Transforming Health Care Access in the Pacific Islands with World Bank Support

KEY HIGHLIGHTS

• Between 2020 and 2024, about 340,000 people in Kiribati, Samoa, and Tuvalu have benefited from improved access to quality health care brought by World Bank-supported health system strengthening projects.
• In Samoa, the rural district health facilities—with additional doctor, nursing and public health staff and with the support of the local women’s group—have reached their target of screening at least 70 percent of the adult population for hypertension and diabetes in 12 of the 34 districts, identifying individuals who need further treatment or counselling. According to a survey, 97 percent of people screened reported substantially improved knowledge and awareness of Non-Communicable Disease (NCD) risk factors.
• In Kiribati, 40 percent of the health workforce has participated in new training programs, and transport services for hospitals covering 80 percent of the population have been upgraded.
• In Tuvalu, the Princess Margaret Hospital—its only hospital—is being upgraded to ensure better access to essential health services for all citizens and reduce reliance on costly overseas referrals. At the same time, efforts are underway to improve health services in the outer islands and expand outreach to tackle NCDs, which have become the leading health challenge across many Pacific small island developing states.

“I am glad that the World Bank is funding this [health system strengthening project] and I’m sure that it will be important for us to deliver better services to people in the outer islands.”

— Tuafafa Latasi, Minister for Health and Social Welfare, Tuvalu

“We are thankful to the World Bank for this health system strengthening project, which is helping us move toward providing better access to underprivileged populations across Kiribati, particularly those people who are living in our remote outer islands.”

— Dr. Tekeua Uriam Kabiri, Director of Hospital Services, Ministry of Health, Kiribati

“The beauty of having this health system strengthening program is that we expand on preventing and treating non-communicable diseases. We are also utilizing the opportunity to address communicable diseases, especially in schools.”

— Siufaga Simi, Principal Health Promotion Officer, Ministry of Health, Samoa

CHALLENGE

The Small Island Developing States (SIDS) of the Pacific comprise diverse economies distributed across 30 million square kilometers of ocean. National populations are dispersed among many islands, creating challenges in financing and managing healthcare despite commitment to universal coverage. When in-country services are unavailable, patients often need costly overseas referrals. Pacific populations also face some of the world’s highest rates of non-communicable diseases (NCDs), leading to significant pre-mature mortality and disability.  Poor diet and inactivity have resulted in obesity rates among the highest globally, affecting reproductive maternal, newborn, child, and adolescent health (RMNCAH) outcomes and necessitating integrated health interventions. Women are particularly vulnerable and often must care for ill family members. Recurrent infectious diseases like typhoid, dengue, tuberculosis (TB), and HIV add to the disease burden. Existing health facilities are aging and vulnerable to climate-induced disasters. In addition, inadequate service delivery models are unable to manage conditions before complications arise. Pacific SIDS face a shortage of essential human resources, medicines, and adherence to the evidence-based protocols necessary to improve health outcomes.

APPROACH

Since 2016, the World Bank has engaged continuously with Pacific SIDS to strengthen their health systems. Successive programs of advisory services and analytics have enabled Pacific countries, including Kiribati, Samoa, and Tuvalu, to develop a nuanced understanding of the state of their health systems and helped lay the foundation for strategic transformations.

A growing understanding of countries and lessons from the COVID-19 pandemic has informed investment operations. For example, they have leaned towards developing national service delivery capacity to deliver quality primary and secondary health care, to address growing challenges such as NCDs and climate resilience. At the same time, they have prioritized remote communities and responsiveness to vulnerable groups (e.g., people with disabilities). Innovations have included the use of a results-based approach through country systems in Samoa—the only Program for Results in the Pacific—to leverage the ”Samoa way” by using community groups for health promotion and supporting country investments in digital infrastructure to improve the backbone systems needed to improve patient management for conditions like hypertension and diabetes.

World Bank-supported projects have also strengthened digital connectivity for better remote support and mentoring in Tuvalu and Kiribati—particularly considering limited health human resources. Other innovations under these projects include increased collaboration with third-party entities—like the United Nations Office for Project Services (UNOPS)—to supplement and build project management capacity.

RESULTS

Between 2020 and 2024, World Bank operations to strengthen health systems have improved access to better quality health services for the populations of Kiribati, Samoa, and Tuvalu, some 340,000 people.

In Samoa, World Bank support has enabled the rapid expansion of PEN Fa’a Samoa, a community-focused program whose name references the “Samoa Way” and that is bolstering systems to detect, manage, and prevent NCDs. Communications and advocacy initiatives that inform the public of NCD risk factors—including media campaigns and village-led health activities like regular Zumba classes—are being rolled out across the entire population. Ninety seven percent of those screened in the first two years of the Program reported improved knowledge and awareness of NCD risk factors and a third of respondents reported positive changes in health behavior. Screening programs have been rolled out in 19 of 34 districts prioritized by the Ministry of Health, and 12 of these districts reached the target of having at least 70 percent of their adult population and 60 percent of the male population screened. The size of the health workforce has increased. All eight of Samoa’s rural district hospitals have expanded staff and half now have fully expanded teams of frontline workers, including doctors, nurses, environmental health officers, and data officers. Samoa is the only country in the Pacific region to use the World Bank’s Program for Results financing instrument to strengthen on-budget and on-government-system implementation of its NCD program.

In Kiribati, approximately 30 percent of the workforce, comprising 334 health professionals, have received training on a range of topics, including mental health, effective communication, and working with infectious substances. Of these professionals, nearly 75 percent are women. The long-term management of digital patient data at the national referral hospital in Kiribati’s capital, Tarawa, has been enhanced by the purchase of a Picture Archiving and Communication System with an integrated computed tomography (CT) scanner. This has enabled radiologists and doctors to receive patients’ CT scan images instantly, streamlining patient assessments and diagnoses, speeding up treatment times and reducing waiting times. Each of the four main hospitals—which together provide services to around 106,000 people, or 80 percent of the population—invested in new ambulances to expand patient transfer and emergency response. Assessments of 75 outer-island health facilities, which represent 63 percent of the country’s health facilities, have been completed, giving the authorities a clear view of infrastructure, medical equipment, and training needs.

In Tuvalu, the Princess Margaret Hospital (PMH), the only hospital in the country has improved its dentistry services and its existing operating theatre with a state-of-the-art operating table.  A new wing is expected to be completed in 2027 to significantly improve essential health services that can be offered in-country for 100 percent of population of Tuvalu, roughly 11,000 people. In 2025, Tuvalu purchased Starlink for 11 Outer Island health clinics and PMH, which will improve communications between healthcare service providers, enable the transition from paper to digital records and lay the foundation for digital health and trainings. In the same logic of serving patients closer to home, Tuvalu has completed an assessment of Outer Island services to underpin the formulation of a standardized primary healthcare service package and the design of clinics that are fit for purpose for small, remote populations. These are to be delivered by 2027. To ensure services that are accessible for all, Tuvalu has invested in a vehicle adapted to accommodate people with disabilities as part of its outreach program. It will significantly improve screenings and check-ups to improve disease management and prevent complications that may require hospital treatment. Tuvalu has also strengthened its healthcare workforce through a training program to increase the number of first responders able to recognize and respond to victims of gender-based violence.

ONE WORLD BANK GROUP IN ACTION

The Samoa Health System Strengthening Program for Results is funded by a $9.3 million International Development Association (IDA) grant, providing a small part of the recurrent costs of the NCD Program implemented by the government. The Kiribati Health System Strengthening Project is supported by an original $14 million IDA grant with additional financing of $14 million. Additionally, the Tuvalu Health System Strengthening Project receives a $15 million IDA grant.

PARTNERSHIPS

The governments of Australia and New Zealand are key partners for health system strengthening in the region. In 2023 they provided a $7.8 million grant to expand the Samoa program so that it could increase healthy living communications campaigns; boost NCD screening, referral, and treatment; and improve community health care services. The Advance Universal Health Coverage Multi Donor Trust Fund (known as Advance UHC), established by the World Bank and the government of Australia in 2015, has played an important role in facilitating advisory services and analytical work—including support to the hypertension implementation cascade study for Samoa in 2019, and a primary healthcare performance assessment for Kiribati in 2023—that subsequently informed health system strengthening projects across the region.

LOOKING AHEAD

The World Bank continues to prioritize health in the Pacific as a critical human capital asset to respond to the challenges Pacific people face at home or when they seek opportunities abroad. The country-specific strategies outlined in the Regional Partnership Framework 2017-2024 clearly identifies system strengthening and addressing NCDs as one of its four focus areas.  At the same time, the forward-looking approach will seek to further balance the national approach with regional strategies like the 2050 Strategy for the Blue Pacific, which seeks regional approaches, greater collaboration and harmonization across the Pacific including in health. While strengthening capacity in-country remains a critical strategy to improve the well-being of populations of Pacific SIDS, there are several health challenges that cannot be addressed in isolation. Following a request by the Pacific Islands Forum Leaders, the World Bank is in discussion with several Pacific Island Countries to deploy regional solutions to improve access to quality care. This includes strengthening institutions in the region to lead on the provision of tertiary care services and health workforce education and training, and strengthening regional networks through connectivity and shared experience in strengthening service delivery to respond to the growing epidemic of NCDs.