National Health Report 2005

MINISTRY OF HEALTH
Solomon Islands
NATIONAL HEALTH REPORT 2005
June 2006
Ministry of Health: National Health Report 2005
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CHAPTER 1 INTRODUCTION.............................................................................................................................. 7
1.1 BACKGROUND:................................................................................................................................................... 7
1.2 AIM .................................................................................................................................................................... 7
1.3 OBJECTIVES ....................................................................................................................................................... 7
1.4 REPORT PROCESS AND STRUCTURE .................................................................................................................... 7
CHAPTER 2 SOLOMON ISLANDS DEMOGRAPHIC AND HEALTH STATUS INDICATORS ................ 8
2.1 DEMOGRAPHIC, GENDER AND POVERTY:........................................................................................................... 8
2.2 FERTILITY AND POPULATION GROWTH:.............................................................................................................. 8
2.3 LIFE EXPECTANCY :............................................................................................................................................ 8
2.4 AGE AND SEX STRUCTURE .................................................................................................................................. 9
CHAPTER 3 HEALTH SYSTEM AND NATIONAL RESPONSE: .................................................................. 11
3.1 SOLOMON ISLAND’S GOVERNMENT’S MAJOR ROLE IN ENSURING HEALTH FOR ALL ........................................ 11
3.2 ORGANIZATIONAL CHANGE IN THE STRUCTURE IN 2005: ................................................................................. 11
3.3 NATIONAL GOALS AND STRATEGIES FOR 2005: MINISTRY OF HEALTH OPERATIONAL PLANS 2005: .............. 14
3.3.1 Operational Planning:................................................................................................................................ 14
3.4 KEY GOVERNMENT’S NATIONAL HEALTH POLICIES: PLANS AND PRIORITIES: ................................................ 16
3.4.1 Solomon Islands Government Leadership .................................................................................................. 16
3.4.2 MOH Vision and Mission Statement........................................................................................................... 16
3.5 3.5. MINISTRY OF HEALTH’S COOPERATE PLAN 2006-8: ................................................................................. 16
3.6 3.6. MINISTRY OF HEALTH NATIONAL GOALS AND STRATEGIC PLANS:: ......................................................... 16
3.6.1 Revised National Goals and Strategies (in 2005, for 2006); ...................................................................... 16
3.7 MEETING UP WITH THE MILLENNIUM ............................................................................................................... 16
3.7.1 Development Goals: ................................................................................................................................... 16
3.7.1.1.1..............................................................................................................................................................................16
3.8 HEALTH INSTITUTIONAL STRENGTHENING PROJECT ........................................................................................ 16
3.8.1 Key Outcomes ............................................................................................................................................. 16
3.8.2 Constraints.................................................................................................................................................. 16
3.8.3 Future directions......................................................................................................................................... 16
CHAPTER 4 HEALTH SYSTEMS: HEALTH SERVICE DELIVERY AND EPISODES OF SERVICE
(DEMAND): 16
4.1 DEMAND ON THE PRIMARY HEALTH CARE: ..................................................................................................... 16
4.1.1 Access: ........................................................................................................................................................ 16
4.2 DEMAND ON HEALTH CARE INSTITUTIONS AND SERVICES: ............................................................................. 16
4.2.1 National Referral Hospital ......................................................................................................................... 16
4.2.2 Nursing in Solomon Islands:....................................................................................................................... 16
4.2.3 SI Nursing Council: .................................................................................................................................... 16
4.2.4 National Medical Imaging Division............................................................................................................ 16
4.2.5 National Pathology Services....................................................................................................................... 16
4.2.6 Dental (Oral) Services 2005 ....................................................................................................................... 16
4.2.7 Rehabilitation Division National Referral Hospital ................................................................................... 16
4.2.8 Distance Education Program: Ongoing Education for Nurses: ................................................................. 16
CHAPTER 5 HEALTH BURDEN......................................................................................................................... 16
5.1 OVERVIEW: ...................................................................................................................................................... 16
5.2 THERE ARE SEVERAL MAJOR HEALTH ISSUES AFFECTING SOLOMON ISLANDS.................................................. 16
5.3 COMMUNICABLE DISEASES:............................................................................................................................. 16
5.3.1 Acute Respiratory Infection: ....................................................................................................................... 16
5.3.2 Clinical Malaria ......................................................................................................................................... 16
5.3.3 Yaws and Skin Disease ............................................................................................................................... 16
5.3.4 Ear Infection ............................................................................................................................................... 16
5.3.5 Red Eye:...................................................................................................................................................... 16
5.3.6 Diarrhoea ................................................................................................................................................... 16
5.4 TUBERCULOSIS AND LEPROSY CONTROL PROGRAM ........................................................................................ 16
5.4.1 Tuberculosis Control Program:.................................................................................................................. 16
5.4.2 Objectives of the National TB Program (NTP): ......................................................................................... 16
5.4.3 General Objective:...................................................................................................................................... 16
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5.4.4 Specific Objectives...................................................................................................................................... 16
5.4.5 Activities Conducted in 2005 ...................................................................................................................... 16
5.4.6 Health Education / Community Awareness ................................................................................................ 16
5.4.7 World TB Day Commemoration – 2005 ..................................................................................................... 16
5.4.8 Monitoring and Supervision: ...................................................................................................................... 16
5.4.9 Annual TB/ Leprosy Review........................................................................................................................ 16
5.4.10 TB Situation by 2005 .............................................................................................................................. 16
5.4.11 New Case Detection Rate:...................................................................................................................... 16
5.4.12 Case Notification by Provinces .............................................................................................................. 16
5.4.13 Age and Sex Distribution of New Sputum Smear Positive Cases ........................................................... 16
5.4.14 TB Infection by Site ................................................................................................................................ 16
5.4.15 Case Holding and Treatment Outcome .................................................................................................. 16
5.4.16 Tuberculosis Death................................................................................................................................. 16
5.4.17 Leprosy Control Program ...................................................................................................................... 16
5.4.18 New Leprosy Case Notification .............................................................................................................. 16
5.4.19 National Leprosy Prevalence ................................................................................................................. 16
5.4.20 Capacity Building in Leprosy ................................................................................................................. 16
5.4.21 Constraints and Weakness...................................................................................................................... 16
5.4.22 Recommendations: ................................................................................................................................. 16
5.4.23 Acknowledgement ................................................................................................................................... 16
5.4.24 Compiled By:.......................................................................................................................................... 16
5.4.25 Core Indicators for TB Program in 2005:.............................................................................................. 16
5.5 ENVIRONMENTAL HEALTH............................................................................................................................... 16
5.5.1 Overview:.................................................................................................................................................... 16
5.5.2 Priority Strategy/Action .............................................................................................................................. 16
5.5.3 Immediate ................................................................................................................................................... 16
5.5.4 Long Term Objectives ................................................................................................................................. 16
5.5.5 Strategies for 2005...................................................................................................................................... 16
5.5.6 Solid Waste ................................................................................................................................................. 16
5.5.7 Net Working with NGOs ............................................................................................................................. 16
5.5.8 Integrated Research on Approaches ........................................................................................................... 16
5.5.9 Food Safety and Quality Control- ICU....................................................................................................... 16
5.5.10 Health Quarantine Services.................................................................................................................... 16
5.5.11 EHD Training Report 2005 .................................................................................................................... 16
5.6 NON- COMMUNICABLE DISEASES .................................................................................................................... 16
5.7 COMMUNITY-BASED SERVICES:....................................................................................................................... 16
5.8 SOCIAL WELFARE DIVISION:............................................................................................................................ 16
5.8.1.1 Brief Background/Introduction:...........................................................................................................................16
5.8.1.2 Social Welfare Data Summary (Brief):................................................................................................................16
5.8.1.3 Organization & Staff: Social Welfare Office:......................................................................................................16
5.8.1.4 Trainings Undertaken During the Year:...............................................................................................................16
5.8.1.5 Organisation Structure: ........................................................................................................................................16
5.8.1.6 Activities Taken During the Year: .......................................................................................................................16
5.8.1.7 Activities and Achievements: ..............................................................................................................................16
5.8.1.8 Annual Health Outcomes (relates to Goals/Outputs/Indicators: ..........................................................................16
5.8.1.9 HR. Issues:...........................................................................................................................................................16
5.8.1.10 Infrastructure/Maintenance/Equipment Issues:....................................................................................................16
5.8.1.11 Issues for Consideration in Future Planning: .......................................................................................................16
5.8.1.12 Any Other Comments: .........................................................................................................................................16
5.9 HEALTH PROMOTION: ...................................................................................................................................... 16
5.9.1 Activities and Accomplishments.................................................................................................................. 16
5.9.1.1 National Level .....................................................................................................................................................16
5.9.1.2 Provincial Level...................................................................................................................................................16
5.9.1.3 Financial Information ..........................................................................................................................................16
5.9.1.4 Issues for Consideration In Future Planning........................................................................................................16
5.9.1.5 Constraints and Possible Strategies/Actions ........................................................................................................16
CHAPTER 6 SYSTEMS PERFORMANCE- MONITORING AND EVALUATION: .................................... 16
6.1 MINISTRY OF HEALTH: PERFORMANCE EVALUATION ...................................................................................... 16
6.1.1 The Scan of the Public Administration Functions....................................................................................... 16
6.1.1.1.1 Fig 25 and Table 6 shows the ratings for the MOH: 1 –lowest, and 5-highest................................................16
6.2 PRIMARY HEALTH CARE CLINICS UTILISATION ................................................................................................. 16
6.2.1 Solomon Islands Primary Health Care Clinics Utilisation Review ............................................................ 16
6.2.1.1 Major discussion points: ......................................................................................................................................16
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6.2.1.2 Recommendations Clinic Utilisation Review ......................................................................................................16
6.3 ROLE DELINEATION FOR PHC CLINICS AND HOSPITALS: .................................................................................. 16
6.3.1 Introduction ................................................................................................................................................ 16
6.3.2 What are packages of care?........................................................................................................................ 16
6.3.3 How do packages of care articulate with role delineation? ....................................................................... 16
6.3.4 Continuum of Care...................................................................................................................................... 16
6.4 PHC QUALITY CHECK : ................................................................................................................................... 16
6.4.1 MOH Infrastructure -Issues:...................................................................................................................... 16
6.4.2 National Infrastructure Management: ........................................................................................................ 16
6.4.3 Provincial Infrastructure Management: ..................................................................................................... 16
6.4.4 Local Infrastructure Management .............................................................................................................. 16
6.4.5 Health Infrastructure Reviews .................................................................................................................... 16
6.4.6 Provincial Hospitals & housing.................................................................................................................. 16
6.4.7 AHC Rehabilitation Plans........................................................................................................................... 16
6.4.8 RHC Clinic Review:.................................................................................................................................... 16
6.4.9 Unfit or inappropriate birthing facilities .................................................................................................... 16
6.4.9.1 Need for upgrade of equipment & furniture: .......................................................................................................16
6.5 PROGRAM PERFORMANCE:............................................................................................................................... 16
6.5.1 Program achievements of Outputs in 2006:................................................................................................ 16
6.5.1.1 Environmental Health Division- : ........................................................................................................................16
6.5.1.2 HIV/STI Prevention- Disease Prevention and Control Unit ................................................................................16
6.5.1.3 NCD Prevention: Disease Prevention and Control Unit ......................................................................................16
6.5.1.4 Community Based Rehabilitation ........................................................................................................................16
6.5.1.5 Distance Education Program: ..............................................................................................................................16
6.5.1.6 Social Welfare .....................................................................................................................................................16
6.5.1.7 TB and Leprosy Prevention and Control. ............................................................................................................16
CHAPTER 7 PROVINCIAL HEALTH SERVICES ........................................................................................... 16
7.1 CHOISEUL PROVINCE: ...................................................................................................................................... 16
7.2 HEALTH BURDEN IN CHOISEUL 1996-2005...................................................................................................... 16
7.2.1 Introduction ................................................................................................................................................ 16
7.2.2 Major Health Issues.................................................................................................................................... 16
7.3 WESTERN PROVINCE ........................................................................................................................................ 16
7.3.1 Health Burden in Western........................................................................................................................... 16
7.4 ISABEL PROVINCES .......................................................................................................................................... 16
7.5 CENTRAL ISLANDS PROVINCE .......................................................................................................................... 16
7.6 GUADALCANAL ................................................................................................................................................ 16
7.7 MALAITA ......................................................................................................................................................... 16
Fig 35 Population of Malaita by Gender 7 yr trend ..................................................................................................................16
7.8................................................................................................................................................................................. 16
7.9 MAKIRA:.......................................................................................................................................................... 16
7.10 TEMOTU . ......................................................................................................................................................... 16
7.11............................................................................................................................................................................... 16
7.12 RENNELL BELLONA ......................................................................................................................................... 16
7.13 HONIARA ......................................................................................................................................................... 16
CHAPTER 8 RESOURCE UTILISATION .......................................................................................................... 16
8.1 FUNDING FOR HEALTH IN 2005:....................................................................................................................... 16
8.1.1 Issues: ......................................................................................................................................................... 16
8.2 HUMAN RESOURCE FOR HEALTH IN 2005 ........................................................................................................ 16
8.3 ISSUES:............................................................................................................................................................. 16
CHAPTER 9 HEALTH LEGISLATION.............................................................................................................. 16
9.1 HEALTH CARE LEGISLATION REVIEW:............................................................................................................. 16
9.2 HEALTH SERVICES ACT 1979........................................................................................................................... 16
9.3 THE HEALTH SERVICES (HOSPITALS) REGULATIONS 1980 .............................................................................. 16
9.4 ENVIRONMENTAL HEALTH ACT 1980 .............................................................................................................. 16
9.5 MENTAL HEALTH ACT 1970: ........................................................................................................................... 16
9.6 HEALTH WORKERS ACT 1982:......................................................................................................................... 16
9.7 MEDICAL AND DENTAL PRACTITIONERS ACT 1988 ......................................................................................... 16
9.8 NURSING COUNCIL ACT 1987 .......................................................................................................................... 16
9.9 PHARMACY AND POISONS ACT 1941................................................................................................................ 16
9.10 PHARMACY PRACTITIONERS ACT 1997............................................................................................................ 16
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9.11 OVERVIEW:: KEY HEALTH PROBLEMS .............................................................................................................. 16
9.12 ISSUES RAISING AND FACT (EVIDENCE) FINDING: ............................................................................................ 16
9.12.1 10.2.2. Findings: .................................................................................................................................... 16
9.12.2 Pattern of resorts: .................................................................................................................................. 16
9.12.3 Barriers to seeking health care .............................................................................................................. 16
9.12.4 Usual attitude towards health: ............................................................................................................... 16
9.12.5 Factors affecting provider choice........................................................................................................... 16
9.12.6 Cultural barriers to specific disease –Malaria....................................................................................... 16
9.12.7 Cultural barriers to – i. Reproductive health ......................................................................................... 16
9.12.8 Problems with service delivery and human resource issues: ................................................................. 16
9.13 THE WAY FORWARD:....................................................................................................................................... 16
CHAPTER 10 KEY ACTIVITIES FOR 2006 ........................................................................................................ 16
10.1 OVERVIEW ....................................................................................................................................................... 16
10.2 SOME OF THE KEY ACTIVITIES FOR 2006 ......................................................................................................... 16
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AHC Area Health Clinics

ARI Acute Respiratory Infection
CHP Choiseul Province
CIP Central Islands Province
EHD Environmental Health Division
GP Guadalcanal Province
HCC Honiara City Council
HISP Health Institutional Strengthening Project
HISP Health Information System
Human Immunodeficiency Virus and Sexually Transmitted
HIV/STI Infections
HR Human Resource
ICPD International Convention Population Development
ICU infection Control Unit
MDG Millennium Development Goals
MOH Ministry of Health
MP Malaita Province
MUP Makira Ulawa Province
NAP Nurse Aide Post
NCD Non-Communicable Diseases
NGOs Non-Governmental Organizations
NHR National Health Review
NRH National Referral Hospital
OP Operational Plan
PHC Primary Health Care
PHD Provincial Health Directors
RBP Rennell Bellona Province
RHC Rural Health Clinic
RWSS Rural Water Supply and Sanitation
TB Tuberculosis
TP Temotu Province
WHO World Health Organization
WP Western Province
YP Ysabel Province
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Chapter 1 Introduction
1.1 Background:
The purpose of this report is to provide information and feedback on the local activities undertook by the
divisions and disease control programs both at the national and provincial levels in order to achieve a
highest quality of care and to ensure that the health and well being of the people in the country is guaranteed
and attained.
The “National Health Report 2005 (NHR)”, details trends and changes in diseases of public health
importance in Solomon Islands and describes some aspects of health service delivery, against national and
international health indicators. By doing so the report provides information for development of the revised
National Goals and Strategies in 2005 and hints on MOH National Health Strategic Plan 2006-2010 and sets
baselines against which future change can be measured.
The report attempts as close as possible reporting on available information as it emphasizes on ‘evidence-
based’ policy and decision making as pivot for future directions on health.
This report is primarily build on the, “Solomon Islands Health Status Assessment 20051
1.2 Aim
To report the health of Solomon Islands people in the period 1993-2005 against Solomon Islands MOH and
appropriate international indicators, and systems performance in 2005.
1.3 Objectives
Identify and utilize available MOH division health data sets for the health status report
Identify and utilize available data and information from researches and studies on health systems and human
resource performances.
Identify MOH and international health indicators against which to report data (as permitted by available data)
To present the national and provincial health data for the decade 1995-2005 so that trends in disease
incidence can be reported
To identify and utilizes sources of issues affecting the health status and system in 2005 and the past years.
To present some of the broad strategies developed in addressing the issues and flag the way forward.
1.4 Report process and structure

The National Health Report 2005 takes a slightly different turn in featuring;
Brief overview of provincial health burden and the response by the provincial health services Chapter 7.
Review of existing health legislation in Chapter 9
The report begun with reviewing the demographic and health status indicator in 2005 in Chapter 2.
In Chapter 3 the report highlighted two key changes in the organizational structure of the Ministry of Health.
Also in the same Chapter, Solomon Islands standing MDGs2.
The report covers the demand on health care system of the country in Chapter 4.
In Chapter 5 the update on the health burden of the country is covered. Further review of the trend of the
common illnesses was presented in detail in Chapter 7.
Chapter 8 briefly covers the resources utilized for health services delivery in 2005.
Chapter 10 summarizes the broad issues in a presentable way, and the like strategies developed to solve or
alleviate the health problems and issues identified.
Chapter 11 briefly concerns with the key activities for the first half of 2006.
1 Health Institutional Strengthening Project / MOH (2005): “Solomon Islands Health Status Assessment 20051
2 Millennium Development Goals
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Chapter 2 Solomon Islands Demographic and Health Status

Indicators
2.1 Demographic, Gender and Poverty: “A key
indicator of
Solomon Islands population is fast growing and remained very young. It is evident concern is
that the young population health demand on the system is ever growing in the past the high
decades and at present.
maternal
deaths at
around 236
in 2005”
Table 1. Core population and health data (2005)

Population [Total] 471,266 [1] Life [Both] 63.4
expectancy
[0-14 years] 225,615 (47..9%) [1] at birth [Male] 62.6
(years)
[65+ years] 3.12% [1] [Female] 64.3
Crude birth rate 23.2 [1] Total fertility 3.79

(per 1000 pop) rate
Crude death 6.7 [2] % of [Total]* 71
rate population
(per 1000 pop) served with [Urban]* 94
safe water [Rural]* 65
Infant mortality 16.3 [1] % of [Total]* 34
rate population
(per 1000 live with adequate [Urban*] 98
births) sanitary [Rural]* 18
facilities
Maternal 236 [1]
mortality rate
(per 100 000
live births)
2.2 Fertility and population growth:
According to the various available data on population growth
Total fertility rate in 1987-1999 was 4.8 (decreased from 6.1 in 1984-1986).
TFR has been estimated to be reduced to 4.053 in 2003 and now to 3.794.
Crude birth rate is 36 per 1,000
Crude death rate 9 per 1,000 (9.6/1000 males, 8.4/1000 females)
Total population growth 2.7 percent in 1999
Average population growth 2.8 percent 1986-1999
2.3 Life expectancy :
3 Figure for the Annual Health Report 2003

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Life expectancy at birth 1999 males 60.6 years
Life expectancy at birth 1999 females 61.6 years
2.4 Age and sex structure
Sex ratio 107 males/100 females at birth
Median age in 1999, 18.7 years (18.6 males, 18.9 females)

Population aged less than 15 years, 41.5% of the total population and 2)
The population less than 15 has declined from 47.3% in 1986 reflecting decreasing fertility
Figure 1 - the proportion of population by age group
C h a r t S h o w in g p r o p o r tio n b y a g e -g r o u p
600000
500000
65+
400000
5 0 -6 4
Pop
300000
1 5 -4 9
200000
0 -1 4
100000
0
2001 2002 2003 2004 2005
Y e ars
Issues/ constraints/ Evidence

challenges:
Population projections5 This is best demonstrated through vaccination rates of infants. In
some provinces vaccination coverage rates exceed 100% across
several vaccination types indicating that the estimated cohort for the
particular province is too low. Nationally the number of infants
vaccinated falls in a range that never exceeds 12,000, less than the
13,000 + estimated < 1 year old population. This may indicate that
the under 1 cohort is overestimated or that a number of children are
never vaccinated.
The 1999 – 2004 population projections, derived from census data, were estimated according to
the national medium high projection variant (N2). Based on past and current (at the time of writing
in 1999) population trends, this was considered by census authors the most likely variant to
plausibly indicate future population growth, gave the closest population forecast and so was
recommended for planning use. Methods for estimating population projections and their limitations
are discussed in the census analysis document.
While the census authors do not give similar recommendations for provincial population figures
(these may not be as accurate, given economic and political change), these were used as
denominators in this report as they are the best estimate available. As a result of possible
inaccuracies of these provincial projections, rates of disease may be over or underestimated.
Options & Strategies:
Despite the difficulties observed, a single standard set of population projections based on the most
recent evidence available (1999 census), need to be adopted by MOH and each division to ensure
that there is consistency of denominators when calculating rates of disease.
5HISP/MOH (2005) Issues of population projection flagged in the , “Solomon Islands Health Status Assessment 2005
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Figure 2 - Population by 5 year age group and sex, Solomon Islands, 1999
80-84
70-74
60-64
50-54
40-44
30-34
20-24
10-14
0-4
-10 -8 -6 -4 -2 0 2 4 6 8 10
M% F%
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Chapter 3 Health System and National Response:

3.1 Solomon Island’s Government’s Major role in ensuring health for all
“Existing Health
The Solomon Islands Government is a major health provider, funder Legislation needs
and regulator of health services for the people in the country. The updated”
governing legislation for health services delivery is enacted under the
Health Services Act 1988, which is outdated and need significant changes.
In the past few years Government’s role as a key funder was denied by the economic crisis due to
the past ethnic tension. Fortunately the economic recovery has enabled the return of health
services as it is evident in the reports from the provinces. Nonetheless, whilst we have improved in
increasing Solomon Islands Government’s share in the health expenditure
in 2005 and also in 2006, all the cost of the medicines and other essential “HSTA to
pharmaceutical supplies are currently paid by the AusAID funded Health transfer some
Sector Trust Fund. SIG is still faced with USD120,000 debt to UNICEF for costs to SIG in
vaccines used since early 1990s. This is are some outstanding financial
issues, which has cost our incredibility to external supporting organizations.
The Ministry of Health Executive soon be making a decision on how to transfer the costs into the
SIG funds as the HSTA will be reduced. The total cost of all medicines the Ministry orders and
purchase for the country is around SDB16-20 Million.
3.2 Organizational change in the structure in 2005:
In 2005 there are two organization changes to the structure of the Ministry of Health. (1) is the
realignment and re-emphasis on Health Improvement which is the public health programs in the
national provincial and community levels, and the national and provincial curative services under
the Health Care paradigm, and extra emphasis on the logistic and administration and management
support to the health care (HC) and the health improvement programs at the national strategic and
provincial operational and implementation levels. The changes have been discussed in all major
health meetings and conferences in 2005.
(2) The second change is really to the signify and to institutionalized effectively the public health
functions of the Governments’ Ministry of Health in order to respond effectively and efficiently to
common and emerging diseases that causes illnesses and death to the people of the Solomon
Islands. In 2004 and then in 2005 national health conference in December 2005 the Public Health
Vision6 declaration was endorsed for adoption and further strengthening and development.
6 Ministry of Health (2005): USHI presentation on the Public Health Vision

Figure 3 - Organization Chart: Ministry of Health with position holders in 2005
Minister of Health
Permanent Secretary Dr. Judson Leafasia
Under Secretary Health Improvement Under Secretary Health Care (by Dr.G.Malefoasi) Under Secretary Administration (vacant)
Dr.G.Malefoasi
National Prevention & Control Programs: Professional Boards: National Policy & Planning (Mr.
Environmental Health (Mr. Robinson Fugui) Nursing & Medical services A.Namokari)
Health Promotion (Mr. Alby Lovi) Specialist Care Services: Coordination & Integration with
Vector Born Disease Control (Mr. Bernard National Referral Hospital (Mr. R.Suinao) External
Bakotee) Provincial Hospitals (Prov. Directors) Stakeholders
HIV/STI (Dr J. Paulsen) National Psychiatric Unit (Dr. Judie) Health Asset Management & Planning
TB & Leprosy (Mr. N. Itogo) Paramedical Services: National Medical stores
Non Communicable Diseases (Ms. Diagnostic Services (X-Ray, Laboratory, Information Technology
N.Laesango) Tele-pathology) Human Resources Management
Reproductive/Child Health (Dr.J.Pikacha) Dental Services (Dr. C. Alependava) Human Resources Development
SIMTRI (Public Health Training & Research) Pharmacy (Mr.R.Skinner) Finance:
(Mr. M.Tuni) Physiotherapy (Mr.C.Gauba) Financial Management
Epidemiology & Disease Surveillance (Vacant) Monitoring & Evaluation: Resource Allocation Formula
Provincial Health Services: Health Information Systems (Ms. Bakaai)
Provincial Primary Health Care (vacant) Coordination: Coordination:
Honiara City Council (Dr. Scott Siota Aid-Donor Coordination Aid-Donor Coordination
Community Based Services: Cross-sectoral Development Cross-sectoral Development
Social Welfare (P.Fia) Planning:; Policy Development; Health Planning:
Community Based Rehabilitation Legislation Policy Development; Health Legislation
(Ms.D.Yates)
Mental Health (Mr. W.Same)
Coordination:
Partner development Coordination (churches,
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Figure 4 Public Health Vision for Strengthening and Improvement
Undersecretary Health Improvement
Secretary-admin + management
All Notifiable Diseases – Reproductive Health Psycho-Social Welfare Vector Borne Disease Env health CBR Mental Health
Disease Prevention and Control
NCD (Non-communicable Diseases) Health Promotion

Communicable Diseases (CD)
National Capacity Development Provincial CD programs
HIV/ STI Control Prevention

ARI/ Influenza IMCI TB + Leprosy
HIV/STI Planning +Coordination ME)
Diarrhoea Disease Staffing Staffing
Nutrition Service delivery PHC-Clinics Service delivery PHC-Clinics
Epidemic-Disaster Alert & Response Community Partnership Community Partnership
Information + Surveillance
Public Health Laboratory
NGO/ Civil Society partnership

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3.3 National Goals and Strategies for 2005: Ministry of Health Operational Plans
2005:
3.3.1 Operational Planning:
In 2005 further development and improvement were made in the operational plans of the divisions and
specific programs: The operational plan framework7 include the following as summarized in the diagram
below:
Division/Department:
National Goal:
Outcome Indicator:
Strategy:
Objective:
Activity Input Input Resource Funding When & Person Output Date
Staff Resources Costs Source Location Responsible Indicator Achieved
Table 2 Operational Planning Guideline and Templates Source: HISP:
Evidence
Issues raised on operational planning of health services:
Supporting Evidence:
Level of implementation has been very low8
Program Implementation by Divisions by end of Sep 2005
90% 90%
80% 80%
70% 69%
64%
60% 1ST
50% 2ND
44%
40% 36% 3RD
33%
30%
24%
20% 20%
10% 6%
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2005 the overall implementation of the Ministry of Health national programs was just below fifty
percent (i.e. 36%) by end of the third quarter.
Provincial health services and national programs are to meet regularly as teams to monitor Op plans;
activities are reprioritized
Further assistance required with translation of goals, strategies, objectives – some confusion &
further knowledge on outputs & outcomes
7 Ministry of Health/ HISP:

8 USHI/ MOH (2005) ME implementation rates: Presentation by USHI at the National Health Conference 2005 November.
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Need for Op plan activities to be linked to budget [this is the most significant feedback] further training
in budget management required
Within the operational plan need for more information on quality improvement and service/program
integration
Need for further consultation with health teams, communities, etc – consultation while touring, with
village health committees & village meetings
Feedback on Op plans essential and request one on one feedback
For 2007 – no significant changes, focus on activities with budget with a simplification of the
operational plan template as well as HR & budget templates; developing the op plans as a team.
Many programs and divisions have implemented genuine and (many other authorized activities).
Options & Strategies
For 2006: The Operational Planning Guidelines was strengthened and linked to the Budgeting
process for 20069. The National Goals and Strategies were revised and strengthened along
First Steps
Get basic
+ Describe =
Describe Planned Operational
Core Initiatives Pl
Core Marginal Total

Business + Costs of = Divisional
Budget Planned Budget
Divisional SIG Developme Output &

Establishm Recurrent nt Budget Outcome
t B d t I di t
Planning Flow Chart10 (Quantify what we plan to do):
The National Goals and Strategies were revised and strengthened along with the budget.11
Executive Development Program12 was planned and resourced. The purpose is to buld the
capacity of senior health managers and middle managers to manage, plan and supervise their
program and divisional activities.
9 HISP/MOH: Operational and Budgeting Guidelines and Templates: For 2006 operational and budgeting process.
10 Planning Flow Chart was presented by Mr. Abraham Namokari during the National Health Conference 7-11 November 2005.
11 Ministry of Health (2005): MOH 2006 Operational Plans and Budget.
12 HISP/MOH (2005): Executive Development Program developed by HISP and run by the University of NSW.
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3.4 Key Government’s National Health Policies: Plans and Priorities:
3.4.1 Solomon Islands Government Leadership
The changes incorporated within the MOH structure and the efforts through the HISP describes the task of
defining new strategic directions for the Government health sector as integral to the search for a new and
comprehensive health and well-being paradigm for the Solomon Islands. This search enlivens the MHMS
vision and mission statement and creates the motivation to move towards meeting that challenge..
3.4.2 MOH Vision and Mission Statement
The MOH endorses the Solomon Islands Constitution (and the WHO definition of health) as the
fundamental right of every human being without distinction of race, gender, religion, political belief,
economic or social condition to enjoy the highest attainable standard of health.
The MOH envisions “open, healthy, happy and productive Solomon Islander people” and
continually upgrades its activities to fulfill its mission of “promoting, protecting, and maintaining the
good health and well being and hence improve the quality of life of all people in the Solomon
Islands”
The MOH will strive to fulfill that mission within the context of National Health Legislation and within
the limits of resource availability.
Our guiding principle is “the people’s health is our passion” and the MOH will do all its best with the
resources available to serve our people with love, commitment and dedication so that the health of
our nation becomes an asset rather than a liability.
3.5 3.5. Ministry of Health’s Cooperate Plan 2006-8:
The Ministry of Health and Medical Services developed a “Corporate Plan for 2006-2008”13 based
on the gain during 2004 and 2005 with the following eight priority areas.
Improvement of management and supervision of services;

Improved access to quality care;
Management and development of human resources for health care;
Mortality and morbidity reduction;
Maintain healthy environments;
Promote healthy living and lifestyles;
Improve reproductive health and family planning and;
Forge partnerships in health development.
This plan entails the future directions in terms of strategies and plans for the next three years
demonstrating the Government’s commitment to meeting the MDG Goals.
However, improving of Public Health and Primary Health Care functions, focusing
on the prevention and control of no communicable diseases and STI/HIV/AIDS
will be among the top priority programmes.
3.6 3.6. Ministry of Health National Goals and Strategic Plans::
In April 2005, the national goals and strategies during a planning workshop14. The review is done in light of
review of the health status report in 2004, the new goals and strategies will be implemented in the 2006
operational plans.
13 Ministry of Health (2005) Corporate Plan 2006-8 (The Ministry of Health has planned and already into a National Health
14 MOH (2005): National Strategic Workshop 11-15 April 2005: National Health Status Report presentation by Dr G Malefoasi
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3.6.1 Revised National Goals and Strategies (in 2005, for 2006);
Reduce Maternal Mortality Rate from 184/100,000 live births to 125/100,000 live births by 2010
Reduce morbidity and mortality rate of children below 5 years of age due to common childhood
illnesses and vaccine preventable diseases.
Reduce impact (morbidity) and severity (epidemics, mortality) of Communicable diseases in
Solomon Islands.
Implement the ‘National HIV Policy and Multi sect oral strategic plan 2005-10’15 with the aim to
sensitize people through informed HIV awareness and behavioral change interventions to stop the
transmission of HIV, and to ensure accessibility to quality voluntary, confidential, counseling and
testing as the entry point for continuum of quality care, including anti retro-viral treatment, for
people living with HIV/AIDS.
Reduce incidence of preventable skin diseases by 2010.
Promote clean water, proper sanitation (including waste disposal), food quality and food safety
(incl. food hygiene)
Reduce the incidence of Malaria from 184/1000 people in 2004 to 80/1000 people by 2010.
Reduce impact (morbidity) and severity (disability, mortality) of all Non Communicable Diseases in
Solomon Islands.
Reduce prevalence of dental caries in all children by 2010
Raise public and health service provider awareness on the impact of substance misuse and
assess the level of psycho-social problems resulting from substance abuse.
Reduce incidence of suicide in SI over next 10 years.
Provide essential primary health care to all individuals and families, in an acceptable and cost-
effective, affordable way, and with their full involvement ensuring best practice, high quality and
improved patient/client/community care.
Enhance behavioral change which promotes a healthy lifestyle and family health, especially related
to reproductive health, child health, NCD’s, mental health and Communicable Diseases like
malaria and HIV/STIs.
Improve access to required essential drugs, medical equipment and medical supplies of
appropriate quality at all levels of health service
Improve infection control practices at all levels of health services with the aim of reducing infections
acquired within health settings.
Ensure appropriate referral between all levels of health service.
Improve continuum of patient care by strengthening the admission and discharge processes
(including communication) at all levels of health service.
Ensure early diagnosis and consequently appropriate treatment for patients.
Provide quality patient care to a level consistent with best practice with the aim of reducing length
of stay in hospital.
Provide appropriate level of patient care in hospital settings by ensuring minimal level of services
and minimum staffing requirements
Provide a safe environment for patients and staff
Undertake evidence based health service planning and management
Increase capacity of all managers and their health teams to be involved in operational planning and
its use to ensure appropriate, effective and efficient health service delivery
Ensure funds allocated in the budget are spent appropriately and in a timely manner to ensure
planning and implementation of appropriate health services
Improve the management of health assets and equipment at all levels of the health care system
Improve management and supervision of health services/health workers in order to manage and
sustain positive change in health service delivery
Establish a MOH information center where information can be accessed by all stakeholders
Enhance development of partnerships with stakeholders to ensure effective delivery of health
services
Improve health infrastructure to support health service provision.
15 National HIV Policy and Multi sectoral strategic plan 2005-10 Solomon Islands, January 2005, 3rd edition
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3.7 Meeting up with the Millennium

3.7.1 Development Goals:
The Solomon Islands Government through the Ministry of Health is committed in meeting the MDG. The
Ministry of Health continued to report against the MDG’s indicators.
Goal 1: Eradicate hunger and poverty

Goal 4: Reduce child mortality
Goal 5: Improve maternal mortality
Goal 6: Combat HIV/AIDS, Malaria and other diseases
Goal 7: Ensure environmental sustainability
Goal 8: Develop a global partnership for development
National Health Policies & Development Goals 1999-2003: and 2004-5 Work Plans
Policy 1: Improvement of management and supervision of service.

Policy 2: Access and Improvement of Care and Quality of service
Policy 3: Human Resource Development for Health
Policy 4: Morbidity and Mortality Reduction
Policy 5: Environmental Health
Policy 6: Health Promotion and Education
Policy 7: Reproductive Health, Family Planning and Population Concerns.
Policy 8: Developing Partnership in Health Development
3.7.1.1.1
Diagram 1: MDGs and ICPDS and National Health Policy Goals:
Table 3 showing updates of the MDGs, ICPDs and National Health Policies Goals Indicators:
MDGs Goal ICPD Goals/ National Health Goals/ 2004 Indicators 2005 Indicators
Target Target
Reduce Child Goal: To reduce infant 17 per 1,000 live 16.3 per 1,000 live
Mortality Mortality mortality from 42.7% births birth
reduction in 1990 to less than
Infant 30% by 2003.
mortality rate:
50 infant
deaths per To reduce child
1,000 per live mortality rate (1-4)
births from 7.1% to less than
5% by 2003. 1.8 per 1,000 pop
0.9/1,000 1-4 yrs
population 1-4 yrs
Improve Maternal To reduce maternal 276 per 100,000 236 per 100,000
maternal mortality ratio: mortality rate from live births live births
mortality 100 maternal 357/100,000 live births
deaths per by 50% by 2003 (less
100,000 live than 178/ 100,000 live
births birth).
Page 19 of 250
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MDGs Goal ICPD Goals/ National Health Goals/ 2004 Indicators 2005 Indicators
Target Target
Combat HIV/STI:
HIV/AIDS, To reduce the STI cases STI rate per 1,000
Malaria and morbidity rate of STI increased >2,000 in pop adults
other from 1,464 cases in 2003. increased from 11
diseases. 1995 by 50% by 2003. per 1,000 pop in
To prevent HIV/ AIDS Four (4) new HIV 2001 to 17 per
infection. positive people 1,000 pop in 2005.
detected in 2004.
In 2005 one new
infected person:
Cumulative total of
6.
HIV Prevalence –
0.13 per 10,000
population
Malaria:
To reduce malaria Malaria incidence Clinical Malaria
incidence rate from rose in 2004 to 340 per 1,000
160 cases per 1000 184/1,000 pop. population.
population in 1997 to (microscopists also
fewer cases less than doubled).
80 cases/ 1000 by
2003.
To increase the Treated bed net
insecticide treated bed coverage below
net coverage from 80%.
70% end of 1997 to
95% of the population
by 2003.
In short, whilst there is some improvement in reducing maternal and infant mortality in 2004, the level of STI
and Malaria incidences is till not within control or elimination. More attention is required in-terms of reviewing
the existing strategies and plans to combat these diseases.
3.8 Health Institutional Strengthening Project
Objective of the Health Institutional Strengthenthing Project
The objective of the AusAID funded Health Institutional Strengthenthing Project (HISP) is to
improve the management and operational capacity of the Solomon Islands Ministry of Health
(MOH) to deliver essential health services leading to improved health outcomes for the Solomon
Islands population.
3.8.1 Key Outcomes
Reviewing the history of the MOH and HISP working together, much progress has been made to
improve capacity of the MOH to manage the health system at all levels. Specifically progress has
been made in the key areas outlined below:
Operational planning and the monitoring and evaluation of these plans by means of bi-annual
reports.
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Increase in integrated outreach activities for primary and public health in all provinces.
Budgets for national divisions and provinces developed.
Health services management and governance including primary health care strengthened.
National Strategic Health Plan developed with involvement of key stakeholders.
Evidence based planning and decision making at national and provincial level with an increased
focus on outcome, in addition to inputs and outputs.
Revised Scheme of Service for Medical Doctors resulted in an increased return of doctors working
in the Ministry.
Increased capacity of MOH staff to use relevant computer applications.

Installation and support of the Health Radio Network (approximately 200 radio’s).
Support for building a national public health laboratory.
Strengthening of hospital management at both the National Referral Hospital and provincial
hospitals.
3.8.2 Constraints
Public Service Division recruitment processes continue to be slow and the ongoing vacancy of key
roles has impeded MOH service delivery. For HISP, the vacancy of key counterpart roles has at
times required operational outputs by the Project and has been an obstacle to institutional
strengthening throughout the five year life of the Project. Strategies for timely recruitment need to
be discussed by all SIG stakeholders.
3.8.3 Future directions
HISP will conclude its current form on 6 August 2006 and there is in principle support for an
extension to Phase Four until August 2007. It is the intention for Australian and World Bank
assistance to the health sector to transition to a Sector Wide Approach (SWAp). This will allow for
greater harmonisation between donors and allow the MOH to take the driving seat in the
management of donor assistance as support is provided to the MOH identified priorities in the
National Health Strategic Plan. HISP Phase 4 aims for sustainability of capacity building and
procedures put in place during the previous 5 years as well as provide support to the MOH to
transition towards a SWAp.
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Chapter 4 Health Systems: Health service delivery and

episodes of service (Demand):
4.1 Demand on the Primary Health Care:
Primary Health Care in Solomon Islands is delivered by a network of over 323 PHC clinics – NAP,
rural health centres (RHC), area health centres (AHC) and urban clinics (UC) and by outpatients
clinics based at provincial and the national hospitals. These provide acute care
“Demand on
outpatient services, maternal care (antenatal visits, births and post natal care) and
PHC clinics
child health services (vaccinations and growth monitoring), outreach satellite
increases but
clinics, health education and inpatient services (with the exception of hospital
are managed
outpatient clinics which would admit directly to the provincial or national hospital).
well in the
PHC clinics are the main providers of health care nationally, apart from small
past 5 years”
numbers of private practitioners who are based largely in the national capital.
Table 3: National and provincial PHC outpatient contacts (x10,000) – new and return cases and maternal and child health
activities, Solomon Islands, 1995-2005.
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
National 129.22 134.71 121.11 121.66 112.74 115.38 113.41 100.33 106.75 121.48 82.0
Renbel 0.66 0.46 0.62 0.74 0.45 0.73 0.72 0.51 0.75 0.59 0.41
Temotu 5.88 5.40 4.56 4.66 4.74 5.46 5.45 5.50 5.23 5.88 3.9
Choiseul 5.96 6.43 5.42 6.15 5.80 5.70 7.03 5.90 6.75 6.23 4.0
Makira 8.23 6.67 7.22 8.69 7.13 8.27 7.41 6.82 9.04 10.53 6.9
Western 26.41 24.61 24.70 22.25 21.02 22.13 19.87 16.97 18.05 21.73 13.4
Guadalcanal 21.86 21.21 22.62 26.27 19.55 13.51 8.20 11.34 16.42 17.09 12.5
Honiara 12.80 10.98 12.12 13.00 9.69 8.60 11.67 10.09 11.48 14.84 11.1
Central 6.35 6.88 5.88 6.14 6.41 6.30 5.39 6.98 4.68 6.39 4.8
Isabel 6.49 6.66 6.03 5.06 5.12 5.89 6.33 5.92 6.34 6.94 4.3
Malaita 32.87 42.72 29.00 24.03 30.73 36.93 33.72 27.77 23.23 31.16 20.7
Fig 5: National and provincial PHC outpatient contacts (x10,000) – new and return cases and maternal and child health
activities, Solomon Islands, 1995-2005.
45
40
35
30
25
20
15
10
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Renbel Temotu Choiseul Makira Western Guadalcanal Honiara Central Isabel Malaita
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In 2005, PHC clinics reported over 0.8 million clinical contacts nationwide, slightly lesser than in
2004 around 1.2 million (Fig. 3).
This is the highest total since 1996 and 200,000 more than the lowest reported in last year, and a
national average of 2.6 per capita.
Of all provinces, the largest increase in contacts in recent years have been in Honiara and
Guadalcanal
Following declines beginning in 2001, PHC outreach activities by clinics exceeded 295716 in 2004,
with largest increases in village meetings and satellite clinics.
The number of school visits also increased but have yet to reach the totals reached in 1996.
It should be noted that increased numbers of NAPs constructed in recent years may have reduced
the number of satellite clinics required, however, as there is no record of the total satellite points it
is unclear what level should be achieved.
Areas far from clinics we get to them through outreach or satellite clinics. This is also a formal way
of getting people access to essential health care.
Fig 6: Health outreach activities PHC clinics (excluding Western Province), Solomon Islands 1995-2004.
3500
3000
2500
Tota l a c tiv itie s
2000
1500
1000
500
0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Total outreach School health Village meetings Satellite clinics
16Western outreach activities are excluded from this total as 6 clinics account for 60% of reported outreach (several hundred
outreach activities each) showing a reporting problem in the HIS software or by clinics. Thus national total outreach activities are
underreported.
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Figure 7 Health outreach activities PHC clinics Solomon Islands 2001- 2005.
2500
2000
1500
1000
500
0
2001 2002 2003 2004 2005
Outreach Satellite School Village meeting
Inpatient admissions to PHC clinics continued to strengthen and referrals to AHC and RHC
increased considerably in 2004 (Fig 3).
Child welfare activities were maintained even when service delivery decreased overall and the
number of infants born in PHC clinics continues to increase.
Figure 8: Annual numbers of referrals to AHC, RHC, provincial and national referral hospitals, Solomon Islands 1995-2004
10000
9000
8000
N um ber of re ferrals
7000
6000
5000
4000
3000
2000
1000
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Referrals to AHC's Referrals to RHC's Referrals to province Referrals to central hospital
Overall the picture is one of increasing provision of clinical services by PHC clinics and improved
referral patterns in line with the MOH Primary Health Care Strategy (PHCS) which recommends
patient referral from NAP to RHC to AHC.
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Referrals to provincial hospitals and the NRH also increased, though reasons for “Transport
this are unclear. There are no data about the nature of referrals (eg for acute ation cost
medical emergency, surgical review, medical review, eye check). impact
Increased capacity, in fuel and canoes, may be part of the explanation or change negatively
in type of presentations at PHC clinics (eg. suspected chronic disease or condition) on people
that cannot be managed without medical support or review. The practicality of data accessing
collection about the reason for referrals needs to be discussed and considered health
further by MOH Executive. services,
may
The greatest increases in service delivery in recent years have been in acute care explain
services for new cases of disease. More than 900,000 new cases were reported in increase
2004. Return visits for care were just 6.3% of total clinic contacts continuing a inpatient
downward trend that commenced in 1994.
Reasons for decreasing numbers of return visits are unknown but may signify effective treatment of
conditions.
Presenting condition February % August %

Other 90 21.6% 117 23.8%
Malaria slide (negative) 105 25.2% 100 20.4%
Pain (body, joint, back) 41 9.9% 57 11.6%
Skin sores 61 14.7% 99 20.2%
Worm infestations 23 5.5% 17 3.5%
Chest pain 5 1.2% 3 0.6%
Headache 34 8.2% 35 7.1%
Anaemia 16 3.8% 17 3.5%
Abdo Pain 11 2.6% 17 3.5%
Trauma 27 6.5% 28 5.7%
Chronic chest 3 0.7% 1 0.2%
Totals 416 491
Table 4: Other reasons for attendance to PHC clinic, PHC AHC Solomon Islands, February and August 2004.
Hon Minister the demand for primary health care services in the clinics come from people that
suffer from Acute respiratory illnesses, fever and clinical malaria. The trend have continued to
be the most commonly reported new cases. Skin diseases reported have declined considerably,
red eye less so. Ear diseases and yaws have continued to account for similar proportions of clinic
contacts each year
As highlighted above when we quantify and aggregate the total visits (demand) per year it amounts
up to millions)
And it also means that a person in Solomon Islands in a year is sick 2.6 times or more as an
average.
Earlier studies found that there is economic loss when a person is absent from work due to
malaria. And in our vision and mission we promised to ensure that our people is happy, healthy
and productive.
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Figure 9 (a): Diarrhoea, red eye, yaws, skin diseases, ear infections as % total new cases, Solomon Islands, 1995-2004.
14%
12%
10%
8%
Percent
6%
4%
2%
0%
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
Diarrhoea Red eyes Yaw s Skin diseases Ear infection
Figure (9b): Diarrhoea, red eye, yaws, skin diseases, ear infections as rate per 1,000 population Solomon Islands, 1995-
2005.
120.0
100.0
80.0
65 63.1
60.0 57.6
56.2
47 49
46.7 50.7 51 50
40.0
34 36.2
32.0
30 30
26.3
25 23.8 26.7
20.0
0.0
2001 2002 2003 2004 2005
Red eye Ear infection skin disease yaw s Total diarrhoea

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Figure 10: ARI, fever, clinical malaria and other illness as % of total new cases, Solomon Islands 1995-2004.
40%
35%
30%
25%
Percentage
20%
15%
10%
5%
0%
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
ARI Fever Clinical malaria Other
4.1.1 Access:
The report is only being able to provide access in terms of population per facility.
As this point of time, it is anticipated that many more community (>70%) are within one kilometer of
walk to the nearest clinic or within one hour travel. In 2005 and shown in Fig 11 and Table 5
clinics in Malaita and Guadalcanal are serving more people than others. These two provinces rely
much of their basic health on clinics. Obviously, the travel time will be of some consideration.
7,028 Honiara
1,945 Malaita
1,655 Guadalcanal
1,459 National
1,355 Temotu
1,265 Western
1,087 Makira
919 Central
895 Ren Bell
851 Choiseul
631 Isabel
There has been improvement in the access of people to primary health care in the clinics. In
1997 one clinic is to 1,737. In 2005 it is 1,459 people per health clinic. Honiara has the highest
population per facility, however residents of the city has more access to higher level of health care
and other choice of service providers.
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Fig 11.and Table 5 Ratio of population per clinic in 2005. Source: Medical Statistics Unit, MOH (2005);
8,000 7,028
Ratio: Population per clinic
7,000
6,000
5,000
4,000
3,000 1,945
1,355 1,087 1,265 1,655 1,459
2,000 851 919 895
631
1,000
0
al
u
l
C
el
ta
ira
IP
rn
eu
I
S
ot
an
C
B
ab
ai
te
C
ak
is
m
H
R
al
lc
es
Is
ho
Te
da
M
W
ua
G
The question to ask, therefore, is should there be additional clinics in the provinces or should it be
improving quality of health care and more outreach and expanding the level of services17 to
include a more preventive role on top the exiting curative responsibilities.
17 Also raised by the Clinic Utilization Review: See below

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4.2 Demand on Health Care Institutions and Services:
4.2.1 National Referral Hospital
Introduction: CORPORATE SUPPORT SERVICES: Annual Report 2005
‘Completed by each Divisional Director & Provincial Health Director in liaison with each other ‘
Due: 10th March 2006 To: MoH Permanent Secretary
Brief Background:
The Hospital Corporate Support services under the direction and supervision of the Executive
Management Committee headed by the chief Executive Officer, Raymond Suinao, has pledge their
support in working closely with the Ministry of Health and development partners of this
organization. The Institution is vested with responsibilities to provide secondary and tertiary
standard of clinical, administration and management to care for the sick people who enter and
seeking medical treatment.
The NRH provides the following services:- Surgery, Medicine, Obstetric and Gynaecology,
Paediatric (children care), Anaesthetics services, Radiology Services, Medical & Laboratory
services, Pharmacy services, Accident and Emergency & Ambulatory services, Dental Services,
Physiotherapy, Rehabilitation and Prostheses, Referral Specialists and Clinical Services, Eye
Services , Nursing Services and Corporate Support Services which includes the following:-
Administration, Accounts , Domestic stores, Catering, Laundry, Medical Library, Transport,
Communication, Security Services, Medical Records, Domestic and Grounds Cleaning Services,
Engineering, Biomedical & Electrical Repair Services, Carpentry, Plumbing Section and Porterage.
The Clinical and Diagnostic Services departments are headed by the Medical Superintendent; the
Nursing by the Nursing Superintendent and Corporate Support Services by the Hospital Secretary
together with the Chief Executive Officer and the Hospital Advisor forms the National Referral
Hospital Executive Management Committee, which is directly responsible to the Permanent
Secretary, Ministry of Health.
Health data Summary (Brief) with analytical interpretation based on best data/evidence
only:
Collecting and entering data and reporting against Operational plans are new to most of the
Support Service Managers. Whilst some can, others are familiar with but do not keep proper
records and lack how to write reports. Also appropriate data base spreadsheets need to be
installed in respective divisions. In due respect, I am committed to try and establish some form of
the hospital data collection and entry in all divisions and ensure staff are trained to be able to use
and provide us with required information on a monthly basis or when required. HR Expertise
assistance in establishing these spreadsheets in their respective settings will be required from
HISP or MOH. The only division who has a system installed for recording of their work activity by
an advisor is the Building and Engineering apart from Accounts, Stores and Medical Records, who
have been trialing on the new system with the assistance of Elizabeth Moss (MRA). The catering
maintains manual records with regards to food orders and usage. But the problem is, not all staff
is able to use and lack the analytical interpretation skills. See table below under activity report for
task performance extracted from the Building & Engineering data base entries.
Activity Report – progress against Operational Plan / Budget (include % for the year):
Administration
One of the main disadvantages in this hospital setting is the one basket of money with no direct
divisional allocations, whereby managers are able to trace and monitor their progresses against
their operational plans and normal activities easily. Only a very few were given special allocations
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However, since some of our plans are absorbed within the operational budget, the expenditure
budget charts below can be seen as progresses and failures as a whole. Others were specific.
Accounts
Most of the objectives indicated inside the 2005 National Operational Plan written by FMA, HQ
(which is also applicable to NRH Accounting) is still to be implemented. A one time Budget Advisor,
Chris Donovan was going to start with all of that but he left in a rush, leaving myself and the
accounts suspense, not knowing what to do. With due respect, I am requesting that a Budget
advisor be identified and posted to us to improve the procurement and service delivery at the NRH.
The under spending and overspending as indicated below are apparent indicators of the poor and
non compliance by Managers of operational plans to allocated budgets. In some cases,
clarification needs to be done.
Also, there is need to mention that the one basket budget may not be the best option for NRH as
expressed by the support service managers and other clinical mangers as well. It may need future
considerations to departmental allocations whereby, divisional managers have ownership and
appropriate usage of their yearly allocations and according to their approved operational plans.
The expenditure below is not necessarily by division but by line items only. Divisional future
strategic planning and managerial decision making would be very difficult. Currently, only the very
demanding costs like Catering have been separated .The expenditure graphs were inserted to
show and support this idea.
The graphs and tables are obtained from the NRH Budget 2005, report compiled by Ron Hickey,
Hosp Adviser.
Expenditure by existing cost centers is outlined below.
Account – NRH
01-01-05 through 30-06-05
Budget Proportion Actual Variance
Income
SIG - Health Service Funds NRH $0 $7,650
AusAID – HSTA Untied Funds $5,500,000 $2,750,000 $3,943,228 -$1,193,228
Patient Fees and Charges $0 $0 $30,117
Rental Fees & Charges $0 $0 $1,925
Misc Fees - Other Revenue $0 $0 $4,629
FR – Donations $0 $0 $5,595
Miscellaneous Income $0 $0 $25,146
Total Income $5,500,000 $2,750,000 $4,018,290 -$1,193,228
Expenses
Bank & Finance Charges $2,953
Building Repairs and Maintenance $41,813
Catering Services $1,304,993
Communication Costs $7,406
Conference Expenses $33,158
Equipment Repairs & Maintenance $70,937
Equipment Replacements $161,920
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External Services $27,950
Fuel & Lubricant $11,014
Functions and Entertainment $5,049
Insurance & Registration – Mis $1,694
Med Referral : To NRH $7,891
Med Referral : From NRH $756,382
Med Referral : Charter to NRH $29,070
Medical Stationary : Health Su $50,536
Msupp - Drugs – Rawmat $254
Msupp - Other – Gases $72,104
Msupp - Laboratory – Sundries $26
Motor Vehicle : Fuel & Oil $98,416
Motor Vehicle : R&M $93,029
Motor Vehicle : Other $34
Rates & Charges $1,500
Supplies Gen - Cleaning Equipm $9,306
Supplies Gen - Laundry Service $545
Supplies Gen - Bedding & Linen $4,040
Supplies Gen - Furniture & Fit $7,824
Supplies Gen – Misc $30,095
Supplies Office - Computer Sup $6,336
Supplies Office - Equipment & $2,228
Supplies Office - Stationery & $112,387
Supplies Office – Misc $41,587
Supplies Distribution – Sea $2,760
Supplies Distribution – Air $1,725
Supplies Distribution – Shippi $624
Staff Housing & Accomodation $97,118
Staff Other Costs $1,600
Staff Remuneration - Other All $24,954
Staff Remuneration – NPF $492
Staff Training – General $1,044
Staff Training - Student Fees $65,550
Staff Travel – Compassionate $880
Staff Travel - Local (Work) $6,406
Staff Travel – Misc $2,794
Staff Uniforms – Theatre $245
Staff Uniforms – Nursing $216
Staff Uniforms – Misc $18,109
Telephone/Email/Internet $289,616
Waste Disposal Costs $4,455
Total Expenses $3,511,062
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PROGRESSIVE ACTUAL EXPENDITURE vs BUDGET PROPORTION TOTAL BUDGET - 2005
$ 9 ,0 0 0 ,0 0 0
$ 8 ,0 0 0 ,0 0 0
$ 7 ,0 0 0 ,0 0 0
$ 6 ,0 0 0 ,0 0 0
$ 5 ,0 0 0 ,0 0 0
$ 4 ,0 0 0 ,0 0 0 A c tu a l
$ 3 ,0 0 0 ,0 0 0 B u dg e t
$ 2 ,0 0 0 ,0 0 0
$ 1 ,0 0 0 ,0 0 0
$ 0
J u n J u l A u g S e p t O c t N o v D e c
To Budget Actual Proportion Under Spent %

End Jun $8,422,000 $3,727,209 $4,211,000 $453,791 10.78%
End Jul $8,422,000 $4,473,016 $4,912,833 $439,817 8.95%
End Aug $8,422,000 $5,224,199 $5,614,667 $390,468 6.95%
End Sep $8,422,000 $5,951,454 $6,316,500 $365,046 5.78%
End Oct $8,422,000 $6,696,419 $7,018,333 $321,914 4.59%
End Nov $8,422,000 $7,346,096 $7,720,167 $374,071 4.85%
End Dec $8,422,000 $7,913,966 $8,422,000 $508,034 6.03%
OPERATIONAL COMPONENT - 2005
$ 8 ,0 0 0 ,0 0 0
$ 7 ,0 0 0 ,0 0 0
$ 6 ,0 0 0 ,0 0 0
$ 5 ,0 0 0 ,0 0 0
$ 4 ,0 0 0 ,0 0 0
$ 3 ,0 0 0 ,0 0 0
$ 2 ,0 0 0 ,0 0 0 A c tu a l
$ 1 ,0 0 0 ,0 0 0 B u dg e t
$ 0
To Budget Actual Proportion Overspend %

End Jun $5,500,000 $3,511,062 $2,750,000 $761,062 27.67%
End Jul $5,500,000 $4,050,009 $3,208,333 $841,676 26.23%
End Aug $5,500,000 $4,689,817 $3,666,667 $1,023,150 27.90%
End Sep $5,500,000 $5,218,188 $4,125,000 $1,093,188 26.50%
End Oct $5,500,000 $5,735,043 $4,583,333 $1,151,710 25.13%
End Nov $5,500,000 $6,239,251 $5,041,667 $1,197,584 23.75%
End Dec $5,500,000 $6,807,121 $5,500,000 $1,307,121 23.77%
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MEDICAL REFERRALS EXPENDITURE PROFILE
FROM THE NRH AS A PERCENTAGER OF THE TOTAL EXPENDITURE
June to December 2005
2 5 %
2 4 %
2 4 %
2 3 %
2 3 %
2 2 %
2 2 %
2 1 %
2 1 %
2 0 %
J u n J u l A u g S e p O ct N o v D e c
Jun 05 Jul 05 Aug 05 Sep 05 Oct 05 Nov 05 Dec 05

21.54% 22.17% 22.06% 22.14% 22.3% 22.69% 23.87%
ACTUAL EXPENDITURE BY MONTH - 2005
$ 2 5 0 ,0 0 0
$ 2 0 0 ,0 0 0
$ 1 5 0 ,0 0 0
$ 1 0 0 ,0 0 0
$ 5 0 ,0 0 0
$ 0

$127,672 $141,515 $139,290 $120,588 $126,696 $145993 $214,950
Catering
The Cost of Food
The Executive has undertaken an extensive examination of the Catering Services Department with
the ultimate involvement of the Office of the Auditor General following the completion of a report on
activities.
The expenditure on Food within the hospital has been at totally unacceptable levels and significant
reductions in costs have been made in the last quarters of 2005 and into 2006.
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Although we had done a fair bit in trying to control the costs, a lot more still needs to be done in
2006 and we should be able to provide information on this including 2006 goals by the end of the
new year.
CATERING EXPENDITURE PROFILE

AS A PERCENTAGE OF THE TOTAL EXPENDITURE
4 0 %
3 5 %
3 0 %
2 5 %
2 0 %
1 5 %
1 0 %
5 %
0 %

37.17% 34.69% 33.33% 32.23% 31.69% 30.96% 30.08%
ACTUAL EXPENDITURE BY MONTH - 2005
$ 3 0 0 ,0 0 0
$ 2 5 0 ,0 0 0
$ 2 0 0 ,0 0 0
$ 1 5 0 ,0 0 0
$ 1 0 0 ,0 0 0
$ 5 0 ,0 0 0
$ 0

$283,078 $110.764 $147,585 $118,261 $136,112 $114,072 $115,750
Building & Engineering
The accounts processing for this component is managed by the NRH & MoH and the latest figures
available are for the period to end Dec 2005.
Expenditure plus the value of orders placed (shown under Commitments) is detailed below:
The advantage of this division is it had a separate budget allocation from the operational cost
therefore, it is manageable. But in view of the 2006 draft copy , there is no separate budget for
them.
CAPITAL / ENGINEERING & MAINTENANCE COMPONENT - 2005

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A c tu a l
$ 3 ,5 0 0 ,0 0 0 B u dg e t
$ 3 ,0 0 0 ,0 0 0
$ 2 ,5 0 0 ,0 0 0
$ 2 ,0 0 0 ,0 0 0
$ 1 ,5 0 0 ,0 0 0
$ 1 ,0 0 0 ,0 0 0
$ 5 0 0 ,0 0 0
$ 0
To Budget Actual Proportion Under spent %

End Jun $2,922,000 $246,147 $1,461,000 $1,214,853 83.15%
End Jul $2,922,000 $423,007 $1,704,500 $1,281,493 75.18%
End Aug $2,922,000 $534,382 $1,948,000 $1,413,618 72.57%
End Sep $2,922,000 $733,266 $2,191,500 $1,458,234 66.54%
End Oct $2,922,000 $961,376 $2,435,000 $1,473,624 60.52%
End Nov $2,922,000 $1,106,845 $2,678,500 $1,571,655 58.68%
End Dec $2,922,000 $1,106,845 $2,922,000 $1,815,155 62.12%
Task Performance Table:
Division Work Orders Received Work Orders %

Completed
Electrical 275 275 100%
Biomedical 55 55 100%
Maintenance 120 data up to June 80 66%
only due to computer
breakdown
Plumbing 61 data up to June 47 77%
only , reason as above
Annual Health Outcomes (relates to goals/outputs/indicators):
Also, there is need to mention that operational planning is new and that most of the Support
Service Managers were unable to complete their 2005 Operational Plans to submit in time.
However, they were able to work on 2006 National Goals with some assistance. Only Admin,
Catering and Building & Engineering divisions were able to complete their 2005 Operational Plans
Admin
Goal No. 1
With the arrival of the Infection Control 3 ton pick truck, part of the domestic waste disposal is
being addressed. The clinical waste disposal from wards to collection points still needs
improvement in their packaging and in a timely manner. Because they are not properly closed and
sometimes late, it is very unsafe being along the main corridors overnight. Also, the clinical waste
disposal to Ranandi is still a problem. The Honiara City Council is responsible for this area.
Goal No. 2
More of my staff and especially managers are being selected and have attended some in- service /
induction courses at the IPAM. This will continue into 2006.
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We were able to improve the registry setting as proposed but adherence to rules is still a problem.
The retrenchment exercise endorsed by NRH Executive was not approved by MoH or may have
been overlooked, thus a fresh submission will be made in 2006.
More effort is still to be done to the reduction or elimination of overtime claims incurred at the
NRH.
Goal No.3
Infrastructure
Hospital corridor was not completed due to shortage of funds .Allocated funds for this was used in
the operational costs to level the overspending incurred.
Fencing project was completed
Painting of the hospital as a whole was completed using ward changes allocated funds because
specially donated funds for this by HISP were inadequate.
Under ward changes, the Gebbie wing was renovated to be used by all first on calls overnight in an
effort to reduce transport expenses and patient service be delivered in a timely manner. Also, the
re-establishment of the Telepath logy office and its lab, the cashiers office and the tiling of the
new medical record and new domestic stores offices were made possible.
Goal NO. 4
The Security Service still needs more improvement. Although, more effort was injected in
controlling the flow of visitors by erecting the seafront fence, the infrastructure works being carried
out at the NRH by outside contractors still makes it difficult to control ( rear fences are pulled down
and eastern main entrance control by contractor securities). Therefore, we are unable to measure
the outcome of our efforts with regards to this.
Goal No 5
Communication of information to divisional managers has improved a lot. Quick responses from
some managers to delegated duties and requirements are an indication of this. This was a very big
problem identified when first assumed duties.
Goal No. 6
More awareness programs needs to be conducted for both the Support Service staff and the
clinical staff. Patient approach at times is still not acceptable. Personal interest might be a
contributing factor.
Catering
The crucial situation in this division becomes evident in the second quarter of the year. Instead of
implementing the Operational plan, 2005 proposal, the division was actually far from the plans.
Following immediate actions by the NRH Executive to remove the Manager, it became stabilize
again and the Supervising manager was able to follow and implement the plans following
instructions from the office of the Hospital Secretary and NRH Executive. The improvements could
be seen in the reducing figures on the actual expenditures during the 3rd and 4 th quarter, on the
Catering expenditure charts above. This office is still to receive a register of all the assets in the
division.
Building and Engineering

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This section consists of four divisions namely, electrical, engineering & biomedical, carpentry
and plumbing. These divisions also need a lot of improvement before we are able to measure
against goal 1. The overcrowding of the various sections under one roof is not acceptable. Their
practical application of goal 6 is evident from their work activity report above. But their timeliness
and cost effectiveness cannot be measured. Although their working conditions and settings are
not of required standard, these officers still perform at their best.
HR issues:
The Corporate Support Service has a staffing which consists of 59 established and 74 non-
established posts, a total of 133. One hundred and seventeen (117) had been substantively filled
and 16 still vacant. Certain recruitments that were endorsed by the NRH Executive were submitted
to your office mid this year are still pending results either from your office or PSD.
Also, position descriptions for vacant positions submitted to your office mid this year are still
pending
advertisement or results.
Recruitment - 4 newly appointed staff and 9 casual workers joined these services this year.
Promotions - 7 officers also received promotions from PSD.
The Transport and Security Services were regarded as rather tough to manage; therefore the NRH
Executive had proposed outsourcing these divisions in the future. The idea will be reviewed and
forwarded to the MOH Executive for further deliberations.
Also, the NRH Executive sees the need to have able and capable staff at the most demanding
division of this expanding and growing services and organization, the Switchboard. It had been
unfortunate that former managements sees it fit to employ disable personnel to Mann this division
The retrenchment list which will be resubmitted for consideration covers a wide range of staff from
various support service divisions. The recommendations for each vary as well from non -
performing to compulsory retirement age.
The return of ARC’s to my office had been slow or none at all. Reason expressed was, many forms
had been filled over the past years and nothing has happened. I in turn follow up with PAO’s
office, HQ and PSD for recent submissions. Some of the latest promotions received were direct
result of my follow ups to PSD.
Appraisals in respect of some upgrading with regards to the non- established staff will be submitted
in due course as well.
The Engineering and Building staff being frequently requested by Provincial Health Director’s for
repair and maintenance of their biomedical equipment needs clarification from the Permanent
Secretary, MoH, HQ. These officers may have become victims of an arrangement by the former
managements but the current management at NRH is not happy with that.
Number Supervision tours 12 Proportion of staff with ACR 5%

conducted completed
Infrastructure / maintenance / equipment issues:
Infrastructure
The refurbished wards were completed and occupancy has just begun and should be fully
occupied by the earmarked wards in the next couple of week or so, this movement also includes
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the telepath logy, transport, electrical, domestic stores, medical records and the switch board
respectively. Work has resumed following the release of more than $800,000 and it was agreed
upon by the contractor that the building should be completed within one month of receiving the
cash. I understand the payment was made last week. We are not directly responsible for this, but
follow ups are frequent with the DID officers responsible but less response from them.
Maintenance & Equipment
We are also concerned about the fact that this division is understaffed both in general
maintenance, biomedical equipment and electrical. The Provinces have been using the NRH staff
for all their repairs without proper arrangements. Inappropriate remunerations have been raised by
the staff themselves and given the many daily rising and outstanding tasks at the NRH , it is
rather odd to release them for several days as has been, in most cases.
Assets Inventory Completed? Inventory last updated on:
NO, I am still to receive asset registers from Unable to tell because of various inventories
either the domestic stores or whichever kept in different divisions. Proposing that a
divisions have been keeping their own central inventory be appropriate and probably
inventories. within domestic stores division.
Issues for consideration in future planning:
Terms and conditions surrounding and affecting work performance of the corporate staff, especially
the ones required to work on weekends, on call and standby.
Overtime and other related allowances
Basic salary/ remunerations does not match work performed
Outsourcing of Transport and Security Services
A separate vehicle for Admin and Accounts Division.
Clinical and Support Service divisional allocations in the yearly budgets
A budget advisor be identified and posted to NRH
Provinces to cater for biomedical technicians in their manpower and budgeting
Any other comments:
The only thing I wish to make additional comment on is the slowness or the non replying from the
MoH on many of our queries or submissions with ease as experienced. Because I have to make
several follow ups before action I feel this is wastage of time and effort. The follow ups and
attempts are time consuming. This can be eliminated and reduced by injecting more commitment
to work by appropriate staff at all levels. Also, in the event of relaying messages on formal queries
must be documented for future reference. The telephone seems to be taking over the
documentation process. I understand the telephone is appropriate in some cases only.
However, with the introduction of the email system within the NRH and among the NRH Executive
members and some Head of Departments, I am very glad that movement of information is very fast
and effective. I would like to thank all who have assisted me in these necessary training, though I
am slow.
Summary of Major Constraints Strategies / Action plan for the way forward
Some Support Service managers lack Additional & appropriate training and recruitment of
managerial and academic skills able and capable managers
A budget advisor be identified and posted to NRH

Non compliance to budget limits
To be reviewed ,improved and centralized within the
Requisition and Procurement processes NRH and perhaps to Domestic Stores & Accounts
improved
Steps to be reviewed and improved
Recruitment processes very slow
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Signature: Rachel Tigita Position: Hospital Secretary Date: 27th Dec,

2005
4.2.2 Nursing in Solomon Islands:
4.2.3 SI Nursing Council:
Brief Background/introduction:
Solomon Island Nursing Council is the legal body of the nursing profession. It exist purposely to
monitor and guide the nurses in their professional role in caring for the public, it is not to terminate
the nurse but to guide her back into her expected practices as required within the boundary of the
professional discipline.
Health data Summary (Brief) with analytical interpretation based on best data/evidence only:
2005 has been a very tough year. The Retirement of the two very experienced and senior staff in
the Department left on retirement. Three vacant posts which were eventually filled at the beginning
at year 2006.
The existing manpower 2005 was two. Despite that, the council managed to Graduate, 43 nurses.
Also facilitated two provincial workshop mainly Nursing Council Awareness in collaboration with the
national Nursing Division head (Nursing management skills).
Activity Report – progress against Operation Plan/Budget (include% for the year):
Nursing Council meetings 4 times a year - 100%
Nursing Council awareness only two programmes - 20% (Two Provinces, Western and Isabel)
Registration target x 1 group 100%
No investigation done only follow ups.
Clinical attachment/community x 2 groups
Filling and documentation – little has been done
Nursing Council Regulation draft – funded by AUSAID – in the process
Council Board yet to be Gazetted.
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The Solomon Island Nursing Council has exhausted its budget before the year ends.
We have achieved few goals but not all.
We will have to relook at our Operational plan for the year 2006.
We have a full manpower so we hope to do better this year 2006.
HR issues:
Structure: 2 staff
Discussion
Address constraints to the right channels
Don’t sit back but always seeking advices from the experienced, the skillful and those in Authority.
Number Supervision tours Nil Proportion of staff with ACR completed Nil
conducted %
Infrastructure/maintenance/equipment issues:
Concrete Building – ground level, 5 rooms allocated for the council sharing with the Nursing
Director Mental Health x 5 tables, 1 computer, a chair each. X 14 old cabinets (4 drawers each)
without keys. Filling system yet to be up-dated. No inventory system record. May need more in
infrastructure to accommodate Probation Nurse trainings.

Teaching in the programme for nurses is an important issue – teaching tools, conference room in
the MHMS Structure RWSS is always busy, this is to avoid extra spending for hiring venues for the
block sessions in the probation programme.
Photocopy machine would be helpful.

Helpful if the Nursing Council is in the ‘Internet’
RWSS is charging usage $50-00 per day.
Any other comments

The nursing council welcomes any helpful suggestion from everybody for its welfare towards those
whom their purpose it served.
Training locally with regards to legal aspects.
Summary of Major Constraints Strategies/Action plan for the way forward

Resources 2005 – only 2 staff – 3 vacancies
2006 Jan all filled.
Training Data-base
More computing skills
On job training with regards to legal aspect.
Power Point Teaching purposes
Vehicle Easy to travel, collect stationary Hilux would be
better.
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4.2.4 National Medical Imaging Division
Brief Background/Introduction:
The National Medical Imaging Services is one of the main Diagnostic arms of the Ministry of health
and
Medical Services in the Solomon Islands. It establishes its departments in six of the nine provinces
plus the
National Referral Hospital. Eg: NRH, Gizo, Kilu'ufi. Buala. Kirakira, Lata, Taro. It also provided
technical and.
services support to the church Hospitals, Atoifi, HGH and Sasamunga.
The main aim of the Division is to provide and maintain an acceptable, affordable and accessible
level of Medical
Imaging services to the Medical officers and the people of the Solomon Islands so that they can
improve their quality
and standard of life.
Health data Summary (Brief) with analytical interpretation based on best data/evidence only:
At all the Hospital departments, the division has provided three main services. They are the
General radiography, Radiology and ultrasonography services. The total statistical examination
data in all the services provided at NRH and Provincial Hospital department in year 2005 were as
follows.
1. NRH = 15'642. Examinations - This performance statistical data shows a marked increase
when compared to that of the year 2004 which is only about 14,357 examinations.
2. For four Provincial Departments. = 7'457 examinations. This has also increased when
compared to that of the 2004 statistical performances
This marked increase of services can be seen in all the departments. These increases can be
attributed to various factors some of which were as follows.
The increase demands from the medical Officers and the patients for the services.
Improve services due to installations of new equipments in most of the main provincial hospitals
and at NRH.
Good and improved working performances of all the medical imaging staff.
It is hope that this increase will continue this year 2006.
At the end of the year 2005 the Division has accomplish most of its planned programs under its
National operational
plan to about 90% success.
It overspent its oversea Supplies budget at the NMS for oversea purchase which is only
$900,000.00. It spent about
$1.2M. This is due to the increase demand to. Replace allot of smaller equipments, stocks and
supplies which were
running out during the past years.
The divisions also spent allot of its local national division budgets for local purchases but due to
the slow release of funds from the MOF, it wasn't able to spend all of it.
It if hope that this will continue to improve this year 2006.
Goals: 1. The Division aims to Strengthen the National administration. Including prepare 2006
operational plan and work program with budget and human resource requirement plus monitoring
and evaluation of the whole services.. This has been all accomplished last year 2005. Year 2006
operational plan, Budget plane, establishment plans were completed and submitted to the MHMS
Goal2/3/4. To strengthened the Main services delivery (Radiography, Radiology,

Ultrasonography).
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This goal has been successfully undertaken last year where all the above services were available
in all provincial dept. and at NRH. Workshops and conferences were conducted for staffs to
strengthened the delivery of the above services.
Goal 5. To Improve the operational status of the Medical imaging equipment.

This goal aims at providing proper repair and maintenance to medical imaging equipment.
Although we were success in some places. There are a lot that need to be done on this area.
Lack of properly trained biomedical engineer is the main constraint. A number of provincial and
NRH equipment have been repaired last year 2005 while others still need to be repaired. We hop
to continue it this year 2006.
Goal6. Improve provincial supervision & tours.

Almost all provincial Hospital have been visited last year especially by the quality control officer
who check and document all quality practices in all provincial medical imaging department.
Goal 7. To improve supply support to MID.

This goals aims at purchasing and distribution of national medical imaging supplies from oversea
with the National Medical Store. The Division is very successful in this goal and overspent its
budget allocation of $900,000-00 to $1.2M . Allot of very important supplies and accessories
have been purchase under this program in 2005.
Goal 8. This goal aims to ensure safe radiation environment at the MID.
This goals has been successfully implemented where all staff have been given radiation
monitoring badges and all dose reports received from oversea laboratory analysis in 2005 were
within safe levels.
Goal 9.To improve all computerize patient registry and data information systems.
The main aim of this goal is to fully computerize all patient registry database in GIizo, Kirakira and
Kilu'ufi Hospital. The department is 100% successful in completing this project in 2005,
Goal 10. Develop and improve MID workforce that is professionally effective, efficient and
productive.
The aim of this goal is to review and maintain the staff establishment and standard performances
of all staff through review of job descriptions, posting of staff, promotion, and improve entitlement
and condition of services.
Last year 2005, this goal was slightly difficult to successfully accomplish. This is due mainly to the
following reason:
- Not enough qualified manpower trained for the service to be posted to provincial Hospital.
- All Promotion recommendation made to the MHMS for the Public service Division approval was
not materialized. About 70% of the staffs in the division are not in their correct post levels.
- Paramedical scheme of services (SOS) were not acted upon by the MHMS and the public
service.
Inspite of the above problems, the Medical Imaging staff have improved and increased their
working performances last year 2005. It is hoe that they will continue this year 2006.
Goal 11.Staffs continue educational & training.

National training plan has been prepared and submitted to the MHMS. Staff submission for training
has been done for oversea training. Two students have been trained locally at NRH under local
radiography attendant program and have completed it successfully.
- No new student were sent oversea for trainings
The MHMS needs to support the division in the area of training for Radiographers.
Goal 12. Replacement of all old x-ray equipment and accessories.

The division is very successful in replacing most of its old machines last year 2005.
New Large x-ray machine for - NRH, Kilu'ufi, Gizo, Atoifi. (Valued at about $1.5M)
Mobile x-ray machine to: Lata, Buala, Kirakira, Kilu'ufi
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New film processor to: Kilu'ufi, Gizo, Buala, Kirakira, Taro, Sasamunga, Atoifi.
Two Ultrasound machines has been donated to NRH.
There were allot of other smaller equipment and accessories that have been successfully replaces
under HSTA funding through the NMS..
It is hope that this program of equipment replacement will continue this year 2006.
Goal 13. Improvement of Divisional communications.

This was successfully implemented. A new telephone line and E-mail was installed at the Head of
Radiography's office which now made all communications from / to provincial departments easier
and fast.
Goal 14. Improve all standard stationary supplies within the division.
This was successfully undertaken when all the standard stationeries supplies used within the
division were printed and distributed to all provincial departments.
Goal 15. Safe Holiday passage for staff.

All holiday passages were met successfully last year 2005.
Goaf 16. Quality control and assurance program within the division..
This was successfully implemented when all the provincial departments were visited and all
equipments and standard of practice were assesses. Quality control workshops and training were
conducted.
HR issues:
Pre-service Training of new Radiographers is lacking for the past years including 2005.
There is a need to improve the intake of student for training as Radiographer.

Promotion of staff to their correct post levels was NIL even though ACR forms are completed and
recommendations were made for every staff each year including 2005. Allot of Radiographers are
still acting and not on their correct post levels.
Approval and implementations of the Paramedical Scheme of service which can improve the
standard of performances and entitlement of each staff is still lacking. The MOH must support and
address this issue.
Lack of accommodation for some radiographers in provincial hospital centers. The MOH and
provincial Directors need to provide proper accommodation for radiographers.
The MOH must improve and correct the above anomalies within the system if it wanted to improve
the outcome of the health delivery system which depends on if human resource
Number Supervision tours 5 Proportion of staff with ACR 99%

conducted completed
The Medical Imaging Division is fortunate to replace some of its x-ray equipment last year 2005.
eg: NRH, Gizo Kilu'ufi,& Atoifi. Seven x-ray film processors have been replaced. Three ultrasound
machines have been donated to the NRH.
The main need now is to build a now department at Kilu'ufi Hospital which is too small and also to
replace all old x-ray equipment at Buala and Kirakira Hospital.
Service and maintenance of these equipment is at its very critical stages because no qualifies
Biomedical engineer is available and with knowledge to repair those equipment.
Maintenance of department building in most provincial hospital is still a priority,
Assets Inventory Completed? = Yes Inventory last updated on:- . 2004
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YES / NO
Building of staff accommodation at Honiara and provincial Hospital centers.
Any other comments:
The Medical Imaging Division and its entire staff have worked very hard to implement the
operational plan last year 2005. It is hope that the MOH will support them this year 2006 to do the
same.
1. Limited funding available to continue to Request to increase funding from SIG /HST
purchase new
equipment to replace the old ones
2. Inadequate training of human Continue to request the MOH & NTU to allocate
resources including trainings of sponsorship for Radiographers for oversea trainings. ( in-
Radiographers. service and pre-service)
3. Lack of Improvement on the staff Request the MOH to approve and endorse the
entitlements and condition of service Paramedical scheme of service this year 2006. And all
such as the paramedical scheme of promotional recommendations.
services and the approval of all This issue urgently needs to be address by the MOH. /
promotional recommendation made Permanent secretary.
every year including last year 2005
through the ACR forms.
4. Lack of qualified Biomedical Request the MOH to send and train a Bio-medical engineer
engineers to repair and maintain all to be train on how to repair x-rays and other medical
medical imaging equipment. imaging equipment.
5. Lack of Staff accommodation in

provincial hospitals.
Provinces / Divisions Training Database updated Please circle YES

All activity acquittals completed and balance of cash returned to Accountant YES
By : Sendah Savakana Position: Head of Radiography. Date: 10-3-2006.
Organisation and Staffing- 2005
Division/Section Grade Established Filled posts Vacant Non –

posts/number Posts established
Male Female Total
number posts
number
Medical Imaging
Division
Doctors
Head of Radiology SS1/2 1 1 1
Sen. Registrar. 12/13 1 1 1
Rad
Nurses 7/8 1 1 1
Radiographers
Head of 12/13 1 1
Radiography
Chief 10/11 1 1
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Radiographer
Prin. Radiographer 9/10 1 1
senior 8/9 5 2 1 3 2
radiographer
Radiographers 7/8 2 1 1 1
Asst. Radiographer 6/7 5 1 1 2 3
Radiography Asst. 5/6 1 1
1
Radiography Asst. 4/5 5 2 1 3 2
2
TOTAL EST. 24 6 4 12 13
POST
Domestic/cleaner 2 1 1 1 1
REMARKS More than half of the staff in the division are just acting against their post and
are not yet promoted to their correct levels, therefore their post is still
considered Vacant.
4.2.5 National Pathology Services
Introduction:
The laboratory services are essential to health care delivery and thus it forms an important role in
the Ministry of health. They address both the preventative and curative activities. They are also an
indispensable tool in the surveillance and control of diseases. This is through improved disease
recognition, accurate reporting and the resultant effective national health planning.
The Solomon Islands Pathology Services Division is responsible for the Pathology laboratory
services in the country.
Its key role is to provide:
Framework for laboratory regulations, policies and guidelines on the services provided.
Provide pathology staff development plan, training and staff competency improvement
programmes and on going staff support in the work place.
Management of national pathology finance & budgeting.
Management of equipment & supplies
Ensuring quality services by utilizing quality tools like standardized documentation, external &
national quality assurance programmes through effective communication.
The hospital based laboratories both in the provinces as well as the national referral hospital are
well distributed through out the country. The key functions they provide are guided by the role
delineation document of the MoH.
Each hospital based laboratory strive to provide
A complete test menu as prescribed by the role delineation guideline.
Efficient transfusion services and consultation with the Solomon Islands Red Cross Society
Consultation for use and interpretation of laboratory tests
Continuing education to students, physicians and hospital staff
Laboratory services to patients, hospital employees and regional clients
Laboratory statistics to the medical, administrative and interdepartmental teams
Quality test results in a time frame to support treatment
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Activity Report 2005.
Staff Development
The level of trainings both basic and on going is an important component of providing quality
laboratory services. The trainings undertaken by laboratory personals in 2005 are in table 1. & 1.1.
They are mostly quality management training and lack the professional and technical improvement
that the service desperately needs.
Table1 In country trainings and workshops undertaken in 2005.
Types of training Field of training No Trained Who Rate

IPAM Human resources 3 NRH Management
management
Multi disciplinary 2 NRH IOC staff
Public service 3 New recruits
procedures
Computer literacy Basic Computing 3 NRH staff
training Intermediate computer 1 NRH staff
training
USP Corporate governance 1 HOD
MHMS Quality Workshops 2 National Pathology 2/3
services
Operational planning 2 National Pathology 2/3
workshops services
HIV VCCT Counseling 2 Gizo, Kiluufi
Table 1.1 Professional/Technical training undertaken in 2005
Types of training Institution Field of training Duration Who
Malaysia, National Safe blood transfusion 3 weeks Denton Jimmy

Blood Transfusion Elliot Puiahi
Attachments Center
Royal Brisbane 6 months Michael Aike

Hospital Cytology 3 months Anna Mosese
Pathology
Laboratory
Services
Parasitology &
Mycology Workshop.
Australian 2 days
Microbiology Guest speaker at the
Society ASM Tristate
conference, Darwin, Andrew Darcy
Attachment at (IMVLS) 3 days
Conferences TB reference
laboratory & guest
speaker SA ASM
branch
Guest speaker ASM 1 day
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Queensland branch
Global Fund HIV Presenting SGS report 1 week Elliot Puiahi
Project for Solomon Islands
Pan Pacific Presentation on HIV 1 week Elliot Puiahi
HIV/AIDS SGS in Solomon
Conference Islands
Pacific Laboratory Quality 4 weeks Violine Aruafu
SHORT Paramedical System Management
TRAININGS Training Center
Therapeutic Good Blood & Blood product 1 week Andrew Darcy
Administration of regulations
Australia (TGA)
EBOS (NZ) Equipment Training 1 week Ansa Wate
Douglas Rerese
Management of Laboratory Supplies
The National Pathology Services is managing a budget of $ 800,000 at the National Medical store
to procure laboratory supplies and small equipment replacement. This is obvious not enough as
the commitment made in 2005 is very above this budget. The purchase commitment of the
National Pathology is in table 2.
Table 2. Purchase orders through the National Medical Store 2005.
Date PO Reference Supplier Decription Amt (AUD) Amt SBD

21/01/2005 NMS2005-02 EBOS Biochemistry/Haematology $ 98,612.95 $ 571,669.26
Reagents
2/03/2005 NMS2005-14 B&M HIV,Anisole,ESR,Carbol $ 15,469.00 $ 92,851.14
fucshin,
2/03/2005 NMS2005-15 B&M RPR, HBsAg Reagents $ 3,495.00 $ 26,679.39
16/03/2005 NMS2005-22 B&M PTI cards $ 6,482.00 $ 39,284.85
27/04/2005 NMS2005-33 B&M INR Machine & Reagents $ 6,257.60 $ 37,247.62
20/05/2005 NMS2005-42 EBOS Atoifi instalation $ 6,250.00 $ 34,171.68
16/06/2005 PO:48 EBOS Easylyte repair $ 3,258.60 $ 15,641.28
2/09/2005 PO-136 EBOS PTI manual,Hemocue,PT, $ 14,957.40 $ 74,263.49
Blood agar
7/09/2005 PO:128 B&M HIV,HBsAg,PTI reagents $ 7,330.50 $ 40,669.61
22/09/2005 PO-139 South Austral Chemicals, Stains, $ 47,915.00 $ 261,973.76
Reagents & Consumables
31-Oct-05 PO-192 EBOS Biochemistry reagents $ 105,210.12 $ 575,236.33
Total committed in 2005 $ 315,238.17 $ 1,769,688.41
Laboratory Equipment
Laboratory equipment are expensive and technology constantly changes. The National Pathology
is trying to standardize laboratory equipment and is facing a very difficult time trying to find the best
machine that will cater for the conditions of the country. There is also a need to have back up
system that will ensure that the services may slow down but still functioning. Thus for every
machine purchase the national pathology must also a manual system for back up.
Equipment Repair
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A major hurdle for the pathology services is the lack of equipment service back up in the country. A
lot of times a very small fault resulted in equipment replacement or a visit from which cost almost
the same as the machine.
A number of these equipment are still sitting in the laboratories awaiting repairs. Repairing these
machine by getting someone from overseas to come and do them here will incur cost as in table
3.1
Table 2.1 Cost of repair or installation.
Date Reference No Supplier Detail Cost (foreign) Cost SBD

Cost of an extra trip to
cover installation of
Biochemistry machine
20/05/2005 NMS2005-42 EBOS at Atoifi $ 6,250.00 $ 34,171.68
Cost of repairing an
electrolyte machine
16/06/2005 PO:48 EBOS (Easylyte) sent to NZ. $ 3,258.60 $ 15,641.28
Table 2.12 Repairs covered under warranty in 2005
Date Equipment Supplier

April Installation Echo plus, NRH EBOS Under warranty
Kiluufi & Gizo
Echo plus Atoifi EBOS $15 641.28 NZD
19/04/05 Repairing Coulter Counter EBOS Under Done by Roger Caine
trip Also service Act warranty
2 Gizo, Act8
Atoifi
Echo plus NRH EBOS Under
warranty
Easylyte (Kiluufi) EBOS Under Yet to be fixed
warranty
At the end of the warranty period the laboratory will have to look into the cost of these repair trips
or it must look at ways to train its local biomedical to be capable of handling these equipment.
Table 2.13 Laboratory equipment that needs repair end of 2005.
Machine type Qty institution Remarks

Biochemistry Reflotron 4 Gizo, Kilu’ufi, Atoifi, Needs a service engieneer to
analyser NRH have them fixed and
redistributed to other
provinces.
Biological Safety Cabinet 4 Atoifi, Kiluufi, HGH, Filter change & service
NRH maintenance overdue
Autoclave 1 NRH Lab Not working for 3 years now
Echo plus 1 NRH Lab Under warranty
Easylyte 1 Kilu’ufi Under warranty
Coulter Act2 1 Atoifi Needs board replacement &
adjustment
Coulter Act 5 1 NRH Needs constant attention due
to power sensitivity.
(Under warranty in 2005)
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New equipment acquired
The equipment acquired in 2005 through SIG are mostly tools for the improvement of
communication and management. There are a number of essential basic equipment that need
urgent replacement. The Pathology services would like to thank WHO for facilitating the
acquirement of the most basic but essential equipment for the service
Table 2.23 New equipment acquired 2005.
Equipment type Cost center Programme

2 x Computer National Pathology services NRH Lab Administration &
Data collection
1 x Lap top National Pathology Services National Pathology Services
(NMS)
1x LCD projector WHO Funding National Pathology Services
Training
3 x Centrifuges WHO Replacement for Gizo, Kiluufi,
NRH
1 x Computer HIV programme Serology data collection- NRH
10 x Auto-pipettor (20- WHO Replacement to all laboratory
200ul)
10x Auto-pipettor (200- WHO Replacement to all laboratory
1000ul)
10x Auto-pipettor WHO Replacement to all laboratory
(100ul)
Scanner SIG National Pathology Services
Laboratory Policies/Regulation/Guidelines
The National Pathology services still finds it very difficult to make policies and regulation at this
stage. There is only one Policy being drafted and is yet to be see it through the MoH executive.
The process of making policies and the framework needed to use as a cross cutting department
who serve a lot of programme yet based under the National Referral Hospital is not easy. Most
programme are yet to come up with their policies and thus it is difficult to write laboratory guideline
based on existing policies and or standards.
The other area of great importance to providing the quality service is the clarification of regulation
that governs the pathology services professionals and services in the Solomon Islands.
Provision of Quality service to laboratory users
A network of laboratories are well spread within the country to provide laboratory services for the
user of the services. These laboratory are based at the hospitals as they are the biggest user of
the service. The public health component of the laboratory also exist and they are very
instrumental in TB/Leprosy, HIV/STI and Pap smear screening programme. Whenever needed the
Pathology laboratory are used for outbreak investigation and monitoring. Laboratory data are an
important base line data to see specific problems in any programme.
There is a level of referral within the country and a network of reference laboratories outside the
country can be utilized should the need arise. These ultimately intends to provide the best quality
services for its users.
Activities relating to the services provided in the country is summarized in Section 4 of the report.
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Table 2.4 Showing laboratories in the country
Center Zone No of staff Level of service

NRH Honiara, Guadalcana, 24 Level 4
Renbel, CIP
Sasamunga Choiseul Province 1 Level 1
Gizo Western Province 2 Level 3
Hellena Goldie Western Province 2 Level 2
Hospital
Buala Isabel 1 Level 2
Atoifi East Malaita 1 Level 2
Kilu’ufi Malaita 4 Level 3
Kirakira MUP 1 Level 2
Lata Temotu 1 Level 2
Table 2.41 The Reference Laboratories currently being used.
Institute Test referred Cost

Royal Brisbane All histology, cytology, hormonal, The service is done but
Hospital Pathology and any other test not done locally charged to Solomon
Laboratories government.
QHSS Arbovirus Lab Arboviruses WHO Collaborating Center
Influenza Center Influenza surveillance WHO Collaborating Center
VIDRL Measles surveillance WHO Collaborating Center
IMVS TB Surveillance WHO programme
Pasteur Institute, Leptospirosis reference center PPHSN level 2 laboratory
Noumea
Mataika House Proposed HIV surveillance PPHSN level 2 laboratory
Fiji confirmation center
Management of Finance & Budgeting
The National Pathology was fortunate to be recognized as a cost center in 2005. The budget
provided in 2005 are activity based while the core budget is still handled by the NRH cost center.
With only 2 staff running the office as well as running the NRH laboratory operational supervision, it
is not possible to implement all the activities as planned.
A system to make available funds when needed is the biggest obstacle in the management of the
fund.
As it is our first budget it has no history and so it’s a great learning curve for the division.
The biggest portion of the laboratory allocation is spent on laboratory fee being referred to
Queensland Health as shown in the graph below. The budget estimate for the programme in 2005
is $500 000 and the actual spending is $800 000. A draft guideline proposed to guide the test
referred and possible cost recovery on private sector is not being implemented because it is yet to
be approved.
Page 50 of 250
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Graph3.5 showing cost of test done in QHSS in AUD currency.
Laboratory Overseas Test Fee-RBHPLS
$30,000.00
$25,000.00
$20,000.00
$15,000.00
$10,000.00
$5,000.00
$0.00
0
3
7
0
1
86
1
57
66
0
22
26
78
29
25
08
02
32
38
08
13
02
13
20
90
64
.8
.1
.8
.5
.7
.7
.9
.1
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05
05
05
05
04
04
05
04
05
04
06
06
05
05
05
05
05
04
04
Laboratory Quality Assurance
The assurance that the service obtained are of quality is the paramount importance to the user of
the service. The National Referral Hospital laboratories participated in an external quality
assurance programme. Having participated in the EQA NRHLab should then be involved in
providing similar EQA to the provincial hospitals. Unfortunately this is not happening in 2005 due to
severe shortage of staff and difficulty in getting available funds to run these programme.
A proposed QA & training officer at the National division office will really get this going in 2006.
A regulatory framework that will set a standard for laboratory services in the country is very much
needed. It should be able to provided the minimum standard that all laboratory should operate on
and a possible accreditation recognition.
Page 51 of 250
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Graph 2.6. The NRH EQA score compared to the rest of the Pacific (average participants score)
Haematology Score
100
80
60 Average
40 NRH
20
0
1 2
Serology Score
105
100
Average
95
NRH
90
85
1 2
The above result shows that we have a better than average standard of services in both the
Serology & Hematology sections. This should give confidence to the users of the service in these
area. There is a great need to spread the same confidence to the technologist in the provinces who
are often neglected in both training and support.
Microbes Identification Antibiotic Sensitivity prediction
100 90
80
80
P ercen tag e S co re
70
60
60 Average 50 Average
40 NRH 40 NRH
30
20 20
10
0 0
1 2 3 1 2 3
Microbiology is still struggling in their QA performances with our identification and antibiotic
sensitivity prediction well below the average score. An encouragement is that in the last EQA we
did improve our sensitivity prediction to almost the average level indicating our commitment to
excellence.
Due to the continuous breakdown of the newly installed machine in biochemistry the Solomon does
not participate in the EQA. It would be interesting to find out the QA for the 3 other machine
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installed in the province which does not experience break down. Biochemistry however have a
strict internal QC that was done before any testing is done.
Annual Health Output
Provision of quality laboratory services to the users of the services:
Serology Laboratory Services
The Serology services include serological testing of hepatitis B virus, HIV Syphilis in patients and
blood donors. The national pathology with technical input from NRH Serology are responsible for
the test standardization, and they work very closely with the National Medical Store for their
availability throughout the country. The minimum cost of the test used is
HIV (2.80 AUD) $12.00 SBD

HBsAg (1.05 AUD) $6.00SBD
RPR (0.60 AUD) $3.00SBD
TPHA (1.70 AUD) $8.00 SBD
The HIV testing strategy is being drafted following a workshop organised by the HIV programme.
This will certainly assist the laboratory to standardized testing protocol.
Some of the activities in Serology are summarized in table 4.1/4.2
Table 4.1 National Referral Hospital Serology Tests done in 2005
TESTS Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec TOT
Pos RPR 98 190 63 75 96 86 89 73 50 47 56 48 971
TOT RPR 756 603 267 685 924 876 756 848 752 657 695 578 8397
Pos TPHA 92 74 144 99 91 92 81 66 52 44 54 47 936
TOT TPHA 92 224 347 134 91 92 81 66 45 44 54 47 1317
Pos HBsAg 27 14 23 27 27 24 31 55 24 41 32 17 342
TOT HBsAg 180 79 195 196 164 146 161 218 174 199 159 117 1988
IR HIV 0 0 0 2 0 0 1 3 1 2 6 2 17
TOT HIV 124 94 120 172 118 77 141 180 122 157 151 106 1562
TOT Tested 1369 1020 1159 1390 1511 1377 1323 1491 1220 1191 1185 962 15198
Fig 4 Showng the proportion of test done at NRH serology laboratory
Serology test done in 2005 NRH

N=15198
TOT HIV;
12%
TOT HBsAg;
15%
TOT TPHA; TOT RPR;

10% 63%
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Blood Transfusion Services
The National safe blood policy was drafted and deliberated in 2003 during a technical workshop.
This policy together with its guideline and Standard operation procedures is yet to be fully
implemented. An MOU was signed between the MoH and the Solomon Island Red cross Society
(SIRCS)on the area but this too doesn’t seem to work because SIRCS has not yet replaced the
two personnel made redundant in 2004. The authoritative body to deal with blood activities in the
policy is the National Blood Counsel of Solomon Islands. This body has yet to meet since its
inception and in 2005 there is no meeting.
Proportion of donor blood

grouping 2005 N= 1040
A Rh Positive
25%
B Rh Positive
O Rh Positive 11%
63% AB Rh Positive
1%
National Referral Hospital Blood Transfusion Services
The National referral hospital transfusion service is the main blood bank in the country and they
have traditionally use the services of the SIRCS to do recruitment and awareness. This is no
longer possible in a regular basis and thus the service has yet to meet its objective of 100% non-
renumerated volunteer blood donor services. In 2005 the majority of donation is still family
replacement thus blood safety and confidentiality is very much compromised.
NRH Blood Transfusion Services
600
500
400
Units Collected
Tot. Units Requested
300 Units Used
Units X-matched
Tot. X-match Requests
200
100
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
There is a slight recovery in the blood bank after the delivery of a bus to National Pathology that
can be used for mobile blood collection. The increase in demand for use of blood however is no
where near the amount of blood collected. As seen in the graph the number of blood requested at
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NRH of 4240 is five times more than the units used in 2005 of 864. A lot work is still needed to put
in strategy in both the collection of blood and quality rationale use of blood in the Solomon.
TB/Leprosy Programme
One of the national programme heavily relying on the laboratory to support its activities. The
success of the programme depends on early detection and continuous monitoring of the infectivity
during intensive dots treatment. The laboratory have been struggling to get quality stain since JICA
has left the programme. Its takes a consultant and a National TB workshop in 2003 that the
problem was identified and steps taken to solve it. The year therefore started off with good stains
available but still some administrative problem with distribution of these stain to the provinces. This
year the drug sensitivity surveillance was re-started with Institute for Medical & Veterinary Science
(IMVS) in Adelaide. A total of 93 cultures were sent for investigation, five of them were either
contaminated or can not be recovered. There are only 2 which is not MTBC. The sensitivity
fortunately is still sensitive to the five drug tested (S,I,R,E,Z).
National Referral TB Laboratory
Serves the National referral hospital as well as the base laboratory for HTC, Guadalcanal, Renbel
as well as CIP. Despite this the working space in the laboratory does not allow for two
technologists to work at the same time. The laboratory was also expected by the national
programme to provide National quality programme as well as training support. Apart from training
laboratory trainee as well as Renbel nurse, the later function of the laboratory is yet to be fully
implemented.
Workload for TB NRH Laboratory
TB Work load analysis

265
Dec
35
136
Nov
38 314
Oct
38
240
Sep
73
103
Aug
68
150
Jul
55
213
Jun
44
227
May
73
216
Apr
60
266
Mar
61
169 162
Feb
25
Jan
29
0 50 100 150 200 250 300 350 400
Total Smears TB Culture
The yearly average AFB positivity rate seen at NRH is

New cases Follow ups Old
Total Pos.rate Total Pos.rate Total Pos.rate
NRH 804 9% 122 20% 49 16%
Buala 346 3.5% 15 0% none
Kiluufi 1042 21%
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Microbiology Services
Isolation of infectious agent (bacteria) in patients specimen and testing them invitro for antibiotic
susceptibility is an important aspect of microbiology services. The application of microbiology is for
confirmation of etiological agent in a suspected patient. This can lead to early detection of outbreak
diseases and accurate treatment of cases.
National Referral Hospital
The National Referral Hospital laboratory, Gizo and Kilu’ufi are currently equipped to do culture
isolation and sensitivity testing. They are doing microscopy and culture in clinical specimens as
well monitoring the STI syndromic management.
NRH microbiology statistic is not available when the report is compiled.
Biochemistry Services
Nationally the Biochemistry services actually expanded with the purchase of 4 new wet chemistry
analysers (Echo plus) in 2004. These machine were installed at Gizo, NRH ,Kilu’ufi & Atoifi in April
2005. While the machines for the provinces are doing fine after installation, the one for the NRH
develop problem maybe due to the workload. It appears that the machine is not so suitable for the
high workload in NRH. Until the problem in NRH is fixed there is no way of knowing what the real
work load demand is for Biochemistry in the Solomon Islands. The NRH Biochemistry data was not
available during compilation.
Total Provincial Biochemistry Test 2005

5059
2409
633
135
0 2000 4000 6000 8000 10000
Gizo Atoifi Kilu'ufi Lata
Histology
Histology laboratory investigation is all done at Royal Brisbane Hospital Pathology Laboratories
and they are doing the service at a cost to the MoH. These test can not be done locally because
we do not yet have a pathologist. While a pathologist is currently being trained it is also important
to start working on a pathology laboratory to cater for his return. A temporary site has been
identified at the NRH to accommodate histology service but a concrete solution must be found
sooner than later. There is very little Telepathology being done in 2005 as the makeshift room used
was not safe and National Pathology office has moved in to use the room.
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Anatomical Pathology Specimens
80
70
60
50
Province
40
NRH
30
20
10
0
1 2 3 4 5 6 7 8 9 10 11 12
Province 3 0 9 11 12 3 18 0 13 1 18 8
NRH 13 71 60 46 63 42 49 26 61 31 52 24
Cytology Services
The cytology service in the country is in an infant stage but has taken a very important role in the
cancer diagnosis. Pap smear screening, the primary health care programme for cervical cancer is
still making up the bulk of the cytology specimens. Fine Needle Aspirate (FNAB) is increasingly
contributing to the total workload. It has became the first line of diagnosis before surgery and
should be encourage more.
Pap Smear Screening 2005
Dec
22
12
4
Nov
27
22
13
53
9
Oct
18
11
49
5
8
Sep
23
38
19
61
Aug
18
12
12
27
47
Jul
17
43
52
8
105
Jun
22
43
24
7
May
29
71
32
58
4
108
Apr
10
29
19
4
Mar
33
20
41
56
9
Feb
29
18
38
39
4
Jan
40
6
3
1
0 50 100 150 200 250
Gynae Province HTC Private SIPPA

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FNA & Non Gynae Cytology
40
35
30
25
2004
20
2005
15
10
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Haematology Services
The Hematology department is one of the high through put testing service in the division. They are
responsible for test that include hematopoiesis evaluation, erythrocyte studies, leukocyte studies,
hemostatis and test of hemostatic function. The full blood count is the first line of investigation and
treatment monitoring.
NRH Hematology
The NRH is the busiest hematology laboratory in the country. They started started the year without
a machine and thus they are doing all test manually. A Coulter Act 5 was installed in April but this
developed problem sometime later due to the power disruption. A back up machine was repaired
and is currently being used.
No data is available during compilation of this report.
HR issues:
Human personnel are the most important asset of the division. It can not run without its qualified
competent personnel. It is therefore important that the issues surrounding the personnel are vital to
ensure the smooth running of the service.
Strengthened National Management Body
The current establishment structure does not encourage the pathology services to be able properly
manage and regulate itself as a profession. The lack of the Directors post in the establishment
sees the department lacking direction. It would be very important the division must play an active
role in the national issues both clinically as well as preventative. This can not be done while the
department is still headed by the Medical superintendent of the NRH and NRH manager being the
highest post in the technical cadre. A clear line of command that has all the hospital entities
answerable to will greatly help in the management and independent administration of each
laboratory services.
Staff Quality & Quantity

The laboratory is always being associated with the testing personals of the wide range of
professionals needed in the running of the services. The group most unlikely to be mentioned in
the cycle is the technical consultants for each specialist area. These professional are graduate
scientist with post graduate qualification in their field. These technical consultants are very
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important personals needed to ensure quality procedures are research and authorized for use in
the laboratory. It is sad that of these type of training is seen done in the ministry and yet we expect
high standard of service to be provided from each division.
The division aim to have at least one technical/professional consultant in each field of pathology
laboratory services and to have enough testing personnel for each service. It is now possible to
estimate the quantity of testing personnel required by using the MoH HR model and the annual
statistics of the division. The real issues that need to be addressed is the initial training of the right
mix of personnel so that we will have personnel to work.
Staff motivation & incentives
The current grouping of the pathology laboratory personnel with the rest of the paramedical has
disadvantaged the laboratory very much. The abolishment of overtime and a blanket 25% SDA for
paramedical has not properly renumerated the people who works the longest, as well as the
hardest in the group. Medical laboratory staff were called almost every night to deal with life saving
test.
While the new Paramedical scheme of services has been seen as the most important motivational
factor, the pathology division still see the after hour aspect of the document as unfair. The division
agrees to pursue it with the group in the understanding that this will be reviewed within two year
and this matter dealt with in a more acceptable way.
Quality of service is mostly influenced by the quality of training one get before and during
employed. The lack of formal in-service training for the Medical laboratory staff is not helping in the
improvement of the service. Further more there hardly any degree graduate laboratory scientist
that can be employed and thus the gap between other professional whom we supposed to advise
widens.
Staff development & career pathway.
The staff career pathway is not very clear in the present structure. The present promotion is mainly
due to default rather than in service career development and plan. Again the proposed structure in
the submitted SOS is trying to address this. It hoped to encourage professionals to stay in the field
rather than getting into the administration.
Organisation and Staffing
Division/Section Grade Established Filled posts Vacant Non –

posts/number Posts established
Male Female Total
number posts
number
National Pathology Services
Head of Laboratory 12/13 Abolished in 0 0 0 0
Services 2005
Laboratory Coordinator 10/11 1 1 0 1 0
National Referral Hospital Laboratory

Chief Medical 11/12 1 1 0 1 0
Technologist
Principal Medical 8/9 8 3 2 5 3
Technologist
Senior Medical 7/8 8 3 1 4 4
Technologist
Medical Technologist 6/7 4 4 2 6 -2
Ass.Med.Lab.Technologist 5/6 5 1 2 3 2
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Central Reception 4/5 1 0 0 0 1
Manager
Laboratory Domestic 2 2 0 1 1 1 Non-
established
Medical Lab. Technologist 2 3 0 3 -1 Non-
Trainee established
Provincial Hospital Laboratory

Chief Technologist 9/10 2 1 0 1 1
Principal Medical 8/9 1 0 1 1
Technologist Gizo post
abolished in
2005
Senior Medical 7/8 5 1 2 3 2
Technologist
Medical Technologist 6/7 4 1 0 1 3
Remarks.
All vacant post in NRH (except for 3xmalaria & Central reception manager) are filled with
personnel acting up on their post. This has been going on for two years and despite the paper
works being done no promotion has been received yet. The Malaria has been activated for
advertisement but as of Dec 2005 no recruitment is yet to be done.
The provincial vacancies have attracted some application but as of Dec31, 2005 nor recruitment
has been done. The vacancies in the lab are mostly based on potential availability of qualified
personnel in the market instead of the needs analysis due to unavailability of trained personnel in
the market.
The Medical Laboratory Technologist performs all duties in compliance with all current provincial
and national legislation for the protection of patients, health care providers and the general public.
This also means that the facility & equipment they are using must comply with the current national
safety standards. Unfortunately a lot of the laboratories in the country does not meet even the
WHO Biosafety level 1. A purpose built laboratory is much safer than BSC cabinet that can not be
serviced in the country.
Equipment maintenance
Lack of preventative maintenance is the current biggest laboratory problem. Machine are bought
with out proper maintenance plan. Spares are not stocked and there is no regular preventative
maintenance programme. Operational budget usually is being used to cater for emergency repair.
As the personnel needed to do the usually are brought into the country it is often very expensive.

YES / NO 2001
Guideline for teaching by laboratory staff
The laboratory staff has been requested and have been providing teaching session to SIMTRI
public health programme, SICHE School of nursing programme, and midwifery programme. The
current use of the laboratory testing personal in those programme has put a lot of pressure on the
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laboratory services. A guideline is needed to clarify the role of health experts in providing teaching
service to other programmes needs to be drawn in order to plan absenteeism and compensation.
Overseas Laboratory Referral Costs.
The issue of the cost of sending specimens overseas needs to be addressed. A referral criteria
must be confirmed and enforced so that we can control the laboratory spending on unnecessary
tests. Furthermore a set criteria is needed to continue the service to the private sector at a cost
recovery revolving scheme. This will mean that the budget can be gone over but the actual fund is
paid for by the user.
Histology / Cytology Laboratory
There is need to establish the histopathology laboratory in country to provide a work place for the
new graduate pathologist. Site planning must be done now than later so as not to discourage the
new graduate. Telepathology must be encouraged to reduce the cost of the overseas laboratory
fees.
Laboratory Standards
Quality systems requires standard and regulation to enforce this standard. The laboratory needs a
review of the Acts, regulation & policies governing this to ensure that there is a framework
available to do this in the country.
Any other comments:
Constraints & Strategies
Inadequate supply of safe blood in Review & relook into the 2003 workshop recommendation
the hospitals in blood recruitment for Solomon Islands. (see annex 1)
Recruit 2 nurses to assist in the awareness & volunteer
blood donor recruitment.
Need to strengthened the National Need a review of the top management of the laboratory
Pathology Services management. To have a APW for a consultant
There no clear regulatory policies or to recruit a Laboratory administration adviser to attached
that provided independence and with the division for 1 year.
empowerment to provide
QA – No enough personnel in the Provide in the National pathology Services establishment a

National office to do QA and training post for a QA and training officer.
of staff
Training- No enough trained Establish a needs analysis and forward to planning or

personnel to recruit and fill the post Ministry of Education for student training.
required by the service Establish an Assistant Medical Technology Programme in
the National Pathology Services to cater for the gap in the
testing category.
Equipment repair- Lack of Establish a system to cater for equipment repair.
systematic preventive maintenance
& replace protocol for all laboratory
equipment
Inadequate qualified personnel to Proper analysis of Doctor work generated ratio and plan for
recruit the pathology support services personnel.
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Fair distribution of in-service scholarship.
Provinces / Divisions Training Database updated Please circle YES NO

All activity acquittals completed and balance of cash returned to YES NO
Accountant
Blood Donor Recruitment in Solomon Islands
Introduction
Blood donor recruitment which involves awareness and promotion in the Solomon Island is found
to be victimised by the lack of clear definition on the role of the MOH and Solomon Island Red
Cross society (SIRC). While SIRC is being assumed to be responsible for donor recruitment,
promotion and awareness this is not often possible due to lack of trained personnel and priorities.
Red Cross recruitment personnel are only available in Honiara and the provinces are often
confused as to which role they should assume. Furthermore Provincial laboratory staff are often
manned by only one staff and are often too busy doing other diagnostic services to be involved in
quality recruitment of donors.
The following is being formulated in the workshop on Blood Bank held at the FFA conference
center 10th –13th Feb 2003.
Recommendation
The Ministry of Health & Medical services and the Solomon Island Red Cross Society to clearly
define the role of each partners in the recruitment of blood donor.
4.2.6 Dental (Oral) Services 2005
Services:
Dental service in the past is mostly taken up by provision of pain relief, or emergency type of
treatment.
Very little emphasis is given on the preventive aspect of dental service thus the incident of dental
problems are increasing in Solomon Island and without a proper national survey done on dental
diseases no proper evidence based report will be given on the real picture of dental diseases and
its prevalence in Solomon Islands.
With the introduction of OP and its implementation, budgeting and prioritizing of activities with the
best dental service outcome a new chapter to dental service in SI is being put in place.
The introduction of computers, emailing and internet communication is made easy then ever
before.. The skills of linking Operational Planning to the Budget process is gradually improving.
The clinic infrastructure is deteriorating and needs a face uplift and renovation unless a new dental
complex is being built.
Statistics:
NRH – Based on written data collected
Approximately 10,156 patients seen at the NRH dental department in 2005. This includes both the
adult and the children.
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More then 50% of the patients seen are female.

The commonest dental disease seen is dental caries, and treatment mainly carried out is dental
extraction.
Out reach programs
9 communities in the provinces.
7 school visits to HCC.
5 antenatal clinic visit and talks given
3 days a week dental out patient talks.
Provinces - Provinces show the same pattern trend of cases and treatments .Integrated touring is
one of the activities done in the provinces plus school visitations.
Activities Completed.
Training of Dental Assistants July and October 2005.

Implementation of IC procedures
Dental Health talk conducted in communities both Honiara and provinces (communities in
Provinces visited AHA)
Most time during the year is taken up by out patient duties.
Activities Incomplete.
Supervision tour
Publicity and Promotion
Electronic data collection system not in place yet.
ACR forms although written not processed yet.
Training – Only one officer / year need to send 3-4 officers for post graduate studies.
Budget spending against OP.
Report from Chief Accountant – MOH
From the report it shows that only 19.2% of our budget of $240,000 is spent in 2005.
The above summary report is not consistent with the requisition raised from the Dental Directors
office.
The amount raised from requisition does not match the cheques received.
The problem faced is to raise requisition well in time before the actual activity commences.
It is taking to long for money to be allocated.
Health Outcomes (relates to goals/outputs/indicators):

Goal – Increase primary oral health awareness program by 2010.
Not all HCC schools visited – Transport problem.
Health awareness by NGO – medical dental tours conducted ( Ngela, Auki, Ulawa,
Santa Ann, Kirakira,Simbo, Ranoga) Adventist Health Association plus churches –
2005.
Provinces – Integrated touring done
Goal – To develop dental workforce, professionally efficient, responsible and productive.

Strategies – Create incentives.
Staff still not confirmed and promoted. ACR forms not processed to SPD
Accommodation a problem affecting performance
Paramedical scheme of service not implemented. All the above contributes to staff not
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performing as expected.
Training of Dental Assistants - Achieved Certificate given – dissemination of IC
information to staff and implementation.
Goal- By 2015 50% of dental manpower update on professional skills – provision of
quality dental care.
Number of Officers going for postgraduate training to increase to 2-3 / year.
Only 1 officer going / year.
Due to the above up to date knowledge and skills lacking within dental Service.
Goal – To improve dental supplies delivery system to provinces by 2015.
Computer install for dental supplies
Training on how to do inventory.
Provision of Computers to provinces dental service.
Internet connected for access to dental catalogue to find out prices of materials and
equipments.
Not all our goals were met in 2005. Not the best dental health out come gain. However
this is gradual.
Hope to improve in 2006, with a more comprehensive and manageable OP
HR issues:
Directors post needs to be confirmed – still acting
Oral Surgeons post needs to be filled – for the time acting .
Dental establishment all post still on acting bases.
Urgent need to train dental technician and therapists.
Need to create Dental chair side Assistant posts to 6 provinces with dental officers.
Number Supervision tours nil Proportion of staff with ACR 22%
conducted completed
100% filled but only 9
submitted.
Infrastructure / maintenance / equipment issues

NRH-
Current infrastructure does not allow for full utilization of dental service.
Purpose of a Referral hospital cannot be met.
Some provinces operating space to small thus IC procedures cannot be fully met .
Maintenance – Equipments use in dental need more specialized person to repair.
Equipment - Current Dental settings in SI cannot cater for new equipped dental chairs.
Only very basic chairs should be bought.
Assets Inventory Completed? Inventory last updated on: NIl
NO
Issues for consideration in future planning

1. To reduce the no of out patients seen in NRH and to start implement more of
specialized dental service
2. This will mean open dental clinics in HCC.
3. Change of current dental clinic setting.
4. Training of Dental Technician and Therapist, and continuous post graduate training of
Dentist.
5. To improve on our current data collecting system.
Any other comments:

To ensure that the new dental complex eventuate in the 4th phase of Hospital building
constructions.
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Summary of Major Constraints

Strategies / Action plan for the way forward
1. Training of dental staff. To review the training plan for the department.
2. Infrastructure -Continuous dialogue with NRH administration
regarding the new dental complex.
- short term plan to improve Kukum dental clinic
with HCC
3. Confirmation and promotion of all - To resubmit all ACR forms on a group bases.
dental staff
4. Instrument shortage. Prioritizing ordering of dental supplies.
4.2.7 Rehabilitation Division National Referral Hospital
Service Demand
The most common demand on the acute rehabilitation services is the orthopedic. The unit also
serves as may referral rehabilitation site for other centers.
Total New On-going
1021 792 229
78% 29%
In 2005, there were total of 1,021 treated. Of the total, 78% were newly diagnosed patients. The
staff worked a total of 254 working days.
284 Orthopedic
116 Others
112 Fractures
103 Neck and Back pain
81 Neurological (other)
40 Pulmonary conditions
18 Diabetic
14 Chest Physio (post op)
12 Amputations
6 Spinal Cord injury
5 Burns
1 Gynae
792
Average case load per month attendances -275
Averages monthly case load -85
Average daily attendance per therapist -15
Number of patients treated in rehab unit -467
In 2005, the orthopaedic workshop under the Rehabilitation Division manufactured 15 prosthetics
and repaired 11 (total of 26 done). Total of 246 were either manufactured (227) and repaired (18).
Total of 16 calipers done, and 85 foot wears repaired.
Issues/ Challenges
Increasing need for specialist acute rehabilitation care at the hospital level. In 2005, 284 underwent
orthopedic procedures were rehabilitation followed by 112 fractures, 103 necks and back pain, 81
neurological cases, 40 pulmonary conditions, 16 diabetics and 12 amputates18.
18 Source of data/ information: Gauba, C (2005). Rehabilitation Annual Report 2005, Ministry of Health.
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Recommendations
1. To implement lower back pain and soft tissue injury awareness to the community.
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4.2.8 Distance Education Program: Ongoing Education for Nurses:
Background:
The Ministry of Health and Medical Services has always provided some form of continuing
education program for its staff in rural areas. The continuous need to update nurses’ knowledge
and provide specialized training based on the following arguments
Health is a changing science and much of what is taught during the basic training is forgotten with
in five years.
Knowledge can be forgotten.
Professional isolation can cause deterioration in skills
Roles change as nurses are promoted and take on new jobs.
Roles also change as staff move between clinical hospital services and community health in rural
areas
Distance Education Program in Solomon Islands has grown from strength to strength since 1994
when it started with 15 students and materials were printed on stencil duplicator.
The distance education program has moved on calm seas with the increasing number of
enrolment and the waiting list. The program continues to enrol students in the five courses, which
are Nursing Management, Obstetrics, and Family Planning, Community Health and Paediatric
courses.
Since 2000 there are over 209 students enrolled in five different courses and as many as 40% to
50 % of the Registered nurses and Nurse Aides have requested to participate in the program.
This report will cover program activities from period beginning January 2005 to December 2005.
The report will also high light the main activities which were carried out during the year.
Activity Report-progress against Operational Plan/ Budget (include % for the year: 2005)
Activities:
Enrol new students in January /February in each course to maintain level at 20 active students per
year.
Database of students applications maintained
Support continuing students to complete courses
Students enrolled in three courses (FP pilot still being done) Management students to complete
course before enrollment of students
Ordering of textbooks for the students:
Piloting the Family Planning Practicum in collaboration with RHD
Conducted assessment of clinics/hospitals for Family Planning attachment – Choiseul province,

Makira/Ulawa Province, Guadalcanal Province, Malaita Province and Honiara City Council.
Conducted Family Planning Practicum Training in Isabel, Makira/Ulawa and the Western
Provinces.
Annual Health Outcomes )relates to Goals/ Indicators”
Total of 21 nurses trained in comprehensive Family Planning Practicum course

15 graduates from the five courses offered by Distance Education Centre
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HR Issues:
The Program needs to have another staff – there is a vacant post for the position of a Senior
Program officer that needs to be filled.
Number Supervision tours conducted-6
Infrastructure Maintenance / equipment issues-
Currently the Distance Education office is located in the Planning building. However, the program
needs space for tutorial and consultation purposes. The radio currently is okay however due to
shortage of space it has been used as a storage area as well. There is a need for a photocopier to
produce modules, it is included in the 2006 budget but there is no space to locate it.
There is a computer and a printer – current status working
Other major maintenance on the Equipment is carried out under the planning division.
Assets Inventory Completed? YES Inventory last updated on: 2004
Issues for Consideration in future planning:
The outcome of evaluation to be conducted in 2006 will influence future planning

Anticipate writing up of Diabetes module and the Mental Health Course 2006/2007
Post of Senior Program Officer to be filled
Completing of the pilot Training of the Family Planning Practicum in Malaita Province, Choisuel
Province, Guadalcanal/Honiara City Council and Makira /Ulawa Province in 2006. Staff time for
preparing and delivering training needs to be budgeted for in the future.
Summary of Major Constraints
Strategies / Action plan for the way forward

Text books out of Print Search and locate a new supplier/publisher
Books not arriving on time Early submission of orders for text books
Vacancy to be filled
The need for a Senior Program
Officer
Low supply of Modules for students Need for a photocopy machine to produce
modules when needed
Provinces / Divisions Training Database updated Please circle YES

All activity acquittals completed and balance of cash returned to Accountant YES
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Chapter 5 Health Burden
5.1 Overview:
This Chapter in its very brief, gives you some basic picture on the kinds of health burden and the contributing
factors causing both negative and positive impact our people’s health.
The health burden in the report is defined or related to the outputs or outcomes of the health status, whether
it be the incidence of diseases due to a causative agent or physical, mental and social origin.
The main source of data and information is the national Health Information System.
It is due to limited data from the hospitals that the report concerns with illnesses causing burden to the
individuals, families and communities.
The population health is determined by the social origins of illnesses within the communities.
5.2 There are several major health issues affecting Solomon Islands

Malaria
Acute respiratory infections
STI/HIV
High maternal mortality
Diarrhea
Skin diseases and yaws
TB and leprosy
NCD’s such as diabetes
Mental health problems
Access to sustainable clean water supply and sanitation

500
450
400
Rate per 1,000pop
350
300
250
200
150
100
50
0
ARI clinical f ever skin Ear yaw s Diarrhoea Red eye
malaria disease inf ection
Fig. 12 Commonest illnesses in 2005 in Solomon Islands in PHC Clinics:
Fig. 12 provides evidence that the commonest illnesses suffered among the communities in the Solomon
Islands which is Acute Respiratory Infections, follow by malaria (clinical diagnosed mainly by nurses at the
clinics), fever (as recorded as non-specific), skin diseases and ear infections.
Whilst there is limited information of the primary causative agents to the ARI history has shown in 2003
outbreaks that the cause of ARI was due to Influenza type A similar strain identified in Queensland.
The issue of concern is the ongoing occurrence of skin diseases and ear infections. There are evidences that
skin diseases as
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5.3 Communicable Diseases:
5.3.1 Acute Respiratory Infection:
ARI are important cause of morbidity in Solomon Islands, exceeded only by malaria In 2005 responsible for
25.5% of acute care contacts Population rate increased in 2005 (417 to 470/1000) (Fig 13).
Rates in infants <1 have remained essentially unchanged. In children 1-4 increased in 2005 (Fig 14).
2500
Rate per 1,000 population
2000
1500
1000
500
0
2001 2002 2003 2004 2005
year
total pop <1 1 to 4 5+
Fig. 13 ARI Rate in SI, 2001-2005: Source HIS data/ Med Statistics, MOH
800
700
600
500
400
300
200
100
0
Guadalca
Makira Temotu Malaita Renbel Choiseul Isabel Honiara Western
nal
2001 180 349 531 363 576 588 601 469 420
2002 267 309 489 282 391 413 531 349 341
2003 331 320 450 218 639 480 493 383 304
2004 350 461 656 324 671 478 665 461 432
2005 527 465 634 339 549 399 539 535 458
Rate pe r 1,0001-4 pop
Fig. 14 ARI rate per 1,000 populations in 1-4 years age-group by provinces.
5.3.2 Clinical Malaria
Important cause of attendances at PHC for acute care services.
In 2005 clinical malaria and fever were responsible 28% of acute care attendances (Fig. 15).
Major cause of mortality in children and infants (Fig 16)
The rate of malaria in pregnancy has remain essentially unchanged according to one measure
(HIS) and has been found to be higher by another (Solomon Islands Reproductive Health
Surveillance System) (approximately 8%)
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Difficulties is assessing true rate due to problems with measurement (reporting by PHC clinics
varies).
Nonetheless the level of Malaria infection remains very high.
Very high among children, and issue of public health concern still.
750
600
450
300
150
0
2001 2002 2003 2004 2005
Ye ar
fe ve r c lin ic a l m a la r ia F e v e r a n d c lin ic a l m a la r ia
Fig 15 Clinical Malaria rate per 1,000 populations
180,000
160,101
160,000
140,000
120,000
100,000
80,000
73,600
62,128
60,000
40,000
20,000 11,472
0
Clinical malaria total Total in Children No. cases 1-10 Total cases <1
Fig 16 Clinical malaria cases by age group in 2005 Longer term

implications
It is overwhelming that malaria infection in children and even worse under 1 year old of minor
remain a major health problem. This evidence calls for targeted point of service delivery diseases e.g.
on the various malaria control strategies. skin
However, there are still issues surrounding the diagnosis of malaria as to differencing diseases not
malaria infections from other febrile illness such as influenza and general clinical well
manifestations of other diseases. understand
and may be
harmful later
5.3.3 Yaws and Skin Disease in life as
evident in
Goal: reduce incidence of preventable skin diseases by 2010 (target yaws in children <5 Rheumatic
reduce from 6.5 to 3%, skin diseases total pop. 9.6 to 3%): heart and
In 2005 slight reduction in yaws (this may not be sustainable based on previous trends) kidney
diseases.
Skin diseases – increased population rate from 96 to 107 cases/1000 (10.7%)
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160
140
120
R a te p e r 1 ,0 0 0 p o p
100
80
60
40
20
0
Guadalca
Makira Temotu Malaita Renbel Choiseul Isabel Honiara Western
nal
2001 24 47 48 61 78 20 18 21 64
2002 38 51 145 55 37 19 16 34 58
2003 74 77 141 65 55 40 24 49 77
2004 62 57 40 65 46 14 19 44 44
2005 62 67 41 56 27 21 18 39 40
Fig 17 Yaws Rate per 1,000 pop by provinces 2001-2005
5.3.4 Ear Infection

160
140
120
Rateper 1,000pop
100
80
60
40
20
0
2001 2002 2003 2004 2005
<1year 121 99 114 115 125

1 to 4 years 141 123 135 140 0
5+ years 42 34 37 44 47
Fig 18 Ear diseases rate per 1,000 pop by age-group
The rate of ear infections also increased with 3 provinces - Guadalcanal, Honiara and Choiseul, the source
of the majority of increased cases.
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5.3.5 Red Eye:
National rates of red eye rose from 26.7 to 33.9 per 1,000 between 2004-2005. Rates of red eyeye increased
in Guadalcanal, Makira, Malaita and Honiara (Fig.19)
70
rateper 1,000population
60
50
40
30
20
10
0
2001 2002 2003 2004 2005
ye ar
Re d e ye Ear infe ction
Fig 19 Rate per 1,000 pop Eye and Ear infections 5 yr trend.
60.0
50.0
ateper1,000pop
40.0
30.0
20.0
R
10.0
0.0
Guadalca
Makira Temotu Malaita Renbel Choiseul Isabel Honiara
nal
2001 14.5 28.1 29.4 30.0 24.7 43.0 47.8 20.8

2002 23.3 22.5 31.5 24.2 16.6 41.5 37.7 15.3
2003 36.2 29.6 21.0 17.9 23.5 34.5 29.9 15.6
2004 35.2 26.9 17.8 23.6 11.3 36.8 30.8 19.7
2005 41.1 43.3 27.1 32.3 20.5 27.6 40.0 25.5
Fig 20 Red Eye rate per 1,000 pop 5 yr trend by population.
5.3.6 Diarrhoea
Following a decade during which diarrhoeal disease rates more than halved (1995-2004), 2005 saw
increased incidence (new cases) of diarrhoea and importantly, widespread increases of bloody diarrhoea
It is likely that the bloody diarrhoea cases, indicate several outbreaks of disease
Morbidity is highest in children <5 years
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Fig 21 Diarrhoea (watery and bloody) Rate per 1,000 pop 5 yr Trend.
60
Rateper1,000population
50
40
30
20
10
0
2001 2002 2003 2004 2005
Ye ar
Total w ate ry Total bloody Total diar r hoe a
Fig 22 Diarrhoea Rate per 1,000 pop 5 yr Trend by provinces.
30
Rateper1,000population
25
20
15
10
0
2001 2002 2003 2004 2005
ye ar
Te m otu M alaita Re nbe l Honiar a We s te r n
Fig 23 Diarrhoea Rate per 1,000 pop 5 yr Trend by age group
250
200
150
100
50
0
2001 2002 2003 2004 2005
ye ar
< 1 1 to 4 T o tal < 5 5+
5.4 Tuberculosis and Leprosy Control Program
5.4.1 Tuberculosis Control Program:
Introduction
The National Tuberculosis and Leprosy Control Programs have continued to be one of the priority
public health programs of the Ministry of Health. The management and execution of program
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activities are coordinated from the Disease Prevention and Control Unit by two seconded officers
who report direct to the Under Secretary Health Improvement on matters related to the program
Year 2005 has been a challenging but eventful year for the National TB and Leprosy Control
Program where we saw the continued support from our existing partners like the Global Funds,
World Health Organization (WHO), and Australian Agency for International Development (AusAID)
and the Pacific Leprosy Foundation (PLF). Global Fund however is withdrawing its assistance from
the TB Program as soon as phase two lapses
The National Tuberculosis Control Program has continued to implement activities geared towards
achieving the National and Regional targets. Our National and Regional targets which include: to
increase case detection to 70% and to increase cure rate of newly diagnosed sputum smears
positive cases to 85% has continued to be our focus of implementation
Efforts continued to be made to ensure that the activities are implemented according to the
approved operational plans and the link between the program and laboratory is maintained and
well supported. For example, the DOTS strategy is maintained and continued to be applied during
the intensive and continuation phases for monitoring of treatment. DOTS strategy as has always
been said is the basic strategy to stop TB and the beneficiaries for using DOTS must be attained
such as curing of illness, prevention of death, drug resistance and reducing the incidence of TB in
the communities.
Laboratory is the very important component in NTP as it plays an important role, not only to
diagnose TB patients but also to monitor the progress of these patients (sputum smear positive
cases) during treatment and to determine their cure.
The Leprosy Control Program has also continued to implement activities that will maintain the
elimination target of less than 1/10,000 population in the country. The Multi-Drug Therapy (MDT)
strategy has been the core intervention measure to control leprosy and its impact must be well
documented especially when the declining trend of leprosy prevalence has been noted for years.
This annual report aimed to express the achievements and activities conducted by both the
National Tuberculosis and Leprosy Control Programs at the national level and in the provinces
during 2005.
5.4.2 Objectives of the National TB Program (NTP):
5.4.3 General Objective:
To reduce the mortality, morbidity and transmission of TB until it is no longer regarded as public
health problem
5.4.4 Specific Objectives
To increase the cure rate of newly diagnosed sputum smear positive cases to at least 85% and
To increase case detection to 70% of estimated incidence.
Strategies of NTP
Intensification of health education/promotion by using multi-media to increase community

awareness about TB
Expand and continue to implement Directly Observed Treatment Short course (DOTS) strategy up
to community level
Early case detection through direct sputum microscopy of chest symptomatic patients attending
health services
Regular supervision and monitoring of NTP activities at all levels.
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Capacity building.
5.4.5 Activities Conducted in 2005
5.4.6 Health Education / Community Awareness
Community awareness on TB was further accelerated through community awareness meetings,

workshops and the use of media to disseminate information. In 2005, we have only engaged the
SIBC to broadcast our daily TB spots while community awareness meetings and workshops had
been conducted in some Provinces including Honiara by different stakeholders:
We have also developed a TB/ Video tape which featured mainly about the disease TB.
Three of our Provincial TB Coordinators have conducted community awareness meeting each in
Choiseul, Central and Makira/Ulawa provinces
6 community awareness meetings were held in some identified areas in Malaita, Guadalcanal and
Central Provinces and were conducted by NGO groups especially the church women’s groups
4 community meetings were held in Honiara City Council Suburbs by the health team of Honiara
City Council
5.4.7 World TB Day Commemoration – 2005
The Commemoration of the world TB day was held here in Honiara at the Honiara Central Market
on the 24/03/2005. The slogan for the year 2005 was “Find TB, Cure TB. Cure starts with
detection”. The slogan focused more on improving our case detection strategies to increase
detection rates and putting them on treatment using our famous DOTS strategy. This slogan would
like to see the improvement of our set targets which are stated below:
Increase case detection rate of sputum smear positive cases to at least70%
Increase cure rate of new diagnosed sputum smear positive cases to at least 85% or more
In commemorating the day, several activities were conducted including speeches from the MoH
and the World Health Organization Officials. Some other activities like – publication of TB articles
on the Solomon Star, dramas, speech contest and distribution of leaflets on TB to the general
public were also conducted during the day.
Capacity building – In country workshops and Overseas training
Capacity building was one of the on-going programs organized annually by the Ministry through
our Department to strengthen and also to improve the knowledge and skills of health workers to
enable them to perform their duties more effectively and efficiently.
In 2005 the following training/workshops were conducted locally:
One DOTS training for all Provincial TB Coordinators was conducted in May 2005 by Dr Ichiro
Itoda -WHO Consultant was based in Suva – Fiji
An annual review and planning workshop was also conducted in early December 2005 for all
Provincial Health Directors, TB/Leprosy Coordinators.
Three (3) Provinces namely Isabel, Makira/Ulawa and Central Provinces have managed to conduct
one DOTS training each for their nurses in 2005
On overseas training and workshops - see Table 1. below:
Table . International Training and attendance of meeting/workshops.
No. Name and Designate Duration Attended Course or

Meeting
1. Dr John Paulsen – Medical Officer - 30/03/05 Second Stop TB meeting
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DPCU for PICT – Nadi Fiji
Noel Itogo – National TB/ Leprosy to
Coordinator
Raymond Zonnie – TB Coordinator 02/04/05
– Western Province
Silas Tuita – TB Coordinator –
Makira/Ulawa Province
2. Oliver Sokana – TB Advocacy 12/04/05 Epidemiology training
Facilitator to course on TB - Vietnam
30/04/05
5.4.8 Monitoring and Supervision:
Regular monitoring and supervision of program activities should be an on going activity to be

provided by both the national and provincial program coordinators. This is done to monitor and
assess the work performed by health workers, update of TB and Leprosy data in the provinces and
also to provide guidance and support in terms on the job training on areas that need immediate
attention.
In 2005, the National TB Coordinator managed to conduct five (5) supervisory tours to 5 out of 9
provinces. These tours were conducted mainly in, Isabel, Malaita, Makira/Ulawa and Central
Provinces.
Tours by the Provincial TB coordinators within their own provinces showed a lot of improvement.
The number of tours conducted depends entirely on their work commitment. Some provinces
managed to visit all their clinics while others conducted their visits by zones. Others need to
conduct supervision visits to their clinics as no excuses of funds will be accepted because funds for
such activity have always been available.
5.4.9 Annual TB/ Leprosy Review
In 2005, the National TB/Leprosy Control Program conducted an Annual Review and Planning
workshop which brought together all Provincial Health Directors and TB Coordinators to review and
made operational plans for 2006. At the workshop did we see the provinces submitted their
operational plan with budgets and what they plan to do.
A lot of recommendations were made for the NTP to see and do in order to further improve the
program
5.4.10 TB Situation by 2005
5.4.11 New Case Detection Rate:
Case finding activities in most provinces were still not well implemented as most patients were
detected through passive case finding. This has indicated by the number of cases reported to the
central level from the provinces varies. Malaita reported the highest with about 43% of the total
reported cases. The total number of TB cases (All cases) detected and reported to the Central
Registry increased from 340 cases in 2004 to 397 cases in 2005giving a NCDR of 82 per 100,000
populations. A similar trend is also noted for Sputum smear positive by showing a small increase
from 152 in 2004 to 174 in 2005 with a NCDR of 35 per 100,000 populations.
The New Case Detection Rate (NCDR) in 2005 was about 82% for all cases and about 35% for
Sputum Smear positive cases.
Figure1 below illustrates the result of case finding as well as providing the trend of new case
notification rates for all cases and sputum smear positive cases from 1996 to 2005.
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National TB Notification Rate 1996 - 2005
100
Per 100,000 pop
80
60
40
20
0
96 97 98 99 0 1 2 3 4 5
All cases 80 77 64 70 74 70 62 64 72 82
PTB + ve 28 26 40 22 26 29 26 31 32 35
Table x National TB Notiication Rate 1996-2005
5.4.12 Case Notification by Provinces
The number of cases notified to the Central Registry in 2005 by Provinces varies. Some provinces
especially the bigger provinces like Malaita, Makira, HTC, and Western have detected more cases
than others. The notification rates by provinces as shown in Figure 2 below probably indicate that
a lot of TB infection is still around and we need to do extra work to reduce it transmission
TB Notification Rate by Province 2005 (All cases)
CHP 21
IP 33
CIP 36
GP 39
Provinces
TP 43
RBP 71
WP 77
SI 82
HTC 99
MP 113
MUP 115
0 20 40 60 80 100 120 140

Per 100,000 pop
Fig x TB Notification Rate by Province 2005 (All cases)
5.4.13 Age and Sex Distribution of New Sputum Smear Positive Cases
By age and sex distribution affects almost all the age groups but when see the age and Sex
distribution of new sputum smear positive TB cases reported to the NTP in 2005, it occur more
frequent in age group 15 to 24 and 25 to 34. This is the most mobile and productive age groups in
terms of family earnings. The overall standing for male to female ratio showed that more females
had TB than male. There are many reasons for this, but females tend to stay most of the time at
home in some confine environment where transmission could be high.
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See (Annex 1) for age and sex distribution.
5.4.14 TB Infection by Site
TB infection by site for 2005 as illustrated in (Annex2), showed that pulmonary TB represents
more than 84% of the total cases reported to the central registry and 16% represents extra-
pulmonary cases that includes, Bone/Joint TB, Miliary TB, TB Meningitis and Others form of TB. Of
the total pulmonary cases reported, 52% are sputum smear positive cases and 48% are smear
negative cases. With this high number of sputum smear positives cases, transmission could could
be high in the communities. This call for more effort in conducting contact tracing among the
contacts of smear positive cases. See (Annex 2) for TB infection by site.
5.4.15 Case Holding and Treatment Outcome
For standardization, targets for DOTS implementation must be adhered to by the Provincial TB
Coordinators in monitoring the progress of DOTS strategy in the country. These targets which are
mentioned in Box 1 were also documented in the National Tuberculosis Control Program Manual
and also advocated by the WHO Stop TB Initiative for the period 2000 – 2005 as main indicators to
monitor TB Control activities with regards to achieve global targets and program objectives.
Box 1. Targets for DOTS implementation.
To ensure that 100% of detected new smear positive cases are enrolled under DOTS
To cure more than 85% of smear-positive pulmonary cases under DOTS
To detect 70% of estimated new smear-positive cases (Pacific Strategic Plan to Stop TB
2000) WHO
To compare the above targets to what NTP has achieved with regards to case holding and
treatment outcome, it has been the Policy for many years now that all TB patients should be
hospitalized. This has facilitated and strengthened the TB program with regards to applying DOTS.
In Solomon Islands, DOTS is currently 100% coverage nationwide. DOTS strategy is continuing to
have impact on sputum conversion. Our records showed that in the National Referral Hospital
alone more than 85% conversion rate was achieved after 2 months and 90% after 3 months of
intensive treatment.
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Cure and Treatment Success Rate - 1996 - 2004
100
90
80
70
Percentages
60
50
40
30
20
10
0
96 97 98 99 0 1 2 3 4
Cure Rate 30.8 74.3 83.3 78.4 68.4 68.4 71.3 72 58
Treatm ent Succes s 87.5 92.4 92 86.3 92.1 92.1 92.6 90 87.2
Rate
Fig. x Cure and Treatment Success Rate 1996-2004
Figure 3 above illustrates the result of cure and Treatment Successive Rates (TSR) for the period
from 1996 to 2004. It showed that the Treatment Successive Rate has dropped from 90% in 2003
to 87.2% in 2004.The Cure rate for 2004 dropped to 58%. These results showed that dual strategy
had to be taken and where possible, sputum should be collected from all sputum smear positive
patients for monitoring of cure rates. Again this calls for a concerted effort on the part of program
coordinators and health workers in rural areas to improve DOTS strategy in every where possible.
Table x. Provincial Cohort Analysis for new smear positive cases for year – 2004
Province Cure Complete Transfer Died Default/Lost Total
No % No % No % No % No % No %
CHP 1 50% 0 0 0 0 1 50% 0 0 2 100%
TSR 1(50%)
CIP 3 50% 2 33.3% 1 16.6 0 0 0 0 6 100%
%
TSR 5(83.3%)
GP 8 50% 8 50% 0 0 0 0 0 0 16 100%
TSR 16(100%)
HTC 19 90% 0 0 0 0 0 0 2 10% 21 100%
TSR 19 (90%)
MUP 7 88% 1 12% 0 0 0 0 0 0 8 100%
TSR 8 (100%)
MP 34 46% 24 33% 0 0 5 7% 10 14% 73 100%
TSR 58 (79%)
TP 4 57% 2 29% 0 0 1 14% 0 0 7 100%
TSR 6(86%)
WP 5 45% 6 55% 0 0 0 0 0 0 11 100%
TSR 11 (100%)
YP 4 100% 0 0 0 0 0 0 0 0 4 100%
TSR 4(100%)
RBP 1 100% 0 0 0 0 0 0 0 0 1 100%
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TSR 1 (100%)
Solomon 86 58% 44 30% 1 1% 7 5% 11 7% 149 100%
Islands
TSR 130 (88%)
While it is pleasing to note that nationally, a high treatment successive rate was achieved,
unfortunately provincial achievements vary considerably as indicated in Table 2 above compared
to the global target of more than 85% cure rate. Actually provinces with more patients under case
holding achieve less than 85%. Again provincial TB coordinators need to put more emphasis
sputum monitoring at 5 months and at the end of treatment. This would give them a better chance
of increasing their cure rates.
Table x. Cohort Analysis for Extra- Pulmonary and Sputum Negatives – 2004
Province Completed Transferred Died Default/lost Total
No % No % No % No % No %
CHP 17 94% 0 0 1 6% 0 0 18 100%

CIP 2 67% 0 0 0 0 1 33% 3 100%
GP 17 94% 0 0 1 6% 0 0 18 100%
HTC 17 89% 0 0 0 0 2 11% 19 100%
MUP 10 91% 0 0 1 9% 0 0 11 100%
MP 34 68% 2 4% 5 10% 9 18% 50 100%
TP 4 80% 0 0 1 20% 0 0 5 100%
WP 28 80% 1 3% 6 17% 0 0 35 100%
IP 4 100% 0 0 0 0 0 0 4 100%
RBP 4 100% 0 0 0 0 0 0 4 100%
Solomon 137 82% 3 2% 15 9% 12 7% 167 100%
Islands
Cohort analysis for sputum negative and extra-pulmonary TB cases for 2004 as shown on table 3
above was quiet satisfactory with 82% of the total cases had completed their treatment. The only
concern here was the number of default and lost cases, which showed an increase from 7% in
2003 to 7% in 2004. Again this calls for proper recording and reporting and follow up of cases by
program coordinators and health workers in rural clinics.
5.4.16 Tuberculosis Death.
Death due to TB was also declining since 1997, though the cause of death was un-known. The
results were derived from the cohort analysis from 1996 ~ 2004 and can be seen in (Annex 3). The
number of TB deaths reported in 1996 was more than 10%, which was quite high compare to other
years. The cause of death was unknown, but it was believed that some of the patients detected
very late and died soon after the start of chemotherapy. Delay in case finding is still a problem, with
cases diagnosed in advanced stages. The number of TB patients died on TB treatment while on
treatment in 2004 was about 5.5%
5.4.17 Leprosy Control Program
5.4.18 New Leprosy Case Notification
The number of new leprosy cases notified in 2005 was higher than that of 2004. About 25 new
cases mainly from GP and HTC were notified. Other provinces did not report any case which may
be due to no campaigns conducted in their areas. Leprosy Elimination Campaign is the strategy to
increase community awareness that will foster new cases. This strategy should be carried out in
areas in the provinces that are known to have high case loads in the past so to detect any new
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case that may come out from those areas. The areas where campaigns were carried out were in
Tetekaji and Belanimanu areas on Guadalcanal Province and in the Fishing Village area in Honiara
City Council.
Figure 4 below illustrated the trend of leprosy case notification from 1996 to 2005. The trend shows
a fluctuation trend which indicated that a lot cases are still around and need to be detected
New Leprosy Notification from 1996 - 2005
30
25
20
Number
15
10
0
96 97 98 99 0 1 2 3 4 5
New Leprosy cases 24 21 14 12 9 7 28 5 18 25
Fig. x New Leprosy Notification 1996-2005:
With this fluctuation trend, a lot of new cases may be still present in the communities which need to
be detected. Again this call for concerted efforts on the part of program coordinators and health
workers to conduct leprosy elimination campaign in the areas that were known to have high
leprosy prevalence in the past.
In 2005, the numbers of notified leprosy cases under 14 years old were only 4 cases which could
indicate that a lot transmission has been taking place in the communities where these children
were. None of these notified cases have developed any deformity which means that most of the
cases were detected early and MDT has been very effective.
5.4.19 National Leprosy Prevalence
It has been noted that the use of MDT has been very effective in the treatment and control of
leprosy. In Figure 5 below illustrated the national prevalence rate of leprosy from 1993 – 2005. The
trend showed a declining trend from 2/10,000 population in 1993 to 0.5/10,000 population in 2005.
This showed a remarkable achievement by program.
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National Leprosy prevalence Rate from 1993 - 2005
2.5
2
Per 10,000 pop
1.5
0.5
0
93 94 95 96 97 98 99 0 1 2 3 4 5
Leprosy prevalence 2 1.1 0.6 0.7 1 0.5 0.2 0.5 0.2 0.7 0.1 0.4 0.5
Fig x National Leprosy Prevalence Rate 1993-2005
The Global target to reduce the prevalence of leprosy to less than 1/10,000 population has already
achieved this since 1995 as can be seen on the graph above, but at provincial level, especially on
Guadalcanal and HTC, the prevalence of leprosy has not always been maintained at lower level as
required. It’s always fluctuating. Extra effort is still required to identify those hidden cases in high
prevalence areas of Guadalcanal, HTC and Malaita Provinces.
5.4.20 Capacity Building in Leprosy
In 2005, we have managed to conduct another 4 days leprosy training workshop for all provincial
TB and Leprosy Coordinators in October 2005 This workshop was conducted by a WHO
consultant who was base in Manila – Philippines.
The aim of the workshop was to strengthen the capacity of provincial program coordinators on
Leprosy elimination. It increased their knowledge on how to diagnose and classify leprosy. It also
helped them on how to plan and conduct leprosy elimination campaigns in their provinces.
The training workshop was sponsored by the World Health Organization
5.4.21 Constraints and Weakness
The TB and Leprosy Control Programs despite having achieved some progress and good results,
are like any other programs of the Ministry of Health also has gone through some constraints and
weakness which in some other ways hinder the progress of these two programs both at the
National and Provincial levels. Below are few of these constraints faced:
There is inadequate manpower and frequent changes of Provincial TB Coordinators. At National

level we now have two staff looking after the whole program while at the Provincial level; we have
gone through few changes. Six provinces have new coordinators and these people have to be
trained before they could do their job as required
Recording and reporting between national and provinces is still one of the set back in TB program.
It’s difficult to get reports in time from some provinces where transport again is another problem.
Lack of TB beds in some Provincial Hospitals is a big concern because patients have been
discharged too early causing difficulty for nurses to manage in clinics especially when patients are
still in phase1 or intensive phase of treatment..
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5.4.22 Recommendations:
These recommendations are broad but are important as they should provide a frame work for re-
activation of program activities which could be the set back in the progress of these programs.
All Provincial TB/ Leprosy coordinators be given at least two years to look after the program before
allowed to change or post to other provinces. Posting should be done on swap basis with the other
coordinators
Promotion for all Provincial TB/Leprosy Coordinators should be reviewed by all provincial heads so
that all coordinators be at the same level.
Strengthen the record and reporting system at the provincial level by providing E-mail system to all
provinces so reports could be sent electronically to avoid delays.
The IEC unit of the Ministry be given provision to review all IEC materials and develop the required
amounts require by each programs.
5.4.23 Acknowledgement
The National TB/Leprosy Coordinator wish to acknowledge all the Provincial Program
Coordinators, Doctors, Laboratory Technicians, nurses and those who have contributed to the
overall implementation of the two program activities in the provinces and looking forward for better
collaboration and integration of activities in the years to come.
5.4.24 Compiled By:
Noel Itogo
National TB & Leprosy Coordinator
Ministry of Health & Medical Services
Honiara, Solomon Islands.
5.4.25 Core Indicators for TB Program in 2005:
Table x: CI: Age and Sex Distribution of New Smear Positive cases 2005
AGE GROUP ( YEARS)

Provinces 0 - 14 15 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 + Total
M F M F M F M F M F M F M F M F
CHP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
CIP 0 0 2 1 0 2 0 0 0 0 0 0 0 0 2 3
GP 1 0 0 1 1 5 1 0 1 1 1 0 2 0 7 7
HTC 0 2 5 10 4 3 2 0 0 2 3 1 2 0 16 18
MP 3 5 5 7 7 7 5 6 8 3 4 7 4 0 36 35
MUP 0 2 0 2 1 1 1 2 3 2 3 1 1 0 9 10
RBP 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2 0
TP 0 0 0 1 2 3 0 2 2 0 1 0 1 0 6 6
WP 0 0 2 0 1 0 0 1 1 2 0 0 1 1 5 4
YP 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 3
SI 4 9 14 23 18 21 9 12 15 11 12 9 11 1 83 86
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Fig x C2: TB Infection by site 2005
TB Infection by Site 2005
5%MTB,
6% BJTB,
OTHERS,GTB, 2% 2%
PTB, 84%
Fig x C1 3: TB Death Rate from 1996 - 2004
TB Death Rate from 1996 - 2004
14
12
10
Percentages
8
6
4
2
0
96 97 98 99 0 1 2 3 4
Death Rate 11.8 4.7 3.9 4.1 3.1 3.1 3.9 5.5 5.5
Years
5.5 Environmental Health
5.5.1 Overview:
Environmental Health Division implements it plan of action for 2005 with the aim of fulfilling its
policy statement of “Safe and healthy environmental is the ultimate outcome for the people of this
country.” To achieve this approach is to be holistic in the development and implementation of the
health initiatives that are consistent with the themes of New Horizons in Health and the Yannca
Island Declaration of Health in the 21st Century. EHD has set the policy goal to strengthen it
services in particular on these areas:
Promotion of safe and clean water.

Promotion of proper sanitation and waste disposal
Food hygiene and quality (Inspection & certification)
Sanitary inspections (General)
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Sea and Airport health quarantine services
Health and safety at work place
Human resources development
Review and develop health regulations.
5.5.2 Priority Strategy/Action
5.5.3 Immediate
Construction of proper water supply and sanitary disposal of human excreta in the rural villages
and in urban settings.
Vetting of Food Hygiene and Fish and Fishery Regulations for gazette and put to use.
Strengthen food safety programmes and functions of the Health Competent Authority (Inspection &
certification)
Implement regulatory activities in accordance to the provision of:
Environmental Health Act,
Health Quarantine Act
Pure Food Acts
and subsidiary legislations.
Gazette SARS and HIV AIDS as notifiable diseases under the Environmental Health Act.
Community awareness on food safety and hygiene and safe water.
Construction of Public Health Laboratory and supply of equipment for laboratory uses.
Up-date EHD human resources development.
5.5.4 Long Term Objectives

Public Health Laboratory to be Separate Division form EHD
Health Competent Authority to be a unit within EHD
Establish Occupational Health Unit to deal with all workplaces and homes.
Establish solid and Industrial waste management unit within EHD
National RWSS program to be sustainable in it’s operation
Review existing legislation and introduce relevant regulations
5.5.5 Strategies for 2005
The Government’s policy and decision to support RWSS programme and to fulfil the regulatory
activities as provided for under the Principal Acts on environmental health issues and to respond
adequately to the impending environmental problems of pollution, and waste disposal and
management of hazard and industrial wastes
EHD has within its organization the following units developed and set in motion to deal with specific
issues:
RWSS Unit
Food Safety and Quality Control – (Inspection & Certification Unit’
Health Quarantine Services
Public Health Laboratory
Training & IEC
Administration and Management.
RWSS (Rural Water Supply and Sanitation)
Construction of rural water supply and sanitary facilities for rural communities as shown in the
attach report for 2005
The programme objectives were to complete the outstanding rural water supply projects funded
under the followings:
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a) EU – Micro Scheme,
b) Japanese Grass root Programme
c) ROC
d) Other donors e.g. Canada Funds

.
Refer to report attached for achievement in population coverage. Production of posters and use of
health promotion radio programme on health related issues has captured topic on water and
sanitation and food safety issues as part of awareness programme to the general public. Provincial
Environmental Health outfits continue to organize pre-construction and post construction
awareness talks to communities who have their water supply project completed and commissioned
for use
Collaborative programmes with provincial Health Promotion staff in the province on sanitary
disposal of human excreta and hygiene use of sanitary latrine of water sealed technology continue
to gain momentum. This has been measured by the number of request for the supply of PVC water
seals from provinces. 1000 units of PVC water sealed latrine ordered in 2005 fall short of meeting
the demand by provinces.
Incorporation of hygiene practice in the early childhood education project under New Zealand
Government Assistances has seen the Curriculum Division of the Ministry of Education developed
materials for use in the primary schools throughout the country.
Community participation in the construction of water supply and sanitation has been good and
education on the maintenances and operation has formed the part of the post awareness
programmes by construction teams.
5.5.6 Solid Waste
Joint efforts with Honiara City Council (HCC) Environmental Health Division has been very good,
assistances to improve situation by spreading the huge refuse crudely damped at the site with a
dozer was a short term measure. Lack of funds could not allow for long and permanent hire of
dozer for this work. However, the problem of space to allow for more waste to be damped at the
site was partially resolved, though temporary in nature.
The permanent solution of available land for a new dump site is still far from over therefore, other
measures have to be employed such as the current method of compacting refuse to an acceptable
height above the ground level. This is what is being done at the dump site which appears to
contain the current problem but the question of available land for the new site must be addressed
as this is the only permanent solution to the problem at hand.
Financial constrain with HCC could not allow for regular collection of city refuse, hiring of private
contractors for refuse collection was good but need proper supervision as the exercise was
experimented to supplement HCC’s own programme. Coordination with SPREP has resulted in
New Zealand Govt. support to fund waste control and management, campaign to be launched
early 2006. Problem of waste management at provincial headquarters due mainly to lack of
available land and financial resources. Crude damping is still practiced in all centres. The
scavengers at Ranadi damp were all sent home at the end of 2005 with assistance for them to
make new life at their respective village.
Question of available land for new dump site for Honiara and Provincial Centres still not resolve by
the office of the Commission of Lands therefore, no submission done to the National Planning for
capital project to address solid waste management situation in Honiara and Provincial HQs. in
2005.
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5.5.7 Net Working with NGOs
EHD maintain its networking with NGO’s in its effort to be successful with rural water supply and
sanitation programme in the rural villages
World Vision Solomon Islands has supported water and sanitation programme in the Marau area
and south Guadalcanal by putting finance and its workforce under its management to construct
water supply and sanitation projects. During 2005 some skilled workers from EHD of Guadalcanal
Province was released on unpaid leave for a specific period to serve with World Vision Solomon
Islands in managing its water and sanitation programme. Statistic on the number of projects
completed for 2005 was not available to me right at this time but I should get it in the course of the
week.
SIDT with its village education programme often used when required and funding is available. EHD
was not able to use their services due to resources constrain particularly finance during 2005.
5.5.8 Integrated Research on Approaches
Integrated research into healthy approaches to sanitation in villages was carried out by graduate
students at Fiji School of Medicine in 2005 as a project (thesis) for a BSc degree in Environmental
Health Science. This study was done in Guadalcanal during 2005 and the officer will organzine
series of talks on his studies to staffs of EHD in a hope to devise new approaches to sanitation in
rural Solomon Islands in 2006. National EHD and Guadalcanal Province EHD had supported this
staff with logistics while conducting research locally and to complete the field studies in the time
allowed before returning to Fiji school of medicine for write up. The officer returned from overseas
studies end of 2005.
5.5.9 Food Safety and Quality Control- ICU
This is systematic surveillance and monitoring of food production, processing, handling and
distribution for sale / export. The system ensures that local and imported food stuff meets the
standard and conformance of the country of origin and that of Codex Alimentarius Commission.
Solomon Islands have adopted the Codex standards for food processing and manufacturing both
for local and international markets. Series of activities on this was curried in 2005 leading to
opening of international markets for Soltai and Fish Processing Co to export tuna loins to Italy and
Spain.
The project to provide technical services to the Environmental Health Division, MHMS known as “
Strengthening the Sanitary Production of Fishery Products (SSPFP) was finalized with the Project
Management Unit (PMU) for funding by EU in 2005. Minister for National Planning and Aid
Coordination has approved the project being the Authorising Authority July 2005. Tenders were
called for and decided by the committee comprising of various experts using EU rules to decide the
wining bidder. “Gillett and Preston and Associate Inc” was awarded the consultancy for a period of
18 month to assist EHD develops the Competent Authority so as to be better able to perform its
functions. One major task to achieve during the life of this project is for the EU to recognise the
Solomon Islands ‘C A’ to rule on sanitary standards for fish and fishery products. The recognition of
EHD-‘CA’ will allow the Solomon Islands from among the ACP countries to be elevated from
Group II to group I in order that Solomon Islands can have wider trading scope than when the
country remain in Group II.
This project commence in November 2005 under the supervision of the Director for the EHD,
MHMS whilst the PMU is the Managing Authority for this project. The Team Leader and
consultants have occupied an office within the Environmental Health office Building to work closely
with the Project Supervisor and the staff of “CA”
A review of the licensing and registration of food establishments in Honiara revealed 65 in

procession of valid licence to prepare and sell food to public including Hotels, restaurants and
snack-Bars. Those who are not registered but engage in the sale of food in the streets or target
offices had been warned to discontinue or face legal action.
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Inspectors have been trained on “hazard analysis critical control point (HACCP) and to conduct
health auditing on industries involve in the preparation, processing and packaging of food projects
for local sale / export. Under the current SSPFP training of inspectors and laboratory staff (PHI) will
be arranged in 2006 with overseas laboratories food manufacturing co, on work attachment
Food samples for micro tests have been analysed at the Public Health Laboratory while for
chemical tests samples had been sent to USP / Australian laboratories. The SSPFP will assist with
supply and calibration of equipment and training of staff in 2006. Laboratory testing plays a vital
role in the quality and control measures applied in the food trade.
WHO has supported local training of food handlers and food processing workers from factory,
hotels and restaurants through workshops organised by EHD. Similar workshops had been
organized in the provinces for mothers who involve in the home preparation of food for sale so as
to be issued with certificate of recognition. There were total of five workshops conducted in 2005.
5.5.10 Health Quarantine Services
Sea and airport health quarantine services continue to play its roles in the monitoring of vessels
arriving in Solomon Islands on international voyages and aircrafts arriving at the international
aerodromes. Honiara has two staff while Gizo, Noro, Lata and Tulagi has one staff each at the
declared ports of entries. Honiara being the main port of entry to Solomon Islands recorded the
highest number of foreign vessels entering Solomon Islands. There were three hundred and fifty
(350) vessels declared under the Maritime Declaration of Health as required under the international
health regulation. There was no threat of spread of quarantinable diseases but due to threat of bird
flu foreign ships are subjected to thorough inspection for storage of life birds on board and to
prevent such form getting on shore. Custom, plants Health Quarantine are collaborating very well
in this activity. The activities will continue on in 2006 until such time the threat is removed.
5.5.11 EHD Training Report 2005

This annual report covered three area of training:
a) The overseas scholarship,
b) Local training courses / workshop in food Safety and IPAM courses.
c) The Food Safety and Hygiene workshop for awareness in Provinces as planned under the WHO
local Budget for 2004/2005.
Request for overseas scholarships usually submitted EHD annually to MHMS Training and
Fellowship Committee as outlined below:
1. IPAM Courses
NO COURSE PARTICIPANTS DATE/DURATION

1. Human Resources Management David Ho’ota 17th - 23rd May 2005
Jack Filiomea
Emmanuel Rarumae
2. Food Safety and Hygiene Training Workshop-2005
No TRAINIG WORKSHOP PROVINCE WORKSHOP FACILIATOR (S)

1. Food Safety Lata/Temotu Ethel Mapolu
2. Food Safety Taro/ Choiseul Jocab Makini & Mark Arimalanga
3 Food Safety (2) HCC/Honiara Ethel Mapolu, Mark, Patricia
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Scholarship Training-2003 – 2005
NAME COURSE INSTITUTE DURATION REMARKS

Joe A BSc Environmental FSM –Fiji 1 yrs 2004 Must complete
Maeohu Health final project
Jay Semah BSc Food Technology University of 1 yrs 2004 Course completed
Kabei Sydeny
Atkin Vilaka Dip. Environmental FSM-Fiji 3yrs 2003- Course ends 2005
Health 2005
Edward Dip. Engineering FIT-Fiji 2 yrs 2004- Course 2006
Sarifu 2006
Ethel BSc Environmental FSM 2yrs 2006 Begins 2006
Mapolu Dip Food Tech UWS Hawkesbury
2007
Chris Ruku BSc Applied Science in UWS Hawkesbury Awaiting
Environmental Health 2008 MHMS/PSD
decision
Bobby BSc Environmental FSM- Fiji 2yrs 2006- Begins 2006
Patterson Health 2007
Fred BA Community Planning LAT TROBE 2008 Awaiting
Napthalai & Development University Victoria MHMS/PSD
decision
George BSc Environmental FSM -Fiji 2006 Begins 2006
Titiulu Health
Appointments to Senior Positions
There are senior positions for Chief Health Inspectors post for Malaita, Honiara City Council and
Western Province have had ACRs and appraisal forms completed in 2005 but the appointments
were not eventuated. The delay has demoralised officers hence we need to get this done. Officers
earmarked for these posts are all graduates.
EHD had total budget for 2005 of SBD 470,400-00 excluding donor direct support to rural water
supply projects where communities applied to donors for funding of their water supply projects and
approved by EHD/RWSS for implementation. The EHD wish to express its disappointment when
told in 2005 that we had exhausted our 2005 allocation only to be advised later there was a cut off
point in the budget that we were not allowed to go beyond that. We would appreciate clear advice
from chief accountant on issues of this kind in future.
5.6 Non- Communicable Diseases
The challenges with dealing with NCD problems:-

Chronic non-communicable diseases such as diabetes require lifelong care: Billed people
with NCD stay in the hospital for longer time, therefore having a huge demand on “NCD
finance, beds to keep them. increasing,
and thus
Early detection and management before the onset of symptoms can reduce long term
problems needs more
efforts in
In Solomon Islands rising rates of NCD especially diabetes are contributing to renal prevention,
failure that requires costly interventions care and
Other NCD problems: control”
Diabetes
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Renal diseases
Hypertensive problems
Heart diseases
Trauma/ Injuries
Psychosocial problems
Substance abuse-marijuana
Mental Health- Increasing
neuropsychiatry conditions- due to alcohol use and self-harm. 17.6% of the total disease burden is due to
neuropsychiatry conditions, with 5.5% due to problems related to Alcohol use. Another 2.6% is due to
intentional self-harm.
Leading causes of morality 1990:1999:2003
Leading Causes of Death in SI 1990-2003
14
12.9 Cancer (all)
12
11.7
10.8 Malaria
Specific death rates (%)
10
9.5
8.9 CVA
8 8 8
7.6
6.3 Pneumonia/
6 6.1
6
5.6 5.5 meningitis
4.7 4.8 Hepatitis/
4.1 4.4
4 3.9 Suicide
3.6 3.4 3.7
3.2 3.1
2.6 2.8 2.9
2.6 Renal
2.5 Failure/diarrhoea
2 2.0 2.1 1.8
1.4
1.4 1.6
1.5 Trauma/
1.2 1 1.2
0.79 0.7 cardiac failure
0 0.2
0.0
TB/ Neonatal
1990 1991 1999 2003 causes
Diarrhoea Pneumonia Neonatal causes Total cancers Malaria

Tuberculosis CVA Septicaemia Trauma Suicide/Homicide
Meningitis Diabetes malnutrition Mycardial infarct Hepatitis
Asthma Renal failre Cardiac Failure
Fig 24 Leading Causes of death: NCD
5.7 Community-Based Services:
5.8 Social Welfare Division:
5.8.1.1 Brief Background/Introduction:
Social Welfare Service as the State Service was introduced in mid 1960s. Urbanization and
growth in Honiara Town had not only brought about economic and social benefits but also
introduced changes that had negative impact on people’s life.
Many young people and women moved to Honiara and other urban centers seeking employment.
Most of them had left their villages, schools or control of parents, family or traditional social safety
net for the first time therefore were vulnerable to new changes and environment.
Initially Social Welfare work targeted women, youth/children and destitute. These are vulnerable
groups. As a result of this concern, following legislation was enforced:-
The Affiliation, Separation & Maintenance Act 1971;

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The Juvenile Offenders Act 1972;
Adoption Act;
Education Act – Remission of School Fees;
Policy Paper on Probation Service in Solomon Islands 1992;
Provide Child Protection;
5.8.1.2 Social Welfare Data Summary (Brief):
In 2005, the number of custody cases dealt with by the Family Welfare Section has decreased
compared to year 2004. This was so because in that year, Law and Order in this nation is very
weak and many men had left their wives and marry their 02s. In the Juvenile Justice Section there
is also a decrease in the number of cases dealt with compared to the 2004 records due to the
gradual return of Law and order.
Last year has also seen a rise in the number of self-referral cases due to the confidence and trust
individuals have and placed on the Ramsi and SI Police.
Custody Cases (Family) 15 cases
Self Referrals 65 cases
Juvenile 21 cases
Adoption 1 case
School Fee Remissions 10 cases
5.8.1.3 Organization & Staff: Social Welfare Office:

HQ - 5 established staff
1 Secretary Typist
Male - 2
Female - 4
Gizo Office- 1 Male
Total = 7
Movement of Staff
Recruitment - Nil
Retirement - Nil
Redundancy - Nil
5.8.1.4 Trainings Undertaken During the Year:
Paul - None
Aaron - None
Joana Ahikau
Human Resources Management Course (IPAM)
From 16/05/2005 to 20/5/2005;
Introduction to Laws of SI from 8/8/2005 to 12/8/2005
Hellen Kotty:
Human Resources Management Course (IPAM)
From 16/05/2005 to 20/5/2005;
Introduction to Laws of SI from 8/8/2005 to 12/8/2005
Judy Basi:
Introduction to Laws of SI 8/8/2005 – 12/8/2005
Overseas travel during the year – None

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5.8.1.5 Organisation Structure:
ESTAB ESTAB POST GRADE NOTES

2005 2006 LEVEL
1 1 Head Social Welfare 12/13
1 1 Chief Social Welfare Officer 9/10
1 1 Child Protection Specialist 8/9 Vacant Post
1 1 Senior Social Welfare Officer 7/8
1 1 Senior Social Welfare Officer 7/8
1 1 Social Welfare Officer 6/7
1 1 Child Protection Trainer/Advocator 6/7 Vacant Post
1 1 Probation Officer/Supervisor 6/7 Vacant Post
1 1 Probation Officer/Supervisor 6/7 Vacant Post
1 1 Secretary/Typist 5/6
10 10
5.8.1.6 Activities Taken During the Year:
Family Court:
Report Writing
Home Visits
Court Attendance
(b) Juvenile Court:

Report Writing
Home Visit
Court Attendance
(c) Adoption:
Report Writing
Home Visit
Court Attendance
(d) Destitution: è Assessing Destitute

Cases and asking for
Assistance from Red
Cross;
(e) Education Act:

Remission of School Fees:
Assessing applicants and submitting reports to the Ministry concerned and the two Gov’t Schools
or to Other School Boards;
To provide Child Protection;

To provide Community Service Sentencing
Alternative to Young Offenders;
To play an effective and supportive role in raising Awareness and Advocacy on issues and
problems affecting women, children and other disadvantaged groups;
5.8.1.7 Activities and Achievements:

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On 12/05/2005 – Social Welfare Division purchased a through the recurrent budget. Now it is
easier for us to see our clients, make home visits and to run other office activities.
The Social Welfare Consultant (Mr. Allen Stewart) came last year to make a review of Social
Welfare and to make new Strategic directions for the Division. The job done by this Consultant was
funded by Save the Children Australia. He was working closely with the Head of Division, (Paul
Fia).
What has not been Achieved?

To develop Child Protection Policy for S.I. (Draft) not Endorsed;
To get two Probation Officers/Supervisors;
To get one Child Protection Specialist;
To get Child Protection Trainer/Advocator;
5.8.1.8 Annual Health Outcomes (relates to Goals/Outputs/Indicators:

Goals:
To provide Child Protection Services;
To provide Community Service Sentencing;
Alternative to Young Offenders;
To ensure effective provision of functions and services;
To play an effective and supportive role in raising awareness and advocacy on issues and
problems affecting women, children and other disadvantaged groups;
To ensure effective Probation and Juvenile Services;
The number of cases recorded last year were the only cases been referred to the Division by the
Magistrate/High Court and the Police.
5.8.1.9 HR. Issues:
In year 2005, Social Welfare Division has a total staff of 7. As of early this year, two of our top
officers (Paul Fia and Aaron Olofia) had resigned to run in the upcoming election and there leaves
only two of us (Hellen and Joana) to do operation and at the sametime acting the post of Director
and the Chief Social Welfare.
Last year Judy Basi was given a hand with the two sections of the Division and this was really
helpful.
As of this month, it was suggested by our previous Chief Social Welfare Officer that Judy should be
posted to Gizo due to some personal family problem.
Timothy Tabare (L5 Officer) was manning the Gizo Office. This officer is mentally sick and he
needs a doctor to assess his situation and do something about it. As of 13/12/05, this officer had
been adviced by the Provincial Secretary to stop working until further notice. This was due to an
incident that happened between this officer and the Health Provincial Minister. At the moment he
is on suspension. There is need that Malaita, Makira and Ysabel’s posts should be filled if its been
budgeted for.
In Honiara there is need for the posts of the Director and the Chief Social Welfare Officer to be
filled immediately. Also we need two extra new staff to help out. At the moment only two of us are
working and its too much for us. What we are doing now is just doing our routine job.
Number Supervision tours Proportion of staff with ACR completed %

Conducted 3 0
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5.8.1.10 Infrastructure/Maintenance/Equipment Issues:
Social Welfare Office is been renovated and it was good. But I think if we are to get extra staff then
there is need for an extension of this office. Also we need some new chairs to replace the old ones
to look more like an office. We also need one typist’s chair.

YES/NO NO
5.8.1.11 Issues for Consideration in Future Planning:

Inventory of all office assets;
Keep proper record of tours annual confidential reports;
All vacancy must be filled especially provinces;
Training for In-Service Staff;
We need 2 computers;
5.8.1.12 Any Other Comments:
The Post of the Director and the Chief Social Welfare Officer must be filled immediately with the
other two additional posts.
Summary of Major Strategies/Action Plan for the Way

Constraints forward
Some of the things that hinders Social Welfare Division should work
The division from achieving. closely with other Government
Some of their goals/activities is lack of Ministries and MHMS, Divisions and
consultation between Government with all Non-Government
Ministries and NGOs and also lack of Organisations who are dealing with
funding. Youths, Women and Children.
5.9 Health Promotion:
5.9.1 Activities and Accomplishments
5.9.1.1 National Level
The Operational Plan 2005 was subdivided into Administration and Management, Human
Resource Development, Community Settings, Media and IEC and Research and Development.
Under the Administration and Management, the department was able to implement only 64 percent
9/14 of the planned activities. Four of the activities which required (STC) were not implemented
because of their non availability.
For the Human Resource and Development, the department was only able to implement 78
percent 7/9 of the planned activities. The only two activities not implemented were policy related
needing the (STC).
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For the Community Settings component, the department was only able to implement 50 percent
7/14 of the planned activities. The difficulty encountered was to do with the delays in the securing
of funding and the non availability of the coordinator.
For the Media and IEC component, the department was able to partially implement 86 percent
13/15 of the planned activities. The two activity not implemented relates to IEC training (WHO)
and (STC) policy related activity. Of the 13 activities, only 54 percent was implemented completely.
We do not have the capacity in 2005.
And finally for Research and Evaluation component, only 32 percent 2/6 of the planned activities
were implemented. Low implementation rate is due largely to non availability of a social research
officer we long for years now.
5.9.1.2 Provincial Level
Firstly the Provincial Operational Plans were developed entirely by the provincial health promotion
staff and their Director of Health Services. Health promotion departments at the provincial level do
submit annual reports to the national level. A reporting template have been designed and provided
for the provincial annual reports.
In the 2005, provincial health promotion annual report were compiled under four subjects -
Community trainings and Workshops, Community Settings, Media and IEC and Research and
Evaluation. The community trainings and workshops conducted data reported and compiled was
68 altogether. This figure had dropped markedly by almost 66 percent from 2004. The huge drop
was attributed to non availability of funding for needed community training activities.
For the health promoting school programs, there was increase in the number of model schools
from 1 in 2004 to 14 in 2005, health instructions and health inspections was 208, health services
was 20 and community school organizations was 25 altogether. The increase in activities is
indicative the better understanding of the health promoting school concept and need to address
school health problems.
In the work place settings, health promotion units were able to organize over 100 nutrition and
health talks with video shows, medical examination (weight & height, BP and Glucose) and
physical exercise for workers. A healthy workforce in a healthy work environment is the target.
In the market place setting, health promoters were able to conduct 104 health talks, coordinate
cooking demonstrations, health campaigns and distribution of IEC materials with health video
shows. This is a good learning opportunity for the market authorities, producers and buyers.
In the primary health care facilities and hospitals the health promotion staffs were able to
coordinate and conduct 89 health talks and video shows targeted at visiting ANC mothers, PNC
mothers, child welfare clinics, general out-patients and in the wards. These captive audience learn
a lot from the health information disseminated.
For the healthy town, three of the provinces were able to conduct (19) healthy town activities
ranging from clean up campaigns, public health talks and video shows and inter departmental
soccer competitions. All residents are targeted to empower them to make informed choices in life.
Finally the healthy village and settlements the promotion staff were able to implement the following
health activities in the communities. Village health inspections with health meeting (319), village
health talks with video shows (247), village health campaigns (59), village implementation
programs (174) and village health committees (41). These should empower the people participate
fully in improving their health status.
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The increase in the community settings activities is indicative of the health promotion staff
understanding of the Settings concept to empower the communities to enable them to find solution
for their own health problems.
Media and IEC is another provincial activity reported in the 2005 annual reports. Notably only two
provinces had reported the use of radio and newspaper. Honiara, City Council reported producing
(112) radio programs and the Western Province reported (31) programs. These programs in the
mass media can reach large population and influence people’s behavior.
Further more only one province the HCC has produced 38 health columns in the Solomon Star
paper for the general public in 2005. More over all provinces do not any production of IEC
materials but they reported receiving from the national level.
None of the provinces had reported having conducted any research or evaluation activities. The
only M & E activity conducted was training post test and pretest, community profiling and pretesting
of IEC materials.
5.9.1.3 Financial Information
This information was retrieved from the Ministry of Health Accounts Division. A budget of SBD
$478,500 was approved for the National Health Promotion department. Only SBD $258,337.85 or
54 percent was expended in 2005. Budgeted activities not expended were research, IEC Training
(WHO), Communication & Teaching skills and IEC production (video/print). Entry errors were
identified under sub-heads (fuel & Oil, vehicle maintenance) which we were incorrectly advised to
have been exhausted but still has outstanding balances.
Constraints experienced with the budget was to do with repeated delays of funding request,
infrequent statement of expenditures, non-availability of STC, in adequate capacity for research
and IEC production in 2005.
5.9.1.4 Issues for Consideration In Future Planning
The 2005 Operational Plan for the National Health Promotion was too ambitious and not within the
capacity the department has in 2005.
There is a dire need to have a mechanism in place to monitor the Operational Plan implementation
throughout the year.
Resource allocation for health promotion activities at the provincial level must be improved to
enable the staff to implement the settings activities.
The funding request process at national level must be seriously addressed to avoid bureaucratic
delays thus delays activity implementation.
5.9.1.5 Constraints and Possible Strategies/Actions
Summary of Major Constraints Strategies/ Action Plan
Inadequate IEC capacity Improve the IEC Production Unit.
Recruit qualified IEC personnel
Install proper production Unit & Resource

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Centre.
Inadequate Research & Evaluation Capacity. Recruit a Social Research Officer
Research Officer to drive the Health

Promotion Research Committee activities.
Inadequate Funding Provide more funding & resources to

Provincial HP Units to mobilize community
settings approach.
Inadequate knowledge of HP Concept Training on Health Promotion Concept to all

Health Managers.
Improve Communication , Coordination And Improve communication from Program

Supervision Managers to US/PS vise-versa.
Improve communication from National to

Province.
Improve coordination and supervision of

programs and staff.
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Chapter 6 Systems Performance- Monitoring and Evaluation:

6.1 Ministry of Health: Performance Evaluation19
6.1.1 The Scan of the Public Administration Functions “Scan should help Ministry of Health
to improve areas of low score or
In 2005 the SIG Cabinet approved a reform of public weaknesses” However, the MOH
administration functions across the SIPS that would be may need support from central
based on a Conceptual Model incorporating features of agencies as the issues are of central
public sector governance and organizational capability. The control”
Ministry of Health Executive welcomed the scan as it is an
opportunity for an external and independent performance
evaluation. This has been very timely as the Ministry of Health is undergoing a national health
review in light of the longer term national strategic plan for 2006-2010. The scan is deemed as
complementary to the Health Institutional Strengthening Project coming to its end in August 2006.
Fig 17 is a brief of the admin scan.
Health
4.5 4.4
4.2
4
3.8
3.6
3.5
3.3
3
2.8
2.5
2.2
2
2
1.5
0.5
0
Strategy - Corporate Resource allocation Systems & Procedures Strategy - Work Plan Structures People Capability Legislation Culture & Work Ethic
Plan
Strategy - Corporate Plan 4.4

Resource allocation 4.2
Systems & Procedures 3.8
Strategy - Work Plan 3.6
Structures 3.3
People Capability 2.8
Legislation 2.2
Culture & Work Ethic 2
19
RAMSI Governance Support Facility (2006): SUMMARY ANALYSIS PUBLIC ADMINISTRATION
FUNCTIONS SCAN NOVEMBER – DECEMBER 2005.
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6.1.1.1.1 Fig 25 and Table 6 shows the ratings for the MOH: 1 –lowest, and 5-
highest.
8 scales of Public Comments Each scale is rated from 1

Administration functions: to 5 on very broad criteria.
1 is the lowest score
usually indicating that there
was no evidence at all that
the function was operating,
and 5 is the highest rating
indicating that the function
was operating well and
effectively.
1. Strategy – Corporate The rating of 4.4 is the highest rating of any of the public
Planning administration functions in this Department. Possibly
because this agency has had considerable technical aid
support over many years, the status of strategy setting
and planning is very strong.
They have a very sound current Corporate Plan with very

good performance measures, although one of the US
respondents believes that these could be improved. The
linkage between Plans and Budgets is very sound, and
reviews are completed once the budget is actually handed
down so that targets are aligned.
There is also a conscious management strategy to link the

corporate directions down into both Annual work plans
and Divisional operational plans, although again, there is
a perception that some of the directors are not strong on
this process and there could be improvements.
This Department was one of the only two departments to

consult extensively with clients and stakeholders during
the development of strategic directions statements and
plans
2. Resource Allocation. The function of allocating scarce resources appears to be
managed quite effectively, based on the rating of 4.2.
During both the operational planning and the budget

development processes there are discussions around
what facilities, staff and funds are allocated to various
output indicators, however the executive believe that this
process could still be improved.
In terms of adequacy of resources, most staff who need

computers and other important equipment have access to
them and in general the Department believes that its
resources are adequate, with the assistance of AusAID.
Transport, health clinics and housing both in Honiara and
the Provinces all need serious improvement.
Establishment vacancies are relatively high. However in
comparison to many other departments the staff
resourcing situation is reasonable.
The budget allocation for training and capability building is
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strategically used for the important needs and for example
there was a Leadership and Management course during
2005 out of this allocation.
3. Systems and The rating of 3.8 for this function of having effective
Procedures. systems and procedures to support the management of
the Department is only just above average, but is higher
than in almost all other Departments. Again this might
reflect the result of a number of years of technical
assistance and the current Corporate Services advisory
team’s efforts.
This function was sub clustered into 7 groups: Information

Management, HRM, Procedures & Guidelines, Monitoring
and Reporting, Budget processes, Communication and
Systems Support.
Information Management:
Because of the health related functions within this

Department
there are a number of efficient data bases and Health
Information
Stats developed. However it appears that many of the
systems are
not networked and many others are still manual. General
records
management is in a similar state to most other
departments and
needs to be reviewed and upgraded.
Human Resource Mgmt:
The HRMIS is currently being upgraded within the HISP

project to replace the general 2 file systems. Until this is
completed, any staff statistics is manually collated. There
is a very extensive and convoluted process for identifying
priority professional development and training needs, but
this needs to be streamlined to improve the currency of
capability improvement. Records of this training however,
are not comprehensive nor complete.
Procedures & Guidelines:
There have been a few internal procedures and manuals

developed in relation to general administration, in addition
to a range of procedures relating to clinical practice. There
was a perception that there was little enthusiasm from line
managers for ensuring that work standards were
developed and implemented as a general practice.
Monitoring & Reporting:
Reporting against Corporate and annual plans is only

done at the request of the PS / US and is not a routine
management function. Line managers report annually on
performance against budget spending
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System Support:
Given the intensity of donor investment within this

Department the support for management systems was
adequate. However, the shortage and unreliability of
photocopiers in the headquarters office was an
impediment.
Budget Processes:
All line managers are involved in the development of

budget estimates, and they set activities against the
budgeted programs for the following year. There is then a
review of these activities after the actual budget has been
allocated.
Each manager is also provided with a budget expenditure
spreadsheet monthly, however the reporting back on
these at quarterly intervals is perceived to be a
management weakness.
Communication:
There are regular meetings at the Divisional Heads level

on both administrative and professional matters.
However, the weakness is at the within-division level
where only a few Divisional Heads have regular staff
meetings with operational staff.
Summary:
Given the rating for People Capability analysed later in

this Report, the Department would benefit if the entire
HRM function could be strengthened. This no doubt is
being addressed by the current HISP team.
Performance monitoring and reporting against planned

targets and measures needs to be strengthened to
improve the overall management of the department.
Similarly, line managers could benefit if they were more
aware of setting standards and procedures for required
performance levels to meet service delivery goals.
Performance Management generally could be improved if
Divisional Heads were more committed to communicating
with their operational staff on all matters related to
standards and quality of service delivery.
As the general trend across all departments indicates, this

department could also benefit from a professionalisation
of its records and data management systems.
While the budget development process is a much stronger

management function in this department than in most
others, the full benefit of this is not realized because of the
lack of ongoing management monitoring and reporting
against expenditure.
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Overall the Health Department does have a stronger

rating on this function than all other departments, and this
indicates that managers generally are being supported by
relatively effective administrative functions. However, as
the above comments suggest all seven sub-functions
could be improved, particularly in the areas of managing
and monitoring performance within Divisions.
4. Strategy – Work Plans The rating of 3.6 indicates the need for some directors to
and Policy. improve their development and implementation of
operational plans. While there are many who carry out this
function effectively, it is not an accross-department
strength.
Those whose operational plans are incorporated into

ongoing work activities do have sound performance
measures and report back to the Executive at least
quarterly on progress. Those divisions that are perceived
to be performing well, have informal discussions with the
US more frequently than the formal Quarterly reports.
Those same Directors tend to also link these plans, and
the National Health Strategic Plan, down into individual
staff work targets.
But again, this function is patchy in its effectiveness.

There is a perception that nearly 80% of line managers
are not using their plans to guide daily operations, nor do
they report on them as an aspect of strategically
managing the Department.
In particular, there is a need to build in Workforce

Planning and Resource planning into these Work Plans.
There is currently work being done on a workforce plan to
replace the existing Training needs plans, and they are
currently recruiting an Asset Manager who will be tasked
with developing a full equipment needs analysis to update
the 2004 assessment.
There have been a number of internal departmental

policies developed to support the strategic directions that
conform with the GOs, such as Patient Care and Referral
Guidelines, Delegations Manual etc.
In general there is an ongoing need for improving this

function to ensure consistency of Strategy across the
department
5. Structures. The rating of 3.3 indicates that the Department could
benefit from a closer alignment between its overall
structure, the way the priority work is formed into jobs, and
its strategic direction and performance targets. It is very
difficult to achieve corporate targets when the internal flow
of operational activity is not strategically aligned with
those targets.
There is a current Organisational Chart and a couple of

the Divisions have developed specific structural charts.
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However, these would only be familiar to executives and
line managers. Few staff would have much idea of the
existence of such documents or of where they would fit
into the chart.
Few staff, particularly those under the vertical programs

such as the Vector Borne Disease Program and the
Provincial structures, would be fully aware of their formal
reporting lines. However, those staff in national programs
would be more aware of their internal structures.
Since the HISP project in 2000 the Department has not

carried out even a superficial review of its structure to
align it with the Corporate Plan or the annual working
plans, nor is there any review of how jobs are designed to
meet planned targets, despite there being 99 vacant
positions within health services.
While there is currently a review of some job descriptions,

in general staff are not aware of what their JD actually
contains other than the title of their positions, but when
asked what their role is most people are able to say what
is being expected of them. This does not result in
achieving desired targets or results however, but this is
more a factor of lack of supervision than a ‘not knowing
what to do’.
The Department could expect to see a marked

improvement in performance if this one function received
some attention to align the structure of work with work
targets.
6. People Capability. The rating of 2.8 indicates that the overall levels of skills
and abilities of staff are probably causing serious
impediments to the standards of service delivery required
by the executive.
To improve this situation, line managers could be assisted
if they developed performance development plans for
individual staff that would align their skills and knowledge
with the priority work targets. These Plans would then
inform the annual training or professional development
plans linked to the budget. Further if staff could see that
they had even a basic career path within their work place
that their development was preparing them for, their
overall commitment to their work might improve.
In addition, the centralized performance appraisal system

is not the most effective mechanism to improve individual
staff capability to meet specific service delivery targets.
The Departmental performance generally, but Divisional
work units particularly would be assisted if staff had some
process whereby they were able to receive feedback, both
positive and developmental, on their performance. This
then assists them to be more committed to whatever
development plan has been formed for them.
Given the professions employed in the Health sector, it is

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not surprising that there was a general rating of 3 to 4 on
the Dependency Scale of Staff Capacity, as almost all of
these roles require formal qualifications. To ensure a
basic succession strategy, a targeted Graduate
recruitment program would probably benefit the clinically
related Divisions.
One of the strengths supporting the existing performance

of people is the evidence for a high level of cooperative
team work across most of the Divisions.
7. Legislation. The rating of 2.2 indicates that most of the specific acts
and regulations relating to the Health and Medical
Services portfolio is considered by the executive to be out
of date (1988) and have not kept up with the new
directions in service delivery and what the department is
currently drying to do. The existing legislation is not
useful in providing community based health services, and
the executive and staff have to try to deliver services
based on this philosophy, but within conflicting acts and
regulations. Most of the executive and decision making
managers are aware of the various pieces of specific
legislation, but feel constrained by them.
As found in all other departments, the central agency

legislation – Public Service and Public Finance Acts – are
not incorporated into management functions and few
executives are even aware that there are obligations for
them contained within these Acts.
8. Culture & Work Ethic. The rating of 2.0 was the lowest rating function for this
Department, and indicates that executive directors may
need to pay attention to the general work morale and
commitment within the Divisions.
In terms of a formally defined set of work values which

leaders then manage, the Department does not have any,
apart from professional codes of ethics relating to the
medical professions.
Informally some of the more committed Divisional Heads
attempt to role model a set of positive work values, but
many others are seen not to be good role models
themselves. This flows on to a situation where some
Divisions do have very positive work cultures and high
morale, where as others do not.
For most people in this Department the Public Service

does not provide them with a desirable career, and the
poor standards of wages contribute strongly to this. Many
staff are forced to take on second or part time jobs to
achieve even a basic standard of living. In such situations
it is unlikely that the work culture will be very positive.
Overall Analysis of the Department of Health.

The overall rating for Public Administration functions within the Health & Medical
Services Department is 3.29.
This means that the department generally and executive mangers specifically are being
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fairly adequately supported by their internal administrative systems. However, a rating
between 3.0 and 4.0 indicates that there is room for improvement if the department
desires to strengthen its internal operating efficiencies, and the closer to Rating 3 the
score is, the more improvements can be achieved.
The status of many of the public administration functions in this Department indicated
sound implementation. There was evidence that the corporate planning component of
the Strategy function was operating effectively across the Ministry, closely supported by
a targeted allocation of Resources.
To a lesser extent internal Systems & Procedures and the Strategy sub-function
Operational or Annual Work plans were also supporting line managers, but there was
evidence that there is real room for strengthening both of these processes to achieve
sustainable performance improvement. Of particular priority is a strengthened
management ability to implement sound performance management systems and
processes. A closer Structural alignment could certainly assist the executive ensure
that the flow of work and job requirements were clearly designed to maximize
efficiencies.
Of serious concern are the two functions People Capability and Work Culture, as well
as the Strategy sub-function of Legislation.
In this regard it is suggested that line mangers and executive could benefit if they
adopted a stronger leadership and public management role in their Divisions. The
best Corporate Plans can not deliver the required level of services to the community if
the staff who actually work at the operational level do not have the necessary
commitment to that work, or the required skills and knowledge. Similarly, without the
relevant legislative base decision makers are impeded in their tasks of ensuring that the
priority services are delivered in the manner expected by the public.
6.2 Primary health care clinics utilisation20 “PHC Clinic

At November 2005, there were 323 PHC clinics and 10 hospital outpatients utilization
departments providing Primary Health Care (PHC) services across Solomon Islands. review
A review of PHC clinic utilistation was conducted in 2005 with a view to making highlighted
recommendations for health service rationalization21 clinic
Due to complexity of the report finding, Nurse Aid Posts (NAP) and Rural Health
management
Centres (RHC) that fail to reach or exceed benchmarks should be reviewed in the full issues to
report. For most adjustments of designation or staffing levels can be considered services
delivery and
The results presented in this summary are for RHC and Area Health Centres (AHC) resources,
that require upgrade to AHC or mini hospital status as these have major implications
for health infrastructure development and human resources planning. These are the
and
major utilisation considerations for the NHSP implicates on
infrastructure
planning”
6.2.1 Solomon Islands Primary Health Care Clinics Utilisation Review
Data Source:
Data for the review was obtained from the MOH HIS. Data suitable for assessment of clinic utilisation were:
20
Primary Source for the Clinic Utilization from: HISP/MOH 2006:
Solomon Islands National Health Review – February 2006
21 This review was completed by the HISP NHRA in December 2005
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Total outpatient contacts (new and return cases of disease)
Reproductive health contacts (antenatal and postnatal care, family planning)
Child welfare contacts (growth monitoring and vaccination)
Number of inpatients (defined as “any person admitted to the clinic for any form of medical treatment or bed
rest for one night or more”)22
Number of clinic births:
2004 utilisation data was chosen as it was complete, information previously collected about the number of
months individual clinics were open for the year were available and the monthly reports completion rate of all
clinics was reliably known. The data were visually scanned to identify problems and difficulties. These were
rectified and annual and average weekly statistics for the above calculated and tabulated.
Clinic benchmarks:
\
A set of simple utilisation benchmarks, based on the average number of patient contacts a week, clinic births
and inpatients, were developed against which to assess clinic utilisation. (Table 4). These operate as a guide
that indicate when variations of clinics designation or staffing/skill mix need to be considered by MOH and
Nursing Executives and PHD and Senior Nurses in provinces. The benchmarks are not suitable for
application to urban health services where there is demand for ambulatory care services but not birthing or
inpatient services.
The number of clinic births and inpatients are indicators of the need for access to more complex care and
management or additional training to manage maternity care and birthing and can be used as indicators of
when change of clinic designation or staff skills mix should be considered.
Each clinic assessed by the review was measured against the utilisation benchmarks and on this basis was
rated as having met or exceeded the benchmark for their current designation (AHC, RHC, NAP) or if this was
unclear this is stated.
Benchmark NAP RHC AHC Mini Hospital
Number of weekly contacts – outpatients, 30 to 70 70 to 150 150 + No limit
reproductive health, child welfare
Annual clinic births ≤20 ≤70 ≤200 ≥200
Annual inpatients (total including births) ≤40 ≤150 ≤500 ≥ 500
Table 7: Solomon Islands PHC clinics utilisation benchmarks
Mapping and location:
With the assistance of the staff at Solomon Islands Ministry of Lands and Solomon Islands Institutional
Strengthening of Land Administration Project (SIISLAP) all known PHC clinics were mapped on topographic
maps that also detailed population density and distribution. These maps are important for understanding
distance between clinics, their distribution and isolation and the information they provided was considered in
the discussion of individual clinics and suggested actions.
Limitations
Disaggregated data were not available for 89 PHC clinics because these clinics have not been individually
listed/added to the HIS database. Data for these are aggregated (combined) with data of 47 clinics listed in
the HIS. Eight of these 47 contain aggregate data for 2 or more additional clinics. In total there are no
disaggregated data available for 136 (43%) clinics, hampering interpretation of utilisation data23. Until the
22Guidelines on the monthly reporting on health activities – Statistics Unit MOH, 1994
23For epidemiological analysis and reporting aggregated data are not a problem as the goal is to report total cases of disease at
provincial and national levels.
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PHC HIS is redeveloped this problem will continue to worsen and repeating this review of utilisation using the
same methodology will be difficult or impossible.
Results summary:
PHC clinic utilisation of 232 clinics was compared with the utilisation benchmarks. Of these, 95 (41%) were
assessed as meeting one or more benchmarks, 33 (14%) exceeded the benchmarks for current designation,
55 (24%) met no benchmarks and for 49 (21%) the situation was unclear.
A small number of clinics are very poorly utilised and should be considered for closure as they do not appear
to be sufficiently isolated to maintain a full time clinical service. Identification (tables) and discussion of clinics
failing to meet or exceeding benchmarks is included in the main document.
Two clinics reached the upgrade criteria for mini hospital both in Malaita, 4 RHC met the upgrade criteria for
AHC, all in Malaita. An additional 4 were approaching the AHC upgrade criteria, 2 Malitan clinics, 1 Central
and 1 in Western (see recommendations following).
52% of clinics exceeding benchmarks are in Malaita province. 78% of clinics identified for upgrade from RHC
to AHC or AHC to mini hospital are also in Malaita.
Clinics reaching benchmarks for upgrade to Area Health Centre and mini hospital status
Area health centre to mini hospital status:
Two north Malaitan clinics met the inpatients and clinic births criteria for upgrade to mini hospital status,
Mau’lu AHC and Fau’abu RHC (Table 5).
Grove AHC (Table 5), located on the Guadalcanal plains, does not yet meet the criteria however the 2003 -
June 2005 utilisation trend demonstrates rapid progression toward it. Numbu NAP data is included in Grove
AHC and its contribution cannot be assessed. A mini hospital is currently being constructed at Grove with
assistance from Don Bosco.
2005 (Jan-June data) 2004 2003
Name Province Inpatients Clinic Home Inpatients Clinic Home Inpatients Clinic Home
births births births births births births
Grove GP 242 113 62 251 142 108 197 89 81

Mau’lu MP 1097 107 49 2115 237 117 2143 271 81
Fau’abu MP 629 103 37 1437 212 36 771 217 51
Table 8: Clinic utilisation data Grove AHC, Mau’lu AHC and Fau’abu RHC 2003-2005
Rural health centre to area health centre status:
On recent utilisation trends, Biti’ama RHC in north west Malaita, Gwanuatolo RHC and Takwa RHC in north
east Malaita and Maoa RHC on the central west Malaitan coast all exceed the inpatient criteria for upgrade
to AHC status (Table 6).
Maoa is approximately 40kms south of Auki and more than 90kms north of the next closest AHC Afio. Takwa
is between Gwanatolo RHC (which is about 12 kms south) and Mau’lu AHC to the north west. Bita’ama is
north of Fau’abu and south west of Mau’lu AHC. (Table 6).
Increasing the capacity of Mau’lu, Fau’abu and Gwanatolo to manage inpatients may reduce the inpatient
burden on Bita’ama and Takwa RHC. Maoa needs to be considered for AHC upgrade.
2005 (Jan-June data) 2004 2003
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Name Provinc Inpatient Clini Hom Inpatient Clini Hom Inpatient Clini Hom
e s c e s c e s c e
birth birth birth birth birth birth
s s s s s s
Bita’ama MP 159 39 14 238 51 10 - - -
Gwanuatol MP 134 71 23 237 117 31 99 11 23
o
Maoa MP 105 27 10 155 69 45 130 68 33
Takwa MP 98 25 11 195 118 2 155 93 16
Table 9: Clinic utilisation data Bitiama RHC, Gwanautolo RHC , Maoa RHC, Takwa RHC 2003-2005
2004 data for Batuna RHC in Western province, Tarapaina RHC and Talakali RHC in Malaita province and
Taroniara RHC in Central province indicated these clinics met at least one benchmark for upgrade to AHC.
(Table 8).
Review of data from 2003-2005 do not support upgrade of Batuna at the current time however utilisation
should be monitored over the next 1-2 years.
Taroniara has almost reached the AHC threshold however the impact of utilisation data from Narogu NAP,
(which is recorded in Taroniara), needs further assessment.
Data for Tarapaina suggest that the AHC upgrade threshold will be exceeded in 2005 for births and possibly
inpatients.
The discrepancy between 2004 and 2005 inpatient data for Talakali suggests a change in reporting practice
rather than a change in trend. This clinic should be monitored as it is approaching the upgrade threshold.
2005 (Jan-June data) 2004 2003
Name Provinc Inpatient Clini Hom Inpatient Clini Hom Inpatient Clini Hom
e s c e s c e s c e
birth births birth births birth birth
s s s s
Taroniar CIP 68 30 0 179 50 3 184 77 6
a
Batuna WP 70 26 4 257 51 1 175 66 2
Tarapain MP 77 44 0 238 82 6 169 69 7
a
Talakali MP 28 53 16 130 86 61 128? 103 49
Table 10: Clinic utilisation data Taroniara RHC, Batuna RHC and Tarapaina RHC 2003-200
Linkages with MOH infrastructure review:
The recent report “Primary Health Care Facility Infrastructure Rehabilitation Plan – Stage 1 Area Health
Centers”24 identified several clinics to be considered for upgrade to AHC status.
Choiseul: Wagina RHC data do not support development of an AHC at the current time, however supervision
and support needs of clinics in the south east and south west of Choiseul and distance to other health
centers may outweigh current utilization statistics.
Makira: Marogu RHC utilization data do not support upgrade to AHC at the current time however geographic
location and supervision support needs may outweigh statistics.
24 HISP 2005
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Malaita: Malu’u AHC and Fau’abu RHC are discussed above. Current utilization statistics do not support
upgrade of Afio AHC to mini hospital status at this time. Collection of additional data about referrals against
the MOH referrals policy would be helpful to assess why they are made and whether alternatives to referral
to NRH exist. Utilisation for Rohinari RHC, Sinamauri RHC and Ata’a do not support upgrade at the current
time. Talakali is approaching upgrade benchmarks as discussed above.
Western Province: Utilisation data support Noro Taiyo and Noro public clinics merging to form a single Urban
Health Centre, with consideration given to maintaining a birthing service and limited inpatients. Batuna is
approaching upgrade benchmarks as discussed above; Ughele RHC does not meet benchmarks for a RHC.
Temotu: Dendu RHC does not currently reach, nor is it approaching AHC benchmarks.
6.2.1.1 Major discussion points:

The results of the clinic utilisation review demonstrate different trends and great variability in use of health
services across individual provinces and between provinces.
Clinics not meeting benchmarks require review of staff numbers and skills mix against local health need,
distance and proximity to the nearest clinics. Methods for increasing clinic productivity need exploration, for
example increased outreach and health promotion in response to local health needs.
Results support future posting and training of specialist staff according to clinic workloads, skill mix needed
to meet individual clinic demand and skill mix at adjacent clinics. This argues for adoption of a flexible clinics
designation (e.g. ‘health clinic’ rather than a NAP/RHC) and staffing model based on need rather than
population parameters. The role delineation for PHC clinics developed in December 2005 also supports this
approach as the PHC levels are skill rather than population based.
Because many clinics demonstrate low utilisation and as there are growing numbers of clinics the policy
governing establishment of new health facilities needs to be reviewed. In particular the 3km radius of service
delivery for clinics could be increased.
The HIS from which data used were drawn from cannot readily supply utilisation data in the future. Programs
for health facilities utilisation and planning need to be programmed into future health information systems.
6.2.1.2 Recommendations Clinic Utilisation Review
Recommendation 1:
PHD and senior nurses in each province review clinics not meeting utilisation benchmarks with a view to
determining reasons for poor utilisation and exploring options for increased productivity, closure or change in
staff numbers.
Recommendation 2:
PHD and senior nurses review and further investigate RHC approaching or meeting benchmarks for AHC
upgrade to determine whether high demand for inpatient services could be reduced through increased public
health activity. Priority clinics for investigation and monitoring are:
Talakali RHC Malaita Province
Tarapaina RHC Malaita Province
Takwa RHC Malaita Province
Biti’ama RHC Malaita Province
Batuna RHC Western Province
Taroniara RHC Central Province
Recommendation 3:
MOH executive and Malaitan PHD prioritise:
Upgrade of Mau’lu AHC to mini hospital
Upgrade of Fau’abu RHC to mini hospital or at a minimum AHC
Upgrade of Gwanatolo RHC to AHC
Upgrade of Maoa RHC to AHC
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MOH executive and PHD to monitor impact of any future upgrade of Malu’u AHC, Fau’abu RHC and
Gwanatolo RHC on Takwa RHC Malaita Province and Bita’ama RHC Malaita Province before these clinics
are upgraded.
Recommendation 4:
MOH executive use results of this report, especially findings for RHC to AHC upgrade to priorities health
infrastructure projects.
Recommendation 5:
National nursing executive, provincial senior nurses and PHD use the utilisation statistics to guide nursing
staff postings, skill mix and training plans25. In particular clinics with high numbers of clinic births or RHC
exceeding the clinic births benchmark be prioritised for training and placement of trained midwives.
Recommendation 6:
The approval process for development of new clinics be revised and include elements listed in the discussion
section of the document.
Recommendation 7:
Consideration be given to calling NAP and RHC ‘health clinics’ and staffing these in response to community
health needs26
Recommendation 8:
The HIS (software and data collection processes) be urgently redeveloped so that it provides information that
can be used for ongoing assessment of clinic utilisation.
Recommendation 9:
The clinic benchmarks developed for this review be evaluated within 2 years for ongoing utility.
Recommendation 10:
Maps of health clinic location be reviewed and updated annually at the National Health Conference.
6.3 Role delineation for PHC clinics and hospitals:

In December 2004 the primary health clinics and hospitals role delineation was redeveloped by HISP27 and
accompanies the PHC clinic utilisation review. This section of the report presents the complete role
delineation document as it cannot be summarised.
One of the recommendations made by the utilisation reports is for RHC and NAP to be called by a generic
name ‘health clinic’ and be staffed according to health care need. The role delineation supports this
approach by defining NAP and RHC according to the skills base of staff. Thus a facility staffed by at least
one registered nurse corresponds to a rural health centre in the role delineation and can offer packages of
essential health care appropriate to the nurses training level.
6.3.1 Introduction
25 This analysis should be linked with WHO WISN human resource management approaches currently being implemented by HISP
26 Reference the Solomon Islands Health Facilities Role Delineation developed by HISP in 2005, which supports this via a skill based
approach to PHC clinics role and designations
27 By the roving Primary Health Care Advisor (PHA) for Guadalcanal, Honiara, Renbel and Isabel provinces
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In 2001 the Ministry of Health released a policy entitled “Role delineation of Health Care Services in Solomon
Islands”. The aim of the policy was to improve and upgrade management, supervision and distribution of
health care resources across Solomon Islands. A time frame of 5 years following implementation was set for
review of the policy.
In January 2006, the policy was reviewed and re-developed to frame health services role delineation in terms
of which elements of the ‘packages of essential health care’, they deliver. The new model has five levels of
health service delivery: three primary health care, one general hospital and one specialist hospital level.
The packages of care selected encompass the major communicable causes of morbidity and mortality in
Solomon Islands, emerging health threats and health transition diseases. The selection also encompasses
reproductive and child health needs, rehabilitation, mental health, emergency care, referral and outreach for
services not offered by local or provincial health services.
The packages of care and role delineation outlined in the document will support MOH executive, PHD and
Directors of Nursing (DON) to plan, staff and manage Solomon Islands hospitals, PHC clinics and integrated
public health functions.
6.3.2 What are packages of care?
‘Packages of care’ are essential health care interventions or groups of interventions and services provided by
government and/or the private sector to meet the health care needs of the population. Information to guide
selection and development of packages of care for a country, province, health district or area can be sought
from:
Epidemiological and public health data about disease incidence, prevalence, trends and how these impact
on health services demand
Technical information about disease control and prevention interventions including vaccination, vector control
and health promotion
Documented evidence supporting implementation of health programs shown to decrease morbidity and
mortality (eg pregnancy care and births assisted by trained health providers)
International health trends and evidence (eg rising incidence of mental health disorders)
Evidence of a health transition (eg rising incidence of non-communicable disease in countries with continued
high incidence of communicable diseases)
Emerging health threats (eg HIV/AIDS and avian influenza)
Information about new program approaches to health issues (eg men as partners)
New packages of care can be added to a role delineation matrix as the need arises. Need may be
demonstrated by changing health indicators locally or internationally, new evidence supporting change of
interventions or implementation of new interventions, international health alerts or progression of the health
transition with increasing incidence of non-communicable diseases.
6.3.3 How do packages of care articulate with role delineation?

Packages of care outline the main health care interventions that are implemented in response to a particular
health condition or problem, from simple low technological interventions through to those that are more
complex or specialist in nature.
Put simply health facility role delineation determines what parts of each package of care each level of the
health care system delivers. Health facilities with low technological availability, few staff or less skilled staff
deliver those parts of the package of care that are not reliant on technological interventions or more highly
skilled or specialist staff, for example a nurse aide post or rural health centre.
Health care facilities with infrastructure, equipment and appropriately trained staff to support technologically
complex interventions offer those parts of the package that require these additional technologies or staff
skills. An example is caesarian section, an intervention that can only be offered at health facilities (hospitals)
with a theatre, medical and anaesthetics trained staff. In contrast pregnancy care can be offered at all levels
and women with risk factors or problems can be referred.
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6.3.4 Continuum of Care
The packages of care developed for Solomon Islands recognize and incorporate a continuum of care from
health promotion and prevention activities through to acute care and maintenance as appropriate for the
package. Each health program in the matrix has a core health promotion focus and where applicable,
millennium development indicators are outlined.
The aim of a continuum of care is to highlight that health interventions begin, and have importance, before
the onset of acute disease and that public (population) health approaches that concentrate on disease
prevention and early diagnosis, before onset of complications, are as important as acute care interventions.
A continuum of care also recognises that health interventions do not end with acute care interventions and
for some illnesses must continue through until cure, death or rehabilitation goals are achieved.
6.2.2.5. A continuum of care incorporates:

Health promotion and disease prevention activities (for example HIV/STI prevention campaigns, healthy
diet/lifestyle advice)
Early intervention and management (for example screening of individuals with high risk of diabetes, early
diagnosis and management, voluntary confidential counselling and testing for HIV)
Acute treatment and care services – outpatient and inpatient (for example treatment of medical conditions
and diseases such as malaria, acute respiratory infections, asthma and surgical conditions, conditions
related to AIDS)
Rehabilitation and sub-acute care (follow up care of aged, disabled of post illness/surgery)
Maintenance and palliative care (eg cancer patients, HIV positive, diabetes)
6.4 PHC Quality Check 28:
Between February and May 2004, the MOH conducted a survey of PHC clinics to gather information about a
range of factors that potentially impact on provision of care by PHC clinics. Accordingly transport availability,
communications (radios), infection control infrastructure and equipment, standard treatment protocols and
supplies (essential drugs and EPI) were assessed. Each of the areas assessed provides information about
PHC clinics capacity to provide quality PHC health care services and health programs.
The survey also sought to quantify number of PHC clinics that conducted health education/promotion
outreach activities and had active health committees. The survey report is available from the HISP team in
Honiara and MOH.
“Essential supplies to
clinics remain an
Key Findings: issue”
Infection control:
“Infection control needs

63% of clinics reported access to a steriliser. Of these 65% had a
more effort to improve at all
primus to heat the steriliser. 66% of clinics with a primus had fuel at
the time of survey. NAP had lowest coverage of sterilisers (48%). 71% clinic levels”
reported availability of gloves (surgical) at all times, 23% had gloves
sometimes. Water was piped into 116 clinics (54%) and described as always working by 60%
Transport:
“Lack of transport was
the most commonly
50% (9) AHCs29had access to a canoe. Only 4 of these reported a
working outboard motor (OBM). Distribution of canoes was lower at RHC
cited reason for lack of
outreach, followed by
lack of staff and
28 JTA/HISP/MOH (2006): Primary Health Care Survey 2004: in the SI National Health Review
29 Contents defined by MOH Reproductive Health Unit
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35% (26) having a canoe, and 17 a working OBM. 5% (3) NAP had canoes, 2 with a working OBM
Clinical care protocols:
Overall there was poor availability of standard treatment protocols. 37% of clinics had women’s health
protocols, 57% had family planning, 57% paediatric, 44% adult and 75% malaria protocols. The lowest
availability of protocols was in NAP.
Clinic equipment and supplies:
75% of clinics had a full delivery kit30, 61% had adequate equipment for “Basics day to day
activities and 53% had run short of supplies or drugs in the 3 months lacking or prior to the
survey. NAPs and UHC most commonly reported shortfalls of drugs or inadequate supplies.
There was a good distribution of EPI fridges across Solomon Islands, at the PHC however
results demonstrated that a large proportion did not have a 3 month fuel supply
Health outreach and health committees
Health outreach activities were conducted by 52% of clinics. Lack of transport was the most commonly cited
reason for lack of outreach, followed by lack of staff and distance. Most clinics had health committees but
these met irregularly.
Major discussion points:
The PHC clinics survey identified several areas for action to improve the quality and delivery of health care
services across Solomon Islands. Some can be addressed through provincial action, for example purchase
or redistribution of canoes to AHC, improvement of clinic water supplies and ensuring availability of EPI fuels
to support cold chain and minimise vaccine wastage.
Redevelopment and distribution of clinical protocols requires a national lead from MOH and support of
provinces.
The current poor distribution of clinical protocols does not support nurses and nurse aides as practitioners in
remote areas and increases the risks for making drug administration and treatment errors. An additional
consideration is that protocols in use date from the early 1990’s. Drug names, types and best practice
approaches may have changed in the intervening period and new approaches such as ‘integrated
management of childhood illness’ have been introduced, leading to overlap of protocols and potential to
create confusion.
Difficulties persist with availability of drugs and medical sundries to clinics and may indicate problems with
timely ordering by clinics staff, delays in preparation of supplies by National Medical Store or transport
problems. Adoption of the clinic minimum standards guidelines and
“Overall there was
increasing use of the clinic quality improvement checklists by clinic
nurses and supervisors may help to improve these difficulties. poor availability of
standard treatment
6.4.1 MOH Infrastructure -Issues:

Challenges facing ‘MOH Infrastructure’ fall into two categories, upgrading and renovating existing facilities
and increasing the capacity of the MOH to manage health facilities.
“The current poor
distribution of clinical
Up to 70% of PHC clinics require significant upgrade, repair or
protocols does not
renovation. The degradation of health facilities has happened over
decades. There are many varied projects underway, but work of this support nurses and nature
is needed for many years to come. nurse aides as
practitioners in
6.4.2 National Infrastructure Management: remote areas and
increases the risks
for making drug
30
d i i t ti d
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The recruitment of a National Health Facilities Manager is again underway but as yet no suitable applicants
have been received. The is a key role for a number of reasons including;
The development of a maintenance program, which would be run at provincial level.

Co-ordination of capital works programs and donor activity.
Implementation of policies and guidelines such as the “Minimum Standard for Clinic Infrastructure.”
Represent MOH on important government and donor initiatives such as the “SIG Housing taskforce” or
Global Fund, “VBDC Works Projects”.
As there is no indication the Department of Works will be strengthened in the near future more responsibility
will continue to fall on the Ministry of Health.
The temporary ‘Project Manager’ position will help to manage consultation, liaison with regulatory authorities,
procurement, tender and project management of capital works. Unless a large Capital Works program is
taken up by SIG or a donor the need for this role will continue for more much longer, assuming that health
facilities in need of repair will continue to be rehabilitated.
Requests have been made for technical assistance for projects such as the upgrade of, pharmacies,
microscopy labs, storage sheds and entire clinic or hospital upgrades for which government and donor funds
are becoming available.
6.4.3 Provincial Infrastructure Management:

Much of the work managing infrastructure is falling on the shoulders of the Provincial Health Direcors such
as emergency maintenance and preparing infrastructure proposal for donors.
More work can be done to develop “Provincial Infrastructure Plans” to include Provincial Hospitals, PHC
Clinics and housing.
There needs to be a continuation of a strategic focus as well and operational planning on how go about
improving facilities and managing recurrent cost such as maintenance.
6.4.4 Local Infrastructure Management

The development of preventative maintenance programs (i.e. white ant detection) and increasing the ability
of clinic staff and the community to fix problems when they arise or notify someone is important.
Working with the local community and village health committees which provide support and resources is also
vital.
6.4.5 Health Infrastructure Reviews

By the end of April 2006 we will know, in detail, the condition of all AHCs and RHCs. It is important that the
new RHC infrastructure needs are incorporated into the Provincial Infrastructure Plans. Further evaluation of
provincial hospitals, NAP, Nurse Training Facilities and housing is needed.
6.4.6 Provincial Hospitals & housing

The shortage of adequate housing and ambiguous housing policy is still a major problem. The funds
available to the MOH, and commitments by donors are not meeting the needs. Implementation of the
Regional Assistance Mission to Solomon Islands (RAMSI)/SIG Housing Review’ recommendations may
solve this problem.
Some work is commencing at provincial hospitals, however only limited master-planning, integrated design,
or facility analysis has been done. There are at present no guidelines for design or construction with much
important works needed at all provincial hospitals.
6.4.7 AHC Rehabilitation Plans

Following the AHC Infrastructure review in August 2005, there are plans to improve six of the 19 AHCs
needing improvement.
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Consequently, following further review of the 3 HCC clinics and two AHCs projects dropped by the Solomon
Islands Health Sector Development Program (SIHSDP) there are at present 18 AHCs in need of some
infrastructure work, six of which are in a bad state of repair.
There have been improvements in the form of solar lighting and radio installation.
At bare minimum each of the remaining 18 AHCs need an incinerator, sealed rubbish pit, clean and dirty
utilities, a functioning toilet and shower, a reliable water supply and eradication of white ant infestation.
6.4.8 RHC Clinic Review:

The preliminary results from the RHC infrastructure review are showing the same trends as those found in
the AHC review.
The problems directly linked to poor infrastructure include;
Poor water, power supply and sanitation

Poor housing (or no housing, posted staff returning to villages)
Bad location & poor access to some clinics
Poor Infection control, hygiene & waste disposal
Overcrowded OPD and lack of adequate treatment areas.
6.4.9 Unfit or inappropriate birthing facilities
Lack of infrastructure for PHC activities such as outreach, antenatal classes, health education, counselling,
HIV and STI awareness, condom distribution & integrated medical tours (mostly held in small crowded
outpatients departments or under a tree, lack of privacy etc.)
6.4.9.1 Need for upgrade of equipment & furniture:

Lack of storage for medical supplies, pharmacy, fuel & equipment.
Physical deterioration of buildings due to age, weather and white ant s.
It is also recommended that funding be made available or donors found for the upgrade of the six most
urgent clinics with-in the next year.
6.5 Program Performance:

6.5.1 Program achievements of Outputs in 2006:
6.5.1.1 Environmental Health Division- 31:
By 2005, since 2003, of the total 14 water supply projects funded under EU, 12 (86%) were
completed Only 2 projects are pending completion.
By 2005 10 projects (sanitation projects) funded under ROC completed.
Gazette of Food Hygiene and Fish and Fishery Regulation done.
Office space and health center at Airport completed and in use: Space at Port under negotiation.
6.5.1.2 HIV/STI Prevention- Disease Prevention and Control Unit
VCCT Sites established and operating at SIPPA, Rove Clinic, HIV Prevention Unit and National
Referral Hospital. Auki and Gizo sites visited.
BSS/HIV/STI Surveillance done and report available.
31 Environmental Health Division: 2006 Quarterly Report (3rd Quarter)

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Draft HIV VCCT Protocol completed for finalization.
Stakeholder meetings held regularly.
Solomon Islands National AIDS Council meetings held.
Training of additional 20 VCCT counselors (nurses) begun.
6.5.1.3 NCD Prevention: Disease Prevention and Control Unit
Regional Assistance from NZAID through David and Allen Clark of NZ signed and project
commenced in 2005.
Training (s) of health workers (nurses and doctors) on diabetes held.
A video on smoking and related health problems produced.
Radio spots on NCD prevention continued.
Two supervising tours done: Choiseul and Makira
6.5.1.4 Community Based Rehabilitation
Refresher training for 16 Rehabilitation Aides done.

Draft Legislation on Disability completed, discussed during a one day workshop: Pending further
discussion
Training: Teach Blind people to read and write Braille at least 5 persons per class: (including
Purchase a new Braille equipment and Purchase Braille paper and other materials for the training)
done.
6.5.1.5 Distance Education Program:
Enrolled 20 students ( nurses) for Pediatric, community Health, Obstetrics.

Enrolled students for Family Planning.
Enrolled 15 students for Nursing Management.
Support to the Pacific Online Health Network continued.
6.5.1.6 Social Welfare
Major review of the Social Welfare Division done.

Social Welfare Strategy and Operational Directions done and accepted for implementation by
Ministry of Health.
6.5.1.7 TB and Leprosy Prevention and Control.
Completed TOT for coordinators on DOTS. Choiseul, West, Makira and Malaita completed.
TB Video developed.2 and distributed. Radio spots (cough too long go to clinic, if stop treatment
early TB recurs easily, sharing cigarettes spread TB).
Community awareness, leproy screening done in HCC & GP: Additional new cases found 9 in GP
and 4 in Fishing Village..
Another training done Provincial Leprosy Coordinator held August 8-10.
Leprosy IEC done by FSM students and to be pre-tested later.
All new cases of leprosy on treatment-Pauci and Multi-bacillary treatment inclduing contract
tracing.
Page 119 of 250
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Page 120 of 250
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Chapter 7 Provincial Health Services

Chapter gives a very brief overview of the current status of demography, health burden and the provincial
responses.
7.1 Choiseul Province:
Demography: Gender and Poverty:
25,000
20,000
15,000
P op
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005
Population total 19,787 20,422 21,053 21,680 21,853 22,090 22,974
Population <1 705 684 682 682 670 681 707
Population 1-4 2,554 2,614 2,652 2,690 2,673 2,704 2,697
Population <5 3,259 3,298 3,334 3,372 3,344 3,385 3,404
Fig 26 Population of Choiseul 7 year trend 1999-2005.
Choiseul has a stable and slow increasing population. About 15% of the total population of 22,974 in 2005
were children of less than 5 years old. About 48% are age group of 15-49 years old.
12,000
10,000
8,000
P op
6,000
4,000
2,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 4,455 4,667 4,883 5,096 5,093 5,155 5,446

Expected births 730 723 717 710 703 703 702
Males >5 8,433 8,675 8,920 9,167 9,415 9,541 9,939
Females >5 8,095 8,449 8,799 9,142 9,095 9,164 9,631
Total 15-49 9001 9379 9762 10141 10309 10467 11,035
4 46 4 12 48 9 04 216 621 88
Fig 27 Population of Choiseul by gender 7 year trend 1999-2005.

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7.2 Health Burden in Choiseul 1996-2005
7.2.1 Introduction
In Solomon Islands the main source of information about health status of Solomon Island people is
collected through the Primary Health Care Information System (MOH statistics). Other health
information are also maintained by SIMTRI, CBR, Reproductive health while some data are now
being collected by the National Referral Hospital.
In 2005, a major health review for Solomon Islands was conducted and health indicators were
measured against the MOH and millennium development goals.
900.0
800.0
700.0
Rate per 1,000 pop
600.0
500.0
400.0
300.0
200.0
100.0
0.0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
A RI 298.5 379.9 393.8 337.8 471.1 408.9 587.5 413.4 479.7 477.8 399.1
Diarrho ea 61.2 74.8 48.9 50.1 56.2 57.0 45.5 35.0 47.8 43.8 44.6
Fever 793.1 734.9 541.7 566.4 433.4 338.7 375.4 348.3 475.1 359.8 287.5
Red Eyes 42.2 116.0 38.5 36.3 56.5 40.2 43.0 41.5 34.5 36.8 27.6
Yaws 10.6 29.2 21.1 17.1 18.0 11.8 19.9 18.6 40.2 14.2 21.2
Skin Diseases 285 258 213 209 198 180 187 162 161 151 118
Ear disease 70 79 71 69 74 97 108 77 89 82 98
STI rate in 15-49 years 13.6 12.0 9.4 8.2 10.0 17.6 10.5
Clinical malaria 260.8 436.8 272.2 369.5 247.6 223.3 295.2 266.1 324.7 213.1 132.7
Others Diseases 413.5 516.5 429.5 646.8 659.3 749.8 806.5 684.4 747.3 747.9 741.4
This report will present the progress of health status of Choiseul people in the period 1995 to 2005
against national figures and Solomon Islands MOH and appropriate international indicators.
The aim of this report is to present Choiseul health data for period 1996 – 2005 so that trends in
disease incidence can be reported.
7.2.2 Major Health Issues
There are several major health issues affecting Solomon Islanders. Some of these are
communicable for example, acute respiratory infection (ARI), malaria, skin diseases and yaws,
sexually transmitted diseases and HIV, diarrhoea, and TB and leprosy. Others are chronic non-
communicable such as, diabetes and mental, which are becoming increasingly important and
demand attention by health service planners as they require long term care for those affected.
Each of these health issues provide challenges for health care planners particularly to reduce high
levels of morbidity and mortality caused by them.
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Fig 28 Common illness per 1,000 population 11 years trend 1995-2005 in Choiseul: Source HIS MOH (2006).
300
250
R ate p er 1,000 p o p
200
150
100
50
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Diarrhoea Red Eyes Yaw s

Skin Diseases Ear disease STI rate in 15-49 years
Fig 29 Lesser common illnesses rate per 1,000 pop 11 yr trend 1995-2005 in Choiseul
Disease Incidence Trend of Choiseul 1996-2005:

Figure 1 below demonstrates the proportion of acute care contacts in Choiseul by common diseases. It is
obvious that other disease has gain importance as a major cause of attendance at any primary health care
clinic in Choiseul during the last decade.
Page 123 of 250
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Fig 1. Proportion of new cases by major disease, Choisuel 1996-2005

45%
40%
35%
30%
25%
percent
20%
15%
10%
5%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI Diarrhoea Fever Red eyes
Yaw s Skin diseases Ear infection STI diseases
Clinical malaria Other diseases
Acute Respiratory Infections

ARI are major cause of morbidity worldwide and in Solomon Islands. In Choiseul, ARI has been the major
cause of attendance at any primary health care clinics. In 2005, ARI was responsible for 26% of all acute
care contacts in Choiseul.
Figure 2 below demonstrate the incidence rate of ARI in Choiseul and Solomon Islands over the past 10
years. The graph illustrates that in the early years of last decade, incidence rate of ARI for Choiseul was
below national average. However, between 1998 and 2005 the situation was reversed. The highest
incidence rate of ARI in Choiseul occurred in 2001 reaching 586 cases per 1000 population. The trend of
ARI rate in Choiseul had continued to increased between 2002 and 2005.
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Fig 2. Incidence rate of ARI, Choisuel & Solomon Is
700.0
600.0
500.0
ra te p e r 1 ,0 0 0
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI, Choisuel ARI, Solomon Is
Incidence rate of ARI by age group – Choiseul
Fig 3. Incidence rate of ARI by age group, Chosiuel 1996-2005
2500
2000
rate per 1,000
1500
1000
500
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
rates <1 rates 1-4 rates >5
Figure 3 above demonstrates the incidence rate of ARI in Choiseul by age – group. The graph reveals that
in Choiseul the rates of ARI are highest in babies and in recent years, that is, between 2001 and 2005, the
rate has exceeded 2000 cases per 1000 population annually. This would mean that between 2001 and 2005
every baby in Choiseul had been presented more than once with ARI at any primary health care clinic.
The graph also shows that in 2005 the incidence rate of ARI in Choiseul in the age group 1-4 has shown a
markedly increased from 1199 cases per 1000 in 2004 to 1740 cases per 1000 in 2005.
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Malaria
In Solomon Islands malaria has been a major cause of attendance at primary health care clinics. Recorded
as fever and clinical malaria in the Primary Health Care Information System, malaria was responsible for
36% of all acute care contacts in 2005 in the country. In Choiseul, malaria is responsible for 24% of all acute
care contacts in 2005.
Fig. 4 Incidence rate of clinical malaria, Choiseul and Solomon Islands 1996-2005
700.0
600.0
500.0
rate per 1000
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
Clinical malaria - Choiseul Clinical malaria - Solomon Is.
Figure 4 demonstrates the incidence rate of clinical malaria in Choiseul and Solomon Islands.
The graph shows that the incidence rate of clinical malaria in Choiseul had remained below
national averages since 1999. Between 2003 and 2005 clinical malaria rate in Choiseul had
declined from 325 cases per 1000 in 2003 to 168 cases per 1000 population in 2005.
Incidence rate of fever and clinical and slide confirmed malaria

Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide confirmed malaria in
Choiseul for the past 10 years. It is clear from the graph that over the 10 year period, the trend of fever and
clinical malaria in Choiseul has declined while the rate for slide confirmed malaria had increased. The graph
also shows that between 2003 and 2005 slide confirmed malaria rate had exceeded demonstrating a highest
slide confirmed rate in 2004 before it declined to 300 cases per 1000 population in 2005.
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Fig. 5 Incidence rate of clinical malaria, fever, slide confirmed, Choisuel 1996-2005
800.0
700.0
600.0
rate per 1,000
500.0
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
clinical malaria fever slideconfirmed
Diarrhoeal disease
Diarrhoeal diseases are major cause of morbidity and mortality in infants and children worldwide and in
Solomon Islands. In Choiseul, diarrhoea in particular with no blood and no dehydration is more common
(see figure 6 below).
Fig 6. Incidence rate of diarrhoea by type, Choisuel 1996-2005

70.0
60.0
50.0
rate per 1,000
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
no blood no dehy no blood w ith dehy blood no dehy blood dehy
Bloody Diarrhoea by age group

Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group in Choiseul. The graph
shows that in Choiseul bloody diarrhoea is more common in children less than 5 years and more importantly
in babies.
Over the past 10 years incidence rate of bloody diarrhoea in babies in Choiseul has increased markedly.
Though the graph shows a decline in bloody diarrhoea rates in babies between 2000 and 2004, in 2005 the
rate increased dramatically. In 2004, the rate also increased significantly in babies however, in 2005 a slight
decline was noted.
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Fig 7. Incidence rate of bloody diarrhoea by age group, Choisuel 1996-2005
30.0
25.0
20.0
rate per 1,000
15.0
10.0
5.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Skin disease and Yaws

Skin disease and Yaws are common health problems in Solomon Islands. In Choiseul, yaws and more
importantly skin disease are also common health problems in the people aged more than 1.
Fig 8. Incidence rate of yaw s and skin disease, Choisuel & Solomon Is 1996-2005
300.0
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
yaw s, Choisuel yaw s, Solomon Is skin disease, Choisuel skin disease, Solomon Is
Figure 8 demonstrates the incidence rate of yaws and skin disease in Choiseul and Solomon Islands over
the past 10 years. The graph shows that the trend of yaws and skin disease incidence rate in Choiseul and
Solomon Islands had declined over the past 10 years.
The graph also reveals that while yaws incidence rate in Choiseul had remained below national average
during the past 10 years, skin disease rate demonstrates the opposite. As depicted in the graph, the rate of
skin disease in Choiseul remained above national average through out the 10 year period.
Yaws by age group
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Figure 9 below demonstrates the incidence rate of yaws in Choiseul by age group. The graph shows that
incidence rate of yaws in Choiseul was more prominent in children aged 1 – 4 followed by people aged 5
years and over. The graph also reveals that yaws is not a common health problem for babies in Choiseul.
Fig 9. Incidence rate of yaw s by age group, Choisuel 1996-2005

60.0
50.0
40.0
rate per 1,000
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 9 also reveals that in Choiseul the trends of yaws rate particularly in children aged 1-4 between 1996
and 2000 had declined. Then between 2000 and 2005 the graph shows are very fluctuating pattern of yaws
rate amongst children aged 1-4 reaching it highest point in 2004 where the rate was 50 cases per 1000
population.
The fluctuating pattern of yaws incidence rate in Choiseul particularly in the aged groups 1-4 indicates clearly
that though incidence rate of yaws had declined in some years it had remained to be a problem amongst
children aged 1-4 in recent years.
Skin disease by age group
Figure 10 below demonstrates the incidence rate of skin disease by age group in Choiseul.
The graph reveals that in Choiseul skin disease was more common in children aged 1-4 and people 5 years
and over. The graph also shows that over the past 10 years the trend of skin disease rate in Choiseul for all
age group has declined.
Fig 10. Incidence rate of skin disease by age group, Choisuel 1996-2005
450.0
400.0
350.0
300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

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Red Eye
Figure 11 demonstrates the incidence rate of red eye in Choiseul and Solomon Islands for the past 10 years.
The graph shows that incidence rate of red eye in Choiseul had declined markedly from 116 cases per 1000
population in 1996 to 32 cases per 1000 population in 2005.
Fig 11. Incidence rate of red eye, Choisuel & Solomon Is 1996-2005
140.0
120.0
100.0
rate p er 1 ,00 0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
red eye, Choisuel red eye, Solomon Is
The graph also shows that in Choiseul the highest rate of red eye occurred in 1996 then it dropped
significantly in 1997 reaching 40 cases per 1000 population. In 1998 the rate increased again before it
dropped from 57 cases per 1000 population in 1999 to 40 cases per 1000 in 2000. Between 2000 and 2005
the rate of red eye in Choiseul had moderately declined.
Red Eye by Age Group

Figure 12 below demonstrates the incidence rate of red eye in Choiseul over the past 10 years. The graph
shows that in Choiseul red eye was more common in children under 5. The graph also shows that the trend
of red eye for all aged group in Choiseul experienced a significant dropped from 1996 to 1997. Then it had
remained below 100 cases per 1000 all through out the 10 year period.
Fig 12. Incidence of red eye by age group, Choisuel 1996-2005
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Ear Infection
Figure 13 below demonstrates the incidence rate of ear infection in Choiseul and Solomon Islands. The
graph shows that the rate of ear infection in Choiseul had been higher than national average since 1998.
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The graph also shows that the trend of ear infection rate in Choiseul had increased from 82 cases per 1000
population in 2004 to 116 cases per 1000 population in 2005.
Fig 13. Incidence rate of ear infection, Choisuel & Solomon Is 1996-2005
140.0
120.0
100.0
rate per 1,000
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ear infection ear infection, Solomon Is
Ear infection by age-group

Figure 14 below demonstrates the incidence rate of ear infection by age group in Choiseul. From the graph
it is obvious that in Choiseul ear infection is more common in children aged 1-4. The incidence rates of ear
infection in this age group has increased over the years from 131 cases per 1000 population in 1996 to it
highest point 230 cases per 1000 in 2005.
The graph also shows that in Choiseul the incidence rate of ear infection in the aged 1-4 had declined
slightly between 1996 and 1998. This was followed by a continuous increased between 1998 and 2002
reaching 200 cases per 1000 population in 2002. Then between 2002 and 2004 incidence rate of ear
infection for aged group 1-4 dropped from 200 cases per 1000 population in 2002 to 140 cases per 1000
population in 2004 before it increased in 2005 reaching 230 cases per 1000 population.
Fig 14. Incidence rate of ear infection by age group, Choisuel 1996-2005
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Summary:
Acute Respiratory Infections and other febrile illnesses are commonest cause of health burden to the people
of Choiseul as well as demand to the primary health care services.
In 2005, ARI accounts for 399 per 1,000 population whilst fever causes 288 per 1,000 population to attend
clinics in the provinces.
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Interesting enough record on clinical malaria has declined although it was fluctuating in the past five years. In
2005 it was recorded at around 133 per 1,000 populations. It was understood that there was an intense
malaria control program funded by Rotary Club in the past years.
Migration or cross border issues with Bougainville has raised alarm especially in light on HIV transmission.
Whilst there hasn’t been contextual evidence. The National HIV Policy has flagged concerns around HIV and
migration.
Provincial Response:
In 2005 Choiseul has total of 27 registered clinics (and one Village Health Worker’s Post). There are two
hospitals. Taro was recently upgraded to a mini-hospital status. The other is Sasamuga.
Choiseul reached the ratio of 1 clinic to 851 population as compared to the national figure of 1:1,459.
Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic No of
Clinic clinics without closed requires MOH
VHW formal Health
upgrade Radios
in
Province
Choiseul 2 1 11 13 1 28 27 4 to 14
RHC +
2 NAP
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Map 1: Location of Clinics in Choiseul Province in 2005: Source: Ministry of Lands
Ratio: I
clinic to
population
1,459 Solomon
Islands
851 Choiseul
Page 133 of 250
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7.3 Western Province

Core population and Health datas on Western Province:
1995 2000 2005

Clinical
857 Fever 557 malaria 458 ARI
Clinical
462 ARI 376 ARI 191 malaria
Skin
290 Diseases 333 Fever 165 Fever
Clinical Skin Skin
218 malaria 102 Diseases 110 Diseases
Ear Ear Ear
117 Disease 83 Disease 77 Disease
99 Diarrhoea 77 Yaws 54 Diarrhoea
69 Yaws 44 Diarrhoea 40 Yaws
80,000
60,000
Po p
40,000
20,000
0
1999 2000 2001 2002 2003 2004 2005

Population <1 2,003 1,908 1,902 1,931 1,988 2,159 2,187
Population 1-4 7,550 7,613 7,641 7,704 7,836 8,269 7,966
Population <5 9,552 9,520 9,543 9,634 9,824 10,428 10,153
Pop-15-49 All 30316 31392 32474 33557 34790 36339 37,188
Fig 30 Population of Western 7 year trend 1999-2005
Western Province is the second largest populated province in Solomon Islands. In 2005 the
estimated population was around 72,124 people. Children under 5 years old make up 14%, whilst
majority of 51.6% are within the age-group of 15-49.
Page 134 of 250
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40,000
35,000
30,000
25,000
Pop
20,000
15,000
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 14,107 14,597 15,100 15,613 16,272 17,003 17,456
Expected births 2,205 2,211 2,216 2,222 2,228 2,233 2,238
Males >5 27,854 28,689 29,496 30,267 31,012 32,470 32,608
Females >5 24,633 25,374 26,107 26,825 27,772 33,937 29,363
total 15-49 30,316 31,392 32,474 33,557 34,790 36,339 37,188
males 15-49 16,209 16,795 17,374 17,944 18,517 19,335 19,732
Fig 31 Population of Western by gender 7 year trend 1999-2005
900
800
700
Rateper 1,000pop
600
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
ARI 462 440 593 457 470 376 420 341 304 432 458
Diarrhoea 99 79 82 74 53 44 36 31 32 44 54
Fever 857 650 555 408 340 333 331 243 234 203 165
Yaw s 69 84 72 75 68 77 64 58 77 44 40
Skin Diseases 290 163 172 122 94 102 81 89 90 98 110
Ear Disease 117 107 113 105 86 83 74 59 68 84 77
Clinical malaria 218 584 469 485 473 557 482 345 272 257 191
Fig 31 Common illness per 1,000 population 11 years trend 1995-2005 in Western: Source HIS MOH (2006).
7.3.1 Health Burden in Western
Disease Incidence Trend of Western Province 1996-2005

Page 135 of 250
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Figure 1 below demonstrates the proportion of acute care contacts in Western by
common diseases. It is obvious from the graph that ARI has been the major cause of
attendance at any primary health care clinic in Western during the last decade.
Fig 1. Proportion of new cases by major disease, Western 1996-2005
70%
60%
50%
40%
percent
30%
20%
10%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI Diarrhoea Fever Red eyes Yaw s

Skin diseases Ear infection STI diseases Clinical malaria Other diseases
ARI are major cause of morbidity worldwide and in Solomon Islands. In Western, ARI
has been the major cause of attendance at any primary health care clinics. In 2005, ARI
was responsible for 51% of all acute care contacts in Western.
Figure 2 below demonstrate the incidence rate of ARI in Western and Solomon Islands
over the past 10 years.
The graph shows that the trend of ARI incidence rate for both Western and Solomon
Islands is pretty much the same. Though a decline in the incidence rate of ARI for both
Western and Solomon Islands was noted between 1997 and 2003, the situation has
been reversed between 2003 and 2005.
Page 136 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 2. Incidence rate of ARI, Western & Solomon Is 1996-2005
700.0
600.0
500.0
rate per 1,000
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI, Western ARI, Solomon Is
Incidence rate of ARI by age group – Western
Fig 3. Incidence rate of ARI by age group, Western 1996-2005
2500
2000
rate per 1,000
1500
1000
500
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 3 demonstrates the incidence rate of ARI by age group in Western. The graph
reveals that in Western ARI has become a more common health problem in children
aged less than five and more importantly infant. It also shows that the trend of ARI
incidence rate has remained beyond a 1500 cases per 1000 population. Though the
rate in infants had declined between 2001 and 2003, in 2004 the rate went up again and
then decline slightly in 2005. However, for children aged 1-4, the incidence rate of ARI
had continued to rise between 2003 and 2005 after a constant declined that occurred
between 2001 and 2003. The highest incidence rate of ARI in infant and children aged
1-4 occurred in 1997 reaching 1868 cases per 1000 population and 1031 cases per
1000 population respectively.
Malaria
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In Solomon Islands malaria has been a major cause of attendance at primary health
care clinics. Recorded as fever and clinical malaria in the Primary Health Care
Information System, malaria was responsible for 36% of all acute care contacts in 2005
in the country. In Western, malaria is responsible for 19% of all acute care contacts in
2005.
Fig 4. Incidence rate of clinical malaria, Western & Solomon Is 1996-2005
700.0
600.0
500.0
400.0
percent
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Clinical malaria, Western Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Western and Solomon
Islands. The graph shows that incidence rate of clinical malaria in Western is lower than
national averages in the past 10 years. The graph also shows that the trend of clinical
malaria in Western and in Solomon Islands has declined over the last ten years.
Figure 5 below demonstrates the incidence rates of clinical malaria, fever and slide
confirmed malaria in Western for the past 10 years. It is obvious from the graph that the
trend of the incidence rate for fever, clinical malaria and slide confirmed malaria in
Western has declined over the years. The graph also shows that over the years the
incidence rate of slide confirmed malaria was below that of clinical malaria.
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Fig 5. Incidence rate of clinical malaria, fever, slide confirmed, Western 1996-
2005
700.0
600.0
500.0
rate per 1,000
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
clinical malaria fever slide confirmed
Diarrhoeal disease
Diarrhoeal diseases are major cause of morbidity and mortality in infants and children
worldwide and in Solomon Islands. In Western, diarrhoea in particular with no blood and
no dehydration is more common (see figure 6 below).
Fig 6. Incidence rate of diarrhoea by type, Western 1996-2005
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 7a and 7b below demonstrates the incidence rate of Bloody diarrhoea by Age
group. The graph reveals that bloody diarrhoea was more common in children aged less
than 5 years. The graph also shows that in 2005 there was a significant increase in the
incidence rate of bloody diarrhoea amongst children aged less than five.
Page 139 of 250
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Fig 7a. Incidence rate of bloody diarrhoea by age group, Western 1996-2005
45.0
40.0
35.0
30.0
rate per 1,000
25.0
20.0
15.0
10.0
5.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Fig. 7b Incidence rate of bloody diarrhoea by age group, Western 1996-2005

45
40
35
rates per 1000 population
30
25
20
15
10
5
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
rates <5 rates >5
Skin disease and Yaws are common health problems in Solomon Islands. In Western,
yaws and more importantly skin disease are common health problems amongst it
people.
Page 140 of 250
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Fig 8. Incidence rate of yaw s and skin disease, Western & Solomon Is 1996-
2005
200.0
180.0
160.0
140.0
rate per 1,000
120.0
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
yaw s, Western yaw s, Solomon Is

skin disease, Western skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Western
and Solomon Islands. The graph shows that the trend of yaws and skin disease rate
has declined over the past 10 years for both Solomon Islands and Western.
Yaws by age group
Figure 9 below demonstrates the incidence rate of yaws in Western by age group. The
graph shows that rate of yaws in Western was more prominent in children aged 1 – 4
followed by people aged 5 years and over. The graph also reveals that yaws is not a
common health problem for babies in Western.
Fig 9. Incidence rate of yaw s by age group, Western 1996-2005
160.0
140.0
120.0
rate per 1,000
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 9 reveals that in Western the trend of yaws rate particularly in the aged group 1-4
has declined between 1996 and 2005. However, it is also evident that over the past 10
years the situation that is the incidence of yaws particularly in the aged group 1-4 had
never been improved. This is demonstrated clearly in figure 9 where yaws incidence
Page 141 of 250
---------------------------------------------------------------------------------------------------------------------
rate in the aged group 1-4 had shown a fluctuating pattern in the years between 1996
and 2005.
This pattern may strongly indicate that vaccine coverage had not been adequate to
prevent the disease from spreading.
Figure 10 below demonstrates the incidence rate of skin disease by age group in
Western.
The graph shows clearly that skin disease in Western Province was more common in
children aged 1-4. It also shows that over the years, the rate of skin disease in Western
has declined particularly in the aged group 1-4 and 5 years and over. However, for
infants the situation has been the opposite.
The graph also shows that in recent years, that is, between 2003 and 2005, the rate of
skin disease in infants has demonstrated the highest increase than any of the other age
groups.
Fig 10. Incidence rate of skin disease by age group, Western 1996-2005
300.0
250.0
200.0
rateper 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Red Eye
Figure 11 demonstrates the incidence rate of red eye in Western and Solomon Islands
for the past 10 years. The graph shows that over the past 10 years the trend of red eye
incidence rate had declined by more than halved for both Western and Solomon Islands.
Page 142 of 250
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Fig 11. Incidence rate of red eye, Western & Solomon Is 1996-2005
100.0
90.0
80.0
70.0
rateper 1,000
60.0
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
red eye, Western red eye, Solomon Is

Page 143 of 250
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Figure 12 below demonstrates the incidence rate of red eye by age group in Western, for
the past 10 years. The graph shows that in Western red eye was more prominent in
children less than 5 years but more importantly in babies.
In 1998, the graph shows that there was an outbreak of red eye in babies reaching 274
cases per 1000 population. In 1999 the rate significantly dropped to 139 cases per 1000
population. The graph also shows that in recent years that is between 2003 and 2005
the rate of red eye in all aged groups had experienced a slight increased.
Fig 12. Incidence rate of red eye by age group, Western 1996-2005
300.0
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Ear Infection
Figure 13 demonstrates the incidence rate of ear infection in Western and Solomon
Islands. The graph also shows that the trend of ear infection rate in Western and
Solomon Islands had declined over the past 10 years reaching it lowest level in 2002
before it increased again between 2002 and 2005. In 2005, while ear infection rate in
Solomon Islands experienced a constant increase, the rate of ear infection in Western
had experienced a moderate decline that is from 84 cases per 1000 in 2004 to 77 cases
per 1000 population in 2005.
Page 144 of 250
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Fig 13. Incidence rate of ear infection, Western & Solomon Is 1996-2005
120.0
100.0
80.0
rate per 1,000
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ear infection ear infection, Solomon Is
Figure 14 below demonstrates the incidence rate of ear infection by age group in
Western. From the graph, it is obvious that in Western ear infection is more common in
children aged less than five but more importantly in children aged 1-4. The graph also
shows that between 2002 and 2005 the rate of ear infection particularly in children aged
1-4 has been constantly increasing reaching 168 cases per 1000 population in 2005.
Fig 14. Incidence rate of ear inf ection by age group, Western 1996-2005
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Conclusion:
The disease burden in the Western Province is not different from that of Choiseul Province and
other provinces. In both provinces the trend of clinical malaria has steadily declined (Fi.g 31).
Page 145 of 250
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There is no clear reason for this reduction but malaria control program in Western and Choiseul
Province were supported financially by Rotary Club. ARI remains the commonest acute illness.
There was an increasing trend of clinical malaria in the past five years, from 1995 to 2000,
however the trend has been declined significantly from 557 to 191 per 1,000 populations.
VHW formal Health
upgrade Radios
in
Province
Western 2 5 23 27 1 58 57 6 to 32
RHC
TOTAL 10 29 5 106 173 14 7 149
TOTAL 10 29 5 106 173 323 323

2005
-1 -5 15
2004 10 30 5 111 158 314
The people of the Western Province have access to both primary and secondary health care
services. The provincial health service also provide public health programs such as the
Environmental health division ensuring safe water and proper sanitary facilities as well as the
commercial support activities like environmental and health quarantine duties to the foreign liners.
The primary health care service comprises of total of 58 clinics (including one Village Health
Workers Post. There are two hospitals (one Government and one Church owned).
In 2005, the ratio of a clinic to population is 1: 1,265. Ratio of 1 clinic to

pop in 2005
There are many more people served by one clinic. Obviously islands and
villages are geographically more scattered. The recent clinic utilization 1,459 National
review supports two clinics in Western Province namely Noro Taiyo and Noro
public to merge into a single Urban clinic. 1,265 western
Health Workforce
In 2005 Western Province employed total of 177 direct employees from the province to join 104
seconded staff from National mother Ministry to drive the health services in the province. Of the
total 300 position allocated for the WP, 94% (281 positions were filled).
Page 146 of 250
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Medical, 4 Laboratory, 2
Pharmacy , 4
Physiotherapy, 1
Radiography, 4
Health Promotion, 8
Dental, 0
Environmental Hlth, Social Service , 0

15
Support services ,
36
Vector Borne Nursing , 164

Disease Control,
43
Fig 32 Proportion of category of health workers in Western Province
Key issues in 2005(32)
Two maternal deaths were recorded in 2005. Twenty two infant deaths were recorded, an
increase from 15 in 2004. the crude birth rate continues its slow increase in Western Province
contributed to by a steadily increasing adolescent fertility rate which more than doubled between
2004 and 2005 and continuing low contraceptive prevalence rates.
Sexual : Overall there appears to be a continuing increase in sexually transmitted

infections. No cases of HIV have been detected in Western Province to date.
Vaccine Preventable: A small outbreak of whooping cough in August 2005 was quickly
stemmed with treatment and immunization catch-up. Under 1 year immunization 2005
coverage, based on available data is shown in Graph 1 below. These data must view
cautiously given the probable underreporting of immunizations in 3 health zones.
32 Western Province Health Service Annual Health Report 2005.

Page 147 of 250
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Map 2: Location of Clinics in Western Province in 2005: Source: Ministry of Lands

Page 148 of 250
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7.4 Isabel Provinces
Demography: Gender and Poverty

25,000
20,000
15,000
Pop
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005

Population <1 692 677 665 641 616 596 613
Population 1-4 2,385 2,430 2,454 2,470 2,500 2,463 2,491
Population <5 3,077 3,107 3,119 3,112 3,117 3,059 3,104
Pop 15-49 9,247 9,550 9,869 10,202 10,637 10,535 12,172
Fig 33 Population of Isabel 7 year trend 1999-2005.
25,000
20,000
15,000
Pop
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 20,198 4,819 4,965 5,116 5,357 5,248 5,727
Expected births 657 670 683 697 711 727 744
Males >5 8,707 8,910 9,135 9,382 9,646 9,604 10,237
Females >5 8,414 8,625 8,845 9,070 9,462 9,212 10,023
total 15-49 years 9,247 9,550 9,869 10,202 10,637 10,535 12,172
Fig 33 Population of Isabel Province by gender 7 year trend 1999-2005.
There is no disparity in proportion of male to females (about 1;1) Fig 33, however, there are
differences in cultural recognition of gender especially women in different provinces in terms of
land ownerships and decision making by provinces which may affect and influence how health
services are distributed. The Isabel is an interesting province with a maternal influence in land
ownership. There has been evidence of community partnership within themselves and a strong
recognition and adherence to their chief system33.
33There are evidence building to affirm this nortion of strong community partnership having an positive impact of health
status of the people.
Page 149 of 250
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Health Burden
Disease Incidence Trend of Isabel
Figure 1 below demonstrates the proportion of acute care contacts in Isabel by diseases.
From the graph it is obvious that malaria and ARI are major common health problems
affecting Isabel people.
Fig 1. Proportion of new cases by major disease, Isabel 1996-2005

45.0%
40.0%
35.0%
30.0%
25.0%
percent
20.0%
15.0%
10.0%
5.0%
0.0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI are major cause of morbidity worldwide and in Solomon Islands. In Isabel, ARI is
second only importance to ‘Other’ disease category. In 2005, ARI was responsible for
29% of all acute care contacts in Isabel.
Figure 2 below demonstrates the incidence rate of ARI in Isabel and Solomon Islands
over the past 10 years. The graph shows that the trend of ARI incidence rate in Isabel
has increased from 478 cases per 1000 in 1996 to 639 cases per 1000 in 2005. Over
the years, ARI has remained to be a common illness for Isabel people.
Page 150 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 2. Incidence rate of ARI, Isabel & Solomon Is 1996-2005
700.0
600.0
500.0
rate per 1,000
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI, Isabel ARI, Solomon Is
Incidence rate of ARI by age group – Isabel
Figure 3 demonstrates the incidence rate of ARI by age group in Isabel for the past 10
years. The graph reveals that ARI incidence rate is higher in children aged less than 5
and more importantly in infants. The graph also shows the increasing trend of ARI in
infants while a slight increase was observed in children aged 1-4 and the trend remained
constant in the aged group 5 years and older over the years. The graph also depicted
that ARI rate in infants has exceeded more than 2000 cases per 1000 population all
through out the 10 year period. In 2005, the trend of ARI in infants has dropped from it
highest 665 cases per 1000 population in 2004 to 539 cases per 1000 population in
2005.
Fig 3. Incidence rate of ARI by age group, Isabel 1996-2005
4500
4000
3500
3000
rate per 1,000
2500
2000
1500
1000
500
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Malaria
Page 151 of 250
---------------------------------------------------------------------------------------------------------------------
in the country. In Isabel, malaria is responsible for 22% of all acute care contacts in
2005.
Fig 4. Incidence rate of clinical malaria, Isabel & Solomon Is 1996-2005
700.0
600.0
500.0
rate per 1,000
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Clinical malaria, Isabel Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria in Isabel and Solomon
Islands in the past 10 years. The graph shows that incidence rate of clinical malaria in
Isabel has remained below national average all through out the 10 year period.
confirmed malaria in Isabel for the past 10 years. The graph shows that the trend of the
rates for fever, clinical malaria and slide confirmed malaria in Isabel has declined over
the past 10 years. The rate of slide confirmed malaria has remained below clinical
malaria and fever rates.
Fig 5. Incidence rate of clinical malaria, f ever, slide conf irmed, Isabel 1996-
2005
500.0
450.0
400.0
350.0
rate per 1,000
300.0
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Diarrhoeal disease
Page 152 of 250
---------------------------------------------------------------------------------------------------------------------
worldwide and in Solomon Islands. In Isabel, diarrhoea and more importantly with no
blood and no dehydration is more common (see figure 6 below).
Fig 6. Incidence rate of diarrhoea by type, Isabel 1996-2005
90.0
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group over
the past 10 years. The graph reveals that bloody diarrhoea was more common in
children aged less than 5 years but more importantly in infants. The trend of bloody
diarrhoea in infants has increased in recent years that is, between 2001 and 2005. An
increasing trend was also observed in the age group 1-4 in 2005.
Fig 7. Incidence rate of bloody diarrhoea by age group, Isabel 1996-2005
35.0
30.0
25.0
rate per 1,000
20.0
15.0
10.0
5.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Skin disease and Yaws are common health problems in Solomon Islands. In Isabel,
people. The graph shows a decreasing trend of skin disease for Isabel and Solomon
Islands while a constant trend was observed in the yaws rate for the two.
Page 153 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 8. Incidence rate of yaw s and skin disease, isabel & Solomon Is 1996-2005
200.0
180.0
160.0
140.0
rate per 1,000
120.0
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
yaw s, Isabel yaw s, Solomon Is

skin disease, Isabel skin disease, Solomon Is
Figure 8 above also demonstrates that yaws rate in Isabel has remained below national
averages all through out the 10 year period while skin disease rates has reflects no
significant difference in Isabel and Solomon Islands especially between 2000 and 2005.
Between 1996 and 1998 the rate for skin disease in Isabel has shown a significant
dropped from 184 cases per 1000 population in 1996 to 100 cases per 1000 population
in 1998.
Yaws by age group
Figure 9 below demonstrates the incidence rate of yaws in Isabel by age group. The
graph shows that the incidence rate of yaws in Isabel was higher in children aged 1 – 4
followed by people aged 5 years and over then in infants. The graph also shows a
declining trend of yaws rate in both age group 1-4 and 5 years and over. However the
decline was more significant in the age group 1-4.
Page 154 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 9. Incidence rate of yaw s by age group, Isabel 1996-2005
70.0
60.0
50.0
rate per 1,000
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 10 below demonstrates the incidence rate of skin disease by age group in Isabel
for the past 10 years. From the graph it is clear that incidence rate of skin disease in
Isabel was more common the age group 1-4 followed by infants then people 5 years and
over.
The highest rate of skin disease was observed in children aged 1-4 reaching 400 cases
per 1000 population in 1996. This has significantly declined to 166 cases per 1000
population in 1998, then a slight increased was observed in the next two years reaching
246 cases per 1000 in 2000. Between 2000 and 2002 the rate of skin disease for
children aged 1-4 dropped again to 156 cases per 1000 population and between 2002
and 2005 skin disease rate in this age group has shown an increasing trend reaching
221 cases per 1000 in 2005.
Fig 10. Incidence rate of skin disease by age group, Isabel 1996-2005
450.0
400.0
350.0
300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Red Eye
Page 155 of 250
---------------------------------------------------------------------------------------------------------------------
Figure 11 demonstrates the incidence rate of red eye in Isabel and Solomon Islands for
the past 10 years. The graph demonstrates clearly the declining trend of red eye
incidence rate for both Solomon Islands and Isabel in the past 10 years. The highest
incidence rate of red eye experienced in both these places was in 1996. The graph also
shows that between 2003 and 2005, the rate of red eye in both places has experienced
a slight increase.
Fig 11. Incidence rate of red eye, Isabel & Solomon Is 1996-2005
120.0
100.0
80.0
rate per 1,000
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
red eye, Isabel red eye, Solomon Is
Figure 12 below demonstrates the incidence rate of red eye by age group in Isabel for
the past 10 years. The graph shows that the incidence rate of red eye in Isabel was
higher in children aged less than 5 years followed by people 5 years and over. From the
graph it is obvious that red eye incidence rate has shown a decreasing trend over the
past 10 years, however in 2005 a slight increase in the rate was observed in children
less than 5 years.
Fig 12. Incidence rate of red eye by age group, Isabel 1996-2005
300.0
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

Page 156 of 250
---------------------------------------------------------------------------------------------------------------------
Ear Infection
Figure 13 demonstrates the incidence rate of ear infection in Isabel and Solomon Islands
for the past 10 years. The graph demonstrates that trend of ear infection rate in Isabel
was higher than national averages particularly in the early years of last decade and
between 2000 and 2005. The graph also shows that between 2003 and 2005 the trend
of ear infection rate has dropped from it highest 85 cases per 1000 population in 2003 to
64 cases per 1000 population in 2005.
Fig 13. Incidence rate of ear inf ection, Isabel & Solomon Is 1996-2005
90
80
70
60
rate per 1,000
50
40
30
20
10
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ear inf ection, Isabel ear inf ection, Solomon Is
Figure 14 demonstrates the incidence rate of ear infection by age group in Isabel for the
past 10 years. From the graph, it is obvious that in Isabel ear infection is common health
problem in children aged 1-4 followed by infants.
The graph also shows that incidence rate of ear infection remained to be seen in
children aged less than 5 all throughout the 10 year period. The highest rate of ear
infection occurred in 2003 reaching 243 cases per 1000 in the aged group 1-4 and 169
cases per 1000 population in infants. The graph also reveals that an outbreak of ear
infection was experienced in 2003 where more than 20% of children aged 1-4 where
infected whereas 15% of infants were infected too in the same year. However, between
2003 and 2005 the trend of ear infection rate for both these age groups has declined.
Page 157 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 14. Incidence rate of ear infection by age group, Isabel 1996-2005
300.0
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Conclusion:
Acute Respiratory Infection is recorded the highest commonest illnesses like Choiseul and
Western Province. However, the prevalence is very high than the two former provinces. In 2004-5
the level of 540 to 665 per 1,000 population (Fig. 34).
However, the interesting finding is that clinical malaria is far lower than the two above provinces.
In 2005 the incidence of clinical malaria was 145 per 1,000 population. Choiseul and Western are
showing decline in trend in the incidence of clinical malaria, however, Isabel has been stable
around and below 200 per 1,000 population.
Page 158 of 250
---------------------------------------------------------------------------------------------------------------------
700
600
500
Rate per 1,000 pop
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
ARI 453 478 512 358 476 509 601 531 493 665 539
Diarrhoea 88 92 56 50 47 69 48 36 51 57 55
Fever 535 474 412 302 303 308 350 361 315 348 260
Eye 95 98 46 36 38 35 48 38 30 31 40
Yaw s 41 34 29 24 14 17 18 16 24 19 18
Skin diseases 217 184 131 99 104 121 90 84 97 90 96
Ear disease 69 78 80 49 48 61 65 53 82 75 64
Fig 34 Common illness per 1,000 population 11 years trend 1995-2005 in Isabel: Source HIS MOH (2006
In responding to the common illnesses and related issues, Isabel Province have built 43 clinics
(including 6 Village Health Workers Posts). In 2005 the measure of access is 1 clinic to 631
people.
Table 11 Number of clinics in Isabel Province in 2005: MOH Clinic database (2005)
Province Hospital ANC UH RHC NAP VHW Total Total Clinics No of

Clinic clinics without closed MOH
VHW Health
Radios
in
Province
Isabel 1 4 11 21 6 43 37 1 15
TOTAL 10 29 5 106 173 14 7 149
TOTAL 10 29 5 106 173 323 323

2005
-1 -5 15
2004 10 30 5 111 158 314
Page 159 of 250
---------------------------------------------------------------------------------------------------------------------
Map 3: Location of Clinics in Isabel Province in 2005: Source: Ministry of Lands
7.5 Central Islands Province

Page 160 of 250
---------------------------------------------------------------------------------------------------------------------
30,000
25,000
20,000
Pop
15,000
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005
Population <1 703 677 676 679 687 678 737
Population 1-4 2,541 2,598 2,634 2,673 2,716 2,667 2,772
Population <5 3,244 3,276 3,310 3,352 3,403 3,345 3,509
Total 15-49 10,169 10,497 10,812 11,124 11,468 11,238 12,172
Fig 35 Population of CIP 7 y trend
14,000
12,000
10,000
8,000
Pop
6,000
4,000
2,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 4,961 5,119 5,274 5,431 5,612 5,479 5,960

Expected births 766 773 781 788 796 806
Males >5 9,355 9,609 9,869 10,137 10,414 10,223 11,000
Females >5 8,738 8,987 9,239 9,488 9,776 9,477 10,293
Total 15-49 10,169 10,497 10,812 11,124 11,468 11,238 12,172
males 15-49 5,208 5,378 5,538 5,694 5,856 5,759 6,211
Fig 36 Population of CIP by Gender 7 yr trend.
Health Burden in Central Islands Province 1996-2005
Disease Incidence Trend of CIP

Figure 1 below demonstrates the proportion of acute care contacts in Central by
diseases. From the graph it is obvious that malaria (fever and clinical malaria) and ARI
are cause of attendance at primary health care clinics.
Page 161 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 1. Proportion of new cases by major disease, central 1996-2005
45%
40%
35%
30%
25%
percent
20%
15%
10%
5%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

Skin diseases Ear inf ection STI diseases Clinical malaria Other diseases
ARI are major cause of morbidity worldwide and in Solomon Islands. In Central, ARI is
second only importance to malaria. In 2005, ARI was responsible for 21% of all acute
care contacts in Central.
Figure 2 below demonstrates the incidence rate of ARI in Central and Solomon Islands
over the past 10 years. The graph shows that the trend of ARI incidence rate in Central
is remain below national average all through out the ten year period.
Page 162 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 2. Incidence of ARI, Central & Solomon Is 1996-2005
500.0
450.0
400.0
350.0
rate per 1,000
300.0
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI, Central ARI, Solomon Is

Page 163 of 250
---------------------------------------------------------------------------------------------------------------------
Incidence rate of ARI by age group – Central
Figure 3 demonstrates the incidence rate of ARI by age group in Central. The graph
reveals that in Makira ARI was more common in children under 5 but more importantly in
babies. The graph also reveals that except in 2003 and 2005 incidence rate of ARI in
babies exceeded 2000 cases per 1000, indicating that for every Central baby they have
been presented with ARI at any primary health care clinics two times in a year.
The graph also demonstrates that ARI rate in children aged 1-4 was also high through
out the 10 year period. The incidence rate of ARI in people aged 5 years or more had
remained constantly low through out the 10 year period.
Fig 3. Incidence rate of ARI by age group, Central 1996-2005
3000
2500
2000
rate per 1,000
1500
1000
500
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Malaria
in the country. In Central, malaria (fever and clinical malaria) is responsible for 54% of
all acute care contacts in 2005. This clearly indicates that fever and clinical malaria are
leading causes of morbidity in Central.
Page 164 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 4. Proportion of clinical malaria, Central & Solomon Is 1996-2005
35%
30%
25%
20%
perc ent
15%
10%
5%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Clinical malaria, Central Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Central and Solomon Islands. The graph
clearly demonstrates an increasing trend of clinical malaria in Central over the past 10 years.
Central for the past 10 years. From the graph it is obvious that slide confirmed malaria had remained below
incidence rate of fever and clinical malaria through out. The graph also shows the increased trend for slide
confirmed malaria over the past 7 years.
Fig 5. Incidence rate of clinical malaria, fever, slide confirmed, Central 1996-2005
700.0
600.0
500.0
rate per 1,000
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

Page 165 of 250
---------------------------------------------------------------------------------------------------------------------
Diarrhoeal disease
worldwide and in Solomon Islands. In Central, diarrhoea and more importantly with no
blood and no dehydration is more common (see figure 6 below). Figure 6 below also
shows a declining trend of diarrhoea (no blood no dehy.) over the past 10 years.
Fig 6. Incidence rate of diarrhoea by type, Central 1996-2005

70.0
60.0
50.0
rate per 1,000
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 7 below demonstrates the incidence rate of Bloody diarrhoea by Age group in
Central. The graph reveals that bloody diarrhoea in Central was more common in
children aged less than 5 years. There’s no significant difference observed in the
incidence rate of bloody diarrhoea in the aged group 1-4 and infants.
Figure 7 also reveals that an outbreak of bloody diarrhoea in children aged less than 5
occurred in 2005. For aged group 5 years and over a slight increase in bloody
diarrhoea rate was also observed in 2005.
Fig 7. Incidence rate of bloody diarrhoea by age group, Central 1996-2005
60.0
50.0
40.0
rate per 1,000
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

Page 166 of 250
---------------------------------------------------------------------------------------------------------------------
Skin disease and Yaws are common health problems in Solomon Islands. In Central,
people.
Fig 8. Incidence rate of yaw s and skin disease, Central & Solomon Is 1996-2005
300.0
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
yaw s, Central yaw s, Solomon Is skin disease, Central skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Central and
Solomon Islands in the past 10 years. The graph shows that yaws incidence rate for
Central was lower than national average, while the rate of skin disease was slightly over
national average. Figure 8 also demonstrate a declining trend for skin disease rate while
yaws rate for both Solomon Islands and Central had remained constant through out the
ten year period.
Yaws by age group
Figure 9 below demonstrates the incidence rate of yaws in Central by age group. The
graph shows that the incidence rate of yaws in Central was higher in children aged 1 – 4
followed by people aged 5 years and over then aged group less than one year old.
Fig 9. Incidence rate of yaw s by age group, Central 1996-2005

100.0
90.0
80.0
70.0
rate per 1,000
60.0
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

Page 167 of 250
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Figure 9 clearly demonstrates that between 1996 and 2001 the rate of yaws in the age
group 1-4 had varied considerably, demonstrating high incidence in one year followed by
significant dropped in the next year and so on. This inconsistent pattern of yaws rate
clearly indicates that vaccine coverage must be improved in order to prevent the disease
from occurring. However, between 2001 and 2004 yaws rate in this age group has
constantly increased then slightly decline in 2005.
Central. The graph demonstrates clearly that in Central the incidence rate of skin
disease is higher in children aged 1 – 4, followed by infants then people aged 5 years or
more.
Fig 10. Incidence rate of skin diseases by age group, Central 1996-2005
450.0
400.0
350.0
300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 10 also demonstrates a declining trend in incidence rate of skin disease in

Central in all age groups.
Red Eye
Figure 11 demonstrates the incidence rate of red eye in Central and Solomon Islands for
the past 10 years. The graph demonstrates that the incidence rate of red eye had
remained somewhat higher than national average through out the 10 year period. It is
also clear that in 1997 there was a significant dropped in the incidence of red eye in
Central then a decline in the trend of red eye incidence rate was noted all through out to
2005.
Page 168 of 250
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Fig 11. Incidence rate of red eye, Central & Solomon Is 1996-2005
140.0
120.0
100.0
rate per 1,000
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
red eye, Central red eye, Solomon Is
Figure 12 below demonstrates the incidence rate of red eye by age group in Central, for
the past 10 years. The graph shows that in Central the incidence rate of red eye was
higher in babies, followed by children aged 1-4 then people aged 5 years and over. The
graph also shows a decline trend of red eye rate in all age groups.
Fig 12. Incidence rate of red eye by age group, Central 1996-2005
400.0
350.0
300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Ear Infection
Figure 13 demonstrates the incidence rate of ear infection in Central and Solomon
Islands. The graph also demonstrates that the incidence rate of ear infection rate in
Central was below national averages during the past 10 years. The graph also shows
that ear infection rate for Central had increased between 2003 and 2005.
Page 169 of 250
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Fig 13. Incidence rate of ear inf ection, Central & Solomon Is 1996-2005
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ear inf ection, Central ear inf ection, Solomon Is
Figure 14 demonstrates the incidence rate of ear infection by age group in Central. It
reveals that the incidence rate of ear infection is in Central is higher in children aged 1-4
followed by infants then people aged 5 years or more. The graph also shows that the
trend in ear infection rate in infants and children 1-4 does not reflect much difference.
It is also revealed in the graph that ear infection rate in infants and children aged 1-4 has
experienced a significant increase between 2003 and 2005.
Fig 14. Incidence rate of ear inf ection by age group, Central 1996-2005
180.0
160.0
140.0
120.0
rate per 1,000
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
As opposite to the first three provinces, incidence of clinical malaria is higher and increasing in
Central Islands.
Like other provinces, febrile illnesses such as Acute Respiratory infections have increased.
Other less common diseases remained in the communities at a lower incidence around 50 per
1,000 population or lesser.
There has been a steady decline in the skin diseases and yaws.
In response to the common illnesses affecting the population of Central, the province has a total
of 27 clinics. The ratio of clinic to population stands at 1 clinic to 919 population. (Table 12).
Page 170 of 250
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VHW formal Health
upgrade Radios
in
Province
Central 1 1 7 18 27 27 2 to 10
Island RHC
TOTAL 10 29 5 106 173 14 7 149
TOTAL 10 29 5 106 173 323 323
2005
-1 -5 15
2004 10 30 5 111 158 314
Table 12 Number of clinics in Central Province in 2005: MOH Clinic database (2005)
7.6 Guadalcanal
Guadalcanal has the third largest population of 69,527 in 2005 with a higher proportion of around
50% of age group of 15-49 years. In 2005, Gudalcanal recorded some of the worse health status
indicators such as high maternal mortality and an out break whooping cough.
80,000
70,000
60,000
50,000
Pop
40,000
30,000
20,000
10,000
0
1999 2000 2001 2002 2003 2004 2005
Population <1 2,204 2,142 2,116 2,069 2,011 2,069 2,035
Population 1-4 7,541 7,742 7,873 7,983 8,082 8,428 8,084
Population <5 9,745 9,885 9,989 10,052 10,092 10,497 10,119
total 15-49 years 28,768 29,795 30,840 31,911 33,009 34,331 35,237
Page 171 of 250
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Fig 37 Population of Guadalcanal 7 y trend
40,000
35,000
30,000
25,000
Pop
20,000
15,000
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 13,898 14,365 14,843 15,334 15,845 16,548 16,894
Expected births 2,110 2,182 2,251 2,318 2,381 2,439
Males >5 25,983 26,737 27,522 28,340 29,186 30,359 30,918
Females >5 23,884 24,583 25,310 26,064 26,859 28,075 28,490
total 15-49 years 28,768 29,795 30,840 31,911 33,009 34,331 35,237
males 15-49 years 14,870 15,431 15,997 16,577 17,164 17,781 18,343
Fig 38 Population of Guadalcanal by Gender 7 yr trend
Health Burden in Guadalcanal 1996-2005
It should be noted also that the social unrest that prevailed in the country between 1999
until the arrival of Regional Assistance Mission to Solomon Islands (RAMSI) in 2003 had
great impact on the provision and delivery of health services to Guadalcanal people.
The effect of the social unrest is revealed in Figure 1 and furthermore in all graphs under
each headings below.
Page 172 of 250
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Fig. 1 Incidence rate of major diseases, Guadalcanal 1996-2005
900.0
800.0
700.0
600.0
ra te p e r 1 0 0 0
500.0
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
Figure 1 demonstrates incidence rates of all major diseases affecting the health of
Guadalcanal people. From the graph it is obvious that between 1998 and 2001 the
incidence rates of all causes of illnesse in Guadalcanal dropped severely reaching it
lowest point in 2001. The decline in incidence rates may reflects the effect of social
unrest on the health service delivery in Guadalcanal.
Disease Incidence Trend of Guadalcanal
Figure 2 below demonstrates a very clear pattern of the main causes of attendance at
primary health care clinics over the past 10 years in Guadalcanal. It is obvious that
apart from ‘Other’ diseases, ARI, fever and clinical malaria are major common health
problems affecting Guadalcanal people. Over the past 10 years, the proportion of
clinical malaria has constantly increased from 2% in 1996 to 21% in 2005. This figure
indicates that the proportion of clinical malaria as a main cause of attendance at any
primary health care clinic has constantly increased over the past 10 years, though the
proportion dropped slightly in 2005.
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Fig. 2 Proportion of new cases by major disease, Guadalcanal 1996-2005
40%
35%
30%
25%
p e rce n t
20%
15%
10%
5%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
ARI are major cause of morbidity worldwide and in Solomon Islands. In Guadalcanal
ARI is second most importance cause of attendance at primary health care clinics. In
2005, ARI was responsible for 29% of all acute care contacts in Guadalcanal.
Fig. 3 Incidence rate of ARI - Guadalcanal,Solomon Is. 1996-2005
700.0
600.0
500.0
rate per 1000
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
ARI rates - Guadalcanal ARI rates - Solomon Is.
Page 174 of 250
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Figure 3 above illustrates that the incidence rate of ARI prior to the social unrest was well above national
average. Then between 1998 and 2001 it dropped markedly from 580 cases per 1000 in 1998 to 180 cases per
1000 in 2001. Between 2001 and 2004 the incidence rate went up again reaching 350 per 1000 in 2004 and in 2005 a
continuous increase was noted reaching 527 cases per 1000.
Fig 4. Incidence rate of ARI by age group, Guadalcanal 1996-2005

4000
3500
3000
2500
rate per 1,000
2000
1500
1000
500
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
rates<1 rates 1-4 rates >5
It is very obvious from Figure 4 above that ARI in Guadalcanal is a major health problem
in children under 5 and more importantly in infants. As depicted in the graph, the
incidence rate of ARI in babies was more than 1000 per population every year. What
this figure tells us is that every year each baby in Guadalcanal has been presented with
ARI more than once at any primary health care clinic.
Malaria
Information System, malaria was responsible for 36% of all acute care contacts in the
country in 2005. In Guadalcanal, malaria (i.e. fever and clinical malaria) account for
37% of all acute care contacts in 2005.
Incidence rate of fever, clinical malaria and slide confirmed malaria
confirmed malaria in Guadalcanal for the past 10 years. It is obvious from the graph that
through out the last decade incidence rate of slide confirmed malaria had been lower
than incidence rate of clinical malaria. The graph also shows that the incidence rates of
clinical and slide confirmed malaria had continued to rise since 1996 and 1998
respectively while the incidence rate of fever had declined considerably. One reason for
the increased in trend of clinical malaria and decline trend of fever is that in about 1995
the system has changed in counting all fever cases as malaria.
Page 175 of 250
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Fig 6. Incidence rate of clinical malaria, fever, slide confirmed, Guadalcanal 1996-2005
900.0
800.0
700.0
600.0
Rate per 1,000
500.0
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Diarrhoeal disease
worldwide and in Solomon Islands. In Guadalcanal, diarrhoea and more importantly
bloody diarrhoea is also a common illness affecting people of Guadalcanal (see figure 7
below).
Fig. 7 Incidence rate of Diarrhoea by Type, Guadalcanal 1996-2005

80.0
70.0
60.0
rates per 1000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
bloody no dehy no blood w ith dehy no bloody no dehy blood w ith dehy
Bloody diarrhoea by age group
Figure 8 below demonstrates the incidence rate of bloody diarrhoea in Guadalcanal by

age group. The graph clearly shows that over the past 10 years bloody diarrhoea was
more common in infant than in any other age groups. While the incidence rate declined
from 266 cases per 1000 population in 1996 to 232 cases per 1000 population in 1997,
in 1998 a significant increased was noted reaching 355 cases per 1000 population.
Then between 1998 and 2001 the incidence rate dropped dramatically from 355 cases
per 1000 in 1998 to 37 cases in 2001. Again this severely decline may be attributed to
the impact of the social unrest on health service delivery in Guadalcanal. And between
Page 176 of 250
---------------------------------------------------------------------------------------------------------------------
2001 and 2003 the incidence rate increased again reaching 178 cases per 1000. In
2005 a further increase was also noted.
Fig 8. Incidence rates of bloody diarrhoea by age group, Guadalcanal 1996-2005
400.0
350.0
300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Skin disease and Yaws are common health problems in Solomon Islands. In
Guadalcanal yaws and more importantly skin disease are also common illness affecting
the people.
Fig 9. Incidence rates of yaw s and skin disease, Guadalcanal & Solomon Is
350.0
300.0
250.0
rate per 1,000
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
yaw s, Guadalcanal yaw s, Solomon Is skin disease, Guadalcanal skin disease, Solomon Is
From Figure 9, the incidence rate of skin diseases in Guadalcanal particularly in the
years prior to the social unrest was well beyond national averages. Being the second
largest province in terms of population size, it is no doubt that the above figure had great
impact on the national average for skin disease rates. Between 1998 and 2001 skin
disease incidence rate declined then in 2002 it remain constant and between 2002 and
2005 the incidence rate increased slightly from 60 cases per 1000 population in 2002 to
100 cases per 1000 in 2004. In 2005 a further increased was also noted.
Page 177 of 250
---------------------------------------------------------------------------------------------------------------------
Yaws by age group
Figure 10 below illustrates the incidence rate of yaws by age group. It is obvious from
the graph that incidence rate of yaws is highest in children aged 1 – 4 followed by people
aged 5 years and over. The graph also reveals that yaws is not a common health
problem in Guadalcanal babies.
Figure 10 below incidence rates of yaws in children aged 1-4 was very high prior to the
social unrest period reaching 102 cases per 1000 in 1998. Then during the social unrest
period, the incidence rate declined considerably reaching 30 cases per 1000 population
in 2001. However, between 2001 and 2003 the incidence rate of yaws in children aged
1-4 increased reaching 103 cases per 1000 in 2003. Then between 2003 and 2005 the
rate had dropped from 103 cases per 1000 in 2003 to 78 cases per 1000 in 2005.
Fig 10. Incidence rates of yaw s by age group, Guadalcanal 1996-2005
120.0
100.0
80.0
rate per 1,000
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Again the significant dropped in the incidence rates between 1998 and 2001 may be
associated with the impact of the social unrest that had caused suspension of many
health services to people of Guadalcanal in most affected areas. However, the rise in
the incidence rate between 2001 and 2003 may indicate that the suspension to health
service delivery in some affected areas in Guadalcanal has been lifted and that more
people have now accessed to health services.
Figure 11 below demonstrates the incidence of skin disease by age group in

Guadalcanal. As shown in the graph, over the past 10 years, skin disease in
Guadalcanal is more common in children aged 1-4 than other age groups. Figure 11
also indicates that in Guadalcanal incidence rate of skin disease in children aged 1-4
had declined from 482 cases per 1000 population in 1996 to 175 cases per 1000 in
2005.
Page 178 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 11.Incidence rates of skin disease by age group, Guadalcanal 1996-2005
600.0
500.0
400.0
rate per 1,000
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Red Eye
The incidence rate of red eye in Guadalcanal had been higher than national average
during the past 10 years. The highest incidence rate of red eye occurred in 1996
reaching 85 cases per 1000 population. In 1997 there was a sudden dropped in red eye
incidence rate and in 1998 it went up again reaching 75 cases per 1000 population.
Between 1998 and 2001 a continuous declined was experienced and between 2001 and
2004 the rate went up again reaching 167 cases per 1000 in 2004. In 2005 a further
increased in red eye incidence rate was noted.
Fig 12. Incidence rates of red eye, Guadalcanal & Solomon Is 1996-2005
90.0
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
red eye, Guadalcanal red eye, Solomon Is
Red eye by age group
Figure 13 below shows that in Guadalcanal red eye was more common in children under
5 but more importantly in infants. Between 1996 and 1997 incidence rate of red eye for
Page 179 of 250
---------------------------------------------------------------------------------------------------------------------
all age group declined. Then in 1998 it went up again to the about same rate in 1996.
Between 1998 and 2001, the incidence rate dropped markedly. Then between 2001 and
2004 there was a significantly rise in the rate particularly in infants. In 2005, while
incidence rate for age groups 1-4 and 5 years and over remain constant, the incidence
rate of red eye in infants experienced a further increase.
Fig. 13. Incidence rate of red eye by age group, Guadalcanal 1996-2005
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Ear Infection
Fig.14. Incidence rate of ear infection, Guadalcanal & Solomon Is 1996-2005
120.0
100.0
80.0
rate per 1,000
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ear infection, Guadalcanal ear infection, Solomon Is
Figure 14 above shows the incidence rate of ear infection in Guadalcanal and in
Solomon Islands. Prior to the social unrest period, the incidence rate of ear infection
was higher than national averages, however a constant declined was experienced
between 1997 and 2001 reaching 17 cases per 1000 population in 2001. Then between
1999 and 2005 the incidence rate of ear infection had remained below national
averages.
Page 180 of 250
---------------------------------------------------------------------------------------------------------------------
Between the years 1997 and 2001 there was a considerable decline in ear infection
incidence rate reaching 17 cases per 1000 in 2001. However, between 2001 and 2005
a continuous increased was noted. While the incidence rate of ear infection in Solomon
Islands had dropped from 80 cases per 1000 in 2004 to 60 cases per 1000 in 2005, in
Guadalcanal incidence rate had increased from about 40 cases per 1000 in 2004 to 50
cases per 1000 in 2005.
Guadalcanal. From the graph it is very obvious that ear infection is more common in
children under 5. The graph also shows that the incidence rates in all age groups had
dropped between 1997 and 2001 but more profoundly in children under 5. Between
2001 and 2005, incidence rate of ear infection for all age group has increased.
Fig 15. Incidence rate of ear infection by age group, Guadalcanal 1996-2005
300.0
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Conclusion:
The three common illnesses in Guadalcanal are Acute Respiratory infection, malaria and other
febrile diseases.
Malaria is a major acute illness in Guadalcanal, there has been an increasing trend. In 2005
Guadalcanal recorded 370 per 1,000 population sick with malaria and had attended the clinics.
Page 181 of 250
---------------------------------------------------------------------------------------------------------------------
1,000
900
800
700
Rate per 1,000 pop
600
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
ARI 398 376 513 581 453 282 180 267 331 350 527
Diarrhoea 87 77 69 82 51 28 6 15 35 27 46
Fever 884 714 717 768 576 383 140 312 376 312 292
Red Eye 62 86 51 75 60 27 14 23 36 35 41
Yaws 82 70 58 69 66 50 24 38 74 62 62
Skin diseases 228 260 208 288 155 100 59 60 95 99 113
Ear disease 66 68 97 77 60 37 17 27 43 42 51
Fig 39 Common illness per 1,000 population 11 years trend 1995-2005 in Central Islands: Source HIS MOH (2006).
There are total of 44 clinics (including 2 Village Health Workers Post). These primary health care
clinics provided basic treatment for the common illnesses. In 2005, the ratio of clinic to population
stands at 1 clinic to 1,655 population.
VHW formal Health
upgrade Radios
in
Province
GCP 0 6 12 24 2 44 42 2 now 17
AHC +
2 to
RHC +
5 new
NAP
TOTAL 10 29 5 106 173 14 7 149
TOTAL 10 29 5 106 173 323 323

2005
-1 -5 15
2004 10 30 5 111 158 314
Page 182 of 250
---------------------------------------------------------------------------------------------------------------------
7,028 Honiara
1,945 Malaita
1,655 Guadalcanal
1,459 National
1,355 Temotu
1,222 western
1,087 Makira
919 Central
895 Renbel
851 Choiseul
Table 13 Number of clinics in Guadalcanal Province in 2005: MOH Clinic database (2005)
7.7 Malaita
Malaita is the largest population and also a very challenging one items of implementing primary
health care services. Malaita has a more young population than Guadalcanal. The proportion of
15-49 age groups is around 47% whereas Guadalcanal has 50% on productive age group.
Page 183 of 250
---------------------------------------------------------------------------------------------------------------------
160,000
140,000
120,000
100,000
Pop
80,000
60,000
40,000
20,000
0
1999 2000 2001 2002 2003 2004 2005

Population <1 4,403 4,286 4,303 4,342 4,388 4,351 4,733
Population 1-4 15,772 16,156 16,437 16,741 17,015 16,882 17,422
Population <5 20,175 20,442 20,740 21,083 21,403 21,233 22,154
Total 15-49 53,633 55,759 57,919 60,110 62,121 62,125 66,422
Fig 34 Population of Malaita 7 y trend
70,000
60,000
50,000
40,000
o
Pp
30,000
20,000
10,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 15-49 28,263 29,284 30,295 31,302 32,103 32,378 34,047

Ex pec ted births 1,842 2,361 3,026
Males >5 50,029 51,643 53,305 55,000 56,728 55,533 59,948
Females >5 51,095 52,661 54,223 55,772 56,959 57,101 59,916
Total 15-49 53,633 55,759 57,919 60,110 62,121 62,125 66,422
Males 15-49 25,371 26,476 27,623 28,808 30,017 29,745 32,375
Fig 35 Population of Malaita by Gender 7 yr trend
Health Burden
Malaita recorded the highest incidence of malaria (430 per 1,000 populations despite substantial
efforts in terms of control measures on the Islands. This trend becomes to raise issues of efficacy
of the control measures. CIP and Guadalcanal Provinces recorded 398 and 370 per 1,000
population being infected by malaria respectively. Isabel and Western Province recorded 191 and
145 per 1,000 population respectively.
Page 184 of 250
---------------------------------------------------------------------------------------------------------------------
700
600
500
Rateper1,000pop
400
300
200
100
0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
ARI 412 274 349 316 399 290 385 393 363 282 218 324 339
Diarrhoea 42 33 64 50 32 34 41 34 26 21 17 24 39
Fever 649 567 640 483 434 380 336 377 355 345 230 316 323
Red Eye 36 37 56 62 31 30 42 38 30 24 18 24 32
Yaw s 122 64 77 84 60 64 58 89 61 55 65 65 56
Skin diseases 297 177 190 152 121 112 123 127 97 77 66 75 95
Ear Diseases 32 31 43 43 33 26 29 32 30 23 17 25 27
Fig 36 Common illness per 1,000 population 13 years trend 1993-2005 in Malaita Province: Source HIS MOH
(2006).
Malaita has the highest number of clinics (73 with 3 Village Health Workers Post),
followed by Western Province (57) and Guadalcanal (42). However, the clinic to
population is still at 1 clinic to around 2,000 population (1,945).
Province Hospital ANC UH RHC NAP VHW Total Total Clinics Clinic No o
VHW formal Healt
upgrade Radi
in
Prov
Malaita 2 4 21 46 3 76 73 6 28
TOTAL 10 29 5 106 173 14 7 149
TOTAL 10 29 5 106 173 323 323

2005
-1 -5 15
2004 10 30 5 111 158 314
Page 185 of 250
---------------------------------------------------------------------------------------------------------------------
Map x Location of clinics in Malaita in 2005
7.8
7.9 Makira:

Page 186 of 250
---------------------------------------------------------------------------------------------------------------------
40,000
35,000
30,000
25,000
Pop
20,000
15,000
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005

Population <1 1,223 1,240 1,243 1,205 1,138 1,098 1,118
Population 1-4 3,740 3,946 4,120 4,266 4,361 4,432 4,462
Population <5 4,963 5,187 5,362 5,470 5,498 5,530 5,580
total 15-49 years 14,498 15,067 15,640 16,217 16,706 16,845 17,692
Fig 37 Population of Makira 7 year trend
In 2005 Makira Province estimated population was 35,865. About 49% were between the age-
group of 15-49 years old. Around 16% were less than 5 years and understandably cause a great
demand to preventive services such as immunization.
20,000
15,000
Population
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 7,324 7,594 7,866 8,142 8,331 8,527 8,790

Expected births 1,153 1,200 1,249 1,300 1,353 1,404 1,458
Males >5 13,181 13,505 13,871 14,283 14,738 14,599
Females >5 12,525 12,836 13,181 13,576 13,880 14,231
total 15-49 years 14,498 15,067 15,640 16,217 16,706 16,845 17,692
Fig 38 Population of Makira 7 trend by gender
Health Burden in Makira 1996-2005:

Disease Incidence Trend in Makira
Page 187 of 250
---------------------------------------------------------------------------------------------------------------------
Figure 1 below demonstrates the proportion of acute care contacts in Makira by diseases. From the graph it is
obvious that malaria and ARI are major common health problems affecting Makira people.
Fig 1. Proportion of new cases by major diseases, Makira 1996-2005
40%
35%
30%
25%
percent
20%
15%
10%
5%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

ARI are major cause of morbidity worldwide and in Solomon Islands. In Makira, ARI is
second only importance to malaria. In 2005, ARI was responsible for 24% of all acute
care contacts in Makira.
Figure 2 below demonstrates the incidence rate of ARI in Makira and Solomon Islands
over the past 10 years. The graph shows that the trend of ARI incidence rate in Makira
has been increasing from 297 cases per 1000 in 1996 to 465 cases per 1000 in 2005.
Over the years, ARI has remained to be seen as a common illness for Makira people.
Page 188 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 2. Incidence rate of ARI, Makira & Solomon Is 1996-2005
500.0
450.0
400.0
350.0
rateper 1,000
300.0
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI, Makira ARI, Solomon Is
Incidence rate of ARI by age group – Makira
Figure 3 demonstrates the incidence rate of ARI by age group in Makira. The graph
reveals that in Makira ARI has been a major health problem in babies. As also depicted,
the trend of ARI rate in babies have increased considerably over the past 10 years,
reaching 3075 cases per 1000 population in 2005. This would mean that every Makira
baby have been presented more than once with ARI at any primary health care clinics.
The graph also shows that in the recent years, the rate of ARI in Makira has increased
considerably. The increase in the ARI rate was also experienced in the aged group 1-4
between 2003 and 2004.
Page 189 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 3. Incidence rate of ARI by age group, Makira 1996-2005
3500
3000
2500
rate per 1,000
2000
1500
1000
500
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Malaria
in the country. In Makira, malaria is responsible for 48% of all acute care contacts in
2005.
Page 190 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 4. Incidence rate of clinical malaria, Makira & Solomon Is 1996-2005
700.0
600.0
500.0
400.0
percent
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Clinical malaria, Makira Clinical malaria, Solomon Is
Figure 4 demonstrates the incidence rate of clinical malaria for Makira and Solomon Islands. The graph shows
that incidence rate of clinical malaria in Makira has increased and exceeded national average in recent years.
The graph also reveals that the rate of clinical malaria in Makira increased dramatically between 2001 and 2004
reaching 505 cases per 1000 population in 2004. In 2005 clinical malaria rate in Makira decreased to 487
cases per 1000 population.
Makira for the past 10 years. It is obvious from the graph that the trend of the rate for fever, clinical malaria
and slide confirmed malaria in Makira has gone up over the past 10 years and the significant rise is more
prominent in recent years.
Page 191 of 250
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Fig 5. Incidence rate of clinical malaria, f ever, slide conf irmed, Makira 1996-
2005
600.0
500.0
400.0
rate per 1,000
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
clinical malaria f ever slide conf irmed
Diarrhoeal disease
worldwide and in Solomon Islands. In Makira, diarrhoea and more importantly with no
blood and no dehydration is more common (see figure 6 below).
Fig 6. Incidence rate of diarrhoea by type, Makira 1996-2005
20.0
18.0
16.0
14.0
rate per 1,000
12.0
10.0
8.0
6.0
4.0
2.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
no dehy no blood no blood dehy no dehy blood blood dehy

Page 192 of 250
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Figure 7 below demonstrates the incidence rate of Bloody diarrhoea by Age group. The
graph reveals that bloody diarrhoea was more common in children aged less than 5
years but more importantly in infants. The graph also shows that the rate for bloody
diarrhoea in Makira has declined in the aged group 1-4 over the past 10 years, however
for infants bloody diarrhoea rate remain to be a health problem despite reduction in the
rate in some years.
Fig 7. Incidence rate of bloody diarrhoea by age group, Makira 1996-2005
18.0
16.0
14.0
12.0
rate per 1,000
10.0
8.0
6.0
4.0
2.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Skin disease and Yaws are common health problems in Solomon Islands. In Makira,
people.
Page 193 of 250
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Fig 8. Incidence rate of yaw s and skin disease, Makira & Solomon Is 1996-2005
200.0
180.0
160.0
140.0
rate per 1,000
120.0
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
yaw s, Makira yaw s, Solomon Is skin disease, Makira skin disease, Solomon Is
Figure 8 above demonstrates the incidence rate of yaws and skin disease in Makira and
Solomon Islands in the past 10 years.
The graph shows that while national rate (skin disease incidence rate in Solomon
Islands) for skin diseases have decreased over the past 10 years, in Makira the trend of
skin disease rate demonstrates the opposite and in recent years that is between 2001
and 2005 it has exceeded national average.
Yaws by age group
Figure 9 below demonstrates the incidence rate of yaws in Makira by age group. The
graph shows that the incidence rate of yaws in Makira was higher in children aged 1 – 4
followed by people aged 5 years and over. The graph also reveals that yaws is not a
common health problem for babies in Makira.
Page 194 of 250
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Fig 9. Incidence rate of yaw s by age group, Makira 1996-2005
120.0
100.0
80.0
rate per 1,000
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
The highest rate of yaws in children aged 1-4 occurred in 2003 reaching 111 cases per
1000 population. The increase in yaws incidence rate in children 1-4 in 2003 signifies
the outbreak of yaws in this age group in Makira during the year. In 2004 yaws rate in
the aged group 1-4 dropped to 77 cases per 1000 population and then increased slightly
in 2005 reaching 90 cases per 1000 population.
The graph also reveals that between 1998 and 2002, yaws rate in the age group 1-4
experienced a continuous decline reaching 57 cases per 1000 population in 2002 before
an outbreak occurred in 2003.
This pattern clearly indicates that vaccine coverage must be improved in order to
prevent the disease from occurring.
Figure 10 below demonstrates the incidence rate of skin disease by age group in Makira.
The graph below shows clearly that in the past 10 years, skin disease in Makira was a
common health problem in people. However, skin disease rate is highest in children
aged 1-4 except in 2005 where skin disease rate in infants exceeded that of rate for
aged group 1-4.
The graph also shows that in 2005 the rate of skin disease had increased considerably
from about 150 cases per 1000 population in 2004 to 244 cases per 1000 population in
2005. This signifies an outbreak of skin disease amongst babies in Makira in 2005.
Page 195 of 250
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Fig 10. Incidence rate of skin disease by age group, Makira 1996-2005
300.0
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Red Eye
Figure 11 demonstrates the incidence rate of red eye in Makira and Solomon Islands for
the past 10 years. The graph demonstrates clearly the decline in the red eye incidence
rate for Solomon Islands and Makira in the past 10 years. Despite the decline that is
being noted over the years in Makira and Solomon Islands, in 2005 there was an
outbreak of red eye experienced in both.
Fig 11. Incidence rate of red eye, Makira & Solomon Is 1996-2005
90.0
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
red eye, Makira red eye, Solomon Is

Page 196 of 250
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Figure 12 below demonstrates the incidence rate of red eye by age group in Makira, for
the past 10 years. The graph shows that in Makira the incidence rate of red eye was
highest in babies. The graph also shows that in Makira the highest incidence rate of red
eye in babies occurred in 1996 reaching 170 cases per 1000 population. In 1997, the
rate had dropped by halved then increased again in 1998 reaching 140 cases per 1000.
Between 1998 and 2004, the trend of red eye in babies had constantly decreasing.
However, in 2005 an outbreak of red eye in Makira was experienced in all aged group
but more importantly in babies.
Fig 12. Incidence rate of red eye by age group, Makira 1996-2005
180.0
160.0
140.0
120.0
rate per 1,000
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Ear Infection
Figure 13 demonstrates the incidence rate of ear infection in Makira and Solomon
Islands. The graph also demonstrates that trend of ear infection rate in Makira was
higher than national averages during the past 10 years.
Page 197 of 250
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Fig 13. Incidence rate of ear infection, Makira & Solomon Is 1996-2005
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ear infection, Makira ear infection, Solomon Is
Figure 14 demonstrates the incidence rate of ear infection by age group in Makira. From
the graph, it is obvious that in Makira ear infection is a common health problem in
babies.
Figure 14 also reveals that between 1996 and 1998 the incidence rate of ear infection in
babies in Makira increased from 85 cases per 1000 in 1996 to 138 cases per 1000
population. Then a constant declined in ear infection rate for babies was noted between
1998 and 2001. In 2002, ear infection rate dropped significantly reaching 43 cases per
1000 population. Between the years 2002 and 200 the rate of ear infection rate in
Makira babies rose dramatically reaching it highest, 136 cases per 1000 population in
2005.
Fig 14. Incidence rate of ear inf ection by age group, Makira & Solomon Is 1996-
2005
160.0
140.0
120.0
rate per 1,000
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

Page 198 of 250
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Makira has a total of 33 clinics (not including Village Health Workers Post). The province has a
provincial base hospital, 3 Area Health Clinic, 14 Rural Health Clinic and 15 Nurse Aid Posts. The
33 clinics offer treatment to common illnesses, child health and also maternal health services.
Really these are the core business of the clinics. There has been referral system to ensure the
sick people needing higher care of services are accessed as appropriate.
VHW formal Health
upgrade Radios
in
Province
Makira 1 3 14 15 1 34 33 18
TOTAL 10 29 5 106 173 14 7 149
TOTAL 10 29 5 106 173 323 323

2005
-1 -5 15
2004 10 30 5 111 158 314
The numbers of satellite clinics, and community mobilization and awareness have increased
since 2001 after a significant declined since 1999. This is good news as the province is
reestablishing the PHC to complement and supplement the 16 clinics.
The number of outreach has increased in the past years. This happens with the support from
operational funds support from the Health Sector Trust Fund funded by AusAID, and the Solomon
Islands Health Sector Development Project funded through World Bank loan.
900
800
700
600
Number
500
400
300
200
100
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
satellite Total health ed health ed school village total outreach
Table 14 Core Indicators for Makira by 2005
Makira SI
No of health facilities 35 328
Total population 35,865 471,266
Pop<1yr 1,118 14,465
Pop1-4 yr 4,462 55,240
Page 199 of 250
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Pop.WBA 15-49 8,790 115,730
Expected birth 1,532 20,354
TotaL deliveries/ births 985 10,948
Total births in health clinic 842 8,878
Home births 143 2,071
TBA - -
Total Live births 956 9,319
Perinatal/ Still births 29 262
Neonatal deaths
Total SB+NND 29 262
% Perinatal rate= No.of SB + Deaths 1000.0 1000.0
first week / number SB and no. LB x
1000
Crude Birth Rate=No. of live births in 27.5 23.2
a year / Total mid yr x1000
Total deaths 134 1,135
Crude Death Rate 0.4 0.2
Number of births by skilled health 842 8,878
personel
Total reported births 985 10,948
% Birth attended by skilled health 85 81
personel (incl trained TBAs)= No
births attendd by trained skilled
personnel/ tot reported births
Maternal Deaths 3 22
Maternal Mortality Rate = No. 314 236
maternal deaths in a year/ total live
births x100,000
Infant deaths 21 152
Infant Mortality Rate=No. of infant 22.0 16.3
deaths in a yr/ Total no. of live
birthsx1000
FP Total users (HCC + SIPPA-1714) 816 8365
Total Child deaths-1-4 Yrs. 9 97
Child Mortality Rate-Deaths in 2.0 1.8
children 1-4yrs/ 1,000 pop of children
1-4)
% Contraceptive Prevalence 9.3 7.2
Rate=CBA using contraception/Total
CBA X100
Total ANC First Visit (or total Preg. 1194 14,794
Mothers)
Tot. Preg mothers-na (Expected 1,532 20,354
births)
% ANC Coverage=no. of preg 78 73
women attending 3 or more ANC/
Tot. preg mothersx100
Page 200 of 250
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7.10 Temotu .
The population of Temotu in 2005 was 21,678, with about 14.8% children less than 5
years old, and 48.6% are 15-49 years old.
25,000
20,000
Population
15,000
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005

Population <1 538 525 545 583 637 661 769
Population 1-4 2,054 2,084 2,117 2,175 2,264 2,263 2,455
Population <5 2,591 2,609 2,661 2,758 2,901 2,924 3,223
Total 15-49 8664 8992 9308 9606 9938 9746 10,527
Page 201 of 250
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Fig x Population of Temotu 7 yr trend.
12,000
10,000
8,000
Pop u latio n
6,000
4,000
2,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 4,813 4,985 5,143 5,285 5,459 5,414 5,739

Expected births 629 586 546 509 474 450 427
Males >5 7,709 7,892 8,077 8,263 8,453 8,031 8,852
Females >5 8,406 8,643 8,858 9,039 9,266 9,122 9,603
Total 15-49 8,664 8,992 9,308 9,606 9,938 9,746 10,527
males 15-49 3,851 4,007 4,165 4,321 4,479 4,333 4,788
Fig x Population by gender 7 year trend.
Temotu is the only province where by trend of population of females slight higher than
males.
Disease Incidence Trend 1996-2005
Acute Respiratory Infections:
ARI are major cause of morbidity worldwide and in Solomon Islands. Over the past 10
years, ARI has been the second most importance cause of attendance at primary health
care clinic in Temotu.
Page 202 of 250
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Fig. 1 Percent of ARI new cases 1996-2005
40%
35%
30%
25%
percent
20%
15%
10%
5%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
ARI as % total HIS - Temotu ARI as % total HIS - Sol Is.
As depicted in Figure 1, percentage of ARI at primary health care clinic in Temotu has remained above
national average in the past 10 years. In 2005, ARI was responsible for 36% of acute care contacts in Temotu.
It is no doubt that this figure could have had contributed to the high rate ARI contacts in Solomon Islands in
2005.
Page 203 of 250
---------------------------------------------------------------------------------------------------------------------
Fig. 2 Incidence rate of ARI 1996-2005
700.0
600.0
500.0
ra t e s /1 0 0 0 p o p
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
year
ARI rates - Temotu ARI rates - Solomon Is.
Figure 2 above demonstrated the incidence rate of ARI in Temotu and Solomon Islands. From the graph it is
obvious that incidence rate of ARI in Temotu are higher than that of national averages. While there has been a
decreasing in population rate in Temotu between the years 1999 to 2003, in 2004 the population rate increased
dramatically reaching 657 cases per 1000 population before it slightly decline to 634 cases per 1000
population in 2005.
Fig. 3 Incidence Rate of ARI by age group in Temotu 1996-2005
3500.0
3000.0
2500.0
incidence rate
2000.0
1500.0
1000.0
500.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
tot. pop. rates <1 rates 1-4 rates >5

Page 204 of 250
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Figure 3 above clearly demonstrated that under 5 children and in particular children under 1 year old are the
most affected ones by the disease (ARI).
Malaria
country.
In Temotu, the situation is slightly different and this is depicted in Figure 4 below. From
the graph below, it is obvious that percent of clinical malaria as total acute care contact
remain below national average through out the ten year period.
Fig. 4 Percent of Clinical Malaria New cases 1996-2005
45%
40%
35%
30%
perc ent
25%
20%
15%
10%
5%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
clinic malaria %HIS - Sol clinic malaria %HIS - Tem
The above graph shows that over the last decade incidence rate of clinical malaria in
Temotu has been fluctuating. As revealed in Figure 5 below in the early years of last
decade that is between 1996 to 1998 population rate of clinical malaria have dropped by
halved, then between 1999 to 2001 the population rate doubled reaching 472 cases per
1000 population in 2001 and between 2002 to 2004 population rate declined again. In
2005, the incidence rate has been increased from 272 cases per 1000 population in
2004 to 313 cases per 1000.
Page 205 of 250
---------------------------------------------------------------------------------------------------------------------
Fig. 5 Incidence rate of fever, clinical malaria and slide confirmed Temotu 1996-
2005
500.0
450.0
400.0
in c id e n c e ra t e /1 0 0 0 p o p
350.0
300.0
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
Temotu - fever Temotu - clinical malaria Temotu - slide confirmed
Figure 5 also reveals that since 1999 incidence rate of slide confirmed malaria have been lower than incidence
rate of fever and clinical malaria.
Diarrhoeal disease
worldwide and in Solomon Islands. In Temotu, diarrhoea and more importantly bloody
diarrhoea has been the major cause of illnesses for people of Temotu.
Page 206 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 7. Incidence rate of Diarrhoea by type, Temotu 1996-2005
45.0
40.0
35.0
30.0
rate per 1000
25.0
20.0
15.0
10.0
5.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
bloody no dehy bloody w ith dehy no blood no dehy no blood w ith dehy
Fig. 8 Incidence rate of Bloody Diarrhoea Temotu 1996-2005
250.0
200.0
rate per 1000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
under 1 aged 1-4 aged >5+
Figure 8 clearly demonstrates that in Temotu bloody diarrhoea is a common disease

affecting children under 5 and more importantly infants in the last decade. From the
above graph, the incidence rate of bloody diarrhoea particularly in children under 5 has
not been stable during the last decade. In 2005 incidence rate for children under 1 has
dropped significantly from 161 cases per 1000 to 70 cases per 1000 whilst incidence
rate for children 1-4 experience a moderate decline.

Page 207 of 250
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Skin disease and Yaws are common health problems in Solomon Islands. In Temotu,
they are also common illnesses amongst children under 5 years.
Fig. 9 Incidence rate of Yaw - Temotu and Sol 1996-2005
250.0
200.0
rate per 1000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
yaw s - Temotu skin disease - Temotu yaw s - Sol Is. skin disease - Sol Is.
Figure 9 above shows that incidence rate of yaws and skin diseases are higher in
Temotu compared to that of national average. In 1998, incidence rate of yaws in
Temotu rose dramatically from 34 cases per 1000 population to 103 cases per 1000 in
1999. Then followed by a continuous decline for two years, a slightly increase in 2001
and then in 2002 there was a significant rise in the incidence rate of yaws again reaching
145 cases per 1000 population. Then between 2003 and 2004 yaws incidence rate in
Temotu dropped significantly from 141 cases per 1000 in 2003 to 40 cases per 1000 in
2004.
The fluctuating pattern of yaws incidence rate in Temotu could imply that though
something has been done to reduce the incidence rate, vaccine coverage was not
enough to prevent the disease from spreading.
Page 208 of 250
---------------------------------------------------------------------------------------------------------------------
Fig. 10 Incidence rate of Yaw s by age group Temotu 1996-2005
300.0
250.0
rate per 1000
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
Figure 10 shows the incidence rate of yaws by age group. It is clear that yaws is more
common in children aged 1-4 followed by age group 5 years and older but not a common
disease in infants in Temotu. In 2002 incidence rate of yaws for children aged 1-4
reached it highest peak with 254 cases per 1000 population, then dropped significantly
to 66 cases per 1000 in 2004 and in 2005 a further decline was also noted.
Fig. 11 Incidence rate of skin disease Temotu 1996-2005

500.0
450.0
400.0
350.0
rate per 1000
300.0
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
Figure 11 reveals that skin diseases is also common in Temotu in infants and more
importantly in children aged 1-4. The graph also shows that the highest incidence rate
of skin disease occurred in 1998 where more than 45% of children aged 1-4 were
infected. In 1999 the rate for children 1-4 dropped to a third then remained constant in
the next four (4) years. However, in 2004 the incidence rate increased from 307 cases
per 1000 in 2003 to 430 cases per 1000. The graph also shows that in 2005 the
incidence rate of skin disease in Temotu for other age groups (infants and people aged 5
years and over) have also declined.
Page 209 of 250
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Red Eye
In Temotu, red eye and ear infection are more common in children under 5 years during
the last decade. Figure 12 below illustrates that the incidence rate of red eye has
declined from 50 cases per 1000 population in 1996 to 27 cases per 1000 in 2005. The
graph also shows that incidence rate of red eye has gradually decreasing during the last
decade and had remained below national averages. However in 2005 there was a slight
increase in red eye incidence rate in Solomon Islands and in Temotu.
Fig. 12 Incidence rate of Red Eye 1996-2005
90.0
80.0
70.0
60.0
rate per 1000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
red eye-tem red eye-sol
Figure 13 below reveals that incidence rate of red eye was highest in infants through out
the last 10 years. This is followed by children aged 1-4 and then people 5 years and
over. In 1999 red eye incidence rate for infants reached it highest point with 186 cases
per 1000 population, then in 2002 it dropped to 120 cases per 1000 and had continued
declining until 2004. Figure 13 also shows that in 2005 there was a slight increase in red
eye incidence rate in all aged groups.
Page 210 of 250
---------------------------------------------------------------------------------------------------------------------
Fig. 13 Incidence rate of Red Eye by Age Group Temotu 1996-2005
200.0
180.0
160.0
140.0
rate per 1000
120.0
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
years
Ear Infection
Table 1. Ear Infection by age-group, 1996-2005
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
ear infection - Solomon Is. 66.2 71.2 62.6 57.8 55.0 56.2 46.7 50.7 57.6 60.7
ear infection - Temotu 93.1 80.8 73.4 90.5 87.4 87.3 128.1 108.0 127.1 112.5
rates <1 161.9 198.2 143.9 321.8 266.6 268.0 333.0 268.6 307.3 277.1
rates 1-4 232.7 225.9 197.1 280.5 248.1 249.9 379.2 359.9 379.1 345.4
rates >5 72.3 57.7 55.3 58.5 61.5 61.2 89.6 70.0 86.9 74.7
Source HIS 1996-2005
Table 1 above shows that the incidence rate of ear infection for Temotu was higher than
national averages in the last decade. The table also shows that the highest incidence
rate was experienced in 2002 where 13% of Temotu people were infected. In 2005, a
slight decrease in incidence rate in all age group was also noted.
From table 1, it is obvious that ear infection was more common in children under 5. As
also revealed in table 1, incidence rate of ear infection in Temotu in the last decade has
been increasing however a slight decrease was experienced in 2005.
Health Infrastructure:
The foundation of health services in the provinces are the primary health clinics. By 2005, Temotu
has a total of 16 clinics, of which 75% of the total clinics a have a working radio clinic.
VHW formal Health
upgrade Radios
in
Province
Temotu 1 1 5 9 16 16 12
7 149
TOTAL 10 29 5 106 173 14
TOTAL
2005 10 29 5 106 173 323 323
Page 211 of 250
---------------------------------------------------------------------------------------------------------------------
-1 -5 15
2004 10 30 5 111 158 314
Table x Total of clinics in Temotu by 2005
By 2005 the ratio of clinic to population was 1: 1,355

Primary Health Care services:
Fig x below shows very low levels of primary health care activities (satellites, community
mobilization and awareness meetings) in Temotu compared with Makira Province. The cyclone
Zoë in 2003 had a devastating impact on the level of services delivery in the province.
250
No. of PHC activities
200
150
100
50
0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Satellite Total health ed health ed school village
Fig x number of primary health care activities by 13 yr trend:
800
1993
700
1994
600 1995
1996
No. of patients
500
1997
400
1998
300 1999
2000
200
2001
100 2002
2003
0
2004
inpatients Referrals Referrals Referrals Referrals Total
AHC RHC Prov NRH outreach
Fig x Level of referrals and admissions at clinic level.
Inpatients and referrals:

Page 212 of 250
---------------------------------------------------------------------------------------------------------------------
The numbers of inpatients in the clinics have increasing. Conversely, the total number of outreach
services also declined since 2000.
Table x Core Indicators of Temotu Province by 2005:
Temotu SI
Pop<1yr 769 14,465
Pop1-4 yr 2,455 55,240
Pop.WBA 15-49 5,739 115,730
Expected birth 890 20,354
TBA - -
Neonatal deaths
Total SB+NND 17 262
% Perinatal rate= No.of SB + Deaths 1000.0 1000.0
1000
Crude Birth Rate=No. of live births in a 24.9 23.2
year / Total mid yr x1000
personel
personel (incl trained TBAs)= No births
attendd by trained skilled personnel/ tot
reported births
Maternal Mortality Rate = No. maternal 192 236
deaths in a year/ total live births
x100,000
Infant deaths 9 152
birthsx1000
Child Mortality Rate-Deaths in children 2.0 1.8
1-4yrs/ 1,000 pop of children 1-4)
CBA X100
Mothers)
Tot. Preg mothers-na (Expected births) 890 20,354
Page 213 of 250
---------------------------------------------------------------------------------------------------------------------
% ANC Coverage=no. of preg women 63 73
attending 3 or more ANC/ Tot. preg
mothersx100
7.11
7.12 Rennell Bellona
Rennell Bellona is the smallest province in the country. In 2005 the total population of Rennell
Bellona was 2,686. Of which around 11.6% are aged less than 5 years old.
3000
2500
2000
Pop
1500
1000
500
0
1999 2000 2001 2002 2003 2004 2005
Population total Population <1 Population <5 Population >5
1,400
1,200
1,000
800
Pop
600
400
200
0
1999 2000 2001 2002 2003 2004 2005
WCBA Total 15-49 males 15-49
Disease Incidence Trend of Rennell Bellona 1996-2005:

Page 214 of 250
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Figure 1 demonstrates the proportion of acute care contacts by major diseases in
Renbel. In Renbel, the most common cause of attendance at any primary health care
clinics between 1996 and 2005 were ‘Other’ diseases and ARI.
Fig 1. Proportion of new cases by major disease, Renbel 1996-2005

80%
70%
60%
50%
percent
40%
30%
20%
10%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

Skin diseases Ear inf ection STI diseases Clinical malaria Other diseases
ARI are major cause of morbidity worldwide and in Solomon Islands. In Renbel, ARI is
second most importance cause of attendance at primary health care clinics. In 2005,
ARI was responsible for 36% of all acute care contacts in RenBellona.
Fig 2. Incidence rate of ARI, Renbel & Solomon Is 1996-2005
800.0
700.0
600.0
rateper 1,000
500.0
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI, Renbel ARI, Solomon Is
Figure 2 shows that in the past 10 years the incidence rate of ARI in Renbel was above
national average. The graph also shows an increasing trend of ARI rate in Renbel over
the past 10 years.
Acute Respiratory Infection by Age Group

Page 215 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 3. Incidence rate of ARI by age group, Renbel 1996-2005
3500
3000
2500
rate per 1,000
2000
1500
1000
500
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 3 demonstrates the incidence rate of ARI in Renbel by age-group in the past 10
years. The graph shows that ARI rate is higher in infants, followed by children aged 1-4,
then people 5 years and over. The graph also reveals that ARI had remained to be a
common health problem in infants in the last decade. The graph also shows that ARI
rates in children aged 1-4 had shown a rise in trend over the last 4 years (between 2002
and 2005).
Malaria
care clinics. In Renbel malaria is non endemic.
Diarrhoeal disease
worldwide and in Solomon Islands. In Renbel, diarrhoea and more importantly with no
blood and no dehydration was also a common illness in Renbel.
Page 216 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 4. Incidence rate of diarrhoea by type, Renbel 1996-2005
80.0
70.0
60.0
rateper 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 5 below demonstrates the incidence rate of bloody diarrhoea by age group in
Renbel for the past 10 years. The graph shows that in 2005 there was an outbreak of
bloody diarrhoea in children aged less than 5.
Fig 5. Incidence rate of bloody diarrhoea by age group, Renbel 1996-2005
90.0
80.0
70.0
60.0
rateper 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Skin disease and Yaws are common health problems in Solomon Islands. In Renbel
yaws and more importantly skin disease are also common illness affecting the people.
Page 217 of 250
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Fig 6. Incidencce rate of yaw s and skin disease, Renbel & Solomon Is 1996-2005
250.0
200.0
rate per 1,000
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
yaw s, Renbel yaw s, Solomon Is

skin disease, Renbel skin disease, Solomon Is
Figure 6 demonstrates the incidence rate of yaws and skin disease in Renbel and
Solomon Islands in 1996 – 2005. Figure 6 shows that in 2000 there was an outbreak of
skin disease in Renbel. This is clearly demonstrated in the significant rise in skin
disease rate from 30 cases per 1000 population in 1999 to 224 cases per 1000
population in 2000. Between 2000 and 2002 the rate of skin disease reduced for more
than half. Then between 2002 and 2004 skin disease rate rose again reaching 169
cases per 1000 population in 2004 then in 2005 it dropped to 45 cases per 1000
population.
Yaws by age group
Figure 9 below demonstrates the incidence rate of yaws by age group in Renbel for the
past 10 years. It is obvious from the graph that yaws is more common in the age group
1-4 and 5 years and older.
Fig 7. Incidence rate of yaw s by age group, Renbel 1996-2005
90.0
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Based on figure 7 yaws remained to be seen through out the 10 year period.
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Figure 8 below demonstrates the incidence rate of skin disease by age group in Renbel
for the past 10 years. The graph shows skin disease in more common in infants and
children 1-4. From the graph it is also clear that skin disease remained to be seen in
children through out the 10 year period.
Fig 8. Incidence rate of skin disease by age group, Renbel 1996-2005
700.0
600.0
500.0
rate per 1,000
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

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Red Eye
Figure 9 demonstrates the incidence rate of red eye in Renbel and Solomon Islands over
the past 10 years. The graph clearly shows a declining trend of red eye incidence rate in
Renbel and Solomon Islands over the past 10 years. The graph also shows that red eye
rate in Renbel has remained below national average.
Fig 9. Incidence rate of red eye, Renbel & Solomon Is 1996-2005
90.0
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
red eye, Renbel red eye, Solomon Is
Figure 10 below demonstrates the incidence rate of red eye by age group in Renbel for
the past 10 years. The graph also reveals that through out the 10 year period, red eye
incidence rate was higher in babies, followed by children aged 1-4 and then the age
group 5 years and over. The graph also shows that the trend of red eye incidence in
recent years for babies has declined from it highest level 142 cases per 1000 population
in 2000 to 21 cases per 1000 population in 2005.
Fig 10. Incidence rate of red eye by age group, Renbel 1996-2005
160.0
140.0
120.0
rateper 1,000
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year

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Ear Infection
Figure 11 demonstrates the incidence rate of ear infection in Renbel and in Solomon
Islands for the past 10 years.
Fig 11. Incidence rate of ear inf ection, Renbe & Solomon Is 1996-2005l
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ear inf ection, Renbel ear inf ection, Solomon Is
Figure 14 below demonstrates the incidence rate of ear infection by age group in Renbel
for the past 10 years. The graph shows that through out the past 10 years ear infection
in REnbel is more common is babies, followed by children age 1-4 then people age 5
years or more. The highest rate of ear infection in babies reached 317 cases per 1000
population in 1998. Then in 1999 no ear infection cases were reported. However
between 2003 and 2005 the trend of ear infection is increasing once again.
RBP SI
Pop<1yr 71 14,465
Pop1-4 yr 1,201 55,240
Pop.WBA 15-49 598 115,730
Expected birth 114 20,354
TBA - -
Neonatal deaths
Page 221 of 250
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Total SB+NND 0 262
% Perinatal rate= No.of SB + Deaths #DIV/0! 1000.0
1000
Crude Birth Rate=No. of live births in a 8.9 23.2
year / Total mid yr x1000
personel
personel (incl trained TBAs)= No births
attendd by trained skilled personnel/ tot
reported births
Maternal Mortality Rate = No. maternal 0 236
deaths in a year/ total live births
x100,000
Infant deaths 1 152
birthsx1000
Child Mortality Rate-Deaths in children 0.0 1.8
1-4yrs/ 1,000 pop of children 1-4)
CBA X100
Mothers)
Tot. Preg mothers-na (Expected births) 114 20,354
% ANC Coverage=no. of preg women 70 73
attending 3 or more ANC/ Tot. preg
mothersx100
7.13 Honiara
Honiara has a very complex and mixed ethnicity. As the capital and key commercial and
industrail areas in the country, the demand for health case services is wide and more
than the provinces even the major of the country’s population is in the provinces.
Page 222 of 250
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70,000
60,000
50,000
40,000
Pop.
30,000
20,000
10,000
0
1999 2000 2001 2002 2003 2004 2005

Population <1 1,427 1,391 1,397 1,405 1,417 1,559 1,495
Population 1-4 4,796 4,979 5,134 5,290 5,498 6,273 5,690
Population <5 6,223 6,370 6,531 6,694 6,915 7,832 7,185
total 15-49 30,349 31,030 31,633 32,188 32,937 37,236 34,156
Fig x Population of Honiara City 7 r Trend
40,000
35,000
30,000
25,000
Pop
20,000
15,000
10,000
5,000
0
1999 2000 2001 2002 2003 2004 2005
WCBA 13,080 13,374 13,653 13,929 14,421 16,041 15,073

Expected births 1,989 2,709 3,688 5,022
Males >5 23,868 24,456 24,994 25,487 25,942 34,611
Females >5 21,462 18,842 19,299 19,796 20,632 27,101
total 15-49 30,349 31,030 31,633 32,188 32,937 37,236 34,156
males 15-49 17,269 17,656 17,980 18,259 18,516 21,196 19,083
Figx Population of Honiara City 7 r Trend by gender (incomplete)
Disease Incidence Trend of Honiara 1996-2005:
Disease Incidence
Figure 1 demonstrates the proportion of acute care contacts by major diseases in

Honiara. In Honiara, the most common cause of attendance at any primary health care
clinics between 1996 and 2005 was apart from ‘Other’ disease, were ARI and clinical
malaria.
Page 223 of 250
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Fig 1. Proportion of new cases by major disease, Honiara 1996-2005
50%
45%
40%
35%
30%
percent
25%
20%
15%
10%
5%
0%
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI are major cause of morbidity worldwide and in Solomon Islands. In Honiara, ARI is
second most importance cause of attendance at primary health care clinics. In 2005,
ARI was responsible for 27% of all acute care contacts in Honiara.
Fig 2. Incidence rate of ARI, Honiara & Solomon Is 1996-2005
600.0
500.0
400.0
rate per 1,000
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ARI, Honiara ARI, Solomon Is
Figure 2 shows that the highest rate of ARI in Honiara occurred in 1997 reaching 524
cases per 1000 population. Between 1997 and 2000 ARI rate in Honiara declined
reaching 371 cases per 1000 population. In 2001, the ARI rate increased again then
dropped from 469 cases per 1000 population in 2001 to 349 cases per 1000 in 2002.
Between 2002 and 2004 the incidence rate of ARI increased from 349 cases per 1000
population to 506 cases per 1000 population then slightly declined to 487 cases per
1000 population in 2005.
Page 224 of 250
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Acute Respiratory Infection by Age Group
Fig 3. Incidence rate of ARI by age group, Honiara 1996-2005

4000
3500
3000
rate per 1,000
2500
2000
1500
1000
500
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 3 above shows that in the past 10 years incidence rate of ARI was higher in
children aged less than 5 but more importantly in infants. The graph also shows that
through out last decade, incidence rate of ARI in infants has exceeded 2000 cases per
1000 population. In 2000 ARI rate in infants almost doubled that of 1999. Though
Figure 2 indicates a continuous decline of the overall ARI rate in Honiara was
experienced between 1997 and 2000, ARI rate for infants as demonstrated in Figure 3
reached it highest point in 2000 when every baby in Honiara were presented 3 times
with ARI at any primary health care clinics.
However, between 2000 and 2002 ARI rate in infants declined reaching 2066 cases per
1000 population. Then in 2003 ARI rate in infants rose again and between 2004 and
2005 a slight increase of ARI rate was noted.
Malaria
country in 2005. In Honiara, malaria (i.e. fever and clinical malaria) account for 26% of
all acute care contacts in 2005.
Page 225 of 250
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Fig 4.Incidence rate of clinical malaria, Honiara & Solomon Is 1996-2005
700.0
600.0
rate p er 1000 p o p u latio n
500.0
400.0
300.0
200.0
100.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Clinical malaria, Honiara Clinical malaria, Solomon Is
Figure 4 demonstrates the trend of clinical malaria rate in Honiara and Solomon Islands
for the past 10 years. The graph shows that clinical malaria rate in Honiara dropped
from 420 cases per 1000 population in 1996 to 179 cases per 1000 population in 1999.
Between 1999 and 2001 clinical malaria rates increased to 368 cases per 1000
population. Then between 2001 and 2005, a slight declined was noted over the years.
Incidence rate of fever, clinical malaria and slide confirmed malaria
Fig 5. Incidence rate of clinical malaria, fever, slide conf irmed, Honiara 1996-2005
450.0
400.0
350.0
300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
clinical malaria fever slide conf irmed
Figure 5 above demonstrates the trend of the incidence rate of clinical malaria, fever and
slide confirmed malaria. The graph shows that between 1996 and 1999 the rate of
clinical malaria had dropped reaching it lowest level 179 cases per 1000 population.
Page 226 of 250
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Then between 1999 and 2001 clinical malaria increased significantly reaching 368 cases
per 1000. Then between 2001 and 2005 a slight decrease in the rate of clinical malaria
was observed.
Diarrhoeal disease
worldwide and in Solomon Islands. In Honiara, diarrhoea and more importantly with no
blood and no dehydration was also affecting people in Honiara.
Fig 6. Incidence rate of diarrhoea by type, Honiara 1996-2005

90.0
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 7 below demonstrates the incidence rate of bloody diarrhoea by age group in
Honiara for the past 10 years. The graph shows that the incidence rate of bloody
diarrhoea over the past 10 years was higher in children aged less than 5 years.
Figure 7 also reveals that in Honiara the trend of bloody diarrhoea in children aged less
than 5 years but more importantly in infants has increased significantly between 2001
and 2005. This clearly indicates that bloody diarrhoea is becoming a major health
problem affecting children and more importantly babies in Honiara.
Page 227 of 250
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Fig 7. Incidence rate of bloody diarrhoea by age group, Honiara 1996-2005
70.0
60.0
50.0
rate per 1,000
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Skin disease and Yaws are common health problems in Solomon Islands. In Honiara
yaws and more importantly skin disease are also common illness affecting the people.
Fig 8. Incidence rate of yaw s and skin disease, Honiara & Solomon Is 1996-2005
200.0
180.0
160.0
140.0
rate per 1,000
120.0
100.0
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
yaw s, Honiara yaw s, Solomon Is skin disease - Hon skin disease, Solomon Is
Figure 8 shows the trend of yaws and skin disease rate for Honiara and Solomon
Islands. The graph shows that the trend of skin disease in Honiara is declining and has
remained below national average through out the past 10 years. However, the trend of
yaws rate in Honiara had remained constant between 1996 and 2001 then increased
from 2001 to 2005.
The graph shows clearly the skin diseases rate has remained higher than yaws rate
through out the past 10 years. This clearly indicates that skin disease is a more
common disease than yaws among the people in Honiara.
Yaws by age group

Page 228 of 250
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Figure 9 below demonstrates the incidence rate of yaws by age group in Honiara for the
past 10 years. It is obvious from the graph that incidence rate of yaws is higher in the
age group 1 – 4 followed by people aged 5 years and over.
Figure 9 also demonstrates the increasing trend of yaws in the age group 1-4 and 5
years and over. The increase in the trend was more significant in the age group 1-4
between 2001 and 2005 where yaw rate rose significantly from 35 cases per 1000
population in 2001 to it highest level, 98 cases per 1000 population in 2004. Then in
2005, yaws rate dropped to 59 cases per 1000 population.
Fig 9. Incidence rate of yaw s by age group, Honiara 1996-2005

120.0
100.0
80.0
rate per 1,000
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Guadalcanal for the past 10 years. The graph shows a decreasing trend of skin disease
in all age group in Honiara for the past 10 years. The graph also shows that the highest
rate of skin disease occurred in 1998 and the increase was experienced in all age
groups. Though the graph reflects a decreasing trend of skin disease rate in all age
group, in recent years, that is between 2003 and 2005 a slight increase in skin disease
rate was experienced.
Page 229 of 250
---------------------------------------------------------------------------------------------------------------------
Fig 10. Incidence rate of skin disease by age group, Honiara 1996-2005
450.0
400.0
350.0
300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Red Eye
Figure 11 demonstrates the incidence rate of red eye in Honiara and Solomon Islands
over the past 10 years. The graph clearly shows a declining trend of red eye incidence
rate in Honiara and Solomon Islands over the past 10 years. The graph also shows that
red eye rate in Honiara has remained below national average in last decade.
Fig 11. Incidence rate of red eye, Honiara & Solomon Is 1996-2005
90.0
80.0
70.0
60.0
rate per 1,000
50.0
40.0
30.0
20.0
10.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
red eye, Honiara red eye, Solomon Is
Figure 12 below demonstrates the incidence rate of red eye by age group in Honiara for
the past 10 years. The graph also reveals that through out 10 year period, red eye
Page 230 of 250
---------------------------------------------------------------------------------------------------------------------
incidence rate was higher in babies, followed by children aged 1-4. The graph also
reveals that the trend of red eye incidence through out the 10 year period was declining
in all age groups however in 2005 an increased in the trend of red eye rate was noted in
all age groups but more importantly in infants.
Fig 12. Incidence rate of red eye by age group, Honiara 1996-2005
160.0
140.0
120.0
rate per 1,000
100.0
80.0
60.0
40.0
20.0
0.0
1 2 3 4 5 6 7 8 9 10
Year
Ear Infection
Figure 13 demonstrates the incidence rate of ear infection in Honiara and in Solomon
Islands for the past 10 years. It is obvious from figure 13 below that the incidence rate of
ear infection in Honiara over the past 10 years was well above national averages.
Fig 13. Incidence rate of ear infection, Honiara & Solomon Is 1996-2005
140.0
120.0
100.0
rate per 1,000
80.0
60.0
40.0
20.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
ear infection, Honiara ear infection, Solomon Is
Honiara for the past 10 years. The graph shows that through out the past 10 years ear
infection in Honiara is more significant in children age less than 5. The rate of ear
Page 231 of 250
---------------------------------------------------------------------------------------------------------------------
infection rate has fluctuated over the years but a considerable decline was noted
between 2003 and 2005 in infants.
Fig 14. Incidence rate of ear infection by age group, Honiara 1996-2005
450.0
400.0
350.0
300.0
rate per 1,000
250.0
200.0
150.0
100.0
50.0
0.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Honiara Response:
There are total of 8 Government run clinics in Honiara, and about 6 smaller private practitioners’
clinics. The key target areas are the suburbs and residential areas within and around the city
boundary. Honiara health services also received referrals from the provinces.
Page 232 of 250
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Chapter 8 Resource Utilisation

8.1 Funding for Health in 2005:
Ensuring adequate funds for maintaining health services in order to meet the health needs of the
population has been challenging in the past five years.
2000 2001 2003 2004 2005 2006

Total operational 65,937,79 59,100,30
cost 2 0 70,376,851 52,980,902 90,698,547 97,229,810 SIG
68,000,000 34,000,000 HSTA
30,221,01 35,631,86
Total Staff costs 8 2 42,863,938 54,224,094 45,460,431 45,531,308
96,158,81 94,732,16 113,240,78 107,204,99 204,158,97 176,761,11
Total Budget 0 2 9 6 8 8
Table x and Fig x Trend of Health Expenditure Estimates 6 yr trend (Exc 2002) in SBD:
8.1.1 Issues:
Total Health Expenditure 6 yr trend
250,000,000
200,000,000
150,000,000
SBD
100,000,000
50,000,000
0
2000 2001 2003 2004 2005 2006
There is an 84% increase in the health costs in the six year trend. In 2000 the total
health expenditure budget was SBD 96, 158,810. In went up as SDB 176,761,118 in
2006. In 2005 in tipped up to SBD 204, 158, 978 as the HSTA AusAID funded put in
substantial fund to drive the operational plans at the national and provinces.
The staff cost have increased by 51% since 2000 from SBD 30Milliom to 45.5M. in the
past two years. The revised scheme of services for the doctors and the nurses has been
significant contributing factor to the increase. How more would the staff cost increased in
light of the proposed scheme of services for the Paramedic staff in at the negotiation
stage.
Page 233 of 250
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The operational cost increased by 48% since 2000. In 2004 and 2005 the cost further
surged because of extra support from the Budgetary Support and the HSTA Trust fund.
Within the health sector additional funding was allocated and used for high impact
development initiatives for the provincial health services.
8.2 Human Resource for Health in 2005

.
1800
1600
1400
1200
No. of staff
1000
800
600
400
200
0
2000 2001 2002 2005 2006
Non-Estab 172 161 140 134 132

Estab 1200 1253 1253 1425 1469
Grand Total 1372 1414 1393 1559 1601
Table x Number of health workers 2000-2006 Source Staff Establishment MOH
8.3 Issues:
There has been very little increase in the level of staffing in the country. Since 2000 and
even previous years, there was only 16% increase in staffing.
However, the staffing cost has increased by 51% and this is the limiting factor to ensure
that our clinics are fully staffed.
It is also a concern that many highly qualified local doctors are leaving the Public Sector
and also to overseas to look for high and lucrative conditions. The challenge for the
Government is to retain the few qualified local specialists.
General work morale is very low34 (Department the Public Service does not provide
them with a desirable career, and the poor standards of wages contribute strongly to
this): Work ethics and culture very poor.
Peoples’ capability is low (skill and knowledge is very low and causing serious
impediments on service delivery)35 and, too centralized performance appraisal system is
not the most effective mechanism to improve individual staff capability to meet specific
service delivery targets.
34 Admin Scan by RAMSI Mahcinery of Government 2005

35 Ibid
Page 234 of 250
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Staff performance and task level in relation to the Essential Public Health Functions
varies significantly. Key areas of weakness are on functions related to emergency
preparedness and disaster management”, “research” and “enforcement” or health
legislations i.e. limited skill)36.
Staff productivity also affected as shown in Clinic utilization review-“Results support

future posting of nursing staff according to clinic workloads, skill mix needed to meet
individual clinic demand and skill mix at adjacent clinics. This approach argues for
adoption of a flexible clinics designation and staffing model based on need rather than
population parameters. It also suggests that designating clinics as RHC or NAP be
reconsidered and a more generic term such as ‘health clinic’ be adopted”37.
Many more doctors migrated out in the past three years despite the revised scheme
of service for doctors. In 2003 around 20% (19) of the total registered doctors migrated
out. In 2006 it increased to 22% (24) doctors all together migrated out to work
elsewhere.38
Nursing personnel were not fully conversant with the new Scheme of Service39.
Unequal distribution of health staff number and skill mix among the provinces40.
Health workers attitude (esp. nurses in hospitals and clinics) very poor causing people to
access health care41.
Poor HR Management-Part of report on the Essential Public Health Review by David

Philips:
Strengthen Weaknesses
Human Donor support ++ Lot of staff near retirement age
Resource Good regional training No consultation of field staff on training
Development progs needs – HQ decisions
TNA at provincial level Resources for training programme
across teams dependant and centrally controlled
New Cert in PH @ Lots of overlap in differing courses
SIMTRI good in Lot of material not relevant to Solomons
developing generic PH Training needs often self identified and not
workers organisationally done
Training not linked to local needs – reflect
course availability & donor priorities
Lack of priority given to ensuring senior
staff in provinces well trained – “$$ goes to
NRH because they complain loudest”
Staff capability in areas often limited by
other factors eg staff housing
Lack of multi-skilling of staff
PSC Promotion system works against
36 David Philips (2005). SI Essential Public Health Functions Assessment

37 Solomon Islands Primary Health Care Clinics Review Report by Chris Evans of HISP
38 G..Malefoasi (2006). Technical Briefing to the Minister of Health: Info to the 59th World Health Assembly May 2006
39
PHD Capacity Assessment Report by Vicki HISP PHC Advisor
40 PHD Capacity Assessment Report by Vicki HISP PHC Advisor and Solomon Islands Primary Health Care Clinics
Review Report by Chris Evans of HISP
41 Community Assessment by Alex (2006)
Page 235 of 250
---------------------------------------------------------------------------------------------------------------------
young people
Options to solutions:
HR Issues & Problems Recommendations/ Options to solutions:

General work morale is very low- HRM function could be strengthened
poor work ethics and culture Performance monitoring and reporting against
planned targets and measures needs to be
strengthened to improve the overall management
of the department. Similarly, line managers could
benefit if they were more aware of setting
standards and procedures for required
performance levels to meet service delivery goals.
Performance Management generally could be
improved if Divisional Heads were more committed
to communicating with their operational staff on all
matters related to standards and quality of service
delivery;
Career path development inline with condition of
services/ Terms of Conditions
Peoples’ capability is low To improve this situation, line managers could be
assisted if they developed performance
development plans for individual staff that would
align their skills and knowledge with the priority
work targets. These Plans would then inform the
annual training or professional development plans
linked to the budget.
Establish feed back mechanisms to staff on
performance etc.
To ensure a basic succession strategy, a targeted
Graduate recruitment program would probably
benefit the clinically related Divisions.
Staff performance and task Develop a coordinated approach to training and

level in relation to the Essential workforce development across stakeholders,
Public Health Functions varies agencies, institutions and programmes based on
significantly. EPHFs.
Increase the geographic equity of EPHF

skills distribution, especially with regard to
provinces.
Ensure some local workforce surge

capacity to address unexpected events
(e.g. a local disaster/emergency situation)
possibly by more multi-skilling.
Page 236 of 250
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Staff productivity also affected Need for a need-based clinic designation and
staffing model
Many more doctors migrated Need further review on shortage and retention of
specialist doctors.
Nursing personnel were not fully Need further communication
conversant with the new Scheme
of Service.
Unequal distribution of health Need for a need-based deployment and staffing
staff number and skill mix among model
the provinces
Health workers attitude (esp. Reorientation and people centered approaches of
nurses in hospitals and clinics) training to nurses.
very poor causing people to
access health care
Page 237 of 250
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Chapter 9 Health Legislation

The area of health legislation has been an area for need substantial effort in strengthening. The
administration scan done by RAMSI also identified the field of legislative support as area for
improvement. (Refer Chapter 6: Section 6.1.1).
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.
9.1 Health Care Legislation Review:

The health care system in Solomon Islands is primarily provided and funded by the Government.
It has adopted and practiced the British National Health Services where by health care services
is provided free at point of delivery. Thus, health care services is centralized in regards of binding
rules and regulation in nearly all field of health financing, manpower management and discipline,
and authority.
Solomon Islands health care legislation sits within a broader public legislative framework42 as
shown in the table below.
Table x Sumarizes the current legislations and regulations in health.
Area Titles of Laws and Date of Issue Date of Last

Regulations Revision
1.Public Health Health services Act 1st October
1979 1979
Health Act (Health 1st May 1980
services (Hospital
Regulations) 1980)
Subsidiary
Legislation.
Public Health Act Repealed and
1970 revised into The
Environment Act
1980
The Environmental 1st August 1980
Health (Public Health
Act) Regulations
Quarantine Act 1st April 1931 1930, 1931, 1940,
1946, 1968, 1978
42 SIG (1996). The Laws of Solomon Islands, Revised Edition, Title XVI: Medical & Public Health, Printed by Eyre and
Spottiswoode Ltd, Chapters 97-116.

Page 238 of 250
---------------------------------------------------------------------------------------------------------------------
2.Environmental Health The Environment
Health Act 1980
3.Food Safety Environmental Health Repealed and

Act 1980 (Part XII) revised into Pure
Food Act 1997.
Pure Food Act

4.Mental Health Mental Treatment Act 11th December
1970 1970
5.Health Practitioners Health Workers Act Repealed and
1982 revised into Health
Workers 1990
Health Workers Act 23rd February None

1990 1990
Medical and Dental 1st July 1988 Repealed and
Practitioners Act 1988 revised into
Medical and Dental
Practitioners Act
1990
Medical and Dental 1st July 1990 None
Practitioners Act 1990
Nursing Council Act 1st December Revised (amended)

1997 in 1997
The Nursing Council None
(Amendment) Act
1997
The Pharmacy
Practitioners Act 1997
(to repeal certain
portions of the
Pharmacy and
Posions Act 1991
below)
6.Pharmaceutical Pharmacy and 28th July 1941 Revised in 1953,
products and therapeutic Poisons Act 1941 1958, 1967, 1973,
goods 1978, 1981, 1988
Page 239 of 250
---------------------------------------------------------------------------------------------------------------------
7.Health Care Financing No specific Act but None
provisions are
provided by theses
Acts:
Health Services Act
1979
Medical & Dental

Practitioners (Chapter
14)
9.2 Health Services Act 1979
This is a relatively short Act setting out matters of administration and the range of health services
to be provided. Chapter 3 establishes a Ministry of Health and Medical Services with a
Permanent Secretary and other staff as are from time to time appointed. The Ministry is under
the direction and control of a Permanent Secretary, subject to any directions received from the
Minister (Chapter 3(2).
The Act provides that it is the duty of the Health Minister:
“to promote the establishment in Solomon Islands of a comprehensive primary health care
service designed to secure the prevention, diagnosis and treatment of illness, and for that
purpose to provide or secure the effective provision of services in accordance with the provisions
of this Act.” (Chapter 4).
The Act expressly provides that “the services so provided shall be free of charge” except insofar
as rules are made authorising or prescribing charges for such services [Chapter 4(2)]. The Act
also provides for the establishment of health advisory committees, although it appears that there
are none at present.
Hospital Services are dealt with in Part II of the Act, primarily by setting out that the Minister may
provide hospital accommodation and other treatment services and by listing the various matters
in respect of which regulations may be made. In particular, regulations may be made relating to:
the management of hospitals
charges for maintenance and treatment of patients in hospitals and supply of medicines and
services
charges for services performed outside public hospitals
Part III of the Act deals with primary health care services. The Ministry is responsible for
providing primary health care services as directed by the Minister. The Ministry has a statutory
duty to provide, equip, and maintain health centres, clinics, satellite clinics and aid posts
throughout the Solomon Islands “having regard to the needs in the area and the resources
available to the Ministry” [Chapter 11(1)]. The Ministry is also required to act in consultation with
Provincial Assemblies. Provincial Assemblies and the Honiara Town Council are authorised to
provide clinics in their own areas (Chapter 12). The Minister may also contract with non-
governmental or church groups (Chapter 13).
Part IV deals with other health services. Here the powers of the Minister are set out in Chapter
16 and include the power to employ officers and provide buildings for pathological and other
services, to employ staff and provide buildings for blood transfusion services, and undertake
public education campaigns, research, and international liaison.
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Financial matters are set out in Chapter 17, which provides that health funding is to be by way of
an expropriation from Parliament. Pursuant to Chapter 17, any charges or fees levied under the
Act and collected by the Ministry “shall be paid into the Consolidated Fund”. The Minister
prescribes responsibility for fee collection. Any fees payable are deemed a debt due to the
Crown. The Act does not prescribe the particular form of Ministry accounts or deal with matters
of budgetary structure.
The principal Act then amended in 1988 as Health Services (Amendment) Act 1988. The
amendments reflect the provisions for the following;
Primary health care as the fundamental course for basic health services to the people (Chapter 2
(a) and (d) of Act No.5 of 1979).
Recognition of the Village Health Aides (or VH workers) as the component of the health care
referral system or front line health workers (Chapter 2).
Autonomy to the Minister to make regulations in areas of (Chapter 5.1):
management of public hospitals (through committees if necessary) (Chapter
5.1.a)
patient care (Chapter 5.1.b).
visitors (Chapter 5.1.c)
payment of fees by external users of public hospitals e.g. private practitioners (5.1.d)
fee for services –treatment of patients in public hospitals, and service delivery (5.1.e)
public officers performing and charging for services provided outside the public hospitals and
dispensary (5.1.f)
line of command or authority and powers and duties of staff of public hospitals.
Patient care (referrals) (5.1.h)
Staff discipline in public hospitals, clinics and Aide posts.
Confidentiality of patients’ information.
Board of visitors (Chapter 6, replaces Chapter 9 in the principal act). The functions of the board
and their relevancy in the current and future prospect are to be reviewed.
The rest of amendments are in respect of changes with terminology.
The current Health Services Act obviously needs reviewing and changing. It lacks the provision
for the following fundamental and important aspects of health development to achieve the
Government’ future direction policy;
clear organizational structure or health reform
clear line of command and authority and reporting
management of public hospitals by CEO
secondary health care
tertiary health care
role delineation of health care services
cost recovery through user pay system in public hospitals (need further elaboration), and
collection and retaining of funds raised.
total quality management
management of public hospitals
private-public mix
right to private practice
health insurance act- universal or private
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9.3 The Health Services (Hospitals) Regulations 1980
These regulations require the person charged with administration of the regulations to convene
the Hospital Committee (reg 6). Little information was available about the functions and operation
of these Committees.
The regulations do prescribe a set of fees for private patients including fees for:
Ward patients
Outpatients
The private antenatal clinic
Special consultation
Physiotherapy treatment
X-ray examinations
Authentication and certification
However, there was general agreement among Ministry and hospital staff and non-government
organisations that in practice fees are not charged and collection is rarely enforced because of
public resistance to paying and lack of willingness for administrators to collect them. It appears
that a scheme for a user pays system was devised in 1979, however, it was never implemented,
apparently due to community opposition. There is also some government subsidisation of private
health care with opportunities being missed for revenue collection as between public and private
patients. For example, some private patients are being referred to the hospital pharmacy for
pharmaceuticals that are available to the public for no charge, when there are strong arguments
for requiring private patients to pay for these even when these are available only from the hospital
pharmacy.
9.4 Environmental Health Act 1980
This Act provides a mechanism for dealing with a range of public health matters including: public
nuisances, building defects, excessive dust, fumes, smoke or effluent, the supply and sale of
food, the prevention and supression of notifiable diseases, public drainage systems, public water
supplies, noxious waste, the keeping of animals, refuse and rubbish disposal, residential
overcrowding, factory and trade premises, cemetery and burial places, septic tanks, and other
public health risks.
The Minister may delegate certain authorities to Enforcement Authorities, namely, the Provincial
Assemblies and the Honiara Town Council (Chapter 6). The Minister may require an
Enforcement Authority to act on a public health matter and if it does not, the Minister can
authorise some other person to do so and seek remuneration from the Enforcement Authority for
any costs incurred (Chapter 7).
The procedures for the issue of abatement notices, including consequences for non-compliance,
are set out in Chapter s 12-14. Prosecutions are to be taken by the Enforcement Authority. Any
fines gained as a result of enforcement activity are to be paid into the general revenue of the
relevant Authority, pursuant to Chapter 15(2). Expenses incurred in the taking of prosecution
action may also be pursued and interest of 5% charged on any outstanding sum (see Chapter
17).
The Environmental (Public Health Act) Regulations deal with procedures for notification of public
nuisances, court orders for abatement, and a range of specific areas such as offensive trades,
filthy or verminous premises, water supplies, vessels, buildings and housing, drainage and
sanitation, and food and drugs. Powers of seizure, entry and search and prosecution and
procedural matters also included (reg 105-111). The Schedules to the Regulations include a list
of notifiable diseases, offensive trades, and rules dealing with the treatment of malaria.
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9.5 Mental Health Act 1970:
This act consolidates the law relating to persons of unsound mind and makes further and better
provision for the care of persons suffering from mental disorder or mental defect, for the custody
their persons and the management and control of mental hospitals. Whilst the current Act focuses
mainly on treatment at a health institution, the Ministry is adventuring into getting (rehabilitative)
community services to the village level through primary health care approach. Thus, the Act my
need to accommodate the changes if necessary.
9.6 Health Workers Act 1982:
The Health Workers Act 1982 was revised and repealed into the Health Workers Act 1990, which
was issued on the 23rd February 1990. This Act regulates the functions and duties of various
categories of health workers, to confer on the board powers to prescribe registration, deal with
matters pertaining to discipline and other connected matters;
This Act establishes a Health Worker Board, which oversees the registration and discipline of
health workers. The health care referral system consists of a network of four different levels of
health workers:
Village health worker – in village health posts delivering first aid supplies on restricted hours
Nurse aide – in Area Health Centres and Nurse Aides Posts
Registered Nurses – in Area Health Centres and Provincial hospitals
Doctors – most of whom are in the Central Referral Hospital and the Provincial hospitals
The practical flaw of the Act is it deals with the classification of health workers, primarily village
health workers and nurse aides. At this stage there is no board to carry out functions of the Act
as nurse aides, registered nurses and doctors’ registrations are dealt with by a separate
legislations. The Village Health Workers are not recognized as a permanent health worker
because of their limited knowledge and skills in health without background ideology, despite their
important role in the health care referral system in the country. In short Health Workers Act
never applied because legislation overlap with other Acts, whilst other important health workers
such as the paramedics are missed out or not under the regulation.
However, in the medium to long term, this Act should be fully reviewed to ensure a consistency
and cohesiveness with overall developments in other parts of the government health sector. It is
therefore recommended that the Act should be reviewed to ensure a consistency with overall
restructuring in the health sector.
9.7 Medical and Dental Practitioners Act 1988
This Act establishes a Medical and Dental Board. The Board is a body corporate and its function
include:
Registration of medical and dental practitioners
Regulation of their training
Appointment of examiners
Issuing certificates of registration
Exercising disciplinary control over, and ensure the maintenance of, proper standards of
professional conduct by persons registered as medical and dental practitioners.
Chapter 6(3) provides that every person whose name is entered on the Medical and Dental
Register is entitled to use the term “doctor implying that he is recognized by law as a person
authorized or qualified to practice in Solomon Islands.” Chapter 14 provides:
“Every registered medical or dental practitioner shall be entitled to practice medicine or dentistry,
as the case may be, in Solomon Islands, and to demand and recover any reasonable charges for
services rendered by him and for all drugs, medicine and appliances supplied by him.”
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The statutory right to establish a private practice and charge fees and the relationship of this to
employment by the Ministry appears to cause some difficulty with some doctors who are
employed by MHMS, particularly those in hospitals. It appears that some doctors who are
employed in public hospitals are also running private clinics.
There is a concern that some way should be found to accommodate the desire to see private, fee
paying, and patients so as to encourage those doctors working in the hospital to remain. For
example, some doctors expressed a desire to use the public hospitals after hours to see private
patients.
9.8 Nursing Council Act 1987
This Act establishes a Nursing Council and matters related to the registration of nurses in the
Solomon Islands. The Nursing Council is a body corporate and its functions are to:
Arrange and regulate examinations, courses and training for persons wishing to be nurses
Keep and maintain a register of nurses and issue certificates to suitably qualified nurses
Regulate and supervise the practice of nurses, including the maintenance of professional
standards by nurses
Approve training courses for nurses
View matters related to the profession of nursing in light of the development in technology,
medical and nursing care for the benefit of patients and the nursing profession
Chapter 8 provides that the Council may register a person who is qualified in terms of Chapter 9
of the Act and not disqualified under Chapter 10, “but otherwise it shall reject the application.”
The Council may cancel or suspend registration. The Act also prescribes certain offences for
practicing without registration and other matters (Chapter s 18-20).
The constitution and liability provisions of the Council were substantively amended in 1997. Prior
to the amendments, the Nursing Council was headed by the Under Secretary for MHMS, with a
deputy who was the head of nursing services. The Council included the heads of training
institutions, the respective heads of hospital and community health services, a registered nurse
nominated by the Nursing Association and a registered nurse employed in the private sector.
However, in 1997 the Director of Nursing (a position within MHMS) was designated the chair of
the Council and the deputy chair become the Assistant Director of Nursing. The Under Secretary
of MHMS is no longer a member of the Council, having been replaced by the Assistant Director of
Nursing. Other members of the Council are the heads of approved training and educational
institutions, a registered nurse employed in the service of a religious organisation in Solomon
Islands, a registered nurse nominated by the Nurses Association and the newly created position
of Registrar of Nursing. The position of Secretary (who was also the Registrar to the Council)
appears to have been amalgamated with that of the Registrar who now has the same statutory
responsibilities of the Secretary for the keeping of a nurses’ register and the issuing of
appropriate certificates.
9.9 Pharmacy and Poisons Act 1941
This (principle) Act establishes a Pharmacy and Poisons Board as a separate corporate body.
The Board comprise three persons, the Under Secretary for Health (who is retained as the Board
Chair) and two other persons appointed by the Minister.
The Board’s functions are not clearly defined in the Act, but appear to be to authorise persons to
practice as pharmacists and to keep a register of pharmacists (maintained by a Registrar
(Chapter s 16 to 26). The Act allows a body corporate to carry on the business of a pharmacy,
provided it is under the management supervision of a registered pharmacist. The Board may
disqualify a body corporate from practicing, but only with the approval of the Minister (Chapter
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27). Conditions for practice, including the procedure for disqualification, are set out in Chapter s
28 to 33.
Only persons registered and approved under the Act may practice as a pharmacist, but the Board
may issue a temporary licence to practice (Chapter 35).
The Act requires a medical practitioner to sign prescriptions (Chapter 36) and for pharmacists to
keep a register of prescriptions (Chapter 37). Chapter 39 permits a medical practitioner to
dispense medicines and drugs without being registered as a pharmacist, provided an adequate
record of any such prescriptions. In limited circumstances, a pharmacist may give medical or
surgical advice or aid (Chapter 38). Automatic dispensing machines are prohibited (Chapter
40). There are restrictions on the supply of reproductive and sexual health medicines and
advertisements or other material on these (Chapter 41 and 42).
Part V of the Act deals with the sale and supply of medicines. Only medicines authorized for sale
under the Act may be made available to the public, although the Minister may amend Schedule A
of the Act, which sets out permitted medicines. A person may be licensed to sell medicines, but
not fill subscriptions (Chapter 45). The Police must be notified of persons licensed to sell
medicines (Chapter 46). Wholesale supply of medicines is prohibited and there are restrictions
on important of medicines (Chapter s 48 and 49). A general provision on labeling is included
(Chapter 50), and the Minister is empowered to order the restriction of some drugs.
There is a range of rules that have been made under the Act including rules relating to
commercial samples. Other aspects of the rules deal with exemptions and the form of
prescriptions, record keeping, labeling of poisons, storage and transport of poisons, manufacture
of poisons, and forms and fees.
9.10 Pharmacy Practitioners Act 1997

The Pharmacy Practitioners Act is an extract from the certain provisions of the Pharmacy and
Poisons Act, and to matters connected to therewith or incidental thereto. It is specific to regulation
of the Practice of Pharmacy in Solomon Islands.
The provisions include;
Establishment of Board and its functions
Registration of pharmacists and pharmacy assistant
Disciplinary
Chapter 10: KEY ISSUES CHALLENGES AND WAY FOWARD
9.11 Overview:: Key health problems

The Annual Health Report 2005 hereby raised many key issues for consideration in
policy decisions, planning, and management.
The following health problems and diseases were presented with evidences (not in any priority
order as this stage).
Skin diseases
Diabetes
Malaria
Oral health
Disaster management
Epidemic response
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TB/ Leprosy
Maternal mortality
Family planning
Eye and ear diseases
Trauma and accidences
Common childhood infections
Non-communicable diseases
Inter-sectoral and partnership of multisector for health
9.12 Issues Raising and Fact (evidence) finding:
Listed below is a brief overview of issues:-
The issues are categorized into 5 key Result Areas (as a possible area for changes to outputs,
outcomes and impacts):
10.2.1. Key Social Health Determinants:
Listed below are the key social health determinants, affecting health status of the people and
imposing challenge on the health services delivery:
Conflict
Health seeking behavior-socio-cultural –kastom medicine
Geographical – distance
Costs
9.12.1 10.2.2. Findings:
SI faces some unique challenges in the effective delivery of health service:

Utilisation of health care is on the increase
Country struggles with a high burden of disease and reductions in common diseases has stalled
Communities make decisions in a society that utilises home care with traditional healers and
western medicine. ( medical pluralism)
Power of the health worker to affect health outcomes is increasingly acknowledged
Kastom medicine widely used, even in the treatment of new diseases, including STI’s, but
households can disagree. i.e clinic or kastom
Kastom doctors declining, healing traditions are in a state of rapid change
9.12.2 Pattern of resorts:
Symptoms – assessment of threat – first resort of minor illnesses is Kastom medicine

When illness has been described as serious ( bigfala siki) clinics and hospitals are generally the
first treatment preference – leads to delays in tx.
However, can be disagreements over how to characterise serious illnesses ( eg. Diabetes, stroke,
TB, cancer, heart problems, malaria and diarrhoea and mental illnesses)
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9.12.3 Barriers to seeking health care
Distance to clinic, transport accessibility, available childcare, quality of service and medicine
stocks, fear of injections, drugs, surgery etc / then resort to Kastom
BUT – patterns of resort vary by region and household
Some argue that kastom is more effective in the early stages of an illness
“kastom doctors and medical doctors should work together in treating illness”
9.12.4 Usual attitude towards health:

Self medication commonly practiced, especially in malaria
Kastom illnesses / medical illness – but a readiness to adjust to new beliefs
Once a decision is made to seek formal health care – nearest health facility generally first choice
9.12.5 Factors affecting provider choice

Clinics – close, referred, quality of service
Hospitals – more trust in Drs, harder to visit relatives, quality – long lines, rudeness hygiene,
absenteeism
Private .Practitioners –regarded as high standard of care, but expensive, last resort when other
treatments have failed/wantok discount.
Referral system not well understood and often bypassed – bad experience in a
clinic/reimbursement issues/hospital closer
Transportation and treatment costs a significant barrier
Service quality – overall high trust in nurses – but many complaints which weaken community
confidence, e.g. competence, attitudes, facility, drugs, long waits and wantokism,lack of adequate
triage for emergency cases and privacy
9.12.6 Cultural barriers to specific disease –Malaria

So common its significance is undervalued – and assessment of health risk depends upon
access issues.
Tends to be treated at home first – a range of factors affect decision to seek health care –access,
side effects of chloroquine, microscopists ( part time)
Nets not used – too hot, smell bad and many feel “there re just too many mosquitos everywhere”
9.12.7 Cultural barriers to – i. Reproductive health

In a context of rapidly changing social frameworks in which women make decisions ( highly
contested )
But – introduction of medical birth practices has not eliminated old beliefs
Ongoing issues of lack of privacy, assisted deliveries all part of broader social issues –
violence/shame etc
Demand for a/n care varies – lack of support from husbands
Medically assisted deliveries – variations in utilisation depends upon a variety of reasons – but
the emphasis appears to be more in favour of home births expertise of TBA’s.
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ii. Family Planning;
Demand higher that present coverage
Disagreements with husbands/stronger role
Low levels of awareness of FP programs ---confidentially and attitude a barrier
Decline in available contraception to single women as it is under the FP model.
Some secrecy with FP/may contribute towards negative feelings about it.
Economic situation – bride price
Education programs effective on BR – but when discontinued birth rates rise again
iii. Other related findings:

Malnutrition- little awareness of malnutrition issues – in some cases food sold at market and
children given candy.
Health promotion/education – widespread interest in having more – but poor planning ( night )
and lack of visual or dramatic component affected attendance rates
People want improved health, but disagreements over how it should be done at village level –
need for external organisation to lead PHP
Demonstrated interest in organising “ healthy village” activities and improving sanitation
9.12.8 Problems with service delivery and human resource issues:

Lack of supervision
Same people get all the training – demand is high
Nurses feel disadvantaged
Wantokism ( favouritism)
Lack of health information given to clients
Uneven case loads at the hospitals and clinics
Patients can demand unavailable or inappropriate treatment
Nurses say that barriers to attending clinics may be overcome if there was better perception by
the community on illness severity or by improving the relationship with nurses
In Conclusion:
Socio – cultural knowledge and practices, service quality issues and clinic access all act as
barriers to health service utilisation
Local understanding of disease and health and reliance on Kastom medicine and TBAs also
impact on health seeking behaviour
“substantial room for improving the delivery of service”
“ an approach that encourages community
participation may be especially suitable in this country given the transportation barriers”
9.13 The Way Forward:

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During the coming national strategic workshop on the 8-12th May 2006, all stakeholders will
further review the issues and possible options for strategies raised.
Preliminary discussions have started to flag some crucial points for long strategic directions;-
Examples:
In the Key Result Area (KRA): People focused:-
Advocate more on the positive aspects of the local cultural imperatives to protect health of the
people: e.g. circumcism as evident as preventive to HIV infection.
Community education and interventions at the people level for illnesses such as skin diseases,
malaria control, oral health of children, destigmatization of PLWHA, disaster preparedness for
vulnerable communities to natural disaster, women’s right to choose the types and access to FP,
harm reduction against substance abuse, life skills at the community level, participation of local
people in disease controls.
In KRA: Public health strategies:
Whilst focusing on the people, the public health strategies must be to supportive;-
Increase the health education and promotion activities to the community and emphasis behavioral
change as the outcome for good health impact in reducing the skin diseases, diabetes, malaria,
HIV and other communicable diseases.
Review and incorporating a supportive health laws supporting the public health strategies by
providing and protecting healthy lifestyles and reducing hazardous environment and vulnerability
to child sex, sexual abuse etc.
In KRA Organizational change:
The evidences so far lead to an inevitable need to change how we do things for the betterment
the people as our value and to strengthen our public health strategies.
In KRA Accountability:
This KRA run across all the other KRAs. Since “health is every body’s business”, every one in the
communities are accountable for to ensure the vision and mission for happy, healthy and
productive Solomon Islands”.
This area includes ensuring that various kinds mechanisms for good governance and
accountability are developed, advocated widely, enforced, monitored and evaluated
Examples;
Clear position descriptions in the malaria control programs
More intersect oral and community approaches for all communicable diseases.
Performance appraisal for all programs
Transparency and financial accountability for all funded disease control programs.
Good leadership and governance
Improve monthly annual reporting
In KRA information management:
This is the conceptual underpinning across all issues. This will provide clear evidence and acts
radar for the strategies and activities planed and implemented.
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Chapter 10 Key Activities for 2006

10.1 Overview
The options for solutions and then action steps for the issue raised in the report will be dealt with
a more detail in some forthcoming activities in 2006.
Nearly all disease prevention and activities will continue and/ or even strengthened in 2006.
From August 2006 will be the transitional phase of the existing HISP, in preparation for a next
project design in light of the forthcoming SWAp (Sector Wide Appraoch) collaboration by key
external assistance to the national health response.
10.2 Some of the Key Activities for 2006
1. National Strategic Planning Workshop 8-112th May 2006 (MOH Executive and the Policy
and Planning Division/ HISP).
2. Drafting of the National Health Strategy for the next ten years. (including submission to
the Cabinet) (MOH Executive and the Policy and Planning Division/ HISP)
3. 59th World Health Assembly in Geneva 22-26 May 2006 (To be attended by Hon Minister
of Health and the Permanent Secretary).
4. First Quarter Review of 2005: Feed Back from all Provincial Health Directors, NRH, and
National Divisions (MOH Executive and the Policy and Planning Division/ HISP)
5. Development of Activities for the Operational Plans for 2007 (MOH Executive and the
Policy and Planning Division/ HISP and all Provinces and Divisions).
6. Inception of the Budgetary Process for the 2007 Budget (MOH Executive and the Policy
and Planning Division/ HISP and all Provinces and Divisions..
7. Start the implementation of the civil work: Renovation of the selected Area Health
Centers and Rural Health Centers (Policy and Planning Division/ HISP and Provincial
Health Directors).
8. Work closely SWAp for Project Design (MOH Executive and the Policy and Planning
Division/ HISP).
9. Expansion of the Measles (EPI) Campaign (Child Health, Reproductive Health Division).
10. Review / and Prioritization of Health Legislations for cabinet submission and
endorsement. – E.g. Draft Tobacco Control Legislation for cabinet endorsement (MOH
Executive and the Policy and Planning Division and Health Promotion Division) .
11. Second Planning Workshop for the Pandemic Influenza Preparedness (Avian Flue)
(MOH Executive and the Policy and Planning Division, and Environmental Health and the
Public Health Laboratory and the NRH Med Laboratory)
12. Monitoring and Evaluation Workshop on the National HIV Policy and Multi-Sectoral
Strategic Plan 2005-2010, and planning for the Mid-Term Review in 2007 (HIV
Prevention Unit, Disease Prevention and Control Unit, and Oxfam Australia along with all
partners).
13. Continuation with the Tobacco Control Project with Allen and David Clarke of NZ (Health
Promotion and NCD Unit of the Disease Prevention and Control Unit).
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Table x: Authors of the National Health Report 2005
Author Sections
1 Dr. George Malefoasi (Permanent Secretary) Main Author
2 Ms. Petra Veerger Health Institutional
Strengthening Project
3 Ms. Christina Evans (HISP/ NHRA) Primary Health Care Demand
and PHC Clinic Utilization and
other related reviews report.
4 Mr. Amos Lapo (Ag. Nat Head of Nursing) Nursing in Solomon Islands
5 Mr. Seda Savakana (Head-Radiography) National Medical Imaging
6 Mr. Andrew Darcy (National Pathology) National Pathology Services
7 Dr. Lorraine Oti (Director Dental Services) Dental Services
8 Mr. Charles Gauba (Head Rehabilitation Dept Rehabilitation Services
NRH)
9 Ms. Iakoba Baakai Health Burden, Communicable
Diseases, and Provincial
Health Services disease
trends.
10 Mr. Noel Itogo TB/ Leprosy
11 Mr. Robinson Fugui Environmental Health
11 Joanne Ahikau and Helen Koti Social Welfare
12 Mr. Alby Lovi Health Promotion Activities and
Achievements
13 Ms. Vaelyn Gagahe Distance Education: Program
Outputs
14 RAMSI-Machinery of Government Dr. David The Scan of the Public
Snowball and Mr. Joseph Wale Administration Functions
15 Dr Greg Jilini Western Provincial Health
Services
16 Dr. Patrick Toitona (and Ms. Tracey Isabel Province
HISP/PHA)
17 Dr Gunter Kitel Temotu Province
18 Ms. Rachel Tigita National Referral Hospital

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MINISTRY OF HEALTH

NATIONAL HEALTH REPORT 2005

AHC Area Health Clinics

1.4 Report process and structure

Chapter 2 Solomon Islands Demographic and Health Status

Table 1. Core population and health data (2005)

Crude birth rate 23.2 [1] Total fertility 3.79

2.2 Fertility and population growth:

According to the various available data on population growth

2.3 Life expectancy :

3 Figure for the Annual Health Report 2003

2.4 Age and sex structure

Sex ratio 107 males/100 females at birth

Median age in 1999, 18.7 years (18.6 males, 18.9 females)

Figure 1 - the proportion of population by age group

Issues/ constraints/ Evidence

Chapter 3 Health System and National Response:

3.2 Organizational change in the structure in 2005:

6 Ministry of Health (2005): USHI presentation on the Public Health Vision

Figure 3 - Organization Chart: Ministry of Health with position holders in 2005

Permanent Secretary Dr. Judson Leafasia

Undersecretary Health Improvement

NCD (Non-communicable Diseases) Health Promotion

National Capacity Development Provincial CD programs

HIV/ STI Control Prevention

HIV/STI Planning +Coordination ME)

Diarrhoea Disease Staffing Staffing

Nutrition Service delivery PHC-Clinics Service delivery PHC-Clinics

Epidemic-Disaster Alert & Response Community Partnership Community Partnership

Public Health Laboratory

NGO/ Civil Society partnership

3.3.1 Operational Planning:

Program Implementation by Divisions by end of Sep 2005

7 Ministry of Health/ HISP:

Feedback on Op plans essential and request one on one feedback

Core Marginal Total

Divisional SIG Developme Output &

Planning Flow Chart10 (Quantify what we plan to do):

3.4.1 Solomon Islands Government Leadership

3.4.2 MOH Vision and Mission Statement

3.5 3.5. Ministry of Health’s Cooperate Plan 2006-8:

Improvement of management and supervision of services;

3.6 3.6. Ministry of Health National Goals and Strategic Plans::

3.7 Meeting up with the Millennium

Goal 1: Eradicate hunger and poverty

Policy 1: Improvement of management and supervision of service.

3.8 Health Institutional Strengthening Project

Objective of the Health Institutional Strengthenthing Project

3.8.1 Key Outcomes

Increased capacity of MOH staff to use relevant computer applications.

3.8.3 Future directions

Chapter 4 Health Systems: Health service delivery and

Total outreach School health Village meetings Satellite clinics

Outreach Satellite School Village meeting

Referrals to AHC's Referrals to RHC's Referrals to province Referrals to central hospital

Presenting condition February % August %

Red eye Ear infection skin disease yaw s Total diarrhoea

ARI Fever Clinical malaria Other

17 Also raised by the Clinic Utilization Review: See below

4.2.1 National Referral Hospital

Introduction: CORPORATE SUPPORT SERVICES: Annual Report 2005

Due: 10th March 2006 To: MoH Permanent Secretary

Expenditure by existing cost centers is outlined below.

PROGRESSIVE ACTUAL EXPENDITURE vs BUDGET PROPORTION TOTAL BUDGET - 2005