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211. In most rural areas the recovery of money for child maintenance is relatively insignificant compared to the issue of land inheritance for a child of divorced or separated parents. Most people in rural areas have had little access to cash; therefore, maintenance has not been seen as an issue. Access to land on which to live and grow food is important. Land inheritance varies from matrilineal to patrilineal amongst the Solomon Islands.
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In situations of parental separation, the side of the family that will pass land down to the children most often provides for the child. Although such matters are probably beyond the scope of the CRC, the fact remains that in the Solomon Islands, as elsewhere; many such children’s economic opportunities are determined by familial contacts. 3. Constraints and recommendations 212. The 1992 Amendment to the Act, paragraph 5, extends the situations in which men can make applications under the Act.
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The applications referred to are for separations, custody, access and maintenance. However an element of confusion comes in under section 10 of the Act in which reference to maintenance does talk about “husbands paying to wives”. This is countered by section 16 of the Act which refers to interim maintenance orders and talks about “respondents paying to applicants”, which could be for husbands or wives. The Act, therefore, could be improved by clarifying this wording. 213.
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213. It is worthy of note that under the terms of a normal business contract, e.g. entering into an agreement with another person to provide a service, the statute of limitations for appealing a grievance against one of the contractual partners is six years. However, in cases of maintenance of illegitimate children, the statute of limitations is only three years.
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Perhaps this apparent inequity could be addressed through a modification of the current law via a recommendation to the Law Reform Commission to extend the period during which a parent can seek maintenance for a child born out of wedlock. CRC/C/51/Add.6 page 53 C. Children deprived of a family environment 1. Legal context 214.
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Legal context 214. There are no laws in Solomon Islands relating to establishment of orphanages as this has historically been considered to be in direct conflict with the Solomon Islands institution of the extended family. The extended family continues to function well and is considered an essential part of the culture of the country. The Preamble of the Constitution (d) states the pledge to “cherish and promote the different cultural traditions within the Solomon Islands”.
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According to Schedule 3 to the Constitution, in the absence of UK legislation (in this case, establishing orphanages), then the principles and rules of the common law and equity shall have effect as part of the law of the land with particular exceptions (paras. 1 and 2). 2. Implementation 215. There is no government provision for children living outside the home. Solomon Islands does not have an orphanage.
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Solomon Islands does not have an orphanage. Implicitly, governments in the past and today have been relying on the traditional system such as the extended family network, which is believed to be very strong in rural communities. It is expected that the extended family will provide for children not living with their parents. The churches provide some temporary facilities.
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The churches provide some temporary facilities. However, only one church (Church of Melanesia) appears to have a particular mission with regard to caring for those with no others to look after them. 216. As is the case with orphanages, Solomon Islands does not have an alternative home for delinquent children or juvenile offenders. The Central Prison at Rove accommodates both adult and minor prisoners.
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The current construction and renovation work at the prison includes plans for a juvenile section, which will separate minors from mixing with hardened criminals. However, that renovation has been significantly delayed to date. 217. As there are no institutions for alternative care per se there is no governmental monitoring of services or statistical data maintained. 218. There are many issues to be discussed on the question of creating an alternative home or care for abandoned or delinquent children.
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Government has historically objected to institutionalization of minors even for the purposes of rehabilitation. 219. Some juvenile offenders (primarily “pick-pockets”), caught more than once in urban areas, may be sent back to their villages in order to deny them access to their habitual environment. This policy appears to have deterred some juveniles from continuing their criminal lifestyles.
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This practice is facilitated by the Social Welfare officer who asks for a “residential order” after gaining the consent of a relative in the village that they will live with and look out for the juvenile. The Social Welfare officer seeks reports on the status of the affected child as frequently as possible, varying from once a month, if the village is relatively close, to three months if the village is quite distant. CRC/C/51/Add.6 page 54 220.
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CRC/C/51/Add.6 page 54 220. In the capital, Honiara, the presence of a population of “street kids” has prompted a number of concerned individuals to organize a committee to address their needs. This effort has brought together lawyers; representatives of NGOs; church members and other concerned citizens to advocate for protection of these children. D. Adoption 1. Legal context 221.
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D. Adoption 1. Legal context 221. The UK Adoption Act 1958 protects the welfare or interest of the child so that the High Court must first be satisfied that the child will be cared for properly before it grants an adoption order. 222. Any adoption, to be legally recognized, must follow or adhere to the Adoption Act. Any ad hoc or custom adoption is not legally recognized. 2. Implementation 223.
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2. Implementation 223. In legal adoption proceedings the mother must consent to the adoption and the matter is heard in the High Court. 224. The laws covering adoption, custody, access and guardianship also require Social Welfare to make a social welfare enquiry background report on applicants and parties concerned. As a practice, the courts write to the Social Welfare Office to request such reports.
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These reports help the courts to make decisions, and paramount consideration is given to the best interests of the child. 225. Systems of informal adoption are widespread amongst different cultural groups in Solomon Islands. These practices are often circumscribed and consistent within each particular culture, but vary widely across the country. Some practices are clearly to benefit the clan, e.g. the Bellonese custom of ensuring a male heir for the first son.
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In Temotu, a couple’s unborn children may traditionally have been assigned to particular relatives at the time of the betrothal or marriage. In such a culture, it is common that several children may be born to the mother, and given into other families, before she is allowed to “keep” one. Other practices benefit the child; e.g. a decision by grandparents to adopt a child to ensure the child is properly cared for.
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Although it is difficult to make generalizations, agreements for informal adoptions within families are usually intended to benefit the child. Despite this, however, attention must also be directed to the situation facing a child who becomes victimized by mistreatment, servitude or enslavement as a result of informal adoption. Children at particular risk are those who are split up amongst their deceased father’s relatives and separated from their mother, e.g.
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within certain cultures payment of bride price has ensured that such children stay in the father’s clan. In Bellona and some parts of Malaita, parents of girls may agree to let them be adopted expressly because a sister or brother lacks enough girl children to help the mother do the work required. Families in town areas where both parents work often require a young female relative to come live and care for children and do housework.
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Some of these girls have no rights to pursue their own education nor opportunities to seek paid employment elsewhere, effectively they have become enslaved. In areas where families and communities are healthy and functional, the CRC/C/51/Add.6 page 55 victimized child may be identified and “rescued” from a poor living situation. In situations of ill will between families or physical isolation, there is essentially no protection for such children. 226.
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226. According to the participants’ wishes informal adoptions may become formalized at any time as the child encounters the legal system by entering the school system, obtaining a passport or applying for residency outside of the Solomon’s, etc. There are cases where informally adopted children have been issued passports without going through legal adoption proceedings.
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However, in these cases the parent, during application procedures, has probably not mentioned the status of the informally adopted child nor would the issuing official have questioned the child’s status. 227. Intercountry adoptions do not involve Solomon Islands’ children being sent abroad for adoption as is done periodically by certain other countries.
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A very strong indicator of the high value placed on children by Solomon Islanders is the ability to find homes for most children within or amongst their own communities and cultural groups. The lack of orphanages and other care facilities in Solomon Islands attests to the strength of traditional society in this area. Foreigners who wish to adopt a Solomon Islands child must adhere to the terms stated in the UK Adoption Act 1958. 228.
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228. As required by law, Solomon Islands monitor pending intercountry adoptions involving residents who adopt children from other countries. Adopting a child from another country must follow the appropriate laws and procedures belonging to that country. Social Welfare (MHMS) coordinates or liaises with the Social Welfare office of that country to ensure necessary reports pertaining to applicants, children or legal parents are made. E. Illicit transfer and non-return 1. Legal context 229.
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Legal context 229. The Penal Code, Part XXVI, “Offences Against Liberty”, refers to sanctions prohibiting kidnapping, abduction, concealing abducted persons, etc. Section 246 specifically deals with child stealing. 2. Implementation 230. Protection provided by the Penal Code has only recently been tested in court. In at least two informal adoption cases the help of the public solicitor has been sought in instances of birth parents charged with child stealing, kidnapping or abduction of children.
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In the older case the public solicitor discouraged the adoptive family against pursuing the case in court due to the difficulty in proving that there had been an informal agreement to adopt the child who had subsequently been abducted by the birth family. However, in the second more recent case, the public solicitor was willing to pursue the case in court on the grounds that the birth mother that had abducted the child might be unfit.
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Informal adoption amongst certain cultural groups may also result in abduction of the child by the birth family after a period in the care of another family. This practice varies amongst cultural groups. Anecdotal information suggests that abduction may also be common in custodial disputes between families in cases of separation or divorce. CRC/C/51/Add.6 page 56 231.
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CRC/C/51/Add.6 page 56 231. The local radio recently reported a case of a boy being returned to his parents in the Solomon Islands after enduring sexual abuse at the hands of two adult Australian males in the Riverland district of South Australia: “... The prosecutor told the court the men procured the 13-year-old boy from the Islands last year after gaining the confidence of his family.
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She said he was taken away from the people who could protect him to the remote community of Morgan where he had no one to turn to. He had a limited grasp of English. She said it was fortuitous police visited the men’s home and discovered the boy. She said the boy’s parents lived in poverty and believed the men were giving their son a great opportunity.”78 This case illustrates the ease with which those who misrepresent themselves to trusting parents may take advantage of children.
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The modern climate of international cooperation amongst police is crucial to stopping these activities. In a country like Solomon Islands where education is difficult to obtain and therefore highly sought after, opportunities for these sorts of criminals are plentiful. F. Abuse and neglect of children and their physical and psychological rehabilitation and social reintegration 1. Legal context 232.
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Legal context 232. Under section 14 of the Penal Code, a male person under the age of 12 years is presumed to be incapable of having sexual intercourse. 233. According to section 38 of the Penal Code, a court may order that in the case of a person under the age of 16 who is found guilty of a crime, the parents or guardians of that person may be ordered to pay fine, costs or compensation. 234.
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Part XVI of the Penal Code (Offences Against Morality) contains many provisions protecting children against rape and attempted rape, abduction, abduction of a girl under 18 years with intent to have sexual intercourse, indecent assault on females, defilement of a girl under 13, defilement of a girl between 13 and 15 years of age, or of an “idiot or imbecile”, procuration, procuring defilement of a woman by threats or fraud or administering drugs, permitting defilement in householder’s premises (of girls under 13 and under 15), detention with intent or in a brothel, disposing of minors under 15 for immoral purposes, obtaining minors for immoral purposes, custody of girl victims away from offenders within the family, living on earnings of prostitution, conspiracy to defile, “unnatural offences” (buggery etc.
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), incest. However, very few cases of sexual assault/abuse/incest are pursued by police or brought to court. This is probably due to unwillingness to prosecute within the extended family. 235. It is a defence to claim that an accused did not know or did not believe a girl was under the age of 15 for the offence of defilement of a girl between 13 and 15 (sect. 135, Penal Code). The same defence holds for a householder permitting defilement (sect. 138, Penal Code). CRC/C/51/Add.6 page 57 236.
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138, Penal Code). CRC/C/51/Add.6 page 57 236. Part XXI of the Penal Code, entitled “Duties Relating to the Preservation of Life and Health”, and section 225 specify that it is the duty of any person having charge of a child under 15 years to provide the “necessaries of life” to such a child.
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Section 226 of the Penal Code provides penalties for any person over 15 having charge of any person under that age who wilfully assaults, neglects, abandons, or exposes him, or causes or procures him to be assaulted, ill-treated, neglected, abandoned, or exposed in a manner likely to cause him unnecessary suffering or injury to health. 237. Some protection from sexual abuse, especially of girls, is provided for in the Penal Code under “Offences Against Morality”, sections 128-161. 2. Implementation 238.
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2. Implementation 238. In most cases of family violence women and children are victims. Women are frequently beaten, kicked, punched and verbally or sexually abused by their husbands or male relatives at home. Children who witness these acts in the home become victims themselves, either physically or psychologically.
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For the period 1990-1992, police authorities recorded these figures for family/domestic violence in table 4, below: Table 4 Family/domestic violence, 1990-1992 Reported violence Alcohol-related violence Offences 1990 1991 1992 1990 1991 1992 ACABHa 135 147 137 18 98 91 Affray 59 20 9 39 13 11 Rape 4 4 3 0 0 0 Drunk/disorderly 0 0 0 0 0 0 Indecency 19 11 69 0 0 0 Total 217 182 218 57 111 102 Source: Criminal Records Unit, RSIPF.79 a Assaults causing actual bodily harm. 239.
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239. In October 1994 a survey sample of 1,000 people, evenly divided between urban males and females and rural males and females, provided valuable baseline data in the first known research study conducted in the area of domestic violence in Solomon Islands. The survey was restricted to Guadalcanal Province and Honiara Town and did not address child abuse directly. However one aspect of the study quantified the presence of children during incidents of domestic violence.
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“Of the 303 people who indicated they were victims of domestic violence, 210 (69 per cent) indicated that there were children present.
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These findings have implications for the welfare of [Solomon Islands] children as research from other countries suggests that children who witness domestic violence suffer from a range of behavioural, emotional and cognitive problems.”80 See table 5, below: CRC/C/51/Add.6 page 58 Table 5 Victims indicating children present during domestic violence incident Urban male (17) Urban female (149) Rural male (10) Rural female (127) Total (303) No. % No. % No. % No. % No.
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% No. % No. % No. % No. % Children present 11 5.2 87 41.4 10 4.7 103 49 210 69 Source: Poerio (1995). 240. The same report mentioned above states: “Police training in how to deal with domestic violence cases was completed for all provinces in Solomon Islands in September 1995.
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This training is the first of its kind and represents acknowledgement by the police that domestic violence is no longer considered a ‘private family matter’ but a crime.”81 If improved awareness by police through training results in increased responsiveness by police officers to crimes of domestic violence, the current repetitive and pervasive incidence of domestic violence may be reduced.
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In January 1998 Family Support Centre staff conducted an 11-day training/awareness-raising course for all Solomon Islands’ police women to assist with this very issue.82 241. Data has also been published on crimes against young people for the first half of the decade.
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What percentage of these are cases of crimes within the family are not clear (See tables 6 and 7): Table 6 Crimes against children and youth, 1990-1994 Offences 1990 1991 1992 1993 1994 Rape 11 4 6 10 14 Attempted rape 0 0 13 0 1 Indecent assault 13 13 14 17 16 Abduction of girl/female 1 0 0 1 1 Incest by male 5 2 0 7 1 Incest by female 2 1 0 2 0 Total 32 20 33 37 33 Source: Ministry of Police Annual Report 1994.
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CRC/C/51/Add.6 page 59 Table 7 Crime committed against children (as per Criminal Code Act (Cap 18)) Offences 1990 1991 1992 1993 1994 Carnal knowledge of child under 12 years 4 4 9 4 3 Attempted carnal knowledge of child under 12 years 1 3 0 1 0 Cruelty to child 2 9 7 9 2 Taking away of child 1 1 1 2 1 Total 8 17 17 16 6 Source: Ministry of Police Annual Report 1994.83 242.
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A community policing unit comprised of police and social welfare officers in the capital district visits schools and conducts talks raising awareness among school children of what constitutes child abuse. Sometimes police will initiate an investigation based on interactions with children after these talks. 243. The Family Support Centre in Honiara has conducted several Child Abuse Awareness and Legal Rights workshops for members of the community who have contact with children, e.g.
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church leaders, teachers, nurses, women’s group members, etc. There is concern that there will be an increased need for counselling services for children as people become aware of their needs and begin to pursue options available to them through the courts. 3. Constraints and recommendations 244. There is a need for continued development of positive working relationships amongst police and others that might advocate for children in the community.
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There have been complaints of punitive behaviour of police toward street children, in particular. However, generally speaking, the police are well-known to have taken punitive roles when encountering juveniles in the act of criminal activity. This is a worldwide phenomenon and a human rights issue for Solomon Islands as everywhere.
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Juveniles should be protected from such violence despite the intentions of those who “discipline” them to exact instantaneous juvenile reform by hitting them or with public humiliation. 245. There is a need for increased awareness and understanding of what actions constitute child abuse (physical, sexual, verbal, emotional) and neglect in relation to disciplinary measures imposed by parents upon their own children. Some feel that CRC’s definition of child abuse or exploitation needs discussion.
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They feel Solomon Islands cannot, as a result of acceding to the CRC, accept all provisions of the Convention without questioning each one. Each provision must, therefore, be compared and weighed against traditional Solomon Islands family values and norms with respect to traditional disciplinary mechanisms. The family is certainly an institution wherein each member contributes to its various functions and equilibrium. Parents play the important role of being head of the family.
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The rights and responsibilities of parents and CRC/C/51/Add.6 page 60 guardians to control and discipline their children must be considered. Lack of control or discipline can lead to disharmony and disequilibrium. Solomon Islands is one society with its own sets of values and western values are those of another society, which are sometimes seen to be in conflict with ours. What is good for western society is not necessarily good for Solomon Islands. 246.
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246. It is said that in rural areas, a child who is encountering trouble at home may leave his or her own home and seek refuge in another home, either of extended family members or others within the community. If this practice does exist in the village, it is certainly an avenue for children who suffer abuse. In the towns, however, especially Honiara, this traditional safety net is probably not available to children of troubled households.
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Without a shelter or method of intervening protectively on behalf of children who have been abused, intervention by authorities is likely to backfire into punitive repercussions for the child who “caused trouble”. The Family Support Centre recently mentioned in the media the pressing need for a specialized centre for child protection.84 247. Presently there are no facilities for protecting abused children or meeting their needs for counselling and support in Solomon Islands.
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Unless there are members of the family who are knowledgeable and capable of intervening, there is no system in place to meet the needs such children encounter as victims of abuse. These needs are occasionally addressed by church leaders and other individuals if not by NGOs and government agencies. The plight of the informally adopted child continues to be even more worrisome than that of the natural child who is abused. 248.
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248. In April and May 1997 the World Health Organization sponsored an Adolescent Health mission to Honiara. Interviews were held with 28 relevant professionals and focus groups were conducted with young people and parents to investigate the health issues of young people. One of the resulting recommendations highlighted the need to investigate the nature and extent of child sexual abuse and explore the development of child protection legislation.
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These recommendations followed the reasoning that some cases of girls and young women who have sexually transmitted diseases (STDs) are evidence of child sexual abuse. Thus the nature and extent of child sexual abuse, currently unknown, should be studied. It was also recommended that a legal mandate be developed and action taken to protect children from child sexual abuse, especially with regard to mandated reporting of child sexual abuse by health workers.
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G. Review of arrangements for children not living with their immediate family 1. Legal context 249. The Affiliation, Separation and Maintenance Act states (under the Affiliation Section) that a Social Welfare officer may make the appointment of a custodian for a child upon application. CRC/C/51/Add.6 page 61 2. Implementation 250.
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CRC/C/51/Add.6 page 61 2. Implementation 250. There are currently no legal protective powers to be exercised by any organizations on behalf of an endangered child when faced with the prospect of remedying a dangerous living situation. In cases where well meaning intervention by an outside person may well result in more bodily harm to the child, there is an intolerable dilemma for the person who can do nothing to protect the child.
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H. Future implementation of measures to ensure child rights in regard to the family environment and alternative care 251. The Social Welfare Division of MHMS has a Legal Rights Programme addressing rights of women and children in Solomon Islands.
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The first workshop, held 10-13 June 1996 stated its aims to include: Improving Social Welfare Officers’ knowledge and understanding of “core” Solomon Islands laws dealing with legal rights and responsibilities of citizens in relation to women and children; and Introduction of women leaders and workshop participants to Human Rights Education (legal literacy), the laws of Solomon Islands and laws specifically relating to women and children. 252.
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252. The Workshop was attended by 31 representatives from Government, NGOs and churches. It was the first in a series of three workshops, which Social Welfare is to conduct in collaboration with the Pacific Regional Human Rights Education Resource Team (RRRT), based in Suva, Fiji. Core topics covered were criminal offences, the constitution and fundamental rights and freedoms, the relationship between international conventions e.g.
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CRC, the Convention on the Elimination of All Forms of Discrimination against Women, the Solomon Islands Constitution and customary law. 253.
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The NACC Draft Policy, Strategy and Outline Plan of Action for Children (March 1996), still not formally adopted by Cabinet, outlines in “Activities to upgrade social services” the following goals to be met in this area: Develop legislation on social development and welfare; Secure more public participation in the development and delivery of social welfare programmes through the support of local governments, NGOs, women’s organizations and the churches; Establish day-care facilities available to working parents; Secure financial and technical assistance from bilateral and multilateral agencies; CRC/C/51/Add.6 page 62 Establish training programmes in counselling of children and their families for nurses, social welfare workers, teachers, church ministers and NGO workers; Establish women’s and children’s crisis centre/counselling facility; Establish family courts for child victims and offenders; Establish rehabilitation facilities for juvenile offenders.
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Also included in the Draft Policy and Outline Plan of Action for Children are “Activities to support urban families”: Develop an urban service network to support low income groups in urban and peri-urban areas; Develop community programmes which promote greater self-sufficiency of families in order to secure basic food, income and housing; Provide viable programmes of employment or other productive activities especially to women and unemployed youth; Encourage communities to establish youth recreational facilities; Encourage employers to offer incentives for their employees’ children to be educated.85 VI.
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BASIC HEALTH AND WELFARE A. Survival and development 1. Legal context 255. The Constitution stipulates that all citizens have the right to health services. The goal of the national health services of Solomon Islands is to promote, protect, maintain, restore and improve the health and well-being of its people so to achieve a better quality of life. This is being fostered through primary health care, health promotion, health protection and disease prevention and control programmes of the country.
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Solomon Islands is also party to the “1978 Alma Ata Declaration Of Health For All By The Year 2000”. 2. Organizational network 256. The organizational network of the Child Health Services of the Ministry of Health and Medical Services is comprised of one national referral hospital, seven (7) provincial hospitals, fourteen (14) area health centres, 123 health clinics, 61 nurse aide posts and 128 village health worker posts.
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Both health care and health improvement services are being addressed through these health facilities into the communities through primary health-care initiatives. The maternal CRC/C/51/Add.6 page 63 and child health division of the Ministry of Health and Medical Services (MHMS) coordinates, monitors, implements and develops national programme policies and guidelines for child health improvement programmes in coordination with the provincial health authorities and specialists in the various fields.
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The organizational structure of the Ministry of Health and Medical Services is illustrated in the following chart: Figure 1 Ministry of Health and Medical Services functional structure and organization Source: MHMS. 257. Churches, non-governmental organizations and the private sector contribute in providing health services to the communities governed by policies and guidelines set by the Ministry of Health and Medical Services. These organizations work closely with the Ministry of Health.
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The Government provides financial grants to church organizations and other assistance in forms of drugs, supplies, vaccines and staff training.
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MINISTER PERMANENT SECRETARY UNDER-SECRETARY HEALTH CARE UNDER-SECRETARY HEALTH IMPROVEMENT FIRST ASSISTANT SECRETARY • Curative Services (hospitals and clinics) • Provincial Health Services • Nursing Services • Health Planning and Human Resources Development • Paramedical and Support Services • Health Facilities, Equipment and Infrastructure • Pharmacy • Dental • Rehabilitation • Health Research/ Traditional Medicine • Maternal and Child Health, Family Planning, Reproductive Health • Environmental Health • Health Promotion and Education • Disease Prevention and Control • Social Welfare • Health Information and Statistics • Administration • Accounts • Personnel CRC/C/51/Add.6 page 64 258.
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The health services in the Solomon Islands promote primary health-care concepts and encourage parents and caretakers of children to be responsible for their own and their children’s health.
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These goals are implemented by the Maternal and Child Health Division of MHMS and are being fostered through such programmes as: Child Immunization; Nutrition and Growth Monitoring; Control and reduction of childhood diseases - diarrhoea, acute respiratory infections, EPI (Expanded Programme of Immunization) diseases, malaria; Promotion, Support and Protection of Breastfeeding Practice including Baby Friendly Hospital Initiatives; Promotion of local foods rich in Vitamin A and Vitamin A Supplements for “at risk” children; Safe Motherhood including family planning, and antenatal care; Safe water and excreta disposal and vector control, especially as relates to malaria.
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3. Implementation 259.
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Current programmes under way to improve children’s health include: Family Health Programme that caters for the strengthening of maternal child health services throughout the country, including reproductive health services; Strengthening the national immunization programme and especially support of Hepatitis B vaccine procurement; Breastfeeding support, promotion and protection and the Baby Friendly Hospital Initiative; Strengthening the development of IEC materials for MCH/FP programmes e.g.
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prevention of child abuse, prevention of domestic violence, prevention of diseases which are leading causes of childhood morbidity and mortality etc. through SCFA, UNICEF and UNFPA support. Maternal child health services are provided free at the point of delivery by the Government; Nutrition and growth monitoring by UNICEF. CRC/C/51/Add.6 page 65 260. Between 80-86 per cent of deliveries take place in health facilities attended by trained health workers.
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The other 14-20 per cent of births takes place at home by Traditional Birth Attendants (TBAs), mainly within three provinces, Central Island Province, Malaita and Guadalcanal. Because of this, TBA training has been conducted in these three provinces over the past three-four years. The Safe Motherhood programme encourages women to receive antenatal care and to deliver in a health facility. Approximately 79 per cent of pregnant women attend antenatal clinics.
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Health awareness campaigns are of paramount importance to inform communities and pregnant women of the benefits of antenatal care, choosing to deliver at health facilities and protecting their own health while pregnant and lactating. These consist primarily of health-care workers talking with pregnant mothers while they are waiting at the clinic for their antenatal checks. Videos are also shown and nurses freely dispense advice on these topics. 261.
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261. In the last five years family planning services have been expanded and developed into the national Family Planning and Population Awareness/Education Programme. The Ministry of Health and Medical Services emphasizes the health benefits of both mother and child through spacing of births. Modern methods of family planning are still not widely used due to lack of correct information and misconceptions. The contraceptive prevalence rate was approximately 11 per cent in 1995.
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This is probably an underreporting.86 However, Ministry of Health and Medical Services, with assistance from its partners (NGOs, churches and donors), has embarked on population and family planning awareness education from the national to the village level. This has been done in the hope that people will have the chance to make informed choices over their fertility for the benefit of the health of women and children.
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In recent years, the reasons people give for increased use of family planning seem to stem from economics rather than consideration for the health of women and children. Contraceptive Technology Update is an ongoing programme directing resources and information to all health workers as well as making modern contraceptives available and accessible to the rural people. 262. Estimating child immunization coverage rates in the Solomons is difficult.
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This is largely due to the fact that the numbers of estimated births given for each province based on the 1986 National Census seem to be overestimated compared to the numbers of actual births recorded by each province in 1996.
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When per cent coverage is calculated according to the actual births recorded, the immunization coverage is all above 90 per cent.87 The Expanded Programme of Immunization (EPI) covers BCG, Diphtheria, Polio, Tetanus, Pertussis, Measles, Hepatitis B and Tetanus Toxoid for pregnant women. National Disease surveillance and catch-up campaigns have prevented major epidemics of measles, whooping cough and other immunizable disease outbreaks over the last seven years.
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There are still sporadic cases of neonatal tetanus but the incidence has been reduced markedly over the past years. It is the aim of the programme to eliminate neonatal tetanus by the year 2000. There have not been any cases of polio and diphtheria reported for some decades. 263. The Growth Monitoring and Nutrition Programme, which entails regular monitoring of growth of children 0-5 years, is an important aspect of the Maternal, and Child Health Programme of the country.
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An “At risk” registry for home visits and follow-up of malnourished children as well as children needing special care and attention has been developed and is CRC/C/51/Add.6 page 66 effective in some provinces and in the capital of Honiara. National programmes promoting local foods rich in vitamins and minerals have been extended throughout the country. A National Vitamin A guideline has been implemented for two years now.
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A National Food and Nutrition Policy and the Breastfeeding Policy were passed in Cabinet in 1995 and 1996, respectively. A National Nutrition Plan of Action is soon to be completed, however, implementation of certain aspects of this plan have already been carried out by responsible parties in government, non-governmental organizations and church organizations.
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These activities are coordinated by the National Food and Nutrition Committee, which is approved by cabinet and draws its members from appropriate government ministries, NGOs and churches. A developmental checklist is attached to the Baby Health Book and health workers have been trained and are now using the checklist throughout the country. 264.
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264. Control of infectious diseases entails intense training of health workers and ongoing support and supervision, especially for acute respiratory infection and diarrhoeal diseases. These are ongoing activities of the Maternal and Child Health Unit. Other infectious diseases such as measles are controlled through immunization and promotion of clean/safe environment and sanitation programmes. 265.
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265. Emergency services are provided through 24-hour emergency services in all clinics, area health centres and hospitals. Doctors are on-call 24 hours at all hospitals, while nurses are on-call at all area health centres and clinics. Emergency evacuations by plane, boat or helicopter are the usual ways emergency patients are evacuated from remote areas. 4. Future implementation 266.
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4. Future implementation 266. The major goals of Maternal and Child Health Programmes are: To reduce the major causes of childhood morbidity and mortality, e.g. acute respiratory infection, diarrhoeal diseases, malaria, perinatal and neonatal infections by at least 25 per cent of the 1990 level by the year 2000; To improve and protect the health of mothers and children; To educate communities on the important role they can play in assisting to achieve the major MCH goals. 267.
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267. The Ministry of Health and Medical Services is being supported by local, regional and international agencies in its effort to improve the health of children. 268. As part of its endeavour to achieve its goal, the Ministry of Health and Medical Services is looking at expanding its community education and awareness programmes, through NGO and church networks and especially through women’s groups. It plans to expand the use of these networks in future.
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The Ministry of Health is also expanding its Reproductive Health programmes to include such activities as Cancer screening, strengthening STD programmes especially STD screening during antenatal care and adolescent health. Also the existing and CRC/C/51/Add.6 page 67 ongoing programmes such as family planning, immunization, growth monitoring and nutrition, intrapartum care and postnatal care, school health services, acute respiratory infection programme, control of diarrhoeal diseases, malaria etc.
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will require further expansion, improvement and strengthening. Specific objectives, strategies, and activities are included in the National Health Plans 1997-2001. B. Safe water and sanitation 269. Most urban and peri-urban households have access to chlorinated water supply through metered pipes.88 Besides the chlorinated water supply, many urban households have tank water as well. 270. Sixty per cent of the rural population has access to clean water.
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This is in the form of “gravity feed” supply and there is no form of chemical treatment. Protection of water sources from animals, people and land “run-off” is all that is feasible to do at present. In the atolls and outlying islands, the main source of water is from wells and water tanks. 271. Most urban households have access to toilet facilities, either septic systems, or pour flush.
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In peripheral urban areas septic system, pour flush, squatting or VIP (ventilated improved pit latrine) are available but may not be installed or in use. 272. Only 19 per cent of the rural population have access to proper toilet facilities, which include either pour flush, squatting or VIP latrines and very few septic systems. 273. Every effort is being made by the Rural Water Supply and Sanitation Project to provide safe drinking water to children and to dispose excreta by sanitary means.
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A special school water and sanitation project is also being implemented to improve these items for school children. 274. The Government of Solomon Islands recognizes the close link between good water supply and good public health. This is demonstrated by the expansion and development of a national water and sanitation project in the country, supported by AusAid, which is being implemented right now and includes training for women in water and sanitation.
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The UNICEF primary schools water and sanitation programmes have installed systems in 25 schools since 1995. C. Health status of children under 5 in Solomon Islands 275. The infant mortality rate has declined from 67/1,000 in 1976 to an estimate of 38/1,000 in 1995. The maternal mortality rate - based on the sisterhood method - was 549/100,000 live births in 1992. However, it is generally felt that the rate expressed is an overestimate.
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The current situation is more likely to be around 356/100,000 live births, still unacceptably high. CRC/C/51/Add.6 page 68 Table 8 Health indicators of Solomon Islands, 1986 and 1995 1986a 1995b Population 285 176 393 759 Women (15-49 years) 59 887 83 752 Total live births ?
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17 350 Crude birth rate (per 1,000 population) 42 38 Crude death rate (per 1,000 population) 10 7 Population growth rate 3.4% 2.8% Infant mortality rate (per 1,000 live births) 40 38 1-4 years Child mortality rate (per 1,000 population) N/A 7.1% Maternal mortality rate (per 100,000 births) N/A 549 Total fertility rate 6.1 5.4 Low birth weight babies (less than 2500g) N/A 11% Underweight children (under 5 years) N/A 23% Births attended by a health worker N/A 86% Life expectancy at birth (years) - male 59.9 63 Life expectancy at birth (years) - female 62 65 Sources: a National Census, 1986; b Ministry of Health and Medical Services, 1997.
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276. The main causes of death in infants in Solomon Islands in 1993 and 1994 are shown both in tabular form and as column charts following: Table 9 Causes of infant mortality (<1 year old), 1993 Causes of infant mortality (<1 year old) 1993 Percentage Pneumonia 27.3 Bacterial infections (meningitis/septicaemia etc.)
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21.2 Complications of delivery including: prematurity and low birth weight and aspiration 21.2 Malaria 7.6 Diarrhoea 6.1 Accidents (drowning, poisoning) 6.1 Congenital abnormalities 4.5 Others 6.1 Source: MHMS, 1995.
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