The Ministry of Health and Medical Services (MHMS) would like to respond to the various claims and concerns raised by Transparency Solomon Islands (TSI) last week and Solomon Island Democratic Party’s (SIDP) President yesterday to the media regarding the National Referral Hospital.
This is important to ensure that we do not impose any unnecessary fears and anxiety and more importantly distrust among the members of the public towards our health care systems and its capacities especially at this time.
The annual number of deaths recorded at NRH in the past three years, which includes pre COVID-19 (2018-2019) and during COVID-19, response (2020) remained between 500 – 600 deaths annually. The number of deaths recorded in NRH was 549 in 2019 and 566 in 2020 resulting in 17 additional deaths. The number of hospital admissions in the two years was 12,568 and 11,466, which translates into death rate of 43.6 and 49.3 in the years 2019 and 2020 respectively.
One of the main reason behind the increase in death rate is explained by case mix approach. As part of COVID response, we discouraged people with mild illnesses to come to the NRH, and criteria for admission into the hospital was made rigid to admit cases strictly requiring admission in the NRH. As a result, we ended up with more proportion of serious cases in the hospital, which resulted in higher death rates. It will be irrational to attribute this increase to COVID response.
During the initial months of the COVID-19 preparedness phase (first half of the year), around 170 NRH staff were engaged mainly in getting trained, development of guidelines, standard operating procedures, and strengthening infection prevention and control activities in health facilities, and sensitization of staff at the NRH , all needed for an effective and safe discharge of their duties. More importantly, the preparedness phase also enabled health for an efficient allocation of its resources for operational readiness. Thus, when the country actually recorded its first COVID-19 positive case on the 1st of October 2020, the number of NRH staff that were actually engaged in COVID-19 had been reduced to 85 personals.
On 3rd of January when the remaining three COVID positives were moved to the COVID-19 Central Field Hospital, NRH further down scaled to only 15 personals (2 doctors, 5 nurses and 8 support staff) who are providing services to cases referred from the quarantine stations and central field hospital. The remaining returned to their normal duties but are on standby should National Health Emergency Operation Centre (NHEOC) require their support.
In terms of, facilities, equipment and all other COVID-19 resources, the COVID-19 preparedness and response had actually contributed towards strengthening health services and health systems. Initially efforts and resources were focused on COVID-19, today these resources have been of great use to other health services at the NRH and in the provinces. For instance, the X-ray machine donated by the New Zealand government for COVID-19 had been useful in the management of COVID-19 symptomatic patients but also used for other health examinations. Other additional COVID-19 supplies such as Personal Protective Equipment and Infection Prevention and Control supplies have also been allocated to health workers providing health services at various departments within NRH to enhance work safety, mitigate spread of infection diseases and so forth.
Laboratory services for COVID were strengthened in provinces and these will enable us to use GeneXpert machines to carry out other tests too. Therefore, resources were actually redirected back to normal health services, COVID-19 positions reduced and consequently payment of COVID-19 allowances to health workers.
TSI raised concerns with the location of COVID-19 isolation ward within the hospital’s compound and its close proximity to the TB ward that poses risk of COVID to non-COVID patients including TB Patients.
It must be understood that the proposed COVID-19 Isolation ward for severe cases of COVID-19 or more precisely the Infectious Disease Precinct (IDP) that is being planned for NRH will be at the eastern end of the hospital. All TB patients have already been shifted to the Lee Kwok Kuen wing next to the medical ward as a temporary location. Thus, they will not be in close proximity.
Additionally having an isolation ward within a hospital’s vicinity is common; in fact many hospitals around the world have such wards inbuilt within their hospital’s structure and others within the hospital’s compound. Actually, establishment of a ward dedicated for infectious disease patients (IDP) will reduce the chances of spread of respiratory infections from one patient to other in the hospital as all the patient with severe life threating infections will be sent to IDP and isolated from other patients.
NRH had accommodated all 17 registered COVID-19 positive cases since October 2020 and today there has not been an incidence of a health worker contracting the virus nor other non COVID patients at NRH getting COVID-19 infection. Therefore to make commentaries about risks of COVID-19 spread in such a setting requires good knowledge on the measures set in place by NRH to ensure the virus is contained where patients are isolated and the mode of spread. Such information can easily be accessed if formal requests are received in which the ministry will be happy to respond to.
The statement also claimed that nurses under practical training are left to handle patients without supervision as a result of resource redirection to COVID-19. Handling a patient by way of moving and administering minor drugs such as pain killers etc does not require intensive and strict supervision or for a nursing supervisor to be on bedside with the trainees. These trainees are under the constant watch of the senior staff at the hospital. As per the protocol in place, supervision is strictly required when administering specialized drugs and when handling of very sick patients with chronic diseases.
With regards to claims that malaria test kits have ran out in the provinces, it is possible that one or two rural clinics may ran out due to the influx of people to the provinces to celebrate the Christmas and New Year festivities. It could also be that the clinic’s request for stock replenishment is still in the process of ordering and that the National Medical Store (NMS) is in the process of dispatching the kits. Nevertheless, in such a case, notifications from the provincial health pharmacies would always have reached the national medical store for new stocks. As per the current requests received there is no urgent request for Malaria test kits although we have stock at the NMS and around 15 months worth of stock coming in this month. COVID-19 cannot in anyway affect resources allocated for Malaria as funding sources and supply chains are different.
Lastly, with respect to the concerns raised by the President of the Solomon Islands Democratic Party (SIDP) regarding limited resources, overcrowding and unhygienic status of NRH, the Government has already put in place the vision and position to improve and upgrade the current NRH. This is reflected in the NRH Business Case, which was completed and endorsed by Cabinet in 2020. Now, health is prioritizing the 3 phases of the business case for implementation and resource mobilization. The first phase being the NRH improvement and upgrade to which requires fully-fledged scoping assessment of NRH in its entirety towards fully-fledged master plan, design and contractual works.
With business case endrosed the NRH management have endorsed its Business Plan for 2021 and onwards in its meeting on Friday last week which incorporated priority infrastructures, clinical services deepening strategic actions, inpatient care improvements to include patients’ food, beddings, water and sanitation, and infection control facilities. At the moment private contractors are hired to clean the wards toilets and showers regular, and external surroundings including the gutters and drainage. Soon there will be new security measures put in place to control number of visitors and timing of the visiting hours. Nevertheless, it also takes cooperation and respect from the public and users of the NRH hospital ensure that our facilities are well kept for our people today and into the future.
Overall, no one can deny the fact that COVID-19 pandemic has adversely impacted resources and health services in all the countries and it will be futile to say that it is not the case with Solomon Islands. However, we have used this pandemic to understand our weaknesses and make judicious use of resources to contribute to resilient health systems. In terms of other health programs, we are constantly monitoring the delivery of programs and take appropriate steps to address any deficiencies or decline in health services delivery.