It’s been a long, dusty drive to get to Aola in east central Guadalcanal, through river beds and over deep ruts and potholes. But still I am not prepared for the last steep climb up a red dirt track to the local health clinic. I can’t help but shudder when Dr Joel Denty, the Provincial Health Director travelling with us, tells me at least one woman has had to give birth here, within metres of the high concrete steps to the centre doors.
Other women have opted to travel back to Honiara to have their babies at the National Referral Hospital (NRH) where they felt they would get proper care. One out of every three births in the Solomon Islands takes place in the NRH – about 5,500 babies a year. It is a less than ideal situation for patients and their families, and for the doctors and nurses at NRH who work long hours just to keep up with the workload.
But things are about to change for the people of east central Guadalcanal. Our visit today is to meet with representatives of the Aola community to discuss plans for the refurbishment of the local Area Health Centre, which will result in major improvements to current services, particularly in maternal and child health.
The upgrade is part of the Government’s programme to reform the entire health system to provide quality healthcare that is more accessible for all Solomon Islanders. The Role Delineation Policy, as it is known, is the country’s roadmap towards universal health coverage. It is a tool for health services planning and infrastructure development and sets out the different levels of primary care that are expected to be provided at health facilities throughout the Solomon Islands. WHO has been integrally involved in the development of the Policy, and has worked with the Ministry of Health to design and develop standards for health care facilities as well as supporting reproductive, maternal, neonatal and child health programmes.
Aola is one of 34 Area Health Centres earmarked for renovation and, with funding from the Korean International Cooperation Agency (KOICA) and technical support from WHO, it will be among the first to be completed.
The centre supports around 3,000 people, and employs a nurse and a midwife. The project will see the old, dilapidated clinic completely remodelled and a new septic tank and running water installed, along with toilets and showers. There will be a confidential space for the care for survivors of violence and sexual abuse – a first for the country – and separate wards for male and female patients, as well as a new delivery suite and a pharmacy. Solar panels will provide electricity, including lighting for emergencies, 24 hours a day. And the access road will be improved.
All going to plan, construction should get under way in October this year. In the meantime, nursing staff will continue to provide basic care in a temporary clinic while the renovations are going on.
Beyond “bricks and mortar”
The significance of this project, however, goes beyond mere “bricks and mortar”. East central Guadalcanal has high infant mortality rates and low childhood vaccination rates, compared to the rest of the country. Once the renovation is done, there will be a fulltime doctor based at Aola and staff will be able to provide full obstetric care before, during and after delivery, including ultrasound scanning, and early newborn care. “We are hopeful that health outcomes will improve as more mothers choose to come here for their care,” Dr Denty tells me.
Philip Maneka, from the local Clinic Committee, is hopeful too; that the “new” Aola Area Health Centre will benefit generations of east central Guadalcanal families to come.
Throughout our meeting, he listens quietly as Dr Denty explains the features of the renovation to the committee, and arrangements for services while the build takes place. Dr Denty emphasises the need for the community to support the project at every step, from ensuring the site is secure once construction starts, to helping to maintain the facility once it is finished. After everyone has shared their views, Philip rises from his seat and speaks from the heart.
“This project gives me great joy,” he says. “It has given us a future. Our committee will try our best, working with staff, to look after the clinic, for the betterment of the community – for our children and our children’s children.”
Those around him nod in agreement. It is clear that they take this commitment very seriously; because, without community support, this project will not succeed. The most important partners in this, and in the entire reform of the country’s health system, are the communities themselves. It’s no overstatement to say that lives depend on it.
- Tanya St George, WHO Solomon Islands.