Helping Rural Clinics Work in Solomon Islands

Hayleen Dusaru is the Moli clinic's registered nurse

I recently spent almost a week calf deep in mud, shooting around islands, and speaking to beneficiaries and community helpers of the Solomon Islands Rural Development Program (RDP). The trip was an illuminating and uplifting opportunity to get out into rural areas and meet the people that are experiencing the direct benefits of one of the World Bank’s most dynamic projects within Solomon Islands.

Terms like ‘bottom up approach’ and ‘grass roots focus’ are catch-cries that are often heard but not always followed within development projects. However, spending some time in villages that are controlling the funds and direction of infrastructure projects and seeing clear and sometimes astounding benefits from them reinforces the principle that this program is not offering simple lip-service or superficial checklists of community involvement. This is really what community direction of projects looks like. (The Country Manager in Solomon Islands, Edith Bowles, has blogged about this  program before, read her views on its agricultural aspects and on the effects of the islands’ remoteness.)

I had flown into Choiseul's small and sleepy provincial capital of Taro the previous afternoon and had spent the night speaking with Community Helpers. Community Helpers travel through villages in their respective wards, assisting with technical design, procurement, and general questions regarding rural infrastructure.

The next day I was eager to get on a boat and out of the capital, which sits on a small island off the mainland. By mid-morning, after scrounging up enough fuel and getting everyone together, we set off down the south coast of the province. We had been lucky enough to secure a 60 horsepower engine (which is apparently rare in Choiseul, judging by the intense debate over who was going to captain the small boat) and the powerful outboard sent us skimming over the glass-flat waters between islands and towards our first destination, Moli.

About 2,000 people rely on the Moli clinic for their health needs.

Moli is a quite a large village for the area with 500 people, a school, and by rural Solomon Islands’ standards, a large and very well resourced clinic. The clinic was built by a logging company operating in the area but has been staffed up until recently by only a nurse’s aide. With no doctor or registered nurse the Moli clinic represented something of a wasted resource for the roughly 2,000 people that rely on it as their closest point for medical care.

The Ministry of Health in Solomon Islands will usually supply a registered nurse to all clinics, however, there has to be dedicated accommodation for the nurse within the village, which Moli did not have. As such, the people of Moli decided to build staff housing for the clinic.

The staff house sat away from the shore towards the back of the village on a small but steep hill that looked over the thin channel in front of Moli and over the sloping, thatched roofs of the village. With only a short time left till the house will be completed, a nurse is already present at the clinic and the chairman of the local Sub-Project Implementation Committee (SIC), Raymond Vapusiava, was beaming with pride over the new house.

“This is great, there is no way the village could afford to build this house and we were desperate for a nurse here,” Raymond told me. The SIC that he chairs is an essential part of the Rural Development Program’s structure. It is a committee of local villagers that has the first and final word on what piece of infrastructure they need. The SIC then has the responsibility of using program funds to procure and construct their project.

The new registered nurse for the clinic, Hayleen Dusaru, said the clinic was important to a large number of people in and around Moli. “There is much work to be done at this clinic.” Hayleen said. “About 2,000 people rely on it and I’m often very busy, it’s very important that I’m here and I am happy the village put in so much work to help with the building of the house.”

A light rain started soon after I had spoken to Hayleen and we went down to the local canteen to huddle away from the brief storm. I spoke to a man who had volunteered to work on the nurse’s house, dragging gravel and sand up to the house for two days until everyone gathered around the store fell quiet and I realized that most people were standing there to listen to the radio as much as to escape the rain. The new Prime Minister of Solomon Islands had just been announced and he was making his first speech as PM elect. An excited buzz worked its way through the small crowd and I found it bizarre to listen to goings on of the capital in a secluded village so far away.

The next village I visited had chosen to have a water supply and sanitation system put in because flooding would often damage all their pipes and water sources. The one after that needed water tanks because a tsunami in 2007 had destroyed their old tanks and run-off from a logging site had made the nearest stream undrinkable.

Every project I saw was informed and controlled by community needs and nearly all the people I spoke to had similar things to say about community involvement and ownership of RDP projects.

One conversation that represents much of sentiments I found over the trip was when I was speaking to a vice chairman of a Sub-Project Implementation Committee in a village called Vuza. The vice-chairman, Schiva Madau, said of the RDP, “it’s not like some other donor programs we’ve had where it feels like the donor has put something of theirs in to the village, this is different, it is like the pipes are ours, and the water is ours.” He said. “Yes the funding came from RDP but the SIC had to learn how to administer a project, we had to learn about finances and procurement, and we had to learn quickly. There was training too and some help from Community Helpers, but ultimately, it was up to us.”

The RDP is a project run out of the Solomon Islands Ministry for Development Planning and Aid Coordination. It is being supported by the Solomon Islands Government, the European Union, AusAid, and the World Bank.  It has three main components: the provision of rural infrastructure, improving agricultural extension in rural areas, and providing small loans for rural businesses. The approach of the RDP is one of community driven development. The logo of the program: “Community Decides, Community Manages, Community Maintains”, reflects this focus and the organizational structure, which utilizes and relies mainly upon people at the village level to implement the program, reinforces it.