26 January 2019
Solomon Islands: A national health service needing urgent funding leading to a transformation in better health services.
The Solomon Islands National Development Strategy 2016-2035 was launched in April 2016 with the vision of “Improving the Social and Economic Livelihoods of all Solomon Islanders.”
The SINDS emphasized a Role Delination Policy which, according to the then Permanent Secretary for Health, Dr Tenneth Dalipanda, would help define the range and level of services – or packages of care – to be delivered to given populations across the Solomons.
It would give answers to the questions: who does what, where, and for whom? What staffing and drugs would be required? What sort of buildings and transport? What would be needed in terms of drugs, energy, water, etc? What would be the cost to build, and more importantly what would be the cost to run each year and how many health workers would be required?
A health system review in 2015 by the WHO summarised the then current strengths and weaknesses of the health system as follows:
“The Solomon Islands is a small, low-middle income Pacific island country. With a population of some 670 000 and per capita health spend of SB$600 a year, its health system can be characterized as conceptually “fit for purpose” but needing ongoing maintenance and development in some key areas such as management and service administration. The system has significant weaknesses but also considerable strengths. With limited resources, the country achieves comparatively high rates of equitable access to basic services. It achieves this through a nurse-run provincial primary care system, with a relatively functional referral system and subsidized patient transport.
“Another description of primary health care has noted serious shortages of health workers, essential drugs, clinical equipment and medical supplies. The country is dealing with the “… double disease burden of both communicable and non-communicable diseases”.
“WHO has noted that there is steady progress in combating malaria and tuberculosis. NCDs are increasing, and 30.8% of men and 44.4% of women are overweight or obese, while early detection of diabetes remains a challenge.
“80% of the population lives in rural areas. But Rural Health Centres are often run down and have no staff.
“Surveys of area health centres and rural health clinics in 2005 in 2012 highlighted the urgent need for upgrade, repair or renovation; many facilities were operating without proper water and sanitation, electricity and basic medical equipment. Up to 70% of health clinics required significant upgrade, repair or renovation. The degradation of health facilities has happened over many decades, and while not properly and regularly maintained due to funding constraints and poor budgeting. There are serious shortages of clinical equipment and medical supplies at most health facilities, with hospitals often relying on old and poorly maintained medical, diagnostic and surgical equipment.”
Now in 2019 the WHO observations are as relevant today as in the period from 2005 to 2012 and the question to be posed is when will those earlier recognized “weaknesses” in health services be remedied and who will do what, where, when and for whom?
One might also pose the added, but important question, when will the National Referral Hospital (NRH) stop being used as a primary health care service, instead of being able to give specialist referred services and provided with the necessary diagnostic equipment, tools and trained, fully resourced medical personnel to function as it should?
The incoming government administration, following the general election in March, must support the current dedicated professionals in the MHMS, including the doctors, nurses, health care workers and other support personnel by fully funding the needs of the National Health Strategic Plan to ensure a better functioning health care system and a transformation beneficial to the health and welfare of all citizens.