Piloting subnational health sector strengthening

“Change does not happen overnight,” says Salome Kenneth, the Public Health Manager for Malampa Province. “But gradually we are seeing changes!”

Three islands in Vanuatu form Malampa Province, one of the largest provinces in the country, and home to around 43,000 people. Like the rest of the provinces, access to quality health care in Vanuatu and delivery of essential health services to scattered populations remains a challenge. In addition, travelling within and between the islands can sometimes be treacherous, with limited infrastructures and rough seas to contend with, often meaning high costs.

With just under 13 percent of Vanuatu’s total population living in Malampa Province, UNICEF and the Vanuatu Ministry of Health chose the province to pilot the sub-national health sector strengthening scheme. The idea is to support the planning, provision, utilization, quality, and efficiency of health services, to include both preventive and curative care, and the system’s resilience.

In Malampa, there are just over 5,200 children under the age of 5. Thankfully, each of these children has a much higher life expectancy now compared with a few decades ago. But with an under-5 mortality rate of 25 per 1,000 nationally, this still means that 105 of Malampa’s children risk not seeing their 5^th birthday without concerted efforts to change this.

Those efforts are underway, with a strong focus on strengthening the health system to implement new approaches and improve the quality of existing key maternal, newborn and child health interventions according to national priorities.

Creating a well-functioning management team with problem solving, management and leadership skills is essential to build a strong health system and ensure effective and efficient delivery of quality services that are aligned with the national priorities.  It is also an essential element to ensuring a robust health system, that supports the optimum healthcare for families, and especially for children and newborn babies.

With that in mind, Getu Tarekegn, a UNICEF consultant, spent 6 months working closely with Salome Kenneth and the Malampa Provincial Health Management Team, in part to support management training.

“From the management trainings, the line of communication between managers and staff has improved,” said Salome. Indeed, a key outcome of the management trainings is increased collaboration between the clinical/hospital team and the public health team.

 “Although the hospital has their own clinical structure, there are now regular joint meetings to discuss common issues,” she added.

This bodes especially well for the children of Malampa Province. With this improved communication between the various levels of health care managers and providers, more and more of these children will have the chance to grow up healthy and happy.

But it’s not enough for UNICEF to train from the top down and not see and understand the situation on the ground. Part of the support included strengthening supportive supervision to primary healthcare facilities. This is a process of guiding, monitoring, and coaching health workers to promote compliance with standards of practice and to ensure the delivery of quality health services. The supervisory process permits supervisors and supervisees to work to meet common goals, and improves healthcare worker capacity, for example, to increase immunization uptake and integrate it with other essential services.

Part of Getu’s work was to accompany the Malampa team on their supervisory visits. This gave him a great chance to meet the healthcare workers and understand what challenges they may need extra support with. After all it is, they who are responsible for ensuring their communities are well looked after, and able to live their best lives.

“The consultant was willing to go out to the communities visiting some extremely remote areas,” says Salome. “Often the team travelled by boat experiencing very rough seas. This is the reality of working in Malampa”.

The Malampa story demonstrates that change can and does happen. Investments in management style and mindset to strengthen the health system from the ground up, starting at the provincial level, provide opportunities for learnings that could be replicated across other provinces as well as the national level. For Salome and her team in Malampa, having the additional set of hands, ears and expertise certainly goes a long way.