Human Resources for Health Country Profiles Republic of Kiribati WHO Library Cataloguing-in-Publication Data Human resources for health country profiles: Republic of Kiribati 1. Delivery of healthcare – manpower. 2. Health manpower - education. 3. Health resources - utilization. I. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 668 9 (NLM Classification: W76 LA1) © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased 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 non-commercial distribution– should be addressed to WHO Press through the WHO web site (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 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. Table of contents Acronyms v Acknowledgements vi Executive summary vii 1. Introduction 1 1.1 Demographic, social and political background 1 1.2 Current economic situation and macroeconomic indicators 2 1.3 Main health indicators 2 1.4 Health system 3 2. Health workforce supply and trends 4 3. Health workforce distribution 6 3.1 Distribution of health workers by gender 6 3.2 Distribution of health workers by age 6 3.3 Sectoral distribution 7 3.4 Distribution of health workers by citizenship 7 3.5 Skills distribution 7 4. Health professions education 7 4.1 Medical education 7 4.2 Nursing education 7 4.3 Medical assistants 9 4.4 Other health workers 9 4.5 Education capacities 11 4.6 Physical infrastructure 12 4.7 Technical infrastructure 12 4.8 Accreditation mechanisms 12 4.9 In-service and continuing professional education 13 5. Human resources for health (HRH) utilization 14 5.1 Recruitment 14 5.2 Deployment and distribution policies and mechanisms 14 5.3 Vacancies 16 6. Financing HRH 17 6.1 HRH expenditure 17 6.2 Remuneration to health workers 17 7. Governance of HRH 19 7.1 HRH policies and plans 19 7.2 Policy development, planning and management for HRH 19 7.3 Professional regulation 19 7.4 HRH information systems 21 8. Concluding remarks 21 References 22 Annexes 23 Annex A. Ministry of Health and medical services organizational chart 23 Annex B. Distribution of health workers by gender, April 2013 24 Annex C. Distribution of health workers by age, April 2013 25 Republic of Kiribati iii List of tables Table 1. Selected sociodemographic indicators 1 Table 2. Selected economic indicators 2 Table 3. Selected health indicators 3 Table 4. Number of health workers at the national level in 2008 and April 2013 5 Table 5. Skills distribution in March 2013 7 Table 6. Number of first-year enrolments by year, 2008–2012 12 Table 7. Number of graduates by year, 2008–2012 13 Table 8. Allowances and entitlements for Kiribati public service workers 15 Table 9. Vacant posts by April 2013 17 Table 10. Average entry-level incomes by profession in 2013 18 Table 11. Registration requirements for health workers in Kiribati 20 List of figures Figure 1. Gender distribution (%), April 2013 6 Figure 2. Age group distribution (%), April 2013 6 iv Human Resources for Health Country Profiles Acronyms A$ Australian dollar AusAID Australian Agency for International Development CPE continuing professional education FNU Fiji National University GDP gross domestic product HRH human resources for health KANI Kiribati-Australia Nursing Initiative KSN Kiribati School of Nursing MHMS Ministry of Health and Medical Services NCD noncommunicable disease P&O prosthetist and orthotist PHRHA Pacific Human Resources for Health Alliance POLHN Pacific Open Learning Health Network PSO Public Service Office SKH Southern Kiribati Hospital SPC Secretariat of the Pacific Community SSCSIP Strengthening Specialised Clinical Services in the Pacific UNDP United Nations Development Programme UNICEF United Nations Children’s Fund US$ United States dollar USP University of the South Pacific WHO World Health Organization Republic of Kiribati v Acknowledgements The Kiribati Human Resources for Health Country (Senior Local Government Auditor) from the Ministry Profile is the result of the collaboration of Wiriki of Internal and Social Affairs; and Sophia Lin. Tooma (Secretary for Health), Teatao Tiira (Director Public Health) and Kaateti Tooto (Senior Assistant The Human Resources for Health Country Profiles in Secretary) from the Ministry of Health and Medical the Western Pacific Region are prepared under the Services, Republic of Kiribati; Tareti Ioane Ruaia logistical and editorial support of the WHO Western (Deputy Principal) from the Kiribati School of Nursing; Pacific Regional Office Human Resources for Health Beniana Atantaake (Scholarships Officer) from the unit and coordinated by a team composed of Ministry of Education; Moannata Ientaake (Director) Gulin Gedik, Rodel Nodora, Jose Aguin and Dyann from the Public Service Office; Teewaa Tonaeka Severo. vi Human Resources for Health Country Profiles Executive summary Background workers, there are no private practitioners. Services are almost all provided by government at no or low The Republic of Kiribati consists of 32 low-lying cost to locals. atolls and one volcanic island arranged in three main groups: the Gilbert, Phoenix and Line Islands. While a large proportion of the workforce is young Most atolls are less than two metres above sea level, (almost half are between the ages of 30 and 39), making the country vulnerable to climate change and many of the formally qualified, senior-level staff natural disasters. Kiribati ranks low on the Human are approaching retirement age. The practice of Development Index and is unlikely to meet any of the contracting retired staff to fill specialist posts is Millennium Development Goals by 2015. increasing. The workforce is mostly female. Nurses provide many of the services across the country The population of Kiribati is 103 058. Most live in the and are usually the only types of health workers Gilbert Island group, and the capital Tarawa is densely available in the outer islands. While health services populated. As birth rates are high and international are concentrated on Tarawa atoll due to the high migration is minimal, population growth is one of population density, there are few outreach services the highest in the region. Significant rural-to-urban to the outer islands, which disadvantages those who migration has produced new “urban” settlements are already unable to afford transport to access the that have placed stress on limited resources, jobs services they need. and infrastructure. Sanitation is often poor, leading to high rates of communicable disease. Overcrowding Main HRH issues and social decline have contributed to increased youth violence and alcohol abuse. The main issues that affect human resources for health in Kiribati are all underpinned by a lack of finances. Compared to other Pacific island countries, life These are: critical shortages of skilled health workers; expectancy is shorter, and child and maternal lack of central HRH management; and inadequate mortality rates are some of the highest in the region. health worker production. Noncommunicable disease is the major cause of mortality and morbidity, but communicable diseases Critical shortage of skilled health workers such as tuberculosis and diarrhoeal disease still cause The Kiribati workforce is ageing and there is an one third of all deaths, many among children. increasing reliance on retired staff (compulsory retirement is set at 50 years) to fill nursing and Attempts to decentralize the health system have been medical positions. unsuccessful thus far. The four tiers of health facilities provide increasing levels of medical care, starting with Several departments, particularly laboratory, medical dispensaries and health centres in the outer islands, imaging, health promotion and environmental health, followed by subdivisional hospitals, and finally the have staff who are not formally