Challenges to Child Health in Solomon Islands

1. Challenges to Child HealthinSolomon Islands James Auto Pediatrician

2. Large Numbers of Children • Total Population: 536, 000 (2010) • Nation’s population of 536,000 is spread over 29,000 square km of land. • 40% of Population <15 yrs • 15% of Population < 5 yrs

3. High Childhood Mortality Rates • U5MR: 36 per 1000 live births • IMR: 27 per 1000 live births • NMR: 17 per 1000 live births • 36% • Newborns • Global Distribution of U5M

4. Malnutrition • Underweight Prevalence: 21% (2006 NCHS) • Stunting Prevalence: 27% (2006 NCHS)

5. Health Infrastructure Civil Conflict • Hospital services for children in the Solomon Islands: Rebuilding after the civil conflict • J. Auto, T. Nasi, D. Ogaoga, Julian Kelly & Trevor Duke in the JPCH • Human resources • Most hospitals were poorly resourced in terms of staff numbers and capacity • Essential drugs • provision of essential drugs was not adequate for optimal treatment of common bacterial infections. Other equipment was often not available • Health financing • The Solomon Islands health service is almost entirely dependent on international donor funds to continue operating. The only major exceptions are nurse and doctor salaries that are paid from Government funds • Referral and access to paediatric referral services • Many seriously ill children never reach hospital. Referral was highly dependent on distance from a hospital and the availability and cost of transport. Tsunami

6. Low Health Expenditure • GDP/Capita 2010: US$1,340 (www.dfat.gov.au/geo/fs/solo.pdf • Total HE/Capita

7. Low Immunization Coverage Rates • DTP3 Coverage: >90%: 20% of Provinces 80%-89%: 30% of Provinces 50-79%: 50% of Provinces <50%: 0

8. Separation by Sea, Terrain & High Rainfall Total land area of 28,900 sq. km widely scattered over 1.3 million sq. km of sea Source: Meteorology, 2002

9. Transport & Communication • Lack of regular road maintenance • High air travel costs • No regular shipping schedules • Low communication coverage

10. Low Health Workforce to Population Ratios

11. Population Using Improved Drinking Water & Sanitation

12. Illiteracy • 5m old girl with fever 4 days was admitted to remote Babanakira Clinic on the weathercoast of Guadalcanal island. 2 days prior treatment was by traditional therapist. After a day of clinic treatment with antibiotics the father returned the girl to the traditional healer because she had not gotten better on the nurses treatment. The girl was returned to the nurse the next day because of convulsions and sleepiness. The next day a plane was on the nearest airstrip about 4 walk away and the nurse transferred the child to National Hospital where coma and Hemophilus meningitis was diagnosed. The father then wanted to return his child home because condition did not improve. The next day the little girl died. • Traditional concepts of disease • Sorcery • Disease is a function of the spirits and can be cured by traditional healers who have connection with this spiritual realm • High health illiteracy and fatalistic population • Girls education • Lack of knowledge of the germ theory of disease • Implications on cleanliness, hygiene

13. Radio Australia: Pacific Beat • Commenting on Solomon Islands High CMRs • Dr IsiyeNdombi (UNICEF Pacific Representative): “If you look at what is underlying these differences [between Solomon Islands & other countries] the first is the quality of life at the family level, … the education of the mother of the child, that is a major determinant of how the child fares” • “and the second thing you are looking at is the quality of health care.” • Commenting on Interventions to be done • Dr DiviOgaoga (Director of Child Health): “improve the health systems and tools, not some fancy equipment but those effective low cost interventions that save lives”

14. Child Health Sector Strategies • Low cost interventions • Breastfeeding: can reduce up to 22% of Newborn Deaths • Community Based Newborn Care (MoH/UNICEF/WHO Baby Friendly Hospital Initiative) 3. Emergency Obstetric and Newborn Care (EmONC) (MoH/UNFPA & UNICEF)

15. Child Health Sector Strategies • Appropriate technology at Rural Health Clinics, Area Health Centers, Provincial Hospitals, National Hospitals to address newborn care. Neonatal care project (NICU Project L1, L2, L3). On-going planned project with UNICEF/MoH input. Needs funding so exploring funding opportunities with partners, AusAID MDG 4&5 funds. • IYCF, Growth Monitoring, Complementary feeding (AusAID funds) • To continue the gains in EPI • To continue the support to nurses in the clinics by way of resources which will support them in the care of children • To creatively address short falls in medical supplies to address ongoing curative needs

16. Education • Ministry of Education, NZ Aid, UNICEF especially to address education of girls and to disseminate basic health care education in the schools and their curricula

17. In our National Children’s Policy, Strategy and Outline Plan of Action for Children we affirm the unassailable: Investment in children’s health, nutrition and education is the foundation for national development. Our dedication to the children and young people of Solomon Islands will create a better, richer, and more peaceful country today, filled with support and promise, and the development and social contribution of our children and young people will in turn shape a future that joyously reflects the environment of their upbringing.