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          "url": "https://apo.who.int/publications/i/item/9789290227700"
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      ]
    },
    {
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          "country-improvement-source:TUV:world-bank-health-system-project-pad-2022"
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        "support_state": "candidate_supported",
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      "display_status": "shown_in_full",
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        "description": "Health Reform Strategy, page 13; World Bank PAD, Project Development Objective and components."
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      "material_id": "material:2d33ba86411acaafa498f643",
      "notes": [
        "Keep reform plans distinct from verified implementation and outcomes."
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      "statement": "The 2016 strategy set objectives through 2019, while a 2022 project appraisal specifies planned system strengthening through 2028. Neither source alone verifies reform completion or effects.",
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        {
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          "source": "not supplied",
          "url": "https://documents1.worldbank.org/curated/en/099102824011037014/pdf/P175170-0e2d7116-75d7-49e0-899f-89a77787e601.pdf"
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    },
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      "display_status": "shown_in_full",
      "document_type": null,
      "evidence_mode": "formal",
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        "description": "Budget PDF physical page 99; PLOS Digital Health article, Introduction."
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        "Do not infer statutory ownership, facility management, or a current facility census."
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      "origin": "candidate-analytical-mappings",
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      "statement": "The 2024 budget formally assigns health-care service responsibility to the Ministry. A 2022 study describes a hospital and outer-island clinic network, without establishing legal ownership or operational authority.",
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        {
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          "url": "https://finance.gov.tv/wp-content/uploads/2024/03/2024-National-Budget-Half-Year-2.pdf"
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          "source": "The impact of digital communication and data exchange on primary health service delivery in a small island developing state setting",
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    },
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      "citation": "Government of Tuvalu, Ministry of Finance. 2024 National Budget. 2024; Ministry of Health, Tuvalu. Health Reform Strategy 2016-2019. 2016.",
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      "display_status": "shown_in_full",
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      "evidence_mode": "formal",
      "excerpt": "provides strategic policy direction in Tuvalu's health and social welfare sectors",
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        "Do not infer an operational decision-right allocation beyond the named national roles."
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        {
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          "url": "https://finance.gov.tv/wp-content/uploads/2024/03/2024-National-Budget-Half-Year-2.pdf"
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      "citation": "World Health Organization. Tuvalu: WHO Results Report country profile 2024. Accessed 22 August 2026.",
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        "Do not infer who approves individual referrals or how review recommendations were implemented."
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          "url": "https://www.who.int/about/accountability/results/who-results-report-2024-2025/country-profile/2024/tuvalu"
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        "mapping_basis": "2025 World Bank results article and 2024 WHO country profile",
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      "annotation_status": "open",
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      "citation": "World Bank. Transforming Health Care Access in the Pacific Islands with World Bank Support. 2025; World Health Organization. Tuvalu Results Report profile 2024.",
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        "description": "World Bank results article, Tuvalu section; WHO country profile, Overseas Medical Referral Scheme section."
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        "support_state": "candidate_supported",
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        "target_view": "referrals",
        "typed_fields": {
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          "observed_study_finding": "Health-worker accounts linked VSAT-enabled communication with remote clinical decision-making and fewer referrals required."
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      "citation": "Fowler L, O'Connor M, et al. PLOS Digital Health. 2022.",
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      "evidence_mode": "observed",
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        "Do not treat participant accounts as a current referral count, completion rate, or causal national evaluation."
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