Date: 2011 - 2013
WHO CC involvement: Professor Caroline Homer, Prof Pat Brodie, Michele Rumsey, Felicity Copeland, Monica Sanderson

Improving maternal health care in Papua New Guinea

The World Health Organization Collaborating Centre at UTS (WHO CC UTS) with the Office of the WHO Representative, Papua New Guinea, are leading an exciting new initiative, which has been funded by AusAID, focussing on Millennium Development Goal 5 (Improve Maternal Health).

Papua New Guinea (PNG), with a population of about 6.6 million, low literacy levels and over 87% of its population widely dispersed in rural areas, has a high maternal mortality rate. Between the 1996 and 2006 Demographic and Health Surveys (DHS) the maternal mortality ratio (MMR) for PNG increased from 370 to 733 deaths for every 100 000 live births1,2. The UN officially released figures in August/September 2010 which stated that PNG's maternal mortality was 250/100,0003 (Uncertainty bounds 110-560). The UN figures are based on a statistical model while the DHS is based on a household survey. Despite the different figures and methodology, the clear messages is that MDG 5 progress in PNG is still significantly off track and maternal mortality is unacceptably high in the range of 250 to 733 per 100 000 live births. The vast majority of maternal deaths (88-90%) are preventable4 and human resource and health system policies are urgently being addressed to increase the number of births attended by skilled health personnel as only 39%5 of births in PNG are reported as being attended by a skilled birth attendant. Furthermore, only 55%5 of pregnant women have the minimum internationally recommended number of four antenatal visits.

The Ministerial Taskforce on Maternal Health has identified an urgent need for 'functioning hospitals and other health facilities with midwives practising closer to the communities'. Ambitious human resources for health targets have been established to increase the number of obstetrically skilled doctors, registered midwives and community midwives. By 2015, the Government of Papua New Guinea aims to have achieved a significant increase in registered midwife numbers. Additionally, every health centre is to have a community health worker who has additional maternal health training. Registered midwives will be required to support and supervise the cadre of community maternal and infant health workers.

Currently four schools prepare midwives for qualifications to practise (the University of PNG in Port Moresby; Pacific Adventist University in Port Moresby; Lutheran School of Nursing in Madang; and University of Goroka). Although most facilities have a core of skilled and motivated tutors over-all the skill level of tutors and institutional capacities for safe and high quality maternal and infant care are insufficient. Clinical skills require refresher training, as do corresponding teaching, clinical supervision and precepting skills, to be refreshed and teaching skills upgraded if the quality of skills if the entry to practice skills of graduates are to improve and quality services be delivered.

Eight international midwives and two obstetricians were recruited to work in PNG. The midwives work closely with academic and clinical personnel in the midwifery education programmes of the four PNG schools and two regional hospitals that prepare midwives for qualifications to practise. The obstetricians are based in two regional hospitals providing maternity services.

A number of activities have been coordinated by the WHO CC UTS in partnership with WHO PNG as part of the initiative including:

  • Recruitment of CMFs and obstetricians
  • Induction in Sydney for the CMFs
  • Orientation in PNG for the CMFs and MCHI obstetricians
  • Several workshops in PNG with PNG national counterparts
  • Clinical supervision and mentoring for CMFs and MCHI obstetricians
  • Monitoring and Evaluation; collecting, analysing data and reporting on data
  • Member of WHO Steering committee

A number of challenges remain. These include developing fully appropriate communication channels, developing sufficient material resources as well as IT and Internet access in the schools, the capacity of the midwifery schools to take more students in 2013 and on-going safety and security issues. On a broader level, there are significant challenges relating to the effective and timely implementation of the National Midwifery Curriculum Framework, registration of midwives and regulation of midwifery in Papua New Guinea.

The WHO CC UTS as the sub-contractor for this 2-year initiative in close collaboration with WHO will be responsible for: mentoring, action research and ongoing monitoring and evaluation and overall employer accountability for the professional staff deployed to Papua New Guinea. Professor Caroline Homer, the project Director, will work closely with relevant staff of the National Department of Health, WHO, and AusAID. This contract will be coordinated by accessUTS Pty Ltd.

1. National Statistics Office (2009) Demographic and Health Survey, Port Moresby
2. WHO Western Pacific Region, Country health information profiles, Papua New Guinea, 2010. Manila, 2010
3. World health statistics 2011, World Health Organization, Geneva 2011
4. Papua New Guinea Report of the Ministerial Taskforce on Maternal Health in Papua New Guinea, Port Moresby, May 2009
5. World health statistics 2011, World Health Organization, Geneva 2011