Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1696590783421.pdf (Vanuatu)
GOUVERNEMENT DE LA REPUBLIQUE DE VANUATU MINISTERE DE LA SANTE GOVERNMENT OF THE REPUBLIC OF VANUATU MINISTRY OF HEALTH MINISTRY OF HEALTH POLICIES November 2016 (Reviewed) Preface Dear Colleagues, As Minister responsible for Health I have great privilege to comment this document to you as the Vanuatu National Policy for the Ministry of Health This is a great stepping stone for the Ministry of Health to come up with its first ever major National Policy document for the Ministry of Health.
In the past the Ministry had no policies of its own and relied heavily on the ratifying international treaties as the basis of providing services delivery for the nation.

This policy that is now before you has been well planned out through a services of consultation with stakeholders by conducting phase mode with individuals, conducting workshops and conferences in identifying health areas that would need policy guidelines.
The challenge now is for the Ministry of Health to implement these health policies as the way forward for improving health services in Vanuatu.

The Ministry looks forward to every individual to play its role in ensuring that these policies are well implemented so that together we can all improve the health services of this nation so that Vanuatu in the future will be able to have a better healthier and prospective future.
With these remarks, I have the honor to comment this Vanuatu National Policy for the Ministry of Health for your pursual The Honorable Mr. Donald Kalpokas Masikevanua Minister of Health Dated: 22 June 2002 CONTENT 1 - Community Based Public Health Management 2 - Patient Rights 3 - Devolution 4 - Equity 5 - Health Services Board 6 - Minimum standards 7 - Human Resource Development 8 - Legislative issues 9 - Planning and development 10 - Private health practices 11 - International commitment 12 - Drug use 13 - Financial resource allocation 1 4 - Environmental health 1 5 - Revenue measures MINISTRY OF HEALTH POLICIES POLICY TITLE: COMMUNITY BASED PUBLIC HEALTH MANAGEMENT BACKGROUND Health is a state of complete physical, mental and social wellbeing and not merely the absence of diseases or infirmity.
It is also the science and art of preventing diseases, prolonging life and promoting health through the organized effort of society (WHO statement) Community based Public Health Management aims to protect and promote the health of the people of Vanuatu.
The public health system in Vanuatu addresses the following priorities: Family Health (EPI, Reproductive Health, Non Communicable Diseases, STI, TB, Leprosy, Nutrition, ARI, CDD) Environmental Health, Health standards and health inspection, malaria and vector borne diseases, health promotion and oral health.
The concepts is to prevent the population from diseases through community mobilization programs to improve individual and collective responsibility for good health Policy principles The Ministry of Health recognizes it’s responsibilities to implementing community based public health policies and program which:  Promote leadership at community level  Ensure sufficient dissemination of information and mobilization at community level   Promote integration and coordination of appropriate programs among relevant stake holders at all Improve social mobilization skills of health staff and community leaders levels  Have mechanisms for consultation in the development of health programs between the ministry of health and non government organizations  Ensure administration and logistics are in place to support health program implementation  Provide organization structure that promote clear channels of communication  Strengthen supervision management  Promote capacity building for health staff and community level in project management and planning Involve better coordination and support (financial and administrative) from provincial councils   Ensure adequate numbers of staff at Health Centers and dispensaries  Provide adequate accommodation /facilities for health staff POLICY STATEMENTS The Ministry of Health will:  Organize community education programs based on community level education, social mobilization and community leaders capacity building to facilitate active community participation, community management and empowerment, participatory process in the community health program  Consult relevant staff, expert NGOs and target groups to develop an integrating health service delivery plan, manpower and human resources development plan, training and capcity plan, resources distribution and budgeting into a comprehensive business plan consultation and collaboration with NGOs for community health service delivery  Develop standard working procedures for coordination with other agencies (such as provincial councils, NGOs, community leaders)  Design a program that puts more emphasis on capacity building and training (including  curriculum modification) in line with the human resources development policy so that health workers have the skills to carry out the community based health management In consultation with relevant authorities prepare standards for the construction of health facilities (health center, dispensary, aid post) to ensure proper building (including staff house) and minimum equipment requirement POLICY TITLE: PATIENT RIGHTS BACKGROUND In the twenty years of independence the population is gradually becoming more aware of it’s rights in relation to a range of issues that include access to and use of health services facilities POLICY PRINCIPLES The Ministry of Health recognizes it’s responsibilities to protect the privacy of the individual and promote continual quality care and accessibility to it’s services The Ministry of Health is committed to implementing a policy that: improves facilities so that privacy is ensured, implements basic and in service training that addresses issues related to patient privacy, confidentiality, quality care and access are widespread in all health facilities in Vanuatu.
(the causes of these problems range from inadequate space for consultation or care, staff attitudes, staff and community knowledge levels, local kastom and an increasing and more aware population.
The Ministry of Health acknowledges the importance of being able to assure the community health that information will be protected with regards to access by health professionals, health statistics and research officers, consent for access where the citizen is a minor, aims to recognize specific legislation regarding access by police and access by subpoena.
POLICY STATEMENT The Ministry of Health will ensure that, in the execution of any policy, the international declarations that the republic of Vanuatu has signed will be observed.

Should certain aspects of declarations be sensitive in the Vanuatu context, they will be subject to widespread consultation with stakeholders.

The Ministry of Health will implement these policies within the current and future constraints of the government of Vanuatu.
The Ministry of Health will review staff distribution to ensure fairer allocation The Ministry of Health will ensure that appropriate health education conducted by the Ministry will include counseling skills and medico-legal issues The Ministry of Health will increase the provision of security and privacy in consulting and caring patients The Ministry of Health will develop a national standard for patient consent forms The Ministry of Health will consult relevant stakeholders to asses the suitability of sterilization consent and the CEDOW The Ministry of Health recognizes the patients right to refuse or withdraw from treatment but will have due regard to the Public Health Act The Ministry of Health recognizes the importance of patient participation in decision making on any aspects of their care The Ministry of Health will develop a patient care rights charter The Ministry of Health will develop policies regarding the confidentiality of medical records, their care, access, archiving and destruction The Ministry of Health will develop and implement a complaints procedure that includes stakeholders and is available at all levels.
The Ministry of Health will ensure discipline procedures exists at all levels to deal with poor staff attitude POLICY TITLE: DEVOLUTION BACK GROUND The experience of many developed and developing countries has shown to be a positive development in health services delivery.

In the 1960s devolution was first seen as an option for delivery of health services in Vanuatu.
In 1980 the Local Government Act introduced 11 Government councils, and between 1980 and 1994 devolution was discussed at several seminars, but not formally adopted.
In 1994 the Decentralization Act provided for the creation of the present six provinces Definition of devolution “A transfer of authority from a central government or organization to regional governments or administration” In Vanuatu the devolution of authority is developed within the Ministry of Health, except frew cases at urban level POLICY PRINCIPLES The Ministry of Health recognizes that devolution is not taken to mean devolution of powers to provincial government, but devolution of health care services provision (curative, preventive, rehabilitation) to, and the regional health care directorates.
The Ministry is mindful that it should follow the principles of access, equity, and health needs, and rational resource allocation, and where there is potential conflict of interest, the above principle should prevail.
The Ministry resolves that Human Resources Management should be a function devolved to the two regional health care directorates The Ministry agrees to:  Recognize and promote the importance of community involvement in a devolved health service  Emphasize the need to improved referral systems  Require that community and public health integration should be assured at the provincial and community level  Require promotion of supervisory and management skills to strengthen a devolved health care service  Require appropriate training of staff and other stakeholders at all levels within a devolved health care service  Require effective communication between all levels of health care service POLICY STATEMENTS The Ministry of Health resolves to continue, where appropriate, to devolve current centralize health service functions to the hospitals, provincial health offices, health centers, and dispensaries which come under it’s responsibility The Ministry undertakes to devolve centralize health service functions to all areas of Vanuatu in accordance with the principles of access, equity and health needs.
The Ministry resolves to support all developed health service functions with adequate staff, equipment and other resources to allow them to operate effectively The Ministry resolves to continue to improve the patient referral system under a devolved health structure, and shall encourage optimal utilization of health care officers through appropriate referral The Ministry undertakes to devolve over time a significant degree of planning, management and financial responsibility and health service delivery to the southern and northern health care directorates The Ministry resolves to support the process of devolution by providing adequate compensation and benefits to staff wishing to work in non urban locations The Ministry regards community participation as an essential element of devolution of health services (with service integration of aid posts) The Ministry shall develop means to facilitate appropriate involvement of NGOs and other stakeholders in the devolved health service functions The Ministry will promote integration of devolved health service delivery systems.
The Ministry shall promote the vital role of supervision with special emphasis on the role of the community health Manager and the medical officer responsible (provincial health manager) for each province and the establishment of a appropriate network of supervision at all levels of health service provision The Ministry will maintain ongoing support and technical input as appropriate at all levels of health service provision The Ministry shall define and facilitate a broader role for doctors with the service, to include advisory and supervisory responsibility for community health services and shall promote the appropriate use of clinical skills The Ministry will encourage the setting up of health management groups at provincial level, having responsibility for coordination and shall assert the integration of hospital and community based services, strongly promoting a process of integration of involvement in service provision, and a programmed pattern of services.
The composition of the groups shall include the community health and hospital managers and doctor responsible for the province, other provincial officers as appropriate, and representation from the local population groups The Ministry shall clarify the role of nurse practitioners (and other cadres of staff as appropriate) particularly in the relation to community and hospital based services The Ministry shall encourage the integration of provincial hospitals as providers of community health care, and of secondary and referral/specialist services as appropriate The Ministry shall undertake a comprehensive programme for all staff to explain and promote effective devolution of health services The Ministry shall undertake a comprehensive programme for local populations, to explain and promote effective devolution of health services The Ministry shall establish means for the evaluation and assessment of all activities directed toward devolution of health services as outlined POLICY TITLE: EQUITY BACK GROUND Both the public service Act and staff manual both emphasis implementing equity in the work place and the MOH is committed to implementing these instruments with in the Ministry Investigations on staff anomalies in 1999 revealed many situations where corrective equity measures where needed (eg.. daily rated nurses, industrial unrest and threats of industrial action) and many of these corrective measures where implemented during 1999 and 2000 In September 1999 the MOH endorsed for implementation a set of Equity Guidelines Despite the above initiatives, much remains to be done and this policy seeks to guide future work in the implementation of equity and the valuing of health personnel POLICY PRINCIPLES The Ministry of Health is committed to :  Eliminating all forms discrimination of staff in the work place based on age, sex, race, place of origin, geographical location – urban/rural, cultural, language, physical, intellectual or psychological disability, industrial activity, political beliefs or activities, religious belief or activity, sexual preference, pregnancy, status as parent or care/family responsibilities or by personal association with anyone who has any of these characteristics Implementing proper merit based selection procedures using job related criteria   Developing proper career paths for health work categories  Building and maintaining positive staff relations based on good work places  Good governance, transparency and openness  Building a productive workplace through being a Good Employer and consulting with staff on employment related matters  Developing and implementing MOH code of ethics POLICY TITLE: HEALTH SERVICE BOARD BACK GROUND The Ministry of health is managed as a government organization accountable to the Parliament utilizing the normal mechanisms of government.
These have included the employment of all staff as public servants under the public service commission and the management of the Ministries financed by the Ministry of Finance and Economic Management.
While these arrangements have enabled the Ministry of Health to function at the basic level, in practice they inhibit the special needs of the Ministry to deliver efficient health services The Ministry believes that the health needs of the people of Vanuatu will be better met if the Ministry resources are managed under a Health Service Board (HSB).
Correctly formulated, a Health Service Board encourages more efficient and decentralized decision-making and resource management at the level where services are being delivered.

These factors are a prerequisite to an important health service delivery POLICY PRINCIPLES The Ministry recognize it’s responsibility under the CRP program and belives that these will be better implemented through HSB.
These responsibilities are to: Improve service delivery   Make provision for adequate resource  Ensure equity in service delivery  Be responsive in service delivery  Be responsible for human resource management and human resource development (eg..recruitment, discipline and training) The Ministry notes that HSB will encourage more integration and collaboration between public and private sectors and bodies regulating the health profession The Ministry believes that the impact of the establishment of a HSB is consistent with the principles of CRP.
These include improve service delivery to the rural areas and the devolution of decision making to where services are delivered POLICY STATEMENT The Ministry of Health will, in due course and after appropriate consultation, establish a HSB that has the power to directly manage it’s human and other resources, independent from other organs of Government.

However, the Ministry of Health recognize that bot the PSC and the MEFM must maintain an oversight for audit purposes.
In addition the Ministry of Health accepts that any government funded organization must ultimately be accountable to the Parliament of Vanuatu, and arrangement for HSB must preserve the accountability In relation to training, the Ministry recognize the following needs: training for all fields within the Ministry, allocation of appropriate budget for in country training, te need for external training to be in line with the Ministries HRD needs, the need to keep national register of trained personnel in different fields and the need for all training at institutions accredited by the National Training Council be recognized by the Ministry The Ministry further acknowledges that human resource planning and development is essential though only in the development stages here in Vanuatu POLICY STATEMENTS The Ministry will undertake to develop it’s human resources by establishing a Human Resource Development steering body to advance the Policy Principles above The Ministry will encourage in country training overseas training, and distance education POLICY TITLE: LEGISLATIVE ISSUES BACKGROUND Medical issues, services and practices are used to be a service many for free and or in kind for the benefit of customers.
The Ministry recognize that licensing of medical (Health) practices is and has become a means to deliver a service.

The Ministry accepted that medical issues could be addressed in legal manner both in service and practice.

For example Public Health used to be considered as a service based on human need.
The later developed into the concept of Public Health as Right for all, and the development of Legislations and Regulations POLICY PRINCIPLES In the development of health legislations, the Ministry of Health will ensure and encourage broad public consultation and consultations with appropriate medical experts in legislative related matters.
The Ministry of Health notes the importance of the office of the Attorney General in supporting the development of legislations and pledges to consult and collaborate with the office in the drafting or amending of health legislations The Ministry of Health requests that legislative issues be addressed in a standard, acceptable and appropriate administrative manner, such as Boards or Tribunals, as an alternative means to the ombudsman The Ministry of Health undertakes to have policies and procedures to address all priority programs and the following issues which cut across all programs., health promotion, policy, and legislation for health protection, essential drugs, monitoring and evaluation, and staff training.
In relation to priority programs, policies and procedures will include: Non Communicable Diseases: a policy for tobacco control including a legislation within a Tobacco Control Act, standard guidelines for screening and treatment of diabetes, hypertension and asthma, and promotion of local foods/regulation of imported foods in terms of fat content Environmental Health: development of programmes to create, promote and protect a better environment and hygienic conditions to improve health and well being of the people of Vanuatu.
These programmes will be carried out in the following areas: water and sanitation, food safety control, rodent and vector control , and health quarantine The Ministry of Health will work with the Provincial Governments to promote the training of village sanitarians and to provide them with adequate resources Oral Health: strengthening and enhancing oral health programmes in schools, strongly encouraging the use of fluoride toothpaste, discouraging the sale of sweets and soft drinks in schools, and providing a rural oral health program to ensure equity of access to oral health services Reproductive health: in addition to regular maternal and child health activities, the following new priority areas will be included: domestic violence, women’s health, adolescent reproductive health, training of staff/community and NGO partners, promoting awareness of reproductive health, ensuring adequate supplies, strengthening management capability, involvement of men in reproductive health, minimum training standards for traditional birth attendants, and resource (materials, technical skills, management capability)collaboration with NGOs and the private sector Communicable Diseases: policies and procedures to address communicable diseases which pose a threat to pubic health, including those infectious diseases which are notifiable under the Public Health Act, and procedures for responding to outbreaks of communicable diseases Preventable Cancers: a cancer control policy aimed at reducing the occurrence, morbidity and mortality of preventable cancers The Ministry of Health will also amend it’s current Health Promotion Policy to include: support for health promoting schools, the elements of primary health care and primary eye care The Ministry of Health agrees to develop procedures for public health responses to notifications of infectious diseases received under public health legislations, and to provide information to the community concerning the implementation of public health legislation POLICY TITLE: PLANNING AND DEVELOPMENT BACKGROUND The Ministry has for the past decade embarked on two major 5 years strategic plans.
(National Health Development Plan 1991 – 1996, Second NHDP 1997 – 2001.

These two Strategic plans have paved way as well as were the milestone for major health developments during the two periods.

While planning is basically the decision we make about tomorrow, like policy it a plan or course of action in directing affairs.
This is especially important in managing large organization like health in terms of prioritizing, acquiring and allocating resources POLICY PRINCIPLES The government encourages Ministries, their advisors and other arms of national and local government to be mindful of the need for consultation with the Director General of Health prior to committing the resources of the Ministry.
Moreover, the Ministry notes that unstable government causes a loss of confidence for civil servants, leading to low productivity The Ministry of Health notes that the successful implementation of plans is dependant on a funded budget from the Ministry of Finance and Economic Management.
However, the Ministry of Health also recognizes that the Vanuatu economy impacts greatly on the money supply and this the ability to implement activities in plans The Ministry of Health is committed to implementing a Human Resource Development Plan to ensure integrated support for Corporate and Business Plans The Ministry of Health resolves to undertake the implementation of three year corporate plans and one year business plans.
Moreover the Ministry pledges to provide feedback to stakeholders on the results of the evaluation and monitoring of plans, as well as to disseminate appropriate reports and other information The Ministry of Health is mindful of the importance of planning in cycles within the Ministry of Finance and the Department of Strategic and Economic Management, and agrees to integrate these cycles into the preparation of plans As resources for health services are limited, the Ministry of Health will ensure that activities in plans are prioritized to reflect the health needs of the people of Vanuatu The Ministry of Health notes that it is desirable for all donor activity to be identified within corporate and Business Plans .
To this end, the Ministry of Health resolves to establish a due process in relation to GIP procedures NGO activities in the health field are acknowledged and appreciated by the Ministry of health.

To enhance the effectiveness of these services the Ministry believes that NGO activities should be monitored and evaluated in collaboration with the Ministry.
The Ministry of Health appreciate to carrying out integrated public health programmes in the following priority areas: non communicable diseases, environmental health, oral health, communicable and vector borne diseases, cancer, the Expanded Program of Immunization, Reproductive Health.
Reproductive Health includes the following components: Maternal Child Health, Family Planning and Sexual Health POLICY STATEMENTS The Ministry of Health is mindful that the Parliament of Vanuatu makes policy decisions for the benefit of it’s people.
In the preparation of policies, the Ministry recognize the importance of the due process of decision making by the government and the need for legislative provisions to implement some policies The Ministry of Health is committed to the Policy Principles of this document, and will ensure that plans, policies and structures of the Ministry are kept intact for an adequate period unless changes are absolutely necessary.
In the preparation and implementation of policies and plans, the Ministry of Health pledges to undertake adequate consultation with all stakeholders to ensure ownership in the implementation of plans The Ministry of Health endorses the principles of inter-sectoral collaboration in the delivery of all health policy.
At all levels of public health activity, the Ministry of Health undertakes to consult with other relevant Government Ministries, provincial Government and Municipalities, local, national and international non government agencies and community organizations In implementing public health legislation the Ministry of Health recognizes the duties and responsabilities of all levels of health staffs and sectors The Ministry of health further recognize the need to empower people to take active roles in the implementation of health legislations and associated programmes POLICY STATEMENTS The Ministry of Health, as a government organization recognize its responsibility to implement health legislation and affirms its commitment to improve legislation to benefit the health of the people of Vanuatu Moreover the Ministry of health resolves to continue to develop and review health policy, with supporting medical legislation to protect and support the rights of patients and staff and to improve health in Vanuatu The Ministry of Health agrees to delegate relevant authority to other public sectors to implement public health legislation In developing and implementing public health legislation, the Ministry of Health undertakes to consult widely at all levels including with Ministers, Parliamentarians, Provincial councilors, Municipal councilors, health directors and officers, chiefs and other community leaders and members of the public The Ministry of Health will in consultation with stakeholders, consider mechanisms to generate funds to implement public health legislations through self financing The Ministry of Health will ensure that there is fair distribution of funds at all levels to implement public health and other health legislations The Ministry of Health recognizes the role of chiefs in strengthening the roles of Malvatumauri, inclusive of the roles in the National Leadership Code and the Administration of the Public Health Act.
The Ministry of health supports chiefs taking active roles in re directing customary fines into vatu and encourages the establishment of local chief and or community trust funds to support the implementation of public health programs and public health legislation POLICY TITLE: PRIVATE HEATLH PRACTICES BACKGROUND There are existing health practitioners whose practices are generally not controlled or regulated by the Ministry of Health, although private practitioners are regulated to some extend by the Nursing Council and the Health Practitioners Board.
There is an identified demand for private health care POLICY PRINCIPLES The Ministry is mindful that private practices will develop in Vanuatu and pledges to recognize private health practices, monitor and regulate these practices and recognize professionally incorporated medical bodies such as the Ni Vanuatu Doctors Association, Health Practitioners Board, Nurses Association, and the Environmental Health Officers Association The Ministry recognizes the widespread use of traditional medicine and undertakes to allow regulation of this practice at the community level, and promote issues of interaction between traditional and western health practices POLICY STATEMENTS The Ministry of health will:  Survey the current practices, likely future needs and collect baseline monitoring data on private  practice In conjunction with professional interest groups and other relevant stake holders develop a framework for the regulation of private health care practices including the minimum requirements for standards, facilities and fee sharing where appropriate  Require private practitioners to ensuring that continuous monitoring of private practices occurs  Control future openings of private facilities and integrate current private practices into the framework outlined above and,  Clarify the right of health professionals to operate either privately, publicly or both in a way that avoids conflict of interest POLICY TITLE: DRUG USE BACKGROUND There are many problems in the acquisition and supply of drugs including the need to purchase drugs not listed in the essential drugs list, the need from time to time to enable the satisfactory treatment of a patient, and the availability of medicines at health facilities.
Also occasionally discharged patients need to be continued on medication not normally available at their own village facility level and health facilities have more qualified staff who have training for more medicines than are normally available at the facility The Ministry currently has no donations policies for drugs and many donations received in Vanuatu are not appropriate or are useless.

The Central Medical Stores supplies many facilities, some of whom pay and some of whom don’t.
The list needs to be rationalized.
POLICY PRINCIPLES The Ministry recognizes that medical supplies are key to the operations of the Ministry and is committed to rationalize the number, type and way it supplies medicine items The Ministry supports the need to vigorously promoting a drugs donations policy and to prosecute anyone found inappropriately using drug supplies for personal use POLICY STATEMENTS The Ministry of Health will develop and enforce guidelines concerning the purchase of medicines that are not normally available within the essential drugs list, will put the welfare of the patient as a priority and will research alternative methods of payment on cases by case basis The Ministry of health recognizes that under certain situation there is a need for health facilities to have access to extra drugs, but identifies the need for guidelines to be developed and regularly reviewed concerning training, supervision, geography, cost, storage, security and communications The Ministry of Health is committed to the development of a Vanuatu national donations policy to monitor, control and guide the donation of drugs and equipment that come into Vanuatu.
This policy will be rational, flexible and enforceable (legally if necessary) and recognize the needs of both recipient and donor and will encompass regular awareness campaigns The Ministry of health will recognize only the following facility types for supply by CMS and will work with these stakeholders to charge accordingly i) ii) iii) iv) v) vi) Government facilities – free of charge Aid posts within the government plan – free of charge Government sporting events – free of charge Schools that are not near a health facility or have a health facility inside them – payment required Local doctors for dangerous drugs – payment required Charities NGOs and private church facilities – flat rate fee with each order (vary by facility type) The Ministry will review medical item distribution operations on a regular basis and will upgrade the infrastructure and training according to the recommendations made POLICY TITLE: FINANCIAL RESOURCE ALLOCATION BACK GROUND Resource allocation within the publicly funded health sector has largely been based upon historical allocations., staffing appointments, decision on capital spending, donor projects priorities and successful budget initiatives In 2000 a per capita approach has been used to modify recurrent budgets to more equitable levels in community health.
In the past there has been little consideration of the effects of resource allocation to hospitals, except that three be two larger specialist hospitals (also having provincial role) and three smaller provincial hospitals.

These hospitals have grown incrementally over the years, based on a range of decisions relating to perceived acute care needs.
POLICY PRINCIPLES The Ministry regards equal access to the health services for all people of Vanuatu an important human right The Ministry believes that allocating it’s resources based upon recognized health needs, per capita allocation per defined geographical area, and resource technical and geographic limitations, disease pattern will ultimately improve the health of all people in Vanuatu The Ministry recognizes that there are specific geographical areas for community health as well as specialize and provincial hospital services The Ministry believes that it should pursue preventative health practices as a priority in order to create a more effective health system POLICY STATEMENT The Ministry is committed to allocating resources to pursue greater access and equity in the use of health services to respond to recognized health needs and to prioritize preventative and health practices, and to bringing about grater effectiveness in the health system The Ministry will allocate resources taking into account minimum requirements for treatment and care by hospitals, health centers and dispensaries The Ministry will ensure that per capita resource allocation for community health, provincial and specialist hospital service delivery functions should have minimum variation across the provinces of Vanuatu The Ministry will also take into account the disease trend or pattern on allocating resources in order to bring about much greater effectiveness in its service delivery likewise ensuring equity Capital allocations The Ministry will create a separate annual capital budget which provides for purchase, replacement and upgrading of capital assets and that the allocation of capital assets through out the health system should be based upon the need for such assets in operating the health efficiently and effectively The Ministry will ensure that the allocation of capital assets will be accompanied by related allocations of operational funds for adequate repairs and maintenance and normal operating costs of these assets The Ministry will utilize the National Policy and Guidelines for Management of Equipment int eh acquisition of capital assets.
Donors, NGOs and Private Sector The Ministry of Health will establish an internal mechanism to ensure that as much as possible, donor, NGO and private sector health activities comply with the principles and policies of resource allocation as given above Staffing Allocations The Ministry will endeavor to ensure that resources be allocated to improve remuneration and benefits to all staff and provide more incentives to health care specialists and those working in the rural areas The Ministry will make sure that overall staffing costs will not exceed sixty percent of total operational costs in order to ensure adequate operational funding within the Vanuatu health system.
POLICY TITLE: ENVIRONMENTAL HEALTH BACKGROUND The urban environment in Vanuatu is characterized by a rapid population increase due to urban drift, overcrowding in settlements, increasing unemployment, lack of proper water and sanitation services for large segments of the population and growth of new industries POLICY PRINCIPLES The Ministry of Health acknowledges the need for minimum standards in the following areas of Environmental health: Clean water, food, water, solid waste management, hosing, pollution, sanitation, and port health.
The Ministry of Health recognizes that there are special stresses/problems faced by the urban environment including: collection and disposal of large quantities of rubbish, sub-standard housing, water quality, availability of water is not keeping up with population growth, unhygienic conditions of food for sale, industrial pollution, and lack of proper drainage system.
The Ministry recognizes that an Environmental Health Authority of the Ministry establishment is necessary step towards addressing the above issues.

The Ministry of Health further recognizes the in-tersectoral collaboration is essential in the implementation of environmental health programmes.
POLICY STATEMENTS The Ministry of Health undertakes to establish an Environmental Health Authority that with relevant stakeholders develop standards for all Vanuatu in the areas of Clinical waste, food, water, solid waste management, housing, pollution, sanitation and port health The Ministry of Health agrees, in consultation with relevant stakeholders, to develop procedures and protocols for measuring compliance with these standards, develop mechanisms for enforcement., upgrade staff training, and support the further development of legislation to protect the environment and public health POLICY TITLE: REENUE MEASURES BACKGROUND In previous years user fees have been charged in the public funded health sector of Vanuatu.
In recent years, governments have pursued a policy of free health care in Vanuatu., except for inpatient charges, charges made by Health committees and charges for non – citizens.
POLICY PRINCIPLES The Ministry regards movement towards equity in access to health services for all people of Vanuatu an important policy principle and that user fees, if applied, should be in accordance with this principle The Ministry believes that it should pursue preventive health practices as a priority in order to bring about a more effective health system, and that the application of user fees should not hinder such an approach The Ministry believes that health service provision based on health needs of the population is an important policy principle, and that the application of user fees reflects this approach The Ministry believes that the application of user fees should reflect, to some degree, ability to pay, and that generally non-citizens should accordingly pay higher levels of fees.
In certain situation, including hardship, personal tragedy and natural disasters, the Ministry acknowledges the need to waive the charging of user fees The Ministry recognizes that the application of user fees in the health system can only feasibly bring about a minor contribution to meeting overall operational and capital costs, and that contributions by taxation revenue will continue to comprise the major form of government health care financing The Ministry believes that any increase in revenue as a result of user fees or donation raised by the Ministry or Health committees , should either be kept or shared by the Ministry or the relevant committee or reflected in higher approved expenditure budgets allocated to relevant cost centers The Ministry believes that a percentage of revenue raised from taxes on tobacco and alcohol beverages should be allocated to the health sector in order to pay for the treatment costs relating to tobacco and alcohol abuse and to provide health promotion and education to reduce usage It is the Ministries view that a percentage of revenue raised from increase of fines from road safety breaches of the law, including speeding, dangerous driving and drink/driving should partially be allocated to the health sector in order to pay for the treatment cost relating to resultant road trauma and to provide for health promotion and education to reduce read, pedestrian and traffic accidents POLICY STATEMENTS The Ministry resolves that any additional introduction of user fees be accompanied by relevant consultation at various levels, including at community level The Ministry will encourage health facilities to rise funds through health Committees, Boards and to make arrangements for protection of people on low incomes or with low levels of wealth.
The Ministry Executive will approve all significant revenue raising measures and guarantee funds raised are applied to improving health services The Ministry will support other methods of payment.
Where patients are unable to pay user fees in cash, alternative arrangements to pay with fresh quality food of equal value as determined by the Ministry, may be entered into, if food can be utilized effectively by the relevant health facility at that time The Ministry will regularly revise the list of exemptions to user fees, in accordance with changes in disease patterns and other factors The Ministry will ensure that all no citizens pay user fees charged to them immediately on or after treatment by a hospital, health centre or dispensary The Ministry will charge fees relating to licensing of health practitioners The Ministry resolves that fees charged to staff for housing should be returned the Ministry, either as direct revenue or an increase in the relevant expenditure budgets