Issues in primary health care development in Vanuatu

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Although the primary health care model was adopted officially in the Vanuatu archipelago in 1984 inherent obstacles of limited resources manpower conflicts of interest and geographically dispersed small units necessitated a national task force in 1989 to co-ordinate implementation at the local level. Vanuatu with a population of 142600 in 1989 over 80 islands has a traditional Melanesian culture and 45% under 5 years old. Health problems include both tropical less-developed country issues and increasing degenerative diseases. The health care system formerly emphasized curative care by doctors in hospitals in the capital where a nursing school also focused on technologically based care. The new primary health care system adopted in the 2nd National Development Plan and coordinated by a committee in a Workshop in 1987 puts control at the district level. Each district consists of 2 or 3 local governments. The plan established rural health districts of 2- 40000 people under rural health supervisors requires cooperation of the PHC nutrition environmental health and AIDS sectors trains local aid post workers established a drug list and includes primary health care in undergraduate nursing training. Due to increasing problems a regional review of the plan was held in 1989 which found problems such as poor role definition and accountability in the districts competing demands on local sanitarians low community involvement with unused resources conflicting training programs no evidence of improved regional planning since the 1987 workshop insufficient resources for transport reduced budget with increased proportion going to hospitals too much emphasis on sanitation. Some improvements were noted to immunization prenatal care and medically assisted deliveries and placement of 110 aid post workers although many were untrained and not engaged in preventive activities. Some benefits could probably be obtained by integrating the vertical programs of malaria control immunization and maternal-child health; by seeking ways to involve Melanesian culture in primary health care activities; and by extending nurse training to include practical experience in the islands.