The Pacific Islands are vulnerable to climate change and increased risk of disasters not only because of their isolated and often low lying geographical setting but because of their economic status which renders them reliant on donor support. In a qualitative study exploring the adaptive capacity of Pacific Island Countries (PICs) across four countries, Cook Islands, Fiji, Samoa, and Vanuatu, it was clear that traditional coping strategies are consistently being applied as part of response to disasters and climate changes. This paper describes five common strategies employed in PICs as understood through this research: recognition of traditional methods; faith and religious beliefs; traditional governance and leadership; family and community involvement; and agriculture and food security. While this study does not trial the efficacy of these methods, it provides an indication of what methods are being used and therefore a starting point for further research into which of these traditional strategies are beneficial. These findings also provide important impetus for Pacific Island governments to recognise traditional approaches in their disaster preparedness and response processes.

Global aid programs and the recipients of the program would benefit from comparable health strengthening approaches to nursing and midwifery in similar developing countries.

Introduction:The recent policy environment in both Papua New Guinea and Australia for partnering with private entities to address health issues has led to a public-private partnership (PPP) between the National Department of Health in Papua New Guinea, the Australian Government and the Oil Search Foundation. A reproductive health training unit was formed to provide health worker training in essential obstetric care and emergency obstetric care. This article provides a qualitative evaluation of the PPP, looking at facilitating features and barriers to the PPP's target of improving the competence of frontline health workers in obstetric care service provision in Papua New Guinea. Method: A qualitative methodology gathered data since the PPP's inception in 2012. A dataset of 85 interviews with partners and relevant stakeholders from across Papua New Guinea was analysed using thematic analysis. Results: Themes of facilitating features of the PPP were (1) understanding and agreeing with the national plan for PPPs and maternal and child health; (2) having strong champions, strong relationships and a formal decision-making body; and (3) creating autonomy and branding. Themes outlining the barriers to the PPP's effectiveness were (1) lacking governance framework creating confusion in decision making and roles and responsibilities; (2) differing institutional cultures and ownership struggles; and (3) lacking capacity within the institutes themselves, particularly the National Department of Health. Conclusion: The findings of this service provision case study confirm what has been found in other infrastructure-led PPPs.Further research into how to overcome power imbalances between partners in a PPP as well as setting up a governance framework in a dynamic environment could inform this growing area of collaboration between the private and public sectors.

BackgroundThere is a growing body of evidence that the impacts of climate change are affecting population health negatively. The Pacific region is particularly vulnerable to climate change; a strong health-care system is required to respond during times of disaster. This paper examines the capacity of the health sector in Pacific Island Countries to adapt to changing disaster response needs, in terms of: (i) health workforce governance, management, policy and involvement; (ii) health-care capacity and skills; and (iii) human resources for health training and workforce development.MethodsKey stakeholder interviews informed the assessment of the capacity of the health sector and disaster response organizations in Pacific Island Countries to adapt to disaster response needs under a changing climate. The research specifically drew upon and examined the adaptive capacity of individual organizations and the broader system of disaster response in four case study countries (Fiji, Cook Islands, Vanuatu and Samoa).Results‘Capacity’ including health-care capacity was one of the objective determinants identified as most significant in influencing the adaptive capacity of disaster response systems in the Pacific. The research identified several elements that could support the adaptive capacity of the health sector such as: inclusive involvement in disaster coordination; policies in place for health workforce coordination; belief in their abilities; and strong donor support. Factors constraining adaptive capacity included: weak coordination of international health personnel; lack of policies to address health worker welfare; limited human resources and material resources; shortages of personnel to deal with psychosocial needs; inadequate skills in field triage and counselling; and limited capacity for training.ConclusionFindings from this study can be used to inform the development of human resources for health policies and strategic plans, and to support the development of a coordinated and collaborative approach to disaster response training across the Pacific and other developing contexts. This study also provides an overview of health-care capacity and some of the challenges and strengths that can inform future development work by humanitarian organizations, regional and international donors involved in climate change adaptation, and disaster risk reduction in the Pacific region.

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