Samoa Deploys Multidisciplinary Teams to Revitalize Primary Health Care in Rural Areas

While Samoa is facing significant challenges of rising NCDs, the current health service delivery system is not well poised to tackle the challenges. The system is largely publicly owned and heavily hospital centric. Patients often bypass primary health care (PHC) and overcrowd the main national referral hospital in the capital, Apia.

In an effort to revitalize Samoa’s primary health care and community engagement, the government of The World Bank supports the government’s deployment of multidisciplinary teams (MDTs) back to the rural health care facilities, with the Advance UHC Multi-Donor Trust Fund (MDTF) funding technical assistance for project implementation.

Samoa used to have a service delivery model with a strong focus on Primary Health Care. Doctors were deployed in the rural district hospitals working with village women’s committees (VWCs) to facilitate access to health services. Gradually, doctors were pulled back from rural facilities to national and referral hospitals, compromising the quality of the health service delivery system.

In a country of less than 200,000 people, Samoa has two main hospitals (one in Apia and another on Savaii Island) and 11 rural health facilities comprising 6 rural district hospitals and 5 community health centers—the latter open during working hours and only from two to five days a week. The rural health facilities are staffed mainly by nurses. Doctors are concentrated at the national hospital in Apia and typically spend only one day a week at rural district hospitals. This model moved health services from the community to the main hospitals and patients have to travel there to see the doctors.

The government aims to reverse this situation with the deployment of multidisciplinary teams. Each MDT includes a primary care physician, nurses, nutrition assistant, allied health workers, and members of the Village Women’s Committee. The MDTs have clearly defined functions to provide a coordinated continuum of care for the community. This is an approach to reorient the service delivery system to address rising NCDs through integrated service provision with the rural district hospitals at the center.

In late 2020, following the approval of the cabinet, two multi-disciplinary teams were successfully deployed at Foailalo District Hospital and Lalomanu District Hospital. Each hospital welcomed seven additional personnel, including a district medical officer, district nurse manager, midwife, senior health inspector, public health nurse, community nutrition officer, and data management administration officer. The multidisciplinary team plays a central role in the service delivery chain covering screening, early detection, chronic disease management, infectious disease control, immunization, and community outreach. It serves as both the care coordinator and the care provider for NCD patients and people at high risk of developing NCDs.

The team’s task is also to register and track the high-risk groups and provide proactive health promotion and disease prevention services to these high-risk citizens. The goal is to ensure good health for the community and reduce the risk of villagers becoming NCD patients.