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29
September
2011

Ministry of Health

The Vanuatu MOH is guided by the Health Sector strategy (HSS) (2010 – 2016).  The Health Sector Strategy 2010-2016 (HSS) defines our vision for the development of the health sector in the country. It provides broad objectives and the strategies to be employed in meeting them.

The HSS is the principle reference for all actors working in the health sector. It is coordinated with the Comprehensive Reform Program (CRP), the Priority Action Agenda (PAA) and the policies developed for the specific public health programs. It is also in harmony with the principles and statements in the 15 policies established in the MOH Policies document approved by the Council of Ministers in 2002.

In 2010, the MOH was executively managed by a Minister of Health, 3 Political Advisers, the Director General and a Director (Director of Public Health) and 2 Acting directors (Acting Director of Northern Health Care Group and Acting Director of Southern Health Care group). The Ministry of Health Executive is chaired by the Director General, and comprises the First Political Adviser and three Directors, who are responsible over the leadership and decision-making; health policy administration and service delivery and development across the country.

God health for all and Primary Health Care remain fundamental aspects for the Ministry of Health.   Apart from the preventive and curative services, other support services such as planning, Health Information System, Financial management and Human Resources Management and Development are key support services for the Ministry.

This annual report outlines the summary of the Ministry’s major activities and developments for the financial year 2009 and the achievements and challenges.

MISSION, VISION AND VALUES

Mission

The mission of the MOH is to protect and promote the health of all people in Vanuatu.’

In seeking to achieve this mission, we will seek to uphold these values:
A consumer focus
Consumers are the first priority and concern in the provision of health care.
Equity
Irrespective of culture, ethnicity, location, disability, age, gender, religious and political affiliation, all clients must be treated as equal, and according to their health needs.
Quality
All our health care activities will pursue high quality outcomes using safe and affordable interventions and the application of science and technology to maximize benefits to health while minimizing risks.
Integrity
We commit to the highest ethical standards in the provision of care and will strive constantly for improvement.
Efficiency
We will be cost-conscious, and aim to avoid wasting resources by achieving value for money for all funds allocated to the sector.

Our Vision

Our vision is to have an integrated and decentralized health system that promotes an effective, efficient and equitable health services for the good health and general well being of all people in Vanuatu.

POLICIES, INDICATORS AND STRATEGIC PLANS

Policies

Since independence, the Government took over the responsibilities of running health care services across Vanuatu of which were usually run by mission Hospitals and clinics; and was normally free. The Government immediately introduced User-fees to both the Inpatient and Outpatient services of all health facilities (Hospitals, Health Centers and Dispensaries) to help run its services. By 1990’s most of the former Mission Hospitals were scaled down to a Health Centre level. By 1993, the re-introduction of “Free Health Care” came about but ironically, outpatient has never been made free. Rather, the outpatient charge is renamed as contribution fee.

The Decentralization Policy and Act of the Government of Vanuatu was in force in 1994 creating six provinces in the Country. In response to that the Ministry of health has committed itself and has devolved to provide Hospital services to five of these Provinces and administration in two health care boundaries “Northern Region and the Southern Region”. The ministry is proud to have devolved further its Health Centre and Dispensary services management to the responsibility of the local Communities around the country under the “Health committee Act”. 

In 2010 the MOH delivers its services through program budgeting, which usually done on an annual basis. The Ministry also observes the principle of Good governance in all its dealings. The MOH is also guided by the following broad internal policies which are umbrella polices under the HSS namely Equity, Community Based Public Health Management, Minimum Standards, Human Resource Development, Legislative Issues, Planning and Development, Private Health Practices, International Commitment, Financial Resource Allocation, and Environmental Health; and other government and specific public health program policies and guidelines not mentioned here.   Likewise the Ministry also abide to regional and international obligations.

As of 2009, the Ministry of health delivers its services through two regional referral hospitals (VCH & NPH), 3 provincial hospitals, 30 health centers, 97 dispensaries and 231 Aid posts; making health facility in Vanuatu per capita is one of the most highest and accessible amongst the least developed countries in the world.

Policy objective
The HSS provides for four broad objectives for the sector which are:-
•    Improve the health status of the population
•    Ensure equitable access to health services at all levels of services
•    Improve the quality of services delivered at all levels
•    Promote good management and the effective and efficient use of resources.

The HSS provides the overall priority health direction for Vanuatu for a six year period and has suggested major indicators as target goals for the ministry of health that aligns with the PAA, PLAS and the MDGs.

The 3 overall strategy directions provided in the HSS are:

Organizational re-structuring and strengthening

1. Strategy for services

Improvement in health status of all the people of Vanuatu will be achieved through a strengthened evidence-based public health and promotional approach aimed at reducing risk factors for conditions associated with use of substances, lifestyles, poor environments and other determinants of health.

Diagnostic and curative health care will be provided through effective, efficient, high-quality and evidence-based clinical services at all levels of the health care system, but with an emphasis on strengthening primary care services.

We aim to develop and maintain an integrated spectrum of services in which preventive, curative and rehabilitative care are offered through a hierarchy of health facilities and support services connected by referral and supervisory links

Our health services will promote continuous improvement in quality and standards by implementing best practices that are consumer focused while also ensuring that health legislation is enforced effectively.
Services will be supported by ensuring that all health facilities have water supply, sanitation, and communications, and are properly equipped and supplied for provision of the health services they offer. Information technology will be used to generate and act upon health information effectively in order to improve performance.

Plans will be put in place to reduce the health consequences of emergencies, man-made and natural disasters, and to minimize their social, health and economic impacts.


2. Strategy for organisational development and management

The MOH will investigate the potential for organisational restructuring to improve performance in its key functions. This has been ongoing and the MOH hopes to finalize the new MOH organizational structure in the first quarter of 2011.  Planning and management of health services will be delegated or decentralized to the provincial level, which is responsible for managing and providing healthcare to the inhabitants in their respective areas. Health systems including financial management and health financing will be strengthened and best practices adopted to ensure transparency and accountability at all levels.
The MOH will explore alternative sustainable methods of funding (health financing) to improve and support health care delivery incorporating donor’s contributions.
The Health Information System will be strengthened to facilitate the systematic collection and analysis of data to provide accurate information to support policy, planning and decision making at all levels. 
The MOH will support development of a National Health Advisory Committee as an avenue for the public to raise concerns regarding health services, and direct these to the MOH with the expectation that concerns will be acted upon and improvements put in place.


3. Human Resources development and management

Sustained efforts will be made to produce adequate numbers of trained personnel and to create modern human resource systems and career pathways in which the workforce can develop through adequate incentives and rewards.
The MOH will work towards implementing an effective performance management system ensuring that individual staff roles and responsibilities contribute effectively to the overall performance of the organization in achieving its goals. A modern human resource function will be developed to support managers and team leaders in working with staff to match their job descriptions to the key objectives of the organization.
Reforms will include revision of the Health Practitioners Act (and the Nursing Act) to establish an effective Health Practitioners Board, Vanuatu Centre for Nursing Education Board, Vanuatu Health Training Institute Board (VHTI) and developing an appropriate career path and
commensurate salary structure for all health staff aimed at retaining skilled staff, and at attracting home the medical students currently training overseas.
Nurse training will be strengthened through the further training of nurse educators, and further in-service training for practicing nurses will be provided. The MOH is reviving nurse aide training and for the further development of village health workers and village sanitarians.

Better coordination with our partners

1.A sector-wide approach

Donors and partner organizations are very important in Vanuatu. More than half of the health programs in the Ministry of Health are donor funded, particularly; the public health programs. The number of donors is likely to increase and the volume of support provided by individual donors is already increasing. It is essential, therefore, that our external financial and technical assistance is well coordinated and avoids duplications and gaps in relation to our strategic priorities . Specifically we require that, in line with accepted good international practice, our donors and partners ensure that their support is harmonized and aligned to our national strategy and plans. The Ministry of health and its partners has developed a Joint Partners Agreement (JPA) which will see the intent of the Arrangement is to set out the Partners’ joint understandings and commitments that support the Mission, Vision and Values of the HSS through the implementation of the Ministry of Health Corporate and Business Plans.

2.Strengthening of international, regional and sub-regional partnerships

Vanuatu is engaged in many international, regional and sub-regional strategies, programs and projects with other Pacific Island countries. These engagements are complementary to the national partnership and, most of the time, are developed with the same technical and financial external partners. These partnerships play an important role and it is important to ensure they are effective and add value.

Development of our strategic and operational planning processes

This covers main areas:-

  • Corporate plans
  • Business Plans and;
  • Monitoring and Evaluation

All strategies above and especially strategy one is focused on service delivery which directly address the Millennium Development Goals of particular relevance to the Ministry of Health to: Reduce Child Mortality; Improve Maternal Health and Combat HIV/AIDS, Malaria and Other Diseases in a primary health care approach. Further, they also aligned to other cross-cutting MDGs of which MOH plays an important role to achieve such as MDG seven (7) and most importantly improved the health status of the people of Vanuatu.

Priority Policy Highlights

Launching of the Health Sector Strategy (HSS)(2010 – 2016)

Since the development of this HSS in 2007, the MOH has finally completed this in 2010 where the Minister of Health (Hon. Moses Kahu) launched in the presence of the MOH partners and other government representatives.  This HSS is not a detailed prescription for activities, but rather the context that will guide the MOH efforts throughout the next six years. It lays out the overall objectives and specifies the directions the MOH will take to address major constraints and to meet those objectives. It is the context within which detailed plans will be developed and implemented, and is the guide for all participants working to improve the nation’s health services: government, national and international non-governmental organizations, international technical agencies and our other development partners.
3.3.2 Finalization of Sector- Wide Approach (SWAp)

The finalization of the Sector Wide Approach (SWAp) by the Ministry of Health and our partners.  The Joint Partners Agreement (JPA) which binds the MOH and its partners in working together in terms of planning and budgeting.  This arrangement will see donor funding used more in an effective and need based on MOH priorities.  There will be better management of funds as requirement of the JPA.
3.3.3 Malaria elimination program in Tafea Province

The MOH has set a target to eliminate malaria in the province of Tafea by 2014.  This financial year 2010 has seen immense work been carry-out in Tafea Province which includes:- -

  • 95% of household has been sprayed through Indoor Residual Spraying  in Tafea
  • Increased population coverage (90%  plus) of Long Lasting Nets (LLN)
  • 95% of health facilities equipped with Solar and Tele-radio communication systems
  • 60 +  health staffs trained in the use of  Rapid diagnostic Test
  • 60+  health staff trained for new treatment of malaria (ACT)
  • 90% mapping activity of health facilities and households on Tanna and outer islands
  • Increase usage of nets.
  • Increase of human resource capacity in technical areas in the province.
  • Established strong engagement/involvement of community leaders through community mobilization

Immunization

In 2010 At least 90% of boys and girls aged one year and under are immunized with potent childhood vaccines as per national schedules and at least 80% in all Provinces with a special focus on low-performing Provinces. Since measles elimination by 2012 is a goal for Vanuatu as part of a WHO regional initiative. Measles vaccines coverage was estimated at about 37.2 % for children ages 1-4 years in Vanuatu for 2009 has now escalated to 86% in 2010. The 2009 nationwide catch-up campaign coverage was 97%.

Pacific Food Summit
Pacific Regional Food summit highlights one of the biggest MOH achievements of 2010.  Environmental Health Unit of the Public Health directorate, being the focal point for food safety was able to effectively spearhead the logistical arrangements for such a big regional event.  It is indicating the Vanuatu MOH intention of championing food security issues in country and regionally.


HEALTH STATUS
Vanuatu has population of 234,023 people (2009 National Census). The population is young with around 45% at the age of 15 years old or younger. The growth rate is 2.3% a year and the population is expected to double by 2030. Life expectancy at birth is 67.4 for males and 70.4 females (2005 est.) and increasing. The infant mortality rate is relatively low (27 per 1000 live births -). This population profile is likely to lead in the near future to a double burden of diseases, with high demand of health service for infectious diseases and ailments characteristic of developing country, as well as life style related diseases of the developed world.

The MOH services must cater for the diseases of childhood as well as for diseases of elderly. The past has seen infectious diseases to be prominent in the country. Now, due to the rapid change in lifestyles, the non-communicable diseases are acquiring prominence. The mortality pattern in 2010 is no different to previous years which is showing increases in non-communicable diseases and is currently the leading causes of death.  It is anticipated that this change in mortality trend will continue to accentuate.

4.1 Epidemiological Profile

Malaria, Dengue and Lymphatic Filariasis
Communicable and non-communicable diseases remain the priority diseases of Vanuatu. Malaria and Tuberculosis (TB)are still major public health concern along with Sexually Transmitted Infections, Acute Respiratory Tract Infections, Diarrhea and Viral Hepatitis. Dengue Fever and Measles are other major concerns among communicable diseases.
To combat Malaria the MOH introduced ITN with GFATM funding. The Annual Parasite Incidence (API) decreased from a baseline of 73.9 positive cases per 1,000 inhabitants to 33.3 per 1,000 in 2010. This remarkable decline opened the prospect of further reduction and eventual elimination of Malaria from Vanuatu beginning in Tafea Province by 2014. The use of bed nets seems to be widespread, with 85% of children sleeping under net and 95% of households having at least one long lasting treated nets. Nevertheless, concentrated efforts are still needed to achieve the elimination target by 2030. The Ministry of Health and its stakeholders have pledge to eradicate malaria in Tafea Province by 2014 and Vanuatu by 2030.

Dengue fever and dengue hemorrhagic fever and Lymphatic Filariasis are also important communicable diseases in Vanuatu. The Vector Borne Disease Control Unit has implemented an extensive program over the past 20 years. To date only 5% of the population has Lymphatic filariasis.  The prevalence has been maintained at 0% in high risk areas in 2010. Mass Drug Administration against filariasis has been introduced and followed up.


Diarrhea and Helminthes
To combat poor sanitation diseases like diarrhea and helminthes, the Vanuatu government with funding assistance from UNICEF has implemented the Rural Sanitation Project (RSP). This project has seen 64% of household in Vanuatu with proper ventilated pit latrines (VIP). The Project ceased in 1999, however, there is still need for proper sanitation facilities in the country as diarrheal diseases and helminthes incidence is still a concern in the country especially amongst children. The de-worming program, a program currently looking at schools also supports in building Ventilated Pit Latrine. Helminthes treatment coverage using Albendazole against worm infections throughout six provinces targeting school children has dropped from 50,197 in 2008 to 23,651 in 2009.
In 2010 the MOH has strengthened the H2s test that is simple to use in the rural areas to identify water contamination. This will greatly assist in identifying contaminated sites for intervention purposes. Unlike toilet facilities, 85% of the rural population has access to improve water supply and only 15% have treated water supply.  Polluted water supply is a major cause of diarrhea in Vanuatu among rural communities and urban slams.

Food safety is another area where the MOH is emphasizing as it is a global concern. The unhygienic preparation of food, improper labeling, expired foods, genetically modified food, pesticides and many more are a major concern to Public health. The incidence of diarrhea in Vanuatu is decreasing due to programs of proper water supply, safe food handling practices and proper sanitation practices.  

Tuberculosis (TB)
Tuberculosis is a national concern in both urban and rural settings. From 2000 to 2007 the average yearly prevalence rate was 6 cases per 10,000 inhabitants, what corresponds to 120 TB cases a year in Vanuatu. Although small, this number has proved difficult to reduce despite the efforts of the MOH in introducing (Direct Observed Treatment) DOTS covering 100% of the identified cases. Despite many efforts to control TB it is fact that there is new incidence of TB every year.


Sexual Transmission Infection (STI)
Sexually transmitted infections (STI) were once identified as highly prevalent. In 2000 a survey of women visiting the antenatal clinic at the Vila Central Hospital showed incidence rates of 27.5% for Trichomonal vaginalis and 21.5% for Chlamydia trachomatis. However, the results of a cervical cancer screening project carried out in 2007 in 500 women in Efate found Chlamydia in only 2% of the sample. On the other hand the survey revealed that 9% of the sample had cervical pre-cancer or cancer lesions. A number of STI were also identified as Syphilis in 4% of the sample. STI is still a problem in Vanuatu.
Vanuatu officially reported 5 HIV-positive cases with its first case in 2002. Four other confirmed HIV cases have been reported since then including two AIDS related deaths, one in 2006 and one in 2007. There was considerable public interest in the first case/death of 2006, giving impetus to health services improvements in the areas of counselling, blood safety and an increase in the number of people requesting HIV tests. Such interest in the public seemed to be less in October 2007 after the two new and last cases including one death but the issue remains the same today with the problem to develop and sustain an efficient counselling and testing system with a very low prevalence situation. Globally, the situation in Vanuatu is very small; however, it is still very important to emphasize the dangers of HIV/AIDS.


Infant Mortality
Infant Mortality Rate (IMR) can be easily reduced if Acute Respiratory Infections (ARI), diarrhoeal diseases and Neo natal care are consistently tackled. These are major health concerns contributing significantly to the morbidity and mortality burden. It is still been seen as children under two years of age were accounted for about 50% of all hospital admissions for ARI. The Multiple Indicator Cluster Survey (MICS) in 2007 found that in the previous two weeks 13.9% of children younger than 5 years of age had diarrhoea and 3% had ARI. The MICS found that only 40% of the surveyed children aged between 12 and 23 months were fully immunized. The introduction of the Integrated Management of Childhood Illness (IMCI) strategy in Vanuatu tries to address these problems. Current infant mortality rate as report by the 2007MICs survey is 25/1000.
4.1.6 Ante Natal Care

Ante Natal Care (ANC) and assistance during delivery have reasonable coverage, the MICS has also found; with 60% or more deliveries assisted by skilled birth attendants across provinces (except Torba – around 40%). 98% of mothers have received some sort of ANC, although this can be improved, considering the range of care supposed to be provided in ANC clinic. Skilled birth attendance is now 91%.

Non- Communicable diseases
Non-communicable diseases (NCD), an emerging issue of concern, especially diabetes and hypertension, are increasing. Outpatient cases of diabetes grew from 112 in 1995, to 163 in 1996, to 247 in 1997. Lifestyle changes and a growing urban population appear to be the main culprits. The cervical cancer screening sample carried-out in 2005 found that 36% of the women were obese. Hypertension and its complications, heart diseases, cancers, diabetes and injuries, are becoming serious burden to the health services. Due to proper health information system the MOH is yet to verify the exact magnitude NCD.


Deliveries
Vanuatu’s referral hospital (VCH) has report an increase in births from 2007 -2009 (FIG 1).  Deliveries for VCH in 2010 was 2,828 compared to 2,492 in 2009 a significant increase. With the VCH situation we can expect similar trend in other health facilities in Vanuatu and especially the Northern Provincial Hospital (NPH) in Luganville, Santo.  The two referral hospitals (VCH & NPH) performed more deliveries than the other provincial hospitals. The reason had been better skilled birth attendants and the increasing child-bearing age mothers in the two urban areas. Figure 1 shows the increase over the 3 years period.

Source: MOH, 2010

Morbidity and Mortality
The Ministry of health keeps records of morbidity and mortality annually; however, an update record for 2010 cannot be produced due to the absence of a Health Information System (HIS) Officer. The record outlined in table 2 and 3 for the 2009 financial year is only for cases that have gone through the health facilities. The date highlights that maternal problems are common out-patent concerns while NCDs are major cause of death.

Most Diagnosed Diseases
Keeping comprehensive and accurate statistics of notifiable diseases is of paramount importance. Such statistics help the Ministry of Health to assess the health situation and develop intervention programs.
Currently there is a serious problem with under reporting of notifiable diseases. The reports received by the National Health Information System (HIS) only accounts for 60% of notifiable diseases. The other 40% is not reported which warrants an urgent need to improve the HIS by injecting more resources in to the unit. However, with limited human resources available data can still be made available. The 20 most common diseases diagnosed in 2009 as reported by hospitals are listed in table 3 below.

Table 1: Top diagnosed health problems reported by hospitals for 2009 for all ages.


N0

Diagnosed diseases

N0

Diagnosed Disease

1

Single spontaneous delivery

11

False labor

2

Perineal laceration during delivery

12

Bacterial sepsis of new born

3

Pneumonia

13

Acute bronchitis

4

Asthma

14

Spontaneous arbortion

5

Diarrhoeal diseases

15

Primary hypertension

6

Abscess

16

Diabetes mellitus

7

Lower respiratory infection

17

Single delivery by caesarean section

8

Upper respiratory infection

18

Other respiratory infections

9

Abnormal & pelvic pain

19

Food poisoning

10

Chronic obstructive pulmonary diseaseas

20

Plasmodium falciparum malaria

Source: MOH, 2010
The most common cause of deaths in 2009 reported by health facilities is outlined in table 6 below.

Table 2: 10 most common causes of death for year 2009

N0

Cause of mortality (death)

N0

Cause of mortality (death)

1

Stroke

6

Malignant neoplasm

2

Renal failure

7

Heart failure

3

Bacterial sepsis of new born

8

Rheumatic diseases

4

Septicemia

9

Hemorrhage

5

Cardiac arrest

10

Chronic obstructive pulmonary disease

Table 3: major health indicators


Indicator

Proportion

Year

Vanuatu Population

243,304

2009 Census

Infant Mortality Rate (IMR)

27/1000

2007

Maternal Mortality Rate (MMR)

68/100,000

2006

Crude Birth Rate (CBR)

28/1000

2007

Crude Death Rate (CDR)

6/1000

2007

Malaria Annual Parasite Incidence(API)

33/1000

2010

% of pregnant women cared for by skilled birth attendants (SBA)

91%

2007

Measles (routine)

86%

2010

Access to improved water sources

85%

2007

Access to improved sanitation facilities

64%

2007

Source: MOH 2010

HUMAN RESOURCES AND CAPACITY BUILDING

This year 2010 there was no new in-take for Cuba. Cuba has an agreement between the Vanuatu government to have students to be sent there to study medicine. Vanuatu send a total of 10 students to Cuba to take up medical studies in 2009 compared to 17 students in 2008. By 2015/2016 Vanuatu should have around 24 new graduate doctors to return to Vanuatu and work to ease the burden of shortage of medical doctors in the country. Further, to the issue of shortage of health personnel the MOH increase its human resources by providing a bridging course for 17 nurses and 62 Aid nurses which all graduated in 2010. Aid nurses were trained both in Port Vila and Lugnaville.

Further to these the Vanuatu Centre for Nursing Education (VCNE) also graduated 21 registered nurses and the Vanuatu Health Training Institute (VHTI) graduated 16 Advance Nurse Practitioners. A further 5 nurses graduated from the Solomon Islands and 3 new graduate doctors from the Fiji School of Medicine. All these new human resources have joined the health workforce plus many more in the corporate services and support services in 2010. The Ministry of Health has now over 800 staff which are currently paid by the Vanuatu government.

These include all health professional by categories. For medical doctors Vanuatu has 29 local doctors currently working and some foreign doctors including 3 from Cuba who joined the MOH in 2010. They are more than 400 nurses. Apart from doctors and nurses the ministry of health also employed other medical professionals such as dentist, pharmacist, physiotherapist, laboratory technicians, radiologist, environmental health specialist and other categories of medical professionals.

Further, the Ministry of health also employs support staff who works on areas of planning, finance, human resources, clerical, cleaners, grounds man and other staff. In fact, the exact figure is over 900 staff working for the Ministry of Health if those on projects and volunteers are included.

Table 4: Current Medical and Nursing Workforce (excluding Allied Health, Public Health, Corporate Services, Support Services & foreigners).

Category

Number currently working

Doctors

29

Nurse Practitioners(NP)

37

Mid-Wives

52

Registered Nurses(RN)

423

Nurse Aides

96

Village Health Workers(VHW)

210

Total

847

Source: MOH, 2010

The Ministry of Health Organizational Structure

The organization of the Ministry of Health has three directorates and corporate services under the office of the Director –General. The Director-general is responsible to the Executive arm of the Ministry and corporate services which includes the planning, Projects & donor co-ordination, the assets and infrastructure, Finance and accounts, Human resources management and development, the Principal pharmacy, Central Medical Store, internal auditor and the Vanuatu Centre for Nursing Education (VCNE).

The directorate of Northern Health Care is responsible for hospital and community Health services in Malampa province, Sanma province, Torba province and Penama province. The Directorate of Southern Health Care is responsible for hospital and community health services in Sherfa and Tafea Province.

Distribution of Health Facilities

The Ministry of Health comprises of the Executive, planning and corporate services, the directorate of Public Health, the directorate of Northern Health Care Group (NHCG) and the directorate of Southern Health Care Group (SHCG) services. The directorate of NHCG and SHCG are responsible for the 5 hospitals including VCH and the peripheral health facilities including health centers, dispensaries and Aid Post. They also administer the public health programs in the provincial level.   The distribution of health facilities is outlined below (table 5).

Table 5: Distribution of Health Facilities and Administration

Type of Institution

Torba Province

Sanma Province

Penama Province

Malampa Province

Sherfa Province

Tafea Province

Total

Executive and National Administration

 

 

 

 

 

1

 

 

1

Provincial Health Administration

 

1

 

1

 

1

 

1

 

1

 

1

 

6

Referral hospitals

 

1

 

 

1

 

2

Provincial hospitals

1*

 

1

1

 

1

4

Health Centers

2

7

6

9

4

2

30

Dispensaries

6

21

22

18

17

13

97

Aid Posts

19

49

38

44

35

46

231

Public Health Program Offices

 

1

 

1

 

1

 

1

 

2

 

1

 

7

Information Technology

The information technology Unit has make a huge leap in 2010 by connecting the Provincial Health offices with internet and email making communication easier now than previous years. 30 computers and 10 laptops have been installed in various MOH offices in 2010. The following places have been connected:-

  1. Lenakel hospital
  2. Lolowai hospital
  3. Norsup hospital
  4. Lamap Health Centre
  5. Torba provincial Health Office

Central Medical Store (CMS)

Central Medical Stores (CMS) procures and distributes pharmaceuticals and medical supplies to five Provincial Hospitals in the country. CMS operates in a decentralized PULL supply and distribution system where CMS supplies Provincial Pharmacies and they supply their respective Rural Health Facilities except for Ambrym and Paama in Malampa Province. Due to transport difficulties from Malekula, it was agreed that CMS supplies the health facilities on both Islands.
The Provincial Hospitals including the rural health facilities mentioned above order from CMS on a two monthly basis. This means that CMS is expected to supply all these health facilities six times in a year.

p>Table 6: Distribution of medical supplies in 2010

 

Provincial Health Facility

Number of Orders/year

Total number of orders received and sent from CMS

Normal

Urgent

Northern Provincial Hospital

6

134

140

Lenakel Hospital

6

56

62

Norsup Hospital

6

20

26

Lolowai Hospital

6

18

24

Vila Central Hospital

6

161

167

Ambryn and Paama

84

20

104

Overall Total

114

389

523

Source: MOH, 2010

Table 7: Overseas Purchases by CMS in 2010

Departments

Number  of Normal Orders placed

Total orders placed

CMS Drugs and Consumables

34

34

Laboratory

20

20

X-ray

1

1

Dental

3

3

Orthopedics

1

1

Overall Total

 

59

Source: MOH, 2010

Public Health Directorate

The Public Health directorate is responsible for delivery of all public health intervention activities. It’s primarily concern is more on prevention of diseases than treatment. Further it focuses more on population as whole rather than individual. Based in Port Vila, but have offices in the 6 Provincial Health Offices that delivers public health programs directly to the community level.  The foundation of people’s health is the sole role of this directorate. In 2010, the following were established section of the directorate:-

  1. Malaria and Other Vector-Borne Unit
  2. Environmental Health Unit
  3. Health Promotion Unit
  4. Tuberculosis and Leprosy
  5. Expanded Program on Immunization (EPI)
  6. Maternal and Child Health (MCH)
  7. Integrated Management on Childhood Illnesses (IMCI)
  8. Reproductive Health
  9. Sexually Transmitted Infections (STI) and HIV/AIDS
  10. Mental Health/Nutrition & Non-Communicable Diseases

Malaria and other Vector-borne diseases Unit.

Malaria

  1. Disbursement of 102,000 nets to six provinces
  2. Increased population coverage of Long Lasting Nets
  3. Increased usage of nets
  4. Introduction of ACT and RDT roll out to six provinces in all health facilities representing 100%  coverage
  5. Improved LLN systematic distribution system through development of Standard Operational Procedures and  stock management tools
  6. Generation geo reference information to assist with distribution of nets
  7. Complete 2 rounds of LLN distribution in six provinces
  8. Complete 2 rounds of Indoor Residual Spraying in Tafea province

 

The Malaria program has covered 95% of households with at least one ITN and 85% of children under 5 years sleeping under ITN. Further, 85% of pregnant women sleep under an ITN. The Annual Parasite Incidence (API), number of slides and RDT confirmed positive with malaria per 1000 population.  At the end of 2010 the API was 33.3%.  Note that the API is expected to increase afterwards indicating improved coverage of laboratory diagnosis with the use of Rapid Diagnostic Test (RDT) which is expected to cover all health facility in Vanuatu. Eventually the program expects a dramatic decrease of malaria to reduce by 70% after vigorous and higher coverage of control intervention such as ITN and IRS by the end of 2014 and improved treatment access.

Dengue Fever

  1. Development of dengue strategic plan 2009 – 2011
  2. Dengue surveillance team conducted clinical and vector surveys on weekly basis
  3. Training activities for health workers on clinical management and Indoor Residual Spraying
  4. Dengue cases were reported in 2010

Lymphatic Filariasis

  1. Maintain 0% prevalence rate of microfilaria of LF in highly endemic areas
  2. Integrate treatment activity into de-worming program in schools
  3. Successfully implement sentinel site surveys in 3 endemic sites in the country

De-worming program

  1. Establish strong working relationship with the Department of Education at the Teachers level
  2. Other sanitation issues such improvement of water supply and  standard toilets have been initiated
  3. Strengthening  supply chain system of medicine and reporting system  on six monthly basis since treatment is administered twice a year
  4. Secure funding externally with WHO for successive implementation of treatment and improvement of environment
  5. Ownership of program with Department of Education

Treatment coverage using Albendazole against worm infections through out the six provinces targeting school children has dropped from 50,197 in 2008 to 23,651 in 2009

Environmental Health, Health Standards and Inspection Unit

The Environmental Health Unit is responsible for food safety, water and sanitation, waste management and pollution control.

  1. Food Act Enforcement / Prosecution Training
  2. Capacity Building – Training on Food Safety Administration in Japan
  3. Development of draft Environmental Health Strategic Plan
  4. Development of draft Environmental Health Emergency Response Plan
  5. Conducting H2S water testing across the country to ensure safe water for consumption.
  6. Attending to Climate Change and Health activities. This resulted in the development of Climate Change and Health Communication Strategy.
  7. Pacific Food Summit – remains our biggest achievement of 2010.  Environmental Health Unit, being the focal point for food safety was able to effectively spearheading the logistical arrangements for such big event.  It is indicating our championing of food security issues in country and regionally.
  8. Routine food inspections and Complaints investigation.
  9. Reached agreement with Live and Learn with a memorandum of understanding agreement to work on issues of water and Sanitation (WASH).

Health Promotion

This unit consists of Oral Health and hygiene, Health promotion and communication, Village health worker, Health promoting school, Tobacco Free Initiative, Health Graphic and illustration.

  1. Coordinate and organize World No tobacco Day celebration, 31st May,2010
  2. Launching of enforcement of Tobacco Control legislation
  3. Accessing tobacco health labeling in three languages
  4. Input of tobacco control strategy into national NCD frame work.
  5. National enforcement training on tobacco control
  6. Production of mass media communication strategy for tobacco control
  7. Monitor Country  obligation to FCTC
  8. PHC Revitalization
  9. Site visits to Torba, Sanma and Tafea province to follow-up on Village Health Workers.
  10. Nurses training of VHW manual.
  11. Oral Hygiene Talks, Dental examinations and T.B.I. demonstration in 30 primary schools around Vila and Efate
  12. Oral Health workshops with the Heads of the Primary Schools and interested Health Workers in Santo.

Tuberculosis (TB) and Leprosy

The TB and leprosy unit is responsible for controlling tuberculosis and leprosy in Vanuatu.

  1. Screening of TB cases
  2. Screening of prisoners (Luganville, Santo)
  3. Supervisory visits

Expanded Program on immunization (EPI)

This program is responsible for the immunization of children in Vanuatu especially those less than 5 years of age. Immunization coverage is a major indicator for health as it contributes to MDG 4 (Reduce child mortality).The program has achieved the following:-

  1. Measles vaccination coverage rate (routine) has reached 86% compared to 61% in 2009.
  2. DPT3 coverage rate increased from 58.3%  in 2009 to 85% in 2010
  3. HB3 coverage is 92%
  4. OPV coverage is 76%
  5. BCG coverage is 98%

Author: Administrator