Nurses Aid, Lucy, manages the Galma Community Clinic on her own and has worked at the clinic since 1999. Galma has a population of 428.

Supporting frontline vaccinators on the edge of Solomon Islands

Reaching every child with life-saving vaccines is no small task in Solomon Islands, a nation of nearly 1,000 islands where vast stretches of ocean separate communities and many health facilities are staffed by just one nurse.

NCIRS-supported Technical Advisor Paddy Cashman travelled to some of the country’s most remote communities as part of an Essential Programme on Immunization (EPI) supportive supervision project in the Western Province. Between the 26th and 30th of June, Paddy visited 5 health facilities across the Shortland Islands, accompanied by Western Province pharmacist Frederick Nego, to support frontline health workers delivering immunisation services in challenging and isolated settings. 

Located at the westernmost edge of Solomon Islands, the Shortland Islands are the closest islands to from Bougainville, Papua New Guinea (PNG). The border location makes maintaining strong immunisation coverage particularly important, given lower vaccination rates in neighbouring PNG and the ongoing risk of vaccine preventable disease outbreaks in the region.
 

Supporting, not inspecting

The World Health Organization (WHO) recognises supportive supervision as a key strategy for improving the quality of health service delivery, including immunisation services. 

Unlike traditional inspection-based approaches, supportive supervision encourages open, 2-way communication between supervisors and health workers, helping staff strengthen their skills while working together to identify practical solutions to local challenges. It is designed to build stronger health systems by improving performance, fostering teamwork and supporting frontline staff in their day-to-day work.

Supportive supervision is particularly important in the Solomon Islands, with many of the approximately 345 primary healthcare clinics across the archipelago operating as single-nurse posts. Travelling to centralised training courses can be costly, time-consuming and disruptive to services, making on-site mentoring one of the most effective ways to strengthen immunisation delivery.

NCIRS has worked alongside Solomon Islands’ partners to strengthen supportive supervision tools and practices, including supporting development of a revised supervision checklist and investing in visits to remote communities. 

During the Shortland Islands trip, Paddy used the newly revised national supportive supervision checklist to assess clinic performance and provide practical guidance to staff. 
 

Visiting some of the country’s most remote clinics

Travelling by small boat between islands, the team visited clinics at Nila, Gaowai, Harapa, Kariki and Toumoa. 

The trip highlighted the realities of delivering healthcare across remote island communities. In video updates, Paddy documented the experience, including navigating weather disruptions and witnessing the impacts of recent Cyclone Maila, which had damaged homes, vegetation and transport links across parts of the province.

At several locations, clinics were operating under difficult conditions. Many facilities were ageing and in need of repair, with limited access to infrastructure and resources. Despite these challenges, frontline nurses continued to provide essential healthcare services to their communities.

'The commitment of the nurses is remarkable,' Paddy reflected during the trip. 'Health workers are often running services alone, supporting scattered island populations and overcoming significant logistical barriers.'
 

Identifying strengths and opportunities

A highly dedicated workforce with a strong understanding of immunisation delivery and a long history of serving their communities was observed across the facilities visited. Vaccines in use were generally being managed appropriately, and staff demonstrated a clear commitment to protecting children against vaccine preventable diseases.

The visits also identified several opportunities to strengthen the local EPI, including improving vaccine cold chain monitoring, strengthening the use of child health registers, improving the tracking of children who have missed vaccinations, enhancing disease surveillance and expanding outreach services to reach families who cannot easily attend clinics. 

Several health facilities required additional support to maintain vaccine refrigeration equipment, while limited transport funding and the cost of petrol continued to affect the nurses’ ability to conduct outreach activities to neighbouring communities.

Throughout the trip, Paddy and Frederick provided practical, hands-on support. This included refrigerator maintenance, cleaning solar panels powering vaccine fridges, troubleshooting cold chain equipment problems, reviewing patient records and providing on-the-job mentoring consistent with supportive supervision principles. 
 

Building a stronger immunisation system

For Paddy, the Shortland Islands visit reinforced the importance of investing in systems that support frontline health workers wherever they are based. It provided valuable first-hand insight into the realities facing remote health facilities and practical improvements that can strengthen service delivery nationwide.

In a video update from Harapa Clinic, Paddy described supportive supervision as ‘the cornerstone of a quality EPI program’, noting that these visits are not simply about checking performance, but about understanding local challenges and building sustainable systems that enable health workers to succeed. 

As NCIRS’ embedded Technical Advisor within the Solomon Islands Ministry of Health and Medical Services, Paddy works alongside nurses in some of the most remote communities in Solomon Islands, helping to ensure that geography does not become a barrier to immunisation and that children have access to the protection vaccines provide, wherever they live.