The Healthcare System in the Solomon Islands: Organisation, Access to Care and Health Risks

The World Health Organization (WHO) describes a role delineation policy defined by the Ministry of Health and Medical Services, which divides services into four levels: small rural health posts for basic primary care, area health centres with doctors able to perform simple surgery, provincial hospitals, and the national referral hospital in Honiara. The WHO indicated that the plan was to upgrade nine provincial hospitals and 34 area health centres, and to close or convert 202 nurse aide posts into rural health centres.

The country has more than 600 islands for about 620,000 inhabitants (WHO), 13% of whom live in Honiara. According to the same source, 126 of the 157 doctors practised in the capital, and the national referral hospital handled about 30% of all births. For residents of remote islands, the WHO mentions several days of travel by truck and boat to reach a doctor, and a clinic sometimes six hours away on foot. The World Bank gives fewer than one doctor and about 2 nurses and midwives per 1,000 inhabitants.

France Diplomatie mentions in its country overview Japanese funding of 2 billion yen for a hospital. For a foreign resident, the practical consequence is simple: the quality and availability of care vary greatly by island, and the place of residence is chosen according to the distance from Honiara and air links.

The World Bank, drawing on the WHO health expenditure database, puts current health expenditure at about 5% of gross domestic product. It indicates that about a third of this spending is financed from abroad, whereas direct household payments account for only 3%. The WHO already noted that nearly half of health spending came from donors, often targeted at specific diseases rather than at the system as a whole, and that hospitals had been built without coordination with the ministry, resulting in fragmented services.

These figures describe the funding of the public system and its partners. They do not indicate what a foreigner pays for a consultation or a hospital stay: the official sources read publish neither tariffs nor billing rules for non-residents.

The official sources consulted describe neither a compulsory health insurance scheme nor the conditions for foreign residents to access public care. The national provident fund, to which employees and employers contribute, is a savings account: it provides for withdrawals in the event of medical disability but does not reimburse care. The Ministry of Health and Medical Services is the contact to ask about the reception of non-residents.

For a French citizen, the benchmark is that of France Diplomatie: insurance or an assistance contract covering all medical costs (surgery, hospitalisation) and medical repatriation is essential, failing which access to care may be refused, even in a life-threatening emergency. The French embassy cannot pay these costs. The possible reimbursements by France or the CFE (Caisse des Français de l’Étranger, the voluntary health insurance body for French people abroad) are detailed in the guide to healthcare reimbursement in the Solomon Islands.

Day to day, first-line care is the nearest rural health post or area centre, then the provincial hospital, according to the role delineation described by the WHO. In the capital, the national referral hospital sits at the top of the four levels of care described by the WHO. The official sources read do not publish the list of private establishments, which are not assessed here either.

The local emergency numbers could not be read from an official source. France Diplomatie does however give, for the French embassy in Vanuatu (competent for the Solomon Islands), +678 28 700 and, in an emergency, +678 7777 033. A decompression chamber is reported at Tulagi Dive, in Honiara. In the event of a serious problem, France Diplomatie recommends considering evacuation to Brisbane; Solomon Airlines operates links to that city, which means anticipating the assistance company’s agreement and transport times (see medical evacuation).

France Diplomatie recommends taking a personal first-aid kit limited to what is needed, in the original packaging, together with a prescription giving names in international non-proprietary form. You should check that the medicines are permitted locally and never buy medicines on the street, because of counterfeits. Regular treatment should be planned for the whole length of the stay, given the distance separating part of the country from the referral hospital. Seeing your treating doctor, and possibly your dentist, well before departure is advised.

France Diplomatie recommends being up to date with the French vaccination schedule, in particular against diphtheria, tetanus, polio, whooping cough and measles. Proof of measles vaccination is required on entry for travellers coming from Australia, New Zealand, Fiji, Samoa, Tonga, the Philippines, Kiribati or Papua New Guinea, and yellow fever is compulsory for travellers coming from endemic zones. Depending on the length and conditions of the stay, vaccinations against hepatitis A, typhoid fever, hepatitis B, tuberculosis (children under 15 in the case of frequent or prolonged stays), as well as chikungunya and dengue in the event of an epidemic or a prolonged stay, are advised.

Mosquito-borne diseases come first: malaria (more than 200 cases per 1,000 people at risk according to the World Bank), dengue, chikungunya and Zika, the latter posing a risk to the foetus of women who are pregnant or planning to be. Typhoid fever, transmitted by water and food, and tuberculosis complete France Diplomatie’s list. Protection relies on covering clothing, repellents, mosquito nets and getting rid of standing water, malaria being prevented in addition by preventive treatment. In the event of fever during the stay or in the weeks after returning, you should consult quickly.

Measles vaccination coverage for children aged 12 to 23 months stands at about 80%, with variations from one year to the next (according to the World Bank). For water and food, France Diplomatie advises drinking only sealed, filtered, boiled or disinfected water, cooking food thoroughly and peeling or washing fruit and vegetables. It also mentions road safety, swimming, venomous bites and stings and heat among the common risks. The WHO finally mentions the effects of climate, with frequent floods and droughts.

Before departure, you need to take out an assistance contract or insurance that covers all medical costs, including surgery and hospitalisation, and medical repatriation (see repatriation assistance). The points to read in the contract are validity in the territory, the annual limit, evacuation to Australia, cover for weather events and the handling of medical history. The page on expat health insurance helps you compare policies, and Expavy can support you in this comparison. During the cyclone season from November to May, France Diplomatie recommends following local instructions and being insured accordingly.