National Health Report 2006

2006

Ministry of Health & Medical Services

5/30/2006

MINISTRY OF HEALTH

NATIONAL HEALTH ANNUAL

REPORT

Chapter 1 About the Organization-Ministry of Health ___________________ 8

1.1 Introduction/ Background _______________________________________________________ 8 1.1.1 Report on the Grand For Change Coalition Government (Health) Political Statements ________________ 8 1.1.2 Observations of the changes in 2006: _______________________________________________________ 8

1.2 The �ational Health Policies: Plans and Priorities: _________________________________ 11 1.2.1 Solomon Islands Government Leadership. __________________________________________________ 11 1.2.2 The Health Corporate Plan 2006-2008 _____________________________________________________ 11

1.3 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 Solomon Islands Demographic and Health Status Indicators _____ 19

3.1 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 Acute Respiratory Infections _____________________________________________________________ 20 4.2.2 Diarrhoeal disease _____________________________________________________________________ 22 4.2.3 Watery Diarrhoea _____________________________________________________________________ 24 4.2.4 Bloody Diarrhoea _____________________________________________________________________ 24 4.2.5 Fever, clinical malaria and slide confirmed malaria ___________________________________________ 25 4.2.6 Red eye _____________________________________________________________________________ 27 4.2.7 Ear disease ___________________________________________________________________________ 30 4.2.8 Sexually transmitted infections ___________________________________________________________ 31 4.2.9 Other diseases ________________________________________________________________________ 32 4.2.10 Other Diseases category – Senior Medical Statistician study ___________________________________ 33 4.2.11 Skin infections, trauma and gastrointestinal problems category _________________________________ 34

Chapter 5 Health Systems: Performance (Productivity) Reporting: ________ 36

5.1 Implementation Rating of Health Programs for 2006 ________________________________ 36 5.1.1 Over view: ___________________________________________________________________________ 36 5.1.2 Reporting rate of divisions in 2006: _______________________________________________________ 36 5.1.3 Challenges and issues: __________________________________________________________________ 37

5.2 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 SI Nursing Council: ____________________________________________________________________ 48 5.5.2 Dental Services _______________________________________________________________________ 50

5.6 Public Health Divisional Programs _______________________________________________ 53 5.6.1 Distance Education Program _____________________________________________________________ 53 5.6.2 Tuberculosis and Leprosy Control Program _________________________________________________ 55 5.6.2.1 Disease Burden Status Report: National TB Situation: ____________________________________ 55 5.6.2.2 Disease Burden Status Report: National Leprosy Situation ________________________________ 59 5.6.3 Environmental Health __________________________________________________________________ 63 5.6.3.1 Public Health Laboratory: __________________________________________________________ 67 5.6.4 Non- Communicable Diseases ___________________________________________________________ 68 5.6.4.1 Diabetes: ________________________________________________________________________ 68 5.6.4.2 Physical Exercise: _________________________________________________________________ 71 5.6.4.3 4. Cancer ________________________________________________________________________ 72 5.6.5 Community-Based Rehabilitation Services: _________________________________________________ 73 5.6.6 Social Welfare Division: ________________________________________________________________ 81 5.6.7 Health Promotion: _____________________________________________________________________ 83 5.6.8 STI/ HIV Prevention Program ___________________________________________________________ 87 5.6.9 Integrated Mental Health Services ________________________________________________________ 90 5.6.10 Reproductive Health: ___________________________________________________________________ 92 5.6.11 Malaria Control _______________________________________________________________________ 97 5.6.11.1 Overview: _______________________________________________________________________ 97 5.6.11.2 A: Prompt diagnosis and treatment: ___________________________________________________ 97 5.6.11.3 B. Malaria prevention – vector control: ________________________________________________ 98 5.6.11.4 New Policy Directions: ____________________________________________________________ 98 5.6.11.5 Microscopy in Solomon Islands; _____________________________________________________ 98

5.7 Private Health Provider: Solomon Islands Planned Parent Hood Association (SIPPA) ____ 99 5.7.1 SIPPA Overview: _____________________________________________________________________ 99 5.7.2 Strategies and Programs: ________________________________________________________________ 99 5.7.3 Achievements _______________________________________________________________________ 100 5.7.4 Challenges & Issues: __________________________________________________________________ 101

Chapter 6 Provincial Health Services ______________________________ 103

6.1 Government Health Sector: ____________________________________________________ 103 6.1.1 Over view___________________________________________________________________________ 103 6.1.2 Access indicators: ____________________________________________________________________ 103 6.1.3 Health seeking behaviour of Solomon Islands people at the community level. ____________________ 104 6.1.4 Achievements/ Output Reporting: _______________________________________________________ 107 6.1.5 Challenges and Issues _________________________________________________________________ 108

6.2 Church Hospitals in the provinces ______________________________________________ 109 6.2.1 Atoifi Hospital: ______________________________________________________________________ 109 6.2.2 Helena Goldie Hospital ________________________________________________________________ 110 6.2.3 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 HSTA Expenditure ___________________________________________________________________ 112 7.2.2 Control and Governance Issues __________________________________________________________ 114

7.3 Human Resource for Health in 2006 _____________________________________________ 114 7.3.1 Overview: __________________________________________________________________________ 114 7.3.2 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 Annexures ___________________________________________ 120

9.1 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 105

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 13

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 26

Figure 10 Incidence rate fever by province 1997-2006 ............................................ 26

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 Area Health Clinics

ARI Acute Respiratory Infection

AusAID Australian AID

CHP Choiseul Province

CIP Central Islands Province

EHD Environmental Health Division

GP Guadalcanal Province

HCC Honiara City Council

HISP Health Institutional Strengthening Project

HISP Health Information System

HIV/STI Human Immunodeficiency Virus and Sexually Transmitted Infections

ICPD International Convention Population Development

ICU infection Control Unit

MDG Millennium Development Goals

MOH Ministry of Health

MP Malaita Province

MUP Makira Ulawa Province

NAP Nurse Aide Post

NCD Non-Communicable Diseases

NGOs Non-Governmental Organizations

NHR National Health Review

NRH National Referral Hospital

OP Operational Plan

PHC Primary Health Care

PHD Provincial Health Directors

RBP Rennell Bellona Province

RHC Rural Health Clinic

RWSS Rural Water Supply and Sanitation

SWAp Sector Wide Approach TB Tuberculosis

TP Temotu Province

WHO World Health Organization

WISN Workload Indicator of Staffing Need WP Western Province

YP 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

Permanent Secretary Dr. G

Malefoasi

Under Secretary Health Improvement Dr.D. Ogaoga

Under Secretary Health Care (Cedric Alependava) 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

Professional Boards: Nursing & Medical services Specialist Care Services: National Referral Hospital (Mr. R.Suinao) Provincial Hospitals (Prov. Directors) National Psychiatric Unit (Dr. Judie) Paramedical Services: Diagnostic Services (X-Ray, Laboratory, Tele-pathology) Dental Services (Dr. 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

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)

Minister of Health

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)


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Chapter 2 Reporting against the national goals- targets and indicator

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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 rs a n it a t io n is a c c e s s ib le to a ll c o m m u n it ie s ;

W o r k to w a r d s b e t te r a w a r e n e s s o f th ed y n a m ic s o f p o p u la t io n g r o w th a n d i t s e f fe 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 t o c a r r y o u t a n e f fe c t iv ea n d e f f ic 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 t ic m e a s u r e s to p r e p a r e a s w e ll a sa d d r e s s p a n d e m ic in fe c t io u s d is e a s e s , s u c ha s S e x u a lly T r a n sm it te d In fe c t io 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 l ic y w ith av 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 t r 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 leg r o 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 ep r o v id e r s in th e c o u n t r y ;

Im p r o v e a n d m a in ta in e x is t in g p u b lic h e a lt hp r o g r a 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 t r yth r o u g h th e P r im a r y H e a lth C a r e P o l ic y a n de s ta b lis h H e a lth P r o m o t io n C e n t r e s in a ll

E m p h a s iz e , s t r e n g th e n a n d p r o m o tep r e v e n ta t iv e h e a lth c a r e th r o u g h a l l

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 ili t ie ss 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 dp r o v id e t h e n e c e s s a r y e q u ip m e n t to e n a b leP r o v id e p r o p e r a n d a d e q u a te t r a in in g a n dim p r o v e d te rm s a n d c o n d it io 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 t te 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 lls ta k e h o ld e r s s u c h a s c o m m u n it ie s , c h u r c h e sE n c o u r a g e c o m m u n ity p a r t ic ip a t io n in h e a lthp r o m o t io n a n d d e l iv e r y , a n d p r o m o te h e a lth y

lif e - 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

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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 births to 125/100,000 live births by 2010

Maternal mortality rate reduced from 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 years of age due to common childhood illnesses and vaccine preventable diseases.

Acute respiratory infection continue to be the most common cause of morbidity 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, mortality) of Communicable diseases in Solomon Islands.

Reported case of confirmed influenza type A H1N1 in 2006): No deaths reported. no major admissions –all outpatient visits.

Implement the ‘National HIV Policy and Multi sect oral strategic plan 2006-10’3 the aim to sensitize people through informed HIV prevention awareness and behavioural change interventions to stop the transmission of HIV, and to ensure accessibility to quality voluntary, confidential, counselling and testing as the entry point for continuum of quality care, including anti retro-viral treatment, for people living with HIV/AIDS.

Low prevalence still Cumulative cases of 8 by end 2006. 4 died and 4 People living with the HIV/AIDS (PLWHA). Low prevalence status: estimated people infected around 150-200 people.

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 disposal), food quality and food safety (incl. food hygiene)

No new updated figure: Access to clean water 70% of pop: 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, mortality) of all Non Communicable Diseases in Solomon Islands.

Diabetes cumulative incidence 6%

Reduce prevalence of dental caries in all children by 2010

No data available during compilation of report


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Raise public and health service provider awareness on the impact of substance misuse and assess the level of psycho-social problems resulting from substance abuse.


Reduce incidence of suicide in SI over next 10 years. No data available during compilation of report

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.


Enhance behavioural change which promotes a healthy lifestyle and family health, especially related to reproductive health, child health, NCD’s, mental health and Communicable Diseases like malaria and HIV/STIs.

Behavioural change approach taken by the MHMS programs includes sensitization and awareness through 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 equipment and medical supplies of appropriate quality at all levels of health service


Improve infection control practices at all levels of health services with the aim of reducing infections acquired within health settings.


Ensure appropriate referral between all levels of health service.


Improve continuum of patient care by strengthening the admission and discharge processes (including communication) at all levels of health service.


Ensure early diagnosis and consequently appropriate treatment for patients.


Provide quality patient care to a level consistent with best practice with the aim of reducing length of stay in hospital.



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Provide appropriate level of patient care in hospital settings by ensuring minimal level of services and minimum staffing requirements


Provide a safe environment for patients and staff No data available during compilation of report

Undertake evidence based health service planning and management


Increase capacity of all managers and their health teams to be involved in operational planning and its use to ensure appropriate, effective and efficient health service delivery

In 2006, health leadership and management course held for around 30 senior and middle managers both at the national and provincial level run by University of NSW Public Health and Community Medicine

Ensure funds allocated in the budget are spent appropriately and in a timely manner to ensure planning and implementation of appropriate health services

By end of 2006, MHMS left with underspent fund of around 2.8Million. 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 equipment at all levels of the health care system

Planning for recruitment of procurement officer to also asset management and inventory. Not fully implemented

Improve management and supervision of health services/health workers in order to manage and sustain positive change in health service delivery

Planning workshops were held for all divisional heads and program managers. Budgeting process also linked with operational planning.

Establish a MOH information center where information can be accessed by all stakeholders

Not implemented.

Enhance development of partnerships with stakeholders to ensure effective delivery of health services

A standard Draft MOU developed for 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 provision.

Phase 3 National Referral Hospital 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.


17

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 2004 2005 2006

Child Mortality- deaths / 1,000 live births 42.7 17 16.3 9.8

Maternal Mortality deaths-pregnancy/ 100,000 live births

357 276 236 223

HIV (Cumulative cases) 0 1 6 8

STI rate 12 16 21

Malaria (clinical) 340 349.5

Malaria confirmed slide/ 1000 pop 160 190 184 156


18

Figure 3 Shows the MDG indicators trend 1990-2006

17 16.39.8

Maternal Mortality

deaths-pregnancy/

100,000 live births,

357

12

Malaria confirmed

slide/ 1000 pop, 160

Child Mortality- deaths /

1,000 live births , 42.7

223

276

236

HIV (Cumulative cases),

8

610

STI rate, 21

16

Malaria (clinical), 349.5

340

156

190184

0

15

30

45

60

75

90

105

120

135

150

165

180

195

210

225

240

255

270

285

300

315

330

345

360

375

1990 2004 2005 2006


19

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 em og rap h ic D a ta fo r S o lom on Is lan d s 2006

In d ic a to rs 2006 % 2007 %

T o ta l P opu la t io n 483083 100% 495026 100%

m a le popu la tio n 248944 52% 255063 52%

fem a le popu la t io n 234139 48% 239963 48%

P opu la tio n le s s th an 1 14445 3% 14448 3%

P opu la tio n le s s th an 5 69559 14% 70380 14%

W om en popu la t io n 15 - 4 9 119160 25% 122573 25%

P opu la tio n 15 - 6 4 yea rs 277139 57% 285168 58%

P opu la tio n 65 yea rs and o ve r 15278 3% 15740 3%

P opu la tio n le s s th an 15 yea rs 190666 39% 194118 39%

sex ra tio 106 106

S ou rce : P ro jec ted P o pu la tio n 2006 an d 2007 , N SO , M in is try o f F in an ce


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

Diseases 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

ARI 21% 18% 21% 19% 21% 19% 18% 21% 21% 23%

Diarrhoea 2% 3% 2% 2% 1% 1% 2% 2% 2% 2%

Fever 21% 19% 17% 16% 16% 18% 15% 14% 14% 14%

Red eyes 2% 2% 2% 2% 2% 2% 1% 1% 2% 2%

Yaws 2% 3% 2% 3% 2% 3% 4% 3% 2% 2%

Skin diseases 7% 7% 6% 6% 5% 5% 5% 5% 5% 4%

Ear infection 3% 3% 3% 3% 3% 3% 3% 3% 3% 3%

STI diseases 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Clinical malaria 13% 14% 14% 16% 18% 19% 21% 17% 17% 16%

Other diseases 29% 31% 31% 34% 32% 31% 31% 34% 33% 34%

Source HIS monthly report forms 1997- 2006

Proportion of Primary Health Care Attendances by Major Causes, Solomon Islands 1997-2006

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

0

100

200

300

400

500

600

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn

mild moderate severe Combined

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


21

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

0

500

1000

1500

2000

2500

3000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn

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

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 513 581 453 282 180 267 331 350 527 497

Western 593 457 470 376 420 341 304 432 458 526

Malaita 399 290 385 393 363 282 218 324 339 343

Temotu 466 411 572 500 531 489 450 656 634 737

Central 409 349 439 358 345 357 253 405 332 400

Choiseul 394 338 471 409 588 413 480 478 536 584

Isabel 512 358 476 509 601 531 493 665 539 633

Makira 381 344 366 399 349 309 320 461 465 624

Honiara 524 452 411 371 469 349 383 505 487 624

Renbel 575 474 274 522 576 391 639 671 549 875

Solomon Is 471 396 431 385 410 331 316 417 433 504

Source HIS monthly report forms 1997- 2006 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.


22

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

0

10

20

30

40

50

60

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn

w atery and bloody w atery 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.


23

Incidence rate of diarrhoea (w atery and bloody) by age


0

50

100

150

200

250

300

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 population


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

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 69 82 51 28 6 15 35 27 46 37

Western 82 74 53 44 36 31 32 44 54 55

Malaita 32 34 41 34 26 21 17 24 39 30

Temotu 27 35 30 42 24 23 31 27 36 22

Central 57 61 58 40 29 36 33 44 46 30

Choiseul 49 50 56 57 46 35 48 44 59 58

Isabel 56 50 47 69 48 36 51 57 55 35

Makira 20 21 15 13 12 12 19 18 25 38

Honiara 72 85 50 43 41 36 46 55 71 63

Renbel 53 102 30 82 42 19 66 28 68 61

Solomon Is 53 56 45 38 30 25 30 34 48 41

Source HIS monthly report forms 1997- 2006 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.


24

4.2.3 Watery Diarrhoea

Incidence rates of w atery diarrhoea by age


0

50

100

150

200

250

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn


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

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 246 384 185 107 41 72 192 141 232 195

Western 75 63 47 40 31 27 30 41 42 51

Malaita 29 29 37 32 24 19 15 22 27 23

Temotu 23 30 24 36 21 20 26 26 25 18

Central 49 55 51 36 27 34 29 39 32 27

Choiseul 46 46 51 53 43 33 46 42 49 52

Isabel 52 48 44 66 45 34 46 53 48 30

Makira 17 16 14 11 10 11 18 17 22 30

Honiara 66 80 44 39 38 33 42 47 57 55

Renbel 48 90 30 77 40 18 63 26 44 54

Solomon Is 49 50 40 35 27 22 28 31 37 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


25

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


0

10

20

30

40

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn


Incidence rate of Bloody Diarrhoea by Province, 1997 - 2006

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 5 6 4 2 1 1 3 2 7 5

Western 6 12 5 4 5 4 2 3 11 5

Malaita 3 4 4 3 2 2 2 3 12 7

Temotu 4 6 6 7 3 3 5 1 11 4

Central 8 7 7 4 2 2 4 4 14 3

Choiseul 2 4 5 4 2 2 2 2 10 6

Isabel 3 2 3 3 3 2 5 3 7 5

Makira 3 4 1 1 2 1 1 1 3 8

Honiara 6 5 6 4 2 3 4 8 15 8

Renbel 5 12 0 5 2 1 3 2 25 7

Solomon Is 4 6 4 3 3 2 3 3 11 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.


26

Figure 9 Incidences rate of fever, clinical and slide confirmed malaria in SI 1997-2006

Incidence rates of fever, clinical and slide confirmed malaria


0

100

200

300

400

500

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn

fever clinical malaria slide confirmed malaria

Figure 10 Incidence rate fever by province 1997-2006

Incidence rate of fever by Province, 1997 - 2006

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 717 768 576 383 140 312 376 312 292 282

Western 555 408 340 333 331 243 234 203 165 242

Malaita 434 380 336 377 355 345 230 316 323 319

Temotu 146 109 107 150 121 103 70 107 102 143

Central 455 367 435 462 251 607 369 522 446 488

Choiseul 542 566 433 339 375 348 475 360 331 381

Isabel 412 302 303 308 350 361 315 348 260 253

Makira 348 416 328 388 271 315 451 443 440 525

Honiara 207 173 116 106 181 142 124 162 161 179

Renbel 68 127 32 102 102 83 94 140 50 113

Solomon Is 451 410 342 329 327 300 272 289 278 302 Figure 11 Incidence rate of clinical malaria by Province 1997-2006

Incidence rates of clinical malaria by Province, 1997 - 2006

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 126 277 298 177 153 245 347 370 373 293

Western 469 485 473 557 482 345 272 257 191 231

Malaita 255 219 271 377 382 348 292 409 430 427

Temotu 250 172 212 422 472 408 287 272 313 357

Central 297 342 365 387 368 457 300 403 412 439

Choiseul 272 369 248 223 295 266 325 213 168 184

Isabel 129 106 100 97 134 153 202 201 149 99

Makira 291 397 298 345 294 314 468 505 487 516

Honiara 400 340 179 216 368 323 311 325 310 297

Renbel 2 6 1 15 21 5 17 29 12 9

Solomon Is 278 301 289 337 349 322 368 347 346 350



27

Figure 12 Incidence rate of slide confirmed malaria by province 1997-2006

Incidence rates of slide confirmed malaria by Province, 1999 - 2006

Provinces 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 225 108 135 169 299 383 298 212

Western 216 320 231 178 153 89 61 64

Malaita 108 122 127 147 175 188 143 191

Temotu 32 46 85 50 68 59 70 67

Central 119 166 134 194 183 279 271 235

Choiseul 242 159 113 153 353 127 69 55

Isabel 27 37 54 63 66 40 19 18

Makira 68 69 63 83 137 174 173 120

Honiara 261 306 261 382 345 244 257 243

Renbel 0 1 2 3 4 5 6 7

Solomon Is 156 164 180 179 204 196 162 156

Source Malaria Information System 1999 - 2006

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

0

20

40

60

80

100

120

140

160

180

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn



28

Incidence rates of red eye by Province, 1997 - 2006

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 51 75 60 27 14 23 36 35 41 46

Western 50 56 64 42 33 27 22 26 38 59

Malaita 31 30 42 38 30 24 18 24 32 33

Temotu 32 32 38 31 29 32 21 18 27 29

Central 42 61 50 46 49 45 27 36 33 57

Choiseul 39 36 56 40 43 41 34 37 32 42

Isabel 46 36 38 35 48 38 30 31 40 71

Makira 34 36 34 35 28 22 30 27 43 84

Honiara 19 27 33 18 21 15 16 22 23 39

Renbel 31 26 20 44 25 17 23 11 20 58

Solomon Is 38 43 47 35 32 26 24 27 35 47

Source HIS monthly report forms 1997- 2006 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

0

20

40

60

80

100

120

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn


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.


29

Incidence rates of yaws by Province, 1997 - 2006

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 58 69 66 50 24 38 74 62 62 63

Western 72 75 68 77 64 58 77 44 40 41

Malaita 60 64 58 89 61 55 65 65 56 33

Temotu 34 105 75 42 48 145 141 40 41 25

Central 17 52 20 23 17 27 27 37 30 32

Choiseul 21 17 18 12 20 19 40 14 25 19

Isabel 29 24 14 17 18 16 24 19 18 15

Makira 66 73 49 52 47 51 77 57 67 71

Honiara 19 27 33 18 21 15 16 22 23 39

Renbel 29 32 18 44 78 37 55 46 27 36

Solomon Is 49 59 49 57 47 49 65 51 48 42

Source HIS monthly report forms 1997- 2006 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


0

50

100

150

200

250

300

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn


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


30

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

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 208 288 155 100 59 60 95 99 113 82

Western 172 122 94 102 81 89 90 98 110 132

Malaita 121 112 123 127 97 77 66 75 95 80

Temotu 173 225 148 171 138 154 148 208 149 146

Central 132 135 103 125 89 70 40 85 57 75

Choiseul 213 209 198 180 187 162 161 151 145 165

Isabel 131 99 104 121 90 84 97 90 96 71

Makira 81 99 73 104 114 94 121 110 115 114

Honiara 94 150 82 60 57 49 50 86 73 79

Renbel 49 59 30 224 182 50 77 169 45 102

Solomon Is 143 153 117 115 95 82 85 96 103 98

Source HIS monthly report forms 1997- 2006 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


0

50

100

150

200

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate by 1,000 popn



31

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

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 97 77 60 37 17 27 43 42 51 58

Western 113 105 86 83 74 59 68 84 77 87

Malaita 33 26 29 32 30 23 17 25 27 24

Temotu 81 73 90 87 87 128 108 127 113 118

Central 34 44 49 39 40 40 28 50 55 62

Choiseul 71 69 74 97 108 77 89 82 116 121

Isabel 80 49 48 61 65 53 82 75 64 58

Makira 36 42 40 36 32 26 32 38 41 51

Honiara 115 103 88 82 109 87 94 101 99 113

Renbel 40 48 12 43 34 20 37 32 26 62

Solomon Is 71 63 58 55 56 47 51 58 61 65

Source HIS monthly report forms 1997- 2006 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.


32

Figure 17 Incidence rates of STI by age SI 1997-2006

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

0

5

10

15

20

25

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn

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 2003 2004 2005 2006

Guadalcanal 8 13 10 12 9 6 5 5 16 9

Western 14 11 10 8 6 8 11 13 15 16

Malaita 5 3 5 7 6 3 2 4 9 4

Temotu 17 33 23 28 25 18 15 12 14 15

Central 7 8 9 6 9 3 8 9 10 12

Choiseul 10 11 14 12 9 8 10 18 13 8

Isabel 11 6 12 5 5 6 6 9 6 7

Makira 18 10 13 22 18 16 21 20 21 21

Honiara 26 30 20 21 17 15 18 27 79 79

Renbel 47 63 17 64 38 23 63 26 39 45

Solomon Islands 14 16 12 13 11 8 9 12 17 21

Source: HIS monthly reports 1997-2006 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.


33

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

0

200

400

600

800

1000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Rate per 1,000 popn


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

Provinces 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Guadalcanal 751 854 705 556 231 367 582 574 632 756

Western 994 935 838 862 745 670 731 1014 890 1074

Malaita 494 483 571 778 703 483 396 513 506 496

Temotu 622 685 570 667 580 590 569 715 663 544

Central 583 726 756 732 615 645 439 556 550 635

Choiseul 429 647 659 750 807 684 747 748 814 895

Isabel 641 587 542 702 720 681 785 867 767 812

Makira 466 573 456 533 448 373 473 612 673 904

Honiara 746 1031 628 689 915 881 1463 1677 1610 2136

Renbel 1029 1009 1000 984 970 632 1119 751 712 1414

Solomon Is 451 410 342 329 327 300 272 289 278 302


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).


34

Distribution of Other Illness by Main Categories

Main_ Category males % females % Total %

anaemia 3 0.7% 12 2.1% 15 1.5%

gastrointestinal 36 8.3% 37 6.5% 73 7.3%

non communicable 7 1.6% 20 3.5% 27 2.7%

other 22 5.1% 35 6.2% 57 5.7%

pain 162 37.3% 233 41.2% 395 39.5%

skin infection 112 25.8% 112 19.8% 224 22.4%

surgical emergency 2 0.5% 7 1.2% 9 0.9%

trauma 54 12.4% 30 5.3% 84 8.4%

women business 0 0.0% 29 5.1% 29 2.9%

ear/nose/throat 8 1.8% 10 1.8% 18 1.8%

eye infection/problem 3 0.7% 8 1.4% 11 1.1%

oral health 10 2.3% 17 3.0% 27 2.7%

respiratory illness 9 2.1% 9 1.6% 18 1.8%

childhood communicable/welfare 6 1.4% 7 1.2% 13 1.3%

Total 434 100.0% 566 100.0% 1000 100.0%

Source: Outpatient Register Books 2005 Pain category Distribution of pain category by gender

Pain Category males % female % Total %

abdo/lower pain 32 19.8% 50 21.5% 82 20.8%

backache 21 13.0% 24 10.3% 45 11.4%

bodyache 18 11.1% 24 10.3% 42 10.6%

chest pain 10 6.2% 8 3.4% 18 4.6%

foot/leg pain 2 1.2% 13 5.6% 15 3.8%

headache 52 32.1% 85 36.5% 137 34.7%

joint pain 13 8.0% 11 4.7% 24 6.1%

muscle pain 11 6.8% 11 4.7% 22 5.6%

neckache 2 1.2% 0 0.0% 2 0.5%

operation wound 0 0.0% 2 0.9% 2 0.5%

other pain 1 0.6% 5 2.1% 6 1.5%

Total 162 100.0% 233 100.0% 395 100.0%

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 % female % total %

cellulitis 1 0.8 2 1.7 3 1.3

abscess/boil 45 37.8 36 30.8 81 34.3

fungus 0 0.0 1 0.9 1 0.4

sore/infected sores 73 61.3 78 66.7 151 64.0

Total 119 100 117 100 236 100

Source: Outpatient Register Books 2005 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).


35

Figure 19 Distribution of trauma by sex 2005

Distribution of Trauma by sex 2005

Trauma type male % female % Total %bone fracture 1 1.9 1 3.3 2 2.4

bruising chest 0 0.0 1 3.3 1 1.2

burn 2 3.7 0 0.0 2 2.4

dislocation 0 0.0 3 10.0 3 3.6

domestic violence 0 0.0 1 3.3 1 1.2

eye injury 1 1.9 0 0.0 1 1.2

fall 1 1.9 0 0.0 1 1.2

head injury 2 3.7 0 0.0 2 2.4

joint injury 0 0.0 1 3.3 1 1.2

laceration 21 38.9 6 20.0 27 32.1

other 1 1.9 3 10.0 4 4.8

soft tissue 2 3.7 0 0.0 2 2.4

swelling/inflammation 14 25.9 10 33.3 24 28.6

wound infection 9 16.7 4 13.3 13 15.5

Solomon Islands 54 100.0 30 100.0 84 100.0

Source: Outpatient Register Books 2005 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 % female % Total %

constipation 3 8.3% 3 8.1% 6 8.2%

food poisoning 0 0.0% 4 10.8% 4 5.5%

haemorrhoid 1 2.8% 3 8.1% 4 5.5%

peptic ulcer 2 5.6% 7 18.9% 9 12.3%

vomiting 4 11.1% 1 2.7% 5 6.8%

worm infestation 16 44.4% 19 51.4% 35 47.9%

chronic bleeding in anus 1 2.8% 0 0.0% 1 1.4%

infection 9 25.0% 0 0.0% 9 12.3%

Total 36 100.0% 37 100.0% 73 100.0%

Source: Outpatient Register Books 2005 Of the gastrointestinal complaints worm infestation accounted for 48% with this complaint highest in males and females (Table 15).


36

Chapter 5 Health Systems: Performance (Productivity)

Reporting:

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 Implementation (completion rate)

Provinces 42%

National Divisions 23%

NRH 6%

Overall 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.


37

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


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

Type health service Workload benchmarks Not meeting the

benchmark is Recommended Actions

Exceeding the

benchmark isRecommended Actions

Between 30 to 70 weekly contacts More than 70 weekly contacts Review staffing levels against workload

Up to 20 births More than 20 births

Up to 40 total inpatients More than 40 total inpatients

Between 70 to 150 weekly

contacts

More than 150 weekly

contactsReview staffing levels against workload

Between 20 and 70 births More than 70 births Review for midwife placement

Between 40 and 150 inpatients More than 150 total inpatients Review for upgrade to AHC

More than 150 weekly visits More than 200 births

Between 70 and 200 births

Between 150 and 500 inpatients

Urban Health

Centre

Nil set benchmarks, staff according

to workload and health program

needs

Provincial

Hospitals

Nil set benchmarks, staff according

to workload and health program

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

Review staffing levels against workload

AND review for midwife placement AND

review for upgrade to mini hospital More than 500 total inpatients

Review staffing levels against workload. Review number of weekly contacts, review number of reproductive health contacts, review number of

treatments and dressings. Review staff needs including midwife placement for ANC, PNC and family planning and trained immunisation

coordinator

Review staffing levels against inpatients and outpatients workload. Review number of weekly OPD contacts, review number of reproductive

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

Rural Health

Centre

Less than 70 weekly contacts

AND less than 40 total

inpatients

Review staffing levels, review

productivity, review factors

influencing use of the RHC, review

number of weekly treatments

Area Health

Centre

Less than 150 weekly

contacts AND less than 150

total inpatients

Review staffing levels, review

productivity, review factors

influencing use of the AHC, review

Solomon Islands Clinics Utilisation Benchmarks for Workforce Planning

Nurse Aid PostLess than 30 weekly contacts

AND less than 20 total

inpatients

Review productivity and factors

influencing use of the NAP (location,

staff skills, community relationship,

population size and isolation)

Review for upgrade to RHC AND review

staff skills and capacity AND review


39

5.2.1.1 Clinic Utilization Result

Table 7: Number of clinics & population 2006

o p e n e d % P o p . R a t io

G u a d a lc a n a l 3 3 1 2% 7 1 2 7 0 2 1 6 0

W e s te rn 5 4 1 9% 7 3 9 3 2 1 3 6 9

M a la ita 5 7 2 0% 1 4 5 5 8 0 2 5 5 4

T em o tu 1 5 5% 2 2 2 2 2 1 4 8 1

C e n tra l Is la n d s 2 4 9% 2 5 4 2 4 1 0 5 9

C h o is e u l 2 4 9% 2 3 5 5 0 9 8 1

Is a b e l 3 1 1 1% 2 3 9 5 0 7 7 3

M a k ira 3 2 1 1% 3 6 7 6 5 1 1 4 9

H o n ia ra 9 3% 5 7 6 3 6 6 4 0 4

R e n b e l 3 1% 2 7 5 4 9 1 8

S o lo m o n Is la n d s 2 8 2 1 0 0% 4 8 3 0 8 3 1 7 1 3

T a b le B . N u m b e r o f C l in ic s O p e n e d a n d P o p u la t io n 2 0 0 6

c l in ic s

P ro v in c e s P o p u la t io n

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 Not Met % Exceeded % Met % Total %

Guadalcanal 1 3% 10 30% 22 67% 33 100%

Western 13 24% 8 15% 33 61% 54 100%

Malaita 7 12% 23 40% 27 47% 57 100%

Temotu 1 7% 0 0% 14 93% 15 100%

Central Islands 6 25% 1 4% 17 71% 24 100%

Choiseul 7 29% 1 4% 16 67% 24 100%

Isabel 20 65% 1 3% 10 32% 31 100%

Makira 5 16% 2 6% 25 78% 32 100%

Honiara 1 11% 0 0% 8 89% 9 100%

Renbel 3 100% 0 0% 0 0% 3 100%

Solomon Islands 64 23% 46 16% 172 61% 282 100%

Primary Health Care Facilities

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.


40

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 AHC % RHC % NAP % Total %

Guadalcanal 0 0% 1 100% 0 0% 1 100%

Western 1 8% 3 23% 9 69% 13 100%

Malaita 0 0% 3 43% 4 57% 7 100%

Temotu 0 0% 1 100% 0 0% 1 100%

Central Islands 0 0% 0 0% 5 100% 5 100%

Choiseul 0 0% 1 14% 6 86% 7 100%

Isabel 3 16% 6 32% 10 53% 19 100%

Makira 1 20% 0 0% 4 80% 5 100%

Honiara 0 0% 0 0% 1 100% 1 100%

Renbel 1 33% 2 67% 0 0% 3 100%

Solomon Islands 6 10% 17 27% 39 63% 62 100%

Did Not Meet

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 AHC % RHC % NAP % Total %

Guadalcanal 1 10% 2 20% 7 70% 10 100%

Western 1 13% 2 25% 5 63% 8 100%

Malaita 1 4% 9 39% 13 57% 23 100%

Temotu 0 0% 0 0% 1 100% 1 100%

Central Islands 0 0% 0 0% 1 100% 1 100%

Choiseul 0 0% 0 0% 1 100% 1 100%

Isabel 0 0% 0 0% 1 100% 1 100%

Makira 0 0% 0 0% 2 100% 2 100%

Honiara 0 0% 0 0% 0 0% 0 0%

Renbel 0 0% 0 0% 0 0% 0 0%

Solomon Islands 3 6% 13 28% 31 66% 47 100%

Exceeded

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


41

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


42

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 280

Total Admission 15,638

Bed Occupancy Rate % 82.8

Total patient days 65,992

Total staff 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 Admissions Discharges Deaths

January 74 43 1

February 76 41 5

March 80 51 6

April 53 34 8

May 84 58 7

June 87 58 7

July 78 63 12


43

August 83 52 10

September 77 42 7

October 75 44 16

Total 767 486 79

Mean 76.7 48.6 7

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percentage

1 2 3 4 5 6 7 8 9 10

Time (Month)

Medical Admissions, Discharges and Deaths

Deaths

Discharges

Admissions

Medical admissions by diseases: Discussions: Problems 10% death rate in the ward High NCD admissions Increasing Malignancy as cause of admission and Death Cardiac disease increasing Anaemia takes up bed Way forward: Training of nurses/Doctor in acute care Provision of 4 acute beds & monitors To link and support Disease control for prevention Need timely and quality back up from the labs/xray/Pharmacy Blood bank need to respond to current need

5.3.3.2 General Surgical Report

0

20

40

60

80

100

120

Number of

patients

Diseases

Diseases

Medical ward Admissions 2006Medical Ward Admissions 2006AneamiaArtheritisAsthsmaCA/LymphomaCardiac DiseaseCOADCVADiabetesDrug Over doseGIT DiseaseHypertensionLiver DiseaseMalariaMeningitisOthersPleural EffusionPneumoniaRenal DiseaseSepticaemiaSplenomegalyTB


44

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 2005 2006

All 537 547

Co-corporate 61 59


45

Dental 24 24

Physiotherapy 10 13

Pharmacy 16 12

Medical Laboratory 28 28

Imaging 13 14

Nurses 220 230

Doctors 32 35

Non Established staff 133 132

Figure 20 NRH workforce by category 2005 and 2006

0

100

200

300

400

500

600

2005 537 61 24 10 16 28 13 220 32 133

2006 547 59 24 13 12 28 14 230 35 132

AllCoorpo

rateDental

Physiot

herapr

y

Pharma

cy

Medical

Laborat

ory

Imaging NursesDoctor

s

Non

Establis

hed


46

Figure 21: Health workforce by skill

Diagnostic support

staff, 150, 27%

Nurses, 230, 43%

Doctors, 35, 6%

Non Established

staff, 132, 24%

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:


47

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.


48

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 Completion % 4 Nursing Council Boards Meeting 100% 2 Nursing Council Awareness (Malaita Province) 50% 1 Registration of Nurses x 1 100% 2 investigation tour 50% 2 clinical attachment at community level 100% 2 sets of computers purchased and installed 50% 1 color printer for certificates purchased 100% 5 cabinets (3 drawers) purchased 100% Nursing council Regulation draft (PENDING) Nursing council Hand book (PENDING) 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.


49

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

2

Proportion of staff with ACR completed

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? YES

Inventory record started and it is being maintained

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

Resources

Need three more computers

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.


50

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.

Activity implemented

Activity not implemented

Problems identified with outcome or output

Possible solution

N0 9 1 4

-School Programs done with difficulty -Out reach done – ongoing. - Portable chairs purchased (x3)

Colgate/tooth paste not purchased

Vehicle was not released till end of year. Therefore fuel not utilised. - Requisition rejected activity not in line with SIG budget line item.


51

No 14 5 6

Provincial feedback -Purchase of 2 computers -Internet installed

Extension of store room not done Therefore budget not spent

Site not approved by NRH

No 15 7 Staff access to IC protocol

8 9 10

Biomedical Technician visits provinces to install chairs and sterilisers. Consumable items readily available from pharmacy

-Protective wears not purchased

-Order made through domestic stores did not get through.

No16 11 12

Constant dialogue with province -Posting of staff

-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

No 19 13 14 15

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

-Treatment guideline not written

- 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


52

-No specialised manpower

Kukum is not enough - G P to have a hospital. - All dentists to at least have a Post graduate qualification in some dental speciality.

N0 22 16 17

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

- Operational plan not realistic, budget still underutilised

Work not completed although $15,000 was spent for the program by NRH

Follow up with the company More senior staff to be involved with OP

N0 23 18/19 Regular staff meeting regarding OP not very successful

No 25 20 21

5-10 plan staff training program written and updated

No formal in-house training

No time for preparation - There is not guarantee that this plan will be implemented

Create time by rotating staff. 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 school visits &student seen

Treatments done Exo Fill Den Surg Sca/pol Sed O/E Misc


53

Western

3,585

8 1357

12 1053

2864

776

122

10

104

730

778

65

Malaita

3,084

3 351

29 4,412

1625

248

45

16

59

518

222

273

Choisuel 363

4 202

12 700

514

-

-

-

-

35

42

-

Isabel 941

2 157

5 648

650

249

-

-

22

135

612

76

Central 253

3 101

-

232

45

-

-

18

16

-

16

Guadalcanal -

1 -

8 -

-

-

-

-

-

-

-

-

Renbel -

4 -

-

-

-

-

-

-

-

-

-

Markira -

-

-

-

-

-

-

-

-

-

-

Temotu -

-

-

-

-

-

-

-

-

-

-

HCC -

-

18

-

-

-

-

-

-

-

-

NRH 11,911

29

-

5573

1149

141

113

112

1242

1172

280

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


54

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.


55

Summary of Major Constraints Strategies / Action plan for the way forward

Text books out of Print Books not arriving on time

Search and locate a new supplier/publisher Early submission of orders for text books

The need for a Senior Program Officer

Vacancy to be filled in 2007

Low supply of Modules for students

With the photocopy now available this can be improved

Lack of Office Space

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

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

0

20

40

60

80

100

Per 100,000 pop

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

96 97 98 99 0 1 2 3 4 5 6

TB Targets and Indicators


56

Box 1. Targets for DOTS implementation.

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)

108

102

88

86

79

74

65

43

41

40

29

0 20 40 60 80 100 120

RBP

MUP

WP

TP

CHP

IP

Provinces

Per 100,000 pop

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


57

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.

Prov Cure Complete Transfer Died Default/Lost Total

No % No % No % No % No % No %

CHP 0 0% 0 0 0 0 0 0 0 0 0 0%

TSR 0(0%)

CIP 3 60% 2 40% 0 0 0 0 0 5 100%

TSR 5(100%)

GP 7 50% 6 38% 0 0 1 7% 0 0 14 100%

TSR 13(88%)

HTC 24 69% 6 17% 1 3% 1 3% 3 9% 35 100%

TSR 30 (88%)

MUP 17 90% 1 5% 0 0 1 5% 0 0 19 100%

TSR 18 (95%)

MP 29 38% 25 33% 3 3% 10 14% 9 13% 76 100%

TSR 50 (70%)

TP 2 18% 10 77% 0 0 1 5% 0 0 13 100%

TSR 10(91%)

WP 5 50% 4 40% 0 0 1 10% 0 0 11 100%

TSR 9 (90%)

YP 3 100% 0 0 0 0 0 0 0 0 3 100%

TSR 3(100%)

RBP 1 50% 1 50% 0 0 0 0 0 0 2 100%

TSR 2 (100%)

SI 95 53% 56 31% 5 3% 14 9% 8 4% 178 100%

TSR 151 (84%)


58

Figure 24 National Trend of cure and treatment rate 1996-2005

Cure and Treatment Success Rate - 1996 - 2005

0

20

40

60

80

100Percentage

Cure Rate 30.8 74.3 83.3 78.4 68.4 68.4 71.3 72 58 53

TSR 87.5 92.4 92 86.3 92.1 92.1 92.6 90 87.2 84

96 97 98 99 0 1 2 3 4 5

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 Completed Transferred Died Default/lost Total

No % No % No % No % No %

CHP 5 100% 0 0 0 0 0 0 5 100%

CIP 3 100% 0 0 0 0 0 0 3 100%

GP 12 86% 0 0 2 14% 0 0 14 100%


59

HTC 26 96% 0 0 0 0 1 4% 27 100%

MUP 23 100% 0 0 0 0 0 0 23 100%

MP 85 91% 1 1% 6 7% 1 1% 93 100%

TP 4 80% 0 0 0 0 1 20% 5 100%

WP 40 91% 0 0 4 9% 0 0 44 100%

IP 4 80% 0 0 1 20% 0 0 5 100%

RBP 1 100% 0 0 0 0 0 0 1 100%

SI 203 92% 1 1% 13 6% 3 1% 220 100%

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:


60

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

0

2

4

6

8

10

Per 100,000 pop

Notification Rate 8 9 5 2 1 1 6 1 3 5 4

96 97 98 99 0 1 2 3 4 5 6

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.


61

Figure 26 National Leprosy prevalence rate 1993-2006

National Leprosy prevalence Rate from 1993 - 2006

0

0.5

1

1.5

2

2.5

Per 10,000 pop

Prevalence Rate 2 1.1 0.6 0.7 1 0.5 0.2 0.5 0.2 0.7 0.1 0.4 0.5 0.4

93 94 95 96 97 98 99 0 1 2 3 4 5 6

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


62

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


63

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 Funding Source Location of beneficiaries

Outcome

Water Supply 6 HSTA/ AusAID (total cost-SB$233,029.01)

Western- Kokete & Patukai; Isabel-Raju; Malaita- Hutohuto & Kiu; Choiseul-Boeboe

5 JICA 1. Burinasi 2. Aimamara


64

3. Oanoha 4. Takwa 5. Kakara (in progress)

4 Canadian Aid (SB$721,181.35)

1.Hagalu (CIP); Malaita- 2. Radefasu 3. Asimana 4. Tauba 5. Nembao 6. Ereeresuli (in progress)

1 CSP (SB$225,000)

Sir. Duddley Tuti College - Kamaosi Iabel

Sanitation Facilities 100 PVC Sanitary Units

All provinces HSTA AusAID (SB$248,567.08)

All provinces Distribution done on demand basis.

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


65

Figure 27 Donor Funded Water Supply projects

% OF PROJECTS CONSTRUCTED, COMPLETED, UNDER PROGRESS AND NON-CONSTRUCTED

0

5

10

15

20

25

30

35

DONORS

NUMBER OF PROJECTS

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

HISTA European UnionJapaness Grass

Root ProgramCanada CSP (AusAid) RWSSP

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.


66

Figure 28 Number of international quarantine activities by route and companies

INCOMING AIRCRAFT/PASSENGERS AS OF JAN-DEC 2006

0

0.5

1

1.5

2

2.5

3

Thousands

AIRCRAFT/PASSENGERS

No OF CALLS/PASSENGERS

NO.call

PAX

NO.call 98 57 33 70 39 21 6 42 9 8 1

PAX 4248 4699 1002 7251 2400 313 127 2972 120 240 17

Air NuiginiAir

VanuatuAlliance Qantas Air Pacific Air Nauru Oz Jet

Solomon

AirlinesRNZAF RAAF

N-338TP.

DC -Jet

Aircraft

Figure 29 Number of vessels cleared at Honiara Port in 2006

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

0

20

40

60

80

100

120

140

160

Shipping Agents

Number of Vessels

Series1 51 148 7 4 5 9

Mako Fisheries Tradco Shipping LTD Sullivans Egon Shipping Pacific Shipping Others


67

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.


68

Figure 30 Number water samples tested in 2006

Water Samples Microbiological Analysis

0

20

40

60

80

100

120

140

160

180

200

Stations

Number of Samples Receive & Tested

Number of Samples Received

Number of Tests

Number of Samples Received 17 33 18 93

Number of Tests 45 69 54 173

Honiara City Council Provinces Individuals Industries

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.


69

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 rate type 2 diabetes in population 15+

0

1

2

3

4

5

6

7

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Cumulative incidence per 1,000

pop (15+)


70

Figure 32 Age at new cases type 2 diabetes 1991-2006

Age at diagnosis new cases type 2 diabetes 1991-2006

0

50

100

150

200

250

300

350

Unknown

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

Age

Number

Total cases male Female

Table 19: % Total cases by ethnicity

Total cases Melanesian Micronesian Polynesian Other Unknown

Total notifications 1420 1282 60 40 22 16

% total cases 90.3% 4.2% 2.8% 1.5% 1.1%

%SI population 94.5% 1.2% 3.3% 1.8% 0.0%

Males 768 700 24 16 19 9

% male notifications 91.1% 3.1% 2.1% 2.5% 1.2%

Females 652 582 36 24 3 7

% female notifications 89.3% 5.5% 3.7% 0.5% 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


0

5

10

15

20

25

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Age

Rate per 1,000 popn

rate 1,000 popn rate 1,000 males rate 1,000 females

Targets and indicators


71

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


72

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.

0

10

20

30

40

50

60

70

80

90

100

cervical

mouth

thyriod

breast

muskularkeletal

lymps node

coles- rectal.

Skin

prostate

uterus

others

Types of cancers.

no. of cases.

2006

2005

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.


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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%


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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


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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


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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)


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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)


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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)


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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


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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


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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:


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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 - 10 Juvenile - 7 Cases only referred from Police Self Referrals - 91 School Fee Remission - 3 Declarations - 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


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Summary of Major Constraints Strategies/Action Plan for way Forward

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

In regards to Child Rights Bill, there is need for more awareness and more Advocacy to the rural communities and the Government.

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 - Review and implement health promotion organizational structure and function 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


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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 of Media and IEC materials for behavioural change communication activities. 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


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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


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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.


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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.


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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.


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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 2004 2005 2006 (*) Cumulative

Suspected infected people 150-200

Confirmed HIV positive 1 0 5 1 1 8

AIDS 0 2 0 0 2

Died of AIDS 1 0 1 1 0 3

Detected by VCCT clinic 0 0 1 1 1 3

Detected by other means of testing

2 0 5

PLWHA 1 0 4

On ARV 0 0 1 0 1 1

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


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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 Partners

45.1%

Proportion of young men using condoms at last commercial sex 41.9%

Consistent condom use of young men with commercial partners in last 12 months.

7.3%

Proportion reporting correct knowledge of HIV/AIDS prevention methods

58.0%

Proportion reporting no incorrect beliefs about HIV/AIDS transmission

55.6%

Proportion who both report correct knowledge of HIV/AIDS prevention and no incorrect beliefs about HIV/AIDS transmission

9.3%

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.


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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.


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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


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Choiseul Province

South Choiseul Zone 2South Choiseul Zone 2South Choiseul Zone 2South Choiseul Zone 2South Choiseul Zone 2South Choiseul Zone 2South Choiseul Zone 2South Choiseul Zone 2South Choiseul Zone 2

East Choiseul Zone 3East Choiseul Zone 3East Choiseul Zone 3East Choiseul Zone 3East Choiseul Zone 3East Choiseul Zone 3East Choiseul Zone 3East Choiseul Zone 3East Choiseul Zone 3

NWest Choiseul Zone 1NWest Choiseul Zone 1NWest Choiseul Zone 1NWest Choiseul Zone 1NWest Choiseul Zone 1NWest Choiseul Zone 1NWest Choiseul Zone 1NWest Choiseul Zone 1NWest Choiseul Zone 1

Contraceptive Prevalence Rate

by Area Health Zone, Choiseul

Above Provincial 17% (1)

Within Nat & Prov (10.8/17) (1)

Below National 10.8% (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 Targeting men as partners

Isabel Province

Western Province zone 4Western Province zone 4Western Province zone 4Western Province zone 4Western Province zone 4Western Province zone 4Western Province zone 4Western Province zone 4Western Province zone 4

Isabel Zone 2Isabel Zone 2Isabel Zone 2Isabel Zone 2Isabel Zone 2Isabel Zone 2Isabel Zone 2Isabel Zone 2Isabel Zone 2





Malaita Northern Region 3Malaita Northern Region 3Malaita Northern Region 3Malaita Northern Region 3Malaita Northern Region 3Malaita Northern Region 3Malaita Northern Region 3Malaita Northern Region 3Malaita Northern Region 3


by Area Health Zone, Isabel

> Provincial Av. 17.8% (1)

> Nat. 10.8% & Prov 17.8% (1)

Within National Average (2)

Below National 10.8% (1)

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


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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

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

Malaita Province


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Contraceptive Prevalence Rate By Area Health Zones (Ranged Map Output)

HoniaraHoniaraHoniaraHoniaraHoniaraHoniaraHoniaraHoniaraHoniara

GuadalcanalGuadalcanalGuadalcanalGuadalcanalGuadalcanalGuadalcanalGuadalcanalGuadalcanalGuadalcanal

Rennell BellonaRennell BellonaRennell BellonaRennell BellonaRennell BellonaRennell BellonaRennell BellonaRennell BellonaRennell Bellona

TemotuTemotuTemotuTemotuTemotuTemotuTemotuTemotuTemotuMakira UlawaMakira UlawaMakira UlawaMakira UlawaMakira UlawaMakira UlawaMakira UlawaMakira UlawaMakira Ulawa

MalaitaMalaitaMalaitaMalaitaMalaitaMalaitaMalaitaMalaitaMalaitaCentral ProvinceCentral ProvinceCentral ProvinceCentral ProvinceCentral ProvinceCentral ProvinceCentral ProvinceCentral ProvinceCentral ProvinceWestern ProvinceWestern ProvinceWestern ProvinceWestern ProvinceWestern ProvinceWestern ProvinceWestern ProvinceWestern ProvinceWestern Province

IsabelIsabelIsabelIsabelIsabelIsabelIsabelIsabelIsabel

ChoiseulChoiseulChoiseulChoiseulChoiseulChoiseulChoiseulChoiseulChoiseul


by Area Health Zone

> 20% (7)

> Nat.Av 10.8% but < 20% (13)

Between 5% and Nat.Av (16)

< 5% (10)

Guadalcanal Province

Guadalcanal Zone 1Guadalcanal Zone 1Guadalcanal Zone 1Guadalcanal Zone 1Guadalcanal Zone 1Guadalcanal Zone 1Guadalcanal Zone 1Guadalcanal Zone 1Guadalcanal Zone 1




Eastern ZoneEastern ZoneEastern ZoneEastern ZoneEastern ZoneEastern ZoneEastern ZoneEastern ZoneEastern ZoneCentral ZoneCentral ZoneCentral ZoneCentral ZoneCentral ZoneCentral ZoneCentral ZoneCentral ZoneCentral ZoneWest ZoneWest ZoneWest ZoneWest ZoneWest ZoneWest ZoneWest ZoneWest ZoneWest Zone




by Area Health Zone, Guadalcanal

Within National 10.8% (2)

Within Provincial 7% (1)

Below 6% (3)

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) STRATEGIES More efforts in ALL zones Family Health Card Strategies Network with NGOS and communities


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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

Contraceptive Prevalence Rate By Area Health Zones Graphic Output (Graphic Output)

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

Lack of Accurate Data Honiara, Renbell


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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)

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

0

50

100

150

200

250

2001 2002 2003 2004 2005 #2006

API per 1,000

0

2

4

6

8

10

12

14

16

18

Mortality per 100,000

API Mortality

# To August 2006

GF Assistance


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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

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%)

Figure 36 Number of LLN’s distributed & proportion of HH with access to

ITN’s [round 2]

0

20000

40000

60000

80000

100000

120000

140000

end phase 1 Y3 Y4 Y5

Timescale

No; LLN's distributed

0%

10%

20%

30%

40%

50%

60%

70%

80%

HH coverage

Vanuatu Solomons Vanuatu Solomons


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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


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- 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 media materials Condom Distribution - Taxi, Motels & Hotels - Youth Centre & clinic - Selected provincial hospitals and Clinics - Individuals 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 of the SRH issues - Create more advocates


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


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Strengthen Partnership Trainings for policy makers & stakeholders Improvement of QOC Further increase Access centers Mainstreaming of programmes Strengthen distribution network


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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

Health Facilities Doctors

1 Makira 37,469 39 33 1

961 1,135 37,469

2 Western Province 73,932 61 56 4

1,212 1,320 18,483

3 CIP 25,424 20 27 1

1,271 942 25,424

4 Isabel 23,950 32 37 1

748 647 23,950

5 Choiseul 23,550 32 27 1

736 872 23,550

6 Malaita 145,580 95 73 4

1,532 1,994 36,395

7 Guadalcanal 71,270 36 42 2

1,980 1,697 35,635

8 Ren Bell 2,754 7 3 1

393 918 2,754

9 Temotu 22,222 29 16 1


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766 1,389 22,222

10 HCC 57,636 36 8 11

1,601 7,205 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 1999 2006

Health Facilities Number. 198 247 282

Population 410,360 459,380 483,787

Ratio 2,073 1,860 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].


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Table 24 Proportion of sample households reporting use of health facilities, SI HIES 2005-2006

N u m b e r %

S o u g h t c a r e 2 3 5 0 8 8 . 7 %

D id n o t s e e k c a r e 2 8 8 1 0 . 9 %

N o t s t a t e d 1 2 0 . 5 %

T o t a l s i c k n e s s p a i n 2 6 5 0 1 0 0 %

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

Males % Females % Sex not stated % NS Total %

Age <5 years 290 24.1% 279 24.4% 0 0 569 24.2%

5 to 9 years 195 16.2% 170 14.8% 0 0 365 15.5%

10 to 14 years 121 10.0% 107 9.3% 0 0 228 9.7%

15 to 29 years 192 15.9% 235 20.5% 0 0 427 18.2%

30 to 49 years 254 21.1% 238 20.8% 0 0 492 20.9%

50 years 152 12.6% 116 10.1% 0 0 268 11.4%

NS 0 0.0% 0 0.0% 1 1 1 0.0%

Totals 1204 100.0% 1145 100.0% 1 0.0% 2350 100.0%

% of total reporting sickness 51.2% 48.7%

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

Yes % No % NS % Total

Choiseul 85 92.4% 7 7.6% 0 0.0% 92

Western 214 93.9% 11 4.8% 3 1.3% 228

Isabel 102 85.7% 17 14.3% 0 0.0% 119

Central 224 92.6% 13 5.4% 5 2.1% 242

Rennell/Bellona 161 93.1% 12 6.9% 0 0.0% 173

Guadalcanal 386 90.6% 39 9.2% 1 0.2% 426

Malaita 405 89.0% 49 10.8% 1 0.2% 455

Makira Ulawa 340 81.7% 76 18.3% 0 0.0% 416

Temotu 186 84.5% 34 15.5% 0 0.0% 220

Honiara 247 88.5% 30 10.8% 2 0.7% 279

Total 2350 88.7% 288 10.9% 12 0.5% 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


106

T yp e c a re N um b e r %

T o ta l a id /c lin ic 1 4 3 7 6 1 .1%

T o ta l p ro v in c ia l h o s p ita l 4 6 7 1 9 .9%

T o ta l N R H 1 3 3 5 .7%

T o ta l p r iv a te 1 0 6 4 .5%

T ra d it io n a l h e a le r 6 4 2 .7%

V il la g e ( re t ire d n u rs e /d o c to r ) 1 1 0 .5%

D e n t is t 4 0 .2%

O th e r 4 5 1 .9%

N o t s ta te d /b la n k 8 3 3 .5%

T o ta l 2 3 5 0 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 ra d it io n a l h e a le r N u m b e r %

C l in ic to fa r 2 6 4 1 %

C l in ic n o t f r ie n d ly 3 5 %

C l in ic n o s ta f f 1 2 %

C a n 't p a y f o r c l in ic 1 2 %

C a n 't p a y f o r t r a n s p o r t 4 6 %

N o t r a n s p o r t a v a i la b le 1 2 %

I l ln e s s a t n ig h t 1 2 %

B a d w e a th e r 3 5 %

I l ln e s s n o t s e r io u s 2 3 %

O th e r r e a s o n 2 3 %

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 1 5 2 3 %

n o t s ta t e d 5 8 %

T o ta l 6 4 1 0 0 % 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


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SI HIES 2005-2006

N u m b e r %

C l i n i c t o f a r 7 6 2 6 . 4 %

C l i n i c n o t f r i e n d l y 0 0 . 0 %

C l i n i c n o t n i c e 1 0 . 3 %

C l i n i c n o s t a f f 4 1 . 4 %

C lo s e r e l a t i v e w o r k s a t c l i n i c 3 1 . 0 %

C l i n i c h a s n o d r u g s 1 0 . 3 %

C a n ' t p a y f o r c l i n i c 1 0 3 . 5 %

C a n ' t p a y f o r t r a n s p o r t 7 2 . 4 %

N o t r a n s p o r t a v a i l a b l e 8 2 . 8 %

I l l n e s s a t n i g h t 1 0 . 3 %

B a d w e a t h e r 1 0 3 . 5 %

T o b u s y t o g o t o c l i n i c 1 7 5 . 9 %

I l l n e s s n o t s e r i o u s 4 9 1 7 . 0 %

O t h e r r e a s o n 9 3 . 1 %

A lw a u y s u s e T H f i r s t 1 0 3 . 5 %

N o t s t a t e d 8 2 2 8 . 5 %

T o t a l 2 8 8 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.


108

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


109

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 A�C 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 Total

March 8 2 4

April 7 4 5

May 4 6 3

June 6 6 0

July 2 8 2


110

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

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

� Figure 38

HGH SERVICES

PRIMARY HEALTH CARE SECONDARY HEALTH CARE

NURSING EDUCATION

-AHC 1 -RHC 4

NATS

HGH


111

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


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Chapter 7 Resource Utilisation: Financial & Human

Resource Reporting

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 41,626,879 50,296,022

Staffing Establishment 45,460,431 46,933,788

Development 9,700,000 18,512,000

SIG Total for Health 96,787,310 115,741,810

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


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7.7%. Over-expenditure on drugs and medicines represented SBD5,884,117 (AUD 980,686) or 12%.

Figure 39 HSTA Expenditure 2006

HSTA Expenditure 2006

0

5

10

15

20

25

30

Medical Dugs

& Supplies

Operational

Grants

Other

Operational

HSTA

Projects

Medical

Equipment

Development

Initiative

Contingency

Fund

2005

unpresented

Other Funds

Expenditure Category

SBD (millions)

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

Actual Budget Variance % Variance

Medical Dugs & Supplies 25,884,117 20,000,000 -5,884,117 129.42%

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 431,079 76,531 -354,548 563.27%

Total Expenditure 51,441,201 47,762,802 -3,678,399 107.70%


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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

2005 2006

Solomon Islands Government 3,787 3,977

MHMS 1,558 1,574

% 41.1% 39.6%


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Figure 40 showing number health workers of the Ministry of Health (Source: 2006 SIG

Establishment)

0

200

400

600

800

1000

1200

1400

1600

1800

2005 1558 314 535 709

2006 1574 298 549 727

All MHMS/HQ NRH Provinces

Figure 41 Proportion of health workforce by locations in 2006

MHMS/HQ, 19%

NRH, 35%

Provinces, 46%


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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 Health

Vector Borne

Dental Pharmacy Laboratory Radiography Nurses in Clinics

Nurses in Hospitals

Gold Standard

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

WISN Index

522% 554% 217% 128% 95% 200% 127% 130%

Excess 5.22 5.54 2.17 1.28 0.95 2 1.27 1.3

Potential unutilized staff

76 82 20 6.1 -2 10 104 101

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.


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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:


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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


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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.


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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


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4 biula wp nap 11

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


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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

9 bita'ama mp rhc 12

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


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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

Temotu Province 2006

1 otomongi tp nap 12

2 community health team tp 12

3 dendu tp rhc 12

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

9 luesalemba tp nap 11

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


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10 mauroloan cip nap 12

11 narogu cip nap 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 cip ahc 12

Choiseul Province 2006

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 11

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

Isabel Province 2006

1 baolo isp rhc 12

2 bara isp nap 10

3 bolotei isp ahc 12

4 buala hospital isp hosp 12


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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

9 kaonasugu mup nap 12

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


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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

Honiara City Council 2006

1 kukum hma uahc 12

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


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National Health Report 2006

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