Government of The Solomon Islands: Health & Medical Services

Annual Report -2000 Guadal Canal Province
II Om-Shri II
GOVERNMENT OF THE SOLOMON

ISLANDS
Ministry of Health and Medical Services
ANNUAL REPORT - 2000
Health & Medical Services

Guadal Canal Province
By:
Dr.H.K.Balachandra
Director of Health & Medical Services
March 31, 2001

Annual Report -2000 2 Guadal Canal Province
“Safe Blood starts with me”
WHO Slogan for the year - 2000
"Safe Blood starts with me" - WHO Slogan for the year -2000
Solomon Islands
Hon’ble Minister for Health,

Mr. Allan Paul
“Commitment from the

community and their
participation towards
health service delivery is

the need of today”
Table of Contents
1 PREFACE...................................................................................................................................................... 6
2 ACKNOWLEDGEMENTS.............................................................................................................................. 7
3 EXECUTIVE SUMMARY............................................................................................................................... 8
4 PART I-INTRODUCTION............................................................................................................... 9
4.1 Solomon Islands.........................................................................................................................................................10
4.2 Guadal Canal Province.............................................................................................................................................11

4.2.1 Population............................................................................................................................................................11
4.2.2 Socio-Economic Factor.......................................................................................................................................14
4.2.3 Natural Environment:..........................................................................................................................................14
4.2.4 Political environment:..........................................................................................................................................14
4.2.5 Ethnic Crisis........................................................................................................................................................14
4.2.6 Health Status........................................................................................................................................................15
4.3 Provincial Health System:.........................................................................................................................................17
5 PART II -RESOURCE ANALYSIS............................................................................................................... 19
5.1 Health facilities..........................................................................................................................................................20

5.1.1 Introduction.........................................................................................................................................................20
5.1.2 Health Centres:....................................................................................................................................................20
5.1.3 Existing Health Facilities:...................................................................................................................................20
5.2 Health personnel........................................................................................................................................................21

5.2.1 Organisational Structure......................................................................................................................................21
5.3 Nursing Management................................................................................................................................................23

5.3.1 Clinic Nurses GPHQ / Referral Health Centre....................................................................................................23
5.3.2 GP Referral Clinic at National Referral Hospital................................................................................................23
5.3.3 Supervisory Tour/Training Workshops................................................................................................................23
5.3.4 Impacts of the Ethnic Tension.............................................................................................................................23
5.3.5 Costing Containment Strategies..........................................................................................................................24
5.4 Wages and service Grant..........................................................................................................................................27
5.5 Expenditure................................................................................................................................................................27
6 PART III-PRIMARY HEALTH CARE ELEMENTS.......................................................................................29
6.1 Treatment of common diseases & injuries..............................................................................................................30

6.1.1 Out Patient Services.............................................................................................................................................30
6.1.2 Emergency services.............................................................................................................................................30
6.1.3 Psychiatric Health Programme............................................................................................................................30
6.2 MCH and Family Planning activities.......................................................................................................................30
6.2.1 Introduction.........................................................................................................................................................30
6.2.2 Women’s Right....................................................................................................................................................30
6.2.3 Women's Reproductive life and Sexual health....................................................................................................31
6.2.4 Organisation of the MCH/FP unit........................................................................................................................31
6.2.5 Total Number of Health Promotion & Disease prevention activities..................................................................31
6.3 Expanded Programme of Immunization.................................................................................................................37
6.4 Health education........................................................................................................................................................38

6.4.1 Health education..................................................................................................................................................38
6.4.2 Training / workshops...........................................................................................................................................38
6.4.3 School Health Education.....................................................................................................................................38
6.4.4 Community Information Education communication...........................................................................................38
6.4.5 Campaigns...........................................................................................................................................................38
6.4.6 Health Committee and Implementation...............................................................................................................39
6.4.7 Audio Visual Aid Production...............................................................................................................................39
6.5 Provision of essential drugs......................................................................................................................................39

6.5.1 NGO-World Vision..............................................................................................................................................39
6.6 Control of communicable diseases...........................................................................................................................40

6.6.1 Malaria: Vector Bourne Disease Control Program..............................................................................................40
6.6.2 Tuberculosis Situation.........................................................................................................................................46
6.6.3 Leprosy Situation.................................................................................................................................................50
6.7 Safe water supply & basic sanitation.......................................................................................................................50
6.8 Environmental Health Division................................................................................................................................51
7 PART IV-MANAGEMENT & SUPPORT ACTIVITIES..................................................................................58
7.1 Administration & Management...............................................................................................................................59
7.2 Human Resource Medical Training Centre............................................................................................................59

7.2.1 Introduction.........................................................................................................................................................59
7.2.2 Training Activities...............................................................................................................................................59
7.2.3 Training Overseas:...............................................................................................................................................60
7.3 Supervisory Tours......................................................................................................................................................60

7.3.1 Introduction.........................................................................................................................................................60
7.3.2 Objective..............................................................................................................................................................60
8 CONCLUSION............................................................................................................................................. 61
9 KEY HEALTH INDICATORS........................................................................................................................ 62
10 ACRONYMS............................................................................................................................................ 63
11 References............................................................................................................................................... 63
1 Preface
The development of health services in Solomon Islands has gone
through many stages from the colonial days to the present
situation. According to WHO’s Constitution, “the enjoyment of the
highest attainable standard of health is one of the fundamental
rights of every human being”.
Development has often been described as being concerned with growth and
structural change. It has also been referred to as a process or a state or
situation where the production goods and services is raised in quantity and
quality and the benefits consequent to this improved production is distributed
to the most number of people, paying special attention to the less privileged
members of society.
All over the world the health care situation is characterized by an increasing
demand for health services and by decreasing financial resources. Many
countries have been forced to redress the balance between the amount they
spend and the amount of money they have at their disposal for health care
sector. With the advent of these technologies the costs of National health
care rise every year, amount over and above the previous years figures,
upsetting national health programmes, raising public anger against
governments demanding more services and funds.
We are at the end of the century and entering a new millennium. The
priorities of half a century ago are still remain the same. 25 years ago when
the World Health Assembly called for “the attainment by all citizens of the
world by the year 2000 of a level of health that would permit them to lead a
socially and economically productive life” has come to a reality.
In the year 1978 the International Conference in Alma-Ata, declared that
Primary health care was the key to reaching that target by the end of the
century. The drive for primary health care had been a drive to provide a
network of basic health services that were both available and accessible to
everyone. Healthy living standards and universal access to affordable health
care were the basis on which the campaign for “health for all by the end of
century” was built.
Primary health care refers to the kind of care that is provided at the first point
of contact with the health care system. Thus, it has more to do with the
community in which people live than with high-technology hospitals. It means
ensuring eight basic elements – safe water supply and sanitation, nutrition,
health education, immunization, provision of essential drugs, maternal and
child care, prevention communicable diseases, and treatment of common
diseases and injuries. Primary health care also refers to the provision of
health care that is characterized by equity, intersectoral action, and
community participation.
This report is aimed at the health administrators of the health ministry at the
national level, and other architects of health system, to provide a clear
picture of the strength and weaknesses of the health system in the Guadal
Canal Province.
Report focuses the performance of the implementation of the health policy
and strategies, and the extent to which these policies and strategies have
translated into action in the province.
Reader will be able to gain an insight of the pattern, trends and health impact
upon the population, of the health developmental activities in the province for
the year 1998. The overall objective is to draw the attention of the policy
makers at the centre, the needs and the priorities of health in the province,
so as to facilitate them for their developmental activities.
Dr.H.K.Balachandra
Director of Health & Medical Services
Guadal Canal Province
31 March 2001
2 Acknowledgements
This successful task has been made possible by the efforts and co-operation
by the entire staff of Guadal Canal Medical division and Above all I thank the
God Almighty for having given this opportunity of presenting this report to
the best of my ability.
I am grateful to following distinguished personalities:

 Hon’ble Ezekiel Alibua – Hon’ble Premier Guadal Canal Province
 Mr. Eliam Tangirongo - Provincial Secretary in giving all the
administrative support and guiding force in the day-to-day affairs.
 Mr.George Maebata -CNO, for all the assistance in the administration
through out the year.
I will be failing in my duty if I do not acknowledge the following staff:
Mr.Batram Manu-PNO and his team
Mr.Gabriel Vagi -SNO (Training) and his staff
Ms.Alice Watoto SNO Mr.Noel-SNO, Mr.Soram-NO, and all the other nursing
staff.
Mr.EddyLeamae-SAMO Mr.Aloysis Vakeke-SHE
Mr.Leonard Olivera -PHI,Mr.George Titiulu-AHI, Mr.Francis Sade-AHI,
Ms.Methoda-HI
Mr.Benson Anisi Senior Accountant,
Ms.Christina Legumana, Ms.Jane Roy
Last but not the least the multipurpose man Mr.John Mupphet Driver.
My special thanks goes to my close friend Dr.Bharat G Patel, Los Angeles,
California, who gifted a Digital Camera, which enabled me to incorporate
actual photographs in this document.
Staff of Guadal Canal Province - Medical

Division
3 Executive Summary
The aim of this report is to diagnose, evaluate, appraise the situation analysis of the
prevailing health in the community in the province and its appropriateness of the
health delivery system with regard to PHC, and to ascertain the extent to which the
national and provincial policies and strategies have been translated into action
throughout the province.
The objective description of this report from the standpoints of Public Health
Management has following features:
1. Performance to indicate how the national health policies and strategies were
being implemented, the conditions that facilitated the progress, and various
challenges faced by the health providers in the implementation.
2. A current situation of population, health status, health resources and the socio-
economic factors.
3. Trends in the pattern of specific diseases.
4. Community diagnosis
The goals of the ministry of health and medical services is to:

 Improve health management, supervision, health financing and strategic
planning in the health sector.
 Reorganize the management structure to enable them to be effectively and
efficiently respond to the issues related to the health sector.
 Achieve an efficient and cost-effective health care service delivery to the
populace.
 Develop multidimensional approach towards integrated health promotional
activity.
4 Part I-Introduction
4.1Solomon Islands
he Solomon Islands, are an archipelago consisting of six main islands and

many smaller ones extending over 1600 kilometres, with a total land area of
T
28,450 square kilometres, in the South Pacific Ocean, east of Papua New
Guinea.
 Latitudes: 8:00 South and Longitudes 159:00 East

 Climate: tropical monsoon; few extremes of temperature and weather.
 Terrain: mostly rugged mountains with thick vegetation and some low coral
atolls.
 Natural resources: fish, forests, gold, bauxite, phosphates, lead, zinc, and nickel.
 Land use: forests and woodland 88% and remaining distributed for crops,
pastures and others.
 Natural hazards: typhoons, more than the destruction the transportation gets
affected; geologically active region with frequent earth tremors; volcanic activity.
 Environment-current issues: deforestation; soil erosion; much of the surrounding
coral reefs are dead or dying.
 Environment -international agreements: party to: Bio-diversity, Climate Change,
Environmental Modification, Law of the Sea, Marine Dumping, Marine Life
Conservation, Ozone Layer Protection.
 Population: 409,039 (1999 Census)
 Growth rate: 2.8%
 Birth rate: 36.62 births/1000 population
 Death rate: 4.21 deaths/1000 population
 Infant mortality rate: 23.93 deaths/1000 live births
Guadal Canal Island is the main island constituting provincial boundary. The
capital town of Solomon Islands-Honiara is situated in this island and constitutes its
own town council boundary and its health service delivery for the inhabitants of the
town. Honiara is urbanized town with modern road, water supply and electric supply
round the clock.
The government of Solomon Islands being a member country to WHO, holds itself
responsible to cater to its citizen, a simple, effective, efficient, accessible, and
affordable (free at the point of delivery) health delivery system based on the
principles of Primary Health Care for our country is certainly a matter of great
challenge.
The Ministry of Health and Medical services through the Director of Health and
Medical services, governs the provincial health activities chiefly outside the
boundary of Honiara Town council round the island through the network of health
infrastructure comprising of health personnel and facilities. Head quarters of Guadal
Canal medical division based in Honiara, comprising of semi permanent building
situated in a half an acre of land facing the northern coast of pacific ocean.
Unfortunately entire building and its contents were destroyed during ethnic conflict
between people of Guadal Canal and Malaita. Health service delivery activities to
the people of Guadal Canal, largely rural dwellers are carried out with the
Government established peripheral centres- 3 Area Health Centres, 13 Rural Health
Clinics, and 13 Nurse Aide Posts.
National Referral hospital situated in Honiara consists of 220 beds in the various
disciplines. Medical, Surgical, Orthopaedic, O&G and Paediatric including Accidents
& Emergency department’s functions in its fullest capacity. NRH is also forms a base
hospital for Guadal Canal Province, as the province does not have a separate
hospital of its own. Besides, serving the inhabitants of Honiara, in and around
Guadal Canal, also serves as main referral centre for the other provincial hospital.
4.2Guadal Canal Province

4.2.1 Population
In 2000, the estimated Guale population was 62,083(Projection based on 1999
Census - Ministry of National Planning and Development). About one third was over
35 years of age. More than 90% of the population lived in rural areas. Population
density in Guadalcanal is around 11 persons per square kilometer – a bit lower than
the national figure of 13 persons per square kilometer.
According to the 1999 Census, the population of Guadalcanal Province iii was 60,275
– a significant drop from the estimated 78,563 cited in the National Health Status
report. This reflects both a slowing of population growth due to lower fertility rates
but the main impact was from the exodus of Malaitans during the ethnic tension.
Estimates of the number of people from other provinces leaving Guadalcanal over
the past two years vary, but are in the order of 20,000. The population remains
concentrated around the coast, with larger populations in the north.
Population by wards 1999 Census
1338
East Ghaobata 609
729
2601
West Ghaobata 1240
1361
4105
Malango 1874
2231
2716
Vulolo 1292
1424
4832
East Tasimboko 2309
2523
2584
Paripao 1268
1316
3527
Aola 1720
1807
2869
Longgu 1407
1462
1232
Kolokarako 582
650
1098
Valasi 536
562
2271
Birao 1093
1178
974
Tetekanji 515
459
3534
Moli 1750
1784
1970
AvuAvu 955
1015
2014
Talise 1023
991
2113
Vatukulau 1066
1047
3163
Duidui 1532
1631
2880
Wanderer Bay 1394
1486
2913
Tangarare 1381
1532
2199
Savulei 1036
1163
3372
Saghalu 1572
1800
5970
Tandai 2698
3272
0 2000 4000 6000 8000

Male Female Total
Some shifts are known to have occurred after the census, particularly around the
time of crisis in mid 2000, but these have not been formally recorded. Population
mobility continues, as villages and houses are rebuilt and Honiara returns to a state
of ‘normalcy’.
Around 1,200 births p.a. were reported in both 1999 and 2000. HIS data from the
province show that birth registrations in Guadalcanal increased by 23% between
1999 and 2000. (See table at Attachment 1) These data exclude births at the NRH.
While the overall increase is believed to reflect population shifts away from Honiara
and a reduction in Guadalcanal Province resident births at NRH, the changes in
distribution of births may also indicate population shifts. The low birth rates per
1000 in some wards suggest under-reporting, possibly due to people living in more
isolated hill villages.
The Guadalcanal Province population, like most of the Solomons is very young, with
42% of people aged 14 years or less in 1999. Women of childbearing age made up
22% of the population. This highlights the importance of reproductive and child
health services. The figure below shows the age distribution of the population in
1999.
60+
45-59
15-44
Females
5-14 Males
1-4
- 5,000 10,000 15,000
Figure 1: Guadalcanal population age distribution, 1999
Estimated Population Chart
62,500 62,083
62,000
61,500
61,000
60,275
60,500
60,000
59,500
59,000
1999 2000
4.2.2 Socio-Economic Factor

Habitat of the people here are predominantly rural—depend on subsistence
farming and, majority live on the coasts, thrive on fishing. Very scarce population
lives in the bush up in the highland not more than 1000 feet above the sea level.
Diets are composed of various kinds of marine life, and plants such as taro,
cassava, yams, breadfruit, bananas, and several other fruits. The coconut palm
grows in abundant and an important plantation, as each and every part is put to
use. Coconut water is a commonly used beverage, and the milk extracted from the
fruit is used for cooking in day-to-day life, and also made use in festivities for
making a special kind of pudding.
Clothing is typically lightweight, and often is being shared by the contemporaries
among younger generation and it is social obligation and a custom. Houses on the
islands are typically constructed from sago palm leaves.
Education standard is quite low as compared to the any country in the Pacific
Islands, and Guadal Canal Province is no exception. Literacy rate in Men <30% and
Women <16 %. Low educational and literacy levels affect patterns of use of health
services, and limit the impact of health education and information.
Occupation is chiefly logging, fishing, Copra, and Cocoa farming, besides
subsistence agriculture.
4.2.3 Natural Environment:

Climate is tropical monsoon few extremes of temperature and weather. Cyclone
during the wet season supposedly between November and April occasionally
account for the destruction, with some geologically active region with frequent earth
tremors.
Geographical area is mostly rugged
mountains terrain with thick vegetation
and some low coral atolls. Natural
resources are chiefly fish, forests, gold,
bauxite, phosphates, lead, zinc, and nickel.
Forests and woodland accounts for 88%
and thus logging is of the main occupation and remaining distributed for crops,
pastures and others.
4.2.4 Political environment:

A democratic system of government exists in the center as well as in province. The
people elect members of Parliament, as well as provincial members. As Rural
Health clinics are tangible and the only activity centre in the villages, which forms
a part and parcel of life in the village community, thus the local politicians
leverage this factor for the development of health clinics in their constituency.
4.2.5 Ethnic Crisis

Almost 22 months old ethnic conflict finally ended in “Peace” on 15 th of October
2000, in Townsville Australia with signing of peace agreement by the two warring
faction in Solomon Islands. Warring militants were ‘Isatabu Freedom Movement’
from Gaudal Canal Province, and ‘Malaita Eagle Force’ from Malaita Province.
Gradual occupation of sizable piece of land in Gaudal Canal by the hard working
enterprising Malaitans over a long period time led to dissatisfaction amongst the
younger generation of people of Gaudal Canal, and hence the dispute for
compensation in cash or kind.
In the initial stages then emerged a militant group known as Gaudal Canal
Revolutionary Army (GRA), began to chase all the Malaitan settlers at the gunpoint
from the outskirts of Honiara who were mainly labour oriented people working in
SIPL and GOLD ridge mine. In retaliation to this Malaitans formed a MEF and began
to drive all the people of GP from Honiara. This led to check-post manned by the two
militants group to prevent each other from crossing the border formed by these
militants. At several occasions there were exchange of gunfire leading to a total
casualty of 70 from both sides.
MEF put up a sort of an embargo on the people of GP, in the sense they restricted all
services to be carried out by the Government or NGOs. This also affected Health &
Medical Services to a large extent in the GP. Militants destroyed the offices of the
Provincial Government, including the Headquarters and Clinic of Health services of
Guadal Canal located in the heart of Honiara. Eastern side a bridge was damaged
and western side a water tank was destroyed putting a loss of potable water supply
to the inhabitants of western portion Honiara. Some private properties were
damaged and seized at the gunpoint for their use, mainly vehicles and fuel.
The capital town of Honiara is located in G Province and largely dominated by
Malaitans, practically holding key positions in Government and managing several
private enterprise.
4.2.6 Health Status

Malaria remains to be still one of the major causes of the morbidity in the province.
Maternal and Child health care needed additional focus of attention. Rise in the
Sexually transmitted diseases in young adolescents, unhealthy sexual habits, and
unwanted pregnancies were a matter of concern for the rising population of the
Solomon Islands. Tuberculosis still remains a cause of concern, despite International
support and DOTS strategy.
 2000 recorded 115 cases of malaria per 1000 population, drastic decrease in the
incidence rate. Previous years recorded 1995-337, 1996-242, 1997-235, 1998-
253, 1999 -163 cases of malaria per 1000 population
 21 cases of TB were detected in the year 2000.
 One of the lowest Year 2000 rates of deliveries in
health facilities, with only about half
of all deliveries S/Birth 16 occurring in clinics
or health centres. NND 8 Family planning
coverage is low Others < 1 year (HIS reports a rate
of 6-7% compared with 18%
nationally). A Total deaths 151 major cause of
infant mortality is M/Deaths complications of
delivery. The total numbers of
deliveries were
Total Deliveries 1299 1299. The IMR was
33 per 1000 Live births births, and MMR was
3 per 100,000 IMR/1000 24 births.
 The Sexually Transmitted
Diseases
MMR/100,000 80 recorded 5 positive
cases out of 15 suspected
adolescent males aged between 10
and19 years. 3 positive cases out of 21 suspected adolescent females aged
between 10 and 19 years.
The two years of ethnic tension in GP is expected to have some adverse effects of
health. Over this period, some preventive activities such as malaria control,
environmental health and satellite clinics providing antenatal care, immunisation
etc. have been substantially reduced. Touring medical services have been irregular
and have been totally suspended since the latter part of 2000. Access to diagnostic
and treatment services has been restricted by the loss of health transport (OBM
canoes and vehicles) and restricted access to other transport providers.
There is anecdotal evidence that rural services have been less able and patients
less willing to use the NRH for cases of serious illness or obstetric complications.
Even travel to rural health clinics has been restricted due to fear of hostilities. These
factors are expected to have some impact on health in the affected areas.
At national level, gains have been made in life expectancy and in areas such as
malaria and TB control, immunization coverage and maternal and infant mortality. It
is fair to assume that these trends will be reflected in Guadalcanal Province.
However, the provincial population still has higher rates of malaria and maternal
and infant mortality than the Solomon Islands as a whole.
Health Indicators
25 24
20
15 14
10 2000
5
1.7
0 0.3 0.8
CBR CDR IMR CMR MMR
4.3Provincial Health System:

A comprehensive range of health activities based on principles of primary health
care, in a well-defined population living within a clearly delineated administrative
and geographical area.
Providing health care in the province is through a network of health workers and
health facilities. This ranges from a village health worker’s post - a basic health
facility as the first point of contact with the community at the peripheral level, to
provincial hospital - the first referral level hospital, in order to assess the patient’s
condition, either to treat him directly or to pass on for further course of
management at the higher level.
Apart from the treatment of individual patients, provincial hospital is also involved in
the planning, co-ordination and evaluation of the implementation of the eight
elements of Primary health care. Therefore, a provincial health system consists of
large variety of inter-related elements that contribute to health in homes, schools,
work places and communities.
One of the key features of the provincial health system is that it is people centred,
emphasising all the health-related elements of their behaviour and their
environment, and their right to shape their own health care with professional health.
Provincial planning usually starts analysis of the current situation often called
situational analysis. Therefore provincial health directors and other senior health
officer’s need a comprehensive and integrated view of the health needs of the
entire population of the province. A provincial health profile containing range of
essential indicators serves to choose the provincial priorities and agreeing future
programme goals and objectives.
It also examines the possibilities of various strategies to implement it successfully in
the health care system, and a possible solutions for the changes that might needed
to bring the average nearer the best in the year ahead.
Organisation &
Management
Resource  Planning,
Primary
s implementati Health
on, monitor,
Human evaluation
Care
Material  HRM
Technical  Materials
Financial management
 Information
systems
Health of the
Community
No women should die in childbirth

The tragedy of maternal death has multiple causes and requires a comprehensive strategy
comprising community mobilization, parental care, clean and safe delivery with trained assistance
and, most critically, first referral care for management of complications……
Quality of care is essential in ensuring that women enjoy good reproductive health throughout their
lives. Such care is based on respect of women and their particular needs, participation of women in
the design and delivery of services, and the provision of information which allows women to make
informed choices about their sexual and reproductive lives.
 Women's health: towards a better world. Report of the First meeting of the Global Commission on
Women's Health. Geneva, World Health Organization, 1994 pp.18, 19
(document WHO/ DGH/94.4). p.55, Vol. 16, No. 1, 1995 , World Health Forum.
5 Part II -Resource
Analysis
5.1Health facilities
5.1.1 Introduction
A comprehensive range of health activities providing health care in the province is
through a network of health workers staffed at various health centres. This range
from aide post - a basic health facility as the first point of contact with the
community at the peripheral level, to provincial hospital - the first referral level
hospital.
5.1.2 Health Centres:

These are designed to provide comprehensive, integrated health services. These
include curative, promotional and preventive care, and community-based
rehabilitation. They are also responsible for health development in their respective
catchments areas through community activities and innovative approaches.
One of the key features of the provincial health system is that it is people centred,
emphasising all the health-related elements of their behaviour and their
environment, and their right to shape their own health care with professional health.
5.1.3 Existing Health Facilities:

GP Head Quarters/Referral & Management Health Centre – based in Honiara,
capital town of Solomon Islands. The Establishment had an Office at the head
quarter levels to host General Medical Staff, Environmental Staff, Health Education
and Malaria staff, Storage centre, Clinic for carrying out day-to-day Out Patient
service and the facility for Family Planning.
A. Area Health Centre - Three

 Grouve NO-Ms.Noami Vouza, RN- Kerry Alekuata, RN-Glence Faka RN-Philip
Neisa
 Lambi ANO-Ms.Ethel Tinoni, RN-Jackson Beikera, NA-Julian Beikera
NA- Francis Lagui
 Marau NO-Soram Osifera, ANO-Ms.Maria Hamarasi, RN-Bartholemew
Fonotau, NA-Ms.Rose Tovosia
B. Rural Health Centre - Fourteen
 Visale RN-Ms.Theresa Vinano, NA-Ms.Michaela Keni
 Tangarare RN-Mark Caleb, NA-Ms.Mensensa Caleb
 Foxbay RN-Ms.Jesinta Labacha, NA-Ms.Alice Kavigau
 MBabanakira RN-Ms.Albetta Veo, NA-Ms.Delrose Chiria
 Viso RN-Ms.Bethphage Buapechi, NA-Gordon Liu
 Kuma RN-Ms.Vinaka Pitchakinbo, NA-Vacant
 Madakacho(SDA) RN-Ms.Marylin Kavoara
 AvuAvu RN- Bartholemew Fonotau, NA-Ms.Rose Anea, NA-
Ms.Josephine Saia
 Balolava (SDA) RN- NA-Ms.Rose Tovosia
 Totongo RN- Ms.Junelyn Thugea
 Aola ANO-Jimmy Leni, RN-Vivian Leni, RN-John Tagabasoe, NA-
Alwin Pini
 New-Tenabuti RN-Ms.Vivian Jim, RN-Ms.June Topilu
 Ruvavatu RN-Samuel Topilu, RN-Ms.Julia Topilu, RN-Ms.Sharon
 Turarana RN-Peter Kakamo, NA-Philip Ngosakobu
C. Nurse Aide Posts - Sixteen
 Tamboko NA-Ms.Emma Frenold
 Kohimarama (COM) RN-Dorothy Korakau, NA-Abraham Hou
 Selwyn College(COM) RN-Ms.Hilda Roikera, NA-Ms.Alice Matenagai
 Marumbo Under Renovation and Upgrading to Permanent
Structure
 Mbiti NA-Edwin Kakau
 Nagho NA-Jeremiah Loise
 Saro NA-Ms .Jessy Rickson, NA-Ms.Prudence Koni
 Marapa RN-Adrian Manikera
 Luguvasa NA-Lazarus Galua
 Vatulava NA-Ms.Eunice Niaba
 Bolale NA-John Ligi
 Bubunuhu NA-Samuel Paralonga
 Kolosulu NA-Robert Pitua
 Haiparia(SDA) NA-VHW Mr.Joshua Koti
 Numbu(Community) NA-Ms.Everlyn Thao (Com)
 Lunga RN-Ms.Christina Sau
5.2Health personnel
5.2.1 Organisational Structure
H o s p it a l O r g a n is a t io n a l S t r u c t u r e
D r . H .K .B al ac h an d r a
D i r ec t o r o f H eal th & M ed i c al S er v i c es
N u r si n g P ar am ed
A dm n G eo r g e M aeb at a L eo n ar d O l i v er a E d d y L em ae A l o y si s V ai k ek e
C N O P H I S. M O S .H .E .O
B en so n A n i si B at r am M an u V ac an t A sst M .O M R .A d r i an L eam an a
A c c t .C l er k P N O H I A sst .E .O .
T y p i st s/ M ai n t . N o el I to g o G ab er i al V ag i A l i c e W at o t o F . S ad e G .T i tu l u M i c r o sco p i st/
C l er k s O ffi c er / SN O SN O SN O A .H I A .H I E n t o m o l o g i st /
D r i v er T ec h n i c i an
M eth o d a
N o am i S o u r am O si f er a H .A
N O N O
J i m m y L en i E th el T i n o n i C h an n i el l a
A N O A N O A N O
R eg i st er ed
N u r ses
N u r se
A i d es
Table no 1. Table no: 5.1 Staffing in the Guadal Canal Province
Staff Establishment Actual

Director 1 1
Medical Doctors 2 0
CNO 1 1
PNO 1 1
SNO 2 2
NO 3 3
ANO 4 4
RNs 26 24
Nurse Aides 30 28
Principle Field Officer 1 0
Senior Field Officer 1 1
Field Officers 2 1
Assistant Field Officers 4 3
Field Assistant 1 1
Feild Technician 1 1 1
Assistant Lab Officer 1 1
Lab Technician 1 1
Assistant Monitoring Officer 1 0
Principle Health Education Officer 1 0
(PHEO)
Senior Health Education Officer (SHEO) 1 1
Health Education Officer (HEO) 1 1
Health Education Assistant (HEA) 1 1
Chief Health Inspector 1 0
Health Inspector 1 1
Assistant Health Inspector 1 1
Environmental Health Assistant 2 1
Supportive Staff 1 1
TOTAL 93 72
Table no 2. Table no: 5.2 Staffing in the Provincial Direct Employees
Staff Establishment Filled

Nurse Aides 30 28
Malaria Technicians 11 11
Dental Therapist 1 1
Pharmacist 1 1
Pharmacy Asst. 1 1
Health Educators 2 2
Environmental Health Worker (Officers) 3 3
Env.Supporting Staff 6 6
Clerical Staff 3 1
Transport 1 1
“Safe Blood starts with me" WHO Slogan for the year - 2000
Domestic 1 1
TOTAL 60 56
5.3Nursing Management
5.3.1 Clinic Nurses GPHQ / Referral Health Centre.
All the nurses based at GPHQ/ Ref. Health Center were deployed to Honiara City
Council clinics both seconded and direct employee. The idea of the deployment
exercise had been implemented in the light that Guale patients would be using the
Honiara City Council Health facilities for Medical care.
5.3.2 GP Referral Clinic at National Referral Hospital.
During the height of the ethnic tension Mondays and Fridays Guadal Canal Referral
clinic at the National Referral Hospital was suspended for indefinite period. The
suspension then lifted for the normal referral clinic after the signing of the Peace
Agreement in the month of November 2000.
Dr’s weekly visit to Ghorou AHC on the east and western parts of Guadalcanal on
the roadside clinics was scheduled effectively after the signing of TPA.
5.3.3 Supervisory Tour/Training Workshops.
 Supervisory visit to the clinics was hampered due to the effect of two years
ethnic unrest.
 An integrated health team comprising of all Divisional representatives
conducted a weeklong health assessment and immunization programme on
two separate occasions at Marapa health post.
 The International Red Cross vessel the M.V Princess made a trip to weather
coast to make a rapid health assessment headed by Dr.Herman Oberly and
SNO G. Vagi performed the cold chain distribution and assessment
programme.
 Inland Rapid Health Assessment also carried out by SNO G. Vagi Malaria
Health.
 Another survey was conducted at Veraboli and carried out EPI and bed net
distribution.
5.3.4 Impacts of the Ethnic Tension
 A total destruction of Marau Area Health Center and staff accommodation.
 GPHQ Health Management / Referral Health Center also left into destruction
following intended one when the Para military and Malaita Eagle force took
over the premises.
 Medical essential supplies were distributed to the appropriate health facilities

through airlift, sea and land transports in the early stage of ethnic tension
appeared to have been operational effectively, thus following the restriction
movement which had been enforced by the militants for the east/ west
Honiara boundaries the essential medical supplies could only guarantee for
discrimination to intended destination under a negotiated approach.
 The health workers could not perform their routine duties to the expected
standard mainly out of fear and disturbances.
 Outreach programme had to be suspended.
5.3.5 Costing Containment Strategies.
5.3.5.1 NON – Clinical

 Reimbursement of Patients to & fro fares was abolished.
 Usage of fuel was cut down to a great extent.
 Touring allowances was minimized.
 Stationary purchase was curtailed and control usage of existing stationeries.
 Community was made to take up the responsibility and to participate in the
evacuation of emergency patients.
5.3.5.2 Human Resources
 Direct employees sent on unpaid leave.

 Allowances ceased and medical drivers overtime.
 In-Service Training for nurses was suspended.
 Redeployment of nurses to most needed health facilities and Health
Authorities to serve Guadal Canal patients.
5.3.5.3 Staff
HEALTH FACILITY POS NAME RESPONSIBILITY

T
GPHQ Health Management CNO G. Maebata Overall Nursing
PNO B. Manu Management P/Admin
SNO G. Vagi activities Prov. Training
SNO N. Itogo Coordinator TB/ Lep, Eye
NO A. Watoto CBR MCH/ FP EPI/STD.
NO S. Osifera
Referral Health Center ANO B. Keumeru Clinic/ outreach
RN A. Vakeke supervisor
RN E. Marahare
RN B. Kafo
NA L. Sanga
NA A. Tahiuru
NA N. Hasi
Unpaid Leave
Ghorou AHC Temporary in NO N. Vouza Health Center Supervisor
Balasuna RN K. Alekuata
RN G. Faka
RN P. Neisa
Lambi AHC ANO E. Tinoni Center Supervisor
RN J. Beaker
NA J. T. Beaker
Tang rare RHC RN M. Caleb

NA M. Caleb
Fox bay RHC RN J. Labacha

NA A.Kavigau
Mbabanakira RHC RN A. Veo

NA D. Chiria
Viso RHC RN B. Buapechi

NA G. Liu
Kuma RHC RN D. Voli Resigned 2001

RN V. Pitchakibo
Madakacho RHC (SDA) RN M. Kavura
Avuavu RHC RN B. Fonotau

NA R. Anea
NA J. Saia
Balolava RHC (SDA) RN N. Vozoto

RN H. Vozoto
NA R. Tovusia
Marapa health Post RN A. Manekera Resumed duty May 2001

ANO M. Hamarasi Post out to NR Hospital
Totongo RHC RN J. Thugea On unpaid leave

NA R. Rotasi
Aola RHC ANO J. Leni PHC/ Health Promotion
RN V. Leni
RN J. Tagabasoe
NA A. Pini
Ruavatu RHC RN S. Topilu

RN J. Topilu
RN S. Philip 2001 in coming posting
NewTenabuti RHC RN V. Jim

RN J. Topilu
Turarana RHC RN P. Kakamo

NA P. Ngosakobu
Visale RHC RN T. Vinano

NA M. Keni
Nurse Aid Posts
Kolosulu NAP NA R. Pitua
Bubunuhu NAP NA S. Paralonga
Bolale NAP NA J. Ligi
Vatulava NAP NA E. Niaba
Luguvasa NAP NA L. Galua
Saro NAP NA J. Rickson

NA P. Koni
Nagho NAP NA J. Louis
Lunga NAP RN B. Sau

C.
Tamboko NAP NA E. Frenold
Numbu NAP NA E. Thao
Kohimarama NAP (COM) RN D.B. Korakau

NA A. Hou
Selwyn College NAP (COM) RN H. Ruinikera

NA F. Lagui
NA A. Matenigai
Haiparia NAP (SDA) NA Joshua
Name Post Course Training Overseas Achievement
Noel Itogo SNO ADV. DIP in Community Obtained Adv Dip in

Nursing in PNG. Community Nursing year
2000.
Ethel Tinoni ANO ADV DIP in Midwifery in PNG Obtained Adv Dip in
Midwifery year 1999.
Mark Caleb RN Dip in Paediatric in PNG Still abroad on training 1

year 2001
Georgina Mau RN ADV. DIP in Midwifery in PNG Still abroad on training 1

year.
5.3.5.4 Kudos to Vagi
A commendable task by SNO Gabriel Vagi in the provision of health services

through out the tension in the most critical area, where the exchange of gunfire
was taking place. He courageously faced all the consequences and his approach
with the warring parties proved him successfully to be seen as a neutral person
who worked closely with the Red Cross to meet the objective.
5.4Wages and service Grant.

The division through its wages and services grants directly finances the delivery of
health and medical services. The grants are payable directly to the division on a
monthly basis
However due to the current cash flow problem that the central government is
facing, wages and services grant were delayed for payments since September
2000. This has a significant implication besides others to the services of the
division.
5.5 Expenditure
Head Subhead Actual
310 110/01 Medical $13,177.46

310 110/02 h. Environmental $6,185.00
310 110/03 h. Education $3,906.45
310 110/04 Finance $2,303.00
310 110/05 Paramedics -
310 110/06 Director $455.05
Travelling, transport.
310 112/01 Medical $28,827.21
310 112/02 h. Environmental $25,327.42
310 112/03 H education $4,595.00
310 112/04 Paramedics $160.00
310 112/05 Director $533.00
Uniform
310 113/01 Medical $824.80
310 113/02 h. Environmental -
310 113/03 h. Education -
Telephone telegrams
310 114/01 Medical $5,857.29
310 114/02 h. Environmental $4,053.11
310 114/03 h. Education $3,130.35
310 114/04 Director $1,849.98
310 115/ h. Environmental $2,353.40
310 116/ Clinic supplies $46,791.27
310 117/ Patients travelling $12,968.65
310 118/ -
119/ Shipping charter $520.00
310 120/ Education supplies -
310 121/01 Main eng canoe $3,473.05
310 121/02 " " " Environmental $110.00
310 121/03 " " " Education -
310 122/01 " " " Building $7,544.85
310 122/02 " " " Environmental $2,344.01
310 122/03 " " " Education $111.80
310 123/01 " " " Vehicles $34,204.12
310 123/02 " " " Environmental $4,715.67
310 123/03 " " " Education $15.00
310 123/04 " " " Director $658.40
310 124/ Training workshop -
310 125/ Rows workshop -
310 126/ Main m/cycle $3,603.00
Pol
310 127/01 Medical $43,452.72
310 127/02 h. Environmental $7,194.15
310 127/03 h. Education $1,208.05
Paramedics -
Director $250.00
310 128/ -
310 129/ Service develop -
310 130/ -
310 131/ Utilities $32,667.15
Vbdcp
310 132/ Building rent -
310 133/ Purchase 1 computer printer $9,800.00
310 134/ Purchase 1 25 hp -
310 135/ Purchase 1 hf radio $14,704.00
310 136/ Purchase 1 canoe -
$332,276.36
6 Part III-Primary Health Care Elements
6.1Treatment of common diseases &

injuries
6.1.1 Out Patient Services
The Outpatient service offered to Guadal Canal
patients as Referral clinics on Monday and
Friday, besides daily out patients at GP HQ clinic.
Expert opinion and complicated cases were
routinely referred to National Referral Hospital,
which is situated close to the GPHQ.
6.1.2 Emergency services
Emergency and casualties’ patients were directly

taken to the National Referral hospital by virtue of its location and availability of 24
hours service, as there is no provincial hospital exclusively for Guadal Canal
Province.
6.1.3 Psychiatric Health Programme
6.1.3.1 Impact:
The psychological disturbances in any given population can lead disturbed peace
and harmony in a community or a family. Sporadic cases of Schizophrenia and
suspected PTSD were brought to the notice of National Psychiatric Centre at
Honiara.
6.1.3.2 Priorities
Psychiatric health care should not be neglected, as it is one of the important
components of the public health. Hence, it was essential on part of health workers
in our province as a Public Health point of view to refer all the suspected cases of
Psychosis and Suspected PTSDs arose out of ethnic tension to NPU.
6.2MCH and Family Planning activities

6.2.1 Introduction
Women’s health in the world is that many
individuals fall far below the ideal definitions of
health. Women are systematically denied basic
human rights such as the right to information,
the right to adequate nutrition, the right to
health services including family planning, as well
as to basic primary care throughout their lives.
6.2.2 Women’s Right

All women should have access to basic maternity care during pregnancy and
delivery.iii This comprises quality antenatal care and clean and safe delivery
whether the delivery takes place at home or in a health facility. It also includes
early postpartum care for mother and infant to detect and manage complications,
and to promote healthy behaviors, including offering support for breast-feeding.
Appropriate care during the continuum of pregnancy, delivery and the postpartum
period helps to reduce complications and mortality in mother and baby.
6.2.3 Women's Reproductive life and Sexual health

In most of the world, the majority of young women become sexually active during
their teenage years. In some societies, women begin having sex during
adolescence because they are expected to marry and begin child bearing at an
early age. Regardless of the norms that influences young woman, beginning sexual
activity during the teenage years carries certain risks. Women who marry young
often have little say in fertility-related decisions and limited opportunity to obtain
education and job-related skills. Literacy amongst women is 16% in Solomon
Islands, least in the South Pacific region. Besides risks involved in the teenage
pregnancies, married and unmarried women are vulnerable to sexually transmitted
diseases.
6.2.4 Organisation of the MCH/FP unit

In our province, this
programme conducted
under auspices of
Community Health Services
in the Nursing Sub-division,
in which the PNO-
Community, who is also the
PHC coordinator being the
incumbent. The unit were
managed by the provincial
MCH/FP coordinator SNO
Alice Watoto, and assisted
by RN Edna Titiulu.
6.2.5 Total Number of Health Promotion & Disease

prevention activities
Table no 3. Deliveries
Total Deliveries
1200
1000 972 1030
873 840
800 746
600
400
200
0
1994 1995 1996 1997 1998
6.2.5.1 Family planning

Total Family Planning coverage was 5 %. One of the major causes of unavailability
of health services due to tension.
Table no 4. Table Part III-Primary Health Care Elements.26 various methods of
Contraception
1999 2000
Method No. of Cases Coverage % No. of Cases Coverage %
Depo-Provera 699 4
Pills 116 6
Condom 45 0.2
IUCD 2 0.0
Vasectomy 0 0
Tubal-Ligation - -
Total 862 5%
Family Planning Coverage
5% 0%
0%
0%
13%
Depo-Provera
Pills
Condom
IUCD
Vasectom y
Tubal-Ligation
82%
6.2.5.2 Antenatal Coverage

The Antenatal check up serves as one of the important component in the prevention
and reduction of morbidity and mortality amongst mother and child. Categorically
the attendance preferably is one in each trimester and fourth between 36 and 40
weeks of pregnancy. The first visit in the first trimester serves to detect the risks
involved early and enables the health worker to take appropriate action. The ANC
coverage recorded here were only a single visit by the mother in any trimester.
Table no 5. Table Part III-Primary Health Care Elements.17 ANC Coverage
1992 1993 1994 1995 1996 1997 1998 1999 2000

63.3% 51.6% 65.9% 61.8% 69.1% 66% 73.7% 55.8% 47.2%
Table no 6.
ANC Coverage
73.70%
80.00% 65.90% 69.10% 66%
63.30% 61.80%
70.00%
55.80%
60.00% 51.60%
47.20%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
1992 1993 1994 1995 1996 1997 1998 1999 2000
ANC
Table no 7. Total Child Births in the Province-1997
ANC A/N PNC P/N Ave Births

1Visit Cov 1 Visit Cov Visit Home HC Tot
1992 1614 63.3% 2136 83.8% 4.25 444/22 319/3 788
1993 1361 51.6% 1162 43.8% 4.05 389/13 230/7 639
1994 1825 65.9% 1210 43.7% 4.16 425/10 269/7 711
1995 1875 61.8% 1425 47.0% 4.35 337/14 312/14 677
1996 2186 69.1% 583 18.4% 4.32 458/10 341/7 816
1997 2176 66.0% 951 28.8% 4.15 406/1 359/7 773
1998 2537 73.7% 1084 31.5% 4.48 518/11 398/11 938
1999 2004 55.8% 956 26.6% 4.28 513/24 538/11 1086
2000 1768 47.2% 770 20.6% 3.92 669/12 606/12 1299
Table no 8. Table Part III-Primary Health Care Elements.29 PNC

Coverage
1992 1993 1994 1995 1996 1997 1998 1999 2000

83.8% 43.8% 43.7% 47% 18.4% 28.8% 31.5% 26.6% 20.6%
PNC Coverage
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
1992 1993 1994 1995 1996 1997 1998 1999 2000
PNC 83.80%43.80%43.70%47.00%18.40%28.80%31.50%26.60%20.60%
6.2.5.3 Selwyn College TBA Workshop.
6.2.5.3.1 Introduction.
A five days TBA training workshop was conducted at Maravovo area from 11 th
December to 15th December 2000. The motivation behind this workshop emerged
out of the necessity of provision of safe delivery under a trained hand and better
facility, due to the fact that a large number of deliveries were being conducted
outside clinics. Then under the leadership of SNO Gabriel Vagi of Guadalcanal
Province was conducted the TBA Training workshop in the communities marked
out.
6.2.5.3.2 Aims.
To help the existing untrained birth assistants to enhance and widen their sphere of
knowledge and to have better understanding of the concept of hygienic and safe
delivery of Pregnant mothers in the community.
6.2.5.3.3 Objectives.
At the end of the TBA workshop, the participants were in a position to identify the
normal sign of a healthy mother and child, the high-risk signs of an ill mother and
child. To empower the participants in their role of provision of safe delivery.
6.2.5.3.4 Venue.
The workshop was conducted at Vura School, which was a bit inland from the main
road. The venue, peaceful environment and it has all the needed materials for
learning such as boards to write on chalk, desks and stools to sit on. This area is
under the catchments of Selywin college clinic.
6.2.5.3.5 Participants.
The participants were those women of the community who were helping and
assisting the mothers already during delivery at home and others were totally fresh
candidates, who were eager and willing to learn to assist mothers and children
during delivery. There were also some elderly women who had shared their
experiences.
6.2.5.3.6 Methods Adopted

 Lecturing
 Question and Answer session
 Group work & Presentation
 Demonstration
6.2.5.3.7 Resource Personnel.

 1. Gabriel Vagi (SNO GP and Training Officer)
 2. Ethel Tinoni (ANO GP) Lambi Clinic.
 3. Francis Lagui (N/A GP)
 4. Naomi Vouza (ANO GP) Balasuna clinic
The officer stressed the importance of early antenatal care, which should
commence in the 1st trimester. She also highlighted that the role of TBA to
encourage the mother to go for antenatal care in the clinic. She also stressed to
the participants that if they happen to sight any mother who has signs of Abnormal
Pregnancy to play out her part in advising and encourage the mother to go to clinic
to avoid difficulties.
6.2.5.3.8 Growth Monitoring. (Presented by ANO E. Tinoni)
She explained the important of knowing the 3 curves in the growth chart. The
most important thing to know is if the child is growing. These 3 curves are
important to know which direction the child is growing:
The curve is going up from last month. The child is growing.
A straight line. No growth from last month. Something is wrong.
The curve is going down. There is no growth. This is a

dangerous sign.
6.2.5.3.9 Family Planning/Importance/Problems/Modern Methods.
(Presented by ANO E. Tinoni & N. Vouza)
The two officers explained that Family Planning is a daily planning of the family,
whether it be planning to make a garden, or planning a family budget etc. It is not
a thing to stop having children as many- may have heard from friends or wantoks.
So it is same that a married couple in their household, they should plan for how
many children should be in the family and the spacing they have for each child.
This is for the good health of the child and mother.
The problems of no family planning will affect the whole family: There would be
not enough money to meet each member’s needs. Health problems will increase,
overcrowding in the house and food and clothing will not be enough for everyone.
The modern methods were talked about and were shown to the participants,
explaining the advantages and disadvantages of each method. It was for the time
that such methods e.g. Loop insertion was witnessed by some participants
6.2.5.3.10 Conclusion.
The workshop was found to be very successful to fulfil the goal and objective. The
contribution, co-operation and support by participants all through the workshop
enriched everyone.
LIST OF PARTICIPANTS.
NAMES AGE SEX OCCUPATION

Ellen Taveko 43 F House wife
Harriet Tada 23 F House wife
Beverly Ise 44 F Teacher
Priscilla Fakafu 37 F House wife
Pauline Lolopo 28 F House wife
Irene Tada 29 F House wife
Evarlyn Vitale 21 F House wife
Regina Kenihau 28 F House wife
Irene Kovohi 29 F House wife
Melda Taruga 25 F House wife
Dora Kauli 40 F House wife
Maria Noela Savani 30 F House wife
Alice Basile 31 F House wife
Joycelyn Lise 31 F House wife
Bernadeth Raymond 28 F House wife
Sesarina Vou 24 F House wife
Veronica Kesale 48 F House wife
Batistina Kotova 52 F House wife
Mary Odlia Logo 34 F House wife
6.3 Expanded Programme of Immunization

6.3.1.1 Introduction
The objective of EPI programme is to reach as many infants as possible to
immunise before the child attains first birthday.
6.3.1.2 Immunization Coverage
Table no 9. Table no: 6.34 Immunization coverage for 9 years

Vaccines C o v e r a g e
1992 1993 1994 1995 1996 1997 1998 1999 2000 200
1
BCG 38.5 26% 69.1 56.7 46.4 69.4 56.5 36.7 37.9
% % % % % % % %
Measles 60.2 42.3 55% 61.1 59% 60.6 59.3 53.6 39.3
% % % % % % %
D.P.T 71.9 51.7 68.6 66.8 73.5 73.9 73.6 57.8 44.6
I % % % % % % % % %
II
III 67.7 48.5 60.8 63% 68.1 66.4 67.4 54.7 38.1
% % % % % % % %
O.P.V. 71.6 50.8 68.7 67.2 70.9 72% 73.4 57.3 44%
I % % % % % % %
II
III 67.3 48.4 60.6 63% 68.5 66.5 67.4 55.6 38.9
% % % % % % % %
Hepatitis B 38.8 25.1 67.5 57.2 48.4 71.7 58% 36.9 35.5
I % % % % % % % %
II
III 53.6 40% 59.9 61.1 67.6 65.3 68.6 55% 37.8
% % % % % % %
Ante natal Mothers
Tet. Toxoid
I
II
Booster
Expected
Births
Women’s income:
Studies highlight the fact that women’s earnings not only increase the aggregate income levels of the poorest
households, but that they also contribute a much larger share to basic family maintenance. Increases in female
earning power translate more directly into better child health and nutritional status, with important short-term
effects of reducing the incidence and severity of morbidities at household level and positive long-term
generational effects on the quality of human capital. The enhancement of women’s economic productivity is,
therefore, to be regarded as an important strategic necessity for improving the condition of those in poverty.
* Women,health and development in the South-East Asia Region, N.Delhi, WHO regional office for South-East Asia, 1992: p.
14 ( SEARO Regional Health Papers, No.22)
6.4 Health education

6.4.1 Health education
The aim of the Health Education division was to encourage good health for
individuals and population groups through various awareness programmes about
the health in wider dimension as stated by WHO. Health education is not just the
adding of new knowledge, but the rational appraisal of traditional customs.
Strategy adopted was involving community
themselves to participate in health
promotion activities.
The division participated along with other
divisions of our health centre in carrying out
the “Integrated Community Health Talk”
programme.
6.4.2 Training / workshops

In this year 8 workshops was conducted, 5
on reproductive health and 3 on nutrition.
All training was informal, relying on group
discussion and audiovisual aids rather than classroom lectures. The ultimate object
was to increase the knowledge and awareness about the health, personal hygiene,
nutrition, and reproductive health in the community. Women comprised the target
audience amongst 531 participants. As they were responsible for the care of
families, the houses they lived in, and their surroundings. Childbearing group was
paid special attention because of their role in Childcare and welfare.
6.4.3 School Health Education

The general policy was to place a high priority to promote “Health Values” in
Primary and Secondary Schools. The division was able to manage to conduct
health talks and educate 1,370 pupils in 7 Primary Schools. The Sexual health and
knowledge about sexually transmitted diseases was emphasized to higher primary
classes such as 5 and 6 standards. Three Secondary schools namely Burns Creek,
Selwyn College, Betikama High School, and Potau’u were visited for the AIDS
awareness and Sex education programme and 1150 participated the events.
Schools did not function to its fullest capacity in terms of providing education and
running the classes due to ethnic unrest.
6.4.4 Community Information Education communication

Table no 10. Village and Clinic
Type of Activity Number Ward/Area Total Attended

Achieved
Village Inspection 20 Burao/Tasimate 1000
Village Meetings 20 Tasimauri/Geawa 1000
Village Health
Talks
Clinic/Hospital 100+ GPHQ Clinic 2000+
Talks
The division managed to conduct various programmes in the community to cover
approximately of 1320 population.
6.4.5 Campaigns
Type of Activity Number Ward/Area Total Attended
Achieved
Health Campaigns 4 Honiara 800+
Radio 63 Honiara National Coverage
Programmes
6.4.6 Health Committee and Implementation

Though the Health Committee was formed but was unable to sustain to progress
and work along with the Health Educational team due various constraints.
6.4.7 Audio Visual Aid Production

The year 2000 marked a great achievement with respect to the publicity and
awareness programme. Health education messages in the mass media are
frequently valuable in creating an awareness of problems but do not always result
in improved behaviour or the consolidation of healthy behaviour.
The Posters usually carries an illustration presenting the solution to a problem.
They are displayed in public places so that people can study them in their own
time; they serve as visual reminders to behave in a certain way.
The Flip Charts contains illustrations that pose the problem. They are displayed
only to groups of people who have been brought together to engage in discussion.
6.5 Provision of essential drugs

The supply of drugs to Provincial Health Clinics in any given year is largely
determined on the basis of orders made during the preceding year rather than on
requirements estimated from such criteria as past consumption, prevailing
diseases, standard treatment schedules and the sizes of the populations served.
National Medical Store was efficient through out the year despite the tension in
supplying drugs, however impediments curtailed their task.
The Drug and Therapeutics Committee of the MHMS, Honiara published in 1996 a
user-friendly list of drugs and vaccines, considered essential for treatment of
patients and prevention of diseases commonly occurring in Solomon Islands. A
standard drug treatment schedule together with dosage forms and strengths for
the use of the health worker at all levels, commonly known as "Green Book" was
also instituted to facilitate the health worker in administration of therapeutic drugs.
6.5.1 NGO-World Vision
World Vision an NGO donated 40 kits (Boxes)

of the basic medical Drugs and Medicines to
the peripheral Clinics in the Guadal Canal
Province in December 2000. Director is seen
in the above picture receiving the donation
from Tevihta Ravumaidama, WV Country
Program Manager, SI.
World Vision is a non-profit Christian
international humanitarian relief and
development organization working with the poorest of the poor in more than one
hundred countries around the world. World Vision is a partnership of nations with
the objective to help alleviate the living conditions of the most under-privileged
people in different parts of the world. World Vision established its presence in the
Solomon Islands since 1982. Community development projects have addressed the
issues of primary health, child survival, education, adult literacy, street children
rehabilitation, water supply and sanitation, vocational skills training, appropriate
technology and leadership development at grass root level.
In September 1999, WV Solomon Islands with the assistance of Asia-Pacific
regional office along with the European Union a joint venture funded for a
rehabilitation programme to assist the internally displaced people (IDPs) of
Guadalcanal and Malaita. Both EU and WV had identified 2,000 families in both
provinces to be assisted with the provision of some basic food, medical kits,
housing tools and materials, seeds and agriculture tools.
6.6 Control of communicable diseases

6.6.1 Malaria: Vector Bourne Disease Control Program
6.6.1.1 History
Malaria is a protozoal disease transmitted by the Anopheles mosquito, caused by
minute parasitic protozoa of the genus Plasmodium, which infect human and insect
hosts alternatively. It is a very old disease and prehistoric man is thought to have
suffered from malaria. It probably originated in Africa and accompanied human
migration to the Mediterranean shores, India and South East Asia. In the past it
used to be common in the marshy areas around Rome and the name is derived
from the Italian, (mal-aria) or "bad air"; it was also known as Roman fever. Today
some 500 hundred million people in Africa, India, South East Asia and South
America are exposed to endemic malaria and it is estimated to cause two and a
half million deaths annually, one million of which are children.
Fishermen and traders, long before British colonisation, probably introduced the
disease into northern Australia and in the past malaria were not uncommon in the
northern parts of the country. In Western Australia an explosive outbreak of
falciparum malaria occurred at Fitzroy Crossing in 1934, which at first was
mistaken for influenza and resulted in 165 deaths. WHO declared Australia free of
malaria in 1981, however since that time 9 patients have contracted locally
acquired malaria.
The so called "airport malaria" has become a problem in recent years. A publican
working in an establishment close to London's Heathrow Airport became acutely ill
and was found to be suffering from falciparum malaria, he had never been out of
the country. A lady driving her car past the same airport became ill with malaria
although she too had never been out of the country. Four workers unloading a
cargo plane at Amsterdam airport became infected with malaria. It is assumed that
infected mosquitoes were carried on planes from Africa and released at the
destination airport.
WORLD DISTRIBUTION OF MALARIA
While it was recognised that the Anopheles mosquito played a key role in the
transmission of the disease it was not until 1948 that all the stages in its life cycle
were identified. The parasite undergoes a development stage in the mosquito and
the female of the species requires a blood meal to mature her eggs. She bites a
human and injects material from her salivary glands, which contains primitive
malarial parasites called sporozoites, before feeding. These sporozoites circulate in
the blood for a short time and then settle in the liver where they enter the
parenchymal cells and multiply; this stage is known as pre-erythrocytic schizogony.
After about 12 days there may be many thousands of young parasites known as
merozoites in one liver cell, the cell ruptures and the free merozoites enter red
blood cells. In the case of P. vivax, and P.ovale the liver cycle continues and
requires a course of primaquine to eliminate it. P.falciparum on the other hand
does not have a continuing liver cycle.
In the red blood cells the parasites develop into two forms, a sexual and an asexual
cycle. The sexual cycle produces male and female gametocytes, which circulate in
the blood and are taken up by a female mosquito when taking a blood meal. The
male and female gametocytes fuse in the mosquito's stomach and form oöcysts in
the wall of the stomach. These oöcysts develop over a period of days and contain
large numbers of sporozoites, which move to the salivary glands and are ready to
be injected into man when the mosquito next takes a meal. In the asexual cycle
the developing parasites form schizonts in the red blood cells, which contain many
merozoites, the infected red cells rupture and release a batch of young parasites,
merozoites, which invade new red cells. In P.vivax, P.ovale and probably P.malariae,
all stages of development subsequent to the liver cycle can be observed in the
peripheral blood. However, in the case of P.falciparum only ring forms and
gametocytes are usually present in the peripheral blood. Developing forms appear
to stick in the blood vessels of the large organs such as the brain and restrict the
blood flow with serious consequences.
While all four species have a haemolytic component i.e. when a new brood of
parasites break out of the red blood cell this is usually of little consequence. The
exception is falciparum malaria where the parasites multiply very rapidly and may
occupy 30% or more of the red blood cells causing a very significant level of
haemolysis. One reason for this is that P.falciparum invades red cells of all ages
whereas P.vivax and P.ovale prefer younger red cells, while P.malariae seeks
mature red cells.
6.6.1.2 Introduction:
Malaria is by far the world's most important tropical disease, and kills more people
than any other communicable disease except tuberculosis. Malaria is a public
health problem today in more than 90 countries, inhabited by a total of some 2,400
million people-40% of the world's population. Mortality due to malaria is estimated
to be over 1 million deaths each year.
The disease is endemic in 100 countries. The aim of the current global malaria
strategy was to reduce mortality by at least 20% compared to 1995 in at least 75%
of affected countries by the year 2000iv. We have entered a new millennium with
the same figure to combat with.
Malaria remains a critical public health problem in Solomon Islands, despite
extensive work to eradicate, contain and control
measures were adopted since 40 years. Efforts at
control began in the 1960s, with residual spraying
with DDT. The success of several pilot efforts resulted
in the initiation of a national
6.6.1.3 Overall Objectives:

 To reduce clinical malaria and prevent mortality
by providing early diagnosis and effective
treatment in suspected cases, as well as
confirmed malarial ones.
 To reduce morbidity, especially in children and pregnant mothers through
applying appropriate malaria control measures.
6.6.1.4 Specific Strategies:

 To continue with Bed net sales, distribution and retreatment of old mosquito
nets.
 To carry out indoor residual spraying to all problem villages.
 To continue malaria educational programme through meetings to communities.
 To strengthen the use of other control measures as larvicidings and source
reductions.
6.6.1.5 Epidemiological report:
Table no 11. Table no: Part III-Primary Health Care Elements.37

Malaria Annual Report-1995-2000
SPECIES INFANT EPI-DATA
Year Total Total PF PV Rate SPR IR/1000 PFRate
Slides +ve % % %
1995 55031 25605 19094 6511 29 46.5 337 74
1996 62266 18214 12582 5632 27 29.2 242 69
1997 55561 24863 13975 4773 25 44.7 235 56
1998 50065 20804 16452 4035 39.7 41.7 253 79.7
1999 32760 13397 10777 2620 36.5 40.0 163 79.6
2000 16579 6,931 5,376 1,581 38.4 41.8 115 77.6
6.6.1.6 Number of Hospital Admission Data
Paediatric Admission in 2000 at NRH
8
7
Number of Cases
6
5
4
3
2
1
0
Aug
July
Apr
Jan
Feb
Sep
Dec
May
June
Nov
Mar
Oct
Month
Malaria Meningitis
Rainfall in Solomon Islands in 2000
500
Rainfall in millimeter
400
300
200
100
0 May
Sep
Feb
Mar
Apr
July
Nov
Dec
Oct
Jan
Aug
June
Month
Honiara Henderson Airport

Guadal Canal Province: Total population 60,021
Total malarial slides: 16,579
3000
2500
2000
1500
1000
500
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Total Slides 2200 2692 2553 1809 1768 794 235 344 571 1057 1612 944
Total Positive 911 1004 1215 744 731 326 99 122 183 378 768 450
Percentage PF Positive in Malarial slides
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
1995 1996 1997 1998 1999 2000
PF RATE 74% 69% 56% 79.70% 79.60% 77.60%

Infant Rate 29% 27% 25% 39.70% 36.50% 38.40%
Malaria-one of the most important tropical disease in the world. Globally the
malaria situation is serious and getting worse. About 10 % of hospital admissions
and 20-30 % of outpatient consultations are due to Malaria. Malarial morbidity
among children and pregnant women is quite high. It also affects the working
capacity of adults. Malaria is a curable disease if promptly diagnosed and
adequately treated.
6.6.1.7 Incidence per 1000 population

Malaria remains to be still one of the major causes of the morbidity in our province.
However, the Incidence per thousand populations was gradually decreasing. In
1998 -253, 1999-163, were the cases of malaria per 1000 population, where as in
2000-115 though a slight decrease in the IR the morbidity remains very high
especially P. falciparum. Globally P.falciparum accounts for the majority of
infections and is the most lethal. In our province P.falciparum had the highest
infection rate, on an average 75 %.
Annual Malaria Incidence

1995-2000
337
350
300
253
242 235
250
200
163
Cases/1000 Pop
150
115
100
50
0
1995 1996 1997 1998 1999 2000
Incidence rate 337 242 235 253 163 115
6.6.1.8 Vector Control
6.6.1.8.1 Mosquito habitat

Anopheline mosquitoes transmit malaria; the number and type of which determine
the extent of transmission in a given area. Transmission of malaria is affected by
climate and geography, and often coincides with the rainy season. The most
important environmental factors are temperature and water, with wind, phases of
the moon and human activity having lesser effects. Temperature determines the
length of developmental cycle of the parasite and the survival of the mosquito
vector. Tropical regions, altitude alters the temperature, and therefore, highland
areas have less incidence of malaria. The mosquito being a fragile flyer is easily
1000
No of Positive Slides
800
600
400
200
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
PF 696 775 961 595 613 229 82 75 139 286 580 345
PV 215 229 254 148 118 97 17 43 44 92 215 105
blown by the wind, sometimes to its advantage but generally to its disadvantage.
Nocturnal mosquitoes are sensitive to light so, on a moonlit night the number is
found to be reduced.
Table no 12. PF & PV infection rate in 2000
6.6.1.9 Bed net Distribution

Supplied the new bed nets in the year 2000:
 Single bed mosquito nets: 302
 Double bed mosquito nets: 909
 Family size mosquito nets: 725
21%
21%
21%
20%
20%
20%
20%
1999 2000
Cov erage 21% 20.30%
Table no 13. Bed net coverage in 1999-2000
6.6.2 Tuberculosis Situation
6.6.2.1 Global Trend

Tuberculosis is responsible for over 2 million deaths each year worldwide. The
situation is further complicated in developing countries by the breakdown in health
services, poorly managed programmes, the spread of HIV/AIDS and the emergence
of multidrug resistance. Countries most affected are India, China, Indonesia,
Bangladesh, Pakistan, Nigeria, Philippines, South Africa, Ethiopia, Russian
Federation, Viet Nam, Democratic Republic of Congo, Brazil, United Republic of
Tanzania, Kenya, Thailand, Myanmar, Afghanistan, Uganda, Peru, Zimbabwe and
Cambodia.
6.6.2.2 Personnel -TB Co-ordinator:

The TB Co-ordinator SNO Mr.Noel Itago was sponsored by WHO for further studies
and successfully completed Post Graduate Diploma in Community Health Nursing
Administration of one year duration in the year 2000, at College of Allied Health
Science, University of Papua-New Guinea at Port Moresby.
6.6.2.3 Public Health Management

Support for tuberculosis research capacity building restricted to the 22 high-burden
countries mentioned above, which account for 80% of new cases. Areas of greatest
interest for capacity building are: health system and services research to improve
TB control operations and to expand the DOTS strategy (directly –observed
treatment, short-course); public-private partnership experiments including
community-based programmes; field-site preparation for diagnostic and
therapeutic trials (which would involve improvement of surveillance and control
coverage, development of data management and analysis expertise, better
documentation systems, improved communication, etc); policy research and cost-
effectiveness studies; TB control in special situations; and evaluation of multidrug
resistance and second-line treatment.v
TB was declared by WHO to be a global emergency in April 1993. Worldwide, TB is
the leading cause of death due to a single infectious agent.
Table no 14. Table Part III-Primary Health Care Elements.35 Newly Reported
Tuberculosis Cases.
Population Total Cases Case Rate Per 1,000

Pop.
1999 60275 (Census) 37 0.61
2000 62083(Estimat 21 0.3
ed)
6.6.2.4 Resurgence of TB
The main reasons for the resurgence of the TB are the neglect of the disease by
the governments has allowed TB control systems to deteriorate or even disappear
in many parts of the world. Poorly managed and incorrectly conceptualised TB
control programmes have contributed to an increase in the burden of the disease
as well as to the emergence of multi-drug resistant TB. The link between TB and
HIV co-infection has lead to an explosion of TB cases in HIV endemic areas; HIV
activates TB in individuals who are TB infected, accelerating the breakdown from
infection to disease.
6.6.2.5 Guadal Canal Province Situation

During the year 2000, there were total no of 21 cases of Tuberculosis diagnosed.
 PTB (+ve)-9 cases, PTB (-ve) -4 cases
 Extra pulmonary cases - 8 cases
 From the no of PTB (+ve) cases diagnosed, 5 cases released from treatment.
 For PTB (-ve) cases, only one released from treatment.
Table no 15. NUMBER OF TB CASES BY CLINICS FOR 2000.
HEALTH PTB PTB GTB BJTB TBM MTB OTHER TOTA

CENTRES +ve –ve S L
Grove 1 1 1 1 0 0 0 4
Turarana 0 1 0 0 0 0 0 1
Tangarare 0 0 0 1 0 0 0 1
Foxbay 2 1 0 0 0 1 0 4
Newtenabuti 1 0 0 0 0 0 0 1
Selwyn 1 0 0 1 0 0 0 2
Viso 0 0 0 1 0 0 0 1
MBabanakira 1 1 0 0 0 0 0 2
AvuAvu 1 0 0 0 0 0 0 1
Balolava 2 0 0 0 0 0 0 2
Marau 0 0 0 0 0 1 0 1
Tamboko 1 0 0 0 0 0 0 1
Total 10 4 1 4 0 2 0 21
Table no 16. TB Cases by Age group
Disease 0-14 15- 25- 35- 45- 55- >65 Total

type 24 34 44 54 64
M F M F M F M F M F M F M F M F
PTB 0 3 1 0 0 4 1 3 0 1 0 0 0 0 2 11
GTB 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1
BJTB 0 0 0 1 1 0 0 0 0 0 1 1 0 0 2 2
TBM 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MTB 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 1
Others 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 1 3 1 3 1 4 2 3 0 1 1 1 0 0 6 15
Short-course treatment regimens for tuberculosis:

The last twenty years have seen substantial improvements in tuberculosis treatment, with the development of
highly efficacious treatment regimens. As a result of large-scale programmes of carefully controlled clinical trials,
the duration o treatment has been progressively reduced from 18-24 months to 9 months, and now 6 months.
However, in order for this intensive, short-course regimens to be effective, antituberculosis drugs must be available
to patients. This requires an efficient and effective system of drug procurement and distribution, as well as the
availability of health workers to ensure that patients continue to receive these drugs until cured.
 Treatment of tuberculosis. Guidelines for national programmes. Geneva, World Health Organization, 1993: p.2.
P 51, Vol.16, No. 1, 1995, World Health Forum.
Agewise Distribution of TB
0-14
7%
>65
15-24
14%
3%
25-34
55-64 14%
17%
45-54 35-44
14% 31%
6.6.2.6 DOTS Strategy

The resurgence of TB in recent years has made an effective control strategy
indispensable. The strategy is known as DOTS- Directly Observed Treatment Short-
course. The same strategy is being adopted in our province under the guidance of
the National TB control unit.
Table no 17. RATIO OF PULMONARY WITH EXTRA-PULMONARY
No. of New TB Cases by Category
13
Pulm onary Extra-Pulm onary
6.6.2.7 WHO’s goal

The DOTS system is that it makes it possible to set precise and attainable goals for
public health services. WHO’s worldwide goal is to treat successfully 85 % of all
new active (Smear -positive) TB cases and to detect 70 % of such cases by the
year 2000. In 1999 Guadal Canal province the Cure rate was 50 %.
Table no 18. Categories in Pulmonary
10
0
SPT +ve SPT -ve SPT not done
New 9 4 0
Com pleted RX 5 1 0
Table no 19. Number of All Pulmonary cases & PTB Sputum Positive by Age Group
0
0-14 15-24 25-34 35-44 45-54 55-64 >65
All PTB 3 3 3 1 0 2 0
PTB SPT +ve only 1 1 2 4 1 0 0
6.6.2.8 BRIEF REMARKS.

The year 2000 created a history in Solomon Islands, especially on Guadalcanal.
Guns again came into action after the Guadal Canal battle in 1944 WW II.
The result of the ethnic conflict ended in the suspension of all the Health activities
around the Island. Medical supplies were supplied to peripheral clinics only
through the International Red Cross organisation. Hence, the TB/Leprosy
programmes were also was badly affected. The temporary officer NO Mr.Soram
Osifera as an acting coordinator of TB/Leprosy programmes, who had only means
of communication was through radio with the nurses, for all the activity pertaining
to the programme. Few sick patients suspected to be TB were transferred to the
base hospital through the ICRC transportation.
Although things were difficult as transport, the team did manage to detect 21
cases of TB (all cases) for the whole year. The number could have been higher if
there were no crisis. The total no of TB cases in the year 2000, was 16 less than
the cases detected during 1999.
Due to displacement and migration of the people from their villages to various
different locations up in the mountainous region, became a difficult task for the
nurses to reach. Some patients with PTB (+ve) were among those that fled from
the place of settlement during the heat of the ethnic crisis, which resulted in delay
of follow up treatment.
6.6.3 Leprosy Situation

The following were cases of Leprosy detected and undergone on treatment at the end of 2000.
N Name Ag Se Addre Clinic Disea Typ Rx Date Date Stat
o e x ss se e Regime Starte Complet us
Type n d ed
1 Martin P 38 M Tutum Grove MB Ne MDT 17/1/ Dec Activ
u w 00 2000 e
2 Joseph C 13 M Purala Marau MB Ne MDT 20/1/ Dec Activ
va w 00 2000 e
3 Victor T 25 M Sungi Turara MB Ne MDT 04/4/ Apr Activ
na na w 00 2001 e
6.7 Safe water supply & basic sanitation

As we enter the new millennium, the bounties
of technology are going to pave the way for a
new, modern tomorrow. But are such
technological innovations going to be shared
equitably throughout the world?
UNESCO has been focusing on environment
and development issues for the past 50 years.
Water, the source of life and human civilization
is set to become one of the major issues of the
21st century. Regions of the world facing water
shortages are increasing. In the next
millennium, one hopes that the demands of the
environment and development be transformed
into a partnership between the two, so that the
goal of sustainable development is met with.
Another area of prime concern “GLOBAL WARMING” is the preservation of the
biosphere. As Pacific countries are the foremost victims of this changes. Using
biosphere reserves, countries can address issues such as the conservation of
genetic resources and landscapes, and the ways whereby local people and
different institutions can work together to plan and manage a given land area.
"To reduce health risks caused by basic sanitation deficiencies in the environment people live"
The Program on Basic Sanitation (HES)
supports country efforts to provide
infrastructure and services required by the
population to meet their basic environmental
health needs. The activities are aimed at:
Reducing environmental risks associated with

diarrhoeal diseases by increasing access to
water and sanitation services, improving
drinking water quality, and strengthening the
institutions of the sector.
Improving health and life quality conditions by increasing coverage of public

cleaning services, strengthening responsible organizations, and upgrading waste
final disposal.
Strengthening the capability of national institutions to face health and housing
problems, as well as promoting the importance of a healthy housing and the
establishment of centers specialized in housing hygiene.
6.8Environmental Health Division

The environmental health division that functions under the Ministry of Health and
Medical services in Guadalcanal province is one of the major components of the
health delivery system in the province.
Until up to the period of the ethnic tension, the division had been keeping a good
pace on the development of its services to the rural population of Guadalcanal
province. People have continued to benefit from services such as rural water
supplies, installation of improved sanitary systems through its awareness and
implementation program. This was an increase of coverage of water supply and
sanitation facilities of 60% since 1996.
The monitoring of environmental

health problems that were arising due
to commercial and industrial
developments on Guadalcanal
province was also one of the major
roles of the division.
The division therefore plays an

important part in the development of
preventive and promotional health in
the overall agenda of health services
in the country.
The need to revitalize and to resume the delivery of health and social services on
Guadalcanal province particularly, the provision of water supply and sanitation
facilities, and medical supplies should be a priority, despite the desperate situation
the government and its department agency were facing, in terms of finance, law
and order and the uncertainties surrounding the peace process.
The national government through the ministries of health and medical services is
committed to rehabilitate and revitalize health services in Guadalcanal Province.
This commitment were reflected in the Environmental health division (MHMS)

internal re-adjustment and strengthening program. (July-October 2000)
While the division was from time and again maintained its commitment, the
financial uncertainty has put enormous pressure on the division to take some
drastic steps to ensure that services is back to the communities.
The environmental health division (MHMS) in its internal re-adjustment and

strengthening program highlighted its commitment to assist the environmental
health division (Guadalcanal Province) in achieving this goal. Part of the program
was the,
1. Reorganization of the EHD Guadalcanal Province and Manpower
strengthening.
2. Re-construct storage shed and re-stock materials and supplies.
3. Conduct rapid assessment of damaged water supply systems, displaced
population and resettlement camps
4. Repair/ reconstruct of damaged water supply systems and provision of water
supply for displaced population
5. Resume the implementation of approved RWSS projects
6.8.1.1 Rationale
The uncertainty surrounding the peace process and the underlying needs to
provide health services to the rural communities was not compromised.
Further to that, the greater movement or displacement of people for the last two
years due to the social unrest was directly affecting the distribution of services,
and which required the redirection of services in many cases.
To achieve this the division realized the great need for the availability of
information for planning and delivery of services on Guadalcanal Province.
Thus, it is because of the need and importance of information at this time that, the
director of environmental health, (MHMS) had arranged for this survey and
assessment.
The description is an overview of the situation of Guadalcanal Province

environmental health division and discusses important issues here to highlighted.
6.8.1.2 Staff movements and relocations during the tension
To ensure the safety of ethnic composition of workforce, following measures were

taken to relocate and post them at the same division in different provinces:
 The Principal Health Inspector, Mr. Leonard Olivera, from Guadalcanal was
given temporary posting to Isabel province where he remained for a period
of one and half years.
 Two health workers from Malaita were removed from their respective
substations to the Headquarter and one staff and a health worker of
Guadalcanal origins from the head quarter were transferred to substations
outside Honiara.
In the absence of the Principal Health Inspector, Assistant Health Inspector, George
Titiulu was mandated to be in charge of the division. When the office at the
Guadalcanal provincial headquarters was destroyed, the division operation was
transferred to the Environmental Health Division Headquarters.
This arrangement remained in place until the government unpaid leave exercise,
whereby two staff and four direct employees of the division were affected.
Upon recalling staff after the peace celebrations, an arrangement was made by the
Director of Environmental Health (MHMS) for an office space at the HQ RWSS
project office. Health workers were recalled in December 2000 for a briefing and
resume duties.
Since 1998, project activities were continuing though at a slower phase because of
regular disturbance from militant activities. When the tension was at its height no
more activities was done leaving a number of projects only partly done.
In summary, the division suffered a setback not only in its programs, but also the
organizational set up that occurred as a result, of the destruction of office buildings
and staff accommodation.
Table no 20. Table 1.0 Summary of Manpower Allocation (EHD) 1998-2000
Strength
Manpower Designation Level Category
1. Leonard Olivera Principal Health Inspector 8 Seconded-SIG.MHMS
2. George Titiulu Assistant Health Inspector 5 Seconded “
3. Francis Sade Assistant Health Inspector 5 Seconded ”
4. Methoda Boli Health Assistant 3 Seconded “
5. Rini Suia Health Worker 4 Directed-GProvince
6. Daniel Taurikeni Health Worker 3 Directed “
7. James Boli Health Worker 3 Directed “
8. Joshua Martin Health Worker 3 Directed “
9. Alfred Vili Health Worker 3 Directed “
10. Samson Ezekiel Health Worker 2 Directed “
11. Jack Abel Health Worker 2 Directed “
12. Rowley Alatala Health Worker 4 Directed “
13. Jimmy Sanga Health Worker 3 Non-established MHMS
Note: Two seconded staff transferred in 1999, however the substantial post was
not affected.
Table no 21. Internal staff postings and logistics EHD Guadalcanal Province 1998-2000
Location No. & Category Office Space & Work Assets and
of staff on post Accommodation other facilities.
GP 4 Staff and 4 direct Accommodation rented from 1 x 3 ton truck
headquarters employees province by staff and 1 mini bray boat
workers. 1 large bray boat
One two rooms office Computer sets
accommodation Furniture
One shed office
Materials storage facilities
and working space.
Marau 2 Direct employees 2 permanent tie up house 1 x 25 hp OBM engine

Substation accommodation 1x 21 ft Alum boat
1 storage and working shed
Aola 1 direct employee One Leaf house 1 x 15 hp OBM engine
Substation accommodation
1 working shed
Avuavu 1 direct employee 1 leaf house Accommodation 1 x 15 hp OBM engine
1 x 18 ft fibreglass
canoe
Table no 22. Table 1.2 RWSS Project Submission 1994-1999
Projects Year or Locatio Type Cost

submission n
Bolale 1994 Ward 14 Gravity $13,2741
Papangu 1995 Ward 21 Hand pump $14,083
BelahaSchool 1995 Ward 20 FC $28,969
Beaufort bay 1995 Ward 4 FC $31,350
School
Ghombuale 1995 Ward 4 Gravity Extension $10,584
Rere/Susu 1995 Ward 15 FC $10,7959
Mbabasu 1995 Ward 15 Ram pump $20,3281
Tulagi 1998 Ward 4 Gravity $36,905
Rarata 1998 Ward 20Ya hand pump/Tank $3,404
Aruligo 1998 Ward 2 Gravity $1,773
6.8.1.3 Damaged and stolen properties.

During the take over of the Guadalcanal Provincial headquarter on June 2000, the
division had lost numerous items, either stolen or damaged. However, efforts were
made to recover some of the valuable assets from the division at GP headquarter
and Marau.
Table no 23. T
abl e
2.0
Damaged and stolen properties during June- October 2000
Property/Item Location Stolen/Damaged Estimated total value

description in SI$
2 staff Houses Marau Completely Burned 50,000.00
down
Shed and Marau Completely burned 25,000.00
storage house. down
GP headquarter Partly Damaged 30,000.00
works compound
Headquarter GP HQ compound Completely damaged 25,000.00
Office
100 bags x 40 kg HQ Shed and Marau Stolen 3,500.00
cement
6 rolls x 40 mm HQ shed Stolen 3,900.00
polythene pipe
60 x 50 mm GI HQ shed Stolen 12,000.00
pipe
10 x wire mesh HQ shed Stolen 2,000.00
sheets
50 lengths steel HQ shed Stolen 1,400.00
rods
339 x 50 mm HQ shed Stolen 10,200.00
PVC pipes
I computer chair Store house Ranadi Stolen 3,000.00
1 craw bar 400.00
3 spades 360.00
10 sheets X 14 ft GP HQ shed Stolen 980.00
roofing iron
Water supply GP HQ shed Stolen 2,000.00
fittings
1 office table GP HQ shed Stolen 500.00
1 office cabinet GP HQ shed Stolen 1,000.00
TOTAL VALUE $171,240.00
The following projects have been resubmitted for the next six months (July –
December 2001) construction program, Papangu, Belaha, Beaufort Bay, Reresusu,
Babasu, Tulagi and Rarata, and would depend very much on the availability of
material from the project management.
The following projects have been surveyed and awaiting funds from World Vision.
They were,Tetupa, Tavisana, Kaotina, and Bubuli/Tenamaota.
Work on these projects depends on confirmation of funding. Projects should be
included in the construction program for this year and will be as substitute for the
above
Table 2.1 Activities/Project Outline for year 2001

N Project Activities Duratio Cost Location Implement Variable
o n er indicator
1 New Construction of 12 16,000 Mbabanakira RWSS, Numbers of
water 8 water supply months NAC World Vision, water
supply Talaura NZ High supply
Tetupa, Com Completed.
Komuisia,
Titinge
Tetupa
Chelamamata.
2 Maint /Ext Carry out repair 12 10,000 Paru-Naro, AusAid Numbers of
of & Months Kombuale, RWSS water
Existing maintenance. Visale Tasahe supply
System Aruiligo Completed.
3 10 Implementatio 12 24,000 Lumuiko. RWSS Numbers of
sanitation n Months Bulukalai AusAid sanitation
Projects Beautfortbay Projects
Sch Completed.
Tamboko
Obobo
Suhgu
West
Guad/Primary
Sch.
Mbabanakira
Tiaro.
Belaha.
4 Water Conduct 12 8,000 Around RWSS Numbers of
supply & Survey & Months Guadalcanal sanitation
sanitation Assessment Projects
Assessme Assessed
nt and, report
Submitted.
Numbers of
5 Awarenes Conduct 4 2 6,500 Project Site RWSS Training
s Training Months Completed
workshop
6 Public Conduct & 3 2,000 Following EHD Numbers of
Health Monitor Months Complaint Inspection
Inspection Industrial & conducted
Food Premises and actions
taken.
7 Office Construction Of 6 70,000 ? RWSS Completion
Building EHD Office Months SI.Govt
G. Province
6.8.1.4 Social Survey.
There are 400 village communities involved in the survey with a total population of
around 5000 people.
The table below presents community responses
Table 3.0 Social Survey response for community EHD /01/01
RESPONSE
ISSUES Y N O N/O N/S E N/E (S)/E I V/I
Displaced 143 7
Repatriation 140 0
Peace Process 45 100 5
Service by EHD 30 111 9
Support for EHD Programs 150
Deployment of Staff 80 20 50
Staff Safety 60 30 60
Importance of Services 100 50
Community Contribution 150
Water Supply 20
RESPONSE
ISSUES Y N O N/O N/S E N/E (S)/E I V/I
Displaced 101 29
Repatriation 126
Peace Process 26 21 43
Support for EHD Programs 130
Deployment of Staff 82 13 35
Staff Safety 86 9 35
Importance of Services by EHD 23 107
Community Contribution 123 7
Water Supply 60 70
Keys: Y=yes N=No O= Ok N/O= Not Ok N/S=Not Sure E=Enough N/E=Not Enough
(S)/E= Some Effort I=Important V=Very Important
RESPONSE
ISSUES Y N O N/O N/S E N/E (S)/E V/I
Displaced 22 3
Repatriated 21
Peace Process 18 7
Support for EHD Programs
25
Deployment of Staff 20 5
Staff Safety 22 3
Importance of Services 25
Community Contribution 25
Water Supply 5
Keys: Y=yes N=No O= Ok N/O= Not Ok N/S=Not Sure E=Enough N/E=Not Enough
(S)/E= Some Effort I=Important V=Very Important
6.8.1.5 Discussion
It costed the division an exorbitant amount of money, manpower and logistics to

provide its services to the communities due the tension.
The financial loss incurred by the division in terms of materials, equipments, and
assets valued to, more than ½ a million dollars. This includes damages to water
supply systems, damaged or stolen materials, equipment and assets, and the
delays attributed to the constructions of water and sanitation facilities for the past
two years and repair and maintenance of equipments.
Besides the costs, the division is facing financial constraints. As figured out in the
review, health and medical services, wages and services grants is badly affected
by the governments cash flow problem. This will have great implications on the
rehabilitation and the re-adjustments program of the Environmental Health Division
(MHMS). Already an unpaid leave exercise will affect 30% of the workforce of the
division, a set back to the revitalization and resumption of environmental health
services.
Shipping services around Guadalcanal Province is yet to make regularly services.
However, the division had managed to ship some of the water supply materials to
project sites in the last few weeks.
Fortunately, the underline accounts of the division from sales of toilet slab,
culverts, and some materials from the division’s store, have greatly assisted the
division to continue providing some of the services. This includes payments of
wages, freights, and others such as fuel.
The effects of the ethnic tension, has had its social implications on the services of
the division. For instance, the greater internal movement of people has had its
implication on the distribution and delivery of services, such as health and medical,
schools, and other social services. This is clearly indicated by the demand for
water supply in many communities and the shortage of medicine in most clinics.
According to the survey, there is an increase of 15% of the population in most
communities. Thus, it means, an extra demand exerted on existing services such
as water supply and sanitation, and medical services. On the other hand, 6%
reduction in local population is attributed in some areas. This will have greater
implication on the planning of services in the future.
The need to revitalize and resume environmental health services to the
communities is realized by the division, but the need have really been felt by the
communities.
This however, is indicated by the high response to such needs by the communities,
in terms of repair and maintenance of damaged and aging water supply systems in
their areas. Further to that, the enormous response in support for the EHD
PROGRAMS and their awareness of the community contribution has indicated their
willingness to assist the division in its programs.
Finally, the effect of the ethnic tension on the rural people is clearly indicated by
their response in terms of their views on the peace process. While 38 % of the
respondents have agreed that, the peace process is progressing, an overwhelming
60% are not sure what direction the peace process is heading. This view had been
highly attributed to the slow progress of the disarmament process.
6.8.1.6 Recommendations
The successful implementation of environmental health programs will be attributed

to the level of participation of both the communities and the division. Thus, the
division will have to re-iterate the importance and significant of community
participation and the levels of cooperation needed to complete the work
successfully. However, the division should commit itself for the implementation of
the community participation strategies. Thus, this report recommends the
following,
1. Health awareness and workshops should be included in all projects as a

component of the project. Thus, funds should be secured for this purpose.
2. Despite the setbacks and constraints, services should resume at whatever

means and cost.
3. Actions plan to be drawn up and schedule. The plan should focus and
address areas on assessment of damages to existing water supply systems,
and sanitation demand as result of resettlement of people.
4. Conduct rapid assessment of damaged water supply systems, displaced

population and resettlement camps
5. Repair/ reconstruct of damaged water supply systems and provision of water
supply for displaced population
6. Resume the implementation of approved RWSS projects
7 Part IV-Management & Support activities
7.1Administration & Management

Dr.H.K.Balachandra was transferred by the ministry of health from Makira Ulawa
Province to Guadal Canal Province as Director of health and assumed the office on
September 12, 2000 in the light of ethnic situation to have neutrality amongst
health provider. He succeeded Dr.Lipson Sissiolo, who in turn was transferred to
Choiseul Province.
CNO Mr.George Maebata managed the office efficiently in the absence of the
Director. He also worked continuously and tirelessly through out the ethnic tension.
PNO Batram Manu took charge whenever found necessary. Mr.Benson Anisi
accountant all strived hard all through the year.
7.2 Human Resource Medical Training

Centre
7.2.1 Introduction
World Health Assembly in 1987 urged its Member states "to ensure that human
resources be not only adequately planned for and trained, but also skillfully
managed, including the improvement of career development and incentive
schemes, to ensure its most effective utilization" vi.
Provincial health services largely depend on auxiliary health personnel. It has been
described as "Skill pyramid" in which skills in health care are widely distributed
amongst those who provide health services, and not restricted to doctors and
senior nurses who have had intensive medical and clinical training. Training needs
to be 'built in' as part of the normal activity of the province, and not seen solely as
something which takes place in training schools.
It was reported that the main focus and the priority were given to MCH/FP unit and
non-availability of the fund to address the refresher courses for registered nurses,
and nurse-aides.
7.2.2 Training Activities

Following training were conducted before the crisis and after the signing of
Townsville Peace Agreement
Table no 24. Staff Training
DATE VENUE TOPIC CONDUCTED BY

(a) 22/2/00 Tamboko Reproductive MCH/ Sr Vika
Health
(b) 29/3/00 Tamboko Forming Health GP Med Team
Committee
(c) 11/11/00 Tetere Parish STI & Reproductive GP Med Team
(d) 20/11/ - Balasuna COC Traditional birth GP Med. Team

24/11/00 Centre attendance
(e) 27/11/00 Kolina Traditional birth GP Medical
-1/12/00 attendance Team
(f) 11/12/00 Maravovo Traditional birth GP Medical
-14/12/00 attendance Team
Table no 25. Overseas training
Perio Name Course Institution

d
a 2000 Noel Itogo Diploma in Collage of Allied health Science
Nursing
b 2000 Mark Caleb Paediatric Depo MHMS
c 2000 Christine Paediatric Depo MHMS

Sau
7.2.3 Training Overseas:

One of our senior staff SNO Mr.Noel Itago successfully completed Post Graduate
Diploma in Community Health Nursing Administration of one year duration in the
year 2000, at College of Allied Health Science, University of Papua-New Guinea at
Port Morsby.
7.3Supervisory Tours
7.3.1 Introduction
The supervisory tour, one of
the important out-reach
activities in the management
of Curative, Preventive and
Rehabilitative process in the
Provincial Health Services
delivery. It also examines the
possibilities of highlighting the
neglected issues, and to
strengthen the health worker
and the community on the
whole.
The main island has

mountainous interior and
virtually all settlements are
along the coast, but the
southwest (weather coast) is very exposed making travel along it difficult and
dangerous.
7.3.2 Objective
Purpose of the tour to these areas Marau – Marapa clinic and Makina was on the
request from the community in that remote part of the island become a main
concern to their leaders that the Health problems had increased to a significant
level, after the Nurse left the clinic in that area. Team left Honiara on Wednesday
at 2 pm 09/05/2000 by OBM/Canoe, which took 4 hours, and reached late in the
evening. The clinic sessions commenced the next day Thursday 10/5/2000.
The main focus was the children’s immunization schedules, besides screening for
general illnesses. Immunizations was followed by ante-natal checkup and the
general outpatients clinic for all minor illnesses and other health problems.
8 Conclusion
Health is the outcome of a combination of various factors--biological, genetic,
environmental and socioeconomic. The elements that condition people’s health go
beyond physiological factors to include gross national product, wealth distribution
and access to income-earning capacity and opportunities, availability of and access
to educational resources, the urban and rural living environment and physical
infrastructure, and, for instance,
political structures through which
individuals and groups can
influence distribution of resources
that affect health status.vii
The numerical data on disease

distribution is necessary to
determine the priorities for the
health services and to ensure that
the activities of medical staff are
in accord with these priorities.
Public health studies can help to
guide physicians to the proper
diagnosis, treatment and
prevention of disease in individual
patients. Prevention may be applied at various stages of the disease process.
Primary prevention works during the susceptibility stage of disease by minimizing
exposure or altering immunity. Secondary prevention tries to identity cases in the
pre-clinical and early clinical stages through early detection and treatment. Pap
smears would be an example of the secondary prevention of cervical cancer.
Tertiary prevention aims to limit disability from the advanced stages of disease and
restore function.
Good health makes to economic activity - this is not fully understood. Health
expenditures are still too often considered to be a drain on national and community
resources, and another misconception is the idea that prosperity will automatically
improve health and welfare, whereas in reality this is not the case.
There is thus a need for research on health in relation to various social, economic,
environmental and demographic factors. Research must be carried out in
collaboration with other sectors such as agriculture, education, employment,
industry and transport.
Commitment from the community and their participation towards health
service delivery is the need of today.
The spiritual and scientific legacy of Sir Ronald Ross:
It was the spiritual and scientific legacy left by Ross [ whose discoveries led to identification of the carrier and mode
of transmission of malaria in 1897-1898] that inspired the WHO when, in May 1955, it decided to "take the initiative,
provide technical guidance, and encourage research and coordination of resources in the implementation of a
programme having as its ultimate objective the worldwide eradication of malaria"
-From an address by Dr M.G. Candau, Director - General of WHO, in June 1957 on the hundredth anniversary of the birth
of Sir Ronald Ross. In: Chronicle of the WHO, 1957, 11: 302.
9 Key Health Indicators

 Population with safe water in the home or with reasonable access…………65 %
 Population with adequate facilities for excreta disposal. …(1996)………… 9.0 %
 Immunisation performed during the last 5 years:-
 Population with access to local health care and essential drugs…….. 65- 70 %
Criteria involved:
- Availability of treatment for common diseases and injuries.
- A regular supply of essential drugs
- Health facility with 1 hour walk/travel.
 Expected number of births(n)…………………………………….……………….. 1299
 No. of pregnant women seen by trained personnel………………………….. 76 %
 No. of deliveries attempted by trained personnel……………………………. 80 %
 New born infants with birth weight <2.5kg. ………………………………….. 7%
 Children below 5 years of age below reference value of weight for age…… 11 %
 Cases of Diarrhoea below 5 years………………………………..Mild………. 12.7 %
Moderate….… 2.2 %
Severe ….….. 5 %
.
10 Acronyms
AFB-Acid Fast Bacilli MHMS-Ministry of Health & Medical
AHC-Area Health Centre Services
ANC-Ante Natal Care MUP-Makira/Ulawa Province
ANO-Assistant Nursing Officer NA-Nurse Aide
BCG-Bacillus Calmette Gurine NAP-Nurse Aide Post
CHT-Community Health Team NO-Nursing Officer
CNO-Chief Nursing Officer OBM-Out Board Motor
DHMS-Director of Health & OPD-Out patient Department
Medical Services OPV-Oral Polio Vaccine
DOTS-Directly Observed PB-Pauci Bacillary
Treatment Shortcourse PF-Plasmodium Falsiparum
DPT-Diphtheria Polio Tetanus PHC-Primary Health Care
EHD-Environment Health Division PNC-Post Natal Care
EPI-Expanded Programme of PNO-Principal Nursing Officer
Immunization PTB-Pulmonary Tuberculosis
ESR-Erythrocyte Sedimentation PV-Plasmodium Vivax
Rate RHC-Rural Health Clinic
EU-Eoropeon Union RN-Registered Nurse
FP-Family Planning RWSS-Rural Water Supply &
GP-Guadal Canal Province Sanitation
GPHQ-Guadal Canal Province SAMO-Senior Anti-Malaria Officer
Head Quarters Medical Division SNO-Senior Nursing Officer
HIV-Human Immunodefiency TB-Tuberculosis
Virus TPA-Townsville Peace Agreement
IDP – Internally displaced people VDRL-Venereal Disease Research
IR-Incidence Rate Laboratory
MB-Multibacillary VHW-Village Health Worker
MCH-Mother & Child Health WHO-World Health Organisation
MDT – Multi Drug Therapy WV – World Vision
11 References
i
This excludes Honiara City Council, which had a population of just over 49,000 in 1999.
ii
World Health Organization (WHO). Mother and Baby Package:Implementing safe motherhood in countries
iii
(WHO/FHE/MSM/94.11 Rev.1). Geneva, 1996.

iv
Disease trends," Life in the 21st century - A vision for all", World Health Report 1998 Executive Summary,
http://www.who.int/whr/1998/exsum98e.htm
v
Weekly epidemiological record, No.37, 2000, 75, page 303. http://www.who.int/wer
Fortieth World Health Assembly, Geneva, 4-15 May 1987, resolutions and decisions, WHO document
vi
WHA40/1987/REC/1, Geneva, 1987.

vii
Health dimensions of economic reform. Geneva, WHO, 1992.
Thank you

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Annual Report -2000 Guadal Canal Province

GOVERNMENT OF THE SOLOMON

ANNUAL REPORT - 2000

Health & Medical Services

March 31, 2001

“Safe Blood starts with me”

WHO Slogan for the year - 2000

Hon’ble Minister for Health,

“Commitment from the

health service delivery is

4.2 Guadal Canal Province.............................................................................................................................................11

4.3 Provincial Health System:.........................................................................................................................................17

5 PART II -RESOURCE ANALYSIS............................................................................................................... 19

5.1 Health facilities..........................................................................................................................................................20

5.2 Health personnel........................................................................................................................................................21

5.3 Nursing Management................................................................................................................................................23

5.4 Wages and service Grant..........................................................................................................................................27

6 PART III-PRIMARY HEALTH CARE ELEMENTS.......................................................................................29

6.1 Treatment of common diseases & injuries..............................................................................................................30

6.3 Expanded Programme of Immunization.................................................................................................................37

6.4 Health education........................................................................................................................................................38

6.5 Provision of essential drugs......................................................................................................................................39

6.6 Control of communicable diseases...........................................................................................................................40

6.7 Safe water supply & basic sanitation.......................................................................................................................50

6.8 Environmental Health Division................................................................................................................................51

7 PART IV-MANAGEMENT & SUPPORT ACTIVITIES..................................................................................58

7.1 Administration & Management...............................................................................................................................59

7.2 Human Resource Medical Training Centre............................................................................................................59

7.3 Supervisory Tours......................................................................................................................................................60

9 KEY HEALTH INDICATORS........................................................................................................................ 62

I am grateful to following distinguished personalities:

Staff of Guadal Canal Province - Medical

The goals of the ministry of health and medical services is to:

he Solomon Islands, are an archipelago consisting of six main islands and

 Latitudes: 8:00 South and Longitudes 159:00 East

4.2Guadal Canal Province

Population by wards 1999 Census

0 2000 4000 6000 8000

- 5,000 10,000 15,000

Figure 1: Guadalcanal population age distribution, 1999

Estimated Population Chart

4.2.2 Socio-Economic Factor

4.2.3 Natural Environment:

4.2.4 Political environment:

4.2.5 Ethnic Crisis

4.2.6 Health Status

4.3Provincial Health System:

No women should die in childbirth

5.1.2 Health Centres:

5.1.3 Existing Health Facilities:

A. Area Health Centre - Three

C. Nurse Aide Posts - Sixteen

Staff Establishment Actual

Table no 2. Table no: 5.2 Staffing in the Provincial Direct Employees

Staff Establishment Filled

5.3.2 GP Referral Clinic at National Referral Hospital.

5.3.3 Supervisory Tour/Training Workshops.

5.3.4 Impacts of the Ethnic Tension

 A total destruction of Marau Area Health Center and staff accommodation.

 Medical essential supplies were distributed to the appropriate health facilities

 Outreach programme had to be suspended.

5.3.5 Costing Containment Strategies.

5.3.5.1 NON – Clinical