A fairer share: resourcing health in Solomon Islands

The Solomon Islands has committed to achieving a stronger, sustainably financed health system that provides Universal Health Coverage (UHC) for all its people. Yet navigating the complexities of health funding is a significant challenge in achieving this. In particular, the interconnected relationships health managers must maintain with other government departments, donors, and development partners who help them with much-needed resources. 

As part of the World Bank’s health team, we have been assisting the Solomon Islands Ministry of Health and Medical Services to put together reliable data and analysis so they are able to make better-informed planning and budgeting decisions. The three pieces of work we reflect on below have also helped the Ministry unravel some of the financing complexities they had previously been facing.

Firstly, to help inform the 2022 budget process, a health sector mapping exercise was carried out with World Bank support to identify how domestic and external funding contributions have previously been used. This helped highlight USD$11.7 million of health-related spending that was funded by development partners not accounted for in the Health Ministry’s financial management systems. Further analysis revealed that only 29 percent of these funds were linked to ministry work plans and budgets, making it difficult for the Ministry to assess the full cost of health resources and activities. This mapping exercise has provided a compelling overview of the complex nature of the Solomon Islands’ health financing structure and is helping the ministry work towards a funding model that is more sustainable in the long term.

Secondly, a budget expenditure trend analysis was undertaken to study how public health funding had been allocated and spent in the past. This helped identify budget lines that were likely to become pressure points in the future. One significant observation that emerged was that the Solomon Islands Government has been increasingly taking on full budgeting responsibility for medicine purchasing. In 2013, 73 percent of the medicine purchased for the National Medical Stores were paid for by external funding sources, whereas in 2021, all purchases have been funded domestically. This reflects the strong work done by the Solomon Islands Government in recent years to assume responsibility for funding core health services. However, the analysis also showed that the transport and freight of medicines were still predominantly funded through external development partners. This leaves the drug supply chain vulnerable to the risk of sudden external funding changes in the future. Both insights helped highlight budgetary allocation decisions that need careful consideration in future years.

And finally, the Ministry of Health requested analysis to look at options for evaluating how provincial health grants could be allocated in an equitable way, with the Provincial resource allocation analysis evaluating two options for the Ministry’s team to consider. The outcome was that health officials were able to draw on evidence-based analysis to inform their decision-making for provincial health budgets.

Results from the work have been noticed by the Ministry of Health and Medical Services (MHMS) through direct improvements to budgeting processes and decision making.

“The work supported by the World Bank has added value to the decision making of [the]Ministry team,” said Dr. Lazarus Neko, Deputy Secretary of Corporate Services within the MHMS. “As a result, our budgets have been submitted on time, there has been a fair allocation of funds across provinces and divisions where funding is really needed, and the allocations have been based on clear evidence.”

Providing health care across the Solomon Islands is a challenge, and the COVID-19 pandemic has helped highlight the need for a well-informed and well-resourced health system. This analysis work has helped develop a deeper understanding of some of the ways that the current system can be strengthened to ensure the resources that are available get to the people who need them most.  

This work was supported by the Australian Government, through the World Bank-managed Advance Universal Health Coverage Multi-Donor Trust Fund. This fund aims to drive the more equitable expansion of Universal Health Coverage in the Solomon Islands and 12 other countries across East Asia and the Pacific. It is funded primarily by the Australian Government, in collaboration with GAVI, The Global Fund, and the Bill and Melinda Gates Foundation.