Chapter 3 of Palau NSOAP

Disease burden: Non communicable diseases are the most prominent diseases on the island,
and policies with the WHO have worked to faciliate in improving this metric

Service Delivery: On average, 30 surgeries are performed at the main Belau National Hospital.
The surgical system has the capacity for laparotomies, pediatric surgeries, emergent/ urgent
(non-elective) cases. In addition Normal obstetric delivery, management of non-displaced
fractures. drainage of superficial abscess, suturing laceration, wound debridement, biopsy
(lymph node, mass, other), removal of foreign body (throat/eye/ear/nose) and male circumcision

Human Resources

The healthcare system has a number of specialists including general surgeons, obstetrician-
gynaecologists and anaesthesiologists

Infrastructure, Equipment and Supplies

One main hospital provides surgeries including c-sections and minor injuries and transport is
provided via cargo plane if overseas referral takes place.
▪ Blood bank - Blood bank works with WHO and radio calls if more blood is
needed
▪ Radiology – USS, CT
● One CT scanner and X ray machine
▪ Anaesthesia machines, O2
o Supplies and consumables
▪ Essential medications, sutures, gowns, sterile dressings
● Working with the WHO to find suitable manufacturers
● Delays due to COVID-19
● Medication shortages, outsourced from private clinics on island

Information Management

The Information, Communications, and Technology Center was created by The Ministry of
Health Information Technology Department in 20created , which houses a comprehensive
database for patient information. The department also manages all computing and electronic
transmission hardware and software, including servers, work stations, telephone, and internet
systems.

The Quality Assurance/Quality Improvement division monitors best practices and work
performance to ensure quality of care. As of 2014, there were 48 specific policies on quality and
safety, which included nursing infection control, code blue practices, nursing documentation,
narcotic medication control, and patient feedback, among others. The role of the division also
includes reviewing and responding to Accident, Incident, Hazard, and Near Miss reports, which
numbered 45 in 2014.

Recommendations
1. Routinely collect data on all aspects of quality utilizing a comprehensive surgical quality
tool.
2. Develop a policy on surgical safety that is integrated within the Quality
Assurance/Quality Improvement division.
3. Develop a system for measuring indicators of surgical access, productivity and
affordability, such as the Lancet Commission on Global Surgery indicators.
4. Create a plan for frequent reporting and review of surgical data to identify areas in need
of improvement.
Finance

Health care in Palau is financed through the HealthCare Fund, which consists of individual
Medical Savings Accounts (MSA) and a universal social health insurance fund known as
National Health Insurance (NHI). Private and government employees contribute a payroll tax of
2.5% to the MSA, with employers also contributing 2.5% to the NHI. Self-employed individuals
contribute 5%, and unemployed individuals must pay voluntary premiums of $40.95 per quarter
to enroll. Premiums for individuals over the age of 60 and those who are disabled are paid by
the national government (5). The NHI provides coverage for inpatient care at Belau National
Hospital (patients pay 20% of charges with a maximum of $200-400 based on household
income), off-island medical treatment (20% copayment with a ceiling of $1,000-4,000),
transportation for approved off-island referrals, and preventive services both in Palau and with
off-island providers [16]. With the current funding scheme, out of pocket expenditure for
healthcare has ranged from 10% to 25% (Figure 3.)

Services covered by the NHI include surgical supplies, hospital room and board, operating room
and anesthesia services, medications, and specialist physician services. While a range of
surgical procedures are available to patients, data are not available on non-medical and indirect
costs associated with surgery. Non-medical costs can arise from transportation and
accommodation needs, and indirect costs result from time away from work and the family.

Recommendations

1. Examine the sources of out of pocket expenditure for surgical patients, including both
direct medical and non-medical costs.
2. Explore possibilities for funding surgical care of patients without NHI or MSA.
3. Evaluate health expenditure contributions from private or NGO sources and consider
options for collaboration or public-private partnerships.

Disaster Preparedness & COVID-19

As of October 26, 2020:

At least 42,916,971* confirmed cases of COVID-19 globally, including 4,141*** in Guam,

88 in the Northern Mariana Is. (CNMI), 14,672 cases in Hawaii, 5,797 in French Polynesia, 27 in
New Caledonia, 33 in Fiji, and 583 in Papua New Guinea.

707,355** confirmed cases within the Western Pacific Region.

1,152,770* deaths reported globally – 15,167** deaths in the Western Pacific Region, 69***
deaths on Guam, 212 in Hawaii, 2 in CNMI, 20 in French Polynesia, 2 in Fiji, 7 in Papua New
Guinea.

28,892,041* people have recovered from COVID-19 globally

Palau Readiness and Response

There are NO SUSPECTED or CONFIRMED CASES of COVID-19 in Palau.

MOH Emergency Operations Center (EOC) activated on Jan. 22, 2020 to implement
preparedness and response measures to minimize the risk of importation and potential local
transmission of COVID-19 to Palau. ●

BNH ventilators: 30 total capacity, 5 portable vent, 2 pediatric vent, 18 adult vents ( 0 in use), 5
in calibration. COVID-19 Isolation & Quarantine: 28 in quarantine facility, 8 in self-quarantine, 0
in BNH isolation, 0 in alternative care and isolation site.

COVID-19 Testing (since Apr. 14): 2,559 tests conducted, 0 total positive, 2,559 total negative,
0 pending results. ● COVID-19 testing ongoing based on priority groups including persons
meeting COVID-19 case definition, symptomatic patients, first responders and front-line
workers, and quarantined inbound travelers.

Alternative Care Site (ACS) is currently being prepared to receive and care for positive cases.
Health screening continues at Palau International Airport for chartered and private aircrafts;
health screening at Malakal seaport continues for incoming vessels.