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- Health care
There is a well-established, publicly funded and provided health system in Kiribati which is administered by the Ministry of Health and Medical Services. There are no private or church-provided health services; as such, the government is the only provider of health services.
Despite the presence of a publicly funded health care system, the island’s small size and remoteness means that health care services can be limited in availability and quality. As such, the Ministry of Health has begun taking steps to improve access to health care on the islands. The Kiribati Health Strategic Plan 2012–15 outlines six strategic objectives for improving health care provision for the population, which include: increasing access to and use of comprehensive family planning services, particularly for vulnerable populations; improving maternal, newborn and child health; preventing the introduction and spread of communicable diseases through strengthening existing programmes of control and ensuring readiness for any future outbreaks; strengthening initiatives to combat NCD risk factors and reduce morbidity, disability and mortality from NCDs; strengthening the health system and addressing gaps in service delivery; and improving access to appropriate services for youths and victims of gender-based violence.
Health care facilities in Kiribati are adequate for routine medical care, but extremely limited in availability and quality. As of 2006, the Kiribati health system comprised a central hospital that received referrals from three sub-divisional hospitals, more than 20 health centres and around 70 dispensaries. In 2013, the Kiribati government received funds to improve health care related to climate change, including facility refurbishment, new equipment and staff training. Tungaru Central Hospital on Tarawa provides a medical service to all the islands. Government dispensaries on all islands are equipped to handle minor ailments and injuries.
Most of the pharmaceuticals in the country are obtained through pooled procurement methods, in this case known as the Fiji national bulk purchase scheme. To some degree, such programmes overcome the issues regarding poor transportation and communications, and ensure the prices paid for such a range of supplies are fair and competitive. Supplies, especially urgently needed medicines, are also donated by American pharmaceutical companies.
Communicable and non-communicable diseases
Non-communicable diseases (NCDs) accounted for an estimated 68% of all mortality in Kiribati in 2008. The most prevalent NCDs in Kiribati are cardiovascular diseases, which accounted for 23% of total deaths across all age groups in 2008. Non-communicable variants of respiratory diseases, cancer and diabetes contributed 4%, 5% and 8% to total mortality, respectively (2008). Communicable diseases, along with maternal, perinatal and nutritional conditions in Kiribati, accounted for an estimated 29% of all mortality in 2008. A government paper on HIV/AIDS reported that there were an estimated 28 people living in the country with HIV in 2013. Malaria is non-endemic to Kiribati. In the period 1990–2013 tuberculosis (TB) showed an overall increase in estimated incidence, while estimated mortality (when mortality data excludes cases comorbid with HIV) remained the same.
Kiribati’s public spending on health was 8.3% of GDP in 2013. In the most recent survey, conducted in the period 1997–2010, there were 38 doctors, and 371 nurses and midwives per 100,000 people. Additionally, in 2010, 98% of births were attended by qualified health staff and in 2013, 91% of one-year-olds were immunised with one dose of measles. In 2014, 67% of people were using an improved water source and 40% had access to adequate sanitation facilities.
Less than a fifth of health care in Kiribati (17%) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 8.9% of GDP in 2012, of which 83% was covered by the government.
Kiribati is not a signatory to the International Covenant on Economic, Social and Cultural Rights, the covenant that commits signees to the ensuring ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’.
The pharmacy department of the government of Kiribati is responsible the management of medicines for all disease programmes in the country. In 2010 pharmaceutical imports represented 0.12% of Kiribati’s total GDP.
There are no licensed pharmaceutical manufacturers in Kiribati.
The budget estimate for procurement of medicines in 2009 was USD$1.8 million (WHO 2010). There are no retail pharmacies in Kiribati, pharmaceuticals and medical supplies are distributed to the rural islands via Tungaru Central Hospital.
There is no official regulation of medicines in Kiribati; while such legislation was initially drafted in 2004 it has yet to be implemented. The most recent survey, conducted between 2000 and 2011, reports that Kiribati has 21 pharmaceutical personnel per 100,000 people
|Health and Medical organisations in Kiribati|
|Ministry of Health and Medical Services||