Tuvalu Health System Strengthening Project

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The Tuvalu National Health Strategic Plan for 2020-2024 (NHSP) provides a point of departure to identify priority interventions, new development activities, and programs for the Tuvalu Health System Strengthening Project (HSSP). Development of the Project and its implementation will be aligned, coordinated, and planned in conjunction with engaged bilateral partners such as New Zealand and Australia, regional entities such as Secretariat of the Pacific Community (SPC), Asian Development Bank (ADB), and key technical partners, including World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF).Component 1: Improve the Availability of Essential Public Health and Health Care Services Provided at Princess Margaret Hospital (US$9.92 million equivalent)Subcomponent 1a: Increase the Physical Capacity of the Princess Margaret Hospital (US$9.10 million equivalent). The intent of this subcomponent is to support an increase in the service capacity of PMH through the construction of a new building or wing of the hospital. The enhanced service capacity includes both clinical and public health functions. The clinical capacities include diagnostic services (notably radiology and laboratory), emergency/urgent care, basic surgical operations and post-operative recovery, intensive care, TB inpatient ward, mental health, and rehabilitation. The public health capacities will include an expansion of the laboratory’s environmental health testing capacity and expansion of the central medical store which provides warehousing capacity to centrally manage the pharmaceuticals and medical supplies. An emphasis will be placed on improving the patient experience through an integrated approach to providing health promotion, detection, and management of NCDs as well as integration of social service counselling (for GBV and other social needs) at the location of the hospital. The subcomponent activities include: (a) conducting a more detailed needs assessment to define the specific services further taking into consideration the current and emergent health needs of the population, the service requirements (human resources, equipment, space) as well as assessing the viability for providing these services in-country given the human resources options (in-country, visiting or teleconsultation), financial costs of in-country service versus overseas medical referrals and ensuring minimum standards of quality. (b) following agreement on the service description, hospital design and engineering technical assistance will be provided for: (i) detailing the functional layout and physical requirements of the facility, including all necessary requirements for ensuring that the facility adapts to the local hazards, changing climatic conditions and energy efficiency; (ii) detailed review of the planned location and site specific plans for mitigation against environmental and social (E&S) impacts as specified in the requirements for environment and social standards; (iii) a procurement and contracting strategy ; and (iv) technical support to the procurement for the detailed architectural design, construction and supervision phases of the Project. (c) with the functional plan and environmental assessments agreed and in accordance with the agreed procurement and contracting strategy, hospital design and construction would include: (a) a detailed architectural design; (b) any demolition works and construction of a new hospital wing on the territory of the PMH complex, including the design characteristics for energy efficiency and resilience to significant weather and climate change events; and (c) purchase of related medical equipment (including digital to enhance teleconsultation capacity), information or communication technology equipment, furniture, and related supplies. (d) to support the functioning of the national public health laboratory and support the medical waste management (MWM) collection and disposal systems, two field vehicles for specimen collection and outreach services and a vehicle for medical waste collection (at Port, at PMH, Funafuti Island) will be supported. Eligible expenditures to support the above-described activities include technical assistance, works, medical equipment (including radiological equipment), reagents, and medical supplies, furniture, information communication technology equipment and other related goods, and vehicles. Subcomponent 1b: Increase the Human Resource Capacity of the Princess Margaret Hospital (US$0.81 million equivalent). The intent of this subcomponent is to support an increase in the service capacity of PMH by investing in different means of expanding its human resource capacity.The subcomponent activities include:(a) the design and then implementation of a human resource development strategy on the basis of the service expansion plan of PMH. The plan will review options for (i) expanding telemedicine consultations with an international provider; (ii) contracting of international medical providers for specific periods of in-country service; (iii) upgrading of Tuvalu’s general practitioners with specialists skills; (iv) organizing short visits of international medical teams for services in Tuvalu; and (v) providing short-term training of the health and auxiliary staff including in IPC and MWM, GBV detection, treatment and referral, and other areas as the needs arise. (b) as a basis for the training in IPC and MWM, technical assistance to assess the current system, standard operating procedures, capacities of human resources and gaps against the MoH’s National IPC Policy and Guidelines to define the specifics of the training and any other support to be provided. (c) to inform the telemedicine approach, technical assistance to assess the context that would allow for making full use of telemedicine including legal environment (i.e., clarifying medical liability), assess the market for provision and contracting models, and the organization requirements for integrating the teleconsultation into the PMH clinical services. Eligible expenditures to support the above-described activities include technical assistance, training fees and related costs, travel, accommodation, contracting of health providers for in-country consultation and contracting for telemedicine consultations. Component 2: Strengthen the Delivery of Primary Health Care and Primary Prevention, with a Focus on Non-Communicable Diseases (US$3.02 million equivalent)Subcomponent 2a: Improve the Delivery of Essential Primary Health Care Services at the Health Clinics, with a Focus on NCD Services (US$2.35 million equivalent). The intent of this subcomponent is to support a more comprehensive and systematic approach to early detection and routine management of NCDs, as well as ensure the readiness of the 11 health clinics to provide comprehensive PHC. The subcomponent activities include:(a) the design and implementation of an integrated screening program of the adult population (i.e., over the age of 30), including for diagnosis and risk stratification for NCDs, particularly for hypertension and diabetes on the basis of national protocols. In order to raise demand for screening, the screening program would include support community awareness raising and outreach activities.(b) adaptation and rollout of a simplified digital patient record that can be used from the point of screening, risk identification (or stratification), to the management of NCDs which could be viewed by the health clinic nurse or PMH doctor. (c) maintaining service capacity of the 11 health clinics to ensure their readiness in providing all essential PHC services through regular monitoring and addressing gaps that arise. To monitor the readiness on a regular basis, a digital system and dashboard will be supported that will routinely measure and identify gaps in service capacity at the health clinics to provide NCD and other essential PHC services, including disaster response. Mai