Solomon Islands: Improving Rural Health Services, Investing in Systems

New boats don’t arrive every day in Kia Village, Solomon Islands.

Gliding toward the shore, children surge forward for a closer look.

One boy shouts “sei,” – “wow” in the local Pijin language - “Guys, whose boat is this?”

“The boat is here for your health needs and those of your community,” says an official from Buala Hospital, the main health facility for Santa Isabel province. Till now, Buala has been a dangerous, four-to-five-hour boat ride away in a leaking old boat, making emergency trips in rough weather particularly concerning.

Providing quality medical care and services to the people of Solomon Islands’ is a challenge. Situated in the western Pacific near Australia and Papua New Guinea, the archipelago comprises nearly a thousand islands, 5300 kilometers of coastline, and densely forested mountain ranges. Tropical rain falls regularly, and the Happy Isles, as they are affectionately known, are no stranger to powerful storms and cyclones. 82 percent of the population live in remote rural areas with limited access to roads and vehicles.

Over the last four years, the country’s Ministry of Health and Medical Services, with support from the World Bank, has been building a stronger health system that is better prepared to meet these challenges, particularly at the provincial level.

“We really want to decentralize the health care system,” says Dr. Paul Bosawai, Solomon Islands’ Minister for Health and Medical Services. “We want the urban areas, like at the National Referral Hospital, to be focused on tertiary and specialized health care, and the provincial areas, like in our provincial towns, will focus more on secondary health care services. And in our communities, our rural communities, we want to see primary health care. If we address primary health care in an effective and sustainable way, we are addressing the health care system in Solomon Islands.”

Increasing health coverage on the ground

Facing uncertainty as the COVID-19 pandemic swept the world, the Solomon Islands Government drew on US$13 million in financing from the World Bank’s International Development Association (IDA) and Health Emergency Preparedness and Response Trust Fund. In the short term, this enabled the health ministry to fund vaccination deployment, emergency medical equipment and infectious disease training. In the longer term, it is supporting investment in strategic health system strengthening activities.

“The World Bank helped us manage our pandemic response and invest in infrastructure and training that is improving our ability to provide health services, especially to people living in rural and hard to reach places,” says Pauline McNeil, Permanent Secretary of the Ministry of Health and Medical Services.

20 boats and 13 4-wheel drive vehicles have been procured and distributed across the country, enabling doctors and nurses at local level health centers to connect more easily with the communities they serve, as well as providing essential health services like vaccinations.  

“The [vehicles] have really changed the system for transportation,” says Rev. Caleb Kotali, Hospital Secretary at Sasamunga area health center on the southern coast of Choiseul province. “All the old people, people with disabilities, and the elders during an emergency, instead of travelling through rough seas, we use the land cruiser.”

Gwenneth Pitanoe, a regular patient at Sasamunga who has had difficulty walking since cancer surgery in 2019, agrees. “Before the vehicle was donated, I used to travel to the clinic for my weekly appointments by boat. Sometimes when there was no fuel, I’d have no choice but to stay back at home.”

Improved infrastructure

Since their construction some 30 years ago, Solomon Islands’ National Medical Store had received little maintenance and increasingly struggled to house sufficient medical supplies for the country. The project has enabled not only a renovation but also an expansion to increase its storage capacity by 23 percent.

The health ministry has also embarked on a work program to upgrade key provincial health facilities. Two of the country’s oldest provincial hospitals - Tulagi in Central Islands province and Helena Goldie in Western province – have received much needed renovations, better equipping them not only for health care service delivery but also for the increasingly frequent extreme weather events brought on by climate change.

“The project has been a great opportunity to improve the quality and increase the capacity of our facility,” says Lorraine Sartorara, Tulagi Provincial Health Director which serves close to 30,000 people.

Building on important lessons learned around managing infectious diseases during COVID, new isolation units are being constructed at Helena Goldie Hospital, Good Samaritan Hospital in Guadalcanal province, and Nila Area Health Centre in Western province.

Incinerators supplied to Tulagi Hospital, Good Samaritan, Noro Area Health Centre in Western province, and Kilu’ufi in Malaita province will support more effective healthcare waste management. New waste management vehicles have also been supplied to seven hospitals.

Training

Workforce training has been another important aspect of the strengthening capacity in the health sector. Solomon Islands has one of the highest rates of gender-based violence in the world and its medical professionals are frequently among the first to engage with injured survivors. Through the project, over 800 health care workers have received training to help them recognize, medically manage, and refer gender-based violence survivors to appropriate services.

“As a registered nurse, gender-based violence is something we always deal with in our clinic,” says Betty Tagi of the Mataniko health clinic in the capital city of Honiara. “One thing I got from the training is [an understanding of the] referral pathways for gender-based violence victims. I’ll use the knowledge I gained during the workshop to help my colleagues.”

In addition to the gender-based violence workshops, the health ministry has also rolled out programs to upskill staff in the areas of health waste management, and infection prevention and control.

A deeper understanding of Solomon Islands’ health system

Complementing investments in infrastructure and training, a program of analysis and technical assistance supports the Solomon Islands Government in understanding key health system aspects—health financing, service delivery, and system preparedness. Backed by the Advance Universal Health Coverage Trust Fund (a World Bank and Australian Government partnership), this effort has yielded annual health budget analyses, a medical supply chain review, and a primary health care system report.  Future analytical support will focus on human resources for health, harnessing information and communications technology, addressing climate impacts on health, and ongoing efforts to strengthen public financial management, with greater emphasis on provincial health services.

Taking good care of communities

Ongoing health sector support has established strong partnerships that are well placed to continue driving critical reforms that will benefit all Solomon Islanders, including those in rural outer islands and hard to reach communities. Looking ahead, there is energy for a greater focus on human capital. While the current project has supported health infrastructure, which offers significant benefits, it is also critical to invest in the health workforce, the people responsible for managing, maintaining, and sustaining these assets.

 “I’ve always been an advocate that we must not see health as an expense, we must see health as an investment,” says Dr. Bosawai.

“When we strengthen our healthcare system, we will be able to provide a sustainable healthcare services to our people and also effective health care service delivery across Solomon Islands.”

The benefits from the health ministry’s recent investments are already being felt and it’s particularly heartwarming to see the way local communities are responding to the support. Back in Kia village, following a short handover ceremony for the new boat, Joseph Patalo, the nurse in charge, receives the keys and describes the boat as a blessing before telling the crowd, “We will take good care of it so that it also takes good care of us.”