Build resilience in health systems and improve accessibility

We are trying to prevent and/or reduce the high maternal and child mortality rates in the rural communities in Papua New Guinea (PNG). More than 75% of the PNG's total population live in rural communities, who are marginalised and under served due to poor health services systems in PNG. Thus, more mothers and new born babies are dying from pregnancy related complications that can be prevented in our rural communities.

Articles, Research paper, and Reports published by WHO, UNICEF, UNDP, and others show that, "PNG has the highest Maternal Mortality rate in the Asia-Pacific is at 127 per 100,000 live births. In addition, a report by UNICEF, 2019 estimates that 580 women die annually from pregnancy and birthing related complications. These deaths can be prevented and/or treated.

Our aim now through this Challenge, is to advocate for girls and mothers to be trained and informed on their Sexual and Reproductive Health Rights, Maternal and Child care health services, and identify existing health care services, and improve accessibility. 

There are maternal and child health care services put in by the Health Department, but accessibility is difficult, either the girls and women find it hard to access or the services are limited or unavailable, especially in the rural communities. 

Having lived with the local communities, experienced the local cultures, being part of the health services providing health teams, PNGRWHA beliefs in taking the different approach through this Challenge to make girls and women realise the importance of being personally responsible for their own personal and family health. Learn to look out for available health services when have a health problem.

Advocacy and training in their own local languages helps girls and women understand and take appropriate actions respectively. Constant community training and discussions help girls and women to be more familiar with their rights to access health services and identification of services locations.

This process through our challenge will definitely address the high maternal and child mortality rates by a 30 - 40% in our target rural communities in the province, and most likely to be adopted and implemented through the nation, and even the other under developed countries in the world. 

Our approach is boosting the existing health services by making the girls and women to be responsible of their own health by understanding in detail their own sexuality, and seeking services when in need. On the other hand, the existing system is in place, waiting for people to access them when in need. There is no established pull or push factors in place to improve the and promote health of the population in rural communities (Poor communication, poor health infrastructure, low health staffing, accessibility to services in difficult, poor transport systems, and many reasons that contribute to poor health indicators in PNG).

Our solution is to create awareness and training on the availability and accessibility of existing health services to girls and women in remote rural communities, and promote equality and equity in accessibility to health services.

Young girls and women at childbearing ages (15 - 45 years) awareness and accessibility to health care services are limited in rural remote communities. Due to frequent tribal fights, poverty, weak infrastructure, lack of reporting and monitoring, and disparities in health coverage are barriers to improving Maternal and Child Health Outcomes in PNG.

To bridge the gaps of awareness and accessibility to vital health care services, PNGRWHA conducts Sexual and Reproductive Health (SRH),  Awareness and Training, Family Planning, Pregnancy care, and Safe Birthing.

SRH awareness and health promotion training is conducted in rural communities allowing the target population to identify problems affecting their lives themselves. In our group training in rural communities, problems are identified and solutions are resolved by the community themselves.

The main findings based on our frequent meetings with rural communities affecting girls' and women's health lives are;

1. Lacking health information and awareness

2. Lack of health services (health staff, and Infrastructure) in rural communities

3. Different Cultures, Social Norms, and social taboos that create barriers to access

4. Language Barriers to understanding health Information, and

5. Distance to the nearest health facility, and

6. Many other reasons for poor health outcomes in rural PNG.

Therefore, our Solution to solve and build resilience in awareness and accessibility to quality health services for girls and women in rural communities, we focus on two main projects. We involve and partner with the Health Department, Education, Churches, and other NGOs for sustainability. 

1. Training and Awareness on Sexual and Reproductive Health, Pregnancy, and Safe Birthing, and neonatal care.

2. Introducing a "Waiting House" in strategic locations for pregnant mothers to use in their trimester of pregnancy, for pregnancy management and supervised birthing.

Health Awareness and Training using the local language and dialect in strategic rural locations to deliver health messages to girls and women who will understand and act upon the messages. This is important as health messages in other languages can not be understood. In our rural communities in PNG, 75% of our total population in rural PNG is illiterate.

There is effective communication in their own language. The important factors that impact their healthy lives are highlighted in our meetings. Their understanding of healthy lives, and unhealthy practices of life help us find solutions to work on to improve. This is promoted by community training in local languages.

The other project that evolved from our discussions and training is to build a "waiting house" for pregnant mothers to use during their third -trimester of pregnancy. This "waiting house" is introduced to be used to conduct health awareness and training, and health workers assess and manage their pregnancy. 

This initiative promotes the safe management of pregnancy (prenatal care), and early detection of pregnancy-related medical conditions (high Blood pressure, fetal malpresentation, diabetes, anemia, pre-eclampsia, etc). Health workers use the opportunity at the "waiting house" to give all the health education messages and make necessary medical decisions related to pregnancy. 

And so, the pregnant mothers wait at the "waiting house" until a safe birthing. At the "waiting house", health workers can supervise birthing and assist mothers. This process prevents birthing-related or associated medical conditions both the mother and the infant may face. And the care continues to post-natal. 

This project will target young girls and women of childbearing age (15 - 45 years). This target population is most impacted by inadequate and inaccessible to healthcare services in this country. Also, their health is affected by poor education. Illiteracy rates in rural communities in PNG is high, estimated to be at 75%.

 Due to the fragile healthcare system, healthcare services needed by the target population are limited and/or fragmented. Therefore, accessibility is limited or low, especially for the target population. As a result, the maternal and infant morbidity and mortality rates in Papua New Guinea are high in the Pacific, 127 per 100,000 live births.

Health care services such as, Antenatal care clinics during pregnancy, birthing facilities, family planning services, sexual and reproductive health care services, and health promotion activities are all inaccessible or limited in all rural remote communities in PNG. 

Reasons for not accessing the existing health services are;

1. It is a cultural or social norm for girls and women to isolate themselves in family homes or in their local communities than freely moving in and out of those boundaries. Their free movement from village/community to community is a violation of the norms, and are regarded as valueless humans in the communities. 

2. Health care services infrastructure in PNG is poor, and also health staffing is another issue that delivers services and limits the accessibility to services by people when in need. Health facilities are poorly constructed, are far away to access by the target population, and/or are poorly staffed. 

3. Language barrier. PNG is a multi-lingual or multicultural society where language varies from tribe to tribe or cultural group. Due to being illiterate, as illiteracy rates are high in PNG, the rural population can not understand and determine the health impacts. Cultural norms and taboos, and language create barriers to health information sharing

4. Geography of the rural communities in PNG. Very raged mountains, fast-flowing rivers, and scattered villages cause the isolation of villages from each other. Because of the geographical locations of communities, when people are sick, and/or pregnant mothers needing assistance or attention, walking is very difficult. 

To address issues associated with the above causes of inequality in accessing health and education services, PNGRWHA is striving to highlight and break the barriers through its health and education awareness and training in remote rural communities.

Identifying the issues and contributing factors to ill health and inaccessibility to vital services by the rural population, especially girls and women, PNGRWHA conducts awareness, and training and introduces innovations that can be locally accepted and adopted. 

From the information provided through awareness and training, people will identify issues, and develop strategies to address or work against to make possible progress in life. People will know their problems and change their way of business to adapt to new changes for improvement in life.

We are very confident that people will make positive changes in life and contribute to the National Health Indicators (reduced maternal and infant morbidity rates, and mortality rates, increased family planning, increased supervised deliveries, more girls going to schools, and every bad indicator will improve. These figures will be collected and reported every month through the existing health systems in PNG.

The members of PNGRWHA are originally from rural remote communities in PNG, our target provinces, and the districts who were lucky to be educated, and working in towns and cities who can access health information to share with girls and women in their rural communities.

Members of the team are technical officers in health (Specialist Midwife Nurses, Health Educators, Public Health Specialists, Environmental Health Officers, and Education Officers).

The members having natives of rural communities and experienced local situations combine their expertise to form this Association (PNGRWHA). Members know their respective local dialects and languages to communicate. 

Communication is an issue to disseminate vital public information. This is again due to the high illiteracy rates in rural communities. 

We are located in the center of the Highlands Region of Papua New Guinea (PNG). It is a strategic location in PNG to move in all directions with our work. Our current project sites or the focus provinces and districts are;

1. Western Highlands Province

2. Jiwaka Province

3. Enga province

4. Southern Highlands Province

5. Madang Province

6. East Sepik Province

7. Wester Sepik Province

From our Head Quarters in Mt Hagen, WHP we travel and reach out to our other districts and provinces.

Because of the different languages and dialects used by different districts and provinces, our teams have frequent (quarterly) outreach to all identified strategic rural communities. Conduct training, health promotion, and awareness. All our projects promote partnership and we are open to any interested partner in our work.

Our team is formed of staff who are from all of our project sites (districts and provinces). When visiting a rural community, the local staff member is the team leader of his/her province/district visit team. Having a local member on our team creates an environment for us and the rural communities to communicate freely and understand each other well. Local cultures, social norms, taboos, local issues, and the language for effective communication.

Traveling in and out of our location is effective with access to all transport with established infrastructure, it's the central location. We are up to date with our schedules except funding is an issue with us. So we are well-positioned geographically and with all mixed staff with the same interests. We are focused and determined to prevent Maternal and Child Morbidity and Mortality rates in PNG. And educating our young girls will help them develop and understand the basics of health care.

Our focus is to educate girls and women to learn the importance of healthy living, benefiting from all developments and services, and having equal rights to live a happy healthy life. 

We are already working in six districts of our seven provinces in the Highlands and Momase Regions in PNG. Since 2018, we have covered the following provinces and districts with their population.

A. We focus on seven Provinces (WHP, Enga, Jiwaka, ESP, WSP, Madang, and Hela provinces)

B. Six districts in the seven provinces (the seven provinces have an estimated total population between 4 to 5 million,30% of the population are our target population)

C. Covered 100 council wards or communities in the six provinces

D. Trained 20,000 women, 5,000 young girls, and 260 fathers (total of 25,260 people)

E. Partnered with six different agencies (both government agencies, NGOs, LLGs, Women groups, Churches, and INGOs)

Through this challenge, we hope Solve will help us continue and improve our work in the rural marginalised communities in the following areas;

1. Monetary support to continue and maintain our work

Money is needed to support us in our programs sustainability, staff program meetings, performance review meetings, program visit transport costs, and marketing.

2. Leadership coaching and support to manage our work effectively

MIT working with us to update on technical information, support on technology use, staff training, coaching and mentoring. 

3. Help us with Media exposure and networking to share our work with others and also learn from them. 

Designing of our web sites, technology updating, training and information sharing to share and market our services for others to learn from by accessing our information, and also they can help us in our work.

4. Technical advice and support in monitoring and reviewing our to improve quality with our work and report

We need to monitor and analysis our services outcome to ensure efficiency in our projects. Tecnicalities of measuring human behaviour towards our services and the outcome.

We are not exposed to technology in our work here in most cases as there is limited infrastructure. Thus our work is mainly person to person focused in all our target communities. Information sharing, training and awareness, and all other means of transferring news and information is very difficult here in PNG rural communities, due to language barriers, and poor infrastructure. In this scenario, we will need financial assistance to physically attend to rural communities by our staff to promote and maintain our work.

Our solution is innovative in the sense that we are refining and reforming our solution into the existing services that are fragile and fragmented. Existing services can not meet the health and education services needs of our remote rural [population (girls and women). Attempts made by concerned government agencies have failed and/or are not effective, resulting in high maternal and neonatal mortalities in the Pacific, high rates of teenage pregnancies, and low female school enrollments. 

Our solution uses two methods to address and bridge gaps in accessing health and education services by our target population from the rural communities in PNG; 

1 The local language and its dialects to communicate health information. Information is what has been lacking for the rural female population and their families to make informed life impactful decisions. 

2. A "waiting house", for pregnant mothers to use in their last term of pregnancy to address the accessibility issues with distances and transport costs. 

Our "waiting house" initiative addresses a lot of barriers that prevent girls and women from addressing health issues and accessing existing healthcare services.       

It is innovative with its added value to reforming and refining the services in the existing systems. Our solution visits our target population community by community to closer look and allow communities to express their beliefs in the systems, their views on the existing health issues, and the impacts of the existing services on their lives and their community. We share and plan together using the technical information we give for an improved outcome. We allow two-way communication and a better understanding of our process.

And the added value to our solution is the building of a "waiting house" using local materials suitable and adaptable for easy use by the local community at the lowest cost. 

A "waiting house" solves the following issues and bridges the gaps to better health for mothers and newborn babies;

1. Health workers assess pregnant mothers during antenatal visits and make appropriate technical decisions on the status of the pregnancy, and manage accordingly for the good health of the unborn baby and the mother

2. Make appropriate referrals based on the pregnancy assessments for further treatment during pregnancy.

3. Saves costs for pregnant mothers and families to travel to and from antenatal clinics monthly and fortnightly. 90% of the rural population can not afford these costs so stay away from visits to health facilities

4. Social issues prevent pregnant mothers to travel distances to have antenatal clinics, and/or to go and give birth at health facilities

5. Social norms and taboos that prevent pregnant mothers to expose their pregnancy to the public. This is for reasons that vary from tribal zeon to zeon or tribal communities to community, and the common reason for giving birth at home is

6. Pregnant mothers' private parts (vaginal openings) are exposed to other people during birthing which is shameful in society. The birthing mother and her family are liable to pay compensation to those who witness the birthing by seeing the private parts and touching the blood of the newborn baby. 

These are a few reasons that commonly contribute to preventing pregnant mothers from seeking health care services during pregnancy and in labor for birthing. In addition, young girls who are not officially married are not allowed to have family planning services, which leads to increased teenage pregnancy, STIs, and HIV/AIDS among the rural population.

Our Impact Goals are to see results from the following indicators from our work targeting the issues affecting girls, women, and infants' lives in rural communities in PNG;

1. Increased Antenatal clinic attendance by pregnant women

2. Increased supervised birthing by trained health workers

3. Reduced maternal mortality rates

4. Reduced infant mortality rates

5. Increased Immunization rates

6. A "waiting house" built at each strategic health facility in rural communities

7. Increased modern Family Planning Acceptors 

All our Impact Goals above are identified as our project indicators and are believed to collectively contribute to our main Goals of "Preventing/Reducing Maternal Mortality rates and Reducing/Preventing Infant Mortality Rates in Rural Communities in PNG. 

Our Health Promotion, Health Education, Health Advocacy and Training, and mentoring, with the introduction of physical innovation into "waiting houses" will eventually lead to reducing maternal and infant death rates. Thus every family will live a happy healthy and productive life by participating in every community event. 

Our target is to reduce Maternal Mortality rates and Infant Mortality rates which are high putting PNG number one in the Asia-Pacific. Most of these deaths can be prevented and/or treated. Most of these cases (health issues) develop from pregnancy-related complications. Poor maternal and infant care services or ignorance by service providers and/or families from being healthy.

In our work, we have set eight indicators to assess the progress of our work in the communities in those provinces and districts we are targeting with our project. These Indicators are identified from the areas we are advocating and putting a lot of emphasis on for our communities and partners to put efforts to improve on which will give us better health outcomes. Therefore our Indicators are as indicated elsewhere above that will be measured each time we review our progress;

1. Increased Antenatal clinic attendance by pregnant women

At the moment, health information data shows Antenatal Clinic attendance by pregnant women at 40 - 50% as reflected by health reports. We plan to increase by 25 - 30% increase through our work. after five years of work, we will have reached 80%

2. Increased supervised birthing by trained health workers

Currently, the supervised birthing rate is 52% at health facilities as shown by health data. We are planning to increase by 30 - 35% to get an 80 - 90%. 

3. Reduced maternal mortality rates

Though reporting rates are not very accurate, the current maternal rate is 37.67 per 1000 live births in PNG, and in our target provinces is between 10 -13 per 1000 live births. We plan to bring it to 2 per 1000 live births in our provinces.

4. Reduced infant mortality rates

Our current infant mortality rate is 3.7 per 1000 live births in the provinces we work in. We set our target at 2% after five years.

5. Increased Immunization rates

Health data shows differing Immunization rates per Province depending on different reasons for different Vaccines. We plan to increase by 10 - 20% coverage for all under five years population.

6. A "waiting house" built at each strategic health facility in rural communities.

A "waiting house" is our initiative to motivate pregnant women and girls to use it during the third trimester so health workers can assess and manage their pregnancies - birthing, and postnatally giving supervised care appropriately. This will reduce home birthing, and maternal deaths in pregnancy from pregnancy-related health issues. 

7. Increased modern Family Planning Acceptors 

Family Planning indicators are at 45%, so we want to increase by 30 - 40% through our work. It should be at 80 - 90% after five years in our target provinces.

8. Increased referral of pregnant women for specialist care

We plan to see more pregnant women identified with pregnancy-related health issues to be referred to specialist care. This will reduce complications leading to maternal and neonatal deaths. Early detection and treatment is better than treating when conditions get worse, and/or deaths that can be prevented can not be reversed. We set our indicator at 50%, thus 50% of our pregnant women should be referred if has a complication in pregnancy that cannot be managed at lower-level health facilities.

From our experiences with how the health system is operating in PNG, we believe that our theory of change will have a greater impact on rural communities.

The current health system does not build partnerships with other parties, stakeholders, and the communities concerned. The health system is fragmented and fragile, thus health services flow is ineffective and delivery is poor. Consequently, health outcomes are poor too.

We believe that by working in partnership with all stakeholders and partners to routinely emphasize and remind our population and update with updated health information, people will change their perceptions. Having closer contact with rural communities and giving them the information through awareness and training. This will build the community's capacity to change their traditional practices in life and switch to living a life that will benefit them. Learning and adapting according to the health information provided, Information is what people need to change their way of behavior and attitude.

Over time, people will adapt to and act upon the health training and health advocacy information that will lead to following or living a healthy life. Having understood the importance of pregnant women attending antenatal clinics, reasons for bringing infants to immunization clinics, and so on will boost parents to accept family planning services, go to clinics and so forford. 

In this regard, our belief is for people to change their perceptions to turn to follow healthy living techniques.  It's just like our children being taught by teachers to follow certain steps that help them (children) be educated and become good citizens of communities. Consequently, we believe that our theory will influence and change their behavior.

Papua New Guinea lacks improved Information and Communication Infrastructure, worse in the rural communities. Therefore, we are not really using any specific technology to transmit our information and other messages. However, we use multi-media equipment in our programs. Training, health promotion awareness, and health advocacy. Mobile telephones in some rural communities only, video showing and recording during training and advocacy. 

Follow-up on our work, contact tracing, partner information on our programs, and counseling is usually done using mobile telephones with communities that can access mobile network services. We now consider using mobile telephones in our work but the network services are low in most communities. Also, most rural populations can not afford to buy a mobile phone and purchase mobile data to make calls and/or send text messages. In this regard, we ask rural communities to send a call-me request to our main office number from which we contact them and communicate with them. 

PNGRWHA was formed by both men and women professionals who saw the need to fit in the gaps to address issues faced by girls and women which can be met by existing systems and services of governments.

Papua New Guinea is multi-lingual, multicultural, and made up of many different tribal groups, and its health system is fragile and fragmented. Thus healthcare services outcomes are poor in the Pacific. This needs a joint effort by every actor in health and education services delivery systems.

PNGRWHA works to promote and strengthen the partnership with every stakeholder, church, government agency, women's group, business houses, politicians and other local leaders, and other NGOs/ICS, and INGOs, and importantly the girls and mothers in the rural communities.

Girls and women are allowed to express their local issues and expectations that vary greatly between tribal communities and regions. Based on the information contributed by the local communities, with clear knowledge on social issues and expectations, our solutions are implemented to avoid resistance from cultural beliefs and practices.

 Having learned from our training and advocacy on Health Promotion and disease prevention, Sexual and Reproductive Health Rights, and their (community) rights to access existing health and education services, communities offer support and cooperation. 

Our partners and the community are involved in activity planning, meaningful contributions in materials, labor, and reviewing and monitoring of the progress. We allow teamwork to promote sustainability in the future. PNGRWHA staff get to provide information and train to fill the service and accessibility gaps by bridging to service sources.   

Our target in our projects is mainly girls, women, and their newborn babies health and education of young girls in rural remote communities. We work to ensure good health, reduce morbidity and mortality rates and promote health. However, our target population comes from a family, a community, and a population group. Therefore, we partner with and use community leaders, church leaders, local health workers, women groups, LLG ward clerks, and other influential people in the communities.

We involve influential people so they help us extend our information, and/or negotiate for an extension of our work in communities. The community influential groups are the important people who work between us and the communities. 

We arrange meetings, community training, and all other activity is conducted through and in partnership and involving the community influencers. They are our contact points as well. In addition, in most cases, the influence team is our communication point to report back to us on the progress of our work as well. 

In some cases, we load their (influence contact points) with mobile data so they communicate with us as a means of motivating them on a weekly basis. We have a list of contact points in all rural communities (100) of both genders, including our main local partners.

We are an NGO that usually in our country is not used to be a revenue-raising entity to sustain our work. We work as a charity team on our team expenses, donations, and community contributions. 

We don't have any promising opportunities to help us raise any income to offset our credits and continue our operations. Therefore, we continue to communicate with our local politicians to help us at times. But not very often. 

We want to start our work with the aim to raise awareness for the existing government services providers so they can sustain the work in the future. This is the reason why we involve and partner with many partners so our work can be sustained. We look forward to International Philadelphia donations most of the time but we don't meet their funding criteria so fail. Therefore, we work with very small money when there is too much work to do. Agenda 2030 SDGs promises will be a mere talk on paper by 2030 as we still have issues unaddressed in this part of the world. I mean the work towards meeting UN 2030 Agenda for SDGs is low, and issues are persistent here in our rural communities.

So far we have requested funding from Irish Government Emphassy in Canberra - Australia in 2021. They have given us 10,000 Euros which has been used on specified projects and used within a year. It was K40,400.00 in our currency then.

Also, our local politician gave us K20,000. It's $662.00 in 2022. We used this money to fund our projects. Other Operations were from our own member contributions. Contributions are normally from our own staff. Our staff contribution is K2000 in a year which totals to 20,000. We use this money mostly for transport and stationaries, and mobile phone data purchases.