National Health Report 2006

2006

MINISTRY OF HEALTH NATIONAL HEALTH ANNUAL REPORT

Ministry of Health & Medical Services 5/30/2006

Chapter 1 1.1 1.1.1 1.1.2

1.2 1.2.1 1.2.2

1.3

About the Organization-Ministry of Health ___________________ 8

Introduction/ Background _______________________________________________________ 8 Report on the Grand For Change Coalition Government (Health) Political Statements ________________ 8 Observations of the changes in 2006: _______________________________________________________ 8

The ational Health Policies: Plans and Priorities: _________________________________ 11 Solomon Islands Government Leadership. __________________________________________________ 11 The Health Corporate Plan 2006-2008 _____________________________________________________ 11

The ational Health Strategies 2005-2010: ________________________________________ 11

Chapter 2

Reporting against the national goals- targets and indicator ______ 12

2.1

Report on the Government’s Policy Statement _____________________________________ 13

2.2

Report on the ational Health Goals and Targets___________________________________ 14

2.3

Meeting up with the Millennium Development Goals: _______________________________ 17

Chapter 3 3.1

Solomon Islands Demographic and Health Status Indicators _____ 19

Demographic, Gender and Poverty: ______________________________________________ 19

Chapter 4

Report on Disease Burden- Health Information System 2006 ____ 20

4.1

Overview ____________________________________________________________________ 20

4.2

Disease Specific _______________________________________________________________ 20

4.2.1 4.2.2 4.2.3 4.2.4 4.2.5 4.2.6 4.2.7 4.2.8 4.2.9 4.2.10 4.2.11

Acute Respiratory Infections_____________________________________________________________ 20 Diarrhoeal disease _____________________________________________________________________ 22 Watery Diarrhoea _____________________________________________________________________ 24 Bloody Diarrhoea _____________________________________________________________________ 24 Fever, clinical malaria and slide confirmed malaria___________________________________________ 25 Red eye _____________________________________________________________________________ 27 Ear disease ___________________________________________________________________________ 30 Sexually transmitted infections ___________________________________________________________ 31 Other diseases ________________________________________________________________________ 32 Other Diseases category – Senior Medical Statistician study ___________________________________ 33 Skin infections, trauma and gastrointestinal problems category _________________________________ 34

Chapter 5 5.1 5.1.1 5.1.2 5.1.3

5.2

Health Systems: Performance (Productivity) Reporting: ________ 36

Implementation Rating of Health Programs for 2006 ________________________________ 36 Over view: ___________________________________________________________________________ 36 Reporting rate of divisions in 2006: _______________________________________________________ 36 Challenges and issues: __________________________________________________________________ 37

Primary Health Care: __________________________________________________________ 38

5.2.1 Clinic Utilization Report for 2006 ________________________________________________________ 38 5.2.1.1 Clinic Utilization Result ____________________________________________________________ 39 5.2.1.2 Primary Health Care Facilities and Benchmark Status ____________________________________ 39 5.2.1.3 Health Facilities Not Meeting the Benchmark __________________________________________ 40 5.2.1.4 Health Facilities Exceeding the Benchmark ____________________________________________ 40

5.3

Secondary and Tertiary Health Care: ational Referral Hospital _____________________ 41

5.3.1 Overview: ___________________________________________________________________________ 41 5.3.1.1 New Changes at the NRH in 2006: ___________________________________________________ 41 5.3.1.2 Audit Report: ____________________________________________________________________ 41 5.3.2 NRH Productivity (selected) indicators and assessment: _______________________________________ 42 5.3.2.1 Admissions and Bed Capacity: ______________________________________________________ 42 5.3.3 NRH Report on Selected Health Care Services ______________________________________________ 42 5.3.3.1 Internal Medicine Report ___________________________________________________________ 42

5.3.3.2 General Surgical Report ____________________________________________________________ 43 5.3.4 source Utilization and assessment: ________________________________________________________ 44 5.3.4.1 Human resource: NRH Total staff ____________________________________________________ 44

5.4

Health Institutional Strengthening Project Report 2006 _____________________________ 46

5.5

Health Care Divisions Programatic Report 2006____________________________________ 48

5.5.1 5.5.2

5.6

SI Nursing Council: ____________________________________________________________________ 48 Dental Services _______________________________________________________________________ 50

Public Health Divisional Programs _______________________________________________ 53

5.6.1 5.6.2 5.6.2.1 5.6.2.2 5.6.3 5.6.3.1 5.6.4 5.6.4.1 5.6.4.2 5.6.4.3 5.6.5 5.6.6 5.6.7 5.6.8 5.6.9 5.6.10 5.6.11 5.6.11.1 5.6.11.2 5.6.11.3 5.6.11.4 5.6.11.5

5.7 5.7.1 5.7.2 5.7.3 5.7.4

Distance Education Program _____________________________________________________________ 53 Tuberculosis and Leprosy Control Program _________________________________________________ 55 Disease Burden Status Report: National TB Situation: ____________________________________ 55 Disease Burden Status Report: National Leprosy Situation ________________________________ 59 Environmental Health __________________________________________________________________ 63 Public Health Laboratory: __________________________________________________________ 67 Non- Communicable Diseases ___________________________________________________________ 68 Diabetes: ________________________________________________________________________ 68 Physical Exercise: _________________________________________________________________ 71 4. Cancer ________________________________________________________________________ 72 Community-Based Rehabilitation Services: _________________________________________________ 73 Social Welfare Division: ________________________________________________________________ 81 Health Promotion: _____________________________________________________________________ 83 STI/ HIV Prevention Program ___________________________________________________________ 87 Integrated Mental Health Services ________________________________________________________ 90 Reproductive Health: ___________________________________________________________________ 92 Malaria Control _______________________________________________________________________ 97 Overview: _______________________________________________________________________ 97 A: Prompt diagnosis and treatment: ___________________________________________________ 97 B. Malaria prevention – vector control: ________________________________________________ 98 New Policy Directions: ____________________________________________________________ 98 Microscopy in Solomon Islands; _____________________________________________________ 98

Private Health Provider: Solomon Islands Planned Parent Hood Association (SIPPA) ____ 99 SIPPA Overview: _____________________________________________________________________ 99 Strategies and Programs: ________________________________________________________________ 99 Achievements _______________________________________________________________________ 100 Challenges & Issues: __________________________________________________________________ 101

Chapter 6 6.1 6.1.1 6.1.2 6.1.3 6.1.4 6.1.5

6.2 6.2.1 6.2.2 6.2.3

Provincial Health Services ______________________________ 103

Government Health Sector: ____________________________________________________ 103 Over view___________________________________________________________________________ 103 Access indicators: ____________________________________________________________________ 103 Health seeking behaviour of Solomon Islands people at the community level. ____________________ 104 Achievements/ Output Reporting: _______________________________________________________ 107 Challenges and Issues _________________________________________________________________ 108

Church Hospitals in the provinces ______________________________________________ 109 Atoifi Hospital: ______________________________________________________________________ 109 Helena Goldie Hospital ________________________________________________________________ 110 Sasamuga AHC: _____________________________________________________________________ 111

Chapter 7

Resource Utilisation: Financial & Human Resource Reporting __ 112

7.1

Funding for Health in 2006: ____________________________________________________ 112

7.2

Role of Health Sector Trust Account Fund: AusAID _______________________________ 112

7.2.1 7.2.2

7.3 7.3.1 7.3.2

HSTA Expenditure ___________________________________________________________________ 112 Control and Governance Issues __________________________________________________________ 114

Human Resource for Health in 2006 _____________________________________________ 114 Overview: __________________________________________________________________________ 114 Health workforce workload assessment: __________________________________________________ 116

Chapter 8

Key Health Challenges & Way Forward ___________________ 117

8.1

Overview: Key health challenges: ______________________________________________ 117

8.2

Opportunities _______________________________________________________________ 118

8.3

The Way Forward: ___________________________________________________________ 119

Chapter 9 9.1

Annexures ___________________________________________ 120

Annex 1: List of registered clinics in 2006 ________________________________________ 120

Tables: Table 1 Report on National Health Targets and Indicators ....................................... 14 Table 2 MDG Indicators 1990- 2006 ........................................................................ 17 Table 3 Proportion of PHC Attendances by major causes, SI 1997-2006 ................. 20 Table 4 Program Implementation rates 2005 ............................................................ 36 Table 5 Program Implementation rates 2006 ............................................................ 36 Table 6 Clinic Utilization Benchmark ....................................................................... 38 Table 7: Number of clinics & population 2006 ......................................................... 39 Table 8 Primary Health Care Facilities by Provinces Benchmark Status.................. 39 Table 9 Primary Health Care Facilities Did Not Meet the Benchmark by Province 2006 40 Table 10 Bed Capacity of NRH ................................................................................ 42 Table 11 Admissions, Discharges and Deaths in 2006 (Jan to Oct) .......................... 42 Table 12 Top 9 Leading causes in adults .................................................................. 44 Table 13: Total NRH Staff by category .................................................................... 44 Table 14 Summary of Activities of Dental Division NRH........................................ 50 Table 15 Brief Annual Statistics on Dental Service in SI for 2006 ........................... 52 Table 16 Provincial cohort analysis for new smear positive cases 2005 ................... 58 Table 17 Cohort Analysis for Extra Pulmonary and Sputum Negatives 2005 .......... 58 Table 18 Record of completed Water Supply projects in 2006 ................................. 63 Table 19: % Total cases by ethnicity........................................................................ 70 Table 20 Case Declaration end of 2006 .................................................................... 89 Table 21 Prevention indicators for Behavioural Change ABC ................................. 89 Table 22 Population Health Facility/ Workers/ Doctors ......................................... 103 Table 23 Ratio of population to Health workers: .................................................... 104 Table 24 Proportion of sample households reporting use of health facilities, SI HIES 2005-2006 Table 25 Use of healthcare for pain sickness by sex and age group SI HIES 2005-2006 105 Table 26 Use of health care for pain/sickness, by province. SI HIES 2005-2006 ... 105 Table 27 Type of health care sought for illness pain in past month. SI HIES 2005-2006 105 Table 28 Reasons for using traditional healer, SI HIES 2005-2006 ........................ 106 Table 29 Reasons a clinic/hospital were not used for help/care for recent sickness 106 Table 30 Number of surgical operations Jan-Oct 2006 ........................................... 109 Table 31 Summary of fund for health services and development in 2006 .............. 112 Table 32 HSTA Expenditure 2006 .......................................................................... 113 Table 33 Proportion of health staff in the Government workforce 2005 & 2006.... 114

Figures: Figure 1 - Organization Chart: Ministry of Health with position holders in 2006 .... 10 Figure 2: completion rates of key activities under the GCC Policy Statements by end 2006 Figure 3 Shows the MDG indicators trend 1990-2006.............................................. 18 Figure 4 Demographic Data for Solomon Islands 2006 ............................................ 19 Figure 5 Population incidence rate ARI by type, SI 1997-2006................................ 20 Figure 6 Incidence rate ARI SI 1997-2006 ............................................................... 21 Figure 7 Incidence rate of ARI combined by province 1997-2006 ........................... 21 Figure 8 Total pop incidence of diarrhoea by type 1997-2006 ................................. 22 Figure 9 Incidences rate of fever, clinical and slide confirmed malaria in SI 1997-2006 Figure 10 Incidence rate fever by province 1997-2006 ............................................ 26

13

26

105

Figure 11 Incidence rate of clinical malaria by Province 1997-2006 ........................ 26 Figure 12 Incidence rate of slide confirmed malaria by province 1997-2006 ........... 27 Figure 13 Incidence rates of red eye by age SI 1997-2007 ....................................... 27 Figure 14 Incidence rate of yaws Solomon Islands 1997-2006 ................................. 28 Figure 15 Incidence rate of skin disease by age SI 1997-2006 ................................. 29 Figure 16 Incidence rates of ear disease by age SI 1997-2006.................................. 30 Figure 17 Incidence rates of STI by age SI 1997-2006 ............................................. 32 Figure 18 Incidence rates of other diseases SI 1997-2006 ........................................ 33 Figure 19 Distribution of trauma by sex 2005........................................................... 35 Figure 20 NRH workforce by category 2005 and 2006 ............................................ 45 Figure 21: Health workforce by skill ........................................................................ 46 Figure 22 National TB Notification rate 1999-2006 ................................................. 55 Figure 23 National TB Notification rate by provinces in 2006 ................................. 56 Figure 24 National Trend of cure and treatment rate 1996-2005 .............................. 58 Figure 25 Leprosy Notification Rate 1996-2006....................................................... 60 Figure 26 National Leprosy prevalence rate 1993-2006 ........................................... 61 Figure 27 Donor Funded Water Supply projects ....................................................... 65 Figure 28 Number of international quarantine activities by route and companies .... 66 Figure 29 Number of vessels cleared at Honiara Port in 2006 .................................. 66 Figure 30 Number water samples tested in 2006 ...................................................... 68 Figure 31 Cumulative incidence rate type 2 diabetes in pop 15+.............................. 69 Figure 32 Age at new cases type 2 diabetes 1991-2006 ............................................ 70 Figure 33 Cumulative incidence rate of type 2 diabetes by age and sex SI 1991-200670 Figure 34 Type of cancers 2005 -2006 NRH Cancer program .................................. 72 Figure 35 National Trend of Annual Parasite Incidence and Mortality (2001- August 2006) 97 Figure 37 Organogram for Helena Goldie Hospital Services .................................. 110 Figure 39 HSTA Expenditure 2006......................................................................... 113 Figure 40 showing number health workers of the Ministry of Health (Source: 2006 SIG Establishment) 115 Figure 41 Proportion of health workforce by locations in 2006 ............................. 115 Figure 42 WISN indicators (Source MHMS and HISP 2005) ................................ 116

AHC ARI AusAID CHP CIP EHD GP HCC HISP HISP HIV/STI

Area Health Clinics Acute Respiratory Infection Australian AID 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 Infections

ICPD

International Convention Population Development

ICU MDG MOH MP MUP NAP NCD NGOs NHR NRH

infection Control Unit Millennium Development Goals Ministry of Health Malaita Province Makira Ulawa Province Nurse Aide Post Non-Communicable Diseases Non-Governmental Organizations National Health Review National Referral Hospital

OP PHC PHD RBP RHC RWSS SWAp TB TP WHO WISN WP YP

Operational Plan Primary Health Care Provincial Health Directors Rennell Bellona Province Rural Health Clinic Rural Water Supply and Sanitation Sector Wide Approach Tuberculosis Temotu Province World Health Organization Workload Indicator of Staffing Need Western Province Ysabel Province

Forward: It is indeed a privilege for me to present the National Health Report 2006. When coming in as the Minister of Health around mid 2006, I could see how important is this Ministry to the lives of the residents and people of the country. I personally value this Ministry very high and the lifeline of the people of this country. I am so delighted to be part of the health system as the political head of this Ministry. The challenges faced ahead of us are not easy, and will need a great deal of commitment, passion and political will to do it. Hence the participation of the local people at the community level is crucial. As our health logo clearly states “Health is our passion and everyone’s business”. The National Health Report 2006 is comprehensive to provide some information and evidences of the current health status of the people and the health care systems put in placed to help prevent, control, treat and eradicate the common health illnesses affecting the people as well as newly established and emerging diseases. The report also helps us to review our status in terms of health output and outcome indicators and performance indicators as required by our national health goals, and international health conventions. Whilst we are far from reaching absolute perfect, I am pleased to see some improvements in the maternal and infant mortality and also some gains in the primary health care indicators such as ratio of population to health workers (especially nurses) and clinics. There are many more rooms for improvement in the health services provision and other related developments. It is also indeed my pleasure and opportunity to commend all health workers at the national and provincial level to maintain their commitments one way or another in carrying forward health services. I am also proud to reflect here the growing interest and passion for the health of our people by our partners both internal and external; especially our developing partners for their sustained funding efforts, and the NGOs and the Churches for their willingness to play significant role on the services delivery, and capacity building. Let me take this opportunity to bid you a very fruitful and eventful 2007.

Hon. Clay Forau Soalaoi MP Minister of Health & Medical Services.

Chapter 1 About the Organization-Ministry of Health 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. Aim: To report the health of Solomon Islands people in the period 1993-2006 against Solomon Islands MOH and appropriate international indicators, and systems performance in 2006. Objectives: To report against the Grand Coalition Policy Statements To report against the National Health Cooperate Plan objectives To report on achievements, issues and constraints experienced in 2006 operational and service provision.

1.1.1 Report on the Grand For Change Coalition Government (Health) Political Statements Solomon Island’s Government’s Major role in ensuring health for all. The Grand Coalition For Change has been providing political leadership through the Honourable Minister of Health (Hon. Clay F Soalaoi)1. Show update progress on the implementation of the GCC policy statements here Supporting 2005 Organizational change in the structure in 2006. In 2005 there were organizational changes that forester greater emphasis on public health programs and public health functions of the Ministry health in-terms of responding to the emerging diseases:

1.1.2 Observations of the changes in 2006: [1] Public health programs: Strengthening of the national programs. Whilst there is a clear structure and functions of the public health programs the linkages between the national and provincial centers are still to be seen or materialized. [2] Public health programs: Roll out to provinces. The programs that are currently rolling out national programs to the provincial level are: Established at provincial level: • • • • • • •

TB/ Leprosy Vector Borne Disease Control Program- mainly malaria control programs Rural Water Supply Reproductive health programs Health promotion program Provincial STI/HIV Coordinators Provincial CBR coordinators

There are also programs that need more effort and support by the MOH to the provincial level. There are the newly or revised strategies which are the recent outputs in 2006. Outputs:

• The Delegation Manual developed with the support of HISP has helped to clarify the line of authority and approval for decision for national interest. • The revised 2005 mental health strategy to the provinces • The revised 2005 Social Welfare strategy to the provinces • The revised 2005 Community-Based Rehabilitation strategy to the provinces • HIV/STI Prevention and control programs and interventions • NCD/ Diabetic prevention and control programs • Healthy Islands settings module (part pf health promotion programs) to the provincial community settings.

Ministry of Health: National Health Report 2006 ================================================================== Figure 1 - Organization Chart: Ministry of Health with position holders in 2006 Minister of Health Permanent Malefoasi Under Secretary Health Improvement Dr.D. Ogaoga National Prevention & Control Programs: Environmental Health (Mr. Robinson Fugui) Health Promotion (Mr. Alby Lovi) Vector Born Disease Control (Mr. Albino Bobogare) 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.Elsie Taloifiri) Mental Health (Mr. W.Same) Coordination: Partner development Coordination (churches, NGO’s)

Secretary

Dr.

G

Under Secretary Health Care (Cedric Alependava)

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, Telepathology) Dental Services (Dr. L.Oti/ W. Qalo) 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 (O. Ramo spg) 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 2006 ==================================================================

1.2 The ational Health Policies: Plans and Priorities: 1.2.1 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.

1.2.2 The Health Corporate Plan 2006-2008 The Ministry of Health and Medical Services developed a “Corporate Plan for 2006-2008”2 based on the gain during 2004 and 2006 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.

1.3 The ational Health Strategies 2005-2010: In April 2006, the national goals and strategies during a planning workshop. 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. Revised National Goals and Strategies (in 2006, for 2006); The key strategic areas of the National Health Strategy are listed below: Enhance and strengthen People focus (or people centered) health services Strengthen priority public health programs. Prevent, control and eradicate malaria. Prevent and treat common childhood diseases. Prevent, control and treat on-Communicable diseases. Access to prevention, treatment and care of HIV/AIDS and Sexually transmitted diseases. Enhance Family Planning and Reproductive health. Health system strengthening (accountability, infrastructure, information management, organizational change and the National Referral Hospital)

Ministry of Health: National Health Report 2006 ==================================================================

Chapter 2 Reporting against the national goals- targets and indicator

12

(o) (p) (q) (b) (c) (d) (e) (f) (j)

Ministry of Health: National Health Report 2006 ==================================================================

(l)

2.1 Report on the Government’s Policy Statement

(n)

Figure 2: completion rates of key activities under the GCC Policy Statements by end 2006

(a) (g)

By end of 2006 the level of completion and progress of activities under the Grand Coalition For Change Government is around 40%. This is only for the first six months since the GCC came into to power [Figure 2]. Those with highest completion rates are the health sector’s routine implemented national programs. This report of level of complementation rates is not comprehensive enough to look in depth of the policy statements but it provide some brief idea of what has been implemented by the health sector. There are policy areas that need for work in 2007 and years to come.

120%

100%

80%

60%

40%

(i) (k) (m)

Im p r o v e a n d m a in ta in e x is tin g p u b lic h e a lth p ro g ra m s. P r o m o te p r im a r y h e a lth c a r e in th e c o u n tr y th r o u g h th e P r im a r y H e a lth C a r e P o lic y a n d e s ta b lis h H e a lth P r o m o tio n C e n tr e s in a ll E m p h a s iz e , s tr e n g th e n a n d p r o m o te p r e v e n ta tiv e h e a lth c a r e th r o u g h a ll a p p r o p r ia te a v e n u e s ; U p g r a d e a n d m a in ta in h e a lth c a r e fa c ilitie s s u c h a s h o s p ita ls , c lin ic s a n d a id p o s ts a n d p r o v id e th e n e c e s s a r y e q u ip m e n t to e n a b le P r o v id e p r o p e r a n d a d e q u a te tr a in in g a n d im p r o v e d te r m s a n d c o n d itio n s fo r m e d ic a l a n d h e a lth w o r k e r s ; E n s u r e th a t b e tte r n e tw o r k in g in th e p r o v is io n o f h e a lth c a r e s e r v ic e s a m o n g a ll s ta k e h o ld e r s s u c h a s c o m m u n itie s , c h u r c h e s E n c o u r a g e c o m m u n ity p a r tic ip a tio n in h e a lth p r o m o tio n a n d d e liv e r y , a n d p r o m o te h e a lth y life - s ty le s ; R e c o g n iz e th e v a lu e a n d s a fe u s e o f tr a d itio n a l m e d ic in e s b y s c ie n tific a lly v e r ify in g th e p o te n c y a n d c u r a tiv e p r o p e r tie s o f s u c h E n c o u r a g e th e u s e o f m o b ile m e d ic a l te a m s to r e a c h r e m o te c o m m u n itie s in th e c o u n tr y o n a r e g u la r b a s is ; in th is r e g a r d , m o b ile R e a c tiv a te th e P a r lia m e n ta r y S ta n d in g C o m m itte e o n H e a lth ;

20%

0%

(h)

E n s u r e th a t c le a n w a te r a n d p r o p e r s a n ita tio n is a c c e s s ib le to a ll c o m m u n itie s ; W o r k to w a r d s b e tte r a w a r e n e s s o f th e d y n a m ic s o f p o p u la tio n g r o w th a n d its e ffe c ts o n d e v e lo p m e n t; E n s u r e th a t th e H e a lth S e c to r r e c e iv e s a d e q u a te fu n d in g to c a r r y o u t a n e ffe c tiv e a n d e ffic ie n t h e a lth c a r e s e r v ic e T a k e d r a s tic m e a s u r e s to p r e p a r e a s w e ll a s a d d r e s s p a n d e m ic in fe c tio u s d is e a s e s , s u c h a s S e x u a lly T r a n s m itte d In fe c tio n s , H IV / A ID S R e v ie w th e o v e r s e a s r e fe r r a l p o lic y w ith a v ie w to in c lu d e s e v e r a l o th e r o v e r s e a s h o s p ita ls ; S tr e n g th e n m e n ta l h e a lth s e r v ic e s a n d ta k e m e a s u r e s to e x te n d s u c h to v u ln e r a b le g ro u p s; E n c o u r a g e a n d s u p p o r t o th e r h e a lth c a r e p r o v id e r s in th e c o u n tr y ;

Ministry of Health: National Health Report 2006 ==================================================================

2.2 Report on the ational Health Goals and Targets This is reporting of the progress of the targets and indicators for health [Table 1]. Table 1 Report on National Health Targets and Indicators

End 2006 update achievments Reduce Maternal Mortality Rate from 357/100,000 live Maternal mortality rate reduced from births to 125/100,000 live births by 2010 276/ 100,000 live births in 2004 to 223 per 100,000 live births in 2006. Reduce morbidity and mortality rate of children below 5 Acute respiratory infection continue to years of age due to common childhood illnesses and be the most common cause of morbidity vaccine preventable diseases. for children under 5 with high prevalence less than 1 years old. In 2006, ARI accounts for 23% of total clinic visits. Reduce impact (morbidity) and severity (epidemics, Reported case of confirmed influenza mortality) of Communicable diseases in Solomon type A H1N1 in 2006): No deaths Islands. reported. no major admissions –all outpatient visits. Implement the ‘National HIV Policy and Multi sect oral Low prevalence still Cumulative cases strategic plan 2006-10’3 the aim to sensitize people of 8 by end 2006. 4 died and 4 People through informed HIV prevention awareness and living with the HIV/AIDS (PLWHA). behavioural change interventions to stop the transmission of HIV, and to ensure accessibility to quality voluntary, confidential, counselling and testing Low prevalence status: estimated people as the entry point for continuum of quality care, infected around 150-200 people. including anti retro-viral treatment, for people living with HIV/AIDS. Reduce incidence of preventable skin diseases by 2010. Yaws in chidren reduced to around 2% of total clinic visits. Yaws no more recorded in babies (<1 years old). Promote clean water, proper sanitation (including waste No new updated figure: disposal), food quality and food safety (incl. food Access to clean water 70% of pop: hygiene) Access to proper sanitation 34% of pop Reduce the incidence of Malaria from 184/1000 people in 2004 to 80/1000 people by 2010. 2006 figures: Clinical malaria =349.5 cases per 1000 population Fever = 302 cases per 1000 population Slide confirmed = 156 cases per 1000 population Reduce impact (morbidity) and severity (disability, Diabetes cumulative incidence 6% mortality) of all Non Communicable Diseases in Solomon Islands. Reduce prevalence of dental caries in all children by No data available during compilation of 2010 report

Ministry of Health: National Health Report 2006 ================================================================== Raise public and health service provider awareness on No data available during compilation of the impact of substance misuse and assess the level of report psycho-social problems resulting from substance abuse. Reduce incidence of suicide in SI over next 10 years. No data available during compilation of report Provide essential primary health care to all individuals No data available during compilation of and families, in an acceptable and cost-effective, report affordable way, and with their full involvement ensuring best practice, high quality and improved patient/client/community care. Enhance behavioural change which promotes a healthy Behavioural change approach taken by lifestyle and family health, especially related to the MHMS programs includes reproductive health, child health, NCD’s, mental health sensitization and awareness through and Communicable Diseases like malaria and HIV/STIs. mass media such as TV and radios. This is followed by distribution of IEC materials and making available health educational resources at various strategic areas. Recently with the support from Oxfam International an integrative community participative approach called “stepping stone” was introduced later half of 2006. This is acting out the (skilling) the knowledge learned in various ways. This approach has been the back bone of behavioural change towards HIV prevention and care. Quantitative information can be seen in various prevention programs in this report. There is plan to evaluate (qualitative) the effectiveness of these behaviour change interventions. Improve access to required essential drugs, medical No data available during compilation of equipment and medical supplies of appropriate quality report at all levels of health service Improve infection control practices at all levels of health No data available during compilation of services with the aim of reducing infections acquired report within health settings. Ensure appropriate referral between all levels of health No data available during compilation of service. report Improve continuum of patient care by strengthening the No data available during compilation of admission and discharge processes (including report communication) at all levels of health service. Ensure early diagnosis and consequently appropriate No data available during compilation of treatment for patients. report Provide quality patient care to a level consistent with No data available during compilation of best practice with the aim of reducing length of stay in report hospital.

15

Ministry of Health: National Health Report 2006 ================================================================== Provide appropriate level of patient care in hospital No data available during compilation of settings by ensuring minimal level of services and report minimum staffing requirements Provide a safe environment for patients and staff No data available during compilation of report Undertake evidence based health service planning and No data available during compilation of management report Increase capacity of all managers and their health teams In 2006, health leadership and to be involved in operational planning and its use to management course held for around 30 ensure appropriate, effective and efficient health service senior and middle managers both at the delivery national and provincial level run by University of NSW Public Health and Community Medicine Ensure funds allocated in the budget are spent By end of 2006, MHMS left with appropriately and in a timely manner to ensure planning underspent fund of around 2.8Million. and implementation of appropriate health services The level of implementation by programs have improved. By November 2006 as reported by the Policy and Planning Division of Ministry of Health. National Divisions and Program have an implemented rate of (average) 63% an increase from 34% in 20054. Improve the management of health assets and Planning for recruitment of procurement equipment at all levels of the health care system officer to also asset management and inventory. Not fully implemented Improve management and supervision of health Planning workshops were held for all services/health workers in order to manage and sustain divisional heads and program managers. positive change in health service delivery Budgeting process also linked with operational planning. Establish a MOH information center where information Not implemented. can be accessed by all stakeholders Enhance development of partnerships with stakeholders A standard Draft MOU developed for to ensure effective delivery of health services Church service delivery: for further development and, negotiation and signing. Sector Wide Approach agreed as a mechanism for partnership. Improve health infrastructure to support health service Phase 3 National Referral Hospital provision. project proceed with significant delay due to poor contractor performance. Preparation work on Choiseul staff housing, Tulagi Hospital renovation and other provincial house started with support from the MHMS Infrastructure Committee. Health Promotion HQ Office renovated.

16

Ministry of Health: National Health Report 2006 ==================================================================

2.3 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 Table 2 and Figure 3 shows the updates of the MDGs Indicators: In short, whilst there is some improvement in reducing maternal and infant mortality in 2006, the level of STI and Malaria incidences is till not within control or elimination level. Table 2 MDG Indicators 1990- 2006

MDG indicators (Solomon Islands) estimates 1990-2006 1990 42.7

2004 17

2005 16.3

2006 9.8

Maternal Mortality deaths-pregnancy/ 100,000 live 357 births

276

236

223

HIV (Cumulative cases) STI rate Malaria (clinical) Malaria confirmed slide/ 1000 pop

0

1 12

160

190

6 16 340 184

8 21 349.5 156

Child Mortality- deaths / 1,000 live births

17

Ministry of Health: National Health Report 2006 ================================================================== Figure 3 Shows the MDG indicators trend 1990-2006

375 360 345 330 315

Maternal Mortality deaths-pregnancy/ 100,000 live births, 357

Malaria (clinical), 349.5

340

300 285

276

270 255 240

236

225 210

223

195 180 165 150

190

184

Malaria confirmed slide/ 1000 pop, 160

156

Child Mortality- deaths / 1,000 live births , 42.7

STI rate, 21

135 120 105 90 75 60 45 30 15 0

0 1990

17 12 1

16 16.3 6

2004

2005

18

9.8 HIV (Cumulative cases), 2006 8

Ministry of Health: National Health Report 2006 ==================================================================

Chapter 3 Solomon Islands Demographic and Health Status Indicators 3.1 Demographic, Gender and Poverty: In Solomon Islands, male population outnumbered female population with the sex ratio of 106 males per 100 females. Children less than 5 years of age account for 14% of total population while infants (children less than 1 year old) account for 3%. Of the children in the age group less than 5 years, 21% were infants. Women in the child bearing age account for 25% of total population. While only 3% of the total population were in the old age category (65 years and over), 39% of total population were under 15 years of age. Assuming the cut off points for economic activity age group were 15 and 64 years, then the proportion of Solomon Island population still within the dependency age range account to 42%. Figure 4 Demographic Data for Solomon Islands 2006 D e m o g r a p h ic D a ta fo r S o lo m o n Is la n d s 2 0 0 6 In d ic a to rs 2006 T o ta l P o p u la tio n 483083 m a le p o p u la tio n 248944 fe m a le p o p u la tio n 234139 P o p u la tio n le s s th a n 1 14445 P o p u la tio n le s s th a n 5 69559 W o m e n p o p u la tio n 1 5 - 4 9 119160 P o p u la tio n 1 5 - 6 4 y e a rs 277139 P o p u la tio n 6 5 y e a rs a n d o v e r 15278 P o p u la tio n le s s th a n 1 5 y e a rs 190666 s e x ra tio 106 S o u r c e : P r o je c te d P o p u la tio n 2 0 0 6 a n d 2 0 0 7 , N S O ,

19

% 100% 52% 48% 3% 14% 25% 57% 3% 39%

2007 495026 255063 239963 14448 70380 122573 285168 15740 194118 106 M in is tr y o f F in a n c e

% 100% 52% 48% 3% 14% 25% 58% 3% 39%

Ministry of Health: National Health Report 2006 ==================================================================

Chapter 4 Report on Disease Burden- Health Information System 2006 4.1 Overview In Solomon Islands, the major causes of attendance at primary health care clinic were other diseases category followed by fever and clinical malaria combined, then acute respiratory infection (ARI)5. In 2006, their corresponding proportions as cause of attendance were 34%, 30% and 23% [Table 3]. Table 3 Proportion of PHC Attendances by major causes, SI 1997-2006 Proportion of Primary Health Care Attendances by Major Causes, Solomon Islands 1997-2006 Diseases 1997 1998 1999 2000 2001 2002 ARI 21% 18% Diarrhoea 2% 3% Fever 21% 19% Red eyes 2% 2% Yaws 2% 3% Skin diseases 7% 7% Ear infection 3% 3% STI diseases 0% 0% Clinical malaria 13% 14% Other diseases 29% 31% Source HIS monthly report forms 1997- 2006

21% 2% 17% 2% 2% 6% 3% 0% 14% 31%

19% 2% 16% 2% 3% 6% 3% 0% 16% 34%

21% 1% 16% 2% 2% 5% 3% 0% 18% 32%

19% 1% 18% 2% 3% 5% 3% 0% 19% 31%

2003

2004

2005

2006

18% 2% 15% 1% 4% 5% 3% 0% 21% 31%

21% 2% 14% 1% 3% 5% 3% 0% 17% 34%

21% 2% 14% 2% 2% 5% 3% 0% 17% 33%

23% 2% 14% 2% 2% 4% 3% 0% 16% 34%

4.2 Disease Specific 4.2.1 Acute Respiratory Infections Worldwide ARI is a common cause of morbidity in children and babies less than 1 year. In Solomon Islands it is one of the leading causes of morbidity too especially in children and babies less than 1 [Figure 5]. Over the past 10 years, ARI was the third major cause of attendance at primary health care clinics in the country. In 2006 it contributed to 23% of total acute care contacts in the country. Figure 5 Population incidence rate ARI by type, SI 1997-2006 Population incidence rate ARI by type, Solomon Islands 1997-2006

Rateper 1,000popn

600 500 400 300 200 100 0 1997

1998

1999

mild

2000

2001 2002 Year

moderate

2003

severe

2004

2005

2006

Combined

ARI moderate (pneumonia) followed by ARI mild (no pneumonia) are common health problems in Solomon Islands [Figure 6].

Ministry of Health: National Health Report 2006 ================================================================== In recent years, especially between 2003 and 2006, the ARI rate increased reaching it highest point in 2006. The rate of ARI mild was highest between 1997and 2000 despite a declining trend. Between 2003 and 2006 the trend of ARI mild rose again reaching more than 200 cases per 1000 population in 2006. Over the past 10 years, the incidence rate of ARI moderate demonstrates an upward trend. On the other hand, the rate of ARI mild was higher in the early years of the decade, declined during the tension period and on the rise again since 2003. The increase in the rate of ARI mild and ARI moderate observed in recent years may demonstrate the actual rise in the rate of the disease, but may also reflect the increased availability of health services to people of Solomon Islands. Figure 6 Incidence rate ARI SI 1997-2006

Incidence rate of ARI (combined), Solomon Islands 1997-2006

Rate per 1,000 popn

3000 2500 2000 1500 1000 500 0 1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year Total population

rates < 1

rates 1-4

rates 5+

. Since 2003 the rate of ARI in total population increased consistently with a similar pattern demonstrated across all age groups. In 2006, the rate of ARI showed a further increase notably in babies less than 1year old. Figure 7 Incidence rate of ARI combined by province 1997-2006 Incidence rate of ARI combined by Province, 1997 - 2006 1997 1998 1999 Provinces Guadalcanal 513 581 453 Western 593 457 470 Malaita 399 290 385 Temotu 466 411 572 Central 409 349 439 Choiseul 394 338 471 Isabel 512 358 476 Makira 381 344 366 Honiara 524 452 411 Renbel 575 474 274 Solomon Is 471 396 431 Source HIS monthly report forms 1997- 2006

2000 282 376 393 500 358 409 509 399 371 522 385

2001 180 420 363 531 345 588 601 349 469 576 410

2002 267 341 282 489 357 413 531 309 349 391 331

2003 331 304 218 450 253 480 493 320 383 639 316

2004 350 432 324 656 405 478 665 461 505 671 417

2005 527 458 339 634 332 536 539 465 487 549 433

2006 497 526 343 737 400 584 633 624 624 875 504

The rate of ARI combined has consistently increased since 2003. In 2006 ARI rate for Solomon Islands increased considerably reaching 504 cases per 1000 population. 21

Ministry of Health: National Health Report 2006 ================================================================== Across the provinces, Renbel demonstrates the highest rate of ARI combined in 2006 with 875 cases per 1000 population followed by Temotu 737 cases per 1000, then Isabel with a rate of 633 cases per 1000 population while Malaita demonstrates the lowest rate of ARI combined reaching 343 cases per 1000 population [Figure 7].

4.2.2 Diarrhoeal disease World wide diarrhoeal diseases are major cause of morbidity and mortality in babies less than 1 year as well as in children ages 1 to 4. In Solomon Islands, diarrhoea is a common health problem affecting children less than 5 in particular babies less than 1 year old. Over the past 10 years, diarrhoea has contributed a small proportion of total acute care contacts in Solomon Islands, 2% in 2006 [Figure 8]. Figure 8 Total pop incidence of diarrhoea by type 1997-2006

Total population incidence of diarrhoea by type Solomon Islands 1997-2006

Rate per 1,000 popn

60 50 40 30 20 10 0 1997

1998

1999

2000

2001 2002 Year

w atery and bloody

2003

w atery

2004

2005

2006

bloody

Over the past 10 years the rate of diarrhoea (watery and bloody) for total population declined slightly from 53 cases per 1000 population in 1997 to 41 cases per 1000 population 2006. During the tension period, the rate of diarrhoea declined across all age groups with a marked dropped noted in babies less than 1 year. Between 2003 and 2005 the rate of diarrhoea reversed it’s trend and increased. Over the past 10 years the rate of watery diarrhoea was higher than bloody diarrhoea. Between 1998 and 2002 while the trend of bloody diarrhoea remained constant, the incidence of watery diarrhoea plunged reaching it lowest point in 2002. Between 2002 and 2005 the rate of watery diarrhoea rose from it lowest point of 22 cases per 1000 population in 2002 to 37 cases per 1000 population in 2005. In 2006 the rate of watery diarrhoea demonstrated a downward trend. In 2005 the rate of bloody diarrhoea increased markedly suggesting an outbreak if not across the country then in some parts of Solomon Islands. In 2006 the rate of bloody diarrhoea dropped from 11 cases per 1000 population in 2005 to 6 cases per 1000 population.

22

Ministry of Health: National Health Report 2006 ==================================================================

Rate per 1,000 population

Incidence rate of diarrhoea (w atery and bloody) by age Solomon Islands 1997-2006 300 250 200 150 100 50 0 1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year Total population

rates < 1

rates 1-4

rates 5+

In 2006 the total population rate of diarrhoea declined with a marked dropped observed in children age between 1 and 4. Conversely, the rate of diarrhoea in babies less than 1 year in 2006 demonstrates an upward trend. Incidence rates of diarrhoea combined by Province, 1997 - 2006 1997 1998 1999 2000 Provinces Guadalcanal 69 82 51 28 Western 82 74 53 44 Malaita 32 34 41 34 Temotu 27 35 30 42 Central 57 61 58 40 Choiseul 49 50 56 57 Isabel 56 50 47 69 Makira 20 21 15 13 Honiara 72 85 50 43 Renbel 53 102 30 82 Solomon Is 53 56 45 38 Source HIS monthly report forms 1997- 2006

2001

2002

2003

2004

2005

2006

6 36 26 24 29 46 48 12 41 42 30

15 31 21 23 36 35 36 12 36 19 25

35 32 17 31 33 48 51 19 46 66 30

27 44 24 27 44 44 57 18 55 28 34

46 54 39 36 46 59 55 25 71 68 48

37 55 30 22 30 58 35 38 63 61 41

While a decreased in the rate of diarrhoea was observed across all provinces in 2006, Makira experienced the increased incidence. The table also shows that in 1998, 2003 and 2005 outbreaks of diarrhoea were experienced in Renbel. In 2001 there was a significant drop in the rate of diarrhoea in Guadalcanal which may reflect the impact of ethnic tension on the provision of health services to Guadalcanal people.

23

Ministry of Health: National Health Report 2006 ==================================================================

4.2.3 Watery Diarrhoea Incidence rates of w atery diarrhoea by age Solomon Islands 1997-2006

Rate per 1,000 popn

250 200 150 100 50 0 1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year Total population

rates < 1

rates 1-4

rates 5+

Over the past 10 years, the rate of watery diarrhoea was highest in children less than 5 years and more importantly in babies less than 1 year. Between 1997 and 2002 the rate of watery diarrhoea dropped across all age groups with a significant drop noted in babies less than 1 year. Between 2002 and 2005 the rate of watery diarrhoea demonstrates an upward trend across all age groups. In 2006, the rate of watery diarrhoea dropped in children age between 1 and 4, and the rate in babies less than 1 year increased. Nationally watery diarrhoea dropped slightly between 2005 and 2006. Guadalcanal continued to demonstrate the highest rate of watery diarrhoea over the years. Incidence rate of Watery Diarrhoea by Province, 1997 - 2006 1997 1998 1999 Provinces Guadalcanal 246 384 185 Western 75 63 47 Malaita 29 29 37 Temotu 23 30 24 Central 49 55 51 Choiseul 46 46 51 Isabel 52 48 44 Makira 17 16 14 Honiara 66 80 44 Renbel 48 90 30 Solomon Is 49 50 40 Source HIS monthly report forms 1997- 2006

2000

2001

2002

2003

2004

2005

2006

107 40 32 36 36 53 66 11 39 77 35

41 31 24 21 27 43 45 10 38 40 27

72 27 19 20 34 33 34 11 33 18 22

192 30 15 26 29 46 46 18 42 63 28

141 41 22 26 39 42 53 17 47 26 31

232 42 27 25 32 49 48 22 57 44 37

195 51 23 18 27 52 30 30 55 54 35

4.2.4 Bloody Diarrhoea Over the past 10 years, the rate of bloody diarrhoea was highest in babies less than 1 year followed by children age between 1 and 4. In 2005, the rate of bloody diarrhoea increased across all age groups with a marked rise noted in children and babies less than 1 year. The rise suggests that there was an outbreak of bloody diarrhoea in the country in 2005. In 2006 the rate of bloody diarrhoea across all age groups dropped. Nationally bloody diarrhoea dropped from 11 cases per 1000 in 2005 to 6 cases per 1000 population and in 2006 with

24

Ministry of Health: National Health Report 2006 ================================================================== significant decreases occurring in Renbel and Central. While most provinces experienced a drop in bloody diarrhoea rate in 2006, Makira demonstrated the opposite trend. Incidence rates of bloody diarrhoea by age Solomon Islands 1997-2006

Rate per 1,000 popn

40 30 20 10 0 1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year Total population

Incidence rate of Bloody Diarrhoea by Province, 1997 - 2006 1997 1998 1999 Provinces Guadalcanal 5 6 4 Western 6 12 5 Malaita 3 4 4 Temotu 4 6 6 Central 8 7 7 Choiseul 2 4 5 Isabel 3 2 3 Makira 3 4 1 Honiara 6 5 6 Renbel 5 12 0 Solomon Is 4 6 4 Source HIS monthly report forms 1997- 2006

rates < 1

2000 2 4 3 7 4 4 3 1 4 5 3

2001 1 5 2 3 2 2 3 2 2 2 3

rates 1-4

2002 1 4 2 3 2 2 2 1 3 1 2

2003 3 2 2 5 4 2 5 1 4 3 3

rates 5+

2004 2 3 3 1 4 2 3 1 8 2 3

2005 7 11 12 11 14 10 7 3 15 25 11

2006 5 5 7 4 3 6 5 8 8 7 6

4.2.5 Fever, clinical malaria and slide confirmed malaria Fever (presumptive malaria) and clinical malaria accounted for 30% of total acute care contacts, the second most important cause of illness among people in Solomon Islands in 2006 [Figure 9]. While the rate for fever demonstrates a downward trend between 1997 and 2003, the rate of clinical malaria displays an increase and has been around 350 cases per 1,000 since 2001. For slide confirmed malaria, the incidence rate has been declining since 2003.

25

Ministry of Health: National Health Report 2006 ================================================================== Figure 9 Incidences rate of fever, clinical and slide confirmed malaria in SI 1997-2006

Incidence rates of f ever, clinical and slide conf irmed malaria Solomon Islands 1997-2006

Rate per 1,000 popn

500 400 300 200 100 0 1997

1998

1999

f ever

2000

2001 2002 Year

clinical malaria

2003

2004

2005

2006

slide confirmed malaria

Figure 10 Incidence rate fever by province 1997-2006 Incidence rate of fever byProvince, 1997 - 2006 Provinces 1997 1998 Guadalcanal 717 768 Western 555 408 Malaita 434 380 Temotu 146 109 Central 455 367 Choiseul 542 566 Isabel 412 302 Makira 348 416 Honiara 207 173 Renbel 68 127 Solomon Is 451 410

1999 576 340 336 107 435 433 303 328 116 32 342

2000 383 333 377 150 462 339 308 388 106 102 329

2001 140 331 355 121 251 375 350 271 181 102 327

2002 312 243 345 103 607 348 361 315 142 83 300

2003 376 234 230 70 369 475 315 451 124 94 272

2004 312 203 316 107 522 360 348 443 162 140 289

2005 292 165 323 102 446 331 260 440 161 50 278

2006 282 242 319 143 488 381 253 525 179 113 302

2003 347 272 292 287 300 325 202 468 311 17 368

2004 370 257 409 272 403 213 201 505 325 29 347

2005 373 191 430 313 412 168 149 487 310 12 346

2006 293 231 427 357 439 184 99 516 297 9 350

Figure 11 Incidence rate of clinical malaria by Province 1997-2006

Incidence rates of clinical malaria byProvince, 1997 - 2006 1997 1998 1999 Provinces Guadalcanal 126 277 298 Western 469 485 473 Malaita 255 219 271 Temotu 250 172 212 Central 297 342 365 Choiseul 272 369 248 Isabel 129 106 100 Makira 291 397 298 Honiara 400 340 179 Renbel 2 6 1 SolomonIs 278 301 289 Source HISmonthly report forms 1997- 2006

2000 177 557 377 422 387 223 97 345 216 15 337

26

2001 153 482 382 472 368 295 134 294 368 21 349

2002 245 345 348 408 457 266 153 314 323 5 322

Ministry of Health: National Health Report 2006 ================================================================== Figure 12 Incidence rate of slide confirmed malaria by province 1997-2006 Incidence rates of slide confirmed malaria by Province, 1999 - 2006 1999 2000 2001 2002 Provinces Guadalcanal 225 108 135 169 Western 216 320 231 178 Malaita 108 122 127 147 Temotu 32 46 85 50 Central 119 166 134 194 Choiseul 242 159 113 153 Isabel 27 37 54 63 Makira 68 69 63 83 Honiara 261 306 261 382 Renbel 0 1 2 3 Solomon Is 156 164 180 179 Source Malaria Information System 1999 - 2006

2003 299 153 175 68 183 353 66 137 345 4 204

2004 383 89 188 59 279 127 40 174 244 5 196

2005 298 61 143 70 271 69 19 173 257 6 162

2006 212 64 191 67 235 55 18 120 243 7 156

4.2.6 Red eye Nationally red eye contributed to 2% of total new cases in 2006 and with the exception of 2003 and 2004 the proportion has remained the same over the last 10 years. The rate of red eye was highest in babies less than 1 year, followed by children ages between 1 and 4. The rate of red eye in these age groups exceeded national average for the last 10 years. Since year 2000 the incidence of red eye across all age groups declined reaching it lowest point in 2003. Between 2003 and 2006 the rate of red eye increased in all age groups. The increased rate in 2006 reflected reflected an outbreak of red eye between January and March 2006. Figure 13 Incidence rates of red eye by age SI 1997-2007

Incidence rates of red eye by age, Solomon Islands 1997-2006 180 Rate per 1,000 popn

160 140 120 100 80 60 40 20 0 1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year Total population

rates < 1

27

rates 1-4

rates 5+

Ministry of Health: National Health Report 2006 ================================================================== Incidence rates of red eye by Province, 1997 - 2006 1997 1998 1999 Provinces Guadalcanal 51 75 60 Western 50 56 64 Malaita 31 30 42 Temotu 32 32 38 Central 42 61 50 Choiseul 39 36 56 Isabel 46 36 38 Makira 34 36 34 Honiara 19 27 33 Renbel 31 26 20 Solomon Is 38 43 47 Source HIS monthly report forms 1997- 2006

2000

2001

2002

2003

2004

2005

2006

27 42 38 31 46 40 35 35 18 44 35

14 33 30 29 49 43 48 28 21 25 32

23 27 24 32 45 41 38 22 15 17 26

36 22 18 21 27 34 30 30 16 23 24

35 26 24 18 36 37 31 27 22 11 27

41 38 32 27 33 32 40 43 23 20 35

46 59 33 29 57 42 71 84 39 58 47

Nationally the rate of red eye in 2006 was 47 cases per 1000 population. Rates were highest in in Makira followed by Isabel, Western, Renbel and Central. Temotu on the other hand had the lowest rate red eye last year. Yaws and skin infections Yaws is a common illness affecting children age between 1 and 4. Over the past 10 years yaws contributed to small proportion of total acute care contacts. In 2006 the proportion of yaws as a reason for clinic visit was 2%. Figure 14 Incidence rate of yaws Solomon Islands 1997-2006

Incidence rates of yaw s by age, Solomon Islands 1997-2006

Rate per 1,000 popn

120 100 80 60 40 20 0 1997

1998

1999

2000

Total population

2001 2002 Year rates < 1

2003

2004

rates 1-4

2005

2006

rates 5+

The rate of yaws remained highest in children age between 1 and 4 years and exceeded the population rate over the last 10 years. In 2003 the rate in total population increased with a marked rise noted in children and people age 5 years and over. Since 2003 the rate of yaws in total population, children and people over 5 years, demonstrates a downward trend for three consecutive years reaching it lowest point in 2006. The trend of yaws rate in babies less than 1 year has remained below 20 cases per 1000 population over the years. This clearly indicates that yaws is not a common health problem in babies less than 1 year.

28

Ministry of Health: National Health Report 2006 ================================================================== Incidence rates of yaws by Province, 1997 - 2006 Provinces 1997 1998 Guadalcanal 58 69 Western 72 75 Malaita 60 64 Temotu 34 105 Central 17 52 Choiseul 21 17 Isabel 29 24 Makira 66 73 Honiara 19 27 Renbel 29 32 Solomon Is 49 59 Source HIS monthly report forms 1997- 2006

1999 66 68 58 75 20 18 14 49 33 18 49

2000 50 77 89 42 23 12 17 52 18 44 57

2001 24 64 61 48 17 20 18 47 21 78 47

2002 38 58 55 145 27 19 16 51 15 37 49

2003 74 77 65 141 27 40 24 77 16 55 65

2004 62 44 65 40 37 14 19 57 22 46 51

2005 62 40 56 41 30 25 18 67 23 27 48

2006 63 41 33 25 32 19 15 71 39 36 42

Nationally, the rate of yaws (Table 6) declined from 49 cases per 1000 population in 1997 to 42 cases per 1000 population in 2006. The 2003 rate of yaws was the highest for several years reaching 65 cases per 1000 population. Across the provinces, Temotu demonstrated the highest national incidence rate of yaws in two consecutive years reaching 145 cases per 1000 population in 2002 and 141 cases per population in 2003. These were the highest rates experienced in Temotu since 1998. In 2006, Temotu demonstrates the third lowest rate of yaws across the country (Table 6). Figure 15 Incidence rate of skin disease by age SI 1997-2006

Incidence rate of skin disease by age Solomon Islands 1997-2006

Rate per 1,000 popn

300 250 200 150 100 50 0 1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year Total population

rates < 1

rates 1-4

rates 5+

Over the years skin disease contributed small proportion of total new cases and the proportion has consistently declined since 1997. In 2006 the proportion of skin disease as a reason of clinic visit in Solomon Islands was 4%, a drop from 7% reported in 1997. Skin disease is more common in children and babies less than 1 year. Over the past 10 years, the rate of skin disease was highest in children followed by babies less than 1 year and the rate in both age groups exceeded total population rates. For children age between 1 and 4 the rate of skin diseases decreased between 1997 and 2002 but the pattern shows an upward trend between 2003 and 2006 though the rate was still low compared to rates in the early years of the 1990’s

29

Ministry of Health: National Health Report 2006 ================================================================== The rate of skin disease in babies less than 1 shows an upward trend between 2003 and 2005 with a further increase observed in 2006. Incidence rates of skin disease by Province, 1997 - 2006 1997 1998 1999 Provinces Guadalcanal 208 288 155 Western 172 122 94 Malaita 121 112 123 Temotu 173 225 148 Central 132 135 103 Choiseul 213 209 198 Isabel 131 99 104 Makira 81 99 73 Honiara 94 150 82 Renbel 49 59 30 Solomon Is 143 153 117 Source HIS monthly report forms 1997- 2006

2000 100 102 127 171 125 180 121 104 60 224 115

2001 59 81 97 138 89 187 90 114 57 182 95

2002 60 89 77 154 70 162 84 94 49 50 82

2003 95 90 66 148 40 161 97 121 50 77 85

2004 99 98 75 208 85 151 90 110 86 169 96

2005 113 110 95 149 57 145 96 115 73 45 103

2006 82 132 80 146 75 165 71 114 79 102 98

Nationally, the rate of skin disease decreased over the years from it highest point of 153 cases per population in 1998 to 98 cases per 1000 population in 2006. Across the provinces, Choiseul followed by Guadalcanal, Temotu, Central and Western demonstrated the highest rate of skin disease in the early years of last decade. In 2000, Renbel also experienced an increased rates of skin disease and in 2004 Temotu again demonstrate an increase in skin disease rate. In 2006 the skin disease rate was highest in Choiseul (165 cases per 1000), followed by Temotu (146 cases per 1000), Westen Province (132 cases per 1000 population), Makira (114 cases per 1000 population), then Renbel (102 cases per 1000 population). The province with the lowest rate of skin disease in 2006 was Isabel (71 cases per 1000 population).

4.2.7 Ear disease Ear infection has consistently contributed to 3% of total acute care contacts in the country since 1997. Figure 16 Incidence rates of ear disease by age SI 1997-2006

Incidence rates of ear disease by age Solomon Islands 1997-2006

Rate by 1,000 popn

200 150 100 50 0 1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year Total population

rates < 1

30

rates 1-4

rates 5+

Ministry of Health: National Health Report 2006 ================================================================== Nationally ear infection was a common health problem affecting children and babies less than 1 year Between 1997 and 2002 the rate of ear infection dropped across all age groups. Between 2002 and 2006 the pattern demonstrates the opposite trend across all age groups. Incidence rate of ear infection by Province, 1997 - 2006 1997 1998 1999 Provinces Guadalcanal 97 77 60 Western 113 105 86 Malaita 33 26 29 Temotu 81 73 90 Central 34 44 49 Choiseul 71 69 74 Isabel 80 49 48 Makira 36 42 40 Honiara 115 103 88 Renbel 40 48 12 Solomon Is 71 63 58 Source HIS monthly report forms 1997- 2006

2000 37 83 32 87 39 97 61 36 82 43 55

2001 17 74 30 87 40 108 65 32 109 34 56

2002 27 59 23 128 40 77 53 26 87 20 47

2003 43 68 17 108 28 89 82 32 94 37 51

2004 42 84 25 127 50 82 75 38 101 32 58

2005 51 77 27 113 55 116 64 41 99 26 61

2006 58 87 24 118 62 121 58 51 113 62 65

Nationally the rates of ear infection declined from 71 cases per 1000 population in 1997 to 65 cases per 1000 population in 2006. In the early years of the 1990’s, Honiara followed by Western, Guadalcanal and Temotu demonstrate the highest rates of ear infection during those years. In 2001 there was an outbreak of ear infection in Honiara and Choiseul as demonstrated by the sudden rise in the rate for that year. Between 2002 and 2004, Temotu demonstrates the highest rate of ear infection across all provinces, and second in highest to Choiseul in 2005 and 2006. In 2006, Choiseul demonstrates the highest rate of ear infection, followed by Temotu, Honiara and Western Province. The rates in these four provinces also exceeded national average in 2006. The province with the lowest incidence rate of ear infection in 2006 was Malaita.

4.2.8 Sexually transmitted infections Although STI have contributed only a small proportion of total acute care contacts for the past 10 years, it is important that the trend is monitored closely due to their potential to facilitate the spread of HIV/AIDS in the country. It is important to note that reporting of vaginal discharge is not a sensitive measure of STI incidence in women as a discharge may not always be an STI. STI rates are reported using a population aged 15 to 49 years as the denominator.

31

Ministry of Health: National Health Report 2006 ================================================================== Figure 17 Incidence rates of STI by age SI 1997-2006

Incidence rates of STI by age, Solomon Islands 1997-2006

Rate per 1,000 popn

25 20 15 10 5 0 1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year STI combined

penile discharge

vaginal discharge

genital ulcer

Over the past 10 years, the rate of STI doubled. Between 2002 and 2006 the trend of STI diseases increased reaching 21 cases per 1000 population (aged 15-49 years) in 2006. The rate of vaginal discharge rose from 8.7 cases per 1000 population in 2005 to 21 cases per 1000 population in 2006 and the rate of penile discharge doubled between 2005 and 2006. The rise in STI disease rate between in 2005 and 2006 is attributed to the increased case reporting from other agencies such as SIPPA. Incidence rate of STI combined by province (reported against population 15-49 years) Provinces 1997 1998 1999 2000 2001 2002 Guadalcanal 8 13 10 12 9 6 Western 14 11 10 8 6 8 Malaita 5 3 5 7 6 3 Temotu 17 33 23 28 25 18 Central 7 8 9 6 9 3 Choiseul 10 11 14 12 9 8 Isabel 11 6 12 5 5 6 Makira 18 10 13 22 18 16 Honiara 26 30 20 21 17 15 Renbel 47 63 17 64 38 23 Solomon Islands 14 16 12 13 11 8 Source: HIS monthly reports 1997-2006

2003 5 11 2 15 8 10 6 21 18 63 9

2004 5 13 4 12 9 18 9 20 27 26 12

2005 16 15 9 14 10 13 6 21 79 39 17

2006 9 16 4 15 12 8 7 21 79 45 21

In 2006 Honiara demonstrates the highest rate of combined STI (vaginal discharge, penile discharge and genital ulcers) followed by Makira, Renbel then Western. Malaita and Isabel demonstrate the lowest rates. The rate of STI in Temotu also shows a declining trend over the years.

4.2.9 Other diseases For more than 10 years, the ‘other’ disease (these are reasons for attendance that are not specially monitored by a problem specific category in the HIS) category of the HIS have constituted more than one third of total acute care contacts in the country and about 50% of contacts in those aged 5 years and over. 32

Ministry of Health: National Health Report 2006 ================================================================== In 2006, the proportion of other diseases category as a major cause of attendance at primary health care clinic in Solomon Islands was 34%. Figure 18 Incidence rates of other diseases SI 1997-2006

Incidence rates of other diseases, Solomon Islands 1997-2006

Rate per 1,000 popn

1000 800 600 400 200 0 1997

1998

1999

2000

2001 2002 Year

Total population

2003

rates < 1

2004

2005

rates 1-4

2006

rates 5+

The rate of other diseases increased over the years in all age group and in all provinces and in 2006 the rate reached 800 cases per 1000 population. In 2006, the rate of other diseases in Honiara followed by Western, Renbel, Makira, and Choiseul exceeded national average. The rate doubled between 2005 and 2006 in Renbel. Incidence rates of other diseases by Province, 1997 - 2006 1997 1998 1999 Provinces Guadalcanal 751 854 705 Western 994 935 838 Malaita 494 483 571 Temotu 622 685 570 Central 583 726 756 Choiseul 429 647 659 Isabel 641 587 542 Makira 466 573 456 Honiara 746 1031 628 Renbel 1029 1009 1000 Solomon Is 451 410 342 Source HIS monthly report forms 1997- 2006

2000 556 862 778 667 732 750 702 533 689 984 329

2001 231 745 703 580 615 807 720 448 915 970 327

2002 367 670 483 590 645 684 681 373 881 632 300

2003 582 731 396 569 439 747 785 473 1463 1119 272

2004 574 1014 513 715 556 748 867 612 1677 751 289

2005 632 890 506 663 550 814 767 673 1610 712 278

2006 756 1074 496 544 635 895 812 904 2136 1414 302

4.2.10 Other Diseases category – Senior Medical Statistician study In 2006 the Senior Medical Statistician investigated the components of other disease category by reviewing some of the outpatient register books for 2005 from some busiest clinics in Honiara and Guadalcanal. The findings showed that pain accounted for the 40% of the other disease category followed by skin infection 22%, trauma 8%, and gastrointestinal complaints 7% (Table 11).

33

Ministry of Health: National Health Report 2006 ================================================================== Distribution of Other Illness by Main Categories Main_ Category males anaemia 3 gastrointestinal 36 non communicable 7 other 22 pain 162 skin infection 112 surgical emergency 2 trauma 54 women business 0 ear/nose/throat 8 eye infection/problem 3 oral health 10 respiratory illness 9 childhood communicable/welfare 6 Total 434 Source: Outpatient Register Books 2005

% 0.7% 8.3% 1.6% 5.1% 37.3% 25.8% 0.5% 12.4% 0.0% 1.8% 0.7% 2.3% 2.1% 1.4% 100.0%

females 12 37 20 35 233 112 7 30 29 10 8 17 9 7 566

% 2.1% 6.5% 3.5% 6.2% 41.2% 19.8% 1.2% 5.3% 5.1% 1.8% 1.4% 3.0% 1.6% 1.2% 100.0%

Total 15 73 27 57 395 224 9 84 29 18 11 27 18 13 1000

% 1.5% 7.3% 2.7% 5.7% 39.5% 22.4% 0.9% 8.4% 2.9% 1.8% 1.1% 2.7% 1.8% 1.3% 100.0%

% 19.8% 13.0% 11.1% 6.2% 1.2% 32.1% 8.0% 6.8% 1.2% 0.0% 0.6% 100.0%

female 50 24 24 8 13 85 11 11 0 2 5 233

% 21.5% 10.3% 10.3% 3.4% 5.6% 36.5% 4.7% 4.7% 0.0% 0.9% 2.1% 100.0%

Total 82 45 42 18 15 137 24 22 2 2 6 395

% 20.8% 11.4% 10.6% 4.6% 3.8% 34.7% 6.1% 5.6% 0.5% 0.5% 1.5% 100.0%

Pain category Distribution of pain category by gender Pain Category males abdo/lower pain 32 backache 21 bodyache 18 chest pain 10 foot/leg pain 2 headache 52 joint pain 13 muscle pain 11 neckache 2 operation wound 0 other pain 1 Total 162 Source: Outpatient Register Books 2005

Of the pain category, headache accounted for the highest proportion 35%, followed by abdominal/lower abdominal pain 21%. Backache and body ache each accounted for 11%, and joint pain, muscle pain and foot/leg pain collectively accounted for 16% (Table 12). Headache was the highest proportion for males and females.

4.2.11 Skin infections, trauma and gastrointestinal problems category Skin infection by type by sex 2005 Types of skin infection male cellulitis 1 abscess/boil 45 fungus 0 sore/infected sores 73 Total 119 Source: Outpatient Register Books 2005

% 0.8 37.8 0.0 61.3 100

female 2 36 1 78 117

% 1.7 30.8 0.9 66.7 100

total 3 81 1 151 236

% 1.3 34.3 0.4 64.0 100

Of skin infection, 64% were for sores/infected sores, 34% were for abscesses and boils while cellulitis and fungal infection collectively accounted for the remaining 2% (Table 12). 34

Ministry of Health: National Health Report 2006 ==================================================================

Figure 19 Distribution of trauma by sex 2005 Distribution of Trauma by sex 2005 Trauma type male bone fracture 1 bruising chest 0 burn 2 dislocation 0 domestic violence 0 eye injury 1 fall 1 head injury 2 joint injury 0 laceration 21 other 1 soft tissue 2 swelling/inflammation 14 wound infection 9 Solomon Islands 54 Source: Outpatient Register Books 2005

% 1.9 0.0 3.7 0.0 0.0 1.9 1.9 3.7 0.0 38.9 1.9 3.7 25.9 16.7 100.0

female 1 1 0 3 1 0 0 0 1 6 3 0 10 4 30

% 3.3 3.3 0.0 10.0 3.3 0.0 0.0 0.0 3.3 20.0 10.0 0.0 33.3 13.3 100.0

Total 2 1 2 3 1 1 1 2 1 27 4 2 24 13 84

% 2.4 1.2 2.4 3.6 1.2 1.2 1.2 2.4 1.2 32.1 4.8 2.4 28.6 15.5 100.0

Lacerations were the most commonly recorded trauma (32.1%) followed by swelling/inflammation then wound infection (Table 13). In females the most commonly reported trauma was swelling/inflammation in males it was laceration Distribution of gastrointestinal complaints by sex Gastrointestinal Complaint male % constipation 3 8.3% food poisoning 0 0.0% haemorrhoid 1 2.8% peptic ulcer 2 5.6% vomiting 4 11.1% worm infestation 16 44.4% chronic bleeding in anus 1 2.8% infection 9 25.0% Total 36 100.0% Source: Outpatient Register Books 2005

female 3 4 3 7 1 19 0 0 37

% 8.1% 10.8% 8.1% 18.9% 2.7% 51.4% 0.0% 0.0% 100.0%

Total 6 4 4 9 5 35 1 9 73

% 8.2% 5.5% 5.5% 12.3% 6.8% 47.9% 1.4% 12.3% 100.0%

Of the gastrointestinal complaints worm infestation accounted for 48% with this complaint highest in males and females (Table 15).

35

Ministry of Health: National Health Report 2006 ==================================================================

Chapter 5 Health Systems: Reporting:

Performance

(Productivity)

5.1 Implementation Rating of Health Programs for 2006 Source: Presentation by Mr Abraham Namokari and Ms. Delilah Lowe (Policy and Planning Division/ MHMS) at the National Health Conference November 2007.

5.1.1 Over view: The Policy and Planning Division of the Ministry of Health have developed a ongoing template for monitoring and evaluation of the health programs. The purposes of the ME framework are: • • • • •

Obligation by Law Part of Monitoring Value for Money Part of Good Governance Information sharing

Frequency of reporting: • • • •

Quarterly Bi-Annual Three Quarterly Annual

5.1.2 Reporting rate of divisions in 2006: The general reporting rates has been very low in 2006. A challenge for the future. The overall reporting from all divisions and programs for the first six months was only 22%. Table 4 Program Implementation rates 2005

Provinces and National Programs Provinces National Divisions NRH Overall

Implementation (completion rate) 42% 23% 6% 22%

Table 5 Program Implementation rates 2006

Programs Implementation (completion rate) Provinces 52% National Divisions 63% NRH 48% Overall 70% The level of implementation rates of the programs for the first 6 months was below 70%. An area of concern. 36

Ministry of Health: National Health Report 2006 ==================================================================

5.1.3 Challenges and issues: Provinces: • • • • •

High Turn over of PHDs Bad Weather Equipment Breakdown Program activities not funded Capacity problem

National Divisions: • Non Approval of Relevant Policies • Delay in accessing Funds form Treasury • Capacity issue NRH: • • • •

Timely release of Funds Activities maintained with no Funding allocation Over Editing of Proposed programs Equipment breakdown

• • • •

Focus on core business then Initiatives Alternative activities A lot of activities not included in OP Difficulty in getting financial reports

37

Ministry of Health: National Health Report 2006 ==================================================================

5.2 Primary Health Care: 5.2.1 Clinic Utilization Report for 2006 Clinic Utilization Reporting started in 2005 by the Health Information System supported by the HIS Adviser, Christina Evans. The rationale of the clinic utilization is to monitor clinics and evaluate the level of access of primary health care to the population served (also refereed to as catchment). There is a set bench mark or guidelines approved by the Ministry of Health. Clinic Utilization process continued in 2006 Data Collection: The efforts of all Nurses together with Health Information System Coordinators are gratefully acknowledged as it is their work and efforts that ensures that all data are collected and reported to the MOH HIS Unit on time. Report Editing and Guidance: Ms Christine Evans – Health Information System Development Advisor – HISP Table 6 Clinic Utilization Benchmark Solomon Islands Clinics Utilisation Benchmarks for Workforce Planning Type health service

Nurse Aid Post

Rural Health Centre

Workload benchmarks

Not meeting the benchmark is

Between 30 to 70 weekly contacts Less than 30 weekly contacts AND less than 20 total Up to 20 births inpatients Up to 40 total inpatients Between 70 to 150 weekly contacts Less than 70 weekly contacts Between 20 and 70 births AND less than 40 total inpatients Between 40 and 150 inpatients

Recommended Actions

Exceeding the benchmark is

Review productivity and factors More than 70 weekly contacts influencing use of the NAP (location, staff skills, community relationship, More than 20 births population size and isolation) More than 40 total inpatients More than 150 weekly Review staffing levels, review contacts productivity, review factors More than 70 births influencing use of the RHC, review number of weekly treatments More than 150 total inpatients

Recommended Actions Review staffing levels against workload Review for upgrade to RHC AND review staff skills and capacity AND review Review staffing levels against workload Review for midwife placement Review for upgrade to AHC

Area Health Centre

Less than 150 weekly Review staffing levels, review Review staffing levels against workload More than 150 weekly visits More than 200 births contacts AND less than 150 productivity, review factors AND review for midwife placement AND Between 70 and 200 births More than 500 total inpatients influencing use of the AHC, review review for upgrade to mini hospital Between 150 and 500 inpatients total inpatients

Urban Health Centre

Nil set benchmarks, staff according Review staffing levels against workload. Review number of weekly contacts, review number of reproductive health contacts, review number of to workload and health program treatments and dressings. Review staff needs including midwife placement for ANC, PNC and family planning and trained immunisation coordinator needs

Provincial Hospitals

Nil set benchmarks, staff according Review staffing levels against inpatients and outpatients workload. Review number of weekly OPD contacts, review number of reproductive to workload and health program health contacts, review number of treatments and dressings. Review for staff needs including midwives and specialist staff for ANC, PNC and family planning, trained immunisation coordinator/provider, paediatrics etc needs

Inpatients = total admissions for childbirth and for sickness care Weekly contacts for benchmarks = reproductive health contacts (ANC, PNC, family planning, STI), child welfare contacts, outpatients contacts (approximately 15 minutes each) Births = number of births in the clinics Treatments = dressings and injections (approximately 5 minutes each). These are not counted in the benchmarks but should be considered when clinics are below benchmark (as they add additional utilisation information) and should be considered as part of workforce planning for busy urban and hospital OPD and large AHC's

Ministry of Health: National Health Report 2006 ==================================================================

5.2.1.1

Clinic Utilization Result

Table 7: Number of clinics & population 2006 T a b le B . N u m b e r o f C lin ic s O p e n e d a n d P o p u la tio n 2 0 0 6 c lin ic s opened % P r o v in c e s P o p u la tio n G u a d a lc a n a l 33 12% 71270 W e s te rn 54 19% 73932 M a la it a 57 20% 145580 T e m o tu 15 5% 22222 C e n t r a l I s la n d s 24 9% 25424 C h o is e u l 24 9% 23550 Is a b e l 31 11% 23950 M a k ir a 32 11% 36765 H o n ia r a 9 3% 57636 R enbel 3 1% 2754 S o lo m o n Is la n d s 282 100% 483083

P o p . R a tio 2160 1369 2554 1481 1059 981 773 1149 6404 918 1713

282 primary health care facilities were functioning in Solomon Islands in 2006. 20% were in Malaita, 19% in Western, 12% in Guadalcanal while 1%, 3% and 5% were in Renbel, Honiara and Temotu respectively (Table A). The population to clinic ratio also reveals that on average Honiara demonstrates the highest population ratio with 1: 6404. This is followed by Malaita 1:2554, Guadalcanal 1: 2160, Temotu 1:1481 and Western 1: 1369. Provinces like Isabel, Choiseul and Renbel demonstrates a ratio of below 1000 population per health facility in 2006 (Table B).

5.2.1.2

Primary Health Care Facilities and Benchmark Status

Table 8 Primary Health Care Facilities by Provinces Benchmark Status Table C. Primary Health Care Facilities by Province by Benchmark Status Provinces Guadalcanal Western Malaita Temotu Central Islands Choiseul Isabel Makira Honiara Renbel Solomon Islands

Not Met 1 13 7 1 6 7 20 5 1 3 64

% 3% 24% 12% 7% 25% 29% 65% 16% 11% 100% 23%

Primary Health Care Facilities Exceeded % Met 10 30% 22 8 15% 33 23 40% 27 0 0% 14 1 4% 17 1 4% 16 1 3% 10 2 6% 25 0 0% 8 0 0% 0 46 16% 172

% 67% 61% 47% 93% 71% 67% 32% 78% 89% 0% 61%

Total 33 54 57 15 24 24 31 32 9 3 282

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

Table C shows the proportions of health facilities not meeting, meeting and or exceeding the benchmark in 2006 for each province. In 2006, 23% of all health facilities did not meet the benchmark, 16% exceeded and 61% met the benchmark. All health facilities in Renbel did not meet their benchmark in 2006. 65% of all health facilities in Isabel Province did not meet the benchmark while 40% of all health facilities in Malaita exceeded the benchmark. 39

Ministry of Health: National Health Report 2006 ==================================================================

5.2.1.3

Health Facilities ot Meeting the Benchmark

Table 9 Primary Health Care Facilities Did Not Meet the Benchmark by Province 2006 Table D1. Primary Health Care Facilities Did Not Meet the Benchmark by Province 2006 Provinces Guadalcanal Western Malaita Temotu Central Islands Choiseul Isabel Makira Honiara Renbel Solomon Islands

AHC 0 1 0 0 0 0 3 1 0 1 6

% 0% 8% 0% 0% 0% 0% 16% 20% 0% 33% 10%

RHC 1 3 3 1 0 1 6 0 0 2 17

Did Not Meet % 100% 23% 43% 100% 0% 14% 32% 0% 0% 67% 27%

NAP 0 9 4 0 5 6 10 4 1 0 39

% 0% 69% 57% 0% 100% 86% 53% 80% 100% 0% 63%

Total 1 13 7 1 5 7 19 5 1 3 62

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

Of all health facilities not meeting the benchmark 10% were AHC, 27% were RHC and 63% were NAP.

5.2.1.4

Health Facilities Exceeding the Benchmark

Table E1. Primary Health Care Facilities Exceeding their Benchmark by Province 2006 Provinces Guadalcanal Western Malaita Temotu Central Islands Choiseul Isabel Makira Honiara Renbel Solomon Islands

AHC 1 1 1 0 0 0 0 0 0 0 3

% 10% 13% 4% 0% 0% 0% 0% 0% 0% 0% 6%

RHC 2 2 9 0 0 0 0 0 0 0 13

Exceeded % 20% 25% 39% 0% 0% 0% 0% 0% 0% 0% 28%

NAP 7 5 13 1 1 1 1 2 0 0 31

% 70% 63% 57% 100% 100% 100% 100% 100% 0% 0% 66%

Total 10 8 23 1 1 1 1 2 0 0 47

% 100% 100% 100% 100% 100% 100% 100% 100% 0% 0% 100%

Of all health facilities exceeding their benchmark 6% were AHC, 28% were RHC and 66% were NAP (Table E1).

40

Ministry of Health: National Health Report 2006 ==================================================================

5.3 Secondary and Tertiary Health Care: ational Referral Hospital 5.3.1 Overview: The NRH is the designated National Referral Hospital for the country. Please note that this is very simple and may be over-simplified assessment of a very complex hospital entity. Unfortunately the data available does not allow for a comprehensive report on the status of productivity and case mix of the major referral and teaching hospital. 5.3.1.1

ew Changes at the RH in 2006:

Infrastructure: Phase 3 NRH ROC Funded Project. Demountable building – Psychiatric & Physio Departments have moved in their respective rooms. One room for sick prison inmates consultation. 3-4 Bed Prison inmates Ward – Room formerly used as toilet & showers, CSSD & Operation Theatre use as storage, New incinerator – Charles comments yesterday; Children’s Play school – SWIM initiative. Planned Extension of A&E to former Physio room to give adequate space at the Outpatients.

5.3.1.2

Audit Report:

NRH initiative – not Auditor General’s Office. NRH Executive fully supports report. Started implementation of some key recommendations – two cases been identified as cases involving fraudulent practices by previous staff are in process of handing over to Police. Audit report Recommendations & Action Plan for NRH currently in process of implementation

41

Ministry of Health: National Health Report 2006 ==================================================================

5.3.2 RH Productivity (selected) indicators and assessment: 5.3.2.1

Admissions and Bed Capacity:

The total admissions for the NRH in 2006 were 15,6386. The total Bed Occupations rate was 82.8%, which implied that total beds occupied at one given time last year was 232 beds. Otherwise the bed capacity of the NRH has been stretched beyond 80% according to the 2006 NRH Nursing Report. The total patient days were 65,992 days that means an overall ALOS (Average length stay of 4.2). Table 10 Bed Capacity of NRH

2006 Total Beds Total Admission

280 15,638

Bed Occupancy Rate %

82.8

Total patient days Total staff

65,992 547

In summary: The NRH is a very busy hospital but available information shows that it is not use at its maximum.

5.3.3 RH Report on Selected Health Care Services Source: Dr Tenneth Dalipada (Head of Internal Medicine) NRH Presentations at the National Health Conference 13-17 November 20077) 5.3.3.1

Internal Medicine Report

Admissions, Discharges and Deaths in 2006 (Jan to October): Table 11 Admissions, Discharges and Deaths in 2006 (Jan to Oct)

Month January February March April May June July

Admissions 74 76 80 53 84 87 78

Discharges 43 41 51 34 58 58 63 42

Deaths 1 5 6 8 7 7 12

Ministry of Health: National Health Report 2006 ================================================================== August September October Total Mean

83 77 75 767 76.7

52 42 44 486 48.6

10 7 16 79 7

Medical Admissions, Discharges and Deaths

Percentage

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Deaths Discharges Admissions

1

2

3

4

5

6

7

8

9

10

Time (Month)

Medical admissions by diseases:

Medical ward Admissions 2006 Discussions: 120 Problems 10% death100 rate in the ward High NCD admissions Increasing Malignancy as cause of admission and Death 80 Cardiac disease increasing Number of takes up bed Anaemia 60 patients Way forward: 40

Training of nurses/Doctor in acute care 20 Provision of 4 acute beds & monitors To link and support Disease control for prevention Need timely0and quality back up from the labs/xray/Pharmacy Diseases Blood bank need to respond to current need Diseases 5.3.3.2 General Surgical Report

43

Medical Ward Admissions 2006 Aneamia Artheritis Asthsma CA/Lymphoma Cardiac Disease COAD CVA Diabetes Drug Over dose GIT Disease Hypertension Liver Disease Malaria Meningitis Others Pleural Effusion Pneumonia Renal Disease Septicaemia Splenomegaly TB

Ministry of Health: National Health Report 2006 ================================================================== Source: Dr Dudley Baerodo (Head of Surgical Department) Presentation at the National Health Conference 13-17 November 20068) New Developments in 2006: Monthly Cancer clinics: Admissions of Ca patients for chemotherapy. Fine Needle Aspiration (FNA) can now be done for all lumps. Table 12 Top 9 Leading causes in adults

Diseases

Total

Average Length of stay

Cancer

162 (16%)

7

Appendicitis

148 (14.5%)

2

Abscesses

138(13.5%)

2

Hernia

96(9.4%)

2

Trauma cases

87(8.2%)

3

Diabetes

75(7.1%)

75

Lumps

67(6.3%)

2

Nasal polyps

48(4.6%)

2

BPH

41(4%)

3

Others

199(18.9%)

Total

1061

5.3.4 source Utilization and assessment: 5.3.4.1

Human resource: RH Total staff

Thirty-five percent (35% / 549) of the total health workforce is allocated for the NRH to provide higher level of health care service for the people of the country. Table 13: Total RH Staff by category and Figure 20 RH workforce by category 2005 and 2006 shows the total number of staff by category at the NRH in 2005 and 20069. Table 13: Total NRH Staff by category

Total staff All Co-corporate

2005 537 61

44

2006 547 59

Ministry of Health: National Health Report 2006 ================================================================== Dental Physiotherapy Pharmacy Medical Laboratory Imaging Nurses Doctors Non Established staff

24 10 16 28 13 220 32 133

24 13 12 28 14 230 35 132

Figure 20 NRH workforce by category 2005 and 2006

600

500

400

300

200

100

0 All

Coorpo Dental rate

Physiot Non Medical Pharma Doctor herapr Establis Laborat Imaging Nurses cy s y hed ory

2005

537

61

24

10

16

28

13

220

32

133

2006

547

59

24

13

12

28

14

230

35

132

45

Ministry of Health: National Health Report 2006 ================================================================== Figure 21: Health workforce by skill

Non Established staf f , 132, 24%

Diagnostic support staff , 150, 27%

Doctors, 35, 6%

Nurses, 230, 43%

Observations: The level of staffing at the NRH has been stable at its basic minimum, except for number of doctors for the hospital. Of the total 43 doctors required for service at the NRH, only 37 (81%) were available and active at post. Bed capacity of the NRH was used up to 82% line. For an extremely busy hospital it may reach between 85% and 90%. The additional 5-10% is left for an outbreak. However, in 2006 there was no major outbreak that needs days admissions. The level of output is generally good. There were more than 95% discharges and the average level of stay (ALOS) was around 4.2 days. Unfortunately there is limited information to review the status of output by various wards and specialist services.

5.4 Health Institutional Strengthening Project Report 2006 The AUSAID funded Health Institutional Strengthening Project (HISP) has worked closely with the MoH since 2001 to improve the management and operational capacity of the ministry to deliver essential health services leading to improved health outcomes for the Solomon Islands population10. HISP was scheduled to conclude in August 2006; however the project was extended to support the transition to the next phase of health sector support under a Sector Wide Approach (SWAp). HISP will conclude in August 2007. Key Activities: During 2006 HISP and MoH continued to build on the foundations established in previous years of the project, and further improve the capacity of MoH to strengthen and manage the Solomon Islands health system. Progress continued in a number of key areas: 46

Ministry of Health: National Health Report 2006 ==================================================================

Operational Planning and budgeting (this marked the third (or for some provinces and divisions the fourth) annual planning cycle by MoH. Evidence based planning was strengthened by the availability of 10 year health trend information compiled using Health Information System (HIS) data. This allowed an increased focus on prioritization of activity towards improving health outcomes. Assist in the development and completion of National Strategic Health Plan 2006-2010 Strengthening of HR through the recruitment of a number of key positions, WISN analysis, and completion of the Executive management and leadership course Completion of clinic infrastructure review of all AHCs and RHCs, installation of clinic radios (now over 250 installed), finalised planning of National Public Health Laboratory . Review, update and strengthening of the HIS Development and implementation of Audit Action Plan in response to MoH/NRH audit by the OAG Strengthening of hospital management at NRH and Provincial hospitals through the establishment of Communications and Logistics Centres and executive management structures. Primary health care strengthened by evidenced based prioritisation, integrated outreach activities, Healthy Islands programs and enhanced EPI Enhanced capacity development of MoH senior and middle management through a structured capacity development program Constraints: While there is much evidence of improvements in the functioning of the MoH as an institution, there remain some areas (some external, some internal) that continue to impede progress. Public Service recruitment processes continue to be slow with long delays in appointments. Acquisition of funds from MoF also remains slow and this impede the day to day running of the health service.

Areas under more direct control of MoH where improvements would enhance MoH operations include supervision and performance management, financial management (provincial health service accounting, HQ accounts team) and reporting, monitoring and evaluation of services.

47

Ministry of Health: National Health Report 2006 ==================================================================

5.5 Health Care Divisions Programatic Report 2006 5.5.1 SI ursing Council: 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/him back to their expected area of practice as required by the nursing Profession. With the expanded knowledge and technology however nursing is expected always to perform within the boundary of the professional discipline. Health data Summary (Brief)with analytical interpretation based on best data/evidence only: 2006 has been a challenging year despite the filled vacant posts. It is no fun being responsible for line up posts. Now there is the ACR to complete and other management matters to consider The existing manpower which used to be two is now five (5). The Nursing council with the National Nursing Division managed to Graduate, 45 nurses whom were successfully posted out to the various Provinces. One provincial workshop was also conducted in collaboration with the National Nursing Division for nursing management skills. Activity Report – progress against Operation Plan/Budget (include% for the year): Activities 4 Nursing Council Boards Meeting 2 Nursing Council Awareness (Malaita Province) 1 Registration of Nurses x 1 2 investigation tour 2 clinical attachment at community level 2 sets of computers purchased and installed 1 color printer for certificates purchased 5 cabinets (3 drawers) purchased Nursing council Regulation draft (PENDING) Nursing council Hand book (PENDING)

Completion % 100% 50% 100% 50% 100% 50% 100% 100%

Annual Health Outcomes (relates to goals/outputs/indicators): The Nursing council has some difficulties in achieving its outcomes. Some of the issues are the endorsing of the Nursing council Regulation and the Nursing council Hand book. Also the big set back to meet its goal is the delay in completion of the Nursing Accreditation and Education template, which will be done in a process and the State Final Examination for Nurses to be funded The Council’s need is yet to finalized the Disciplined Committee and activate as stated by the Nursing Regulation, not only that there are investigations to be carried out in the provinces. The Nurse Probationers Program is yet to consider: The Council planned was to register two groups of Probation Nurses – 2007. Two groups will be going out to the Provinces for Practical Community experiences. 48

Ministry of Health: National Health Report 2006 ================================================================== The Council is recruiting a new group- 2007 activities involved must be considered. We will have to re look at our Operational plan for the year 2007 in anticipating our limited Budget.

Number Supervision tours conducted

Proportion of staff with ACR completed

2

100%l

Infrastructure/maintenance/equipment issues: Concrete Building – ground level, 6 rooms allocated for the council x 6 tables, 2 computer transferred from Nursing Admin, 2 chairs each. X 14 old cabinets (4 drawers each) without keys and x5 new cabinet with keys Filling system yet to be up-dated.

Assets Inventory Completed?

Inventory record started and it is being maintained

YES Issues for consideration in future planning: 1) Training Venue Teaching in the program 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 program. 2) Training Locally . It is cheaper and only short courses. Summary of Major Constraints

Strategies/Action plan for the way forward Need three more computers

Resources Training

Data-base More computing skills On job training with regards to legal aspect.

Power Point

Teaching purposes

Vehicle

Easy to travel, collect stationary Hilux would be better.

49

Ministry of Health: National Health Report 2006 ==================================================================

5.5.2 Dental Services Brief Background / Introduction: Dental Services in SI has gone through a tough time over the past 15 years. The main focus of attention is more on a curative emergency service and very little of a tertiary service. Public awareness and preventative dental service has picked up in the past 3 years with the introduction of medical tours by churches, increase tours by provincial dental officers and a comprehensive coverage of school visitation by HCC.

The main constraints that has prevent dental service from advancing with change that is happening around the world are – Poor infrastructure Provincial Clinics not equipped to standard. Less manpower Training of Post graduates in Dental specialities. Leadership needs improvement – May be slower in implementation and need support. Challenges and issues: The introduction of Operational Plans has given us more focus and direction on what activities needed to be carried out. Each year however new methods / templates were introduced thus causing setbacks in the trend of thought and time it takes to do Operational Plans with budgeting. Lastly but not the least more effort needs to be put into making Operational Plans more realistic with the utilization of allocated budget. Activity Report – Progress against Operational Plan / Budget: Table 14 Summary of Activities of Dental Division NRH

National goal

Activity Code No.

N0 9

1 4

Activity implemented

Activity not Problems Possible implemented identified solution with outcome or output -School Vehicle was Programs done not released with difficulty till end of -Out reach done Colgate/tooth year. – ongoing. paste not Therefore fuel - Portable chairs purchased not utilised. purchased (x3) - Requisition rejected activity not in line with SIG budget line item.

50

Ministry of Health: National Health Report 2006 ================================================================== No 14

No 15

5

6

Provincial feedback -Purchase of 2 computers -Internet installed

7

Staff access to IC protocol Biomedical Technician visits provinces to install chairs and sterilisers. -Protective wears not purchased Consumable items readily available from pharmacy Constant dialogue with province -Posting of staff

8

9

10 No16

11 12

No 19

Extension of Site not store room not approved by done Therefore NRH budget not spent

13

14

15

Postoperative care instructions given to patients -Treatment guideline Other written specialized dental treatments still not done well

51

-Order made through domestic stores did not get through.

-Posting late -Markira was not fully covered due to staff –sick -Officers normally have excuses for not going to post area,

-Posting committee be firm on decisions

- With limited space to work with time is taken up with basically emergency service

Increase working space -Work with HCC to set up clinics for emergency service (x3) 1 clinic in

not

Ministry of Health: National Health Report 2006 ==================================================================

N0 22

16

Kukum is not enough - G P to -No have a specialised hospital. manpower - All dentists to at least have a Post graduate qualification in some dental speciality. Work not Follow up completed with the although company $15,000 was spent for the program by NRH

Engage IT to install data recording system - Identify Officer to be responsible computers purchased for NRH and Gizo

17

N0 23

18/19

No 25

20

Operational plan not realistic, budget still underutilised Regular staff meeting regarding OP not very successful No formal in- No time for house training preparation

More senior staff to be involved with OP

Create time by rotating staff.

21 5-10 plan staff training program written and updated

- There is not guarantee that this plan will be implemented

To liaise with MHMS to ensure training plan is carried out

Table 15 Brief Annual Statistics on Dental Service in SI for 2006

Province

OPD pt seen

No. of Dental tours & patient seen

No. of Treatments done school visits Exo Fill Misc &student O/E seen

52

Den

Surg

Sca/pol

Sed

Ministry of Health: National Health Report 2006 ================================================================== Western

12 1053 29 4,412 12 700 5 648

-

8 1357 3 351 4 202 2 157 3 101 1 4 -

-

3,585

2864

776

122

10

104

730

778

65

1625

248

45

16

59

518

222

273

514

-

-

-

-

35

42

-

650

249

-

-

22

135

612

76

8 -

232

45

-

-

18

16

-

16

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

18

-

-

-

-

-

-

-

-

-

5573

1149

141

113

112

1242

1172

280

Malaita 3,084 Choisuel 363 Isabel 941 Central 253 Guadalcanal Renbel Markira Temotu HCC NRH

11,911 29 Conclusion:

In conclusion I would like to high light the need for improvement in infrastructure and manpower. Especially to have our dentists go for post graduate studies to improve our clinical performance and to upgrade the standard input to Pre registration training for dentists. Also to be able to perform dental procedures that cannot be performed due to these constraints.

5.6 Public Health Divisional Programs 5.6.1 Distance Education Program Overview: The Ministry of Health and Medical Services has always provided some form of continuing education program for its staff in rural areas11. The continuous need to update nurse’s knowledge and provide specialized training is 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 to take on new jobs. Roles also change as staff move between clinical hospital services and community health in rural areas

53

Ministry of Health: National Health Report 2006 ================================================================== The core business of the Distance Education Program is to train health workers (registered nurses and nurses aides) to improve knowledge, skills and provide opportunities for further studies right down to the rural areas... 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 2006 to December 2006. The report will also high light the main activities which were carried out during the year. Activity Report – progress against Operational Plan / Budget (include % for the year): 2006 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 Obstetrics, Community Health and Paediatrics courses. 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. Facilitator in the Integrated Management of Childhood Illness training in Guadalcanal and Makira /Ulawa Provinces. Photocopying Machine Purchased Stationery purchased Output Reporting: Total of 32 nurses trained in comprehensive Family Planning Practicum course 22 graduates from the Obstetrics, Paediatric, Community Health, Nursing Management and family Planning courses offered by Distance Education Centre. Facilitator in 3 IMCI training in Malaita, Makira/Ulawa and Guadalcanal provinces Challenges and Issues: The Program need s to have another staff – there is a vacant post for the position of a Senior Program officer that needs to be filled in 2007. Plans are under way to recruit an officer in 2007. Infrastructure: Currently the Distance Education office is located in the Planning building. However, the program needs space for storage, 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. The need for space to place working equipment such as a photocopier machine, binders etc. The program needs to be located where nurses can easily access it. A senior program officer too needs space to work in. For future planning: Evaluation of the Program to be to done in 2007 Anticipate writing up of Diabetes module and the Mental Health Course 2007/2008 Post of Senior Program Officer to be filled Completing of the pilot Training of the Family Planning Practicum in Malaita Province, Choiseul Province, Guadalcanal/Honiara City Council and Makira /Ulawa Province in 2006. Staff time for assessing students according to criteria for practicum on family planning. 54

Ministry of Health: National Health Report 2006 ==================================================================

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 in 2007

Lack of Office Space

Office Space to be considered in the light of Storage/Consultative/Tutorial/Conference room.

With the photocopy now available this can be improved

5.6.2 Tuberculosis and Leprosy Control Program 5.6.2.1

Disease Burden Status Report: ational TB Situation:

Tuberculosis remains a public health problem in the country. In 2006 total of 371 cases were detected compared to 403 in 200512. More infection is recorded in Malaita Province. About 36% of the total reported cases came from Malaita while the other 64% were shared by others provinces. The total number of TB cases (All cases) detected and reported to the Central Registry in 2006 was 371 which was about 7% less from what was reported in 2005 giving a NCDR of 74 per 100,000 populations. A similar downward trend is also noted for Sputum smear positive cases which gave a NCDR for sputum smear positive 28 per 100,000 populations. Figure 22 below illustrated 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 2006. Figure 22 National TB Notification rate 1999-2006

National TB Notification Rate 1999 - 2006

Per 100,000 pop

100 80 60 40 20 0

96

97

98

99

0

1

2

3

4

5

6

All Cases

80

77

64

70

74

70

62

64

72

82

74

PTB +ve

28

26

40

22

26

29

26

31

32

35

28

TB Targets and Indicators 55

Ministry of Health: National Health Report 2006 ==================================================================

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

Detection rate in 2006: The New Case Detection Rate (NCDR) in 2006 was about 74% for all cases and about 28% for Sputum Smear positive cases. This calls for more effort to improve case detection activities in the provinces. TB Notification rate in 2006 The number of cases notified to the Central Registry in 2006 by Provinces varies. Some provinces especially the bigger provinces like Malaita, HTC, Makira and Western Provinces have continued to detect more cases than others. The notification rates by provinces as shown in Figure 23 below probably indicate that TB transmission is still high in some provinces especially those above the national average of 74/100,000 population and especially provinces like the Honiara city Council, Rennell Bellona and Malaita Provinces Figure 23 National TB Notification rate by provinces in 2006

TB Notification Rate by Provinces 2006(All Cases) IP

29 40

Provinces

CHP

41 43

TP

65 74

WP

79 86

MUP

88 102

RBP

108 0

20

40

60 Per 100,000 pop

56

80

100

120

Ministry of Health: National Health Report 2006 ================================================================== Prov Cure Complete Transfer Died Default/Lost Total No CHP

%

No

%

No

%

No

%

No

%

No

%

0

0

0

0

0

0

0

0

0

0%

2

40%

0

0

0

0

0

5

100 %

CIP

0 0% TSR 0(0%) 3 60%

GP

TSR 5(100%) 7 50%

6

38%

0

0

1

7%

0

0

14

100 %

HTC

TSR 13(88%) 24 69%

6

17%

1

3%

1

3%

3

9%

35

100 %

MUP

TSR 30 (88%) 17 90%

1

5%

0

0

1

5%

0

0

19

100 %

MP

TSR 18 (95%) 29 38%

25

33%

3

3%

10

14%

9

13%

76

100 %

TP

TSR 50 (70%) 2 18%

10

77%

0

0

1

5%

0

0

13

100 %

WP

TSR 10(91%) 5 50%

4

40%

0

0

1

10%

0

0

11

100 %

YP

TSR 9 (90%) 3 100%

0

0

0

0

0

0

0

0

3

100 %

RBP

TSR 3(100%) 1 50%

1

50%

0

0

0

0

0

0

2

100 %

SI

TSR 2 (100%) 95 53%

56

31%

5

3%

14

9%

8

4%

178

100 %

TSR 151 (84%) Treatment rate in 2006: Treatment Successive Rate has dropped from 92.6% in 2002 to 84% in 2005. Cure rate in 2006: The Cure rate has also dropped from 72% in 2003 to 53% in 2005. 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.

57

Ministry of Health: National Health Report 2006 ================================================================== Figure 24 National Trend of cure and treatment rate 1996-2005

Cure and Treatment Success Rate - 1996 - 2005 100

P ercen tag e

80 60 40 20 0

97

98

99

0

1

2

3

4

5

Cure Rate 30.8

74.3

83.3

78.4

68.4

68.4

71.3

72

58

53

87.5

92.4

92

86.3

92.1

92.1

92.6

90

87.2

84

TSR

96

Figure 24 illustrated the result of cure and Treatment Successive Rates (TSR) for the period from 1996 to 2005. Table 16 Provincial cohort analysis for new smear positive cases 2005

While it is pleasing to note that nationally, a high treatment successive rate was achieved, unfortunately provincial achievements vary considerably as indicated in Table 16 Provincial cohort analysis for new smear positive cases 2005 above compared to the global target of more than 85% cure rate. As can be seen in the cohort analysis above for sputum smear positive cases, most provinces except for Temotu and Malaita Provinces achieved more than 50%. For Malaita, the cure rate was 38% and Temotu 18%. This has indicated that these two provinces need to put more emphasis on sputum monitoring at 5 months and at the end of treatment. This would give them a better chance of increasing their cure rates. Table 17 Cohort Analysis for Extra Pulmonary and Sputum Negatives 2005

Province

CHP CIP GP

Completed

Transferred

Died

No

%

No

%

No

5 3 12

100% 100% 86%

0 0 0

0 0 0

0 0 2 58

Default/lost

Total

%

No

%

No

%

0 0 14%

0 0 0

0 0 0

5 3 14

100% 100% 100%

Ministry of Health: National Health Report 2006 ================================================================== HTC MUP MP TP WP IP RBP SI

26 23 85 4 40 4 1 203

96% 100% 91% 80% 91% 80% 100% 92%

0 0 1 0 0 0 0 1

0 0 1% 0 0 0 0 1%

0 0 6 0 4 1 0 13

0 0 7% 0 9% 20% 0 6%

1 0 1 1 0 0 0 3

4% 0 1% 20% 0 0 0 1%

27 23 93 5 44 5 1 220

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 92% of the total cases had completed their treatment. Only 8% were either died, transferred and defaulted. Achievements (Output Reporting): Case Holding and Treatment Outcome DOTS Coverage: Solomon Islands has achieved 100% DOTS coverage. Cure and Treatment Rates: However, there are great concern the trend of our cure and treatment success rate has not shown any improvement. We haven’t reached the target advocated by WHO and something has to be done to increase the cure rate. TB Deaths: Deaths due to TB continued to decline. The number of TB deaths reported in 1996 was more than 10%, which was quite high compare to 7% in 2005. 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 total number of TB patients died of TB while on treatment in 2005 was about 27 cases which is about 7% of total cases reported 5.6.2.2

Disease Burden Status Report: ational Leprosy Situation

New cases: 18 new cases were detected in 2006 from Guadalcanal, Honiara City Council, Central, Western and Choiseul Provinces. 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. In 2006, the numbers of notified leprosy cases under 14 years old were 4 cases which could indicate that a few cases of multibacilliary were still around and need to be identified. None of these notified cases have developed any deformity which means that most of the cases were detected early and put on MDT. Targets and indicators: Leprosy Notification rate:

59

Ministry of Health: National Health Report 2006 ================================================================== Figure 25 Leprosy otification Rate 1996-2006, below illustrated the trend of leprosy notification from 1996 to 2006. The trend shows a fluctuation trend which indicated that a lot cases are still around but need to be detected Figure 25 Leprosy Notification Rate 1996-2006

Leprosy Notificaton Rate from 1996 - 2006

Per 100,000 pop

10 8 6 4 2 0 Notification Rate

96

97

98

99

0

1

2

3

4

5

6

8

9

5

2

1

1

6

1

3

5

4

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. Leprosy prevalence rate: Below 1/10,000 population target advocated by WHO which showed the program is on the right tract. In Figure 26 National Leprosy prevalence rate 1993-2006 below illustrated the national prevalence rate of leprosy from 1993 – 2006. The trend showed a declining trend from 2/10,000 population in 1993 to less than 0.4/10,000 population in 2006. This showed a remarkable achievement by program.

60

Ministry of Health: National Health Report 2006 ================================================================== Figure 26 National Leprosy prevalence rate 1993-2006

National Leprosy prevalence Rate from 1993 - 2006 2.5

Per 10,000 pop

2 1.5 1 0.5 0 Prevalence Rate

93 94 95 96 97 98 99 2

1.1 0.6 0.7

1

0

1

2

3

4

5

6

0.5 0.2 0.5 0.2 0.7 0.1 0.4 0.5 0.4

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 to further reduce the prevalence rate. Challenges and Issues: Improving quality of DOTS. Declining cure and treatment rates. High record of TB Mortality in 2006 New cases of leprosy still detected. It still a challenge to eradicate leprosy in Solomon Islands. Constrains and weaknesses: In spite of the progress and advance in program development, there are few weakness and constraints experienced by the programs. This has hindered the smooth implementation of the program activities both at the national and provincial levels. Below are some examples of major constraints and weakness There is inadequate manpower both at the national and provincial level. Also the frequent changes of Provincial TB/Leprosy Coordinators at the Provincial level hinders the progress of the program Political commitment is becoming a concern for the program as funding assistance given under the government is continuously reducing. If the current donors especially the GFATM withdrew their support, the government should continue to sustain the program

61

Ministry of Health: National Health Report 2006 ================================================================== 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 in the clinics to manage these patients in the clinics especially when patients are still on intensive phase of treatment because they don’t have funds to keep and feed them for their daily DOTS. Recommendations: These recommendations are broad but are important as they should provide a frame work for re-activation 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. Political commitment for the TB Control Program should be improved and strengthened to further improve DOTS implementation in the provinces. 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. There is need to boost and improve on TB and Leprosy IEC materials already developed especially in relation to pre testing and editing for better understanding by the general population and specific target groups such as the health workers. Acknowledgement The National TB/Leprosy Coordinator would like to acknowledge the following people and organization for their support in the two programs during the year: To all the Provincial Program Coordinators, Provincial Health Directors, 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. To the Global Fund for their funding support in most of the TB Control Program activities. We look forward for their continued support in years especially when Round Seven Application is coming. To the Pacific Leprosy Foundation – New Zealand for their financial support in the Leprosy Elimination Program. PLF has support the Leprosy Program in all our planned activities for this year and I look forward to their continued assistance in years to come

62

Ministry of Health: National Health Report 2006 ==================================================================

5.6.3 Environmental Health Introduction Designed to achieve the objectives of the following National Goals: 1. Promote clean water and proper sanitation 2. Promote food hygiene, safety and quality control. 3. Prevention of international quarantinable diseases 4. Improve management and supervision skills of staff of Environmental Health Division Activity Reporting: Key areas of Service Delivery Areas in 2006 are in the following areas of work: Water Supply construction Distribution of sanitation facilities to communities Food safety inspections and auditing; workshops & seminar Export product certifications Attending to overseas requirements such Codex Meetings Product Recalls Public health activities- international quarantine Staff management Advocacy promotion work- Training and IEC Public Health Laboratory Microbiology- water testing unit. Output Reporting: Water Supply Construction: The aim is to increase the present coverage from 70% to 80% by 2010 for improved and protected water supplies to rural communities and from 30% to 50% achievement in the sanitation sector also at the rural community level. Of the total 40 water supply planned projects; in 2006, about 16 were completed in 200613. In implied that 40 % of the five year planned projects were done in 2006. Table 18 Record of completed Water Supply projects in 2006

Project/ Activity

Completed

Water Supply

6

5

Funding Source

Location of Outcome beneficiaries HSTA/ AusAID Western- Kokete (total cost- & Patukai; IsabelSB$233,029.01) Raju; MalaitaHutohuto & Kiu; Choiseul-Boeboe JICA 1. Burinasi 2. Aimamara 63

Ministry of Health: National Health Report 2006 ================================================================== 3. Oanoha 4. Takwa 5. Kakara progress)

(in

4

Canadian Aid 1.Hagalu (CIP); (SB$721,181.35) Malaita2. Radefasu 3. Asimana 4. Tauba 5. Nembao 6. Ereeresuli (in progress)

1

CSP (SB$225,000)

Sanitation All provinces Facilities 100 PVC Sanitary Units

Sir. Duddley Tuti College - Kamaosi Iabel HSTA AusAID All provinces Distribution done (SB$248,567.08) on demand basis.

All projects are external donor funded projects. Figure 27 shows the number of donor funded water supply projects implemented in 2006.

64

Ministry of Health: National Health Report 2006 ================================================================== Figure 27 Donor Funded Water Supply projects % OF PROJECTS CONSTRUCTED, COMPLETED, UNDER PROGRESS AND NON-CONSTRUCTED 35

30

NUMBER OF PROJECTS

25

20

15

10

5

0 HISTA

European Union

Japaness Grass Root Program

Canada

CSP (AusAid)

RWSSP

Proposed Projectd

10

9

13

6

1

1

Actual Funded

10

3

13

6

1

1

%

2.5

7.5

32.5

15

2.5

2.5

DONORS

Public Health Activities: International Quarantine The revised International Health Regulation has been endorsed by the SIG in 2004. The SIG is putting in efforts in various ways to prevent importation and exportation of diseases. Regular health quarantine of international vessels continued as what of the key public health activities of EHD. Figure 28 show the number of incoming aircrafts and passengers quarantined in 2006. Total of 224 international ships were cleared in 2006. All quarantine done were uneventful. The 2006 Health Quarantine annual report contains mainly statistical dates, collected from incoming vessels and aircrafts into the country. 2006 saw a very healthy and smooth running in the quarantine section as no major incidences encountered, except for minor accidents especially on foreign fishing vessel which requires medical attention, such as broken arm, leg and deep cuts etc. Challenges & constraints: Inadequate capacity to handle H5 N1 virus. Inadequate infection control at the international airport. Not meeting needs to meet the International Health Regulation (IHR) e.g. limited knowledge. Inadequate logistic such as transport. There is increasing shipping and flights into the country which is pressing on the limited resources. lack of adequate skilled manpower at the provincial level to aggressively implement the number of water supply projects approved for construction. inadequate logistical supports on the part of provincial governments to mobilize staff, materials and supplies to constructional sites. Apparent lack of water supply ordinance in most of the provinces does not help to foster effective operation and maintenance of their water supply systems.

65

Ministry of Health: National Health Report 2006 ==================================================================

Figure 28 Number of international quarantine activities by route and companies

No OF CALLS/PASSENGERS

Thousands

INCOMING AIRCRAFT/PASSENGERS AS OF JAN-DEC 2006 3

2.5

2 NO.call PAX

1.5

1

0.5

0 Air Nuigini NO.call PAX

Air Vanuatu

Alliance

Qantas

Air Pacific Air Nauru

Solomon Airlines

Oz Jet

RNZAF

RAAF

N-338TP. DC -Jet Aircraft

98

57

33

70

39

21

6

42

9

8

1

4248

4699

1002

7251

2400

313

127

2972

120

240

17

AIRCRAFT/PASSENGERS

Figure 29 Number of vessels cleared at Honiara Port in 2006

Vessels Cleared at Honiara as of Jan 1st -Dec 31st 2006 160

140

Number of Vessels

120

100

80

60

40

20

0 Series1

Mako Fisheries

Tradco Shipping LTD

Sullivans

Egon Shipping

Pacific Shipping

Others

51

148

7

4

5

9

Shipping Agents

66

Ministry of Health: National Health Report 2006 ==================================================================

5.6.3.1

Public Health Laboratory:

Overview: The functions and role of the NAPHL (National Analytical Public Health Laboratory) is to facilitate and enhance or fulfill appropriate regulatory requirements within the MoH service delivery system, for example in facilitating the enactment of the Solomon Island Pure Food Act 1996. This should be seen though as an alternative means of strengthening the overall National Prevention & Control programs within the Health Improvement sector. As such we are anticipating the incorporation of the fast response unit which will be part of the serology and HIV/AIDS unit. We hope that relevant tests and assays can be scientifically evaluated and data collected can be made available to respective health authorities and other stakeholders through the dissemination of scientific data information, thus, enhancing appropriate treatments and relevant remedial measures. With current developments, the laboratory is embarking on a laboratory policy in an effort to deliver credible results or services to all its clients both abroad and locally by upgrading and validating laboratory methodology plus seeking accreditation status with overseas accreditation facilities like the National Association of Testing Authority (NATA) Australia. Activity Reporting: Microbiology Section: Water Protection and Testing: Total of 161 samples were received from various sites and communities including the provinces. Of which about 341 different tests were done (Figure 30 Number water samples tested in 2006. The laboratory plays a pivotal role in the EU/SIG (more particularly SolTai) move to get Solomon Islands into EU list 1 status to access EU lucrative markets. Laboratory duties unlike normal administrative or office work is far more complex than one would perceive, hence there is little room for irrational opinions that would otherwise be counter productive to such developments. Quality Assurance and Quality Control are constant tools used by Laboratory accredited Scientists (Auditors/Inspectors) to verify Laboratory performances including staffing, methodologies, equipment performances etc. Without a permanent home for the NAPHL, it would cast doubts on our ability to fulfill EU requirements let alone its impact on the Country’s exports to European markets, something that would be silly enough to be ignored or be underestimated.

67

Ministry of Health: National Health Report 2006 ================================================================== Figure 30 Number water samples tested in 2006

Water Samples Microbiological Analysis 200 180

Number of Samples Receive & Tested

160 140 120 Number of Samples Received Number of Tests

100 80 60 40 20 0

Honiara City Council

Provinces

Individuals

Number of Samples Received

17

33

18

Industries 93

Number of Tests

45

69

54

173

Stations

5.6.4 on- Communicable Diseases Overview: NCD Programs consist of these components. 1. Diabetes, 2. Cancers & Tobacco Smoke free initiative. 3. Physical Activity 4. Nutrition’s. 5. Alcohol & Betel Nut. 6. Cardiovascular, Hypertensions. 7. Surveillances of NCDs, e.g. NCD Step wise Survey. 8. Monitoring & Evaluation of programs.

5.6.4.1

Diabetes:

Disease burden status of diabetes Since 1991, and by end of 2006 there were total of 1,420 people recorded as suffering of diabetes.

68

Ministry of Health: National Health Report 2006 ================================================================== Cumulative incidence was 6.1 cases per 1,000 in the population 15+, (Figure 31 Cumulative incidence rate type 2 diabetes in pop 15+) although this figure is likely to be an overestimate as it is not possible to identify deaths in reported cases Although a small number of overall notifications, people of Micronesian descent comprise 4.2% of notifications and are 1.2% of the population. Micronesian females are 5.5% of female notifications, and Micronesian males 3.1% of male notifications 49% of total reported cases were less than 50 years (Figure 32 Age at new cases type 2 diabetes 1991-2006) 54% of female type 2 cases were aged less than 50 years at diagnosis compared to 46% of males To end 2006, 1420 cases of type 2 diabetes had been notified to the National Diabetes Unit, 54% male and 46% female (Figure 33 Cumulative incidence rate of type 2 diabetes by age and sex SI 1991-2006.) Figure 31 Cumulative incidence rate type 2 diabetes in pop 15+

Cumulative incidence per 1,000 pop (15+)

Cumulative incidence rate type 2 diabetes in population 15+ 7 6 5 4 3 2 1 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year

69

Ministry of Health: National Health Report 2006 ================================================================== Figure 32 Age at new cases type 2 diabetes 1991-2006

Age at diagnosis new cases type 2 diabetes 1991-2006 350 300

Number

250 200 150 100 50

60 -6 4

65 +

Age

Total cases

male

55 -5 9

50 -5 4

45 -4 9

40 -4 4

35 -3 9

30 -3 4

25 -2 9

20 -2 4

15 -1 9

U

nk no w n

0

Female

Table 19: % Total cases by ethnicity

Total notifications % total cases %SI population Males % male notifications Females % female notifications

Total cases 1420

768 652

Melanesian 1282 90.3% 94.5% 700 91.1% 582 89.3%

Micronesian 60 4.2% 1.2% 24 3.1% 36 5.5%

Polynesian 40 2.8% 3.3% 16 2.1% 24 3.7%

Other 22 1.5% 1.8% 19 2.5% 3 0.5%

Unknown 16 1.1% 0.0% 9 1.2% 7 1.1%

Figure 33 Cumulative incidence rate of type 2 diabetes by age and sex SI 1991-2006

Cumulative incidence of type 2 diabetes by age and sex Solomon Islands 1991-2006

Rate per 1,000 popn

25 20 15 10 5 0 15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

Age rate 1,000 popn

rate 1,000 males

Targets and indicators

70

rate 1,000 females

65+

Ministry of Health: National Health Report 2006 ================================================================== Cumulative rate - 6.1 in 1,000 population of age 15yrs + Output Reporting 1. Diabetes Training: A one week Diabetes Training workshop was organized for NCD Provincial coordinators and training coordinators together with Dietician. The Aims and the Objectives of the workshop were: It was a successful workshop with the support from the Diabetes centers, New Castle staff, Sydney Australia. Namely Dr. Kerry Bowen – Professor Endocrinolist. Ms Harrison. - Diabetes Educator. Peter - Podiatrist. 22 Participants from the National Hospital, Provincial NCD coordinators and other health Professionals attended the workshop. Thanks to Dr Paulsen [director DPCU] Dr. Tenneth Dalipanda {Physician, NRH} who also facilitate. JICA Training: For the first 2 NCD staff has the privilege to attend JICA Program. It was a 6 weeks training at different sites in Japan. 2. NCD Researches: NCD Step wise survey: This year the ministry of health has carry a NCD step wise Survey. Site selected Honiara- 2,500 samples, Gizo – 200 samples, Auki – 300 samples. Report of the survey will be available 1st quarter 2007. This will help the programs and the Ministry for future planning and plan of Actions. Data analysis not completed. Global Tobacco Youth Survey: The proposed Global Tobacco Youth Survey (GYTS) will gather information on smoking prevalence, attitude and knowledge of smoking and smoking habits among young people. From observation influences from peers, accessible to tobacco and lack of alcohol and tobacco may have to be some of the negative factors to this issues. 5.6.4.2

Physical Exercise:

Overweight and obesity is becoming an increasing problem in the Solomon Islands especially in the urban centers such as Honiara city & provincial centers like Auki, malaita Province & Gizo, Western province. There fore the Ministry of Health has a leading role in promoting Physical activities in the country. The Ministry of health under the lifestyle committee has a program to support its workers Lifestyle by organizing sports at the Ministry Headquarter. The turn up was not encouraging for this year since the Subsection does not have a separate budget and also lack of commit staff. However, hopefully the STEPS survey will provide the latest information on physical activity. From observation most people had engaged in sports and regular physical activities but there no supportive environment such a safe walkway. Aerobics session and other sports were on-going however lack of facilities, faced in regards to exercise

71

Ministry of Health: National Health Report 2006 ================================================================== and relaxation. Sessions on Physical activity has been also organized for Provincial NCD coordinators. Provinces Hospital and communities are also encouraged to develop similar programs. 5.6.4.3 4. Cancer Disease burden status of cancer: Cancer is increasing in an Alarming Rate and so needs quick intervention to control the current rise. The establishment of the cancer clinic {Oncology} at the Diabetes center is one step forward; this is one Milestone achieved, With the establishment of the oncology clinic, cancer Patient can be seen weekly by the consultant for their follow –up and counseling. A Cancer Data base was established for data entry at the oncology clinic and manned by the Medical laboratory Technician and the oncology Nurse (Figure 34 Type of cancers 2005 -2006 RH Cancer program. Collections of incidence of cancer are still in progress at the National Referral Hospital by NCD staff, Dr Baerodo & Dr Jacgilly. {Surgeon at the NRH}. The NCD task force is also working on the Specialized Cancer protocols and Need collective guidelines to include the NCD Guideline. With the completion of the Cancer Protocols and Guidelines we can do early detection e.g. Pap smear screenings to communities and clinics. Attached are incidences of confirmed cancers at the NRH. Figure 34 Type of cancers 2005 -2006 NRH Cancer program

Types of cancers, 2005 to 2006. Oncology clinic. NRH. 100 90 80

no. of cases.

70 60 50

2006 2005

40 30 20 10

Types of cancers.

Challenges/ Issues: 1. Formation of the NCD task force & Lifestyle committee. 2. Development of NCD Guideline & Diabetes Treatment Guidelines. 3. Completion NCD step-wise survey data Collections. 4. Financial Support from SIG & Donors Funds to the NCD Programs.

72

s ot he r

s ut er u

te st a pr o

Sk in

al . re ct co le s-

no de

el e la rk us ku m

ly m ps

ta l

st br ea

io d th yr

th m ou

ce rv i

ca l

0

Ministry of Health: National Health Report 2006 ================================================================== 5. Training 2 National NCD staff in Japan. 6. Diabetes workshop for Provincial coordinators by Newcastle Hospital staff, Australia. 7. Shortage of manpower in the National & Provincial sectors. 8. Lack of Logistic support to purchase the NCD Vehicle that was in the Operation Plan. 9. Strengthen of co ordinations & collaboration with the NGOs. Recommendations: 1- Logistic support especially a vehicle for the Programs implementation. 2. Provide Permanent Diabetes Site for some Provincial Diabetes Clinic. 3. Sufficient Allocation of Funds for NCD / Diabetes Programs in the Provinces. 4. Passing of the Tobacco Bill through Parliament to help with implementation of FCTC. 5. Full time NCD coordinators in some provinces to run the NDC/Diabetes clinic. 6. Adequate supply of equipments & training in some provinces.

5.6.5 Community-Based Rehabilitation Services: National Goal (Goal 1): Reduce MMR from 184/100,000 live births by 2010 Objective: To reduce Risk of disability before birth and at birth Status on output indicator Activity 1 IEC material have been developed and given to NIEC committee to look through and comment on, however CBR has participated in the EPI campaign on Measles through Media. Activity 2 Disability register books has been printed and distributed to all provinces during CBR Aides placement in October to December 2006. Activity 3 A 2 week workshop has been completed for 15 PWD (Both Male and females) and 5 caregivers which were facilitated by Family Planning Australia through SIPPA which was jointly funded by SIG and Family Planning Australia. Problems identified with outcome or output Activity 1 Production of IEC Material was delayed due to the person who had the contract to do the Materials has failed to completed his job, however payment has been collect in full since last year 2005. However currently some of CBR IEC materials are with the IEC Committee for approval and awaiting printing. 70% achieved Activity 2: Achieved 100%

73

Ministry of Health: National Health Report 2006 ================================================================== Activity 3 :100% Achieved Suggested Solutions Activity 1 IEC Material should be done by staff within CBR Dept / Rehabilitation dept and not contracted out to people who do not have Rehabilitation Background. IEC Committee should always give feedback to CBR on the progress of the IEC materials that has been give to them. National Goal 2 : Reduce morbidity and mortality rate of children below 5 years of age due to common childhood illness and vaccine preventable diseases. Objective: Early identification and intervention of services for new born babies, infants and children under the age of 5 years Increase public awareness on disability due to common childhood illnesses and vaccine preventable diseases Increase awareness on the early identification and referral of babies and children with disabilities (children with special needs) Status on output indicator Activity 4 There was no training done for midwives and nurses at SICHE to recognize children with disability at birth and high risk babies and nothing with child development has been included in nurses refresher course. Activity 5 Shots has been taken in western province, Honiara City Council Clinics, labor ward and Post natal (NRH) for the development of the video. Analysis of pictures has been done. Script still in progress Activity 6 & 7 All IEC Materials on TB, Measles, rubella, polio, meningitis, tetanus, vitamin a deficiency are on hold due to contract signed has been withdrawn, however payment has been collected already. Participated in EPI Campaign on Measles in HCC. Activity 8 : 8 workshops have been completed during CBR aides’ placement between Mid October and mid December 2006. These workshops have been done for the communities to be able to identify children with disability and early referrals can be done for proper intervention and rehab can be done. Activity 9 :All nurses in the HCC council have been taught the early child development checklist and also the clinics which have a CBR Aide worker attached to. Problems identified with outcome or output Activity 4 :Lack of HR was the problem and set back for implementing this activity

74

Ministry of Health: National Health Report 2006 ================================================================== Activity 5 :CBR staff and Health Promotion are still too busy to complete the script. 60% Achieved. Activity 6 & 7 :Lack of HR to do IEC Materials Activity 8 :100% achieved during CBR Aides placement. Activity 9: 80% achieved since some clinics in some of the provinces has not received these DRB (Disability Register Book) Suggested Solutions Activity 4 :Delegate activities to staffs to carry out the duties and implementing the planned activity. Activity 5: Project is also half way through will need to complete in 2007. Activity 6 & 7: All IEC Materials that has been contracted out will be done by the OT Rehab Aides students during their placements and it will be compiled by the beginning of next year 2007. Activity 9 :For other provinces and clinics that does not Rehab Aides in their area, it will be done by the Provincial coordinator during the satellite meetings in the clinics / integrated tours National Goal: [3] : Reduce impact (morbidity) and severity (epidemics, mortality) of Communicable Diseases in Solomon Islands Objective: Increase Public awareness on disability caused by TB and Leprosy Status on output indicator Activity 10: IEC Material Developed for leprosy and distributed during Leprosy campaign week from the 13th – 17th of Feb 2006. Awareness talks have been done to all secondary and primary schools in HCC including St. Joseph Tenaru. Problems identified with outcome or output Activity 10: Well implemented according to the plan. 100% achieved National Goal: 6 Promote clean water, proper sanitation (including waste disposal), food quality and food safety (incl. food hygiene) Objective: To provide safe & accessible water and proper accessible sanitation for people with disabilities in the Rural areas To educate people with disabilities on the importance of food preparation and proper waste disposal and encourage sup sup gardens Status on output indicator

75

Ministry of Health: National Health Report 2006 ================================================================== Activity 11: Submission sent to Chief Architect at Ministry of Infrastructure and Development with 3 quotes collected from pacific Architect, Wantok architect and wise architect Problems identified with outcome or output Delay of response with MID fro which company they will engage in the completion of the design for accessible water and sanitation facility for PWD Suggested Solutions Better for MHMS to get 3 quotes raise for payment according to their allocated budget to promote progress of activity. (I.e. for this activity CBR has the budget for it but we could not use). Better to give the MHMS Infrastructure manager to deal with. National Goal 8: Reduce impact (morbidity) and severity (disability, mortality) of all Non Communicable Diseases in Solomon Islands Objective: Primary and secondary prevention of disability from NCD and Accidents Status on output indicator Activity 12: IEC materials on hold due to the contract has been terminated Public awareness on NCD (Diabetes) has been done during the international disability day on the 4th of December 2006. 100% achieved Awareness on vision impairment from Albino has already been done HCC primary schools – 100% Achieved Problems identified with outcome or output Activity 12: IEC Material has been contracted to a person that does not have any medical or rehabilitation background Suggested Solutions Activity 12: IEC Material must not be contracted to people who do not have rehab background National Goal: 12 : Provide essential primary health care to all individuals and families, in an acceptable and cost-effective, affordable way, and with their full involvement ensuring best practice, high quality and improved patient/client/community care. Objective: Improve Rehabilitation services to people with disabilities in the community Secondary prevention of disability Establish a National Coordinating body to look after the needs and issues affecting people with disability and disability development in the country Status on output indicator Activity 13: Recruitment for AEW staff still not done Production of crutches and special seating is done by AEW Staff and rehab aides doing OT Training with sitting done by HCC CBR Aide and JICA physiotherapist at Red Cross (100% Achieved) 76

Ministry of Health: National Health Report 2006 ================================================================== Network support group has been set up with S.W.I.M (Short workshop In Mission), DPASI (Disabled persons Association Of Solomon Islands) with few relatives and family members of PWD. (100% achieved) Interim Committee has been formed up for the formation of the National Coordinating body on Disability, however still awaiting advertisement for the Position of NCCD position. (60 % Achieved) Number of Children with disability attending schools is gradually increasing as awareness on disability is also increasing in the HCC schools and in some provinces. (achieved) No progress on MOU between CBR and Social Welfare Division Problems identified with outcome or output Slow Process with MHMS HQ Administration Staff No one is allocated to do the discussion with the MOU to be signed between CBR and Social Welfare (HR Problem) Suggested Solutions AEW should follow with the current procedure of recruitment instead of following the old system MOU with Social welfare Need to be done when the dept has its new National Coordinator. National Goal: 14: Improve access to required essential drugs, medical equipment and medical supplies of appropriate quality at all levels of health service Objective: To ensure that people with disabilities have access to their medical supplies and equipment to improve their standard of living. Status on output Activity 14: Clinic order forms for PWD are done – Completed (100% Achieved) List of medical supplies to be ordered given to NMS – done (100 %achieved) List of Medical Equipment and medications needed by PWD are ordered through NMS and also at provincial Level – Done (100% achieved) Problems identified with outcome or output All Activities Have been Implemented Suggested Solutions Cooperation is still Number one here National Goal: 16 : Ensure appropriate referral between all levels of health service Objective: People with disabilities are referred early for the proper rehabilitation management

Status on output indicator PWD are given specialized treatment through the channel of communication and care given to them by the CBR Aides and the provincial CBR Coordinators. Referrals have been done accordingly by CBR Aides to respective rehabilitation management (i.e. Eye Dept, Psychiatric team etc for further assessment. Well ongoing and implemented (100 % Achieved) 77

Ministry of Health: National Health Report 2006 ==================================================================

Problems identified with outcome or output None National Goal: 21: Provide a safe environment for patients and staff Objective: To ensure that the MHMS HQ are accessible to people with disabilities to set an example to other Ministries and organizations Status on output Activity 15: Submission sent to Chief Architect at Ministry of Infrastructure and Development for approval, however still awaiting their response Problems identified with outcome or output Process to long if it goes through MID for approval of which architect firm to do the activity when money has been already allocated for in the budget. Suggested Solutions Activity 15: If budget has been allocated for the activity why not use the 3 quotes system to implement the activity National Goal: 22: Undertake evidence based health service planning and management Objective: To input disability data into HIS data Status on output Progress well; however still liaising with HIS redevelopment team to add in disability records in the statistics and it is well underway in draft stage. Problems identified with outcome or output It will take a while since it will change the whole system of statistic information to add in the CBR reporting bit. It will not happen as soon as we expect since it is still in its draft stage. Suggested Solutions Continuation of cooperation between HIS redevelopment team and CBR should be also close and linked to make it really happen. National Goal: 23 : 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 Objective: To implement a operational plan that is agreed upon by all staff Status on output indicator Activity 17: Completed CBR Provincial coordinators Meeting for 10 provinces (12th June – 14th June 2006) (100% Achieved) 78

Ministry of Health: National Health Report 2006 ==================================================================

Activity 18: Training for 13 Rehab Aides has started in June 2006 and will continue until 2008 June – training being coordinated by Australian Volunteers (Successfully Started). CBR Aides has successfully completed their year 1 and semester 1. Year 1 semester 2 will begin on the 22nd January 2007. Problems identified with outcome or output Activity 17 & 18 : 100% achieved National Goal: 25 :Improve the management of health assets and equipment at all levels of the health care system Objective: To be able to identify which assets are still usable and which ones need repair and maintenance and which one need replacement Status on output indicator Activity 19: All assets have been maintained and kept well with their location and who is responsible to look after especially those ones in the provinces and Blind Services at Disability Support Centre. Problems identified with outcome or Activity 19: Some assets needs maintenance especially those in the provinces. Suggested Solutions Activity 19: For each province to be responsible for the maintenance out from the provinces budget. National Goal: 26: Improve management and supervision of health services/health workers in order to manage and sustain positive change in health service delivery Objective: To upgrade knowledge, skills and attitudes of Rehabilitation Aides and Provincial Coordinators on Disability issues Status on output Activity 20: CBR Has already got a photocopier. Activity 21: Braille and computer classes is still in progress for both children and adults that have visual impairment and also for CBR Aides – doing Associate diploma in Occupational Therapy (100% achieved) Activity 22: Workshops have been organized for teachers at Ysabel (Moana School), 17th August – 26th August 2006 from Makira (Namuga and Campbell School) 26th Oct – 2nd Nov 2006 and Malaita (North Region Community) 3rd Sept – 10th Sept 2006. By the Blind Services for visually impaired children and teachers with family members of visually impaired children.– 100% Achieved Activity 23: BIP has developed a structured computer lesson for visually impaired and blind students that are still attending high schools. 100% achieved

79

Ministry of Health: National Health Report 2006 ================================================================== Activity 24: No IEC Material being developed Children and adults have been referred to Blind Services for assessment and Vise versa from CBR – Blind services to eye Dept to be assessed and training has been arranged for those need proper training program for mobility and orientation. (100% achieved) Jaws software has been purchased and install for computer classes (100% Achieved) World Sight Day Campaign has been successfully completed on October 13th 2006 – (100% Achieved) Sporting activities for children in HCC with visual Impairment has been completed (100% achieved) No teachers has yet been identified to work with visual impaired children Consultation is on hold for liaising with SICHE (Curriculum Dept) for enlargement prints of text books for visually impaired and brailed text book for blind students. Activity 25: In-service training has been completed for 6 rehab aides (9th October - 13th October 2006) (100% Achieved) Training needs has been sent out to all rehab aides in the provinces and the in -services training was completed according to their identified areas that they need improvement on. (100% Achieved) Supervisory tour has been completed for 4 provinces with the rehab aides are currently working and areas that need review has been made (100% achieved) Records of all trainings have been kept with the names of all the participants involved. (100% Achieved) Problems identified with outcome or output Activity 20: Disability Survey project has already purchased a photocopier therefore CBR is also using the photocopier. Activity 21: Well implemented and achieved (100% achieved) Activity 22: Well Implemented (100% achieved) Activity 24: Still awaiting response from SICHE for their further to arrange for discussion on this issue All teachers in the primary schools have not taken any special education unit and no one has shown any interest as of yet. IEC Material has been given to HPD however the person responsible has lost his copy. Activity 25: Well achieved and implemented (100% achieved) Suggested Solutions Activity 24: Follow up to be done next year 2007 and also to involve staff responsible for special education at SICHE Awareness needs to go out to schools that have visually impaired students. Additional Achievements Disability Survey Report Launching – Report information is about total number of PWD (People with Disabilities) registered in the Solomon Islands, what their needs are and recommendations. Also summaries of each Province with PWD in report therefore it would be

80

Ministry of Health: National Health Report 2006 ================================================================== easier for follow up purposes with CBR Aides. Launching already done on the 26th of July 2006. National Disability Policy – Prime Minister Manasseh Sogavare launched this policy on the 28th of July 2006. A National Disability Policy Awareness and Advocacy workshop took place before this launching and it’s aims were to provide opportunities for PWD to discuss and high light issues affecting them, raise human rights issues affecting them, discuss priority areas high lighted in the National Disability Policy with stakeholders in which they would identify clear outputs of each stakeholders and develop action plans to implement them. Also form a NCCD (National Coordinating Committee for Disability) and ensure disability policy is being implemented. Housing Projects and School Fees under Pacific Leprosy Foundation – for the Housing projects, we have quiet a number of houses that have started before the ethnic tension and are yet to be complete. This year only one house has been complete, we are trying to complete all theses past projects before accepting new ones. Housing projects are funded for clients that are graded two in leprosy and have deformity and cannot help themselves, school fees for their dependents and income generating projects. School fees so for this year there are 42 students sponsored all attending various schools and training centers ’within Honiara and in the provinces.

5.6.6 Social Welfare Division: Overview: Social Welfare was started way back in the early 1960s especially to provide Social Welfare Services to the disadvantaged individuals or groups as minor offers (Juvenile), Probationers, Families, Destitute, Child and Prisoners as an alternative state support welfare service in absence of traditional and Community Social Support Service. Social welfare functions: Family Affairs: Family Reconciliation; Affiliation, Separation and Maintenance; Custody of Children; Divorce; Adoption; Juvenile & Child Protection: Juvenile Offenders Act; Probation of Offenders Act; Child Protection & Children’s Rights; Activity Reporting:

81

Ministry of Health: National Health Report 2006 ================================================================== The following number of cases dealt with by the Juvenile and the Family Section of the Division as of May to December 2006:Custody Cases Juvenile Self Referrals School Fee Remission Declarations

-

10 7 Cases only referred from Police 91 3 8

In 2006, Social Welfare Division has been operating with two staff only manning the office and therefore its really hard to fully fulfill all the requirements of the Division especially with the Operational Plan. What the two officers were doing was just dealt with cases as they come especially from the Courts and self referrals (individuals); Also in 2006, Social Welfare has not been able to meet all the requirements in the Operational Plans especially with the setting up the Child Protection Unit as the Child Rights Bill is yet to be submitted into Cabinet for approval and endorsement; Finally last year (2006), all the long existing vacant posts of the Division is been advertised and very soon interviews will take place and to take new officers to joint the Division and that’s when the Division would be able to carry out its functions effectively; Challenges/ Issues: Infrastructure/ maintenance/ equipment Many years back under the previous governments, Social Welfare has been moving from previous Ministries to another and for the past few years, Social Welfare has ended up with the Ministry of Health and we are so lucky that we’ve got a building (office) of our own that suits our clients. We are hoping that we still remain with the Ministry of Health despite any change of governments. Before we get our new officers to joint the Department, there is an urgent need for an extension of the current office to cater for the new officers who would be joining the Department very shortly. We are so privileged to get three new computers and the fourth one is provided by the Law & Justice for our Volunteer Officer (Lizzie). Future Planning: Inventory of all office assets; SWD (Head Office) to have regular tours to all provincial staff to monitor them; Training for In-service staff; Summary of major constraints and strategies/ action plans

82

Ministry of Health: National Health Report 2006 ================================================================== Summary of Major Constraints

Strategies/Action Plan for way Forward

Social Welfare has not been able to fulfill the In regards to Child Rights Bill, there is need for requirements in the Operational Plan of more awareness and more Advocacy to the 2005/2006 in regards to the setting up of the rural communities and the Government. Child Protection Unit, as the Child Rights Bill is yet to be submitted to Cabinet for approval and endorsement.

5.6.7 Health Promotion: Major activities of 2006: There are five (5) core business of the Health Promotion Department. These functions have been enlisted in the 2006 Operation under which specific health promotion activities have been enlisted and budgeted. The functions supplement each other to ensure that there is successful planning, coordination, implementation, monitoring and evaluation of the health promotion activities. Below are the core functions. Capacity Building Community Healthy Settings: Healthy settings approach has been adopted as a way of approaching the healthy islands concept. IEC And Media Support: Information Education Communication (IEC) and media support is paramount in the provision of advocacy to promote health and targeted at specific audiences in the community Research Development: Research is very crucial in Health Promotion as all interventions should be evidence based. Administration and Development: Planning is important because it helps direct resources to where they will have most impact. Activity and Output Reporting: Key Strategic Area 1 and function

Review and implement health promotion organizational structure

National Health Promotion Committee Meetings Output -

The NHPC was called upon 5 times to discuss important health promotion issues.

Staff and Program Supervision Output There were only 4 visitation conducted to the provinces to meet and discuss with the staff and assess health promotion interventions. 1.2. Office Equipment Repairs and Maintenance

83

Ministry of Health: National Health Report 2006 ==================================================================

Output -

There are 7 piece of equipments put to repair.

1.3. IEC Resource Centre Output This particular activity was partially implemented. The sketch for the IEC resource centre was put together by the AVA officer and the MOH building Supervisor. It was later discovered that the WHO has no funding under the budget line for IEC resource centre in the 2006- 2007 Bi-annum. Key Strategic Area 2 - Review and endorse National Health Promotion Policy 2.1. National Health Promotion Committee meetings. Output The NHPPC was called upon 4 times during the year to discuss the draft Health Promotion Policy. The document awaits the HSSP consultant completes her consultation on the 2006-2010 NHSP with the different national health programs. To be reviewed by HSSP consultant in 2007. The draft to be amended and submitted to the MOH Executive. Output -

This activity has not been implemented.

Key Strategy Area 3 – Training of health promoters, health workers and stakeholders. 3.1. Refresher training for the health promotion staff Output -

This refresher training was implemented in November.

3.2. BCC and SS training for health promotion staff. Output This behaviour change communication and stepping stone training was implemented in November. 3.3. Training of Audio Visual Officer in the SPCA Media Centre – Fiji Output -

The AVA Officer has received training at the SPC Media Centre in Fiji in August.

3.4. Training of the Graphic Officer in the SPC Media Centre – Fiji Output -

The graphic assistant was trained at the SPC Media Centre in Fiji in August.

Key Strategic Area 4 - Increase the production materials for behavioural change communication activities.

of

Media

and

IEC

4.1. National IEC Committee Meetings Output The NIEC Committee was called upon 4 times during the year to discuss and approve IEC materials from the MOH and stakeholders. 4.2. Weekly IEC Production Committee Meetings 84

Ministry of Health: National Health Report 2006 ==================================================================

Output A number of 38 weekly IEC Production committee meetings were conducted through out the year. 4.3. Daily Radio Program and Spots Output A total of 152 radio health programs plus radio spots were broadcasted through the SIBC and FM radio stations. 4.4. Weekly Solomon Star Health Column Output A total of 17 health columns were released on the Solomon Star Newspaper since the contract was renewed in June 2006. Key Strategic Area 5 - Integrated Health Promotion and health education activities into core public health programs. Production of IEC Materials Key Strategic Area 6 - Review and implementation of school curriculum on Health and Hygiene issues. 6.1. Coordinate meetings with Health Curriculum Committee (CDU/MEHRD) Output -

Meeting attended with the curriculum committee was three (3). -

The Health Curriculum was workshopped in September 2006 for teachers.

Key Strategic Area 7 - Establish research in health promotion practice to support health promotion intervention. 7.1. Coordinate meetings for National Health Promotion Committee Output -

The National Health Promotion Research Committee met three (3) times in 2006.

Key health promotion research areas identified are skin diseases in schools, health promoting school program, tobacco/alcohol and drugs. But no formal research conducted. Audit on all social research conducted by the school of public health and the Nursing School/SICHE and the MBBS students/FSM. Other Activities For your information the department has been involve in many other non operational plan activities which has consumed time and energy of the staff. Some of these activities are enlisted below:Training on Health Promotion for IPAM/PSD Training in Health Promotion for the Eye School Training in Health Promotion for the Midwifery school

85

Ministry of Health: National Health Report 2006 ================================================================== Requested as resource personal in other National Health Program trainings, seminar, workshops. Coordinate EPI communication training with EPI, UNICEF in Honiara and Auki National Health Campaigns to promote global and National Health Program events. Challenges and Issues There numerous issues that have been experienced during the implementation of each key strategic Area in the 2006 Operational Plan. The following are some of these issues. The NHPC attendance particularly the churches. There is no available funding for the IEC resource centre development. Continues delay in the funding process for training Programs Most AVA equipments put to the repair shops were beyond repair. Delay in purchase of new AVA equipments through the W.H.O system. The graphic officer is overloaded with material request from national health programs. Continuous delay in IEC material printing from local printers. Audio Visual Aid Unit –The unit do not have any editing suit to produce video. No right equipment to transfer VHS health videos to DVD Stoppage of daily radio health program due to non payment of arrears with the SIBC by the MOH/WHO. Future Direction: The following are some of the steps the Health Promotion Department needs to advance into in order to strengthen the department in the Ministry of Health into the future. Review of the department’s organization structure and functions. Strengthen the IEC and Media Unit in the department and establish resource centre in the provinces Develop stronger partnership and net working with all stakeholders at all level. Adoption of the Health Promotion Policy and the development of a 5 year Strategic Plan. Strengthen the Research and development component of the department. Develop and establish a Health Promotion Authority in the Ministry of Health.

86

Ministry of Health: National Health Report 2006 ==================================================================

5.6.8 STI/ HIV Prevention Program In this report highlights some of the achievements acquired in year 2006. This would include activities implemented, capacity buildings in terms of trainings and attending workshops etc. Situational analysis of STI and HIV&AIDS would also be highlighted; including some of the STI reports from the few provinces who managed to send their report to STI/HIV Unit, and followed by some recommendations of which the author thinks would help improved future planning of program activities. Achievements/ Activities implemented: Establishment of 5 VCCT sites Training of new VCCT counsellors Visitation and procurement of indemnified VCCT sites in all other provinces Meetings of stakeholder and Solomon Islands National Council Meetings with support from the Capacity Development Organization (CDO) Oxfam International. Activity and Output Reporting: Increase Procurement of Condoms through out the primary health Care. The unit managed to keep record of condom usage. This includes both the male and female Condoms. So for male condoms, the unit distributed 42,390 pieces and 746 female condoms. These condoms were distributed to some of Non Government Organizations, Clinics and individuals (General Public). Procurement of Leaflets &IECs: STI/HIV Unit purchased three types of Leaflets from Save the Children, namely HIV facts, Safe Sex and VCCT. Out of those leaflets, two types were given to the National Medical Store to be included in the current STI treatment pack. (HIV Facts and Safe Sex). The total numbers of leaflets distributed were as follows:HIV Facts: - 19,009 leaflets Safe Sex: - 18,292 leaflets VCCT: - 4,250 leaflets STI/HIV Department also engages one person to work on HIV Posters and were managed to complete seven different Posters and one STI Flip Chart for educational purposes. About 50 copies of posters were printed for the World AIDS Day. However, the Unit was hoping to reprint those Posters next year, 2007. Mass Media Production Honestly speaking, most of the mass media productions were done towards the end of the year, purposely to promote World AIDS Day. During the promotion, communities were informed of about activities prior World AIDS Day through life coverage in Radio, ONE NIUS, and basic HIV and AIDS Information covering one full page in the Solomon Star. There was an on going awareness program like radio spot, invitation for HIV awareness from private sectors etc.. There has been a good collaboration and strong linkage network with NGOs and other stakeholders in terms of implementing activities. Good classic example, the togetherness during the one week long of campaign for World AIDS Day, 2006.

87

Ministry of Health: National Health Report 2006 ================================================================== Workshops: Year 2006, STI/HIV Program Officers hosted two workshops. The first workshop was organized in February in completion of the Second VCCT group training that was held in late 2005. The second workshop was held in August, two weeks purposely for health care givers. Therefore representatives from each province were invited to attend that STI Syndromic Management Workshop. This workshop was funded by Global Fund. STI/HIV Specialist from Lautoka Hospital was invited to facilitate the training. VCCT Sites: Currently, Solomon Islands have six functioning sites. Three sites were located in the provinces, one in Malaita, one in the Western Provinces and the third one was located at Choiseul Provinces. The other three sites were located in the National Capital City. Rove, National Referral Hospital, and STI/HIV Department in the Ministry of Health, Head Quarter. Other proposed site in the capital was an extension of Kukum Clinic for VCCT. Project Planning of the extension being submitted and approval was granted. This project will be funded under Global Funds, therefore next year, the project implementation should proceed. Regarding those who voluntary stride forward to be screened for HIV in the existing sites, the author believed to be more than 150 clients. However, the exact number would be informed later during the year. World AIDS Day: One week prior to world AIDS Day, several meetings were held with other stakeholders to discuss activities for that particular day. The theme was “Accountability, Stop AIDS, Keep the Promise” Thousands of campaigns around the world are preparing local and national events to raise awareness of HIV and to call on leaders to keep the promises they have made to tackle the AIDS pandemic. So stated below was the program of the 2006 World AIDS Day Celebration in the Capital city of Honiara. HIV/AIDS awareness program for business houses, including Netball teams from the Provinces who were here at that time for the Provincial tournament. One week Radio Health Program (Basic HIV information, world AIDS Day Activities. Printing of T/Shirts to be worn by World AIDS Day participants. On the 1st of December, general populaces were asked to assemble in front of Lawson National Stadium, and then by 8:30am everybody would parade down to Main market where the Official Launching and highlight of the day would occur. Organizations took part in the World AIDS Day Activities include Save the Children Australia, OXFAM, SIPPA, Roman Catholic Members, National Referral Nurses, HCC Health Staff, Ministry of Health Staff, HQ , Uncles Soccer Club, and members of the Public. Budget for World AIDS Day was funded under SIG, with the help of Global funding in terms of printing of Posters needed for World AIDS Day. Capacity Building: With in the unit itself, Helena & Isaac were invited to attend Stepping Stone Approach workshop, organized by Oxfam and facilitated by two officers who imported all the way from South Africa.

88

Ministry of Health: National Health Report 2006 ================================================================== In July, Isaac was invited to attend a TB/HIV Co-infection workshop in Noumea, New Caledonia. Later date on October, the Unit sent four participants to attend a Workshop on Supportive Communication Skills for health workers and VCCT Counselors held in Lautoka in FIJI. The Participants were Silas Torihahia, from HIV Department, Elliot Puiahi from Medical Laboratory, Loverlyn an NGO rep and Joyce Gumi representatives for Provinces. Collaborative Funded by PRHP and Solomon Island Governments. Situational Analysis: Sexually Transmitted Diseases by service providers: A summary of STI reported and treated cases shown in section 4.9 above HIV status Report Epidemiological Reporting: HIV Prevalence (<1%) About 150-200 likely infected 8 confirmed 4 PLWHA Level of detection has been low/ but yearly positive STI Prevalence -15.5% (1 in 3) Case reporting not effective Table 20 Case Declaration end of 2006 1994 2003 Suspected infected people Confirmed HIV positive 1 0 AIDS 0 Died of AIDS 1 0 Detected by VCCT clinic 0 0 Detected by other means of 2 0 testing PLWHA 1 0 On ARV 0 0

2004

2005

5 2 1 1

1 0 1 1

1

0

Prevention Indicators for Behavioural Change ABC Table 21 Prevention indicators for Behavioural Change ABC

Behaviour towards (unsafe) sex: About half of our youth population are sexually active

89

2006 (*) 150-200 1 0 0 1

1

Cumulative 8 2 3 3 5 4 1

Ministry of Health: National Health Report 2006 ================================================================== Proportion of young men reporting sex with men in the last year

0.7%

Behaviour towards condom: Youth condom use at first sex is very low

(14.4%)

Proportion of youth using condoms at last sex with non-commercial 45.1% Partners Proportion of young men using condoms at last commercial sex

41.9%

Consistent condom use of young men with commercial partners in last 7.3% 12 months. Proportion reporting correct knowledge of HIV/AIDS prevention 58.0% methods Proportion reporting no incorrect beliefs about HIV/AIDS transmission 55.6% Proportion who both report correct knowledge of HIV/AIDS prevention 9.3% and no incorrect beliefs about HIV/AIDS transmission Proportion reporting accepting attitudes towards those living with HIV 28.3%

5.6.9 Integrated Mental Health Services Overview: Consist of 3 component of services i.e. National Psychiatric Unit at Kiluufi Hospital, Acute Ward (NRH) and the Mental Health Services Honiara (MHMS) We have 22 nurses at NPU,12 nurses NRH and 3 at the Ministry of Health Provincial Mental Health Coordinators. Choiseul, Makira Ulawa, Isabel and Guadalcanal Provinces One Volunteer Psychologist Local One is on training Local Psychiatrist still on training ( Final year this year) Was allocated total of $833,224.00 to run the three components of services. Activity Reporting: Community based activities: Outreach Touring: Three (3) tours were conducted for Western, Makira and Choiseul Provinces.

90

Ministry of Health: National Health Report 2006 ================================================================== Training of Health Workers in Mental Health Services: Two trainings were done for Makira and Choiseul Provinces. Psychosocial visits for the families and consumers; it is continuous program activities. Have used so far $365,941 of the total amount and it is about 69% of the total mental health budget. We under spent by $167,283.00 (31%) However, we still have more pending requisitions for payment so by December we should exhaust our budget for this year 2006. Four Bed Unit established at the National Referral Hospital. This is purposely for very acutely ill patient(s) and for some cases that needing one or two day’s treatment before repatriating back to the families and communities. Headquarter office was renovated into a new office space. Challenges & Issues: There is unequal distribution of mental health resources. There is a lot of resources spend in the Acute Care (at the moment) than the Primary Health Cares which is not our focus.

91

Ministry of Health: National Health Report 2006 ==================================================================

5.6.10 Reproductive Health: Data Dissemination and Utilization for Monitoring and Evaluation of Reproductive & Child Health Programmes Source14: Dr Junilyn Pikacha: Presentation at the National Health Conference 13-17 November 2007. Issues: More data collection but less data utilization Minimal skills for analysis and interpretation for relevance and meaning – utilization of information for planning, monitoring and evaluation of programs Lack of “user-friendly” application tools Linkages between National, Regional and International Goals and Frameworks - data requirements HIS Data not sufficient Proposed Solutions: SI RH Surveillance System Reproductive and Child Health Template Family Health Card Solomon Islands POPGIS Innovative strategy for Data Dissemination and Utilization User-friendly Data Management Tools Training and Local Capacity Development Appropriate Equipment and Resources Continuous Follow-up Training and Support Monitoring and Evaluation

92

Ministry of Health: National Health Report 2006 ================================================================== Choiseul Province

NW NWest est Choiseul Choiseul Zone Zone 1 1

KEY FACTS National Average is 10.8% Provincial Average is 17% Zone 1 above Provincial and National Averages, Zone 2 is within and Zone 3 is below STRATEGIES Zone 3 priority area Motivating and awareness strategies East East Choiseul Choiseul Zone Zone 3 3 Targeting men as partners

South South Choiseul Choiseul Zone Zone 2 2

Contraceptive P revalence Rate by Area Health Zone, Choiseul Above P rovincial 17% (1) W ithin Nat & P rov (10.8/17) (1) Below National 10.8% (1)

Isabel Province

Isabel Isabel Zone Zone 5 5

Isabel Isabel Zone Zone 4 4

KEY FACTS Provincial Average is 17.8% Zone 3 is < National Av Zones 2 and 4 is within Zone 1 is > Provincial Zone 5 well above STRATEGIES Zone 3 priority area Motivating and awareness strategies Targeting men as partners Isabel Isabel Zone Zone 1 1

Contraceptive P revalence Rate by Area Health Zone, Isabel

Isabel Isabel Zone Zone 3 3 Isabel Isabel Zone Zone 2 2

> P rovincial Av. 17.8% (1) > Nat. 10.8% & P rov 17.8% (1) W ithin National Average (2) W Western estern P Province rovince zone (1) 4 4 Below National 10.8% zone

Malaita Malaita Northern Northern R Regi egi

93

Ministry of Health: National Health Report 2006 ================================================================== Central Islands Province KEY FACTS Provincial Average is 19% Zones 2 & 5 < National Average Zones 4 and 6 are within Zone is > Provincial Average Zone 3 is well above STRATEGIES Zones 2 and 5 are priority areas Motivating and awareness strategies Targeting men as partners

Malaita Province KEY FACTS Provincial Average is 6.59% Central, East and South < Provincial Average Northern Region is within STRATEGIES Central, East and South are priority areas Motivating and awareness strategies Targeting men as partners

94

Ministry of Health: National Health Report 2006 ================================================================== Guadalcanal Province KEY FACTS Provincial Average is 7% Zones 1,3 and 6 < Provincial Average Zone 4 < National but with Provincial, and zones 2 and 5 are within National average (no zones > National average)

Guadalcanal Guadalcanal Guadalcanal Zone Zone Zone 1 1 1

Guadalcanal Guadalcanal Guadalcanal Zone Zone Zone 6 6 6

Guadalcanal Zone Guadalcanal Guadalcanal Zone Zone 5 5 Guadalcanal Guadalcanal Guadalcanal Zone Zone 2 2 2

Guadalcanal Guadalcanal Guadalcanal Zone Zone Zone 3 3

STRATEGIES More efforts in ALL zones Family Health Card Strategies Network with NGOS and communities Guadalcanal Guadalcanal Guadalcanal Zone Zone 4 4 4

Contraceptive P revalence Rate by Area Health Zone, Guadalcanal W ithin National Eastern Eastern Eastern Zone Zone Zone 10.8% (2) West est Zone W est Zone Zone Central Central Central Zone Zone W ithin P rovincial 7% Below 6%

(1) (3)

Contraceptive By Area (Ranged Map Output)

Prevalence Health

Rate Zones

Choiseul

Isabel Isabel

Western Western Province Province

Central Central Province Province

Malaita Malaita

Honiara Honiara

Guadalcanal Guadalcanal Makira Ulawa Ulawa Makira Contraceptive P revalence Rate by Area Health Zone > 20% (7) > Nat.Av 10.8% but < 20% (13) Between 5% and Nat.Av (16) < 5% (10)

Rennell Rennell Bellona Bellona

95

Temotu Temotu

Ministry of Health: National Health Report 2006 ================================================================== Contraceptive By Area (Graphic Output)

Prevalence Zones

Health

Better data management to achieve set targets CP, IP, CIP, MUP and TP

Graphic

Lack of Accurate Data Honiara, Renbell

Future Directions: Consultation Process with HIS to minimize duplications Follow-up trainings to refine monitoring tool Broaden skill-base of provincial staff Recommend recruitments and training of fulltime statistic clerks at provincial level

96

Rate Output

Ministry of Health: National Health Report 2006 ==================================================================

5.6.11 Malaria Control 5.6.11.1 Overview: National Goal is to Reduce the incidence of malaria from 184/1000 people in 2004 to 80/1000 people by 2010 There are 3 Strategies with Objectives to achieve these Goal: Diagnosis and Treatment Prevention and control Programme management Strengthening

Figure 35 National Trend of Annual Parasite Incidence and Mortality (2001- August 2006)

GF Assistance

250

18 16

200

API per 1,000

12

150 10 8

100 6

Mortality per 100,000

14

4

50

2

0

0 2001

2002

2003

2004 API

2005

#2006

Mortality

# To August 2006

5.6.11.2 A: Prompt diagnosis and treatment: Health staff trained on malaria treatment and management of severe malaria Children under five and other target groups with severe or uncomplicated malaria receiving APPROPRIATE treatment Training of microscopists – basic malaria, refresher, QA

97

Ministry of Health: National Health Report 2006 ================================================================== Mass blood surveys in problem areas Expanding Rapid Diagnostic tests to health facilities without microscopy services Intermittent preventive treatment (IPTp) for pregnant women Drug resistance monitoring in sentinel sites New malaria drug treatment protocol (tomorrow 5.6.11.3 B. Malaria prevention – vector control: Distribution of 200,000 Long lasting insecticide nets via antenatal clinics, EPI (measles campaign) and social marketing (R2 & R5, GFATM) Retreatment of existing mosquito nets Free nets for pregnant women, under 5, disabled & handicapped

140000

80%

120000

70% 60%

100000

50% 80000 40% 60000 30% 40000

HH coverage

No; LLN's distributed

Figure 36 Number of LLN’s distributed & proportion of HH with access to ITN’s [round 2]

20%

20000

10%

0

0% end phase 1

Y3

Y4

Y5

Timescale Vanuatu

Solomons

Vanuatu

Solomons

5.6.11.4 ew Policy Directions: Diagnostics – RDTs, portable light illuminators for microscopy in remote areas Treatment protocols – Artemisinin Combination Treatment (2nd line)- due to change soon. Intermittent preventive Treatment (IPT) for pregnant mothers – randomized control trial in HCC and GP

5.6.11.5 Microscopy in Solomon Islands; ~Maintained at present level in 173 health facilities (56%) Hospitals =11(100%) Area health centers (AHC) =29(100%) Rural health centers (RHC) =107(90%)

98

Ministry of Health: National Health Report 2006 ================================================================== Nurse aid posts NAP)

= 157 (24%)

Ensure good and realistic quality assurance Used where case numbers are high and infrastructure / support is available Use in ‘sentinel sites’ to monitor RDT sensitivity (RDTs don’t replace good microscopy)

5.7 Private Health Provider: Solomon Islands Planned Parent Hood Association (SIPPA) 5.7.1 SIPPA Overview: SIPPA is an excellent example of a local private health provider with very clear mission to promote sexual reproductive health and rights; provides sexual reproductive health services. SIPPA is an Associate Member of the IPPF. It has branches in Malaita (Auki), Western (Gizo) and Choiseul (Taro) Provinces. SIPPA has been a key partner to the Ministry of Health in several health serviced delivery programs.

5.7.2 Strategies and Programs: SIPPA Strategic Plans: SIPPA is guided by its strategic plans, which shape their act or work and service provision. SIPPA Strategic Plan 2004 - 2009 is based on IPPF’s Framework on 5 A’s Adolescents Access Advocacy HIV and AIDS Abortion Adolescence programs: SIPPA run various youth programs from regular one-off events such youth forums and band contest and regular youth friendly confidential services. Youth Band Contest 2006 29 local youth bands from Honiara and Guadalcanal ~ 1,000 youth from Honiara attended Music on SRH issues Funded by FPA Stakeholder Talks Quiz Youth Forum Weekly forum at the Youth Centre Honiara Youth groups only Funded by AHD Project Youth Friendly Clinic

99

Ministry of Health: National Health Report 2006 ================================================================== -

Confidential services

Sports Sports gear with SIPPA logo on Access: SIPPA is one of key private health providers complementing and supplementing the Government in providing access for people to health services mainly in major centers. They provide both curative and also health protection and prevention public health programs. SIPPA provide access through various modes: Clinical Service Mobile Clinic QOC VCCT (voluntary confidential counseling and testing for HIV) In 2006 SIPPA played an important role in health promotion behavioral change interventions. Especially in the area of youth and STI and HIV prevention. They are a focal point in production and distribution of IEC materials and condoms. IEC -

DVD on youth services Production and distribution of small

Condom Distribution Taxi, Motels & Hotels Youth Centre & clinic Selected provincial hospitals and Individuals

media materials

Clinics

SIPPA is a very active Health and rights Advocacy organization. In 2006 SIPPA utilized various media means for their advocacy activities. Radio (AM/FM) Programme Daily SRH spots IEC Materials Brochures & Videos Forum & Awareness talks - Interactive/Participatory

5.7.3 Achievements SIPPA in 2006 has recorded some achievements as listed below:Adolescents: More young people are informed Create more advocates

100

of the SRH issues

Ministry of Health: National Health Report 2006 ================================================================== Access: -

Build partnership with more youth Increase number of youth clients Funding support (FPA/AHD) Build self confidence in young people

groups

Increased number of clients Establish new access points (CCC) Maintain & strengthen current distribution centres

Advocacy Wider media coverage Programme integration Gain more advocates StrengthenLinks - Financial support HIV & AIDS Mainstreaming of programme Increase in condom use Increase in knowledge Volunteer support Abortion Better understanding of complications and consequences FP access increase Safe sex practices (condom use)

5.7.4 Challenges & Issues: SIPPA like the Government did face some constraints and challenges; some listed below: Local geography Religious and Cultural barriers Lack of specialised training Inadequate IEC materials Available IEC are very general High staff turnover SIPPA also experience some lessons learned: Little collaboration and consultations Lack of Monitoring and Evaluation of programmes Poor management coordination Inadequate specialised trainings Need to break some barriers Need effective IEC materials with specific target audience Way Forward: SIPPA does think of way forward in meeting up the requirements and expectation of the organization. The key directions are listed below:

101

Ministry of Health: National Health Report 2006 ================================================================== Strengthen Partnership Trainings for policy makers & stakeholders Improvement of QOC Further increase Access centers Mainstreaming of programmes Strengthen distribution network

102

Ministry of Health: National Health Report 2006 ==================================================================

Chapter 6 Provincial Health Services 6.1 Government Health Sector: 6.1.1 Over view Provinces continued to provide services mainly in the areas of provincial hospital services, the primary health care and erratic health promotion and social medical services such as social welfare and environmental health, and other public health functions. May be provinces vary in many instances.

6.1.2 Access indicators: Error! Reference source not found. shows the current access indicators by ratio of population to health workers (nurses), health facilities and doctors. Table 22 Population Health Facility/ Workers/ Doctors

Population

Health workers 39 961

Health Facilities

Doctors

33 1,135

1 37,469

1

Makira

37,469

2

Western Province

73,932

61 1,212

56 1,320

4 18,483

3

CIP

25,424

20 1,271

27 942

1 25,424

4

Isabel

23,950

32 748

37 647

1 23,950

5

Choiseul

23,550

32 736

27 872

1 23,550

6

Malaita

145,580

95 1,532

73 1,994

4 36,395

7

Guadalcanal

71,270

36 1,980

42 1,697

2 35,635

8

Ren Bell

2,754

7 393

3 918

1 2,754

9

Temotu

22,222

29

16

1

103

Ministry of Health: National Health Report 2006 ==================================================================

10

HCC

57,636

766

1,389

22,222

36 1,601

8 7,205

11 5,240

It is clear that the level of access to health workers have vary between provinces. Table 23 Shows in Ratio of population to Health workers: Table 23 Ratio of population to Health workers: 1996 Health Facilities Number. 198 Population 410,360 Ratio 2,073

1999 247 459,380 1,860

2006 282 483,787 1,716

There has been some improvement in the ratio of population to health facilities. In 1996 there was; one health facility (clinic) to 2,073 people. In 2006 there were total of 282 functioning clinics. Hence one clinic cares for 1,702 people. The improvement is due to an increase in the number of new clinics compared to 1996. However in 2006 only about 87.5% of total of 322 registered clinics in 2005 were functioning. Clinic utilization by people in the community depends on the functioning clinics. It is often asked that how many of the people served are accessing the clinics and the services offered?

6.1.3 Health seeking behaviour of Solomon Islands people at the community level. A quality study was done (SI Household Income Expenditure Survey 2006): below is a very brief summary report: Question 1.1: Was any member of this household sick or in pain or had a health problem in the last month? Question 1.2: Did you get any help or care for the sickness or pain or health problem? 2,650 sample households (69%) reported a person sick or pain in the month before the survey (Table 2) 2,350 of those reporting sickness said they got help or care (88.7%) [Table 24]. Males and females reported illness/pain in almost equal proportions (51.2% male and 48.7% female) and children less than 5 were the greatest users of acute care services. The proportion of those sick seeking health care varied across provinces from a low of 81.7% in Makira Ulawa Province to a high of 93.9% in Western Province [Table 25].

104

Ministry of Health: National Health Report 2006 ================================================================== Table 24 Proportion of sample households reporting use of health facilities, SI HIES 2005-2006

Num ber 2350 288 12 2650

S o u g h t c a re D id n o t s e e k c a r e N o t s ta te d T o ta l s ic k n e s s p a in

% 8 8 .7 % 1 0 .9 % 0 .5 % 100%

Table 25 Use of healthcare for pain sickness by sex and age group SI HIES 2005-2006

Age <5 years 5 to 9 years 10 to 14 years 15 to 29 years 30 to 49 years 50 years NS Totals %of total reportingsickness

Males 290 195 121 192 254 152 0 1204 51.2%

% 24.1% 16.2% 10.0% 15.9% 21.1% 12.6% 0.0% 100.0%

Females 279 170 107 235 238 116 0 1145 48.7%

% 24.4% 14.8% 9.3% 20.5% 20.8% 10.1% 0.0% 100.0%

Sex not stated 0 0 0 0 0 0 1 1

%NS Total 0 569 0 365 0 228 0 427 0 492 0 268 1 1 0.0% 2350

% 24.2% 15.5% 9.7% 18.2% 20.9% 11.4% 0.0% 100.0%

Table 26 Use of health care for pain/sickness, by province. SI HIES 2005-2006

Choiseul Western Isabel Central Rennell/Bellona Guadalcanal Malaita Makira Ulawa Temotu Honiara Total

Yes 85 214 102 224 161 386 405 340 186 247 2350

% 92.4% 93.9% 85.7% 92.6% 93.1% 90.6% 89.0% 81.7% 84.5% 88.5% 88.7%

No 7 11 17 13 12 39 49 76 34 30 288

% 7.6% 4.8% 14.3% 5.4% 6.9% 9.2% 10.8% 18.3% 15.5% 10.8% 10.9%

NS 0 3 0 5 0 1 1 0 0 2 12

% 0.0% 1.3% 0.0% 2.1% 0.0% 0.2% 0.2% 0.0% 0.0% 0.7% 0.5%

Total 92 228 119 242 173 426 455 416 220 279 2,650

Question 1.4: Where did you go to get help for the sickness pain or health problem? 2,037 used a clinic or hospital (86.7%%) for health services, 106 (4.5%) used a private health service (doctor or nurse or clinic) [Table 26], 11 (0.5%) went to a retired nurse or doctor in the village. 64 (2.7%) used a traditional healer [Table 27] Table 27 Type of health care sought for illness pain in past month. SI HIES 2005-2006

105

Ministry of Health: National Health Report 2006 ================================================================== T yp e c a re T o t a l a id / c lin ic T o t a l p r o v in c ia l h o s p it a l T o ta l N R H T o t a l p r iv a t e T r a d it io n a l h e a le r V illa g e ( r e t ir e d n u r s e / d o c t o r ) D e n t is t O th e r N o t s t a t e d / b la n k T o ta l

N um ber 1437 467 133 106 64 11 4 45 83 2350

% 6 1 .1 % 1 9 .9 % 5 .7 % 4 .5 % 2 .7 % 0 .5 % 0 .2 % 1 .9 % 3 .5 % 1 0 0 .0 %

Question 1.5: If you got help but did not use a clinic, what were the main reasons? Use of a traditional healer was reported by 64 people (2.7%) reporting sickness/pain. The main reasons given for using a traditional healer were: the clinic being to far (41%) and that a traditional healer was always used first (23%) [Table 28]. Table 28 Reasons for using traditional healer, SI HIES 2005-2006 T r a d it io n a l h e a l e r C l in ic t o f a r C l in ic n o t f r ie n d l y C l in ic n o s t a f f C a n 't p a y f o r c l in ic C a n 't p a y f o r t r a n s p o r t N o tr a n s p o rt a v a ila b le Illn e s s a t n ig h t B a d w e a th e r Illn e s s n o t s e rio u s O th e r re a s o n A lw a y s u s e t r a d it io n a l h e a le r f i r s t n o t s ta te d T o ta l

N um ber 26 3 1 1 4 1 1 3 2 2 15 5 64

% 41% 5% 2% 2% 6% 2% 2% 5% 3% 3% 23% 8% 100%

Question 1.9: If you did not seek care for the sickness, pain or health problem what were the main causes? A relatively small number of households (288) (compared to the number reporting sickness) said they did not seek help or care at a clinic for a recent sickness. The most important reasons for not seeking care were [Table 29] that the clinic was too far, 76 (26.4%) the illness was not serious 49 (17%) 82 (28.5%) gave no reason for not seeking help 17 (5%) were unable to pay either clinic or transport charges 10 (3.5%) said they always used a traditional healer first [Table 29]. Table 29 Reasons a clinic/hospital were not used for help/care for recent sickness

106

Ministry of Health: National Health Report 2006 ================================================================== SI HIES 2005-2006 N um ber 76 0 1 4 3 1 10 7 8 1 10 17 49 9 10 82 288

C lin ic to fa r C lin ic n o t fr ie n d ly C lin ic n o t n ic e C lin ic n o s ta ff C lo s e r e la tiv e w o r k s a t c lin ic C lin ic h a s n o d r u g s C a n 't p a y f o r c lin ic C a n 't p a y f o r t r a n s p o r t N o tr a n s p o r t a v a ila b le Illn e s s a t n ig h t B a d w e a th e r T o b u s y to g o to c lin ic Illn e s s n o t s e r io u s O th e r re a s o n A lw a u y s u s e T H fir s t N o t s ta te d T o ta l

% 2 6 .4 % 0 .0 % 0 .3 % 1 .4 % 1 .0 % 0 .3 % 3 .5 % 2 .4 % 2 .8 % 0 .3 % 3 .5 % 5 .9 % 1 7 .0 % 3 .1 % 3 .5 % 2 8 .5 % 1 0 0 .0 %

6.1.4 Achievements/ Output Reporting: Radio communication: nearly all provinces have being installed brand new radios to cover all Area Health Clinics and RN Clinics. Only a few Nurse Aide Posts are to be installed new radios. For example Guadalcanal Province has 100% installation on all their Area Health Centers and RN Clinics. Isabel also reported 100% new radio installation coverage. Operational activities: A few provinces such as Guadalcanal reported 100% implementation of their planned operational activities for 2006. And have reported 83% coverage for Antenatal Clinic and 100% completion of their mental health programs. And this is very encouraging. Infrastructure: Don Bosco started construction on the new Hospital Building which will be a first GP’s provincial hospital. Partnership: Like many other provinces: Guadalcanal Province has experienced a very good partnership between communities and NGOs and Government and Church Organizations such as the Don Bosco. Western Province in 2006 has entered into a service agreement with KFPL, Helena Goldie Hospital and Sivania. Honiara City Health Services has also established a model school with Bishop Epalle Secondary School. Tidy Village Model a success in Isabel Province: This is a community based healthy lifestyle practice introduced some years back and re-enforced recently by the Isabel Provincial Health Services in support by the Health institutional Strengthening Project advisers.

107

Ministry of Health: National Health Report 2006 ================================================================== Great improvement on logistics (transport-OBMs and Canoes) and development initiatives funded by AusAID Health Sector Trust Fund: Choiseul under the HSTA funding had established a sea ambulance referral system. Choiseul Staff Housing project: Choiseul is one of the first province to start implementing the provincial health staff housing project. Infrastructure: minor to major infrastructure development such as Buala Hospital extension. Choiseul Province has newly built a TB ward. JICA funded incinerators have been installed after a while. HCC have extended the Kukum Clinic to accommodate a VCCT services for youth and antenatal clinics. Primary Health Care activities implemented by provinces: all provinces in 2006 have completed some high impact primary health care initiatives such as the Integrated Medical tours, EPI catch up campaign, Eye team visits, and Healthy island concept (e.g. extending the approach to the Eastern Region of Choiseul). Bed net distribution has improved to 101% coverage in Honiara after the review of the Bed Net Policy that allow free bed nets to certain vulnerable people (women and children) in the City. Computerization of HIS at the provincial level: All provinces have a computerized Health Information System by end 2006. This will enable them to update and compile their monthly clinic report on time. This also allows them to pick up sudden upsurge of diseases among the community served by the clinics. Increasing Contraceptive Prevalence: Makira has been reporting an increasing CPR (contraceptive prevalence rate) from 13% in 1998 to 21% in 2005.

6.1.5 Challenges and Issues Maternal Deaths: Mothers are still dying of pregnancy. CIP in 2006 recorded 4 deaths which are mainly due to Post Partum Hemorrhages, and this implicated on inadequate quality management of delivery and emergencies obstetric care. Water supply: inadequate water supply to provincial hospitals has been a major concern still to many provincial health services. Population and pressure: pressure on hospital beds have raised concerns to the provincial authorities and may need further strategic planning on this issue. Supply problems: many provinces still having problems with delay supply of materials e.g. Guadalcanal Province experience supply of malaria control materials not reaching the sites on time. And the main cause is erratic shipping, and drug supply has been affected as a concern rose by Western Province. Poor Staff Housing Condition: general concerns still on poor staff housing conditions for health workers across all provinces; despite attempts by the Ministry of Health to provide

108

Ministry of Health: National Health Report 2006 ================================================================== minimal funds to renovate provincial staff houses. Work on repairs and maintenance has been very slow. Staff management has been an issue at the provincial levels. Waste management is a problem. Mobile population: Honiara City Council health services have experiencing increasing migration sick population. Many people move from clinic to clinic causing over utilization and repetition of clinics visits. Unfortunately not all patients have a unique identifier on their health cards. An idea the family heath cared should be able to address but still short fall. Poor AC first visit: Provinces such as GP still reporting concern over poor first ANC visits.

6.2 Church Hospitals in the provinces 6.2.1 Atoifi Hospital: The Seventh Day Adventist Church owned Atoifi Hospital has been operating for many years providing both hospital and public health programs for Eastern Malaita region. Atoifi is one of the three Church hospitals subsidized by the Solomon Islands Governments. In the past years the church hospital also received direct funding from the AusAID Health Trust Fund. In 2006, the 90 bed Atoifi Hospital admitted more than 1,000 patients (970 patients admitted Jan-Oct 200615). There were more than 7,000 people sick patients attended by the hospitals outpatient department. Atoifi Hospital Nursing School continued to enrol 60 students in 2006 for nursing professional. The students played vital role in providing basic care and outreach programs. In 2006 there were 2 doctors and 30 nurses. It was reported that there were marked reduction of referral cases to National Referral Hospital in 2006. From January to October 2006, there were total of 105 surgical operations done that could have been referred. Table 30 Number of surgical operations Jan-Oct 2006

Year 2006

Case type

Month

Minor

Intermediate

Major

March

8

2

4

April

7

4

5

May

4

6

3

June

6

6

0

July

2

8

2 109

Total

Ministry of Health: National Health Report 2006 ==================================================================

August

11

7

0

September

4

1

3

October

10

1

1

52

35

18

105

6.2.2 Helena Goldie Hospital Helena Goldie Hospital is located at Western Province, and served a significant proportion of the province’s population. Historically HGH was established in 1903 by the Methodist Church and now United Church. The 55 bed hospital employed around 76 employees including a Nurse Aide Training School16. Figure 37 illustrates the organogram of HGH, and in 2006 the Nurse Aide School continued to enrol students from all over the country. HGH is also subsided by the Solomon Islands Government by seconded health staff and also direct funding annually to run the hospital. Figure 37 Organogram for Helena Goldie Hospital Services


Figure 38 HGH SERVICES

PRIMARY HEALTH CARE

SECONDARY HEALTH CARE

NURSING EDUCATION -AHC 1 -RHC 4

HGH

NATS

In 2006 there were 2 doctors, a (1 dentist), 9 registered nurses, 25 nurse aides and 39 supporting staff. In 2006, HGH signed a service agreement on the 13 October 2006 with the Western Provincial Health Services as a key partner in providing health services to the people of the provinces. The MOU should also affirm and strengthen the current relationship with the Church and the Provincial Government and the SI National Government. The principle of the MOU is to forester good governance and accountability, and it forms basis for further 110

Ministry of Health: National Health Report 2006 ================================================================== development. There were external assistance with the Council for World Mission (CWM) providing a Canoe and two OBMs. There was also an understanding and plan for the Burnside Rotary Club (Australia) to repair and renovation of the hospital buildings. There is also the plan to upgrade the nurse aide school to a Diploma Nursing.

6.2.3 Sasamuga AHC: In 200617, Sasamuga was without a doctor but the primary health care continued and managed by clinical nurses seconded from the Government. There were facilities for inpatient services but unutilized due to no doctor. The centre continued to imply the planned activities for 2006. Referrals were done to either Taro or Gizo Hospital Western Province. For emergency referrals the National Referral Hospital is often were consulted before medical evacuations. Achievement for Sasamuga listed below: A qualified pharmacist graduated and posted to Sasamuqa: -to improved ordering, management and distribution of medical supplies. A midwife graduated and posted to Sasamunga to improved management of maternal cases thus reducing the cost of referrals on maternal case. Medical laboratory: Well equipped with basic things functioning. Malaria laboratory : well equipped and functioning Radio communication: to improved through barrette radio. Rubbish disposal: a new Incinerator installed 2005 and holes for sharps and bottles dug.

Sasamuga plans to further develop the following areas in 2007: Proper establishment of IMCI clinic for better assessment and detection, recording & reporting of childhood illness. Establishment of Adolescence friendly clinic accommodating reproductive heath information &HIV/AIDS. Increase number of outreach & awareness programmes. Bi-Monthly In-service training for Nurses Strengthen heath information system Recruitment of Dental Officer

111

Ministry of Health: National Health Report 2006 ==================================================================

Chapter 7 Resource Utilisation: Resource Reporting

Financial

&

Human

7.1 Funding for Health in 2006: The total fund available for health services in 2006 was around sbd$115,741,810 ($116Million), which is 14% of the total SIG Budget for 200618. However, the overall total of fund spent in health services and development including the AusAID/ Health Sector Trust Fund was around sbd$282,924,821 ($283Million) which is push up the percentage to SIG fund to 34%. Table 31 Summary of fund for health services and development in 2006

2005

2006

SIG Recurrent/operations Staffing Establishment Development SIG Total for Health

41,626,879 45,460,431 9,700,000 96,787,310

50,296,022 46,933,788 18,512,000 115,741,810

HSTA Operational/ development

51,762,802

51,441,201

Grand Total

245,337,422

282,924,821

SIG Grand Total Budget

690,821,598

829,401,356

%

14.0%

14.0%

7.2 Role of Health Sector Trust Account Fund: AusAID HSTA continued to be the lifeline for the health services delivery and development in complimenting the slowly reviving Solomon Islands Government health funding. However, slowly the SIG will have to take additional responsibility for the operational costs as external partners will support in developmental aspects of the health services. In 2006 HSTA enabled health services to reach to the people coupled with the SIG’s operational capacity. Some important items significantly affected by the HSTA funding is the procurement of essential medicines, whilst the SIG funds distribute them to the provincial level.

7.2.1 HSTA Expenditure Medical supplies and drugs accounted for 50.3% of total HSTA expenditure. Overall the HSTA budget for 2006 was overspent by SBD3,678,399 (AUD613,066) out of a total AusAID allocation for the period of SBD53.7M (AUD 9.3M) which equates to an over-expenditure of

112

Ministry of Health: National Health Report 2006 ================================================================== 7.7%. Over-expenditure on drugs and medicines represented SBD5,884,117 (AUD 980,686) or 12%. Figure 39 HSTA Expenditure 2006

Other Funds

2005 unpresented

Contingency Fund

Development Initiative

Medical Equipment

HSTA Projects

Other Operational

Operational Grants

30 25 20 15 10 5 0 Medical Dugs & Supplies

SBD (millions)

HSTA Expenditure 2006

Expenditure Category

The summary table below shows expenditure against budget for the December quarter. All data is expressed in Solomon Dollars (SBD) with Australian Dollar (AUD) transactions converted to SBD at the rate applicable on the date of the transaction. Table 32 HSTA Expenditure 2006

Medical Dugs & Supplies

Actual 25,884,117

Budget 20,000,000

Variance -5,884,117

% Variance 129.42%

Operational Grants

10,690,630

10,400,000

-290,630

102.79%

Other Operational Expenditure

2,542,908

1,500,000

-1,042,908

169.53%

HSTA Projects

2,956,307

3,403,387

447,080

86.86%

Medical Equipment Replacement Plan

3,593,705

4,000,000

406,295

89.84%

Development Initiative Grants

2,553,148

3,327,208

774,060

23.26%

Contingency Fund

2,430,294

4,730,021

2,299,726

51.38%

2005 unpresented cheques

359,013

325,655

-33,358

110.24%

Other Funds Total Expenditure

431,079 51,441,201

76,531 47,762,802

-354,548 -3,678,399

563.27% 107.70%

113

Ministry of Health: National Health Report 2006 ==================================================================

There was significant over-expenditure on overseas locum doctors’ costs, overseas referrals and overseas pathology services which exceeded budget by 32%, 38% and 30% respectively. Details of income and expenditure for the period can be seen on the attached financial schedules.

7.2.2 Control and Governance Issues Work continued through the MoH Executive in dealing with the matters raised by the Office of the Auditor General, OAG resulting from the 2005 audit. The audit action plan continues to be a major item for discussion at the regular MOH Executive meetings. The police fraud squad investigation of the fraudulent activities noted in the Audit Report has now commenced but as yet there is no indication as to when the investigation will be completed. The National Medical Store and MoH HQ bank accounts were closed and all transactions for these entities are now passed through the main HSTA bank account. This has had a significant positive effect on control processes including compliance. All other HSOAs are in the process of being closed and SIG operated bank accounts opened in their stead. NRH expenditure (Solomon Island Government and HSTA funded) is now under the control of MOH Head Office as a result of continuing over expenditure by the NRH. One of the accounting staff has been relocated from NRH to Head Office and all payments for NRH are dealt with by that person. The signatories on the cheque account are the same as for the main HSTA bank account.

7.3 Human Resource for Health in 2006 7.3.1 Overview: Ministry of health workforce make up a significant portion of the total Government’s public servants [Table 33 Proportion of health staff in the Government workforce 2005 & 2006]. Majority are in the provinces and the National Referral Hospital). Table 33 Proportion of health staff in the Government workforce 2005 & 2006

Solomon Islands Government

2005 3,787

2006 3,977

MHMS %

1,558 41.1%

1,574 39.6%

114

Ministry of Health: National Health Report 2006 ================================================================== Figure 40 showing number health workers of the Ministry of Health (Source: 2006 SIG Establishment)

1800 1600 1400 1200 1000 800 600 400 200 0

All

MHMS/HQ

NRH

Provinces

2005

1558

314

535

709

2006

1574

298

549

727

Figure 41 Proportion of health workforce by locations in 2006

MHMS/HQ, 19%

Provinces, 46%

NRH, 35%

115

Ministry of Health: National Health Report 2006 ==================================================================

7.3.2 Health workforce workload assessment: The Ministry of Health have been looking at mechanisms to help evaluate the workforce needs and their performance, and a method developed with the support of the Health Institutional Strengthening Project is the WISN (WHO method “Work Indicator Staffing Need). The ratio, i.e. actual/calculated. This ratio is called the Workload Indicator of Staffing Need (WISN) and gives its name to the method as a whole. If the WISN ratio is 1.00, i.e. actual staff = calculated staffing requirement, then the current staff is just sufficient to meet the workload according to the professional standards which have been set. If the WISN is less than <1.00, then the current staff is not sufficient to meet these standards. Continuing with the example above, if a facility has radiographers but is calculated to need eight, then the WISN for this category is 6/8 = 0.75 or 75%, and only 75% of the required staff are available or only 75% of the standards can be achieved. If the WISN is greater than 1.00, then there are more than enough staff to meet the standards set. For example, the facility mentioned above has 10 midwives but is calculated to need only eight; the WISN for this category is 10/8 = 1.25 or 125%, and there is an excess of 25% in the midwives above the number needed to achieve the standards set. The WISN ratio is one of the novel features of this method. It shows the degree of pressure which each staff category is under in coping with the annual workload it is actually dealing with in the facility. WISN Indicators (Source: Ministry of Health and Health Institutional Strengthening (HISP) study done in 2005). Figure 42 WISN indicators (Source MHMS and HISP 2005)

Environmental Vector Dental Pharmacy Laboratory Radiography Health Borne Gold Standard WISN Index Excess Potential unutilized staff

100%

100%

100%

100%

100%

100%

Nurses in Clinics 100%

522%

554%

217%

128%

95%

200%

127%

130%

5.22 76

5.54 82

2.17 20

1.28 6.1

0.95 -2

2 10

1.27 104

1.3 101

Challenges and issues: There has been a general excess of staff according to Figure 42 WISN indicators (Source MHMS and HISP 2005). There is no follow up qualitative study to ascertain areas of need for strengthening. However, it implies the need for better human resources planning and deployment. There has not been a proper needs-based human resource development. There is no standard operating procedures that help staff in their daily work.

116

Nurses in Hospitals 100

Ministry of Health: National Health Report 2006 ==================================================================

Chapter 8 Key Health Challenges & Way Forward 8.1 Overview: Key health challenges: The report highlights some key issues which are both ongoing and others newly experienced. Political level: Implementing of the GCC Policy Statements needs harmonization of activities at sector level and commitment. Achieving the MDGs goals need more political commitment and more coordination among key stakeholders.

Central agent level: Bottlenecks at the public services procedures and beaurecracies partly responsible for weakness in human resources management at sectoral level. Lack of financial and accounting support from Ministry of Finance causes poor communication affecting the implementation of health programs and service deliveries. Ministry level: Implementing of the national health strategies needs effective mechanisms. Implementation rates of operational plans by division and programs need more attention and concern from respective heads of department. Gender mainstreaming needs more attention in terms of policy, service delivery, monitoring and evaluation. Staff capacities, capabilities; and work culture and ethics of health workers remain a significant issue to address. Further improvement of the Health Information System is required ensure coordination and integration of much needed data and information for ME and planning, strategic management, policy and financial planning purposes. The speed at adopting the new changes into integration of certain national programs (such as mental health, social welfare, health promotion and integrated community-based rehabilitation programs is still slow and needs more understanding and structural support to do it.

Disease burden: Double burden disease trend with increasing threat of HIV/AIDS and other emergency diseases. Acute infections major causes of health attendances. 16% of people at the community suffered chronic diseases without much attention. Need more commitment and efforts into strengthening the HIV national response.

Health Status inequality remains:

117

Ministry of Health: National Health Report 2006 ================================================================== It is evident from the report: There is inequality in terms of access to health facilities (clinics), health resources, and health workers. Health seeking behavior is very much determined by other geographical, social and cultural factors such as transportation, distance to clinics, and lack of clear understanding of the diseases affecting the people. Provincial health services: Provincial financial and management capacity Reaching more people in need, people of vulnerable and most at risk to social, mental and health problems.

8.2 Opportunities Political vision for people centered or bottom approach There is a clear direction by the Government to wards “bottom-approach” and so as the new revised health strategy in enhancing this theme through people-centered (or people focused). The Government is clear in its stands to ensure the MDGs are captured in its national programs by relevant sectors. Human Resource The level of human resources has improved in terms of numbers and skill mix. According to the staff establishment for 2006, there were no foreigner medical specialists. In 2006 there were all national clinical specialists. There are also national public health specialists to run the national health services. Among paramedics there were also newly graduates at a higher level of academic achievements. Health Institutional Strengthening Project The previous five-years health institutional strengthening project have put in place a track record of institutional strength in management, planning and policy development at the national level. It creates some cultural change in areas of financial management and accounting. The auditing of the health accounts in 2006 was very lesson learnt opportunity that also set up baselines for improvement. Funding support Solomon Islands Government has maintained its funding commitment in the past two years to around 14% of the total SIG annual national budget. Similarly, external funding opportunities have come in 2006 in the way of the Global Fund to fight HIV/AIDS, TB, and Malaria. and the bilateral donor assistance from AusAID Health Trust Fund. Other development bilateral and unilateral partners are acknowledged here as significant funding donors; and they are Republic of China (Taiwan), JICA, and the World Bank. Partnership with non-state actors or private sectors, NGOs, Churches, and community people

118

Ministry of Health: National Health Report 2006 ================================================================== It is encouraging that the participation of non-state actors such as NGOs and Churches have significantly increased in the last two years. The interest of these groups has been recognized and acknowledge in the report. Clinical capacity of the departments at the National level The clinical capacity at the national level has the capacity to improve further to meet the needs of the people. The self reliance at the national level is acknowledged. Even with basic modern technology much of the people’s problems are treated and managed competently by the doctors, nurses supported by the paramedics. Nonetheless, there are still severe problems with individual staff attitudes towards work, which is a management problem for managers of hospitals and clinics.

8.3 The Way Forward: The revised national health strategic plans have set the directions towards achieving the health goals for a better health outcome. The Corporate Plan provides the work specifications to be adopted in each year’s operational plan and budgeting. There are also key themes that are the underpinning to the future directions of the national health development. They are summarized; People centered approach in reaching the most at risk and vulnerable; Adopting the GCC’s bottom-approach and utilizing existing community structures that show potential and capacity to improve local participation in health. Health systems strengthening of health institutions to be efficient and national programs to effectively deliver to the people at large; Systems strengthening at the community levels such as financial management capacity building and support at national, provincial and program levels. Strengthening the existing programs to prevent, control, treat and eliminate common health illnesses and the increasing non-communicable diseases causing widening of poverty status of people. Good governance and accountability should also be the paramount importance in the national and provincial health systems.

119

Ministry of Health: National Health Report 2006 ==================================================================

Chapter 9 Annexures 9.1 Annex 1: List of registered clinics in 2006 Table 34 List of registered clinics by 2006

Guadalcanal Province 2006 1

aola

gp

ahc

12

2

avuavu

gp

ahc

11

3

balolava

gp

rhc

12

4

bolale

gp

nap

10

5

bubunuhu

gp

nap

11

6

foxbay

gp

rhc

12

7

grove

gp

ahc

12

8

haiparia

gp

nap

11

9

kohimarama

gp

nap

11

10

kolosulu

gp

nap

11

11

konga

gp

nap

11

12

kuma

gp

rhc

11

13

lambi

gp

rhc

12

14

lunga

gp

nap

11

15

mandacacho

gp

rhc

10

16

marara

gp

ahc

12

17

marau

gp

ahc

12

18

marumbo

gp

nap

9

19

mbabanakira

gp

rhc

12

20

nagho

gp

nap

11

21

new tenabuti

gp

rhc

11

22

numbu

gp

nap

12

23

ruavatu

gp

rhc

12

24

saro

gp

nap

9

25

selwyn college

gp

nap

12

26

tamboko

gp

nap

12

27

tangarare

gp

ahc

12

28

tinagulu

gp

nap

11

29

totongo

gp

rhc

12

30

turarana

gp

rhc

11

31

verani

gp

nap

2

32

visale

gp

rhc

12

33

viso

gp

rhc

12

Western Province 2006 1

arara

wp

nap

12

2

baniata

wp

nap

12

3

batuna

wp

rhc

12

120

Ministry of Health: National Health Report 2006 ==================================================================

4

biula

wp

nap

5

buni

wp

rhc

12

6

dovele

wp

rhc

12

7

dunde

wp

nap

10

8

falamae

wp

rhc

11

9

gaomai

wp

nap

10

10

ghatere

wp

nap

10

11

gizo hosp

wp

hosp

12

12

goldie college

wp

nap

11

13

harapa

wp

rhc

12

14

helena goldie

wp

hosp

12

15

hopongo

wp

nap

12

16

iringgula

wp

rhc

12

17

jella

wp

nap

6

18

kara

wp

nap

11

19

karaka

wp

nap

9

20

kariki

wp

nap

8

21

kavolavata

wp

nap

12

22

keru

wp

rhc

12

23

kolokolo

wp

rhc

12

24

koriovuku

wp

ahc

12

25

kukudu

wp

rhc

11

26

lale

wp

rhc

12

27

lambulambu

wp

nap

12

28

leona

wp

rhc

12

29

lokuru

wp

nap

12

30

maleai

wp

nap

11

31

maravari

wp

nap

12

32

merusu

wp

rhc

12

33

mondo

wp

nap

11

34

nila

wp

ahc

12

35

noro public

wp

rhc

12

36

noro soltai

wp

nap

12

37

nusa hope

wp

nap

12

38

nusa roviana

wp

nap

11

39

paradise

wp

rhc

12

40

penjuku

wp

rhc

12

41

pienuna

wp

rhc

12

42

poitete

wp

rhc

12

43

rarumana

wp

nap

12

44

ringgi

wp

rhc

12

45

seghe

wp

ahc

12

46

tingge

wp

nap

12

47

toumoa

wp

rhc

12

121

11

Ministry of Health: National Health Report 2006 ==================================================================

48

tumbi

wp

rhc

12

49

ughele

wp

rhc

12

50

vakambo

wp

nap

11

51

vanga

wp

nap

11

52

varese

wp

nap

11

53

viru

wp

rhc

11

54

vonunu

wp

ahc

12

Malaita Province 2006 1

afio

mp

ahc

11

2

ambeo

mp

nap

11

3

anomasu

mp

nap

10

4

apuapu

mp

nap

11

5

arao

mp

nap

11

6

ata'a

mp

rhc

7

7

atoifi

mp

hosp

10

8

auki

mp

uahc

12 12

9

bita'ama

mp

rhc

10

buma

mp

nap

9

11

busufosae

mp

nap

10

12

busurata

mp

nap

11

13

fauabu

mp

rhc

12

14

fo'ondo

mp

nap

12

15

gwaiau

mp

nap

11

16

gwaonaoa

mp

nap

7

17

gwarata

mp

nap

10

18

gwaunatolo

mp

rhc

11

19

honoa

mp

nap

8

20

hauhui

mp

rhc

10

21

heukasia

mp

nap

6

22

keukwao

mp

nap

10

23

kilu'ufi hosp

mp

hosp

12

24

kiu

mp

nap

11

25

kwailabesi

mp

rhc

10

26

lagefasu

mp

nap

5

27

malou

mp

nap

1

28

malu'u

mp

ahc

12

29

mamulele

mp

nap

12

30

manawai

mp

rhc

10

31

maoa

mp

rhc

12

32

nafinua

mp

ahc

12

33

namolaelae

mp

nap

6

34

ndai

mp

nap

9

35

olomburi

mp

rhc

11

36

oneone

mp

nap

12

37

oneoneambu

mp

nap

12

38

ota

mp

nap

10

122

Ministry of Health: National Health Report 2006 ==================================================================

39

ote

mp

nap

12

40

pipisu

mp

nap

6

41

rafufu

mp

nap

6

42

lalaro

mp

nap

10

43

rohinari

mp

rhc

5

44

rokera

mp

nap

7

45

saa

mp

rhc

10

46

sango

mp

rhc

11

47

sikaiana

mp

rhc

11

48

sinamauri

mp

rhc

12

49

sinaragu

mp

nap

12

50

su'u school

mp

nap

1

51

takataka

mp

rhc

10

52

takwa

mp

rhc

11

53

talakali

mp

rhc

12

54

taramata

mp

rhc

10

55

tarapaina

mp

rhc

12

56

tawanaora

mp

nap

6

57

tawaro

mp

rhc

11

nap

12

rhc

12

Temotu Province 2006 1

otomongi

tp

2

community health team

tp

3

dendu

tp

4

emua

tp

rhc

12

5

kala bay

tp

nap

12

6

kati

tp

nap

12

7

lagoon

tp

nap

12

8

lata hosp

tp

hosp

12 11

12

9

luesalemba

tp

nap

10

manuopo

tp

ahc

12

11

nea/noole

tp

nap

12

12

nembao

tp

rhc

12

13

neo

tp

nap

12

14

ngauta

tp

nap

12

15

nuoba

tp

rhc

12

16

tukutanga

tp

rhc

12

Central Islands Province 2006 1

belaga

cip

nap

12

2

bonala

cip

nap

12

3

borohinaba

cip

rhc

12

4

boromole

cip

nap

10

5

dende

cip

rhc

12

6

koela

cip

nap

11

7

koilavaka

cip

nap

11

8

leitongo

cip

nap

5

9

louna

cip

nap

12

123

Ministry of Health: National Health Report 2006 ==================================================================

10

mauroloan

cip

nap

11

narogu

cip

nap

12 6

12

olevuga

cip

rhc

12

13

panueli

cip

rhc

11

14

pepesala

cip

rhc

12

15

ravu

cip

nap

12

16

salisapa

cip

rhc

12

17

siota pss

cip

nap

11

18

taroniara

cip

rhc

12

19

tathi

cip

nap

12

20

toga

cip

nap

10

21

tulagi hosp

cip

hosp

12

22

vura

cip

nap

11

23

vuturua

cip

nap

12

24 yandina Choiseul Province 2006

cip

ahc

12

1

bangara

chp

nap

8

2

boeboe

chp

nap

12

3

choiseul bay

chp

nap

9

4

lamuni

chp

nap

8

5

loloko

chp

nap

11

6

luti

chp

nap

10

7

moli

chp

rhc

12

8

ngarione

chp

rhc

9

nuatabu

chp

rhc

11

10

ogho

chp

nap

11

11

pangoe

chp

ahc

12

12

papara

chp

rhc

12

13

polo

chp

rhc

12

14

posarae

chp

rhc

12

15

sasamugga

chp

hosp

12

16

sepa

chp

nap

11

17

sirovanga

chp

rhc

12

18

soranomola

chp

nap

11

19

susuka

chp

rhc

12

20

taro hosp

chp

hosp

12

21

varuga

chp

nap

12

22

voza

chp

rhc

9

23

vurago

chp

nap

8

24

wagina

chp

rhc

12

11

Isabel Province 2006 1

baolo

isp

2

bara

isp

nap

10

3

bolotei

isp

ahc

12

4

buala hospital

isp

hosp

12

124

rhc

12

Ministry of Health: National Health Report 2006 ==================================================================

5

dedeu

isp

nap

5

6

goveo

isp

nap

11

7

guguha

isp

nap

12

8

hageulu

isp

nap

11

9

hoffi

isp

nap

10

10

kalenga

isp

rhc

11

11

kamaosi

isp

nap

8

12

kia

isp

ahc

12

13

kilokaka

isp

nap

9

14

kmaga

isp

nap

10

15

koge

isp

nap

9

16

koisisi

isp

nap

11

17

kolomola

isp

rhc

10

18

kolotubi

isp

nap

11

19

konide

isp

ahc

12

20

lelegia

isp

nap

8

21

moloforu

isp

rhc

11

22

muana chs

isp

nap

7

23

nagolau

isp

nap

10

24

nodana

isp

rhc

9

25

poro

isp

rhc

12

26

samasodu

isp

rhc

11

27

sigana/tasina

isp

rhc

12

28

sisiga

isp

nap

10

29

susubona

isp

rhc

12

30

tataba

isp

ahc

12

31

vulavu

isp

rhc

10

Makira Province 2006 1

aorigi

mup

nap

9

2

aringana

mup

rhc

12

3

aruraha

mup

nap

3

4

aua

mup

rhc

12

5

gupuna

mup

rhc

12

6

haupala

mup

ahc

12

7

heraniau

mup

nap

10

8

hunuta

mup

nap

10 12

9

kaonasugu

mup

nap

10

karie

mup

rhc

12

11

kerepei

mup

rhc

12

12

kirakira

mup

hosp

12

13

maerongasia

mup

nap

9

14

manasugu

mup

rhc

12

15

marogu

mup

rhc

12

16

mwakorukoru

mup

nap

11

125

Ministry of Health: National Health Report 2006 ==================================================================

17

mwaniwiriwiri

mup

nap

11

18

na'ana

mup

nap

12

19

naharahau

mup

nap

11

20

namuga

mup

ahc

12

21

narame

mup

rhc

12

22

narate

mup

nap

12

23

ngarigohu

mup

rhc

12

24

pamua nss

mup

nap

8

25

parego

mup

rhc

12

26

su'ulopo

mup

nap

8

27

taheramo

mup

rhc

12

28

tawairamo

mup

nap

11

29

tawaraha

mup

ahc

12

30

tetere

mup

rhc

12

31

ubuna

mup

rhc

12

32

waihaga

mup

rhc

11

hma

uahc

12

Honiara City Council 2006 1

kukum

2

mataniko

hma

uahc

12

3

mbokona

hma

urhc

12

4

mbokanavera

hma

urhc

12

5

naha

hma

urhc

12

6

nrh

hma

hosp

8

7

rove

hma

uahc

12

8

vura

hma

urhc

12

9

whiteriver

hma

urhc

12

Rennell Bellona 1

nuku

rbp

rhc

11

2

tengano

rbp

rhc

12

3

tingoa

rbp

ahc

12

126

Ministry of Health: National Health Report 2006 ==================================================================

127

Ministry of Health: National Health Report 2006 ==================================================================

128

Ministry of Health: National Health Report 2006 ==================================================================

129

Ministry of Health: National Health Report 2006 ==================================================================

130

Ministry of Health: National Health Report 2006 ==================================================================

131

Ministry of Health: National Health Report 2006 ==================================================================

132

Ministry of Health: National Health Report 2006 ==================================================================

133

Ministry of Health: National Health Report 2006 ==================================================================

134

Ministry of Health: National Health Report 2006 ==================================================================

135

Ministry of Health: National Health Report 2006 ==================================================================

136

Ministry of Health: National Health Report 2006 ==================================================================

137

Ministry of Health: National Health Report 2006 ==================================================================

138

Ministry of Health: National Health Report 2006 ==================================================================

139

Ministry of Health: National Health Report 2006 ==================================================================

140

Ministry of Health: National Health Report 2006 ==================================================================

141

Ministry of Health: National Health Report 2006 ==================================================================

142

Ministry of Health: National Health Report 2006 ==================================================================

143

Ministry of Health: National Health Report 2006 ==================================================================

144

Ministry of Health: National Health Report 2006 ==================================================================

145

Ministry of Health: National Health Report 2006 ==================================================================

146