WHO forecast in 2017 for a bold new plan for Solomons health services seemingly fallen short to-date.
In 2016 the Ministry of Health and Medical Services launched its strategic plan for medical services for the period 2016 to 2020.
The MHMS plan contained an essential package of health services that the government was then providing or was aspiring to provide to its citizens in an equitable manner.
The following year in March 2017, the World Health Orgnisation (WHO) issued a statement which forecast a bold new plan developed by the Ministry of Health and Medical Services, with support from WHO, setting out a roadmap towards universal health coverage and the Sustainable Development Goals.
The plan defined what services were to be offered at each of the 4 levels of the health system, from small rural health clinics offering basic primary care to area health clinics with simple surgical services, provincial hospitals, and the National Referral Hospital.
It was said that developing the plan had involved not only the Ministry of Health, but also the Public Services Ministry and the Ministry of Infrastructure Development.
At the time, Dr Sevil Huseynova, the WHO Representative to the Solomon Islands said the whole new reform agenda that the health ministry had embarked could be a game changer.
To evaluate what Dr Huseynova thought would be a game changer; I will quote the development report unveiled by the MOHMS very nearly three years ago.
Quote:
“Almost half of all health expenditure in the Solomon Islands comes from donors. But much of that funding has targeted specific diseases, rather than strengthening the country’s health system and improving overall services. In addition, well-meaning local politicians and churches have built hospitals with little or no coordination with the Ministry of Health, and then seek the ministry’s support to run them.
“The result: Fragmented services, and health gains that haven’t matched the levels of investment.
"With all the increased investments in the recent past, there have not been proportionately significant health gains," says Dr Tenneth Dalipanda, the Solomon Islands' Permanent Secretary for Ministry of Health and Medical Services. "For the last so many years measles immunization coverage has hovered around 75%, and we’ve never been able to get past the 85% mark despite increased investments. That’s what convinced us that something must be done differently."
“The plan, called the Role Delineation Policy, also maps out the human resources, infrastructure, and equipment that will be needed at every level.
"The health ministry is undergoing reforms which will enable us to implement the new policy," Dr Tenneth said. "The provinces need to take control of delivering health services while the central ministry will deal with policy, resourcing, and governance."
“Under the plan, 9 provincial hospitals and 34 area health centres will be upgraded, while 202 nurse aid posts will either be closed or upgraded to become rural health centres to ensure resources are used most efficiently to provide health services at strategic locations.
“The plan also includes staffing area health centres – previously run by nurses – with doctors, ensuring that the health services people need are available closer to where they live.
“To meet that demand, almost 100 medical graduates are being trained in Cuba, about half of whom have already returned to the Solomon Islands.
“The plan will begin implementation after it is finalized in June this year. But some changes are already happening. Infrastructure upgrades have begun, and lists of equipment and the human resources needed have been drawn up.
“Of course, all of that will cost money.
“A grant from the Republic of Korea to improve infrastructure in one province will help to determine how much investment will be needed to implement the full plan across the archipelago.
“The Solomon Islands faces a "triple burden" of disease: communicable diseases such as dengue, combined with increasing rates of non-communicable diseases and the effects of climate change, which cause frequent floods and droughts.
“If successful, the plan may become a blueprint for some of the Solomon Islands' Pacific neighbours, says Dr Greg Jilini, an Under-Secretary to the Ministry of Health who leads the taskforce that drew up the plan.
"There are other countries interested to see what we are doing, like Vanuatu who have very similar problems," he said. "They’re very interested to take the same path."
“WHO is helping other countries and regions learn from the Solomon Islands' example. A website launched last year on "integrated people-centred care" provides resources and real-life examples of people-centred health service reform.
“The website allows ministries of health, health-care providers, policy-makers and other interested parties to access the latest knowledge on integrated people-centred health services and to build a global network of people who work towards the same goal,
I fear that Dr Huseynova’s hopes have not been fully met to-date and perhaps the reasons are similar to the impediments to the MHMS strategic plans in past years, and again I quote the MHMS own findings.
“A number of reasons for the slow progress have been put forward during the strategic planning process by the MHMS staff and development partners. Most groups identified aspects of leadership and delays in financial and human resource administrative systems as the main problem. “
“Resources (especially pharmaceuticals and supplies) did not flow to the periphery of the system.”
“ Activities were fragmented, with poor coordination, particularly between the public health divisions.”
“No clear prioritisation meant the agenda was crowded and there was a lack of priority.”
“Resources were insufficient, or resources were available but not spent. “
“Strategic leadership was primarily focused on donor-led, rather than MHMS led activities.”
“ Social conditions were deteriorating.”
“Disasters and disease outbreaks interrupted service delivery.”
“A fraud case crippled core functions such as procurement, and dented confidence within the sector and with donors. “
“ Some staff showed lack of discipline, including not showing up for work and not carrying out their functions, but were not disciplined.”
“Decision-makers at provincial and national levels were unable to direct available resources to where needs were greatest.”
“ Operating budgets were tied up in specific programme funds, were not fully used, and could not be used to support core functions in the provinces.”
Last January a group of Solomon Islands health staff wrote in the ‘Bulletin’ published in Australia, quote:
(Credit:
“The creation of operational plans and budgets requires a considerable amount of work on forecasting activities, particularly in identifying the cost of implementation and the sources of funds. Annual planning starts with an assessment of what might be achieved in the forthcoming year. These plans are often not prioritised and are unrealistic, and budgets are sometimes overestimated. Staff who make funding submissions are trained as clinicians or public health staff, not versed in financial processes and untrained in the applications of financial instructions.
“The inclusion of external funds in annual plans and budgets depends on funding ceilings agreed with MHMS centrally. Criteria for funding releases and acquittals are not clearly understood at the provincial level. The perception that funding will be released at agreed levels and within timelines may be unrealistic given that funding processes are not well understood and that the human resource capacity to implement plans is often overestimated.
“Despite significant improvement to the availability of health information, there is little use of such information in preparing annual plans, resulting in the inclusion of activities that may produce limited health gains or divert staff from higher priority concerns. Proposed budgets may be based on an idealistic approach to achieving gains that are beyond the capacity of staff to achieve, or on the assumption that development partner funds are unlimited.”
“Variable timing of funding releases results in implementation of activities in periods inconsistent with the annual plan, while planned activities are deferred until funding becomes available. Once the annual plan is prepared and agreed, monitoring of implementation needs to be more frequent and active, and plans adjusted in response to changing circumstances and funding availability.”
The MOHMS is essential to the Solomon Islands and the dedicated doctors, nurses and ancillary medical personnel do magnificent work. If the health service envisaged gains are indeed still lacking, as the lack of medical clinics and restored hospitals rather suggest from regular media reports, it is very much hoped the Solomon Islands Government together with its development partners will give priority to ensuring a fully functional medical care system for the benefit of all its people.
Yours sincerely
Frank Short
