Kiribati Annual Health Bulletin 2015

17.06.2016 red

General Information

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Country Background

Kiribati officially the Republic of Kiribati, is an island nation in the Central Pacific ocean. The nation comprises 33 atolls and reef islands and one raised coral island, Banaba. They have a total land area of 811 square kilometers and are dispersed over 3.5 million square kilometers.
Their spread straddles the equator and the International Date Line (Figure 1).

According to 2010 population and housing census the total population of Kiribati is 103,058 (latest official figure). The vast majority (>90%) of people inhabit the Gilbert Islands, with more than 33% populating an area of about 16 km2 on South Tarawa. Until recently, the people of Kiribati mostly lived in villages with populations between 50 and 3,000 on the outer islands. Most houses are made of materials obtained from coconut and pandanus trees.

Frequent droughts and infertile soil hinder reliable large-scale agriculture, so the islanders have largely turned to the sea for livelihood and sustenance. Most are outrigger sailors and fishermen. Copra plantations serve as a second source of employment. In recent years large numbers of citizens have moved to the more urban island capital of Tarawa. Increasing urbanisation has raised the population of South Tarawa to 50,182.

Kiribati became independent from the United Kingdom in 1979. The capital and now most populated area, South Tarawa, consists of a number of islets, connected by a series of causeways. These comprise about half the area of Tarawa Atoll. Kiribati is a member of the Commonwealth of Nations, the IMF and the World Bank, and became a full member of the United Nations in 1999.

Administrative divisions

There are a total of 23 inhabited islands in Kiribati. Kiribati is divided into three island groups, and include Gilbert, Phoenix and Line Islands group. Most of the country’s population lives in the Gilbert Islands group including the capital Tarawa. Five of the Line Islands are uninhabited (Malden Island, Starbuck Island, Caroline Island, Vostok Island and Flint Island). The Phoenix Islands are uninhabited except for Kanton. Banaba itself is sparsely inhabited. Each of the 23 inhabited islands has a local council that takes care of the daily affairs. Tarawa Atoll has three councils; Betio Town Council, Te Inainano Urban Council (for the rest of South Tarawa) and Eutan Tarawa Council (for North Tarawa).

Ethnic groups

The native people of Kiribati are called I-Kiribati. Ethnically, the I-Kiribati are Micronesians.
Recent archaeological evidence indicates that Austronesians originally settled the islands thousands of years ago. Around the 14th century, Fijians, Samoans, and Tongans invaded the islands, thus diversifying the ethnic range and introducing Polynesian linguistic traits.
Intermarriage among all ancestral groups, however, has led to a population reasonably homogeneous in appearance and traditions.

Language

The people of Kiribati speak an Oceanic language called ‘Gilbertese’. Although English is also an official language, it is not used very often outside the island capital of Tarawa. It is more likely that English is mixed in its use with Gilbertese.

Religion

Christianity is the major religion, having been introduced by missionaries in the 19th century.
The population is predominantly Roman Catholic (56%), although a substantial portion of the population is Kiribati Uniting Church (34%). Many other Protestant denominations, including more evangelical types, are also represented. The Bahá’í faith religion also exists in Kiribati (2.2%), along with Jehovah’s Witnesses and The Church of Jesus Christ of Latter-Day Saints (LDS Church) (4.7%).

Health situation and trends

While the country only has a total land area of 811 square kilometres, it covers over 3.5 million kilometres of ocean, presenting significant challenges for both the healthcare and social service systems. With such a widely dispersed population, those living on outlying islands are not always able to access (or afford) an airlift or boat to the nearest medical facilities.
Furthermore, the low-lying atolls of Kiribati are very vulnerable to climate change and rising sea-levels, with issues already arising from groundwater depletion, marine-life and sea-water contamination from human and solid waste, and over-fishing of the reefs and lagoons.
Protection of water sources from pollution, mainly from nearby sanitation systems, is a constant public health concern. High internal migration from the outer islands to the capital,
Kiribati Annual Health Bulletin 2015South Tarawa, coupled with ad-hoc urban planning and management has resulted in overcrowding, and inadequate sanitation. As with many countries in the Pacific region, communicable diseases remain a significant disease burden in Kiribati. Overall, life expectancy in Kiribati is low for the Pacific region. In 2011, life expectancy at birth was estimated at 70 for males and 80.1 for females (Ministry of Health and Medical Services, 2011).

Organization of the Health Sector

Kiribati Ministry of Health and Medical Services (MHMS) functions and operate at four levels namely Central, District, Island and Community. The entire system from central to community level is publicly financed. Primary health care is provided through a network of health centres and outreach village clinics extending from district to community level. Essential referral care is provided through 4 referral hospitals and the main being the Tungaru Central Hospital (TCH).

Primary Health Care

Administratively Kiribati is divided into six health districts namely Tarawa & Banaba, Central,
Northern, South Eastern, South Western and Linnix. Primary health care services are provided within the district health structure through a network of island health centres and village clinics.
The smallest and lower most facility based primary care service at grass root level is named as village clinics and are manned by a specially trained Public Health Nurse (PHN). They are able to deliver a minimum package of curative and preventive health care. Village clinics are situated in each village and number at present stand at 81.
At island level, health centres provides a higher and wider range of services than a village clinic. They provide both inpatient and outpatient services manned by a Medical Assistant (MA). The MAs either possess a degree in bachelor of nursing or a public health degree. At least one health centre is situated in each inhabited island and at present the number stands at 21.

Hospital Care

In Kiribati, secondary care is provided through four hospitals. TCH is the specialized 126 bedded hospital in the country located in Nawerewere, Tarawa. It provides emergency & outpatient care facilities and inward facilities in four major specialties namely Internal Medicine, Surgery, Paediatrics and Gynaecology & Obstetrics. In addition a special ward for Tuberculosis patients and a paying ward is also present at TCH. TCH is staffed with medical specialists as well as general medical officers. It also functions as a training centre for Intern Medical Officers (IMO) and for primary health care workers. Southern Kiribati Hospital (SKH) situated in South Tarawa is a 20 bed hospital while Betio Hospital (BH) located in Tabiteuea, North Island consist of 18 beds. Another 8 bedded facility is located in Kiritimati, Line & Phoenix Islands and is named as London Kiritimati Hospital (LKH).

Private Health Sector

The private health care facilities are not available in Kiribati at present.

Kiribati health system

The government of Kiribati is the main provider of health services in the country. Government health facilities includes the four hospitals, 21 health centres and 81 village clinics. In addition to these health facilities there are six other health care providers that also report to the Health Information Unit (HIU), and include Integrated Management of Children’s Illness (IMCI) clinic,
Gynaecology clinic, Kiribati Family Health Association (KFHA), Diabetic clinic, Reproductive Health Development and Adolescent Health Development. All heath care services are provided free to all Kiribati residents by the government and there is very minimal out-of-pocket spending for health. In 2009, the government spent approximately 16.5% of its total recurrent budget on health, taking the second largest share next to education (MHMS, 2011).

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