Advocacy and social mobilization for safe motherhood have also been strengthened. There is an increasing awareness of the need for improving the quality of care in the provision of MCH services. The main constraints are limited resources and the wide variation in topography, sociocultural behaviour and available health infrastructure between the provinces. Immunization Achievements of the immunization programme have been considerable. The immunization programme is sustainable and is valued by parents and well supported by volunteer health workers.
Funds are mainly from the national budget with only a small fraction of foreign assistance.
The main constraints are the lack of good quality surveillance and budgetary constraints to undertake operational research studies, etc. Prevention and control of locally endemic diseases Partial success has been achieved in the prevention and control of locally endemic diseases. With regard to the directly transmitted diseases, such as pulmonary tuberculosis, leprosy, diarrhoeal diseases, childhood pneumonia and STDs, considerable reduction in cases and deaths, as well as improvements in programme management have been achieved. With regard to vector-borne diseases such as dengue, malaria, filariasis and schistosomiasis, no major improvement has been noted. The incidence of malaria has fluctuated among the islands.