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Mapping Human Resources for Health Profiles from 15 Pacific Island Countries

Report to the Pacific Human Resources for Health Alliance From the Human Resources for Health Knowledge Hub

April 2009

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w.sphcm

.unsw.edu.au

2 | P a g e M a p p i n g H u m a n R e s o u r c e s f o r H e a l t h

P r o f i l e s f r o m 1 5 P a c i f i c I s l a n d C o u n t r i e s

Contents

Acknowledgements .................................................................................................................................. 3

Executive Summary ................................................................................................................................. 8

Background ........................................................................................................................................... 11

Section 1: Human Resources for Health Country Maps ................................................................. 14

Cook Islands.......................................................................................................................................... 15

Federated States of Micronesia ............................................................................................................. 19

Fiji ......................................................................................................................................................... 24

Kiribati .................................................................................................................................................. 27

Niue ....................................................................................................................................................... 35

Palau ...................................................................................................................................................... 39

Papua New Guinea ................................................................................................................................ 42

Republic of the Marshall Islands .......................................................................................................... 45

Samoa .................................................................................................................................................... 48

Solomon Islands .................................................................................................................................... 52

Tokelau ................................................................................................................................................. 55

Tonga .................................................................................................................................................... 59

Tuvalu ................................................................................................................................................... 65

Vanuatu ................................................................................................................................................. 68

Section 2: In-Country and Regional Education Institutions .......................................................... 71

Section 3: External Partners Providing Assistance in HRH ........................................................... 84

Discussion ............................................................................................................................................. 96

Conclusion and Recommendations ....................................................................................................... 98

References ............................................................................................................................................. 99

Appendices ......................................................................................................................................... 100

Appendix 1: Terms of Reference ........................................................................................................ 101

Appendix 2: Survey Questionnaire Instrument ................................................................................... 102



Acknowledgements

The HRH Hub@UNSW wishes to thank all of the people of Pacific Health Ministries who have

helped to progress this document. Thank you for your support, your time, and your valuable

contributions. The HRH Hub particularly wishes to acknowledge the guiding support of Dr Ken Chen,

Dr Juliet Fleischl, and Ms Monica Fong from the World Health Organization, Suva, Fiji.

Special thanks to the project team in developing the mapping profiles:

Ms Jacqui Davison

Ms Michele Vanderlanh Smith

Associate Professor Rohan Jayasuriya

Associate Professor John Hall

Dr Augustine Asante (Ph.D)

Mr Alan Hodgkinson

We also wish to thank Ms Lorraine Kerse, who provided technical review assistance, and would like

to acknowledge the assistance provided by Ms Michelle Imison, Dr Angela Dawson (Ph.D), Ms

Vanessa Traynor and Ms Waireti Amai.

If you would like to discuss any of the information in this report or find out more about the HRH Hub

then please contact:

Associate Professor John Hall, Director, email: [email protected] or telephone: 61 2 9385 8464

Vanessa Traynor, Manager, email: [email protected] or telephone: 61 2 9385 8459

For copies of the report contact Waireti Amai via email: [email protected] or telephone 61 2 9385

8464 or why not download a copy from our website:

http://www.sphcm.med.unsw.edu.au/SPHCMWeb.nsf/page/HRHHub

The Human Resources for Health Knowledge Hub is funded through a grant from the Australian Agency for

International Development (AusAID) under the Strategic Partnerships Initiative.

mailto:[email protected]:[email protected]:[email protected]://www.sphcm.med.unsw.edu.au/SPHCMWeb.nsf/page/HRHHub



Acronyms

AusAID Australian Agency for International Development

ADB Asian Development Bank

ADS Australian Development Scholarships

ARDA Anglican Relief Development Agency

BE Bachelor of Education

B Med Bachelor of Medicine

BN Bachelor of Nursing

CBR Certificate in Community Based Rehabilitation

CDC Centre for Disease Control and Prevention

CDU Charles Darwin University (Australia)

CEO Chief Executive Officer

Cert Certificate

CHIPs Community health Information Profiles

CHE Commission for Higher Education

CN Community Nursing

CPE Continuing Professional Education

CWM Colonial War Memorial Hospital

DAC Development Assistance Committee

DFaT Department of Foreign Affairs and Trade (Australia)

DfID Department for International Development (UK)

DHA Demographic Health Survey

DHS Department of Health Services

Dip Diploma

DoH Department of Health

DOTs Directly Observed Treatment, Short

DPH Diploma Public Health

EHW Environmental health Worker

EN Enrolled Nurse



FSM Federated States of Micronesia

FSMed Fiji School of Medicine

FSoN Fiji School of Nursing

FTE Full Time Equivalent

GDP Gross National Product

Gvt Government

HSIP Health Sector Improvement Program

HR Human Resources

HRH Human Resources for Health

HRD Human Resource Development

IMCI Integrated Management of Childhood Illness

INTV Institute National de Technologie de Vanua

IT Information Technology

JCU James Cook University (Australia)

JICA Japan International Cooperation Agency

KANI Kiribati-Australia Nursing Initiative

KANGO Kiribati Association of NGOs

KIR-EU Kiribati European Union Health Improvement Project

KSoN Kiribati School of Nursing

LDCs Least Developed Countries

LPNs Licensed Practical Nurses

MBA Master of Business Administration

MBBS Bachelor of Medicine, Bachelor of Surgery

MCH Maternal and Child Health

MDG Millennium Development Goal

M Med Master of medicine

MoE Ministry of Education

MoH Ministry of Health

MoU Memorandum of Understanding

MTS Medical Treatment Scheme



NA Nurse Anaesthetist

NCDs Non-Communicable Diseases

NDoH National Department of Health

NZRDS New Zealand Regional Development Scholarships

NGO Non government organization

NP Nurse Practitioner

NSA Non State Actors

NUS National University of Samoa

NZAID New Zealand Agency for International Development

NZ New Zealand

OGI Outer Gilbert Islands

OUMS Oceania University of Medicine Samoa

PacLII Pacific Islands Legal Information Institute

PBL Problem based Learning

PCC Palau Community College

PHC Primary Health Care

PHN Public Health Nursing

PHRHA Pacific Human Resources for Health Alliance

PICs Pacific Island Countries and Territories

PIP Pacific Islands Project (AusAID)

PIHOA Pacific Health Officers Association

PMU Project Management Unit

PNG Papua New Guinea

POLHN Pacific Open Learning Health Network

POHW Primary Oral Health workers

PPP Purchasing Power Parity

PPHSN Training in Communicable Disease Surveillance

PPTC Pacific Paramedic Training Centre (New Zealand)

PREPP Training on pandemic preparedness and outbreak investigation.

RAMSI Regional Assistance to the Solomon Islands



RMI Republic of the Marshall Islands

ROC Republic of China

RN Registered Nurse

SICHE Solomon Islands College of Higher Education

SIS Small Island States

SPC Secretariat of the Pacific Community (New Caledonia, Fiji)

SWAp Sector Wide Approach

UoA University of Auckland ( New Zealand)

UoF University of Fiji

UoG University of Guam

UoO University of Otago (New Zealand)

UN United Nations

UNFPA United Nations Population Fund

UNICEF United Nations Children's Fund

UNSW University of New South Wales (Australia)

UPNG University of Papua New Guinea

USA United States of America

USAID United States Agency for International Development

USP University of South Pacific

UTS University of Technology (Australia)

UT University of Technology (New Zealand)

VMSS Visiting Medical Specialists Scheme (NZAID Project)

WB World Bank

WHO World Health Organization

WPRO Western Pacific Regional Office (World Health Organization)



Executive Summary

Human Resources for Health (HRH) are central to the performance of health systems. Limited HRH

has been identified as a major obstacle to achieving the health-related MDGs. Health Ministers of

Pacific Island Countries have committed themselves and their governments to implementing strategic

measures to strengthen their national HRH capacities and address the varied health workforce

challenges they face. The Pacific Human Resources for Health Alliance (PHRHA) is the regional

body mandated to identify and implement strategies to strengthen HRH capacities in the Pacific. It

brings together national governments, international agencies and other stakeholders in the health

sector to address HRH issues of common concern in a unified manner.

In their July 2008 meeting, the PHRHA member countries identified strengthening HRH data

collection and information management systems as priority areas requiring collaboration.

Consequently, the PHRHA secretariat in conjunction with WHO Western Pacific office contracted the

Human Resources for Health Knowledge Hub at the University of New South Wales (HRH

Hub@UNSW) to undertake a rapid mapping of HRH resources in Pacific Island countries. As

specified in the Terms of Reference, the mapping exercise was to generate baseline data on the current

HRH situation in the region, information on in-country and external education institutions involved in

HRH development, and data on external partners providing HRH-related assistance.

The study was undertaken between November 2008 and March 2009 using semi-structured

questionnaire to gather data from PHRHA member countries. The data collection was undertaken

mainly through telephone interviews and email communications. Fifteen (15) Pacific Island countries,

all members of the PHRHA, participated in the study: Cook Islands, Federated States of Micronesia,

Fiji, Kiribati, Nauru, Niue, Palau, Papua New Guinea, Republic of the Marshall Islands, Samoa,

Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu. Additional data was gathered from secondary

sources to supplement the primary data obtained through the questionnaire. The key findings of the

study include the following:

1. Variations in workforce data availability

2. Lack of disaggregated workforce data

3. Varied HRH data repositories

4. Limited continuing education and training resources

5. Limited coordination among external partners engaged in HRH support



Variations in the availability of workforce data

Marked variations exist in the availability of workforce data across the 15 countries studied. Countries

like Tonga, PNG and Cook Islands had detailed workforce data including numbers of health personnel

disaggregated by gender and age. By contrast, the majority of the countries had limited workforce

data readily accessible. Data on recruitment and retention including incentive schemes designed to

retain personnel were unavailable in many countries.

Varied HRH data repositories

Almost all the countries studied had varied HRH data repositories. The Ministries of Health had

information on the number of personnel (nurses, doctors, dentist, etc.) currently working in the

government health sector but knew very little about the education and training institutions and the

annual turnover of health personnel of these institutions. Such information was largely held at the

Ministries of Education and the various medical and nursing training institutions. Information on

current vacancies was generally limited in all the countries.

Lack of disaggregated workforce data

There were significant gaps with regards to disaggregated data. Only five (Tonga, PNG, Cook Islands,

Nauru and Niue) of the 15 countries studied had disaggregated workforce data by gender, age or

nationality. Such disaggregated information is essential for effective workforce planning including

planning for education and training.

Limited continuing education and training development

Limited continuing education, training and development of health professionals emerged as a key

issue in the Pacific. There were wide variations across Pacific Island countries in terms of the

existence and appropriateness of health worker education and training, as well as their type,

frequency, coverage and quality.

Limited coordination among external partners engaged in HRH support

To enhance the impact and effectiveness of donor support to the PICs, it is essential that the support to

be better coordinated as well as aligned to meet the goals and objectives of national HRH programmes

/strategies of each country, with government taking the lead.

Conclusion and Recommendations

Most Pacific Island Countries have attempted to enhance their national health information systems,

often with the support of partner agencies (i.e. SPC, WHO). However, the findings of this mapping

exercise demonstrate that significant deficiencies in the collection, analysis, management and

application of HRH data persist in many PICs. Additionally, there appears to be no systematic way of

linking HRH information to policy-making at the national level. The main factors underpinning these

deficiencies as evident in the study include:

Weak organizational support for data collection systems

Lack of standardization and coherence in attempts to improve health information systems

Decentralised/autonomous/fragmented systems in some countries

Limited capacity for data management and use of workforce data to guide policy making at

the national level

Lack of coordination among external partners supporting HRH development



Although not directly evident from the study, other factors such as inadequate collaboration between

the Ministry of Health and other Ministries such as Education, Finance and the Public Services

Commission appear to also constrain HRH data collection and management in the Pacific.

On the basis of the above findings the following recommendations have been made:

RECOMMENDATION 1: That support be provided to countries to develop a standard and coherent

system of health workforce information gathering. This should include a system of disaggregating

workforce data by gender, age and nationality

RECOMMENDATION 2: That countries be supported to develop one centralised HRH data

repository that brings together data on all aspects of HRH including data on education and training

resources as well as donor support for HRH development.

RECOMMENDATION 3: That greater attention be paid to providing continuing education and

training services/resources that contribute to the goals of building capacity and capability in HRH in

the region. It is crucial that external donors support this engage adequately with Pacific Island Health

Ministries in order to identify accurately their education and training needs.

RECOMMENDATION 4: That donor support to be better coordinated as well as aligned to meet the

goals and objectives of national HRH programmes/strategies, with government taking the leadership

role. The primary value of this approach, builds on the efforts of The Pacific Plan, which provides a

contextual framework for implementation of the key health Millennium Development Goals.



Background

Human Resources for Health (HRH) play a pivotal role in strengthening health systems. Limited HRH

is widely recognised as an impediment to achieving the health-related Millennium Development

Goals (MDGs) (WHO 2006; UN 2008). Health Minsters of Pacific Island Countries have committed

themselves and their governments to implementing strategic measures to strengthen their national

HRH capacities and address the varied health workforce challenges they face. The key areas the

ministers have agreed to focus attention include collation and use of reliable HRH data to inform

policy, strengthening of effective health workforce planning and management systems, and scaling up

education and training of the health workforce to meet current shortages.

The Pacific Human Resources for Health Alliance (PHRHA) is the regional body dedicated to

identifying and implementing strategic measures to strengthen HRH capacities in the Pacific region. It

brings together national governments, international agencies and other stakeholders in the health

sector. In July 2008 the PHRHA member countries identified HRH information management systems

as a key priority area where collaboration is required to strengthen national health systems and

accelerate progress towards achieving the health-related MDGs (Minutes of PHRHA Meeting 2008).

The PHRHA Secretariat in conjunction with the WHO Western Pacific office drafted a Terms of

Reference (refer to Appendix 1) establishing the basis for country resource maps that will identify

gaps in the basic HRH data and tools used by regional Ministries of Health. The PHRHA and WHO

envisaged that the country maps will be developed into comprehensive HRH profiles that could be

used across the region to guide policy makers, development partners and other stakeholders identify

key areas where investments in HRH are required. The University of New South Wales Human

Resources for Health Knowledge Hub (HRH Hub@unsw) was contracted to undertake, between

November 2008 and March 2009, HRH resource mapping that will produce baseline data on current

HRH situation in the PHRHA member countries.

This report presents HRH maps based on situation analysis in fifteen Pacific Island countries (Cook

Islands, Federated States of Micronesia, Fiji, Kiribati, Republic of Marshall Islands, Nauru, Niue,

Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu, Tokelau, Vanuatu). The findings

are presented in three inter-related sections:

SECTION 1 Baseline data on current HRH situation across the region – Country

SECTION 2 In-country and external education institutions assisting in HRH development

SECTION 3 External partners providing HRH assistance



Method

A pragmatic and flexible approach was adopted for this study. Previous Hub work including a

literature review of HRH profiling methodology provided a foundation for this task. The timeframe

and resources allocated to this study for the PHRHA required that data be collected from Ministries of

health via telephone, fax and email. A questionnaire tool was deemed most appropriate. Data was

collected over a 3 month period and compiled in an excel spreadsheet. Additional supportive data was

collected in some cases. Progress was monitored through regular team meetings and the report was

collaboratively complied.

The Questionnaire

The semi-structured questionnaire developed for this study was designed to capture quantitative

workforce data as well as narratives concerning retention and incentives, legislation related to

practice, workforce planning initiatives, education and training and donor activity. This covers the

three components of the study specified in the Terms of Reference: baseline information on current

HRH situation, information on education and training resources, and external partners providing

assistance in HRH development. The questionnaire was 10 pages long and had three workforce tables,

a training activity table, and external partners providing HRH assistance (Appendix 3). The

questionnaire was developed using standard occupational cadres and indicators specified by WHO

and reviewed by technical experts and modified accordingly before use.

Data collection

The questionnaire was primarily administered through telephone interviews and email exchanges with

PHRHA Country Focal Points and representatives of the Ministries of Health (see list of participants –

Appendix 2). The list of PHRHA Country Focal Points was provided by WHO (Suva). The

questionnaire was initially distributed to the Focal Points, together with an explanatory letter from the

HRH Hub. Follow-up telephone interviews were then conducted to complete the questionnaire. Some

participants chose to complete the questionnaire independently and returned by email, rather than

completing it over phone. In such instances, follow up calls were made to clarify the responses

provided.

In addition to the primary data gathered through the questionnaire, data were also collated from

secondary sources. These were mainly data on education and training resources available in-country

and externally. The four main documents from which these data were collated are:

Human Resources for Health in Pacific Island Countries – A Situational Analysis, University

of Western Sydney 2007

Situational analysis of mental health needs and resources in Pacific Island Countries,

University of Auckland NZ, 2005

HRH Training in Pacific Island Countries-PNG, Samoa, and Fiji. Asia-Pacific Action

Alliance on Human Resource for Health, 2008

Expanding the Professional Healthcare Education Resources in Pacific Countries, Hezel

Associates, 2001

Data were also collated from a CD Rom provided to the HRH Hub by WHO (Suva) containing

various documents of recent studies on HRH in the Pacific region. Data to address the third

component of the study i.e. donors involved in HR capacity building and donor fund flows, was



obtained from the country questionnaires (as outlined above), and through contact with development

agencies – AusAID, NZAID, SPC, WHO etc, either directly of via their websites. The data (both

primary and secondary) were gathered over the period of four weeks. In line with the Terms of

Reference (TOR) of the contract, the data were not analysed.

Data collation and presentation

The questionnaire data was compiled into an excel spreadsheet and then checked against the

questionnaire. The quantitative data was presented in a series of tables for presentation in this report

and additional information sourced from documents listed above were added to the narrative.



Results

Section 1: HRH Country Maps



Cook Islands

Cook Islands has a population of 21 000, spread across 15 islands and atolls with a total land area of

241 square kilometres. About 90% of people in the territory are Cook Island Maoris and the country

is predominantly Christian. Cook Islands is a self-governing parliamentary democracy in „free

association‟ with New Zealand. The Cook Islands has limited natural resources and a shortage of

skilled labour due to the continuous emigration of skilled workers to New Zealand. Isolation and a

dependence on government-generated economic activity and employment provide further constraints

on development. Cook Islands‟ relatively high income per person (in 2005 the estimated GDP per

capita (PPP) was $9100) reflects the impact of expatriate residents, close alignment to New Zealand

remuneration scales and the tourist-based economy of Rarotonga. Disparities between the Main Island

and outer islands in relation to access to healthcare reflect differences in the health workforce. During

recent years, the Ministry of Health has concentrated on providing sufficient general practitioners to

provide health services in the outer islands. Whilst four islands (Pukapuka, Penrhyn, Mitioro and

Rakahanga) have health officers they do not have a resident doctor.

Workforce Data

Table 1a describes the distribution of the health workforce by occupation and gender and includes the

number of non-nationals in each occupational category. Gender specific data is current for 2009. Data

on midwives and nursing personnel is aggregated.

Table 1.a Distribution of health workforce occupation by gender and number of non-nationals

Occupation Number

male female Total non-nationals

Physicians 17 7 24 10

Nursing and Midwifery Personnel 3 113 116 8

Dentists 4 0 4 0

Dental technicians/assistants 6 9 15 0

Pharmacists 1 0 1 1

Pharmaceutical technicians/assistants 4 3 7 0

Laboratory scientists 2 4 6 0

Laboratory technicians/assistants 0 1 1 0

Radiographers 2 0 2 1

Environmental Health Workers 0 1 1 0

Public Health Workers 19 3 22 0

Community health workers 2 7 9 0

Medical Assistants 1 1 2 0

Personal Care Workers - - - -

Other health workers 29 43 72 1

Health management workers 5 13 18 0

TOTAL 95 205 300 21



It was reported that expatriates (non-Cook Islander residents) working with the MoH, were most

likely to be senior medical officers and nurses, predominantly from Fiji. The current anaesthetist is

from the Solomon Islands. Table 1.b describes the distribution of the health workforce by occupation

and age group. Over half of the workforce (59.8%) fell in the 30-49 years age group, 18.6% in the 0-

29 group and 21.6% were in the 50+ group.

Table 1.b Distribution of health workforce occupation by age group

Occupation Age group (in years)

Number

0-29 30-49 50+ Total



Dentists - 1 3 4


Pharmacists 0 0 1 1












TOTAL 56 180 65 301

The current vacancy rate (March 2009) is 5.3% of the total health workforce (n=301), or 16 full time

equivalent (FTE) positions - 6 physicians, 5 nurses, 1 dentist, 1 theatre technician, 1 Environmental

Health Officer, 2 support staff.

Workforce Retention and Incentives

The key incentive provided for health workers is training support. This includes payment of full salary

for training under 12 months (or a base salary level if training is over 12 months) for Ministry of

Health employees. Following graduation, employees receive an increase in their salary increment

level. Reimbursement of course fees, for those not on a scholarship, is available if employees graduate

with at least a „B‟ grade average and the course is deemed relevant to their area of work.

Professional Registration and Legislation

No national legislation outlining scopes of practice for health workers is currently in place, however

health workforce standards are contained in the draft national HRH Plan. It is expected that the



standards will be finalised once the plan itself is endorsed. A Nursing Code of Practice already

existed, but it was unlikely to be a legislated code. Professional registration is under review. The

Medical and Dental Board of the Cook Islands currently registers physicians and dentists only, while

the Cook Islands Nursing Council registers professional nurses and midwifes. The MoH has sought

approval from NZAID to fund a consultant to assist in the establishment of an overarching Health

Professionals‟ Council, which will include all health professionals.

Planning

A ten year Human Resources for Health Development Plan has been developed and will be endorsed

by the Minister of Health by June 2009 for implementation from July 2009. The MoH also meets with

the following central agencies to improve yearly health sector planning:

National Human Resources Department to determine numbers for in-country scholarships,

short-term training attachments, Government scholarship recipients, student assistance fund

eligibility

Public Service Commission to discuss employee numbers and job sizing for future year(s)

Ministry of Finance & Economic Management regarding payroll, bulk funding, capital

expenditure items and yearly budgets

Current Donor Support

HRH-related support includes:

WHO Fellowships (2009 biennium) – MBBS, Pharmacy Technician, Bachelor of Dentistry,

Masters in Surgery, Medical Intern trainee at CWM; Primary Oral Health workers (POHW)

POHLN – distance online learning

Pacific Paramedical Training Center in Wellington, NZ – upgrading the skills of 2 or 3

laboratory scientists

UNFPA – Midwifery Certificate, Reproductive Health (WHO)

Cook Islands Nursing School – Diploma in Nursing

NZAID In Country Training – Nurse Practitioner Training Program

NZAID Scholarships – Dietetics & Nutrition

NZAID short-term training attachment - Ophthalmology

Cook Islands Government Scholarship Scheme – USP courses (finance, management

including MBA)

Fred Hollows Foundation – Diploma in Ophthalmology

Education, Training and Development Activities

The Cook Islands School of Nursing offers a 3 year Diploma in Nursing, funded by the Cook Islands

Government, which provides Registered Nurses for the country. There are approximately 20

prospective applicants per year, with 12 nurses graduating in 2008. There is also a Nurse Practitioner

course based at the Nursing School for graduate nurses, which is funded by NZAID. This 9-month

course produces local graduates with on-the-job training at the central hospital (and on selected outer

islands) with a theoretical underpinning. There is also a local, 1 year Dental Training program, which

produces Dental Practitioners. Curriculum review dates or modes of teaching of these courses are not

known. MBBS, Bachelor of Pharmacy, and Bachelor of Dentistry courses are run through the Fiji

School of Medicine, while the Pacific Paramedic Training Centre (PPTC)s used to up skill laboratory



scientists, usually in 1 to 3 months courses. WHO and NZAID provide support for Cook Island

trainees at these institutions, respectively.

Sources of Data

Initial data regarding planning, legislation and professional registration was collected via a self-

completed questionnaire which was emailed to key informants, and follow-up information was

collected via telephone. Workforce data was retrieved from the Cook Islands Health Information

System, March 2009, whilst demographic and economic data were sourced from the AusAID country

program website for Cook Islands and the DFAT Country Information websites [9 March 2009].



Federated States of Micronesia

The Federated States of Micronesia (FSM) consists of 607 mountainous volcanic islands and coral

atolls in four major island groups across 1 million square miles in the northern Pacific Ocean. FSM‟s

scattered population numbers about 120 000 (2008) and is composed largely of ethnic Micronesians.

The country‟s age profile is very young, with the median age of both men and women around 20

years. Growing urbanisation and a decline in subsistence production have increased the population

density in each of its four state capitals - Chuuk, Kosrae, Pohnpei and Yap. Whilst the population

shows continuing susceptibility to both communicable and non-communicable diseases, citizens enjoy

a relatively high level of health care in comparison to the rest of the Pacific region. Large-scale

unemployment and reliance on US aid, the levels of which are decreasing under the terms of the

Compact of Free Association with the USA, are the two greatest economic vulnerabilities.

The Division of Health of the National Department of Health, Education and Social Affairs does not

have a direct role in the provision of health services. The Department of Health Services (DHS) in

each of the four States has primary responsibility for curative, preventive and public health services.

This responsibility includes the main hospital, peripheral health centres and dispensaries (primary

health centres). Only residents of urban centres have direct access to the main hospital in each State,

with transportation issues often preventing residents who live on the outer islands from accessing

hospital care.

Workforce Data

Table 1.a on the following page reports available data on the distribution of the health workforce by

occupation. Neither gender nor age-specific data was available. Data on the number of non-nationals

for each occupational group was also unavailable at the time of data collection, however it should be

noted that there is a decreasing reliance on US doctors and specialists as more FSM-born doctor‟s

graduate and are employed by the FSM government (WPRO CHIPS 2008 FSM).



Table 1.a Distribution of health workforce by occupation

Number

Occupation male female total non-

nationals

Physicians - - 64 -

Nursing Personnel - - 264 -

Midwifery Personnel - - 16 -

Dentists - - 14 -

Dental technicians/assistants - - 26 -

Pharmacists - - 0 -

Pharmaceutical technicians/assistants - - 16 -

Laboratory scientists - - 0 -

Laboratory technicians/assistants - - 33 -

Radiographers - - 16 -

Environmental Health Workers - - 40 -

Public Health Workers - - 393 -

Community health workers - - 31 -

Medical Assistants - - 8 -

Personal Care Workers - - 0 -

Other health workers - - 93 -

Health management workers - - 43 -

TOTAL - - 1057 -

Whilst data on current vacancy rates are not available, the number of expected vacancies in each cadre

for the next 7 years are described in Table 1.b on the following page. These expected vacancies are

derived from the FSM Health Workforce Development Plan 2000-2019.



Table 1.b Number of expected vacancies for the next 7 years

Occupation Number

Vacancies

Physicians 10

Nursing Personnel 40

Midwifery Personnel 12

Dentists 4

Dental technicians/assistants 8

Pharmacists 8

Pharmaceutical technicians/assistants 0

Laboratory scientists 8

Laboratory technicians/assistants 0

Radiographers 8

Environmental Health Workers 8

Public Health Workers 8

Community health workers 20

Medical Assistants 4

Personal Care Workers 20

Other health workers 20

Health management workers 4


The following incentives and conditions are available for public sector employees in the FSM

Division of Health or State-based Divisions of Health: (i) an employment MOU that guarantees a job

immediately after completing their training; (ii) increased annual leave and home leave (as compared

with other public sector employees; (iii) merit-based increment increases; (iv) increased professional

development or continuing education (short courses or workshops) as compared with other public

sector employees.


The FSM Legislative Code (1997) and its amendments, provides for the licensing of medical officers,

dentists, optometrists and pharmacists (FSM Code 1997 § 201-213). Nevertheless, the FSM informant

advised there is a range of licensing mechanisms operating in FSM, possibly due to the FSM Compact

of Free Association with the USA. The informant listed the current licensing boards below.



Table 2. Workforce Occupation by Registration Board

Occupation Registration Board System of governance/ delegated

authority for registration

Physicians Yes/Licensure Board Medical Association/PBMA

Nursing and Midwifery Personnel Yes/Licensure Board APNLC/FSM Nursing Act

Pharmaceutical Personnel Licensure for Importation* International Treaty on CS

Dentistry Personnel Yes Dental Association

Laboratory Health Workers Yes PACT

Environment and public health workers Yes EPA/SPREP

Other Health Workers Yes Public Service System

Community & traditional health workers Yes Public Service System

Health management and support workers Yes Public Service System

Planning

FSM utilises a range of planning tools, in particular the FSM Health Sector Strategic Development

Plan, the WPRO Regional Strategy on HRH 2006-2015, the Nahlap Action Plan, Licensure

Development Plan, COM-FSM Public Health Program Proposal, COM-FSM Nursing Program

Proposal and PACT Plan for Continuing Education Program. In addition, consultation around the

development of a FSM HRH Development Plan has recently been supported by the Pacific Health

Officers Association (PIHOA) through the World Health Organization. Regular meetings are held

between the FSM Department of Health and Social Affairs and other agencies, including Financial

Year Budgetary meetings with Department of Finance and FSM Congress, annual budget review with

the Executive Budget Review Committee, Cabinet meetings on National Health issues on a periodic

basis and annual Audit Finding meetings with the Public Auditor.



WHO Fellowships (2009 biennium) – At various countries, including Japan, Malaysia, Korea,

Philippines etc

POHLN – distance learning

AusAID - support a selection of students at Fiji School of Medicine, especially from Kosrae

State FM (3-4 students currently in Fiji School of Medicine studying MBBS, pharmacy,

nursing)


Local on-the-job training exists for health assistants for dispensaries (rural health centre) in remote

villages and outer islands, community health DOTs workers (for TB and Leprosy), community mental

health outreach workers (counsellors) and program coordinators and managers. The majority of the

health workforce are trained at the following regional institutions: University of Hawaii, Fiji School

of Medicine, New Zealand universities, University of Guam, various universities in the USA

mainland, CDC, Atlanta, Palau Community College, Republic of Palau and Republic of Marshall

Islands Nursing School. The Department of Health and Social Affairs have put forward a proposal to



initiate two health practitioner training programs at the College of Micronesia located in FSM. This

proposal is drawn from the current National Health Sector Plan and the four state health plans. A

Certificate in Public Health to train public health workers is the most advanced, where it is proposed

that the College could manage a yearly intake of 30 students funded by donors, government

traineeships, WHO and individuals themselves. A similar local nursing program proposal is at an

early stage of development.

Sources of Data

Workforce data was provided by the FSM Department of Health and Social Affairs, demographic and

economic data was sourced from the DFAT and AusAID Country Information websites [9 March

2009] and health systems data from WHO/WPRO 2008 CHIPs for Micronesia, available at

http://www.wpro.who.int/countries/2008/mic/. All other data reported here was collected via

telephone interview with key informants with email follow up where required. The Medical

Licensing section of the 1997 FSM Legislative Code is Title 41. Public Health, Safety and Welfare -

Chapter 2 Health Services Personnel (§201-213) and can be accessed via PacLii or directly via

http://fsmlaw.org./fsm/code/index.htm

http://www.wpro.who.int/countries/2008/mic/http://fsmlaw.org/



Fiji

Fiji comprises 332 islands and coral atolls, about 110 of them inhabited, located in the South Pacific

Ocean. It has a population estimated at 931 741 (July, 2008), just over half of whom are Fijian and

around a third of whom are Indian. Fiji enjoys a relatively high income level compared with

neighbouring Pacific island countries (in 2008 the per capita GDP was estimated at $3,700), a skilled

and educated workforce and a well-developed private sector. It is not aid-dependent (total donor aid to

Fiji is around 2.4 per cent of GDP) and tourism, sugar, clothing and mining are among its main export

industries.

Though access to health and education is reasonably good by Pacific standards, the quality of services

is poor, particularly outside urban areas (AusAID, Fiji Country Profile). Health sector reform during

the early 2000‟s led to the restructuring of health management services with a move to decentralised

health service delivery. Health services are delivered through 900 village clinics, 124 nursing stations,

three area hospitals, 76 health centres, 19 sub-divisional medical centres and three divisional hospitals

and three speciality hospitals, with TB, leprosy and medical rehabilitation units at Tamavua Hospital

and St Giles Mental Hospital. Increasing demand for services has led to an expansion in the number

of private general practitioners and specialists practising in Fiji under the Fiji Medical Council.

Despite MoH commitment to the promotion of a healthy population and a well-financed health

system, maintenance of health infrastructure remains a challenge and the non-communicable disease

burden in Fiji continues to grow (WPRO Fiji 2008 CHIPs).

Workforce Data

Table 1a on the following page describes the distribution of the health workforce and number of

vacancies by occupation. Gender specific and age specific data is unavailable. Vacancy rates vary

widely across occupational categories, with the highest evident in the Health Management category

(21%, n=70) and the lowest amongst Environmental Health Workers (0.8%, n=1).



Table 1a. Distribution of health workforce and number of vacancies by occupation

Occupation Number

filled

positions

vacancies

(%)

positions

available

Physicians 372 24 (6.1%) 396

Nursing and Midwifery Personnel 1957 147 (7.0%) 2104

Dentists and Dental technicians/assistants 171 30 (14.9%) 201

Pharmacists and Pharmaceutical technicians/assistants 76 8 (9.5%) 84

Laboratory scientists - - -

Laboratory technicians/assistants 125 9 (6.7%) 134

Radiographers (incl. x-ray technicians) 56 9 (13.8%) 65

Environmental Health Workers 118 1 (0.8%) 119

Public Health Workers - - -

Community health workers - - -

Medical Assistants - - -

Personal Care Workers - - -

Other health workers (incl. social welfare, domestic, bio-

medical technicians, OT, physio and dieticians)

124 21 (14.5%) 145

Health management workers (Exec., IT, Admin, Finance etc) 264 70 (21.0%) 334

TOTAL 3263 319 (8.9%) 3582


Medical, nursing and allied health professionals employed by the public sector in Fiji are eligible for a

„country allowance‟ if they work in a rural area. Doctors are also offered an on-call allowance if they

work in a rural or remote area. In these locations housing is also provided. Public and private sector

doctors are allowed to undertake locum work, with some doing up to 20 hours per week in hospitals.

One of the most significant issues facing Fiji‟s health workforce is the emigration of skilled health

professionals from the public sector to the private sector, tourism operations or other countries in the

region. The Ministry of Health has developed a strategic plan focussed on retention strategies to

(S.Tagilaga, 2005).


The Fiji Medical Council regulates all doctors and dental officers who work in-country. The Nurses,

Midwives and Nurse Practitioners Board deals with nursing registration, under the Nurses and

Midwives Act (1982). The Nurses Board provides a framework of practice, but this is not legally

binding. Allied health workers have their own individual association which functions like a union, and

are not covered by any legislation. A bill to support the registration of pharmacists, the Pharmacy

Professions Bill (2006), has been drafted, but is yet to be endorsed by Cabinet. Laboratory technicians

and other support personnel have a Code of Conduct from the Public Service Commission, whilst

traditional practitioners are not governed by any legislation.

Planning

Fiji has a National Health Workforce Plan - 1997-2012. The plan is yet to be fully implemented due

to resource constraints and has been under review for some time. The Ministry of Health's National



Strategic Plan 2007-2011 has a specific theme on the retention of skilled workforce with calls for the

“Development and retention of a valued, committed and skilled workforce to enhance the delivery of

quality health services” (2007). The MoH meets regularly with other Ministries - Health and Finance

meet around June each year to plan the following year's budget. The Corporate Services Division

meets with the MoH‟s Deputy Secretary, the Public Service Commission and Finance, specifically

regarding HRH.


WHO support to the Ministry of Health in developing biennial budgets. In the latest round, the

Ministry has requested technical assistance in the development of policy, staffing, planning, etc.

Clinical training - Several Medical officers and nurses are currently training overseas - some are

studying paediatrics with AusAID support, some are undergoing management training with Korean

assistance.


Fiji is a major regional training provider in the South Pacific, helping to meet not only its own human

resource training needs but also those of its neighbours. Nurses are trained locally at either the Fiji

School of Nursing (a government institution which offers a three-year diploma program) or the

Sangam Nurse Training School (which produced its first cohort of 48 graduates last year). In addition,

nurses can complete a Bachelor‟s or Masters Degree through James Cook University. Midwives also

train through the Nursing School, as well as in Tonga and Western Samoa. Many NGOs provide

assistance for community health worker training and the MoH trains village health workers.

Undergraduate training for medical officers is offered at the Fiji School of Medicine (FSMed), which

also provides instruction for dieticians, physiotherapists, laboratory technicians and radiographers. In

May 2009 the FSMed will undertake a regional consultation and needs analysis process with various

stakeholder groups. The Umanand Prasad School of Medicine at the University of Fiji is based in

Lautoka and is in the second year of offering a six year undergraduate entry medical program. Its first

intake in 2008 was 40 students. The MBBS course is based on a traditional curriculum with the pre

clinical sciences taught in the early years before moving onto the clinical sciences in the latter years of

the program. The main teaching hospital is Lautoka Hospital which had previously been a FSMed

teaching hospital. All students in the program have been offered scholarships by the Fiji Government.

Information on other local training programs for Community Health Workers, Public Health Officers,

Nurse Assistants is unavailable.

Sources of Data

Workforce data was sourced from the Health Planning and Infrastructure Development department,

Fiji Ministry of Health. Gender and age-specific was unavailable at the time of collection. Information

on planning, legislation, professional registration and training was collected via telephone interview,

with follow-up information via email Demographic and economic data was sourced from the DFAT

and AusAID Country Information websites [March 11 2009]. Health situation and system information

was obtained from the WPRO CHIPS 2008 Fiji profile, accessed at

http://www.wpro.who.int/countries/2008/fij/national_health_priorities.htm

Fiji Medical and Dental Practitioners Act 1978 accessed Pacific Islands Legal Information Institute on

20 March 2009 at http://www.paclii.org/fj/legis/consol_act/madpa281/ Fiji Nurses and Midwifes Act

(amended 1982) was also accessed at PacLII http://www.paclii.org/fj/legis/consol_act/nama223/

http://www.wpro.who.int/countries/2008/fij/national_health_priorities.htmhttp://www.paclii.org/fj/legis/consol_act/madpa281/http://www.paclii.org/fj/legis/consol_act/nama223/



Kiribati

Kiribati is composed of three island groups in the Pacific Ocean that straddle the Equator. It is made

up of 33 mostly low-lying coral atolls surrounded by extensive reefs, of which 21 are inhabited. The

low level of some of the islands makes them sensitive to changes in sea level and vulnerable to

cyclones. Kiribati gained its independence from the UK in 1970 and is now governed by a 46-seat

unicameral parliament. In July 2008, Kiribati‟s population was estimated at around 110 000, 99% of

them Micronesian with a median age 20.6 years and life expectancy of about 63 years. Kiribati has

few natural resources and is one of the least developed Pacific Islands, with GDP per capita estimated

at $3700 per person (2008). Economic development is constrained by a shortage of skilled workers,

weak infrastructure and remoteness from international markets. Private sector initiatives and a

financial sector are in their early stages. Foreign financial aid from the EU, UK, US, Japan, Australia,

New Zealand, Canada, UN agencies and Taiwan accounts for 20-25% of GDP. Kiribati receives

around $15 million annually for the government budget from an Australian trust fund and another $5

million as remittances for seamen on merchant ships abroad. Kiribati is still categorised as a Least

Developed Country (LDC) by the UNDP.

Kiribati has a well-established health system - a national referral hospital in South Tarawa, a surgical

and maternity level hospital on Kiritimati Island and two smaller basic hospitals, followed by a

primary health care network that consists of 92 health centres of varying capacity and usually headed

by a medical assistant/nurse. There has been a steady improvement in key health indicators over the

last decade, however the country faces the double burden of disease, with high rates of communicable

disease (especially TB and diarrhoeal disease) accompanied by increasing rates of non-communicable

disease. A parallel traditional health system exists offered by traditional healers, providing pregnancy

and childbirth services, local medicines and massage. Most of the population use both formal and

traditional health services.

Workforce Data

Table 1. Details the distribution of the health workforce by occupation for the year 2008. Gender and

age specific data was unavailable.

Table 1 Distribution of health workforce by occupation 2008

Occupation Number of staff

Physicians 25

Nurses and Midwives (Health Assistants incl.) 361

Dentists and technicians 18

Pharmacists and technicians 22

Environmental & public health workers (health promotion) 13

Laboratory technicians 27

Other health workers 34

Community health workers 0

Administrative and support staff 32

Nursing School staff (lecturers etc) 20

TOTAL 552




Data not reported/unavailable


The Kiribati Medical Council and Nursing Council act as controlling authorities for the registration

and discipline of medical practitioners; dentist; nurses and members of para-medical services, and for

connected purposes. The principle objective of this Act is to enact one comprehensive Medical

Services Act which governs and controls all medical services in Kiribati.

Planning

The Ministry of Health works within a comprehensive framework for policies, plans and legislation,

the implementation and enforcement of which is variable. The Government has introduced an annual

performance-based planning process that requires all line ministries to develop annual output-based

operational plans known as Ministry Operational Plans (MOPs).

The strategic objectives set out in the national Development Plan for the period 2008-2011 guide the

formulation of the Ministry of health‟s annual operational plans. The overall goal of the Ministry of

Health, as stated in the National Development Plan 2004-2007, is “Continuous improvement in the

provision and delivery of preventative and curative health services and equitable distribution of the

benefits attained nationwide through effective and efficient allocation of scarce resources and good

governance (accountability and transparency)”. The Ministry is in the process of completing its sector

wide plan for the period 2008 to 2011) to focus its attention and coordinate donor support to achieve

this goal.


The Ministry of Health receives significant technical and financial support from development

partners.

WHO provides funding and technical support to: epidemic alert and response; HIV care and

treatment; health promotion, including tobacco control; environmental health; essential health

technologies and medicines; health information; and health system development.

UNFPA supports reproductive health activities and UNICEF supports the expanded programme on

immunization, nutrition and infant feeding, and IMCI. The South Pacific Community supports the

control of tuberculosis, HIV/STIs, noncommunicable diseases, disease surveillance and pandemic

preparedness. Considerable support is also provided by the Australian Agency for International

Development, the New Zealand Agency for International Development, and the governments of Cuba

and Taiwan (China).

Like other countries in Oceania, Kiribati is a beneficiary of Cuban medical aid and resources. There

are currently sixteen doctors providing specialised medical care in Kiribati, with sixteen more

scheduled to join them [1]

. Cubans have also offered training to I-Kiribati doctors [2]

. Cuban doctors

have reportedly provided a dramatic improvement to the field of medical care in Kiribati, reducing the

child mortality rate in the country by 80%.[3]

As of September 2008, twenty I-Kiribati were studying medicine in Cuba, their expenses paid for by

Cuba, and more may join them as Cuba increases the number of scholarships provided to Pacific

Islander medical students.[4]

http://en.wikipedia.org/wiki/Kiribati%E2%80%93Cuba_relations#cite_note-0http://en.wikipedia.org/wiki/Kiribati%E2%80%93Cuba_relations#cite_note-1http://en.wikipedia.org/wiki/Kiribati%E2%80%93Cuba_relations#cite_note-2http://en.wikipedia.org/wiki/Kiribati%E2%80%93Cuba_relations#cite_note-3



Kiribati-Australia Nursing Initiative (KANI)

The KANI is a 5-year pilot, Australian Government Funded, program designed to contribute to

Kiribati government‟s effort to address rapid growing population, urbanization and youth

unemployment through emigration of skilled labour and advancement of nursing care services.

The objectives of the KANI therefore is to:

Educate and skill the I-Kiribati youth to gain Australian and International employment in the

nursing sector

Upgrade nursing education in Kiribati to reduce the cost and period required to gain

internationally accepted qualification offshore

The European Union (EU) has allocated Euro 8.8 million for the project “Improvement of Health

Services on the Outer Islands” The grant is divided into two parts. Euro 7.7 million is to be provided

through FSM for the KIR-EU Health Project. An amount of Euro 880,000 has also been allocated to

Non-State Actors (NSA) and will be managed through the Kiribati Association of NGOs (KANGO).

The overall objective of the Project is to improve the living conditions on the Outer Gilbert Islands

(OGI) in a sustainable manner, through increased access to primary health care (PHC). The Project

purpose is to provide Kiribati inhabitants, in the OGI, with improved quality of PHC services with a

view to increasing acceptance and utilization of health facilities.


The Ministry of Health has a workforce training plan to guide the awarding of overseas fellowships,

but there is not systematic process in place to ensure the ongoing competency of health workers, and

no routine clinical supervision or support. Absenteeism and attrition is through to impact on

productivity, and staff motivation is reported to be a human resource management problem.

The nursing staff in Kiribati has lately received training in priority areas as identified by a situation

analysis conducted on serving staff and sanctioned by the Ministry of Health & Medical Services

through funding of the Health Improvement project by the European Union. The training is provided

by the Fiji School of Medicine and the University of the South Pacific as well as locally facilitated

ones as detailed below:

IMCI

Post basic Public Health

Post basic Midwifery

Fiji School of Medicine

RHTP

Primary Trauma Care

Health Service Management

Post Graduate Certificate in Health Service Management

Post Graduate Diploma in Public Health

University of the South Pacific

Post Graduate Certificate in Tertiary Teaching



Sources of Data

Demographic and economic information was sourced from DFAT and AusAID Country Profiles.

Kiribati health system and disease burden information is sourced from WPRO CHIPS 2008 for

Kiribati, accessed at http://www.wpro.who.int/countries/2008/kir/national_health_priorities.htm

1. "Six More Cuban Physicians To Serve In Kiribati”, Pacific Magazine, October 1, 2007 2. "Kiribati discusses medical training with Cuba,” Radio New Zealand International, September 6, 2006 3. "Cuban doctors reduce Kiribati infant mortality rate by 80 percent", Radio New Zealand International,

July 19, 2008

4. "Small Island States and Global Challenges", Cuban News Agency, September 30, 2008

http://www.wpro.who.int/countries/2008/kir/national_health_priorities.htmhttp://www.pacificmagazine.net/news/2007/10/01/six-more-cuban-physicians-to-serve-in-kiribatihttp://www.rnzi.com/pages/news.php?op=read&id=26617http://www.rnzi.com/pages/news.php?op=read&id=33793http://www.cubanews.ain.cu/2008/0929especialnusa.htm



Nauru

Nauru is a single-island nation with an estimated population of 13 770 (July 2008). Fifty eight per

cent are Nauruan. The country gained independence in 1968 following a period of rule under a UN

trusteeship. Nauru‟s primary export is phosphate but these deposits are now significantly depleted,

and maybe completely exhausted by 2010. Most commodities are imported, mainly from Australia.

Income from phosphate mining is directed to the country‟s trust funds, which were established as a

means of anticipating and managing the predicted decline in mining. These funds however have now

been heavily drawn down. As a result the government has been forced to freeze wages and reduce

public service staffing. Nauru lost further revenue in 2008 with the closure of Australia‟s refugee

processing centre, making it heavily dependent on imports and foreign aid.

The decline in Nauru‟s economy over the past 15 years has had a impact on population health. The

Nauru National Development Strategy (2005-2025) states that:

Decreasing financial resources has led to a sharp drop in the provision of basic health services.

Policies, programs and projects are inadequate and regulations are largely ineffective. Limited

programs to prevent malnutrition exist and implementation is weak. There are limited standards and

epidemiological information available. Limited funding is available for preventative and curative

services. Public resources do not achieve intended goals; especially community education. A growing

proportion of the population cannot afford the financial burdens of illnesses including the care of

women and children. (p. 19)

Nauru is reported to have the poorest health indicators for NCDs (cardiovascular disease, diabetes,

cancer and respiratory diseases) in the Pacific region. Other health-related development priorities for

Nauru are stated as the provision of a reliable supply of clean water, governance and policy reforms,

and improved human resource development. The key vehicle for health care service delivery remains

the Nauru General Hospital.

Workforce Data

Gender disaggregated data for Nauru, dated 2009, is available and provided below.



Table 1.a. Distribution of health workforce occupation by gender and number of non-nationals

Occupation Number

male female total non-nationals

Physicians 9 1 10 9


Dentists 1 - 1 1

Dental technicians/assistants 2 - 2 -

Pharmacists - - 0 -

Pharmaceutical technicians/assistants 4 3 7 -

Laboratory scientists - - 0 -

Laboratory technicians/assistants 2 3 5 -


Environmental Health Workers 5 - 5 1

Public Health Workers 2 3 5 -

Community health workers - - 3 -

Medical Assistants - - - -




TOTAL 43 124 170 24

The workforce data for Nauru demonstrates a reliance on highly skilled staff from other countries.

This includes physicians, radiographers, dentists and pharmacists. These non-nationals are

predominantly from Fiji, Tuvalu, Tonga and Burma. There have been long-term difficulties filling the

pharmacist position on Nauru. In contrast most nurses and health management workers are Nauruan.

The workforce is predominantly female.


Occupation Number




Dentists 4 0 4 0


Pharmacists 1 0 1 1












Occupation Number




TOTAL 95 205 300 21

The majority of nurses, physicians, laboratory workers and health management workers are in the

middle age bracket, while the radiographers are both recently qualified. Despite the number of

unreported ages 45% of staff across all groups are aged between 30-49 years. The recorded vacancies

in the health workforce in March 2009 included four physicians, one dentist, three pharmacists, four

health management workers and four other health workers. No nursing or midwifery personnel

positions are currently vacant.


The Nauruan MoH reported that expatriate health professionals (doctors, nurses and allied health

staff) are on a higher salary scale than other expatriates in other departments, and are paid tax-free.

Housing and electricity are provided free of charge.


Medical officers (in 1999), nurses and midwives (in 2000) and pharmacists (in 2001) are all registered

under the Health Practitioners Act of Nauru (1999). The Republic of Nauru Health Practitioners

Registration Board is appointed and approved by Cabinet. No other health professions are required to

be registered. No scopes of practice currently exist; however the Ministry of Health is at the moment

drafting its first: a National Nursing Scope of Practice. Locally-trained Nurse Aides and District

Public Health Officers have a competency-based assessment.

Planning

The following HRH plans are used by the Ministry of Health:

Nauru Workforce Planning Report, June 2004, prepared by AusHealth International, July

2004 and companion Workforce Implementation Report, August 2008

Nauru National Sustainable Development Strategy (NNSDS) 2005-2015

MoH Organisational Reform Report, October 2008

The Ministry of Health meets regularly with the Department of Finance and international

donors, however not all these meetings are formal events. A report regarding staff training is

delivered to the donor agencies on a three-monthly basis


AusAID is the key donor partner to Nauru who currently support undergraduate training for Nauruans

in the region. This includes:

Undergraduate regional training support at USP in Preliminary (nursing) and Foundational

(laboratory, dental, pharmacy) courses. Five nursing trainees (three-year training) are

currently studying at the Kiribati School of Nursing (KSoN), and midwifery trainees are

studying at the Fiji School Nursing (FSoN)



Australian Regional Development Scholarships, there are currently four Nauruan recipients in

nursing (three-year training at FSoN) one in radiologist (three- year training,) and one for

medicine (six-year training in FSMed).


There are two cadres in the health sector trained locally on Nauru. They are:

Nurse Aides – this is a hospital-based in-country training program which includes classroom

session to complete 16 modules, self-learning packages, lectures, clinical competency

assessment and written assessment. This is AusAID-funded. Nurse Aides who wish to

continue further training at a regional Nursing School must apply to enter the University of

the South Pacific centre (in Nauru) to complete Preliminary Courses first. Both AusAID and

the Government of Nauru fund this training.

District Public Health Workers - a similar in-country training program, combining lectures,

self-learning packages, competency assessment and written assessment AusAID-funded.

Funding support for Nauruan trainees either comes from the Government of Nauru itself, or

WHO or AusAID.

Sources of Data

Descriptive data contained in this map is based on email responses provided by the Nauruan Ministry

of Health. The Republic of Nauru Health Practitioners Act (1999) can be found online at PacLII:

http://www.paclii.org/nr/legis/num_act/hpa1999223/

http://www.paclii.org/nr/legis/num_act/hpa1999223/



Niue

Niue is one of the world‟s largest coral islands. The population of the island has fallen from a peak of

5200 in 1966 to an estimated 1444 in 2008. There is substantial emigration to New Zealand, 2400 km

to the southwest. Niue is a self-governing parliamentary democracy in free association with New

Zealand. Its citizens also hold New Zealand passports. The economy is based on tourism, agriculture

and light industry involving the processing of passion fruit, lime oil, honey, and coconut cream.

Grants from New Zealand are used to pay wages to public employees. Economic aid from New

Zealand in 2002 was US$2.6 million. Niue suffered a devastating cyclone in January 2004, which

decimated nascent economic programs. While in the process of rebuilding, Niue has been dependent

on foreign aid. Despite the difficult financial situation of the Niue government, the GDP per capita is

quite high – US$5800 (2003 estimate) – literacy is 100% and the population health situation is

indicative of a developed country.

National health priorities are focused on public health prevention strategies to reduce risk factors

associated with causes of morbidity/mortality and lifestyle diseases. Niue's estimated total health

expenditure in 2006 was US$ 1.9 million, with per capita total health expenditure of US$974. The

major health service facility is the new Niue Foou Hospital, rebuilt with NZAID, European Union and

WHO support in 2005 following the cyclone. Most of the health workforce is based at this facility

with regular village visits made by community health nurses and public health officers. (WPRO

CHIPS 2008 Niue).

Workforce Data

As can be seen in table 1.a below the health workforce is made up of predominantly female Niuen

staff.

Table 1.a Distribution of health workforce occupation by gender and number of non-nationals

Occupation Number


Physicians 1 2 3 1

Nursing Personnel 1 13 14 0

Midwifery Personnel 0 2 2 0

Dentists 2 0 2 0


Pharmacists 1 0 1 0










Other health workers/Caregivers 0 7 7 0


TOTAL 12 29 41 2



Table 1.b describes the distribution of the health workforce by age. The majority of the workforce are

over 30 years of age with just over 10% under 30 years.


Occupation Age group (yrs)

Number

0-29 30-49 50+ not spec. Total

Physicians 0 2 1 - 3

Nursing Personnel 4 3 7 - 14

Midwifery Personnel 0 1 1 - 2

Dentists 1 0 1 - 2

Dental technicians/assistants 0 1 1 - 2

Pharmacists 0 1 0 - 1

Pharmaceutical technicians/assistants 0 0 0 - 0

Laboratory scientists 0 0 0 - 0

Laboratory technicians/assistants 0 1 0 - 1

Radiographers 0 0 1 - 1

Environmental Health Workers 0 2 0 - 2

Public Health Workers 0 2 1 - 3

Community health workers 0 0 0 - 0

Medical Assistants 0 0 0 - 0

Personal Care Workers - - - - -

Other health workers 0 4 3 - 7

Health management workers - 2 1 - 3

TOTAL 5 19 17 - 41

Table 2 describes the number of vacancies across the health workforce. The majority of workforce

vacancies fall in the nursing area with other vacancies in specialist areas.

Table 2 Number of vacancies by health workforce occupation group (as at March 2009)

Occupation Number of Vacancies

Physicians 2

Nursing Personnel 5

Midwifery Personnel 2

Dentists 2

Dental technicians/assistants 2

Pharmacists -

Pharmaceutical technicians/assistants 1

Laboratory scientists -

Laboratory technicians/assistants -

Radiographers -

Environmental Health Workers -

Public Health Workers -

Community health workers -

Medical Assistants -

Personal Care Workers -

Other health workers -

Health management workers -

TOTAL 14




No data reported/available.


Niue does not have an authorised Board of Registration for the health professions. All health workers

are registered in the country in which they trained. Neither is there a legislated scope of practice for

health workers. However, as public servants all health workers are covered by the Public Service

Regulations and any individual employment contracts. There are no current occupational standards or

workforce competencies in use in Niue.

Planning

There is a Department Human Resource Plan and Department Corporate Plan and Annual Report that

all incorporate HRH. The National Training Council, which has overall responsibility for national

Human Resources, also has a HRH development plan. There is a Mental Health workforce plan for

health workers still in draft and yet to be finalised; this forms part of the Pacific Mental Health

Network (PIMHNet) work undertaken in 2008. Meetings to plan the yearly budget and other matters

of importance, including training needs, are held approximately twice a year between the Departments

of Health and Finance. Similarly, a meeting between the Director/Manager of Health and the National

Training Council are held 2-3 times a year to discuss departmental training needs.



WHO Fellowships (2009 biennium) – for base-level nursing degree at FSoN numbers of

trainee nurses not stated. One doctor was funded in 2007 to commence post-graduate

anaesthetics training at FSMed.

Republic of China – funding was provided for one trainee in dentistry, commencing training

in 2007 at FSMed.

NZAID – one undergraduate medicine trainee commenced training at Otago University, NZ,

in 2006. One radiographer commenced training at Auckland University, NZ in 2008 (also

supported by the Niue Government). Two nurses also commenced their foundation and

degree program in 2007 in NZ (name of university not stated)


For the following occupations training is provided by senior staff in the relevant section on-the-job:

Nurse Aides and caregivers, Environmental Health Assistants and drivers and staff nurses. The

remainder of the health workforce is trained in the region, primarily in Fiji and New Zealand, as per

the following table. The Health Department was unable to recruit school leavers for training as dental

technicians, laboratory technicians and nursing in 2007-2009, despite funding being available. Low

levels of achievement in science subjects and low numbers of high school students choosing science

are the major factors for trainees not being eligible for nurse training at FSoN.

Sources of Data

Descriptive data was collected via an email questionnaire from the Niue Department of Health.

Demographic and economic data was sourced from the DFAT and AusAID Country Information



websites [15th March 2009]. Health Systems data was retrieved from WHO/WPRO 2008 CHIPs for

Niue available at http://www.wpro.who.int/countries/2008/niu/national_health_priorities.htm

http://www.wpro.who.int/countries/2008/niu/national_health_priorities.htm



Palau

This North Pacific island group consists of about 300 islands ranging from its mountainous main

island, Babelthuap, to low, coral islands fringed by large barrier reefs. Palau has a population of 21

093 people (July 2008 estimate) who are a diverse mix of Palauan (Micronesian with Malayan and

Melanesian admixtures), Filipino, Chinese and other Asian nationalities. Palau ratified a Compact of

Free Association with the US in 1993, bringing independence into law, after three decades as part of

the UN Trust Territory of the Pacific. The Palauan economy consists primarily of tourism, subsistence

agriculture and fishing. The government is the major employer. Financial assistance is provided by

the US. The population has a GDP per capita income of US$8 100 (2008 estimate) which is 50%

higher than that of the Philippines and much of Micronesia, that is a per capita. Plans for expansion in

the tourist sector have been greatly bolstered by the expansion of air travel in the Pacific, the rising

prosperity of leading East Asian countries, and the willingness of foreigners to finance infrastructure

development. Business and tourist arrivals numbered 85 000 in 2007.

A number of key government health priorities have been identified, including addressing the burden

of non-communicable diseases, solid and liquid waste management, human resources in health; and

improvement of legal frameworks for health in Palau. The current health service is centralised on the

Belau National Hospital on Koror. Four community health centres, and several primary healthcare

centres, support this health structure. The transition of the nat

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