‘Other’ diseases, ARI, fever and clinical malaria are major common health problems affecting Guadalcanal people. Over the past 10 years, the proportion of clinical malaria has constantly increased from 2% in 1996 to 21% in 2005. This figure indicates that the proportion of clinical malaria as a main cause of attendance at any primary health care clinic has constantly increased over the past 10 years, though the proportion dropped slightly in 2005.
Ministry of Health: National Health Report 2005 Page 173 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 2 Proportion of new cases by major disease, Guadalcanal 1996-2005 40% 35% 30%
p e rce n t
25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000 2001 years
2002
2003
2004
2005
ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Guadalcanal ARI is second most importance cause of attendance at primary health care clinics. In 2005, ARI was responsible for 29% of all acute care contacts in Guadalcanal.
Fig. 3 Incidence rate of ARI - Guadalcanal,Solomon Is. 1996-2005 700.0 600.0
rate per 1000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years ARI rates - Guadalcanal
ARI rates - Solomon Is.
Ministry of Health: National Health Report 2005 Page 174 of 250 --------------------------------------------------------------------------------------------------------------------Figure 3 above illustrates that the incidence rate of ARI prior to the social unrest was well above national average. Then between 1998 and 2001 it dropped markedly from 580 cases per 1000 in 1998 to 180 cases per 1000 in 2001. Between 2001 and 2004 the incidence rate went up again reaching 350 per 1000 in 2004 and in 2005 a continuous increase was noted reaching 527 cases per 1000. Fig 4. Incidence rate of ARI by age group, Guadalcanal 1996-2005 4000 3500
rate per 1,000
3000 2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates<1
rates 1-4
rates >5
It is very obvious from Figure 4 above that ARI in Guadalcanal is a major health problem in children under 5 and more importantly in infants. As depicted in the graph, the incidence rate of ARI in babies was more than 1000 per population every year. What this figure tells us is that every year each baby in Guadalcanal has been presented with ARI more than once at any primary health care clinic. Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in the country in 2005. In Guadalcanal, malaria (i.e. fever and clinical malaria) account for 37% of all acute care contacts in 2005. Incidence rate of fever, clinical malaria and slide confirmed malaria Figure 6 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Guadalcanal for the past 10 years. It is obvious from the graph that through out the last decade incidence rate of slide confirmed malaria had been lower than incidence rate of clinical malaria. The graph also shows that the incidence rates of clinical and slide confirmed malaria had continued to rise since 1996 and 1998 respectively while the incidence rate of fever had declined considerably. One reason for the increased in trend of clinical malaria and decline trend of fever is that in about 1995 the system has changed in counting all fever cases as malaria.
Ministry of Health: National Health Report 2005 Page 175 of 250 --------------------------------------------------------------------------------------------------------------------Fig 6. Incidence rate of clinical malaria, fever, slide confirmed, Guadalcanal 1996-2005 900.0 800.0
Rate per 1,000
700.0 600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
fever
slide confirmed
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Guadalcanal, diarrhoea and more importantly bloody diarrhoea is also a common illness affecting people of Guadalcanal (see figure 7 below). Fig. 7 Incidence rate of Diarrhoea by Type, Guadalcanal 1996-2005 80.0 70.0
rates per 1000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years bloody no dehy
no blood w ith dehy
no bloody no dehy
blood w ith dehy
Bloody diarrhoea by age group Figure 8 below demonstrates the incidence rate of bloody diarrhoea in Guadalcanal by age group. The graph clearly shows that over the past 10 years bloody diarrhoea was more common in infant than in any other age groups. While the incidence rate declined from 266 cases per 1000 population in 1996 to 232 cases per 1000 population in 1997, in 1998 a significant increased was noted reaching 355 cases per 1000 population. Then between 1998 and 2001 the incidence rate dropped dramatically from 355 cases per 1000 in 1998 to 37 cases in 2001. Again this severely decline may be attributed to the impact of the social unrest on health service delivery in Guadalcanal. And between
Ministry of Health: National Health Report 2005 Page 176 of 250 --------------------------------------------------------------------------------------------------------------------2001 and 2003 the incidence rate increased again reaching 178 cases per 1000. In 2005 a further increase was also noted. Fig 8. Incidence rates of bloody diarrhoea by age group, Guadalcanal 1996-2005 400.0 350.0
rate per 1,000
300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Guadalcanal yaws and more importantly skin disease are also common illness affecting the people. Fig 9. Incidence rates of yaw s and skin disease, Guadalcanal & Solomon Is 350.0 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Guadalcanal
yaw s, Solomon Is
skin disease, Guadalcanal
skin disease, Solomon Is
From Figure 9, the incidence rate of skin diseases in Guadalcanal particularly in the years prior to the social unrest was well beyond national averages. Being the second largest province in terms of population size, it is no doubt that the above figure had great impact on the national average for skin disease rates. Between 1998 and 2001 skin disease incidence rate declined then in 2002 it remain constant and between 2002 and 2005 the incidence rate increased slightly from 60 cases per 1000 population in 2002 to 100 cases per 1000 in 2004. In 2005 a further increased was also noted.
Ministry of Health: National Health Report 2005 Page 177 of 250 --------------------------------------------------------------------------------------------------------------------Yaws by age group Figure 10 below illustrates the incidence rate of yaws by age group. It is obvious from the graph that incidence rate of yaws is highest in children aged 1 – 4 followed by people aged 5 years and over. The graph also reveals that yaws is not a common health problem in Guadalcanal babies. Figure 10 below incidence rates of yaws in children aged 1-4 was very high prior to the social unrest period reaching 102 cases per 1000 in 1998. Then during the social unrest period, the incidence rate declined considerably reaching 30 cases per 1000 population in 2001. However, between 2001 and 2003 the incidence rate of yaws in children aged 1-4 increased reaching 103 cases per 1000 in 2003. Then between 2003 and 2005 the rate had dropped from 103 cases per 1000 in 2003 to 78 cases per 1000 in 2005. Fig 10. Incidence rates of yaw s by age group, Guadalcanal 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Again the significant dropped in the incidence rates between 1998 and 2001 may be associated with the impact of the social unrest that had caused suspension of many health services to people of Guadalcanal in most affected areas. However, the rise in the incidence rate between 2001 and 2003 may indicate that the suspension to health service delivery in some affected areas in Guadalcanal has been lifted and that more people have now accessed to health services. Skin disease by age group Figure 11 below demonstrates the incidence of skin disease by age group in Guadalcanal. As shown in the graph, over the past 10 years, skin disease in Guadalcanal is more common in children aged 1-4 than other age groups. Figure 11 also indicates that in Guadalcanal incidence rate of skin disease in children aged 1-4 had declined from 482 cases per 1000 population in 1996 to 175 cases per 1000 in 2005.
Ministry of Health: National Health Report 2005 Page 178 of 250 --------------------------------------------------------------------------------------------------------------------Fig 11.Incidence rates of skin disease by age group, Guadalcanal 1996-2005 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Red Eye The incidence rate of red eye in Guadalcanal had been higher than national average during the past 10 years. The highest incidence rate of red eye occurred in 1996 reaching 85 cases per 1000 population. In 1997 there was a sudden dropped in red eye incidence rate and in 1998 it went up again reaching 75 cases per 1000 population. Between 1998 and 2001 a continuous declined was experienced and between 2001 and 2004 the rate went up again reaching 167 cases per 1000 in 2004. In 2005 a further increased in red eye incidence rate was noted. Fig 12. Incidence rates of red eye, Guadalcanal & Solomon Is 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Guadalcanal
red eye, Solomon Is
Red eye by age group Figure 13 below shows that in Guadalcanal red eye was more common in children under 5 but more importantly in infants. Between 1996 and 1997 incidence rate of red eye for
Ministry of Health: National Health Report 2005 Page 179 of 250 --------------------------------------------------------------------------------------------------------------------all age group declined. Then in 1998 it went up again to the about same rate in 1996. Between 1998 and 2001, the incidence rate dropped markedly. Then between 2001 and 2004 there was a significantly rise in the rate particularly in infants. In 2005, while incidence rate for age groups 1-4 and 5 years and over remain constant, the incidence rate of red eye in infants experienced a further increase. Fig. 13. Incidence rate of red eye by age group, Guadalcanal 1996-2005 250.0
rate per 1,000
200.0
150.0
100.0
50.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Fig.14. Incidence rate of ear infection, Guadalcanal & Solomon Is 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection, Guadalcanal
ear infection, Solomon Is
Figure 14 above shows the incidence rate of ear infection in Guadalcanal and in Solomon Islands. Prior to the social unrest period, the incidence rate of ear infection was higher than national averages, however a constant declined was experienced between 1997 and 2001 reaching 17 cases per 1000 population in 2001. Then between 1999 and 2005 the incidence rate of ear infection had remained below national averages.
Ministry of Health: National Health Report 2005 Page 180 of 250 --------------------------------------------------------------------------------------------------------------------Between the years 1997 and 2001 there was a considerable decline in ear infection incidence rate reaching 17 cases per 1000 in 2001. However, between 2001 and 2005 a continuous increased was noted. While the incidence rate of ear infection in Solomon Islands had dropped from 80 cases per 1000 in 2004 to 60 cases per 1000 in 2005, in Guadalcanal incidence rate had increased from about 40 cases per 1000 in 2004 to 50 cases per 1000 in 2005. Ear infection by age-group Figure 15 below demonstrates the incidence rate of ear infection by age group in Guadalcanal. From the graph it is very obvious that ear infection is more common in children under 5. The graph also shows that the incidence rates in all age groups had dropped between 1997 and 2001 but more profoundly in children under 5. Between 2001 and 2005, incidence rate of ear infection for all age group has increased. Fig 15. Incidence rate of ear infection by age group, Guadalcanal 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999 rates <1
2000
2001
Year rates 1-4
2002
2003
2004
2005
rates >5
Conclusion: The three common illnesses in Guadalcanal are Acute Respiratory infection, malaria and other febrile diseases. Malaria is a major acute illness in Guadalcanal, there has been an increasing trend. In 2005 Guadalcanal recorded 370 per 1,000 population sick with malaria and had attended the clinics.
Ministry of Health: National Health Report 2005 Page 181 of 250 --------------------------------------------------------------------------------------------------------------------1,000 900 800
Rate per 1,000 pop
700 600 500 400 300 200 100 0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
ARI
398
376
513
581
453
282
180
267
331
350
527
Diarrhoea
87
77
69
82
51
28
6
15
35
27
46
Fever
884
714
717
768
576
383
140
312
376
312
292
Red Eye
62
86
51
75
60
27
14
23
36
35
41
Yaws
82
70
58
69
66
50
24
38
74
62
62
Skin diseases
228
260
208
288
155
100
59
60
95
99
113
Ear disease
66
68
97
77
60
37
17
27
43
42
51
Clinical malaria
17
38
126
277
298
177
153
245
347
373
370
Fig 39 Common illness per 1,000 population 11 years trend 1995-2005 in Central Islands: Source HIS MOH (2006).
Provincial Response: There are total of 44 clinics (including 2 Village Health Workers Post). These primary health care clinics provided basic treatment for the common illnesses. In 2005, the ratio of clinic to population stands at 1 clinic to 1,655 population.
Clinics Clinic Province Hospital ANC UH RHC NAP VHW Total Total clinics without closed requires Clinic VHW formal upgrade GCP
0
6
TOTAL
10
29
TOTAL 2005
10
29
10
-1 30
2004
12
24
2
44
5
106
173
14
5
106
173
323
5
-5 111
15 158
314
42
2 now AHC + 2 to RHC + 5 new NAP 7
323
No of MOH Health Radios in Province 17
149
Ministry of Health: National Health Report 2005 Page 182 of 250 --------------------------------------------------------------------------------------------------------------------7,028 1,945 1,655 1,459 1,355 1,222 1,087 919 895 851
Honiara Malaita Guadalcanal National Temotu western Makira Central Renbel Choiseul
Table 13 Number of clinics in Guadalcanal Province in 2005: MOH Clinic database (2005)
7.7
Malaita
Demography: Gender and Poverty: Malaita is the largest population and also a very challenging one items of implementing primary health care services. Malaita has a more young population than Guadalcanal. The proportion of 15-49 age groups is around 47% whereas Guadalcanal has 50% on productive age group.
Ministry of Health: National Health Report 2005 Page 183 of 250 --------------------------------------------------------------------------------------------------------------------160,000 140,000 120,000
Pop
100,000 80,000 60,000 40,000 20,000 0 Population total
1999
2000
2001
2002
2003
2004
2005
121,299
124,746
128,268
131,855
135,090
133,867
142,018
Population <1
4,403
4,286
4,303
4,342
4,388
4,351
4,733
Population 1-4
15,772
16,156
16,437
16,741
17,015
16,882
17,422
Population <5
20,175
20,442
20,740
21,083
21,403
21,233
22,154
Total 15-49
53,633
55,759
57,919
60,110
62,121
62,125
66,422
Fig 34 Population of Malaita 7 y trend 70,000 60,000 50,000
P o p
40,000 30,000 20,000 10,000 0 WCBA 15-49
1999
2000
2001
2002
2003
2004
2005
28,263
29,284
30,295
31,302
32,103
32,378
34,047
1,842
2,361
3,026
Males >5
50,029
51,643
53,305
55,000
56,728
55,533
59,948
Females >5
51,095
52,661
54,223
55,772
56,959
57,101
59,916
Total 15-49
53,633
55,759
57,919
60,110
62,121
62,125
66,422
Males 15-49
25,371
26,476
27,623
28,808
30,017
29,745
32,375
Ex pec ted births
Fig 35 Population of Malaita by Gender 7 yr trend Health Burden Malaita recorded the highest incidence of malaria (430 per 1,000 populations despite substantial efforts in terms of control measures on the Islands. This trend becomes to raise issues of efficacy of the control measures. CIP and Guadalcanal Provinces recorded 398 and 370 per 1,000 population being infected by malaria respectively. Isabel and Western Province recorded 191 and 145 per 1,000 population respectively.
Ministry of Health: National Health Report 2005 Page 184 of 250 --------------------------------------------------------------------------------------------------------------------700 600 Rateper1,000pop
500 400 300 200 100 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 ARI Diarrhoea Fever
412
274
349
316
399
290
385
393
363
282
218
324
42
33
64
50
32
34
41
34
26
21
17
24
339 39
649
567
640
483
434
380
336
377
355
345
230
316
323
36
37
56
62
31
30
42
38
30
24
18
24
32
Yaw s
122
64
77
84
60
64
58
89
61
55
65
65
56
Skin diseases
297
177
190
152
121
112
123
127
97
77
66
75
95
Ear Diseases
32
31
43
43
33
26
29
32
30
23
17
25
27
115
277
255
219
271
377
382
348
292
400
430
Red Eye
Clinical malaria
Fig 36 Common illness per 1,000 population 13 years trend 1993-2005 in Malaita Province: Source HIS MOH (2006).
Malaita has the highest number of clinics (73 with 3 Village Health Workers Post), followed by Western Province (57) and Guadalcanal (42). However, the clinic to population is still at 1 clinic to around 2,000 population (1,945). Provincial Response: Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade Malaita
2
4
TOTAL
10
29
TOTAL 2005
10
29
10
-1 30
2004
21
46
3
5
106
173
14
5
106
173
323
5
-5 111
15 158
314
76
73
323
6
No o MOH Healt Radi in Prov 28
7
149
Ministry of Health: National Health Report 2005 Page 185 of 250 --------------------------------------------------------------------------------------------------------------------Map x Location of clinics in Malaita in 2005
7.8 7.9
Makira:
Demography: Gender and Poverty:
Ministry of Health: National Health Report 2005 Page 186 of 250 --------------------------------------------------------------------------------------------------------------------40,000 35,000 30,000 Pop
25,000 20,000 15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005
30,668
31,527
32,414
33,330
34,116
34,359
35,865
Population <1
1,223
1,240
1,243
1,205
1,138
1,098
1,118
Population 1-4
3,740
3,946
4,120
4,266
4,361
4,432
4,462
Population <5
4,963
5,187
5,362
5,470
5,498
5,530
5,580
14,498
15,067
15,640
16,217
16,706
16,845
17,692
Population total
total 15-49 years
Fig 37 Population of Makira 7 year trend In 2005 Makira Province estimated population was 35,865. About 49% were between the agegroup of 15-49 years old. Around 16% were less than 5 years and understandably cause a great demand to preventive services such as immunization. 20,000
Population
15,000 10,000 5,000 0 WCBA
1999
2000
2001
2002
2003
2004
2005
7,324
7,594
7,866
8,142
8,331
8,527
8,790 1,458
Expected births
1,153
1,200
1,249
1,300
1,353
1,404
Males >5
13,181
13,505
13,871
14,283
14,738
14,599
Females >5
12,525
12,836
13,181
13,576
13,880
14,231
total 15-49 years
14,498
15,067
15,640
16,217
16,706
16,845
Fig 38 Population of Makira 7 trend by gender
Health Burden in Makira 1996-2005: Disease Incidence Trend in Makira
17,692
Ministry of Health: National Health Report 2005 Page 187 of 250 --------------------------------------------------------------------------------------------------------------------Figure 1 below demonstrates the proportion of acute care contacts in Makira by diseases. From the graph it is obvious that malaria and ARI are major common health problems affecting Makira people.
Fig 1. Proportion of new cases by major diseases, Makira 1996-2005 40% 35% 30%
percent
25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Makira, ARI is second only importance to malaria. In 2005, ARI was responsible for 24% of all acute care contacts in Makira. Figure 2 below demonstrates the incidence rate of ARI in Makira and Solomon Islands over the past 10 years. The graph shows that the trend of ARI incidence rate in Makira has been increasing from 297 cases per 1000 in 1996 to 465 cases per 1000 in 2005. Over the years, ARI has remained to be seen as a common illness for Makira people.
Ministry of Health: National Health Report 2005 Page 188 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence rate of ARI, Makira & Solomon Is 1996-2005 500.0 450.0 400.0
rateper 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Makira
ARI, Solomon Is
Incidence rate of ARI by age group – Makira Figure 3 demonstrates the incidence rate of ARI by age group in Makira. The graph reveals that in Makira ARI has been a major health problem in babies. As also depicted, the trend of ARI rate in babies have increased considerably over the past 10 years, reaching 3075 cases per 1000 population in 2005. This would mean that every Makira baby have been presented more than once with ARI at any primary health care clinics. The graph also shows that in the recent years, the rate of ARI in Makira has increased considerably. The increase in the ARI rate was also experienced in the aged group 1-4 between 2003 and 2004.
Ministry of Health: National Health Report 2005 Page 189 of 250 --------------------------------------------------------------------------------------------------------------------Fig 3. Incidence rate of ARI by age group, Makira 1996-2005 3500 3000
rate per 1,000
2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Makira, malaria is responsible for 48% of all acute care contacts in 2005.
Ministry of Health: National Health Report 2005 Page 190 of 250 --------------------------------------------------------------------------------------------------------------------Fig 4. Incidence rate of clinical malaria, Makira & Solomon Is 1996-2005 700.0 600.0
percent
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Makira
Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Makira and Solomon Islands. The graph shows that incidence rate of clinical malaria in Makira has increased and exceeded national average in recent years. The graph also reveals that the rate of clinical malaria in Makira increased dramatically between 2001 and 2004 reaching 505 cases per 1000 population in 2004. In 2005 clinical malaria rate in Makira decreased to 487 cases per 1000 population.
Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Makira for the past 10 years. It is obvious from the graph that the trend of the rate for fever, clinical malaria and slide confirmed malaria in Makira has gone up over the past 10 years and the significant rise is more prominent in recent years.
Ministry of Health: National Health Report 2005 Page 191 of 250 --------------------------------------------------------------------------------------------------------------------Fig 5. Incidence rate of clinical malaria, f ever, slide conf irmed, Makira 19962005 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
f ever
slide conf irmed
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Makira, diarrhoea and more importantly with no blood and no dehydration is more common (see figure 6 below). Fig 6. Incidence rate of diarrhoea by type, Makira 1996-2005 20.0 18.0 16.0 rate per 1,000
14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no dehy no blood
Bloody Diarrhoea by age group
no blood dehy
no dehy blood
blood dehy
Ministry of Health: National Health Report 2005 Page 192 of 250 --------------------------------------------------------------------------------------------------------------------Figure 7 below demonstrates the incidence rate of Bloody diarrhoea by Age group. The graph reveals that bloody diarrhoea was more common in children aged less than 5 years but more importantly in infants. The graph also shows that the rate for bloody diarrhoea in Makira has declined in the aged group 1-4 over the past 10 years, however for infants bloody diarrhoea rate remain to be a health problem despite reduction in the rate in some years. Fig 7. Incidence rate of bloody diarrhoea by age group, Makira 1996-2005 18.0 16.0
rate per 1,000
14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Makira, yaws and more importantly skin disease are common health problems amongst it people.
Ministry of Health: National Health Report 2005 Page 193 of 250 --------------------------------------------------------------------------------------------------------------------Fig 8. Incidence rate of yaw s and skin disease, Makira & Solomon Is 1996-2005 200.0 180.0
rate per 1,000
160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Makira
yaw s, Solomon Is
skin disease, Makira
skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Makira and Solomon Islands in the past 10 years. The graph shows that while national rate (skin disease incidence rate in Solomon Islands) for skin diseases have decreased over the past 10 years, in Makira the trend of skin disease rate demonstrates the opposite and in recent years that is between 2001 and 2005 it has exceeded national average. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws in Makira by age group. The graph shows that the incidence rate of yaws in Makira was higher in children aged 1 – 4 followed by people aged 5 years and over. The graph also reveals that yaws is not a common health problem for babies in Makira.
Ministry of Health: National Health Report 2005 Page 194 of 250 --------------------------------------------------------------------------------------------------------------------Fig 9. Incidence rate of yaw s by age group, Makira 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
The highest rate of yaws in children aged 1-4 occurred in 2003 reaching 111 cases per 1000 population. The increase in yaws incidence rate in children 1-4 in 2003 signifies the outbreak of yaws in this age group in Makira during the year. In 2004 yaws rate in the aged group 1-4 dropped to 77 cases per 1000 population and then increased slightly in 2005 reaching 90 cases per 1000 population. The graph also reveals that between 1998 and 2002, yaws rate in the age group 1-4 experienced a continuous decline reaching 57 cases per 1000 population in 2002 before an outbreak occurred in 2003. This pattern clearly indicates that vaccine coverage must be improved in order to prevent the disease from occurring. Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Makira. The graph below shows clearly that in the past 10 years, skin disease in Makira was a common health problem in people. However, skin disease rate is highest in children aged 1-4 except in 2005 where skin disease rate in infants exceeded that of rate for aged group 1-4. The graph also shows that in 2005 the rate of skin disease had increased considerably from about 150 cases per 1000 population in 2004 to 244 cases per 1000 population in 2005. This signifies an outbreak of skin disease amongst babies in Makira in 2005.
Ministry of Health: National Health Report 2005 Page 195 of 250 --------------------------------------------------------------------------------------------------------------------Fig 10. Incidence rate of skin disease by age group, Makira 1996-2005 300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Red Eye Figure 11 demonstrates the incidence rate of red eye in Makira and Solomon Islands for the past 10 years. The graph demonstrates clearly the decline in the red eye incidence rate for Solomon Islands and Makira in the past 10 years. Despite the decline that is being noted over the years in Makira and Solomon Islands, in 2005 there was an outbreak of red eye experienced in both. Fig 11. Incidence rate of red eye, Makira & Solomon Is 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
Year red eye, Makira
Red Eye by Age Group
red eye, Solomon Is
2005
Ministry of Health: National Health Report 2005 Page 196 of 250 --------------------------------------------------------------------------------------------------------------------Figure 12 below demonstrates the incidence rate of red eye by age group in Makira, for the past 10 years. The graph shows that in Makira the incidence rate of red eye was highest in babies. The graph also shows that in Makira the highest incidence rate of red eye in babies occurred in 1996 reaching 170 cases per 1000 population. In 1997, the rate had dropped by halved then increased again in 1998 reaching 140 cases per 1000. Between 1998 and 2004, the trend of red eye in babies had constantly decreasing. However, in 2005 an outbreak of red eye in Makira was experienced in all aged group but more importantly in babies. Fig 12. Incidence rate of red eye by age group, Makira 1996-2005 180.0 160.0
rate per 1,000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Makira and Solomon Islands. The graph also demonstrates that trend of ear infection rate in Makira was higher than national averages during the past 10 years.
Ministry of Health: National Health Report 2005 Page 197 of 250 --------------------------------------------------------------------------------------------------------------------Fig 13. Incidence rate of ear infection, Makira & Solomon Is 1996-2005 80.0 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection, Makira
ear infection, Solomon Is
Ear infection by age-group Figure 14 demonstrates the incidence rate of ear infection by age group in Makira. From the graph, it is obvious that in Makira ear infection is a common health problem in babies. Figure 14 also reveals that between 1996 and 1998 the incidence rate of ear infection in babies in Makira increased from 85 cases per 1000 in 1996 to 138 cases per 1000 population. Then a constant declined in ear infection rate for babies was noted between 1998 and 2001. In 2002, ear infection rate dropped significantly reaching 43 cases per 1000 population. Between the years 2002 and 200 the rate of ear infection rate in Makira babies rose dramatically reaching it highest, 136 cases per 1000 population in 2005. Fig 14. Incidence rate of ear inf ection by age group, Makira & Solomon Is 19962005 160.0 140.0
rate per 1,000
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 198 of 250 --------------------------------------------------------------------------------------------------------------------Provincial Response: Makira has a total of 33 clinics (not including Village Health Workers Post). The province has a provincial base hospital, 3 Area Health Clinic, 14 Rural Health Clinic and 15 Nurse Aid Posts. The 33 clinics offer treatment to common illnesses, child health and also maternal health services. Really these are the core business of the clinics. There has been referral system to ensure the sick people needing higher care of services are accessed as appropriate.
Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade Makira
1
3
14
15
1
TOTAL
10
29
5
106
173
14
TOTAL 2005
10
29
5
106
173
323
2004
10
-1 30
5
-5 111
15 158
314
34
33
7 323
The numbers of satellite clinics, and community mobilization and awareness have increased since 2001 after a significant declined since 1999. This is good news as the province is reestablishing the PHC to complement and supplement the 16 clinics.
Number
The number of outreach has increased in the past years. This happens with the support from operational funds support from the Health Sector Trust Fund funded by AusAID, and the Solomon Islands Health Sector Development Project funded through World Bank loan. 900 800 700 600 500 400 300 200 100 0 1995
1996 satellite
1997
1998
1999
Total health ed
2000
2001
health ed school
2002 village
2003
2004
2005
total outreach
Table 14 Core Indicators for Makira by 2005
No of health facilities Total population Pop<1yr Pop1-4 yr
Makira 35 35,865 1,118 4,462
SI 328 471,266 14,465 55,240
No of MOH Health Radios in Province 18
149
Ministry of Health: National Health Report 2005 Page 199 of 250 --------------------------------------------------------------------------------------------------------------------Pop.WBA 15-49 8,790 115,730 Expected birth 1,532 20,354 TotaL deliveries/ births 985 10,948 Total births in health clinic 842 8,878 Home births 143 2,071 TBA Total Live births 956 9,319 Perinatal/ Still births 29 262 Neonatal deaths Total SB+NND 29 262 % Perinatal rate= No.of SB + Deaths 1000.0 1000.0 first week / number SB and no. LB x 1000 Crude Birth Rate=No. of live births in 27.5 23.2 a year / Total mid yr x1000 Total deaths 134 1,135 Crude Death Rate 0.4 0.2 Number of births by skilled health 842 8,878 personel Total reported births 985 10,948 % Birth attended by skilled health 85 81 personel (incl trained TBAs)= No births attendd by trained skilled personnel/ tot reported births Maternal Deaths 3 22 Maternal Mortality Rate = No. 314 236 maternal deaths in a year/ total live births x100,000 Infant deaths 21 152 22.0 16.3 Infant Mortality Rate=No. of infant deaths in a yr/ Total no. of live birthsx1000 FP Total users (HCC + SIPPA-1714) 816 8365 Total Child deaths-1-4 Yrs. 9 97 2.0 1.8 Child Mortality Rate-Deaths in children 1-4yrs/ 1,000 pop of children 1-4) 9.3 7.2 % Contraceptive Prevalence Rate=CBA using contraception/Total CBA X100 Total ANC First Visit (or total Preg. 1194 14,794 Mothers) Tot. Preg mothers-na (Expected 1,532 20,354 births) 78 73 % ANC Coverage=no. of preg women attending 3 or more ANC/ Tot. preg mothersx100
Ministry of Health: National Health Report 2005 Page 200 of 250 ---------------------------------------------------------------------------------------------------------------------
7.10 Temotu . Demography: Gender and Poverty: The population of Temotu in 2005 was 21,678, with about 14.8% children less than 5 years old, and 48.6% are 15-49 years old. 25,000
Population
20,000 15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005 21,678
18,706
19,144
19,596
20,061
20,619
20,077
Population <1
538
525
545
583
637
661
769
Population 1-4
2,054
2,084
2,117
2,175
2,264
2,263
2,455
Population <5
2,591
2,609
2,661
2,758
2,901
2,924
3,223
Total 15-49
8664
8992
9308
9606
9938
9746
10,527
Population total
Ministry of Health: National Health Report 2005 Page 201 of 250 --------------------------------------------------------------------------------------------------------------------Fig x Population of Temotu 7 yr trend.
12,000 10,000 Pop u latio n
8,000 6,000 4,000 2,000 0
1999
2000
2001
2002
2003
2004
2005
4,813
4,985
5,143
5,285
5,459
5,414
5,739
629
586
546
509
474
450
427
Males >5
7,709
7,892
8,077
8,263
8,453
8,031
8,852
Females >5
8,406
8,643
8,858
9,039
9,266
9,122
9,603
Total 15-49
8,664
8,992
9,308
9,606
9,938
9,746
10,527
males 15-49
3,851
4,007
4,165
4,321
4,479
4,333
4,788
WCBA Expected births
Fig x Population by gender 7 year trend.
Temotu is the only province where by trend of population of females slight higher than males. Disease Incidence Trend 1996-2005 Acute Respiratory Infections: ARI are major cause of morbidity worldwide and in Solomon Islands. Over the past 10 years, ARI has been the second most importance cause of attendance at primary health care clinic in Temotu.
Ministry of Health: National Health Report 2005 Page 202 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 1 Percent of ARI new cases 1996-2005 40% 35% 30%
percent
25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years
ARI as % total HIS - Temotu
ARI as % total HIS - Sol Is.
As depicted in Figure 1, percentage of ARI at primary health care clinic in Temotu has remained above national average in the past 10 years. In 2005, ARI was responsible for 36% of acute care contacts in Temotu. It is no doubt that this figure could have had contributed to the high rate ARI contacts in Solomon Islands in 2005.
Ministry of Health: National Health Report 2005 Page 203 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 2 Incidence rate of ARI 1996-2005 700.0 600.0 ra t e s /1 0 0 0 p o p
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
year ARI rates - Temotu
ARI rates - Solomon Is.
Figure 2 above demonstrated the incidence rate of ARI in Temotu and Solomon Islands. From the graph it is obvious that incidence rate of ARI in Temotu are higher than that of national averages. While there has been a decreasing in population rate in Temotu between the years 1999 to 2003, in 2004 the population rate increased dramatically reaching 657 cases per 1000 population before it slightly decline to 634 cases per 1000 population in 2005.
Fig. 3 Incidence Rate of ARI by age group in Temotu 1996-2005
3500.0
3000.0
incidence rate
2500.0
2000.0
1500.0
1000.0 500.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years tot. pop.
rates <1
rates 1-4
rates >5
Ministry of Health: National Health Report 2005 Page 204 of 250 --------------------------------------------------------------------------------------------------------------------Figure 3 above clearly demonstrated that under 5 children and in particular children under 1 year old are the most affected ones by the disease (ARI).
Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 40% of all acute care contacts in the country. In Temotu, the situation is slightly different and this is depicted in Figure 4 below. From the graph below, it is obvious that percent of clinical malaria as total acute care contact remain below national average through out the ten year period. Fig. 4 Percent of Clinical Malaria New cases 1996-2005 45% 40% 35% perc ent
30% 25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years clinic malaria %HIS - Sol
clinic malaria %HIS - Tem
The above graph shows that over the last decade incidence rate of clinical malaria in Temotu has been fluctuating. As revealed in Figure 5 below in the early years of last decade that is between 1996 to 1998 population rate of clinical malaria have dropped by halved, then between 1999 to 2001 the population rate doubled reaching 472 cases per 1000 population in 2001 and between 2002 to 2004 population rate declined again. In 2005, the incidence rate has been increased from 272 cases per 1000 population in 2004 to 313 cases per 1000.
Ministry of Health: National Health Report 2005 Page 205 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 5 Incidence rate of fever, clinical malaria and slide confirmed Temotu 19962005 500.0
in c id e n c e ra t e /1 0 0 0 p o p
450.0 400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years Temotu - fever
Temotu - clinical malaria
Temotu - slide confirmed
Figure 5 also reveals that since 1999 incidence rate of slide confirmed malaria have been lower than incidence rate of fever and clinical malaria.
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Temotu, diarrhoea and more importantly bloody diarrhoea has been the major cause of illnesses for people of Temotu.
Ministry of Health: National Health Report 2005 Page 206 of 250 --------------------------------------------------------------------------------------------------------------------Fig 7. Incidence rate of Diarrhoea by type, Temotu 1996-2005 45.0 40.0
rate per 1000
35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years bloody no dehy
bloody w ith dehy
no blood no dehy
no blood w ith dehy
Fig. 8 Incidence rate of Bloody Diarrhoea Temotu 1996-2005 250.0
rate per 1000
200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years under 1
aged 1-4
aged >5+
Figure 8 clearly demonstrates that in Temotu bloody diarrhoea is a common disease affecting children under 5 and more importantly infants in the last decade. From the above graph, the incidence rate of bloody diarrhoea particularly in children under 5 has not been stable during the last decade. In 2005 incidence rate for children under 1 has dropped significantly from 161 cases per 1000 to 70 cases per 1000 whilst incidence rate for children 1-4 experience a moderate decline. Skin disease and Yaws
Ministry of Health: National Health Report 2005 Page 207 of 250 --------------------------------------------------------------------------------------------------------------------Skin disease and Yaws are common health problems in Solomon Islands. In Temotu, they are also common illnesses amongst children under 5 years.
Fig. 9 Incidence rate of Yaw - Temotu and Sol 1996-2005 250.0
rate per 1000
200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years yaw s - Temotu
skin disease - Temotu
yaw s - Sol Is.
skin disease - Sol Is.
Figure 9 above shows that incidence rate of yaws and skin diseases are higher in Temotu compared to that of national average. In 1998, incidence rate of yaws in Temotu rose dramatically from 34 cases per 1000 population to 103 cases per 1000 in 1999. Then followed by a continuous decline for two years, a slightly increase in 2001 and then in 2002 there was a significant rise in the incidence rate of yaws again reaching 145 cases per 1000 population. Then between 2003 and 2004 yaws incidence rate in Temotu dropped significantly from 141 cases per 1000 in 2003 to 40 cases per 1000 in 2004. The fluctuating pattern of yaws incidence rate in Temotu could imply that though something has been done to reduce the incidence rate, vaccine coverage was not enough to prevent the disease from spreading.
Ministry of Health: National Health Report 2005 Page 208 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 10 Incidence rate of Yaw s by age group Temotu 1996-2005 300.0
rate per 1000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years rates <1
rates 1-4
rates >5
Figure 10 shows the incidence rate of yaws by age group. It is clear that yaws is more common in children aged 1-4 followed by age group 5 years and older but not a common disease in infants in Temotu. In 2002 incidence rate of yaws for children aged 1-4 reached it highest peak with 254 cases per 1000 population, then dropped significantly to 66 cases per 1000 in 2004 and in 2005 a further decline was also noted. Fig. 11 Incidence rate of skin disease Temotu 1996-2005 500.0 450.0
rate per 1000
400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years rates <1
rates 1-4
rates >5
Figure 11 reveals that skin diseases is also common in Temotu in infants and more importantly in children aged 1-4. The graph also shows that the highest incidence rate of skin disease occurred in 1998 where more than 45% of children aged 1-4 were infected. In 1999 the rate for children 1-4 dropped to a third then remained constant in the next four (4) years. However, in 2004 the incidence rate increased from 307 cases per 1000 in 2003 to 430 cases per 1000. The graph also shows that in 2005 the incidence rate of skin disease in Temotu for other age groups (infants and people aged 5 years and over) have also declined.
Ministry of Health: National Health Report 2005 Page 209 of 250 --------------------------------------------------------------------------------------------------------------------Red Eye In Temotu, red eye and ear infection are more common in children under 5 years during the last decade. Figure 12 below illustrates that the incidence rate of red eye has declined from 50 cases per 1000 population in 1996 to 27 cases per 1000 in 2005. The graph also shows that incidence rate of red eye has gradually decreasing during the last decade and had remained below national averages. However in 2005 there was a slight increase in red eye incidence rate in Solomon Islands and in Temotu. Fig. 12 Incidence rate of Red Eye 1996-2005 90.0 80.0
rate per 1000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years red eye-tem
red eye-sol
Figure 13 below reveals that incidence rate of red eye was highest in infants through out the last 10 years. This is followed by children aged 1-4 and then people 5 years and over. In 1999 red eye incidence rate for infants reached it highest point with 186 cases per 1000 population, then in 2002 it dropped to 120 cases per 1000 and had continued declining until 2004. Figure 13 also shows that in 2005 there was a slight increase in red eye incidence rate in all aged groups.
Ministry of Health: National Health Report 2005 Page 210 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 13 Incidence rate of Red Eye by Age Group Temotu 1996-2005 200.0 180.0 160.0 rate per 1000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years rates <1
rates 1-4
rates >5
Ear Infection ear infection - Solomon Is. ear infection - Temotu rates <1 rates 1-4 rates >5 Source HIS 1996-2005
1996 66.2 93.1 161.9 232.7 72.3
Table 1. Ear Infection by age-group, 1996-2005 1997 1998 1999 2000 2001 71.2 62.6 57.8 55.0 56.2 80.8 73.4 90.5 87.4 87.3 198.2 143.9 321.8 266.6 268.0 225.9 197.1 280.5 248.1 249.9 57.7 55.3 58.5 61.5 61.2
2002 46.7 128.1 333.0 379.2 89.6
2003 50.7 108.0 268.6 359.9 70.0
2004 57.6 127.1 307.3 379.1 86.9
2005 60.7 112.5 277.1 345.4 74.7
Table 1 above shows that the incidence rate of ear infection for Temotu was higher than national averages in the last decade. The table also shows that the highest incidence rate was experienced in 2002 where 13% of Temotu people were infected. In 2005, a slight decrease in incidence rate in all age group was also noted. From table 1, it is obvious that ear infection was more common in children under 5. As also revealed in table 1, incidence rate of ear infection in Temotu in the last decade has been increasing however a slight decrease was experienced in 2005. Provincial Response: Health Infrastructure: The foundation of health services in the provinces are the primary health clinics. By 2005, Temotu has a total of 16 clinics, of which 75% of the total clinics a have a working radio clinic.
Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade
No of MOH Health Radios in Province
Temotu
12
TOTAL TOTAL 2005
1
1
5
9
10
29
5
106
173
10
29
5
106
173
16
16 7
14 323
323
149
Ministry of Health: National Health Report 2005 Page 211 of 250 ---------------------------------------------------------------------------------------------------------------------1 10
30
5
15
111
158
314
Table x Total of clinics in Temotu by 2005 By 2005 the ratio of clinic to population was 1: 1,355
Primary Health Care services: Fig x below shows very low levels of primary health care activities (satellites, community mobilization and awareness meetings) in Temotu compared with Makira Province. The cyclone Zoë in 2003 had a devastating impact on the level of services delivery in the province.
No. of PHC activities
250 200 150 100 50 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Satellite
Total health ed
health ed school
village
Fig x number of primary health care activities by 13 yr trend:
800 1993
700
1994 No. of patients
2004
-5
600
1995
500
1996 1997
400
1998 1999
300
2000
200
2001 2002
100
2003
0 inpatients Referrals Referrals Referrals Referrals Total AHC RHC Prov NRH outreach
Fig x Level of referrals and admissions at clinic level.
Inpatients and referrals:
2004
Ministry of Health: National Health Report 2005 Page 212 of 250 --------------------------------------------------------------------------------------------------------------------The numbers of inpatients in the clinics have increasing. Conversely, the total number of outreach services also declined since 2000. Table x Core Indicators of Temotu Province by 2005:
No of health facilities Total population Pop<1yr Pop1-4 yr Pop.WBA 15-49 Expected birth TotaL deliveries/ births Total births in health clinic Home births TBA Total Live births Perinatal/ Still births Neonatal deaths Total SB+NND % Perinatal rate= No.of SB + Deaths first week / number SB and no. LB x 1000 Crude Birth Rate=No. of live births in a year / Total mid yr x1000 Total deaths Crude Death Rate Number of births by skilled health personel Total reported births % Birth attended by skilled health personel (incl trained TBAs)= No births attendd by trained skilled personnel/ tot reported births Maternal Deaths Maternal Mortality Rate = No. maternal deaths in a year/ total live births x100,000 Infant deaths Infant Mortality Rate=No. of infant deaths in a yr/ Total no. of live birthsx1000 FP Total users (HCC + SIPPA-1714) Total Child deaths-1-4 Yrs. Child Mortality Rate-Deaths in children 1-4yrs/ 1,000 pop of children 1-4) % Contraceptive Prevalence Rate=CBA using contraception/Total CBA X100 Total ANC First Visit (or total Preg. Mothers) Tot. Preg mothers-na (Expected births)
Temotu 16 21,678 769 2,455 5,739 890 539 432 107 522 17
SI 328 471,266 14,465 55,240 115,730 20,354 10,948 8,878 2,071 9,319 262
17 1000.0
262 1000.0
24.9
23.2
82 0.4 432
1,135 0.2 8,878
539 80
10,948 81
1 192
22 236
9 17.2
152 16.3
548 5 2.0
8365 97 1.8
9.5
7.2
560
14,794
890
20,354
Ministry of Health: National Health Report 2005 Page 213 of 250 --------------------------------------------------------------------------------------------------------------------% ANC Coverage=no. of preg women 63 73 attending 3 or more ANC/ Tot. preg mothersx100
7.11 7.12 Rennell Bellona Demography: Gender and Poverty: Rennell Bellona is the smallest province in the country. In 2005 the total population of Rennell Bellona was 2,686. Of which around 11.6% are aged less than 5 years old.
3000 2500
Pop
2000 1500 1000 500 0 1999 Population total
2000
2001
Population <1
2002
2003
Population <5
2004
2005
Population >5
1,400 1,200
Pop
1,000 800 600 400 200 0 1999
2000 WCBA
2001
2002
2003
Total 15-49
2004
males 15-49
Disease Incidence Trend of Rennell Bellona 1996-2005:
2005
Ministry of Health: National Health Report 2005 Page 214 of 250 --------------------------------------------------------------------------------------------------------------------Figure 1 demonstrates the proportion of acute care contacts by major diseases in Renbel. In Renbel, the most common cause of attendance at any primary health care clinics between 1996 and 2005 were ‘Other’ diseases and ARI. Fig 1. Proportion of new cases by major disease, Renbel 1996-2005 80% 70% 60%
percent
50% 40% 30% 20% 10% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear inf ection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Renbel, ARI is second most importance cause of attendance at primary health care clinics. In 2005, ARI was responsible for 36% of all acute care contacts in RenBellona. Fig 2. Incidence rate of ARI, Renbel & Solomon Is 1996-2005 800.0 700.0
rateper 1,000
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Renbel
ARI, Solomon Is
Figure 2 shows that in the past 10 years the incidence rate of ARI in Renbel was above national average. The graph also shows an increasing trend of ARI rate in Renbel over the past 10 years. Acute Respiratory Infection by Age Group
Ministry of Health: National Health Report 2005 Page 215 of 250 --------------------------------------------------------------------------------------------------------------------Fig 3. Incidence rate of ARI by age group, Renbel 1996-2005 3500 3000
rate per 1,000
2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 3 demonstrates the incidence rate of ARI in Renbel by age-group in the past 10 years. The graph shows that ARI rate is higher in infants, followed by children aged 1-4, then people 5 years and over. The graph also reveals that ARI had remained to be a common health problem in infants in the last decade. The graph also shows that ARI rates in children aged 1-4 had shown a rise in trend over the last 4 years (between 2002 and 2005). Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. In Renbel malaria is non endemic. Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Renbel, diarrhoea and more importantly with no blood and no dehydration was also a common illness in Renbel.
Ministry of Health: National Health Report 2005 Page 216 of 250 --------------------------------------------------------------------------------------------------------------------Fig 4. Incidence rate of diarrhoea by type, Renbel 1996-2005 80.0 70.0
rateper 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody diarrhoea by age group Figure 5 below demonstrates the incidence rate of bloody diarrhoea by age group in Renbel for the past 10 years. The graph shows that in 2005 there was an outbreak of bloody diarrhoea in children aged less than 5. Fig 5. Incidence rate of bloody diarrhoea by age group, Renbel 1996-2005 90.0 80.0
rateper 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Renbel yaws and more importantly skin disease are also common illness affecting the people.
Ministry of Health: National Health Report 2005 Page 217 of 250 --------------------------------------------------------------------------------------------------------------------Fig 6. Incidencce rate of yaw s and skin disease, Renbel & Solomon Is 1996-2005 250.0
rate per 1,000
200.0
150.0 100.0
50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Renbel skin disease, Renbel
yaw s, Solomon Is skin disease, Solomon Is
Figure 6 demonstrates the incidence rate of yaws and skin disease in Renbel and Solomon Islands in 1996 – 2005. Figure 6 shows that in 2000 there was an outbreak of skin disease in Renbel. This is clearly demonstrated in the significant rise in skin disease rate from 30 cases per 1000 population in 1999 to 224 cases per 1000 population in 2000. Between 2000 and 2002 the rate of skin disease reduced for more than half. Then between 2002 and 2004 skin disease rate rose again reaching 169 cases per 1000 population in 2004 then in 2005 it dropped to 45 cases per 1000 population. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws by age group in Renbel for the past 10 years. It is obvious from the graph that yaws is more common in the age group 1-4 and 5 years and older. Fig 7. Incidence rate of yaw s by age group, Renbel 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
Year rates <1
rates 1-4
rates >5
Based on figure 7 yaws remained to be seen through out the 10 year period.
2005
Ministry of Health: National Health Report 2005 Page 218 of 250 --------------------------------------------------------------------------------------------------------------------Skin disease by age group Figure 8 below demonstrates the incidence rate of skin disease by age group in Renbel for the past 10 years. The graph shows skin disease in more common in infants and children 1-4. From the graph it is also clear that skin disease remained to be seen in children through out the 10 year period. Fig 8. Incidence rate of skin disease by age group, Renbel 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 219 of 250 --------------------------------------------------------------------------------------------------------------------Red Eye Figure 9 demonstrates the incidence rate of red eye in Renbel and Solomon Islands over the past 10 years. The graph clearly shows a declining trend of red eye incidence rate in Renbel and Solomon Islands over the past 10 years. The graph also shows that red eye rate in Renbel has remained below national average. Fig 9. Incidence rate of red eye, Renbel & Solomon Is 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Renbel
red eye, Solomon Is
Red eye by age group Figure 10 below demonstrates the incidence rate of red eye by age group in Renbel for the past 10 years. The graph also reveals that through out the 10 year period, red eye incidence rate was higher in babies, followed by children aged 1-4 and then the age group 5 years and over. The graph also shows that the trend of red eye incidence in recent years for babies has declined from it highest level 142 cases per 1000 population in 2000 to 21 cases per 1000 population in 2005. Fig 10. Incidence rate of red eye by age group, Renbel 1996-2005 160.0 140.0
rateper 1,000
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 220 of 250 --------------------------------------------------------------------------------------------------------------------Ear Infection Figure 11 demonstrates the incidence rate of ear infection in Renbel and in Solomon Islands for the past 10 years. Fig 11. Incidence rate of ear inf ection, Renbe & Solomon Is 1996-2005l 80.0 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear inf ection, Renbel
ear inf ection, Solomon Is
Ear infection by age-group Figure 14 below demonstrates the incidence rate of ear infection by age group in Renbel for the past 10 years. The graph shows that through out the past 10 years ear infection in REnbel is more common is babies, followed by children age 1-4 then people age 5 years or more. The highest rate of ear infection in babies reached 317 cases per 1000 population in 1998. Then in 1999 no ear infection cases were reported. However between 2003 and 2005 the trend of ear infection is increasing once again. Provincial Response:
No of health facilities Total population Pop<1yr Pop1-4 yr Pop.WBA 15-49 Expected birth TotaL deliveries/ births Total births in health clinic Home births TBA Total Live births Perinatal/ Still births Neonatal deaths
RBP 3 2,686 71 1,201 598 114 24 7 17 24 0
SI 328 471,266 14,465 55,240 115,730 20,354 10,948 8,878 2,071 9,319 262
Ministry of Health: National Health Report 2005 Page 221 of 250 --------------------------------------------------------------------------------------------------------------------Total SB+NND 0 262 % Perinatal rate= No.of SB + Deaths #DIV/0! 1000.0 first week / number SB and no. LB x 1000 23.2 Crude Birth Rate=No. of live births in a 8.9 year / Total mid yr x1000 Total deaths 17 1,135 Crude Death Rate 0.6 0.2 Number of births by skilled health 7 8,878 personel Total reported births 24 10,948 29 % Birth attended by skilled health 81 personel (incl trained TBAs)= No births attendd by trained skilled personnel/ tot reported births Maternal Deaths 0 22 236 Maternal Mortality Rate = No. maternal 0 deaths in a year/ total live births x100,000 Infant deaths 1 152 16.3 Infant Mortality Rate=No. of infant 41.7 deaths in a yr/ Total no. of live birthsx1000 FP Total users (HCC + SIPPA-1714) 0 8365 Total Child deaths-1-4 Yrs. 0 97 Child Mortality Rate-Deaths in children 0.0 1.8 1-4yrs/ 1,000 pop of children 1-4) % Contraceptive Prevalence 0.0 7.2 Rate=CBA using contraception/Total CBA X100 Total ANC First Visit (or total Preg. 80 14,794 Mothers) Tot. Preg mothers-na (Expected births) 114 20,354 73 % ANC Coverage=no. of preg women 70 attending 3 or more ANC/ Tot. preg mothersx100
7.13 Honiara Demography: Gender and Poverty: Honiara has a very complex and mixed ethnicity. As the capital and key commercial and industrail areas in the country, the demand for health case services is wide and more than the provinces even the major of the country’s population is in the provinces.
Ministry of Health: National Health Report 2005 Page 222 of 250 --------------------------------------------------------------------------------------------------------------------70,000 60,000 50,000 Pop.
40,000 30,000 20,000 10,000 0
1999
2000
2001
2002
2003
2004
2005
Population total
48,513
49,668
50,824
51,977
53,489
61,712
56,227
Population <1
1,427
1,391
1,397
1,405
1,417
1,559
1,495
Population 1-4
4,796
4,979
5,134
5,290
5,498
6,273
5,690
Population <5
6,223
6,370
6,531
6,694
6,915
7,832
7,185
total 15-49
30,349
31,030
31,633
32,188
32,937
37,236
34,156
Fig x Population of Honiara City 7 r Trend
40,000 35,000 30,000 Pop
25,000 20,000 15,000 10,000 5,000 0 WCBA
1999
2000
2001
2002
2003
2004
2005
13,080
13,374
13,653
13,929
14,421
16,041
15,073
Expected births
1,989
2,709
3,688
5,022
Males >5
23,868
24,456
24,994
25,487
25,942
34,611
Females >5
21,462
18,842
19,299
19,796
20,632
27,101
total 15-49
30,349
31,030
31,633
32,188
32,937
37,236
34,156
males 15-49
17,269
17,656
17,980
18,259
18,516
21,196
19,083
Figx Population of Honiara City 7 r Trend by gender (incomplete)
Disease Incidence Trend of Honiara 1996-2005: Disease Incidence Figure 1 demonstrates the proportion of acute care contacts by major diseases in Honiara. In Honiara, the most common cause of attendance at any primary health care clinics between 1996 and 2005 was apart from ‘Other’ disease, were ARI and clinical malaria.
Ministry of Health: National Health Report 2005 Page 223 of 250 --------------------------------------------------------------------------------------------------------------------Fig 1. Proportion of new cases by major disease, Honiara 1996-2005 50% 45% 40% 35%
percent
30% 25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Honiara, ARI is second most importance cause of attendance at primary health care clinics. In 2005, ARI was responsible for 27% of all acute care contacts in Honiara. Fig 2. Incidence rate of ARI, Honiara & Solomon Is 1996-2005
600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Honiara
ARI, Solomon Is
Figure 2 shows that the highest rate of ARI in Honiara occurred in 1997 reaching 524 cases per 1000 population. Between 1997 and 2000 ARI rate in Honiara declined reaching 371 cases per 1000 population. In 2001, the ARI rate increased again then dropped from 469 cases per 1000 population in 2001 to 349 cases per 1000 in 2002. Between 2002 and 2004 the incidence rate of ARI increased from 349 cases per 1000 population to 506 cases per 1000 population then slightly declined to 487 cases per 1000 population in 2005.
Ministry of Health: National Health Report 2005 Page 224 of 250 --------------------------------------------------------------------------------------------------------------------Acute Respiratory Infection by Age Group Fig 3. Incidence rate of ARI by age group, Honiara 1996-2005 4000 3500
rate per 1,000
3000 2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 3 above shows that in the past 10 years incidence rate of ARI was higher in children aged less than 5 but more importantly in infants. The graph also shows that through out last decade, incidence rate of ARI in infants has exceeded 2000 cases per 1000 population. In 2000 ARI rate in infants almost doubled that of 1999. Though Figure 2 indicates a continuous decline of the overall ARI rate in Honiara was experienced between 1997 and 2000, ARI rate for infants as demonstrated in Figure 3 reached it highest point in 2000 when every baby in Honiara were presented 3 times with ARI at any primary health care clinics. However, between 2000 and 2002 ARI rate in infants declined reaching 2066 cases per 1000 population. Then in 2003 ARI rate in infants rose again and between 2004 and 2005 a slight increase of ARI rate was noted. Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in the country in 2005. In Honiara, malaria (i.e. fever and clinical malaria) account for 26% of all acute care contacts in 2005.
Ministry of Health: National Health Report 2005 Page 225 of 250 --------------------------------------------------------------------------------------------------------------------Fig 4.Incidence rate of clinical malaria, Honiara & Solomon Is 1996-2005 700.0
rate p er 1000 p o p u latio n
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Honiara
Clinical malaria, Solomon Is
Figure 4 demonstrates the trend of clinical malaria rate in Honiara and Solomon Islands for the past 10 years. The graph shows that clinical malaria rate in Honiara dropped from 420 cases per 1000 population in 1996 to 179 cases per 1000 population in 1999. Between 1999 and 2001 clinical malaria rates increased to 368 cases per 1000 population. Then between 2001 and 2005, a slight declined was noted over the years. Incidence rate of fever, clinical malaria and slide confirmed malaria Fig 5. Incidence rate of clinical malaria, fever, slide conf irmed, Honiara 1996-2005 450.0 400.0 350.0
rate per 1,000
300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
fever
slide conf irmed
Figure 5 above demonstrates the trend of the incidence rate of clinical malaria, fever and slide confirmed malaria. The graph shows that between 1996 and 1999 the rate of clinical malaria had dropped reaching it lowest level 179 cases per 1000 population.
Ministry of Health: National Health Report 2005 Page 226 of 250 --------------------------------------------------------------------------------------------------------------------Then between 1999 and 2001 clinical malaria increased significantly reaching 368 cases per 1000. Then between 2001 and 2005 a slight decrease in the rate of clinical malaria was observed. Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Honiara, diarrhoea and more importantly with no blood and no dehydration was also affecting people in Honiara. Fig 6. Incidence rate of diarrhoea by type, Honiara 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody diarrhoea by age group Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group in Honiara for the past 10 years. The graph shows that the incidence rate of bloody diarrhoea over the past 10 years was higher in children aged less than 5 years. Figure 7 also reveals that in Honiara the trend of bloody diarrhoea in children aged less than 5 years but more importantly in infants has increased significantly between 2001 and 2005. This clearly indicates that bloody diarrhoea is becoming a major health problem affecting children and more importantly babies in Honiara.
Ministry of Health: National Health Report 2005 Page 227 of 250 --------------------------------------------------------------------------------------------------------------------Fig 7. Incidence rate of bloody diarrhoea by age group, Honiara 1996-2005 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Honiara yaws and more importantly skin disease are also common illness affecting the people. Fig 8. Incidence rate of yaw s and skin disease, Honiara & Solomon Is 1996-2005 200.0 180.0 160.0
rate per 1,000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Honiara
yaw s, Solomon Is
skin disease - Hon
skin disease, Solomon Is
Figure 8 shows the trend of yaws and skin disease rate for Honiara and Solomon Islands. The graph shows that the trend of skin disease in Honiara is declining and has remained below national average through out the past 10 years. However, the trend of yaws rate in Honiara had remained constant between 1996 and 2001 then increased from 2001 to 2005. The graph shows clearly the skin diseases rate has remained higher than yaws rate through out the past 10 years. This clearly indicates that skin disease is a more common disease than yaws among the people in Honiara. Yaws by age group
Ministry of Health: National Health Report 2005 Page 228 of 250 --------------------------------------------------------------------------------------------------------------------Figure 9 below demonstrates the incidence rate of yaws by age group in Honiara for the past 10 years. It is obvious from the graph that incidence rate of yaws is higher in the age group 1 – 4 followed by people aged 5 years and over. Figure 9 also demonstrates the increasing trend of yaws in the age group 1-4 and 5 years and over. The increase in the trend was more significant in the age group 1-4 between 2001 and 2005 where yaw rate rose significantly from 35 cases per 1000 population in 2001 to it highest level, 98 cases per 1000 population in 2004. Then in 2005, yaws rate dropped to 59 cases per 1000 population. Fig 9. Incidence rate of yaw s by age group, Honiara 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Guadalcanal for the past 10 years. The graph shows a decreasing trend of skin disease in all age group in Honiara for the past 10 years. The graph also shows that the highest rate of skin disease occurred in 1998 and the increase was experienced in all age groups. Though the graph reflects a decreasing trend of skin disease rate in all age group, in recent years, that is between 2003 and 2005 a slight increase in skin disease rate was experienced.
Ministry of Health: National Health Report 2005 Page 229 of 250 --------------------------------------------------------------------------------------------------------------------Fig 10. Incidence rate of skin disease by age group, Honiara 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Red Eye Figure 11 demonstrates the incidence rate of red eye in Honiara and Solomon Islands over the past 10 years. The graph clearly shows a declining trend of red eye incidence rate in Honiara and Solomon Islands over the past 10 years. The graph also shows that red eye rate in Honiara has remained below national average in last decade. Fig 11. Incidence rate of red eye, Honiara & Solomon Is 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Honiara
red eye, Solomon Is
Red eye by age group Figure 12 below demonstrates the incidence rate of red eye by age group in Honiara for the past 10 years. The graph also reveals that through out 10 year period, red eye
Ministry of Health: National Health Report 2005 Page 230 of 250 --------------------------------------------------------------------------------------------------------------------incidence rate was higher in babies, followed by children aged 1-4. The graph also reveals that the trend of red eye incidence through out the 10 year period was declining in all age groups however in 2005 an increased in the trend of red eye rate was noted in all age groups but more importantly in infants. Fig 12. Incidence rate of red eye by age group, Honiara 1996-2005 160.0 140.0
rate per 1,000
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1
2
3
4
5
6
7
8
9
10
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Honiara and in Solomon Islands for the past 10 years. It is obvious from figure 13 below that the incidence rate of ear infection in Honiara over the past 10 years was well above national averages. Fig 13. Incidence rate of ear infection, Honiara & Solomon Is 1996-2005 140.0 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection, Honiara
ear infection, Solomon Is
Ear infection by age-group Figure 14 below demonstrates the incidence rate of ear infection by age group in Honiara for the past 10 years. The graph shows that through out the past 10 years ear infection in Honiara is more significant in children age less than 5. The rate of ear
Ministry of Health: National Health Report 2005 Page 231 of 250 --------------------------------------------------------------------------------------------------------------------infection rate has fluctuated over the years but a considerable decline was noted between 2003 and 2005 in infants. Fig 14. Incidence rate of ear infection by age group, Honiara 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Honiara Response: There are total of 8 Government run clinics in Honiara, and about 6 smaller private practitioners’ clinics. The key target areas are the suburbs and residential areas within and around the city boundary. Honiara health services also received referrals from the provinces.
Ministry of Health: National Health Report 2005 Page 232 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 8 8.1
Resource Utilisation
Funding for Health in 2005:
Ensuring adequate funds for maintaining health services in order to meet the health needs of the population has been challenging in the past five years.
Total operational cost
Total Staff costs Total Budget
2000 65,937,79 2
2001 59,100,30 0
30,221,01 8 96,158,81 0
35,631,86 2 94,732,16 2
2003
2004
2005
2006
70,376,851
52,980,902
90,698,547
97,229,810
SIG
68,000,000
34,000,000
HSTA
45,460,431 204,158,97 8
45,531,308 176,761,11 8
42,863,938 113,240,78 9
54,224,094 107,204,99 6
Table x and Fig x Trend of Health Expenditure Estimates 6 yr trend (Exc 2002) in SBD:
8.1.1
Issues: Total Health Expenditure 6 yr trend
250,000,000
200,000,000
SBD
150,000,000
100,000,000
50,000,000
0 2000
2001
2003
2004
2005
2006
There is an 84% increase in the health costs in the six year trend. In 2000 the total health expenditure budget was SBD 96, 158,810. In went up as SDB 176,761,118 in 2006. In 2005 in tipped up to SBD 204, 158, 978 as the HSTA AusAID funded put in substantial fund to drive the operational plans at the national and provinces. The staff cost have increased by 51% since 2000 from SBD 30Milliom to 45.5M. in the past two years. The revised scheme of services for the doctors and the nurses has been significant contributing factor to the increase. How more would the staff cost increased in light of the proposed scheme of services for the Paramedic staff in at the negotiation stage.
Ministry of Health: National Health Report 2005 Page 233 of 250 --------------------------------------------------------------------------------------------------------------------The operational cost increased by 48% since 2000. In 2004 and 2005 the cost further surged because of extra support from the Budgetary Support and the HSTA Trust fund. Within the health sector additional funding was allocated and used for high impact development initiatives for the provincial health services.
8.2
Human Resource for Health in 2005
. 1800 1600 1400
No. of staff
1200 1000 800 600 400 200 0
2000
2001
2002
2005
2006
Non-Estab
172
161
140
134
132
Estab
1200
1253
1253
1425
1469
Grand Total
1372
1414
1393
1559
1601
Table x Number of health workers 2000-2006 Source Staff Establishment MOH
8.3
Issues:
There has been very little increase in the level of staffing in the country. Since 2000 and even previous years, there was only 16% increase in staffing. However, the staffing cost has increased by 51% and this is the limiting factor to ensure that our clinics are fully staffed. It is also a concern that many highly qualified local doctors are leaving the Public Sector and also to overseas to look for high and lucrative conditions. The challenge for the Government is to retain the few qualified local specialists. General work morale is very low34 (Department the Public Service does not provide them with a desirable career, and the poor standards of wages contribute strongly to this): Work ethics and culture very poor. Peoples’ capability is low (skill and knowledge is very low and causing serious impediments on service delivery)35 and, too centralized performance appraisal system is not the most effective mechanism to improve individual staff capability to meet specific service delivery targets.
34 35
Admin Scan by RAMSI Mahcinery of Government 2005 Ibid
Ministry of Health: National Health Report 2005 Page 234 of 250 --------------------------------------------------------------------------------------------------------------------Staff performance and task level in relation to the Essential Public Health Functions varies significantly. Key areas of weakness are on functions related to emergency preparedness and disaster management”, “research” and “enforcement” or health legislations i.e. limited skill)36. Staff productivity also affected as shown in Clinic utilization review-“Results support future posting of nursing staff according to clinic workloads, skill mix needed to meet individual clinic demand and skill mix at adjacent clinics. This approach argues for adoption of a flexible clinics designation and staffing model based on need rather than population parameters. It also suggests that designating clinics as RHC or NAP be reconsidered and a more generic term such as ‘health clinic’ be adopted”37. Many more doctors migrated out in the past three years despite the revised scheme of service for doctors. In 2003 around 20% (19) of the total registered doctors migrated out. In 2006 it increased to 22% (24) doctors all together migrated out to work elsewhere.38 Nursing personnel were not fully conversant with the new Scheme of Service39. Unequal distribution of health staff number and skill mix among the provinces40. Health workers attitude (esp. nurses in hospitals and clinics) very poor causing people to access health care41. Poor HR Management-Part of report on the Essential Public Health Review by David Philips: Strengthen Weaknesses Lot of staff near retirement age Donor support ++ Human No consultation of field staff on training Good regional training Resource needs – HQ decisions Development progs Resources for training programme TNA at provincial level dependant and centrally controlled across teams Lots of overlap in differing courses New Cert in PH @ Lot of material not relevant to Solomons SIMTRI good in Training needs often self identified and not developing generic PH organisationally done workers Training not linked to local needs – reflect course availability & donor priorities Lack of priority given to ensuring senior staff in provinces well trained – “$$ goes to NRH because they complain loudest” Staff capability in areas often limited by other factors eg staff housing Lack of multi-skilling of staff PSC Promotion system works against
David Philips (2005). SI Essential Public Health Functions Assessment Solomon Islands Primary Health Care Clinics Review Report by Chris Evans of HISP 38 G..Malefoasi (2006). Technical Briefing to the Minister of Health: Info to the 59th World Health Assembly May 2006 36 37
39
PHD Capacity Assessment Report by Vicki HISP PHC Advisor
PHD Capacity Assessment Report by Vicki HISP PHC Advisor and Solomon Islands Primary Health Care Clinics Review Report by Chris Evans of HISP 41 Community Assessment by Alex (2006) 40
Ministry of Health: National Health Report 2005 Page 235 of 250 --------------------------------------------------------------------------------------------------------------------young people Options to solutions: HR Issues & Problems General work morale is very lowpoor work ethics and culture
Peoples’ capability is low
Staff performance and task level in relation to the Essential Public Health Functions varies significantly.
Recommendations/ Options to solutions: HRM function could be strengthened Performance monitoring and reporting against planned targets and measures needs to be strengthened to improve the overall management of the department. Similarly, line managers could benefit if they were more aware of setting standards and procedures for required performance levels to meet service delivery goals. Performance Management generally could be improved if Divisional Heads were more committed to communicating with their operational staff on all matters related to standards and quality of service delivery; Career path development inline with condition of services/ Terms of Conditions To improve this situation, line managers could be assisted if they developed performance development plans for individual staff that would align their skills and knowledge with the priority work targets. These Plans would then inform the annual training or professional development plans linked to the budget. Establish feed back mechanisms to staff on performance etc. To ensure a basic succession strategy, a targeted Graduate recruitment program would probably benefit the clinically related Divisions. Develop a coordinated approach to training and workforce development across stakeholders, agencies, institutions and programmes based on EPHFs.
Increase the geographic equity of EPHF skills distribution, especially with regard to provinces. Ensure some local workforce surge capacity to address unexpected events (e.g. a local disaster/emergency situation) possibly by more multi-skilling.
Ministry of Health: National Health Report 2005 Page 236 of 250 --------------------------------------------------------------------------------------------------------------------Staff productivity also affected Need for a need-based clinic designation and staffing model Many more doctors migrated Need further review on shortage and retention of specialist doctors. Nursing personnel were not fully Need further communication conversant with the new Scheme of Service. Unequal distribution of health Need for a need-based deployment and staffing staff number and skill mix among model the provinces Health workers attitude (esp. Reorientation and people centered approaches of nurses in hospitals and clinics) training to nurses. very poor causing people to access health care
Ministry of Health: National Health Report 2005 Page 237 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 9
Health Legislation
The area of health legislation has been an area for need substantial effort in strengthening. The administration scan done by RAMSI also identified the field of legislative support as area for improvement. (Refer Chapter 6: Section 6.1.1). The Government through the Ministry of Health is planning to review and update the existing health legislation in line with the needs of today and the future. As eluded in the several meetings all the existing health legislations and other related legislations are out of date. Some health legislations need updated and improvements. The priority areas are the Health Services Act 1979 (& Health Services (Hospital Regulations) 1980), the Pharmacy and Poisons Act 1941, Pharmacy Practitioners Act 1997, and the Mental Treatment Act 1970. The Health Services Act 1979 needs changing to focus and promote and support the health reform policies and strategies, the Ministry is undertaking.
9.1
Health Care Legislation Review:
The health care system in Solomon Islands is primarily provided and funded by the Government. It has adopted and practiced the British National Health Services where by health care services is provided free at point of delivery. Thus, health care services is centralized in regards of binding rules and regulation in nearly all field of health financing, manpower management and discipline, and authority. Solomon Islands health care legislation sits within a broader public legislative framework42 as shown in the table below. Table x Sumarizes the current legislations and regulations in health.
Area 1.Public Health
Titles of Laws and Regulations Health services Act 1979 Health Act (Health services (Hospital Regulations) 1980) Subsidiary Legislation. Public Health Act 1970 The Environmental Health (Public Health Act) Regulations Quarantine Act
Date of Issue 1st October 1979 1st May 1980
1st August 1980 1st April 1931
Date of Last Revision
Repealed and revised into The Environment Act 1980
1930, 1931, 1940, 1946, 1968, 1978
42 SIG (1996). The Laws of Solomon Islands, Revised Edition, Title XVI: Medical & Public Health, Printed by Eyre and Spottiswoode Ltd, Chapters 97-116.
Ministry of Health: National Health Report 2005 Page 238 of 250 --------------------------------------------------------------------------------------------------------------------Area Titles of Laws and Date of Issue Date of Last Regulations Revision 2.Environmental Health The Environment Health Act 1980 3.Food Safety
4.Mental Health 5.Health Practitioners
Environmental Health Act 1980 (Part XII)
Pure Food Act Mental Treatment Act 1970
Repealed and revised into Pure Food Act 1997.
11th December 1970
Health Workers Act 1982
Repealed and revised into Health Workers 1990
Health Workers Act 1990
23rd February 1990
None
Medical and Dental Practitioners Act 1988
1st July 1988
Medical and Dental Practitioners Act 1990
1st July 1990
Repealed and revised into Medical and Dental Practitioners Act 1990 None
Nursing Council Act
1st December 1997
Revised (amended) in 1997
The Nursing Council (Amendment) Act 1997
6.Pharmaceutical products and therapeutic goods
The Pharmacy Practitioners Act 1997 (to repeal certain portions of the Pharmacy and Posions Act 1991 below) Pharmacy and Poisons Act 1941
None
28th July 1941
Revised in 1953, 1958, 1967, 1973, 1978, 1981, 1988
Ministry of Health: National Health Report 2005 Page 239 of 250 --------------------------------------------------------------------------------------------------------------------Area Titles of Laws and Date of Issue Date of Last Regulations Revision None 7.Health Care Financing No specific Act but provisions are provided by theses Acts: Health Services Act 1979 Medical & Dental Practitioners (Chapter 14)
9.2
Health Services Act 1979
This is a relatively short Act setting out matters of administration and the range of health services to be provided. Chapter 3 establishes a Ministry of Health and Medical Services with a Permanent Secretary and other staff as are from time to time appointed. The Ministry is under the direction and control of a Permanent Secretary, subject to any directions received from the Minister (Chapter 3(2).
The Act provides that it is the duty of the Health Minister: “to promote the establishment in Solomon Islands of a comprehensive primary health care service designed to secure the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with the provisions of this Act.” (Chapter 4). The Act expressly provides that “the services so provided shall be free of charge” except insofar as rules are made authorising or prescribing charges for such services [Chapter 4(2)]. The Act also provides for the establishment of health advisory committees, although it appears that there are none at present. Hospital Services are dealt with in Part II of the Act, primarily by setting out that the Minister may provide hospital accommodation and other treatment services and by listing the various matters in respect of which regulations may be made. In particular, regulations may be made relating to: the management of hospitals charges for maintenance and treatment of patients in hospitals and supply of medicines and services charges for services performed outside public hospitals Part III of the Act deals with primary health care services. The Ministry is responsible for providing primary health care services as directed by the Minister. The Ministry has a statutory duty to provide, equip, and maintain health centres, clinics, satellite clinics and aid posts throughout the Solomon Islands “having regard to the needs in the area and the resources available to the Ministry” [Chapter 11(1)]. The Ministry is also required to act in consultation with Provincial Assemblies. Provincial Assemblies and the Honiara Town Council are authorised to provide clinics in their own areas (Chapter 12). The Minister may also contract with nongovernmental or church groups (Chapter 13). Part IV deals with other health services. Here the powers of the Minister are set out in Chapter 16 and include the power to employ officers and provide buildings for pathological and other services, to employ staff and provide buildings for blood transfusion services, and undertake public education campaigns, research, and international liaison.
Ministry of Health: National Health Report 2005 Page 240 of 250 --------------------------------------------------------------------------------------------------------------------Financial matters are set out in Chapter 17, which provides that health funding is to be by way of an expropriation from Parliament. Pursuant to Chapter 17, any charges or fees levied under the Act and collected by the Ministry “shall be paid into the Consolidated Fund”. The Minister prescribes responsibility for fee collection. Any fees payable are deemed a debt due to the Crown. The Act does not prescribe the particular form of Ministry accounts or deal with matters of budgetary structure. The principal Act then amended in 1988 as Health Services (Amendment) Act 1988. The amendments reflect the provisions for the following; Primary health care as the fundamental course for basic health services to the people (Chapter 2 (a) and (d) of Act No.5 of 1979). Recognition of the Village Health Aides (or VH workers) as the component of the health care referral system or front line health workers (Chapter 2). Autonomy to the Minister to make regulations in areas of (Chapter 5.1): management of public hospitals (through committees if necessary) (Chapter 5.1.a) patient care (Chapter 5.1.b). visitors (Chapter 5.1.c) payment of fees by external users of public hospitals e.g. private practitioners (5.1.d) fee for services –treatment of patients in public hospitals, and service delivery (5.1.e) public officers performing and charging for services provided outside the public hospitals and dispensary (5.1.f) line of command or authority and powers and duties of staff of public hospitals. Patient care (referrals) (5.1.h) Staff discipline in public hospitals, clinics and Aide posts. Confidentiality of patients’ information. Board of visitors (Chapter 6, replaces Chapter 9 in the principal act). The functions of the board and their relevancy in the current and future prospect are to be reviewed. The rest of amendments are in respect of changes with terminology. The current Health Services Act obviously needs reviewing and changing. It lacks the provision for the following fundamental and important aspects of health development to achieve the Government’ future direction policy; clear organizational structure or health reform clear line of command and authority and reporting management of public hospitals by CEO secondary health care tertiary health care role delineation of health care services cost recovery through user pay system in public hospitals (need further elaboration), and collection and retaining of funds raised. total quality management management of public hospitals private-public mix right to private practice health insurance act- universal or private
Ministry of Health: National Health Report 2005 Page 241 of 250 ---------------------------------------------------------------------------------------------------------------------
9.3
The Health Services (Hospitals) Regulations 1980
These regulations require the person charged with administration of the regulations to convene the Hospital Committee (reg 6). Little information was available about the functions and operation of these Committees.
The regulations do prescribe a set of fees for private patients including fees for: Ward patients Outpatients The private antenatal clinic Special consultation Physiotherapy treatment X-ray examinations Authentication and certification However, there was general agreement among Ministry and hospital staff and non-government organisations that in practice fees are not charged and collection is rarely enforced because of public resistance to paying and lack of willingness for administrators to collect them. It appears that a scheme for a user pays system was devised in 1979, however, it was never implemented, apparently due to community opposition. There is also some government subsidisation of private health care with opportunities being missed for revenue collection as between public and private patients. For example, some private patients are being referred to the hospital pharmacy for pharmaceuticals that are available to the public for no charge, when there are strong arguments for requiring private patients to pay for these even when these are available only from the hospital pharmacy.
9.4
Environmental Health Act 1980
This Act provides a mechanism for dealing with a range of public health matters including: public nuisances, building defects, excessive dust, fumes, smoke or effluent, the supply and sale of food, the prevention and supression of notifiable diseases, public drainage systems, public water supplies, noxious waste, the keeping of animals, refuse and rubbish disposal, residential overcrowding, factory and trade premises, cemetery and burial places, septic tanks, and other public health risks. The Minister may delegate certain authorities to Enforcement Authorities, namely, the Provincial Assemblies and the Honiara Town Council (Chapter 6). The Minister may require an Enforcement Authority to act on a public health matter and if it does not, the Minister can authorise some other person to do so and seek remuneration from the Enforcement Authority for any costs incurred (Chapter 7). The procedures for the issue of abatement notices, including consequences for non-compliance, are set out in Chapter s 12-14. Prosecutions are to be taken by the Enforcement Authority. Any fines gained as a result of enforcement activity are to be paid into the general revenue of the relevant Authority, pursuant to Chapter 15(2). Expenses incurred in the taking of prosecution action may also be pursued and interest of 5% charged on any outstanding sum (see Chapter 17). The Environmental (Public Health Act) Regulations deal with procedures for notification of public nuisances, court orders for abatement, and a range of specific areas such as offensive trades, filthy or verminous premises, water supplies, vessels, buildings and housing, drainage and sanitation, and food and drugs. Powers of seizure, entry and search and prosecution and procedural matters also included (reg 105-111). The Schedules to the Regulations include a list of notifiable diseases, offensive trades, and rules dealing with the treatment of malaria.
Ministry of Health: National Health Report 2005 Page 242 of 250 ---------------------------------------------------------------------------------------------------------------------
9.5
Mental Health Act 1970:
This act consolidates the law relating to persons of unsound mind and makes further and better provision for the care of persons suffering from mental disorder or mental defect, for the custody their persons and the management and control of mental hospitals. Whilst the current Act focuses mainly on treatment at a health institution, the Ministry is adventuring into getting (rehabilitative) community services to the village level through primary health care approach. Thus, the Act my need to accommodate the changes if necessary.
9.6
Health Workers Act 1982:
The Health Workers Act 1982 was revised and repealed into the Health Workers Act 1990, which was issued on the 23rd February 1990. This Act regulates the functions and duties of various categories of health workers, to confer on the board powers to prescribe registration, deal with matters pertaining to discipline and other connected matters; This Act establishes a Health Worker Board, which oversees the registration and discipline of health workers. The health care referral system consists of a network of four different levels of health workers: Village health worker – in village health posts delivering first aid supplies on restricted hours Nurse aide – in Area Health Centres and Nurse Aides Posts Registered Nurses – in Area Health Centres and Provincial hospitals Doctors – most of whom are in the Central Referral Hospital and the Provincial hospitals The practical flaw of the Act is it deals with the classification of health workers, primarily village health workers and nurse aides. At this stage there is no board to carry out functions of the Act as nurse aides, registered nurses and doctors’ registrations are dealt with by a separate legislations. The Village Health Workers are not recognized as a permanent health worker because of their limited knowledge and skills in health without background ideology, despite their important role in the health care referral system in the country. In short Health Workers Act never applied because legislation overlap with other Acts, whilst other important health workers such as the paramedics are missed out or not under the regulation. However, in the medium to long term, this Act should be fully reviewed to ensure a consistency and cohesiveness with overall developments in other parts of the government health sector. It is therefore recommended that the Act should be reviewed to ensure a consistency with overall restructuring in the health sector.
9.7
Medical and Dental Practitioners Act 1988
This Act establishes a Medical and Dental Board. The Board is a body corporate and its function include: Registration of medical and dental practitioners Regulation of their training Appointment of examiners Issuing certificates of registration Exercising disciplinary control over, and ensure the maintenance of, proper standards of professional conduct by persons registered as medical and dental practitioners. Chapter 6(3) provides that every person whose name is entered on the Medical and Dental Register is entitled to use the term “doctor implying that he is recognized by law as a person authorized or qualified to practice in Solomon Islands.” Chapter 14 provides: “Every registered medical or dental practitioner shall be entitled to practice medicine or dentistry, as the case may be, in Solomon Islands, and to demand and recover any reasonable charges for services rendered by him and for all drugs, medicine and appliances supplied by him.”
Ministry of Health: National Health Report 2005 Page 243 of 250 --------------------------------------------------------------------------------------------------------------------The statutory right to establish a private practice and charge fees and the relationship of this to employment by the Ministry appears to cause some difficulty with some doctors who are employed by MHMS, particularly those in hospitals. It appears that some doctors who are employed in public hospitals are also running private clinics. There is a concern that some way should be found to accommodate the desire to see private, fee paying, and patients so as to encourage those doctors working in the hospital to remain. For example, some doctors expressed a desire to use the public hospitals after hours to see private patients.
9.8
Nursing Council Act 1987
This Act establishes a Nursing Council and matters related to the registration of nurses in the Solomon Islands. The Nursing Council is a body corporate and its functions are to: Arrange and regulate examinations, courses and training for persons wishing to be nurses Keep and maintain a register of nurses and issue certificates to suitably qualified nurses Regulate and supervise the practice of nurses, including the maintenance of professional standards by nurses Approve training courses for nurses View matters related to the profession of nursing in light of the development in technology, medical and nursing care for the benefit of patients and the nursing profession Chapter 8 provides that the Council may register a person who is qualified in terms of Chapter 9 of the Act and not disqualified under Chapter 10, “but otherwise it shall reject the application.” The Council may cancel or suspend registration. The Act also prescribes certain offences for practicing without registration and other matters (Chapter s 18-20). The constitution and liability provisions of the Council were substantively amended in 1997. Prior to the amendments, the Nursing Council was headed by the Under Secretary for MHMS, with a deputy who was the head of nursing services. The Council included the heads of training institutions, the respective heads of hospital and community health services, a registered nurse nominated by the Nursing Association and a registered nurse employed in the private sector. However, in 1997 the Director of Nursing (a position within MHMS) was designated the chair of the Council and the deputy chair become the Assistant Director of Nursing. The Under Secretary of MHMS is no longer a member of the Council, having been replaced by the Assistant Director of Nursing. Other members of the Council are the heads of approved training and educational institutions, a registered nurse employed in the service of a religious organisation in Solomon Islands, a registered nurse nominated by the Nurses Association and the newly created position of Registrar of Nursing. The position of Secretary (who was also the Registrar to the Council) appears to have been amalgamated with that of the Registrar who now has the same statutory responsibilities of the Secretary for the keeping of a nurses’ register and the issuing of appropriate certificates.
9.9
Pharmacy and Poisons Act 1941
This (principle) Act establishes a Pharmacy and Poisons Board as a separate corporate body. The Board comprise three persons, the Under Secretary for Health (who is retained as the Board Chair) and two other persons appointed by the Minister. The Board’s functions are not clearly defined in the Act, but appear to be to authorise persons to practice as pharmacists and to keep a register of pharmacists (maintained by a Registrar (Chapter s 16 to 26). The Act allows a body corporate to carry on the business of a pharmacy, provided it is under the management supervision of a registered pharmacist. The Board may disqualify a body corporate from practicing, but only with the approval of the Minister (Chapter
Ministry of Health: National Health Report 2005 Page 244 of 250 --------------------------------------------------------------------------------------------------------------------27). Conditions for practice, including the procedure for disqualification, are set out in Chapter s 28 to 33. Only persons registered and approved under the Act may practice as a pharmacist, but the Board may issue a temporary licence to practice (Chapter 35). The Act requires a medical practitioner to sign prescriptions (Chapter 36) and for pharmacists to keep a register of prescriptions (Chapter 37). Chapter 39 permits a medical practitioner to dispense medicines and drugs without being registered as a pharmacist, provided an adequate record of any such prescriptions. In limited circumstances, a pharmacist may give medical or surgical advice or aid (Chapter 38). Automatic dispensing machines are prohibited (Chapter 40). There are restrictions on the supply of reproductive and sexual health medicines and advertisements or other material on these (Chapter 41 and 42). Part V of the Act deals with the sale and supply of medicines. Only medicines authorized for sale under the Act may be made available to the public, although the Minister may amend Schedule A of the Act, which sets out permitted medicines. A person may be licensed to sell medicines, but not fill subscriptions (Chapter 45). The Police must be notified of persons licensed to sell medicines (Chapter 46). Wholesale supply of medicines is prohibited and there are restrictions on important of medicines (Chapter s 48 and 49). A general provision on labeling is included (Chapter 50), and the Minister is empowered to order the restriction of some drugs. There is a range of rules that have been made under the Act including rules relating to commercial samples. Other aspects of the rules deal with exemptions and the form of prescriptions, record keeping, labeling of poisons, storage and transport of poisons, manufacture of poisons, and forms and fees.
9.10 Pharmacy Practitioners Act 1997 The Pharmacy Practitioners Act is an extract from the certain provisions of the Pharmacy and Poisons Act, and to matters connected to therewith or incidental thereto. It is specific to regulation of the Practice of Pharmacy in Solomon Islands. The provisions include; Establishment of Board and its functions Registration of pharmacists and pharmacy assistant Disciplinary
Chapter 10: KEY ISSUES CHALLENGES AND WAY FOWARD
9.11 Overview:: Key health problems The Annual Health Report 2005 hereby raised many key issues for consideration in policy decisions, planning, and management. The following health problems and diseases were presented with evidences (not in any priority order as this stage). Skin diseases Diabetes Malaria Oral health Disaster management Epidemic response
Ministry of Health: National Health Report 2005 Page 245 of 250 --------------------------------------------------------------------------------------------------------------------TB/ Leprosy Maternal mortality Family planning Eye and ear diseases Trauma and accidences Common childhood infections Non-communicable diseases Inter-sectoral and partnership of multisector for health
9.12 Issues Raising and Fact (evidence) finding: Listed below is a brief overview of issues:The issues are categorized into 5 key Result Areas (as a possible area for changes to outputs, outcomes and impacts): 10.2.1. Key Social Health Determinants: Listed below are the key social health determinants, affecting health status of the people and imposing challenge on the health services delivery: Conflict Health seeking behavior-socio-cultural –kastom medicine Geographical – distance Costs
9.12.1 10.2.2. Findings: SI faces some unique challenges in the effective delivery of health service: Utilisation of health care is on the increase Country struggles with a high burden of disease and reductions in common diseases has stalled Communities make decisions in a society that utilises home care with traditional healers and western medicine. ( medical pluralism) Power of the health worker to affect health outcomes is increasingly acknowledged Kastom medicine widely used, even in the treatment of new diseases, including STI’s, but households can disagree. i.e clinic or kastom Kastom doctors declining, healing traditions are in a state of rapid change
9.12.2 Pattern of resorts: Symptoms – assessment of threat – first resort of minor illnesses is Kastom medicine When illness has been described as serious ( bigfala siki) clinics and hospitals are generally the first treatment preference – leads to delays in tx. However, can be disagreements over how to characterise serious illnesses ( eg. Diabetes, stroke, TB, cancer, heart problems, malaria and diarrhoea and mental illnesses)
Ministry of Health: National Health Report 2005 Page 246 of 250 --------------------------------------------------------------------------------------------------------------------9.12.3 Barriers to seeking health care Distance to clinic, transport accessibility, available childcare, quality of service and medicine stocks, fear of injections, drugs, surgery etc / then resort to Kastom BUT – patterns of resort vary by region and household Some argue that kastom is more effective in the early stages of an illness “kastom doctors and medical doctors should work together in treating illness”
9.12.4 Usual attitude towards health: Self medication commonly practiced, especially in malaria Kastom illnesses / medical illness – but a readiness to adjust to new beliefs Once a decision is made to seek formal health care – nearest health facility generally first choice
9.12.5 Factors affecting provider choice Clinics – close, referred, quality of service Hospitals – more trust in Drs, harder to visit relatives, quality – long lines, rudeness hygiene, absenteeism Private .Practitioners –regarded as high standard of care, but expensive, last resort when other treatments have failed/wantok discount. Referral system not well understood and often bypassed – bad experience in a clinic/reimbursement issues/hospital closer Transportation and treatment costs a significant barrier Service quality – overall high trust in nurses – but many complaints which weaken community confidence, e.g. competence, attitudes, facility, drugs, long waits and wantokism,lack of adequate triage for emergency cases and privacy
9.12.6 Cultural barriers to specific disease –Malaria So common its significance is undervalued – and assessment of health risk depends upon access issues. Tends to be treated at home first – a range of factors affect decision to seek health care –access, side effects of chloroquine, microscopists ( part time) Nets not used – too hot, smell bad and many feel “there re just too many mosquitos everywhere”
9.12.7 Cultural barriers to – i. Reproductive health In a context of rapidly changing social frameworks in which women make decisions ( highly contested ) But – introduction of medical birth practices has not eliminated old beliefs Ongoing issues of lack of privacy, assisted deliveries all part of broader social issues – violence/shame etc Demand for a/n care varies – lack of support from husbands Medically assisted deliveries – variations in utilisation depends upon a variety of reasons – but the emphasis appears to be more in favour of home births expertise of TBA’s.
Ministry of Health: National Health Report 2005 Page 247 of 250 --------------------------------------------------------------------------------------------------------------------ii. Family Planning; Demand higher that present coverage Disagreements with husbands/stronger role Low levels of awareness of FP programs ---confidentially and attitude a barrier Decline in available contraception to single women as it is under the FP model. Some secrecy with FP/may contribute towards negative feelings about it. Economic situation – bride price Education programs effective on BR – but when discontinued birth rates rise again iii. Other related findings: Malnutrition- little awareness of malnutrition issues – in some cases food sold at market and children given candy. Health promotion/education – widespread interest in having more – but poor planning ( night ) and lack of visual or dramatic component affected attendance rates People want improved health, but disagreements over how it should be done at village level – need for external organisation to lead PHP Demonstrated interest in organising “ healthy village” activities and improving sanitation
9.12.8 Problems with service delivery and human resource issues: Lack of supervision Same people get all the training – demand is high Nurses feel disadvantaged Wantokism ( favouritism) Lack of health information given to clients Uneven case loads at the hospitals and clinics Patients can demand unavailable or inappropriate treatment Nurses say that barriers to attending clinics may be overcome if there was better perception by the community on illness severity or by improving the relationship with nurses In Conclusion: Socio – cultural knowledge and practices, service quality issues and clinic access all act as barriers to health service utilisation Local understanding of disease and health and reliance on Kastom medicine and TBAs also impact on health seeking behaviour “substantial room for improving the delivery of service” “ an approach that encourages community participation may be especially suitable in this country given the transportation barriers”
9.13 The Way Forward:
Ministry of Health: National Health Report 2005 Page 248 of 250 ---------------------------------------------------------------------------------------------------------------------
During the coming national strategic workshop on the 8-12th May 2006, all stakeholders will further review the issues and possible options for strategies raised.
Preliminary discussions have started to flag some crucial points for long strategic directions;Examples: In the Key Result Area (KRA): People focused:Advocate more on the positive aspects of the local cultural imperatives to protect health of the people: e.g. circumcism as evident as preventive to HIV infection. Community education and interventions at the people level for illnesses such as skin diseases, malaria control, oral health of children, destigmatization of PLWHA, disaster preparedness for vulnerable communities to natural disaster, women’s right to choose the types and access to FP, harm reduction against substance abuse, life skills at the community level, participation of local people in disease controls. In KRA: Public health strategies: Whilst focusing on the people, the public health strategies must be to supportive;Increase the health education and promotion activities to the community and emphasis behavioral change as the outcome for good health impact in reducing the skin diseases, diabetes, malaria, HIV and other communicable diseases. Review and incorporating a supportive health laws supporting the public health strategies by providing and protecting healthy lifestyles and reducing hazardous environment and vulnerability to child sex, sexual abuse etc. In KRA Organizational change: The evidences so far lead to an inevitable need to change how we do things for the betterment the people as our value and to strengthen our public health strategies. In KRA Accountability: This KRA run across all the other KRAs. Since “health is every body’s business”, every one in the communities are accountable for to ensure the vision and mission for happy, healthy and productive Solomon Islands”. This area includes ensuring that various kinds mechanisms for good governance and accountability are developed, advocated widely, enforced, monitored and evaluated Examples; Clear position descriptions in the malaria control programs More intersect oral and community approaches for all communicable diseases. Performance appraisal for all programs Transparency and financial accountability for all funded disease control programs. Good leadership and governance Improve monthly annual reporting In KRA information management: This is the conceptual underpinning across all issues. This will provide clear evidence and acts radar for the strategies and activities planed and implemented.
Ministry of Health: National Health Report 2005 Page 249 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 10 Key Activities for 2006 10.1 Overview The options for solutions and then action steps for the issue raised in the report will be dealt with a more detail in some forthcoming activities in 2006. Nearly all disease prevention and activities will continue and/ or even strengthened in 2006. From August 2006 will be the transitional phase of the existing HISP, in preparation for a next project design in light of the forthcoming SWAp (Sector Wide Appraoch) collaboration by key external assistance to the national health response.
10.2 Some of the Key Activities for 2006 1. National Strategic Planning Workshop 8-112th May 2006 (MOH Executive and the Policy and Planning Division/ HISP). 2. Drafting of the National Health Strategy for the next ten years. (including submission to the Cabinet) (MOH Executive and the Policy and Planning Division/ HISP) 3. 59th World Health Assembly in Geneva 22-26 May 2006 (To be attended by Hon Minister of Health and the Permanent Secretary). 4. First Quarter Review of 2005: Feed Back from all Provincial Health Directors, NRH, and National Divisions (MOH Executive and the Policy and Planning Division/ HISP) 5. Development of Activities for the Operational Plans for 2007 (MOH Executive and the Policy and Planning Division/ HISP and all Provinces and Divisions). 6. Inception of the Budgetary Process for the 2007 Budget (MOH Executive and the Policy and Planning Division/ HISP and all Provinces and Divisions.. 7. Start the implementation of the civil work: Renovation of the selected Area Health Centers and Rural Health Centers (Policy and Planning Division/ HISP and Provincial Health Directors). 8. Work closely SWAp for Project Design (MOH Executive and the Policy and Planning Division/ HISP). 9. Expansion of the Measles (EPI) Campaign (Child Health, Reproductive Health Division). 10. Review / and Prioritization of Health Legislations for cabinet submission and endorsement. – E.g. Draft Tobacco Control Legislation for cabinet endorsement (MOH Executive and the Policy and Planning Division and Health Promotion Division) . 11. Second Planning Workshop for the Pandemic Influenza Preparedness (Avian Flue) (MOH Executive and the Policy and Planning Division, and Environmental Health and the Public Health Laboratory and the NRH Med Laboratory) 12. Monitoring and Evaluation Workshop on the National HIV Policy and Multi-Sectoral Strategic Plan 2005-2010, and planning for the Mid-Term Review in 2007 (HIV Prevention Unit, Disease Prevention and Control Unit, and Oxfam Australia along with all partners). 13. Continuation with the Tobacco Control Project with Allen and David Clarke of NZ (Health Promotion and NCD Unit of the Disease Prevention and Control Unit).
Ministry of Health: National Health Report 2005 Page 250 of 250 --------------------------------------------------------------------------------------------------------------------Table x: Authors of the National Health Report 2005
1 2
Author Dr. George Malefoasi (Permanent Secretary) Ms. Petra Veerger
3
Ms. Christina Evans (HISP/ NHRA)
4 5 6 7 8 9
Mr. Amos Lapo (Ag. Nat Head of Nursing) Mr. Seda Savakana (Head-Radiography) Mr. Andrew Darcy (National Pathology) Dr. Lorraine Oti (Director Dental Services) Mr. Charles Gauba (Head Rehabilitation Dept NRH) Ms. Iakoba Baakai
10 11 11 12
Mr. Noel Itogo Mr. Robinson Fugui Joanne Ahikau and Helen Koti Mr. Alby Lovi
13
Ms. Vaelyn Gagahe
14
RAMSI-Machinery of Government Dr. David Snowball and Mr. Joseph Wale Dr Greg Jilini
15 16 17 18
Dr. Patrick Toitona (and Ms. Tracey HISP/PHA) Dr Gunter Kitel Ms. Rachel Tigita
Sections Main Author Health Institutional Strengthening Project Primary Health Care Demand and PHC Clinic Utilization and other related reviews report. Nursing in Solomon Islands National Medical Imaging National Pathology Services Dental Services Rehabilitation Services Health Burden, Communicable Diseases, and Provincial Health Services disease trends. TB/ Leprosy Environmental Health Social Welfare Health Promotion Activities and Achievements Distance Education: Program Outputs The Scan of the Public Administration Functions Western Provincial Health Services Isabel Province Temotu Province National Referral Hospital
NATIONAL HEALTH REPORT 2005
June 2006
Ministry of Health: National Health Report 2005 Page 2 of 250 --------------------------------------------------------------------------------------------------------------------------------
CHAPTER 1 1.1 1.2 1.3 1.4
BACKGROUND:................................................................................................................................................... 7 AIM .................................................................................................................................................................... 7 OBJECTIVES ....................................................................................................................................................... 7 REPORT PROCESS AND STRUCTURE .................................................................................................................... 7
CHAPTER 2 2.1 2.2 2.3 2.4
INTRODUCTION.............................................................................................................................. 7
SOLOMON ISLANDS DEMOGRAPHIC AND HEALTH STATUS INDICATORS ................ 8
DEMOGRAPHIC, GENDER AND POVERTY:........................................................................................................... 8 FERTILITY AND POPULATION GROWTH:.............................................................................................................. 8 LIFE EXPECTANCY :............................................................................................................................................ 8 AGE AND SEX STRUCTURE .................................................................................................................................. 9
CHAPTER 3
HEALTH SYSTEM AND NATIONAL RESPONSE: .................................................................. 11
3.1 SOLOMON ISLAND’S GOVERNMENT’S MAJOR ROLE IN ENSURING HEALTH FOR ALL ........................................ 11 3.2 ORGANIZATIONAL CHANGE IN THE STRUCTURE IN 2005: ................................................................................. 11 3.3 NATIONAL GOALS AND STRATEGIES FOR 2005: MINISTRY OF HEALTH OPERATIONAL PLANS 2005: .............. 14 3.3.1 Operational Planning:................................................................................................................................ 14 3.4 KEY GOVERNMENT’S NATIONAL HEALTH POLICIES: PLANS AND PRIORITIES: ................................................ 16 3.4.1 Solomon Islands Government Leadership .................................................................................................. 16 3.4.2 MOH Vision and Mission Statement........................................................................................................... 16 3.5 3.5. MINISTRY OF HEALTH’S COOPERATE PLAN 2006-8: ................................................................................. 16 3.6 3.6. MINISTRY OF HEALTH NATIONAL GOALS AND STRATEGIC PLANS:: ......................................................... 16 3.6.1 Revised National Goals and Strategies (in 2005, for 2006); ...................................................................... 16 3.7 MEETING UP WITH THE MILLENNIUM ............................................................................................................... 16 3.7.1 Development Goals: ................................................................................................................................... 16 3.7.1.1.1..............................................................................................................................................................................16
3.8 HEALTH INSTITUTIONAL STRENGTHENING PROJECT ........................................................................................ 16 3.8.1 Key Outcomes ............................................................................................................................................. 16 3.8.2 Constraints.................................................................................................................................................. 16 3.8.3 Future directions......................................................................................................................................... 16 CHAPTER 4 (DEMAND):
HEALTH SYSTEMS: HEALTH SERVICE DELIVERY AND EPISODES OF SERVICE 16
4.1 DEMAND ON THE PRIMARY HEALTH CARE: ..................................................................................................... 16 4.1.1 Access: ........................................................................................................................................................ 16 4.2 DEMAND ON HEALTH CARE INSTITUTIONS AND SERVICES: ............................................................................. 16 4.2.1 National Referral Hospital ......................................................................................................................... 16 4.2.2 Nursing in Solomon Islands:....................................................................................................................... 16 4.2.3 SI Nursing Council: .................................................................................................................................... 16 4.2.4 National Medical Imaging Division............................................................................................................ 16 4.2.5 National Pathology Services....................................................................................................................... 16 4.2.6 Dental (Oral) Services 2005 ....................................................................................................................... 16 4.2.7 Rehabilitation Division National Referral Hospital ................................................................................... 16 4.2.8 Distance Education Program: Ongoing Education for Nurses: ................................................................. 16 CHAPTER 5
HEALTH BURDEN......................................................................................................................... 16
5.1 OVERVIEW: ...................................................................................................................................................... 16 5.2 THERE ARE SEVERAL MAJOR HEALTH ISSUES AFFECTING SOLOMON ISLANDS.................................................. 16 5.3 COMMUNICABLE DISEASES:............................................................................................................................. 16 5.3.1 Acute Respiratory Infection: ....................................................................................................................... 16 5.3.2 Clinical Malaria ......................................................................................................................................... 16 5.3.3 Yaws and Skin Disease ............................................................................................................................... 16 5.3.4 Ear Infection ............................................................................................................................................... 16 5.3.5 Red Eye:...................................................................................................................................................... 16 5.3.6 Diarrhoea ................................................................................................................................................... 16 5.4 TUBERCULOSIS AND LEPROSY CONTROL PROGRAM ........................................................................................ 16 5.4.1 Tuberculosis Control Program:.................................................................................................................. 16 5.4.2 Objectives of the National TB Program (NTP): ......................................................................................... 16 5.4.3 General Objective:...................................................................................................................................... 16
Ministry of Health: National Health Report 2005 Page 3 of 250 -------------------------------------------------------------------------------------------------------------------------------5.4.4 Specific Objectives...................................................................................................................................... 16 5.4.5 Activities Conducted in 2005 ...................................................................................................................... 16 5.4.6 Health Education / Community Awareness ................................................................................................ 16 5.4.7 World TB Day Commemoration – 2005 ..................................................................................................... 16 5.4.8 Monitoring and Supervision: ...................................................................................................................... 16 5.4.9 Annual TB/ Leprosy Review........................................................................................................................ 16 5.4.10 TB Situation by 2005 .............................................................................................................................. 16 5.4.11 New Case Detection Rate:...................................................................................................................... 16 5.4.12 Case Notification by Provinces .............................................................................................................. 16 5.4.13 Age and Sex Distribution of New Sputum Smear Positive Cases ........................................................... 16 5.4.14 TB Infection by Site ................................................................................................................................ 16 5.4.15 Case Holding and Treatment Outcome .................................................................................................. 16 5.4.16 Tuberculosis Death................................................................................................................................. 16 5.4.17 Leprosy Control Program ...................................................................................................................... 16 5.4.18 New Leprosy Case Notification .............................................................................................................. 16 5.4.19 National Leprosy Prevalence ................................................................................................................. 16 5.4.20 Capacity Building in Leprosy ................................................................................................................. 16 5.4.21 Constraints and Weakness...................................................................................................................... 16 5.4.22 Recommendations: ................................................................................................................................. 16 5.4.23 Acknowledgement ................................................................................................................................... 16 5.4.24 Compiled By:.......................................................................................................................................... 16 5.4.25 Core Indicators for TB Program in 2005:.............................................................................................. 16 5.5 ENVIRONMENTAL HEALTH............................................................................................................................... 16 5.5.1 Overview:.................................................................................................................................................... 16 5.5.2 Priority Strategy/Action .............................................................................................................................. 16 5.5.3 Immediate ................................................................................................................................................... 16 5.5.4 Long Term Objectives ................................................................................................................................. 16 5.5.5 Strategies for 2005...................................................................................................................................... 16 5.5.6 Solid Waste ................................................................................................................................................. 16 5.5.7 Net Working with NGOs ............................................................................................................................. 16 5.5.8 Integrated Research on Approaches ........................................................................................................... 16 5.5.9 Food Safety and Quality Control- ICU....................................................................................................... 16 5.5.10 Health Quarantine Services.................................................................................................................... 16 5.5.11 EHD Training Report 2005 .................................................................................................................... 16 5.6 NON- COMMUNICABLE DISEASES .................................................................................................................... 16 5.7 COMMUNITY-BASED SERVICES:....................................................................................................................... 16 5.8 SOCIAL WELFARE DIVISION:............................................................................................................................ 16 5.8.1.1 5.8.1.2 5.8.1.3 5.8.1.4 5.8.1.5 5.8.1.6 5.8.1.7 5.8.1.8 5.8.1.9 5.8.1.10 5.8.1.11 5.8.1.12
Brief Background/Introduction:...........................................................................................................................16 Social Welfare Data Summary (Brief):................................................................................................................16 Organization & Staff: Social Welfare Office:......................................................................................................16 Trainings Undertaken During the Year:...............................................................................................................16 Organisation Structure: ........................................................................................................................................16 Activities Taken During the Year: .......................................................................................................................16 Activities and Achievements: ..............................................................................................................................16 Annual Health Outcomes (relates to Goals/Outputs/Indicators: ..........................................................................16 HR. Issues:...........................................................................................................................................................16 Infrastructure/Maintenance/Equipment Issues:....................................................................................................16 Issues for Consideration in Future Planning: .......................................................................................................16 Any Other Comments: .........................................................................................................................................16
5.9 HEALTH PROMOTION: ...................................................................................................................................... 16 5.9.1 Activities and Accomplishments.................................................................................................................. 16 5.9.1.1 5.9.1.2 5.9.1.3 5.9.1.4 5.9.1.5
National Level .....................................................................................................................................................16 Provincial Level...................................................................................................................................................16 Financial Information ..........................................................................................................................................16 Issues for Consideration In Future Planning........................................................................................................16 Constraints and Possible Strategies/Actions ........................................................................................................16
CHAPTER 6
SYSTEMS PERFORMANCE- MONITORING AND EVALUATION: .................................... 16
6.1 MINISTRY OF HEALTH: PERFORMANCE EVALUATION ...................................................................................... 16 6.1.1 The Scan of the Public Administration Functions....................................................................................... 16 6.1.1.1.1
Fig 25 and Table 6 shows the ratings for the MOH: 1 –lowest, and 5-highest................................................16
6.2 PRIMARY HEALTH CARE CLINICS UTILISATION ................................................................................................. 16 6.2.1 Solomon Islands Primary Health Care Clinics Utilisation Review ............................................................ 16 6.2.1.1
Major discussion points: ......................................................................................................................................16
Ministry of Health: National Health Report 2005 Page 4 of 250 -------------------------------------------------------------------------------------------------------------------------------6.2.1.2
Recommendations Clinic Utilisation Review ......................................................................................................16
6.3 ROLE DELINEATION FOR PHC CLINICS AND HOSPITALS: .................................................................................. 16 6.3.1 Introduction ................................................................................................................................................ 16 6.3.2 What are packages of care?........................................................................................................................ 16 6.3.3 How do packages of care articulate with role delineation? ....................................................................... 16 6.3.4 Continuum of Care...................................................................................................................................... 16 6.4 PHC QUALITY CHECK : ................................................................................................................................... 16 6.4.1 MOH Infrastructure -Issues:...................................................................................................................... 16 6.4.2 National Infrastructure Management: ........................................................................................................ 16 6.4.3 Provincial Infrastructure Management: ..................................................................................................... 16 6.4.4 Local Infrastructure Management .............................................................................................................. 16 6.4.5 Health Infrastructure Reviews .................................................................................................................... 16 6.4.6 Provincial Hospitals & housing.................................................................................................................. 16 6.4.7 AHC Rehabilitation Plans........................................................................................................................... 16 6.4.8 RHC Clinic Review:.................................................................................................................................... 16 6.4.9 Unfit or inappropriate birthing facilities .................................................................................................... 16 6.4.9.1
Need for upgrade of equipment & furniture: .......................................................................................................16
6.5 PROGRAM PERFORMANCE:............................................................................................................................... 16 6.5.1 Program achievements of Outputs in 2006:................................................................................................ 16 6.5.1.1 6.5.1.2 6.5.1.3 6.5.1.4 6.5.1.5 6.5.1.6 6.5.1.7
Environmental Health Division- : ........................................................................................................................16 HIV/STI Prevention- Disease Prevention and Control Unit ................................................................................16 NCD Prevention: Disease Prevention and Control Unit ......................................................................................16 Community Based Rehabilitation ........................................................................................................................16 Distance Education Program: ..............................................................................................................................16 Social Welfare .....................................................................................................................................................16 TB and Leprosy Prevention and Control. ............................................................................................................16
CHAPTER 7
PROVINCIAL HEALTH SERVICES ........................................................................................... 16
7.1 CHOISEUL PROVINCE: ...................................................................................................................................... 16 7.2 HEALTH BURDEN IN CHOISEUL 1996-2005...................................................................................................... 16 7.2.1 Introduction ................................................................................................................................................ 16 7.2.2 Major Health Issues.................................................................................................................................... 16 7.3 WESTERN PROVINCE ........................................................................................................................................ 16 7.3.1 Health Burden in Western........................................................................................................................... 16 7.4 ISABEL PROVINCES .......................................................................................................................................... 16 7.5 CENTRAL ISLANDS PROVINCE .......................................................................................................................... 16 7.6 GUADALCANAL ................................................................................................................................................ 16 7.7 MALAITA ......................................................................................................................................................... 16 Fig 35 Population of Malaita by Gender 7 yr trend ..................................................................................................................16
7.8................................................................................................................................................................................. 16 7.9 MAKIRA:.......................................................................................................................................................... 16 7.10 TEMOTU . ......................................................................................................................................................... 16 7.11............................................................................................................................................................................... 16 7.12 RENNELL BELLONA ......................................................................................................................................... 16 7.13 HONIARA ......................................................................................................................................................... 16 CHAPTER 8
RESOURCE UTILISATION .......................................................................................................... 16
8.1 FUNDING FOR HEALTH IN 2005:....................................................................................................................... 16 8.1.1 Issues: ......................................................................................................................................................... 16 8.2 HUMAN RESOURCE FOR HEALTH IN 2005 ........................................................................................................ 16 8.3 ISSUES:............................................................................................................................................................. 16 CHAPTER 9 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10
HEALTH LEGISLATION.............................................................................................................. 16
HEALTH CARE LEGISLATION REVIEW:............................................................................................................. 16 HEALTH SERVICES ACT 1979........................................................................................................................... 16 THE HEALTH SERVICES (HOSPITALS) REGULATIONS 1980 .............................................................................. 16 ENVIRONMENTAL HEALTH ACT 1980 .............................................................................................................. 16 MENTAL HEALTH ACT 1970: ........................................................................................................................... 16 HEALTH WORKERS ACT 1982:......................................................................................................................... 16 MEDICAL AND DENTAL PRACTITIONERS ACT 1988 ......................................................................................... 16 NURSING COUNCIL ACT 1987 .......................................................................................................................... 16 PHARMACY AND POISONS ACT 1941................................................................................................................ 16 PHARMACY PRACTITIONERS ACT 1997............................................................................................................ 16
Ministry of Health: National Health Report 2005 Page 5 of 250 -------------------------------------------------------------------------------------------------------------------------------9.11 OVERVIEW:: KEY HEALTH PROBLEMS .............................................................................................................. 16 9.12 ISSUES RAISING AND FACT (EVIDENCE) FINDING: ............................................................................................ 16 9.12.1 10.2.2. Findings: .................................................................................................................................... 16 9.12.2 Pattern of resorts: .................................................................................................................................. 16 9.12.3 Barriers to seeking health care .............................................................................................................. 16 9.12.4 Usual attitude towards health: ............................................................................................................... 16 9.12.5 Factors affecting provider choice........................................................................................................... 16 9.12.6 Cultural barriers to specific disease –Malaria....................................................................................... 16 9.12.7 Cultural barriers to – i. Reproductive health ......................................................................................... 16 9.12.8 Problems with service delivery and human resource issues: ................................................................. 16 9.13 THE WAY FORWARD:....................................................................................................................................... 16 CHAPTER 10 10.1 10.2
KEY ACTIVITIES FOR 2006 ........................................................................................................ 16
OVERVIEW ....................................................................................................................................................... 16 SOME OF THE KEY ACTIVITIES FOR 2006 ......................................................................................................... 16
Ministry of Health: National Health Report 2005 Page 6 of 250 -------------------------------------------------------------------------------------------------------------------------------AHC ARI CHP CIP EHD GP HCC HISP HISP
Area Health Clinics Acute Respiratory Infection Choiseul Province Central Islands Province
Environmental Health Division Guadalcanal Province Honiara City Council Health Institutional Strengthening Project Health Information System Human Immunodeficiency Virus and Sexually Transmitted HIV/STI Infections HR Human Resource ICPD International Convention Population Development ICU infection Control Unit MDG Millennium Development Goals MOH Ministry of Health MP Malaita Province MUP Makira Ulawa Province NAP Nurse Aide Post NCD Non-Communicable Diseases NGOs Non-Governmental Organizations NHR National Health Review NRH National Referral Hospital OP Operational Plan PHC Primary Health Care PHD Provincial Health Directors RBP Rennell Bellona Province RHC Rural Health Clinic RWSS Rural Water Supply and Sanitation TB Tuberculosis TP Temotu Province WHO World Health Organization WP Western Province YP Ysabel Province
Ministry of Health: National Health Report 2005 Page 7 of 250 --------------------------------------------------------------------------------------------------------------------------------
Chapter 1 1.1
Introduction
Background:
The purpose of this report is to provide information and feedback on the local activities undertook by the divisions and disease control programs both at the national and provincial levels in order to achieve a highest quality of care and to ensure that the health and well being of the people in the country is guaranteed and attained. The “National Health Report 2005 (NHR)”, details trends and changes in diseases of public health importance in Solomon Islands and describes some aspects of health service delivery, against national and international health indicators. By doing so the report provides information for development of the revised National Goals and Strategies in 2005 and hints on MOH National Health Strategic Plan 2006-2010 and sets baselines against which future change can be measured. The report attempts as close as possible reporting on available information as it emphasizes on ‘evidencebased’ policy and decision making as pivot for future directions on health. This report is primarily build on the, “Solomon Islands Health Status Assessment 20051
1.2
Aim
To report the health of Solomon Islands people in the period 1993-2005 against Solomon Islands MOH and appropriate international indicators, and systems performance in 2005.
1.3
Objectives
Identify and utilize available MOH division health data sets for the health status report Identify and utilize available data and information from researches and studies on health systems and human resource performances. Identify MOH and international health indicators against which to report data (as permitted by available data) To present the national and provincial health data for the decade 1995-2005 so that trends in disease incidence can be reported To identify and utilizes sources of issues affecting the health status and system in 2005 and the past years. To present some of the broad strategies developed in addressing the issues and flag the way forward.
1.4
Report process and structure
The National Health Report 2005 takes a slightly different turn in featuring; Brief overview of provincial health burden and the response by the provincial health services Chapter 7. Review of existing health legislation in Chapter 9 The report begun with reviewing the demographic and health status indicator in 2005 in Chapter 2. In Chapter 3 the report highlighted two key changes in the organizational structure of the Ministry of Health. Also in the same Chapter, Solomon Islands standing MDGs2. The report covers the demand on health care system of the country in Chapter 4. In Chapter 5 the update on the health burden of the country is covered. Further review of the trend of the common illnesses was presented in detail in Chapter 7. Chapter 8 briefly covers the resources utilized for health services delivery in 2005. Chapter 10 summarizes the broad issues in a presentable way, and the like strategies developed to solve or alleviate the health problems and issues identified. Chapter 11 briefly concerns with the key activities for the first half of 2006.
1 2
Health Institutional Strengthening Project / MOH (2005): “Solomon Islands Health Status Assessment 20051 Millennium Development Goals
Ministry of Health: National Health Report 2005 Page 8 of 250 --------------------------------------------------------------------------------------------------------------------------------
Chapter 2 2.1
Solomon Islands Demographic and Health Status Indicators
Demographic, Gender and Poverty:
Solomon Islands population is fast growing and remained very young. It is evident that the young population health demand on the system is ever growing in the past decades and at present.
“A key indicator of concern is the high maternal deaths at around 236 in 2005”
Table 1. Core population and health data (2005) Population
[Total]
471,266 [1]
[0-14 years]
225,615 (47..9%) [1]
[65+ years]
3.12% [1]
Crude birth rate (per 1000 pop) Crude death rate (per 1000 pop)
23.2 [1] 6.7 [2]
Infant mortality rate (per 1000 live births)
16.3 [1]
Maternal mortality rate (per 100 000 live births)
236 [1]
2.2
Life expectancy at birth (years)
Total fertility rate % of population served with safe water % of population with adequate sanitary facilities
Fertility and population growth:
According to the various available data on population growth Total fertility rate in 1987-1999 was 4.8 (decreased from 6.1 in 1984-1986). TFR has been estimated to be reduced to 4.053 in 2003 and now to 3.794. Crude birth rate is 36 per 1,000 Crude death rate 9 per 1,000 (9.6/1000 males, 8.4/1000 females) Total population growth 2.7 percent in 1999 Average population growth 2.8 percent 1986-1999
2.3
3
Life expectancy :
Figure for the Annual Health Report 2003
[Both]
63.4
[Male]
62.6
[Female]
64.3 3.79
[Total]*
71
[Urban]*
94
[Rural]* [Total]*
65 34
[Urban*]
98
[Rural]*
18
Ministry of Health: National Health Report 2005 Page 9 of 250 -------------------------------------------------------------------------------------------------------------------------------Life expectancy at birth 1999 males 60.6 years Life expectancy at birth 1999 females 61.6 years
2.4
Age and sex structure
Sex ratio 107 males/100 females at birth Median age in 1999, 18.7 years (18.6 males, 18.9 females) Population aged less than 15 years, 41.5% of the total population and 2) The population less than 15 has declined from 47.3% in 1986 reflecting decreasing fertility Figure 1 - the proportion of population by age group C h a r t S h o w in g p r o p o r tio n b y a g e -g r o u p 600000 500000
65+
Pop
400000
5 0 -6 4
300000
1 5 -4 9
200000
0 -1 4
100000 0 2001
2002
2003
2004
2005
Y e ars
Issues/ constraints/ challenges:
Evidence
Population projections5
This is best demonstrated through vaccination rates of infants. In some provinces vaccination coverage rates exceed 100% across several vaccination types indicating that the estimated cohort for the particular province is too low. Nationally the number of infants vaccinated falls in a range that never exceeds 12,000, less than the 13,000 + estimated < 1 year old population. This may indicate that the under 1 cohort is overestimated or that a number of children are never vaccinated. The 1999 – 2004 population projections, derived from census data, were estimated according to the national medium high projection variant (N2). Based on past and current (at the time of writing in 1999) population trends, this was considered by census authors the most likely variant to plausibly indicate future population growth, gave the closest population forecast and so was recommended for planning use. Methods for estimating population projections and their limitations are discussed in the census analysis document. While the census authors do not give similar recommendations for provincial population figures (these may not be as accurate, given economic and political change), these were used as denominators in this report as they are the best estimate available. As a result of possible inaccuracies of these provincial projections, rates of disease may be over or underestimated. Options & Strategies: Despite the difficulties observed, a single standard set of population projections based on the most recent evidence available (1999 census), need to be adopted by MOH and each division to ensure that there is consistency of denominators when calculating rates of disease.
5HISP/MOH
(2005) Issues of population projection flagged in the , “Solomon Islands Health Status Assessment 2005
Ministry of Health: National Health Report 2005 Page 10 of 250 -------------------------------------------------------------------------------------------------------------------------------Figure 2 - Population by 5 year age group and sex, Solomon Islands, 1999
80-84 70-74 60-64 50-54 40-44 30-34 20-24 10-14 0-4 -10
-8
-6
-4
-2 M%
0
2 F%
4
6
8
10
Ministry of Health: National Health Report 2005 Page 11 of 250 --------------------------------------------------------------------------------------------------------------------------------
Chapter 3 3.1
Health System and National Response:
Solomon Island’s Government’s Major role in ensuring health for all
“Existing Health The Solomon Islands Government is a major health provider, funder Legislation needs and regulator of health services for the people in the country. The updated” governing legislation for health services delivery is enacted under the Health Services Act 1988, which is outdated and need significant changes. In the past few years Government’s role as a key funder was denied by the economic crisis due to the past ethnic tension. Fortunately the economic recovery has enabled the return of health services as it is evident in the reports from the provinces. Nonetheless, whilst we have improved in increasing Solomon Islands Government’s share in the health expenditure in 2005 and also in 2006, all the cost of the medicines and other essential “HSTA to pharmaceutical supplies are currently paid by the AusAID funded Health transfer some Sector Trust Fund. SIG is still faced with USD120,000 debt to UNICEF for costs to SIG in vaccines used since early 1990s. This is are some outstanding financial issues, which has cost our incredibility to external supporting organizations. The Ministry of Health Executive soon be making a decision on how to transfer the costs into the SIG funds as the HSTA will be reduced. The total cost of all medicines the Ministry orders and purchase for the country is around SDB16-20 Million.
3.2
Organizational change in the structure in 2005:
In 2005 there are two organization changes to the structure of the Ministry of Health. (1) is the realignment and re-emphasis on Health Improvement which is the public health programs in the national provincial and community levels, and the national and provincial curative services under the Health Care paradigm, and extra emphasis on the logistic and administration and management support to the health care (HC) and the health improvement programs at the national strategic and provincial operational and implementation levels. The changes have been discussed in all major health meetings and conferences in 2005. (2) The second change is really to the signify and to institutionalized effectively the public health functions of the Governments’ Ministry of Health in order to respond effectively and efficiently to common and emerging diseases that causes illnesses and death to the people of the Solomon Islands. In 2004 and then in 2005 national health conference in December 2005 the Public Health Vision6 declaration was endorsed for adoption and further strengthening and development.
6
Ministry of Health (2005): USHI presentation on the Public Health Vision
Ministry of Health: National Health Report 2005 Figure 3 - Organization Chart: Ministry of Health with position holders in 2005
Minister of Health Permanent Secretary Dr. Judson Leafasia Under Secretary Health Improvement Dr.G.Malefoasi
Under Secretary Health Care (by Dr.G.Malefoasi)
National Prevention & Control Programs: Environmental Health (Mr. Robinson Fugui) Health Promotion (Mr. Alby Lovi) Vector Born Disease Control (Mr. Bernard Bakotee) HIV/STI (Dr J. Paulsen) TB & Leprosy (Mr. N. Itogo) Non Communicable Diseases (Ms. N.Laesango) Reproductive/Child Health (Dr.J.Pikacha) SIMTRI (Public Health Training & Research) (Mr. M.Tuni) Epidemiology & Disease Surveillance (Vacant) Provincial Health Services: Provincial Primary Health Care (vacant) Honiara City Council (Dr. Scott Siota Community Based Services: Social Welfare (P.Fia) Community Based Rehabilitation (Ms.D.Yates) Mental Health (Mr. W.Same) Coordination: Partner development Coordination (churches,
Professional Boards: Nursing & Medical services Specialist Care Services: National Referral Hospital (Mr. R.Suinao) Provincial Hospitals (Prov. Directors) National Psychiatric Unit (Dr. Judie) Paramedical Services: Diagnostic Services (X-Ray, Laboratory, Tele-pathology) Dental Services (Dr. C. Alependava) Pharmacy (Mr.R.Skinner) Physiotherapy (Mr.C.Gauba) Monitoring & Evaluation: Health Information Systems (Ms. Bakaai) Coordination: Aid-Donor Coordination Cross-sectoral Development Planning:; Policy Development; Health Legislation
Under Secretary Administration (vacant) National Policy & Planning (Mr. A.Namokari) Coordination & Integration with External Stakeholders Health Asset Management & Planning National Medical stores Information Technology Human Resources Management Human Resources Development Finance: Financial Management Resource Allocation Formula Coordination: Aid-Donor Coordination Cross-sectoral Development Planning: Policy Development; Health Legislation
Ministry of Health: National Health Report 2005 Page 13 of 250 --------------------------------------------------------------------------------------------------------------------Figure 4 Public Health Vision for Strengthening and Improvement
Undersecretary Health Improvement Secretary-admin + management All Notifiable Diseases – Disease Prevention and Control
Reproductive Health Psycho-Social Welfare
Communicable Diseases (CD)
NCD (Non-communicable Diseases)
Env health
Health Promotion
Provincial CD programs
National Capacity Development ARI/ Influenza
Vector Borne Disease
HIV/ STI Control Prevention
HIV/STI
IMCI
TB + Leprosy Planning +Coordination ME)
Diarrhoea Disease
Staffing
Staffing
Nutrition
Service delivery PHC-Clinics
Service delivery PHC-Clinics
Epidemic-Disaster Alert & Response
Community Partnership
Community Partnership
Information + Surveillance Public Health Laboratory NGO/ Civil Society partnership
CBR
Mental Health
Ministry of Health: National Health Report 2005 Page 14 of 250 ---------------------------------------------------------------------------------------------------------------------
3.3 3.3.1
National Goals and Strategies for 2005: Ministry of Health Operational Plans 2005: Operational Planning:
In 2005 further development and improvement were made in the operational plans of the divisions and specific programs: The operational plan framework7 include the following as summarized in the diagram below:
Division/Department: National Goal: Outcome Indicator: Strategy: Objective: Activity Input Input Resource Funding When & Person Output Staff Resources Costs Source Location Responsible Indicator
Date Achieved
Table 2 Operational Planning Guideline and Templates Source: HISP:
Evidence Issues raised on operational planning of health services: Supporting Evidence: Level of implementation has been very low8 Program Implementation by Divisions by end of Sep 2005
90% 80% 70% 60% 50% 40% 30% 20% 10% 0%
90% 80% 69%
64%
1ST 2ND
44% 36%
33% 24%
3RD
20% 6%
a gr ro lP tro on C se ea is D I ne SH or U rB re th o lfa al ct Ve We He al tive ci n uc tio th So d o al ro m He ep Pro R l lth nta ea me tio H n en v ro D re vi C P tio En -N TI ta U S ili / y ab PC HIV ros D eh U Lep R ed PC B/ D /T Bas U PC nity D u m om C
In
2005 the overall implementation of the Ministry of Health national programs was just below fifty percent (i.e. 36%) by end of the third quarter. Provincial health services and national programs are to meet regularly as teams to monitor Op plans; activities are reprioritized Further assistance required with translation of goals, strategies, objectives – some confusion & further knowledge on outputs & outcomes
7 8
Ministry of Health/ HISP: USHI/ MOH (2005) ME implementation rates: Presentation by USHI at the National Health Conference 2005 November.
Ministry of Health: National Health Report 2005 Page 15 of 250 --------------------------------------------------------------------------------------------------------------------Need for Op plan activities to be linked to budget [this is the most significant feedback] further training in budget management required Within the operational plan need for more information on quality improvement and service/program integration Need for further consultation with health teams, communities, etc – consultation while touring, with village health committees & village meetings Feedback on Op plans essential and request one on one feedback For 2007 – no significant changes, focus on activities with budget with a simplification of the operational plan template as well as HR & budget templates; developing the op plans as a team. Many programs and divisions have implemented genuine and (many other authorized activities). Options & Strategies For 2006: The Operational Planning Guidelines was strengthened and linked to the Budgeting process for 20069. The National Goals and Strategies were revised and strengthened along First Steps Get basic
Describe Core Core Business Budget
Divisional Establishm t
Describe Planned Initiatives
+
+
Marginal Costs of Planned
SIG Recurrent B d t
=
=
Operational Pl
Total Divisional Budget
Developme nt Budget
Output & Outcome I di t
Planning Flow Chart10 (Quantify what we plan to do): The National Goals and Strategies were revised and strengthened along with the budget.11 Executive Development Program12 was planned and resourced. The purpose is to buld the capacity of senior health managers and middle managers to manage, plan and supervise their program and divisional activities.
HISP/MOH: Operational and Budgeting Guidelines and Templates: For 2006 operational and budgeting process. Planning Flow Chart was presented by Mr. Abraham Namokari during the National Health Conference 7-11 November 2005. 11 Ministry of Health (2005): MOH 2006 Operational Plans and Budget. 12 HISP/MOH (2005): Executive Development Program developed by HISP and run by the University of NSW. 9
10
Ministry of Health: National Health Report 2005 Page 16 of 250 ---------------------------------------------------------------------------------------------------------------------
3.4 3.4.1
Key Government’s National Health Policies: Plans and Priorities: Solomon Islands Government Leadership
The changes incorporated within the MOH structure and the efforts through the HISP describes the task of defining new strategic directions for the Government health sector as integral to the search for a new and comprehensive health and well-being paradigm for the Solomon Islands. This search enlivens the MHMS vision and mission statement and creates the motivation to move towards meeting that challenge..
3.4.2
MOH Vision and Mission Statement
The MOH endorses the Solomon Islands Constitution (and the WHO definition of health) as the fundamental right of every human being without distinction of race, gender, religion, political belief, economic or social condition to enjoy the highest attainable standard of health. The MOH envisions “open, healthy, happy and productive Solomon Islander people” and continually upgrades its activities to fulfill its mission of “promoting, protecting, and maintaining the good health and well being and hence improve the quality of life of all people in the Solomon Islands” The MOH will strive to fulfill that mission within the context of National Health Legislation and within the limits of resource availability. Our guiding principle is “the people’s health is our passion” and the MOH will do all its best with the resources available to serve our people with love, commitment and dedication so that the health of our nation becomes an asset rather than a liability.
3.5
3.5. Ministry of Health’s Cooperate Plan 2006-8:
The Ministry of Health and Medical Services developed a “Corporate Plan for 2006-2008”13 based on the gain during 2004 and 2005 with the following eight priority areas. Improvement of management and supervision of services; Improved access to quality care; Management and development of human resources for health care; Mortality and morbidity reduction; Maintain healthy environments; Promote healthy living and lifestyles; Improve reproductive health and family planning and; Forge partnerships in health development. This plan entails the future directions in terms of strategies and plans for the next three years demonstrating the Government’s commitment to meeting the MDG Goals. However, improving of Public Health and Primary Health Care functions, focusing on the prevention and control of no communicable diseases and STI/HIV/AIDS will be among the top priority programmes.
3.6
3.6. Ministry of Health National Goals and Strategic Plans::
In April 2005, the national goals and strategies during a planning workshop14. The review is done in light of review of the health status report in 2004, the new goals and strategies will be implemented in the 2006 operational plans.
13 14
Ministry of Health (2005) Corporate Plan 2006-8 (The Ministry of Health has planned and already into a National Health MOH (2005): National Strategic Workshop 11-15 April 2005: National Health Status Report presentation by Dr G Malefoasi
Ministry of Health: National Health Report 2005 Page 17 of 250 --------------------------------------------------------------------------------------------------------------------3.6.1 Revised National Goals and Strategies (in 2005, for 2006); Reduce Maternal Mortality Rate from 184/100,000 live births to 125/100,000 live births by 2010 Reduce morbidity and mortality rate of children below 5 years of age due to common childhood illnesses and vaccine preventable diseases. Reduce impact (morbidity) and severity (epidemics, mortality) of Communicable diseases in Solomon Islands. Implement the ‘National HIV Policy and Multi sect oral strategic plan 2005-10’15 with the aim to sensitize people through informed HIV awareness and behavioral change interventions to stop the transmission of HIV, and to ensure accessibility to quality voluntary, confidential, counseling and testing as the entry point for continuum of quality care, including anti retro-viral treatment, for people living with HIV/AIDS. Reduce incidence of preventable skin diseases by 2010. Promote clean water, proper sanitation (including waste disposal), food quality and food safety (incl. food hygiene) Reduce the incidence of Malaria from 184/1000 people in 2004 to 80/1000 people by 2010. Reduce impact (morbidity) and severity (disability, mortality) of all Non Communicable Diseases in Solomon Islands. Reduce prevalence of dental caries in all children by 2010 Raise public and health service provider awareness on the impact of substance misuse and assess the level of psycho-social problems resulting from substance abuse. Reduce incidence of suicide in SI over next 10 years. Provide essential primary health care to all individuals and families, in an acceptable and costeffective, affordable way, and with their full involvement ensuring best practice, high quality and improved patient/client/community care. Enhance behavioral change which promotes a healthy lifestyle and family health, especially related to reproductive health, child health, NCD’s, mental health and Communicable Diseases like malaria and HIV/STIs. Improve access to required essential drugs, medical equipment and medical supplies of appropriate quality at all levels of health service Improve infection control practices at all levels of health services with the aim of reducing infections acquired within health settings. Ensure appropriate referral between all levels of health service. Improve continuum of patient care by strengthening the admission and discharge processes (including communication) at all levels of health service. Ensure early diagnosis and consequently appropriate treatment for patients. Provide quality patient care to a level consistent with best practice with the aim of reducing length of stay in hospital. Provide appropriate level of patient care in hospital settings by ensuring minimal level of services and minimum staffing requirements Provide a safe environment for patients and staff Undertake evidence based health service planning and management Increase capacity of all managers and their health teams to be involved in operational planning and its use to ensure appropriate, effective and efficient health service delivery Ensure funds allocated in the budget are spent appropriately and in a timely manner to ensure planning and implementation of appropriate health services Improve the management of health assets and equipment at all levels of the health care system Improve management and supervision of health services/health workers in order to manage and sustain positive change in health service delivery Establish a MOH information center where information can be accessed by all stakeholders Enhance development of partnerships with stakeholders to ensure effective delivery of health services Improve health infrastructure to support health service provision.
15
National HIV Policy and Multi sectoral strategic plan 2005-10 Solomon Islands, January 2005, 3rd edition
Ministry of Health: National Health Report 2005 Page 18 of 250 ---------------------------------------------------------------------------------------------------------------------
3.7 3.7.1
Meeting up with the Millennium Development Goals:
The Solomon Islands Government through the Ministry of Health is committed in meeting the MDG. The Ministry of Health continued to report against the MDG’s indicators.
Goal 1: Eradicate hunger and poverty Goal 4: Reduce child mortality Goal 5: Improve maternal mortality Goal 6: Combat HIV/AIDS, Malaria and other diseases Goal 7: Ensure environmental sustainability Goal 8: Develop a global partnership for development National Health Policies & Development Goals 1999-2003: and 2004-5 Work Plans Policy 1: Policy 2: Policy 3: Policy 4: Policy 5: Policy 6: Policy 7: Policy 8:
Improvement of management and supervision of service. Access and Improvement of Care and Quality of service Human Resource Development for Health Morbidity and Mortality Reduction Environmental Health Health Promotion and Education Reproductive Health, Family Planning and Population Concerns. Developing Partnership in Health Development
3.7.1.1.1 Diagram 1: MDGs and ICPDS and National Health Policy Goals:
Table 3 showing updates of the MDGs, ICPDs and National Health Policies Goals Indicators:
MDGs Goal
ICPD Goals/ Target
Reduce Child Goal: Mortality Mortality reduction Infant mortality rate: 50 infant deaths per 1,000 per live births
National Health Goals/ Target
2004 Indicators
2005 Indicators
To reduce infant mortality from 42.7% in 1990 to less than 30% by 2003.
17 per 1,000 live births
16.3 per 1,000 live birth
To reduce child mortality rate (1-4) from 7.1% to less than 5% by 2003. 0.9/1,000 population 1-4 yrs
Improve maternal mortality
Maternal mortality ratio: 100 maternal deaths per 100,000 live births
To reduce maternal mortality rate from 357/100,000 live births by 50% by 2003 (less than 178/ 100,000 live birth).
276 per 100,000 live births
1.8 per 1,000 pop 1-4 yrs 236 per 100,000 live births
Ministry of Health: National Health Report 2005 Page 19 of 250 --------------------------------------------------------------------------------------------------------------------MDGs Goal ICPD Goals/ National Health Goals/ 2004 Indicators 2005 Indicators Target Target Combat HIV/AIDS, Malaria and other diseases.
HIV/STI: To reduce the morbidity rate of STI from 1,464 cases in 1995 by 50% by 2003. To prevent HIV/ AIDS infection.
STI cases increased >2,000 in 2003. Four (4) new HIV positive people detected in 2004.
STI rate per 1,000 pop adults increased from 11 per 1,000 pop in 2001 to 17 per 1,000 pop in 2005. In 2005 one new infected person: Cumulative total of 6. HIV Prevalence – 0.13 per 10,000 population
Malaria: 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.
Malaria incidence rose in 2004 to 184/1,000 pop. (microscopists also doubled).
Clinical Malaria 340 per 1,000 population.
Treated bed net coverage below 80%.
In short, whilst there is some improvement in reducing maternal and infant mortality in 2004, the level of STI and Malaria incidences is till not within control or elimination. More attention is required in-terms of reviewing the existing strategies and plans to combat these diseases.
3.8
Health Institutional Strengthening Project
Objective of the Health Institutional Strengthenthing Project The objective of the AusAID funded Health Institutional Strengthenthing Project (HISP) is to improve the management and operational capacity of the Solomon Islands Ministry of Health (MOH) to deliver essential health services leading to improved health outcomes for the Solomon Islands population. 3.8.1
Key Outcomes
Reviewing the history of the MOH and HISP working together, much progress has been made to improve capacity of the MOH to manage the health system at all levels. Specifically progress has been made in the key areas outlined below: Operational planning and the monitoring and evaluation of these plans by means of bi-annual reports.
Ministry of Health: National Health Report 2005 Page 20 of 250 --------------------------------------------------------------------------------------------------------------------Increase in integrated outreach activities for primary and public health in all provinces. Budgets for national divisions and provinces developed. Health services management and governance including primary health care strengthened. National Strategic Health Plan developed with involvement of key stakeholders. Evidence based planning and decision making at national and provincial level with an increased focus on outcome, in addition to inputs and outputs. Revised Scheme of Service for Medical Doctors resulted in an increased return of doctors working in the Ministry. Increased capacity of MOH staff to use relevant computer applications. Installation and support of the Health Radio Network (approximately 200 radio’s). Support for building a national public health laboratory. Strengthening of hospital management at both the National Referral Hospital and provincial hospitals. 3.8.2
Constraints
Public Service Division recruitment processes continue to be slow and the ongoing vacancy of key roles has impeded MOH service delivery. For HISP, the vacancy of key counterpart roles has at times required operational outputs by the Project and has been an obstacle to institutional strengthening throughout the five year life of the Project. Strategies for timely recruitment need to be discussed by all SIG stakeholders. 3.8.3
Future directions
HISP will conclude its current form on 6 August 2006 and there is in principle support for an extension to Phase Four until August 2007. It is the intention for Australian and World Bank assistance to the health sector to transition to a Sector Wide Approach (SWAp). This will allow for greater harmonisation between donors and allow the MOH to take the driving seat in the management of donor assistance as support is provided to the MOH identified priorities in the National Health Strategic Plan. HISP Phase 4 aims for sustainability of capacity building and procedures put in place during the previous 5 years as well as provide support to the MOH to transition towards a SWAp.
Ministry of Health: National Health Report 2005 Page 21 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 4 4.1
Health Systems: Health service delivery and episodes of service (Demand):
Demand on the Primary Health Care:
Primary Health Care in Solomon Islands is delivered by a network of over 323 PHC clinics – NAP, rural health centres (RHC), area health centres (AHC) and urban clinics (UC) and by outpatients clinics based at provincial and the national hospitals. These provide acute care “Demand on outpatient services, maternal care (antenatal visits, births and post natal care) and PHC clinics child health services (vaccinations and growth monitoring), outreach satellite increases but clinics, health education and inpatient services (with the exception of hospital are managed outpatient clinics which would admit directly to the provincial or national hospital). well in the PHC clinics are the main providers of health care nationally, apart from small past 5 years” numbers of private practitioners who are based largely in the national capital. Table 3: National and provincial PHC outpatient contacts (x10,000) – new and return cases and maternal and child health activities, Solomon Islands, 1995-2005.
National Renbel Temotu Choiseul Makira Western Guadalcanal Honiara Central Isabel Malaita
1995 129.22 0.66 5.88 5.96 8.23 26.41 21.86 12.80 6.35 6.49 32.87
1996 134.71 0.46 5.40 6.43 6.67 24.61 21.21 10.98 6.88 6.66 42.72
1997 121.11 0.62 4.56 5.42 7.22 24.70 22.62 12.12 5.88 6.03 29.00
1998 121.66 0.74 4.66 6.15 8.69 22.25 26.27 13.00 6.14 5.06 24.03
1999 112.74 0.45 4.74 5.80 7.13 21.02 19.55 9.69 6.41 5.12 30.73
2000 115.38 0.73 5.46 5.70 8.27 22.13 13.51 8.60 6.30 5.89 36.93
2001 113.41 0.72 5.45 7.03 7.41 19.87 8.20 11.67 5.39 6.33 33.72
2002 100.33 0.51 5.50 5.90 6.82 16.97 11.34 10.09 6.98 5.92 27.77
2003 106.75 0.75 5.23 6.75 9.04 18.05 16.42 11.48 4.68 6.34 23.23
2004 121.48 0.59 5.88 6.23 10.53 21.73 17.09 14.84 6.39 6.94 31.16
Fig 5: National and provincial PHC outpatient contacts (x10,000) – new and return cases and maternal and child health activities, Solomon Islands, 1995-2005. 45 40 35 30 25 20 15 10 5 0 1995 Renbel
1996 Temotu
1997 Choiseul
1998 Makira
1999 Western
2000
2001
Guadalcanal
2002
2003
Honiara
Central
2004 Isabel
2005 Malaita
2005 82.0 0.41 3.9 4.0 6.9 13.4 12.5 11.1 4.8 4.3 20.7
Ministry of Health: National Health Report 2005 Page 22 of 250 --------------------------------------------------------------------------------------------------------------------In 2005, PHC clinics reported over 0.8 million clinical contacts nationwide, slightly lesser than in 2004 around 1.2 million (Fig. 3). This is the highest total since 1996 and 200,000 more than the lowest reported in last year, and a national average of 2.6 per capita. Of all provinces, the largest increase in contacts in recent years have been in Honiara and Guadalcanal Following declines beginning in 2001, PHC outreach activities by clinics exceeded 295716 in 2004, with largest increases in village meetings and satellite clinics. The number of school visits also increased but have yet to reach the totals reached in 1996. It should be noted that increased numbers of NAPs constructed in recent years may have reduced the number of satellite clinics required, however, as there is no record of the total satellite points it is unclear what level should be achieved. Areas far from clinics we get to them through outreach or satellite clinics. This is also a formal way of getting people access to essential health care. Fig 6: Health outreach activities PHC clinics (excluding Western Province), Solomon Islands 1995-2004.
3500
Tota l a c tiv itie s
3000 2500 2000 1500 1000 500 0 1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year Total outreach
School health
Village meetings
Satellite clinics
Western outreach activities are excluded from this total as 6 clinics account for 60% of reported outreach (several hundred outreach activities each) showing a reporting problem in the HIS software or by clinics. Thus national total outreach activities are underreported.
16
Ministry of Health: National Health Report 2005 Page 23 of 250 --------------------------------------------------------------------------------------------------------------------Figure 7 Health outreach activities PHC clinics Solomon Islands 2001- 2005.
2500 2000 1500 1000 500 0 2001
2002
2003
Outreach
Satellite
2004 School
2005
Village meeting
Inpatient admissions to PHC clinics continued to strengthen and referrals to AHC and RHC increased considerably in 2004 (Fig 3). Child welfare activities were maintained even when service delivery decreased overall and the number of infants born in PHC clinics continues to increase. Figure 8: Annual numbers of referrals to AHC, RHC, provincial and national referral hospitals, Solomon Islands 1995-2004
10000
N um ber of re ferrals
9000 8000 7000 6000 5000 4000 3000 2000 1000 0 1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year Referrals to AHC's
Referrals to RHC's
Referrals to province
Referrals to central hospital
Overall the picture is one of increasing provision of clinical services by PHC clinics and improved referral patterns in line with the MOH Primary Health Care Strategy (PHCS) which recommends patient referral from NAP to RHC to AHC.
Ministry of Health: National Health Report 2005 Page 24 of 250 --------------------------------------------------------------------------------------------------------------------Referrals to provincial hospitals and the NRH also increased, though reasons for “Transport this are unclear. There are no data about the nature of referrals (eg for acute ation cost medical emergency, surgical review, medical review, eye check). impact Increased capacity, in fuel and canoes, may be part of the explanation or change negatively in type of presentations at PHC clinics (eg. suspected chronic disease or condition) on people that cannot be managed without medical support or review. The practicality of data accessing collection about the reason for referrals needs to be discussed and considered health further by MOH Executive. services, may explain The greatest increases in service delivery in recent years have been in acute care increase services for new cases of disease. More than 900,000 new cases were reported in inpatient 2004. Return visits for care were just 6.3% of total clinic contacts continuing a downward trend that commenced in 1994. Reasons for decreasing numbers of return visits are unknown but may signify effective treatment of conditions. Presenting condition Other Malaria slide (negative) Pain (body, joint, back) Skin sores Worm infestations Chest pain Headache Anaemia Abdo Pain Trauma Chronic chest Totals
February 90 105 41 61 23 5 34 16 11 27 3 416
% 21.6% 25.2% 9.9% 14.7% 5.5% 1.2% 8.2% 3.8% 2.6% 6.5% 0.7%
August 117 100 57 99 17 3 35 17 17 28 1 491
% 23.8% 20.4% 11.6% 20.2% 3.5% 0.6% 7.1% 3.5% 3.5% 5.7% 0.2%
Table 4: Other reasons for attendance to PHC clinic, PHC AHC Solomon Islands, February and August 2004.
Hon Minister the demand for primary health care services in the clinics come from people that suffer from Acute respiratory illnesses, fever and clinical malaria. The trend have continued to be the most commonly reported new cases. Skin diseases reported have declined considerably, red eye less so. Ear diseases and yaws have continued to account for similar proportions of clinic contacts each year As highlighted above when we quantify and aggregate the total visits (demand) per year it amounts up to millions) And it also means that a person in Solomon Islands in a year is sick 2.6 times or more as an average. Earlier studies found that there is economic loss when a person is absent from work due to malaria. And in our vision and mission we promised to ensure that our people is happy, healthy and productive.
Ministry of Health: National Health Report 2005 Page 25 of 250 --------------------------------------------------------------------------------------------------------------------Figure 9 (a): Diarrhoea, red eye, yaws, skin diseases, ear infections as % total new cases, Solomon Islands, 1995-2004.
14% 12%
Percent
10% 8% 6% 4% 2% 0% 1993
1994
1995
1996
1997
Diarrhoea
1998
Red eyes
1999 Year Yaw s
2000
2001
2002
Skin diseases
2003
2004
Ear infection
Figure (9b): Diarrhoea, red eye, yaws, skin diseases, ear infections as rate per 1,000 population Solomon Islands, 19952005.
120.0 100.0 80.0
65
60.0
56.2 47
40.0
32.0 30
20.0
49 46.7
50.7
57.6 51
26.3 25
30 23.8
34 26.7
63.1 50 36.2
0.0 2001 Red eye
2002 Ear infection
2003 skin disease
2004 yaw s
2005 Total diarrhoea
Ministry of Health: National Health Report 2005 Page 26 of 250 --------------------------------------------------------------------------------------------------------------------Figure 10: ARI, fever, clinical malaria and other illness as % of total new cases, Solomon Islands 1995-2004.
40% 35%
Percentage
30% 25% 20% 15% 10% 5% 0% 1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year ARI
Fever
Clinical malaria
Other
4.1.1 Access: The report is only being able to provide access in terms of population per facility. As this point of time, it is anticipated that many more community (>70%) are within one kilometer of walk to the nearest clinic or within one hour travel. In 2005 and shown in Fig 11 and Table 5 clinics in Malaita and Guadalcanal are serving more people than others. These two provinces rely much of their basic health on clinics. Obviously, the travel time will be of some consideration. 7,028 1,945 1,655 1,459 1,355 1,265 1,087 919 895 851 631
Honiara Malaita Guadalcanal National Temotu Western Makira Central Ren Bell Choiseul Isabel
There has been improvement in the access of people to primary health care in the clinics. In 1997 one clinic is to 1,737. In 2005 it is 1,459 people per health clinic. Honiara has the highest population per facility, however residents of the city has more access to higher level of health care and other choice of service providers.
Ministry of Health: National Health Report 2005 Page 27 of 250 ---------------------------------------------------------------------------------------------------------------------
8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0
7,028
1,655
895
1,459
S I
919
C G IP ua da lc an al
851
R B P
1,945
M ak ira W es te rn C ho is eu l M al ai ta
H C
1,355 1,087 1,265
Is ab el Te m ot u
631
C
Ratio: Population per clinic
Fig 11.and Table 5 Ratio of population per clinic in 2005. Source: Medical Statistics Unit, MOH (2005);
The question to ask, therefore, is should there be additional clinics in the provinces or should it be improving quality of health care and more outreach and expanding the level of services17 to include a more preventive role on top the exiting curative responsibilities.
17
Also raised by the Clinic Utilization Review: See below
Ministry of Health: National Health Report 2005 Page 28 of 250 ---------------------------------------------------------------------------------------------------------------------
4.2 4.2.1
Demand on Health Care Institutions and Services: National Referral Hospital
Introduction: CORPORATE SUPPORT SERVICES: Annual Report 2005 ‘Completed by each Divisional Director & Provincial Health Director in liaison with each other ‘ Due:
10th March 2006
To:
MoH Permanent Secretary
Brief Background: The Hospital Corporate Support services under the direction and supervision of the Executive Management Committee headed by the chief Executive Officer, Raymond Suinao, has pledge their support in working closely with the Ministry of Health and development partners of this organization. The Institution is vested with responsibilities to provide secondary and tertiary standard of clinical, administration and management to care for the sick people who enter and seeking medical treatment. The NRH provides the following services:- Surgery, Medicine, Obstetric and Gynaecology, Paediatric (children care), Anaesthetics services, Radiology Services, Medical & Laboratory services, Pharmacy services, Accident and Emergency & Ambulatory services, Dental Services, Physiotherapy, Rehabilitation and Prostheses, Referral Specialists and Clinical Services, Eye Services , Nursing Services and Corporate Support Services which includes the following:Administration, Accounts , Domestic stores, Catering, Laundry, Medical Library, Transport, Communication, Security Services, Medical Records, Domestic and Grounds Cleaning Services, Engineering, Biomedical & Electrical Repair Services, Carpentry, Plumbing Section and Porterage. The Clinical and Diagnostic Services departments are headed by the Medical Superintendent; the Nursing by the Nursing Superintendent and Corporate Support Services by the Hospital Secretary together with the Chief Executive Officer and the Hospital Advisor forms the National Referral Hospital Executive Management Committee, which is directly responsible to the Permanent Secretary, Ministry of Health. Health data Summary (Brief) with analytical interpretation based on best data/evidence only: Collecting and entering data and reporting against Operational plans are new to most of the Support Service Managers. Whilst some can, others are familiar with but do not keep proper records and lack how to write reports. Also appropriate data base spreadsheets need to be installed in respective divisions. In due respect, I am committed to try and establish some form of the hospital data collection and entry in all divisions and ensure staff are trained to be able to use and provide us with required information on a monthly basis or when required. HR Expertise assistance in establishing these spreadsheets in their respective settings will be required from HISP or MOH. The only division who has a system installed for recording of their work activity by an advisor is the Building and Engineering apart from Accounts, Stores and Medical Records, who have been trialing on the new system with the assistance of Elizabeth Moss (MRA). The catering maintains manual records with regards to food orders and usage. But the problem is, not all staff is able to use and lack the analytical interpretation skills. See table below under activity report for task performance extracted from the Building & Engineering data base entries. Activity Report – progress against Operational Plan / Budget (include % for the year): Administration One of the main disadvantages in this hospital setting is the one basket of money with no direct divisional allocations, whereby managers are able to trace and monitor their progresses against their operational plans and normal activities easily. Only a very few were given special allocations
Ministry of Health: National Health Report 2005 Page 29 of 250 --------------------------------------------------------------------------------------------------------------------However, since some of our plans are absorbed within the operational budget, the expenditure budget charts below can be seen as progresses and failures as a whole. Others were specific. Accounts Most of the objectives indicated inside the 2005 National Operational Plan written by FMA, HQ (which is also applicable to NRH Accounting) is still to be implemented. A one time Budget Advisor, Chris Donovan was going to start with all of that but he left in a rush, leaving myself and the accounts suspense, not knowing what to do. With due respect, I am requesting that a Budget advisor be identified and posted to us to improve the procurement and service delivery at the NRH. The under spending and overspending as indicated below are apparent indicators of the poor and non compliance by Managers of operational plans to allocated budgets. In some cases, clarification needs to be done. Also, there is need to mention that the one basket budget may not be the best option for NRH as expressed by the support service managers and other clinical mangers as well. It may need future considerations to departmental allocations whereby, divisional managers have ownership and appropriate usage of their yearly allocations and according to their approved operational plans. The expenditure below is not necessarily by division but by line items only. Divisional future strategic planning and managerial decision making would be very difficult. Currently, only the very demanding costs like Catering have been separated .The expenditure graphs were inserted to show and support this idea. The graphs and tables are obtained from the NRH Budget 2005, report compiled by Ron Hickey, Hosp Adviser. Expenditure by existing cost centers is outlined below. Account – NRH 01-01-05 through 30-06-05 Budget
Proportion
Actual
Variance
Income SIG - Health Service Funds NRH AusAID – HSTA Untied Funds Patient Fees and Charges Rental Fees & Charges Misc Fees - Other Revenue FR – Donations Miscellaneous Income
$0 $5,500,000 $2,750,000 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
$7,650 $3,943,228 $30,117 $1,925 $4,629 $5,595 $25,146
Total Income
$5,500,000 $2,750,000 $4,018,290
Expenses Bank & Finance Charges Building Repairs and Maintenance Catering Services Communication Costs Conference Expenses Equipment Repairs & Maintenance Equipment Replacements
$2,953 $41,813 $1,304,993 $7,406 $33,158 $70,937 $161,920
-$1,193,228
-$1,193,228
Ministry of Health: National Health Report 2005 Page 30 of 250 --------------------------------------------------------------------------------------------------------------------External Services $27,950 Fuel & Lubricant $11,014 Functions and Entertainment $5,049 Insurance & Registration – Mis $1,694 Med Referral : To NRH $7,891 Med Referral : From NRH $756,382 Med Referral : Charter to NRH $29,070 Medical Stationary : Health Su $50,536 Msupp - Drugs – Rawmat $254 Msupp - Other – Gases $72,104 Msupp - Laboratory – Sundries $26 Motor Vehicle : Fuel & Oil $98,416 Motor Vehicle : R&M $93,029 Motor Vehicle : Other $34 Rates & Charges $1,500 Supplies Gen - Cleaning Equipm $9,306 Supplies Gen - Laundry Service $545 Supplies Gen - Bedding & Linen $4,040 Supplies Gen - Furniture & Fit $7,824 Supplies Gen – Misc $30,095 Supplies Office - Computer Sup $6,336 Supplies Office - Equipment & $2,228 Supplies Office - Stationery & $112,387 Supplies Office – Misc $41,587 Supplies Distribution – Sea $2,760 Supplies Distribution – Air $1,725 Supplies Distribution – Shippi $624 Staff Housing & Accomodation $97,118 Staff Other Costs $1,600 Staff Remuneration - Other All $24,954 Staff Remuneration – NPF $492 Staff Training – General $1,044 Staff Training - Student Fees $65,550 Staff Travel – Compassionate $880 Staff Travel - Local (Work) $6,406 Staff Travel – Misc $2,794 Staff Uniforms – Theatre $245 Staff Uniforms – Nursing $216 Staff Uniforms – Misc $18,109 Telephone/Email/Internet $289,616 Waste Disposal Costs $4,455 Total Expenses
$3,511,062
Ministry of Health: National Health Report 2005 Page 31 of 250 --------------------------------------------------------------------------------------------------------------------PROGRESSIVE ACTUAL EXPENDITURE vs BUDGET PROPORTION TOTAL BUDGET - 2005 $ $ $ $ $ $ $ $ $
9 8 7 6 5 4 3 2 1
,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0
0 0 0 0 0 0 0 0 0 $
0 0 0 0 0 0 0 0 0 0
A c tu a l B u dg e t
J u n
To End Jun End Jul End Aug End Sep End Oct End Nov End Dec
Budget $8,422,000 $8,422,000 $8,422,000 $8,422,000 $8,422,000 $8,422,000 $8,422,000
J u l
A u g
Actual $3,727,209 $4,473,016 $5,224,199 $5,951,454 $6,696,419 $7,346,096 $7,913,966
S e p t
O c t
Proportion $4,211,000 $4,912,833 $5,614,667 $6,316,500 $7,018,333 $7,720,167 $8,422,000
N o v
D e c
Under Spent $453,791 $439,817 $390,468 $365,046 $321,914 $374,071 $508,034
% 10.78% 8.95% 6.95% 5.78% 4.59% 4.85% 6.03%
OPERATIONAL COMPONENT - 2005 $ $ $ $ $ $ $ $
8 7 6 5 4 3 2 1
,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
,0 ,0 ,0 ,0 ,0 ,0 ,0 ,0
0 0 0 0 0 0 0 0 $
0 0 0 0 0 0 0 0 0
A c tu a l B u dg e t J u n
To End Jun End Jul End Aug End Sep End Oct End Nov End Dec
Budget $5,500,000 $5,500,000 $5,500,000 $5,500,000 $5,500,000 $5,500,000 $5,500,000
J u l
A u g
Actual $3,511,062 $4,050,009 $4,689,817 $5,218,188 $5,735,043 $6,239,251 $6,807,121
S e p t
O c t
Proportion $2,750,000 $3,208,333 $3,666,667 $4,125,000 $4,583,333 $5,041,667 $5,500,000
N o v
D e c
Overspend $761,062 $841,676 $1,023,150 $1,093,188 $1,151,710 $1,197,584 $1,307,121
% 27.67% 26.23% 27.90% 26.50% 25.13% 23.75% 23.77%
Ministry of Health: National Health Report 2005 Page 32 of 250 --------------------------------------------------------------------------------------------------------------------MEDICAL REFERRALS EXPENDITURE PROFILE FROM THE NRH AS A PERCENTAGER OF THE TOTAL EXPENDITURE June to December 2005 2 2 2 2 2 2 2 2 2 2
5 4 4 3 3 2 2 1 1 0
% % % % % % % % % % J u n
Jun 05 21.54%
J u l
Jul 05 22.17%
A u g
Aug 05 22.06%
S e p
Sep 05 22.14%
O ct
N o v
Oct 05 22.3%
D e c
Nov 05 22.69%
Dec 05 23.87%
ACTUAL EXPENDITURE BY MONTH - 2005 June to December 2005 $ 2 5 0 ,0 0 0 $ 2 0 0 ,0 0 0 $ 1 5 0 ,0 0 0 $ 1 0 0 ,0 0 0 $ 5 0 ,0 0 0 $ 0 J u n
Jun 05 $127,672
Jul 05 $141,515
J u l
A u g
Aug 05 $139,290
S e p
Sep 05 $120,588
O ct
Oct 05 $126,696
N o v
D e c
Nov 05 $145993
Dec 05 $214,950
Catering The Cost of Food The Executive has undertaken an extensive examination of the Catering Services Department with the ultimate involvement of the Office of the Auditor General following the completion of a report on activities. The expenditure on Food within the hospital has been at totally unacceptable levels and significant reductions in costs have been made in the last quarters of 2005 and into 2006.
Ministry of Health: National Health Report 2005 Page 33 of 250 --------------------------------------------------------------------------------------------------------------------Although we had done a fair bit in trying to control the costs, a lot more still needs to be done in 2006 and we should be able to provide information on this including 2006 goals by the end of the new year. CATERING EXPENDITURE PROFILE AS A PERCENTAGE OF THE TOTAL EXPENDITURE June to December 2005 4 3 3 2 2 1 1
0 5 0 5 0 5 0 5 0
% % % % % % % % % J u n
Jun 05 37.17%
J u l
Jul 05 34.69%
A u g
Aug 05 33.33%
S e p
Sep 05 32.23%
O ct
N o v
Oct 05 31.69%
D e c
Nov 05 30.96%
Dec 05 30.08%
ACTUAL EXPENDITURE BY MONTH - 2005 June to December 2005 $ 3 0 0 ,0 0 0 $ 2 5 0 ,0 0 0 $ 2 0 0 ,0 0 0 $ 1 5 0 ,0 0 0 $ 1 0 0 ,0 0 0 $ 5 0 ,0 0 0 $ 0 J u n
Jun 05 $283,078
Jul 05 $110.764
J u l
A u g
Aug 05 $147,585
S e p
Sep 05 $118,261
O ct
Oct 05 $136,112
N o v
D e c
Nov 05 $114,072
Dec 05 $115,750
Building & Engineering The accounts processing for this component is managed by the NRH & MoH and the latest figures available are for the period to end Dec 2005. Expenditure plus the value of orders placed (shown under Commitments) is detailed below: The advantage of this division is it had a separate budget allocation from the operational cost therefore, it is manageable. But in view of the 2006 draft copy , there is no separate budget for them. CAPITAL / ENGINEERING & MAINTENANCE COMPONENT - 2005
Ministry of Health: National Health Report 2005 Page 34 of 250 ---------------------------------------------------------------------------------------------------------------------
A c tu a l B u dg e t
$ 3 ,5 0 0 ,0 0 0 $ 3 ,0 0 0 ,0 0 0 $ 2 ,5 0 0 ,0 0 0 $ 2 ,0 0 0 ,0 0 0 $ 1 ,5 0 0 ,0 0 0 $ 1 ,0 0 0 ,0 0 0 $ 5 0 0 ,0 0 0 $ 0 J u n
To End Jun End Jul End Aug End Sep End Oct End Nov End Dec
J u l
Budget $2,922,000 $2,922,000 $2,922,000 $2,922,000 $2,922,000 $2,922,000 $2,922,000
A u g
Actual $246,147 $423,007 $534,382 $733,266 $961,376 $1,106,845 $1,106,845
S e p t
O c t
Proportion $1,461,000 $1,704,500 $1,948,000 $2,191,500 $2,435,000 $2,678,500 $2,922,000
N o v
D e c
Under spent $1,214,853 $1,281,493 $1,413,618 $1,458,234 $1,473,624 $1,571,655 $1,815,155
% 83.15% 75.18% 72.57% 66.54% 60.52% 58.68% 62.12%
Task Performance Table: Division
Work Orders Received
Electrical Biomedical Maintenance
275 55 120 data up to June only due to computer breakdown 61 data up to June only , reason as above
Plumbing
Work Orders Completed 275 55 80
% 100% 100% 66%
47
77%
Annual Health Outcomes (relates to goals/outputs/indicators): Also, there is need to mention that operational planning is new and that most of the Support Service Managers were unable to complete their 2005 Operational Plans to submit in time. However, they were able to work on 2006 National Goals with some assistance. Only Admin, Catering and Building & Engineering divisions were able to complete their 2005 Operational Plans Admin Goal No. 1 With the arrival of the Infection Control 3 ton pick truck, part of the domestic waste disposal is being addressed. The clinical waste disposal from wards to collection points still needs improvement in their packaging and in a timely manner. Because they are not properly closed and sometimes late, it is very unsafe being along the main corridors overnight. Also, the clinical waste disposal to Ranandi is still a problem. The Honiara City Council is responsible for this area. Goal No. 2 More of my staff and especially managers are being selected and have attended some in- service / induction courses at the IPAM. This will continue into 2006.
Ministry of Health: National Health Report 2005 Page 35 of 250 --------------------------------------------------------------------------------------------------------------------We were able to improve the registry setting as proposed but adherence to rules is still a problem. The retrenchment exercise endorsed by NRH Executive was not approved by MoH or may have been overlooked, thus a fresh submission will be made in 2006. More effort is still to be done to the reduction or elimination of overtime claims incurred at the NRH. Goal No.3 Infrastructure Hospital corridor was not completed due to shortage of funds .Allocated funds for this was used in the operational costs to level the overspending incurred. Fencing project was completed Painting of the hospital as a whole was completed using ward changes allocated funds because specially donated funds for this by HISP were inadequate. Under ward changes, the Gebbie wing was renovated to be used by all first on calls overnight in an effort to reduce transport expenses and patient service be delivered in a timely manner. Also, the re-establishment of the Telepath logy office and its lab, the cashiers office and the tiling of the new medical record and new domestic stores offices were made possible. Goal NO. 4 The Security Service still needs more improvement. Although, more effort was injected in controlling the flow of visitors by erecting the seafront fence, the infrastructure works being carried out at the NRH by outside contractors still makes it difficult to control ( rear fences are pulled down and eastern main entrance control by contractor securities). Therefore, we are unable to measure the outcome of our efforts with regards to this. Goal No 5 Communication of information to divisional managers has improved a lot. Quick responses from some managers to delegated duties and requirements are an indication of this. This was a very big problem identified when first assumed duties. Goal No. 6 More awareness programs needs to be conducted for both the Support Service staff and the clinical staff. Patient approach at times is still not acceptable. Personal interest might be a contributing factor. Catering The crucial situation in this division becomes evident in the second quarter of the year. Instead of implementing the Operational plan, 2005 proposal, the division was actually far from the plans. Following immediate actions by the NRH Executive to remove the Manager, it became stabilize again and the Supervising manager was able to follow and implement the plans following instructions from the office of the Hospital Secretary and NRH Executive. The improvements could be seen in the reducing figures on the actual expenditures during the 3rd and 4 th quarter, on the Catering expenditure charts above. This office is still to receive a register of all the assets in the division. Building and Engineering
Ministry of Health: National Health Report 2005 Page 36 of 250 --------------------------------------------------------------------------------------------------------------------This section consists of four divisions namely, electrical, engineering & biomedical, carpentry and plumbing. These divisions also need a lot of improvement before we are able to measure against goal 1. The overcrowding of the various sections under one roof is not acceptable. Their practical application of goal 6 is evident from their work activity report above. But their timeliness and cost effectiveness cannot be measured. Although their working conditions and settings are not of required standard, these officers still perform at their best. HR issues: The Corporate Support Service has a staffing which consists of 59 established and 74 nonestablished posts, a total of 133. One hundred and seventeen (117) had been substantively filled and 16 still vacant. Certain recruitments that were endorsed by the NRH Executive were submitted to your office mid this year are still pending results either from your office or PSD. Also, position descriptions for vacant positions submitted to your office mid this year are still pending advertisement or results. Recruitment Promotions
- 4 newly appointed staff and 9 casual workers joined these services this year. - 7 officers also received promotions from PSD.
The Transport and Security Services were regarded as rather tough to manage; therefore the NRH Executive had proposed outsourcing these divisions in the future. The idea will be reviewed and forwarded to the MOH Executive for further deliberations. Also, the NRH Executive sees the need to have able and capable staff at the most demanding division of this expanding and growing services and organization, the Switchboard. It had been unfortunate that former managements sees it fit to employ disable personnel to Mann this division The retrenchment list which will be resubmitted for consideration covers a wide range of staff from various support service divisions. The recommendations for each vary as well from non performing to compulsory retirement age. The return of ARC’s to my office had been slow or none at all. Reason expressed was, many forms had been filled over the past years and nothing has happened. I in turn follow up with PAO’s office, HQ and PSD for recent submissions. Some of the latest promotions received were direct result of my follow ups to PSD. Appraisals in respect of some upgrading with regards to the non- established staff will be submitted in due course as well. The Engineering and Building staff being frequently requested by Provincial Health Director’s for repair and maintenance of their biomedical equipment needs clarification from the Permanent Secretary, MoH, HQ. These officers may have become victims of an arrangement by the former managements but the current management at NRH is not happy with that. Number Supervision tours conducted
12
Proportion of staff with ACR completed
5%
Infrastructure / maintenance / equipment issues: Infrastructure The refurbished wards were completed and occupancy has just begun and should be fully occupied by the earmarked wards in the next couple of week or so, this movement also includes
Ministry of Health: National Health Report 2005 Page 37 of 250 --------------------------------------------------------------------------------------------------------------------the telepath logy, transport, electrical, domestic stores, medical records and the switch board respectively. Work has resumed following the release of more than $800,000 and it was agreed upon by the contractor that the building should be completed within one month of receiving the cash. I understand the payment was made last week. We are not directly responsible for this, but follow ups are frequent with the DID officers responsible but less response from them. Maintenance & Equipment We are also concerned about the fact that this division is understaffed both in general maintenance, biomedical equipment and electrical. The Provinces have been using the NRH staff for all their repairs without proper arrangements. Inappropriate remunerations have been raised by the staff themselves and given the many daily rising and outstanding tasks at the NRH , it is rather odd to release them for several days as has been, in most cases. Inventory last updated on: Assets Inventory Completed? Unable to tell because of various inventories NO, I am still to receive asset registers from kept in different divisions. Proposing that a either the domestic stores or whichever central inventory be appropriate and probably divisions have been keeping their own within domestic stores division. inventories. Issues for consideration in future planning: Terms and conditions surrounding and affecting work performance of the corporate staff, especially the ones required to work on weekends, on call and standby. Overtime and other related allowances Basic salary/ remunerations does not match work performed Outsourcing of Transport and Security Services A separate vehicle for Admin and Accounts Division. Clinical and Support Service divisional allocations in the yearly budgets A budget advisor be identified and posted to NRH Provinces to cater for biomedical technicians in their manpower and budgeting Any other comments: The only thing I wish to make additional comment on is the slowness or the non replying from the MoH on many of our queries or submissions with ease as experienced. Because I have to make several follow ups before action I feel this is wastage of time and effort. The follow ups and attempts are time consuming. This can be eliminated and reduced by injecting more commitment to work by appropriate staff at all levels. Also, in the event of relaying messages on formal queries must be documented for future reference. The telephone seems to be taking over the documentation process. I understand the telephone is appropriate in some cases only. However, with the introduction of the email system within the NRH and among the NRH Executive members and some Head of Departments, I am very glad that movement of information is very fast and effective. I would like to thank all who have assisted me in these necessary training, though I am slow. Summary of Major Constraints
Strategies / Action plan for the way forward
Some Support Service managers lack managerial and academic skills
Additional & appropriate training and recruitment of able and capable managers A budget advisor be identified and posted to NRH
Non compliance to budget limits Requisition and Procurement processes improved
To be reviewed ,improved and centralized within the NRH and perhaps to Domestic Stores & Accounts Steps to be reviewed and improved
Recruitment processes very slow
Ministry of Health: National Health Report 2005 Page 38 of 250 ---------------------------------------------------------------------------------------------------------------------
Signature:
Rachel Tigita
4.2.2
Nursing in Solomon Islands:
4.2.3
SI Nursing Council:
Position:
Hospital Secretary
Date:
27th Dec, 2005
Brief Background/introduction: Solomon Island Nursing Council is the legal body of the nursing profession. It exist purposely to monitor and guide the nurses in their professional role in caring for the public, it is not to terminate the nurse but to guide her back into her expected practices as required within the boundary of the professional discipline. Health data Summary (Brief) with analytical interpretation based on best data/evidence only: 2005 has been a very tough year. The Retirement of the two very experienced and senior staff in the Department left on retirement. Three vacant posts which were eventually filled at the beginning at year 2006. The existing manpower 2005 was two. Despite that, the council managed to Graduate, 43 nurses. Also facilitated two provincial workshop mainly Nursing Council Awareness in collaboration with the national Nursing Division head (Nursing management skills). Activity Report – progress against Operation Plan/Budget (include% for the year): Nursing Council meetings 4 times a year - 100% Nursing Council awareness only two programmes - 20% (Two Provinces, Western and Isabel) Registration target x 1 group 100% No investigation done only follow ups. Clinical attachment/community x 2 groups Filling and documentation – little has been done Nursing Council Regulation draft – funded by AUSAID – in the process Council Board yet to be Gazetted.
Ministry of Health: National Health Report 2005 Page 39 of 250 --------------------------------------------------------------------------------------------------------------------Annual Health Outcomes (relates to goals/outputs/indicators): The Solomon Island Nursing Council has exhausted its budget before the year ends. We have achieved few goals but not all. We will have to relook at our Operational plan for the year 2006. We have a full manpower so we hope to do better this year 2006. HR issues: Structure:
2 staff Discussion Address constraints to the right channels Don’t sit back but always seeking advices from the experienced, the skillful and those in Authority. Number Supervision tours conducted
Nil
Proportion of staff with ACR completed
Nil %
Infrastructure/maintenance/equipment issues: Concrete Building – ground level, 5 rooms allocated for the council sharing with the Nursing Director Mental Health x 5 tables, 1 computer, a chair each. X 14 old cabinets (4 drawers each) without keys. Filling system yet to be up-dated. No inventory system record. May need more in infrastructure to accommodate Probation Nurse trainings. Issues for consideration in future planning: Teaching in the programme for nurses is an important issue – teaching tools, conference room in the MHMS Structure RWSS is always busy, this is to avoid extra spending for hiring venues for the block sessions in the probation programme. Photocopy machine would be helpful. Helpful if the Nursing Council is in the ‘Internet’ RWSS is charging usage $50-00 per day. Any other comments The nursing council welcomes any helpful suggestion from everybody for its welfare towards those whom their purpose it served. Training locally with regards to legal aspects. Summary of Major Constraints Resources Training Power Point Vehicle
Strategies/Action plan for the way forward 2005 – only 2 staff – 3 vacancies 2006 Jan all filled. Data-base More computing skills On job training with regards to legal aspect. Teaching purposes Easy to travel, collect stationary Hilux would be better.
Ministry of Health: National Health Report 2005 Page 40 of 250 --------------------------------------------------------------------------------------------------------------------4.2.4 National Medical Imaging Division Brief Background/Introduction: The National Medical Imaging Services is one of the main Diagnostic arms of the Ministry of health and Medical Services in the Solomon Islands. It establishes its departments in six of the nine provinces plus the National Referral Hospital. Eg: NRH, Gizo, Kilu'ufi. Buala. Kirakira, Lata, Taro. It also provided technical and. services support to the church Hospitals, Atoifi, HGH and Sasamunga. The main aim of the Division is to provide and maintain an acceptable, affordable and accessible level of Medical Imaging services to the Medical officers and the people of the Solomon Islands so that they can improve their quality and standard of life. Health data Summary (Brief) with analytical interpretation based on best data/evidence only: At all the Hospital departments, the division has provided three main services. They are the General radiography, Radiology and ultrasonography services. The total statistical examination data in all the services provided at NRH and Provincial Hospital department in year 2005 were as follows. 1. NRH = 15'642. Examinations - This performance statistical data shows a marked increase when compared to that of the year 2004 which is only about 14,357 examinations. 2. For four Provincial Departments. = 7'457 examinations. This has also increased when compared to that of the 2004 statistical performances This marked increase of services can be seen in all the departments. These increases can be attributed to various factors some of which were as follows. The increase demands from the medical Officers and the patients for the services. Improve services due to installations of new equipments in most of the main provincial hospitals and at NRH. Good and improved working performances of all the medical imaging staff. It is hope that this increase will continue this year 2006. Activity Report – progress against Operational Plan / Budget (include % for the year): At the end of the year 2005 the Division has accomplish most of its planned programs under its National operational plan to about 90% success. It overspent its oversea Supplies budget at the NMS for oversea purchase which is only $900,000.00. It spent about $1.2M. This is due to the increase demand to. Replace allot of smaller equipments, stocks and supplies which were running out during the past years. The divisions also spent allot of its local national division budgets for local purchases but due to the slow release of funds from the MOF, it wasn't able to spend all of it. It if hope that this will continue to improve this year 2006. Annual Health Outcomes (relates to goals/outputs/indicators): Goals: 1. The Division aims to Strengthen the National administration. Including prepare 2006 operational plan and work program with budget and human resource requirement plus monitoring and evaluation of the whole services.. This has been all accomplished last year 2005. Year 2006 operational plan, Budget plane, establishment plans were completed and submitted to the MHMS Goal2/3/4. To strengthened the Main services delivery (Radiography, Radiology, Ultrasonography).
Ministry of Health: National Health Report 2005 Page 41 of 250 --------------------------------------------------------------------------------------------------------------------This goal has been successfully undertaken last year where all the above services were available in all provincial dept. and at NRH. Workshops and conferences were conducted for staffs to strengthened the delivery of the above services. Goal 5. To Improve the operational status of the Medical imaging equipment. This goal aims at providing proper repair and maintenance to medical imaging equipment. Although we were success in some places. There are a lot that need to be done on this area. Lack of properly trained biomedical engineer is the main constraint. A number of provincial and NRH equipment have been repaired last year 2005 while others still need to be repaired. We hop to continue it this year 2006. Goal6. Improve provincial supervision & tours. Almost all provincial Hospital have been visited last year especially by the quality control officer who check and document all quality practices in all provincial medical imaging department. Goal 7. To improve supply support to MID. This goals aims at purchasing and distribution of national medical imaging supplies from oversea with the National Medical Store. The Division is very successful in this goal and overspent its budget allocation of $900,000-00 to $1.2M . Allot of very important supplies and accessories have been purchase under this program in 2005. Goal 8. This goal aims to ensure safe radiation environment at the MID. This goals has been successfully implemented where all staff have been given radiation monitoring badges and all dose reports received from oversea laboratory analysis in 2005 were within safe levels. Goal 9.To improve all computerize patient registry and data information systems. The main aim of this goal is to fully computerize all patient registry database in GIizo, Kirakira and Kilu'ufi Hospital. The department is 100% successful in completing this project in 2005, Goal 10. Develop and improve MID workforce that is professionally effective, efficient and productive. The aim of this goal is to review and maintain the staff establishment and standard performances of all staff through review of job descriptions, posting of staff, promotion, and improve entitlement and condition of services. Last year 2005, this goal was slightly difficult to successfully accomplish. This is due mainly to the following reason: - Not enough qualified manpower trained for the service to be posted to provincial Hospital. - All Promotion recommendation made to the MHMS for the Public service Division approval was not materialized. About 70% of the staffs in the division are not in their correct post levels. - Paramedical scheme of services (SOS) were not acted upon by the MHMS and the public service. Inspite of the above problems, the Medical Imaging staff have improved and increased their working performances last year 2005. It is hoe that they will continue this year 2006. Goal 11.Staffs continue educational & training. National training plan has been prepared and submitted to the MHMS. Staff submission for training has been done for oversea training. Two students have been trained locally at NRH under local radiography attendant program and have completed it successfully. - No new student were sent oversea for trainings The MHMS needs to support the division in the area of training for Radiographers. Goal 12. Replacement of all old x-ray equipment and accessories. The division is very successful in replacing most of its old machines last year 2005. New Large x-ray machine for - NRH, Kilu'ufi, Gizo, Atoifi. (Valued at about $1.5M) Mobile x-ray machine to: Lata, Buala, Kirakira, Kilu'ufi
Ministry of Health: National Health Report 2005 Page 42 of 250 --------------------------------------------------------------------------------------------------------------------New film processor to: Kilu'ufi, Gizo, Buala, Kirakira, Taro, Sasamunga, Atoifi. Two Ultrasound machines has been donated to NRH. There were allot of other smaller equipment and accessories that have been successfully replaces under HSTA funding through the NMS.. It is hope that this program of equipment replacement will continue this year 2006. Goal 13. Improvement of Divisional communications. This was successfully implemented. A new telephone line and E-mail was installed at the Head of Radiography's office which now made all communications from / to provincial departments easier and fast. Goal 14. Improve all standard stationary supplies within the division. This was successfully undertaken when all the standard stationeries supplies used within the division were printed and distributed to all provincial departments. Goal 15. Safe Holiday passage for staff. All holiday passages were met successfully last year 2005. Goaf 16. Quality control and assurance program within the division.. This was successfully implemented when all the provincial departments were visited and all equipments and standard of practice were assesses. Quality control workshops and training were conducted. HR issues: Pre-service Training of new Radiographers is lacking for the past years including 2005. There is a need to improve the intake of student for training as Radiographer. Promotion of staff to their correct post levels was NIL even though ACR forms are completed and recommendations were made for every staff each year including 2005. Allot of Radiographers are still acting and not on their correct post levels. Approval and implementations of the Paramedical Scheme of service which can improve the standard of performances and entitlement of each staff is still lacking. The MOH must support and address this issue. Lack of accommodation for some radiographers in provincial hospital centers. The MOH and provincial Directors need to provide proper accommodation for radiographers. The MOH must improve and correct the above anomalies within the system if it wanted to improve the outcome of the health delivery system which depends on if human resource Number Supervision tours conducted
5
Proportion of staff with ACR completed
99%
Infrastructure / maintenance / equipment issues: The Medical Imaging Division is fortunate to replace some of its x-ray equipment last year 2005. eg: NRH, Gizo Kilu'ufi,& Atoifi. Seven x-ray film processors have been replaced. Three ultrasound machines have been donated to the NRH. The main need now is to build a now department at Kilu'ufi Hospital which is too small and also to replace all old x-ray equipment at Buala and Kirakira Hospital. Service and maintenance of these equipment is at its very critical stages because no qualifies Biomedical engineer is available and with knowledge to repair those equipment. Maintenance of department building in most provincial hospital is still a priority, Assets Inventory Completed? = Yes Inventory last updated on:- . 2004
Ministry of Health: National Health Report 2005 Page 43 of 250 --------------------------------------------------------------------------------------------------------------------YES / NO Building of staff accommodation at Honiara and provincial Hospital centers. Any other comments: The Medical Imaging Division and its entire staff have worked very hard to implement the operational plan last year 2005. It is hope that the MOH will support them this year 2006 to do the same. Summary of Major Constraints
Strategies / Action plan for the way forward
1. Limited funding available to purchase new equipment to replace the old ones
continue to Request to increase funding from SIG /HST
2. Inadequate training of human resources including trainings of Radiographers.
Continue to request the MOH & NTU to allocate sponsorship for Radiographers for oversea trainings. ( inservice and pre-service)
3. Lack of Improvement on the staff entitlements and condition of service such as the paramedical scheme of services and the approval of all promotional recommendation made every year including last year 2005 through the ACR forms.
Request the MOH to approve and endorse the Paramedical scheme of service this year 2006. And all promotional recommendations. This issue urgently needs to be address by the MOH. / Permanent secretary.
4. Lack of qualified Biomedical engineers to repair and maintain all medical imaging equipment.
Request the MOH to send and train a Bio-medical engineer to be train on how to repair x-rays and other medical imaging equipment.
5. Lack of Staff accommodation in provincial hospitals. Provinces / Divisions Training Database updated Please circle All activity acquittals completed and balance of cash returned to Accountant By : Sendah Savakana
Position:
Head of Radiography.
YES YES
Date: 10-3-2006.
Organisation and Staffing- 2005 Division/Section
Medical Imaging Division Doctors Head of Radiology Sen. Registrar. Rad Nurses Radiographers Head of Radiography Chief
Grade
Established posts/number
Filled posts Male
Female
1 1
Total
Vacant Posts number
SS1/2 12/13
1 1
1 1
7/8
1
12/13
1
1
10/11
1
1
1
1
Non – established posts number
Ministry of Health: National Health Report 2005 Page 44 of 250 --------------------------------------------------------------------------------------------------------------------Radiographer Prin. Radiographer 9/10 1 1 senior 8/9 5 2 1 3 2 radiographer Radiographers 7/8 2 1 1 1 Asst. Radiographer 6/7 5 1 1 2 3 Radiography Asst. 5/6 1 1 1 Radiography Asst. 4/5 5 2 1 3 2 2 TOTAL EST. POST Domestic/cleaner REMARKS
4.2.5
24
6
4
12
13
2 1 1 1 1 More than half of the staff in the division are just acting against their post and are not yet promoted to their correct levels, therefore their post is still considered Vacant.
National Pathology Services
Introduction: The laboratory services are essential to health care delivery and thus it forms an important role in the Ministry of health. They address both the preventative and curative activities. They are also an indispensable tool in the surveillance and control of diseases. This is through improved disease recognition, accurate reporting and the resultant effective national health planning. The Solomon Islands Pathology Services Division is responsible for the Pathology laboratory services in the country. Its key role is to provide: Framework for laboratory regulations, policies and guidelines on the services provided. Provide pathology staff development plan, training and staff competency improvement programmes and on going staff support in the work place. Management of national pathology finance & budgeting. Management of equipment & supplies Ensuring quality services by utilizing quality tools like standardized documentation, external & national quality assurance programmes through effective communication. The hospital based laboratories both in the provinces as well as the national referral hospital are well distributed through out the country. The key functions they provide are guided by the role delineation document of the MoH. Each hospital based laboratory strive to provide A complete test menu as prescribed by the role delineation guideline. Efficient transfusion services and consultation with the Solomon Islands Red Cross Society Consultation for use and interpretation of laboratory tests Continuing education to students, physicians and hospital staff Laboratory services to patients, hospital employees and regional clients Laboratory statistics to the medical, administrative and interdepartmental teams Quality test results in a time frame to support treatment
Ministry of Health: National Health Report 2005 Page 45 of 250 --------------------------------------------------------------------------------------------------------------------Activity Report 2005. Staff Development The level of trainings both basic and on going is an important component of providing quality laboratory services. The trainings undertaken by laboratory personals in 2005 are in table 1. & 1.1. They are mostly quality management training and lack the professional and technical improvement that the service desperately needs. Table1
In country trainings and workshops undertaken in 2005.
Types of training
Field of training
No Trained
Who
IPAM
3
NRH Management
2 3
NRH IOC staff New recruits
3 1
NRH staff NRH staff
USP MHMS
Human resources management Multi disciplinary Public service procedures Basic Computing Intermediate computer training Corporate governance Quality Workshops
1 2
HIV
Operational planning workshops VCCT Counseling
HOD National Pathology services National Pathology services Gizo, Kiluufi
Computer literacy training
2 2
Rate
2/3 2/3
Table 1.1 Professional/Technical training undertaken in 2005
Types of training
Institution
Field of training
Safe blood transfusion 3 weeks
Attachments
Malaysia, National Blood Transfusion Center Royal Brisbane Hospital Pathology Laboratory Services
Cytology
Duration
6 months 3 months
Who Denton Jimmy Elliot Puiahi Michael Aike Anna Mosese
Parasitology & Mycology Workshop. Australian Microbiology Society Conferences
2 days Guest speaker at the ASM Tristate conference, Darwin, Attachment at (IMVLS) TB reference laboratory & guest speaker SA ASM branch Guest speaker ASM
Andrew Darcy 3 days
1 day
Ministry of Health: National Health Report 2005 Page 46 of 250 --------------------------------------------------------------------------------------------------------------------Queensland branch Global Fund HIV Presenting SGS report 1 week Elliot Puiahi Project for Solomon Islands Pan Pacific Presentation on HIV 1 week Elliot Puiahi HIV/AIDS SGS in Solomon Conference Islands Pacific Laboratory Quality 4 weeks Violine Aruafu SHORT Paramedical System Management TRAININGS Training Center Therapeutic Good Blood & Blood product 1 week Andrew Darcy Administration of regulations Australia (TGA) EBOS (NZ) Equipment Training 1 week Ansa Wate Douglas Rerese Management of Laboratory Supplies The National Pathology Services is managing a budget of $ 800,000 at the National Medical store to procure laboratory supplies and small equipment replacement. This is obvious not enough as the commitment made in 2005 is very above this budget. The purchase commitment of the National Pathology is in table 2. Table 2. Purchase orders through the National Medical Store 2005.
Date PO Reference Supplier 21/01/2005 NMS2005-02 EBOS 2/03/2005
NMS2005-14
2/03/2005 16/03/2005 27/04/2005 20/05/2005 16/06/2005 2/09/2005
NMS2005-15 NMS2005-22 NMS2005-33 NMS2005-42 PO:48 PO-136
7/09/2005 PO:128 22/09/2005 PO-139 31-Oct-05
PO-192
Decription Amt (AUD) Amt SBD Biochemistry/Haematology $ 98,612.95 $ 571,669.26 Reagents B&M HIV,Anisole,ESR,Carbol $ 15,469.00 $ 92,851.14 fucshin, B&M RPR, HBsAg Reagents $ 3,495.00 $ 26,679.39 B&M PTI cards $ 6,482.00 $ 39,284.85 B&M INR Machine & Reagents $ 6,257.60 $ 37,247.62 EBOS Atoifi instalation $ 6,250.00 $ 34,171.68 EBOS Easylyte repair $ 3,258.60 $ 15,641.28 EBOS PTI manual,Hemocue,PT, $ 14,957.40 $ 74,263.49 Blood agar B&M HIV,HBsAg,PTI reagents $ 7,330.50 $ 40,669.61 South Austral Chemicals, Stains, $ 47,915.00 $ 261,973.76 Reagents & Consumables EBOS Biochemistry reagents $ 105,210.12 $ 575,236.33 Total committed in 2005
$
315,238.17
$ 1,769,688.41
Laboratory Equipment Laboratory equipment are expensive and technology constantly changes. The National Pathology is trying to standardize laboratory equipment and is facing a very difficult time trying to find the best machine that will cater for the conditions of the country. There is also a need to have back up system that will ensure that the services may slow down but still functioning. Thus for every machine purchase the national pathology must also a manual system for back up. Equipment Repair
Ministry of Health: National Health Report 2005 Page 47 of 250 --------------------------------------------------------------------------------------------------------------------A major hurdle for the pathology services is the lack of equipment service back up in the country. A lot of times a very small fault resulted in equipment replacement or a visit from which cost almost the same as the machine. A number of these equipment are still sitting in the laboratories awaiting repairs. Repairing these machine by getting someone from overseas to come and do them here will incur cost as in table 3.1 Table 2.1 Cost of repair or installation.
Date
Reference No Supplier Detail Cost of an extra trip to cover installation of Biochemistry machine at Atoifi 20/05/2005 NMS2005-42 EBOS Cost of repairing an electrolyte machine 16/06/2005 PO:48 EBOS (Easylyte) sent to NZ.
Cost (foreign)
Cost SBD
$
6,250.00
$
34,171.68
$
3,258.60
$
15,641.28
Table 2.12 Repairs covered under warranty in 2005
Date April 19/04/05
Installation Repairing trip
Equipment Echo plus, NRH Kiluufi & Gizo Echo plus Atoifi Coulter Counter Also service Act 2 Gizo, Act8 Atoifi Echo plus NRH Easylyte (Kiluufi)
Supplier EBOS EBOS EBOS Under warranty EBOS Under warranty EBOS Under warranty
Under warranty $15 641.28 NZD Done by Roger Caine
Yet to be fixed
At the end of the warranty period the laboratory will have to look into the cost of these repair trips or it must look at ways to train its local biomedical to be capable of handling these equipment. Table 2.13 Laboratory equipment that needs repair end of 2005.
Machine type Biochemistry Reflotron analyser
Qty 4
institution Gizo, Kilu’ufi, Atoifi, NRH
Biological Safety Cabinet
4
Autoclave Echo plus Easylyte Coulter Act2
1 1 1 1
Atoifi, Kiluufi, HGH, NRH NRH Lab NRH Lab Kilu’ufi Atoifi
Coulter Act 5
1
NRH
Remarks Needs a service engieneer to have them fixed and redistributed to other provinces. Filter change & service maintenance overdue Not working for 3 years now Under warranty Under warranty Needs board replacement & adjustment Needs constant attention due to power sensitivity. (Under warranty in 2005)
Ministry of Health: National Health Report 2005 Page 48 of 250 --------------------------------------------------------------------------------------------------------------------New equipment acquired The equipment acquired in 2005 through SIG are mostly tools for the improvement of communication and management. There are a number of essential basic equipment that need urgent replacement. The Pathology services would like to thank WHO for facilitating the acquirement of the most basic but essential equipment for the service Table 2.23
New equipment acquired 2005.
Equipment type 2 x Computer
Cost center National Pathology services
Programme NRH Lab Administration & Data collection National Pathology Services
1 x Lap top 1x LCD projector
National Pathology Services (NMS) WHO Funding
3 x Centrifuges
WHO
1 x Computer 10 x Auto-pipettor (20200ul) 10x Auto-pipettor (2001000ul) 10x Auto-pipettor (100ul) Scanner
HIV programme WHO
National Pathology Services Training Replacement for Gizo, Kiluufi, NRH Serology data collection- NRH Replacement to all laboratory
WHO
Replacement to all laboratory
WHO
Replacement to all laboratory
SIG
National Pathology Services
Laboratory Policies/Regulation/Guidelines The National Pathology services still finds it very difficult to make policies and regulation at this stage. There is only one Policy being drafted and is yet to be see it through the MoH executive. The process of making policies and the framework needed to use as a cross cutting department who serve a lot of programme yet based under the National Referral Hospital is not easy. Most programme are yet to come up with their policies and thus it is difficult to write laboratory guideline based on existing policies and or standards. The other area of great importance to providing the quality service is the clarification of regulation that governs the pathology services professionals and services in the Solomon Islands. Provision of Quality service to laboratory users A network of laboratories are well spread within the country to provide laboratory services for the user of the services. These laboratory are based at the hospitals as they are the biggest user of the service. The public health component of the laboratory also exist and they are very instrumental in TB/Leprosy, HIV/STI and Pap smear screening programme. Whenever needed the Pathology laboratory are used for outbreak investigation and monitoring. Laboratory data are an important base line data to see specific problems in any programme. There is a level of referral within the country and a network of reference laboratories outside the country can be utilized should the need arise. These ultimately intends to provide the best quality services for its users. Activities relating to the services provided in the country is summarized in Section 4 of the report.
Ministry of Health: National Health Report 2005 Page 49 of 250 --------------------------------------------------------------------------------------------------------------------Table 2.4 Showing laboratories in the country
Center NRH Sasamunga Gizo Hellena Goldie Hospital Buala Atoifi Kilu’ufi Kirakira Lata
Zone Honiara, Guadalcana, Renbel, CIP Choiseul Province Western Province Western Province
No of staff 24
Level of service Level 4
1 2 2
Level 1 Level 3 Level 2
Isabel East Malaita Malaita MUP Temotu
1 1 4 1 1
Level 2 Level 2 Level 3 Level 2 Level 2
Table 2.41 The Reference Laboratories currently being used.
Institute Royal Brisbane Hospital Pathology Laboratories QHSS Arbovirus Lab Influenza Center VIDRL IMVS Pasteur Institute, Noumea Mataika House Fiji
Test referred All histology, cytology, hormonal, and any other test not done locally Arboviruses Influenza surveillance Measles surveillance TB Surveillance Leptospirosis reference center Proposed HIV surveillance confirmation center
Cost The service is done but charged to Solomon government. WHO Collaborating Center WHO Collaborating Center WHO Collaborating Center WHO programme PPHSN level 2 laboratory PPHSN level 2 laboratory
Management of Finance & Budgeting The National Pathology was fortunate to be recognized as a cost center in 2005. The budget provided in 2005 are activity based while the core budget is still handled by the NRH cost center. With only 2 staff running the office as well as running the NRH laboratory operational supervision, it is not possible to implement all the activities as planned. A system to make available funds when needed is the biggest obstacle in the management of the fund. As it is our first budget it has no history and so it’s a great learning curve for the division. The biggest portion of the laboratory allocation is spent on laboratory fee being referred to Queensland Health as shown in the graph below. The budget estimate for the programme in 2005 is $500 000 and the actual spending is $800 000. A draft guideline proposed to guide the test referred and possible cost recovery on private sector is not being implemented because it is yet to be approved.
Ministry of Health: National Health Report 2005 Page 50 of 250 --------------------------------------------------------------------------------------------------------------------Graph3.5 showing cost of test done in QHSS in AUD currency. Laboratory Overseas Test Fee-RBHPLS $30,000.00
$25,000.00
$20,000.00
$15,000.00
$10,000.00
$5,000.00
05 .J an .9 78 04 .D ec .5 22 04 .N ov .8 66 04 .O ct .1 20 1 04 .S ep .1 02 9 04 .A ug .1 32 3 04 .J ul .1 64 0
05 .J un .7 26 05 .M ay .8 86 05 .M ar .1 02 3 05 .F eb .1 13 1
05 .O ct .7 29 05 .S ep .1 57 05 .A ug .1 08 8 05 .J ul .2 90 1
06 .F eb .1 08 0
06 .J an .1 13 3 05 .D ec .1 38 7 05 .N ov .1 25 0
$0.00
Laboratory Quality Assurance The assurance that the service obtained are of quality is the paramount importance to the user of the service. The National Referral Hospital laboratories participated in an external quality assurance programme. Having participated in the EQA NRHLab should then be involved in providing similar EQA to the provincial hospitals. Unfortunately this is not happening in 2005 due to severe shortage of staff and difficulty in getting available funds to run these programme. A proposed QA & training officer at the National division office will really get this going in 2006. A regulatory framework that will set a standard for laboratory services in the country is very much needed. It should be able to provided the minimum standard that all laboratory should operate on and a possible accreditation recognition.
Ministry of Health: National Health Report 2005 Page 51 of 250 --------------------------------------------------------------------------------------------------------------------Graph 2.6. The NRH EQA score compared to the rest of the Pacific (average participants score)
Haematology Score 100 80 60
Average
40
NRH
20 0 1
2
Serology Score 105 100 95 90 85
Average NRH 1
2
The above result shows that we have a better than average standard of services in both the Serology & Hematology sections. This should give confidence to the users of the service in these area. There is a great need to spread the same confidence to the technologist in the provinces who are often neglected in both training and support. Microbes Identification
Antibiotic Sensitivity prediction
P ercen tag e S co re
100 80 60
Average
40
NRH
20 0 1
2
3
90 80 70 60 50 40 30 20 10 0
Average NRH
1
2
3
Microbiology is still struggling in their QA performances with our identification and antibiotic sensitivity prediction well below the average score. An encouragement is that in the last EQA we did improve our sensitivity prediction to almost the average level indicating our commitment to excellence. Due to the continuous breakdown of the newly installed machine in biochemistry the Solomon does not participate in the EQA. It would be interesting to find out the QA for the 3 other machine
Ministry of Health: National Health Report 2005 Page 52 of 250 --------------------------------------------------------------------------------------------------------------------installed in the province which does not experience break down. Biochemistry however have a strict internal QC that was done before any testing is done. Annual Health Output Provision of quality laboratory services to the users of the services: Serology Laboratory Services The Serology services include serological testing of hepatitis B virus, HIV Syphilis in patients and blood donors. The national pathology with technical input from NRH Serology are responsible for the test standardization, and they work very closely with the National Medical Store for their availability throughout the country. The minimum cost of the test used is HIV HBsAg RPR TPHA
(2.80 AUD) (1.05 AUD) (0.60 AUD) (1.70 AUD)
$12.00 SBD $6.00SBD $3.00SBD $8.00 SBD
The HIV testing strategy is being drafted following a workshop organised by the HIV programme. This will certainly assist the laboratory to standardized testing protocol. Some of the activities in Serology are summarized in table 4.1/4.2 Table 4.1 National Referral Hospital Serology Tests done in 2005 TESTS Pos RPR TOT RPR Pos TPHA TOT TPHA Pos HBsAg TOT HBsAg IR HIV TOT HIV TOT Tested
Jan 98 756 92 92 27 180 0 124 1369
Feb 190 603 74 224 14 79 0 94 1020
Mar 63 267 144 347 23 195 0 120 1159
Apr 75 685 99 134 27 196 2 172 1390
May 96 924 91 91 27 164 0 118 1511
Jun 86 876 92 92 24 146 0 77 1377
Fig 4 Showng the proportion of test done at NRH serology laboratory Serology test done in 2005 NRH N=15198
TOT HIV; 12% TOT HBsAg; 15% TOT TPHA; 10%
TOT RPR; 63%
Jul 89 756 81 81 31 161 1 141 1323
Aug 73 848 66 66 55 218 3 180 1491
Sep 50 752 52 45 24 174 1 122 1220
Oct 47 657 44 44 41 199 2 157 1191
Nov 56 695 54 54 32 159 6 151 1185
Dec 48 578 47 47 17 117 2 106 962
TOT 971 8397 936 1317 342 1988 17 1562 15198
Ministry of Health: National Health Report 2005 Page 53 of 250 --------------------------------------------------------------------------------------------------------------------Blood Transfusion Services The National safe blood policy was drafted and deliberated in 2003 during a technical workshop. This policy together with its guideline and Standard operation procedures is yet to be fully implemented. An MOU was signed between the MoH and the Solomon Island Red cross Society (SIRCS)on the area but this too doesn’t seem to work because SIRCS has not yet replaced the two personnel made redundant in 2004. The authoritative body to deal with blood activities in the policy is the National Blood Counsel of Solomon Islands. This body has yet to meet since its inception and in 2005 there is no meeting. Proportion of donor blood grouping 2005 N= 1040 A Rh Positive 25%
B Rh Positive 11% AB Rh Positive 1%
O Rh Positive 63%
National Referral Hospital Blood Transfusion Services The National referral hospital transfusion service is the main blood bank in the country and they have traditionally use the services of the SIRCS to do recruitment and awareness. This is no longer possible in a regular basis and thus the service has yet to meet its objective of 100% nonrenumerated volunteer blood donor services. In 2005 the majority of donation is still family replacement thus blood safety and confidentiality is very much compromised. NRH Blood Transfusion Services 600
500
400 Units Collected Tot. Units Requested Units Used Units X-matched Tot. X-match Requests
300
200
100
0 Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
There is a slight recovery in the blood bank after the delivery of a bus to National Pathology that can be used for mobile blood collection. The increase in demand for use of blood however is no where near the amount of blood collected. As seen in the graph the number of blood requested at
Ministry of Health: National Health Report 2005 Page 54 of 250 --------------------------------------------------------------------------------------------------------------------NRH of 4240 is five times more than the units used in 2005 of 864. A lot work is still needed to put in strategy in both the collection of blood and quality rationale use of blood in the Solomon. TB/Leprosy Programme One of the national programme heavily relying on the laboratory to support its activities. The success of the programme depends on early detection and continuous monitoring of the infectivity during intensive dots treatment. The laboratory have been struggling to get quality stain since JICA has left the programme. Its takes a consultant and a National TB workshop in 2003 that the problem was identified and steps taken to solve it. The year therefore started off with good stains available but still some administrative problem with distribution of these stain to the provinces. This year the drug sensitivity surveillance was re-started with Institute for Medical & Veterinary Science (IMVS) in Adelaide. A total of 93 cultures were sent for investigation, five of them were either contaminated or can not be recovered. There are only 2 which is not MTBC. The sensitivity fortunately is still sensitive to the five drug tested (S,I,R,E,Z). National Referral TB Laboratory Serves the National referral hospital as well as the base laboratory for HTC, Guadalcanal, Renbel as well as CIP. Despite this the working space in the laboratory does not allow for two technologists to work at the same time. The laboratory was also expected by the national programme to provide National quality programme as well as training support. Apart from training laboratory trainee as well as Renbel nurse, the later function of the laboratory is yet to be fully implemented. Workload for TB NRH Laboratory TB Work load analysis
Oct
38
38 314
136
Nov
35
265
Dec
73
240
Sep
68
103
Aug
55
150
Jul
44
213
Jun
73
227
May
60
216
Apr
61
266
Mar
0
50
29
Jan
25
169 162
Feb
100
150
200 Total Smears
250
300
350
400
TB Culture
The yearly average AFB positivity rate seen at NRH is New cases Follow ups Total Pos.rate Total Pos.rate NRH 804 9% 122 20% Buala 346 3.5% 15 0% Kiluufi 1042 21%
Old Total 49 none
Pos.rate 16%
Ministry of Health: National Health Report 2005 Page 55 of 250 ---------------------------------------------------------------------------------------------------------------------
Ministry of Health: National Health Report 2005 Page 56 of 250 --------------------------------------------------------------------------------------------------------------------Microbiology Services Isolation of infectious agent (bacteria) in patients specimen and testing them invitro for antibiotic susceptibility is an important aspect of microbiology services. The application of microbiology is for confirmation of etiological agent in a suspected patient. This can lead to early detection of outbreak diseases and accurate treatment of cases. National Referral Hospital The National Referral Hospital laboratory, Gizo and Kilu’ufi are currently equipped to do culture isolation and sensitivity testing. They are doing microscopy and culture in clinical specimens as well monitoring the STI syndromic management. NRH microbiology statistic is not available when the report is compiled. Biochemistry Services Nationally the Biochemistry services actually expanded with the purchase of 4 new wet chemistry analysers (Echo plus) in 2004. These machine were installed at Gizo, NRH ,Kilu’ufi & Atoifi in April 2005. While the machines for the provinces are doing fine after installation, the one for the NRH develop problem maybe due to the workload. It appears that the machine is not so suitable for the high workload in NRH. Until the problem in NRH is fixed there is no way of knowing what the real work load demand is for Biochemistry in the Solomon Islands. The NRH Biochemistry data was not available during compilation. Total Provincial Biochemistry Test 2005
4000 Gizo
Atoifi
6000 Kilu'ufi
135
2000
2409
0
633
5059
1
8000
10000
Lata
Histology Histology laboratory investigation is all done at Royal Brisbane Hospital Pathology Laboratories and they are doing the service at a cost to the MoH. These test can not be done locally because we do not yet have a pathologist. While a pathologist is currently being trained it is also important to start working on a pathology laboratory to cater for his return. A temporary site has been identified at the NRH to accommodate histology service but a concrete solution must be found sooner than later. There is very little Telepathology being done in 2005 as the makeshift room used was not safe and National Pathology office has moved in to use the room.
Ministry of Health: National Health Report 2005 Page 57 of 250 --------------------------------------------------------------------------------------------------------------------Anatomical Pathology Specimens 80
70
60
50 Province NRH
40
30
20
10
0
1
2
3
4
5
6
7
8
9
10
11
Province
3
0
9
11
12
3
18
0
13
1
18
12 8
NRH
13
71
60
46
63
42
49
26
61
31
52
24
Cytology Services The cytology service in the country is in an infant stage but has taken a very important role in the cancer diagnosis. Pap smear screening, the primary health care programme for cervical cancer is still making up the bulk of the cytology specimens. Fine Needle Aspirate (FNAB) is increasingly contributing to the total workload. It has became the first line of diagnosis before surgery and should be encourage more. Pap Smear Screening 2005
47 52 105 58
32
4 108
56
41
9
39
38
4
18
0
40
1 3 6
Jan
24
7 71
20
29
Feb
19
4
33
Mar
29
10
Apr
61
19 8
43
29
May
53
49 27
43
22
Jun
9
38 12
17
Jul
12
18
Aug
13
22 11
8
23
Sep
5
18
Oct
12
27
Nov
6
22
4
Dec
50
100 Gynae
150 Province
HTC
Private
SIPPA
200
250
Ministry of Health: National Health Report 2005 Page 58 of 250 --------------------------------------------------------------------------------------------------------------------FNA & Non Gynae Cytology 40
35
30
25
2004 2005
20
15
10
5
0 Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Haematology Services The Hematology department is one of the high through put testing service in the division. They are responsible for test that include hematopoiesis evaluation, erythrocyte studies, leukocyte studies, hemostatis and test of hemostatic function. The full blood count is the first line of investigation and treatment monitoring. NRH Hematology The NRH is the busiest hematology laboratory in the country. They started started the year without a machine and thus they are doing all test manually. A Coulter Act 5 was installed in April but this developed problem sometime later due to the power disruption. A back up machine was repaired and is currently being used. No data is available during compilation of this report. HR issues: Human personnel are the most important asset of the division. It can not run without its qualified competent personnel. It is therefore important that the issues surrounding the personnel are vital to ensure the smooth running of the service. Strengthened National Management Body The current establishment structure does not encourage the pathology services to be able properly manage and regulate itself as a profession. The lack of the Directors post in the establishment sees the department lacking direction. It would be very important the division must play an active role in the national issues both clinically as well as preventative. This can not be done while the department is still headed by the Medical superintendent of the NRH and NRH manager being the highest post in the technical cadre. A clear line of command that has all the hospital entities answerable to will greatly help in the management and independent administration of each laboratory services. Staff Quality & Quantity The laboratory is always being associated with the testing personals of the wide range of professionals needed in the running of the services. The group most unlikely to be mentioned in the cycle is the technical consultants for each specialist area. These professional are graduate scientist with post graduate qualification in their field. These technical consultants are very
Ministry of Health: National Health Report 2005 Page 59 of 250 --------------------------------------------------------------------------------------------------------------------important personals needed to ensure quality procedures are research and authorized for use in the laboratory. It is sad that of these type of training is seen done in the ministry and yet we expect high standard of service to be provided from each division. The division aim to have at least one technical/professional consultant in each field of pathology laboratory services and to have enough testing personnel for each service. It is now possible to estimate the quantity of testing personnel required by using the MoH HR model and the annual statistics of the division. The real issues that need to be addressed is the initial training of the right mix of personnel so that we will have personnel to work. Staff motivation & incentives The current grouping of the pathology laboratory personnel with the rest of the paramedical has disadvantaged the laboratory very much. The abolishment of overtime and a blanket 25% SDA for paramedical has not properly renumerated the people who works the longest, as well as the hardest in the group. Medical laboratory staff were called almost every night to deal with life saving test. While the new Paramedical scheme of services has been seen as the most important motivational factor, the pathology division still see the after hour aspect of the document as unfair. The division agrees to pursue it with the group in the understanding that this will be reviewed within two year and this matter dealt with in a more acceptable way. Quality of service is mostly influenced by the quality of training one get before and during employed. The lack of formal in-service training for the Medical laboratory staff is not helping in the improvement of the service. Further more there hardly any degree graduate laboratory scientist that can be employed and thus the gap between other professional whom we supposed to advise widens. Staff development & career pathway. The staff career pathway is not very clear in the present structure. The present promotion is mainly due to default rather than in service career development and plan. Again the proposed structure in the submitted SOS is trying to address this. It hoped to encourage professionals to stay in the field rather than getting into the administration. Organisation and Staffing Division/Section
Grade
National Pathology Services Head of Laboratory 12/13 Services Laboratory Coordinator 10/11
Filled posts Established posts/number Male Female
Abolished in 2005 1
National Referral Hospital Laboratory Chief Medical 11/12 1 Technologist Principal Medical 8/9 8 Technologist Senior Medical 7/8 8 Technologist Medical Technologist 6/7 4 Ass.Med.Lab.Technologist 5/6 5
Total
Vacant Posts number
0
0
0
0
1
0
1
0
1
0
1
0
3
2
5
3
3
1
4
4
4 1
2 2
6 3
-2 2
Non – established posts number
Ministry of Health: National Health Report 2005 Page 60 of 250 --------------------------------------------------------------------------------------------------------------------Central Reception 4/5 1 0 0 0 1 Manager Laboratory Domestic 2 2 0 1 1 1 Nonestablished Medical Lab. Technologist 2 3 0 3 -1 NonTrainee established Provincial Hospital Laboratory Chief Technologist 9/10 Principal Medical 8/9 Technologist Senior Medical Technologist Medical Technologist
1 0
0 1
1 1
1
7/8
2 1 Gizo post abolished in 2005 5
1
2
3
2
6/7
4
1
0
1
3
Remarks. All vacant post in NRH (except for 3xmalaria & Central reception manager) are filled with personnel acting up on their post. This has been going on for two years and despite the paper works being done no promotion has been received yet. The Malaria has been activated for advertisement but as of Dec 2005 no recruitment is yet to be done. The provincial vacancies have attracted some application but as of Dec31, 2005 nor recruitment has been done. The vacancies in the lab are mostly based on potential availability of qualified personnel in the market instead of the needs analysis due to unavailability of trained personnel in the market. Infrastructure / maintenance / equipment issues: The Medical Laboratory Technologist performs all duties in compliance with all current provincial and national legislation for the protection of patients, health care providers and the general public. This also means that the facility & equipment they are using must comply with the current national safety standards. Unfortunately a lot of the laboratories in the country does not meet even the WHO Biosafety level 1. A purpose built laboratory is much safer than BSC cabinet that can not be serviced in the country. Equipment maintenance Lack of preventative maintenance is the current biggest laboratory problem. Machine are bought with out proper maintenance plan. Spares are not stocked and there is no regular preventative maintenance programme. Operational budget usually is being used to cater for emergency repair. As the personnel needed to do the usually are brought into the country it is often very expensive. Assets Inventory Completed? YES / NO
Inventory last updated on: 2001
Issues for consideration in future planning: Guideline for teaching by laboratory staff The laboratory staff has been requested and have been providing teaching session to SIMTRI public health programme, SICHE School of nursing programme, and midwifery programme. The current use of the laboratory testing personal in those programme has put a lot of pressure on the
Ministry of Health: National Health Report 2005 Page 61 of 250 --------------------------------------------------------------------------------------------------------------------laboratory services. A guideline is needed to clarify the role of health experts in providing teaching service to other programmes needs to be drawn in order to plan absenteeism and compensation. Overseas Laboratory Referral Costs. The issue of the cost of sending specimens overseas needs to be addressed. A referral criteria must be confirmed and enforced so that we can control the laboratory spending on unnecessary tests. Furthermore a set criteria is needed to continue the service to the private sector at a cost recovery revolving scheme. This will mean that the budget can be gone over but the actual fund is paid for by the user. Histology / Cytology Laboratory There is need to establish the histopathology laboratory in country to provide a work place for the new graduate pathologist. Site planning must be done now than later so as not to discourage the new graduate. Telepathology must be encouraged to reduce the cost of the overseas laboratory fees. Laboratory Standards Quality systems requires standard and regulation to enforce this standard. The laboratory needs a review of the Acts, regulation & policies governing this to ensure that there is a framework available to do this in the country. Any other comments: Constraints & Strategies Summary of Major Constraints
Strategies / Action plan for the way forward
Inadequate supply of safe blood in the hospitals
Review & relook into the 2003 workshop recommendation in blood recruitment for Solomon Islands. (see annex 1) Recruit 2 nurses to assist in the awareness & volunteer blood donor recruitment. Need a review of the top management of the laboratory To have a APW for a consultant or to recruit a Laboratory administration adviser to attached with the division for 1 year.
Need to strengthened the National Pathology Services management. There no clear regulatory policies that provided independence and empowerment to provide QA – No enough personnel in the National office to do QA and training of staff
Provide in the National pathology Services establishment a post for a QA and training officer.
Training- No enough trained personnel to recruit and fill the post required by the service
Establish a needs analysis and forward to planning or Ministry of Education for student training. Establish an Assistant Medical Technology Programme in the National Pathology Services to cater for the gap in the testing category. Establish a system to cater for equipment repair.
Equipment repair- Lack of systematic preventive maintenance & replace protocol for all laboratory equipment Inadequate qualified personnel to recruit
Proper analysis of Doctor work generated ratio and plan for the pathology support services personnel.
Ministry of Health: National Health Report 2005 Page 62 of 250 --------------------------------------------------------------------------------------------------------------------Fair distribution of in-service scholarship. Provinces / Divisions Training Database updated
Please circle
All activity acquittals completed and balance of cash returned to Accountant
YES
NO
YES
NO
Blood Donor Recruitment in Solomon Islands Introduction Blood donor recruitment which involves awareness and promotion in the Solomon Island is found to be victimised by the lack of clear definition on the role of the MOH and Solomon Island Red Cross society (SIRC). While SIRC is being assumed to be responsible for donor recruitment, promotion and awareness this is not often possible due to lack of trained personnel and priorities. Red Cross recruitment personnel are only available in Honiara and the provinces are often confused as to which role they should assume. Furthermore Provincial laboratory staff are often manned by only one staff and are often too busy doing other diagnostic services to be involved in quality recruitment of donors. The following is being formulated in the workshop on Blood Bank held at the FFA conference center 10th –13th Feb 2003. Recommendation The Ministry of Health & Medical services and the Solomon Island Red Cross Society to clearly define the role of each partners in the recruitment of blood donor. 4.2.6
Dental (Oral) Services 2005
Services: Dental service in the past is mostly taken up by provision of pain relief, or emergency type of treatment. Very little emphasis is given on the preventive aspect of dental service thus the incident of dental problems are increasing in Solomon Island and without a proper national survey done on dental diseases no proper evidence based report will be given on the real picture of dental diseases and its prevalence in Solomon Islands. With the introduction of OP and its implementation, budgeting and prioritizing of activities with the best dental service outcome a new chapter to dental service in SI is being put in place. The introduction of computers, emailing and internet communication is made easy then ever before.. The skills of linking Operational Planning to the Budget process is gradually improving. The clinic infrastructure is deteriorating and needs a face uplift and renovation unless a new dental complex is being built. Statistics: NRH – Based on written data collected Approximately 10,156 patients seen at the NRH dental department in 2005. This includes both the adult and the children.
Ministry of Health: National Health Report 2005 Page 63 of 250 --------------------------------------------------------------------------------------------------------------------More then 50% of the patients seen are female. The commonest dental disease seen is dental caries, and treatment mainly carried out is dental extraction. Out reach programs 9 communities in the provinces. 7 school visits to HCC. 5 antenatal clinic visit and talks given 3 days a week dental out patient talks. Provinces - Provinces show the same pattern trend of cases and treatments .Integrated touring is one of the activities done in the provinces plus school visitations. Activity Report – progress against Operational Plan / Budget (include % for the year): Activities Completed. Training of Dental Assistants July and October 2005. Implementation of IC procedures Dental Health talk conducted in communities both Honiara and provinces (communities in Provinces visited AHA) Most time during the year is taken up by out patient duties. Activities Incomplete. Supervision tour Publicity and Promotion Electronic data collection system not in place yet. ACR forms although written not processed yet. Training – Only one officer / year need to send 3-4 officers for post graduate studies. Budget spending against OP. Report from Chief Accountant – MOH From the report it shows that only 19.2% of our budget of $240,000 is spent in 2005. The above summary report is not consistent with the requisition raised from the Dental Directors office. The amount raised from requisition does not match the cheques received. The problem faced is to raise requisition well in time before the actual activity commences. It is taking to long for money to be allocated. Health Outcomes (relates to goals/outputs/indicators): Goal – Increase primary oral health awareness program by 2010. Not all HCC schools visited – Transport problem. Health awareness by NGO – medical dental tours conducted ( Ngela, Auki, Ulawa, Santa Ann, Kirakira,Simbo, Ranoga) Adventist Health Association plus churches – 2005. Provinces – Integrated touring done Goal – To develop dental workforce, professionally efficient, responsible and productive. Strategies – Create incentives. Staff still not confirmed and promoted. ACR forms not processed to SPD Accommodation a problem affecting performance Paramedical scheme of service not implemented. All the above contributes to staff not
Ministry of Health: National Health Report 2005 Page 64 of 250 --------------------------------------------------------------------------------------------------------------------performing as expected. Training of Dental Assistants - Achieved Certificate given – dissemination of IC information to staff and implementation. Goal- By 2015 50% of dental manpower update on professional skills – provision of quality dental care. Number of Officers going for postgraduate training to increase to 2-3 / year. Only 1 officer going / year. Due to the above up to date knowledge and skills lacking within dental Service. Goal – To improve dental supplies delivery system to provinces by 2015. Computer install for dental supplies Training on how to do inventory. Provision of Computers to provinces dental service. Internet connected for access to dental catalogue to find out prices of materials and equipments. Not all our goals were met in 2005. Not the best dental health out come gain. However this is gradual. Hope to improve in 2006, with a more comprehensive and manageable OP HR issues: Directors post needs to be confirmed – still acting Oral Surgeons post needs to be filled – for the time acting . Dental establishment all post still on acting bases. Urgent need to train dental technician and therapists. Need to create Dental chair side Assistant posts to 6 provinces with dental officers. 22% Number Supervision tours nil Proportion of staff with ACR conducted completed 100% filled but only 9 submitted. Infrastructure / maintenance / equipment issues NRHCurrent infrastructure does not allow for full utilization of dental service. Purpose of a Referral hospital cannot be met. Some provinces operating space to small thus IC procedures cannot be fully met . Maintenance – Equipments use in dental need more specialized person to repair. Equipment - Current Dental settings in SI cannot cater for new equipped dental chairs. Only very basic chairs should be bought. Assets Inventory Completed? Inventory last updated on: NIl NO Issues for consideration in future planning 1. To reduce the no of out patients seen in NRH and to start implement more of specialized dental service 2. This will mean open dental clinics in HCC. 3. Change of current dental clinic setting. 4. Training of Dental Technician and Therapist, and continuous post graduate training of Dentist. 5. To improve on our current data collecting system.
Any other comments: To ensure that the new dental complex eventuate in the 4th phase of Hospital building constructions.
Ministry of Health: National Health Report 2005 Page 65 of 250 --------------------------------------------------------------------------------------------------------------------Summary of Major Constraints Strategies / Action plan for the way forward 1. Training of dental staff.
To review the training plan for the department.
2. Infrastructure
-Continuous dialogue with NRH administration regarding the new dental complex. - short term plan to improve Kukum dental clinic with HCC - To resubmit all ACR forms on a group bases.
3. Confirmation and promotion of all dental staff 4. Instrument shortage. 4.2.7
Prioritizing ordering of dental supplies.
Rehabilitation Division National Referral Hospital
Service Demand The most common demand on the acute rehabilitation services is the orthopedic. The unit also serves as may referral rehabilitation site for other centers. Total New On-going 1021 792 229 78% 29% In 2005, there were total of 1,021 treated. Of the total, 78% were newly diagnosed patients. The staff worked a total of 254 working days. 284 Orthopedic 116 Others 112 Fractures 103 Neck and Back pain 81 Neurological (other) 40 Pulmonary conditions 18 Diabetic 14 Chest Physio (post op) 12 Amputations 6 Spinal Cord injury 5 Burns 1 Gynae 792 Average case load per month attendances -275 Averages monthly case load -85 Average daily attendance per therapist -15 Number of patients treated in rehab unit -467 In 2005, the orthopaedic workshop under the Rehabilitation Division manufactured 15 prosthetics and repaired 11 (total of 26 done). Total of 246 were either manufactured (227) and repaired (18). Total of 16 calipers done, and 85 foot wears repaired. Issues/ Challenges Increasing need for specialist acute rehabilitation care at the hospital level. In 2005, 284 underwent orthopedic procedures were rehabilitation followed by 112 fractures, 103 necks and back pain, 81 neurological cases, 40 pulmonary conditions, 16 diabetics and 12 amputates18.
18
Source of data/ information: Gauba, C (2005). Rehabilitation Annual Report 2005, Ministry of Health.
Ministry of Health: National Health Report 2005 Page 66 of 250 --------------------------------------------------------------------------------------------------------------------Recommendations 1. To implement lower back pain and soft tissue injury awareness to the community.
Ministry of Health: National Health Report 2005 Page 67 of 250 --------------------------------------------------------------------------------------------------------------------4.2.8 Distance Education Program: Ongoing Education for Nurses: Background: The Ministry of Health and Medical Services has always provided some form of continuing education program for its staff in rural areas. The continuous need to update nurses’ knowledge and provide specialized training based on the following arguments Health is a changing science and much of what is taught during the basic training is forgotten with in five years. Knowledge can be forgotten. Professional isolation can cause deterioration in skills Roles change as nurses are promoted and take on new jobs. Roles also change as staff move between clinical hospital services and community health in rural areas Distance Education Program in Solomon Islands has grown from strength to strength since 1994 when it started with 15 students and materials were printed on stencil duplicator. The distance education program has moved on calm seas with the increasing number of enrolment and the waiting list. The program continues to enrol students in the five courses, which are Nursing Management, Obstetrics, and Family Planning, Community Health and Paediatric courses. Since 2000 there are over 209 students enrolled in five different courses and as many as 40% to 50 % of the Registered nurses and Nurse Aides have requested to participate in the program. This report will cover program activities from period beginning January 2005 to December 2005. The report will also high light the main activities which were carried out during the year. Activity Report-progress against Activities:
Operational Plan/ Budget (include % for the year: 2005)
Enrol new students in January /February in each course to maintain level at 20 active students per year. Database of students applications maintained Support continuing students to complete courses Students enrolled in three courses (FP pilot still being done) Management students to complete course before enrollment of students Ordering of textbooks for the students: Piloting the Family Planning Practicum in collaboration with RHD Conducted assessment of clinics/hospitals for Family Planning attachment – Choiseul province, Makira/Ulawa Province, Guadalcanal Province, Malaita Province and Honiara City Council. Conducted Family Planning Practicum Training in Isabel, Makira/Ulawa and the Western Provinces. Annual Health Outcomes )relates to Goals/ Indicators” Total of 21 nurses trained in comprehensive Family Planning Practicum course 15 graduates from the five courses offered by Distance Education Centre
Ministry of Health: National Health Report 2005 Page 68 of 250 --------------------------------------------------------------------------------------------------------------------HR Issues: The Program needs to have another staff – there is a vacant post for the position of a Senior Program officer that needs to be filled. Number Supervision tours conducted-6 Infrastructure Maintenance / equipment issuesCurrently the Distance Education office is located in the Planning building. However, the program needs space for tutorial and consultation purposes. The radio currently is okay however due to shortage of space it has been used as a storage area as well. There is a need for a photocopier to produce modules, it is included in the 2006 budget but there is no space to locate it. There is a computer and a printer – current status working Other major maintenance on the Equipment is carried out under the planning division. Assets Inventory Completed? YES Inventory last updated on: 2004 Issues for Consideration in future planning: The outcome of evaluation to be conducted in 2006 will influence future planning Anticipate writing up of Diabetes module and the Mental Health Course 2006/2007 Post of Senior Program Officer to be filled Completing of the pilot Training of the Family Planning Practicum in Malaita Province, Choisuel Province, Guadalcanal/Honiara City Council and Makira /Ulawa Province in 2006. Staff time for preparing and delivering training needs to be budgeted for in the future. Summary of Major Constraints Strategies / Action plan for the way forward Text books out of Print Books not arriving on time The need for a Senior Program Officer Low supply of Modules for students
Search and locate a new supplier/publisher Early submission of orders for text books Vacancy to be filled Need for a photocopy machine to produce modules when needed
Provinces / Divisions Training Database updated Please circle All activity acquittals completed and balance of cash returned to Accountant
YES YES
Ministry of Health: National Health Report 2005 Page 69 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 5 5.1
Health Burden
Overview:
This Chapter in its very brief, gives you some basic picture on the kinds of health burden and the contributing factors causing both negative and positive impact our people’s health. The health burden in the report is defined or related to the outputs or outcomes of the health status, whether it be the incidence of diseases due to a causative agent or physical, mental and social origin. The main source of data and information is the national Health Information System. It is due to limited data from the hospitals that the report concerns with illnesses causing burden to the individuals, families and communities. The population health is determined by the social origins of illnesses within the communities.
5.2
There are several major health issues affecting Solomon Islands
Malaria Acute respiratory infections STI/HIV High maternal mortality Diarrhea Skin diseases and yaws TB and leprosy NCD’s such as diabetes Mental health problems Access to sustainable clean water supply and sanitation
500 450 Rate per 1,000pop
400 350 300 250 200 150 100 50 0 ARI
clinical malaria
f ever
skin disease
Ear inf ection
yaw s
Diarrhoea
Red eye
Fig. 12 Commonest illnesses in 2005 in Solomon Islands in PHC Clinics: Fig. 12 provides evidence that the commonest illnesses suffered among the communities in the Solomon Islands which is Acute Respiratory Infections, follow by malaria (clinical diagnosed mainly by nurses at the clinics), fever (as recorded as non-specific), skin diseases and ear infections. Whilst there is limited information of the primary causative agents to the ARI history has shown in 2003 outbreaks that the cause of ARI was due to Influenza type A similar strain identified in Queensland. The issue of concern is the ongoing occurrence of skin diseases and ear infections. There are evidences that skin diseases as
Ministry of Health: National Health Report 2005 Page 70 of 250 ---------------------------------------------------------------------------------------------------------------------
5.3 5.3.1
Communicable Diseases: Acute Respiratory Infection:
ARI are important cause of morbidity in Solomon Islands, exceeded only by malaria In 2005 responsible for 25.5% of acute care contacts Population rate increased in 2005 (417 to 470/1000) (Fig 13). Rates in infants <1 have remained essentially unchanged. In children 1-4 increased in 2005 (Fig 14).
Rate per 1,000 population
2500 2000 1500 1000 500 0 2001
2002
2003
2004
2005
year total pop
<1
1 to 4
5+
Fig. 13 ARI Rate in SI, 2001-2005: Source HIS data/ Med Statistics, MOH 800 700 600 500 400 300 200 100 0
Guadalca nal
Makira
Temotu
Malaita
Renbel
Choiseul
Isabel
Honiara
Western
2001
180
349
531
363
576
588
601
469
420
2002
267
309
489
282
391
413
531
349
341
2003
331
320
450
218
639
480
493
383
304
2004
350
461
656
324
671
478
665
461
432
2005
527
465
634
339
549
399
539
535
458
Rate pe r 1,0001-4 pop
Fig. 14 ARI rate per 1,000 populations in 1-4 years age-group by provinces.
5.3.2
Clinical Malaria
Important cause of attendances at PHC for acute care services. In 2005 clinical malaria and fever were responsible 28% of acute care attendances (Fig. 15). Major cause of mortality in children and infants (Fig 16) The rate of malaria in pregnancy has remain essentially unchanged according to one measure (HIS) and has been found to be higher by another (Solomon Islands Reproductive Health Surveillance System) (approximately 8%)
Ministry of Health: National Health Report 2005 Page 71 of 250 --------------------------------------------------------------------------------------------------------------------Difficulties is assessing true rate due to problems with measurement (reporting by PHC clinics varies). Nonetheless the level of Malaria infection remains very high. Very high among children, and issue of public health concern still.
Rate per 1,000 population
750 600 450 300 150 0 2001
2002
2003
2004
2005
Ye ar fe ve r
c lin ic a l m a la r ia
F e v e r a n d c lin ic a l m a la r ia
Fig 15 Clinical Malaria rate per 1,000 populations 180,000
160,101
160,000 140,000 120,000 100,000
73,600
80,000
62,128
60,000 40,000
11,472
20,000 0 Clinical malaria total
Total in Children
No. cases 1-10
Total cases <1
Fig 16 Clinical malaria cases by age group in 2005 It is overwhelming that malaria infection in children and even worse under 1 year old remain a major health problem. This evidence calls for targeted point of service delivery on the various malaria control strategies. However, there are still issues surrounding the diagnosis of malaria as to differencing malaria infections from other febrile illness such as influenza and general clinical manifestations of other diseases.
5.3.3
Yaws and Skin Disease
Goal: reduce incidence of preventable skin diseases by 2010 (target yaws in children <5 reduce from 6.5 to 3%, skin diseases total pop. 9.6 to 3%): In 2005 slight reduction in yaws (this may not be sustainable based on previous trends) Skin diseases – increased population rate from 96 to 107 cases/1000 (10.7%)
Longer term implications of minor diseases e.g. skin diseases not well understand and may be harmful later in life as evident in Rheumatic heart and kidney diseases.
Ministry of Health: National Health Report 2005 Page 72 of 250 ---------------------------------------------------------------------------------------------------------------------
160 140
R a te p e r 1 ,0 0 0 p o p
120 100 80 60 40 20 0
Guadalca Makira nal
Temotu
Malaita
Renbel Choiseul
Isabel
Honiara Western
2001
24
47
48
61
78
20
18
21
64
2002
38
51
145
55
37
19
16
34
58
2003
74
77
141
65
55
40
24
49
77
2004
62
57
40
65
46
14
19
44
44
2005
62
67
41
56
27
21
18
39
40
Fig 17 Yaws Rate per 1,000 pop by provinces 2001-2005
5.3.4
Ear Infection 160 140
Rateper 1,000pop
120 100 80 60 40 20 0
2001
2002
2003
2004
2005
<1year
121
99
114
115
125
1 to 4 years
141
123
135
140
0
42
34
37
44
47
5+ years
Fig 18 Ear diseases rate per 1,000 pop by age-group The rate of ear infections also increased with 3 provinces - Guadalcanal, Honiara and Choiseul, the source of the majority of increased cases.
Ministry of Health: National Health Report 2005 Page 73 of 250 --------------------------------------------------------------------------------------------------------------------5.3.5 Red Eye: National rates of red eye rose from 26.7 to 33.9 per 1,000 between 2004-2005. Rates of red eyeye increased in Guadalcanal, Makira, Malaita and Honiara (Fig.19)
rateper 1,000population
70 60 50 40 30 20 10 0 2001
2002
2003 ye ar
2004
Re d e ye
2005
Ear infe ction
Fig 19 Rate per 1,000 pop Eye and Ear infections 5 yr trend. 60.0
R ateper1,000pop
50.0 40.0 30.0 20.0 10.0 0.0
Guadalca nal
Makira
Temotu
Malaita
Renbel
Choiseul
Isabel
Honiara
2001
14.5
28.1
29.4
30.0
24.7
43.0
47.8
20.8
2002
23.3
22.5
31.5
24.2
16.6
41.5
37.7
15.3
2003
36.2
29.6
21.0
17.9
23.5
34.5
29.9
15.6
2004
35.2
26.9
17.8
23.6
11.3
36.8
30.8
19.7
2005
41.1
43.3
27.1
32.3
20.5
27.6
40.0
25.5
Fig 20 Red Eye rate per 1,000 pop 5 yr trend by population.
5.3.6
Diarrhoea
Following a decade during which diarrhoeal disease rates more than halved (1995-2004), 2005 saw increased incidence (new cases) of diarrhoea and importantly, widespread increases of bloody diarrhoea It is likely that the bloody diarrhoea cases, indicate several outbreaks of disease Morbidity is highest in children <5 years
Ministry of Health: National Health Report 2005 Page 74 of 250 --------------------------------------------------------------------------------------------------------------------Fig 21 Diarrhoea (watery and bloody) Rate per 1,000 pop 5 yr Trend.
Rateper1,000population
60 50 40 30 20 10 0 2001
2002
2003 Ye ar
Total w ate ry
2004
Total bloody
2005 Total diar r hoe a
Fig 22 Diarrhoea Rate per 1,000 pop 5 yr Trend by provinces.
Rateper1,000population
30 25 20 15 10 5 0 2001
2002
2003 ye ar
Te m otu
M alaita
Re nbe l
2004
2005
Honiar a
We s te r n
2004
2005
Fig 23 Diarrhoea Rate per 1,000 pop 5 yr Trend by age group
Rate per 1,000 population
250 200 150 100 50 0 2001 < 1
5.4 5.4.1
2002
2003 ye ar
1 to 4
T o tal < 5
5+
Tuberculosis and Leprosy Control Program Tuberculosis Control Program:
Introduction The National Tuberculosis and Leprosy Control Programs have continued to be one of the priority public health programs of the Ministry of Health. The management and execution of program
Ministry of Health: National Health Report 2005 Page 75 of 250 --------------------------------------------------------------------------------------------------------------------activities are coordinated from the Disease Prevention and Control Unit by two seconded officers who report direct to the Under Secretary Health Improvement on matters related to the program Year 2005 has been a challenging but eventful year for the National TB and Leprosy Control Program where we saw the continued support from our existing partners like the Global Funds, World Health Organization (WHO), and Australian Agency for International Development (AusAID) and the Pacific Leprosy Foundation (PLF). Global Fund however is withdrawing its assistance from the TB Program as soon as phase two lapses The National Tuberculosis Control Program has continued to implement activities geared towards achieving the National and Regional targets. Our National and Regional targets which include: to increase case detection to 70% and to increase cure rate of newly diagnosed sputum smears positive cases to 85% has continued to be our focus of implementation Efforts continued to be made to ensure that the activities are implemented according to the approved operational plans and the link between the program and laboratory is maintained and well supported. For example, the DOTS strategy is maintained and continued to be applied during the intensive and continuation phases for monitoring of treatment. DOTS strategy as has always been said is the basic strategy to stop TB and the beneficiaries for using DOTS must be attained such as curing of illness, prevention of death, drug resistance and reducing the incidence of TB in the communities. Laboratory is the very important component in NTP as it plays an important role, not only to diagnose TB patients but also to monitor the progress of these patients (sputum smear positive cases) during treatment and to determine their cure. The Leprosy Control Program has also continued to implement activities that will maintain the elimination target of less than 1/10,000 population in the country. The Multi-Drug Therapy (MDT) strategy has been the core intervention measure to control leprosy and its impact must be well documented especially when the declining trend of leprosy prevalence has been noted for years. This annual report aimed to express the achievements and activities conducted by both the National Tuberculosis and Leprosy Control Programs at the national level and in the provinces during 2005. 5.4.2
Objectives of the National TB Program (NTP):
5.4.3
General Objective:
To reduce the mortality, morbidity and transmission of TB until it is no longer regarded as public health problem 5.4.4
Specific Objectives
To increase the cure rate of newly diagnosed sputum smear positive cases to at least 85% and To increase case detection to 70% of estimated incidence. Strategies of NTP Intensification of health education/promotion by using multi-media to increase community awareness about TB Expand and continue to implement Directly Observed Treatment Short course (DOTS) strategy up to community level Early case detection through direct sputum microscopy of chest symptomatic patients attending health services Regular supervision and monitoring of NTP activities at all levels.
Ministry of Health: National Health Report 2005 Page 76 of 250 --------------------------------------------------------------------------------------------------------------------Capacity building. 5.4.5
Activities Conducted in 2005
5.4.6
Health Education / Community Awareness
Community awareness on TB was further accelerated through community awareness meetings, workshops and the use of media to disseminate information. In 2005, we have only engaged the SIBC to broadcast our daily TB spots while community awareness meetings and workshops had been conducted in some Provinces including Honiara by different stakeholders: We have also developed a TB/ Video tape which featured mainly about the disease TB. Three of our Provincial TB Coordinators have conducted community awareness meeting each in Choiseul, Central and Makira/Ulawa provinces 6 community awareness meetings were held in some identified areas in Malaita, Guadalcanal and Central Provinces and were conducted by NGO groups especially the church women’s groups 4 community meetings were held in Honiara City Council Suburbs by the health team of Honiara City Council 5.4.7
World TB Day Commemoration – 2005
The Commemoration of the world TB day was held here in Honiara at the Honiara Central Market on the 24/03/2005. The slogan for the year 2005 was “Find TB, Cure TB. Cure starts with detection”. The slogan focused more on improving our case detection strategies to increase detection rates and putting them on treatment using our famous DOTS strategy. This slogan would like to see the improvement of our set targets which are stated below: Increase case detection rate of sputum smear positive cases to at least70% Increase cure rate of new diagnosed sputum smear positive cases to at least 85% or more In commemorating the day, several activities were conducted including speeches from the MoH and the World Health Organization Officials. Some other activities like – publication of TB articles on the Solomon Star, dramas, speech contest and distribution of leaflets on TB to the general public were also conducted during the day. Capacity building – In country workshops and Overseas training Capacity building was one of the on-going programs organized annually by the Ministry through our Department to strengthen and also to improve the knowledge and skills of health workers to enable them to perform their duties more effectively and efficiently. In 2005 the following training/workshops were conducted locally: One DOTS training for all Provincial TB Coordinators was conducted in May 2005 by Dr Ichiro Itoda -WHO Consultant was based in Suva – Fiji An annual review and planning workshop was also conducted in early December 2005 for all Provincial Health Directors, TB/Leprosy Coordinators. Three (3) Provinces namely Isabel, Makira/Ulawa and Central Provinces have managed to conduct one DOTS training each for their nurses in 2005 On overseas training and workshops - see Table 1. below: Table . International Training and attendance of meeting/workshops.
No.
Name and Designate
Duration
1.
Dr John Paulsen – Medical Officer -
30/03/05
Attended Course or Meeting Second Stop TB meeting
Ministry of Health: National Health Report 2005 Page 77 of 250 --------------------------------------------------------------------------------------------------------------------for PICT – Nadi Fiji DPCU to Noel Itogo – National TB/ Leprosy Coordinator 02/04/05 Raymond Zonnie – TB Coordinator – Western Province Silas Tuita – TB Coordinator – Makira/Ulawa Province 2. Oliver Sokana – TB Advocacy 12/04/05 Epidemiology training Facilitator to course on TB - Vietnam 30/04/05 5.4.8
Monitoring and Supervision:
Regular monitoring and supervision of program activities should be an on going activity to be provided by both the national and provincial program coordinators. This is done to monitor and assess the work performed by health workers, update of TB and Leprosy data in the provinces and also to provide guidance and support in terms on the job training on areas that need immediate attention. In 2005, the National TB Coordinator managed to conduct five (5) supervisory tours to 5 out of 9 provinces. These tours were conducted mainly in, Isabel, Malaita, Makira/Ulawa and Central Provinces. Tours by the Provincial TB coordinators within their own provinces showed a lot of improvement. The number of tours conducted depends entirely on their work commitment. Some provinces managed to visit all their clinics while others conducted their visits by zones. Others need to conduct supervision visits to their clinics as no excuses of funds will be accepted because funds for such activity have always been available. 5.4.9
Annual TB/ Leprosy Review
In 2005, the National TB/Leprosy Control Program conducted an Annual Review and Planning workshop which brought together all Provincial Health Directors and TB Coordinators to review and made operational plans for 2006. At the workshop did we see the provinces submitted their operational plan with budgets and what they plan to do. A lot of recommendations were made for the NTP to see and do in order to further improve the program 5.4.10 TB Situation by 2005 5.4.11 New Case Detection Rate: Case finding activities in most provinces were still not well implemented as most patients were detected through passive case finding. This has indicated by the number of cases reported to the central level from the provinces varies. Malaita reported the highest with about 43% of the total reported cases. The total number of TB cases (All cases) detected and reported to the Central Registry increased from 340 cases in 2004 to 397 cases in 2005giving a NCDR of 82 per 100,000 populations. A similar trend is also noted for Sputum smear positive by showing a small increase from 152 in 2004 to 174 in 2005 with a NCDR of 35 per 100,000 populations. The New Case Detection Rate (NCDR) in 2005 was about 82% for all cases and about 35% for Sputum Smear positive cases. Figure1 below illustrates the result of case finding as well as providing the trend of new case notification rates for all cases and sputum smear positive cases from 1996 to 2005.
Ministry of Health: National Health Report 2005 Page 78 of 250 ---------------------------------------------------------------------------------------------------------------------
National TB Notification Rate 1996 - 2005
Per 100,000 pop
100 80 60 40 20 0
96
97
98
99
0
1
2
3
4
5
All cases
80
77
64
70
74
70
62
64
72
82
PTB + ve
28
26
40
22
26
29
26
31
32
35
Table x National TB Notiication Rate 1996-2005
5.4.12 Case Notification by Provinces The number of cases notified to the Central Registry in 2005 by Provinces varies. Some provinces especially the bigger provinces like Malaita, Makira, HTC, and Western have detected more cases than others. The notification rates by provinces as shown in Figure 2 below probably indicate that a lot of TB infection is still around and we need to do extra work to reduce it transmission TB Notification Rate by Province 2005 (All cases) CHP
21
IP
33
CIP
36
Provinces
GP
39
TP
43
RBP
71
WP
77
SI
82
HTC
99
MP
113
MUP
115 0
20
40
60
80
100
120
140
Per 100,000 pop
Fig x TB Notification Rate by Province 2005 (All cases)
5.4.13 Age and Sex Distribution of New Sputum Smear Positive Cases By age and sex distribution affects almost all the age groups but when see the age and Sex distribution of new sputum smear positive TB cases reported to the NTP in 2005, it occur more frequent in age group 15 to 24 and 25 to 34. This is the most mobile and productive age groups in terms of family earnings. The overall standing for male to female ratio showed that more females had TB than male. There are many reasons for this, but females tend to stay most of the time at home in some confine environment where transmission could be high.
Ministry of Health: National Health Report 2005 Page 79 of 250 --------------------------------------------------------------------------------------------------------------------See (Annex 1) for age and sex distribution. 5.4.14 TB Infection by Site TB infection by site for 2005 as illustrated in (Annex2), showed that pulmonary TB represents more than 84% of the total cases reported to the central registry and 16% represents extrapulmonary cases that includes, Bone/Joint TB, Miliary TB, TB Meningitis and Others form of TB. Of the total pulmonary cases reported, 52% are sputum smear positive cases and 48% are smear negative cases. With this high number of sputum smear positives cases, transmission could could be high in the communities. This call for more effort in conducting contact tracing among the contacts of smear positive cases. See (Annex 2) for TB infection by site. 5.4.15 Case Holding and Treatment Outcome For standardization, targets for DOTS implementation must be adhered to by the Provincial TB Coordinators in monitoring the progress of DOTS strategy in the country. These targets which are mentioned in Box 1 were also documented in the National Tuberculosis Control Program Manual and also advocated by the WHO 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
To compare the above targets to what NTP has achieved with regards to case holding and treatment outcome, it has been the Policy for many years now that all TB patients should be hospitalized. This has facilitated and strengthened the TB program with regards to applying DOTS. In Solomon Islands, DOTS is currently 100% coverage nationwide. DOTS strategy is continuing to have impact on sputum conversion. Our records showed that in the National Referral Hospital alone more than 85% conversion rate was achieved after 2 months and 90% after 3 months of intensive treatment.
Ministry of Health: National Health Report 2005 Page 80 of 250 --------------------------------------------------------------------------------------------------------------------Cure and Treatment Success Rate - 1996 - 2004 100 90 80
Percentages
70 60 50 40 30 20 10 0
96
97
98
99
0
1
2
3
4
Cure Rate
30.8
74.3
83.3
78.4
68.4
68.4
71.3
72
58
Treatm ent Succes s Rate
87.5
92.4
92
86.3
92.1
92.1
92.6
90
87.2
Fig. x Cure and Treatment Success Rate 1996-2004
Figure 3 above illustrates the result of cure and Treatment Successive Rates (TSR) for the period from 1996 to 2004. It showed that the Treatment Successive Rate has dropped from 90% in 2003 to 87.2% in 2004.The Cure rate for 2004 dropped to 58%. These results showed that dual strategy had to be taken and where possible, sputum should be collected from all sputum smear positive patients for monitoring of cure rates. Again this calls for a concerted effort on the part of program coordinators and health workers in rural areas to improve DOTS strategy in every where possible. Table x. Provincial Cohort Analysis for new smear positive cases for year – 2004
Province
Cure No
CHP CIP GP HTC MUP MP TP WP YP RBP
%
1 50% TSR 1(50%) 3 50% TSR 5(83.3%) 8 50% TSR 16(100%) 19 90% TSR 19 (90%) 7 88% TSR 8 (100%) 34 46% TSR 58 (79%) 4 57% TSR 6(86%) 5 45% TSR 11 (100%) 4 100% TSR 4(100%) 1 100%
Complete
Transfer
Died
Default/Lost
Total
No
%
No
%
No
%
No
%
No
%
0
0
0
0
1
50%
0
0
2
100%
2
33.3%
1
16.6 %
0
0
0
0
6
100%
8
50%
0
0
0
0
0
0
16
100%
0
0
0
0
0
0
2
10%
21
100%
1
12%
0
0
0
0
0
0
8
100%
24
33%
0
0
5
7%
10
14%
73
100%
2
29%
0
0
1
14%
0
0
7
100%
6
55%
0
0
0
0
0
0
11
100%
0
0
0
0
0
0
0
0
4
100%
0
0
0
0
0
0
0
0
1
100%
Ministry of Health: National Health Report 2005 Page 81 of 250 --------------------------------------------------------------------------------------------------------------------TSR 1 (100%) Solomon 86 58% 44 30% 1 1% 7 5% 11 7% 149 100% Islands TSR 130 (88%) While it is pleasing to note that nationally, a high treatment successive rate was achieved, unfortunately provincial achievements vary considerably as indicated in Table 2 above compared to the global target of more than 85% cure rate. Actually provinces with more patients under case holding achieve less than 85%. Again provincial TB coordinators need to put more emphasis sputum monitoring at 5 months and at the end of treatment. This would give them a better chance of increasing their cure rates. Table x. Cohort Analysis for Extra- Pulmonary and Sputum Negatives – 2004
Province
CHP CIP GP HTC MUP MP TP WP IP RBP Solomon Islands
Completed
Transferred
Died
No
%
No
%
No
17 2 17 17 10 34 4 28 4 4 137
94% 67% 94% 89% 91% 68% 80% 80% 100% 100% 82%
0 0 0 0 0 2 0 1 0 0 3
0 0 0 0 0 4% 0 3% 0 0 2%
1 0 1 0 1 5 1 6 0 0 15
Default/lost
Total
%
No
%
No
%
6% 0 6% 0 9% 10% 20% 17% 0 0 9%
0 1 0 2 0 9 0 0 0 0 12
0 33% 0 11% 0 18% 0 0 0 0 7%
18 3 18 19 11 50 5 35 4 4 167
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Cohort analysis for sputum negative and extra-pulmonary TB cases for 2004 as shown on table 3 above was quiet satisfactory with 82% of the total cases had completed their treatment. The only concern here was the number of default and lost cases, which showed an increase from 7% in 2003 to 7% in 2004. Again this calls for proper recording and reporting and follow up of cases by program coordinators and health workers in rural clinics. 5.4.16 Tuberculosis Death. Death due to TB was also declining since 1997, though the cause of death was un-known. The results were derived from the cohort analysis from 1996 ~ 2004 and can be seen in (Annex 3). The number of TB deaths reported in 1996 was more than 10%, which was quite high compare to other years. The cause of death was unknown, but it was believed that some of the patients detected very late and died soon after the start of chemotherapy. Delay in case finding is still a problem, with cases diagnosed in advanced stages. The number of TB patients died on TB treatment while on treatment in 2004 was about 5.5% 5.4.17 Leprosy Control Program 5.4.18 New Leprosy Case Notification The number of new leprosy cases notified in 2005 was higher than that of 2004. About 25 new cases mainly from GP and HTC were notified. Other provinces did not report any case which may be due to no campaigns conducted in their areas. Leprosy Elimination Campaign is the strategy to increase community awareness that will foster new cases. This strategy should be carried out in areas in the provinces that are known to have high case loads in the past so to detect any new
Ministry of Health: National Health Report 2005 Page 82 of 250 --------------------------------------------------------------------------------------------------------------------case that may come out from those areas. The areas where campaigns were carried out were in Tetekaji and Belanimanu areas on Guadalcanal Province and in the Fishing Village area in Honiara City Council. Figure 4 below illustrated the trend of leprosy case notification from 1996 to 2005. The trend shows a fluctuation trend which indicated that a lot cases are still around and need to be detected New Leprosy Notification from 1996 - 2005 30 25
Number
20 15 10 5 0 New Leprosy cases
96
97
98
99
0
1
2
3
4
5
24
21
14
12
9
7
28
5
18
25
Fig. x New Leprosy Notification 1996-2005:
With this fluctuation trend, a lot of new cases may be still present in the communities which need to be detected. Again this call for concerted efforts on the part of program coordinators and health workers to conduct leprosy elimination campaign in the areas that were known to have high leprosy prevalence in the past. In 2005, the numbers of notified leprosy cases under 14 years old were only 4 cases which could indicate that a lot transmission has been taking place in the communities where these children were. None of these notified cases have developed any deformity which means that most of the cases were detected early and MDT has been very effective. 5.4.19 National Leprosy Prevalence It has been noted that the use of MDT has been very effective in the treatment and control of leprosy. In Figure 5 below illustrated the national prevalence rate of leprosy from 1993 – 2005. The trend showed a declining trend from 2/10,000 population in 1993 to 0.5/10,000 population in 2005. This showed a remarkable achievement by program.
Ministry of Health: National Health Report 2005 Page 83 of 250 --------------------------------------------------------------------------------------------------------------------National Leprosy prevalence Rate from 1993 - 2005 2.5
Per 10,000 pop
2 1.5 1
0.5 0 Leprosy prevalence
93 2
94
95
96
97
1.1 0.6 0.7
1
98
99
0
1
2
3
4
5
0.5 0.2 0.5 0.2 0.7 0.1 0.4 0.5
Fig x National Leprosy Prevalence Rate 1993-2005
The Global target to reduce the prevalence of leprosy to less than 1/10,000 population has already achieved this since 1995 as can be seen on the graph above, but at provincial level, especially on Guadalcanal and HTC, the prevalence of leprosy has not always been maintained at lower level as required. It’s always fluctuating. Extra effort is still required to identify those hidden cases in high prevalence areas of Guadalcanal, HTC and Malaita Provinces. 5.4.20 Capacity Building in Leprosy In 2005, we have managed to conduct another 4 days leprosy training workshop for all provincial TB and Leprosy Coordinators in October 2005 This workshop was conducted by a WHO consultant who was base in Manila – Philippines. The aim of the workshop was to strengthen the capacity of provincial program coordinators on Leprosy elimination. It increased their knowledge on how to diagnose and classify leprosy. It also helped them on how to plan and conduct leprosy elimination campaigns in their provinces. The training workshop was sponsored by the World Health Organization 5.4.21 Constraints and Weakness The TB and Leprosy Control Programs despite having achieved some progress and good results, are like any other programs of the Ministry of Health also has gone through some constraints and weakness which in some other ways hinder the progress of these two programs both at the National and Provincial levels. Below are few of these constraints faced: There is inadequate manpower and frequent changes of Provincial TB Coordinators. At National level we now have two staff looking after the whole program while at the Provincial level; we have gone through few changes. Six provinces have new coordinators and these people have to be trained before they could do their job as required Recording and reporting between national and provinces is still one of the set back in TB program. It’s difficult to get reports in time from some provinces where transport again is another problem. Lack of TB beds in some Provincial Hospitals is a big concern because patients have been discharged too early causing difficulty for nurses to manage in clinics especially when patients are still in phase1 or intensive phase of treatment..
Ministry of Health: National Health Report 2005 Page 84 of 250 --------------------------------------------------------------------------------------------------------------------5.4.22 Recommendations: These recommendations are broad but are important as they should provide a frame work for reactivation of program activities which could be the set back in the progress of these programs. All Provincial TB/ Leprosy coordinators be given at least two years to look after the program before allowed to change or post to other provinces. Posting should be done on swap basis with the other coordinators Promotion for all Provincial TB/Leprosy Coordinators should be reviewed by all provincial heads so that all coordinators be at the same level. Strengthen the record and reporting system at the provincial level by providing E-mail system to all provinces so reports could be sent electronically to avoid delays. The IEC unit of the Ministry be given provision to review all IEC materials and develop the required amounts require by each programs. 5.4.23 Acknowledgement The National TB/Leprosy Coordinator wish to acknowledge all the Provincial Program Coordinators, Doctors, Laboratory Technicians, nurses and those who have contributed to the overall implementation of the two program activities in the provinces and looking forward for better collaboration and integration of activities in the years to come. 5.4.24 Compiled By: Noel Itogo National TB & Leprosy Coordinator Ministry of Health & Medical Services Honiara, Solomon Islands. 5.4.25 Core Indicators for TB Program in 2005: Table x: CI: Age and Sex Distribution of New Smear Positive cases 2005
AGE GROUP ( YEARS) Provinces 0 - 14 15 - 24 25 - 34 M F M F M F CHP 0 0 0 0 0 0 CIP 0 0 2 1 0 2 GP 1 0 0 1 1 5 HTC 0 2 5 10 4 3 MP 3 5 5 7 7 7 MUP 0 2 0 2 1 1 RBP 0 0 0 0 2 0 TP 0 0 0 1 2 3 WP 0 0 2 0 1 0 YP 0 0 0 1 0 0 SI 4 9 14 23 18 21
35 - 44 M F 0 0 0 0 1 0 2 0 5 6 1 2 0 0 0 2 0 1 0 1 9 12
45 - 54 M F 0 0 0 0 1 1 0 2 8 3 3 2 0 0 2 0 1 2 0 1 15 11
55 - 64 M F 0 0 0 0 1 0 3 1 4 7 3 1 0 0 1 0 0 0 0 0 12 9
65 + M F 0 0 0 0 2 0 2 0 4 0 1 0 0 0 1 0 1 1 0 0 11 1
Total M F 0 0 2 3 7 7 16 18 36 35 9 10 2 0 6 6 5 4 0 3 83 86
Ministry of Health: National Health Report 2005 Page 85 of 250 --------------------------------------------------------------------------------------------------------------------Fig x C2: TB Infection by site 2005
TB Infection by Site 2005
2% 2% 5%MTB, OTHERS,GTB, 6% BJTB,
PTB, 84%
Fig x C1 3: TB Death Rate from 1996 - 2004
TB Death Rate from 1996 - 2004 14 Percentages
12 10 8 6 4 2 0 Death Rate
96
97
98
99
0
1
2
3
4
11.8
4.7
3.9
4.1
3.1
3.1
3.9
5.5
5.5
Years
5.5 5.5.1
Environmental Health Overview:
Environmental Health Division implements it plan of action for 2005 with the aim of fulfilling its policy statement of “Safe and healthy environmental is the ultimate outcome for the people of this country.” To achieve this approach is to be holistic in the development and implementation of the health initiatives that are consistent with the themes of New Horizons in Health and the Yannca Island Declaration of Health in the 21st Century. EHD has set the policy goal to strengthen it services in particular on these areas: Promotion of safe and clean water. Promotion of proper sanitation and waste disposal Food hygiene and quality (Inspection & certification) Sanitary inspections (General)
Ministry of Health: National Health Report 2005 Page 86 of 250 --------------------------------------------------------------------------------------------------------------------Sea and Airport health quarantine services Health and safety at work place Human resources development Review and develop health regulations. 5.5.2
Priority Strategy/Action
5.5.3
Immediate
Construction of proper water supply and sanitary disposal of human excreta in the rural villages and in urban settings. Vetting of Food Hygiene and Fish and Fishery Regulations for gazette and put to use. Strengthen food safety programmes and functions of the Health Competent Authority (Inspection & certification) Implement regulatory activities in accordance to the provision of: Environmental Health Act, Health Quarantine Act Pure Food Acts and subsidiary legislations. Gazette SARS and HIV AIDS as notifiable diseases under the Environmental Health Act. Community awareness on food safety and hygiene and safe water. Construction of Public Health Laboratory and supply of equipment for laboratory uses. Up-date EHD human resources development. 5.5.4 Long Term Objectives Public Health Laboratory to be Separate Division form EHD Health Competent Authority to be a unit within EHD Establish Occupational Health Unit to deal with all workplaces and homes. Establish solid and Industrial waste management unit within EHD National RWSS program to be sustainable in it’s operation Review existing legislation and introduce relevant regulations 5.5.5
Strategies for 2005
The Government’s policy and decision to support RWSS programme and to fulfil the regulatory activities as provided for under the Principal Acts on environmental health issues and to respond adequately to the impending environmental problems of pollution, and waste disposal and management of hazard and industrial wastes EHD has within its organization the following units developed and set in motion to deal with specific issues: RWSS Unit Food Safety and Quality Control – (Inspection & Certification Unit’ Health Quarantine Services Public Health Laboratory Training & IEC Administration and Management. RWSS (Rural Water Supply and Sanitation) Construction of rural water supply and sanitary facilities for rural communities as shown in the attach report for 2005 The programme objectives were to complete the outstanding rural water supply projects funded under the followings:
Ministry of Health: National Health Report 2005 Page 87 of 250 --------------------------------------------------------------------------------------------------------------------a) EU – Micro Scheme, b) Japanese Grass root Programme c) ROC d) Other donors e.g. Canada Funds . Refer to report attached for achievement in population coverage. Production of posters and use of health promotion radio programme on health related issues has captured topic on water and sanitation and food safety issues as part of awareness programme to the general public. Provincial Environmental Health outfits continue to organize pre-construction and post construction awareness talks to communities who have their water supply project completed and commissioned for use Collaborative programmes with provincial Health Promotion staff in the province on sanitary disposal of human excreta and hygiene use of sanitary latrine of water sealed technology continue to gain momentum. This has been measured by the number of request for the supply of PVC water seals from provinces. 1000 units of PVC water sealed latrine ordered in 2005 fall short of meeting the demand by provinces. Incorporation of hygiene practice in the early childhood education project under New Zealand Government Assistances has seen the Curriculum Division of the Ministry of Education developed materials for use in the primary schools throughout the country. Community participation in the construction of water supply and sanitation has been good and education on the maintenances and operation has formed the part of the post awareness programmes by construction teams. 5.5.6
Solid Waste
Joint efforts with Honiara City Council (HCC) Environmental Health Division has been very good, assistances to improve situation by spreading the huge refuse crudely damped at the site with a dozer was a short term measure. Lack of funds could not allow for long and permanent hire of dozer for this work. However, the problem of space to allow for more waste to be damped at the site was partially resolved, though temporary in nature. The permanent solution of available land for a new dump site is still far from over therefore, other measures have to be employed such as the current method of compacting refuse to an acceptable height above the ground level. This is what is being done at the dump site which appears to contain the current problem but the question of available land for the new site must be addressed as this is the only permanent solution to the problem at hand. Financial constrain with HCC could not allow for regular collection of city refuse, hiring of private contractors for refuse collection was good but need proper supervision as the exercise was experimented to supplement HCC’s own programme. Coordination with SPREP has resulted in New Zealand Govt. support to fund waste control and management, campaign to be launched early 2006. Problem of waste management at provincial headquarters due mainly to lack of available land and financial resources. Crude damping is still practiced in all centres. The scavengers at Ranadi damp were all sent home at the end of 2005 with assistance for them to make new life at their respective village. Question of available land for new dump site for Honiara and Provincial Centres still not resolve by the office of the Commission of Lands therefore, no submission done to the National Planning for capital project to address solid waste management situation in Honiara and Provincial HQs. in 2005.
Ministry of Health: National Health Report 2005 Page 88 of 250 --------------------------------------------------------------------------------------------------------------------5.5.7 Net Working with NGOs EHD maintain its networking with NGO’s in its effort to be successful with rural water supply and sanitation programme in the rural villages World Vision Solomon Islands has supported water and sanitation programme in the Marau area and south Guadalcanal by putting finance and its workforce under its management to construct water supply and sanitation projects. During 2005 some skilled workers from EHD of Guadalcanal Province was released on unpaid leave for a specific period to serve with World Vision Solomon Islands in managing its water and sanitation programme. Statistic on the number of projects completed for 2005 was not available to me right at this time but I should get it in the course of the week. SIDT with its village education programme often used when required and funding is available. EHD was not able to use their services due to resources constrain particularly finance during 2005. 5.5.8
Integrated Research on Approaches
Integrated research into healthy approaches to sanitation in villages was carried out by graduate students at Fiji School of Medicine in 2005 as a project (thesis) for a BSc degree in Environmental Health Science. This study was done in Guadalcanal during 2005 and the officer will organzine series of talks on his studies to staffs of EHD in a hope to devise new approaches to sanitation in rural Solomon Islands in 2006. National EHD and Guadalcanal Province EHD had supported this staff with logistics while conducting research locally and to complete the field studies in the time allowed before returning to Fiji school of medicine for write up. The officer returned from overseas studies end of 2005. 5.5.9
Food Safety and Quality Control- ICU
This is systematic surveillance and monitoring of food production, processing, handling and distribution for sale / export. The system ensures that local and imported food stuff meets the standard and conformance of the country of origin and that of Codex Alimentarius Commission. Solomon Islands have adopted the Codex standards for food processing and manufacturing both for local and international markets. Series of activities on this was curried in 2005 leading to opening of international markets for Soltai and Fish Processing Co to export tuna loins to Italy and Spain. The project to provide technical services to the Environmental Health Division, MHMS known as “ Strengthening the Sanitary Production of Fishery Products (SSPFP) was finalized with the Project Management Unit (PMU) for funding by EU in 2005. Minister for National Planning and Aid Coordination has approved the project being the Authorising Authority July 2005. Tenders were called for and decided by the committee comprising of various experts using EU rules to decide the wining bidder. “Gillett and Preston and Associate Inc” was awarded the consultancy for a period of 18 month to assist EHD develops the Competent Authority so as to be better able to perform its functions. One major task to achieve during the life of this project is for the EU to recognise the Solomon Islands ‘C A’ to rule on sanitary standards for fish and fishery products. The recognition of EHD-‘CA’ will allow the Solomon Islands from among the ACP countries to be elevated from Group II to group I in order that Solomon Islands can have wider trading scope than when the country remain in Group II. This project commence in November 2005 under the supervision of the Director for the EHD, MHMS whilst the PMU is the Managing Authority for this project. The Team Leader and consultants have occupied an office within the Environmental Health office Building to work closely with the Project Supervisor and the staff of “CA” A review of the licensing and registration of food establishments in Honiara revealed 65 in procession of valid licence to prepare and sell food to public including Hotels, restaurants and snack-Bars. Those who are not registered but engage in the sale of food in the streets or target offices had been warned to discontinue or face legal action.
Ministry of Health: National Health Report 2005 Page 89 of 250 --------------------------------------------------------------------------------------------------------------------Inspectors have been trained on “hazard analysis critical control point (HACCP) and to conduct health auditing on industries involve in the preparation, processing and packaging of food projects for local sale / export. Under the current SSPFP training of inspectors and laboratory staff (PHI) will be arranged in 2006 with overseas laboratories food manufacturing co, on work attachment Food samples for micro tests have been analysed at the Public Health Laboratory while for chemical tests samples had been sent to USP / Australian laboratories. The SSPFP will assist with supply and calibration of equipment and training of staff in 2006. Laboratory testing plays a vital role in the quality and control measures applied in the food trade. WHO has supported local training of food handlers and food processing workers from factory, hotels and restaurants through workshops organised by EHD. Similar workshops had been organized in the provinces for mothers who involve in the home preparation of food for sale so as to be issued with certificate of recognition. There were total of five workshops conducted in 2005. 5.5.10 Health Quarantine Services Sea and airport health quarantine services continue to play its roles in the monitoring of vessels arriving in Solomon Islands on international voyages and aircrafts arriving at the international aerodromes. Honiara has two staff while Gizo, Noro, Lata and Tulagi has one staff each at the declared ports of entries. Honiara being the main port of entry to Solomon Islands recorded the highest number of foreign vessels entering Solomon Islands. There were three hundred and fifty (350) vessels declared under the Maritime Declaration of Health as required under the international health regulation. There was no threat of spread of quarantinable diseases but due to threat of bird flu foreign ships are subjected to thorough inspection for storage of life birds on board and to prevent such form getting on shore. Custom, plants Health Quarantine are collaborating very well in this activity. The activities will continue on in 2006 until such time the threat is removed. 5.5.11 EHD Training Report 2005 This annual report covered three area of training: a) The overseas scholarship, b) Local training courses / workshop in food Safety and IPAM courses. c) The Food Safety and Hygiene workshop for awareness in Provinces as planned under the WHO local Budget for 2004/2005. Request for overseas scholarships usually submitted EHD annually to MHMS Training and Fellowship Committee as outlined below: 1. IPAM Courses NO 1.
COURSE Human Resources Management
PARTICIPANTS David Ho’ota Jack Filiomea Emmanuel Rarumae
DATE/DURATION 17th - 23rd May 2005
2. Food Safety and Hygiene Training Workshop-2005 No 1. 2. 3
TRAINIG WORKSHOP Food Safety Food Safety Food Safety (2)
PROVINCE Lata/Temotu Taro/ Choiseul HCC/Honiara
WORKSHOP FACILIATOR (S) Ethel Mapolu Jocab Makini & Mark Arimalanga Ethel Mapolu, Mark, Patricia
Ministry of Health: National Health Report 2005 Page 90 of 250 --------------------------------------------------------------------------------------------------------------------Scholarship Training-2003 – 2005 NAME Joe A Maeohu Jay Semah Kabei Atkin Vilaka Edward Sarifu Ethel Mapolu
COURSE BSc Environmental Health BSc Food Technology Dip. Environmental Health Dip. Engineering BSc Environmental Dip Food Tech
INSTITUTE FSM –Fiji
DURATION 1 yrs 2004
University of Sydeny FSM-Fiji
1 yrs 2004
FIT-Fiji FSM UWS Hawkesbury
3yrs 20032005 2 yrs 20042006 2yrs 2006
REMARKS Must complete final project Course completed Course ends 2005 Course 2006 Begins 2006
2007 Chris Ruku
BSc Applied Science in Environmental Health
UWS Hawkesbury
Bobby Patterson Fred Napthalai
BSc Environmental Health BA Community Planning & Development
FSM- Fiji
George Titiulu
BSc Environmental Health
FSM -Fiji
2008
LAT TROBE University Victoria
2yrs 20062007 2008 2006
Awaiting MHMS/PSD decision Begins 2006 Awaiting MHMS/PSD decision Begins 2006
Appointments to Senior Positions There are senior positions for Chief Health Inspectors post for Malaita, Honiara City Council and Western Province have had ACRs and appraisal forms completed in 2005 but the appointments were not eventuated. The delay has demoralised officers hence we need to get this done. Officers earmarked for these posts are all graduates. EHD had total budget for 2005 of SBD 470,400-00 excluding donor direct support to rural water supply projects where communities applied to donors for funding of their water supply projects and approved by EHD/RWSS for implementation. The EHD wish to express its disappointment when told in 2005 that we had exhausted our 2005 allocation only to be advised later there was a cut off point in the budget that we were not allowed to go beyond that. We would appreciate clear advice from chief accountant on issues of this kind in future.
5.6
Non- Communicable Diseases
The challenges with dealing with NCD problems:Chronic non-communicable diseases such as diabetes require lifelong care: Billed people with NCD stay in the hospital for longer time, therefore having a huge demand on finance, beds to keep them. Early detection and management before the onset of symptoms can reduce long term problems In Solomon Islands rising rates of NCD especially diabetes are contributing to renal failure that requires costly interventions
Other NCD problems: Diabetes
“NCD increasing, and thus needs more efforts in prevention, care and control”
Ministry of Health: National Health Report 2005 Page 91 of 250 --------------------------------------------------------------------------------------------------------------------Renal diseases Hypertensive problems Heart diseases Trauma/ Injuries Psychosocial problems Substance abuse-marijuana Mental Health- Increasing neuropsychiatry conditions- due to alcohol use and self-harm. 17.6% of the total disease burden is due to neuropsychiatry conditions, with 5.5% due to problems related to Alcohol use. Another 2.6% is due to intentional self-harm.
Leading causes of morality 1990:1999:2003 Leading Causes of Death in SI 1990-2003 14 12.9
Specific death rates (%)
12
Cancer (all)
11.7 10.8
10
Malaria
9.5
8.9
CVA
8
8 7.6
8
6.3
6
6.1 6 5.6
4.8
4.7 4
3.2 2.6 2.0 1.2
2
2.9 2.6 2.1
1.6 1.5 1
1.4 1.4
0.79
0.7
0.2 0.0
0
4.4
4.1 3.9 3.4 2.8 2.5
3.6
1990
5.5
1991
1999
3.7 3.1 1.8
Pneumonia/ meningitis Hepatitis/ Suicide Renal Failure/diarrhoea Trauma/ cardiac failure
1.2 2003
TB/ Neonatal causes
Diarrhoea
Pneumonia
Neonatal causes
Total cancers
Malaria
Tuberculosis
CVA
Septicaemia
Trauma
Suicide/Homicide
Meningitis
Diabetes
malnutrition
Mycardial infarct
Hepatitis
Asthma
Renal failre
Cardiac Failure
6
Fig 24 Leading Causes of death: NCD
5.7
Community-Based Services:
5.8
Social Welfare Division:
5.8.1.1
Brief Background/Introduction:
Social Welfare Service as the State Service was introduced in mid 1960s. Urbanization and growth in Honiara Town had not only brought about economic and social benefits but also introduced changes that had negative impact on people’s life. Many young people and women moved to Honiara and other urban centers seeking employment. Most of them had left their villages, schools or control of parents, family or traditional social safety net for the first time therefore were vulnerable to new changes and environment. Initially Social Welfare work targeted women, youth/children and destitute. These are vulnerable groups. As a result of this concern, following legislation was enforced:The Affiliation, Separation & Maintenance Act 1971;
Ministry of Health: National Health Report 2005 Page 92 of 250 --------------------------------------------------------------------------------------------------------------------The Juvenile Offenders Act 1972; Adoption Act; Education Act – Remission of School Fees; Policy Paper on Probation Service in Solomon Islands 1992; Provide Child Protection; 5.8.1.2
Social Welfare Data Summary (Brief):
In 2005, the number of custody cases dealt with by the Family Welfare Section has decreased compared to year 2004. This was so because in that year, Law and Order in this nation is very weak and many men had left their wives and marry their 02s. In the Juvenile Justice Section there is also a decrease in the number of cases dealt with compared to the 2004 records due to the gradual return of Law and order. Last year has also seen a rise in the number of self-referral cases due to the confidence and trust individuals have and placed on the Ramsi and SI Police. Custody Cases (Family) 15 cases Self Referrals 65 cases Juvenile 21 cases Adoption 1 case School Fee Remissions 10 cases 5.8.1.3 Organization & Staff: Social Welfare Office: HQ 5 established staff 1 Secretary Typist Male 2 Female 4 Gizo Office1 Male Total = 7 Movement of Staff Recruitment Nil Retirement Nil Redundancy Nil 5.8.1.4
Trainings Undertaken During the Year:
Paul Aaron
-
None None
Joana Ahikau Human Resources Management Course (IPAM) From 16/05/2005 to 20/5/2005; Introduction to Laws of SI from 8/8/2005 to 12/8/2005 Hellen Kotty: Human Resources Management Course (IPAM) From 16/05/2005 to 20/5/2005; Introduction to Laws of SI from 8/8/2005 to 12/8/2005 Judy Basi: Introduction to Laws of SI 8/8/2005 – 12/8/2005 Overseas travel during the year – None
Ministry of Health: National Health Report 2005 Page 93 of 250 ---------------------------------------------------------------------------------------------------------------------
Ministry of Health: National Health Report 2005 Page 94 of 250 --------------------------------------------------------------------------------------------------------------------5.8.1.5
Organisation Structure:
ESTAB 2005 1 1 1 1 1 1 1 1 1 1
ESTAB 2006 1 1 1 1 1 1 1 1 1 1
10
10
5.8.1.6
POST Head Social Welfare Chief Social Welfare Officer Child Protection Specialist Senior Social Welfare Officer Senior Social Welfare Officer Social Welfare Officer Child Protection Trainer/Advocator Probation Officer/Supervisor Probation Officer/Supervisor Secretary/Typist
GRADE LEVEL 12/13 9/10 8/9 7/8 7/8 6/7 6/7 6/7 6/7 5/6
NOTES
Vacant Post
Vacant Post Vacant Post Vacant Post
Activities Taken During the Year:
Family Court: Report Writing Home Visits Court Attendance (b) Juvenile Court: Report Writing Home Visit Court Attendance (c) Adoption: Report Writing Home Visit Court Attendance (d) Destitution: Cases and asking for Assistance from Red Cross;
è
Assessing Destitute
(e) Education Act: Remission of School Fees: Assessing applicants and submitting reports to the Ministry concerned and the two Gov’t Schools or to Other School Boards; To provide Child Protection; To provide Community Service Sentencing Alternative to Young Offenders; To play an effective and supportive role in raising Awareness and Advocacy on issues and problems affecting women, children and other disadvantaged groups; 5.8.1.7
Activities and Achievements:
Ministry of Health: National Health Report 2005 Page 95 of 250 --------------------------------------------------------------------------------------------------------------------On 12/05/2005 – Social Welfare Division purchased a through the recurrent budget. Now it is easier for us to see our clients, make home visits and to run other office activities. The Social Welfare Consultant (Mr. Allen Stewart) came last year to make a review of Social Welfare and to make new Strategic directions for the Division. The job done by this Consultant was funded by Save the Children Australia. He was working closely with the Head of Division, (Paul Fia). What has not been Achieved? To develop Child Protection Policy for S.I. (Draft) not Endorsed; To get two Probation Officers/Supervisors; To get one Child Protection Specialist; To get Child Protection Trainer/Advocator; 5.8.1.8 Annual Health Outcomes (relates to Goals/Outputs/Indicators: Goals: To provide Child Protection Services; To provide Community Service Sentencing; Alternative to Young Offenders; To ensure effective provision of functions and services; To play an effective and supportive role in raising awareness and advocacy on issues and problems affecting women, children and other disadvantaged groups; To ensure effective Probation and Juvenile Services; The number of cases recorded last year were the only cases been referred to the Division by the Magistrate/High Court and the Police. 5.8.1.9
HR. Issues:
In year 2005, Social Welfare Division has a total staff of 7. As of early this year, two of our top officers (Paul Fia and Aaron Olofia) had resigned to run in the upcoming election and there leaves only two of us (Hellen and Joana) to do operation and at the sametime acting the post of Director and the Chief Social Welfare. Last year Judy Basi was given a hand with the two sections of the Division and this was really helpful. As of this month, it was suggested by our previous Chief Social Welfare Officer that Judy should be posted to Gizo due to some personal family problem. Timothy Tabare (L5 Officer) was manning the Gizo Office. This officer is mentally sick and he needs a doctor to assess his situation and do something about it. As of 13/12/05, this officer had been adviced by the Provincial Secretary to stop working until further notice. This was due to an incident that happened between this officer and the Health Provincial Minister. At the moment he is on suspension. There is need that Malaita, Makira and Ysabel’s posts should be filled if its been budgeted for. In Honiara there is need for the posts of the Director and the Chief Social Welfare Officer to be filled immediately. Also we need two extra new staff to help out. At the moment only two of us are working and its too much for us. What we are doing now is just doing our routine job. Number Supervision tours Conducted
Proportion of staff with ACR completed 3
% 0
Ministry of Health: National Health Report 2005 Page 96 of 250 --------------------------------------------------------------------------------------------------------------------5.8.1.10
Infrastructure/Maintenance/Equipment Issues:
Social Welfare Office is been renovated and it was good. But I think if we are to get extra staff then there is need for an extension of this office. Also we need some new chairs to replace the old ones to look more like an office. We also need one typist’s chair. Assets Inventory Completed? YES/NO
Inventory last updated on: NO
5.8.1.11 Issues for Consideration in Future Planning: Inventory of all office assets; Keep proper record of tours annual confidential reports; All vacancy must be filled especially provinces; Training for In-Service Staff; We need 2 computers; 5.8.1.12
Any Other Comments:
The Post of the Director and the Chief Social Welfare Officer must be filled immediately with the other two additional posts.
5.9
Summary of Major Constraints
Strategies/Action Plan for the Way forward
Some of the things that hinders The division from achieving. Some of their goals/activities is lack of consultation between Government Ministries and NGOs and also lack of funding.
Social Welfare Division should work closely with other Government Ministries and MHMS, Divisions and with all Non-Government Organisations who are dealing with Youths, Women and Children.
Health Promotion:
5.9.1 5.9.1.1
Activities and Accomplishments National Level
The Operational Plan 2005 was subdivided into Administration and Management, Human Resource Development, Community Settings, Media and IEC and Research and Development. Under the Administration and Management, the department was able to implement only 64 percent 9/14 of the planned activities. Four of the activities which required (STC) were not implemented because of their non availability. For the Human Resource and Development, the department was only able to implement 78 percent 7/9 of the planned activities. The only two activities not implemented were policy related needing the (STC).
Ministry of Health: National Health Report 2005 Page 97 of 250 --------------------------------------------------------------------------------------------------------------------For the Community Settings component, the department was only able to implement 50 percent 7/14 of the planned activities. The difficulty encountered was to do with the delays in the securing of funding and the non availability of the coordinator. For the Media and IEC component, the department was able to partially implement 86 percent 13/15 of the planned activities. The two activity not implemented relates to IEC training (WHO) and (STC) policy related activity. Of the 13 activities, only 54 percent was implemented completely. We do not have the capacity in 2005. And finally for Research and Evaluation component, only 32 percent 2/6 of the planned activities were implemented. Low implementation rate is due largely to non availability of a social research officer we long for years now. 5.9.1.2
Provincial Level
Firstly the Provincial Operational Plans were developed entirely by the provincial health promotion staff and their Director of Health Services. Health promotion departments at the provincial level do submit annual reports to the national level. A reporting template have been designed and provided for the provincial annual reports. In the 2005, provincial health promotion annual report were compiled under four subjects Community trainings and Workshops, Community Settings, Media and IEC and Research and Evaluation. The community trainings and workshops conducted data reported and compiled was 68 altogether. This figure had dropped markedly by almost 66 percent from 2004. The huge drop was attributed to non availability of funding for needed community training activities. For the health promoting school programs, there was increase in the number of model schools from 1 in 2004 to 14 in 2005, health instructions and health inspections was 208, health services was 20 and community school organizations was 25 altogether. The increase in activities is indicative the better understanding of the health promoting school concept and need to address school health problems. In the work place settings, health promotion units were able to organize over 100 nutrition and health talks with video shows, medical examination (weight & height, BP and Glucose) and physical exercise for workers. A healthy workforce in a healthy work environment is the target. In the market place setting, health promoters were able to conduct 104 health talks, coordinate cooking demonstrations, health campaigns and distribution of IEC materials with health video shows. This is a good learning opportunity for the market authorities, producers and buyers. In the primary health care facilities and hospitals the health promotion staffs were able to coordinate and conduct 89 health talks and video shows targeted at visiting ANC mothers, PNC mothers, child welfare clinics, general out-patients and in the wards. These captive audience learn a lot from the health information disseminated. For the healthy town, three of the provinces were able to conduct (19) healthy town activities ranging from clean up campaigns, public health talks and video shows and inter departmental soccer competitions. All residents are targeted to empower them to make informed choices in life. Finally the healthy village and settlements the promotion staff were able to implement the following health activities in the communities. Village health inspections with health meeting (319), village health talks with video shows (247), village health campaigns (59), village implementation programs (174) and village health committees (41). These should empower the people participate fully in improving their health status.
Ministry of Health: National Health Report 2005 Page 98 of 250 --------------------------------------------------------------------------------------------------------------------The increase in the community settings activities is indicative of the health promotion staff understanding of the Settings concept to empower the communities to enable them to find solution for their own health problems. Media and IEC is another provincial activity reported in the 2005 annual reports. Notably only two provinces had reported the use of radio and newspaper. Honiara, City Council reported producing (112) radio programs and the Western Province reported (31) programs. These programs in the mass media can reach large population and influence people’s behavior. Further more only one province the HCC has produced 38 health columns in the Solomon Star paper for the general public in 2005. More over all provinces do not any production of IEC materials but they reported receiving from the national level. None of the provinces had reported having conducted any research or evaluation activities. The only M & E activity conducted was training post test and pretest, community profiling and pretesting of IEC materials. 5.9.1.3
Financial Information
This information was retrieved from the Ministry of Health Accounts Division. A budget of SBD $478,500 was approved for the National Health Promotion department. Only SBD $258,337.85 or 54 percent was expended in 2005. Budgeted activities not expended were research, IEC Training (WHO), Communication & Teaching skills and IEC production (video/print). Entry errors were identified under sub-heads (fuel & Oil, vehicle maintenance) which we were incorrectly advised to have been exhausted but still has outstanding balances. Constraints experienced with the budget was to do with repeated delays of funding request, infrequent statement of expenditures, non-availability of STC, in adequate capacity for research and IEC production in 2005. 5.9.1.4
Issues for Consideration In Future Planning
The 2005 Operational Plan for the National Health Promotion was too ambitious and not within the capacity the department has in 2005. There is a dire need to have a mechanism in place to monitor the Operational Plan implementation throughout the year. Resource allocation for health promotion activities at the provincial level must be improved to enable the staff to implement the settings activities. The funding request process at national level must be seriously addressed to avoid bureaucratic delays thus delays activity implementation. 5.9.1.5
Constraints and Possible Strategies/Actions
Summary of Major Constraints
Strategies/ Action Plan
Inadequate IEC capacity
Improve the IEC Production Unit. Recruit qualified IEC personnel Install proper production Unit & Resource
Ministry of Health: National Health Report 2005 Page 99 of 250 --------------------------------------------------------------------------------------------------------------------Centre. Inadequate Research & Evaluation Capacity.
Recruit a Social Research Officer Research Officer to drive the Health Promotion Research Committee activities.
Inadequate Funding
Provide more funding & resources to Provincial HP Units to mobilize community settings approach.
Inadequate knowledge of HP Concept
Training on Health Promotion Concept to all Health Managers.
Improve Communication , Coordination And Supervision
Improve communication from Program Managers to US/PS vise-versa. Improve communication from National to Province. Improve coordination and supervision of programs and staff.
Ministry of Health: National Health Report 2005 Page 100 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 6 6.1 6.1.1
Systems Performance- Monitoring and Evaluation:
Ministry of Health: Performance Evaluation19 The Scan of the Public Administration Functions
“Scan should help Ministry of Health to improve areas of low score or weaknesses” However, the MOH may need support from central agencies as the issues are of central control”
In 2005 the SIG Cabinet approved a reform of public administration functions across the SIPS that would be based on a Conceptual Model incorporating features of public sector governance and organizational capability. The Ministry of Health Executive welcomed the scan as it is an opportunity for an external and independent performance evaluation. This has been very timely as the Ministry of Health is undergoing a national health review in light of the longer term national strategic plan for 2006-2010. The scan is deemed as complementary to the Health Institutional Strengthening Project coming to its end in August 2006. Fig 17 is a brief of the admin scan.
Health 5
4.5
4.4 4.2
4
3.8 3.6
3.5
3.3
3
2.8
2.5 2.2 2 2
1.5
1
0.5
0 Strategy - Corporate Plan
Resource allocation
Strategy - Corporate Plan Resource allocation Systems & Procedures Strategy - Work Plan Structures People Capability Legislation Culture & Work Ethic
19
Systems & Procedures
Strategy - Work Plan
Structures
People Capability
Legislation
Culture & Work Ethic
4.4 4.2 3.8 3.6 3.3 2.8 2.2 2
RAMSI Governance Support Facility (2006): SUMMARY ANALYSIS PUBLIC ADMINISTRATION FUNCTIONS SCAN NOVEMBER – DECEMBER 2005.
Ministry of Health: National Health Report 2005 Page 101 of 250 ---------------------------------------------------------------------------------------------------------------------
6.1.1.1.1 Fig 25 and Table 6 shows the ratings for the MOH: 1 –lowest, and 5highest. 8 scales of Public Administration functions:
Comments
Each scale is rated from 1 to 5 on very broad criteria. 1 is the lowest score usually indicating that there was no evidence at all that the function was operating, and 5 is the highest rating indicating that the function was operating well and effectively.
1. Strategy – Corporate Planning
The rating of 4.4 is the highest rating of any of the public administration functions in this Department. Possibly because this agency has had considerable technical aid support over many years, the status of strategy setting and planning is very strong. They have a very sound current Corporate Plan with very good performance measures, although one of the US respondents believes that these could be improved. The linkage between Plans and Budgets is very sound, and reviews are completed once the budget is actually handed down so that targets are aligned. There is also a conscious management strategy to link the corporate directions down into both Annual work plans and Divisional operational plans, although again, there is a perception that some of the directors are not strong on this process and there could be improvements.
2. Resource Allocation.
This Department was one of the only two departments to consult extensively with clients and stakeholders during the development of strategic directions statements and plans The function of allocating scarce resources appears to be managed quite effectively, based on the rating of 4.2. During both the operational planning and the budget development processes there are discussions around what facilities, staff and funds are allocated to various output indicators, however the executive believe that this process could still be improved. In terms of adequacy of resources, most staff who need computers and other important equipment have access to them and in general the Department believes that its resources are adequate, with the assistance of AusAID. Transport, health clinics and housing both in Honiara and the Provinces all need serious improvement. Establishment vacancies are relatively high. However in comparison to many other departments the staff resourcing situation is reasonable. The budget allocation for training and capability building is
Ministry of Health: National Health Report 2005 Page 102 of 250 --------------------------------------------------------------------------------------------------------------------strategically used for the important needs and for example there was a Leadership and Management course during 2005 out of this allocation. 3. Systems and The rating of 3.8 for this function of having effective Procedures. systems and procedures to support the management of the Department is only just above average, but is higher than in almost all other Departments. Again this might reflect the result of a number of years of technical assistance and the current Corporate Services advisory team’s efforts. This function was sub clustered into 7 groups: Information Management, HRM, Procedures & Guidelines, Monitoring and Reporting, Budget processes, Communication and Systems Support. Information Management: Because of the health related functions within this Department there are a number of efficient data bases and Health Information Stats developed. However it appears that many of the systems are not networked and many others are still manual. General records management is in a similar state to most other departments and needs to be reviewed and upgraded. Human Resource Mgmt: The HRMIS is currently being upgraded within the HISP project to replace the general 2 file systems. Until this is completed, any staff statistics is manually collated. There is a very extensive and convoluted process for identifying priority professional development and training needs, but this needs to be streamlined to improve the currency of capability improvement. Records of this training however, are not comprehensive nor complete. Procedures & Guidelines: There have been a few internal procedures and manuals developed in relation to general administration, in addition to a range of procedures relating to clinical practice. There was a perception that there was little enthusiasm from line managers for ensuring that work standards were developed and implemented as a general practice. Monitoring & Reporting: Reporting against Corporate and annual plans is only done at the request of the PS / US and is not a routine management function. Line managers report annually on performance against budget spending
Ministry of Health: National Health Report 2005 Page 103 of 250 --------------------------------------------------------------------------------------------------------------------System Support: Given the intensity of donor investment within this Department the support for management systems was adequate. However, the shortage and unreliability of photocopiers in the headquarters office was an impediment. Budget Processes: All line managers are involved in the development of budget estimates, and they set activities against the budgeted programs for the following year. There is then a review of these activities after the actual budget has been allocated. Each manager is also provided with a budget expenditure spreadsheet monthly, however the reporting back on these at quarterly intervals is perceived to be a management weakness. Communication: There are regular meetings at the Divisional Heads level on both administrative and professional matters. However, the weakness is at the within-division level where only a few Divisional Heads have regular staff meetings with operational staff. Summary: Given the rating for People Capability analysed later in this Report, the Department would benefit if the entire HRM function could be strengthened. This no doubt is being addressed by the current HISP team. Performance monitoring and reporting against planned targets and measures needs to be strengthened to improve the overall management of the department. Similarly, line managers could benefit if they were more aware of setting standards and procedures for required performance levels to meet service delivery goals. Performance Management generally could be improved if Divisional Heads were more committed to communicating with their operational staff on all matters related to standards and quality of service delivery. As the general trend across all departments indicates, this department could also benefit from a professionalisation of its records and data management systems. While the budget development process is a much stronger management function in this department than in most others, the full benefit of this is not realized because of the lack of ongoing management monitoring and reporting against expenditure.
Ministry of Health: National Health Report 2005 Page 104 of 250 ---------------------------------------------------------------------------------------------------------------------
4. Strategy – Work Plans and Policy.
Overall the Health Department does have a stronger rating on this function than all other departments, and this indicates that managers generally are being supported by relatively effective administrative functions. However, as the above comments suggest all seven sub-functions could be improved, particularly in the areas of managing and monitoring performance within Divisions. The rating of 3.6 indicates the need for some directors to improve their development and implementation of operational plans. While there are many who carry out this function effectively, it is not an accross-department strength. Those whose operational plans are incorporated into ongoing work activities do have sound performance measures and report back to the Executive at least quarterly on progress. Those divisions that are perceived to be performing well, have informal discussions with the US more frequently than the formal Quarterly reports. Those same Directors tend to also link these plans, and the National Health Strategic Plan, down into individual staff work targets. But again, this function is patchy in its effectiveness. There is a perception that nearly 80% of line managers are not using their plans to guide daily operations, nor do they report on them as an aspect of strategically managing the Department. In particular, there is a need to build in Workforce Planning and Resource planning into these Work Plans. There is currently work being done on a workforce plan to replace the existing Training needs plans, and they are currently recruiting an Asset Manager who will be tasked with developing a full equipment needs analysis to update the 2004 assessment. There have been a number of internal departmental policies developed to support the strategic directions that conform with the GOs, such as Patient Care and Referral Guidelines, Delegations Manual etc.
5. Structures.
In general there is an ongoing need for improving this function to ensure consistency of Strategy across the department The rating of 3.3 indicates that the Department could benefit from a closer alignment between its overall structure, the way the priority work is formed into jobs, and its strategic direction and performance targets. It is very difficult to achieve corporate targets when the internal flow of operational activity is not strategically aligned with those targets. There is a current Organisational Chart and a couple of the Divisions have developed specific structural charts.
Ministry of Health: National Health Report 2005 Page 105 of 250 --------------------------------------------------------------------------------------------------------------------However, these would only be familiar to executives and line managers. Few staff would have much idea of the existence of such documents or of where they would fit into the chart. Few staff, particularly those under the vertical programs such as the Vector Borne Disease Program and the Provincial structures, would be fully aware of their formal reporting lines. However, those staff in national programs would be more aware of their internal structures. Since the HISP project in 2000 the Department has not carried out even a superficial review of its structure to align it with the Corporate Plan or the annual working plans, nor is there any review of how jobs are designed to meet planned targets, despite there being 99 vacant positions within health services. While there is currently a review of some job descriptions, in general staff are not aware of what their JD actually contains other than the title of their positions, but when asked what their role is most people are able to say what is being expected of them. This does not result in achieving desired targets or results however, but this is more a factor of lack of supervision than a ‘not knowing what to do’.
6. People Capability.
The Department could expect to see a marked improvement in performance if this one function received some attention to align the structure of work with work targets. The rating of 2.8 indicates that the overall levels of skills and abilities of staff are probably causing serious impediments to the standards of service delivery required by the executive. To improve this situation, line managers could be assisted if they developed performance development plans for individual staff that would align their skills and knowledge with the priority work targets. These Plans would then inform the annual training or professional development plans linked to the budget. Further if staff could see that they had even a basic career path within their work place that their development was preparing them for, their overall commitment to their work might improve. In addition, the centralized performance appraisal system is not the most effective mechanism to improve individual staff capability to meet specific service delivery targets. The Departmental performance generally, but Divisional work units particularly would be assisted if staff had some process whereby they were able to receive feedback, both positive and developmental, on their performance. This then assists them to be more committed to whatever development plan has been formed for them. Given the professions employed in the Health sector, it is
Ministry of Health: National Health Report 2005 Page 106 of 250 --------------------------------------------------------------------------------------------------------------------not surprising that there was a general rating of 3 to 4 on the Dependency Scale of Staff Capacity, as almost all of these roles require formal qualifications. To ensure a basic succession strategy, a targeted Graduate recruitment program would probably benefit the clinically related Divisions.
7. Legislation.
8. Culture & Work Ethic.
One of the strengths supporting the existing performance of people is the evidence for a high level of cooperative team work across most of the Divisions. The rating of 2.2 indicates that most of the specific acts and regulations relating to the Health and Medical Services portfolio is considered by the executive to be out of date (1988) and have not kept up with the new directions in service delivery and what the department is currently drying to do. The existing legislation is not useful in providing community based health services, and the executive and staff have to try to deliver services based on this philosophy, but within conflicting acts and regulations. Most of the executive and decision making managers are aware of the various pieces of specific legislation, but feel constrained by them. As found in all other departments, the central agency legislation – Public Service and Public Finance Acts – are not incorporated into management functions and few executives are even aware that there are obligations for them contained within these Acts. The rating of 2.0 was the lowest rating function for this Department, and indicates that executive directors may need to pay attention to the general work morale and commitment within the Divisions. In terms of a formally defined set of work values which leaders then manage, the Department does not have any, apart from professional codes of ethics relating to the medical professions. Informally some of the more committed Divisional Heads attempt to role model a set of positive work values, but many others are seen not to be good role models themselves. This flows on to a situation where some Divisions do have very positive work cultures and high morale, where as others do not. For most people in this Department the Public Service does not provide them with a desirable career, and the poor standards of wages contribute strongly to this. Many staff are forced to take on second or part time jobs to achieve even a basic standard of living. In such situations it is unlikely that the work culture will be very positive.
Overall Analysis of the Department of Health. The overall rating for Public Administration functions within the Health & Medical Services Department is 3.29. This means that the department generally and executive mangers specifically are being
Ministry of Health: National Health Report 2005 Page 107 of 250 --------------------------------------------------------------------------------------------------------------------fairly adequately supported by their internal administrative systems. However, a rating between 3.0 and 4.0 indicates that there is room for improvement if the department desires to strengthen its internal operating efficiencies, and the closer to Rating 3 the score is, the more improvements can be achieved. The status of many of the public administration functions in this Department indicated sound implementation. There was evidence that the corporate planning component of the Strategy function was operating effectively across the Ministry, closely supported by a targeted allocation of Resources. To a lesser extent internal Systems & Procedures and the Strategy sub-function Operational or Annual Work plans were also supporting line managers, but there was evidence that there is real room for strengthening both of these processes to achieve sustainable performance improvement. Of particular priority is a strengthened management ability to implement sound performance management systems and processes. A closer Structural alignment could certainly assist the executive ensure that the flow of work and job requirements were clearly designed to maximize efficiencies. Of serious concern are the two functions People Capability and Work Culture, as well as the Strategy sub-function of Legislation. In this regard it is suggested that line mangers and executive could benefit if they adopted a stronger leadership and public management role in their Divisions. The best Corporate Plans can not deliver the required level of services to the community if the staff who actually work at the operational level do not have the necessary commitment to that work, or the required skills and knowledge. Similarly, without the relevant legislative base decision makers are impeded in their tasks of ensuring that the priority services are delivered in the manner expected by the public.
6.2
Primary health care clinics utilisation20
At November 2005, there were 323 PHC clinics and 10 hospital outpatients departments providing Primary Health Care (PHC) services across Solomon Islands. A review of PHC clinic utilistation was conducted in 2005 with a view to making recommendations for health service rationalization21 Due to complexity of the report finding, Nurse Aid Posts (NAP) and Rural Health Centres (RHC) that fail to reach or exceed benchmarks should be reviewed in the full report. For most adjustments of designation or staffing levels can be considered The results presented in this summary are for RHC and Area Health Centres (AHC) that require upgrade to AHC or mini hospital status as these have major implications for health infrastructure development and human resources planning. These are the major utilisation considerations for the NHSP
6.2.1
Solomon Islands Primary Health Care Clinics Utilisation Review
“PHC Clinic utilization review highlighted clinic management issues to services delivery and resources, and implicates on infrastructure planning”
Data Source: Data for the review was obtained from the MOH HIS. Data suitable for assessment of clinic utilisation were:
20
Primary Source for the Clinic Utilization from: HISP/MOH 2006:
Solomon Islands National Health Review – February 2006 21 This review was completed by the HISP NHRA in December 2005
Ministry of Health: National Health Report 2005 Page 108 of 250 --------------------------------------------------------------------------------------------------------------------Total outpatient contacts (new and return cases of disease) Reproductive health contacts (antenatal and postnatal care, family planning) Child welfare contacts (growth monitoring and vaccination) Number of inpatients (defined as “any person admitted to the clinic for any form of medical treatment or bed rest for one night or more”)22 Number of clinic births: 2004 utilisation data was chosen as it was complete, information previously collected about the number of months individual clinics were open for the year were available and the monthly reports completion rate of all clinics was reliably known. The data were visually scanned to identify problems and difficulties. These were rectified and annual and average weekly statistics for the above calculated and tabulated.
Clinic benchmarks: \ A set of simple utilisation benchmarks, based on the average number of patient contacts a week, clinic births and inpatients, were developed against which to assess clinic utilisation. (Table 4). These operate as a guide that indicate when variations of clinics designation or staffing/skill mix need to be considered by MOH and Nursing Executives and PHD and Senior Nurses in provinces. The benchmarks are not suitable for application to urban health services where there is demand for ambulatory care services but not birthing or inpatient services. The number of clinic births and inpatients are indicators of the need for access to more complex care and management or additional training to manage maternity care and birthing and can be used as indicators of when change of clinic designation or staff skills mix should be considered. Each clinic assessed by the review was measured against the utilisation benchmarks and on this basis was rated as having met or exceeded the benchmark for their current designation (AHC, RHC, NAP) or if this was unclear this is stated.
Benchmark Number of weekly contacts – outpatients, reproductive health, child welfare Annual clinic births Annual inpatients (total including births)
NAP RHC AHC Mini Hospital 30 to 70 70 to 150 150 + No limit ≤20 ≤40
≤70 ≤150
≤200 ≤500
≥200 ≥ 500
Table 7: Solomon Islands PHC clinics utilisation benchmarks
Mapping and location: With the assistance of the staff at Solomon Islands Ministry of Lands and Solomon Islands Institutional Strengthening of Land Administration Project (SIISLAP) all known PHC clinics were mapped on topographic maps that also detailed population density and distribution. These maps are important for understanding distance between clinics, their distribution and isolation and the information they provided was considered in the discussion of individual clinics and suggested actions.
Limitations Disaggregated data were not available for 89 PHC clinics because these clinics have not been individually listed/added to the HIS database. Data for these are aggregated (combined) with data of 47 clinics listed in the HIS. Eight of these 47 contain aggregate data for 2 or more additional clinics. In total there are no disaggregated data available for 136 (43%) clinics, hampering interpretation of utilisation data23. Until the
Guidelines on the monthly reporting on health activities – Statistics Unit MOH, 1994 For epidemiological analysis and reporting aggregated data are not a problem as the goal is to report total cases of disease at provincial and national levels.
22 23
Ministry of Health: National Health Report 2005 Page 109 of 250 --------------------------------------------------------------------------------------------------------------------PHC HIS is redeveloped this problem will continue to worsen and repeating this review of utilisation using the same methodology will be difficult or impossible.
Results summary: PHC clinic utilisation of 232 clinics was compared with the utilisation benchmarks. Of these, 95 (41%) were assessed as meeting one or more benchmarks, 33 (14%) exceeded the benchmarks for current designation, 55 (24%) met no benchmarks and for 49 (21%) the situation was unclear. A small number of clinics are very poorly utilised and should be considered for closure as they do not appear to be sufficiently isolated to maintain a full time clinical service. Identification (tables) and discussion of clinics failing to meet or exceeding benchmarks is included in the main document. Two clinics reached the upgrade criteria for mini hospital both in Malaita, 4 RHC met the upgrade criteria for AHC, all in Malaita. An additional 4 were approaching the AHC upgrade criteria, 2 Malitan clinics, 1 Central and 1 in Western (see recommendations following). 52% of clinics exceeding benchmarks are in Malaita province. 78% of clinics identified for upgrade from RHC to AHC or AHC to mini hospital are also in Malaita. Clinics reaching benchmarks for upgrade to Area Health Centre and mini hospital status
Area health centre to mini hospital status: Two north Malaitan clinics met the inpatients and clinic births criteria for upgrade to mini hospital status, Mau’lu AHC and Fau’abu RHC (Table 5). Grove AHC (Table 5), located on the Guadalcanal plains, does not yet meet the criteria however the 2003 June 2005 utilisation trend demonstrates rapid progression toward it. Numbu NAP data is included in Grove AHC and its contribution cannot be assessed. A mini hospital is currently being constructed at Grove with assistance from Don Bosco.
Name
2005 (Jan-June data) 2004 2003 Province Inpatients Clinic Home Inpatients Clinic Home Inpatients Clinic Home births births births births births births
Grove GP Mau’lu MP Fau’abu MP
242 1097 629
113 107 103
62 49 37
251 2115 1437
142 237 212
108 117 36
197 2143 771
89 271 217
81 81 51
Table 8: Clinic utilisation data Grove AHC, Mau’lu AHC and Fau’abu RHC 2003-2005
Rural health centre to area health centre status: On recent utilisation trends, Biti’ama RHC in north west Malaita, Gwanuatolo RHC and Takwa RHC in north east Malaita and Maoa RHC on the central west Malaitan coast all exceed the inpatient criteria for upgrade to AHC status (Table 6). Maoa is approximately 40kms south of Auki and more than 90kms north of the next closest AHC Afio. Takwa is between Gwanatolo RHC (which is about 12 kms south) and Mau’lu AHC to the north west. Bita’ama is north of Fau’abu and south west of Mau’lu AHC. (Table 6). Increasing the capacity of Mau’lu, Fau’abu and Gwanatolo to manage inpatients may reduce the inpatient burden on Bita’ama and Takwa RHC. Maoa needs to be considered for AHC upgrade.
2005 (Jan-June data)
2004
2003
Ministry of Health: National Health Report 2005 Page 110 of 250 --------------------------------------------------------------------------------------------------------------------Name Provinc Inpatient Clini Hom Inpatient Clini Hom Inpatient Clini Hom s c e s c e e s c e birth birth birth birth birth birth s s s s s s Bita’ama Gwanuatol o Maoa Takwa
MP MP
159 134
39 71
14 23
238 237
51 117
10 31
99
11
23
MP MP
105 98
27 25
10 11
155 195
69 118
45 2
130 155
68 93
33 16
Table 9: Clinic utilisation data Bitiama RHC, Gwanautolo RHC , Maoa RHC, Takwa RHC 2003-2005 2004 data for Batuna RHC in Western province, Tarapaina RHC and Talakali RHC in Malaita province and Taroniara RHC in Central province indicated these clinics met at least one benchmark for upgrade to AHC. (Table 8). Review of data from 2003-2005 do not support upgrade of Batuna at the current time however utilisation should be monitored over the next 1-2 years. Taroniara has almost reached the AHC threshold however the impact of utilisation data from Narogu NAP, (which is recorded in Taroniara), needs further assessment. Data for Tarapaina suggest that the AHC upgrade threshold will be exceeded in 2005 for births and possibly inpatients. The discrepancy between 2004 and 2005 inpatient data for Talakali suggests a change in reporting practice rather than a change in trend. This clinic should be monitored as it is approaching the upgrade threshold.
2005 (Jan-June data)
2004
2003
Name
Provinc e
Inpatient s
Clini c birth s
Hom Inpatient e s births
Clini c birth s
Hom Inpatient e s births
Clini c birth s
Hom e birth s
Taroniar a
CIP
68
30
0
179
50
3
184
77
6
Batuna Tarapain a
WP MP
70 77
26 44
4 0
257 238
51 82
1 6
175 169
66 69
2 7
Talakali
MP
28
53
16
130
86
61
128?
103
49
Table 10: Clinic utilisation data Taroniara RHC, Batuna RHC and Tarapaina RHC 2003-200
Linkages with MOH infrastructure review: The recent report “Primary Health Care Facility Infrastructure Rehabilitation Plan – Stage 1 Area Health Centers”24 identified several clinics to be considered for upgrade to AHC status. Choiseul: Wagina RHC data do not support development of an AHC at the current time, however supervision and support needs of clinics in the south east and south west of Choiseul and distance to other health centers may outweigh current utilization statistics. Makira: Marogu RHC utilization data do not support upgrade to AHC at the current time however geographic location and supervision support needs may outweigh statistics.
24
HISP 2005
Ministry of Health: National Health Report 2005 Page 111 of 250 --------------------------------------------------------------------------------------------------------------------Malaita: Malu’u AHC and Fau’abu RHC are discussed above. Current utilization statistics do not support upgrade of Afio AHC to mini hospital status at this time. Collection of additional data about referrals against the MOH referrals policy would be helpful to assess why they are made and whether alternatives to referral to NRH exist. Utilisation for Rohinari RHC, Sinamauri RHC and Ata’a do not support upgrade at the current time. Talakali is approaching upgrade benchmarks as discussed above. Western Province: Utilisation data support Noro Taiyo and Noro public clinics merging to form a single Urban Health Centre, with consideration given to maintaining a birthing service and limited inpatients. Batuna is approaching upgrade benchmarks as discussed above; Ughele RHC does not meet benchmarks for a RHC. Temotu: Dendu RHC does not currently reach, nor is it approaching AHC benchmarks.
6.2.1.1
Major discussion points:
The results of the clinic utilisation review demonstrate different trends and great variability in use of health services across individual provinces and between provinces. Clinics not meeting benchmarks require review of staff numbers and skills mix against local health need, distance and proximity to the nearest clinics. Methods for increasing clinic productivity need exploration, for example increased outreach and health promotion in response to local health needs. Results support future posting and training of specialist staff according to clinic workloads, skill mix needed to meet individual clinic demand and skill mix at adjacent clinics. This argues for adoption of a flexible clinics designation (e.g. ‘health clinic’ rather than a NAP/RHC) and staffing model based on need rather than population parameters. The role delineation for PHC clinics developed in December 2005 also supports this approach as the PHC levels are skill rather than population based. Because many clinics demonstrate low utilisation and as there are growing numbers of clinics the policy governing establishment of new health facilities needs to be reviewed. In particular the 3km radius of service delivery for clinics could be increased. The HIS from which data used were drawn from cannot readily supply utilisation data in the future. Programs for health facilities utilisation and planning need to be programmed into future health information systems.
6.2.1.2
Recommendations Clinic Utilisation Review
Recommendation 1: PHD and senior nurses in each province review clinics not meeting utilisation benchmarks with a view to determining reasons for poor utilisation and exploring options for increased productivity, closure or change in staff numbers.
Recommendation 2: PHD and senior nurses review and further investigate RHC approaching or meeting benchmarks for AHC upgrade to determine whether high demand for inpatient services could be reduced through increased public health activity. Priority clinics for investigation and monitoring are:
Talakali RHC Malaita Province Tarapaina RHC Malaita Province Takwa RHC Malaita Province Biti’ama RHC Malaita Province Batuna RHC Western Province Taroniara RHC Central Province Recommendation 3: MOH executive and Malaitan PHD prioritise: Upgrade of Mau’lu AHC to mini hospital Upgrade of Fau’abu RHC to mini hospital or at a minimum AHC Upgrade of Gwanatolo RHC to AHC Upgrade of Maoa RHC to AHC
Ministry of Health: National Health Report 2005 Page 112 of 250 --------------------------------------------------------------------------------------------------------------------MOH executive and PHD to monitor impact of any future upgrade of Malu’u AHC, Fau’abu RHC and Gwanatolo RHC on Takwa RHC Malaita Province and Bita’ama RHC Malaita Province before these clinics are upgraded.
Recommendation 4: MOH executive use results of this report, especially findings for RHC to AHC upgrade to priorities health infrastructure projects.
Recommendation 5: National nursing executive, provincial senior nurses and PHD use the utilisation statistics to guide nursing staff postings, skill mix and training plans25. In particular clinics with high numbers of clinic births or RHC exceeding the clinic births benchmark be prioritised for training and placement of trained midwives.
Recommendation 6: The approval process for development of new clinics be revised and include elements listed in the discussion section of the document.
Recommendation 7: Consideration be given to calling NAP and RHC ‘health clinics’ and staffing these in response to community health needs26
Recommendation 8: The HIS (software and data collection processes) be urgently redeveloped so that it provides information that can be used for ongoing assessment of clinic utilisation.
Recommendation 9: The clinic benchmarks developed for this review be evaluated within 2 years for ongoing utility.
Recommendation 10: Maps of health clinic location be reviewed and updated annually at the National Health Conference.
6.3
Role delineation for PHC clinics and hospitals:
In December 2004 the primary health clinics and hospitals role delineation was redeveloped by HISP27 and accompanies the PHC clinic utilisation review. This section of the report presents the complete role delineation document as it cannot be summarised. One of the recommendations made by the utilisation reports is for RHC and NAP to be called by a generic name ‘health clinic’ and be staffed according to health care need. The role delineation supports this approach by defining NAP and RHC according to the skills base of staff. Thus a facility staffed by at least one registered nurse corresponds to a rural health centre in the role delineation and can offer packages of essential health care appropriate to the nurses training level.
6.3.1
Introduction
This analysis should be linked with WHO WISN human resource management approaches currently being implemented by HISP Reference the Solomon Islands Health Facilities Role Delineation developed by HISP in 2005, which supports this via a skill based approach to PHC clinics role and designations 27 By the roving Primary Health Care Advisor (PHA) for Guadalcanal, Honiara, Renbel and Isabel provinces 25 26
Ministry of Health: National Health Report 2005 Page 113 of 250 --------------------------------------------------------------------------------------------------------------------In 2001 the Ministry of Health released a policy entitled “Role delineation of Health Care Services in Solomon Islands”. The aim of the policy was to improve and upgrade management, supervision and distribution of health care resources across Solomon Islands. A time frame of 5 years following implementation was set for review of the policy. In January 2006, the policy was reviewed and re-developed to frame health services role delineation in terms of which elements of the ‘packages of essential health care’, they deliver. The new model has five levels of health service delivery: three primary health care, one general hospital and one specialist hospital level. The packages of care selected encompass the major communicable causes of morbidity and mortality in Solomon Islands, emerging health threats and health transition diseases. The selection also encompasses reproductive and child health needs, rehabilitation, mental health, emergency care, referral and outreach for services not offered by local or provincial health services. The packages of care and role delineation outlined in the document will support MOH executive, PHD and Directors of Nursing (DON) to plan, staff and manage Solomon Islands hospitals, PHC clinics and integrated public health functions.
6.3.2
What are packages of care?
‘Packages of care’ are essential health care interventions or groups of interventions and services provided by government and/or the private sector to meet the health care needs of the population. Information to guide selection and development of packages of care for a country, province, health district or area can be sought from: Epidemiological and public health data about disease incidence, prevalence, trends and how these impact on health services demand Technical information about disease control and prevention interventions including vaccination, vector control and health promotion Documented evidence supporting implementation of health programs shown to decrease morbidity and mortality (eg pregnancy care and births assisted by trained health providers) International health trends and evidence (eg rising incidence of mental health disorders) Evidence of a health transition (eg rising incidence of non-communicable disease in countries with continued high incidence of communicable diseases) Emerging health threats (eg HIV/AIDS and avian influenza) Information about new program approaches to health issues (eg men as partners) New packages of care can be added to a role delineation matrix as the need arises. Need may be demonstrated by changing health indicators locally or internationally, new evidence supporting change of interventions or implementation of new interventions, international health alerts or progression of the health transition with increasing incidence of non-communicable diseases.
6.3.3
How do packages of care articulate with role delineation?
Packages of care outline the main health care interventions that are implemented in response to a particular health condition or problem, from simple low technological interventions through to those that are more complex or specialist in nature. Put simply health facility role delineation determines what parts of each package of care each level of the health care system delivers. Health facilities with low technological availability, few staff or less skilled staff deliver those parts of the package of care that are not reliant on technological interventions or more highly skilled or specialist staff, for example a nurse aide post or rural health centre. Health care facilities with infrastructure, equipment and appropriately trained staff to support technologically complex interventions offer those parts of the package that require these additional technologies or staff skills. An example is caesarian section, an intervention that can only be offered at health facilities (hospitals) with a theatre, medical and anaesthetics trained staff. In contrast pregnancy care can be offered at all levels and women with risk factors or problems can be referred.
Ministry of Health: National Health Report 2005 Page 114 of 250 --------------------------------------------------------------------------------------------------------------------6.3.4 Continuum of Care The packages of care developed for Solomon Islands recognize and incorporate a continuum of care from health promotion and prevention activities through to acute care and maintenance as appropriate for the package. Each health program in the matrix has a core health promotion focus and where applicable, millennium development indicators are outlined. The aim of a continuum of care is to highlight that health interventions begin, and have importance, before the onset of acute disease and that public (population) health approaches that concentrate on disease prevention and early diagnosis, before onset of complications, are as important as acute care interventions. A continuum of care also recognises that health interventions do not end with acute care interventions and for some illnesses must continue through until cure, death or rehabilitation goals are achieved.
6.2.2.5. A continuum of care incorporates: Health promotion and disease prevention activities (for example HIV/STI prevention campaigns, healthy diet/lifestyle advice) Early intervention and management (for example screening of individuals with high risk of diabetes, early diagnosis and management, voluntary confidential counselling and testing for HIV) Acute treatment and care services – outpatient and inpatient (for example treatment of medical conditions and diseases such as malaria, acute respiratory infections, asthma and surgical conditions, conditions related to AIDS) Rehabilitation and sub-acute care (follow up care of aged, disabled of post illness/surgery) Maintenance and palliative care (eg cancer patients, HIV positive, diabetes)
6.4
PHC Quality Check 28:
Between February and May 2004, the MOH conducted a survey of PHC clinics to gather information about a range of factors that potentially impact on provision of care by PHC clinics. Accordingly transport availability, communications (radios), infection control infrastructure and equipment, standard treatment protocols and supplies (essential drugs and EPI) were assessed. Each of the areas assessed provides information about PHC clinics capacity to provide quality PHC health care services and health programs. The survey also sought to quantify number of PHC clinics that conducted health education/promotion outreach activities and had active health committees. The survey report is available from the HISP team in Honiara and MOH.
Key Findings:
“Essential supplies to clinics remain an issue”
Infection control: “Infection control needs
63% of clinics reported access to a steriliser. Of these 65% had a more effort to improve at all primus to heat the steriliser. 66% of clinics with a primus had fuel at clinic levels” the time of survey. NAP had lowest coverage of sterilisers (48%). 71% reported availability of gloves (surgical) at all times, 23% had gloves sometimes. Water was piped into 116 clinics (54%) and described as always working by 60%
Transport: 50% (9) AHCs29had access to a canoe. Only 4 of these reported a working outboard motor (OBM). Distribution of canoes was lower at RHC
28 29
“Lack of transport was the most commonly cited reason for lack of outreach, followed by lack of staff and
JTA/HISP/MOH (2006): Primary Health Care Survey 2004: in the SI National Health Review Contents defined by MOH Reproductive Health Unit
Ministry of Health: National Health Report 2005 Page 115 of 250 --------------------------------------------------------------------------------------------------------------------35% (26) having a canoe, and 17 a working OBM. 5% (3) NAP had canoes, 2 with a working OBM
Clinical care protocols: Overall there was poor availability of standard treatment protocols. 37% of clinics had women’s health protocols, 57% had family planning, 57% paediatric, 44% adult and 75% malaria protocols. The lowest availability of protocols was in NAP.
Clinic equipment and supplies: “Basics 75% of clinics had a full delivery kit30, 61% had adequate equipment for lacking or activities and 53% had run short of supplies or drugs in the 3 months inadequate survey. NAPs and UHC most commonly reported shortfalls of drugs or at the PHC There was a good distribution of EPI fridges across Solomon Islands, results demonstrated that a large proportion did not have a 3 month fuel supply
day to day prior to the supplies. however
Health outreach and health committees Health outreach activities were conducted by 52% of clinics. Lack of transport was the most commonly cited reason for lack of outreach, followed by lack of staff and distance. Most clinics had health committees but these met irregularly.
Major discussion points: The PHC clinics survey identified several areas for action to improve the quality and delivery of health care services across Solomon Islands. Some can be addressed through provincial action, for example purchase or redistribution of canoes to AHC, improvement of clinic water supplies and ensuring availability of EPI fuels to support cold chain and minimise vaccine wastage. Redevelopment and distribution of clinical protocols requires a national lead from MOH and support of provinces. The current poor distribution of clinical protocols does not support nurses and nurse aides as practitioners in remote areas and increases the risks for making drug administration and treatment errors. An additional consideration is that protocols in use date from the early 1990’s. Drug names, types and best practice approaches may have changed in the intervening period and new approaches such as ‘integrated management of childhood illness’ have been introduced, leading to overlap of protocols and potential to create confusion. Difficulties persist with availability of drugs and medical sundries to clinics and may indicate problems with timely ordering by clinics staff, delays in preparation of supplies by National Medical Store or transport problems. Adoption of the clinic minimum standards guidelines and “Overall there was increasing use of the clinic quality improvement checklists by clinic poor availability of nurses and supervisors may help to improve these difficulties.
standard treatment
6.4.1
MOH Infrastructure -Issues:
Challenges facing ‘MOH Infrastructure’ fall into two categories, upgrading and renovating existing facilities and increasing the capacity of the MOH to manage health facilities. Up to 70% of PHC clinics require significant upgrade, repair or renovation. The degradation of health facilities has happened over decades. There are many varied projects underway, but work of this is needed for many years to come.
6.4.2 30
National Infrastructure Management:
“The current poor distribution of clinical protocols does not support nurses and nurse aides as practitioners in remote areas and increases the risks for making drug d i i t ti d
nature
Ministry of Health: National Health Report 2005 Page 116 of 250 --------------------------------------------------------------------------------------------------------------------The recruitment of a National Health Facilities Manager is again underway but as yet no suitable applicants have been received. The is a key role for a number of reasons including; The development of a maintenance program, which would be run at provincial level. Co-ordination of capital works programs and donor activity. Implementation of policies and guidelines such as the “Minimum Standard for Clinic Infrastructure.” Represent MOH on important government and donor initiatives such as the “SIG Housing taskforce” or Global Fund, “VBDC Works Projects”. As there is no indication the Department of Works will be strengthened in the near future more responsibility will continue to fall on the Ministry of Health. The temporary ‘Project Manager’ position will help to manage consultation, liaison with regulatory authorities, procurement, tender and project management of capital works. Unless a large Capital Works program is taken up by SIG or a donor the need for this role will continue for more much longer, assuming that health facilities in need of repair will continue to be rehabilitated. Requests have been made for technical assistance for projects such as the upgrade of, pharmacies, microscopy labs, storage sheds and entire clinic or hospital upgrades for which government and donor funds are becoming available.
6.4.3
Provincial Infrastructure Management:
Much of the work managing infrastructure is falling on the shoulders of the Provincial Health Direcors such as emergency maintenance and preparing infrastructure proposal for donors. More work can be done to develop “Provincial Infrastructure Plans” to include Provincial Hospitals, PHC Clinics and housing. There needs to be a continuation of a strategic focus as well and operational planning on how go about improving facilities and managing recurrent cost such as maintenance.
6.4.4
Local Infrastructure Management
The development of preventative maintenance programs (i.e. white ant detection) and increasing the ability of clinic staff and the community to fix problems when they arise or notify someone is important. Working with the local community and village health committees which provide support and resources is also vital.
6.4.5
Health Infrastructure Reviews
By the end of April 2006 we will know, in detail, the condition of all AHCs and RHCs. It is important that the new RHC infrastructure needs are incorporated into the Provincial Infrastructure Plans. Further evaluation of provincial hospitals, NAP, Nurse Training Facilities and housing is needed.
6.4.6
Provincial Hospitals & housing
The shortage of adequate housing and ambiguous housing policy is still a major problem. The funds available to the MOH, and commitments by donors are not meeting the needs. Implementation of the Regional Assistance Mission to Solomon Islands (RAMSI)/SIG Housing Review’ recommendations may solve this problem. Some work is commencing at provincial hospitals, however only limited master-planning, integrated design, or facility analysis has been done. There are at present no guidelines for design or construction with much important works needed at all provincial hospitals.
6.4.7
AHC Rehabilitation Plans
Following the AHC Infrastructure review in August 2005, there are plans to improve six of the 19 AHCs needing improvement.
Ministry of Health: National Health Report 2005 Page 117 of 250 --------------------------------------------------------------------------------------------------------------------Consequently, following further review of the 3 HCC clinics and two AHCs projects dropped by the Solomon Islands Health Sector Development Program (SIHSDP) there are at present 18 AHCs in need of some infrastructure work, six of which are in a bad state of repair. There have been improvements in the form of solar lighting and radio installation. At bare minimum each of the remaining 18 AHCs need an incinerator, sealed rubbish pit, clean and dirty utilities, a functioning toilet and shower, a reliable water supply and eradication of white ant infestation.
6.4.8
RHC Clinic Review:
The preliminary results from the RHC infrastructure review are showing the same trends as those found in the AHC review. The problems directly linked to poor infrastructure include; Poor water, power supply and sanitation Poor housing (or no housing, posted staff returning to villages) Bad location & poor access to some clinics Poor Infection control, hygiene & waste disposal Overcrowded OPD and lack of adequate treatment areas.
6.4.9
Unfit or inappropriate birthing facilities
Lack of infrastructure for PHC activities such as outreach, antenatal classes, health education, counselling, HIV and STI awareness, condom distribution & integrated medical tours (mostly held in small crowded outpatients departments or under a tree, lack of privacy etc.)
6.4.9.1
Need for upgrade of equipment & furniture:
Lack of storage for medical supplies, pharmacy, fuel & equipment. Physical deterioration of buildings due to age, weather and white ant s. It is also recommended that funding be made available or donors found for the upgrade of the six most urgent clinics with-in the next year.
6.5
Program Performance:
6.5.1 6.5.1.1
Program achievements of Outputs in 2006: Environmental Health Division- 31:
By 2005, since 2003, of the total 14 water supply projects funded under EU, 12 (86%) were completed Only 2 projects are pending completion. By 2005 10 projects (sanitation projects) funded under ROC completed. Gazette of Food Hygiene and Fish and Fishery Regulation done. Office space and health center at Airport completed and in use: Space at Port under negotiation. 6.5.1.2
HIV/STI Prevention- Disease Prevention and Control Unit
VCCT Sites established and operating at SIPPA, Rove Clinic, HIV Prevention Unit and National Referral Hospital. Auki and Gizo sites visited. BSS/HIV/STI Surveillance done and report available.
31
Environmental Health Division: 2006 Quarterly Report (3rd Quarter)
Ministry of Health: National Health Report 2005 Page 118 of 250 --------------------------------------------------------------------------------------------------------------------Draft HIV VCCT Protocol completed for finalization. Stakeholder meetings held regularly. Solomon Islands National AIDS Council meetings held. Training of additional 20 VCCT counselors (nurses) begun. 6.5.1.3
NCD Prevention: Disease Prevention and Control Unit
Regional Assistance from NZAID through David and Allen Clark of NZ signed and project commenced in 2005. Training (s) of health workers (nurses and doctors) on diabetes held. A video on smoking and related health problems produced. Radio spots on NCD prevention continued. Two supervising tours done: Choiseul and Makira 6.5.1.4
Community Based Rehabilitation
Refresher training for 16 Rehabilitation Aides done. Draft Legislation on Disability completed, discussed during a one day workshop: Pending further discussion Training: Teach Blind people to read and write Braille at least 5 persons per class: (including Purchase a new Braille equipment and Purchase Braille paper and other materials for the training) done. 6.5.1.5
Distance Education Program:
Enrolled 20 students ( nurses) for Pediatric, community Health, Obstetrics. Enrolled students for Family Planning. Enrolled 15 students for Nursing Management. Support to the Pacific Online Health Network continued. 6.5.1.6
Social Welfare
Major review of the Social Welfare Division done. Social Welfare Strategy and Operational Directions done and accepted for implementation by Ministry of Health. 6.5.1.7
TB and Leprosy Prevention and Control.
Completed TOT for coordinators on DOTS. Choiseul, West, Makira and Malaita completed. TB Video developed.2 and distributed. Radio spots (cough too long go to clinic, if stop treatment early TB recurs easily, sharing cigarettes spread TB). Community awareness, leproy screening done in HCC & GP: Additional new cases found 9 in GP and 4 in Fishing Village.. Another training done Provincial Leprosy Coordinator held August 8-10. Leprosy IEC done by FSM students and to be pre-tested later. All new cases of leprosy on treatment-Pauci and Multi-bacillary treatment inclduing contract tracing.
Ministry of Health: National Health Report 2005 Page 119 of 250 ---------------------------------------------------------------------------------------------------------------------
Ministry of Health: National Health Report 2005 Page 120 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 7
Provincial Health Services
Chapter gives a very brief overview of the current status of demography, health burden and the provincial responses.
7.1
Choiseul Province:
Demography: Gender and Poverty: 25,000 20,000
P op
15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005
Population total 19,787 20,422 21,053 21,680 21,853 22,090 22,974 Population <1
705
684
682
682
670
681
707
Population 1-4
2,554 2,614 2,652 2,690 2,673 2,704 2,697
Population <5
3,259 3,298 3,334 3,372 3,344 3,385 3,404
Fig 26 Population of Choiseul 7 year trend 1999-2005. Choiseul has a stable and slow increasing population. About 15% of the total population of 22,974 in 2005 were children of less than 5 years old. About 48% are age group of 15-49 years old.
12,000 10,000
P op
8,000 6,000 4,000 2,000 0 WCBA
1999
2000
2001
2002
2003
2004
2005
4,455
4,667
4,883
5,096
5,093
5,155
5,446
730
723
717
710
703
703
702
Males >5
8,433
8,675
8,920
9,167
9,415
9,541
9,939
Females >5
8,095
8,449
8,799
9,142
9,095
9,164
9,631
Total 15-49
9001
9379
9762
10141
10309
10467
11,035
4 46
4 12
48 9
04
216
621
88
Expected births
Fig 27 Population of Choiseul by gender 7 year trend 1999-2005.
Ministry of Health: National Health Report 2005 Page 121 of 250 ---------------------------------------------------------------------------------------------------------------------
7.2
Health Burden in Choiseul 1996-2005
7.2.1
Introduction
In Solomon Islands the main source of information about health status of Solomon Island people is collected through the Primary Health Care Information System (MOH statistics). Other health information are also maintained by SIMTRI, CBR, Reproductive health while some data are now being collected by the National Referral Hospital. In 2005, a major health review for Solomon Islands was conducted and health indicators were measured against the MOH and millennium development goals. 900.0 800.0
Rate per 1,000 pop
700.0 600.0 500.0 400.0 300.0 200.0 100.0 0.0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
298.5
379.9
393.8
337.8
471.1
408.9
587.5
413.4
479.7
477.8
399.1
Diarrho ea
61.2
74.8
48.9
50.1
56.2
57.0
45.5
35.0
47.8
43.8
44.6
Fever
793.1
734.9
541.7
566.4
433.4
338.7
375.4
348.3
475.1
359.8
287.5
Red Eyes
42.2
116.0
38.5
36.3
56.5
40.2
43.0
41.5
34.5
36.8
27.6
Yaws
10.6
29.2
21.1
17.1
18.0
11.8
19.9
18.6
40.2
14.2
21.2
Skin Diseases
285
258
213
209
198
180
187
162
161
151
118
70
79
71
69
74
97
108
77
89
82
98
13.6
12.0
9.4
8.2
10.0
17.6
10.5
A RI
Ear disease STI rate in 15-49 years Clinical malaria
260.8
436.8
272.2
369.5
247.6
223.3
295.2
266.1
324.7
213.1
132.7
Others Diseases
413.5
516.5
429.5
646.8
659.3
749.8
806.5
684.4
747.3
747.9
741.4
This report will present the progress of health status of Choiseul people in the period 1995 to 2005 against national figures and Solomon Islands MOH and appropriate international indicators. The aim of this report is to present Choiseul health data for period 1996 – 2005 so that trends in disease incidence can be reported. 7.2.2
Major Health Issues
There are several major health issues affecting Solomon Islanders. Some of these are communicable for example, acute respiratory infection (ARI), malaria, skin diseases and yaws, sexually transmitted diseases and HIV, diarrhoea, and TB and leprosy. Others are chronic noncommunicable such as, diabetes and mental, which are becoming increasingly important and demand attention by health service planners as they require long term care for those affected. Each of these health issues provide challenges for health care planners particularly to reduce high levels of morbidity and mortality caused by them.
Ministry of Health: National Health Report 2005 Page 122 of 250 --------------------------------------------------------------------------------------------------------------------Fig 28 Common illness per 1,000 population 11 years trend 1995-2005 in Choiseul: Source HIS MOH (2006).
300
R ate p er 1,000 p o p
250 200 150 100 50 0 1995 1996 1997
1998 1999
2000 2001 2002
2003 2004 2005
Diarrhoea
Red Eyes
Yaw s
Skin Diseases
Ear disease
STI rate in 15-49 years
Fig 29 Lesser common illnesses rate per 1,000 pop 11 yr trend 1995-2005 in Choiseul
Disease Incidence Trend of Choiseul 1996-2005: Figure 1 below demonstrates the proportion of acute care contacts in Choiseul by common diseases. It is obvious that other disease has gain importance as a major cause of attendance at any primary health care clinic in Choiseul during the last decade.
Ministry of Health: National Health Report 2005 Page 123 of 250 --------------------------------------------------------------------------------------------------------------------Fig 1. Proportion of new cases by major disease, Choisuel 1996-2005 45% 40% 35%
percent
30% 25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI Yaw s Clinical malaria
Diarrhoea Skin diseases Other diseases
Fever Ear infection
Red eyes STI diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Choiseul, ARI has been the major cause of attendance at any primary health care clinics. In 2005, ARI was responsible for 26% of all acute care contacts in Choiseul. Figure 2 below demonstrate the incidence rate of ARI in Choiseul and Solomon Islands over the past 10 years. The graph illustrates that in the early years of last decade, incidence rate of ARI for Choiseul was below national average. However, between 1998 and 2005 the situation was reversed. The highest incidence rate of ARI in Choiseul occurred in 2001 reaching 586 cases per 1000 population. The trend of ARI rate in Choiseul had continued to increased between 2002 and 2005.
Ministry of Health: National Health Report 2005 Page 124 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence rate of ARI, Choisuel & Solomon Is
700.0
ra te p e r 1 ,0 0 0
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Choisuel
ARI, Solomon Is
Incidence rate of ARI by age group – Choiseul
Fig 3. Incidence rate of ARI by age group, Chosiuel 1996-2005 2500
rate per 1,000
2000
1500
1000
500
0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 3 above demonstrates the incidence rate of ARI in Choiseul by age – group. The graph reveals that in Choiseul the rates of ARI are highest in babies and in recent years, that is, between 2001 and 2005, the rate has exceeded 2000 cases per 1000 population annually. This would mean that between 2001 and 2005 every baby in Choiseul had been presented more than once with ARI at any primary health care clinic. The graph also shows that in 2005 the incidence rate of ARI in Choiseul in the age group 1-4 has shown a markedly increased from 1199 cases per 1000 in 2004 to 1740 cases per 1000 in 2005.
Ministry of Health: National Health Report 2005 Page 125 of 250 --------------------------------------------------------------------------------------------------------------------Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Choiseul, malaria is responsible for 24% of all acute care contacts in 2005. Fig. 4 Incidence rate of clinical malaria, Choiseul and Solomon Islands 1996-2005 700.0 600.0
rate per 1000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years Clinical malaria - Choiseul
Clinical malaria - Solomon Is.
Figure 4 demonstrates the incidence rate of clinical malaria in Choiseul and Solomon Islands.
The graph shows that the incidence rate of clinical malaria in Choiseul had remained below national averages since 1999. Between 2003 and 2005 clinical malaria rate in Choiseul had declined from 325 cases per 1000 in 2003 to 168 cases per 1000 population in 2005. Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Choiseul for the past 10 years. It is clear from the graph that over the 10 year period, the trend of fever and clinical malaria in Choiseul has declined while the rate for slide confirmed malaria had increased. The graph also shows that between 2003 and 2005 slide confirmed malaria rate had exceeded demonstrating a highest slide confirmed rate in 2004 before it declined to 300 cases per 1000 population in 2005.
Ministry of Health: National Health Report 2005 Page 126 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 5 Incidence rate of clinical malaria, fever, slide confirmed, Choisuel 1996-2005 800.0 700.0
rate per 1,000
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
fever
slideconfirmed
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Choiseul, diarrhoea in particular with no blood and no dehydration is more common (see figure 6 below). Fig 6. Incidence rate of diarrhoea by type, Choisuel 1996-2005 70.0 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody Diarrhoea by age group Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group in Choiseul. The graph shows that in Choiseul bloody diarrhoea is more common in children less than 5 years and more importantly in babies. Over the past 10 years incidence rate of bloody diarrhoea in babies in Choiseul has increased markedly. Though the graph shows a decline in bloody diarrhoea rates in babies between 2000 and 2004, in 2005 the rate increased dramatically. In 2004, the rate also increased significantly in babies however, in 2005 a slight decline was noted.
Ministry of Health: National Health Report 2005 Page 127 of 250 --------------------------------------------------------------------------------------------------------------------Fig 7. Incidence rate of bloody diarrhoea by age group, Choisuel 1996-2005 30.0
rate per 1,000
25.0 20.0 15.0 10.0 5.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Choiseul, yaws and more importantly skin disease are also common health problems in the people aged more than 1. Fig 8. Incidence rate of yaw s and skin disease, Choisuel & Solomon Is 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Choisuel
yaw s, Solomon Is
skin disease, Choisuel
skin disease, Solomon Is
Figure 8 demonstrates the incidence rate of yaws and skin disease in Choiseul and Solomon Islands over the past 10 years. The graph shows that the trend of yaws and skin disease incidence rate in Choiseul and Solomon Islands had declined over the past 10 years. The graph also reveals that while yaws incidence rate in Choiseul had remained below national average during the past 10 years, skin disease rate demonstrates the opposite. As depicted in the graph, the rate of skin disease in Choiseul remained above national average through out the 10 year period. Yaws by age group
Ministry of Health: National Health Report 2005 Page 128 of 250 --------------------------------------------------------------------------------------------------------------------Figure 9 below demonstrates the incidence rate of yaws in Choiseul by age group. The graph shows that incidence rate of yaws in Choiseul was more prominent in children aged 1 – 4 followed by people aged 5 years and over. The graph also reveals that yaws is not a common health problem for babies in Choiseul. Fig 9. Incidence rate of yaw s by age group, Choisuel 1996-2005 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 9 also reveals that in Choiseul the trends of yaws rate particularly in children aged 1-4 between 1996 and 2000 had declined. Then between 2000 and 2005 the graph shows are very fluctuating pattern of yaws rate amongst children aged 1-4 reaching it highest point in 2004 where the rate was 50 cases per 1000 population. The fluctuating pattern of yaws incidence rate in Choiseul particularly in the aged groups 1-4 indicates clearly that though incidence rate of yaws had declined in some years it had remained to be a problem amongst children aged 1-4 in recent years. Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Choiseul. The graph reveals that in Choiseul skin disease was more common in children aged 1-4 and people 5 years and over. The graph also shows that over the past 10 years the trend of skin disease rate in Choiseul for all age group has declined.
Fig 10. Incidence rate of skin disease by age group, Choisuel 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 129 of 250 --------------------------------------------------------------------------------------------------------------------Red Eye Figure 11 demonstrates the incidence rate of red eye in Choiseul and Solomon Islands for the past 10 years. The graph shows that incidence rate of red eye in Choiseul had declined markedly from 116 cases per 1000 population in 1996 to 32 cases per 1000 population in 2005. Fig 11. Incidence rate of red eye, Choisuel & Solomon Is 1996-2005 140.0
rate p er 1 ,00 0
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Choisuel
red eye, Solomon Is
The graph also shows that in Choiseul the highest rate of red eye occurred in 1996 then it dropped significantly in 1997 reaching 40 cases per 1000 population. In 1998 the rate increased again before it dropped from 57 cases per 1000 population in 1999 to 40 cases per 1000 in 2000. Between 2000 and 2005 the rate of red eye in Choiseul had moderately declined.
Red Eye by Age Group Figure 12 below demonstrates the incidence rate of red eye in Choiseul over the past 10 years. The graph shows that in Choiseul red eye was more common in children under 5. The graph also shows that the trend of red eye for all aged group in Choiseul experienced a significant dropped from 1996 to 1997. Then it had remained below 100 cases per 1000 all through out the 10 year period. Fig 12. Incidence of red eye by age group, Choisuel 1996-2005 250.0
rate per 1,000
200.0
150.0
100.0
50.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 below demonstrates the incidence rate of ear infection in Choiseul and Solomon Islands. The graph shows that the rate of ear infection in Choiseul had been higher than national average since 1998.
Ministry of Health: National Health Report 2005 Page 130 of 250 --------------------------------------------------------------------------------------------------------------------The graph also shows that the trend of ear infection rate in Choiseul had increased from 82 cases per 1000 population in 2004 to 116 cases per 1000 population in 2005. Fig 13. Incidence rate of ear infection, Choisuel & Solomon Is 1996-2005 140.0 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection
ear infection, Solomon Is
Ear infection by age-group Figure 14 below demonstrates the incidence rate of ear infection by age group in Choiseul. From the graph it is obvious that in Choiseul ear infection is more common in children aged 1-4. The incidence rates of ear infection in this age group has increased over the years from 131 cases per 1000 population in 1996 to it highest point 230 cases per 1000 in 2005. The graph also shows that in Choiseul the incidence rate of ear infection in the aged 1-4 had declined slightly between 1996 and 1998. This was followed by a continuous increased between 1998 and 2002 reaching 200 cases per 1000 population in 2002. Then between 2002 and 2004 incidence rate of ear infection for aged group 1-4 dropped from 200 cases per 1000 population in 2002 to 140 cases per 1000 population in 2004 before it increased in 2005 reaching 230 cases per 1000 population. Fig 14. Incidence rate of ear infection by age group, Choisuel 1996-2005 250.0
rate per 1,000
200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Summary: Acute Respiratory Infections and other febrile illnesses are commonest cause of health burden to the people of Choiseul as well as demand to the primary health care services. In 2005, ARI accounts for 399 per 1,000 population whilst fever causes 288 per 1,000 population to attend clinics in the provinces.
Ministry of Health: National Health Report 2005 Page 131 of 250 --------------------------------------------------------------------------------------------------------------------Interesting enough record on clinical malaria has declined although it was fluctuating in the past five years. In 2005 it was recorded at around 133 per 1,000 populations. It was understood that there was an intense malaria control program funded by Rotary Club in the past years. Migration or cross border issues with Bougainville has raised alarm especially in light on HIV transmission. Whilst there hasn’t been contextual evidence. The National HIV Policy has flagged concerns around HIV and migration.
Provincial Response: In 2005 Choiseul has total of 27 registered clinics (and one Village Health Worker’s Post). There are two hospitals. Taro was recently upgraded to a mini-hospital status. The other is Sasamuga. Choiseul reached the ratio of 1 clinic to 851 population as compared to the national figure of 1:1,459.
Clinics Clinic Province Hospital ANC UH RHC NAP VHW Total Total clinics without closed requires Clinic VHW formal upgrade Choiseul 2
1
11
13
1
28
27
4 to RHC + 2 NAP
No of MOH Health Radios in Province 14
Ministry of Health: National Health Report 2005 Page 132 of 250 --------------------------------------------------------------------------------------------------------------------Map 1: Location of Clinics in Choiseul Province in 2005: Source: Ministry of Lands
Ratio: I clinic to population 1,459 851
Solomon Islands Choiseul
Ministry of Health: National Health Report 2005 Page 133 of 250 ---------------------------------------------------------------------------------------------------------------------
7.3
Western Province
Demography: Gender and Poverty: Core population and Health datas on Western Province:
1995 857 462 290 218 117 99 69
2000 Fever
557
ARI 376 Skin Diseases 333 Clinical malaria 102 Ear Disease 83 Diarrhoea 77 Yaws 44
2005 Clinical malaria
458
ARI
191
Fever Skin Diseases Ear Disease Yaws Diarrhoea
165 110 77 54 40
ARI Clinical malaria Fever Skin Diseases Ear Disease Diarrhoea Yaws
80,000
Po p
60,000 40,000 20,000 0
1999
2000
2001
2002
2003
2004
2005
Population total 62,039
66,727
65,146
66,727
68,608
71,846
72,124
Population <1
2,003
1,908
1,902
1,931
1,988
2,159
2,187
Population 1-4
7,550
7,613
7,641
7,704
7,836
8,269
7,966
Population <5
9,552
9,520
9,543
9,634
9,824
10,428
10,153
Pop-15-49 All
30316
31392
32474
33557
34790
36339
37,188
Fig 30 Population of Western 7 year trend 1999-2005 Western Province is the second largest populated province in Solomon Islands. In 2005 the estimated population was around 72,124 people. Children under 5 years old make up 14%, whilst majority of 51.6% are within the age-group of 15-49.
Ministry of Health: National Health Report 2005 Page 134 of 250 --------------------------------------------------------------------------------------------------------------------40,000 35,000 30,000 Pop
25,000 20,000 15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005
14,107 14,597 15,100 15,613 16,272 17,003 17,456
WCBA
2,205
Expected births
2,211
2,216
2,222
2,228
2,233
2,238
Males >5
27,854 28,689 29,496 30,267 31,012 32,470 32,608
Females >5
24,633 25,374 26,107 26,825 27,772 33,937 29,363
total 15-49
30,316 31,392 32,474 33,557 34,790 36,339 37,188
males 15-49
16,209 16,795 17,374 17,944 18,517 19,335 19,732
Fig 31 Population of Western by gender 7 year trend 1999-2005
900 800 Rateper 1,000pop
700 600 500 400 300 200 100 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 462
440
593
457
470
376
420
341
304
432
99
79
82
74
53
44
36
31
32
44
54
Fever
857
650
555
408
340
333
331
243
234
203
165
Yaw s
69
84
72
75
68
77
64
58
77
44
40
Skin Diseases
290
163
172
122
94
102
81
89
90
98
110
Ear Disease
117
107
113
105
86
83
74
59
68
84
77
Clinical malaria
218
584
469
485
473
557
482
345
272
257
191
ARI Diarrhoea
Fig 31 Common illness per 1,000 population 11 years trend 1995-2005 in Western: Source HIS MOH (2006).
7.3.1
Health Burden in Western
Disease Incidence Trend of Western Province 1996-2005
458
Ministry of Health: National Health Report 2005 Page 135 of 250 --------------------------------------------------------------------------------------------------------------------Figure 1 below demonstrates the proportion of acute care contacts in Western by common diseases. It is obvious from the graph that ARI has been the major cause of attendance at any primary health care clinic in Western during the last decade. Fig 1. Proportion of new cases by major disease, Western 1996-2005 70%
60%
percent
50%
40%
30%
20%
10%
0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Western, ARI has been the major cause of attendance at any primary health care clinics. In 2005, ARI was responsible for 51% of all acute care contacts in Western. Figure 2 below demonstrate the incidence rate of ARI in Western and Solomon Islands over the past 10 years. The graph shows that the trend of ARI incidence rate for both Western and Solomon Islands is pretty much the same. Though a decline in the incidence rate of ARI for both Western and Solomon Islands was noted between 1997 and 2003, the situation has been reversed between 2003 and 2005.
Ministry of Health: National Health Report 2005 Page 136 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence rate of ARI, Western & Solomon Is 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Western
ARI, Solomon Is
Incidence rate of ARI by age group – Western
Fig 3. Incidence rate of ARI by age group, Western 1996-2005 2500
rate per 1,000
2000 1500
1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 3 demonstrates the incidence rate of ARI by age group in Western. The graph reveals that in Western ARI has become a more common health problem in children aged less than five and more importantly infant. It also shows that the trend of ARI incidence rate has remained beyond a 1500 cases per 1000 population. Though the rate in infants had declined between 2001 and 2003, in 2004 the rate went up again and then decline slightly in 2005. However, for children aged 1-4, the incidence rate of ARI had continued to rise between 2003 and 2005 after a constant declined that occurred between 2001 and 2003. The highest incidence rate of ARI in infant and children aged 1-4 occurred in 1997 reaching 1868 cases per 1000 population and 1031 cases per 1000 population respectively. Malaria
Ministry of Health: National Health Report 2005 Page 137 of 250 --------------------------------------------------------------------------------------------------------------------In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Western, malaria is responsible for 19% of all acute care contacts in 2005. Fig 4. Incidence rate of clinical malaria, Western & Solomon Is 1996-2005 700.0 600.0
percent
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Western
Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Western and Solomon Islands. The graph shows that incidence rate of clinical malaria in Western is lower than national averages in the past 10 years. The graph also shows that the trend of clinical malaria in Western and in Solomon Islands has declined over the last ten years. Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Western for the past 10 years. It is obvious from the graph that the trend of the incidence rate for fever, clinical malaria and slide confirmed malaria in Western has declined over the years. The graph also shows that over the years the incidence rate of slide confirmed malaria was below that of clinical malaria.
Ministry of Health: National Health Report 2005 Page 138 of 250 --------------------------------------------------------------------------------------------------------------------Fig 5. Incidence rate of clinical malaria, fever, slide confirmed, Western 19962005 700.0
rate per 1,000
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
fever
slide confirmed
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Western, diarrhoea in particular with no blood and no dehydration is more common (see figure 6 below). Fig 6. Incidence rate of diarrhoea by type, Western 1996-2005 80.0 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody Diarrhoea by age group Figure 7a and 7b below demonstrates the incidence rate of Bloody diarrhoea by Age group. The graph reveals that bloody diarrhoea was more common in children aged less than 5 years. The graph also shows that in 2005 there was a significant increase in the incidence rate of bloody diarrhoea amongst children aged less than five.
Ministry of Health: National Health Report 2005 Page 139 of 250 --------------------------------------------------------------------------------------------------------------------Fig 7a. Incidence rate of bloody diarrhoea by age group, Western 1996-2005 45.0 40.0
rate per 1,000
35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Fig. 7b Incidence rate of bloody diarrhoea by age group, Western 1996-2005 45
rates per 1000 population
40 35 30 25 20 15 10 5 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years rates <5
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Western, yaws and more importantly skin disease are common health problems amongst it people.
Ministry of Health: National Health Report 2005 Page 140 of 250 --------------------------------------------------------------------------------------------------------------------Fig 8. Incidence rate of yaw s and skin disease, Western & Solomon Is 19962005 200.0 180.0
rate per 1,000
160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Western
yaw s, Solomon Is
skin disease, Western
skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Western and Solomon Islands. The graph shows that the trend of yaws and skin disease rate has declined over the past 10 years for both Solomon Islands and Western. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws in Western by age group. The graph shows that rate of yaws in Western was more prominent in children aged 1 – 4 followed by people aged 5 years and over. The graph also reveals that yaws is not a common health problem for babies in Western. Fig 9. Incidence rate of yaw s by age group, Western 1996-2005 160.0 140.0
rate per 1,000
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 9 reveals that in Western the trend of yaws rate particularly in the aged group 1-4 has declined between 1996 and 2005. However, it is also evident that over the past 10 years the situation that is the incidence of yaws particularly in the aged group 1-4 had never been improved. This is demonstrated clearly in figure 9 where yaws incidence
Ministry of Health: National Health Report 2005 Page 141 of 250 --------------------------------------------------------------------------------------------------------------------rate in the aged group 1-4 had shown a fluctuating pattern in the years between 1996 and 2005. This pattern may strongly indicate that vaccine coverage had not been adequate to prevent the disease from spreading. Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Western. The graph shows clearly that skin disease in Western Province was more common in children aged 1-4. It also shows that over the years, the rate of skin disease in Western has declined particularly in the aged group 1-4 and 5 years and over. However, for infants the situation has been the opposite. The graph also shows that in recent years, that is, between 2003 and 2005, the rate of skin disease in infants has demonstrated the highest increase than any of the other age groups. Fig 10. Incidence rate of skin disease by age group, Western 1996-2005 300.0
rateper 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Red Eye Figure 11 demonstrates the incidence rate of red eye in Western and Solomon Islands for the past 10 years. The graph shows that over the past 10 years the trend of red eye incidence rate had declined by more than halved for both Western and Solomon Islands.
Ministry of Health: National Health Report 2005 Page 142 of 250 --------------------------------------------------------------------------------------------------------------------Fig 11. Incidence rate of red eye, Western & Solomon Is 1996-2005 100.0 90.0 80.0
rateper 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year red eye, Western
red eye, Solomon Is
2004
2005
Ministry of Health: National Health Report 2005 Page 143 of 250 --------------------------------------------------------------------------------------------------------------------Red Eye by Age Group Figure 12 below demonstrates the incidence rate of red eye by age group in Western, for the past 10 years. The graph shows that in Western red eye was more prominent in children less than 5 years but more importantly in babies. In 1998, the graph shows that there was an outbreak of red eye in babies reaching 274 cases per 1000 population. In 1999 the rate significantly dropped to 139 cases per 1000 population. The graph also shows that in recent years that is between 2003 and 2005 the rate of red eye in all aged groups had experienced a slight increased. Fig 12. Incidence rate of red eye by age group, Western 1996-2005 300.0
rate per 1,000
250.0 200.0
150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Western and Solomon Islands. The graph also shows that the trend of ear infection rate in Western and Solomon Islands had declined over the past 10 years reaching it lowest level in 2002 before it increased again between 2002 and 2005. In 2005, while ear infection rate in Solomon Islands experienced a constant increase, the rate of ear infection in Western had experienced a moderate decline that is from 84 cases per 1000 in 2004 to 77 cases per 1000 population in 2005.
Ministry of Health: National Health Report 2005 Page 144 of 250 --------------------------------------------------------------------------------------------------------------------Fig 13. Incidence rate of ear infection, Western & Solomon Is 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection
ear infection, Solomon Is
Ear infection by age-group Figure 14 below demonstrates the incidence rate of ear infection by age group in Western. From the graph, it is obvious that in Western ear infection is more common in children aged less than five but more importantly in children aged 1-4. The graph also shows that between 2002 and 2005 the rate of ear infection particularly in children aged 1-4 has been constantly increasing reaching 168 cases per 1000 population in 2005. Fig 14. Incidence rate of ear inf ection by age group, Western 1996-2005 250.0
rate per 1,000
200.0
150.0
100.0
50.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Conclusion: The disease burden in the Western Province is not different from that of Choiseul Province and other provinces. In both provinces the trend of clinical malaria has steadily declined (Fi.g 31).
Ministry of Health: National Health Report 2005 Page 145 of 250 --------------------------------------------------------------------------------------------------------------------There is no clear reason for this reduction but malaria control program in Western and Choiseul Province were supported financially by Rotary Club. ARI remains the commonest acute illness. There was an increasing trend of clinical malaria in the past five years, from 1995 to 2000, however the trend has been declined significantly from 557 to 191 per 1,000 populations.
Provincial Response: Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade Western
2
5
23
27
1
TOTAL
10
29
TOTAL 2005
10
2004
10
58
5
106
173
14
29
5
106
173
323
-1 30
5
-5 111
15 158
314
57
6 to RHC 7
No of MOH Health Radios in Province 32 149
323
The people of the Western Province have access to both primary and secondary health care services. The provincial health service also provide public health programs such as the Environmental health division ensuring safe water and proper sanitary facilities as well as the commercial support activities like environmental and health quarantine duties to the foreign liners. The primary health care service comprises of total of 58 clinics (including one Village Health Workers Post. There are two hospitals (one Government and one Church owned). In 2005, the ratio of a clinic to population is 1: 1,265. There are many more people served by one clinic. Obviously islands and villages are geographically more scattered. The recent clinic utilization review supports two clinics in Western Province namely Noro Taiyo and Noro public to merge into a single Urban clinic.
Ratio of 1 clinic to pop in 2005 1,459 National 1,265 western
Health Workforce In 2005 Western Province employed total of 177 direct employees from the province to join 104 seconded staff from National mother Ministry to drive the health services in the province. Of the total 300 position allocated for the WP, 94% (281 positions were filled).
Ministry of Health: National Health Report 2005 Page 146 of 250 --------------------------------------------------------------------------------------------------------------------Medical, 4 Pharmacy , 4 Health Promotion, 8
Radiography, 4
Environmental Hlth, 15
Laboratory, 2 Physiotherapy, 1 Dental, 0 Social Service , 0
Support services , 36
Vector Borne Disease Control, 43
Nursing , 164
Fig 32 Proportion of category of health workers in Western Province
Key issues in 2005(32) Two maternal deaths were recorded in 2005. Twenty two infant deaths were recorded, an increase from 15 in 2004. the crude birth rate continues its slow increase in Western Province contributed to by a steadily increasing adolescent fertility rate which more than doubled between 2004 and 2005 and continuing low contraceptive prevalence rates.
Sexual : Overall there appears to be a continuing increase in sexually transmitted infections. No cases of HIV have been detected in Western Province to date. Vaccine Preventable: A small outbreak of whooping cough in August 2005 was quickly stemmed with treatment and immunization catch-up. Under 1 year immunization 2005 coverage, based on available data is shown in Graph 1 below. These data must view cautiously given the probable underreporting of immunizations in 3 health zones.
32
Western Province Health Service Annual Health Report 2005.
Ministry of Health: National Health Report 2005 Page 147 of 250 ---------------------------------------------------------------------------------------------------------------------
Map 2: Location of Clinics in Western Province in 2005: Source: Ministry of Lands
Ministry of Health: National Health Report 2005 Page 148 of 250 ---------------------------------------------------------------------------------------------------------------------
7.4
Isabel Provinces
Demography: Gender and Poverty 25,000 20,000 Pop
15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005 23,364
20,198
20,642
21,099
21,563
22,225
21,875
Population <1
692
677
665
641
616
596
613
Population 1-4
2,385
2,430
2,454
2,470
2,500
2,463
2,491
Population <5
3,077
3,107
3,119
3,112
3,117
3,059
3,104
Pop 15-49
9,247
9,550
9,869
10,202
10,637
10,535
12,172
Population total
Fig 33 Population of Isabel 7 year trend 1999-2005. 25,000 20,000
Pop
15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005
20,198
4,819
4,965
5,116
5,357
5,248
5,727
657
670
683
697
711
727
744
Males >5
8,707
8,910
9,135
9,382
9,646
9,604
10,237
Females >5
8,414
8,625
8,845
9,070
9,462
9,212
10,023
total 15-49 years
9,247
9,550
9,869
10,202 10,637 10,535 12,172
WCBA Expected births
Fig 33 Population of Isabel Province by gender 7 year trend 1999-2005. There is no disparity in proportion of male to females (about 1;1) Fig 33, however, there are differences in cultural recognition of gender especially women in different provinces in terms of land ownerships and decision making by provinces which may affect and influence how health services are distributed. The Isabel is an interesting province with a maternal influence in land ownership. There has been evidence of community partnership within themselves and a strong recognition and adherence to their chief system33.
There are evidence building to affirm this nortion of strong community partnership having an positive impact of health status of the people.
33
Ministry of Health: National Health Report 2005 Page 149 of 250 --------------------------------------------------------------------------------------------------------------------Health Burden Disease Incidence Trend of Isabel Figure 1 below demonstrates the proportion of acute care contacts in Isabel by diseases. From the graph it is obvious that malaria and ARI are major common health problems affecting Isabel people. Fig 1. Proportion of new cases by major disease, Isabel 1996-2005 45.0% 40.0% 35.0%
percent
30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI Skin diseases
Diarrhoea Ear infection
Fever STI diseases
Red eyes Clinical malaria
Yaw s Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Isabel, ARI is second only importance to ‘Other’ disease category. In 2005, ARI was responsible for 29% of all acute care contacts in Isabel. Figure 2 below demonstrates the incidence rate of ARI in Isabel and Solomon Islands over the past 10 years. The graph shows that the trend of ARI incidence rate in Isabel has increased from 478 cases per 1000 in 1996 to 639 cases per 1000 in 2005. Over the years, ARI has remained to be a common illness for Isabel people.
Ministry of Health: National Health Report 2005 Page 150 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence rate of ARI, Isabel & Solomon Is 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Isabel
ARI, Solomon Is
Incidence rate of ARI by age group – Isabel Figure 3 demonstrates the incidence rate of ARI by age group in Isabel for the past 10 years. The graph reveals that ARI incidence rate is higher in children aged less than 5 and more importantly in infants. The graph also shows the increasing trend of ARI in infants while a slight increase was observed in children aged 1-4 and the trend remained constant in the aged group 5 years and older over the years. The graph also depicted that ARI rate in infants has exceeded more than 2000 cases per 1000 population all through out the 10 year period. In 2005, the trend of ARI in infants has dropped from it highest 665 cases per 1000 population in 2004 to 539 cases per 1000 population in 2005. Fig 3. Incidence rate of ARI by age group, Isabel 1996-2005 4500 4000
rate per 1,000
3500 3000 2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care
Ministry of Health: National Health Report 2005 Page 151 of 250 --------------------------------------------------------------------------------------------------------------------Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Isabel, malaria is responsible for 22% of all acute care contacts in 2005. Fig 4. Incidence rate of clinical malaria, Isabel & Solomon Is 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Isabel
Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria in Isabel and Solomon Islands in the past 10 years. The graph shows that incidence rate of clinical malaria in Isabel has remained below national average all through out the 10 year period. Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Isabel for the past 10 years. The graph shows that the trend of the rates for fever, clinical malaria and slide confirmed malaria in Isabel has declined over the past 10 years. The rate of slide confirmed malaria has remained below clinical malaria and fever rates. Fig 5. Incidence rate of clinical malaria, f ever, slide conf irmed, Isabel 19962005 500.0 450.0
rate per 1,000
400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
Year clinical malaria
Diarrhoeal disease
fever
slide confirmed
2005
Ministry of Health: National Health Report 2005 Page 152 of 250 --------------------------------------------------------------------------------------------------------------------Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Isabel, diarrhoea and more importantly with no blood and no dehydration is more common (see figure 6 below). Fig 6. Incidence rate of diarrhoea by type, Isabel 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody Diarrhoea by age group Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group over the past 10 years. The graph reveals that bloody diarrhoea was more common in children aged less than 5 years but more importantly in infants. The trend of bloody diarrhoea in infants has increased in recent years that is, between 2001 and 2005. An increasing trend was also observed in the age group 1-4 in 2005. Fig 7. Incidence rate of bloody diarrhoea by age group, Isabel 1996-2005 35.0
rate per 1,000
30.0 25.0 20.0 15.0 10.0 5.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Isabel, yaws and more importantly skin disease are common health problems amongst it people. The graph shows a decreasing trend of skin disease for Isabel and Solomon Islands while a constant trend was observed in the yaws rate for the two.
Ministry of Health: National Health Report 2005 Page 153 of 250 --------------------------------------------------------------------------------------------------------------------Fig 8. Incidence rate of yaw s and skin disease, isabel & Solomon Is 1996-2005 200.0 180.0 160.0 rate per 1,000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Isabel
yaw s, Solomon Is
skin disease, Isabel
skin disease, Solomon Is
Figure 8 above also demonstrates that yaws rate in Isabel has remained below national averages all through out the 10 year period while skin disease rates has reflects no significant difference in Isabel and Solomon Islands especially between 2000 and 2005. Between 1996 and 1998 the rate for skin disease in Isabel has shown a significant dropped from 184 cases per 1000 population in 1996 to 100 cases per 1000 population in 1998. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws in Isabel by age group. The graph shows that the incidence rate of yaws in Isabel was higher in children aged 1 – 4 followed by people aged 5 years and over then in infants. The graph also shows a declining trend of yaws rate in both age group 1-4 and 5 years and over. However the decline was more significant in the age group 1-4.
Ministry of Health: National Health Report 2005 Page 154 of 250 --------------------------------------------------------------------------------------------------------------------Fig 9. Incidence rate of yaw s by age group, Isabel 1996-2005 70.0 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Isabel for the past 10 years. From the graph it is clear that incidence rate of skin disease in Isabel was more common the age group 1-4 followed by infants then people 5 years and over. The highest rate of skin disease was observed in children aged 1-4 reaching 400 cases per 1000 population in 1996. This has significantly declined to 166 cases per 1000 population in 1998, then a slight increased was observed in the next two years reaching 246 cases per 1000 in 2000. Between 2000 and 2002 the rate of skin disease for children aged 1-4 dropped again to 156 cases per 1000 population and between 2002 and 2005 skin disease rate in this age group has shown an increasing trend reaching 221 cases per 1000 in 2005. Fig 10. Incidence rate of skin disease by age group, Isabel 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
Red Eye
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 155 of 250 --------------------------------------------------------------------------------------------------------------------Figure 11 demonstrates the incidence rate of red eye in Isabel and Solomon Islands for the past 10 years. The graph demonstrates clearly the declining trend of red eye incidence rate for both Solomon Islands and Isabel in the past 10 years. The highest incidence rate of red eye experienced in both these places was in 1996. The graph also shows that between 2003 and 2005, the rate of red eye in both places has experienced a slight increase. Fig 11. Incidence rate of red eye, Isabel & Solomon Is 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Isabel
red eye, Solomon Is
Red Eye by Age Group Figure 12 below demonstrates the incidence rate of red eye by age group in Isabel for the past 10 years. The graph shows that the incidence rate of red eye in Isabel was higher in children aged less than 5 years followed by people 5 years and over. From the graph it is obvious that red eye incidence rate has shown a decreasing trend over the past 10 years, however in 2005 a slight increase in the rate was observed in children less than 5 years. Fig 12. Incidence rate of red eye by age group, Isabel 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 156 of 250 --------------------------------------------------------------------------------------------------------------------Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Isabel and Solomon Islands for the past 10 years. The graph demonstrates that trend of ear infection rate in Isabel was higher than national averages particularly in the early years of last decade and between 2000 and 2005. The graph also shows that between 2003 and 2005 the trend of ear infection rate has dropped from it highest 85 cases per 1000 population in 2003 to 64 cases per 1000 population in 2005. Fig 13. Incidence rate of ear inf ection, Isabel & Solomon Is 1996-2005 90 80
rate per 1,000
70 60 50 40 30 20 10 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear inf ection, Isabel
ear inf ection, Solomon Is
Ear infection by age-group Figure 14 demonstrates the incidence rate of ear infection by age group in Isabel for the past 10 years. From the graph, it is obvious that in Isabel ear infection is common health problem in children aged 1-4 followed by infants. The graph also shows that incidence rate of ear infection remained to be seen in children aged less than 5 all throughout the 10 year period. The highest rate of ear infection occurred in 2003 reaching 243 cases per 1000 in the aged group 1-4 and 169 cases per 1000 population in infants. The graph also reveals that an outbreak of ear infection was experienced in 2003 where more than 20% of children aged 1-4 where infected whereas 15% of infants were infected too in the same year. However, between 2003 and 2005 the trend of ear infection rate for both these age groups has declined.
Ministry of Health: National Health Report 2005 Page 157 of 250 --------------------------------------------------------------------------------------------------------------------Fig 14. Incidence rate of ear infection by age group, Isabel 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Conclusion: Acute Respiratory Infection is recorded the highest commonest illnesses like Choiseul and Western Province. However, the prevalence is very high than the two former provinces. In 2004-5 the level of 540 to 665 per 1,000 population (Fig. 34). However, the interesting finding is that clinical malaria is far lower than the two above provinces. In 2005 the incidence of clinical malaria was 145 per 1,000 population. Choiseul and Western are showing decline in trend in the incidence of clinical malaria, however, Isabel has been stable around and below 200 per 1,000 population.
Ministry of Health: National Health Report 2005 Page 158 of 250 --------------------------------------------------------------------------------------------------------------------700
600
Rate per 1,000 pop
500
400
300
200
100
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 453
478
512
358
476
509
601
531
493
665
88
92
56
50
47
69
48
36
51
57
55
535
474
412
302
303
308
350
361
315
348
260
Eye
95
98
46
36
38
35
48
38
30
31
40
Yaw s
41
34
29
24
14
17
18
16
24
19
18
217
184
131
99
104
121
90
84
97
90
96
ARI Diarrhoea Fever
Skin diseases
539
Ear disease
69
78
80
49
48
61
65
53
82
75
64
Clinical malaria
79
172
129
106
100
97
134
153
202
201
145
Fig 34 Common illness per 1,000 population 11 years trend 1995-2005 in Isabel: Source HIS MOH (2006
Provincial Response: In responding to the common illnesses and related issues, Isabel Province have built 43 clinics (including 6 Village Health Workers Posts). In 2005 the measure of access is 1 clinic to 631 people. Table 11 Number of clinics in Isabel Province in 2005: MOH Clinic database (2005)
Province
Hospital
ANC
Isabel
1
4
TOTAL
10
29
TOTAL 2005
10
2004
10
UH Clinic
RHC
NAP
VHW
Total clinics
Total without VHW
Clinics closed
11
21
6
43
37
1
No of MOH Health Radios in Province 15
5
106
173
14
7
149
29
5
106
173
323
-1 30
5
-5 111
15 158
314
323
Ministry of Health: National Health Report 2005 Page 159 of 250 ---------------------------------------------------------------------------------------------------------------------
Map 3: Location of Clinics in Isabel Province in 2005: Source: Ministry of Lands
7.5
Central Islands Province
Demography: Gender and Poverty:
Ministry of Health: National Health Report 2005 Page 160 of 250 --------------------------------------------------------------------------------------------------------------------30,000 25,000
Pop
20,000 15,000 10,000 5,000 0
Population total
1999
2000
2001
2002
2003
2004
2005
21,337 21,872 22,419 22,976 23,593 23,045 24,802
Population <1
703
677
676
679
687
678
737
Population 1-4
2,541
2,598
2,634
2,673
2,716
2,667
2,772
3,244
3,276
3,310
3,352
3,403
3,345
3,509
Population <5 Total 15-49
10,169 10,497 10,812 11,124 11,468 11,238 12,172
Fig 35 Population of CIP 7 y trend 14,000 12,000 10,000 Pop
8,000 6,000 4,000 2,000 0 WCBA Expected births Males >5
1999
2000
2001
2002
2003
2004
2005
4,961
5,119
5,274
5,431
5,612
5,479
5,960
766
773
781
788
796
806
9,355
9,609
9,869
10,137
10,414
10,223
11,000
Females >5
8,738
8,987
9,239
9,488
9,776
9,477
10,293
Total 15-49
10,169
10,497
10,812
11,124
11,468
11,238
12,172
males 15-49
5,208
5,378
5,538
5,694
5,856
5,759
6,211
Fig 36 Population of CIP by Gender 7 yr trend.
Health Burden in Central Islands Province 1996-2005 Disease Incidence Trend of CIP Figure 1 below demonstrates the proportion of acute care contacts in Central by diseases. From the graph it is obvious that malaria (fever and clinical malaria) and ARI are cause of attendance at primary health care clinics.
Ministry of Health: National Health Report 2005 Page 161 of 250 --------------------------------------------------------------------------------------------------------------------Fig 1. Proportion of new cases by major disease, central 1996-2005 45% 40% 35%
percent
30% 25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear inf ection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Central, ARI is second only importance to malaria. In 2005, ARI was responsible for 21% of all acute care contacts in Central. Figure 2 below demonstrates the incidence rate of ARI in Central and Solomon Islands over the past 10 years. The graph shows that the trend of ARI incidence rate in Central is remain below national average all through out the ten year period.
Ministry of Health: National Health Report 2005 Page 162 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence of ARI, Central & Solomon Is 1996-2005 500.0 450.0
rate per 1,000
400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year ARI, Central
ARI, Solomon Is
2004
2005
Ministry of Health: National Health Report 2005 Page 163 of 250 --------------------------------------------------------------------------------------------------------------------Incidence rate of ARI by age group – Central Figure 3 demonstrates the incidence rate of ARI by age group in Central. The graph reveals that in Makira ARI was more common in children under 5 but more importantly in babies. The graph also reveals that except in 2003 and 2005 incidence rate of ARI in babies exceeded 2000 cases per 1000, indicating that for every Central baby they have been presented with ARI at any primary health care clinics two times in a year. The graph also demonstrates that ARI rate in children aged 1-4 was also high through out the 10 year period. The incidence rate of ARI in people aged 5 years or more had remained constantly low through out the 10 year period. Fig 3. Incidence rate of ARI by age group, Central 1996-2005 3000
rate per 1,000
2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Central, malaria (fever and clinical malaria) is responsible for 54% of all acute care contacts in 2005. This clearly indicates that fever and clinical malaria are leading causes of morbidity in Central.
Ministry of Health: National Health Report 2005 Page 164 of 250 --------------------------------------------------------------------------------------------------------------------Fig 4. Proportion of clinical malaria, Central & Solomon Is 1996-2005 35% 30%
perc ent
25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Central
Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Central and Solomon Islands. The graph clearly demonstrates an increasing trend of clinical malaria in Central over the past 10 years.
Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Central for the past 10 years. From the graph it is obvious that slide confirmed malaria had remained below incidence rate of fever and clinical malaria through out. The graph also shows the increased trend for slide confirmed malaria over the past 7 years. Fig 5. Incidence rate of clinical malaria, fever, slide confirmed, Central 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year clinical malaria
fever
slide confirmed
2004
2005
Ministry of Health: National Health Report 2005 Page 165 of 250 --------------------------------------------------------------------------------------------------------------------Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Central, diarrhoea and more importantly with no blood and no dehydration is more common (see figure 6 below). Figure 6 below also shows a declining trend of diarrhoea (no blood no dehy.) over the past 10 years. Fig 6. Incidence rate of diarrhoea by type, Central 1996-2005 70.0 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody Diarrhoea by age group Figure 7 below demonstrates the incidence rate of Bloody diarrhoea by Age group in Central. The graph reveals that bloody diarrhoea in Central was more common in children aged less than 5 years. There’s no significant difference observed in the incidence rate of bloody diarrhoea in the aged group 1-4 and infants. Figure 7 also reveals that an outbreak of bloody diarrhoea in children aged less than 5 occurred in 2005. For aged group 5 years and over a slight increase in bloody diarrhoea rate was also observed in 2005. Fig 7. Incidence rate of bloody diarrhoea by age group, Central 1996-2005 60.0
rate per 1,000
50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
Skin disease and Yaws
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 166 of 250 --------------------------------------------------------------------------------------------------------------------Skin disease and Yaws are common health problems in Solomon Islands. In Central, yaws and more importantly skin disease are common health problems amongst it people. Fig 8. Incidence rate of yaw s and skin disease, Central & Solomon Is 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Central
yaw s, Solomon Is
skin disease, Central
skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Central and Solomon Islands in the past 10 years. The graph shows that yaws incidence rate for Central was lower than national average, while the rate of skin disease was slightly over national average. Figure 8 also demonstrate a declining trend for skin disease rate while yaws rate for both Solomon Islands and Central had remained constant through out the ten year period. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws in Central by age group. The graph shows that the incidence rate of yaws in Central was higher in children aged 1 – 4 followed by people aged 5 years and over then aged group less than one year old. Fig 9.
Incidence rate of yaw s by age group, Central 1996-2005
100.0 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 167 of 250 --------------------------------------------------------------------------------------------------------------------Figure 9 clearly demonstrates that between 1996 and 2001 the rate of yaws in the age group 1-4 had varied considerably, demonstrating high incidence in one year followed by significant dropped in the next year and so on. This inconsistent pattern of yaws rate clearly indicates that vaccine coverage must be improved in order to prevent the disease from occurring. However, between 2001 and 2004 yaws rate in this age group has constantly increased then slightly decline in 2005. Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Central. The graph demonstrates clearly that in Central the incidence rate of skin disease is higher in children aged 1 – 4, followed by infants then people aged 5 years or more. Fig 10. Incidence rate of skin diseases by age group, Central 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 10 also demonstrates a declining trend in incidence rate of skin disease in Central in all age groups. Red Eye Figure 11 demonstrates the incidence rate of red eye in Central and Solomon Islands for the past 10 years. The graph demonstrates that the incidence rate of red eye had remained somewhat higher than national average through out the 10 year period. It is also clear that in 1997 there was a significant dropped in the incidence of red eye in Central then a decline in the trend of red eye incidence rate was noted all through out to 2005.
Ministry of Health: National Health Report 2005 Page 168 of 250 --------------------------------------------------------------------------------------------------------------------Fig 11. Incidence rate of red eye, Central & Solomon Is 1996-2005 140.0 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Central
red eye, Solomon Is
Red Eye by Age Group Figure 12 below demonstrates the incidence rate of red eye by age group in Central, for the past 10 years. The graph shows that in Central the incidence rate of red eye was higher in babies, followed by children aged 1-4 then people aged 5 years and over. The graph also shows a decline trend of red eye rate in all age groups. Fig 12. Incidence rate of red eye by age group, Central 1996-2005 400.0 350.0
rate per 1,000
300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Central and Solomon Islands. The graph also demonstrates that the incidence rate of ear infection rate in Central was below national averages during the past 10 years. The graph also shows that ear infection rate for Central had increased between 2003 and 2005.
Ministry of Health: National Health Report 2005 Page 169 of 250 --------------------------------------------------------------------------------------------------------------------Fig 13. Incidence rate of ear inf ection, Central & Solomon Is 1996-2005 80.0 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear inf ection, Central
ear inf ection, Solomon Is
Ear infection by age-group Figure 14 demonstrates the incidence rate of ear infection by age group in Central. It reveals that the incidence rate of ear infection is in Central is higher in children aged 1-4 followed by infants then people aged 5 years or more. The graph also shows that the trend in ear infection rate in infants and children 1-4 does not reflect much difference. It is also revealed in the graph that ear infection rate in infants and children aged 1-4 has experienced a significant increase between 2003 and 2005. Fig 14. Incidence rate of ear inf ection by age group, Central 1996-2005 180.0 160.0
rate per 1,000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
As opposite to the first three provinces, incidence of clinical malaria is higher and increasing in Central Islands. Like other provinces, febrile illnesses such as Acute Respiratory infections have increased. Other less common diseases remained in the communities at a lower incidence around 50 per 1,000 population or lesser. There has been a steady decline in the skin diseases and yaws.
Provincial Response: In response to the common illnesses affecting the population of Central, the province has a total of 27 clinics. The ratio of clinic to population stands at 1 clinic to 919 population. (Table 12).
Ministry of Health: National Health Report 2005 Page 170 of 250 --------------------------------------------------------------------------------------------------------------------Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade Central Island TOTAL TOTAL 2005 2004
1
1
10 10
29 29
10
-1 30
7
18
5 5
106 106
173 173
5
-5 111
15 158
27
27
323
323
2 to RHC 7
14
314
Table 12 Number of clinics in Central Province in 2005: MOH Clinic database (2005)
7.6
Guadalcanal
Demography: Gender and Poverty: Guadalcanal has the third largest population of 69,527 in 2005 with a higher proportion of around 50% of age group of 15-49 years. In 2005, Gudalcanal recorded some of the worse health status indicators such as high maternal mortality and an out break whooping cough. 80,000 70,000 60,000 Pop
50,000 40,000 30,000 20,000 10,000 0
1999
2000
2001
2002
2003
2004
2005
Population total
59,611
61,205
62,821
64,456
66,137
68,931
69,527
Population <1
2,204
2,142
2,116
2,069
2,011
2,069
2,035
Population 1-4
7,541
7,742
7,873
7,983
8,082
8,428
8,084
Population <5
9,745
9,885
9,989
10,052
10,092
10,497
10,119
total 15-49 years
28,768
29,795
30,840
31,911
33,009
34,331
35,237
No of MOH Health Radios in Province 10 149
Ministry of Health: National Health Report 2005 Page 171 of 250 --------------------------------------------------------------------------------------------------------------------Fig 37 Population of Guadalcanal 7 y trend 40,000 35,000 30,000
Pop
25,000 20,000 15,000 10,000 5,000 0
WCBA
1999
2000
2001
2002
2003
2004
2005
13,898
14,365
14,843
15,334
15,845
16,548
16,894
2,110
2,182
2,251
2,318
2,381
2,439
Males >5
25,983
26,737
27,522
28,340
29,186
30,359
30,918
Females >5
23,884
24,583
25,310
26,064
26,859
28,075
28,490
total 15-49 years
28,768
29,795
30,840
31,911
33,009
34,331
35,237
males 15-49 years
14,870
15,431
15,997
16,577
17,164
17,781
18,343
Expected births
Fig 38 Population of Guadalcanal by Gender 7 yr trend
Health Burden in Guadalcanal 1996-2005 It should be noted also that the social unrest that prevailed in the country between 1999 until the arrival of Regional Assistance Mission to Solomon Islands (RAMSI) in 2003 had great impact on the provision and delivery of health services to Guadalcanal people. The effect of the social unrest is revealed in Figure 1 and furthermore in all graphs under each headings below.
Ministry of Health: National Health Report 2005 Page 172 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 1 Incidence rate of major diseases, Guadalcanal 1996-2005
900.0 800.0 700.0
ra te p e r 1 0 0 0
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Figure 1 demonstrates incidence rates of all major diseases affecting the health of Guadalcanal people. From the graph it is obvious that between 1998 and 2001 the incidence rates of all causes of illnesse in Guadalcanal dropped severely reaching it lowest point in 2001. The decline in incidence rates may reflects the effect of social unrest on the health service delivery in Guadalcanal. Disease Incidence Trend of Guadalcanal Figure 2 below demonstrates a very clear pattern of the main causes of attendance at primary health care clinics over the past 10 years in Guadalcanal. It is obvious that apart from ‘Other’ diseases, ARI, fever and clinical malaria are major common health problems affecting Guadalcanal people. Over the past 10 years, the proportion of clinical malaria has constantly increased from 2% in 1996 to 21% in 2005. This figure indicates that the proportion of clinical malaria as a main cause of attendance at any primary health care clinic has constantly increased over the past 10 years, though the proportion dropped slightly in 2005.
Ministry of Health: National Health Report 2005 Page 173 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 2 Proportion of new cases by major disease, Guadalcanal 1996-2005 40% 35% 30%
p e rce n t
25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000 2001 years
2002
2003
2004
2005
ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Guadalcanal ARI is second most importance cause of attendance at primary health care clinics. In 2005, ARI was responsible for 29% of all acute care contacts in Guadalcanal.
Fig. 3 Incidence rate of ARI - Guadalcanal,Solomon Is. 1996-2005 700.0 600.0
rate per 1000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years ARI rates - Guadalcanal
ARI rates - Solomon Is.
Ministry of Health: National Health Report 2005 Page 174 of 250 --------------------------------------------------------------------------------------------------------------------Figure 3 above illustrates that the incidence rate of ARI prior to the social unrest was well above national average. Then between 1998 and 2001 it dropped markedly from 580 cases per 1000 in 1998 to 180 cases per 1000 in 2001. Between 2001 and 2004 the incidence rate went up again reaching 350 per 1000 in 2004 and in 2005 a continuous increase was noted reaching 527 cases per 1000. Fig 4. Incidence rate of ARI by age group, Guadalcanal 1996-2005 4000 3500
rate per 1,000
3000 2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates<1
rates 1-4
rates >5
It is very obvious from Figure 4 above that ARI in Guadalcanal is a major health problem in children under 5 and more importantly in infants. As depicted in the graph, the incidence rate of ARI in babies was more than 1000 per population every year. What this figure tells us is that every year each baby in Guadalcanal has been presented with ARI more than once at any primary health care clinic. Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in the country in 2005. In Guadalcanal, malaria (i.e. fever and clinical malaria) account for 37% of all acute care contacts in 2005. Incidence rate of fever, clinical malaria and slide confirmed malaria Figure 6 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Guadalcanal for the past 10 years. It is obvious from the graph that through out the last decade incidence rate of slide confirmed malaria had been lower than incidence rate of clinical malaria. The graph also shows that the incidence rates of clinical and slide confirmed malaria had continued to rise since 1996 and 1998 respectively while the incidence rate of fever had declined considerably. One reason for the increased in trend of clinical malaria and decline trend of fever is that in about 1995 the system has changed in counting all fever cases as malaria.
Ministry of Health: National Health Report 2005 Page 175 of 250 --------------------------------------------------------------------------------------------------------------------Fig 6. Incidence rate of clinical malaria, fever, slide confirmed, Guadalcanal 1996-2005 900.0 800.0
Rate per 1,000
700.0 600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
fever
slide confirmed
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Guadalcanal, diarrhoea and more importantly bloody diarrhoea is also a common illness affecting people of Guadalcanal (see figure 7 below). Fig. 7 Incidence rate of Diarrhoea by Type, Guadalcanal 1996-2005 80.0 70.0
rates per 1000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years bloody no dehy
no blood w ith dehy
no bloody no dehy
blood w ith dehy
Bloody diarrhoea by age group Figure 8 below demonstrates the incidence rate of bloody diarrhoea in Guadalcanal by age group. The graph clearly shows that over the past 10 years bloody diarrhoea was more common in infant than in any other age groups. While the incidence rate declined from 266 cases per 1000 population in 1996 to 232 cases per 1000 population in 1997, in 1998 a significant increased was noted reaching 355 cases per 1000 population. Then between 1998 and 2001 the incidence rate dropped dramatically from 355 cases per 1000 in 1998 to 37 cases in 2001. Again this severely decline may be attributed to the impact of the social unrest on health service delivery in Guadalcanal. And between
Ministry of Health: National Health Report 2005 Page 176 of 250 --------------------------------------------------------------------------------------------------------------------2001 and 2003 the incidence rate increased again reaching 178 cases per 1000. In 2005 a further increase was also noted. Fig 8. Incidence rates of bloody diarrhoea by age group, Guadalcanal 1996-2005 400.0 350.0
rate per 1,000
300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Guadalcanal yaws and more importantly skin disease are also common illness affecting the people. Fig 9. Incidence rates of yaw s and skin disease, Guadalcanal & Solomon Is 350.0 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Guadalcanal
yaw s, Solomon Is
skin disease, Guadalcanal
skin disease, Solomon Is
From Figure 9, the incidence rate of skin diseases in Guadalcanal particularly in the years prior to the social unrest was well beyond national averages. Being the second largest province in terms of population size, it is no doubt that the above figure had great impact on the national average for skin disease rates. Between 1998 and 2001 skin disease incidence rate declined then in 2002 it remain constant and between 2002 and 2005 the incidence rate increased slightly from 60 cases per 1000 population in 2002 to 100 cases per 1000 in 2004. In 2005 a further increased was also noted.
Ministry of Health: National Health Report 2005 Page 177 of 250 --------------------------------------------------------------------------------------------------------------------Yaws by age group Figure 10 below illustrates the incidence rate of yaws by age group. It is obvious from the graph that incidence rate of yaws is highest in children aged 1 – 4 followed by people aged 5 years and over. The graph also reveals that yaws is not a common health problem in Guadalcanal babies. Figure 10 below incidence rates of yaws in children aged 1-4 was very high prior to the social unrest period reaching 102 cases per 1000 in 1998. Then during the social unrest period, the incidence rate declined considerably reaching 30 cases per 1000 population in 2001. However, between 2001 and 2003 the incidence rate of yaws in children aged 1-4 increased reaching 103 cases per 1000 in 2003. Then between 2003 and 2005 the rate had dropped from 103 cases per 1000 in 2003 to 78 cases per 1000 in 2005. Fig 10. Incidence rates of yaw s by age group, Guadalcanal 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Again the significant dropped in the incidence rates between 1998 and 2001 may be associated with the impact of the social unrest that had caused suspension of many health services to people of Guadalcanal in most affected areas. However, the rise in the incidence rate between 2001 and 2003 may indicate that the suspension to health service delivery in some affected areas in Guadalcanal has been lifted and that more people have now accessed to health services. Skin disease by age group Figure 11 below demonstrates the incidence of skin disease by age group in Guadalcanal. As shown in the graph, over the past 10 years, skin disease in Guadalcanal is more common in children aged 1-4 than other age groups. Figure 11 also indicates that in Guadalcanal incidence rate of skin disease in children aged 1-4 had declined from 482 cases per 1000 population in 1996 to 175 cases per 1000 in 2005.
Ministry of Health: National Health Report 2005 Page 178 of 250 --------------------------------------------------------------------------------------------------------------------Fig 11.Incidence rates of skin disease by age group, Guadalcanal 1996-2005 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Red Eye The incidence rate of red eye in Guadalcanal had been higher than national average during the past 10 years. The highest incidence rate of red eye occurred in 1996 reaching 85 cases per 1000 population. In 1997 there was a sudden dropped in red eye incidence rate and in 1998 it went up again reaching 75 cases per 1000 population. Between 1998 and 2001 a continuous declined was experienced and between 2001 and 2004 the rate went up again reaching 167 cases per 1000 in 2004. In 2005 a further increased in red eye incidence rate was noted. Fig 12. Incidence rates of red eye, Guadalcanal & Solomon Is 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Guadalcanal
red eye, Solomon Is
Red eye by age group Figure 13 below shows that in Guadalcanal red eye was more common in children under 5 but more importantly in infants. Between 1996 and 1997 incidence rate of red eye for
Ministry of Health: National Health Report 2005 Page 179 of 250 --------------------------------------------------------------------------------------------------------------------all age group declined. Then in 1998 it went up again to the about same rate in 1996. Between 1998 and 2001, the incidence rate dropped markedly. Then between 2001 and 2004 there was a significantly rise in the rate particularly in infants. In 2005, while incidence rate for age groups 1-4 and 5 years and over remain constant, the incidence rate of red eye in infants experienced a further increase. Fig. 13. Incidence rate of red eye by age group, Guadalcanal 1996-2005 250.0
rate per 1,000
200.0
150.0
100.0
50.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Fig.14. Incidence rate of ear infection, Guadalcanal & Solomon Is 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection, Guadalcanal
ear infection, Solomon Is
Figure 14 above shows the incidence rate of ear infection in Guadalcanal and in Solomon Islands. Prior to the social unrest period, the incidence rate of ear infection was higher than national averages, however a constant declined was experienced between 1997 and 2001 reaching 17 cases per 1000 population in 2001. Then between 1999 and 2005 the incidence rate of ear infection had remained below national averages.
Ministry of Health: National Health Report 2005 Page 180 of 250 --------------------------------------------------------------------------------------------------------------------Between the years 1997 and 2001 there was a considerable decline in ear infection incidence rate reaching 17 cases per 1000 in 2001. However, between 2001 and 2005 a continuous increased was noted. While the incidence rate of ear infection in Solomon Islands had dropped from 80 cases per 1000 in 2004 to 60 cases per 1000 in 2005, in Guadalcanal incidence rate had increased from about 40 cases per 1000 in 2004 to 50 cases per 1000 in 2005. Ear infection by age-group Figure 15 below demonstrates the incidence rate of ear infection by age group in Guadalcanal. From the graph it is very obvious that ear infection is more common in children under 5. The graph also shows that the incidence rates in all age groups had dropped between 1997 and 2001 but more profoundly in children under 5. Between 2001 and 2005, incidence rate of ear infection for all age group has increased. Fig 15. Incidence rate of ear infection by age group, Guadalcanal 1996-2005 300.0
rate per 1,000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999 rates <1
2000
2001
Year rates 1-4
2002
2003
2004
2005
rates >5
Conclusion: The three common illnesses in Guadalcanal are Acute Respiratory infection, malaria and other febrile diseases. Malaria is a major acute illness in Guadalcanal, there has been an increasing trend. In 2005 Guadalcanal recorded 370 per 1,000 population sick with malaria and had attended the clinics.
Ministry of Health: National Health Report 2005 Page 181 of 250 --------------------------------------------------------------------------------------------------------------------1,000 900 800
Rate per 1,000 pop
700 600 500 400 300 200 100 0
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
ARI
398
376
513
581
453
282
180
267
331
350
527
Diarrhoea
87
77
69
82
51
28
6
15
35
27
46
Fever
884
714
717
768
576
383
140
312
376
312
292
Red Eye
62
86
51
75
60
27
14
23
36
35
41
Yaws
82
70
58
69
66
50
24
38
74
62
62
Skin diseases
228
260
208
288
155
100
59
60
95
99
113
Ear disease
66
68
97
77
60
37
17
27
43
42
51
Clinical malaria
17
38
126
277
298
177
153
245
347
373
370
Fig 39 Common illness per 1,000 population 11 years trend 1995-2005 in Central Islands: Source HIS MOH (2006).
Provincial Response: There are total of 44 clinics (including 2 Village Health Workers Post). These primary health care clinics provided basic treatment for the common illnesses. In 2005, the ratio of clinic to population stands at 1 clinic to 1,655 population.
Clinics Clinic Province Hospital ANC UH RHC NAP VHW Total Total clinics without closed requires Clinic VHW formal upgrade GCP
0
6
TOTAL
10
29
TOTAL 2005
10
29
10
-1 30
2004
12
24
2
44
5
106
173
14
5
106
173
323
5
-5 111
15 158
314
42
2 now AHC + 2 to RHC + 5 new NAP 7
323
No of MOH Health Radios in Province 17
149
Ministry of Health: National Health Report 2005 Page 182 of 250 --------------------------------------------------------------------------------------------------------------------7,028 1,945 1,655 1,459 1,355 1,222 1,087 919 895 851
Honiara Malaita Guadalcanal National Temotu western Makira Central Renbel Choiseul
Table 13 Number of clinics in Guadalcanal Province in 2005: MOH Clinic database (2005)
7.7
Malaita
Demography: Gender and Poverty: Malaita is the largest population and also a very challenging one items of implementing primary health care services. Malaita has a more young population than Guadalcanal. The proportion of 15-49 age groups is around 47% whereas Guadalcanal has 50% on productive age group.
Ministry of Health: National Health Report 2005 Page 183 of 250 --------------------------------------------------------------------------------------------------------------------160,000 140,000 120,000
Pop
100,000 80,000 60,000 40,000 20,000 0 Population total
1999
2000
2001
2002
2003
2004
2005
121,299
124,746
128,268
131,855
135,090
133,867
142,018
Population <1
4,403
4,286
4,303
4,342
4,388
4,351
4,733
Population 1-4
15,772
16,156
16,437
16,741
17,015
16,882
17,422
Population <5
20,175
20,442
20,740
21,083
21,403
21,233
22,154
Total 15-49
53,633
55,759
57,919
60,110
62,121
62,125
66,422
Fig 34 Population of Malaita 7 y trend 70,000 60,000 50,000
P o p
40,000 30,000 20,000 10,000 0 WCBA 15-49
1999
2000
2001
2002
2003
2004
2005
28,263
29,284
30,295
31,302
32,103
32,378
34,047
1,842
2,361
3,026
Males >5
50,029
51,643
53,305
55,000
56,728
55,533
59,948
Females >5
51,095
52,661
54,223
55,772
56,959
57,101
59,916
Total 15-49
53,633
55,759
57,919
60,110
62,121
62,125
66,422
Males 15-49
25,371
26,476
27,623
28,808
30,017
29,745
32,375
Ex pec ted births
Fig 35 Population of Malaita by Gender 7 yr trend Health Burden Malaita recorded the highest incidence of malaria (430 per 1,000 populations despite substantial efforts in terms of control measures on the Islands. This trend becomes to raise issues of efficacy of the control measures. CIP and Guadalcanal Provinces recorded 398 and 370 per 1,000 population being infected by malaria respectively. Isabel and Western Province recorded 191 and 145 per 1,000 population respectively.
Ministry of Health: National Health Report 2005 Page 184 of 250 --------------------------------------------------------------------------------------------------------------------700 600 Rateper1,000pop
500 400 300 200 100 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 ARI Diarrhoea Fever
412
274
349
316
399
290
385
393
363
282
218
324
42
33
64
50
32
34
41
34
26
21
17
24
339 39
649
567
640
483
434
380
336
377
355
345
230
316
323
36
37
56
62
31
30
42
38
30
24
18
24
32
Yaw s
122
64
77
84
60
64
58
89
61
55
65
65
56
Skin diseases
297
177
190
152
121
112
123
127
97
77
66
75
95
Ear Diseases
32
31
43
43
33
26
29
32
30
23
17
25
27
115
277
255
219
271
377
382
348
292
400
430
Red Eye
Clinical malaria
Fig 36 Common illness per 1,000 population 13 years trend 1993-2005 in Malaita Province: Source HIS MOH (2006).
Malaita has the highest number of clinics (73 with 3 Village Health Workers Post), followed by Western Province (57) and Guadalcanal (42). However, the clinic to population is still at 1 clinic to around 2,000 population (1,945). Provincial Response: Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade Malaita
2
4
TOTAL
10
29
TOTAL 2005
10
29
10
-1 30
2004
21
46
3
5
106
173
14
5
106
173
323
5
-5 111
15 158
314
76
73
323
6
No o MOH Healt Radi in Prov 28
7
149
Ministry of Health: National Health Report 2005 Page 185 of 250 --------------------------------------------------------------------------------------------------------------------Map x Location of clinics in Malaita in 2005
7.8 7.9
Makira:
Demography: Gender and Poverty:
Ministry of Health: National Health Report 2005 Page 186 of 250 --------------------------------------------------------------------------------------------------------------------40,000 35,000 30,000 Pop
25,000 20,000 15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005
30,668
31,527
32,414
33,330
34,116
34,359
35,865
Population <1
1,223
1,240
1,243
1,205
1,138
1,098
1,118
Population 1-4
3,740
3,946
4,120
4,266
4,361
4,432
4,462
Population <5
4,963
5,187
5,362
5,470
5,498
5,530
5,580
14,498
15,067
15,640
16,217
16,706
16,845
17,692
Population total
total 15-49 years
Fig 37 Population of Makira 7 year trend In 2005 Makira Province estimated population was 35,865. About 49% were between the agegroup of 15-49 years old. Around 16% were less than 5 years and understandably cause a great demand to preventive services such as immunization. 20,000
Population
15,000 10,000 5,000 0 WCBA
1999
2000
2001
2002
2003
2004
2005
7,324
7,594
7,866
8,142
8,331
8,527
8,790 1,458
Expected births
1,153
1,200
1,249
1,300
1,353
1,404
Males >5
13,181
13,505
13,871
14,283
14,738
14,599
Females >5
12,525
12,836
13,181
13,576
13,880
14,231
total 15-49 years
14,498
15,067
15,640
16,217
16,706
16,845
Fig 38 Population of Makira 7 trend by gender
Health Burden in Makira 1996-2005: Disease Incidence Trend in Makira
17,692
Ministry of Health: National Health Report 2005 Page 187 of 250 --------------------------------------------------------------------------------------------------------------------Figure 1 below demonstrates the proportion of acute care contacts in Makira by diseases. From the graph it is obvious that malaria and ARI are major common health problems affecting Makira people.
Fig 1. Proportion of new cases by major diseases, Makira 1996-2005 40% 35% 30%
percent
25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Makira, ARI is second only importance to malaria. In 2005, ARI was responsible for 24% of all acute care contacts in Makira. Figure 2 below demonstrates the incidence rate of ARI in Makira and Solomon Islands over the past 10 years. The graph shows that the trend of ARI incidence rate in Makira has been increasing from 297 cases per 1000 in 1996 to 465 cases per 1000 in 2005. Over the years, ARI has remained to be seen as a common illness for Makira people.
Ministry of Health: National Health Report 2005 Page 188 of 250 --------------------------------------------------------------------------------------------------------------------Fig 2. Incidence rate of ARI, Makira & Solomon Is 1996-2005 500.0 450.0 400.0
rateper 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Makira
ARI, Solomon Is
Incidence rate of ARI by age group – Makira Figure 3 demonstrates the incidence rate of ARI by age group in Makira. The graph reveals that in Makira ARI has been a major health problem in babies. As also depicted, the trend of ARI rate in babies have increased considerably over the past 10 years, reaching 3075 cases per 1000 population in 2005. This would mean that every Makira baby have been presented more than once with ARI at any primary health care clinics. The graph also shows that in the recent years, the rate of ARI in Makira has increased considerably. The increase in the ARI rate was also experienced in the aged group 1-4 between 2003 and 2004.
Ministry of Health: National Health Report 2005 Page 189 of 250 --------------------------------------------------------------------------------------------------------------------Fig 3. Incidence rate of ARI by age group, Makira 1996-2005 3500 3000
rate per 1,000
2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in 2005 in the country. In Makira, malaria is responsible for 48% of all acute care contacts in 2005.
Ministry of Health: National Health Report 2005 Page 190 of 250 --------------------------------------------------------------------------------------------------------------------Fig 4. Incidence rate of clinical malaria, Makira & Solomon Is 1996-2005 700.0 600.0
percent
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Makira
Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Makira and Solomon Islands. The graph shows that incidence rate of clinical malaria in Makira has increased and exceeded national average in recent years. The graph also reveals that the rate of clinical malaria in Makira increased dramatically between 2001 and 2004 reaching 505 cases per 1000 population in 2004. In 2005 clinical malaria rate in Makira decreased to 487 cases per 1000 population.
Incidence rate of fever and clinical and slide confirmed malaria Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in Makira for the past 10 years. It is obvious from the graph that the trend of the rate for fever, clinical malaria and slide confirmed malaria in Makira has gone up over the past 10 years and the significant rise is more prominent in recent years.
Ministry of Health: National Health Report 2005 Page 191 of 250 --------------------------------------------------------------------------------------------------------------------Fig 5. Incidence rate of clinical malaria, f ever, slide conf irmed, Makira 19962005 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
f ever
slide conf irmed
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Makira, diarrhoea and more importantly with no blood and no dehydration is more common (see figure 6 below). Fig 6. Incidence rate of diarrhoea by type, Makira 1996-2005 20.0 18.0 16.0 rate per 1,000
14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no dehy no blood
Bloody Diarrhoea by age group
no blood dehy
no dehy blood
blood dehy
Ministry of Health: National Health Report 2005 Page 192 of 250 --------------------------------------------------------------------------------------------------------------------Figure 7 below demonstrates the incidence rate of Bloody diarrhoea by Age group. The graph reveals that bloody diarrhoea was more common in children aged less than 5 years but more importantly in infants. The graph also shows that the rate for bloody diarrhoea in Makira has declined in the aged group 1-4 over the past 10 years, however for infants bloody diarrhoea rate remain to be a health problem despite reduction in the rate in some years. Fig 7. Incidence rate of bloody diarrhoea by age group, Makira 1996-2005 18.0 16.0
rate per 1,000
14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Makira, yaws and more importantly skin disease are common health problems amongst it people.
Ministry of Health: National Health Report 2005 Page 193 of 250 --------------------------------------------------------------------------------------------------------------------Fig 8. Incidence rate of yaw s and skin disease, Makira & Solomon Is 1996-2005 200.0 180.0
rate per 1,000
160.0 140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Makira
yaw s, Solomon Is
skin disease, Makira
skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Makira and Solomon Islands in the past 10 years. The graph shows that while national rate (skin disease incidence rate in Solomon Islands) for skin diseases have decreased over the past 10 years, in Makira the trend of skin disease rate demonstrates the opposite and in recent years that is between 2001 and 2005 it has exceeded national average. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws in Makira by age group. The graph shows that the incidence rate of yaws in Makira was higher in children aged 1 – 4 followed by people aged 5 years and over. The graph also reveals that yaws is not a common health problem for babies in Makira.
Ministry of Health: National Health Report 2005 Page 194 of 250 --------------------------------------------------------------------------------------------------------------------Fig 9. Incidence rate of yaw s by age group, Makira 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
The highest rate of yaws in children aged 1-4 occurred in 2003 reaching 111 cases per 1000 population. The increase in yaws incidence rate in children 1-4 in 2003 signifies the outbreak of yaws in this age group in Makira during the year. In 2004 yaws rate in the aged group 1-4 dropped to 77 cases per 1000 population and then increased slightly in 2005 reaching 90 cases per 1000 population. The graph also reveals that between 1998 and 2002, yaws rate in the age group 1-4 experienced a continuous decline reaching 57 cases per 1000 population in 2002 before an outbreak occurred in 2003. This pattern clearly indicates that vaccine coverage must be improved in order to prevent the disease from occurring. Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Makira. The graph below shows clearly that in the past 10 years, skin disease in Makira was a common health problem in people. However, skin disease rate is highest in children aged 1-4 except in 2005 where skin disease rate in infants exceeded that of rate for aged group 1-4. The graph also shows that in 2005 the rate of skin disease had increased considerably from about 150 cases per 1000 population in 2004 to 244 cases per 1000 population in 2005. This signifies an outbreak of skin disease amongst babies in Makira in 2005.
Ministry of Health: National Health Report 2005 Page 195 of 250 --------------------------------------------------------------------------------------------------------------------Fig 10. Incidence rate of skin disease by age group, Makira 1996-2005 300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Red Eye Figure 11 demonstrates the incidence rate of red eye in Makira and Solomon Islands for the past 10 years. The graph demonstrates clearly the decline in the red eye incidence rate for Solomon Islands and Makira in the past 10 years. Despite the decline that is being noted over the years in Makira and Solomon Islands, in 2005 there was an outbreak of red eye experienced in both. Fig 11. Incidence rate of red eye, Makira & Solomon Is 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
Year red eye, Makira
Red Eye by Age Group
red eye, Solomon Is
2005
Ministry of Health: National Health Report 2005 Page 196 of 250 --------------------------------------------------------------------------------------------------------------------Figure 12 below demonstrates the incidence rate of red eye by age group in Makira, for the past 10 years. The graph shows that in Makira the incidence rate of red eye was highest in babies. The graph also shows that in Makira the highest incidence rate of red eye in babies occurred in 1996 reaching 170 cases per 1000 population. In 1997, the rate had dropped by halved then increased again in 1998 reaching 140 cases per 1000. Between 1998 and 2004, the trend of red eye in babies had constantly decreasing. However, in 2005 an outbreak of red eye in Makira was experienced in all aged group but more importantly in babies. Fig 12. Incidence rate of red eye by age group, Makira 1996-2005 180.0 160.0
rate per 1,000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Makira and Solomon Islands. The graph also demonstrates that trend of ear infection rate in Makira was higher than national averages during the past 10 years.
Ministry of Health: National Health Report 2005 Page 197 of 250 --------------------------------------------------------------------------------------------------------------------Fig 13. Incidence rate of ear infection, Makira & Solomon Is 1996-2005 80.0 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection, Makira
ear infection, Solomon Is
Ear infection by age-group Figure 14 demonstrates the incidence rate of ear infection by age group in Makira. From the graph, it is obvious that in Makira ear infection is a common health problem in babies. Figure 14 also reveals that between 1996 and 1998 the incidence rate of ear infection in babies in Makira increased from 85 cases per 1000 in 1996 to 138 cases per 1000 population. Then a constant declined in ear infection rate for babies was noted between 1998 and 2001. In 2002, ear infection rate dropped significantly reaching 43 cases per 1000 population. Between the years 2002 and 200 the rate of ear infection rate in Makira babies rose dramatically reaching it highest, 136 cases per 1000 population in 2005. Fig 14. Incidence rate of ear inf ection by age group, Makira & Solomon Is 19962005 160.0 140.0
rate per 1,000
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 198 of 250 --------------------------------------------------------------------------------------------------------------------Provincial Response: Makira has a total of 33 clinics (not including Village Health Workers Post). The province has a provincial base hospital, 3 Area Health Clinic, 14 Rural Health Clinic and 15 Nurse Aid Posts. The 33 clinics offer treatment to common illnesses, child health and also maternal health services. Really these are the core business of the clinics. There has been referral system to ensure the sick people needing higher care of services are accessed as appropriate.
Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade Makira
1
3
14
15
1
TOTAL
10
29
5
106
173
14
TOTAL 2005
10
29
5
106
173
323
2004
10
-1 30
5
-5 111
15 158
314
34
33
7 323
The numbers of satellite clinics, and community mobilization and awareness have increased since 2001 after a significant declined since 1999. This is good news as the province is reestablishing the PHC to complement and supplement the 16 clinics.
Number
The number of outreach has increased in the past years. This happens with the support from operational funds support from the Health Sector Trust Fund funded by AusAID, and the Solomon Islands Health Sector Development Project funded through World Bank loan. 900 800 700 600 500 400 300 200 100 0 1995
1996 satellite
1997
1998
1999
Total health ed
2000
2001
health ed school
2002 village
2003
2004
2005
total outreach
Table 14 Core Indicators for Makira by 2005
No of health facilities Total population Pop<1yr Pop1-4 yr
Makira 35 35,865 1,118 4,462
SI 328 471,266 14,465 55,240
No of MOH Health Radios in Province 18
149
Ministry of Health: National Health Report 2005 Page 199 of 250 --------------------------------------------------------------------------------------------------------------------Pop.WBA 15-49 8,790 115,730 Expected birth 1,532 20,354 TotaL deliveries/ births 985 10,948 Total births in health clinic 842 8,878 Home births 143 2,071 TBA Total Live births 956 9,319 Perinatal/ Still births 29 262 Neonatal deaths Total SB+NND 29 262 % Perinatal rate= No.of SB + Deaths 1000.0 1000.0 first week / number SB and no. LB x 1000 Crude Birth Rate=No. of live births in 27.5 23.2 a year / Total mid yr x1000 Total deaths 134 1,135 Crude Death Rate 0.4 0.2 Number of births by skilled health 842 8,878 personel Total reported births 985 10,948 % Birth attended by skilled health 85 81 personel (incl trained TBAs)= No births attendd by trained skilled personnel/ tot reported births Maternal Deaths 3 22 Maternal Mortality Rate = No. 314 236 maternal deaths in a year/ total live births x100,000 Infant deaths 21 152 22.0 16.3 Infant Mortality Rate=No. of infant deaths in a yr/ Total no. of live birthsx1000 FP Total users (HCC + SIPPA-1714) 816 8365 Total Child deaths-1-4 Yrs. 9 97 2.0 1.8 Child Mortality Rate-Deaths in children 1-4yrs/ 1,000 pop of children 1-4) 9.3 7.2 % Contraceptive Prevalence Rate=CBA using contraception/Total CBA X100 Total ANC First Visit (or total Preg. 1194 14,794 Mothers) Tot. Preg mothers-na (Expected 1,532 20,354 births) 78 73 % ANC Coverage=no. of preg women attending 3 or more ANC/ Tot. preg mothersx100
Ministry of Health: National Health Report 2005 Page 200 of 250 ---------------------------------------------------------------------------------------------------------------------
7.10 Temotu . Demography: Gender and Poverty: The population of Temotu in 2005 was 21,678, with about 14.8% children less than 5 years old, and 48.6% are 15-49 years old. 25,000
Population
20,000 15,000 10,000 5,000 0
1999
2000
2001
2002
2003
2004
2005 21,678
18,706
19,144
19,596
20,061
20,619
20,077
Population <1
538
525
545
583
637
661
769
Population 1-4
2,054
2,084
2,117
2,175
2,264
2,263
2,455
Population <5
2,591
2,609
2,661
2,758
2,901
2,924
3,223
Total 15-49
8664
8992
9308
9606
9938
9746
10,527
Population total
Ministry of Health: National Health Report 2005 Page 201 of 250 --------------------------------------------------------------------------------------------------------------------Fig x Population of Temotu 7 yr trend.
12,000 10,000 Pop u latio n
8,000 6,000 4,000 2,000 0
1999
2000
2001
2002
2003
2004
2005
4,813
4,985
5,143
5,285
5,459
5,414
5,739
629
586
546
509
474
450
427
Males >5
7,709
7,892
8,077
8,263
8,453
8,031
8,852
Females >5
8,406
8,643
8,858
9,039
9,266
9,122
9,603
Total 15-49
8,664
8,992
9,308
9,606
9,938
9,746
10,527
males 15-49
3,851
4,007
4,165
4,321
4,479
4,333
4,788
WCBA Expected births
Fig x Population by gender 7 year trend.
Temotu is the only province where by trend of population of females slight higher than males. Disease Incidence Trend 1996-2005 Acute Respiratory Infections: ARI are major cause of morbidity worldwide and in Solomon Islands. Over the past 10 years, ARI has been the second most importance cause of attendance at primary health care clinic in Temotu.
Ministry of Health: National Health Report 2005 Page 202 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 1 Percent of ARI new cases 1996-2005 40% 35% 30%
percent
25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years
ARI as % total HIS - Temotu
ARI as % total HIS - Sol Is.
As depicted in Figure 1, percentage of ARI at primary health care clinic in Temotu has remained above national average in the past 10 years. In 2005, ARI was responsible for 36% of acute care contacts in Temotu. It is no doubt that this figure could have had contributed to the high rate ARI contacts in Solomon Islands in 2005.
Ministry of Health: National Health Report 2005 Page 203 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 2 Incidence rate of ARI 1996-2005 700.0 600.0 ra t e s /1 0 0 0 p o p
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
year ARI rates - Temotu
ARI rates - Solomon Is.
Figure 2 above demonstrated the incidence rate of ARI in Temotu and Solomon Islands. From the graph it is obvious that incidence rate of ARI in Temotu are higher than that of national averages. While there has been a decreasing in population rate in Temotu between the years 1999 to 2003, in 2004 the population rate increased dramatically reaching 657 cases per 1000 population before it slightly decline to 634 cases per 1000 population in 2005.
Fig. 3 Incidence Rate of ARI by age group in Temotu 1996-2005
3500.0
3000.0
incidence rate
2500.0
2000.0
1500.0
1000.0 500.0
0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years tot. pop.
rates <1
rates 1-4
rates >5
Ministry of Health: National Health Report 2005 Page 204 of 250 --------------------------------------------------------------------------------------------------------------------Figure 3 above clearly demonstrated that under 5 children and in particular children under 1 year old are the most affected ones by the disease (ARI).
Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 40% of all acute care contacts in the country. In Temotu, the situation is slightly different and this is depicted in Figure 4 below. From the graph below, it is obvious that percent of clinical malaria as total acute care contact remain below national average through out the ten year period. Fig. 4 Percent of Clinical Malaria New cases 1996-2005 45% 40% 35% perc ent
30% 25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years clinic malaria %HIS - Sol
clinic malaria %HIS - Tem
The above graph shows that over the last decade incidence rate of clinical malaria in Temotu has been fluctuating. As revealed in Figure 5 below in the early years of last decade that is between 1996 to 1998 population rate of clinical malaria have dropped by halved, then between 1999 to 2001 the population rate doubled reaching 472 cases per 1000 population in 2001 and between 2002 to 2004 population rate declined again. In 2005, the incidence rate has been increased from 272 cases per 1000 population in 2004 to 313 cases per 1000.
Ministry of Health: National Health Report 2005 Page 205 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 5 Incidence rate of fever, clinical malaria and slide confirmed Temotu 19962005 500.0
in c id e n c e ra t e /1 0 0 0 p o p
450.0 400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years Temotu - fever
Temotu - clinical malaria
Temotu - slide confirmed
Figure 5 also reveals that since 1999 incidence rate of slide confirmed malaria have been lower than incidence rate of fever and clinical malaria.
Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Temotu, diarrhoea and more importantly bloody diarrhoea has been the major cause of illnesses for people of Temotu.
Ministry of Health: National Health Report 2005 Page 206 of 250 --------------------------------------------------------------------------------------------------------------------Fig 7. Incidence rate of Diarrhoea by type, Temotu 1996-2005 45.0 40.0
rate per 1000
35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years bloody no dehy
bloody w ith dehy
no blood no dehy
no blood w ith dehy
Fig. 8 Incidence rate of Bloody Diarrhoea Temotu 1996-2005 250.0
rate per 1000
200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years under 1
aged 1-4
aged >5+
Figure 8 clearly demonstrates that in Temotu bloody diarrhoea is a common disease affecting children under 5 and more importantly infants in the last decade. From the above graph, the incidence rate of bloody diarrhoea particularly in children under 5 has not been stable during the last decade. In 2005 incidence rate for children under 1 has dropped significantly from 161 cases per 1000 to 70 cases per 1000 whilst incidence rate for children 1-4 experience a moderate decline. Skin disease and Yaws
Ministry of Health: National Health Report 2005 Page 207 of 250 --------------------------------------------------------------------------------------------------------------------Skin disease and Yaws are common health problems in Solomon Islands. In Temotu, they are also common illnesses amongst children under 5 years.
Fig. 9 Incidence rate of Yaw - Temotu and Sol 1996-2005 250.0
rate per 1000
200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years yaw s - Temotu
skin disease - Temotu
yaw s - Sol Is.
skin disease - Sol Is.
Figure 9 above shows that incidence rate of yaws and skin diseases are higher in Temotu compared to that of national average. In 1998, incidence rate of yaws in Temotu rose dramatically from 34 cases per 1000 population to 103 cases per 1000 in 1999. Then followed by a continuous decline for two years, a slightly increase in 2001 and then in 2002 there was a significant rise in the incidence rate of yaws again reaching 145 cases per 1000 population. Then between 2003 and 2004 yaws incidence rate in Temotu dropped significantly from 141 cases per 1000 in 2003 to 40 cases per 1000 in 2004. The fluctuating pattern of yaws incidence rate in Temotu could imply that though something has been done to reduce the incidence rate, vaccine coverage was not enough to prevent the disease from spreading.
Ministry of Health: National Health Report 2005 Page 208 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 10 Incidence rate of Yaw s by age group Temotu 1996-2005 300.0
rate per 1000
250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years rates <1
rates 1-4
rates >5
Figure 10 shows the incidence rate of yaws by age group. It is clear that yaws is more common in children aged 1-4 followed by age group 5 years and older but not a common disease in infants in Temotu. In 2002 incidence rate of yaws for children aged 1-4 reached it highest peak with 254 cases per 1000 population, then dropped significantly to 66 cases per 1000 in 2004 and in 2005 a further decline was also noted. Fig. 11 Incidence rate of skin disease Temotu 1996-2005 500.0 450.0
rate per 1000
400.0 350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years rates <1
rates 1-4
rates >5
Figure 11 reveals that skin diseases is also common in Temotu in infants and more importantly in children aged 1-4. The graph also shows that the highest incidence rate of skin disease occurred in 1998 where more than 45% of children aged 1-4 were infected. In 1999 the rate for children 1-4 dropped to a third then remained constant in the next four (4) years. However, in 2004 the incidence rate increased from 307 cases per 1000 in 2003 to 430 cases per 1000. The graph also shows that in 2005 the incidence rate of skin disease in Temotu for other age groups (infants and people aged 5 years and over) have also declined.
Ministry of Health: National Health Report 2005 Page 209 of 250 --------------------------------------------------------------------------------------------------------------------Red Eye In Temotu, red eye and ear infection are more common in children under 5 years during the last decade. Figure 12 below illustrates that the incidence rate of red eye has declined from 50 cases per 1000 population in 1996 to 27 cases per 1000 in 2005. The graph also shows that incidence rate of red eye has gradually decreasing during the last decade and had remained below national averages. However in 2005 there was a slight increase in red eye incidence rate in Solomon Islands and in Temotu. Fig. 12 Incidence rate of Red Eye 1996-2005 90.0 80.0
rate per 1000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years red eye-tem
red eye-sol
Figure 13 below reveals that incidence rate of red eye was highest in infants through out the last 10 years. This is followed by children aged 1-4 and then people 5 years and over. In 1999 red eye incidence rate for infants reached it highest point with 186 cases per 1000 population, then in 2002 it dropped to 120 cases per 1000 and had continued declining until 2004. Figure 13 also shows that in 2005 there was a slight increase in red eye incidence rate in all aged groups.
Ministry of Health: National Health Report 2005 Page 210 of 250 --------------------------------------------------------------------------------------------------------------------Fig. 13 Incidence rate of Red Eye by Age Group Temotu 1996-2005 200.0 180.0 160.0 rate per 1000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
years rates <1
rates 1-4
rates >5
Ear Infection ear infection - Solomon Is. ear infection - Temotu rates <1 rates 1-4 rates >5 Source HIS 1996-2005
1996 66.2 93.1 161.9 232.7 72.3
Table 1. Ear Infection by age-group, 1996-2005 1997 1998 1999 2000 2001 71.2 62.6 57.8 55.0 56.2 80.8 73.4 90.5 87.4 87.3 198.2 143.9 321.8 266.6 268.0 225.9 197.1 280.5 248.1 249.9 57.7 55.3 58.5 61.5 61.2
2002 46.7 128.1 333.0 379.2 89.6
2003 50.7 108.0 268.6 359.9 70.0
2004 57.6 127.1 307.3 379.1 86.9
2005 60.7 112.5 277.1 345.4 74.7
Table 1 above shows that the incidence rate of ear infection for Temotu was higher than national averages in the last decade. The table also shows that the highest incidence rate was experienced in 2002 where 13% of Temotu people were infected. In 2005, a slight decrease in incidence rate in all age group was also noted. From table 1, it is obvious that ear infection was more common in children under 5. As also revealed in table 1, incidence rate of ear infection in Temotu in the last decade has been increasing however a slight decrease was experienced in 2005. Provincial Response: Health Infrastructure: The foundation of health services in the provinces are the primary health clinics. By 2005, Temotu has a total of 16 clinics, of which 75% of the total clinics a have a working radio clinic.
Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic Clinic clinics without closed requires VHW formal upgrade
No of MOH Health Radios in Province
Temotu
12
TOTAL TOTAL 2005
1
1
5
9
10
29
5
106
173
10
29
5
106
173
16
16 7
14 323
323
149
Ministry of Health: National Health Report 2005 Page 211 of 250 ---------------------------------------------------------------------------------------------------------------------1 10
30
5
15
111
158
314
Table x Total of clinics in Temotu by 2005 By 2005 the ratio of clinic to population was 1: 1,355
Primary Health Care services: Fig x below shows very low levels of primary health care activities (satellites, community mobilization and awareness meetings) in Temotu compared with Makira Province. The cyclone Zoë in 2003 had a devastating impact on the level of services delivery in the province.
No. of PHC activities
250 200 150 100 50 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Satellite
Total health ed
health ed school
village
Fig x number of primary health care activities by 13 yr trend:
800 1993
700
1994 No. of patients
2004
-5
600
1995
500
1996 1997
400
1998 1999
300
2000
200
2001 2002
100
2003
0 inpatients Referrals Referrals Referrals Referrals Total AHC RHC Prov NRH outreach
Fig x Level of referrals and admissions at clinic level.
Inpatients and referrals:
2004
Ministry of Health: National Health Report 2005 Page 212 of 250 --------------------------------------------------------------------------------------------------------------------The numbers of inpatients in the clinics have increasing. Conversely, the total number of outreach services also declined since 2000. Table x Core Indicators of Temotu Province by 2005:
No of health facilities Total population Pop<1yr Pop1-4 yr Pop.WBA 15-49 Expected birth TotaL deliveries/ births Total births in health clinic Home births TBA Total Live births Perinatal/ Still births Neonatal deaths Total SB+NND % Perinatal rate= No.of SB + Deaths first week / number SB and no. LB x 1000 Crude Birth Rate=No. of live births in a year / Total mid yr x1000 Total deaths Crude Death Rate Number of births by skilled health personel Total reported births % Birth attended by skilled health personel (incl trained TBAs)= No births attendd by trained skilled personnel/ tot reported births Maternal Deaths Maternal Mortality Rate = No. maternal deaths in a year/ total live births x100,000 Infant deaths Infant Mortality Rate=No. of infant deaths in a yr/ Total no. of live birthsx1000 FP Total users (HCC + SIPPA-1714) Total Child deaths-1-4 Yrs. Child Mortality Rate-Deaths in children 1-4yrs/ 1,000 pop of children 1-4) % Contraceptive Prevalence Rate=CBA using contraception/Total CBA X100 Total ANC First Visit (or total Preg. Mothers) Tot. Preg mothers-na (Expected births)
Temotu 16 21,678 769 2,455 5,739 890 539 432 107 522 17
SI 328 471,266 14,465 55,240 115,730 20,354 10,948 8,878 2,071 9,319 262
17 1000.0
262 1000.0
24.9
23.2
82 0.4 432
1,135 0.2 8,878
539 80
10,948 81
1 192
22 236
9 17.2
152 16.3
548 5 2.0
8365 97 1.8
9.5
7.2
560
14,794
890
20,354
Ministry of Health: National Health Report 2005 Page 213 of 250 --------------------------------------------------------------------------------------------------------------------% ANC Coverage=no. of preg women 63 73 attending 3 or more ANC/ Tot. preg mothersx100
7.11 7.12 Rennell Bellona Demography: Gender and Poverty: Rennell Bellona is the smallest province in the country. In 2005 the total population of Rennell Bellona was 2,686. Of which around 11.6% are aged less than 5 years old.
3000 2500
Pop
2000 1500 1000 500 0 1999 Population total
2000
2001
Population <1
2002
2003
Population <5
2004
2005
Population >5
1,400 1,200
Pop
1,000 800 600 400 200 0 1999
2000 WCBA
2001
2002
2003
Total 15-49
2004
males 15-49
Disease Incidence Trend of Rennell Bellona 1996-2005:
2005
Ministry of Health: National Health Report 2005 Page 214 of 250 --------------------------------------------------------------------------------------------------------------------Figure 1 demonstrates the proportion of acute care contacts by major diseases in Renbel. In Renbel, the most common cause of attendance at any primary health care clinics between 1996 and 2005 were ‘Other’ diseases and ARI. Fig 1. Proportion of new cases by major disease, Renbel 1996-2005 80% 70% 60%
percent
50% 40% 30% 20% 10% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear inf ection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Renbel, ARI is second most importance cause of attendance at primary health care clinics. In 2005, ARI was responsible for 36% of all acute care contacts in RenBellona. Fig 2. Incidence rate of ARI, Renbel & Solomon Is 1996-2005 800.0 700.0
rateper 1,000
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Renbel
ARI, Solomon Is
Figure 2 shows that in the past 10 years the incidence rate of ARI in Renbel was above national average. The graph also shows an increasing trend of ARI rate in Renbel over the past 10 years. Acute Respiratory Infection by Age Group
Ministry of Health: National Health Report 2005 Page 215 of 250 --------------------------------------------------------------------------------------------------------------------Fig 3. Incidence rate of ARI by age group, Renbel 1996-2005 3500 3000
rate per 1,000
2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 3 demonstrates the incidence rate of ARI in Renbel by age-group in the past 10 years. The graph shows that ARI rate is higher in infants, followed by children aged 1-4, then people 5 years and over. The graph also reveals that ARI had remained to be a common health problem in infants in the last decade. The graph also shows that ARI rates in children aged 1-4 had shown a rise in trend over the last 4 years (between 2002 and 2005). Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. In Renbel malaria is non endemic. Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Renbel, diarrhoea and more importantly with no blood and no dehydration was also a common illness in Renbel.
Ministry of Health: National Health Report 2005 Page 216 of 250 --------------------------------------------------------------------------------------------------------------------Fig 4. Incidence rate of diarrhoea by type, Renbel 1996-2005 80.0 70.0
rateper 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody diarrhoea by age group Figure 5 below demonstrates the incidence rate of bloody diarrhoea by age group in Renbel for the past 10 years. The graph shows that in 2005 there was an outbreak of bloody diarrhoea in children aged less than 5. Fig 5. Incidence rate of bloody diarrhoea by age group, Renbel 1996-2005 90.0 80.0
rateper 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Renbel yaws and more importantly skin disease are also common illness affecting the people.
Ministry of Health: National Health Report 2005 Page 217 of 250 --------------------------------------------------------------------------------------------------------------------Fig 6. Incidencce rate of yaw s and skin disease, Renbel & Solomon Is 1996-2005 250.0
rate per 1,000
200.0
150.0 100.0
50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Renbel skin disease, Renbel
yaw s, Solomon Is skin disease, Solomon Is
Figure 6 demonstrates the incidence rate of yaws and skin disease in Renbel and Solomon Islands in 1996 – 2005. Figure 6 shows that in 2000 there was an outbreak of skin disease in Renbel. This is clearly demonstrated in the significant rise in skin disease rate from 30 cases per 1000 population in 1999 to 224 cases per 1000 population in 2000. Between 2000 and 2002 the rate of skin disease reduced for more than half. Then between 2002 and 2004 skin disease rate rose again reaching 169 cases per 1000 population in 2004 then in 2005 it dropped to 45 cases per 1000 population. Yaws by age group Figure 9 below demonstrates the incidence rate of yaws by age group in Renbel for the past 10 years. It is obvious from the graph that yaws is more common in the age group 1-4 and 5 years and older. Fig 7. Incidence rate of yaw s by age group, Renbel 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
Year rates <1
rates 1-4
rates >5
Based on figure 7 yaws remained to be seen through out the 10 year period.
2005
Ministry of Health: National Health Report 2005 Page 218 of 250 --------------------------------------------------------------------------------------------------------------------Skin disease by age group Figure 8 below demonstrates the incidence rate of skin disease by age group in Renbel for the past 10 years. The graph shows skin disease in more common in infants and children 1-4. From the graph it is also clear that skin disease remained to be seen in children through out the 10 year period. Fig 8. Incidence rate of skin disease by age group, Renbel 1996-2005 700.0 600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 219 of 250 --------------------------------------------------------------------------------------------------------------------Red Eye Figure 9 demonstrates the incidence rate of red eye in Renbel and Solomon Islands over the past 10 years. The graph clearly shows a declining trend of red eye incidence rate in Renbel and Solomon Islands over the past 10 years. The graph also shows that red eye rate in Renbel has remained below national average. Fig 9. Incidence rate of red eye, Renbel & Solomon Is 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Renbel
red eye, Solomon Is
Red eye by age group Figure 10 below demonstrates the incidence rate of red eye by age group in Renbel for the past 10 years. The graph also reveals that through out the 10 year period, red eye incidence rate was higher in babies, followed by children aged 1-4 and then the age group 5 years and over. The graph also shows that the trend of red eye incidence in recent years for babies has declined from it highest level 142 cases per 1000 population in 2000 to 21 cases per 1000 population in 2005. Fig 10. Incidence rate of red eye by age group, Renbel 1996-2005 160.0 140.0
rateper 1,000
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
Year rates <1
rates 1-4
rates >5
2004
2005
Ministry of Health: National Health Report 2005 Page 220 of 250 --------------------------------------------------------------------------------------------------------------------Ear Infection Figure 11 demonstrates the incidence rate of ear infection in Renbel and in Solomon Islands for the past 10 years. Fig 11. Incidence rate of ear inf ection, Renbe & Solomon Is 1996-2005l 80.0 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear inf ection, Renbel
ear inf ection, Solomon Is
Ear infection by age-group Figure 14 below demonstrates the incidence rate of ear infection by age group in Renbel for the past 10 years. The graph shows that through out the past 10 years ear infection in REnbel is more common is babies, followed by children age 1-4 then people age 5 years or more. The highest rate of ear infection in babies reached 317 cases per 1000 population in 1998. Then in 1999 no ear infection cases were reported. However between 2003 and 2005 the trend of ear infection is increasing once again. Provincial Response:
No of health facilities Total population Pop<1yr Pop1-4 yr Pop.WBA 15-49 Expected birth TotaL deliveries/ births Total births in health clinic Home births TBA Total Live births Perinatal/ Still births Neonatal deaths
RBP 3 2,686 71 1,201 598 114 24 7 17 24 0
SI 328 471,266 14,465 55,240 115,730 20,354 10,948 8,878 2,071 9,319 262
Ministry of Health: National Health Report 2005 Page 221 of 250 --------------------------------------------------------------------------------------------------------------------Total SB+NND 0 262 % Perinatal rate= No.of SB + Deaths #DIV/0! 1000.0 first week / number SB and no. LB x 1000 23.2 Crude Birth Rate=No. of live births in a 8.9 year / Total mid yr x1000 Total deaths 17 1,135 Crude Death Rate 0.6 0.2 Number of births by skilled health 7 8,878 personel Total reported births 24 10,948 29 % Birth attended by skilled health 81 personel (incl trained TBAs)= No births attendd by trained skilled personnel/ tot reported births Maternal Deaths 0 22 236 Maternal Mortality Rate = No. maternal 0 deaths in a year/ total live births x100,000 Infant deaths 1 152 16.3 Infant Mortality Rate=No. of infant 41.7 deaths in a yr/ Total no. of live birthsx1000 FP Total users (HCC + SIPPA-1714) 0 8365 Total Child deaths-1-4 Yrs. 0 97 Child Mortality Rate-Deaths in children 0.0 1.8 1-4yrs/ 1,000 pop of children 1-4) % Contraceptive Prevalence 0.0 7.2 Rate=CBA using contraception/Total CBA X100 Total ANC First Visit (or total Preg. 80 14,794 Mothers) Tot. Preg mothers-na (Expected births) 114 20,354 73 % ANC Coverage=no. of preg women 70 attending 3 or more ANC/ Tot. preg mothersx100
7.13 Honiara Demography: Gender and Poverty: Honiara has a very complex and mixed ethnicity. As the capital and key commercial and industrail areas in the country, the demand for health case services is wide and more than the provinces even the major of the country’s population is in the provinces.
Ministry of Health: National Health Report 2005 Page 222 of 250 --------------------------------------------------------------------------------------------------------------------70,000 60,000 50,000 Pop.
40,000 30,000 20,000 10,000 0
1999
2000
2001
2002
2003
2004
2005
Population total
48,513
49,668
50,824
51,977
53,489
61,712
56,227
Population <1
1,427
1,391
1,397
1,405
1,417
1,559
1,495
Population 1-4
4,796
4,979
5,134
5,290
5,498
6,273
5,690
Population <5
6,223
6,370
6,531
6,694
6,915
7,832
7,185
total 15-49
30,349
31,030
31,633
32,188
32,937
37,236
34,156
Fig x Population of Honiara City 7 r Trend
40,000 35,000 30,000 Pop
25,000 20,000 15,000 10,000 5,000 0 WCBA
1999
2000
2001
2002
2003
2004
2005
13,080
13,374
13,653
13,929
14,421
16,041
15,073
Expected births
1,989
2,709
3,688
5,022
Males >5
23,868
24,456
24,994
25,487
25,942
34,611
Females >5
21,462
18,842
19,299
19,796
20,632
27,101
total 15-49
30,349
31,030
31,633
32,188
32,937
37,236
34,156
males 15-49
17,269
17,656
17,980
18,259
18,516
21,196
19,083
Figx Population of Honiara City 7 r Trend by gender (incomplete)
Disease Incidence Trend of Honiara 1996-2005: Disease Incidence Figure 1 demonstrates the proportion of acute care contacts by major diseases in Honiara. In Honiara, the most common cause of attendance at any primary health care clinics between 1996 and 2005 was apart from ‘Other’ disease, were ARI and clinical malaria.
Ministry of Health: National Health Report 2005 Page 223 of 250 --------------------------------------------------------------------------------------------------------------------Fig 1. Proportion of new cases by major disease, Honiara 1996-2005 50% 45% 40% 35%
percent
30% 25% 20% 15% 10% 5% 0% 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI
Diarrhoea
Fever
Red eyes
Yaw s
Skin diseases
Ear infection
STI diseases
Clinical malaria
Other diseases
Acute Respiratory Infections ARI are major cause of morbidity worldwide and in Solomon Islands. In Honiara, ARI is second most importance cause of attendance at primary health care clinics. In 2005, ARI was responsible for 27% of all acute care contacts in Honiara. Fig 2. Incidence rate of ARI, Honiara & Solomon Is 1996-2005
600.0
rate per 1,000
500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ARI, Honiara
ARI, Solomon Is
Figure 2 shows that the highest rate of ARI in Honiara occurred in 1997 reaching 524 cases per 1000 population. Between 1997 and 2000 ARI rate in Honiara declined reaching 371 cases per 1000 population. In 2001, the ARI rate increased again then dropped from 469 cases per 1000 population in 2001 to 349 cases per 1000 in 2002. Between 2002 and 2004 the incidence rate of ARI increased from 349 cases per 1000 population to 506 cases per 1000 population then slightly declined to 487 cases per 1000 population in 2005.
Ministry of Health: National Health Report 2005 Page 224 of 250 --------------------------------------------------------------------------------------------------------------------Acute Respiratory Infection by Age Group Fig 3. Incidence rate of ARI by age group, Honiara 1996-2005 4000 3500
rate per 1,000
3000 2500 2000 1500 1000 500 0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Figure 3 above shows that in the past 10 years incidence rate of ARI was higher in children aged less than 5 but more importantly in infants. The graph also shows that through out last decade, incidence rate of ARI in infants has exceeded 2000 cases per 1000 population. In 2000 ARI rate in infants almost doubled that of 1999. Though Figure 2 indicates a continuous decline of the overall ARI rate in Honiara was experienced between 1997 and 2000, ARI rate for infants as demonstrated in Figure 3 reached it highest point in 2000 when every baby in Honiara were presented 3 times with ARI at any primary health care clinics. However, between 2000 and 2002 ARI rate in infants declined reaching 2066 cases per 1000 population. Then in 2003 ARI rate in infants rose again and between 2004 and 2005 a slight increase of ARI rate was noted. Malaria In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for 36% of all acute care contacts in the country in 2005. In Honiara, malaria (i.e. fever and clinical malaria) account for 26% of all acute care contacts in 2005.
Ministry of Health: National Health Report 2005 Page 225 of 250 --------------------------------------------------------------------------------------------------------------------Fig 4.Incidence rate of clinical malaria, Honiara & Solomon Is 1996-2005 700.0
rate p er 1000 p o p u latio n
600.0 500.0 400.0 300.0 200.0 100.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year Clinical malaria, Honiara
Clinical malaria, Solomon Is
Figure 4 demonstrates the trend of clinical malaria rate in Honiara and Solomon Islands for the past 10 years. The graph shows that clinical malaria rate in Honiara dropped from 420 cases per 1000 population in 1996 to 179 cases per 1000 population in 1999. Between 1999 and 2001 clinical malaria rates increased to 368 cases per 1000 population. Then between 2001 and 2005, a slight declined was noted over the years. Incidence rate of fever, clinical malaria and slide confirmed malaria Fig 5. Incidence rate of clinical malaria, fever, slide conf irmed, Honiara 1996-2005 450.0 400.0 350.0
rate per 1,000
300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year clinical malaria
fever
slide conf irmed
Figure 5 above demonstrates the trend of the incidence rate of clinical malaria, fever and slide confirmed malaria. The graph shows that between 1996 and 1999 the rate of clinical malaria had dropped reaching it lowest level 179 cases per 1000 population.
Ministry of Health: National Health Report 2005 Page 226 of 250 --------------------------------------------------------------------------------------------------------------------Then between 1999 and 2001 clinical malaria increased significantly reaching 368 cases per 1000. Then between 2001 and 2005 a slight decrease in the rate of clinical malaria was observed. Diarrhoeal disease Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in Solomon Islands. In Honiara, diarrhoea and more importantly with no blood and no dehydration was also affecting people in Honiara. Fig 6. Incidence rate of diarrhoea by type, Honiara 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year no blood no dehy
no blood w ith dehy
blood no dehy
blood dehy
Bloody diarrhoea by age group Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group in Honiara for the past 10 years. The graph shows that the incidence rate of bloody diarrhoea over the past 10 years was higher in children aged less than 5 years. Figure 7 also reveals that in Honiara the trend of bloody diarrhoea in children aged less than 5 years but more importantly in infants has increased significantly between 2001 and 2005. This clearly indicates that bloody diarrhoea is becoming a major health problem affecting children and more importantly babies in Honiara.
Ministry of Health: National Health Report 2005 Page 227 of 250 --------------------------------------------------------------------------------------------------------------------Fig 7. Incidence rate of bloody diarrhoea by age group, Honiara 1996-2005 70.0
rate per 1,000
60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease and Yaws Skin disease and Yaws are common health problems in Solomon Islands. In Honiara yaws and more importantly skin disease are also common illness affecting the people. Fig 8. Incidence rate of yaw s and skin disease, Honiara & Solomon Is 1996-2005 200.0 180.0 160.0
rate per 1,000
140.0 120.0 100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year yaw s, Honiara
yaw s, Solomon Is
skin disease - Hon
skin disease, Solomon Is
Figure 8 shows the trend of yaws and skin disease rate for Honiara and Solomon Islands. The graph shows that the trend of skin disease in Honiara is declining and has remained below national average through out the past 10 years. However, the trend of yaws rate in Honiara had remained constant between 1996 and 2001 then increased from 2001 to 2005. The graph shows clearly the skin diseases rate has remained higher than yaws rate through out the past 10 years. This clearly indicates that skin disease is a more common disease than yaws among the people in Honiara. Yaws by age group
Ministry of Health: National Health Report 2005 Page 228 of 250 --------------------------------------------------------------------------------------------------------------------Figure 9 below demonstrates the incidence rate of yaws by age group in Honiara for the past 10 years. It is obvious from the graph that incidence rate of yaws is higher in the age group 1 – 4 followed by people aged 5 years and over. Figure 9 also demonstrates the increasing trend of yaws in the age group 1-4 and 5 years and over. The increase in the trend was more significant in the age group 1-4 between 2001 and 2005 where yaw rate rose significantly from 35 cases per 1000 population in 2001 to it highest level, 98 cases per 1000 population in 2004. Then in 2005, yaws rate dropped to 59 cases per 1000 population. Fig 9. Incidence rate of yaw s by age group, Honiara 1996-2005 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Skin disease by age group Figure 10 below demonstrates the incidence rate of skin disease by age group in Guadalcanal for the past 10 years. The graph shows a decreasing trend of skin disease in all age group in Honiara for the past 10 years. The graph also shows that the highest rate of skin disease occurred in 1998 and the increase was experienced in all age groups. Though the graph reflects a decreasing trend of skin disease rate in all age group, in recent years, that is between 2003 and 2005 a slight increase in skin disease rate was experienced.
Ministry of Health: National Health Report 2005 Page 229 of 250 --------------------------------------------------------------------------------------------------------------------Fig 10. Incidence rate of skin disease by age group, Honiara 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Red Eye Figure 11 demonstrates the incidence rate of red eye in Honiara and Solomon Islands over the past 10 years. The graph clearly shows a declining trend of red eye incidence rate in Honiara and Solomon Islands over the past 10 years. The graph also shows that red eye rate in Honiara has remained below national average in last decade. Fig 11. Incidence rate of red eye, Honiara & Solomon Is 1996-2005 90.0 80.0
rate per 1,000
70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year red eye, Honiara
red eye, Solomon Is
Red eye by age group Figure 12 below demonstrates the incidence rate of red eye by age group in Honiara for the past 10 years. The graph also reveals that through out 10 year period, red eye
Ministry of Health: National Health Report 2005 Page 230 of 250 --------------------------------------------------------------------------------------------------------------------incidence rate was higher in babies, followed by children aged 1-4. The graph also reveals that the trend of red eye incidence through out the 10 year period was declining in all age groups however in 2005 an increased in the trend of red eye rate was noted in all age groups but more importantly in infants. Fig 12. Incidence rate of red eye by age group, Honiara 1996-2005 160.0 140.0
rate per 1,000
120.0 100.0 80.0 60.0 40.0 20.0 0.0 1
2
3
4
5
6
7
8
9
10
Year rates <1
rates 1-4
rates >5
Ear Infection Figure 13 demonstrates the incidence rate of ear infection in Honiara and in Solomon Islands for the past 10 years. It is obvious from figure 13 below that the incidence rate of ear infection in Honiara over the past 10 years was well above national averages. Fig 13. Incidence rate of ear infection, Honiara & Solomon Is 1996-2005 140.0 120.0
rate per 1,000
100.0 80.0 60.0 40.0 20.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year ear infection, Honiara
ear infection, Solomon Is
Ear infection by age-group Figure 14 below demonstrates the incidence rate of ear infection by age group in Honiara for the past 10 years. The graph shows that through out the past 10 years ear infection in Honiara is more significant in children age less than 5. The rate of ear
Ministry of Health: National Health Report 2005 Page 231 of 250 --------------------------------------------------------------------------------------------------------------------infection rate has fluctuated over the years but a considerable decline was noted between 2003 and 2005 in infants. Fig 14. Incidence rate of ear infection by age group, Honiara 1996-2005 450.0 400.0
rate per 1,000
350.0 300.0 250.0 200.0 150.0 100.0 50.0 0.0 1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Year rates <1
rates 1-4
rates >5
Honiara Response: There are total of 8 Government run clinics in Honiara, and about 6 smaller private practitioners’ clinics. The key target areas are the suburbs and residential areas within and around the city boundary. Honiara health services also received referrals from the provinces.
Ministry of Health: National Health Report 2005 Page 232 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 8 8.1
Resource Utilisation
Funding for Health in 2005:
Ensuring adequate funds for maintaining health services in order to meet the health needs of the population has been challenging in the past five years.
Total operational cost
Total Staff costs Total Budget
2000 65,937,79 2
2001 59,100,30 0
30,221,01 8 96,158,81 0
35,631,86 2 94,732,16 2
2003
2004
2005
2006
70,376,851
52,980,902
90,698,547
97,229,810
SIG
68,000,000
34,000,000
HSTA
45,460,431 204,158,97 8
45,531,308 176,761,11 8
42,863,938 113,240,78 9
54,224,094 107,204,99 6
Table x and Fig x Trend of Health Expenditure Estimates 6 yr trend (Exc 2002) in SBD:
8.1.1
Issues: Total Health Expenditure 6 yr trend
250,000,000
200,000,000
SBD
150,000,000
100,000,000
50,000,000
0 2000
2001
2003
2004
2005
2006
There is an 84% increase in the health costs in the six year trend. In 2000 the total health expenditure budget was SBD 96, 158,810. In went up as SDB 176,761,118 in 2006. In 2005 in tipped up to SBD 204, 158, 978 as the HSTA AusAID funded put in substantial fund to drive the operational plans at the national and provinces. The staff cost have increased by 51% since 2000 from SBD 30Milliom to 45.5M. in the past two years. The revised scheme of services for the doctors and the nurses has been significant contributing factor to the increase. How more would the staff cost increased in light of the proposed scheme of services for the Paramedic staff in at the negotiation stage.
Ministry of Health: National Health Report 2005 Page 233 of 250 --------------------------------------------------------------------------------------------------------------------The operational cost increased by 48% since 2000. In 2004 and 2005 the cost further surged because of extra support from the Budgetary Support and the HSTA Trust fund. Within the health sector additional funding was allocated and used for high impact development initiatives for the provincial health services.
8.2
Human Resource for Health in 2005
. 1800 1600 1400
No. of staff
1200 1000 800 600 400 200 0
2000
2001
2002
2005
2006
Non-Estab
172
161
140
134
132
Estab
1200
1253
1253
1425
1469
Grand Total
1372
1414
1393
1559
1601
Table x Number of health workers 2000-2006 Source Staff Establishment MOH
8.3
Issues:
There has been very little increase in the level of staffing in the country. Since 2000 and even previous years, there was only 16% increase in staffing. However, the staffing cost has increased by 51% and this is the limiting factor to ensure that our clinics are fully staffed. It is also a concern that many highly qualified local doctors are leaving the Public Sector and also to overseas to look for high and lucrative conditions. The challenge for the Government is to retain the few qualified local specialists. General work morale is very low34 (Department the Public Service does not provide them with a desirable career, and the poor standards of wages contribute strongly to this): Work ethics and culture very poor. Peoples’ capability is low (skill and knowledge is very low and causing serious impediments on service delivery)35 and, too centralized performance appraisal system is not the most effective mechanism to improve individual staff capability to meet specific service delivery targets.
34 35
Admin Scan by RAMSI Mahcinery of Government 2005 Ibid
Ministry of Health: National Health Report 2005 Page 234 of 250 --------------------------------------------------------------------------------------------------------------------Staff performance and task level in relation to the Essential Public Health Functions varies significantly. Key areas of weakness are on functions related to emergency preparedness and disaster management”, “research” and “enforcement” or health legislations i.e. limited skill)36. Staff productivity also affected as shown in Clinic utilization review-“Results support future posting of nursing staff according to clinic workloads, skill mix needed to meet individual clinic demand and skill mix at adjacent clinics. This approach argues for adoption of a flexible clinics designation and staffing model based on need rather than population parameters. It also suggests that designating clinics as RHC or NAP be reconsidered and a more generic term such as ‘health clinic’ be adopted”37. Many more doctors migrated out in the past three years despite the revised scheme of service for doctors. In 2003 around 20% (19) of the total registered doctors migrated out. In 2006 it increased to 22% (24) doctors all together migrated out to work elsewhere.38 Nursing personnel were not fully conversant with the new Scheme of Service39. Unequal distribution of health staff number and skill mix among the provinces40. Health workers attitude (esp. nurses in hospitals and clinics) very poor causing people to access health care41. Poor HR Management-Part of report on the Essential Public Health Review by David Philips: Strengthen Weaknesses Lot of staff near retirement age Donor support ++ Human No consultation of field staff on training Good regional training Resource needs – HQ decisions Development progs Resources for training programme TNA at provincial level dependant and centrally controlled across teams Lots of overlap in differing courses New Cert in PH @ Lot of material not relevant to Solomons SIMTRI good in Training needs often self identified and not developing generic PH organisationally done workers Training not linked to local needs – reflect course availability & donor priorities Lack of priority given to ensuring senior staff in provinces well trained – “$$ goes to NRH because they complain loudest” Staff capability in areas often limited by other factors eg staff housing Lack of multi-skilling of staff PSC Promotion system works against
David Philips (2005). SI Essential Public Health Functions Assessment Solomon Islands Primary Health Care Clinics Review Report by Chris Evans of HISP 38 G..Malefoasi (2006). Technical Briefing to the Minister of Health: Info to the 59th World Health Assembly May 2006 36 37
39
PHD Capacity Assessment Report by Vicki HISP PHC Advisor
PHD Capacity Assessment Report by Vicki HISP PHC Advisor and Solomon Islands Primary Health Care Clinics Review Report by Chris Evans of HISP 41 Community Assessment by Alex (2006) 40
Ministry of Health: National Health Report 2005 Page 235 of 250 --------------------------------------------------------------------------------------------------------------------young people Options to solutions: HR Issues & Problems General work morale is very lowpoor work ethics and culture
Peoples’ capability is low
Staff performance and task level in relation to the Essential Public Health Functions varies significantly.
Recommendations/ Options to solutions: HRM function could be strengthened Performance monitoring and reporting against planned targets and measures needs to be strengthened to improve the overall management of the department. Similarly, line managers could benefit if they were more aware of setting standards and procedures for required performance levels to meet service delivery goals. Performance Management generally could be improved if Divisional Heads were more committed to communicating with their operational staff on all matters related to standards and quality of service delivery; Career path development inline with condition of services/ Terms of Conditions To improve this situation, line managers could be assisted if they developed performance development plans for individual staff that would align their skills and knowledge with the priority work targets. These Plans would then inform the annual training or professional development plans linked to the budget. Establish feed back mechanisms to staff on performance etc. To ensure a basic succession strategy, a targeted Graduate recruitment program would probably benefit the clinically related Divisions. Develop a coordinated approach to training and workforce development across stakeholders, agencies, institutions and programmes based on EPHFs.
Increase the geographic equity of EPHF skills distribution, especially with regard to provinces. Ensure some local workforce surge capacity to address unexpected events (e.g. a local disaster/emergency situation) possibly by more multi-skilling.
Ministry of Health: National Health Report 2005 Page 236 of 250 --------------------------------------------------------------------------------------------------------------------Staff productivity also affected Need for a need-based clinic designation and staffing model Many more doctors migrated Need further review on shortage and retention of specialist doctors. Nursing personnel were not fully Need further communication conversant with the new Scheme of Service. Unequal distribution of health Need for a need-based deployment and staffing staff number and skill mix among model the provinces Health workers attitude (esp. Reorientation and people centered approaches of nurses in hospitals and clinics) training to nurses. very poor causing people to access health care
Ministry of Health: National Health Report 2005 Page 237 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 9
Health Legislation
The area of health legislation has been an area for need substantial effort in strengthening. The administration scan done by RAMSI also identified the field of legislative support as area for improvement. (Refer Chapter 6: Section 6.1.1). The Government through the Ministry of Health is planning to review and update the existing health legislation in line with the needs of today and the future. As eluded in the several meetings all the existing health legislations and other related legislations are out of date. Some health legislations need updated and improvements. The priority areas are the Health Services Act 1979 (& Health Services (Hospital Regulations) 1980), the Pharmacy and Poisons Act 1941, Pharmacy Practitioners Act 1997, and the Mental Treatment Act 1970. The Health Services Act 1979 needs changing to focus and promote and support the health reform policies and strategies, the Ministry is undertaking.
9.1
Health Care Legislation Review:
The health care system in Solomon Islands is primarily provided and funded by the Government. It has adopted and practiced the British National Health Services where by health care services is provided free at point of delivery. Thus, health care services is centralized in regards of binding rules and regulation in nearly all field of health financing, manpower management and discipline, and authority. Solomon Islands health care legislation sits within a broader public legislative framework42 as shown in the table below. Table x Sumarizes the current legislations and regulations in health.
Area 1.Public Health
Titles of Laws and Regulations Health services Act 1979 Health Act (Health services (Hospital Regulations) 1980) Subsidiary Legislation. Public Health Act 1970 The Environmental Health (Public Health Act) Regulations Quarantine Act
Date of Issue 1st October 1979 1st May 1980
1st August 1980 1st April 1931
Date of Last Revision
Repealed and revised into The Environment Act 1980
1930, 1931, 1940, 1946, 1968, 1978
42 SIG (1996). The Laws of Solomon Islands, Revised Edition, Title XVI: Medical & Public Health, Printed by Eyre and Spottiswoode Ltd, Chapters 97-116.
Ministry of Health: National Health Report 2005 Page 238 of 250 --------------------------------------------------------------------------------------------------------------------Area Titles of Laws and Date of Issue Date of Last Regulations Revision 2.Environmental Health The Environment Health Act 1980 3.Food Safety
4.Mental Health 5.Health Practitioners
Environmental Health Act 1980 (Part XII)
Pure Food Act Mental Treatment Act 1970
Repealed and revised into Pure Food Act 1997.
11th December 1970
Health Workers Act 1982
Repealed and revised into Health Workers 1990
Health Workers Act 1990
23rd February 1990
None
Medical and Dental Practitioners Act 1988
1st July 1988
Medical and Dental Practitioners Act 1990
1st July 1990
Repealed and revised into Medical and Dental Practitioners Act 1990 None
Nursing Council Act
1st December 1997
Revised (amended) in 1997
The Nursing Council (Amendment) Act 1997
6.Pharmaceutical products and therapeutic goods
The Pharmacy Practitioners Act 1997 (to repeal certain portions of the Pharmacy and Posions Act 1991 below) Pharmacy and Poisons Act 1941
None
28th July 1941
Revised in 1953, 1958, 1967, 1973, 1978, 1981, 1988
Ministry of Health: National Health Report 2005 Page 239 of 250 --------------------------------------------------------------------------------------------------------------------Area Titles of Laws and Date of Issue Date of Last Regulations Revision None 7.Health Care Financing No specific Act but provisions are provided by theses Acts: Health Services Act 1979 Medical & Dental Practitioners (Chapter 14)
9.2
Health Services Act 1979
This is a relatively short Act setting out matters of administration and the range of health services to be provided. Chapter 3 establishes a Ministry of Health and Medical Services with a Permanent Secretary and other staff as are from time to time appointed. The Ministry is under the direction and control of a Permanent Secretary, subject to any directions received from the Minister (Chapter 3(2).
The Act provides that it is the duty of the Health Minister: “to promote the establishment in Solomon Islands of a comprehensive primary health care service designed to secure the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with the provisions of this Act.” (Chapter 4). The Act expressly provides that “the services so provided shall be free of charge” except insofar as rules are made authorising or prescribing charges for such services [Chapter 4(2)]. The Act also provides for the establishment of health advisory committees, although it appears that there are none at present. Hospital Services are dealt with in Part II of the Act, primarily by setting out that the Minister may provide hospital accommodation and other treatment services and by listing the various matters in respect of which regulations may be made. In particular, regulations may be made relating to: the management of hospitals charges for maintenance and treatment of patients in hospitals and supply of medicines and services charges for services performed outside public hospitals Part III of the Act deals with primary health care services. The Ministry is responsible for providing primary health care services as directed by the Minister. The Ministry has a statutory duty to provide, equip, and maintain health centres, clinics, satellite clinics and aid posts throughout the Solomon Islands “having regard to the needs in the area and the resources available to the Ministry” [Chapter 11(1)]. The Ministry is also required to act in consultation with Provincial Assemblies. Provincial Assemblies and the Honiara Town Council are authorised to provide clinics in their own areas (Chapter 12). The Minister may also contract with nongovernmental or church groups (Chapter 13). Part IV deals with other health services. Here the powers of the Minister are set out in Chapter 16 and include the power to employ officers and provide buildings for pathological and other services, to employ staff and provide buildings for blood transfusion services, and undertake public education campaigns, research, and international liaison.
Ministry of Health: National Health Report 2005 Page 240 of 250 --------------------------------------------------------------------------------------------------------------------Financial matters are set out in Chapter 17, which provides that health funding is to be by way of an expropriation from Parliament. Pursuant to Chapter 17, any charges or fees levied under the Act and collected by the Ministry “shall be paid into the Consolidated Fund”. The Minister prescribes responsibility for fee collection. Any fees payable are deemed a debt due to the Crown. The Act does not prescribe the particular form of Ministry accounts or deal with matters of budgetary structure. The principal Act then amended in 1988 as Health Services (Amendment) Act 1988. The amendments reflect the provisions for the following; Primary health care as the fundamental course for basic health services to the people (Chapter 2 (a) and (d) of Act No.5 of 1979). Recognition of the Village Health Aides (or VH workers) as the component of the health care referral system or front line health workers (Chapter 2). Autonomy to the Minister to make regulations in areas of (Chapter 5.1): management of public hospitals (through committees if necessary) (Chapter 5.1.a) patient care (Chapter 5.1.b). visitors (Chapter 5.1.c) payment of fees by external users of public hospitals e.g. private practitioners (5.1.d) fee for services –treatment of patients in public hospitals, and service delivery (5.1.e) public officers performing and charging for services provided outside the public hospitals and dispensary (5.1.f) line of command or authority and powers and duties of staff of public hospitals. Patient care (referrals) (5.1.h) Staff discipline in public hospitals, clinics and Aide posts. Confidentiality of patients’ information. Board of visitors (Chapter 6, replaces Chapter 9 in the principal act). The functions of the board and their relevancy in the current and future prospect are to be reviewed. The rest of amendments are in respect of changes with terminology. The current Health Services Act obviously needs reviewing and changing. It lacks the provision for the following fundamental and important aspects of health development to achieve the Government’ future direction policy; clear organizational structure or health reform clear line of command and authority and reporting management of public hospitals by CEO secondary health care tertiary health care role delineation of health care services cost recovery through user pay system in public hospitals (need further elaboration), and collection and retaining of funds raised. total quality management management of public hospitals private-public mix right to private practice health insurance act- universal or private
Ministry of Health: National Health Report 2005 Page 241 of 250 ---------------------------------------------------------------------------------------------------------------------
9.3
The Health Services (Hospitals) Regulations 1980
These regulations require the person charged with administration of the regulations to convene the Hospital Committee (reg 6). Little information was available about the functions and operation of these Committees.
The regulations do prescribe a set of fees for private patients including fees for: Ward patients Outpatients The private antenatal clinic Special consultation Physiotherapy treatment X-ray examinations Authentication and certification However, there was general agreement among Ministry and hospital staff and non-government organisations that in practice fees are not charged and collection is rarely enforced because of public resistance to paying and lack of willingness for administrators to collect them. It appears that a scheme for a user pays system was devised in 1979, however, it was never implemented, apparently due to community opposition. There is also some government subsidisation of private health care with opportunities being missed for revenue collection as between public and private patients. For example, some private patients are being referred to the hospital pharmacy for pharmaceuticals that are available to the public for no charge, when there are strong arguments for requiring private patients to pay for these even when these are available only from the hospital pharmacy.
9.4
Environmental Health Act 1980
This Act provides a mechanism for dealing with a range of public health matters including: public nuisances, building defects, excessive dust, fumes, smoke or effluent, the supply and sale of food, the prevention and supression of notifiable diseases, public drainage systems, public water supplies, noxious waste, the keeping of animals, refuse and rubbish disposal, residential overcrowding, factory and trade premises, cemetery and burial places, septic tanks, and other public health risks. The Minister may delegate certain authorities to Enforcement Authorities, namely, the Provincial Assemblies and the Honiara Town Council (Chapter 6). The Minister may require an Enforcement Authority to act on a public health matter and if it does not, the Minister can authorise some other person to do so and seek remuneration from the Enforcement Authority for any costs incurred (Chapter 7). The procedures for the issue of abatement notices, including consequences for non-compliance, are set out in Chapter s 12-14. Prosecutions are to be taken by the Enforcement Authority. Any fines gained as a result of enforcement activity are to be paid into the general revenue of the relevant Authority, pursuant to Chapter 15(2). Expenses incurred in the taking of prosecution action may also be pursued and interest of 5% charged on any outstanding sum (see Chapter 17). The Environmental (Public Health Act) Regulations deal with procedures for notification of public nuisances, court orders for abatement, and a range of specific areas such as offensive trades, filthy or verminous premises, water supplies, vessels, buildings and housing, drainage and sanitation, and food and drugs. Powers of seizure, entry and search and prosecution and procedural matters also included (reg 105-111). The Schedules to the Regulations include a list of notifiable diseases, offensive trades, and rules dealing with the treatment of malaria.
Ministry of Health: National Health Report 2005 Page 242 of 250 ---------------------------------------------------------------------------------------------------------------------
9.5
Mental Health Act 1970:
This act consolidates the law relating to persons of unsound mind and makes further and better provision for the care of persons suffering from mental disorder or mental defect, for the custody their persons and the management and control of mental hospitals. Whilst the current Act focuses mainly on treatment at a health institution, the Ministry is adventuring into getting (rehabilitative) community services to the village level through primary health care approach. Thus, the Act my need to accommodate the changes if necessary.
9.6
Health Workers Act 1982:
The Health Workers Act 1982 was revised and repealed into the Health Workers Act 1990, which was issued on the 23rd February 1990. This Act regulates the functions and duties of various categories of health workers, to confer on the board powers to prescribe registration, deal with matters pertaining to discipline and other connected matters; This Act establishes a Health Worker Board, which oversees the registration and discipline of health workers. The health care referral system consists of a network of four different levels of health workers: Village health worker – in village health posts delivering first aid supplies on restricted hours Nurse aide – in Area Health Centres and Nurse Aides Posts Registered Nurses – in Area Health Centres and Provincial hospitals Doctors – most of whom are in the Central Referral Hospital and the Provincial hospitals The practical flaw of the Act is it deals with the classification of health workers, primarily village health workers and nurse aides. At this stage there is no board to carry out functions of the Act as nurse aides, registered nurses and doctors’ registrations are dealt with by a separate legislations. The Village Health Workers are not recognized as a permanent health worker because of their limited knowledge and skills in health without background ideology, despite their important role in the health care referral system in the country. In short Health Workers Act never applied because legislation overlap with other Acts, whilst other important health workers such as the paramedics are missed out or not under the regulation. However, in the medium to long term, this Act should be fully reviewed to ensure a consistency and cohesiveness with overall developments in other parts of the government health sector. It is therefore recommended that the Act should be reviewed to ensure a consistency with overall restructuring in the health sector.
9.7
Medical and Dental Practitioners Act 1988
This Act establishes a Medical and Dental Board. The Board is a body corporate and its function include: Registration of medical and dental practitioners Regulation of their training Appointment of examiners Issuing certificates of registration Exercising disciplinary control over, and ensure the maintenance of, proper standards of professional conduct by persons registered as medical and dental practitioners. Chapter 6(3) provides that every person whose name is entered on the Medical and Dental Register is entitled to use the term “doctor implying that he is recognized by law as a person authorized or qualified to practice in Solomon Islands.” Chapter 14 provides: “Every registered medical or dental practitioner shall be entitled to practice medicine or dentistry, as the case may be, in Solomon Islands, and to demand and recover any reasonable charges for services rendered by him and for all drugs, medicine and appliances supplied by him.”
Ministry of Health: National Health Report 2005 Page 243 of 250 --------------------------------------------------------------------------------------------------------------------The statutory right to establish a private practice and charge fees and the relationship of this to employment by the Ministry appears to cause some difficulty with some doctors who are employed by MHMS, particularly those in hospitals. It appears that some doctors who are employed in public hospitals are also running private clinics. There is a concern that some way should be found to accommodate the desire to see private, fee paying, and patients so as to encourage those doctors working in the hospital to remain. For example, some doctors expressed a desire to use the public hospitals after hours to see private patients.
9.8
Nursing Council Act 1987
This Act establishes a Nursing Council and matters related to the registration of nurses in the Solomon Islands. The Nursing Council is a body corporate and its functions are to: Arrange and regulate examinations, courses and training for persons wishing to be nurses Keep and maintain a register of nurses and issue certificates to suitably qualified nurses Regulate and supervise the practice of nurses, including the maintenance of professional standards by nurses Approve training courses for nurses View matters related to the profession of nursing in light of the development in technology, medical and nursing care for the benefit of patients and the nursing profession Chapter 8 provides that the Council may register a person who is qualified in terms of Chapter 9 of the Act and not disqualified under Chapter 10, “but otherwise it shall reject the application.” The Council may cancel or suspend registration. The Act also prescribes certain offences for practicing without registration and other matters (Chapter s 18-20). The constitution and liability provisions of the Council were substantively amended in 1997. Prior to the amendments, the Nursing Council was headed by the Under Secretary for MHMS, with a deputy who was the head of nursing services. The Council included the heads of training institutions, the respective heads of hospital and community health services, a registered nurse nominated by the Nursing Association and a registered nurse employed in the private sector. However, in 1997 the Director of Nursing (a position within MHMS) was designated the chair of the Council and the deputy chair become the Assistant Director of Nursing. The Under Secretary of MHMS is no longer a member of the Council, having been replaced by the Assistant Director of Nursing. Other members of the Council are the heads of approved training and educational institutions, a registered nurse employed in the service of a religious organisation in Solomon Islands, a registered nurse nominated by the Nurses Association and the newly created position of Registrar of Nursing. The position of Secretary (who was also the Registrar to the Council) appears to have been amalgamated with that of the Registrar who now has the same statutory responsibilities of the Secretary for the keeping of a nurses’ register and the issuing of appropriate certificates.
9.9
Pharmacy and Poisons Act 1941
This (principle) Act establishes a Pharmacy and Poisons Board as a separate corporate body. The Board comprise three persons, the Under Secretary for Health (who is retained as the Board Chair) and two other persons appointed by the Minister. The Board’s functions are not clearly defined in the Act, but appear to be to authorise persons to practice as pharmacists and to keep a register of pharmacists (maintained by a Registrar (Chapter s 16 to 26). The Act allows a body corporate to carry on the business of a pharmacy, provided it is under the management supervision of a registered pharmacist. The Board may disqualify a body corporate from practicing, but only with the approval of the Minister (Chapter
Ministry of Health: National Health Report 2005 Page 244 of 250 --------------------------------------------------------------------------------------------------------------------27). Conditions for practice, including the procedure for disqualification, are set out in Chapter s 28 to 33. Only persons registered and approved under the Act may practice as a pharmacist, but the Board may issue a temporary licence to practice (Chapter 35). The Act requires a medical practitioner to sign prescriptions (Chapter 36) and for pharmacists to keep a register of prescriptions (Chapter 37). Chapter 39 permits a medical practitioner to dispense medicines and drugs without being registered as a pharmacist, provided an adequate record of any such prescriptions. In limited circumstances, a pharmacist may give medical or surgical advice or aid (Chapter 38). Automatic dispensing machines are prohibited (Chapter 40). There are restrictions on the supply of reproductive and sexual health medicines and advertisements or other material on these (Chapter 41 and 42). Part V of the Act deals with the sale and supply of medicines. Only medicines authorized for sale under the Act may be made available to the public, although the Minister may amend Schedule A of the Act, which sets out permitted medicines. A person may be licensed to sell medicines, but not fill subscriptions (Chapter 45). The Police must be notified of persons licensed to sell medicines (Chapter 46). Wholesale supply of medicines is prohibited and there are restrictions on important of medicines (Chapter s 48 and 49). A general provision on labeling is included (Chapter 50), and the Minister is empowered to order the restriction of some drugs. There is a range of rules that have been made under the Act including rules relating to commercial samples. Other aspects of the rules deal with exemptions and the form of prescriptions, record keeping, labeling of poisons, storage and transport of poisons, manufacture of poisons, and forms and fees.
9.10 Pharmacy Practitioners Act 1997 The Pharmacy Practitioners Act is an extract from the certain provisions of the Pharmacy and Poisons Act, and to matters connected to therewith or incidental thereto. It is specific to regulation of the Practice of Pharmacy in Solomon Islands. The provisions include; Establishment of Board and its functions Registration of pharmacists and pharmacy assistant Disciplinary
Chapter 10: KEY ISSUES CHALLENGES AND WAY FOWARD
9.11 Overview:: Key health problems The Annual Health Report 2005 hereby raised many key issues for consideration in policy decisions, planning, and management. The following health problems and diseases were presented with evidences (not in any priority order as this stage). Skin diseases Diabetes Malaria Oral health Disaster management Epidemic response
Ministry of Health: National Health Report 2005 Page 245 of 250 --------------------------------------------------------------------------------------------------------------------TB/ Leprosy Maternal mortality Family planning Eye and ear diseases Trauma and accidences Common childhood infections Non-communicable diseases Inter-sectoral and partnership of multisector for health
9.12 Issues Raising and Fact (evidence) finding: Listed below is a brief overview of issues:The issues are categorized into 5 key Result Areas (as a possible area for changes to outputs, outcomes and impacts): 10.2.1. Key Social Health Determinants: Listed below are the key social health determinants, affecting health status of the people and imposing challenge on the health services delivery: Conflict Health seeking behavior-socio-cultural –kastom medicine Geographical – distance Costs
9.12.1 10.2.2. Findings: SI faces some unique challenges in the effective delivery of health service: Utilisation of health care is on the increase Country struggles with a high burden of disease and reductions in common diseases has stalled Communities make decisions in a society that utilises home care with traditional healers and western medicine. ( medical pluralism) Power of the health worker to affect health outcomes is increasingly acknowledged Kastom medicine widely used, even in the treatment of new diseases, including STI’s, but households can disagree. i.e clinic or kastom Kastom doctors declining, healing traditions are in a state of rapid change
9.12.2 Pattern of resorts: Symptoms – assessment of threat – first resort of minor illnesses is Kastom medicine When illness has been described as serious ( bigfala siki) clinics and hospitals are generally the first treatment preference – leads to delays in tx. However, can be disagreements over how to characterise serious illnesses ( eg. Diabetes, stroke, TB, cancer, heart problems, malaria and diarrhoea and mental illnesses)
Ministry of Health: National Health Report 2005 Page 246 of 250 --------------------------------------------------------------------------------------------------------------------9.12.3 Barriers to seeking health care Distance to clinic, transport accessibility, available childcare, quality of service and medicine stocks, fear of injections, drugs, surgery etc / then resort to Kastom BUT – patterns of resort vary by region and household Some argue that kastom is more effective in the early stages of an illness “kastom doctors and medical doctors should work together in treating illness”
9.12.4 Usual attitude towards health: Self medication commonly practiced, especially in malaria Kastom illnesses / medical illness – but a readiness to adjust to new beliefs Once a decision is made to seek formal health care – nearest health facility generally first choice
9.12.5 Factors affecting provider choice Clinics – close, referred, quality of service Hospitals – more trust in Drs, harder to visit relatives, quality – long lines, rudeness hygiene, absenteeism Private .Practitioners –regarded as high standard of care, but expensive, last resort when other treatments have failed/wantok discount. Referral system not well understood and often bypassed – bad experience in a clinic/reimbursement issues/hospital closer Transportation and treatment costs a significant barrier Service quality – overall high trust in nurses – but many complaints which weaken community confidence, e.g. competence, attitudes, facility, drugs, long waits and wantokism,lack of adequate triage for emergency cases and privacy
9.12.6 Cultural barriers to specific disease –Malaria So common its significance is undervalued – and assessment of health risk depends upon access issues. Tends to be treated at home first – a range of factors affect decision to seek health care –access, side effects of chloroquine, microscopists ( part time) Nets not used – too hot, smell bad and many feel “there re just too many mosquitos everywhere”
9.12.7 Cultural barriers to – i. Reproductive health In a context of rapidly changing social frameworks in which women make decisions ( highly contested ) But – introduction of medical birth practices has not eliminated old beliefs Ongoing issues of lack of privacy, assisted deliveries all part of broader social issues – violence/shame etc Demand for a/n care varies – lack of support from husbands Medically assisted deliveries – variations in utilisation depends upon a variety of reasons – but the emphasis appears to be more in favour of home births expertise of TBA’s.
Ministry of Health: National Health Report 2005 Page 247 of 250 --------------------------------------------------------------------------------------------------------------------ii. Family Planning; Demand higher that present coverage Disagreements with husbands/stronger role Low levels of awareness of FP programs ---confidentially and attitude a barrier Decline in available contraception to single women as it is under the FP model. Some secrecy with FP/may contribute towards negative feelings about it. Economic situation – bride price Education programs effective on BR – but when discontinued birth rates rise again iii. Other related findings: Malnutrition- little awareness of malnutrition issues – in some cases food sold at market and children given candy. Health promotion/education – widespread interest in having more – but poor planning ( night ) and lack of visual or dramatic component affected attendance rates People want improved health, but disagreements over how it should be done at village level – need for external organisation to lead PHP Demonstrated interest in organising “ healthy village” activities and improving sanitation
9.12.8 Problems with service delivery and human resource issues: Lack of supervision Same people get all the training – demand is high Nurses feel disadvantaged Wantokism ( favouritism) Lack of health information given to clients Uneven case loads at the hospitals and clinics Patients can demand unavailable or inappropriate treatment Nurses say that barriers to attending clinics may be overcome if there was better perception by the community on illness severity or by improving the relationship with nurses In Conclusion: Socio – cultural knowledge and practices, service quality issues and clinic access all act as barriers to health service utilisation Local understanding of disease and health and reliance on Kastom medicine and TBAs also impact on health seeking behaviour “substantial room for improving the delivery of service” “ an approach that encourages community participation may be especially suitable in this country given the transportation barriers”
9.13 The Way Forward:
Ministry of Health: National Health Report 2005 Page 248 of 250 ---------------------------------------------------------------------------------------------------------------------
During the coming national strategic workshop on the 8-12th May 2006, all stakeholders will further review the issues and possible options for strategies raised.
Preliminary discussions have started to flag some crucial points for long strategic directions;Examples: In the Key Result Area (KRA): People focused:Advocate more on the positive aspects of the local cultural imperatives to protect health of the people: e.g. circumcism as evident as preventive to HIV infection. Community education and interventions at the people level for illnesses such as skin diseases, malaria control, oral health of children, destigmatization of PLWHA, disaster preparedness for vulnerable communities to natural disaster, women’s right to choose the types and access to FP, harm reduction against substance abuse, life skills at the community level, participation of local people in disease controls. In KRA: Public health strategies: Whilst focusing on the people, the public health strategies must be to supportive;Increase the health education and promotion activities to the community and emphasis behavioral change as the outcome for good health impact in reducing the skin diseases, diabetes, malaria, HIV and other communicable diseases. Review and incorporating a supportive health laws supporting the public health strategies by providing and protecting healthy lifestyles and reducing hazardous environment and vulnerability to child sex, sexual abuse etc. In KRA Organizational change: The evidences so far lead to an inevitable need to change how we do things for the betterment the people as our value and to strengthen our public health strategies. In KRA Accountability: This KRA run across all the other KRAs. Since “health is every body’s business”, every one in the communities are accountable for to ensure the vision and mission for happy, healthy and productive Solomon Islands”. This area includes ensuring that various kinds mechanisms for good governance and accountability are developed, advocated widely, enforced, monitored and evaluated Examples; Clear position descriptions in the malaria control programs More intersect oral and community approaches for all communicable diseases. Performance appraisal for all programs Transparency and financial accountability for all funded disease control programs. Good leadership and governance Improve monthly annual reporting In KRA information management: This is the conceptual underpinning across all issues. This will provide clear evidence and acts radar for the strategies and activities planed and implemented.
Ministry of Health: National Health Report 2005 Page 249 of 250 ---------------------------------------------------------------------------------------------------------------------
Chapter 10 Key Activities for 2006 10.1 Overview The options for solutions and then action steps for the issue raised in the report will be dealt with a more detail in some forthcoming activities in 2006. Nearly all disease prevention and activities will continue and/ or even strengthened in 2006. From August 2006 will be the transitional phase of the existing HISP, in preparation for a next project design in light of the forthcoming SWAp (Sector Wide Appraoch) collaboration by key external assistance to the national health response.
10.2 Some of the Key Activities for 2006 1. National Strategic Planning Workshop 8-112th May 2006 (MOH Executive and the Policy and Planning Division/ HISP). 2. Drafting of the National Health Strategy for the next ten years. (including submission to the Cabinet) (MOH Executive and the Policy and Planning Division/ HISP) 3. 59th World Health Assembly in Geneva 22-26 May 2006 (To be attended by Hon Minister of Health and the Permanent Secretary). 4. First Quarter Review of 2005: Feed Back from all Provincial Health Directors, NRH, and National Divisions (MOH Executive and the Policy and Planning Division/ HISP) 5. Development of Activities for the Operational Plans for 2007 (MOH Executive and the Policy and Planning Division/ HISP and all Provinces and Divisions). 6. Inception of the Budgetary Process for the 2007 Budget (MOH Executive and the Policy and Planning Division/ HISP and all Provinces and Divisions.. 7. Start the implementation of the civil work: Renovation of the selected Area Health Centers and Rural Health Centers (Policy and Planning Division/ HISP and Provincial Health Directors). 8. Work closely SWAp for Project Design (MOH Executive and the Policy and Planning Division/ HISP). 9. Expansion of the Measles (EPI) Campaign (Child Health, Reproductive Health Division). 10. Review / and Prioritization of Health Legislations for cabinet submission and endorsement. – E.g. Draft Tobacco Control Legislation for cabinet endorsement (MOH Executive and the Policy and Planning Division and Health Promotion Division) . 11. Second Planning Workshop for the Pandemic Influenza Preparedness (Avian Flue) (MOH Executive and the Policy and Planning Division, and Environmental Health and the Public Health Laboratory and the NRH Med Laboratory) 12. Monitoring and Evaluation Workshop on the National HIV Policy and Multi-Sectoral Strategic Plan 2005-2010, and planning for the Mid-Term Review in 2007 (HIV Prevention Unit, Disease Prevention and Control Unit, and Oxfam Australia along with all partners). 13. Continuation with the Tobacco Control Project with Allen and David Clarke of NZ (Health Promotion and NCD Unit of the Disease Prevention and Control Unit).
Ministry of Health: National Health Report 2005 Page 250 of 250 --------------------------------------------------------------------------------------------------------------------Table x: Authors of the National Health Report 2005
1 2
Author Dr. George Malefoasi (Permanent Secretary) Ms. Petra Veerger
3
Ms. Christina Evans (HISP/ NHRA)
4 5 6 7 8 9
Mr. Amos Lapo (Ag. Nat Head of Nursing) Mr. Seda Savakana (Head-Radiography) Mr. Andrew Darcy (National Pathology) Dr. Lorraine Oti (Director Dental Services) Mr. Charles Gauba (Head Rehabilitation Dept NRH) Ms. Iakoba Baakai
10 11 11 12
Mr. Noel Itogo Mr. Robinson Fugui Joanne Ahikau and Helen Koti Mr. Alby Lovi
13
Ms. Vaelyn Gagahe
14
RAMSI-Machinery of Government Dr. David Snowball and Mr. Joseph Wale Dr Greg Jilini
15 16 17 18
Dr. Patrick Toitona (and Ms. Tracey HISP/PHA) Dr Gunter Kitel Ms. Rachel Tigita
Sections Main Author Health Institutional Strengthening Project Primary Health Care Demand and PHC Clinic Utilization and other related reviews report. Nursing in Solomon Islands National Medical Imaging National Pathology Services Dental Services Rehabilitation Services Health Burden, Communicable Diseases, and Provincial Health Services disease trends. TB/ Leprosy Environmental Health Social Welfare Health Promotion Activities and Achievements Distance Education: Program Outputs The Scan of the Public Administration Functions Western Provincial Health Services Isabel Province Temotu Province National Referral Hospital
Related Documents
National Health Report 2005
November 2019 20
National Health Report 2006
November 2019 21
Winona Health 2005 Annual Report
April 2020 5
National Health Report 2003-solomon Islands
November 2019 10
