improves’

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‘The health situation never improves’

Vanuatu’s Principal Planning Officer in the Ministry of Health, Gedeon Mael, gave his view of the health situation in the island state.

By Patrick Decloitre

PIM: What is the health situation like in Vanuatu in terms of infrastructure?

GM; There is a big hospital in Port Vila, Vila Central Hospital, one in Santo, Northern District Hospital, then there are three other regional hospitals. Then you have 20 health centres (each with three medical staff (a nurse, a midwife and a nurse practitioner), 68 dispen saries (with one staff nurse each) and at the last records, 162 aid posts, some of which are no longer working.

To be honest about the health situation in Vanuatu, I think it never improves. The department only tries to maintain a ser vice designed to satisfy areas.

PIM: Why?

GM; When Vanuatu became indepen dent in 1980 ... Vanuatu was not ready for independence; at the time there were not enough nationals who had the skills to take over. So the former colonial powers, France and Britain, had to leave behind their staff to help the country to run the medical service, up until 1986.

This is when a lot of ni-Vanuatu came back for the first time from overseas studies to take over some positions. But even then, with the Health Department, the emphasis was on nurse training but there were very few doctors because it takes longer for a doctor to be trained.

Since 1980, the government had entered a scheme whereby it asks foreign aid donors to provide some of their doctors in various areas of the country. But they come on a short-term basis, many of them for two years. I think this is not enough. Also, in the outer islands, like Ambae, Malekula, Tanna, there are no facilities to treat diseases that are occur

ring there. Only simple surgery, like appendix removal, is possible. But major surgery is never taking place in the islands. And foreign doctors who are posted in the outer islands then say they are wasting their time, they say they’re doing things they’re not supposed to do because they don’t have the facilities to do what they are qualified for. Also, they think that if they’re staying more than one year in an outer island with no operating facility, they lose their skills because they don’t practise.

There should be a clear line between poli tics and administration’

PIM: Do you think foreign aid to the Vanuatu health system has gone down in the last few years?

GM; I think so, although no study has been made so far.A lot of positions filled by foreign aid donors have not been renewed. Some positions remain vacant, either to be localised or to be trans ferred to other areas. Besides, the doc tors are coming from a lot of different places: there is a Nigerian doctor, a French one, a team of Chinese. They never communicate with one another and they use their own methods. There is no cohesion in the spirit.

Also, when there is an offer for assis tance, there are requirements as to how the funds will be used. This needs some people here (at the ministry) to do a report, but this rarely happens, because there is no one skilled enough to do the draft report.

Some donors say they have offered assistance but did not get a reply from the local authority. Is this what you mean?

GM: Yes, for instance last year, the ser vice was affected by the strike. There was no one to formulate a request to foreign donors. Now it’s getting better.

PIM: Did the strike affect the health ser

vice severely?

GM; Yes. There are still some effects being felt now. A lot of skilled people were sacked last year, very few of them have come back. Meanwhile, nurses who are still training have been employed to fill vacant positions, where as they should have first worked under supervision. A lot of people in the ser vice now cannot address problems because they are i new and they don’t know yet. Still, only about 35 percent have been replaced now. I think over 100 people have been sacked altogether last year as result of the strike.

PIM: And has the situation changed now?

GM: The situation is worse. The reasons are the budget is not enough and never has been. For instance, this year, the bud get is smaller than what we had before.

For food, we only have 9 5 million vatu (about US$B5,OOO) in 1995 to cater for our patients in Vila Central Hospital. In 1994, it was 17 million (about U 55153,000). But we should get at least 30 million vatu (about U 55270,000) this year to provide enough nutriments for patients.

PIM: How strong is politics at the min istry? Does it affect your work on a day to-day basis?

GM: There should be a clear line between politics and administration. I’m not saying there shouldn’t be any politi cal involvement in the administration, but the extent of this involvement should be minimised to a level that allows work to progress. The depart ment should be allowed to operate pro fessionally. That is also why a lot of pub lic servants are moving to the private sector these days.

PIM; What should then be done to improve the system?

GM: First, they must recognise the skills of local doctors and improve their salaries. Then they should divide the health sector into two departments... one is preventive the other curative.

These are two different things. Whereas now, it is all under one department and it is too big to be properly controlled by the Director of Health. Also, VCH should be made a specialist area which could also be used as a training facility for doc tors and nurses from the rural areas. For this, the influx of persons into VCH must be stopped. ■