Vanuatu Health Profile 2012

Ministry of Health's mission, vision and objectives

The vision of the Ministry of Health is to protect and promote the health of all people living in Vanuatu. The Ministry’s mission is to establish an integrated and decentralized health system to promote effective, efficient and equitable development and services for the well-being of all people across the country, based on the following values:

Customer focus: Customers are the first priority and concern in the provision of quality care and access, while respecting their geographic situation, economic circumstances, and social and cultural beliefs and values.

Equity: In cultural, ethnic, religious and political diversity, and irrespective of disability, gender and age, fairness, respect and honesty must prevail in all dealings.

Quality: High quality outcomes will be pursued using safe and affordable interventions, and science and technology will be applied to maximize benefits, while minimizing risks in all facets of activities.

Integrity: The health system will strive for improvement and will commit to the highest ethical standards in all that is done in providing quality care in Vanuatu.

The objectives are:

• to restructure the Ministry to ensure effective, efficient and responsive service delivery;
• to strengthen health partnerships to ensure effective, efficient and coordinated service delivery;
• to plan and provide equitable service delivery for the people of Vanuatu;
• to further develop a range of public health programmes and initiatives, including programmes for tuberculosis, leprosy, malaria and HIV/AIDS;
• to provide and promote effective and efficient reproductive health services;
• to improve and strengthen the drug and medical supply system;
• to plan new primary health care facilities based on population numbers;
• to review and develop the patient referral system;
• to develop hospital service standards, policy and regulations to assure quality and customer-focused services;
• to strengthen the national health information system to support planning, management and effective service delivery to patients and customers; and
• * to further develop human resource management and development to achieve a well-managed and well-trained workforce.

Organization of health services and delivery systems

The Ministry of Health is responsible for the provision of curative and preventive health services. The Ministry formulates national health policies, coordinates the development and planning of public health sectors, and regulates health standards.

The five public and one private hospital provide inpatient and specialist outpatient services. Of the five hospitals, there are two tertiary referral public hospitals located in both Port Vila and Luganville. Specialized tertiary services are not available in Vanuatu and are referred for overseas treatment, mainly to Australia and New Zealand.

There are 27 health centres, about four in each province. They provide outpatient and inpatient services (mostly prescription of drugs and deliveries), health promotion and preventive health services, such as immunization. Each of these health centres is staffed by a nurse practitioner, who is also the manager, a midwife and a general nurse. The health centres are the referral centres for dispensaries (referred to as PHC centres in the health databank) and aid posts. There are 97 active dispensaries providing primary care. All the islands have at least one dispensary, which is usually staffed by a general nurse.

Aid posts have been established in most villages and are funded by the community, while the Ministry of Health provides basic medicine and training for the staff. There are about 231 aid posts in the country, each staffed by a village health worker.

The support services for hospitals and primary health care programmes include pharmaceutical, blood-transfusion and laboratory services.

The five public hospitals in the country have a total of 390 beds and the health centres have lower number of beds. In 2006, 14 856 inpatients and 356 236 outpatients attended clinics. Thus, the bed occupancy rate was 2.1 per 1000 population and there were 1.5 outpatient visits per person.

Health policy, planning and regulatory framework

Based on an overarching primary health care philosophy, the policy objectives for the health sector are:

• to improve the health status of the people;
• to improve access to services;
• to improve the quality of the services delivered; and
• to make more effective use of resources.

The strategies to achieve these objectives are as follows:

• Base health services delivery on a primary health care approach to ensure access to sustainable provincial services, including strong links with provincial governments.

* Improve the health status of the people by:

•  reducing illness and death in children under five years of age;
• promoting birth spacing and reducing teenage pregnancies; and
• reducing disability and deaths among productive adults.

* Improve access to services through:

o adoption of the role-delineation tool to distribute resources more fairly based on community health needs;
o implementation of mechanisms to evaluate tertiary services and provide guidance for their access both within Vanuatu and beyond;
o development of an integrated primary health care strategy and public health care strategy for Vanuatu; and
o giving a higher priority to improving transportation and communication to (1) improve access for patients, (2) reduce the isolation of health workers, and (3) improve and strengthen partnerships for and ownership of health programmes through the coordination of donors, NGOs, other sectors of Government, chiefs, churches, etc..

* Improve the quality of services delivered through:

• implementation of a comprehensive hospital and health service quality and safety standards programme; and
• recognition of the potential for a key role to be played by health professionals in providing leadership and ensuring there is continued skills-base development and retention in the workforce.
•  Make more effective use of resources by:
• improving the collection of data to enable monitoring of health status and support health planning and management; and
• adopting only those health initiatives that are cost-effective and proven in the South Pacific, and continuing to roll out the planning process to include high-priority services and new programmes.

The Ministry of Health’s Sector Strategy 2010-2016 contains strategies, targets and performance indicators to measure progress in the priority areas. Performance indicators to reflect overall progress in the sector include those on:

• infant and child mortality;
• maternal mortality;
• births attended by trained health personnel;
• immunization coverage;
• contraceptive prevalence;
• malaria, TB and noncommunicable disease incidence; and
• availability of timely and accurate health statistics.

Health care financing

Until 2005, Vanuatu had one financing scheme represented by national health services operated and funded by the Government and under the supervision of the Ministry of Health. The major sources of funding for the health sector were the government budget and donor contributions. Household contributions consisted of in-kind payments to traditional healers and fees-for-services at government facilities.

The fees-for-service scheme, a Ministry of Health cost-recovery scheme, realized the reasonable amount of 10 to 12 million Vatu (US$ 95 000 to US$ 114 000) between 2002 and 2005, representing 1% to 2% of the Ministry’s executed budget. Unfortunately, these funds are not added to the Ministry of Health budget, but are treated as state revenue and go into the Ministry of Finance account.

National Health Account (NHA 2007) results found that, in 2005, almost 100% of inpatient and 60% of outpatient services were provided by Ministry of Health facilities. Recently, private sector health services have started up. New polyclinics have been established in the capital city of Port Vila and the major city of Luganville, and a private hospital (Vila Bay Hospital) was established in Port Vila in 2006. The private insurance market in the country is utilized mainly by the large number of expatriates residing in the two major cities. Private insurance companies represented 3% of total health expenditure in 2005.

National health expenditure in 2008 was estimated at Vatu 2297 million (US$ 22.7 million), representing 4.1% of GDP. Almost 79.2% of the total health expenditure was from public sources and 20.8% from private funds.

To date, there has been no social health insurance scheme based on the principles of mandatory contribution, risk-sharing and fund-pooling, but such a scheme is now being seriously considered.

Human resources for health

The Ministry of Health is responsible for development of the human resources required to provide health services in the country. A comprehensive Human Resource Development Plan has been prepared by the Ministry and is being implemented with the assistance of WHO and other donors.

There have been developments in the management of human resources in the Ministry of Health towards rationalization of salary levels and a review of career options for health workers. Currently, only clinicians have an established career path, but the Ministry is working towards establishing career paths for technical categories. Salary and career advancement will be tied to the new performance appraisal system and the new structure.

Vanuatu faces major challenges in the development and delivery of health services. Its citizens, numbering about 234 023, are spread over 80 islands and it is a huge task for the Ministry of Health to provide health services to such a dispersed population.

The Government also has to face challenges due to the rapid growth of the population. The number of people will have doubled by 2030 and the population base will keep expanding, resulting in a very young population. As a result, health services will have to provide more and more services in the areas of antenatal, natal and postnatal care, as well as neonatal care. Diseases of childhood will continue and more and more paediatric and obstetric care services will be required. At the same time, the elderly population will also keep increasing due to longer life expectancy, and the diseases of the elderly will be another serious problem.

With urbanization and changing lifestyles, the incidence of chronic diseases, such as diabetes, hypertension and stroke, are increasing. To address these issues properly, the health services need human resources trained in both the clinical and preventive health fields that are adequate in terms of both numbers and quality. Further, proper equipments for good diagnosis, treatment and rehabilitation are needed. Production of human resources for health will be the major challenge to be addressed in the near future.