In 2011, Australia’s maternal death rate of 7.1 women per 100,000 was one of the lowest in the world. In neighbouring Papua New Guinea that same year, the rate was a staggering 129 times higher.
In response, the national Maternal Child Health Initiative (MCHI) for PNG was launched in 2012 under the directorship of UTS Distinguished Professor Caroline Homer, and led by the UTS WHO Collaborating Centre (CC) for Nursing, Midwifery and Health Development and the PNG National Department of Health.
Funded by the Department of Foreign Affairs and Trade (DFAT) and in partnership with the WHO, Australian Awards and numerous NGOs, the initiative aimed to systemically improve PNG’s maternal and child health outcomes, with an emphasis on expanding the midwifery workforce.
“In delivering the MCHI, we worked very closely with those partners in many ways—in capacity building, regulation, research and education. There were many, many people involved and that's what made it so successful,” says Michele Rumsey, Director of the WHO CC.
Research conducted at UTS between 2011 and 2013 revealed that increasing the number of midwives in low-income countries like PNG by just 25 per cent could reduce maternal deaths by up to 75 per cent. In response, Professor Homer and her team embarked on a project to deliver educational interventions that would expand PNG’s midwifery workforce.
Over the course of four years, the UTS team worked alongside the National Department of Health and DFAT to increase the number of midwifery schools in PNG from four to five, and embedded 11 international clinical midwifery facilitators within the schools to educate and mentor the students. They also provided mentoring and teaching resources for PNG educators.
Another body of UTS research that looked at curriculum development and health system capacity building led to a governmental review of the PNG National Framework for Midwifery Education. Ongoing WHO CC UTS support in PNG National Department of Health strengthened regulation, accreditation and established midwifery registration. The result was the introduction of a standard curriculum and accreditation process in all PNG midwifery schools.
“Through the WHO CC, the UTS Faculty of Health is internationally acclaimed for their nursing and midwifery expertise, particularly as it relates to workforce capacity building in developing countries,” says Professor Fiona Brooks, Assistant DVC (Research): Development.
“The MCHI played an important role in empowering health care workforces to address addressing the underlying causes of poor maternal and child health in PNG.”
Between 2012 and 2016, over 400 midwives were educated and registered as a result of the MCHI, more than doubling existing midwifery workforce numbers. Many graduates were placed in rural and remote areas that had long suffered a severe lack of health care services, and two international obstetricians were also placed in regional hospitals that previously had limited access to obstetric care.
The revitalisation of the profession further led to a group of midwives re-establishing the PNG Midwifery Society with support from MCHI midwifery facilitators. The society’s first national conference in more than a decade was held in 2015 and attracted more than 300 midwives from all over the country.
A scarcity of official health care data in PNG makes it difficult to quantify changes in maternal mortality outcomes; however, the MCHI has had a significantly positive impact on maternal and child health across the country. According to PNG obstetricians, the initiative resulted in most health centres in the country being staffed by a qualified midwife, and an increased focus on woman-centred care has improved outcomes and the women’s experiences.
A UTS-led evaluation of the MCHI also found substantial improvements in the quality of clinical education on offer, with a stronger focus on evidence-based clinical skills, among other findings.
The project’s far-reaching impacts were recognised by governments in both Australia and PNG, including by Australia’s Department of Foreign Affairs and Trade, the PNG National Department of Health, and Commonwealth Chief Nursing and Midwifery Officer, Debra Thoms.
“This [work] has made real change to the situation in PNG. The work you have carried out in strengthening governance, regulation and education not only strengthens the PNG health workforce and health systems, but has an impact on health security for the region and Australia,” Ms Thoms says.