Back to the Future: Putting primary back into the Kiribati health care system

This paper explores the introduction of a quality improvement initiative in Kiribati’s primary health care (PHC) system. Revised
supportive supervision guidelines and a simplified tool were formally introduced in late 2018 and piloted in ten outer islands,
comprising three of six of Kiribati’s districts. Perspectives on their introduction as well as initial findings from implementation are
reflected in the paper.
The paper is based on secondary and primary data collection. Secondary data included a desk review of supervision reports and
action plans for the period 2019-2020, complemented by key informant interviews with relevant government and UNICEF staff.
All health facilities demonstrated a significant improvement in performance and quality from one visit to the next when measured
against the standards. Most of the improvements resulted from actions within the control of PHC teams. The tool triggered initiative, but also recognition for such actions, which is important to the motivation of PHC teams working in isolation from the larger health system.
Supportive supervision is not a panacea for weak PHC systems, and challenges remain. Adaptation needs to consider how to motivate
PHC facilities to continue their quality improvement trajectory. This will require more progressive support and needs to address
management and capacity issues within the Ministry of Health and Medical Services. The inclusion of community engagement in the tool has created a sense of healthy competition between Island Councils and PHC facilities. This form of recognition used to exist in Kiribati as the mechanism for countering dispersion and reinforcing cohesion among outer islands.