Health Report 2000 - Solomon Islands

MINISTRY OF HEALTH
SOLOMON ISLANDS
Solomon Islands Government
NATIONAL ANNUAL HEALTH REPORT 2000
Review of Work of Ministry of Health,

Solomon Islands 2000
October 2001
© Lester Ross, George Malefoasi, Dennie Iniakwala, Peter Wale & Abraham Namokari
Ministry of Health
P.O.Box 349
Honiara
Solomon Islands
2
TABLE OF CONTENTS
SECTION 1: GENERAL INFORMATION ................................................................ 4

1.1. INTRODUCTION: .................................................................................................................................... 5
1.2. THE PERMANENT SECRETARY’ S REMARKS: ......................................................................................... 5
SECTION 2: ENVIRONMENTAL SITUATION ................................. 8

2.1. BACKGROUND: ..................................................................................................................................... 8
2.2. THE POLITICAL SYSTEM: ...................................................................................................................... 9
2.3. THE ECONOMY: .................................................................................................................................. 10
2.4. FACTORS AFFECTING SERVICE DELIVERY:......................................................................................... 10
2.4.1. External Factors:...................................................................................................................................... 10
2.4.2. Impact of the Ethnic Conflict on the Health Services Delivery- April 1999-October 2000:.................... 12
2.5. INTERNAL FACTORS: .......................................................................................................................... 15
2.5.1. Management & Planning of Health Services:.............................................................................................. 15
2.5.2. Human Resource Management and Development:..................................................................................... 16
2.5.3. Health Legislation:..................................................................................................................................... 16
2.5.4. Health Financing & Budgeting and Resource Allocation Factors: ............................................................... 16
Table (7) Total government budget and the allocations from 1988 to 2000:.................................... 17
Table (8) Distribution of the Recurrent Health Budget 1991-1 99 9( SBD$’ 0 00)............................. 17
2.5.5. Structural Reform: ..................................................................................................................................... 18
2.5.6. Important Elements in Reform: ................................................................................................................. 19
SECTION 3: TECHNICAL MATTERS-COMBATING

COMMUNICABLE DISEASES ............................................................................... 20
3.1. OVERVIEW: ........................................................................................................................... 20
3.2: ROLL BACK MALARIA ........................................................................................... 20
3.2.1. THE VECTOR BORNE DISEASE CONTROL PROGRAMME- THE MALARIA CONTROL
PROGRAMME –AN OVERVIEW ............................................................................................................. 20
3.2.1.1. MALARIA SITUATION IN HONIARA, 1991 TO 2000........................... 20
3.2.1.2. MALARIA SITUATION IN THE PROVINCES, 1991 - 2000 .................. 21
1) PROVINCES WITH DECLINING OR STABLE TRANSMISSION ....................................................................... 22
2) PROVINCES WITH SIGNS OF INCREASING TRANSMISSION ........................................................................ 23
C) PROVINCES WITH INSUFFICIENT INFORMATION ..................................................................................... 24
3.2.2. BRIEF REPORT OF MALARIA IN SOLOMON ISLANDS (2000) AND THE IMPACT OF THE
ETHNIC CRISIS: ..................................................................................................................................... 25
3.3. STOP TUBERCULOSIS ................................................................................................. 27

Graph Showing New Case Notification for Leprosy 2000............................................................... 30
Table ( ) Provincial Leprosy CaseLoads and prevalence: ................................................................ 30
Graph ( ) Leprosy Prevalence 1997-2000......................................................................................... 31
3.4. STI/ HIV/AIDS: ................................................................................................................... 31

3.4.1. STI/HIV/AIDS PROGRAM:.............................................................................................................. 32
3.5. VACCINE PREVENTABLE DISEASES: ..................................................... 34

3.5.1. NATIONAL DISEASE SURVEILLANCE: .............................................................................................. 34
Graph (1) showing incidence of vaccine preventable Illnesses in SI 1997-99 ................................. 34
Graph (2) showing incidence of vaccine preventable illnesses by provinces in 1997-99:................ 35
3
2.6. THE HEALTHY ISLANDS, HEALTH CITY, INITIATIVES: .. 36

2.6.1. General view: ......................................................................................................................................... 36
3.6.2. Health and Environment....................................................................................................................... 38
3.6.2.1. General protection of the environment............................................................................................. 38
3.6.2.2. Air (pollution)................................................................................................................................... 38
3.6.2.3. Water quality .................................................................................................................................... 38
3.6.2.4. Solid waste disposal ......................................................................................................................... 39
Water supply and sanitation Indicators................................................................................................. 39
3.6.2.5. Food safety ....................................................................................................................................... 39
3.62.6. Housing ............................................................................................................................................. 41
3.6.2.7. Work place........................................................................................................................................ 41
3.7. INFANT AND YOUNG CHILD NUTRITION: ......................................... 41

3.8. REPRODUCTIVE HEALTH AND FAMILY PLANNING .......... 42
3.8.1. Maternal Mortality:............................................................................................................................. 43
Table (1) showing Maternal Mortality Rate/ 100,000 births ............................................................ 43
3.8.2. Strengthening nursing and midwifery: ........................................................................................................ 43
3.8.3. Family Planning:................................................................................................................................. 45
Table (2) Family Planning Coverage (%) total users at end of December/wcba x 100):.................. 45
Graph (3) showing FP coverage by end of December 1997,1998, 1999 & 2000: ............................ 46
Table (3) % Supervised deliveries: .................................................................................................. 46
Table (4) Antenatal Coverage: First antenatal attendance (% first visit / expected births).............. 46
Graph (4) showing antenatal coverage (1st visit/ expected births 1997-2000:.................................. 47
Table (5) Total Fertility Rates 1986,1996,1998: .............................................................................. 47
Table () FERTILITY RATES BY PROVINCES FROM 1997 TO 2000 (births/ 1000 popWCBA. 47
3.9. NON-COMMUNICABLE DISEASES (INCLUDING MENTAL

HEALTH): .......................................................................................................................................... 50
3.9.1. PREVENTION AND CONTROL OF NON-COMMUNICABLE
DISEASES: .......................................................................................................................................... 50
3.9.2. MENTAL HEALTH SERVICES ......................................................................... 52
3.9.2.1. Activities:................................................................................................................................................ 52
3.9.2.2. Findings (Outputs):................................................................................................................................. 53
Table (6): Total Cases Admitted to .................................................................................................. 53
Na tiona lPs y chi a tr icUni t,Ki lu’ uf iHos pi tal( o nl y )I N199 7, 1 99 8, &19 99. ..................................... 53
3.9.2.3. Analysis: ................................................................................................................................................. 53
3.9.2.5. Major Issues/ problems & recommendations: ........................................................................................ 54
3.9.3. INITIATIVE TOWARDS TOBACCO CONTROL: .............................. 54

3.9.3.1. Tobacco Free Initiative ........................................................................................................................... 54
3.10. STRENGTHENING HEALTH SYSTEMS IN SOLOMON

ISLANDS: ............................................................................................................................................ 55
3.10.1. Proposed Health Reform: ........................................................................................................................ 55
3.10.4. Essential drugs and medicines policies:..................................................................................................... 59
3.10.5. Traditional Medicine: ............................................................................................................................... 61
3.11 TECHNICAL COOPERATION AMONG DEVELOPING

COUNTRIES: ................................................................................................................................... 61
Table ( 10)Matrix of Current Donor Activity Impacting Directly on the Solomon Islands Health
Sector: .............................................................................................................................................. 62
4
Emergency Support given by the World Health Organization (WHO) to the Ministry of Health and Medical
Services, Solomon Islands Government .............................................................................................................. 69
3. 12. ERADICATION OF POLIOMYELITIS: ....................................................... 71

3.13. HEALTH PROMOTION:........................................................................................... 72
3.14. EMERGENCY AND HUMANITARIAN ACTION: .............................. 74
4.0. CONCLUSION:..................................................................................................................... 74
ANNEX 1------------------------------.......................................................................... 76
SECTION 1: GENERAL INFORMATION

5
1.1. Introduction:
1.
2.ThePer
manentSecr
etar
y’sRemar
ks:
Aim:
It is a great opportunity and honor for me to present the National Health Report
2000. The intention of this report is to inform every one including the public, of the
challenges, external threats, difficulties the health care system in Solomon Islands had gone
through in the past 12 months of 2000 achievements. This report also stresses the key issues
as experienced and observed in 2000.
Key Issues:
The political and socio-economical factors had a significant pressure and threat on
the health system. These external factors accentuate the existing structural weaknesses of the
public health sector. The impact of the devastating effects of the above external factors was
seen in areas of funding of health services delivery and essential medical supplies to the
people of the country. The twenty-months ethnic tension, which saw its height on June 5th
2000 was the prime factor for the all the adverse impact on health services delivery both at
the National Referral Hospital and all through out the provinces.
[Political and Socio-economical issues]
Health managers at the national, provincial and institutional levels were under
tremendous pressure to ensure that health care services are maintained during the difficult
times. It was a time when serious thoughts were made between personal safety and service
for the people and between professional ethics and personal safety. Staff management was
di
ff
ic
ult
,whe
nthe
rewa
sle
git
ima
tef
earf
ors
afe
ty.Ha
dn’
titnotf
ort
hec
ommi
tme
ntof
many health workers it could have been an anarchy in health in 2000.
6
[staff management issues]
Health funding was practically not there. Like other many public services, provincial
health grants were not paid on time or paid at all in a few service areas. Lack of payment of
provincial wages led to low staff morale and even closure to a few clinics. Debts with the
two main overseas buying agents for medicine led to cessation to supply medical orders
from us. There was obvious lack of commitment to maintain the purchasing power for
essential medicines despite an approval by Cabinet (Paper by the Minister of Health) to debt
service the overseas buying agents concern.
[Health Funding issues]
The health reform initiatives by the Solomon Islands Government through the
Ministry of Health in its pan for 1999-20031 came under pressure in 2000. The issues were
related to getting a coalition and understanding with key stakeholders such as the
Department of Finance and Public Services Division. Nonetheless, there were some success
in creation of a new Chief Executive Officers Post at the National Referral Hospital, and
other key positions vital for the structural reform at the Planning and Accounting Division.
However, the implementation of the structural reform was interrupted by the difficult
imposed by the surrounding milieu, which was such that was not conducive for any reform
to be smoothly implemented.
[Health Institutional Strengthening implementation issues-change management]
There were obvious and practical issues and problems related actual services delivery
and impact of the surrounding milieu to the health status of the people. There were obvious
interruption of both curative (health institutional) and (community based) health protection
and prevention programs. Malaria was reported be on the rise again in some provinces,
particularly on Guadalcanal. Maternal Mortality rate shows an increase again on Guadalcanal,
which is directly affected by the ethnic tension. Prevention programs such as antennal and
1
MOH (2000). National Health Policies and Development Plans 1999-2003.
7
family planning coverage showed significant reduction. Demand for health services on
Malaita increased as a result of exodus of some 20,000 Malaitans from Guadalcanal Islands.
The Pharmacy Services Division reported an increase of 20% drug usage on Malaita a lone.
[Disruption of health services issues as a result of the conflict]
Recent (2000) health statistics and data showed some decline in most service delivery
coverage including family planning, antenatal care, and immunization. The recent Census
1999 revealed a very high infant mortality rate of 66/ 1,000 live births (higher than the
WHO target of 50/1,000 live birth.
[Health Status Issues]
Achievements::
The year 2000 was difficult year to achieve any health objectives stipulated in the
targets of the National Health Policies and Plans 1999-2003. There was not much
development but more or less crisis management. However, there were some moments of
achievements.
The most important achievement is the maintenance of essential health care services
all through out the country during the twelve months old conflict. Despite its erratic ness
and difficulties clinics and hospitals were open. Essential medicine somehow passed through
the battle frontline to the people in desperate need.
[Continuous health care services delivery despite the tension]
The Solomon Islands Health Sector Development Project approved and signed late
1999, started its implementation begging of 2000. Despite its interruption in the mid year,
some activities continued there after. The priority issues to be addressed include;
Maternal care and family planning including the development of midwifery training.
Malaria prevention and control. Provincial health program management. Central capacity
building and project support, which will include Health Management Information System
Development to support the Pilot Projects in the above mentioned service delivery.
[Inception of the Solomon Islands Health Sector Development Project/ World Bank Loan]
8
The Solomon Islands reached the Polio-free status in 2000. Solomon Islands joined
other member states to signed and announced during a WHO Regional session in Kyoto,
Japan a polio-free status in the Western Pacific Region. Nonetheless, Solomon Islands is
committed to continue its national polio and flaccid paralysis surveillance. There is no place
for compliancy.
[Solomon Islands Polio-Free]
SECTION 2: ENVIRONMENTAL SITUATION
2.1. Background:
Solomon Islands is a nation of
island villages scattered over 800,000
square kilometers of sea. It is a home to
people of many races, cultures,
languages and customs. The
predominant race is Melanesians
(93.3%) followed by Polynesians (4%),
Micronesians (1.5%) and others 1.2%.
The nation has a landmass of 28,369
square kilometers. It consists of six
major island groups with thousands of
9
small islands, which are divided, into nine provinces plus Honiara the capital, which is a
separate municipal authority. Some 25% of land are considered arable. Climate and
geography impose constraints on development; the population is dispersed throughout the
islands and equitable access to services, resources and income has proved difficult to
achieve.
As part of the Pacific rim of fire and being inside the cyclone belt, Solomon Islands
is susceptible to natural disasters; mainly earthquakes, landslides, cyclones and flooding,
resulting in the destruction of homes, food crops and sometimes lives. This, plus the
scattered nature of the islands with their small isolated villages imposes significant
c onstrai
ntsont hec ountry’sde vel
opme ntandpr ov i
s i
onofs e
rv i
cesf orwome na ndchildren.
Indicator 1970(a) 1986(a) 1999 (b)
Total Population 160,998 285,176 409,042*
Population growth Rate 3.4 3.5% 2.8*
Total Fertility Rate 7.4 6.1 4.8**
Crude Death Rate 10 10 7
Crude Birth Rate 45 42 38
Infant mortality Rate 67 38 38
Life Expectancy 54 60 65
Population density - - 13
Average household-hold - - 6.3
size
(a) From government census report (1976, 1986) ministry of finance, statistic office
(b) Estimate from World Bank reports (world bank 1994 Health Priorities and Options in Pacific Member
Countries.
(*) National Population Census 1999
(**) UNFPA Source
The population is largely young, dependent and rural. Some 48% are under 15 years
old. 18% is under five years old. With such a young population it can be expected that there
will be a high population growth rate for many years to come, irrespective of reproductive
choi ces,whi chl eadt of ewerc hildren,be i
ngbor nint oda y’sf amili
es. Fa mi l
ypl anni ng
acceptance is currently estimated at about 12% of women of childbearing age.
More than 80% of the people still live in rural areas, although urbanization, especially
in the capital Honiara, is growing at 7% a year. Melanesians from 94% of the population,
Polynesians 4%, Micronesians 1% and Chinese and Europeans 1%.
The majority of Solomon Islanders are Christians (90%). Although Christianity has
had a profound influence, traditional social structures and customs remain important.
Kinship, traced partrilinearly amongst some peoples but most commonly matrilinearly,
remains the basis of Solomon Islands culture.
About 87 distinct languages are spoken throughout
the country. Pidgin is the lingua France and English
is the official language. Dissemination of
information can be a challenge in the Solomon
Islands.
2.2. The Political System:

10
The Solomon Island, which gained independence from Great Britain on the 7th July
1978, is a sovereign democratic state and has a linicameral legislature, The National
Parliament with 50 elected members. It is administratively divided into nine (9) Provinces
and a municipal authority, with their own political and administrative establishment,
resembling the Federal system of government. The Parliament members are elected on
political party basis or as independents, on a four yearly term. The Solomon Islands as a
member of the Commonwealth, the British Monarch, as Head of State, is represented locally
by a Governor-General, who is recommended to the Queen by the National Parliament.
The governmental and political institutions of Solomon Islands are firmly established in
theory and practice on principles and systems of governance, with an exemplary record on
human rights constant with the high ideals of the United Nations Charter. Political stability,
civil order, harmonious ethic religious relations and peaceful social environment were the
characteristics of the Solomon Islands, both in relations to regional and neighbors.
There is a strong move towards Federal and Statehood system of government. The
government is currently looking into this idea. Sooner or later it may come as a parliament
bill. The Ministry is carefully monitoring this move as it may have significant impact in
management and service delivery.
2.3. The Economy:

Since independence in 1978 Solomon Islands has struggled to develop its economy,
to build infrastructure and to provide services to its 409,042 (1999 Census) people who live
in 65,014 households in widely dispersed villages. The subsistence and semi-subsistence
economy is still the major means of survival for most families, but these traditional means of
economic and social support in the rural areas are weakening. Participation in the cash
economy and formal employment opportunities are limited. The main primary sector
exports are copra, timber, cocoa, palm oil and fish.
The ethnic tension on Guadalcanal has had significant adverse effect on the
ec onomyoft hec ou ntry.Asar e sult
,S ol omon I sl
a nds’cur
rentpa ttern ofe
conomi c
development, which was dominated by large-scale logging, mining, fisheries and agricultural
projects financed by foreign capital fell dramatically. The devastation of the economy gives
rise to risk to the health of the people especially to lives of women and children.
TheGov ernme nt’sr ev enuec olle c
ti
onf e
llbyha l
f,compa r
e dt o1 998.Pr ovinc
ial
health and wages grants are not paid for several months. Recently there is a regular untimely
pa yme ntofpu bl i
cs erv ants’s alar
iesandwa ge
s.Ther
ei sa nobv iou sfina nc i
a lande conomi c
crisis, which threatens the health service delivery of the country. The Solomon Islands
Government through the Ministry of Health is currently supported by the Australian
Government though the AusAID Trust Fund, which helps the ministry to maintain basic
health care services delivery to the people.
2.4. Factors Affecting Service Delivery:
2.4.1. External Factors:

The external factors affecting health services delivery in the country are related to its
geography, socioeconomic status, demographic and environmental, political and
11
infrastructure characteristics. We have recognized that the socioeconomic and demographic

trends as major factors affecting health services in the country. Whilst the environmental,
political and infrastructure factors generally affect the health service delivery to a lesser
extend.
Solomon Islands is growing at a declining rate, 3.5% in 1986 (2.8% in 1999) with a
total fertility rate of 6.1 in 1986 to 4.8 in 1999, crude birth rate of 42 per 1,000 poppulation
2
in 1986 to 38/1000 pop. In 1999, and crude death rate of 10 per 1,000 in 1986 to 7/1,000 in
1999. Despite some improvements it is still very high by international standard.
The diversity of the composition of the Solomon Islands population implied the
diversity and complexity of health needs by different socio-cultural background. Therefore
interpretation of health need may be different, that calls for selective and strategic planning
to allow for the demand-supply theory to determine of resources distribution.
The public health sector in the country is labor intensive having very minimal or no
modern technology that fosters efficiency and increase productivity of health institutions.
Nonetheless, there are opportunities yet to be exploited by the Solomon Islands public
health sector.
For this reasons, the Solomon Island health sector is adventuring into practical,
feasible, simple and cost-effective ways of mobilizing local resource inorder to permeate the
‘funda me ntalba r
riers’a ndc ha l
l
enge
sont hehe alt
hs ector ,both,f rom thee xter
nala nd
internal influences mentioned above, to allow the dominant public health sector to reach out
to the vulnerable people which are the women and children of the nation, effectively. The
ma jorityofna tion’spopul ation( about80 %)arer uraldwe ll
e r
s,de spitesignifi
cantmi gration
from rural areas into the capital.
The health implication of these demographic trends is that the demand for health
service by the age group of less than 1 to 4 years old and female of childbearing age is high
and expected to increase in the next five to ten years. It has alerted SIG to focus on health
services towards this category of age group.
The SIG is also faced with challenges of maintaining primary health care services at
thec ommu ni
tyl evelswi tht hel i
mi tedr esou rces,a ggrav atedbyu nwa nt
e d‘ et
hnict
ens
ion’
currently experienced by the country. Coupled with the increasing demand for higher level
of secondary and tertiary health care services at the capital and other urban areas.
The ethnic tension on Guadalcanal Islands has significantly affected health services
delivery. There was migration within Guadalcanal to other provinces. Demand of health
services rose in many provinces. Follow up immunization of children were not received. TB
patients on second phase of treatment were delayed. Health clinic facilities and equipments
in some clinics were either stolen or damaged. Malaria control programs on Guadalcanal
were badly affected. In response the Ministry of Health drew up rehabilitation programs.
However, it is encouraging to note here that despite the difficulties on the Island,
primary health care was maintained all through the height of the conflict. Clinics were kept
opened as much as possible. Drugs and necessary supplies were sent in, from the center to
the peripheral clinics under very difficult circumstances with the help from some local
12
people and the International Red Cross. Communications links through 2-way radio were
kept opened with clinics.
2.4.2. Impact of the Ethnic Conflict on the Health Services Delivery- April
1999-October 2000:
The major impact of the conflict on the Health Service Delivery System, is the
inability of the system to deal with such situation as it has never been planned for or even
experienced in the past. The majority of the activities planned are reactive to the situation as
well as through other organization such as the Red Cross and the National Disaster Council.
However, the impact of the conflict on the health service delivery can be outlined as follows:
During Height of the Conflict:

 During the height of the tension, concentration of displaced population in
care centers, public buildings or other settlements has been a challenge to the system.
This challenge has been alleviated with the help of the Red Cross society. The risk of
acute respiratory infections, diarrhea and dysentery, measles and other epidemics is high
in such cases, however, such risks were averted due to formation of a mobile team by the
Health Division of the Honiara City Council, who regularly visit these care centers.
 Armed attacks, during the height of the tension, in addition to targeting the
civilian population, damaged key infrastructures such as homes, roads, water supply,
communication and even health facilities. These infrastructures are crucial for effective
health delivery on Guadalcanal.
 Due to insecurity and military operations on Guadalcanal access are

restricted to large areas of territory and constrain the delivery of health services, as well
as general response and recovery operations. Supplies of drugs and essential medical
supplies were virtually ceased in restricted areas. Communications to health facilities
were also proven difficult.
 Armed men entered the National Referral Hospital and fatally shot two
militants in July 2000, while recovering in the hospital. This causes fears among the staff
as well as the general public. Hospital staff refuses to attend to duties and the surgical
ward was closed and services were confined to emergency cases only. Hospital admission
was drastically reduced with a bed capacity rate that dropped from above 80% in January
2000 to approximately 36% in July 2000. Outpatient attendants dropped from
approximately 100 patients per day to about 30 patient per day in July/August 2000.
There is lack of public confidence in the safety of the hospital.
 More patients were attending provincial hospital. Gizo hospital in the

Western Pr ovinc ea ndKi lu’uf
ihos pitalinMa laitaPr ovi
nc erepor t
eda lmos tat ri
ple
increase in-patients attending the hospital, especially women and children. Expatriate
doctors were evacuated from these provincial hospitals, thus exacerbating the shortages
of doctors and increasing the workload on the remaining few.
13
As the Conflict Prolonged:
 As the conflict continues, major commercial activities such as the Oil Palm
industry, the Gold Mining Industries, and Fishing ceased operations. Martin J concluded
(Martin J 2000) that the economic effects include declining production, employment,
revenues and investment and destruction of productive investment. This general
economic crisis forced cuts in the budgets to the social services including health.
Procurement of essential drugs and medical supplies becomes a major concern;
especially when there are current debts of about SBD $5 million is yet to be settled.
 Financing of health activities in the provinces such as cold chain

maintenance, fuel for transportation, community outreach programs are being severely
affected. Most provinces have received their health services grants since June 2000, this
has prompted the Directors of Health in the provinces to reduce or cease certain health
activities.
 The inability to pay for wages of provincial health staff has prompted the
Provincial Health Authorities to allow their officers to go unpaid leave. While those
working in hospital and clinics are retained, the primary health care workers in the
communities are severely reduced. Public health programs such as water supply and
sanitation are suspended.
 Epidemiologically, it is difficult to assess the disease pattern as case reporting

are not well maintained. There is a need to for full assessment of morbidity and mortality
situation as soon as feasible.
As the Conflict Subsided and Peace is Negotiated:
 It is anticipated, that when the conflict subsides and eventually resolved

through the peace process, a major impact will be that the health needs will increase and
the health sector will face new demands for curative care as well as major backlog of
preventive measures, which could not be implemented during the tension or conflict.
 Movement of population will increase greatly, while previously cut-off areas

will become accessible. The health sector will be required to re-establish coverage, since
equitable access to services will play a major role in stabilizing the community and
contributing to the peace process. Expansion of certain facilities in these areas will call
extra resources both in terms of finance and human resources.
Re-building and Charting the Way Forward:
It becomes evident that several key areas can be identified as crucial to rebuilding
health services delivery in Solomon Islands as part of confidence building for peace and
concurrently delivers health.
The following are the priority areas were identified by the Ministry of Health:
14
Immediate level one priorities
1. The ongoing procurement of medical supplies must be maintained. Due to

the financial difficulties, it is becoming difficult to finance the debts with buying agents
in Australia and New Zealand. A number of essential drugs were being procured through
funds provided by New Zealand and Australian Governments through the ICRC. This
assistance however, was sufficient to meet the drug requirement for one year. The
problem still remain that funds for drug orders for 2001 needs to be secured, however,
the debts had not been settled prior to processing of the 2001 drug orders. The
approximate total funds required for debt servicing and procurement of new drug orders
would be SBD 12 million.
2. In strengthening and supplementing the management capacity of the

Ministry of Health to cope with current situation, there was the need for interim
Technical Assistance and Advisors. While the current management are pressured and
committed on crisis management, the Ministry needs to have additional experts that
focus on management issues that will aide in advancing the health services delivery
institutional capacity. More specifically, the interim Technical advisors will be focusing
on (a) Budget / Financing; (b) Human Resource Planning and Development, and (c)
Information Technology.
3. The out-reach services to the provinces must be re-established. Funding and

re-sourcing of the provincial health services are often provided and coordinated form
the National Government through provision of financial grants, extended national
services and facilities. There is a need to finance these activities at the provincial level.
4. As the resources available for health services are limited and getting scarcer,
it is important financial management system be strengthened. This should be focussed
on providing on simple but effective accounting software including computer hardware.
A Technical Assistance be provided specifically for this purpose and training of
accounting staff in financial management at both national and provincial levels. The
proposed bulk payment of health funds to the ministry will certainly needs improved
facilities including human resources.
5. Rebuilding the confidence of health workers is crucial and counseling of

those affected by emotional and psychological trauma as direct result of the crisis is
important. Funding for such activities is required.
6. Finally, level one priority for immediate action is the re-establishment of

hea l
ths ervi
cesonGu ada l
canal
.Ac tivi
tiesha v
ebee npl anne df ortheg ov ernme nt
’s100-
day program, which focuses mostly on restoration of health services on Guadalcanal,
including Honiara. This focus area may require rebuilding of heath facilities for
Guadalcanal Province and renovation work on health infrastructures.
Medium level one priorities:
1. As population movement increases demand on health services in the

provinces, there is a need upgrade and /or expand health facilities in the provinces. The
15
activities in this area will be concentrated on the two main provincial hospitals at Gizo
andKi l
u ’
ufi
.Thi swi llalsoi nvolvepr ov i
si
onofhe al
thst
a f
f,accommoda t
iona ndhe al
th
facilities.
2. The immunization program has proven to be very cost efficient measures to

combat major childhood illnesses. Maintenance of the cold chain is very important,
therefore it is crucial that supply of fuel for refrigerator is maintained. Currently WHO
and NZODA has been assisting in this regard, however, a long-term support is required.
3. Due to changes as resulted from reform and the current conflict, all senior
managers and other key stake holders with in the health sector be well informed. A
National Health Conference can be an avenue for such discussion and collaboration. It is
important that a funding should be made available for hosting a National Health
Conference.
4. As population moved to other provinces and the reduced number of patients

attending and referred to the National Referral Hospital, there is a need for
redistribution of medical staff to the provinces. In connection with this redistribution,
certain infrastructures such as housing, clinical facilities and equipment are also provided.
5. Water supply and sanitation has proven to be a very effective approach for
improved general health status of an individual and communities. A lot of health
problems associated with lack of water supplies and poor sanitation has been resolved
through provision of adequate clean water and sanitation facilities. There is a need to
extend the current RWSS/Sanitation program of the Ministry.
6. Finally among the medium term level priorities, there is a need to review the
infrastructure development (Hospitals and Clinics). Building of hospitals and clinics are
to be prioritized as population catchment in certain rural areas changes during the ethnic
unrest.
2.5. Internal Factors:
2.5.1. Management & Planning of Health Services:
Internally, within the health sector, the demand for health care in the country have
been traditionally influenced by what could be regarded as 'medical need' as the basis for
public policy and planning, and resource allocation. However, it has been shown and
highlighted that basing resources allocation decisions solely on medical needs is likely to
cause misallocation of resources. It may result in underutilization or overutilization of
resou rces. Aswi de lypr oc l
ai
me dt ha t‘ need’i sindepende ntofpr ice.The re
fore ,itis
essential to plan according to the 'demand', which would at least ensure against the wasting
of resources, and accurately measure the likely demand for health care services in the next
five to ten years. However, to enable an equitable health resource distribution, a
16
comprehensive health management information system is essential. An area we lacked at the

moment.
Thes urrou ndingmi li
e ui n2 0 00i ne v i
ta
blywa s‘ cris
isma nage ment’r at
hertha n
innovative strategic and development planning for the health sector. It was a time when
attention was to maintain services at its basic minimal level both in Honiara and the
provinces. Coupled with lack of funds it was very difficult situation for the health managers
to manage and implement all planned activities.
2.5.2. Human Resource Management and Development:

Human resource management and development faced difficult times in 2000. Firstly,
staff training at the overseas and local institutions was interrupted because of the ethnic
tension. Opportunities for training scholarships were curtailed. The choric shortage of
manpower (especially doctors) was accentuated, when expatriate doctors and a few foreign
volunteer health workers fled the country during the height of the ethnic crisis. A few local
doctors also fled because of threat to their family.
Management of staff in the health sector could not be handled efficiently, when
pe rsona lgrievance swe rer el
a t
e dt os taffpe r s
ona l(a ndf amily
’s)sa fetya nds ecu ri
ty.Ev en
worse is the lack practicality in assurances from the Police authorities to maintain law and
order at the health institutions (such as the National Referral Hospital) during the ethnic
tension. It was a period where by management could not prescribe or impose directives on
staffbu tratherne gotiatea ndi nc orporates taff’sinvol veme ntindecisions related to the level
of services to be maintained at these times of difficulties and insecurity because of the ethnic
tens i
on.S omu chha dbe eng ainedf rom t hes taff’
si nvol veme ntandc ommi tme nt .Thi sis
evident in the fact that despite the effects of the tension, the National Referral Hospital and
clinics around Guadalcanal Province continue to maintain basic health services to the public.
With this regard the nurses and doctors and many other health workers should be
commended for their courage and commitment to provide much needed health care to the
people of the country. It was a period when management of staff was at its highest attention.
2.5.3. Health Legislation:
The Government through the Ministry of Health is planning to review and update
the existing health legislation in line with the needs of today and the future. As eluded in the
several meetings all the existing health legislations and other related legislations are out of
date. Some health legislations need updated and improvements. The priority areas are the
Health Services Act 1979 (& Health Services (Hospital Regulations) 1980), the Pharmacy
and Poisons Act 1941, Pharmacy Practitioners Act 1997, and the Mental Treatment Act
1970. The Health Services Act 1979 needs changing to focus and promote and support the
health reform policies and strategies, the Ministry is undertaking.
2.5.4. Health Financing & Budgeting and Resource Allocation Factors:
The national government provides the major source of (recurrent) funding for
health services at both the provincial and central levels. Successive governments have always
17
considered health services as an important political priority and a right of its citizen. This has
been reflected in the high proportion of government allocation to health.
Table (7) Total government budget and the allocations from 1988 to 2000:
Years Total Govt. Rec. Health Rec. Share to Health Revenues Per
Budget SBD$M Budget SBD$M Health (%) SBD$M capitaSBD$
1988 101.2 12.7 12.5 0.1 Nominal Real
1989 125.2 14.8 11.8 0.2 42.5 27.5
1990 146.6 18.3 12.5 0.2 47.9 27.2
1991 162.8 20.5 12.6 0.2 57.4 29.9
1992 208.8 24.3 11.6 0.2 62.4 28.1
1993 231 26.9 11.6 0.2 71.7 28.9
1997 412.5 48.8 11.8 76.8 28.4
1998 532.5 54.3 14.4
1999 441.0 56.7 16.3
2000 396.7 64.6 16.0 135
Source: Account Section, MOH (2000.
Table (8) Distribution of the Recurrent Health Budget 1991-1

999(
SBD$
’00
0)
Sections 1991 1992 1993 1994 1995 1997 1998 1999

Total Central 11901.1 15907.8 16758.9 24525.1 23776.8
Total Province 6632 6994.4 8180 10044.2 14928.3 18963.6 21209.2 21306.1
Total National 185331.1 22307.2 24939.3 34569.3 38705.1 31290.5 34070.1 35439.6
%Provincial 35.8 28.7 32.8 29.1 39.6 37.73 38.36 37.21
%Central 64.2 71.3 67.2 70.9 60.4 62.26 61.63 61.89
% National 100.0 100 100 100 100 100 100 100
Source: Account Section, MOH (2000).
One of the fundamental problems contributing to the management of finance is the

lack of appropriate mechanisms or technology to monitor and evaluate the performance
management of the health budget. It is almost impossible to measure both the operational
and the impact of the health care services at the central and provincial level. Item budgeting
rathert ha n‘ ou t
putba sed’bu dg eti
ngi sa ppl ied.Thebu dg e
ts tructu rei sdr i
venby the
De partme ntofFi nance ’
sobj e c
tivesmor et ha npr ovidingoppor tunityf orbi gs penderslike
health to be accountable in cost saving incentives and cost-recovery. The health budget
therefore does not reflect the health care services, so as the allocation of resources in the
health sector 3. The implications of the current budget setting and allocation are an issue to
be addressed in the Health Strengthening Institutional Project.
De spi
tet heGov er
nme nt’
sc ommi tmentt ohe al
tha sr eflecteda s1 6.0%( second
highest to Education), there is the need to review the issue of health financing and
management of health care delivery, particularly at the NRH. The Government in its
Solomon Islands Policy and Structural Reform in 1997 set the direction towards increasing
3
John Izard (1999). Solomon Islands Health Finance Review, ADB Consultant, MHMS/HQ, Honiara,
May.
18
proportion of the recurrent health budget to community and public health programs,
provincial health services, environmental services, and health education and promotion.
Untimely payment of health grants was a problem. Many provinces did not receive
their provincial health grants and wages for about two to six months. This caused
suspension of many health care services including outreach services to most villages living
more than three kilometers from the nearest clinics and most remote areas. This is evident
from the coverage figures of public health programs (see Family Planning and Antenatal
coverage). Some health workers including the direct employed nurse aides were temporarily
laid off resulting in closure of Nurse Aide Post4.
2.5.5. Structural Reform:

The Solomon Islands Government since mid 1997, headed out with a policy
direction of Public Sector Reform & Re-structural program, which principally driven by
economic objectives.
The Solomon Islands Public Service Policy and Structural Reform Program (PSRP)is
shaped by the perception that; the public service was inefficiency; and over-staffed, to the
extent that salaries were absorbing most public expenditure, leaving little for actual
operations or capital investment and maintenance. Salaries were so low that staff had little
incentive to work. Pay differentials had been so eroded by populist policies that the formal
remuneration of senior staff in particular was derisory, making some form of corruption
inevitable. And order and work discipline had deteriorated, such that the government could
no longer look on public service as a reliable instrument for implementing policies.
The Government in its Policy and Structural Reform has set the direction towards
increasing proportion of the recurrent health budget to the rural community and public
health programs, provincial health services, environmental services, and health education and
promotion.
In responding to this policy redirection and adjustment the health sector is reviewing
its organizational and staffing structure to refocus its effort towards supporting the National
Health Policies and Development Plan 1999-2003, which literally aimed at getting a effective
and efficient public health sector as well as improving the national health outcome.
The development so far is that the health sector is in the process of formulating a
ma jor‘ Insti
tutiona lS
trengt hening ’pr ojec ttoe ff ecti
velyma naget hec hangesenv i
sagedt o
improve the delivery of health services. At this stage, with the support from the developing
partners such as the Australian Government through AusAID, and to lesser extend from the
World Bank, intense work is done in identifying priority health issues and priority program
areas. Project goals, objectives, strategies, activities and schedules are under way and near
finali
z a
tionoft hede si
g n.Thef ocu si si nt hea reasofr evi
ewi ngpu bl
iche al
ths ect
or’s
organizational structure and functions, before incorporating changes of improvement to
policy development, management and supervision, planning, monitoring and evaluation of
the health services.
4
Report from Makira Province
19
Whi l
stl i
ttl
et odowi t
hr efor mi mpe rati
v ese x pressedi nt heov erallg overnme nt’s
Policy and Structural Reform program, the sector strongly reckoned that vigorous effort is
needed in getting‘eff i
ci
enc y’i
nma jorc os tc e
nt ersoft hepu bli
che alt
hs ect or,inpa rticular
the National Referral Hospital at the capital, which absorbs a significant portion of the
annual health budget. By doing this it will enable redistribution of resources to other priority
areas, which was undermined in the previous health budgeting process.
The strength of the SIG reform program is the political commitment, which drives
the economic reform. In relation to the health sector, the commitment from executive level
of management staff is there, and which is slowly filtrating down into the middle
management level and to a lesser extend down to the operational level. The obvious
challenge is getting the majority of the operational staff to be part of the change and not to
be left with fear and threat. One of the reasons for the acceptance at the management level is
the notion to improve the management and supervision, planning, monitoring and
evaluation of the services delivered to the customers.
However, the weaknesses of the reform program is the lack of coordination and
linkages between reform by central agencies such as Department of Finance and
De pa r
tmentofPu bl i
cS ervice s,de spi
tea nexistenc eofae xterna l
lyf unded‘ Ins
tit
uti
ona
l
Strengthening Unit, which assist the Government to implement the reform program.
Nonetheless, there are opportunities that would ensure an effective restructuring of
the health sector for the benefit of service delivery to the people of the country. Firstly, the
increasing commitment from external development partners has fostered confidence on the
local counter part officers. Secondly, there is already an effective primary health care
network, which is the road to the people at the community level. Thirdly, the restructuring is
mainly done in a big way within the health sector, whilst outside the sector, appropriate
behavioral changes to healthy life style is promoted through the health promotion.
The threats to the restructuring program so far is very much related to the fear that
the central agencies (who hold the power of authority and delegations) may wrongly perceive
the restructuring of the health sector as threat itself, to them. It is essential that the health
sector having established the effective and efficient organizational structure and process
should have a significant degree of accountability and responsibility in human resource
management and development, financial management, budgeting and resource allocation.
2.5.6. Important Elements in Reform:
Firstly, whatever done must be modified to suit the local context.
Secondly, the customers who are the end users and recipients of the services must be
valued in all the strategies and programs put in placed for the reform. It is about changing
cultures, knowledge, attitudes and current practice of health staff as well as the people of the
country.
Customer focus in programs aimed at changing personal behavior is proven to be
ve ryeff
ec ti
v e.Thisi sbe causeq ualit
yi sbe stjudgedont hecustome r
s’pe r ce
ption.I
tal
so
allows gettingdowna tt hec ommu nityl eveltoi nvesti
g at
ea ndu nde rst
andt hepeopl
e’
s
problems. It provides a structure of solving problems and improving services.
Secondly, all stakeholders must be involved. The process involves teamwork and break
down barriers both external and within the service delivery.
20
It is obvious that theses basic fundamentals are often being over looked. At the end
of the day what matters is the service delivery to the people.
------------------------------------------------------------------------------------------
SECTION 3: TECHNICAL MATTERS-Combating

Communicable Diseases
3.1. Overview:
Despite the financial constraints the government is facing, the Ministry of Health
continues to maintain basic health services, with what is available and can be done. Most
communicable public health programs continue to operate. The two years of 1999-2000
ethnic tension were the most difficult year for the Ministry. Nonetheless, basic services and
emergency were also taken cared of.
3.2: Roll Back Malaria
3.2.1. The Vector Borne Disease Control Programme- THE MALARIA

CONTROL PROGRAMME –An Overview
3.2.1.1. MALARIA SITUATION IN HONIARA, 1991 TO 2000
In 1992 and 1993, Honiara was the place with the highest incidence of malaria in
Solomon Islands. Because of the constant movement of people in and out of the town,
many of the infections were probably acquired elsewhere and brought into town, to act as a
source of new infections for residents.
21
Solomon Islands
Annual Malaria Incidence
500
400
Cases/1000/Year
300
200
100
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
P.falciparum P.vivax Total
Honiara was also the place with the most dramatic fall in incidence of malaria in the
last ten years. Apart from the normal prevention activities of nets and some spraying,
Honiara benefited from an intensified campaign supported by WHO which involved weekly
house to house surveillance for fever cases and visitors to Honiara, who were screened by
blood slide and treated if necessary. Complete coverage of the town became progressively
more difficult in late 1999 and early 2000 because of increasing 'no-go' areas, and
surveillance stopped completely in June 2000. The effects of interruption of activities can be
seen in Figure 2.
It must be noted however that a some of the increase in incidence can be accounted
for by the adjustment of the Honiara population downwards (from 71,628 in 1999 to 49,107
in 2000) after the 1999 census.
3.2.1.2. MALARIA SITUATION IN THE PROVINCES, 1991 - 2000
All the provinces in Solomon Islands except Rennell/Bellona have malaria transmission.
Based on incidence in 2000, the eight malaria-endemic provinces can be divided into three
categories:
1) those where incidence has continued to decline or remained relatively stable

(Choiseul, Makira Ulawa, Malaita)
2) those which show signs of increasing transmission (Central, Isabel, Western,

Temotu)
22
3) those where there is insufficient data to make a judgement on the situation

(Guadalcanal).
1) Provinces with declining or stable transmission
Choiseul Province has benefited from past support from UNDP/WHO, as well as from the
recent (1999) deployment of a very able and active Provincial Supervisor to the province. It
will be receiving support from a Rotary International Project which was due to start in 2000
but has been delayed for a year due to the unrest.
Makira-Ulawa Province has also had a very competent Supervisor and some support from
the World Bank in 2000.
Fig 3a CHOISEUL : Annual Incidence/1000 Fig 3b MAKIRA ULAWA:Annual Incidence/1000
600 600
500 Cases/1000/Year 500

Cases/1000/Year
400 400
300 300
200 200
100 100
0 0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
P.falciparum P.vivax Total P.falciparum P.vivax Total
Fig 3c MALAITA: Annual Incidence/1000
600
500
Cases/1000/Year
400
300
200
100
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Malaita Province is where the majority of AusAID support has been given through
the SPC Regional Vector-Borne Disease Project. Despite the large influx of people back to
the province during 1999 and 2000, incidence has been held relatively stable though an
increase was recorded since the beginning of the crisis in 1998.
23
2) Provinces with signs of increasing transmission
Fig 4a CENTRAL: Annual Incidence/1000
600
500
Cases/1000/Year
400
300
200
100
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Fig 4c TEMOTU: Annual Incidence/1000 Fig 4d WESTERN: Annual Incidence/1000

600 600
500 500
Cases/1000/Year
Cases/1000/Year
400 400
300 300
200 200
100 100
0 0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
P.falciparum P.vivax Total P.falciparum P.vivax Total
Of these four provinces, Western and Central are the most worrying. In fact
Western province data from last year is only from the 10 months Jan - October; the last two
months of the year have still not yet been received. Western Province had an influx of
people from Honiara in the second half of 2000, but most of the problems in the province
appear to result from a breakdown in staff morale, management and planning in the
province.
Central Province has suffered disruption under the ethnic tension and has no means
of donor support planned in the near future.
Isabel has had a very successful programme in recent years, with a large community
participation and health communication component. It has not benefited from any direct
donor support to the province, but has a very active and competent supervisor who has run
the program for many years.
Temotu is similarly at risk for epidemics and in addition suffers from a high
proportion (~20%) of cases showing chloroquine resistance. As in Isabel, there is no past
history or immediate prospect of specific donor support to the province.
24
c) Provinces with insufficient information

Guadalcanal is the province which has shown the slowest progress in reducing incidence
in recent years, although gains have been nevertheless substantial. A first glance at the graph
Fig 5 GUADALCANAL: Annual Incidence/1000
600
500
Cases/1000/Year
400
300
200
100
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
above would suggest that incidence continued to decline in year 2000, but in fact several of
the clinics in the province were closed for more than half of the year and sent in no reports.
Therefore the incidence figure for 2000 is greatly underestimated.
REMEDIAL MEASURES IMPLEMENTED: - WHO with other donor partners

implemented several measures to curb the increase in the number of cases.
- Diagnostic services were restored in several clinics with the provision of rapid diagnostic test
kits;
- A new divisional office with adequate staff was set up to carry out control measures among the
internally displaced people.
o Staff were reassigned to the affected areas so that people of the same ethnic group
carried out the programme in their provinces;
o Indoor residual spaying of houses was carried out in accessible areas and over 50,000
people were protected by this measure along with the provision of insecticide treated
nets.
o Several workshops were organized for nursing staff to guide them on the management
of severe cases.
o Free nets were distributed to pregnant women and mothers with infants through the
international Red Cross.
o Efforts are being made to enhance the level of confidence amongst the community by
familiarizing visit by the staff;
o The community contribution for the nets were lowered to make it more affordable;
o The revolving fund for nets was judiciously used by the programme to overcome the
lack of operational funds;
o Epidemiological case monitoring officers were deployed in all the affected areas to keep
track of increases in the number of reported cases and severe cases;
o The surveillance programme in the capital is also being restored in a phased manner.
Some of these measures have contributed to the lowering of incidence rate in 1999 but the
increase in violence and large-scale movements of people disrupted control operations and led to the
increase in cases in 2000. A special programme for the restoration of all activities will be launched
25
shortly and would depend on the commitments by various partners. The economic crisis faced by the
Govt. and lack of law and order is the only impediment for future success.
3.2.2. BRIEF REPORT OF MALARIA IN SOLOMON ISLANDS (2000) AND THE

IMPACT OF THE ETHNIC CRISIS:
THE CRISIS:- The two-year ethnic conflict between two indigenous island groups in
Solomon Islands has caused serious economic, social and political disruptions in the
country. The ethnic conflict erupted in 1998. In subsequent months armed militants from
Guadalcanal province drove out over 35,000 people, mostly from the island of Malaita,
from their settlements on Guadalcanal and around the capital Honiara. The conflict
resulted in loss of over one hundred lives. The retaliation by the Malaitan militants began on
5J une2 00 0whe nt heyc arri
edou tac ivi
l coupd’ eta ta ndt hePrime Minister was forced out
of office. Frequent clashes between the two groups continued and several villages on
Guadalcanal were destroyed. The new government brought the rival factions to the
negotiating table and it culminated in the signing of the Townsville Peace Agreement on 15
October 2000. The transition to restoration of normalcy continues to be plagued by various
factors. The economic impact of the current crisis is devastating and the annual revenue for
the country has decreased from USD 79 million to 38 million this year (2001). All major
health programmes are affected all over the country.
26
IMPACT ON MALARIA CONTROL:- There has been a steady reduction in

cases of malaria since 1992 and a workable and sustainable program for malaria control was
established (fig 1). An intensified malaria control program in the capital Honiara launched
by WHO in 1995 has reduced the incidence by 82%. Deaths due to malaria have also
Fig. 1 Solomon Islands: Annual Incidence/1000
500
400
Cases/1000/Year
300
200
100
0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

declined by 50% percent since 1995, a new strategic of malaria prevention and control was
introduced in Solomon Islands. Impregnated mosquito nets were introduced combined with
focal spraying, strengthened diagnostic services (microscopists), larval control and health
communication.
The success of this new strategy is indicated in Figure 1, which shows the general
decline in annual incidence per 1000 population during the years 1992 to 1999. The decline
began to plateau out in recent years, and a definite upturn in the curve can be seen in year
2000. This is mostly contributed by an increase in Plasmodium falciparum starting in 1998.
This may be partly due to an increase in chloroquine resistance in this species. Plasmodium
vivax malaria is the relapsing form, and new cases can thus occur in the absence of active
transmission. For this reason, P.vivax often becomes the predominant species of malaria at
low levels of transmission, but this has not happened in Solomon Islands except in Isabel
province.
Despite all these successes the program has suffered a major set back in 1999-2001.
Diagnostic facilities have temporarily closed in several parts of Honiara and Guadalcanal.
Low staff morale, lack of funds and delay in the implementation of control measures are the
main factors hampering the program. Malaria mortality has also increased in these affected
provinces. Preliminary data from the Paediatric ward of the national referral hospital in
Honiara clearly shows an increase in the percentage of malaria admissions from 10.7% in
1998, 15.7% in 1999 and 22.5% in 2000. All the transport vehicles and canoes were stolen in
this crisis. Communities in several villages were frightened to cooperate with the malaria
27
staff in retreatment of nets. Stable malaria endemicity is maintained over a wide range of
transmission intensities in Solomon Islands. The Internally displaced people with higher
parasitimia (> 20% prevalence rate) were displaced to regions with moderate transmission
intensities (prevalence rate <8%). This has resulted in increase in the number of cerebral
malaria cases within the population.
3.3. Stop Tuberculosis

Solomon Islands Context:
The National TB program has been successful in introducing the DOTS. To date
there is 100% coverage. The DOTS strategy has significantly contribution to the increase to
the cure rate. However, there are local issues such as transport that hinders the community
part of the sputum collections. The proposed strategy to the above problem is to use the
existing malaria microscopists at DOTS centers, to be able to read sputum for AFB.
There was a drop in the cure rate to 78.4% compared to 83.3. %. Nonetheless, there
is a strong believe that this is an underestimated because all patients are yet to be checked.
Theses problem was caused by the ethnic tension when many patients were migrating from
one place to another. Some have not settled permanently since their movement.
 TB and leprosy control programs are long established in the country. In 1990 the
program was boosted by JICA completing the traditional donors such as WHO and
Pacific Leprosy Foundation New Zealand.
 . In 1999, the Cure rate for the National Tuberculosis Control Program has also
increased from 30% in 1996 to 83.3% in 1998. However, cure rate is just below 85%
mark by WHO. The treatment successive rate is 92.0%. Nonetheless, individual
provinces like Western (87.5), RBP (100), Temotu (100), Makira (100), Choiseul (94.7),
and Isabel Provinces (92.3) have cure rates more than 85% (higher than WHO mark).
The provinces needing further improvement are Guadalcanal (72.7), Malaita (79.3)
Honiara City Council( 50), and CIP (83.3). The above results are unweighted against the
number of case holdings.
 There has been a significant decline over the past 13 years (1986-1999) irrespective the
fluctuation in between the period, from 102.1 new cases detection rate (NCDR) per
100,000 pop down to 64.2/ 100,000 pop. (I.e. 225 new cases detected end of 1999). Of
the total new cases 72% are PTB and 28% others.
 Relapse of cases of TB amongst children is less frequently notified nowadays. Due to

high treatment successive rate and BCG coverage.
28
 It is apparent that the BCG coverage is underestimated in the Health Information

System. According to the Disease Prevention and Control Center (DPCC?MOH) the
accurate estimate would be more than 80%.
 It is puzzling to variation to conversation rates between hospitals. Sasamuga, HGH,

Kirakira, Buala and Atoifi Hospital have 100% completion rate end of 2 months
inpatient. Whilst, Lata, NRH, Kiluufi Hospitals have less than 80% end of 2 months, but
100% end of three months (a month extra of treatment).
Policy Status:
4.8.0. Policy on Tuberculosis:
4.8.1. Policy Goal:
 To reduce New TB Case Notification Rate 19986 - 2000
transmission, 180
morbidity and
mortality due to 160
Tuberculosis 140
4.8.2. Objectives: 120
 To improve
NCDR 1 per 100,000
100
cure rate
 To reduce 80
mortality rate 60
4.8.3. Indicators: 40
 Cure Rate 20
 Mortality Rate 0
 Treatment
86 87 88 89 90 91 92 93 94 95 96 97 98
All Cases 102.1 115.1 121.6 154.1 116.5 91 107.2 103.5 69.9 94.4 79.7 77.1 63.6
Completion Smear ( +) 35.3 39.8 44.8 46.6 36.8 26.7 38.8 43.8 31.1 29.5 28.4 25.6 39.9
Rate
4.8.4. Strategies:
 Improve case holding and treatment
 Improve contact tracing
 Implementation and extension of short course chemotherapy (SCC)
 Implementation of Direct Observation Therapy Strategy (DOTS)
 Health education and promotion-community awareness
4.8.5. Action Steps:
 Intensified disease surveillance-intensified contact tracing in hospitals and rural facilities by health
workers whilst index case still on treatment.
 Use of chronic cough registry TargetsForDOTSImplementation
To ensure that 100%of detected newsmear positive cases
 The standardization of the treatment regimes, areenrolledunderDOTS;
SCC in the country. To ensure a treatment successive rate of at least 85%for
smear-positivepulmonarycasesinDOTS;
Todetect70%ofestimatednewsmear– positivecases.
(PacificStrategicPlantoStopTB2,000)WHO)
29
 Modification of TB forms for disease notification

 Computerization of TB registry at the center and province/ entry of all data for monitoring and
evaluation purposes in the central data bank/ standardize evaluation epidemiological and operational
indicators for reporting and planing.
 Conduct refresher courses, workshops, conferences for TB & Leprosy coordinators
 Skilled training for staff in program management for middle level managers, program administration for
national TB & Leprosy managers, laboratory staff TB specialists, and communication skills for IEC
officers
 Training for officers in new TB protocol
 Annual supervisory visits to provincial TB coordinators
 Capacity building of TB & Leprosy staff
 Automation of TB/ Leprosy unit at the center
 Continue public health education through media and community talks
4.8.6. Implementing Division/ Department:
Division: TB/ Leprosy Unit of DCC/ MHMS
 Responsible Officer: National TB/Leprosy coordinator, MHMS in collaboration with Provincial
Health Directors and Provincial TB coordinators
-----------------------------------------------------------------------------------------------------------------------------------------
Leprosy:
Solomon Islands is embarking on the Special Action Program to Eliminate Leprosy

(SAPEL) recommended by the WHO and funded by Pacific Leprosy Foundation (PLF),
Ne wZe aland. The reisa nticipationtha tthet rendf orpol
io( ‘pol io-free) could also be
achieved in leprosy (leprosy-free) in the near future.
It is now six years since Solomon Islands maintain its status within the WHO target
of prevalence rate <1 case/ 10,000. In 2000 the prevalence rate for SI is 0.2 cases/ 10,000. It
was 0.17/ 10,000 in 1999. The screening process is confined to high prevalence areas to
detect new cases, and have them treated immediately.
4.9.0. Policy on Leprosy:

4.9.1. Policy Goal:
 To eradicate Leprosy in the country
4.9.2. Objectives:
 To reduce the prevalence rate of leprosy from 0.6/10,000 pop in 1998 to less than 0.3/10,000 pop by
2003.
4.9.3. Indicators:
 Prevalence Rate of Leprosy
4.9.4. Strategies:
 To strengthen and improve case finding, contact tracing and case holding
 Improve current recording and reporting system
 Staff training by workshops on management and treatment of leprosy
30
 Community awareness campaigns

 Division: TB/ Leprosy Unit of DCC/ MHMS
 Responsible Officer: National TB/Leprosy coordinator, MHMS in collaboration with Provincial
Health Directors and Provincial TB coordinators
Graph Showing New Case Notification for Leprosy 2000
Leprosy Cases for Year 2000 ( 28/12/00)
30
25
20
Number
15
10
0
86 87 88 89 90 91 92 93 94 95 96 97 98 99 0
New Leprosy Cases 16 18 17 14 19 20 16 8 10 9 24 21 14 12 6
Table ( ) Provincial Leprosy CaseLoads and prevalence:

Province Patients on Registry Status P/R 10,000
By end of Year 2000 Pop
Gaudalcanal 3 Active 0.4
Malaita 1 Active 0.1
Temotu 1 Active 0.4
HTC 3 Active 0.6
CHP 0 0 0
Rennell and Bellona 0 0 0
Central Islands Province 0 0 0
Isabel 0 0 0
Western 0 0 0
Makira/Ulawa 0 0 0
Total 8 Active 0.2
31
Graph ( ) Leprosy Prevalence 1997-2000
Leprosy Prevalence from 1987 - 2000
12
10
8
PR 1 per 10,000 pop
0
87 88 89 90 91 92 93 94 95 96 97 98 99 0
Leprosy Prevalence 9 10 9 4 3 3 2 1.1 0.63 0.67 0.99 0.45 0.17 0.2
3.4. STI/ HIV/AIDS:

Despite recording one HIV case in Solomon Islands, the risk and potential for the
problem to flare exists because of the socio-cultural behavior of the higher school age and
teenage population, which was evident in a local study. The highest recorded cases of STI
were in 1996-1998.
32
3.4.1. STI/HIV/AIDS Program:
 A Situational Analysis was completed in 19995. This analysis will form the basis of a
STI/HIV/AIDS Strategic Plan to expand responses for prevention of STI and HIV
transmission in a multi-sect oral manner.
Some of the issues revealed were related to lack of knowledge HIV transmission and
related safety issues, counseling skills and training, within the majority of health workers. STI
was indicated as major causes of morbidity for adults and young people and increasing in
urban and rural urbanizing centers. Poor documentation in the Health System was
highlighted. Barriers to the use of STI services in the health system were related to the
stigma associated and the symptomatic nature of the illnesses and attitude of health staff.
Determinants and remedies for HIV epidemic are present, such as high rate of STI,
migration and lack of condom use etc. Behavioral determinants are also present, which is
related to sexual behaviors in relation to homosexuality, heterosexuality in relation
extramaritual and premarital sex and commercial sex worker. There are also demographic,
economic and social determinants revealed as unemployment and opportunities link to
sexual risk taking behaviors.
 A Strategic Planning Core Committee (SPCC) was formed to coordinate and

implemented activities. 14 stakeholders involved from Govt., NGOs and community
based organizations.
 5 priority areas were identified as areas needing strengthening:

1. Reducing the vulnerability of specific groups and promoting safer sexual behaviors.
2. Preventing and control of sexually transmitted infection.
3. Blood supply
4. Promoting multi-sectoral responses
5. Care and support for people infected and effected by HIV/AIDS.
From January to June 2000, the fourth phase of the Strategic Plan Formulation Process took
off. It involved a consultation process driven by SPC and involving key stakeholders such as
Government Miunistries, NGOs and Churches. The fifith pahse is the documentation of the
First National Multi-sectoral Strategic Plan to prevent transmission of HIV Infection and
consequently reduce the socio-economic burden of the potential impact of the infection on
the country.
The key strategies related to; [1] reducting the vulnerability of specific groups amd
promoting safe sexual behaviors in ceratin taget groups such as the sex wokers, married men
and women; seafarers; youth; health workers; and TBA. [2] prevention and control of STI in
certain target groups.
5
H.R.Buchanan, K.Konare, A. Namokari (1999). A Situational Analysis of STI and HIV in Solomon
I
slands:“
Ch anceCh anceNa oI a”
.MOH, November.
33
3.4.2. Current Status of HIV/ AIDS:-
 Only one (1) case was reported in 1994 (but a foreigner from PNG).
 There have been steady increases between 1992 and 1998. The most prevalent
syndromes are discharges and genital ulcers with PID and infertility amongst young girls.
 Penile & vaginal discharges -1992 (398) 1995(1182), 1997(1801) 1998(2134).
 Genital Ulcers- 1992(44) 1995(282), 1997(396), 1998(381). Source: HIS
(underestimation).
 Penicillin Gonorrhea resistant has declined dramatically. 1989(54),1992(41), 1996(32),

1998(15).
 A contributing factor to the decline is the new treatment protocol with syndrome
approach. Standard blister packs (or STD packs) readily available in all clinics. After
introduction of the syndrome treatment, there was 50% reduction of gonorrhea
penicillin resistance. Nonetheless, compliance & KAP of nurses still poor. STI case
management is still poor.
 Condoms restricted only to family planning. Shortage of condom supply scared nurse to
give them away. Inadequate stock at provincial clinics. Counseling skills very deficient
among nurses.
HIV Testing:
 Since 1990-1998 (a period of 9 years) total of 14,055 HIV testing was done (i.e. 1,562
tests per year.
90 91 92 93 94 95 96 97 98
HIV + 0 0 0 0 1 0 0 0 0
No.Tests 762 1,904 1,674 1,748 1,764 1,574 1,639 1,583 1,407
 Testing policy: only suspected cases including cases with STI, relapses of TB, blood
donors, and clinically suspected cases by physician. Blood donors main group for HIV
screening.
 While rural hospitals have been equipped to screened blood prior to transfusion
protocols are not always followed at Gizo, Makira and Lata.
Policy Status:
4.10.Policy on Sexually Transmitted Disease:
4.10.1. Policy Goal:
 To reduce the incidence rate of STD, and prevent HIV/ AIDS infection in the country.
4.10.2. Objectives:
 To reduce the morbidity rate of STD from 1,464 cases in 1995 by 50% by 2003.
To prevent HIV/ AIDS infection.
34
4.10.3. Indicators:
 Morbidity Rate
 HIV infection Rate
4.10.4. Strategies:
 Improve data collection system
 Implement the standard diagnosis and treatment guideline nation wide
 Improve surveillance and screening for STDs/HIV
 Intensify public information and education on STDs/HIV/Aids
4.10.5. Action steps:
 Review of Treatment Guiidelines for STD
 Development of National Policy on HIV/AIDs
 Division: Disease Control Center, MHMS
Responsible Officer: National STD/HIV Coordinator
---------------------------------------------------------------------------------------------------------
3.5. Vaccine preventable diseases:
3.5.1. National Disease Surveillance:
Guadalcanal recorded 29 cases of whooping cough in 1998 and 4 cases in the

previous year by nurses at the rural clinics. Malaita also reported one each cases of neonatal
tetanus and tetanus respectively. However, all these two cases were not clinically confirmed.
Thus, there was doubt in the accuracy of the reporting. In 2000, total number of 28 cases of
whooping cough was recorded under the HIS. Majority of 23 cases were from Makira, two
cases from Malaita and one each from Guadalcanal, Western Province and Isabel Provinces.
Theses cases were not confirmed by medical officers.
Graph (1) showing incidence of vaccine preventable Illnesses in SI 1997-99
Graph showing incidence of vaccine preventable

diseases in SI, 1997-99
0.07 Source: HIS, MOH

0.06
0.05
Neonatal tetanus
Incidence rates
0.04 Tetanus
Whooping cough
0.03 Suspected Polio
Measles
0.02
0.01
0
1997 1998 1999
35
Graph (2) showing incidence of vaccine preventable illnesses by provinces in 1997-99:
Graph showing incidence of vaccine-preventable diseases by

provinces
0.4
0.35
0.3
Incidence rates
Neonatal tetanus
0.25
Tetanus
0.2 Whooping cough
Suspected Polio
0.15
Measles
0.1
0.05
0
1997
1998
1999
1997
1998
1999
1997
1998
1999
1997
1998
1999
1997
1998
1999
1997
1998
1999
1997
1998
1999
1997
1998
1999
1997
1998
1999
1997
1998
1999
ChoiseulWestern CIP Isabel
Guadalcanal
Malaita Makira TemotuHoniaraRenBell
5.2.8.2. Immunization Coverage:
Immunization coverage has remained high but decreasing over the last six years. It is believed that this could
be due to the over estimation of the
% Immunization Coverage Rate (Cases)
population. This has been verified through
1995 1996 1997 1998 1999 2000 an Immunization Coverage Survey
in Malaita (%)
BCG 77 73 73 72 64 49.5
Hep B3 71 72 73 71 62 51.5 1999
DPT3 69 77 72 69 61 57.9 BCG 99.1
Polio3 68 72 70 69 60 57.9 Hep B3 99.1
Measles 68 67 68 64 59 54.7 DPT3 86.7
TT2 71 63 54 55 50 - Polio3 84.6
Measles 58.8
immunization coverage survey in Malaita province in 1999. The overall
immunization coverage has remained over 80% compared to the reported
coverage. However, 2000 was a difficult time in maintaining the health services because of the tension.
5.2.8.3. Immunization drop Outs:

36
The drop out rates of coverage has indicated two issues, viz, firstly, the compliance
from mothers, and secondly, consistency and effectivity of the health programs to sustain
and maintain services. Ideally, the level of coverage of first doses should be around the same
to the third dose. However, according to the HIS data, there is practical implication that first
BCG doses may not be recorded (this is proven by EPI veirification Studies in Gizo 2000),
or otherwise. The discrepancy of the recording of EPI data needs to be reviewed and
strengthened.
1997 1998 1999 2000

BCG-Measles 2.75 7.69 0.9 -10.5
DPT1-DPT3 3.23 3.21 3.72 8.7
HepB1-HepB3 -1.4 -12 -7.16 -9.3
Polio1-Polio3 2.12 2.2 3.73 7.7
2.6. The Healthy Islands, Health City, Initiatives:
2.6.1. General view:
The Healthy Islands, Health City Initiatives is a new approach to ensure multiple
stakeholders involvement in health developments to prevent illnesses and protect health in
the world. The settings represent social systems, which are deeply binding, involve frequent
and sustained interactions, and are characterized by multiple forms of membership and
communication. Settings, as a context for relationships, may also exert direct and indirect
effects on health, and acting on community-level influences may need to parallel
interventions with individuals.
Recognizing that Healthy Islands/Cities initiatives is using the settings approach to promote
and advocate for supportive environment for health, Solomon Islands became a party to the
“Ya nu c
aIs
landDe cl
ar
ati
on”in 1995. This was reaffirmed in “ TheRa ratongaAg r
eement”in 1997.
In adopting this approach, Solomon Islands use the Malaria Control Program as the entry
point.
Solomon Islands joined other Pacific Island Countries in endorsing the Palau Action
Statement in March 1999, Korror, Republic of Palau. The Palau Action Statement calls for
countries to set short-term targets and to increase efforts to involve private sector, especially
in the areas of healthy work place, including tobacco and alcohol consumption. It also calls
on Countries, in collaboration with the World Health Organization (WHO) to address the
issue of alcohol abuse and tobacco consumption.
Other activities following the Palau Meeting:
Following the Palau meeting in March 1999, the following short-term targets were adopted
by the Ministry of Health:
37
 Establishment of the Honiara Healthy City Co-ordination Committee (HHCCC)

 Establishment of the Honiara Youth Taskforce
 Honiara Tree Planting
 Legislation to Control Tobacco promotion, sale, and consumption
Establishment of the Honiara Healthy City Co-ordination Committee (HHCCC):
In June 1999, the HHCCC was established with members drawn from the Ministry of
Health, Honiara City Council, Business, Media, Education and Police sectors. Series of
meetings were held to coordinate activities in Honiara that related to healthy environment.
This includes issues like waste management, tree planting, malaria control and general
cleanliness.
Establishment of the Honiara Youth Taskforce:
Youth issues such as alcohol abuse has been on the rise, especially in Honiara and other
urban centers. A youth taskforce was established in May 2000. The taskforce is comprises of
repres
e nt
ative sofa l
lyou thg roupsinHoni ar a
,inc l
u di
ngthec hu r
che sandNGO’ s.
The 1999 census indicated that almost 42 percent of the population were under 15 years and
the majority of the population was under 25 years. Yet this large population had been
consistently ignored. The National Youth Policy (NYP) defines youth as those between the
age sof1 4a nd2 9y earsold.Li k
et heWome n’sPolicy,the NYP cuts across various sectors.
Two major objectives of the NYP to ensure gender equity and equality for all young people
in the access to education and training, and the promotion of health programs with special
focus on unwanted pregnancies, STD/HIV/AIDS and other youth social problems. The
NYP also aims to promote population education, including family life education, through
the formal education curricula.
Given the high growth rate of the population, high rate of school drop out and/or push
outs, and slower pace in new job creation, youth in Solomon Islands are particularly
disadvantaged in getting employment in the formal sector. In all respects the ethnic tensions
have worsened the situation of youths. Most of the youngsters in the displaced families are
not only disadvantaged from pursuing further education or securing job in the formal sector,
but are now vulnerable to the various kinds of dangerous life styles.
As the social unrest intensified by mid 2000, it became difficult to organize or convene any
meeting as most the youth are either join the militants or left Honiara.
Honiara Tree Planting:
Honiara Tree Planting has been organized by Chamber of Commerce and assisted by the
Honi araCi tyCou nci
l,You t
hGr ou psa ndot he rNGO’ s.ByMa y2000, several trees were
planted along the Honiara main road and was launched by the Governor General.
Young people volunteered to look after the trees and several business houses offered to
support the tree panting at various points along the main street. Due to the ethnic unrest,
38
this activity was halted and although resumed by November 2000, it is difficult to continue
because of lack of interest and destruction of the plants and inability to maintain law and
order in the City.
Legislation to control tobacco promotion, sale and consumption:
A draft Tobacco Product Control Bill approved by Cabinet in September 1999. This was
revised following a review, which identified certain gaps and deficiencies. The re-drafted bill
was sent to the Attorney General Chambers to be reviewed by the Legal Draftsman. Since
the social crisis intensified, the priority for government bill changes and hence the delay in
completing the final draft before it can be tabled in the parliament.
It is anticipated that following the passage of the bill, tobacco control activities will gain
momentum especially in the areas of promotion, sales and consumption.
3.6.2. Health and Environment

3.6.2.1. General protection of the environment
The Solomon Islands Government recognizes the importance of our environment to

the health, welfare and economic development of this country. The Cabinet has endorsed in
1991 the National Environmental Management Strategy, which is implemented by the
Environment and Conservation Division of the Ministry of Forestry, Conservation and
Environment.
The strategy itself is a step forward to ensuring sustainable economic development

and environmental management for the Solomon Islands.
The Environment and Conservation and Environmental Health Divisions

collaborate in ensuring environmental impact assessments are conducted to assess impacts
on development using local staff or overseas consultants.
3.6.2.2. Air (pollution)
The Environment and Conservation and Environmental Health Divisions have

realized that there are potential effects air pollution can cause to the environment. At this
stage the country does not have the means to undertake air quality monitoring.
3.6.2.3. Water quality
The Water Resources Management Division of the Ministry of Forestry, Mines and
Minerals is responsible for the monitoring of water resources in the country. The Division
has trained personnel and the Government has made equipment available with assistance
from overseas donors.
39
The facilities for quality control for both bacteriological and chemical analysis is
inadequate, this is particularly true for chemical analysis. The country is adopting the safe
standards for drinking water recommended by WHO.
3.6.2.4. Solid waste disposal
Solid waste disposal is becoming a problem in urban places like Honiara particularly
for toxic wastes such as hospital and industrial wastes. There is a need for a new dumpsite to
be identified for Honiara as soon as possible and need for improvement in the management
techniques of the dumpsite.
Water supply and sanitation Indicators
1. Percentage of the population with safe drinking water available in the home, or with
reasonable access:
By 1999, 70% of people have access to safe water as compared to 64% in 1996
(estimate from RWSS, MHMS).
2. Percentage of the population with adequate excreta disposal facilities available:
By 1999, it is estimated that 25% of the population have access to proper sanitation
as compared to 9% in 1996 (estimate from RWSS, MHMS)6
3.6.2.5. Food safety
Food safety has been strengthened through the enactment of the Pure Food Act and
the Consumer Protection Act by Parliament to be implemented by the Environmental Health
Division of the Ministry of Health and Medical Services and the Consumer Affairs Divisions of
the Ministry of Commerce Employment and Trade. The Pure Food Act, which aimed at
fostering food safety, is a platform to incorporate multi-sectoral integration involving wider
scope of stakeholders to strengthen the national food safety programs.
The Environmental Health Division has participated in the Codex Alimentarius

Commission through the South Pacific Commission. It is also important for economic
productivity to promote and establish international standards with respect to food safety. All
inspectors of the two ministries have been trained to perform food inspection.
The Public Health Laboratory with the MHMS has limited scope in the food analysis
due to lack of adequate facilities and qualified staff. As stipulated under the National Health
Policies and Development Plans 1999-2003, the strengthening of the Public Health Laboratory
6
Ministry of Health (2001). Report from Environmental Health and Rural Water Supply and Sanitation
Program, Unpublished Paper.
40
is key component to monitor and reduce prevalence of food borne illnesses and their impact on
the communities, coupled with awareness campaigns.
The HTC Health Inspectors have been trained in the HACCP and have been running a
program for selected food establishments in Honiara since 1995.
The HTC has had an educational program for the mothers in town in the hygienic
preparation of food for sale to public. This program has often been disrupted by lack of
financial support.
There has never been a major outbreak of food borne disease recorded in the country
and the situation is considered at present relatively safe.
Policy Status:
5.1. Policy Goal:

 To further strengthen Environmental Health Services in particular promotion of clean water, proper
wastes disposal (sanitation), food hygiene, inspections and quarantine, and occupational heath and safety
at work and at home.
5.2.Objectives:
 To increase environmental public health activities in food hygiene, inspections and quarantine, and
occupational health and safety at work in the next five years.
5.3. Indicators:
 No. of EHD Activities
 No. Water supply & Sanitation projects constructed
 Water Supply coverage
 Sanitation coverage
 No. of Public Health Activities implemented
5.4. Strategies:
 Review of existing legislation and regulations.
 Establishment of a Public Health Laboratory.
 Establishment of refuses dumping sites and incinerators.
 Inspection of food processing outlets, places of work, settlements and villages.
 Establishment of quarantine and vector control units.
5.5. Action Steps:
 Legislative review: Review Environment Health Act 1987. Repeal of 1987 Act to re-install 1970 Act
with modifications: To allow expansion of the role of the division and govt.
 Food hygiene and Safe water
 Safe drinking water and proper sanitation facilities are basic necessities to better health. Commitment is
made to further strengthen and expand the activities of the Rural Water Supply and Sanitation Program
to achieve national coverage by year 2000. The sanitation component will be given grater emphasis to
increase the level of coverage by the same target year.
 National Rural Water Supply and Sanitation Program
41
 Community awareness and training in maintenance of systems.

 Health promotion and personal hygiene on and sanitation.
 Implement the construction of systems as in the 1997 - 2001 project.
 Food safety and Hygiene:
 Op e
ra t
ion aliset hep rovisi
on sof t
h e“ Pu reFo odAc t1
996”.
 Training and awareness on the requirements of the Pure Food Act 1996.
 Establish effective collaboration with other sectors
5.6. Implementing Division/ Department:
Division: Environmental Health Division/ Rural Water Supply and Sanitation
Responsible Officer: Director EHD/RWSS in collaboration with Provincial Health Directors.
3.62.6. Housing
The housing situation in the rural Solomon Islands is that every family has a house built of local
materials, which is adequate in construction. Some well to do Solomon Islanders living in rural
villages have built themselves buildings of permanent structure.
In urban places such as Honiara and other centers the employers provide houses for the
workers both with the public and private sectors. There are people who are unfortunate not to
have a house whereby they have to find a home with a friend or shift to the outskirts of the
township to settle in the slums. This is increasing in Honiara. Some persons have access to
loans from financial institutions to build their houses; this does not apply to most people in the
rural villages since they are not on regular earnings.
3.6.2.7. Work place
Those who are on regular employment both in the public and private sectors are protected
under the Labor Act, which provides the conditions of service regarding wages, and housing
and other benefits to which a worker is entitled. This is being implemented by the Labor
Division.
The Safety at Work Act protects workers who are likely to be subjected to risks of occupational
health and is being implemented by the Labor Division of the MCET. The Workers
Compensation Act is currently under revision, particularly with regard to the medical conditions
covered under the Act.
For environmental issues such as air, radiation and chemicals the country does not have the
necessary equipment and expertise to deal with these and to a large extent depends on overseas
consultants should the need for such risk assessment arises.
----------------------------------------------------------------------------------------------------------------
3.7. Infant and Young Child Nutrition:

42
Policy Status:
The National Nutrition Survey of 1989/90 revealed that malnutrition is a problem of children and women,
with 23% of children being underweight, 7% women underweight and 39% overweight (obese). Vitamin A
deficiency is evident to be increasing and related to Malnutrition in children.
4.5.2. Policy Goal:

 To further strengthen the National Nutritional Program, and increase collaboration with other public
and private sectors, church and Non-Government Organizations.
4.5.3. Objectives:
 To reduce the proportion of children under weight from 23% in 1989/90 to less than 10% by 2003.
 To reduce the proportion of women underweight from 7% underweight to less than 5% by 2003.
 To reduce the proportion of women overweight from 39% in 1989/90 to less than 10% by 2003.
4.5.4. Indicators:
 Proportion of children reported under weight %
 Proportion of women reported underweight %
 Proportion of women reported overweight %
4.5.5. Strategies:
 Strengthening and improvement of primary health care activities at community level;
-community awareness especially among, women, mothers and children
Re-enforcement of prevention of diseases and disability in infants and young children by:
- Provision and increase access to safe water and adequate sanitation.
 Provide appropriate weaning and nutrition practices and adequate diet
 To promote healthy lifestyles programs such as healthy diets, smoking-free environment and exercise
 Endorsement of the National Food and Nutrition Policy 1992 by the cabinet in 1994
 Continue to implement Baby-Friendly Hospital Initiative
 Development of guidelines for nutritional Surveillance in 1991
 Development of Plan of Action for Food and Nutrition
 Development of National Breast-Feeding Policy in 1995
 Establish Growth Monitoring System
 Establish and extend Family Health Card to provinces
 Division: Nutrition Unit of Reproductive Health Division, MHMS,HQ, and Provincial Health
Services
 Responsible Officers: Nutritionists and Provincial Health Directors.
3.8. Reproductive Health and Family Planning

TheMi nistry’
spol ic
yon r eprodu c t
iv
ea nd f a
mi l
ypl anningi
sto pr
omot ea nd
maintain the development of a health family, reduce, maternal and peri-natal, and infant
mortality, and raise the standard of living for mothers and children.
43
The key performance areas of the division responsible is to ensure that every mother
has the best opportunities for appropriate timing and spacing of pregnancies, safe delivery of
a healthy infant in an environment conducive to health with adequate antenatal care,
sufficient nutrition and preparation of breast feeding her child.
3.8.1. Maternal Mortality:
There is marked improvement in reduction of the maternal mortality rate from 549/
100,000 live births to an estimate of 154/ 100,000 in 1999. It took about 13 years to reduce
the level in 1986 by more than half. The policy standard in the National Health Policies and
Development Plans 199-2003 is to reduce the maternal mortality rate by 50% at the end of
the five year planned period. Most causes of maternal mortality are preventable.
Table (1) showing Maternal Mortality Rate/ 100,000 births

1986[i.] 1997[ii.] 1998[iii.] 1999[iv.]
549 209 203 154
Sources: [i.] 1986 census, [ii.] Reproductive Health Division/MOH 1997, [iv.]based on HIS/MOH
Graph showing maternal deaths 1997-1999 by provinces

Guadalcanal recorded the
highest number of maternal
8 deaths with 7 in 1998.
7 7 Choiseul
Western had 4 in that same
6
Western year. There may be
No. of maternal deaths
5
Isabel
Central Islands
underreporting of cases.
Guadalcanal
4 4 4 4
According to the local
Malaita
statistics maternal deaths

3 3 3 Makira Ulawa
Temotu
2 2 2
RenBell made up 1.58% of the total
1 1 1 Honiara
deaths recorded in the
0 0 communities in 1997,
1997 1998 1999
Years
1.86% and 1.18% in 1998
and 1999 respectively (see
table below). Despite the
lower percent, it is very stressful when mothers die, leaving behind many children to care for
by the husband and relatives.
3.8.2. Strengthening nursing and midwifery:
The Ministry of Health, Solomon Islands has acted on the issue of nursing and
midwifery very actively through the Solomon Islands Health Sector Development Project
(SIHSDP). The SIHSDP funds the midwifery-t rainingprogr am,throu gha‘ sof
t’Loanf r
om
the World Bank.
The objective of this project is to assist the Government (Ministry of Health) to

improve the health service of Solomon Islands people through better maternal care and
family planning and more effective prevention and control of malaria and improving the
44
capacity of MOH to plan and manage provincial health programs and mobilize community
awareness and participation.
The objective of the maternal component of the project is to decrease the maternal
complications and deaths during pregnancy and at birth. Training of more nurses in quality
maternal care is an integral strategy to achieve the objectives. This pilot project is a lead up
to the construction of a Midwifery School at the National Referral Hospital, Honiara, which
is planned to start second half of this year. The school will enable the Ministry of Health to
train more nurses into the specialist area of midwifery. The plan is to train about 10-15
nurses from National Referral Hospital and the provinces in midwifery each year.
The Need for Midwifery Training:

The Ministry of Health has reasonable working estimates of the current and future
need for the midwives and obstetrics doctors with obstetrics competence. A practical and
coherent plan is in placed to meet this need through training. This midwifery training is very
focused and objective driven with sound academic background. This pilot initiative will
further strengthen and enhance midwifery training in country. However, there will be
difficulties and external factors that would threaten and weaken the program. Therefore risk
management plans and strategies will be developed as the program continues.
According to the calculations based on the 1997 population figures, the Ministry will
require to train 93 nurses in midwifery that means an intake of 19-20 per annum. This is to
meet the quantification needs of 1 midwife per 500 births plus 1 midwife per 3000 women
of reproductive age (Which was about 96,000 15-49 WBA in 1997) plus extra 27 midwives in
management and supervisory duties, minus the attrition rate of 10% per annum. This is how
the figure of 93 comes about. However, the Midwifery School can only take 10-15 midwives.
But the estimated graduating classes will be between 10-12 per annum. Therefore by end of
20 05 ,whi chi sthepr oject
’sl i
fes pan,wehopet oa chieve6 9mi dwi ves,whi c
hisabou t7 4%
of our requirements. It therefore implies that we should find ways to reduce the attrition
rate, increase number of intakes or continues to train additional 5 nurses in PNG. The above
calculations will be review in view of the 1999 population census.
Maternal Health Status:

The Government is putting more emphasis in improving the health status of
mothers during pregnancy, at birth and after birth. In Solomon Islands this is a very critical
period for the live of the mother and the baby. In so far, our standings by world standards
are very low, although we have been showing significant improvement.
Our information system showed that the major causes of infant mortality are
complications of childbirth. However, there are major improvements during the past 2
decades, dropping from 70/1,000 per live births in 1976 to 28/1,000 live births, in 1999.
Infant mortality rate in Solomon Islands is acceptably below The Global Strategy for Health
for ALL by year 2000 guiding target of IMR 50 per 1,000 live births. Pneumonia, malaria,
diarrhea and meningitis are other causes of infant death.
Solomon Islands have relatively higher maternal deaths by international standards

and in the region. In 1999 it is estimated by the MOH that 154 women out of 100,000 births
die of pregnancy related causes. Again there is marked improvement in reduction of the
45
maternal mortality rate from 549/ 100,000 live births in 1986 to an estimate of 154/ 100,000
in 1999. It took about 13 years to reduce the level in 1986 by more than half. The policy
statement in the National Health Policies and Development Plans 199-2003 is to reduce the
maternal mortality rate by 50% at the end of the five year planned period. It is because most
causes of maternal mortality are preventable.
When we look at the resource needs and the demand for maternal care services,
there is a real challenge ahead of us. The challenge is to reduce the gap between demand for
maternal care services and supply of services. This is evident in the draft Health Status
Review Report 1997-1999 by the Ministry of Health, which revealed that hospital utilization
in maternal care services in the provinces have increased at different rates. That is the
number of admissions in maternal care/ 1,000 populations has increased. Similarly the trend
of the bed occupancy in maternal care also increased in the provinces between the periods
1997 to 1999. That means number of beds occupied at particular time is increasing. Maternal
care also has the highest bed occupancy rate in nearly all hospitals compared to other
services.
Progress of Preparation of the Pilot project on Midwifery training program:
Preparation work took about 12 months, since June 2000. The effect of the ethnic
tension has caused delay in the starting of the midwifery-training program. Project staff left.
One of our key midwifery tutors also left. However, It is because of the commitment and
hard work of the staff of the Project Implementation Coordination Unit, the Project
Coordinator and her staff, the midwifery tutor, and staff from the Reproductive Health
Division of the Ministry of Health that enable us to start the program.
3.8.3. Family Planning:
Family planning contraceptives is widely available in the rural clinics. However,

compliance from clients is observed to be declining. According to available statistics there is
marked drop in the contraceptive prevalence rate from 25% in 1986 to 18.67 in 1997. Table
below clearly shows that level of family planning coverage in population of women of
childbearing age is generally low. FP coverage declined in 1999 and remained the same in
2000, but coverage in many vary significantly. There is a decline in coverage in Choiseul,
Western, Isabel, and CIP, whilst Malaita, Temotu, RenBellona and Honiara showed an
increase. Guadalcanal showed zero coverage. This is related to under-reporting as well as a
direct impact of the ethnic tension on the province.
Table (2) Family Planning Coverage (%) total users at end of December/wcba x 100):
1997 1998 1999 2000
Solomon Islands 8.5 8.6 6.5 6.5
By Provinces: 1997 1998 1999 2000
Choiseul 6.9 5.0 7.8 4.5
Western 11.2 8.2 9.1 3.4
Isabel 7.9 13.2 11.4 5.7
Central Islands 6 15.7 17.9 15.1
7
1997 Estimate by Reproductive Health Division, MOH
46
Guadalcanal 7.1 5.8 5.4 00

Malaita 10.2 11.3 3.9 13.2
Makira Ulawa 7.9 6.9 6 6.1
Temotu 14.2 12.3 13.5 14.5
RenBell 3.3 5.3 2.5 2.7
Honiara 5.6 5.6 2.7 3.0
Source: HIS, clinic monthly reports
Graph (3) showing FP coverage by end of December 1997,1998, 1999 & 2000:
Graph Showing Family Planning

Coverage by end of December 1997-
2000
visit/expected births
% ist Antenatal
20
15
10 1997
5
0 1998
1999
Central
Solomon
Malaita
Temotu
Honiara
Western
2000
Table (3) % Supervised deliveries:
1995 1997 1998 1999

85 86** - -
Sources: **RHD/MOH, 1997
Table (4) Antenatal Coverage: First antenatal attendance (% first visit / expected births)
1997 1998 1999 2000

Solomon Islands 68.9 71.9 65.9 66.7
By Provinces: 1997 1998 1999 2000
Choiseul 59.4 61.7 65.2 56.1
Western 79.8 75.3 74.5 69.7
Isabel 54.6 60.4 68.8 63.2
Central Islands 55.1 73.6 68.9 70.7
Guadalcanal 66.0 72.4 52.1 34
Malaita 70.6 72.8 73.6 104.2
47
Makira Ulawa 54.6 71.7 56.2 70.4

Temotu 53.8 48.4 60.2 51.6
RenBell 46.5 38.5 31.1 56.4
Honiara 78.0 80.5 68.8 55.2
The year 2000 showed some minimal increase in the coverage but still below 1997 and 1998
figures. There was mixed findings by provinces. Malaita showed more than two fold increase
in first antenatal attendance as compared to the previous year 1999. Other provinces like
Makira, Rennell Bellona, CIP, and MUP also showed some increase from the previous year,
whilst Guadalcanal, Choiseul, Western, Isabel, Temotu and Honiara declined in 2000.
Graph (4) showing antenatal coverage (1st visit/ expected births 1997-2000:
Graph showing antenatl coverage (first visit)

1997-2000
% first visit/ expected births
120
100
1997
80
1998
60
1999
40
2000
20
0
ta
ll
ul
el
al
ds
ds
rn
Be
w
ot
se
ab
an
ai
te
an
an
la
m
al
en
es
i
Is
lc
U
ho
l
sl
Te
M
Is
da
R
W
lI
ira
C
on
ra
ua
ak
t
m
G
en
M
lo
C
So
Table (5) Total Fertility Rates 1986,1996,1998:
Years 1986 1996 1999 Total Fertality Rate declined from 6.1 in 1986
(Census) to 4.8 in 1999. Majority of six provinces
(Choiseul, Western, CIP, Malaia, Makira, and
Total 6.1 5.8 4.8 Temotu) have reached 100 births in 1,000
Fertility WCBA population mark during the period
Rate 1997-99. Isabel and Guadalcanal recorded levels
below 100/1,000 WCBA pop. However,
Source: UNFPA
Guadalcanal is also known to have higher level
of maternal mortality rate.
Table () FERTILITY RATES BY PROVINCES FROM 1997 TO 2000 (births/ 1000 popWCBA
Province Year Births Fertility rate
(births/1000pop
WCBA)
Choiseul 1997 449 97.3
1998 555 116.8
1999 509 104.0
48
2000 463 90
Western 1997 1,575 120.8
1998 1,591 118.5
1999 1,329 96.0
2000 1,376 90
Isabel 1997 417 93.14
1998 377 81.6
1999 308 64.5
2000 382 70
Central Islands 1997 397 89.3
1998 486 106.1
1999 584 124.0
2000 630 130
Guadalcanal 1997 773 47.3
1998 932 54.7
1999 1048 59.0
2000 838 40.0
Malaita 1997 2,600 115.7
1998 2,660 115.7
1999 2,917 123.9
2000 4,640 190
Makira Ulawa 1997 682 103.6
1998 839 123.1
1999 591 83.7
2000 778 100
Temotu 1997 438 107.7
1998 403 96.5
1999 480 111.7
2000 503 110
Honiara 1997 10 0.7
1998 6 0.4
1999 2 0.12
2000 6 0.3
Rennell Bellona 1997 19 39.5
1998 16 32.3
1999 10 19.6
2000 23 43.8
Solomon Islands 1997 7360 81.3
1998 7,865 83.7
1999 7,778 79.7
2000 9,017 88.8
*Total births / total pop of WCBA 15-44 x 1000

Source: Health Information System, Annual Health Reports 1997,1998,1999,2000, Statistics Unit,
MOH.
The number of total births in 1,000 Women of Child Bearing Age in Solomon Islands
generally increased from 79.7 in 1999 to 88.8 in 2000. Whilst there is a increasing trend in
the past year, accuracy of reporting and lack of accurate population census may distort the
picture. All provinces except Choiseul and Western showed an upward trend.
In evaluating the national and provincial reproductive health services and program the
following approach could be used:
49
Program Inputs Commitment of the Government Social Development

Institutional Capacity Institutional Capacity Program efficiency
Program Outputs Service Access (proximity to services) Quality care (drop out)
Behavioral changes Fertility rates, contraceptive prevalence
Demography changes TFR, Infant mortality rate, Maternal health
The Strengths:
There are both strengthens and weaknesses of the overall reproductive (& family
planning) programs. On one hand the strengthens of the program lies in the institutional
capacity through the primary health care and community health network which infiltrated as
far as the rural remote areas. There is an existing structure, which has both vertical and
horizontal aspect of service delivery. The vertical aspect concerned with policy development,
planning, supervision and monitoring, training and staff development (Reproductive Health
Division, HQ, MOH). The horizontal aspect concerns with actual service delivery (Maternal
Child Health /Family Planning activities in the provincial centers). The program has been
very effective in staff development. There were training workshops for different category of
health workers in particularly the nurses.
Thepr ogram’ soutpu tcouldbev i

e we dbyt hef ollowi
ngi
ndices:
 Clear policy directions and strategies at all levels
 Number of nurses trained in family planning
 Number of nurses trained in midwifery
 Number of training workshops
 Service delivery indicators; contraceptive prevalence, F.P coverage, % supervised
deliveries, % ANC attendances,
The program developed a clear policy, which is documented in the National Health
Policies and Development Plans 1999-2003. Underneath the policy are the strategies to
achieve the policy objectives. In 1997-1999 number of trainings and staff development were
carried out both locally and overseas.
Thepr ogram’ sa ntici
pa tedou t
comesarevi
ewe da s;
 Behavioural changes – Total Fertility rates and contraceptive
prevalence
 Demographic changes-TFR, Infant Mortality and Maternal Mortality
rates.
There were favorable and unfavorable outcomes experienced by the program. Firstly,
there are definite indications of behavioral changes. The TFR has declined from 6.1 in 1986
to 4.8 in 1998. However, the contraceptive prevalence has dropped according to the
available information. Secondly, there are also positive signs that demographic changes are
happening. Infant mortality and maternal mortality declined in the past thirteen years since
1986.
Weaknesses:
50
However, are the above changes due to the Reproductive Health Programs? Or if
these positive changes are taking place in the past 13 years, what were the driving forces for
the changes? Special care needs to be taken in answering the question. Firstly, because
measurement of changes in behavioral is not only difficult but very lengthy. It would take
more than twenty years before any real change in behavior is seen. Simple questions like
‘wha twa st hei mpactoft hev il
laget alkonf ami lypl a
nni ngwedi di nt hev ill
age ?Oneof
weaknesses of many public health programs including the reproductive health is the lack of
proper monitoring and evaluation of programs involving behavioral changes. There is need
for epidemiological researches to help answer some of the above hypothetical questions.
Secondly, there is no evaluation done on the program efficiency and cost-benefit of
the programs. Thirdly, lack of coordination of multiple donors has been a weak point.
There are inequalities among provinces in areas of maternal health outcomes and
accessibility to MCH/FP care. These are important issues and lessons for provincial health
service planning.
Potential Threats:
In the past experiences, there were threats to the reproductive health programs,
which correspond to the above weaknesses of monitoring and evaluation. The institutional
capacity to evaluate the program efficiency is due to lack of resources such as funding and
skill to do it. There were also other obvious threats to the program. Service delivery was
significantly affected by external influences such as geography, and low socio-economical
factors. The ethnic tension, which started around 1998, had adverse impact on the service
delivery. Traditional custom beliefs and high illiteracy rate among the target customers has
been recognize as negativism to the performances of the service. Unfortunately, it is
apparent that unwanted competition is been experienced with the Department of
Development Planning, which assumed the policy role of population control. Lack of clear
strategies of the National Population Policy does not help the program as the major
stakeholder.
The Gov ernme nt’
sc ommi tme ntt or e produ ctive he alt
hi sl i
terall
yt here.The
National Population Policy was drafted with little integration in implementation as expected.
Involvement of relevant sectors is yet to be seen.
3.9. Non-communicable Diseases (including mental health):
3.9.1. Prevention and control of non-communicable diseases:

The Comprehensive Review of Health Services Report, May 1996 has revealed an
alarming increase in Non-communicable disease such as diabetes, hypertension, and cancer.
It was noted that about 10% of admissions are related to diabetes.
In response to the health need, the Ministry has established under the Disease
Control and Prevention Unit a program called NCD section to evaluate the status of NCD,
develop national strategies on surveillance, treatment, monitoring and prevention of the
problem. Theou t
pu toft heprog r
ami st hede v el
opme ntofa‘ Canc erRegi
stry,andDi abet
es
51
cont
rolpol icyf rame wor k.A ‘ Di abeti
c‘ Ce nteri se sta bl
ishe da
ttheNa
ti
ona
lRe
fer
ral
Hospital for acute care, education and prevention of the illness.
Policy Status:
4.7.0. .Diabetes:
4.7.1. Policy Goal:

 To alleviate the impact (morbidity) and severity (disability) of diabetes in the target population.
4.7.2. Objectives:
 To improve information (IEC production) in diabetes in the next five years.
 To improve clinical management and treatment of diabetes in the next five years.
 To prevent disability due to diabetes through community awareness.
4.7.3. Indicators:
 IEC production on diabetes.
 Clinical Management and Treatment Protocol fully documented and implemented
 Improved collaboration links with the community.
 No. of diabetic cases per year
 No. of diabetic foot ulcers reported
4.7.4. Strategies:
 Increase public awareness,
 Earlier diagnosis and treatment,
 Improved quality of care,
 Improved infrastructure and organization of care.
 Prevention through:
Public Awareness using the media, church groups, and other non-government organizations
and community health talks from the unit.
Healthy life-style promotion
Development of health promotion and education materials
 Improvement of Quality of Care through:
Improve data collection system.
Training of staff at the hospital and rural clinic levels.
Development of clinical guidelines and education and clinical care kits.
Training workshops of health workers within the country.
Establish gestation diabetes program for pregnant mothers.
Provision of adequate equipment and supplies for diagnosis and monitoring patients.
Participation in regional and international conferences and organizations for the control of
diabetes.
 Infrastructure and organizational development:
52
Upgrading of facilities at the National Referral Hospital and establishment of diabetes

center.
procurement of necessary equipment for provincial hospitals and the National Referral
Hospital
strengthen role of primary health care centers
improve health information system for surveillance purposes
 Development of an overall diabetes policy
 Formation of a National Diabetics Society
4.7.6. Implementing Division:
 Division: Disease Control Unit of MHMS, HQ, Medical Department, NRH and Provincial Health
Services.
 Responsible Officers: Officer in charge Diabetes Control Program of DCU in collaboration with Head
of Medical Department, NRH and Provincial Health Directors.
Outputs (Findings):
It is for the first time, that there is actual registration of diabetic cases8 . There is an
increasing number of diabetics since 1990 as recorded by the Diabetic Center. It is
understood that there is more than what is recorded. The cases recorded in 1999 and 2000
have increased from 71 cases in 1996 to 109 and 100, respectively. The actual magnitude of
the problem needs to be accurately measured but it is apparent that impact of the problem
on the health of the people is increasing. The Ministry needs to strengthen its capacity to
address the issue and problems related to increasing burden due to non-communicable
diseases.
3.9.2. Mental Health Services

It is the Ministry mission to increase accessibility to basic mental health services
thr ought hepr ima ryhe alt
hc area ppr
oac
h.I tisa lwa ysac onc er
nt hatpatient
s ’rightsa re
retained and recognized by the community. The National Psychi a
tri
cUni ta tKi l
u ’
u f
i
Hospital, and the Honiara psychiatric unit are the only two service providers. However,
irregular provincial tours do occur.
3.9.2.1. Activities:
The Honiara Psychiatric unit had an average staffing level of three psychiatric nurses.
The Honiara unit did outpatient services, screening, counseling and referral of patients of
patients needing admissions. In 1997 only two provinces were toured. Subsequent years were
affected by the ethnic tension. The unit also did visits to the Rove Central Prison. The
National Psychiatric Unit is the main admitting center for inpatients. The staffing level is
8
Diabetic Center, Disease Prevention and Control Unit Annual Report 2000
53
always around 18 (including 3 domestic workers, a cook and a driver). The condition of the
unit has run down in the past years and needs urgent repair. The Ministry had great difficult
in recruiting a psychiatrist because of several reasons. Firstly, there were no applicants
despite several advertisements overseas. Secondly, there is lack of commitment from higher
authorities, as recruitments were freezed by the Public Service. Thirdly, the issues of financial
constraints were some of the answers the Ministry received. Nonetheless, the psychiatric
nurses were trained and had the capacity to manage the NPU and the Honiara Unit. This
report highly commend the Principal Nursing Officer, Psychiatric Services and the staff for
maintaining the basic level of service with out a qualified psychiatric, after the only one left
in 1997.
3.9.2.2. Findings (Outputs):

Table (6): Total Cases Admitted to
Nationa lPs ychi at
ri
cUni t,Kilu’ufiHos
pit
al . Table B: Total Cases seen and
(only) IN 1997,1998,& 1999. Treated by the National Psychiatric
Unit, Honiara, MHMS,HQ, in 1997,1998 &
1997 1998 1999 1999
Total Admin 358 177 84
New M 79 50 19 1997 1998 1999
F 38 42 11 Total Cases Seen 354 598 830
Total new 117 92 30 New M 79
Old M 164 36 34 F 41
F 75 49 29 Total new 117 130 87
Total old 239 85 54 Old M 162
Point 8.4 4.0 1.8 F 75
prevalence
rate
Per 10,000
pop
Table C: 3.9.2.3. Analysis:

Overall Total Cases
recorded at the National Psychiatric Unit,
The access to mental health services
Kiluufi Hospital & Honiara in 1997,1998,& is fairly limited in terms of mental health
1999. workers to rural population.
1997 1998 1999 Secondly, it is evident that the

Total Admin & 663 715 915 pressure on mental health services is
seen increasing. The total number of cases seen
New M 158 (as outpatient in Honiara Psychiatric
F 79 Center) and admission at the National
Total new 237 222 117 Ps ychiatr
ic Hos pit
a l Kilu’
u f
i Hos pital
Old M 276
54
increased from 663 in 1997 to 915 in 19999, with an average of 764 per year.
Thirdly, it also implied the impact of mental health illness on the local community
has increased. By 1999 in a population of 10,000 people 19.9 (about 20) people have came
down with mental health problem. An increase from 15.6/ 10,000 population in 1997. In
200010, total number of cases admitted at the National Psychiatric Unit, Kiluufi Hospital was
84.
3.9.2.5. Major Issues/ problems & recommendations:
Thema ini ssuei st heMi ni s

try ’
sc apabil
ityt os us
t ai
n bot hi nstit
u t
ionall
ya nd
financially, the psychiatric health services in the country in light of the limited resources.
Secondly, the issue of increasing accessibility through the primary health care
approach has been preferred. A problem experienced with the psychiatric outreach health
visits to other provinces was the irregularities of tours because of untimely payment of
grants (imprest), and limited qualified staff. Recruitment of a psychiatric was difficult
pr oc ess
, whi chi spartlydu etol ac kofg ov ernme nt’
sc ommi tme ntt ot hes ervice s
.
Thus, the drive towards primary health care approach is crucial in light of the current
limited resources in terms of manpower and funding.
It would also be helpful for a detailed epidemiological study on mental health

illnesses to be carried in the next few years to ascertain the attributable factors, so as to
enable existence of a preventable and health promotion program.
3.9.3. Initiative towards Tobacco control:
Solomon Islands Context (Intervention):
3.9.3.1. Tobacco Free Initiative
Solomon Islands fully supports the Tobacco Free Initiatives. The Solomon Islands
Government has approved a draft Tobacco Product Control Legislation in 1999. The Bill is
now with the Legal Draftsman at the Attorney General Chambers. It is hoped that the bill
will be tabled in the sitting of the Parliament 2002, after the elections in December 2001.
Solomon Islands government has received support from WHO in terms of

Technical Assistance in formulating the bill. The technical support received from WHO is
very much appreciated. Solomon Islands, however, needs to build its capacity in assessing
the magnitude of the Tobacco related health problems. In this light, Solomon Islands would
like participate in the Global Youth Tobacco Survey.
9
MOH (2000). National Pyshiatric Reports 1997, 1998, 1999, National Psychiatric Unit.
10
MOH (2000). National Pyshiatric Reports 2000, National Psychiatric Unit
55
However, there real practical challenges including politics, economic, and

sociocultural issues. With the current downturn of economy leading increasing
unemployment and poor financial status of many families, people ventured into selling of
cigarettes and tobacco stick as their quick source of gaining some money. Coupled with no
restrictions and cheap price it is the easiest way to get into business. Sporting organizations
are engaging tobacco companies in the advertisement, and direct financial support. In is a
problem which is appears to get out of hand in the country. At this very moment political
will is the critical success factor for any break through with this sociocultural problem.
3.10. Strengthening Health Systems in Solomon Islands:

3.10.1. Proposed Health Reform:

The Solomon Islands Public Service Policy and Structural Reform program is shaped
by the perception that; the public service was inefficiency; and over-staffed, to the extent
that salaries were absorbing most public expenditure, leaving little for actual operations or
capital investment and maintenance. Salaries were so low that staff had little incentive to
work. Pay differentials had been so eroded by populist policies that the formal remuneration
of senior staff in particular was derisory, making some form of corruption inevitable. And
order and work discipline had deteriorated, such that the government could no longer look
on public service as a reliable instrument for implementing policies.
The Government in its Policy and Structural Reform has set the direction towards
increasing proportion of the recurrent health budget to the rural community and public
health programs, provincial health services, environmental services, and health education and
promotion.
In responding to this policy redirection and adjustment the health sector is reviewing
its organizational and staffing structure to refocus its effort towards supporting the National
Health Policies and Development Plan 1999-2003, which literally aimed at getting a effective
and efficient public health sector as well as improving the national health outcome.
The development so far is that the health sector is in the process of formulating a
ma jor‘ Insti
tutiona lS
trengt hening ’pr ojec ttoe ff ecti
velyma naget hec hangesenv i
sagedt o
improve the delivery of health services. At this stage, with the support from the developing
partners such as the Australian Government through AusAID, and to lesser extend from the
World Bank, intense work is done in identifying priority health issues and priority program
areas. Project goals, objectives, strategies, activities and schedules are under way and near
finali
z a
tionoft hede si
g n.Thef ocu si si nt hea reasofr evi
ewi ngpu bl
iche al
ths ect
or’s
organizational structure and functions, before incorporating changes of improvement to
policy development, management and supervision, planning, monitoring and evaluation of
the health services.
I. Health Reform Goals:

56
To improve the health of the Solomon Islands population by strengthening the management and
operational capacity of the Solomon Islands public health sector through the health reform process.
III. Proposed Reform Strategy:

The reform process envisaged in the next ten years is into two forms, 1} Structural Reform and 2) Process
Reform. They are interdependent. It is planned that structural reform should set the framework and structural
basis for the process and systems to fall in. Nonetheless, there may be areas that both overlap and may happen
at the same time.
Part 1: Structural Reform

1.1; Action Steps:
Several actions steps were carried out as preliminary steps towards the reform recommendations:
Solomon Islands Launched its Policy and Structural Reform Program:
The Solomon Islands Government (SIG) launched its Policy and Structural Reform Program (PSRP) in 1997.
Public sector reform is an element of the PSRP with an emphasis on improving productivity and efficiency of
service delivery.
Health Sector Reform initiative (under Restructuring of the Ministry of Health):
In response to the PSRP agenda, the Ministry of Health is embarking upon a Structural and process reform.
The former concerns with reorganization of the Ministry of Health and its functions whilst the latter deals with
reviewing and changing the process of operations of the ministry. While the ministry is clear about the
directions it wants to take, there are environmental and internal structural and systems issues, which must be
addressed to ensure successful implementation of the health reform. A Cabinet Paper to start the process was
prepared by the Ministry of Health, submitted and approved in 1998.
Request for partnership in the health reform process though developing partner (donor) support and
assistance:
TheMi nist
ryofHe alt
hsubmi tt
eda n‘He althI nsti
tu t
iona lS t
rengtheningPr oj
ectPr opos al
’du ringag rand
donor meeting with the SIG in 1998. This institutional strengthening project should drive the structural as well
as the process reform.
The launching of the Nati0nal Health Policies and Development Plans 1999-2003:
The National Health Policies and Development Plans was drawn up and launched in late 2000. The plan
re
infor
cestheg over nment ’
sc ommi tmentt ohe
althreform. Thek eypri
orit
ypol i
cya r
easa re:
Solomon Islands Key Health Policies Recommendations to Commonwealth

(National Health Policies & Development countries
Plans 1999-2003)
1 Improvement of management and supervision of Quality, Assurance, Monitoring & Evaluation
services (QAME); Strategic planning, policy analysis and
agenda setting in health; Health Information as a
management tool, Sustainable financing of health
care systems, Health Research in health sector
reform; Costs of drugs;
2 Access and Improvement of Care & Quality of QAME, Enhancing service delivery through the
services reform process; traditional systems of health;
3 Human Resource Development For Health HRD in health sector
4 Morbidity & Mortality Reduction Health sector reforms and the improvement of
health status and quality of life,
5 Environmental Health
6 Health Promotion & Education Health Promotion, obesity; physical activity, sport
57
and health
7 Reproductive Health, Family Planning &
Population
8 Developing Partnership in Health Development. Partnership for health
It is clear from the above table that the policy direction of the Solomon Islands Government covers all the
areas of recommendation by the 12th Commonwe al
thHe althMi ni
ste
rs’Me eting5-19 November 1998 in St
Philip: Barbados, which the Solomon Islands Government could not attend because of financial difficulties.
A neighboring commonwealth country (Australia) stepped in to assist the Solomon Islands Health
Sect
orr e
form unde rt
heba
nne rof‘He a l
thIns ti
tut i
ona lStre
ngt heningPr oject’
.
The Australian Government showed interest and commitment in assisting and supporting health reform and
other related health developments. Ultimately the interest eventuates in an AusAID donor Review Mission in
July1 99 9a ft
erha vingre gar
dt oS IG’ swide rreforma g enda.Att heS olomonI sl
ands /Aus trali
aHi g hLe vel
Consultations held in Brisbane on 19-20 August 1999, the SIG supported the recommendation of the AusAID
Health Sector Donor Review Mission (July 1999) that Australia should support a major institutional project in
the Ministry of Health. The review tem also recommended provision of interim technical assistance to help
keep pace with a wider public sector reform agenda, and to help health workers to get the grip of what to come
ahead with the reform agenda echoed in one or two ministerial conferences and meetings.
With the assistance and coordination of the interim TAs, a consultant to help drive the process of developing a
draft MOH Institutional Strengthening Project (guide). A Project Design Document was drafted in April 2000.
The MOH owns this process and the document, and agreed that it reflects the health sectors needs.
By end of May 2001, the project is at the stage of preparation for implementation.
Annex 1 to the Institutional Strengthening Project Program: The desired Outputs and Outcomes:
6) Institutionalization of the Public Sector Structural and Policy Reform: The formation of the Ministry of
Economic and Structural Reform.
The Solomon Islands Government early this year (2001) institutionalized the public sector structural and policy
reform by forming a new Ministry called the Ministry of Economic and Structural Reform. Their role is still not
clear at the moment but assumed to coordinate, spearhead economic and structural reform, and assists and
coordinates reforms in other sectors such as the health reform.
Part 2: Systems and Process Reforms:

2.1: Action Steps:
In this particular process much of activities now are focused to awareness of the proposed health reform
process, and some smaller changes in financing systems and the establishment with in the public health sector.
Presentation on the topic of Health Ref orm dur i

ngaNa tionalSe ni orHe a
lthOf fic ers’Conf erencein
1998.
The awareness campaign begun at the national senior health officers in October 1998. There was a lengthy
discussion on the topic. There was a repetition of the subject of health restructuring in the following two
national senior health conferences in 2000 and 2001.
2) Performance Agreement signed with the Permanent Secretaries and Undersecretaries of the 20
Ministries in 2000.
In an attempt to improve efficiency and productivity, and accountability at the ministerial level, the Solomon
Islands with the external assistance of a ADB consultant, developed a frame work that Permanent Secretaries
signed a performance agreement with the Ministers of respective Ministries on the Outputs assigned in the
work plans to achieve the desired outcomes.
3) Restructuring of the 2000 staffing establishment of the Ministry of Health: Creation of Chief
Executive Post at the National Referral Hospital:
58
A forward step towards the restructuring program (which is Level Restructuring) was the review and
restructuring of the 2000-staffing establishment in the Ministry of Health. The key emphasis of the
restructuring was to put in place key positions for strengthening the Policy, Planning and Evaluation Unit, the
finance management capabilities of the MOH, the accounting section both at the center and the provinces. The
National Referral Hospital in Honiara the referral and specialist hospital now has a Chief Executive Officer
who is on contract, which entails out put requirements. Let alone the administrative problems encountered, it is
a staring point for the program.
3.0: The Effect of the Ethnic Tension on the Health Reform Program:
The recent twenty months old ethnic tension (1999-2000) had severely affected the reform program. Nearly all
programs and activities was interrupted and therefore suspended. The financial crisis, which resulted from the
ethnic tension, had badly affected the program.
However, the conflict caused many policy makers with in the private and public sector the need to be
responsive and manage changes. It was agreed that the existing structure of the public service is static and not
responsive to changes in all aspects of finance and Human resource management and all other related areas.
3.1: Continuation of the Health Reform Program:
The Ministry of Health, Solomon Islands is committed to continue with the implementation of the health
reform program in Solomon Islands. It is hope that the newly elected government after December 2001
elections will remain committed to the proposed reform program.
4.0: Conclusion:
There are strategic plans envisaged by the Ministry of Health in addressing issues highlighted by Dr. Omi
(RD/WHO_WPRO) in his report (The Work of WGHO in Western Pacific Region. These issues are related to
health information and evidence-based policy, health research, and human resource management. The
approach the Solomon Islands Government through the Ministry of Health is in two folds firstly to ensure that
the structure of the public health sector (structural reform) is conducive for the new systems and process.
Secondly introduce the new concepts, processes and systems (process or systems reform).
Nonetheless, more effort and commitment from all stakeholders is needed and crucial for the success
implementation of the health reform program. It has been experienced that external factors such as conflicts
and economical problems have posed threats to the implementation of the reform programs.
Policy Status:
7.1. Policy Directions on Health Sector Reform:
More resources will be shifted towards preventive and promotive health services with concomitant
rationalization of curative services through imperative cost recovery mechanisms and getting major
hospital services to function as a large unit at a minimal production cost.
7.2. Policy Goals:
 To establish a flatter structural organization of the Ministry of Health and Medical Services;
 To provide for clarity of lines of reporting and accountability;
 To ensure separation of policy development and management from operational delivery where appropriate;
 To ensure that Management of key stake holders are effective and to re-define the roles and powers of
Health Statutory Bodies;
 Top ro vi
deg rea t
erf oc uso nt he“ custome rs”o f healthservices;
 Tof ocuso na rea so f theMi n i
stry’
so r ganizationwi thgreatest b
udg
etaryi mp a c
t;
 To provide for budget efficiency and effectiveness.
7.3. Policy Objectives:
 Restructuring of the Ministry of Health and Medical services
 Review job description
 Cost shifting from urban based health services to rural based services
59
 Cost efficient operation of the major hospital

 Improvement of the planning capacity of the Ministry of Health
7.4. Indicators:
 New organizational structure of the Ministry
 New posts identified
 Improved planning office facilities
 Reduction of costs in urban based health services
7.5. Strategies:
 Seek Technical Assistance to review and development appropriate organization structure of the Ministry
 Review job description of officers
 Deploy staff appropriately
 Development appropriate staff establishment with appropriate costs
 Review appropriate health services legislation and regulations
7.6. Action Steps:
 Develop new organizational structure with appropriate staff development
 Seek provision for funds for deployment of staff in new posts
 Deploy staff accordingly
7.7. Implementing Division / Department:
 Executing Office of the Ministry of Health

 Responsible Officers: Secretary to Ministry with Undersecretaries
3.10.4. Essential drugs and medicines policies:
The year 2000 was a very difficult time for the procurement of distribution of much
needed essential drug in the country. As a result of the financial crisis the Government was
not able to clear its debt with the two major buying agents. The debts were at an amount to
approx ima telyS BD5 Milli
onbe t
we e
nt het wobu y i
nga gents.Ha dn’ ti tnotbe enfort he
Au str
alia na ndNe wZe alandGov ernment’sHu ma nit
arianAi d,wewou l
dnotbea bl
etog et
medicines and other essential pharmaceutical supplies for our people, in a time of need,
especially during the ethnic tension.
Activities/ Inputs:
TheMi nist
ry’sef forttofinal
iz et hefirstdraftoft heNa tiona lDr ugPol icywa s
hindered by the 1999-2000 ethnic-tension. However, work has started through a WHO
consultant who had visited and spent three weeks assisting the Ministry to review the
situation and make recommendations to finalize the National Drug Policy. Even before an
official national drug policy document, the pharmacy services have already confined to the
Standard Treatment Guideline and Essential Drug List for the clinical protocol as well as
administrative and procurement of drugs for the country.
60
According to a review done by Pharmacy Services Department11, the key issues are
related re-establishing links with the buying agents by repaying the debts, making fund
available for medicines. Whilst, the National Medical Store has been successful in
maintaining services up to the present, a number of areas can be further improved and
developed. Areas such as the current stock management system, which currently without a
back up system. The current system is limited in function and not user-friendly. The system
does not allow the user to do cost allocation and produce order requirements easily. A more
reliable and user-friendly system with back up capacity is in need at the National Medical
Store.
Procurement done regularly but without guideline and standards to follow. Practice
is based on precedence and what was done previously. Assessment of the current
procurement system and establishment of system for procurement is a need needing
attention in the near future (health institutional strengthening project).
The overall structure of the Pharmacy Services Division needs to be reviewed and
changed. Currently the office of the Director of Pharmacy is based at the National Referral
Hospital Pharmacy Department as supposed to its national functions and responsibilities.
Thus, there is difficulty in focusing on overall management and planning of the pharmacy
services, and day-to-day problems of the NRH are given priority over national
responsibilities. The shortage of qualified pharmacists (and pharmacy manager) has limited
the pha rma cy’sc apa cityt o ma na gea nd s upe rvi
set he pha rma c ys
erv
icese ff
ecti
vely.
Nonetheless, the Director(s) and the staff should be commended for the significant impact
the pharmacy service to be able to proved access to essential medicine to the people of the
country.
The other important function of the pharmacy services department as per the
legislation is the registration of medicine and regulatory affairs. This is an area, which is
apparently weak. The Pharmacy Services Department in liaison with the MOH is seriously
looking at strengthening of the regulatory affairs of the Ministry through the Pharmacy
Services. It does have implications on the current pharmacy legislations.
Policy Status:
2.7.1. Access to Essential Drugs:
2.7.2. Policy Goals:
 To achieve adequate supply of essential drugs and medical sundries
 To achieve training and support of qualified personal
 To have control of dealings in medicinal products through legislative and regulatory mean
2.7.3. Objectives:
 To ensure that essential drugs are always available in 90-100% of rural clinics in a year for within the
plan period. In particular reliable and adequate supply to rural health care facilities.
2.7.4. Performance Indicators:
 Availability of essential drugs at the rural clinics
 No. of trained pharmacy officers
 Legislature reviewed
11
Anna Chao (2001). Review of Report on Status of Pharmacy Service Division February 2001 by Mr RF
Skinner, Unpublished Paper, MOH.
61
2.7.5. Strategies:
 Development of the National Drug Policy
 Organization infrastructure to provide for regular schedules demand-driven supply of essential medical
supplies to rural healthcare facilities, from the responsible provincial distribution center.
 Provision of adequate staffing establishment and deployment to distribution centers to ensure prompt and
efficient processing of orders and prompt and effective dispatch/delivery
 Maintenance and development of means of communication with customers (health care facility personnel)
through radio, telephone, documentation and personal direct and indirect (through other health personnel)
contact, at rural health care center or at province center. Reviewing comments and complaints from
customers, and identifying shortcomings and needs.
 Maintaining and developing regular means of information provision and dissemination (Bulletins,
memoranda, continuing education data etc)
 Development of information on usage of supplies through management of distribution and usage
information. Identification of wastage, dead stock, etc. and recovery, recycling; determination of usage
patterns for national, provincial groups and for individual health care providers.
 Maintenance of Essential Drugs List and other national standards for medical products, treatment
protocols and monitoring of compliance
 Management and review of the procurement activities with attention to efficiencies in costs, quality and
supplier performance.
 Strengthen the establishment
3.10.5. Traditional Medicine:
There is no formal policy on traditional medicine, which is practiced widely in all the
communities in numerous forms. There is mixed feeling about some forms of traditional
medicine, as there were cases of death and severe complications. The issues raised are related
to lack of detail information on the plant or herb used, its pharmacokinetics (if any), and
when and what to use for. However, a research by a senior government officer was done in
1993, which revealed that there are more than forty medicinal plants present in Solomon
Islands. The study also found that these medicinal family plants are also found in China and
Philippines. All these medicinal plants are in their crude form and need refinement and
improvement through a manufacturing process.
The practicality to further go into formalizing traditional medicine is difficult because
of lack of commitment, expertise and research facilities and other support. However, the
issue of registration of traditional medicine can be incorporated in the National Drug Policy
as a way to start, whilst the issue of developing a formal policy can follow. Other
opportunities include expanding the Solomon Islands Medical Training and Research
Institution (SIMTRI) role to traditional medicine. A close collaboration will be built with
other stakeholders such as the Ministry of Forestry.
3.11 Technical Cooperation among developing countries:
WHO according to the Director- General (2000) is putting effort in overseeing the
technical corporation among developing countries (TCDC). For our shake it is important to
62
explore further about the TCDC. There have been changes imposed on many public health
sector organizations within the South Pacific Islands Nations. It is occurring in Samoa,
Vanuatu, Papua New Guinea, and most recently in Fiji, and Solomon Islands starting fairly
recently. Changes in the health sectors are driven by external developing partners on the
basis of the local baseline indications that public sector is inefficient and ineffective. Whilst,
there is genuineness of the need to change the structure and the behavior of people from
traditional restrictive ness to ways that foster efficiency and effectiveness within the public
health sector, it is more important that social values as basis for policy formulation and
planning.
In relation to the Solomon Islands context, the model or approach for technical
cooperation should be like what is currently exercised in the Malaria Control Program. There
isstrongt echni cals upporti nt ermsof‘ perma ne nt’ma lari
at echni ca
ladv i
sera nds ma l
l
operational grant. The conceptual underpinning of the approach is that there is guidance to
other external developing partners who is also interested to participate.
We are clear in our policy that developing partnership for health development is
crucial. We also see the importance of donor coordination, and would like to improve on the
current administrative support, which is on adhoc basis to start. The table below briefly
shows areas of support and assistance by donor agencies or developing partners.
Table ( 10)Matrix of Current Donor Activity Impacting Directly on the Solomon Islands Health
Sector:
DONOR LOCATION PROJECT BRIEF COMPLEMENTA Progress
AGENCY OF TITLE & DESCRIPTION OF RY (2000-March 2001)
ACTIVITY DOLLAR PROJECT (including COMPONENTS
VALUE commencement & OR ACTIVITIES
completion date) WITH SOLOMON
ISLANDS
INSTITUTIONAL
STRENGTHENI
NG PROJECT
World Solomon Solomon The project The SIHSDP is The project is more
Bank Islands Islands Heath commenced in located in the than a year old.
(Soft Makira and Sector February 2000 MOH building However, there was
Loan) Guadalcan Development The priority issues with limited activities done
al Project to be addressed Policy,Planning in 2000 because of
Provinces (SIHSDP) include and Evaluation the ethnic tension.
($4.5 –5.9m Divison. Up till now Oct.
loan)  Maternal care 2001 there were
for 5 year and family already four (4-6
period planning monthly Semi-
including the Annual Reporting
development done. Most activities
of midwifery in 2000 were related
training to establishment of a
 Malaria full PCIU facilities
prevention and staffing, planning
and control of worksplans and
 Provincial budget, and
procurement. Otther
63
health training and service

program delivery programs
management was badly disturbed
 Central by the ethnic tension.
capacity Some of critical point
building and of overlap with this
project the SIHSDP exists in
support which the activities
will include associated with (1)
Health Health Management
Management Information Systems,
Information (2) Services delivery
System components such as
Development Malaria and
to support the Reproductive Health
Pilot Projects programs (including
in the above EPI), and (3)
mentioned Rehabilitation of
service clinics (Civil Works).
delivery
AusAID Solomon Institutional Financial The SIG is

Islands Strengthening accounting systems intending to
Ministry of in Ministry and introduce
Finance other line agencies financial
delegations to
“ st
r ategiclev els
”
within MHMS
and other
ministries.
Restructuring of
MHMS and
capacity building
within this
project will
prepare MHMS
for this
devolution of
authority and
accountability. .
The
development of
management
delegations and
accountabilities
will create
requirements for
financial
management
information
There will need
to be appropriate
utilisation of the
MoF accounting
systems in order
to accommodate
MHMS
64
requirements
AusAID Solomon Scholarships This program Close liaison

Islands, Program $0.6 supports training needed,
M of clinical health especially in
staff including relation to the
 Diploma of health workforce
Nursing at planning and HR
SICHE development
 Critical Care policies and
Nursing at programs, to be
Qld Uni facilitated by the
 Dental Surgery proposed new
at FSM project.
 Medicine/Surg
Potential for
ery at FSM
candidates to be
 Post Grad identified for
Obs/Gyn at training in
PNG support of the
operational
management
initiatives of this
project and the
workforce
planning
strategies which
will be
developed.
AusAID Solomon Rural Water Provision of The project was

and Islands Supply and Potable Water terminated in 200o
cofunded Sanitation supply and earlier than planned.
by $10.3m sanitation facilities
NZODA for rural
communities This
project will be
drawing to close in
2001.
AusAID Solomon Malaria Annual provision This vector The project was
(CASP) Islands Control, of bed nets, anti Borne disease suspended in 2002
Health malarial control program
education and pharmaceuticals, interlinks with
Education larvicide and the MHMS
supplies fogging chemicals policy
development
processes and
the effective
operational
planning and
implementation
within the
Provincial Health
services.
AusAID Regional Hepatitis B Hepatitis B Hepatitis B
program Project immunisation immunisation
65
including ($2.0m) (1997-2000)

the
Solomon
Islands
AusAID Regional Vector-Borne Assists with Malaria and
program Diseases programmed other vector-
including Control medical and borne diseases
the Project ($10) environmental
Solomon health services and
Islands introduction of
vector control
mechanisms.
AusAID Regional Pacific Action The project is NCD’ s
(Regional) program for Health designed to particularly those
including ($3.4mil) provide preventive linked with
the and health tobacco and
Solomon promotional alcohol
Islands support at
community,
national and
regional levels.
AusAID Regional Pacific Islands Supports and TA STD and Situational Analysis
(Regional) program AIDS and to national HIV/AIDS Report on STI/HIV
including STD programs in completed.
the Prevention relation to STD
Solomon Programme) and AIDFS
Islands education,
prevention,
treatment and care.
AusAID Regional Integrated Funding provide Village health
(Regional) Program Community through World care, access to
including Health Project Vision. Objective watersupply,
Solomon Kia/Kotova was to improve literacy,
Islands and Maringe quality of life for improved
areas councils about 8000 agriculture and
in Isabel villagers through environmental
Province the development of health.
an integrated
community health
programme.
Project will cease in
2000
AusAID Regional Family Project Strengthening
(Regional) Programm Planning implemented by family planning
e including regional Family Planning organisation
Solomon development Australia 1994- finances training
Islands ($0.63mil) 2000 and
administration.
AusAID Regional Family Project to be Strengthening
(Regional) Programm Planning extended to family planning
e including regional facilitate inclusion organisation
Solomon development of family planning finances training
Islands (Proposed training into formal and
$2.7mil) curriculum for administration.
nurses and teachers This has policy
To be implemented development
66
by Family Planning implications and

Australia 1999- rural health
2004 service
management
proposals which
are relevant
AusAID Regional Tertiary Volunteer medical Phase 2 end of Phase 3 yet to be
(Regional) Program Health Care teams offering December 2002. finalized.
including Provision specialist services
Solomon Project and local capacity
Islands building through
on-the-job training
in Plastic and
reconstructive
surgery, neurology,
eye care and
paediatric surgery
AusAID Communit Humanitarian See Annex (1)
y Peace & Aid-
Restoration Health
Fund Projects
AUSAID Emergency Procurement Humanitarian Aid Executed by Red 18 months supply of
& Funding of Medical Cross medical supplies was
NZODA Supplies International procured through the
aid, when the country
was not able to pay
up its debts with
international buying
agents.
NZODA Honiara Family Health Reproductive Sexual health for Project terminated
and other Project ($0.3 health and family urban youth and end 2000.
urban areas Mil pa) planning including peer education in
Solomon program squatter
Islands development and settlements to be
IEC production implemented in
association with
churches
NZODA Solomon Training Scheme operates Potential for Suspended in 2000 as
Islands Scholarships through National candidates to be a consequence of the
Training Unit in identified for ethnic tension.
Ministry of training in
Education and is support of the
targeted at nurse operational
training. management
initiatives of this
project and the
workforce
planning
strategies which
will be
developed.
NZODA Solomon Medical To assist with Specialist Suspended in 2000 as

Islands Treatment treatment of treatment in a consequence of the
Scheme patients for which New Zealand. ethnic tension.
(NZD65,000/ specialist treatment Need to maintain
67
yr) is not available in liaison.

Solomon Islands
JICA Solomon Rural Health Construction and Project Design Suspended in 2000 as
Islands Facilities equipping of and functional a consequence of the
Rehabilitation facilities including a brief completed ethnic tension.
Project $15 m possible new by MHMS.
hospital at Choiseul Project has
Bay, a larger new policy
hospital at Gizo development
and selected implications and
upgrading of other rural health
Provincial Health service
facilities management
proposals which
are relevant to
Project.
Eventual design
needs to be
understood by
this Project and
appropriate co-
ordination
maintained.
ADB Solomon Population Reproductive It is understood ADB changed its

Islands and Family Health including this project will stand and opted for
Village Planning development of function in NGOs. Program
areas IEC materials cooperation with never being finalized.
the NZODA to
minimise
duplication and
will involve
churches.
ADB Solomon Public Sector Management Part of a larger Diploma in Public
Islands Executive education Public Sector Services Management
development programme for Reform Project Course with Masset
Program Senior Public operating from University continued
Servants. the Institutional despite the tension.
Strengthening Out of the 20 that
Unit of the started about half
Pr imeMi nister ’s dropped out leaving
Department t 8 regular attendants.
supported by Last Module due 29-
ADB 30.10.01.
WHO Solomon WHO Frameworks and Linkages exist
Islands ongoing technical assistance with a number of
Role for projects to SHP
promote: Healthy components.
Islands, Health
Promoting
Schools, New
Horizons in Health
WHO Solomon Human Funding of Potential for Highly successful.

Islands Resources fellowships candidates to be There was 100%
68
Country Development identified for implementation rate.

Program training in All approved
support of the fellowships were
operational taken.
management
initiatives of this Final draft of the
project and the 2002-3 done in
workforce liaision with the
planning Ministry of Health
strategies which
will be
developed.
WHO Solomon Vector Borne Malaria control Included in the 2002-

Islands Disease 3 Budget
Programme
($200k
WHO Solomon Water Supply Funding of
Islands and sanitation workshops,
($140k) training and
fellowships for
Health Inspectors.
WHO Solomon Primary Health education

Islands Health Care and promotion
including
development of
IEC materials.
Provides
fellowships, limited
supplies and
materials and
WHO office
running costs.
UNFPA Solomon Reproductive Provision of Population

Islands Health contraceptive awareness
material for family activities in
planning training. Family Planning
Scholarships for and Maternal and
midwifery/paediatr Child Health
ic nurse training. No authoritative
documentation
available
UNFPA Solomon Dispossessed No authoritative Pilot one year
Islands Youth Project document project to target
($44k) available. unemployment,
substance abuse
and sexual
health.
UNFPA Solomon IEC Project No authoritative
Islands (80k) document available
European Solomon National Demographic and Census Census successfully

Union Islands Census health data conducted completed in 1999.
Health collection and during
69
planning analysis. November 1999 Data analysis

Unit and with preliminary completed, and
National reports reported.
Census anticipated in
Office mid 2000
Republic Solomon Phase III To implement Mainly Phase 3 continued
of China Island upgrade of Phase III of the Renovation on despite the tension.
National National Hospital the old ward By end of December
referral Referral refurbishment and buildings. Project 2000 there 50%
hospital Hospital upgrading. coordinated and completion rate.
($1.7mill) monitored by the Follow up was done
National Referral in April 2001 to
Hospital enable continuing
Development funding commitment
Project from ROC.
Committee
(Formed by
Ministry of
Health &
Ministry Works
with
representatives
from ROC and
individual
contractors.
Save the Solomon Child Incorporates child SCF normally
Children Islands Protection protection, operates with a
Fund country Project community based government or
Program rehabilitation and a NGO partner
mainly youth outreach and provides
funded by programme and funding and
AusAID family support project
centre. management and
administrative
support
Emergency Support given by the World Health Organization (WHO) to

the Ministry of Health and Medical Services, Solomon Islands
Government
The ministry of Health has approached WHO on several occasions for emergency support
during the two years of this crisis. All the support given is summarized in the Table below. The main
areas of support are:-
1) Reestablishment of malaria control–On Guadalcanal the main emphasis was to establish

diagnostic facilities and distribution of treated mosquito nets. Free nets were distributed to
all pregnant women and mothers with infants through the clinics. The International Red
Cross helped the programme to distribute the nets to the clinics. On Malaita new office and
staff houses were built to accommodate additional staff and create a new operational team to
cater for the displaced people especially in north Malaita. 74% of the population was
provided with nets and the distribution is continuing. The Solomon Islands Medical Training
and Research center was also repaired.
70
In June 2001 further support was provided to the malaria control programme for the
procurement of nets, chemicals, outboard motors, canoes, computers, microscopes and
spray equipments. Funds were also provided for the surveillance activity in Honiara and
training of health personnel on management of severe cases. Fuel requirements for the
programme was also provided.
2) Immunization :- The cold chain for the storage of vaccines were maintained during the
crisis. Funds were provided to procure fuel for the refrigerators and to transport them to the
provinces
3) Drugs:- A list of essential drugs were provided to the ministry. This will ensure the
availability of drugs through out 2001 (AusAID has also provided similar support).
4) Mental Health:- Two workshops were organized for nursing staff in the two provinces to
identify and manage psychiatric problems associated with the crisis. Stress management was
one of the core topics covered in this training.
5) Prosthetic care: - Since more people were admitted to the hospital with various injuries the
demand for prosthetic care has increased. Funds were provided to get essential supplies
from local and overseas suppliers.
6) X-Ray machines:- Two portable units are being procured for the provincial health services.
Month/ Programme and activity Cost Status

Year (USD)
July 1999 Malaria control:- establishment of a new regional office at 30,000 Completed
Malaita to cater for the displaced people.
July 1999 Malaria Control:- Provision of rapid diagnostic test kits and 35,000 Completed
mosquito nets for displaced people of Guadalcanal.
July 1999 Restoration of the Solomon Islands Medical Research and 50,000 Completed
Training Institute
Sept 2000 Immunization programme:- Support to maintain the EPI 6,000 Completed
cold chain
October Health care services:- Provision of essential drugs 91,000 Completed
2000
Nov 2000 Support to Mental Health programme:- to organize 2 7,000 Completed
workshops for peripheral health workers on psychiatric care
and stress management.
Nov 2000 Support to rehabilitation/ orthopedic care:- Prosthetic care. 4,000 Completed
Feb 2001 Procurement of new portable X-ray machines to replaced 62,000 In
damaged ones progresss
July 2001 Maintenance of cold chain for vaccine storage for the whole 14,800 Completed
of 2001
September Installation of a new cold room at the national pharmacy 1,125 In progress
2001
August Support to the prevention and control of Tuberculosis in 21,000 In progress
2001 North Malaita
August Operational funds for the malaria control programme 60,000 In progress
2001
August S&E for the malaria control programme 178,000 In progress
2001
May 2001 Reagents and test kits for STI/HIV detection 5,000 Completed
TOTAL 564,925
USD
SBD = 2,943,260.00 (2.9 million dollars)
71
All the above assistance are provided by WHO from its regional office resources and the
biennium allocation of USD 1.5 million is also being fully utilised for planned activities in
consultation with the Ministry of health.
Policy Status:
Policy 8: Developing Partnership In Health Development

8.0. Policy Statement:
Due to lack of capacity in many aspects of health development at all levels of the (Public) Health Sector,
developing partnership in-country and out of the country will be further developed and strengthened.
8.1. Policy Goals:
 Enhance collaboration with local NGOs and international health developing partners in particular
health services delivery to rural population, health financing e.g. donor assistance, human resource
development, and training and research, and tertiary health care.
8.2. Objective:
 To enhance and improve collaboration and coordination between the Government and developing partners
with in the planned period.
8.3. Indicators:
 More collaboration links through MOU developed with local NGOs, and international developing
partners.
 More donor assistance available for health.
 Greater participation of NGOs in providing health and related services secured.
8.4. Strategies:
 Develop Memorandum Of Understandings (MOU) in Health Development with local NGOs incluing
church es, an dwi thin t
er na tion
ald o
n orp artnersi nl inewi t
ht heGo vernme n t’
sp o l
ic
yobject
ives.
 Increase collaboration with (appropriate) international human resource development institutions e.g.
schools, colleges, universities.
 Improve donor coordination
8.5. Action Steps:
 Review existing MOUs with different stake holders.
 Promote and establish MOU with NGOs including Churches, to assist in health prevention and
promotion, and secondary health care delivery to the rural population.
 Enhance efforts to secure donor assistance
 Enhance efforts to secure accreditation with international universities and other human resource
development sources.
3. 12. Eradication of Poliomyelitis:
Solomon Islands is free of Poliomyelitis. There are no new cases of poliomyelitis

recorded in the past ten years. At the moment Solomon Islands is participating a survey to
ascertain whether poliomyelitis is completely eradicated as apparent.
72
Polio vaccination coverage is very good in the country. Solomon Islands will
continue this high level of immunization coverage. We will also put extra effort in improving
our national surveillance acute flaccid paralysis.
3.13. Health Promotion:

The health sector is anticipating under the health reform package a paradigm shift
from just Health Education to a broader Health Promotion. It is aimed to embed with in
the local culture the notion of living a healthy lifestyle in the context a city, islands,
communities, markets, schools, workplaces and health services. With the restructuring
involvement of stakeholders such as church organizations and non-government
organizations will be the emphasis. Local resources in terms of existing formal and informal
structures, legislation, and systems will be mobilized in order to sustain health promotion
advocacy.
Pr eli
mi narywor kisinpr ogressint hede vel
opme ntoft
he‘
Nat
iona
lHe
alt
hPol
i
cy,
which will be the platform for reform in health promotion.
Policy Status:
Policy 6: Health Promotion And Education
6.1. Policy Statement:
The people of this country will be encouraged to improve and promote personal hygiene, live healthy lifestyles
and take responsibility for their own health through appropriate and effective means of communication.
Formation of linkages with the community and dissemination of health information is an important strategy
ina chievingth ep olic
y’so bject
iv es.
6.2. Policy goal:

 To enhance behavioral changes, that promote healthy lifestyle and family health especially family
planning, maternal care, malaria prevention, and population education.
 To promote healthy lifestyles and make healthy choices possible for the people through a combination of
education and strategies designed to create supportive environments.
6.3. Objectives:
 To increase focus and reorient commitment to enhance preventive and promotion health services to the
local community, especially the vulnerable people, the women and children, in the next five years.
 To carry out more health education and promotion activities in the rural clinics from 37.3% in 1995 to
80% by 2003.
 Increase integration of IEC into all health programs within the ministry as well as other stake holders
(NGOs) in the next five years
 To promote family health from within the village to encourage and support efforts of parents to make
responsible decisions regarding family size and family health.
73
 To strengthen capacity of the health workers to plan, coordinate, implement and evaluate health
promotion activities/ programs in the next five years.
6.4. Indicators:
 No. of health education and health promotion activities
 Fully documented and implemented orientation
 No. of health promotion activities implemented.
 Individuals, and families aware, informed and more responsible for their own health and family' health.
 Integration of IEC into all health programs and other stake holders (NGOs) involved.
 Families aware, informed and more responsible for their own family health.
 Human resource development which reflects new health promotion orientation
 Improved planning, implementation and evaluation
 Key nurses and health educators up to date on promotion on current health issues and problems.
6.5. Strategies:
 Reorientation of the Health Education Division from health education to a wider scope health
promotion.
 Review of roles, jobdescriptions to reflect health promotion priorities.
 Increase funding
 Secure donor assistance
 Identify appropriate IEC training courses.
 Organize regular meetings
 Establish guidelines for development of IEC materials
 Redirect Staff training to health promotion
 Organize regular health promotion workshops for local communities, church, and leaders.
 Improve community out reach programs and establish village health committees
 Strengthen the health education division and the production of IEC materials
 Review & change training programs to reflect health promotion focus, partnership and principles of
sharing resources.
 Improve social research capabilities of health promotion supervisors through training.
 Staff training -conduct refresher courses on health promotion
6.6. Action Steps:
 Reorientation of the Health Education Division
 T.A for IEC & Health Promotion
 Increase funding to Health Promotion from Health Budget
 Staff training
 Resourcing of the division Hard ware & soft ware
 Workshops
6.7. Implementing Division/ Department:
 Division: Health Education Division
 Responsible Officer: Director Health Education in collaboration with USHI and Program Managers.
74
3.14. Emergency and humanitarian action:
Solomon Islands like many other neighbor countries have experienced first hand of
disasters either natural or man-made. The unforgettable natural disasters were the, the Earth
Quark in 1978, Cyclone Namu in 1985, and the recent twenty months old ethnic tension
1999-2000, which its effect is still experienced. In respond to these natural disasters,
management was done through the National Disasters Council. The NDC is created in the
Ministry of Home Affairs under legislation, and is limited only to natural disasters
The Ministry of Health had been managing disasters though the NDC. Areas of
significant involvement in disaster management are the Social Welfare Division, Malaria
Division, Water Supply and Sanitation, Health Education and Promotion Division, the
Hospitals and Clinics.
However, there is no emergency management information system related to health.

There is limited information on the inventory of already identified and potential hazards, the
risk population, and forms of preparedness strategies. A key deficiency is proper emergency
information system.
Nonetheless, there is opportunity that a proper emergency management system can

be established. The key success factor would be to incorporate EMIS in the current Health
Information System at the Statistics Unit, Policy, Planning and Evaluation Division, Ministry
of Health. It may not be necessary to create an entirely new separate network but to see if
the current network could be linked to a database for EMS. The proposed EMS network or
structure will be reviewed in light of the existing Health Information System (HIS).
A project proposal is submitted to Manila office (WHO/WPRO) for funding to
implement EMIS.
4.0. Conclusion:
The report has revealed some achievements in the health sector as well as challenges,
and threats, and opportunities for the future health directions. There are general
improvements in the national malaria program, polio, national tuberculosis control program,
national diseases surveillance, and maternal health care. There also challenges to the
Solomon Islands Government in its planned health developments such as the health reform
programs, re-enforcement of the mental health services in a more active way, and prevention
of non-communicable diseases. The forthcoming tobacco bi llshou l
dt e s
tpol itici
a ns’de gr
ee
of commitment to the health of their people.
The evidence of support from foreign developing partners provide some
opportunities to be exploited especially in getting appropriate technology in the filed of
medicine andma na geme ntt ogether.The‘ r
ol lbackma l
aria’and‘ he al
thyi sl
a ndsi ni
tiati
ves’
are concepts to keep the momentum to drive health development forward. The past twenty-
mont hse thni cc r
isi
sc a usesde v as
tat
ionoft hec ountry ’
se conomya nda ffectedt hehe alt
h
75
services delivery. The rehabilitation and restoration of normal health services delivery will
take sometime.
76
ANNEX 1------------------------------
COMMUNITY PEACE AND RESTORATION FUND:
AUSAID
EXPENDITURE SUMMARY:
Wd No. Type Brief Description Beneficiaries Amt. Request Approved Funded Unused
Western
KeruHealth Centre Extension&
20 Health Extension and Improvement of Clin ic. Recc: Catchment area of 2040 people including 25,000.00 25,000.00 3,911.90 21,088.10
Improvements byPHS about 500 schoolchildren
Kolokolo Clinic Extension
8 Health Extension of health clinic. Recc PHS Catchment area of 1741people 31,945.00 31,945.00 22,203.26 9,741.74
Nila Clinic Repairs

2 Health Repair of existing health clinic due to Catchment are of 4257 people which 20,000.00 20,000.00 26,126.95 -6,126.95
earthquake damage. in cludessome displaced families
VakaboClinicImprovements
21 Health Improvements to Maternity Ward. Recc: PHS 5 communit ies with 1,700 people - about 25,000.00 25,000.00 14,242.30 10,757.70
half are youth and children
Western $101,945.00 $66,484.41 $35,460.59
Choiseul
Nukiki Clinic
6 Health Completio n of final 20% of new clinic. Catchment area of 2000 people. 29,703.50 21,077.50 9,955.15 11,122.35
Community paid for training of Nurse Aid
Pagoe Rural Health Centre
12 Health Construction of new Rural Health Centre. Catchment area of 10,000 31,967.00 31,967.00 12,636.07 19,330.93
(Co-funded)EU &Fly & Build. Fullysupported
Sasamunga xrayroomextension
5 Health extension to hopitalto house xray machin e Allof Choisuel 38,174.00 38,174.00 30,092.76 8,081.24
provided by otherdonor. App: by PHS
Choiseul $91,218.50 $52,683.98 $38,534.52
Isabel
Nodana Clinic
8 Health Upgradin g/Rehabilitation of a health clinic. 600 secondaryshool and 300 primary 30,000.00 30,000.00 10,380.00 19,620.00
Appr. by PHS school child ren. Catchment area of 3490.
Toelegu Aid Post
2 Health Upgradin g/Rehab. Aid Post clin ic. Also called 700 sickpatients from outside community 28,900.00 23,187.50 1,189.26 21,998.24
Isabel Kastom Herbal Clinic. Not part of official
Isabel $53,187.50 $11,569.26 $41,618.24
Central
Koela Aid Post Rehabilitation
13 Health Rehabilitatio n of existing Aid Post. Approved 400 communitymembers 70,000.00 11,512.23 11,362.36 149.87
byPHS
Koilovala Aid PostRehabilitation
5 Health Rehabilitatio n of existing Aid post. Approved 700 communitymembers inclu ding 10 70,000.00 15,244.50 1,525.10 13,719.40
byPHS displacd families
Page 1 CPRF Funded Projects: Expenditure Summary Monday, October 29, 2001
77
WdNo. Type Brief Description Beneficiaries Amt.Request Approved Funded Unused

MaralounAidPostRehabilitation
11 Health Rehabilitatio n ofexistingAid Post. Approved 500 communitymembers 70,000.00 15,244.90 8,958.58 6,286.32
byPHS
NaroguAidPostRehabilitation
3 Health Rehabilitatio n ofexistingAid Post. Approved 1000communitymembers-in clu ding7 70,000.00 15,244.90 926.10 14,318.80
byPHS displacedfamilies.
RavuAidPostRehabilitation
1 Health Rehabilitatio n ofexistingAid Post. Approved 500 communitymembersinclu ding 6 70,000.00 15,244.90 926.10 14,318.80
byPHS displacedfamilies
TogaAidPostRehabilitation
2 Health Rehabilitatio n ofexistingAid Post. Approved 300 communitymembers 70,000.00 15,244.90 926.10 14,318.80
byPHS
Central $87,736.33 $24,624.34 $63,111.99
Guadalcanal
BelahaClinic
20 Health Constructio nof2 unit classroom&turnedinto 300 people 18,143.40 18,143.40 2,176.25 15,967.15
a clinic. ApprovedbyCMO
SaroClinic
10 Health Constructio nofnewsatellite clin ic. Approved 500 people 11,921.00 11,921.00 11,685.65 235.35
byCMO
TasimbokoClinic
22 Health Renovation of clinic. ApprovedbyCMO Catchmentarea of4,200people 20,000.00 20,000.00 20,000.00
VisoClinicUpgrade
6 Health Upgradeof clinic. Approved byCMO 1,500 people 13,000.00 13,000.00 13,978.45 -978.45
Guadalcanal $63,064.40 $27,840.35 $35,224.05
Malaita
AfenakwaiClinic
9 Health Furnitureneededtocompleteclinic-bedsetc Catchmentarea of600 people 11,400.00 11,400.00 12,400.00 -1,000.00
Completion/Furnishing plusmedicin es. PHSapproved
AfioRural HealthCentre
Health Provision to renovate theexistingclin ic Catchmentof 2000people in ward25, 30,000.00 30,000.00 30,000.00
build in g. PHSapproved South Mala ita
AnomasuClinicRebuilding
4 Health Provision of roofing iron toupgradepostto Catchmentarea of550 people 30,952.70 30,952.70 55,243.45 -24,290.75
clinic. PHSapproved
GwarataAidPostUpgrading
14 Health Provision of roofing iron toupgradeAid Post to Catchmentarea of3,822people 16,121.00 16,121.00 36,497.85 -20,376.85
clinic. Agreed toprovide extra fundingdueto
Malu'uAreaHealthCentre
Health Upgradin g ofexistin gAreaHealthCentre. PHS 30,200.00 30,200.00 30,200.00
approved
ManawaiClinicImprovement
19 Health Upgradin g ofclinic. PHSapproved Catchmentarea of3,000people 15,000.00 15,000.00 8,389.05 6,610.95
Mbita'amaClinicUpgrading
7 Health Rehabilitatio n ofexistingclinic.-requested Catchmentarea of5,000people 15,000.00 15,000.00 15,000.00
equip etcetcfor$90,000. PHSapproved
Page 2 CPRFFundedProjects: ExpenditureSummary Monday,October29,2001

78
WdNo. Type Brief Description Beneficiaries Amt.Request Approved Funded Unused

NafinuaClinic Upgrading
15 Health Furniture and improved kitchen, toile tand Catchment area of 20,000 people 20,000.00 20,000.00 20,000.00
showerfacilitie s. PHSapproved in lcudin g 5,000displa cedpeople
OkwalaClinicEquipment
29 Health Sola rpoweretc-needsto be ordered from Popula tio n of 500 19,818.00 19,818.00 19,818.00 0.00
Australia. PHSapproved
OlomburiClinicImprovement 18& Health Provisio n of mattressesforclin ic. PHS Catchment area of 4,000 people 1,158.00 1,158.00 1,158.00 0.00
19 approved.
OteRural HealthClinic Building
11 Health Procurementofbuildin g materia ls - some Catchment area of 4,000 people 67,000.00 67,000.00 19,972.00 47,028.00
equipment costsdeferred. PHSapproved
Malaita $256,649.70 $153,478.35 $103,171.35
Makira-Ulawa
AorigiCommunityHealthAidPost
15 Health Extension to caterforpatie ntsadmitted to stay Catchment area i.e.Isla nd popula tio nof 16,900.00 16,900.00 12,405.80 4,494.20
Extension overnig ht . PHSapproved 2000.
Heraniau'uAidPostCompletion
7 Health Completio n of thefirstaid post -nearly fin ished 5,524 people in area of which1,476 wil 15,652.00 15,652.00 6,325.50 9,326.50
it already. PHSapproved directly benefit
HunutaNurseAidPost Completion
4 Health Const. of a 3 roomNurse Aid Post -Admissio n, 760 people in 7 communities 21,610.75 9,253.35 12,357.40
Office &Outpatie nt rooms. PHSapproved
ManasuguRural HealthClinic
9 Health Constructio nofadmissio n ward alo ngside Catchment are of1,731 in clu dng 10,507.60 8,924.03 1,583.57
existing clinic. PHSapproved displaced families
WaihagaHealthClinicAdmission
18 Health Provisio n of a perm.3 outpatientroomsto All the ward of 1,400 people 12,400.00 12,400.00 7,930.90 4,469.10
Ward repla ce the leaf house. PHSapproved
Makira-Ulawa $77,070.35 $44,839.58 $32,230.77
Temotu
Nea/No'oleClinic Additions
10 Health Additio nsto Clinic. PHSapproved catchement area of2500 9,054.20 9,054.20 2,740.00 6,314.20
Temotu $9,054.20 $2,740.00 $6,314.20
SummaryTotals $739,925.98 $384,260.27 $355,665.71
Page 3 CPRFFunded Projects: ExpenditureSummary Monday,October29,2001

79

Health Report 2000 - Solomon Islands

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Health Report 2000 - Solomon Islands

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MINISTRY OF HEALTH

Solomon Islands Government

NATIONAL ANNUAL HEALTH REPORT 2000

Review of Work of Ministry of Health,

SECTION 1: GENERAL INFORMATION ................................................................ 4

SECTION 2: ENVIRONMENTAL SITUATION ................................. 8

SECTION 3: TECHNICAL MATTERS-COMBATING

3.3. STOP TUBERCULOSIS ................................................................................................. 27

3.4. STI/ HIV/AIDS: ................................................................................................................... 31

3.5. VACCINE PREVENTABLE DISEASES: ..................................................... 34

2.6. THE HEALTHY ISLANDS, HEALTH CITY, INITIATIVES: .. 36

3.7. INFANT AND YOUNG CHILD NUTRITION: ......................................... 41

3.9. NON-COMMUNICABLE DISEASES (INCLUDING MENTAL

3.9.3. INITIATIVE TOWARDS TOBACCO CONTROL: .............................. 54

3.10. STRENGTHENING HEALTH SYSTEMS IN SOLOMON

3.11 TECHNICAL COOPERATION AMONG DEVELOPING

3. 12. ERADICATION OF POLIOMYELITIS: ....................................................... 71

SECTION 1: GENERAL INFORMATION

[Political and Socio-economical issues]

[staff management issues]

[Health Funding issues]

[Health Institutional Strengthening implementation issues-change management]

[Disruption of health services issues as a result of the conflict]

[Health Status Issues]

[Continuous health care services delivery despite the tension]

SECTION 2: ENVIRONMENTAL SITUATION

2.2. The Political System:

2.3. The Economy:

2.4. Factors Affecting Service Delivery:

2.4.1. External Factors:

infrastructure characteristics. We have recognized that the socioeconomic and demographic

During Height of the Conflict:

 Due to insecurity and military operations on Guadalcanal access are

 More patients were attending provincial hospital. Gizo hospital in the

As the Conflict Prolonged:

 Financing of health activities in the provinces such as cold chain

 Epidemiologically, it is difficult to assess the disease pattern as case reporting

As the Conflict Subsided and Peace is Negotiated:

 It is anticipated, that when the conflict subsides and eventually resolved

 Movement of population will increase greatly, while previously cut-off areas

Re-building and Charting the Way Forward:

Immediate level one priorities

1. The ongoing procurement of medical supplies must be maintained. Due to

2. In strengthening and supplementing the management capacity of the

3. The out-reach services to the provinces must be re-established. Funding and

5. Rebuilding the confidence of health workers is crucial and counseling of

6. Finally, level one priority for immediate action is the re-establishment of

Medium level one priorities:

1. As population movement increases demand on health services in the

2. The immunization program has proven to be very cost efficient measures to

4. As population moved to other provinces and the reduced number of patients

2.5. Internal Factors:

2.5.1. Management & Planning of Health Services:

comprehensive health management information system is essential. An area we lacked at the

2.5.2. Human Resource Management and Development:

2.5.3. Health Legislation:

2.5.4. Health Financing & Budgeting and Resource Allocation Factors:

Table (8) Distribution of the Recurrent Health Budget 1991-1

Sections 1991 1992 1993 1994 1995 1997 1998 1999

Source: Account Section, MOH (2000).

One of the fundamental problems contributing to the management of finance is the

2.5.5. Structural Reform:

SECTION 3: TECHNICAL MATTERS-Combating