The key to strengthening governance of Non-communicable Diseases in the Solomon Islands

DEAR EDITOR, Last week in Honiara, the Prime Minister, the Hon. Rick Hou, spoke at the round table meeting with the Ministry of Health and Medical Services and the World Health Organisation (WHO).

The PM outlined the fact that the Pacific Islands countries have the highest prevalence of ‘tobacco use’ than the global average of 23 percent.

In the Solomon Islands, Prime Minister Hou said the average prevalence of tobacco use was almost double the global average of about 44 percent.

The PM went on to say how the Pacific had been described as the epicenter of the global diabetes epidemic and the world’s capital of NCDs.

Referring to Non-communicable diseases (NCDs) the Prime Minister said it was “better late than never to tackle the problem” posed by NCDs.

Given that statistic show that 70 percent of all deaths in the Solomon Islands are attributed to NCD related illnesses such as diabetes, heart disease, cancer, stroke and chronic respiratory diseases, to give just a few examples, it is indeed a very sad irony that it is only now that the “penny seems to have dropped” to do something about tackling the killer disease that has cost so many lives already.

It is also, to my mind, a double irony because it is well documented that in July 2014, Pacific Health Ministers and Economic Ministers approved the Pacific NCD road map, to guide each country’s efforts to reverse the trend of the NCD epidemic in the region.

Sadly, however, 7 years after the declaration of the NCD crisis, and four years after the call to develop national NCD road maps to combat the NCD epidemic, very few countries have heeded the call.

In the Solomons what might now change to make things happen?

One has to comment, despite the excellent set of policy options contained in the NCD road map report, the fact remains that the MHMS is constrained by their lack of resources, including physical infrastructure, health workforce and sustainable financing.

Where health budgets are severely limited, as is the case in the Solomon Islands, the government may be forced to choose between treating people who are sick, and seeking to reduce the future burden of NCDs and associated expenditures.

Quoting an extract from a World Bank report in 2014, one reads:

“It is not surprising that the political imperative to direct limited resources towards those who are currently sick often wins out. For this reason, there is a strong case for governments to seek to expand their revenue base at the same time as they scale up their budget for NCD control, particularly by increasing taxes on those products that most contribute to NCDs, including tobacco, alcohol, and unhealthy foods and sugar‐sweetened beverages.”

“Despite this, raising taxes may be politically challenging for governments: ‘the [political] pain in raising taxes is now, [whereas] the public health gain is later”

One might say here that for all the reasons, the challenge Solomon Islands face it is not the lack of knowledge about the policies that could make a difference, but implementation: translating knowledge into actions at the country level.

Whether seeking to raise taxes, or to implement other regulatory responses the government would likely face resistance from tobacco, alcohol and processed food industries and potentially from other countries, including development partners.

What I see is required today is the political leadership and politicians who will become ‘issue champions, ‘ in pursuing a policy of strengthening health systems, re-focusing on primary care and getting greater regional and international cooperation to be sustained by accountable monitoring systems to measure progress.

Although urgent action on NCDs makes good economic sense for the Solomon Islands government the challenge of NCDs is more than just about responding to rising health expenditures, or the impoverishing impact of out‐of‐pocket payments on families.

The real key is the absolute obligation of the government to take action on NCDs which is enshrined in the right to health, a universal human right.

“All countries have ratified at least one international treaty that imposes obligations on government regarding the right to health.” (WHO 2014)


Yours sincerely

Frank Short

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