The battle for health continues in 2022: will there be triumph or defeat?

There were additional protocols and procedures to optimise, trainings to deliver, community engagement to coordinate, facilities to upgrade, equipment to procure, supplies to distribute — all whilst managing a regular workload.

Finances were re-allocated and stretched thin to ensure priorities could be adequately addressed. Vaccine hesitancy took its toll, not only on progress towards targets but also on the morale of exhausted healthcare workers who were subject to verbal and other attacks merely for doing their job. The Ministry of Health (MOH) leadership sought to keep up with the flood of technical information on COVID-19 from around the world and tailor local strategies and communications accordingly. Yet social media continued to give rise to misinformation and challenge the sector to look towards new solutions for promoting health. Meanwhile, public health teams scrambled to address increases in leptospirosis, tuberculosis, scabies and dengue whilst clinicians fought to maintain critical clinical services.

Military strategy deals with the planning of campaigns, deployment of forces and tactics, and deception of the enemy. Parallels can be drawn with the health sector wherein the enemy is sickness and death. In 2020, the MOH used what could be considered a “defence in depth” approach, with resources concentrated on the frontline to delay an attack rather than advance against the attacker. Such a tactic is not sustainable — the battle is prolonged, momentum is hard to maintain, and as resources dwindle, territory is easily lost. Looking to 2022, the MOH need a new approach to achieve the vision outlined in the Health Sector Strategy of “a healthy population that enjoys a high quality of physical, spiritual and social well-being”. Ultimately, limited resources need to be used sparingly for the greatest positive impact on people’s lives, and to create lasting change. A strong offensive tactic is clearly needed.

History’s most successful military commander, Alexander the Great, commonly used a “hammer and anvil” tactic to create one of the largest empires ever. This tactic involved two primary forces: one to pin down the enemy and the other to defeat the opponent after encircling it. Both forces cause great damage and together they weaken the enemy. Such an approach may be what is needed in the health sector in Vanuatu to address the breadth and depth of health needs in the face of limited resources. The enemy of ill-health should be pinned down at the source, through improving primary health care at the places where people first go to get help when they have an ailment. Secondary and tertiary health facilities such as health centers and hospitals then provide a focused attack on the remaining ill-health.

2022 will see a big push towards decentralizing outpatient services to improve primary health care. Municipal and rural clinics will be strengthened so that more patients can be treated closer to home and only those with more complex needs will be referred to health centers and hospitals. This will ease the burden on secondary and tertiary facilities so they can focus on treating more severe cases. Clinics will also be responsible for awareness building and monitoring of chronic and infectious diseases in their areas. Similar to war, fortifications and personnel are essential components in the battle for health. The Ministry will need to renovate, refurbish, staff and equip health clinics to enable an increase in services available to the public. For when COVID-19 cases are in the community, existing buildings will be converted with the support of the municipal areas and provincial government to act as temporary COVID-19 isolation wards for those infected but with mild or no symptoms.

Another priority of the MOH in 2022 is to support the safe opening of borders to international travellers. A roadmap has been devised with health measures recommended to guide the overall Government strategy. A 3-stage approach is proposed that incorporates vaccination and health systems readiness targets for progressing through the stages. COVID-19 vaccine roll-out will forge forward in 2022 with introduction of the single-dose Johnson and Johnson vaccine for hard-to-reach areas and vaccine expansion to include adolescents. As COVID-19 becomes endemic across the world just like influenza, we need to remain vigilant against other emerging diseases whilst working to strengthen the health system.

The focus will remain on Non-Communicable Diseases (NCDs), to better prevent, detect and treat chronic illnesses such as hypertension and diabetes. With the establishment of the NCD Hub at Freshwota Area, the aim is to recruit and equip appropriate professional surge staff to initiate clinical management and treatment such as a nephrologist to support dialysis. In the meantime, cases will be managed with minimum interventions and a focus on prevention, but the expansion plan allows the Ministry to set goals beyond the current capacity and to dream big for the future to address the scourge of NCDs in Vanuatu. Such aspirations serve to motivate and rally the troops into battle.

With a huge amount of change planned for 2022, the health team is armed and ready to fight for good health for the population of Vanuatu. A strong and continuous health leadership team and good oversight mechanisms are imperative.

Whether there will be triumph or defeat in each area is not yet clear. But knowing the enemy is half the battle, and the MOH, with the support of development partners, are equipped with the expertise and know-how to take up the challenge and re-commence the fight in 2022.

Dr Posikai Samuel Tapo is the Acting Director General of Vanuatu’s Ministry of Health.