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Solomon Islands Health System Review

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Solomon Islands Health System Review 64 Health Systems in Transition Vol. 5 No. 1 2015 Solomon Islands Health System Review Written by: Nicola Hodge, University of Queensland, Brisbane, Australia Beth Slatyer, Honorary Fellow, Nossal Institute, University of Melbourne Linda Skiller, Australian Bureau of Statistics Edited by: Maxine Whittaker, University of Queensland, Brisbane, Australia i WHO Library Cataloguing in Publication Data Solomon Islands health system review (Health Systems in Transition, Vol. 5 No. 1 2015) 1. Delivery of healthcare. 2. Health care economics and organization. 3. Health care reform. 4. Health systems plans – organization and administration. 5. Melanesia. I. Asia Pacific Observatory on Health Systems and Policies. II. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 693 1 (NLM Classification: WA 540 LM5 ) © World Health Organization 2015 (on behalf of the Asia Pacific Observatory on Health Systems and Policies) All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, (fax: +632 521 1036, e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named authors alone are responsible for the views expressed in this publication. ii Contents Preface ................................................................................................................. vii Acknowledgements ............................................................................................ ix List of abbreviations and acronyms ................................................................. x Abstract ................................................................................................................ xii Executive Summary ..........................................................................................xiii 1 Introduction ................................................................................................. 1 Chapter summary ................................................................................................. 1 1.1 Geography and sociodemography ............................................................ 2 1.2 Economic context ........................................................................................ 5 1.3 Political context ........................................................................................... 7 1.4 Health status .............................................................................................. 10 2 Organization and governance ................................................................ 14 Chapter summary ............................................................................................... 14 2.1 Overview of the health system ................................................................ 15 2.2 Historical background .............................................................................. 15 2.3 Organization ............................................................................................... 16 2.4 Decentralization and centralization ....................................................... 22 2.5 Planning ...................................................................................................... 22 2.6 Intersectorality ........................................................................................... 25 2.7 Health information management ........................................................... 25 2.8 Regulation ................................................................................................... 26 2.9 Patient empowerment .............................................................................. 32 3 Financing .................................................................................................... 34 Chapter summary ............................................................................................... 34 3.1 Health expenditure .................................................................................... 35 3.2 Sources of revenue and financial flows ................................................. 41 3.3 Overview of public financing schemes ................................................... 42 3.4 Out-of-pocket payments .......................................................................... 43 3.5 Voluntary health insurance ...................................................................... 45 iii 3.6 Other financing .......................................................................................... 46 3.7 Payment mechanisms .............................................................................. 46 4 Physical and human resources .............................................................. 47 Chapter summary ............................................................................................... 47 4.1 Physical resources .................................................................................... 48 4.2 Human resources ...................................................................................... 56 5 Provision of services ................................................................................ 62 Chapter summary ............................................................................................... 62 5.1 Public health .............................................................................................. 63 5.2 Patient pathways ....................................................................................... 72 5.3 Primary/ambulatory care ......................................................................... 75 5.4 Inpatient care ............................................................................................. 76 5.5 Emergency care ......................................................................................... 77 5.6 Pharmaceutical care ................................................................................. 77 5.7 Rehabilitation/intermediate care ............................................................ 79 5.8 Long-term care .......................................................................................... 79 5.9 Services for informal carers .................................................................... 79 5.10 Palliative care ............................................................................................. 80 5.11 Mental health care .................................................................................... 80 5.12 Dental care ................................................................................................. 81 5.13 Complementary and alternative medicine ............................................ 81 5.14 Health services for specific populations ............................................... 82 6 Principal health reforms ......................................................................... 83 Chapter summary ............................................................................................... 83 6.1 Analysis of recent major reforms ........................................................... 84 6.2 Future developments ................................................................................ 91 7 Assessment of the health system ......................................................... 93 Chapter summary ............................................................................................... 93 7.1 Stated objectives of the health system .................................................. 95 7.2 Financial protection and equity in financing ......................................... 96 7.3 User experience and equity of access to health care .......................... 96 7.4 Health outcomes, health service outcomes and quality of care ..... 102
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