Looking to the Solomons: Why Universal Health Coverage matters
by David Gilchrist
Judith Olivia takes a difficult journey for her children
About 930 million people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of their household budget.
Scaling up primary health care (PHC) interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
A truck bumps along a beach road, throwing up a sandy cloud in its wake. The road is rough, the day is hot and within the truck a woman holds on tight. The ride has cost her entire weekly food budget. It’ll take an hour for her to reach the nearest hospital. It is a drive against time as she is pregnant and her baby needs to be delivered. She has rattled along that track before though. Six times.
That’s the story the World Health Organisation (WHO) tell of the journey Judith Olivia has made to deliver each of her children, from the remote village of Malatoha in the Solomon Islands to the National Referral Hospital in the capital, Honiara.
The closest health clinic to Malatoha is six hours’ walk away, in the town of Belaha, but Ms Olivia says she feels safer in the hands of doctors in Honiara.
"If there was a doctor at Belaha clinic, I would go there to have my children," she says. "It's much easier for me to go there, but right now I’m not confident that the health workers can take care of me."
That’s the reality of life in the Solomon Islands. It is also, in a way, the very reason Rocketship strive to work with communities to improve health care, health education and training in Pacific countries. In terms of need, The Solomon Islands, like other Pacific countries, is striving to improve health care with a goal of universal health coverage (UHC).
The statistics point to why universal health coverage is important and primary health care training invaluable. According to WHO, about 30% of all births in the Solomon Islands happen at the National Referral Hospital. That’s despite the Honiara accounting for just 13% of the sprawling archipelago’s population. Of the nation’s 157 doctors, 126 are based in Honiara.
Universal Health Coverage matters
Universal health coverage is an idea that sounds simple but is quite difficult to achieve. Nonetheless, setting UHC as a goal is worthwhile. That’s because it means that all individuals and communities receive the health services they need without suffering financial hardship.
While primary health services are central to the provision of UHC, the delivery of these services requires adequate and competent healthcare workers with optimal skills at hospital facilities, outreach and community level. What's more each level must be adequately supported.
Among all the lessons the COVID-19 pandemic has delivered, it has clearly shown the invaluable role of the healthcare workforce.
Primary Health Care Key
When Rocketship works to provide primary healthcare training, it is providing training in the most cost-effective, inclusive and equitable way to enhance the physical health, mental health and social wellbeing of Pacific communities.
WHO says, “PHC is also critical to make health systems more resilient to situations of crisis, more proactive in detecting early signs of epidemics and more prepared to act early in response to surges in demand for services.”
The Solomon Islands carries a disease burden of communicable diseases such as dengue, combined with increasing rates of non-communicable diseases and the effects of climate change which causes frequent floods and droughts.
World Bank report shows development support falling as disease burden rises
The World Bank repoted that in 2018 noncommunicable diseases (NCDs) from risk factors like smoking, poor nutrition, alcohol consumption and physical inactivity made up the major share of the overall burden of disease and that burden is rising. Diabetes and adult obesity are also rising. Also, stunting and wasting in children under five years of age remain key health issues. Ongoing challenges with communicable diseases and maternal, neonatal, and nutritional health persist.
Hospital access is most readily available for those in provincial centres and the capital, Honiara. Although the number of health workers per capita has improved in recent years, the skill mix and distribution of health workers across provinces, disease burden, and national programs are generally inequitable.
The World Bank also noted that the health sector is highly dependent on external funding, with development partners (DP) providing more than 40 % of the funds spent on health on average between 2004 and 2014.
Following a decade of substantial external financing to the health sector, Donor Partner (DP) support has started to decrease; this trend is expected to continue, but will most likely remain significant.
However, as early as 2015, Asia Pacific Observatory on Health Systems and Policies recognised that opportunities exist for the Solomon Islands’ Health system. That's largely becuase the Solomon Islands is actively addressing the challenge of managing an effective health system in a low-income context with limited scope for economies of scale in service training. That is th space in which Rocketship works.
The good news for those working with Rocketship to help improve health in the Solomon Islands and so working towards universal health coverage, is that, as the Asia Pacific Observatory on Health Systems and Policies recognised in 2015, with support, the Solomon Islands’ health system, “should be able to be both strong and affordable.”
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Extra images courtesy of Getty Images.