An archipelago of more than 900 islands in the South Pacific, Solomon Islands is a place of rugged natural beauty. But its remoteness presents unique challenges to the nation’s public health sector, with most living far from medical facilities. Roughly 80 percent of deaths in Solomon Islands occur outside the health system and may go unrecorded, leaving a critical gap in public health data.
Without knowing who is dying or why, designing effective prevention or intervention programs is challenging for health officials. As a result, diseases like tuberculosis, diabetes and hypertension could go underreported and unmanaged.
With support from the CDC Foundation and Bloomberg Philanthropies’ Data for Health Initiative, Solomon Islands is using community-based approaches to bridge this gap and offer lessons for other nations facing similar challenges.
Church Notifications
In many communities, church leaders are among the first to know when a person has died. In 2018, the Data for Health team, in collaboration with Solomon Islands’ Health Information System Unit and the Ministry of Health and Medical Services, began training pastors and ministers from the United Church, South Sea Evangelistic Church, Seven Day Adventist (SDA), Roman Catholic and Anglican churches to complete a simple death notification form as part of their burial duties. The forms are initially sent to nearby health facilities, where the details are transcribed onto the official death notification form. This notification is then forwarded to the Health Information System Unit, where the information is formally entered into the national registry.
Piloted first in the Guadalcanal and Western provinces, the results have been promising. In each month of 2024, churches reported as many as 25 deaths that would have otherwise gone unreported. With these four denominations representing about 95 percent of the population, the strategy has the potential to be scaled nationwide.
Lawrence Tonawane, community health nursing consultant in the country’s Western Province. Photo by Juan Arredondo
Comprised of more than 900 islands, Solomon Islands pose serious challenges to public health officlals trying to track cause of death across the nation. Photo by Juan Arredondo
Jack Igolo, a nurse in the Western Province of Solomon Islands. Photo by Juan Arredondo
Verbal Autopsies
In 2016 Solomon Islands introduced verbal autopsies, implementing them in all the country's administrative provinces by 2018. Verbal autopsies (VAs) are structured interviews conducted with a relative of the deceased person's family or caregivers to gather information about the signs, symptoms and circumstances surrounding the death to determine the most likely cause—particularly in situations where a medical professional is not available.
When word of a death is announced in a village or reported to a rural health facility, trained nurses visit the family after a respectful cultural mourning period to gather information about the deceased’s symptoms and health history using a standardized, 10-part form. The completed forms are then hand-delivered to provincial health offices, an often challenging process in rugged and remote areas of the country. Located near the equator, Solomon Islands also faces annual monsoons, intense heat and humidity and cyclone risks, adding to the challenge of accessing rural communities.
“Sometimes I walk from here and go to fill in the death notification form and conduct the interview even though the weather may not be comfortable,” said Jack Igolo, a nurse in the country’s Western Province.
Health workers in the provincial offices digitize the data using tablets and upload them directly to the Open Data Kit (ODK) Aggregate server, a centralized system for managing survey data, or send the data to national health authorities for uploading. The Ministry of Health and Medical Services then downloads the data and uses a computer algorithm, known as computer-coded verbal autopsy, to analyze the information and assign a probable cause of death–data than can identify health trends and help officials better target their resources.
To amplify the reach of health professionals, these verbal autopsies are often carried out with other health services being conducted in rural areas. With chronic diseases like diabetes and hypertension on the rise in Solomon Islands, education on the importance of the data is key, and community understanding and acceptance of the VA process have grown over time.
“Now that we have the system in place, then it becomes a matter to them [community members] that they should inform when a death occurs,” said Lawrence Tonawane, community health nursing consultant in the country’s Western Province.
Jack Igolo often ventures into the deep countryside to gather death data in the country’s Western Province. Photo by Juan Arredondo
Since church leaders are often among the first to be notified of deaths in a community, the Data for Health team began training pastors and ministers to fill out death notification forms. Photo by Juan Arredondo
A medical record health officer sorts through files of the Medical Certificate of Cause of Death (MCCD) for patients at the Medical Records Department of the National Referral Hospital. Photo by Juan Arredondo
Early Impact
The combination of verbal autopsies and church-based notifications is part of the broader efforts to strengthen the country’s civil registration and vital statistics (CRVS) system—ensuring accurate, timely data on births, deaths and causes of death. These efforts to transform death registration and cause of death reporting are having an effect. Since the start of the project, rural deaths from uncontrolled diabetes and hypertension are being reported more frequently. That information is invaluable to tailoring interventions more effectively, helping public health officials better target health emergencies with their limited resources.
The difficult geography of the island nation still presents challenges. Transportation is often difficult and inconsistent, and many nurses still need training in the verbal autopsy techniques. Digital infrastructure can also be weak, making reporting sometimes more difficult. Yet despite the challenges, says Igolo, the project is helping to reshape the country’s understanding of mortality.
“By conducting the verbal autopsy, we know the cause of the disease and we try to minimize the spread of the disease by educating the community and family members,” Igolo said.
Lessons Learned
These community-driven efforts have strengthened the CRVS system in Solomon Islands, including better governance, standardization, training and implementation of digital tools. The Solomon Islands’ experience shows that even in remote areas with limited resources, reporting of deaths can be improved through community-rooted approaches. Verbal autopsies offer a scalable method of identifying most likely causes of death where medical certification is unavailable, and church networks, trusted and embedded in local life, can become powerful partners in health data reporting.
As the country takes steps to expand training, improve digital connectivity and formally integrate verbal autopsy into the national health policy, global health leaders seeking to improve CRVS systems can look to Solomon Islands for a compelling example of how to improve death reporting in remote areas, and bolster public health responses. “Verbal autopsy is very important,” said Tonawane. “Because if those deaths are preventable or avoidable, then [the public health response] will save other lives.”