National Health Report 2003-Solomon Islands

8/14/2019 National Health Report 2003-Solomon Islands

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Report by the Ministry of Health (May 2004):National Health Report 2003:

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

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MAJOR HEALTH POLICY OBJECTIVES AND OUTPUTS-ACHIEVEMENTS & Constraints 2003.

Table of Contents:

NATIONAL HEALTH REPORT 2003 .......................................................................... 1

OUR PEOPLES HEALTH OUR PASSION.................................................................. 1

I. PREAMBLE:................................................................................................................... 41.0. INTRODUCTION: ........................................................................................................ 5

1.1. VISION AND MISSION: ............................................................................................... 5

1.2. THE HISTORICAL DEVELOPMENTS IN THE HEALTH CARE SYSTEM BY END OF 2003: 61.3. HEALTH STATUS: ...................................................................................................... 6

2.0. PROCESS AND OUTPUT EVALUATION OF THE NATIONAL HEALTH POLICIES 1999-

2003: ............................................................................................................................... 9

POLICY 1: IMPROVEMENT OF HEALTH SERVICE PLANNING, MANAGEMENT ANDSUPERVISION. ..................................................................................................................... 9

1.1.Overview:.............................................................................................................. 9

POLICY 2: ACCESSIBILITY, AND IMPROVEMENT OF CARE AND QUALITY OF SERVICES. 12

2.1. Curative Health Services:.................................................................................. 12

2.2.1. Medical Services:............................................................................................ 14

2.6.1. Accident & Emergency Services:.................................................................... 14

2.7.1. Access to Essential Medicines: ....................................................................... 16

2.8.1 Access to community health services through Primary Health Care:............. 17

2.9.1. Health Infrastructure Development:............................................................... 172.10.1. Dental & Oral Health Services: ................................................................... 22

2.11.1. Ophthalmology & Primary Eye Care Services:............................................ 22

2.12.1. Diagnostic Services at Hospitals:................................................................. 24

2.13.1. Rehabilitation Services: ................................................................................ 25

POLICY 3: HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT FOR HEALTH ......... 25

POLICY 4: MORBIDITY AND MORTALITY REDUCTION....................................................... 27

4.0. Overview:........................................................................................................... 27

4.1.Malaria: .............................................................................................................. 28

4.2. Acute Respiratory Infection: .............................................................................. 29

4.3. Malnutrition:...................................................................................................... 314.4.0. Diarrhoeal Diseases:...................................................................................... 32

4.5.1 Diabetes (NCD): .............................................................................................. 32

4.5.2. Tobacco and its Impact and the control measures in Solomon Islands: ........ 42

4.6.0. Tuberculosis:................................................................................................... 53

4.7.0. Leprosy: .......................................................................................................... 60

4.8. Sexually Transmitted Infections ) including HIV: ............................................. 64

4.9. Mental Health Service: ...................................................................................... 66


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POLICY 5: ENVIRONMENTAL HEALTH SERVICES ............................................................. 67

POLICY 6: HEALTH EDUCATION AND PROMOTION........................................................... 69

POLICY 7: REPRODUCTIVE HEALTH & FAMILY PLANNING............................................... 72

Child Health Services & Expanded Program of Immunization (EPI):..................... 74POLICY 8: DEVELOPING PARTNERHSIP IN HEALTH DEVELOPMENTS: ............................ 77

3.0. DISCUSSION ON IMPEDIMENTS/ DIFFICULTIES / ISSUES: .......................................... 80

Compiled by Dr George Malefoasi (Undersecretary Health Improvement) and Mr. AbrahamNamokari (Director Policy and Planning), Ministry of Health.Copyright @ 2004


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I. Preamble:

The draft Report on Health Activities and Outputs for 2003 provides some basic information on the

evaluation on the health inputs or resources and the outputs or (the deliverables). The report alsoprovides the Government information of the achievements and constraints in 2003. Unfortunatelythe limitations of the report are the unavailability of some update information on health events andindicators. Nonetheless, the report is comprehensive enough in identifying some gaps between thedemand and supply of health services.

In general the report has identified areas of improvement in the past years as by end of 2003.Obviously there are also areas of weaknesses within the health sector, which need specific as wellas general multi-sectoral concerted strategies and solutions.

The indicators for the key eight broad health policies were reviewed by end of 2003. In short, there

were outputs, which has positive impact on the population health, whilst there were constraints thataccentuated weaknesses of the existing system.

A paramount output for the Ministry of Health is the development of the National Health Plan 2004-5, which entails the future directions and strategies and plans for the next twenty months.

The Health Institutional Strengthening Project funded by AusAid has impacted positively in buildinglocal capacity at the national and provincial levels in management and supervision issues such asplanning, budgeting, resources management, coordination and communication.

This report will be complemented in detail by the National Health Review 2004 currently in

progress.

Dr George Manimu Hon. Benjamin P UnaPermanent Secretary Minister of Health


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1.0. Introduction:

This report is about measuring the outputs whether achievements or constraints by end of 2003. It

also inform the Government and other key stakeholders new developments in health as well asemerging diseases such as the SARS and cancer of lungs due to smoking..The main body of the report concerns with the review of indicators for the key broad eight policiesadopted and implemented to ensure that population health has improved in the past five yearperiod 1999-2003.The report covers recent researches findings, which helped in appraising the situation of thepopulation health.The report also attaches the approved list of hospitals and clinics by end 2003.

1.1. Vision and Mission:

This is an opportunity to reiterate the Solomon Islands Governments vision for the health of ourpeople and the mission in achieving the best health outcome.

Vision Statement:

At the Ministry or sectoral level it clear that:

The Ministry of Health endorses the World Health Organization Constitution that it is the

fundamental right of every human being without distinction to race, gender, religion,political belief, and economic or social condition to enjoy the highest attainable standard

of health. In that context and through its efforts in the delivery of care, the Ministry of

Health has a vision of A healthy and productive Solomon Islands.

Mission Statement:

The mission set to achieve the vision of the Government is also clear at the Ministerial level, whichform basis for other national plans and strategies such as the Medium Term Development Strategy(1999-2003)1, an the recent National Economic Recovery, Reform and Development Plan (2003-

2006)2

.

The Ministry of Health aims to provide a high quality national health system that is

accessible; appropriate; responsive; and equitable. It must also continually upgrade that

1 SIG ( 1998): Medium Term Development Strategy (1999-2003) : Ministry of National Planning and Development ,Honiara.2

SIG (2003). National Economic Recovery, Reform and Development Plan. Department of National Reform andPlanning, Honiara.


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system to achieve its Mission of Promoting, protecting, and maintaining the goodhealth and well being, and hence improve the quality of life of all people in Solomon

Islands. The Ministry will do its best to fulfill that mission within the context of national

health legislation and within the limits of resource availability.

In the National Economic National Economic Recovery, Reform and Development Plan (2003-2006), the mission is to reduce health inequalities, and infant and maternal mortality.

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

There have been significant socio-political developments since the Independence in July7th 1978 that had impact on the primary health care systems.

STAGE I: 1978-1989Solomon Islands became Independent Nation Provincial Government System adopted.

Decentralization of health care services administrationNational Census

STAGE II: 1990-2000Natural DisasterCylcone Namu hit Solomon Islands

Re-centralization of health care system administrationMalaria hits the highest level in 1992. Honiara the malarious town in the world.

Public Services Policy and Structural Policy emerged for the first time ever.STAGE III: 1990-2003

Ethnic Tension/ PHC CrisisNational Census

RAMSI

National Recovery PlanReconstruction S/PHC-Re-establishment of PH services-Post-conflict

1.3. Health Status:

The general health status indicators for the people of Solomon Islands have been stable throughout the past five years (1999-2003).

Nonetheless, the infant and maternal mortality remains high. Annual growth and death rates arealso high by international standards.It has been evident that the ethnic conflict has caused devastating effect on the social servicessuch as health. This is shown in the service delivery indicators to the provinces. The immunizationoverages have been low below 80% in general (1999-2002). Outreach services were low and poorhealth infrastructure despite an increase of the number of health facilities by end of 2003. Therehas been an increase of malaria incidence by 19% by end of 2003. Sexually Transmitted Infectionshas been reported to be increasing. The threat of HIV/AIDS epidemic has been eminent should


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

1.3. Health Indicators by end of 2003:

Indicators 1996 1997 1999 2003

Number of health

facilities

256 252 247 275

Total Population 410,368 425,4

88

409,042 464,89

8

Population


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live births (1999)[4]

Life Expectancy-

Male: Female

Na Na M-63.6

F-67.4

(2002)[2]

Total Fertility rate 4.7

[5]

4.7 4.7 4.05

[6]

% Family Planning

Coverage

7.7 8.5 8 10

[3]

% Antenatal Coverage 74.4 68.9 84.0 77.2

% Postnatal Coverage 36.6 39.9 44.3 41.2

% Detected malnutrition 1.6 1.5 1.1 1.4

Touring Satellite Clinics 2,309 2,068 1,655 Na

Touring Schools 890 720 509 Na

Village Health Meetings 1,600 1,767 1,907 Na

EPI - BCG (%) 58.1 % 69.4

%

69.4% 79

- Measles (%) 63.8 % 65.2

%

65.2% 69

- DPT3 (%) 71.9 % 68.6

%

68.6% 73

- TT2 + Booster(% 56.1 % 54.8

%

54.8% 56

- Polio 3(%) 69.0 % 69.2

%

69.2% 70

- Hepatitis B 3(%) 68.3 % 69.6

%

69.6% 78

- DPT1 / DPT3

drop out(%)

4.6 % 5.3 % 5.3% Na

- BCG / Measles

drop out

- 9.8 % 6.0 % 6.0% Na

Note: Data for 2003 is incomplete at the time of writing the report.

Key sources of data/ information: [1] WHO Annual Report 2003,[2] WHO Annual Report 2002 [3] Reproductive Health Division, MOH, [4]NationalCensus 1999, SIG, [5] WHO Annual Report 1999, [6] The Work of WHO in the Western Pacific Region Report 2001-2002.


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2.0. Process and Output Evaluation of the National Health

Policies 1999-2003:

Policy 1: Improvement Of Health Service Planning, Management and Supervision.

1.1.Overview:

1.1. Objectives:

To develop efficient and effective organizational health structure within the plan period.To improve networking and coordination of major public health divisions in particular, nursing,Disease Prevention & Control Center, SIMTRI, Health Education Divisions.To improve and strengthen the National health Information and Planning Division of MHMS.To improve management and planning capabilities of heads of divisions within the plan period.To improve monitoring and evaluation of health services.

1.2. Performance Indicators:

Fully documented and implemented structureImproved integration and coordinationImproved planning documented at National, Provincial and Program levelsImproved Monitoring and EvaluationProfessional Staffing

1.3. Outputs-Achievements & Constraints:

Outputs (or Deliverables):

1.3.1 A key development in the health sector in the past two years since 2001, is the healthinstitutional strengthening (HISP) continued through the Phase 1 (2001 to September 2003)


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and 2 (September 2003 to August 2004) of the HISP funded by AusAID3. A report that entailsthe detail outputs of the HISP is attached4.1.3.2. Communication further strengthened through two National Conferences held in April andNovember 2004 respectively. The first meeting was held especially to review the staffing andhealth activities against the limited funding from the Health Sector Trust Account (HSTA)funded by the AusAID. The Solomon Islands funding was never accessed.

1.3.3. The National Health Policies and Development Plans were implemented satisfactorilydespite significant difficulties as result of the two years ethnic tension.Basic and minimal services continued to be provided by the Solomon Islands Governmentthrough the direct budgetary funding support to the Ministry of Health.1.3.4. The Health Institutional Strengthening Project funded by the AusAID provided theemergency health financing of the health services as well as the capacity building to themanagement and supervision of the national and provincial health services.Improvement of the communication network with clinics begun in 2003 and is in progress. Thetotal of 45 new radios and support accessories such as terminals and solar installed at many

clinics. (A detail report on the outputs of the HISP can be obtained from MOH).1.3.5. Policy Governing Establishment of new Health Facilities completed in 2002implemented.1.3.6. A patient satisfaction survey was done in 2001 with the assistance of the HISP project,which helped to raise some key issues related to quality standard of care to the patients at thehospitals. The survey was carried out at the NRH Honiara. Some of the findings will be used inevaluating the workload and level of staffing, the operational structure and staff performancesat the hospitals.

Negatives: Limited output has been achieved in reforming or restructuring of the structure and the

function of the health sector. No implementation of the draft restructuring of the Nursing Structure Completed (HISP) in

2002. Non implementation of the revised doctors scheme of service approved in July 2002,

which provide strategies to retain local qualified specialist doctors.

1.2.1. Health Financing:

1.2.2. Objectives:

To contain production cost at the Central Hospital, National Referral Hospital below 40% of totalhealth expenditure by 2003.To recover 50% of the production cost at the Hospitals within the plan period.

3Health Institutional Strengthening Project (HISP) funded by AusAID, Ministry of Health (2003)

4 HISP (2004). Annual Report February 2003-February 2004: Prepared for the HISP PCC Coordinating

meeting 15th

April 2004.


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To raise revenue collection at the NRH from 0.06% in 1994 to 25% of the health budget to NRH by2003.To increase in terms of nominal budget allocation for prevention and promotive health serviceswithin the plan period.

1.2.3. Performance Indicators:

Annual NRH Expenditure.Annual Health Budget [Estimates)Annual Revenue Collection by NRHBudgetary allocation to preventive and promotive health services

1.2.4. Outputs-Achievements & Constraints:


1.2.4.1 New Accounting System establishedMYOB (HISP) fully implemented.1.2.4.2. Resource Allocation Formula implemented in the 2003 budget.1.2.4.3. Embassy of Republic of China approved a Primary Health Care Rehabilitation Project tore-establish primary health care activities in the provinces. Total of SBD 5.2 M given anddeposited into the HSTA account.1.2.4.4. Sources of revenue for the health services delivery were obtained from the World Bank,

AusAID, and ROC.1.2.4.5. National Referral Hospital contained its service cost well below their acceptable level. The1.2.4.6. NRH spend below 26% of the total Health Recurrent for 2003.

Negative;

Revenue collection at the NRH remained low below planned 25% of the NRH 2003budget. Partly because the Revised Fee Schedules approved by Cabinet in 2002 wasnever implemented. This is it was not gazzetted.

1.3.1. Health Information System

1.3.2 Objectives:

To increase timely clinic reporting coverage form the current level to 100% by 2003

To design and implement a comprehensive HIS for SI within the plan period.To establish a 100% computerized hospital information system in the NRH by 2003.To extend this system to the 6 provincial hospitals, and 2 church hospitals by 2003.

1.3.3. Performance Indicators;

Clinic reporting coverageImplemented Comprehensive HIS


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Implemented computerized hospital information systemExtended computerized system in provinces



1.3.4.1. Health Information System- monthly clinic reporting from all clinics in the provincesand HCC continued despite a low coverage still.

1.3.4.2. Disease surveillances systems for TB, Psychiatry, Diabetes, STI/HIV, and Malaria. 1.3.4.3. Database for Reproductive Health programs completed and piloted in 2003. 1.3.4.4. HIS computerized system updated from windows 3.1 to Microsoft 2000.

Issues and Constraints:

HIS Monthly reporting response still low at 60-70%5

. Establishment of the Hospital Information System never been implemented due to failure

by the private consultant. The computerized Health Information System systems is under the process of

upgrading thus HIS data for 2003 is not available at the time writing this report.

Policy 2: Accessibility, And Improvement Of Care And Quality Of Services.

Rural peoples accessibility to basic reasonable primary health care services is a priorityimportance as 80% of the population lives in the rural areas. Steps are envisaged to consolidate

existing health facilities (not to construct new ones) and to increase utilization, because of thelimited resources. Staff training and community motivation is vital.

2.0. Policy Statement:

It is the constitutional right of each individual of the community to have access and equity to aminimum reasonable quality of health care, and essential medicine, and other public healthservices. (Health For All Strategy).

2.1. Curative Health Services:

2.1.2. Objectives:

To improve doctor to population ratio from 1:7031 in1995 to 1:4500 by 2003.To improve nurse to population ratio from 1:836 in 1995 to 1:500 by 2003.To improve nurse aide to population ratio from 1:1208 in 1995 to 1:800 by 2003.

5HIS Clinic Monthly Reports, Statistics Unit, MOH


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To improve hospital utilization rate in the provincial hospitals from 45-65% in 1995 to 90%by 2003.To improve hospital utilization rate at the National Referral Hospital (Central Hospital) from 70% in1995 to 80-90% by 2003.To increase self-reliance specialist care in 2 major provincial hospitals (Kiluufi and Gizo) to reducenumber of referrals by 50% by 2003.

2.1.3. Performance Indicators.

Doctor to Pop. RatioRegistered Nurse to Pop. RatioNurse Aide to Pop. RatioHospital utilization RateNo. Of referrals

2.1.4. Output-Achievements & Constraints:


2.1.4.1. Total 8 hospitals were fully operational. 2.1.4.2. Medicine supplies to the clinics and hospitals improved more than the 2002. 2.1.4.3. Ongoing training for nurses continued overseas and locally at the SICHE and the

HISP management courses. 2.1.4.4. Five (5) new graduates in the filed of Midwifery to the provinces. 2.1.4.5. By end of 2003, there were total of 1,091 nurses6 (both established and direct

employed nurses in the provinces) with a Nurse: Population Ratio of 1:419 as compared to1999, which was 1:836 in 1986.

2.1.4.5. Tertiary or sub-specialist care of paediatrics surgery, eye, ENT, radiology, andinterplast have been provided locally through the Pacific Island Project (PIP) Phase 2executed by Royal College of Australasia Surgeons (RACS)7.

Issues and Constraints: Access to doctors and nurses by the communities was low than the planned ratio by 2003.

Firstly, capacity of the School of Nursing at the SICHE could not allow for increase intakesbecause limited resources. Secondly, the graduates from other school (Atoifi NursingSchool) has never been formal part of nursing training for the whole country.

Migration of health professionals of the country away to neighboring countries has beenobserved to accentuate the gap. In the past 12 months more than 5 nurses have moved

out to Marshall. Twenty percent (20%) of the national doctors seek jobs outside thecountry8. This is a significant problem for the government to address. The plan to upgrade the Gizo and Kiluufi Hospital in sub-specialist hospital did not

eventuate because of limited resources.

6HISP/ Nurse`Advisers Report (2003)

7PIP/ RACS

8 G.Malefoasi & I.Avui (2003).Migration of skilled health professional: Country Report: Solomon Islands,

May.


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2.2.1. Medical Services:

2.2.2. Objectives:

To upgrade the Level of Service (LOS) at NRH to LOS 3 by 2003.To upgrade Level of Service at Gizo & Kiluufi Hospitals from LOS 2 to LOS 3 by 2003.To upgrade Level of Service in Makira, Isabel, Temotu, Choiseul from LOS 1 in 1998 to LOS 2 by2003.To increase the bed capacity in the 6 government hospitals to 80% BOR by 2003, in order toincrease hospital utilization rate without increasing the number of beds.To have at least two doctors permanently stationed at the 4 smaller provincial hospitals (Buala,Lata, Kirakira, Tulagi)

2.2.3. Performance Indicators:Level of Services (LOS)Bed Occupancy Rate %Hospital Utilization RateDoctors posting in the province

2.2.4. Outputs/ Achievements & Constraints:


2.2.4.1. Medical specialist services was provided to the provinces through the specialist

referral system between the NRH and the provincial hospital. In 2003 a consultantphysician was recruited from India under the Local Supplementation Scheme funded byNZODA and the SIG.


At this stage at the time of writing the report, unavailability of proper hospital informationdata from all hospitals limits the ability to evaluate the productivity and efficiency of thehospitals.

All hospitals are not evaluated against their designated roles under the Policy Guiding theRole Delineation to hospitals because of lack of a comprehensive hospital data and

information system. However, it is anticipated that data for this purpose should becollected as part of the 2004 National Health Review, which is in progress.

Thus, this report is not able to report comprehensively on outputs of the rest of this policy,which covers Surgical, Obstetrics, Child health services and (paediatrics).

2.6.1. Accident & Emergency Services:

2.6.2. Objectives:


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To have at least one nurse specialist in Accident & Emergency at the NRH by 2003.To train one local doctor in specialist Accident & Emergency at the NRH by 2003.

2.6.3. Performance Indicators:No. Of nurse specialist in A&ENo. Of doctor specialist in A&E



2.6.4.1. A post-trauma course was held in 2003 and some nurses from the A& Edepartment attended.

2.6.4.2. A registrar of the AED attended a short term attachment training with theEmergency Department of the St.Vincent Hospital, Melbourne with the assistance of theRE Ross Funding by AusAid through Royal Australasian College.

2.6.4.3. In Honiara alone, road traffic injuries account for 0.2% to 2% of the total casualties(trauma or injuries) recorded at the Accident and Emergency Department of the NationalReferral Hospital from 1996 to 2003 (a period of 8 years). Of the total casualties or traumacases, between 3.3% to 27.3% of the Road Traffic Injuries were fatal (or dead).

2.6.4.4. Looking at the trend in the past eight years (as of 1996 to 2003) in Honiara, at-least an average of 65 cases of injuries related to Road Traffic Accidents, and of theseRTA, an average of at least 2 people suffering from RTA died. Not many people includingpoliticians are fully aware of the magnitude and severity of the road traffic injuries. Healthand social impact of road traffic crash has been studied and concluded to be numerousand significant. Patients who sustained and survived road traffic injuries stayed longer inthe hospital with a mean length of stay around 20 days. These patients are also thefrequent users of operating theater, x-ray and physiotherapy departments for operations, x-rays, physiotherapy and rehabilitation. Whilst there are medical costs and lost productivity,the psychological losses associated road traffic accidents, either to those injured or to theirfamilies are often undermined. Many patients suffer longer-term disabilities.

Table: Road Traffic Injuries or accidents recorded at the NRH 1996-2003:

Year Numberof RTinjuries

% of total injuries due toRT accidents

Total OPDAttendances

Modifiedtrauma fig-10% of theTotal OPDattendeesweretrauma/injury

ALL

No.Deaths

Deathrates dueRT

Accidents(%)

1996 112 1.93 58,111 5,8111997 117 2.10 55,798 5,580


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1998 59 1.18 50,000 5,000

1999 91 1.82 50,000 5,000 3 3.32000 79 1.58 50,000 5,000 3 3.82001 11 0.22 50,000 5,000 3 27.3

2002 20 0.40 50,000 5,000 2 10.02003 29 0.58 50,000 5,000 2 6.9Total 518 1.25 413,909 41,391 13 2.5

Averageper year

65 51,739 2

Source: Medical Records: NRH

2.7.1. Access to Essential Medicines:

2.7.2. Objectives:

To ensure that essential drugs are always available in 90-100% of rural clinics in a year for withinthe plan period. In particular reliable and adequate supply to rural health care facilities.


Availability of essential drugs at the rural clinicsNo. of trained pharmacy officersLegislation reviewed

2.7.4. Outputs-Achievements & Constraints:Outputs (or Deliverables):

2.7.4.1. National Drug Policy completed and endorsed. 2.7.4.2. Scheme of services for the pharmacy officers and assistants accepted by PSD

and gradings revised accordingly. 2.7.4.3. Medical supplies to the clinics and hospitals improved. 2.7.4.4 EPI committee formed to boost the EPI campaign in 2003. 2.7.4.5. Two (2) additional pharmacists graduated. 2.7.4.6. Health Sector Trust Account funded by AusAID has provided direct budgetary to

pay for the medicines. 2.7.4.7. By end of 2003 all clinics and hospitals are supplied with the basic and routine

medical supplies. 2.7.4.8. Clinic supply kit fully implemented in 2003.


Vacancy of Chief and Principal Pharmacist posts since 2002


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National Pharmaceutical status not fully surveyed (due 2004) No implementation plan for Essential Medicines Policy (will follow survey) Regulatory Affairs section understaffed and under-trained Shortage of trained technical officers POC course being restarted in 2004

Poor IT tools for inventory management and medical supply (upgrade due in 2004) Lack of Pharmacy Board meetings to ensure professional standards Lack of attention to upgrading the poisons list and related schedules No officer to focus on research and development in rational use of medicines

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

appropriate for our current needs.

2.8.1 Access to community health services through Primary Health Care:

2.8.2. Objectives:

To have 123 clinics staffed by at least one registered nurse, and a nurse aide at all times in a year,by 2003.To have 61 Nurse Aide clinics staffed by a nurse aide at all times in a year, by 2003.

2.8.3. Performance Indicators:No. of registered nurses and nurse nurses posted at the clinics

2.8.4.Outputs-Achievements & Constraints:


2.8.4.1. All clinics opened. 2.8.4.2. Community nursing re-established at all primary health care centers.

2.8.4.3. By end of 2003, total of 561 nurses (RNs and Nurse Aides) are placed at theprimary care centers (ie. clinics), whilst 533 nurses are placed at secondary care centers(at hospitals). Total of 1,091 nurses are recorded, with a Nurse:Population Ratio of 1:419

2.9.1. Health Infrastructure Development:

2.9.2. Objectives:


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Province Repair/Renovation

13 2.Vakobo Done14 3.Falamae RHC 15 4.Kolokolo RHC Done16 5.Cheara RHC 17 6.Poitete RHC 18 7.Nila RHC Done19 8.Vonunu RHC 20 9.Emu

HarbourRHC

21 10.0Keru Done18 Malaita 1.Masupa RHC Maintenance/

Repair/Renovation

19 2.Manawai RHC Done20 3.Olomburi RHC Resiting/Extension

Done

21 4.Rara NAP Maintenance/Repair/Renovation

22 5.Afenaba Done23 6.Afio Done24 7.Anomasu Done25 8.Ataa RHC 26 9.Gounatolo RHC Done

27 10.Bitaama RHC Done28 11.Hauhui RHC 29 12.Maluu AHC Done30 13.Rohinari RHC Done31 14.Kiu RHC 32 15.Gwarata Done33 16.Nafinua Done34 17.Ote Done35 Guadalcan

al1.Doma AHC Resiting/ New

36 2.Aola RHC Resiting/New

37 3.GP/HQ/clinic

Clinic Maintenance/Repair/Renovation

Site to beidentified

38 4.Saro Done39 5.AvuAvu RHC Proposed to ADB40 6.Turarana RHC 41 7.Malatoha RHC To be resited at

Konga


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42 8.Kolosulu NAP 43 9.Grove Done44 10.Tasimboko Done45 11.Marara Done/New46 12.Marau AHC To be rebuilt in

2004 by WorlBank project-SIHSDP

47 13.Biti NAP Proposed for ADB

48 14.Fox Bay NAP Proposed for World Bankproject/ SIHSDP

49 Isabel 1.Momotu NAP50 2.Nagolau NAP

51 3.Sigana NAP Done

52 4.Vulavu RHC 53 5.Tataba AHC 54 6.Toelegu Done55 7.Kalenga RHC 56 8.Poro 57 9.Susubona RHC

10.Kolomola RHC 58 11.Moloforu RHC 59 12.Samasodu RHC

60 13.Baolo RHC 61 14.Bolotei AHC Done/ upgraded62 15.Guguha RHC 63 16.Nodana Done64 Makira 1.Houpala AHC Maintenance/

Repair/Renovation

65 2.Aorigi Done66 3.Arinagana RHC 67 4.Herainuu Done69 5.Marouvu RHC

70 6.Mamuga RHC 71 7.Kirakira

TrainingCenter

TrainingCenter

72 8.Hunuta Done73 9.Manasugu Done74 10.Waihaga Done75 Temotu 1.Manuopo AHC


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76 2.Tukutaunga RHC 77 3.Anuta Done78 4.Tikopia Done79 5.Nea/Noele Done80

CIP1.Yandina AHC Maintenance/

Repair/Renovation

81 2.Leitongo RHC82 3.Panueli RHC 83 4.Koela Done84 5.Maroloun Done85 6.Koilovala Done86 7.Borohinaba NAP 87 8.Salesapa NAP 88 9.Ravu Done

89 10.Narogu Done90 11.Toga Done91 12.Dende NAP 92 RenBell 1.Tingoa RHC Maintenance/

Repair/Renovation

Done

93 2.Tengano RHC 94 3.Nuku RHC

TOTAL

2.9.4.4. There has been an increase in the number of PHC facilities (clinics-AHC, RHC and

NAP) by end of 2003. By end of 2003 there are additional 49 PHC clinics (excludinghospitals) (i.e.20% rise). There are many more AHC (30% increase) as compared toRHC (25% increase) and NAP (20% increase)

Table showing number of health facilities in 1999 as compared to 2003:

All Hospitals Area HealthCenters

RuralHealthClinics(RNs)

NurseAid Posts

TotalPHCexcludinghospitals)

(2003)9 9 30 119 157 296

(1999)10 9 23 95 129 247% increase 0 30 25 22 20

Annex Table 1 shows the list of approved clinics by end of 2003.

9Health Institutional Strengthening Project (MOH) update on approved health facilities( Hospitals, Area

Health Centers, Rural Health Clinics and Nurse Aid Posts, 2003.10 National Health Report Review, Ministry of Health (1999) in page 13: Sector 2: Types of services:

Table: The Health Care Referral System.


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2.10.1. Dental & Oral Health Services:

2.10.2. Objectives:

To increase the preventive dental health services in the next five year


No. Of health education activitiesNo. Of advocacy activitiesNo. Of school visits


2.10.4.1 The number of dentist increased from 3 to 15 in the past five years. By end of2003, another 4 graduated from the Fiji School of Medicine.


Only 2 of the 15 dentists are posted in the provinces (one each to Gizo and KiluufiHospitals). Major constraint faced at the provinces is lack of housing for the dentists.

2.11.1. Ophthalmology & Primary Eye Care Services:

2.11.2. Objectives:

To reduce the national blindness rate to less than 0.5% by 2003.To upgrade the Level of Service (LOS) from LOS 4 at the National Referral Hospital in 1998 toLOS 5 by 2003.To upgrade LOS at Gizo and Kiluufi Hospitals from LOS 2 to LOS 3 by 2003.To have another local doctor qualified in ophthalmology by 2003.To train one more local doctor by 2003.To increase the number of nurses trained in ophthalmology from---in 1998 to ---by 2003.2.11.3. Performance Indicators:


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National Blindness Rate %LOSNo. of nurses trained in Eye specialty

2.11.4.Outputs-Achievements & Constraints:


2.11.4.1. Primary Eye Care services continued despite no eye specialist in the country. 2.11.4.2. Primary eye care was maintained by the local Eye Nurses at the NRH and the

provinces. 2.11.4.3. Specialist eye care services received through two Eye visits from Australia

through the Pacific Islands Project by RACS and funded by AusAID. 2.11.4.4. The primary eye care services has been maintained the local eye nurse

practitioners whilst there are no eye doctor. 2.11.4.5. The Pacific Islands Project (PIP) funded by AusAID and executed by Royal

College of Australasia Surgeons (RACS) assisted in both stop gap and maintain eye careto support the primary eye care nurses.

2.11.4.6. The Prevalence Rate for diseases of the eye stands at 17.7 per 1,000 population,whilst the incidence rate stands at 7.6 per 1,000population from 1999 to 200311.

Table below shows the indicators for Eye infections recorded by the Eye Dept. of NRH

1999 2000 2001 2002 2003

ALL(new & old) 7,944 5,826 6,762 7,433 10,311

New 3,539 2,737 3,375 3,042 3,858

Major 554 353 427 432 380Int 150 45 39 24 35

Minor 84 97 129 23 25

Total surgery 620 495 595 479 440

Population 409,042 420,856 4 33,035 445,591 457,153

Incidencerate/1,000pop

8.7 6.5 7.8 6.8 8.4

Prevalencerate/1000 pop

19.4 13.8 15.6 16.7 22.6

Cataract surgicalrate calculated byEye Unit

359 496 484 268

Average Prevalence 19.4 13.8 15.6 17.722.5

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

2004)


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rate/1000pop

Average incidencerate/1000pop

8.7 6.5 7.8 7.68.4

2.11.4.2. Issues and Constraints: Since 2000 Solomon Islands was without a consultant eye specialist. The local eye

specialist and the registrar left the country because of the ethnic tension. Most majorsurgeries are carried out by the visiting Eye Specialist Teams from overseas particularlythe EYE PIP (Pacific Islands Project) funded by AusAID and executed by RACS.

(Unfortunately the data on blindness rate is not available at the time of writing the report).

2.12.1. Diagnostic Services at Hospitals:

2.12.2. Objectives:

To establish and develop network of Medical and Health Laboratory Services in support of PrimaryHealth Care by 2003.Expansion of Provincial hospital establishment;Kiluufi - from 3 technicians in 1998 to 4 by 2003Gizo-From 2 technicians in 1998 to 3 by 2003 Lata, Kirakira, Buala- To have at least 1 technicianand 1 medical laboratory assistant (MLA) by 2003.Tulagi- To have 1 post by 2003Sasamuga- Upgrade post to technician level by 2003


Posting of technicians in the provinces



2.12.1. Pilot Tele-pathology project completed. Draft report available. 2.12.2. All provincial hospital laboratories were staffed. 2.12.3. Relatively a wide range Laboratory testing are done. This includes HIV/STI testing,

Biochemistry, Haematology, and Serology. Highly specialist testings are done through thearrangement with the Royal Brisbane Hospital under the Queenslands Pathology ServicesSystem. Specimen are sent for analysis in Australia.


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2.12.2. Issues and Constraints: Human resource objectives for the diagnostic services to the provinces was not achieved

as planned. The reasons are lack of training opportunities for undergraduates because offinancial constraints, and suspension of recruitments.

Basic laboratory testing supplies were also short during the crisis period. The problem hasbeen slowly resolved. Change in the ordering and procurement process has been noted tobe having an effect but this issue is been discussed and solutions reached.

(Details on the testing not available at the time of writing this report).

2.13.1. Rehabilitation Services:

2.13.2. Objectives:

To increase the quality and quantity of services provided to all known or registered people withdisability in the country.

2.13.3. Performance Indicators

No. Of people with disability registered in CBR database.No. Of activities and programs organized for people with disability and respective stakeholders.

2.13.4. Achievements:


2.13.4. First Draft of the Disability Act completed.

2.13.4.2. Issues and Constraints:

Draft Disability Act not followed up into a bill to be passed by the parliament.

Policy 3: Human Resource Management And Development For Health

3.1.1. Objectives:

To develop a workforce plan based on the needs, and implement 75% of its programs by 2003.To increase the proportion of qualified skilled health workers at the provincial levels from 40.5% in1999 to 60% by 2003.Increase training opportunities in health promotion and preventive health within the plan period.


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Implemented training programsProportion of qualified skilled health workers at the provincesNo. of training in health promotion and preventive health services



3.1.4.1. Check list for selection of nominees from departments, drawn up by the Training &Fellowship Committee (TFC), Ministry of Health.

3.1.4.2. Training Plan for 2004-5 was drawn up and endorsed by the TFC/MOH. 3.4.4.3. Draft Training Policy Guideline was developed by FTC/MOH. 3.4.4.4. Total 80 candidates health staff were accepted by the FTC for training 2003. Fifty-

three percent (53%) (i.e.42) were successful in being sponsored. Twenty-nine health staffsuccessfully graduated end of 2003.

3.4.4.5. Training Plan for Psychiatric nurses continued. 3.4.4.6. Implementation of the training for doctors (postgraduate) continued. Ten doctors

trained into different specialties continued. One graduated end of 2003 as a specialist inobstetrics and gynaecology (Dr K Bisili).


Lack of integration of training for the health workforce with the National Training Unit of the

Ministry of Education and Human Resource Development. Lack of proper training needs assessment for the undergraduate for medicine and all other

health related disciplines.


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Policy 4: Morbidity And Mortality Reduction

4.0. Overview:

Most indicators in this sector concerns with the health outcomes measured in rates.The common uses of the indicators are:-

Evaluate the impact of control measures aiming to at reducing the morbidity (illnesses) andmortality (deaths) due to the common diseases in the country as well as emergingillnesses.

Measure the workload on health facilities due to the common diseases. Allocate resource to different treatment; and Evaluate different interventions and control programs.

However, due to lack of proper and timely data and information, the depth of the evaluation is notcomplete. Nonetheless, the available information and data has significant lessons and evidence to

improve the public health programs, the primary health care, the management and supervision.

It is also important to note here that the objectives were set back in 1999 when the national healthpolicies and plans were developed.

As the indicators are reviewed in light of the National Health Policies and Development Plans,other universal indicators are closely monitored locally. Indicators of Millennium DevelopmentGoals (MDGs), the International Conference on Populations and Development (ICPD) Goals andthe World Health Organizations targets for different disease control programs.

4.0.1. Policy Goals:

To decrease the transmission, morbidity and mortality due to the priority health problems.To prevent or delay onset of the non-communicable diseases, including reduction in occupationaldiseases, in order to maximize disability-free and productive lives in older age.To promote environmentally sound practices and technologies for the effective prevention andmanagement of environmental health-related disease and disability.To enhance people's quality of life by preventing disability, including blindness and deafness, andby rehabilitating the handicapped, infirm and disabled.


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To ensure the rights of everyone to enjoy a good quality of life, and to promote equity in access toresources necessary for optimal health.

4.1.Malaria:

Overview:

Malaria infection in the country rose by 19% in 2003. The reasons attributed to the increase are asfollows; Firstly the environmental factors such as soci-economical status of the country in the pastthree years derailed communities from the momentum to protect themselves from malaria.Secondly, due to the significant reduction in the intervention programs in all provinces becausediminished funding, resulting in shortage of larvicidal chemicals for spraying, and decliningmosquito treated bed use through out the country. Thirdly, there was limited malaria awarenesscampaigns for communities to prevent malaria in their areas.

4.1.2. Objectives:

To reduce malaria incidence rate from 160 cases per 1000 population in 1997 to fewer cases lessthan 80 cases/ 1000 by 2003.To increase the insecticide treated bed net coverage from 70% end of 1997 to 95% of thepopulation by 2003.To improve diagnostic services (microscopists coverage) to all provinces by 2003.


Malaria Incidence RatesBed net coverage Rate

Number of Malaria microscopy facilities in provinces



4.1.4.1. Renovation of Solomon Islands Medical Training Institute was completed in 2003. 4.1.4.2. The Revised Malaria Treatment Policy was completed, which re-introduced

primaquine in a safer dose to treat Malaria-PV malaria infections. 4.1.4.3. The main activities implemented during 2003 were:

i) Bednet distribution and retreatment

ii) Residual sprayingiii) Larvicidingiv) Health educationv) Mass Blood Survey (MBS)vi) Source reductionvii) Community participation


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4.1.4.4. Continued support from WHO, Rotary and AusAid Trust Fund ensured that controlactivities were selectively supported. These activities included|: management ofantimalaria drug policy including training for nurses and health workers, bednet distributionand retreatment, residual house spraying, monitoring workshops for Guadalcanal andMalaita; microscopy training for 3 provinces.

4.1.4.5. Implementation of the new antimalaria drug policy; 4.1.4.6. Implementation of the Global Funds for Malaria programme initiated 4.1.4.7.Technical working groups for drug policy, vector control, monitoring and community

development/health promotion established.


Malaria incidence rate rose by 16% from 168 per 1,000 population in 2002 to 200 per 1,000population. This indicator signifies the negative impact of the ethnics crisis and the poor economicsituation. The Vector Borne Disease Control Programme has faced insurmountable problems in2003 and the result could be seen from the provincial malaria epidemiology and situation.Problems faced by the Programme include the following: administration, socio-economic, financialand technical obstacles. The seriousness of each problem varies with each province. Howeverwith all the problems faced the VBDCP had managed to suppress malaria and did not allow it to gouncontrolled.

Indicators 2002 2003 % Change

No. of patients tested for malaria 278,261 297,897 7% increaseNo. of confirmed cases 74,865 91,606 18% increase

No. ofPlasmodium falciparum positivecases 50,105 64,302 22% increase

No. ofPlasmodium vivaxpositive cases 24,736 27,234 9% increaseNo. of admissions due to malaria 1887 1344*No. of deaths 61 41*No. of nets treated per year 79,538 55,435* 30% decreaseNo. of persons protected by house spraying 18,899 32,213 41% increase

Annual incidence rate per 1000 population 168 200 16% increase

* excluding Choiseul, Central and Makira-Ulawa provinces as no reports were received

4.2. Acute Respiratory Infection:

Overview:

Acute respiratory infection has been a common cause of outpatient attendances in all provinces.

4.2.1. Objectives:


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back positive for Influnzae type A (H3)12. Therefore the ARI outbreak is most likely due toInfluenzae A. This is the same type found in Australia and New Zealand.

Other update data analysis on ARI in progress and not available at the time of writing the report

4.3. Malnutrition:

4.3.1. Policy Statement:

The National Nutrition Survey of 1989/90 revealed that malnutrition is a problem of children andwomen, with 23% of children being underweight, 7% women underweight and 39% overweight(obese). Vitamin A deficiency is evident to be increasing and related to Malnutrition in children.

4.3.2. Objectives:

To reduce the proportion of children under weight from 23% in 1989/90 to less than 10% by 2003.To reduce the proportion of women underweight from 7% underweight to less than 5% by 2003.To reduce the proportion of women overweight from 39% in 1989/90 to less than 10% by 2003.

4.3.3. Indicators:

Proportion of children reported under weight %Proportion of women reported underweight %Proportion of women reported overweight %


Integrated in the IMCI approaches

Other update data analysis on Malnutrition in progress and not available at the time of writing thereport

12Report by Mr Andrew Darcy, Senior Medical Laboratory Officer, NRH.


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4.4.0. Diarrhoeal Diseases:

4.4.1. Objectives:

To reduce episodes of diarrhea from 3.5 per year in 1992 to less than 2.0 per year by 2003.To reduce deaths due to diarrhea from 1.7% deaths per 1,000 children per year to less than 1.0%by 2003.4.6.4. Indicators:

Episodes of diarrhea in children per yearDeaths due to diarrhea


No major epidemics recorded as compared to 2000.

Other update data analysis on Diarrohoeal Diseases in progress and not available at the time ofwriting the report

4.5.1 Diabetes (NCD):

4.5.1. Objectives:

To improve information (IEC production) in diabetes in the next five years.

To improve clinical management and treatment of diabetes in the next five years.To prevent disability due to diabetes through community awareness.

4.5.2. Indicators:

IEC production on diabetes.Clinical Management and Treatment Protocol fully documented and implementedImproved collaboration links with the community.No. Of diabetic cases per yearNo. Of diabetic foot ulcers reported

4.5.3.Output-Achievements & Constraints:

Introduction:


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In 200313, we managed to settle down but we still encounter some obstacle. NCD Program forexample, as the current coordinator of the program, I was attending Advanced Diploma at thecollege of higher education and at the same time, supervising the Program.Though attending the advanced course at the college had causes disturbance in the running of theProgram, however the program also achieved some of its activities. Some of the achievements areas follows-;

1. Attachment of three Provincial Diabetes Coordinator at New Castle DiabetesCentre.

2. Printing of Pamphlets for the Provinces funded by World Health Organization(WHO)

3. Supervisory tour to Isabel Province funded by Aus-Aid Trust fund.4. Launching of World Diabetes Day at the Market funded by Aus-Aid fund.

Like wise, the analysis of Diabetes will be included in this Report.

STAFF TRAININGS.

There is a need of Training for both the Provincial Diabetes Coordinators and National NCDcoordinator.In year 2002, Dr Bowen from New Castle Visit Solomon Islands. During his visit, we were lookingat ways on how we can improve diabetes program to work more efficiently and effectively. Some ofthe outcome result of the visit was, each year; we should be sending candidates for attachment atNew Castle in Australia.This year we already sent three Provincial coordinators for one-month attachment at New CastleDiabetes Centre. This process should be continues for next five year if things turn out rightly.Because, capacity building through training and workshops are the main component to increaseknowledge and skills of the health worker and program coordinators both at Provincial and at

National level.However, I was also attending Adv. Diploma in Nursing at the College of Higher Education sincelast year. This year I have completed the course and was graduated with required qualification. Inyear 2004, I should be attending Degree course at UPNG.

TRAINING OF THE DIABETES GIUDE-LINE.

Training of the guideline is a Task needed to be carried out. Out of all the provinces in the SolomonIslands, Choiseul, Makira Ulawa and Malaita are the only provinces that are yet to have workshopson the guideline. Letters and faxes were sent to training officers and diabetes Coordinator of eachProvince concerning training. Despite that no positive respond from them.

The provincial Management might blame the current situation that we were facing with ourfinancial, but that was not the fact. Under ROC Funding, the Ministry of Health had been allocatedmoney for each program.Otherwise, those provinces that still to have workshops on diabetes Guideline will be done laterdepend on the availability of funds.

13Non-Communicable Disease Unit, Disease Prevention and Control Division, MOH Report, 2003.


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WORKSHOPS.

Even though the NCD program manager was committed with other activities like attending courseat the College, dealing with student research etc., several attempts were made to negotiate withprovincial training officers of those whom that are yet to have workshop on the Diabetes Guideline.

As I have stated earlier on, there was no polite respond from them.However, because of no respond from them, the other alternative was to divert that moneyallocated for workshop for supervisory tour to Isabel Province. Again, it was funded by Aus-AidTrust fund.

WORLD DIABETES DAY

Each year on the 14th of November, everywhere in the world commemorates the world DiabetesDay. Moreover, every year world Diabetes Day has a unifying theme. Since 2001, emphasis hasbeen placed upon Diabetes complications. In 2001, we aimed to highlight the link betweencardiovascular disease and Diabetes, while in 2002 we focused on diabetes related eye

complications. This years Diabetes day theme is Diabetes and kidney disease, and our campaigntitle is Diabetes could cost you your kidneys: Act now!Marching from the NRH to the market was organized and various methods were used todisseminate information with emphasis on the Public at the Market. Health talks were the mainactivity conducted. A Week before that day, we were using SIBC for the dissemination of DiabetesInformation. Issuing of diabetes pamphlets and random blood screening were also done at themarket. More than five hundred people attending during the launching of the program and few newcases were detected.Diabetes Information were also disseminated to students doing science research project (SISC)and to other groups who wanted know about Diabetes, therefore including me in their program togive health talk like Mothers Union for instance

A diabetes song was also composed by one of the diabetes coordinators in the provinces. Not onlythat, Isabel province confirmed to us of their participations in launching WDD at their province.

Activities done on that day were diabetes awareness health talks, free blood screening, playing thediabetes SONG and so on.

PROVINCIAL TOUR:

This year 2003 I could only able to make supervisory tour to Isabel Province. The aim of the tourwas to assess the work of the provincial diabetes coordinator. Basically to look at theimplementation of program activities at provincial level especially with regards to diagnosing,

treatment strategies and more over to initiate an effective system of reporting so that we could beable to get correct diabetes data from the province and to ensure reports must be handed in ontime for compilation.For programs to work effectively and efficiently, supervisory tour must be done regularly to theprovinces.Provincial tours by the provincial diabetes coordinator to the clinics should be done twice yearly butagain it will depend very much on the availability of fund. Currently there shouldnt be any excusesfrom the provinces because already there were funds allocated for each activity in the provinces.


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Some provinces, Directors were willing to listen to or accept plans from coordinators and wouldnormally support them while others not regarded diabetes in their priority. After all diabetes wasemerging rapidly in our country.The outcome result of the supervisory tour was, reports have sent in at the right time and provincialdata will be included in this report.

DIABETES SITUATION:

In fact Diabetes in the Solomon Islands is on the rise based on the information received fromNational Diabetic Center alone. If we are to combine reports from the provinces, we could be ableto get a huge number of new confirmed diabetes cases detected each year. Unfortunately it doesnot eventuate as provincial coordinators are confused of what to do. Therefore there is a need forimprovement through quality of care through: -

1. Improving data collecting system.2. Training of staff at the hospital and Rural Health Clinics.3. Training of provincial diabetes coordinators and so fort.

However, all this activities need money. Because of that our reports will focus more only fromNational Diabetes Center source. Data from Isabel will also be included.

New confirm cases by age grouping (Annex i)

Chart 1 describes two different years, last year and this year. If we are to compare the graph, theirimplication is almost the same. Most of the newly confirmed cases are between the age of 31 and60. For year 2002 the mode was between the age 51 and 55 while in year 2003 the mode wasoccurred between the age of 46 and 50, the same as year 2001, which had a mode between theages 46-50.

Newconfirm cases by age group (2003)

Source Diabetes Centre

10

15

20

25

30

35

40

NoofCases

chart1


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Daily patient seen in diabetes center /Race. (Annex ii):

We cannot deny the fact that all the big islands in our country are occupied by mostly Melanesianrace. Not only that but within the capital city itself, Melanesian is also the dominating race.Therefore looking at the data the monthly attendances record of daily patient seen in Diabetes

center clearly indicated the dominating race in the Country.However, most of the people who use the center are those that living in and around Honiara, thosewho have the money from the provinces and have access to transportation to Honiara.


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Dailypatients seen in diabetes centreby race (2003)

source diabetes centre

0

50

100

150

200

250

300

350

400

cases seen permonth/race

no

of

patients

mel 167 185 192 186 246 244 295 305 299 268 242 208

poly 7 12 7 12 19 23 16 20 16 21 11 9

micro 3 3 7 8 12 5 7 12 9 18 3 12

others 3 4 0 2 3 2 3 1 6 7 4 1

total 180 204 206 208 280 274 321 338 330 314 260 230

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

chart 2


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New confirm cases by Gender (1998-2003) (Annex v):

The newly confirmed cases by Gender per year since 1999-2003, male gender was recordedhighest through out. There was an increase in the number of newly confirmed cases compared tolast year.

This does not mean that male gender is more prone to have diabetes than female. In actual fact,there is an equal chance for both. The number of new cases detected depends very much on howpeople understand the disease and their willingness to come forward for blood screening.

0

20

40

60

80

100

120

140

160

180

noof cases

racesper year

New confirm cases by races (1998-2003)

Source diabetes centre

Mel 65 109 100 174 104 167

Poly 1 6 8 8 3 7

Micro 3 7 12 8 14 3

Others 0 5 4 7 2 3

1998 1999 2000 2001 2002 2003

Chart 4


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Therefore because, more adult male educated than female, they understand and aware of thesymptoms of the disease. They are more conscious about their own health. Whenever they felt thesymptoms of the disease, they would go to hospital for checking. This may contribute to the resultwhy male gender was higher than female.Mind you that there are still others out in the provinces that have diabetes but are not aware that

they have diabetes until they have some complications like foot ulcers, eye problems etc. beforegoing to hospital for check up.

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

0

20

40

60

80

100

120

140

160

180

noof patients

years

New confirmcases bygender per year(1998-2003)

source diabetes centre.

Male 33 74 73 127 70 180

Female 36 53 51 70 63 90

1998 1999 2000 2001 2002 2003

Chart 5


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

New confirm cases by provinces (2000-2003) (Annex vii):

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

Diabetic patients ontreatment by years (1997-2003)

Source Diabetes Centre.

0

20

40

60

80

100

120

140

160

Treatments per year

Noofcases

diet alone 5 12 25 31 22 35 45

metformin 7 6 29 24 20 29 35

glibenclimide 83 41 59 51 135 60 71

insulin 3 4 7 10 16 8 21

1997 1998 1999 2000 2001 2002 2003

Chart 6


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

In 2003, only Isabel Province had sent in their report on diabetes. They had a record of 51 newcases detected. Out of which, 31 were female and 21 were male. To add with the record statedabove, they should be totaled up to 61 cases. A well job done by Province diabetes coordinator

from Isabel.

Recommendations:

Conducting training for Health workers on the practical guideline on Diabetes for theProvinces must be carried out.

New confirm cases by provinces (2000-2003)

Source Diabetes Centre

0

20

40

60

80

100

120

years

noofpatien

ts

MP 98 106 59 98

GUADAL 6 17 18 9

WP 37 28 17 29

YP 3 7 7 10MUP 6 6 9 14

TP 2 6 4 2

RENBEL 5 7 1 0

CIP 4 4 3 1

CHP 8 12 10 12

2000 2001 2002 2003

Chart 7


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In order for programs to be effectively and efficiently implemented funds must available fordiabetes activities.

Supervisory tour to the Provinces should be an on-going planned activity for programmanagers in order to assess and assist Provincial coordinators to improve their dailyrunning of the programs.

There is a need of further training for both national and provincial coordinators on jobspecialization, especially diabetes management because in our country nowadays,diabetes has becoming a major problem. Not only that looking after Diabetic patient is veryexpensive for family members, community and also for the Government.

ACKNOWLEDGEMENT.

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

4.5.2. Tobacco and its Impact and the control measures in Solomon Islands:

4.5.2.1. Tobacco a Health Burden in Solomon Islands:

Evidence is beginning to reveal how much Tobacco is damaging the health and social aspects ofthe lives of the people of Solomon Islands. Little is known on the local context in the past. Thepeople have little and no knowledge at all of the negative impacts of tobacco on their socio-economic and physical and mental health. There has been no research on tobacco prevalence inSolomon Islands until recently.

The bad behavior of smoking is spreading widely in all age groups, ethnicity and within theemployment sectors. It is often a disease common among lowly educated and those with out anyform of employment. However, it is devastating to learn that in Solomon Islands significant percent

of employed workers smoke14. A study done found (with a private broad casting firm), 56.5% of thestaff interviewed smoke. Other related studies also found that 44% of government workerssmoke15, whilst 40% of outpatient attendants were found to be active smokers. In the 993Nutritional Survey it was found that 25% of the female population smoke.

14MOH (2002). Health Assessment Report: National SIBC, Honiara, Volume 1, Issue 2, January:

Unpublished Paper.15

MOH. Unpublished paper.


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A historical study was done recently16and found that 60.3% of patients smoking suffered fromrespiratory diseases and admitted to the National Referral Hospital in Honiara between 1999 and2003. Older people smoked (age group 50-65) followed by the productive age group of 21-49years. Within the cohort of those admitted, 45.1% of teens or youths age group of 12-20 years oldsmoked as compared to their non-sm

National Health Report 2003-Solomon Islands

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