Background and Introduction [Review of Kam Pussum Hed (KPH) Clinic]

The Republic of Vanuatu is made up of more than 80 islands. There are 4-5 main islands, 6 provinces and 2 urban centres, Port Vila and Luganville. The 1999 National Census indicated a total population for Vanuatu of 193,219. When compared to the 1989 Census there has been a significant population increase in both the rural and the urban areas. The distribution of the country's population shows an increase of 2.6% average annual growth in the urban population and 4.6% average annual growth in the urban population between 1989 and 1999. This has resulted in an increase in the proportion of the total population residing in the urban areas from 18.4% in 1989 to 21.5% in 1999.

In 1999 the World Health Organisation (WHO) in collaboration with the Health Department conducted a cross-sectional survey of 550 pregnant women aged between 15 and 49 years, attending their first antenatal clinic at the Vila Central Hospital, to determine the prevalence rates of laboratory-confirmed STI's. The preliminary results of the initial 484 pregnant women tested gave prevalence rates of: Trichomonas – 27.7% (134); Chlamydia – 20.1% (97); Gonorrhea – 5.8% (28); and Treponemal antibodies were present in 2.3% (11) of women tested. This shows a 55% prevalence rate of STI's among the women during pregnancy. The preliminary report concludes that the prevalence of STI's in this population of pregnant women in Vanuatu is high and of particular concern in view of the association between STI's and poor pregnancy outcomes. The high prevalence of STIs among pregnant women is a strong indicator that STIs are generally common in other population groups, particularly among those who are sexually active. This puts Vanuatu in a category of high STI rates among other Pacific island countries. A similar research in Samoa revealed a rate much less than 55%.

The Government hospitals and health centres around the country are the main existing sources of information and services for reproductive health including STI's for the people. The service facilities extend from national right down to provincial level - from hospitals to health centres to rural clinics and Aid Posts. However, although this health structure exists, there is no guarantee that reproductive health information and services are being provided. Much depends on the knowledge and skills of health providers stationed in these health facilities.

A number of non-governmental organisations such as the Family Health Association, FSP and Wan Smolbag Theatre have also been heavily involved in the disseminating of information on reproductive health and STI's in selected communities of the country. Some of these NGOs are also providing one-to-one counselling and clinic-based services particularly in the provision of contraceptives and management of STIs. However, despite existing IEC programmes and clinic-based services available for reproductive health, the prevalence of STIs is high in Vanuatu. It should also be noted that although Vanuatu is yet to report a diagnosed case of HIV, this does not mean that HIV is non-existent in the country. The high prevalence of STI would create suspicion that HIV is present, considering that the transmission mode is the same. Such a situation calls for more concerted efforts for strengthening STI prevention strategies.

Wan Smolbag Theatre, a Vanuatu based NGO, was formed in 1989 and has done extensive work in Port Vila and around the country using drama to disseminate information on topics ranging from good governance issues to water issues, domestic violence issues, environment issues and numerous others, including reproductive and sexual health issues. During 1997, Wan Smolbag Theatre spent six months working closely with the peri-urban communities of Blacksands and Tagabe on the main island of Efate. A community play was developed, and research was conducted at community level using custom stories to obtain information regarding the factors and issues affecting the contemporary daily lives of the community.

Follow up work was done in May 1998 on some of the issues from the community project. This brought up plenty of discussions reflecting the needs of the communities in matters pertaining to their reproductive health and health in general. As a result Wan Smolbag Theatre considered undertaking projects outside its core activities of playmaking Theatre.

One such activity suggested by the community was for a drop-in centre. A place where community members could feel comfortable and be able to access important health information, receive counseling and treatment, or even to access easy information through print materials or video showing. Wan Smolbag identified the need to establish a Youth Drop-in Centre that could provide free reproductive health services to the peri-urban settlements in Port Vila. Blacksands, Tagabe and Manples were the main target communities for this centre due to their close proximity to the centre. With a very high rate of population mobility drifting from rural to urban centres, the population of these areas has increased over the last ten years. However, most people in these communities do not have easy access to the existing reproductive health services due to problems of money to pay for bus fares to the hospital while some people have their own concerns and fears about using a public health facility like the hospital.

And so Kam Pussum Hed (KPH), Wan Smolbag's Youth drop-in centre was established in December 1998. The KPH Centre is the only clinic in the country to be attached to a non-medical NGO. It is the first of its kind in Vanuatu as a source of both IEC and clinic-based reproductive health services.

The KPH Centre

KPH Centre is a reproductive health clinic that was designed to target young people in peri-urban communities in Vanuatu. It offers two major types of services: a clinic-based reproductive health facility and an awareness/educational programme. The main components of KPH include:

• A Reproductive Health Clinic providing a range of reproductive health services including counselling, contraceptives, pregnancy care and the management of STIs.
• A Community Education Programme
• A KPH-based Educational Video Programme
• A Peer Education Programme

The Clinic is currently manned by 3 full-time nurses and seven peer educators. The nurses see clients with reproductive health needs, whether for counselling only or for information and also for testing and treatment. A steady clientele has built up since the clinic started and the number of people accessing the services provided at the clinic continues to rise.

A major component of the work of the clinic is its educational programme. The clinic conducts workshops with various community groups and also with different age groups. Workshops are held in the communities with both men and women of all age groups. These workshops are designed to inform the community of the existence of the KPH and what services it offers. In these workshops, topics covered depend on the age group of the participants. Reproductive health issues ranging from family planning to STI's and HIV/AIDS to breast and cervical cancer for women and cancer of the testes for men are covered in these workshops. The clinic nurses and the peer educators are the facilitators at these workshops.

There is a video room in the clinic where a video is on for most part of the day and young people can sit and watch one of the many videos on reproductive health issues like HIV/AIDS. Here the young people can also read any of the educational material that is made available.

The Peer Education programme is also a vital part of the clinic. This involves 8 young people who go out and talk to their peers, and people of other age groups who are interested, about a range of reproductive and sexual health issues, like the use of condoms to promote safe sex practices. They visit different locations in town where young people are known to frequent like kava bars and nightclubs.

UNFPA has been supporting KPH Centre for the last three years to strengthen its outreach awareness and educational activities and its reproductive health clinical services. The clinic has rapidly expanded its operations since it began and its services in reproductive health have reached out to other age groups and to other communities outside its area of focus. Large numbers of people know about KPH Clinic and the services it offers, and for many, it is the preferred health facility for reproductive health services because they are easily accessible and do not cost a fee.

In the interest of UNFPA to continue supporting successful programmes for reproductive health, a review of KPH Clinic was incorporated into the 2002 work-plan of the regional Adolescent Reproductive Health (ARH) Project currently executed by the Secretariat of the Pacific Community (SPC). The review was crucial and timely in view of UNFPA's current stage of developing its next programme cycle of assistance in the Pacific Region. In March 2002, SPC and Wan Smol Bag commenced planning for a joint review.