Action # Action By Whom By When Completion Status 1 GoS to finalise shortfall analysis and submit any request to DPs. MoF To be determined Ongoing 2 The financial and procurement supervision mission would work through the PoW and procurement plan to confirm estimates of the final outputs and any savings from removed or deferred work MoH/DP December 5, 2012 Pending 3 Completion of the evaluation for the Health Care Waste Management truck (due to of bids). MOH/NHS November 15, 2012 Pending 4 Extension of the Biomedical Engineer for NHS. NHS/MOH to revise the TORs and the contract and send a request to the WB for no objection (copying DPs). WB to provide the no objection. NHS/MOH WB November 7, 2012 November 8, 2012 The DPs approval was provided during the Mission. Done and WB no objection provided on 10/31/2012. 5 No Objection on the revised Health Information System (HIS) TORs. DPs/WB November 5, 2012 provided on 11/12/2012. 6 Transition plan for transfer of equipment to new hospital. MOH/NHS November 2012 Pending 7 Maintenance & Operating Plan and budget line item. MOH/NHS March 2013 Ongoing 8 Discussion of new infrastructure and links to PHC program. MOH/DP Ongoing Ongoing 9 Revision to TORs on the HSP and SWAp evaluation would be conducted by the Sector and sent for NOL. MOH/DP November 2012 NoObj provided on 11/15/2012. Action # Action By Whom By When Completion Status 10 AusAID will provide a TA to assist in the situational analysis and other key activities as directed. MOH/AusAid November 15, 2012 Pending 11 The health financing report commissioned by the DPs now be resent to the Ministry of Finance, copied to the Ministry of Health, to finalize prior to dissemination. Pending
Improved maternal and child health Perinatal mortality Rate (Goal: declining rate) 23.9 per 1000 live births (All public health facilities – 2008) 21.7 per 1000 live births (All public health facilities – 2009) Perinatal mortality rate according to DHS 2009 is 37 per 1,000 births Infant Mortality Rate 2006 = 20.4 18.8 per 1000 live births (TTM, MTII & District Hospitals 2011) Source: -PATIS/MOH/NHS -Community Nursing Integrated Services Rural Areas Defn: "Deaths occurring during late pregnancy (at 24 completed weeks gestation and over), during and up to seven completed days of life" Freq: Annual & Defn: “A occurring in the first year of life.” Note: This does not include stillbirths, which should be included in Perinatal Deaths Sourced from all births in public health facilities. Does not include births by TBAs or outside of the public health facilities. Improvements to Sector Wide Health Information System scheduled under SWAP should see 100% coverage of all birth sources by end of Year 5 Current efforts coordinated by the Statistics Bureau to coordinate national births and deaths data will improve coverage. 5yrs
Infant Mortality Rate (IMR) Maternal Mortality Rate (MMR) Infant Mortality Rate 2001 = 19.3 per 1000 live births (Source: National Census Report 2001) 2001 = 0.9 per 1000 live births (Source: TTM, MTII & all public health facilities) per 1000 live births (Source: National Census Report 2006) 2006 = 0 (Source: TTM, MTII & all public health facilities) Infant Mortality Rate 2011 = 15.6 per 1000 live births (Source: National Census Report 2011) 2011 = 0.4 per 1000 live births (Source: TTM, MTII & all public health facilities) Freq: 3-5yrs Defn: The of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Freq: 3-5yrs National Census does not include Perinatal Mortality National Census 2011 did not covere Maternal Universal access to reproductive health services 28.6 annual births per 1000 women aged 38.1 births per 1000 women aged 15-19 yrs (Year 2008 births 26.5 births per 1000 women aged 15-19 yrs (Year 2011 Births @ TTM, MTII & all public health Defn: The adolescent rate measures the annual number of births to women 15 to 19 years of age per Figures are sourced from 2 different information sources- publically funded hospitals (which does
Adolescent birth rate (Goal: declining rate) yrs (Samoa Census 2006) @ public health facilities and age group) Adolescent birth rate 44 per 1,000 women age 15-19 (DHS 2009) facilities- age group Source: -PATIS/MOH/NHS -Community Nursing Integrated Services Areas 39 births per 1000 women aged 15-19yrs (National Census 2011 Report) 1,000 women in that age group. It represents the risk of childbearing among adolescent women 15 to 19 years of age. It is also referred to as the fertility rate for women aged 15-19. Freq: Annual not capture babies born out of public hospitals) and the National Census Reports.
Control of Communicable diseases Incidence of water-and-food borne infections Diarrhoea Typhoid Diarrhoea & Gastroenteritis in <5yr olds presenting to TTM and MTII Hospitals (2008): 1,962 Cases of clinically suspected Typhoid (2008): 771* (Source: Diarrhoea & Gastroenteritis in <5yr olds presenting to TTM and MTII Hospitals (2009): 2,157 Cases of clinically suspected Typhoid (2009): 606 (Source: Diarrhoea & Gastroenteritis in < 5 Yrs old presenting to TTM and MTII Hospitals 2010 = 2,280 Diarrhoea & AGE in children < 2011 for TTM, MTII & all public health facilities= 2056 Source: -PATIS/MOH/NHS -Community Nursing Integrated Services Rural Areas Cases of clinically suspected Typhoid in TTM, MTII & all public health facilities in 2011= 562 Source: -PATIS/MOH/NHS Annual & 3-5yrs Annual Presentations (outpatients/admissions) due to diarrhea and gastroenteritis of all children under 5 yrs old to TTM and MTII hospital; The 2011 figure includes data from the 6 District Hospitals. Cases of clinically diagnosed typhoid diagnosed at TTM, MTII and all rural public health facilities hospitals.
iii Compliance to Sanitation Standards comply with Sanitation Standards from Jan to Jun 2012. Source: Ministry of Health 63% of the lab confirmed typhoid cases were investigated from Jan-June 2012 Source: - Ministry of Health National Laboratory (NHS) 63% of the lab confirmed typhoid cases were investigated from Jan-June 2012 Source: - Ministry of Health National Laboratory (NHS) Leadership) is currently leading the inspections of schools and recommends health issues for improvement to the Cabinet for action The Ministry of Health is still facing with challenges of the typhoid contact tracing implementation.
iv Typhoid Investigation Injury Prevention Injuries in children (under 15yrs) 367 (under 15yrs admission) (TTM & MTII) FY 2008/2009 346 (under 15yrs admissions) (TTM & MTII) FY 2009/2010 310 (under 15 yrs) Admissions to TTM, MTII & all public health facilities 2011 Source: Annual Reports sourced from PATIS. The 2011 figure includes information from the 6 publicly funded District hospitals.
Train of Trainers Programme for three days in April 2008 staffs in Upolu & Savaii (2) availability of colour bins Collection, transportation and disposal also has improved with availability of collection vehicle Still need improvements in most of these areas to maintain/sustain effective collection, coding and disposal of all health care waste especially for services provided outside of public hospitals e.g. private clinics etc… Antenatal care coverage for at least 3 visits 61% of AN mothers seen at TTM had at least 3 visits (2008) Source: 51% at least 3 visits of all antenatal mothers seen at TTM hospital (2009) Source: PATIS DHS 2009: 60% of antenatal mothers at least 3 visits for Antenatal care at TTM, MTII & all public health facilities Source: -PATIS/MOH/NHS -Community Nursing Integrated Services Rural Areas Annual PATIS CHNIS MOH NHS Much work is going into advising mothers
Antenatal care coverage (at one visit) – 92.7 Antenatal care coverage (four visits) – 58.4 of the need to attend antenatal clinics and current efforts for a PHC Facility under SWAp funding at the NHS Motootua Compound will help especially for the growing Apia Urban population. Proportion of Rheumatic Heart Disease (RHD) patients complying with treatment (12/12 months) Compliance to IM Penicillin: 2008 = 84% New RHD 2008 = 55 New ARF: 2008 = 13 Compliance to IM Penicillin: 2009 = 81% New RHD 2009=49 New ARF: 2009 = 17 Compliance to IM Penicillin: 2010 = 86% New RHD 2010 = 117 2011 = 155 New ARF: Annual compliance rates RHD Program Database NHS MOH Figures have increased for new cases captured due to the wider screening programs currently being
Source: Rheumatic Fever Database (NHS) DHS 2009 findings also reveals that RHD is the same across the lowest – highest wealth quintile; but it is common in women between ages 15-49 (0.7) compared to men for the same age group (0.4) 2010 = 21 2011 = 55 Source: Rheumatic Fever Database (NHS) undertaken with funding through the SWAp program. Number of reported drug by facility Not Available March 2012 = 2% stock out from all public health rural facilities March 2012 = 95% availability of essential medicines at all public health facilities at any one time NHS Pharmacy Division Currently putting in place strategies in order to efficiently track stock outages as part of usual key performances indicators for stock management. It is expected that the Health Information system strengthening
Component 3: Baseline UPDATE Frequency and reporting Data collection instruments Responsibility for data collection Staff mix and distribution according to national standards Interim database for HRH for the health sector in place as a starting point in identifying staff gaps by facility and qualification Numbers of APCS issued by the Registrar Healthcare Professionals are as follows: 2012 (Calendar Year) Doctors Employed at: NHS-39; Private Sector-31;OUM-4; MOH-3 Dentists-18 (2 in Private sector, 1 in NGO Clinic, 15 at the NHS) Pharmacists-15 - (8 NHS-7 Private Sector) The staff mix and distribution is based on the national health service demand. The National Health Service , Samoa’s major healthcare service provider bases their staff mix and distribution on service demand at the TTM Hospital, MTII Hospital as well as District Hospitals (3 on Savaii and 3 on Upolu) Due to continuous shortage of doctors and nurses, NHS has contracted the private GPs to assist their workforce in the District Hospitals on a weekly basis. The Integrated Community Health Services at NHS provides staff mix using a multidisciplinary team approach that consists of nurses, doctors, dentists, allied health etc to provide health services in the rural areas. It is a legal requirement that every nurse, doctor, dentist and pharmacist must be registered and hold a Annual Listed Annual Practicing Certificates for each of legally mandated healthcare profession is sourced from the Registrar Healthcare Professionals lists of issued APCs. Ministry of Health and Sector Partners
MOH 3 NS RN-Regsitered Nurse NS- Nurse Specialist including Midwives EN- enrolled Nurse Evidence of performance monitoring leading to policy and regulatory action to improve health services Monitoring and Evaluation Framework developed. All health professions have developed standards to guide and for all to comply with. The Health Sector M&E Framework and Indicators was Officially Launched in Dec 2011. The M&E indicators are divided under 7 long term outcomes based on priority areas of the health sector plan. MOH is responsible with monitoring the implementation of the M&E Operational Manual and update of indicators. All Healthcare Professional standards are in Implementation and compliance Health Sector Plan Corporate Plans Professional Standards MOH
Community Nurses TBAs register Health Expenditure as percentage of total govt. expenditure FY 1998-1999: 16.9% FY 2000-2001: 17.7% FY 2002-2003: 18.1% FY 2004-2005: 16.7% FY 2006-2007: 13.8% FY 2008-2009: 17.4% FY 2009-2010: 12.6% FY 2010-2011: 12.4% FY 2011-2012: 16% Annual GOS Budgets and accounts National Health Accounts MOF (budget estimates) MOH(NHAs) Stakeholders participation in programme planning and implementation reviews Health Sector partners both private and public attended the Health Summit that was held in March 2009. In addition, MOH facilitated the National Health Forum in December 2009 to review the implementation of health reforms, and health sector partners were also involved. Participation of Health Sector partners and stakeholders in programme and planning has very much improved over the years since the launching of the Health Sector Plan The Ministry of Health has been conducting Annual Annual Annual Health Forum Reports Consultation reports MOH & Development Partners
The mid term review of the Health Sector Plan 2008-2018 is in progress. Percentage of SWAp program funds released according to agreed schedule Disbursement as of September 2012 for the SWAp Program 43.9% of total budget not including commitments. Annual MOH Financial Reports GOS, MOH, DPs