Implementing Quality Reproductive Health Programmes in Pacific Island Countries

Pacific island countries are among many nations which are acting on the recommendations of the ICPD to shift from restrictive MCH/Family Planning to a more comprehensive set of Reproductive Health services, including family planning and sexual health.

Although the reproductive health concept is relatively new, the major components were already established as separate departmental programmes of health ministries. Thus, it was necessary to work towards the integration of the various components in a coordinated reproductive health programme. An effort was made by the PICs, in cooperation with the UNFPA, to review progress made, and to assess the major problems and issues to be given priority attention in future years. Already, national programme managers are implementing various measures to strengthen quality aspects in reproductive health activities.

The reproductive health programme in Fiji incorporates STD/HIV/AIDS along with maternal and child health, and family planning. To provide a wider choice of contraceptive methods, Norplant was introduced in 1995 on a pilot basis; it is expected to expand its availability nation-wide. Vasectomy promotion as a procedure in health centres has increased male participation in family planning. Six doctors were trained in vasectomy in South Korea in 1995 in preparation for this campaign. While in 1995/96 activities were concentrated on establishing a comprehensive reproductive health programme and increasing method choice availability, in the next two years the emphasis is on increasing access to contraceptive methods and counseling services. This will be done with reintroduction of the CBD concept in service delivery and formal training for nurses in insertion of IUD. Even though programme managers do not view teenage pregnancies to be a serious problem in Fiji, the incidence of STDs, especially syphilis, is a matter of concern. Active promotion of condoms, including increasing availability through vending machines, is expected to be launched.

The Republic of the Marshall Islands was one of the first Pacific countries to adopt a national population policy in line with the ICPD Programme of Action. The policy takes a holistic view of population problems, although reproductive health is a major plank of the document. A significant step to revamp the reproductive health programme was the undertaking of a Fertility and Family Planning Survey in 1994 and the strengthening of the health information system in 1995. No major problems were encountered in integrating MCH/Safe Motherhood and family planning with STD/HIV/AIDS structurally under the Primary Health Care Bureau of the Ministry of Health and Environment. Priority areas in the programme are said to be maternal morbidity, adolescent health, STD/HIV/AIDS and IEC. Programme activities will address the family as a unit of decision- making and focus on community participation. Particular emphasis is being given to adolescent reproductive health and sexuality problems. The high rate of teenage pregnancy is a major concern. Hence, programme managers are exploring the possibility of providing contraceptive services to adolescents. The ministry is collaborating with The Youth to Youth in Health, an NGO to raise public awareness and mobilize support concerning adolescent health issues.

In Palau, population programme efforts are directed at maintaining availability of contraceptive methods; supporting outreach and community programmes; strengthening human resources development at different levels to ensure quality RH/FP/SH services; developing educational materials; promoting better nutrition for women and children and breastfeeding; and supporting the development of the National Population Policy.

In reproductive health, "the overall goal is to get men and women to see these issues from the point of view of joint responsibilities", said the Minister of Health. "The systems are in place, but providers need to upgrade their knowledge and skills in order to provide a more holistic care to individuals with RH/FP/SH needs." To address adolescent reproductive health problems, especially teen pregnancies and STDs, it is planned to provide health education and counseling at clinics and in schools; to main free condom distribution at accessible (but discreet) sites; work with teenage peer groups to promote responsibility; and initiate a lecture series in all high school freshmen orientation programmes.

Neither Cook Islands nor Tonga see integrating STDs/HIV/AIDS, adolescent reproductive health, and MCH/family planning as a problem. The constraint is limited resources. For the Cook Islands Ministry of Health, the economic difficulties encountered by the government over the past year meant that the priority was to maintain basic services rather than mount new programmes.

The strategy adopted in promoting the integrated reproductive health care concept in the Cook Islands is to decentralize reproductive health, family planning and sexual health activities so that services and information can be obtained from clinics around the island. Information, Education and Communication activities form the core of the strategy to maintain gains made and to keep up awareness through educational programmes, including television and radio spots, newspaper articles, and health education talks and workshops for school children, uniform organizations and community groups on topics targeted at the specific audiences.

In Tonga, while maintaining service delivery and ensuring availability and accessibility of contraceptive choice, advocacy and educational programmes are targeted at women, youth and religious leaders. Efforts are being made to seek funding for activities targeting greater male involvement in family planning and reproductive health programmes. Clearly, also, the plans of programme management to undertake limited research activities, for example operations research and KAP studies, are attempts to find out ways to design a quality of care programme that will reach and serve clients better.

For Tokelau, with a total population of less than two thousand people, the scale of the challenge may not seem forbidding but the transportation difficulties it faces may be a constraint in offering a wider choice of services and timely quality of care. The programme prefers an incremental approach of adding on new services or promoting particular themes in reproductive health. Health management is giving emphasis to improving general diagnostic capability in STD treatment.