“Living their best, healthiest lives”: Delivering Medical Supplies to Remote Islands in Kiribati

It is no exaggeration to say that pharmacist Moannara Benete literally has one of the biggest jobs in the Pacific. Kiribati’s 21 inhabited islands are spread across some 3.5 million square kilometers of ocean, and as leader of the Kiribati Ministry of Health & Medical Services’ Pharmacy team, Moannara’s focus is ensuring medical supplies are available to all people in her country; no matter where they live.

This was already an immense challenge before COVID-19, and the pandemic has only amplified these challenges. Medical supplies have been difficult to source, and there have been significant delays in their arrival. This has led to an increase in urgent medical supply orders, which have driven up prices.

“Procurement of medical supplies is an important part of most health care services,” says Moannara Benete, from her office in Kiribati’s capital, Tarawa. “Our goal is to improve the overall health of the population by sourcing and buying quality cost effective medical supplies. A well-managed procurement program supports economic and social development by keeping the population as healthy as possible.”

The logistics of managing pharmacy supplies across 21 islands spread across 3.5 million square kilometers of ocean are an immense challenge. Photo: Conor Ashleigh/World Bank

Taking control of health service delivery

The World Bank is supporting Kiribati’s commitment to advance Universal Health Coverage so that all I-Kiribati can access health services when they need them. A key part of this work is helping to track development partner contributions to health programs, so they are recognized as part of integrated plans and budgets that are managed by the Ministry of Health and Medical Services. In doing so, the Ministry is then able to make the most of all available resources, ensure it understands where support is coming from and when, and take control of health service delivery in a more efficient and holistic way.

While many can access health care when they need it on Kiribati’s main island of Tarawa, it is a much greater challenge to ensure the clinics, and pharmacies on the outer islands are stocked with sufficient supplies and equipment.

“I am really happy with the progress the pharmacy team is making. We have limited resources, but we work well as a team and there is a lot of enthusiasm for what we are doing,” explains Moannara. “We’re improving supply chain management, and now for the first time we also have a comprehensive national essential medical supplies list – which includes medicines, equipment, and consumables.”

“Health center staff are now using tablets to keep track of what is coming in and going out. This has really helped us develop a better picture of what we need and when we need it.”

Kiribati’s lead pharmacist, Moannara Benete says that getting the supply chain and distribution of medical supplies right will benefit everyone in Kiribati. Photo: Rimon Rimon/World Bank

Improving supply chains

Moanara took up a position in the pharmacy department of Kiribati’s Ministry of Health & Medical Services in 2011 after completing a Pharmacy degree in Fiji. In 2019, she completed a Master’s in Public Health from the University of Melbourne,in Australia. She says her studies helped to shape her vision for improving the health system back home.

“It made me think about the pharmacy area being more than just a curative department. I realized that it sits at the center of health service delivery in many ways – covering the range of preventive, curative, restorative and palliative care needs in this country,” says Moannara. “If we can get the supply chain and distribution right, then everyone across the islands will benefit.”

Accessing contraceptives

An area of particular passion for Moannara is her team’s work on sexual and reproductive health.

“Sexual and reproductive health products have traditionally been difficult for us to get hold of here in Kiribati. We have been dependent on development partner support,” she explains. “And with borders closing due to COVID-19, it has become even harder for us to get enough and there has been a shortage.

“Yet our data shows us that the number of married women accessing contraceptives has increased over the last decade, so if we can make sure the supplies are on the shelves then we know people will use them.”

Dr Jennifer Butler, Pacific Director and Representative for the United Nations Population Fund (UNFPA), which is supporting this sexual and reproductive health work, says that improving access to modern contraceptives and life-saving maternal health medicines is vital work.  

“This is about improving access to contraceptives, increasing visibility around availability – so people know where to get contraceptives – and about building more sustainable systems,” Dr Butler says. “This is critical work that has a strong emphasis on gender equality, human rights and prosperity for all; and is essential for achieving universal health coverage.”

Moannara Benete is committed to strengthening the capacity of the Kiribati’s health system so that all I-Kiribati can access health services when they need them. Photo: Aislinn Healy/World Bank

Living their best lives, in the best of health

Moannara reflects that ensuring equal access to health services is a big challenge for Kiribati, but one that she and her team are up for.

“Our pharmacy team is committed to building the capacity of our health system. We are motivated by opportunities to learn as we go, and we are certainly learning a lot. Leadership and effective transparent decision making are also really important,” says Moannara.

“We want to ensure that everyone has the opportunity to live their best lives in the best of health; no matter who they are, or where they live.”

The World Bank’s support for Kiribati’s Ministry of Health and Medical Services is provided in part through Advance Universal Health Coverage, a multi-donor trust fund set up by Australia’s Department of Foreign Affairs and Trade in 2015 to support strengthened health funding and service delivery systems in countries across East Asia and the Pacific. Other partners include Gavi, the Global Fund, and the Bill and Melinda Gates Foundation.