Ministry of health Republic of the Marshall Islands “KUMITI EJMUUR" ANNUAL REPORT Fy 2011 1 2 3 4 Joint Message from the Minister and Secretary of Health We are pleased to present the Annual Report for the Ministry of Health for Fiscal Year 2011. Although there is so much data and statistics collected for every single program and services in the Ministry, this report is presented for a better understanding of the type of resources allocated for the Ministry such as human and financial resources, and the utilizations of its resources or expenditures incurred during the fiscal year. Section on data and vital statistics presents the health status of RMI in terms of morbidity and mortality just for that fiscal year. Non-communicable Diseases (NCDs) or lifestyles diseases, tuberculosis and leprosy remain the three prioritized areas, and update on activities and data are included in this report. The last section is the Cost Analysis and Expenditures for the fiscal year in selected areas or services. It is important to note that actual costs of services provided by the Ministry are not charged accordingly. If the Ministry was to charge patients according to the costs of services, high revenues will be generated every fiscal year. Because of the high rates of lifestyles diseases or chronic diseases and identified communicable diseases, the Ministry continues to shift its focus on preventive or primary health care’s services in compliance with the Declaration of Primary Health Care by World Health Organization (WHO) on September 12, 1978 in Alma Ata. The Declaration called for urgent action by all governments, all health and development entities and the world community to protect and promote quality health practices for all peoples. Health is a shared responsibility between the RMI Government, communities, non- governmental organizations, churches, women’s groups, business communities, civil society, families and individuals. We are all responsible for our own health because we can make choices to take care of our own health through eating the right kind of food for better health, increase physical activities/exercise, stop smoking, and drink less alcohol. The risk factors related to lifestyles diseases such as tobacco use, alcohol consumption, lack of physical activities and poor diet contribute in high prevalence and incidence rates of NCDs in our nation. 5 RMI fully supports the NCD Declaration by the Pacific Islands Health Officers Association (PIHOA) because NCDs are affecting lives of so many people in our region and around the world including the RMI. We are all Marshallese who live the “kumit” lifestyle, which shows supporting one another in every effort to improve health, education, lifestyles for Marshallese people for now and in the years to come. Improving lives, health and education is a shared responsibility and a healthy kumiti lifestyle for all. There are still challenges in lifestyles that the Ministry encountered during the fiscal year. One of the highlighted challenges was the dengue fever outbreak that occurred towards the end of the fiscal year, which imposed the Ministry to shift resources to focus on the outbreak. The Ministry was able to respond quickly to combat the outbreak with support from the RMI Government, local and regional partners and international partners and agencies. We are indebted for supports received during the outbreak. A detailed report on the dengue fever outbreak will be presented in the Ministry’s Fiscal Year 2012 Annual Report. We extend our sincere appreciation to our local partners and stake holders in the RMI, our regional and international partners and to the RMI Government for your continued support to the Ministry of Health. Kommool tata. 6 TABLE OF CONTENTS A JOINT MESSAGE FROM THE MINISTER AND SECRETARY OF HEALTH ............................................. Error! Bookmark not defined. GEOGRAPHY AND DEMOGRAPHICS ...................................................................................................................................... 11 Table 1: RMI Population Developments .............................................................................................................. 12 Table 2: RMI Projected Population by Age .......................................................................................................... 12 Population Pyramid of RMI in 2011 ..................................................................................................................... 13 Table 3: Health Care System ................................................................................................................................ 14 Table 4: Number of Beds in Two Major Hospitals ............................................................................................... 14 Table 5: Specialized Program ............................................................................................................................... 15 Table 6: Private Clinics ......................................................................................................................................... 15 FINANCIAL RESOURCES AND EXPENDITURES ........................................................................................................................... 17 Table 7: MOH Budget Allocation from All Sources, FY 2008-2011 ...................................................................... 17 Table 8: Basic Health Plan Financial Report- Revenues and Expenditures .......................................................... 17 Table 9: Basic Health Fund Expenditures by Location ......................................................................................... 18 Table 10: Supplemental Health Plan Financial Report – Revenues and Expenditures ........................................ 18 Table 11: Health Care Revenue Fund Expenditures by Location ......................................................................... 18 Table 12: Grants and Financial Resources ........................................................................................................... 19 Table 13: Capital Health Budget Allocation and Expenditure FY2011 ................................................................. 20 HUMAN RESOURCES FOR HEALTH ........................................................................................................................................ 23 Table 14: Medical Providers by Position FY2011 ................................................................................................. 23 Table 15: Nurses by Position FY2011 ................................................................................................................... 24 Table 16: Ancillary Services, FY2011 .................................................................................................................... 24 Table 17: Support Services, FY2011 ..................................................................................................................... 25 DATA AND VITAL STATISTICS ............................................................................................................................................... 29 Table 19: Teen Pregnancy (Mother’s Age is less than 20 years old).................................................................... 29 Table 18: Summary of Birth Information ............................................................................................................. 29 Table 20: Births by Main Islands .......................................................................................................................... 30 Graph 1: Birth Trend from FY2007 to FY2011 ..................................................................................................... 30 Table 21: Births by Gender and Main Islands FY 2011 ........................................................................................ 31 Table 22: Births by Gender .................................................................................................................................. 31 Table 23: Birth by Attendant per Year ................................................................................................................. 31 Table 24: Birth by Attendant FY2011 ................................................................................................................... 31 Table 25: Birth by Mother's Age .......................................................................................................................... 32 Table 26: Summary of Death Data ....................................................................................................................... 33 Table 27: Number of Registered Deaths by Main Islands .................................................................................... 34 7 Graph 2: Maternal Mortality Trend ..................................................................................................................... 34 Table 28: Infant Deaths by Main Islands .............................................................................................................. 35 Graph 3: RMI Infant Mortality Rate Trend ........................................................................................................... 35 Table 29: 5 Leading Cause of Infant Death .......................................................................................................... 36 Graph 4: Child Mortality Rate 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