Vanuatu's central hospital, in Port Vila, has around 150 beds and handles everything from routine deliveries to the referral cases that come by boat or light aircraft from outer islands. It's understaffed relative to need, under-resourced relative to what modern medicine requires, and overworked in a way that the staff — who are typically well-trained and genuinely dedicated — navigate with impressive professionalism. This is Pacific healthcare in a middle-income developing economy, and it's both better and harder than most visitors realize.

The rural health system runs through a network of health centers and aid posts across the islands. Health centers, staffed by nurses, handle most primary care and basic obstetric emergencies. Aid posts, staffed by community health workers with shorter training, provide a first point of contact in the most remote communities. The referral chain from aid post to health center to hospital works when boats run and weather cooperates. When cyclones hit, it breaks down — sometimes fatally.

Maternal mortality remains higher than Vanuatu's government wants it to be, with a significant portion of deaths occurring at home or in transit rather than at health facilities. Increasing skilled birth attendance in remote areas is a consistent health policy priority. Community midwifery programs and improved referral protocols are making incremental progress, but geography and infrastructure continue to impose hard limits.

Communicable disease burden includes malaria in some islands, though elimination campaigns have reduced transmission substantially in recent years. Tuberculosis is present and requires long treatment courses that are hard to complete in remote settings. COVID-19 arrived later and spread more slowly in Vanuatu than in densely populated countries, partly because island geography provides natural quarantine and partly because border closures were effective. Vaccination coverage, when vaccines became available, was uneven — better in urban areas, harder to achieve in remote islands.

Traditional medicine coexists with formal healthcare in ways that are sometimes complementary and sometimes complicated. Kastom medicine — herbal treatments, ritual healing, massage techniques — is widely trusted and widely used. For many conditions, particularly chronic pain, skin issues, and psychological distress, kastom practitioners offer care that the formal system can't provide due to capacity constraints. Where traditional medicine delays care for acute emergencies — complicated deliveries, severe malaria, appendicitis — it can cost lives.

The government's health policy acknowledges traditional medicine's role while trying to strengthen the formal system enough to provide reliable emergency and curative care. Training traditional practitioners in recognizing when to refer patients to formal facilities is one approach. Community health worker programs that bridge between formal and traditional systems have shown promise in several Pacific countries including Vanuatu.

Donor funding from Australia, New Zealand, WHO, and various bilateral partners supplements Vanuatu's own health budget. This creates dependencies that Vanuatu's health planners are trying to manage by building domestic financing capacity and keeping donor commitments aligned with national health priorities rather than donor agency preferences.